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Background: Visual impairment can impact 70% of individuals who have experienced a stroke. Identification and remediation of visual impairments can improve overall function and perceived quality of life. Our project aimed to improve visual assessment and timely intervention for patients with post-stroke visual impairment (PSVI). Methods: We conducted a quality improvement initiative to create a standardized screening and referral process for patients with PSVI to access an orthoptist. Post-stroke visual impairment was identified using the Visual Screen Assessment (VISA) tool. Patients filled out a VFQ-25 questionnaire before and after orthoptic assessment, and differences between scores were evaluated. Results: Eighteen patients completed the VFQ-25 both before and after orthoptic assessment. Of the vision related constructs, there was a significant improvement in reported outcomes for general vision (M=56.9, SD=30.7; M=48.6, SD=16.0), p=0.002, peripheral vision (M=88.3, SD=16; M=75, SD=23.1), p= 0.027, ocular pain (M=97.2, SD=6.9; M=87.5, SD=21.4), p=0.022, near activities (M=82.4, SD=24.1; M=67.8, SD=25.6), p<0.001, social functioning (M=90.2, SD=19; M=78.5, SD=29.3), p=0.019, mental health (M=84.0, SD=25.9; M=70.5, SD=31.2), p=0.017, and role difficulties (M=84.7, SD=26.3; M=67.4, SD=37.9), p=0.005. Conclusions: Orthoptic assessments for those with PSVI significantly improved perceived quality of life in a numerous vision related constructs, suggesting it is a valuable part of a patient’s post-stroke recovery.
This chapter considers the legacy of respect for individual autonomy and ‘informed consent’ in health research. The primacy of informed consent as a safeguard has led to a systemic regulatory tendency to conceive of and protect privacy as an individual rather than a collective concern. This has limited any regulatory ability to grasp broader social concerns with the use and disclosure of data gathered and generated by health research. Any systemic failure to recognise collective interests in data, and the public interest in (non-personal) data protection, has profound implications for an information age. The chapter reflects on the value of re-negotiating the interests and expectations protected by health research regulation. It recognises the significance of Graeme Laurie’s preferred conception of privacy to enabling such negotiation, and the value of stewardship in establishing normative expectations free of historical encumbrance. Laurie’s conceptualisation of ‘privacy as separateness’, when placed alongside the idea of stewardship, may allow us to rebalance respect to encompass collective interests as fundamental to self-determination and mutual respect.
The purpose of this study was to determine if estimated center of pressure (COP) from plantar force data collected using three-sensor loadsol insoles was comparable to the COP from plantar pressure data collected using pedar insoles during walking and running. Ten healthy adults walked and ran at self-selected speeds on a treadmill while wearing both a loadsol and pedar insole in their right shoe. Plantar force recorded from the loadsol was used to estimate COP along mediolateral (COPx) and anteroposterior (COPy) axes. The estimated COPx and COPy were compared with the COPx and COPy from pedar using limits of agreement and Spearman’s rank correlation. There were significant relationships and agreement within 5 mm in COPx and 20 mm in COPy between loadsol and pedar at 20–40% of stance during walking and running. However, loadsol demonstrated biases of 7 mm in COPx and 10 mm in COPy compared to pedar near initial contact and toe-off.
This paper introduces the concept of Natural Capital and explores the implications for actuarial work by way of case studies. It is part of a wider series of IFoA papers focussing on the risks from global biodiversity loss and how these risks can be mitigated.
To understand the transmission dynamics of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) in a hospital outbreak to inform infection control actions.
Design:
Retrospective cohort study.
Setting:
General medical and elderly inpatient wards in a hospital in England.
Methods:
Coronavirus disease 2019 (COVID-19) patients were classified as community or healthcare associated by time from admission to onset or positivity using European Centre for Disease Prevention and Control definitions. COVID-19 symptoms were classified as asymptomatic, nonrespiratory, or respiratory. Infectiousness was calculated from 2 days prior to 14 days after symptom onset or positive test. Cases were defined as healthcare-associated COVID-19 when infection was acquired from the wards under investigation. COVID-19 exposures were calculated based on symptoms and bed proximity to an infectious patient. Risk ratios and adjusted odds ratios (aORs) were calculated from univariable and multivariable logistic regression.
Results:
Of 153 patients, 65 were COVID-19 patients and 45 of these were healthcare-associated cases. Exposure to a COVID-19 patient with respiratory symptoms was associated with healthcare-associated infection irrespective of proximity (aOR, 3.81; 95% CI, 1.6.3–8.87). Nonrespiratory exposure was only significant within 2.5 m (aOR, 5.21; 95% CI, 1.15–23.48). A small increase in risk ratio was observed for exposure to a respiratory patient for >1 day compared to 1 day from 2.04 (95% CI, 0.99–4.22) to 2.36 (95% CI, 1.44–3.88).
Conclusions:
Respiratory exposure anywhere within a 4-bed bay was a risk, whereas nonrespiratory exposure required bed distance ≤2.5 m. Standard infection control measures required beds to be >2 m apart. Our findings suggest that this may be insufficient to stop SARS-CoV-2 transmission. We recommend improving cohorting and further studies into bed distance and transmission factors.
Background: Visual impairment exists for an estimated 70% of individuals who have experienced a stroke. Identification and remediation of visual impairments can improve overall function and perceived quality of life. Our project aims to improve visual assessment and timely intervention for patients with post-stroke visual impairment (PSVI). Methods: We conducted a quality improvement initiative to create a standardized screening and referral process for patients with PSVI to access an orthoptist. Post-stroke visual impairment was assessed by way of the Visual Screen Assessment (VISA) tool, administered by an occupational therapist. Patients filled out a VFQ-25 questionnaire before and after orthoptic assessment and intervention. The VFQ-25 is a validated post-stroke survey assessing a patient’s perceived quality of life. Differences between pre- and post-orthoptic assessment scores will be evaluated. Results: Data collection currently ongoing.The benefits of a standardized screen for PSVI, standardized referral to, and experience with an orthoptist assessment will be determined. Learnings gained will also inform how we can expand the program to benefit a wider demographic of patients. Conclusions: The data gathered and the subsequent analysis will be instrumental in guiding ongoing improvement initiatives for patients with PSVI.
We present an overview of the Middle Ages Galaxy Properties with Integral Field Spectroscopy (MAGPI) survey, a Large Program on the European Southern Observatory Very Large Telescope. MAGPI is designed to study the physical drivers of galaxy transformation at a lookback time of 3–4 Gyr, during which the dynamical, morphological, and chemical properties of galaxies are predicted to evolve significantly. The survey uses new medium-deep adaptive optics aided Multi-Unit Spectroscopic Explorer (MUSE) observations of fields selected from the Galaxy and Mass Assembly (GAMA) survey, providing a wealth of publicly available ancillary multi-wavelength data. With these data, MAGPI will map the kinematic and chemical properties of stars and ionised gas for a sample of 60 massive (
${>}7 \times 10^{10} {\mathrm{M}}_\odot$
) central galaxies at
$0.25 < z <0.35$
in a representative range of environments (isolated, groups and clusters). The spatial resolution delivered by MUSE with Ground Layer Adaptive Optics (
$0.6-0.8$
arcsec FWHM) will facilitate a direct comparison with Integral Field Spectroscopy surveys of the nearby Universe, such as SAMI and MaNGA, and at higher redshifts using adaptive optics, for example, SINS. In addition to the primary (central) galaxy sample, MAGPI will deliver resolved and unresolved spectra for as many as 150 satellite galaxies at
$0.25 < z <0.35$
, as well as hundreds of emission-line sources at
$z < 6$
. This paper outlines the science goals, survey design, and observing strategy of MAGPI. We also present a first look at the MAGPI data, and the theoretical framework to which MAGPI data will be compared using the current generation of cosmological hydrodynamical simulations including EAGLE, Magneticum, HORIZON-AGN, and Illustris-TNG. Our results show that cosmological hydrodynamical simulations make discrepant predictions in the spatially resolved properties of galaxies at
$z\approx 0.3$
. MAGPI observations will place new constraints and allow for tangible improvements in galaxy formation theory.
An adequate intake of PUFA plays a vital role in human health. Therefore, it is important to assess PUFA intakes in different populations and validate them with biomarkers, but only a few small studies are in paediatric populations. We calculated the dietary intake of PUFA and their main food sources in children and assessed associations between PUFA intakes and plasma proportions. Dietary intakes of 7-year-old children (n 8242) enrolled in the Avon Longitudinal Study of Parents and Children were calculated from the parental-completed FFQ. Plasma PUFA were measured in 5571 children 8 months later, and 4380 children had complete dietary and plasma data. The association between dietary and plasma PUFA proportions was estimated using Spearman’s correlation coefficients, quintile cross-classification and Cohen’s κ coefficients. Mean total PUFA intake was 13·2 g/d (sd 4·2), contributing 6·5 % of total energy intake; n-6 PUFA contributed 5·2 % and n-3 PUFA 0·7 %. The n-6:n-3 ratio was 7·9:1. Mean intakes of EPA and DHA were 35·7 mg/d and 49·7 mg/d, respectively. Most n-3 and n-6 PUFA intakes were weakly correlated with their respective plasma lipids (0·07 ≤ r ≤ 0·16, P < 0·001). The correlation between dietary and plasma DHA was stronger though (r = 0·34, P < 0·001), supported by a modest level of agreement between quintiles (k = 0·32). The results indicate that the FFQ was able to reasonably rank the long-chain (LC) PUFA, DHA, in this paediatric population. Public health initiatives need to address the suboptimal ratio of n-6:n-3 PUFA and very low n-3 LC-PUFA intakes in school-age children in the UK.
The first demonstration of laser action in ruby was made in 1960 by T. H. Maiman of Hughes Research Laboratories, USA. Many laboratories worldwide began the search for lasers using different materials, operating at different wavelengths. In the UK, academia, industry and the central laboratories took up the challenge from the earliest days to develop these systems for a broad range of applications. This historical review looks at the contribution the UK has made to the advancement of the technology, the development of systems and components and their exploitation over the last 60 years.
The Cognitive Battery of the National Institutes of Health Toolbox (NIH-TB) is a collection of assessments that have been adapted and normed for administration across the lifespan and is increasingly used in large-scale population-level research. However, despite increasing adoption in longitudinal investigations of neurocognitive development, and growing recommendations that the Toolbox be used in clinical applications, little is known about the long-term temporal stability of the NIH-TB, particularly in youth.
Methods
The present study examined the long-term temporal reliability of the NIH-TB in a large cohort of youth (9–15 years-old) recruited across two data collection sites. Participants were invited to complete testing annually for 3 years.
Results
Reliability was generally low-to-moderate, with intraclass correlation coefficients ranging between 0.31 and 0.76 for the full sample. There were multiple significant differences between sites, with one site generally exhibiting stronger temporal stability than the other.
Conclusions
Reliability of the NIH-TB Cognitive Battery was lower than expected given early work examining shorter test-retest intervals. Moreover, there were very few instances of tests meeting stability requirements for use in research; none of the tests exhibited adequate reliability for use in clinical applications. Reliability is paramount to establishing the validity of the tool, thus the constructs assessed by the NIH-TB may vary over time in youth. We recommend further refinement of the NIH-TB Cognitive Battery and its norming procedures for children before further adoption as a neuropsychological assessment. We also urge researchers who have already employed the NIH-TB in their studies to interpret their results with caution.
Smoking rates in people with depression and anxiety are twice as high as in the general population, even though people with depression and anxiety are motivated to stop smoking. Most healthcare professionals are aware that stopping smoking is one of the greatest changes that people can make to improve their health. However, smoking cessation can be a difficult topic to raise. Evidence suggests that smoking may cause some mental health problems, and that the tobacco withdrawal cycle partly contributes to worse mental health. By stopping smoking, a person's mental health may improve, and the size of this improvement might be equal to taking antidepressants. In this article we outline ways in which healthcare professionals can compassionately and respectfully raise the topic of smoking to encourage smoking cessation. We draw on evidence-based methods such as cognitive–behavioural therapy (CBT) and outline approaches that healthcare professionals can use to integrate these methods into routine care to help their patients stop smoking.
Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care.
Methods.
The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions.
Results.
We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures.
Conclusions.
We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.
Results of in situ U–Pb dating of calcite spherulites, cone-in-cone (CIC) calcite and calcite fibres from a calcareous concretion of the upper Ediacaran of Finnmark, Arctic Norway, are reported. Calcite spherulites from the innermost layers of the concretion yielded a lower intercept age of 563 ± 70 Ma, which, although imprecise, is within uncertainty of the age of sedimentation based on fossil assemblages. Non-deformed CIC calcite from the bottom part of the concretion yielded an age of 475 ± 25 Ma, which is interpreted as the age of CIC calcite formation during a period of fluid overpressure induced during burial of the sediments. Deformed CIC calcite from the top part of the concretion yielded an age of 418 ± 23 Ma, which overlaps with a known Caledonian tectono-metamorphic event, and indicates a potential post-depositional overprint at this time. Calcite fibres that grew in small fissures along spherulite rims, which are interpreted as a recrystallization feature during deformation and formation of a cleavage, gave an imprecise age of 486 ± 161 Ma. Our results show that U–Pb dating of calcite can provide age constraints for ancient carbonates and syn- to post-depositional processes that operated during burial and metamorphic overprinting.
The symptoms of bipolar disorder are sometimes misrecognised for unipolar depression and inappropriately treated with antidepressants. This may be associated with increased risk of developing mania. However, the extent to which this depends on what type of antidepressant is prescribed remains unclear.
Aims
To investigate the association between different classes of antidepressants and subsequent onset of mania/bipolar disorder in a real-world clinical setting.
Methods
Data on prior antidepressant therapy were extracted from 21,012 adults with unipolar depression receiving care from the South London and Maudsley NHS Foundation Trust (SLaM). multivariable Cox regression analysis (with age and gender as covariates) was used to investigate the association of antidepressant therapy with risk of developing mania/bipolar disorder.
Results
In total, 91,110 person-years of follow-up data were analysed (mean follow-up: 4.3 years). The overall incidence rate of mania/bipolar disorder was 10.9 per 1000 person-years. The peak incidence of mania/bipolar disorder was seen in patients aged between 26 and 35 years (12.3 per 1000 person-years). The most frequently prescribed antidepressants were SSRIs (35.5%), mirtazapine (9.4%), venlafaxine (5.6%) and TCAs (4.7%). Prior antidepressant treatment was associated with an increased incidence of mania/bipolar disorder ranging from 13.1 to 19.1 per 1000 person-years. Multivariable analysis indicated a significant association with SSRIs (hazard ratio 1.34, 95% CI 1.18–1.52) and venlafaxine (1.35, 1.07–1.70).
Conclusions
In people with unipolar depression, antidepressant treatment is associated with an increased risk of subsequent mania/bipolar disorder. These findings highlight the importance of considering risk factors for mania when treating people with depression.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
In the UK, mental illness is a major source of disease burden costing in the region of £105 billion pounds. mHealth is a novel and emerging field in psychiatric and psychological care for the treatment of mental health difficulties such as psychosis.
Objective
To develop an intelligent real-time therapy (iRTT) mobile intervention (TechCare) which assesses participant's symptoms in real-time and responds with a personalised self-help based psychological intervention, with the aim of reducing participant's symptoms. The system will utilise intelligence at two levels:
– intelligently increasing the frequency of assessment notifications if low mood/paranoia is detected;
– an intelligent machine learning algorithm which provides interventions in real-time and also provides recommendations on the most popular selected interventions.
Aim
The aim of the current project is to develop a mobile phone intervention for people with psychosis, and to conduct a feasibility study of the TechCare App.
Methods
The study consists of both qualitative and quantitative components. The study will be run across three strands:
– qualitative work;
– test run and intervention refinement;
– feasibility trial.
Results
Preliminary analysis of qualitative data from Strand 2 (test run and intervention refinement) in-depth interviews with service users (n = 2) and focus group with health professionals (n = 1), highlighted main themes around security of the device, multimedia and the acceptability of psychological interventions being delivered via the TechCare App.
Conclusions
Research in this area can be potentially helpful in addressing the demand on mental health services globally, particularly improving access to psychological interventions.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Mood instability is an important problem but has received relatively little research attention. Natural language processing (NLP) is a novel method, which can used to automatically extract clinical data from electronic health records (EHRs).
Aims
To extract mood instability data from EHRs and investigate its impact on people with mental health disorders.
Methods
Data on mood instability were extracted using NLP from 27,704 adults receiving care from the South London and Maudsley NHS Foundation Trust (SLaM) for affective, personality or psychotic disorders. These data were used to investigate the association of mood instability with different mental disorders and with hospitalisation and treatment outcomes.
Results
Mood instability was documented in 12.1% of people included in the study. It was most frequently documented in people with bipolar disorder (22.6%), but was also common in personality disorder (17.8%) and schizophrenia (15.5%). It was associated with a greater number of days spent in hospital (B coefficient 18.5, 95% CI 12.1–24.8), greater frequency of hospitalisation (incidence rate ratio 1.95, 1.75–2.17), and an increased likelihood of prescription of antipsychotics (2.03, 1.75–2.35).
Conclusions
Using NLP, it was possible to identify mood instability in a large number of people, which would otherwise not have been possible by manually reading clinical records. Mood instability occurs in a wide range of mental disorders. It is generally associated with poor clinical outcomes. These findings suggest that clinicians should screen for mood instability across all common mental health disorders. The data also highlight the utility of NLP for clinical research.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
There are often substantial delays before diagnosis and initiation of treatment in people bipolar disorder. Increased delays are a source of considerable morbidity among affected individuals.
Aims
To investigate the factors associated with delays to diagnosis and treatment in people with bipolar disorder.
Methods
Retrospective cohort study using electronic health record data from the South London and Maudsley NHS Foundation Trust (SLaM) from 1364 adults diagnosed with bipolar disorder. The following predictor variables were analysed in a multivariable Cox regression analysis on diagnostic delay and treatment delay from first presentation to SLaM: age, gender, ethnicity, compulsory admission to hospital under the UK Mental Health Act, marital status and other diagnoses prior to bipolar disorder.
Results
The median diagnostic delay was 62 days (interquartile range: 17–243) and median treatment delay was 31 days (4–122). Compulsory hospital admission was associated with a significant reduction in both diagnostic delay (hazard ratio 2.58, 95% CI 2.18–3.06) and treatment delay (4.40, 3.63–5.62). Prior diagnoses of other psychiatric disorders were associated with increased diagnostic delay, particularly alcohol (0.48, 0.33–0.41) and substance misuse disorders (0.44, 0.31–0.61). Prior diagnosis of schizophrenia and psychotic depression were associated with reduced treatment delay.
Conclusions
Some individuals experience a significant delay in diagnosis and treatment of bipolar disorder, particularly those with alcohol/substance misuse disorders. These findings highlight a need to better identify the symptoms of bipolar disorder and offer appropriate treatment sooner in order to facilitate improved clinical outcomes. This may include the development of specialist early intervention services.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
As part of the ongoing effort to improve the Northern Hemisphere radiocarbon (14C) calibration curve, this study investigates the period of 856 BC to 626 BC (2805–2575 yr BP) with a total of 403 single-year 14C measurements. In this age range, IntCal13 was constructed largely from German and Irish oak as well as Californian bristlecone pine 14C dates, with most samples measured with a 10-yr resolution. The new data presented here is the first atmospheric 14C single-year record of the older end of the Hallstatt plateau based on an absolutely dated tree-ring chronology. The data helped reveal a major solar proton event (SPE) which caused a spike in the production rate of cosmogenic radionuclides around 2610/2609 BP. This production event is thought to have reached a magnitude similar to the 774/775 AD production event but has remained undetected due to averaging effects in the decadal calibration data. The record leading up to the 2610/2609 BP event reveals a 11-yr solar cycle with varying cyclicity. Features of the new data and the benefits of higher resolution calibration are discussed.
Transoral laser microsurgery for glottic squamous cell carcinoma is the standard of care at many institutions. Repeat transoral laser microsurgery for recurrence may avoid the need for radiotherapy and total laryngectomy. This study aimed to identify oncological and functional outcomes in a cohort of patients who had undergone repeat transoral laser microsurgery procedures.
Method
A retrospective review of prospectively collected data of patients treated with transoral laser microsurgery for carcinoma in situ or tumour stages T1 or T2 glottic cancer, from 2003 to 2018.
Results
Twenty patients were identified. Additional treatment was not needed in 45 per cent of patients. The five-year overall survival rate was 90 per cent. The disease-specific survival rate was 100 per cent. The laryngeal preservation rate was 85 per cent. There was improvement in mean Voice Handicap Index-10 scores following repeat transoral laser microsurgery treatment, when comparing the pre- and post-operative periods (mean scores = 15.5 vs 11.5, p = 0.373).
Conclusion
Repeat transoral laser microsurgery can be an oncologically safe alternative to other salvage therapies for glottic squamous cell carcinoma recurrence, without sacrificing functional outcomes.