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Results Detailer-entered field notes from 186 AD visits with PCPs were analysed. Barriers to safe opioid prescribing were organised into six themes 1) gaps in knowledge; 2) lack of prescription monitoring programme (PMP) utilisation; 3) patient pressures to prescribe opioids; 4) insurance coverage policies; 5) provider beliefs; and 6) health system pain management practices. Conclusion Barriers to safe opioid prescribing in primary care, identified through AD visits among this large group of PCPs, support the need for continued efforts to enhance pain-management education, maximise PMP utilisation, and increase access to, and affordability of, non-opioid treatments.Background The complex nature of heart failure (HF) management, often involving multidimensional care, is widely recognised, but overall health service utilisation by patients with HF has not previously been described. Aim To describe overall health service use by adults with HF living in a community setting. Design and setting Cross-sectional analysis of prevalent HF cases from January 2015 to December 2018 using an administrative dataset covering primary and secondary care, and 'other' (community, mental health, social care) services in North West London. Method Healthcare use of each service was described overall and by individual components of secondary care (such as, outpatient appointments), and 'other' services (such as, nursing contacts). Usage patterns were identified using k-means cluster analysis, using all distinct contacts for the whole study period, and visualised with a heatmap. Results A total of 39 301 patients with a prevalent diagnosis of HF between 1 January 2015 and 31 December 2018 were found. Of those, approximately 90% used health services during the study period, most commonly outpatient services, GP consultations, unplanned accident and emergency visits, and community services. Use of cardiology-specific services ranged from around 3% (cardiology-related community care) to around 20% (outpatient cardiology visits). GP consultations decreased by 11% over the study period. Five clusters of patients were identified, each with statistically significantly different care usage patterns and patient characteristics. Conclusion Patients with HF make heavy but heterogeneous use of services. Relatively low and falling use of GP consultations, and the apparently low uptake of community rehabilitation services by patients with HF, is concerning and suggests challenges in primary care access and integration of care.Global demand for phosphorus (P) requires new agronomic practices to address sustainability challenges while increasing food production. Foliar P fertilization could increase P use efficiency; however, leaf entry pathways for inorganic phosphate ion (Pi) uptake remain unknown and it is unclear whether foliar P applications can meet plant nutrient demands. We developed two techniques to trace foliar P uptake in P-deficient spring barley (Hordeum vulgare) and to monitor the effectiveness of the treatment on restoring P functionality. Firstly, a whole-leaf P status assay was developed using an Image PAM system;non-photochemical quenching (NPQ) was a proxy for P status, asP-deficient barley developed NPQ at a faster rate than P-sufficient barley.. The assay showed restoration of P functionality in P-deficient plants 24 h after foliar P application. Treated leaves reverted to P-deficiency after 7 d, while newly emerging leaves exhibited partial restoration compared to untreated P-deficient plants, indicating Pi remobilization. Secondly, vanadate (V) was tested as a possible foliar Pi analogue using high resolution laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MS)elemental mapping. The strong co-localization of 51V and 31P signal intensities demonstrated that V was a sensitive and useful Pi tracer. V and Pi uptake predominantly occurred via fiber cells located above leaf veins, with pathways to the vascular tissue possibly facilitated by the bundle sheath extension. Minor indications of stomatal and cuticular Pi uptake were also observed. These techniques provided an approach to understand how Pi crosses the leaf surface and assimilates to meet plant nutrient demands.Uropathogenic E. coli (UPEC) is the leading cause of urinary tract infections (UTI). [https://www.selleckchem.com/products/Cisplatin.html NSC 119875 chemical] These bacteria undertake a multi-stage infection cycle involving invasion of and proliferation within urinary tract epithelial cells, leading to the rupture of the host cell and dispersal of the bacteria, some of which have a highly filamentous morphology. Here we established a microfluidics-based model of UPEC infection of immortalized human bladder epithelial cells that recapitulates the main stages of bacterial morphological changes during the acute infection cycle in vivo and allows the development and fate of individual cells to be monitored in real-time by fluorescence microscopy. The UPEC-infected bladder cells remained alive and mobile in non-confluent monolayers during the development of intracellular bacterial communities (IBCs). Switching from a flow of growth medium to human urine resulted in immobilization of both uninfected and infected bladder cells. IBCs continued to develop and then released many highly filamentous bacteria via an extrusion-like process, whereas others showed strong UPEC proliferation yet no detected filamentation. The filamentation response was dependent on the weak acidity of human urine and required component(s) in a low molecular-mass ( less then 3000 Da) fraction from a mildly dehydrated donor. The developmental fate for bacteria therefore appears to be controlled by multiple factors that act at the level of the whole IBC, suggesting that variable local environments or stochastic differentiation pathways influence IBC developmental fates during infection.Human rhinovirus (hRV) is frequently detected in the upper respiratory tract, and symptomatic infection is associated with increased nasopharyngeal bacterial load with subsequent development of secondary bacterial diseases. Nontypeable Haemophilus influenzae (NTHI) is a commensal bacterial species of the human nasopharynx however, in the context of prior or concurrent upper respiratory tract viral infection, this bacterium commonly causes multiple diseases throughout the upper and lower respiratory tracts. The present study was conducted to determine the mechanism(s) by which hRV infection promotes development of NTHI-induced diseases. We showed that hRV infection of polarized primary human airway epithelial cells resulted in increased adherence of NTHI, due in part to augmented expression of CEACAM1 and ICAM1, host cell receptors to which NTHI binds via engagement of multiple adhesins. Antibody blockade of these host cell receptors significantly reduced NTHI adherence. With a specific focus on the NTHI Type IV pilus (T4P) which we've previously shown binds to ICAM1, an essential adhesin and virulent determinant, we next showed that T4P-directed antibody blockade significantly reduced NTHI adherence to hRV-infected airway cells and further, that expression of this adhesin was required for the observed enhanced adherence.