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Abstract Background The increasing rise of women using opioids during pregnancy across the world has warranted concern over the access and quality of antenatal care received by this group. Scotland has particularly high levels of opioid use, and correspondingly, pregnancies involving women who use opioids. The purpose of this study was to investigate the different models of antenatal care for women using opioids during pregnancy in three Scottish Health Board Areas, and to explore multi-disciplinary practitioners’ perceptions of the strengths and challenges of working with women who use opioids through these specialist services. Methods Thirteen semi-structured interviews were conducted with health and social care workers who had experience of providing antenatal and postnatal care to women who use drugs across three Scottish Health Board Areas: NHS Greater Glasgow and Clyde, NHS Lothian, and NHS Tayside. Framework Analysis was used to analyse interview data. The five stages of framework analysis were undertaken: familiarisation, identifying the thematic framework, indexing, charting, and mapping and interpretation. Results Each area had a specialist antenatal pathway for women who used substances. Pathways varied, with some consisting of specialist midwives, and others comprising a multidisciplinary team (e.g. midwife, mental health nurse, social workers, and an obstetrician). Referral criteria for the specialist service differed between health board areas. These specialised pathways presented several key strengths: continuity of care with one midwife and a strong patient-practitioner relationship; increased number of appointments, support and scans; and highly specialised healthcare professionals with experience of working with substance use. In spite of this, there were a number of limitations to these pathways: a lack of additional psychological support for the mother; some staff not having the skills to engage with the complexity of patients who use substances; and problems with patient engagement. Conclusions Across the three areas, there appears to be high-quality multi-disciplinary antenatal services for women who use opioids during pregnancy. However, referral criteria vary and some services appear more comprehensive than others. Further research is needed into the perceptions of women who use opioids on facilitators and barriers to antenatal care, and provision in rural regions of Scotland.

Background: Apical ground-glass opacification (GGO) identified on CT angiography (CTA) performed for suspected acute stroke was developed in 2020 as a coronavirus-disease-2019 (COVID-19) diagnostic and prognostic biomarker in a retrospective study during the first wave of COVID-19. Objective: To prospectively validate whether GGO on CTA performed for suspected acute stroke is a reliable COVID-19 diagnostic and prognostic biomarker and whether it is reliable for COVID-19 vaccinated patients. Methods: In this prospective, pragmatic, national, multi-center validation study performed at 13 sites, we captured study data consecutively in patients undergoing CTA for suspected acute stroke from January-March 2021. Demographic and clinical features associated with stroke and COVID-19 were incorporated. The primary outcome was the likelihood of reverse-transcriptase-polymerase-chain-reaction swab-test-confirmed COVID-19 using the GGO biomarker. Secondary outcomes investigated were functional status at discharge and survival analyses at 30 and 90 days. Univariate and multivariable statistical analyses were employed. Results: CTAs from 1,111 patients were analyzed, with apical GGO identified in 8.5 % during a period of high COVID-19 prevalence. GGO showed good inter-rater reliability (Fleiss κ = 0.77); and high COVID-19 specificity (93.7 %, 91.8–95.2) and negative predictive value (NPV; 97.8 %, 96.5–98.6). In subgroup analysis of vaccinated patients, GGO remained a good diagnostic biomarker (specificity 93.1 %, 89.8–95.5; NPV 99.7 %, 98.3–100.0). Patients with COVID-19 were more likely to have higher stroke score (NIHSS (mean +/- SD) 6.9 +/- 6.9, COVID-19 negative, 9.7 +/- 9.0, COVID-19 positive; p = 0.01), carotid occlusions (6.2 % negative, 14.9 % positive; p = 0.02), and larger infarcts on presentation CT (ASPECTS 9.4 +/- 1.5, COVID-19 negative, 8.6 +/- 2.4, COVID-19 positive; p = 0.00). After multivariable logistic regression, GGO (odds ratio 15.7, 6.2–40.1), myalgia (8.9, 2.1–38.2) and higher core body temperature (1.9, 1.1–3.2) were independent COVID-19 predictors. GGO was associated with worse functional outcome on discharge and worse survival after univariate analysis. However, after adjustment for factors including stroke severity, GGO was not independently predictive of functional outcome or mortality. Conclusion: Apical GGO on CTA performed for patients with suspected acute stroke is a reliable diagnostic biomarker for COVID-19, which in combination with clinical features may be useful in COVID-19 triage.

Potential host range and spillover risk for novel viruses can be predicted using a network informed by known virus-host associations.

The objective of the paper is to demonstrate how the theoretical ideas of service-dominant logic (S-D logic) can usefully be applied to innovation through collaboration among university, industry and government. The debate around S-D logic has stimulated much discussion of three areas that are particularly pertinent in considering the co-creation of knowledge within the Triple Helix. The first area relates to understanding the nature of the resources provided by all the parties involved and the process through which they are integrated. The second area relates to interaction among the parties involved. The third and most complex area relates to how value is perceived by the different parties. This discussion leads to a proposed model of the co-creation process and four suggested research agendas: Research Agenda One, looking at the resources supplied by the parties and their integration; Research Agenda Two, concerning the interaction practices that enhance co-creation; Research Agenda Three, exploring what value propositions will motivate the different parties to co-create; and Research Agenda Four, considering how co-creation modifies the resources of the parties involved. A model of the co-creation process that encompasses these four research agendas and provides a conceptual framework to analyse Triple Helix initiatives is proposed. Some practical implications are then discussed relating to the challenges posed for researchers.

The ERG28 gene was originally identified by microarray expression profiling as possibly involved in the Saccharomyces cerevisiae sterol pathway. Microarray analyses suggested that the transcription pattern of ERG28 closely followed that of genes involved in sterol synthesis. ERG28 was also found in Schizosaccharomyces pombe and Arabidopsis as well as humans, and in the latter was shown to be highly expressed in adult testis tissue. All four proteins contain potential transmembrane domain(s). Gas chromatographymass spectrometry analysis of an ERG28-deleted S. cerevisiae strain (which is slow growing but not auxotrophic for ergosterol) indicates a lesion in sterol C-4 demethylation. Sterol profiles indicate accumulation of 3-keto and carboxylic acid sterol intermediates, which are involved in removing the two C-4 methyl groups from the sterol A ring. Similar intermediates have previously been demonstrated to accumulate in erg26 (sterol dehydrogenase/decarboxylase) and erg27 (3-ketoreductase) mutants in yeast. We speculate that the role of the Erg28 protein (Erg28p) may be either to tether Erg26p and Erg27p to the endoplasmic reticulum or to facilitate interaction between these proteins.—Gachotte, D., J. Eckstein, R. Barbuch, T. Hughes, C. Roberts, and M. Bard. A novel gene conserved from yeast to humans is involved in sterol biosynthesis. J. Lipid Res. 2001. 42: 150–154.

Abstract Background It is not known whether emergency departments (EDs) with primary care services influence demand for non-urgent care (‘provider-induced demand’). We proposed that distinct primary care services in EDs encourages primary care demand, whereas primary care integrated within EDs may be less likely to cause additional demand. We aimed to explore this and explain contexts (C), mechanisms (M) and outcomes (O) influencing demand. Methods We used realist evaluation methodology and observed ED service delivery. Twenty-four patients and 106 staff members (including Clinical Directors and General Practitioners) were interviewed at 13 EDs in England and Wales (240 hours of observations across 30 days). Field notes from observations and interviews were analysed by creating ‘CMO’ configurations to develop and refine theories relating to drivers of demand. Results EDs with distinct primary care services were perceived to attract demand for primary care because services were visible, known or enabled direct access to health care services. Other influencing factors included patients’ experiences of accessing primary care, community care capacity, service design and population characteristics. Conclusions Patient, local-system and wider-system factors can contribute to additional demand at EDs that include primary care services. Our findings can inform service providers and policymakers in developing strategies to limit the effect of potential influences on additional demand when demand exceeds capacity.

The first-order control of ice thickness and height above sea level is linked to the decreasing strength of ice-bed coupling along flowlines from an interior ice divide to the calving front of an ice shelf. Uncoupling progresses as a frozen bed progressively thaws for sheet flow, as a thawed bed is progressively drowned for stream flow, and as lateral and/or local grounding vanish for shelf flow. This can reduce ice thicknesses by 90 % and ice elevations by 99 % along flowlines. Original work presented here includes (1) replacing flow and sliding laws for sheet flow with upper and lower yield stresses for creep in cold overlying ice and basal ice sliding over deforming till, respectively, (2) replacing integrating the Navier–Stokes equations for stream flow with geometrical solutions to the force balance, and (3) including resistance to shelf flow caused by lateral confinement in a fjord and local grounding at ice rumples and ice rises. A comparison is made between our approach and two approaches based on continuum mechanics. Applications are made to Byrd Glacier in Antarctica and Jakobshavn Isbrae in Greenland.

The second axis of the dual-axis radiography of hydrodynamic testing (DARHT) facility produces up to four radiographs within an interval of 1.6 μs. It does this by slicing four micropulses out of a 2-μs long electron beam pulse and focusing them onto a bremsstrahlung converter target. The 1.8-kA beam pulse is created by a dispenser cathode diode and accelerated to more than 16 MeV by the unique DARHT Axis-II linear induction accelerator (LIA). Beam motion in the accelerator would be a problem for multipulse flash radiography. High-frequency motion, such as from beam-breakup (BBU) instability, would blur the individual spots. Low-frequency motion, such as produced by pulsed-power variation, would produce spot-to-spot differences. In this article, we describe these sources of beam motion, and the measures we have taken to minimize it. Using the methods discussed, we have reduced beam motion at the accelerator exit to less than 2% of the beam envelope radius for the high-frequency BBU, and less than 1/3 of the envelope radius for the low-frequency sweep.