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Alcohol-related presentations to acute hospitals in the UK are increasing, but little is known of the clinical characteristics or natural history of this patient group.
To describe the clinical characteristics, drinking profile and trajectory of a cohort of patients with alcohol use disorder (AUD) attending hospital, and explore participant perspectives of the impact of hospital attendance on their relationship with alcohol.
We conducted a mixed method, prospective, observational cohort study of patients with AUD seen in an acute hospital. Participants were interviewed with a range of questionnaires at baseline and followed up on at 6 months. A subsample also completed in-depth qualitative interviews.
We recruited 141 patients; 132 (93.6%) were followed up at 6 months and 26 completed qualitative interviews. Of the 141 patients, 60 (42.6%) stated the index hospital episode included the first discussion of their alcohol use in a secondary care setting. Most rated discussion of their alcohol use in hospital as ‘very positive’ or ‘positive’ (102/141, 72.3%), but lack of coordinated care with community services undermined efforts to sustain change. At 6 months, 11 (7.8%) patients had died, but in those who survived and completed assessment (n = 121), significant and clinically meaningful improvements were seen across a range of outcomes, with 55 patients (45.5%) showing a favourable drinking outcome at 6 months.
Patients with AUD have high levels of morbidity and mortality, yet many made substantial changes following intervention in hospital for their alcohol use. Prospective trials need to identify the effect of alcohol care teams in optimising this ‘teachable moment’ for patients.
There are growing concerns on use of certain psychotropic medications on women's reproductive health, pregnancy and lactation. Lithium, Sodium valproate, Carbamazepine and Lamotrigine are recommended by National Institute of Clinical Excellence (NICE) in treatment of Bipolar Disorder. While treatment of Bipolar disorder is crucial, it is imperative that there is clear communication between patients, carers and health professionals to enable patients in making informed decisions about their care
NICE recommends that healthcare professionals should give relevant information at every stage of assessment and treatment. They should discuss contraception and risks of pregnancy. Furthermore, it is good practice to assess capacity of service user's to consent to treatment. This enables service user to make well-informed decision.
To find out if relevant steps were taken to aid women in making well-informed decision regarding their treatment i.e by verbal communication and providing written information.
We retrospectively analysed electronic patient record of women meeting inclusion criteria.
Out of 616 women, 119 met the inclusion criteria. Patients’ ages ranged from 20 to 55. 52% were on Lithium, followed by Sodium Valproate(22%), Lamotrigine(14%) and Carbamazepine(12%). There was evidence of verbal communication in only 35% and provision of written information in only 11%. Contraception advice was documented in only 24%. Documentation of assessment of capacity to consent to treatment was found only in 31%.
There is lack of adequate communication between clinicians and patients. There are several possible explanations for this finding with one of the main reasons being poor documentation.
Mycoprotein is a food high in both dietary fibre and non-animal-derived protein. Global mycoprotein consumption is increasing, although its effect on human health has not yet been systematically reviewed. This study aims to systematically review the effects of mycoprotein on glycaemic control and energy intake in humans. A literature search of randomised controlled trials was performed in PubMed, Embase, Web of Science, Google Scholar and hand search. A total of twenty-one studies were identified of which only five studies, totalling 122 participants, met the inclusion criteria. All five studies were acute studies of which one reported outcomes on glycaemia and insulinaemia, two reported on energy intake and two reported on all of these outcomes. Data were extracted, and risk-of-bias assessment was then conducted. The results did not show a clear effect of acute mycoprotein on blood glucose levels, but it showed a decrease in insulin levels. Acute mycoprotein intake also showed to decrease energy intake at an ad libitum meal and post-24 h in healthy lean, overweight and obese humans. In conclusion, the acute ingestion of mycoprotein reduces energy intake and insulinaemia, whereas its impact on glycaemia is currently unclear. However, evidence comes from a very limited number of heterogeneous studies. Further well-controlled studies are needed to elucidate the short- and long-term effects of mycoprotein intake on glycaemic control and energy intake, as well as the mechanisms underpinning these effects.
Geographical disparities in health outcomes have been evident across the UK for decades. Recent analysis on the dietary differences between Scotland and England that might go some way to explain these health differences is limited. This study aimed to assess whether, and to what degree, aspects of diet and nutrition differ between Scottish and English populations, specifically between those with similar household incomes. A period of 12 years of UK food purchase data (2001–2012) were pooled and used to estimate household-level consumption data for Scotland and England. Population mean food consumption and nutrient intakes were estimated, adjusting for known confounders (year, age of household reference person, age they left full-time education and income). Comparison was also made within equivalised income quintiles. Analysis showed that the foods and nutrients that should be increased in the diet (highlighted in the Scottish Dietary Goals) were lower in Scotland than in England (e.g. fruit and vegetables 267 g/d; 99 % CI 259, 274 v. 298 g/d; 99 % CI 296, 301), P<0·001). Similarly, foods and drinks linked with poor health outcomes were higher in Scotland. These regional inequalities in diet were even more pronounced in the lower-income groups (e.g. red and processed meat consumption in the lowest-income quintile was 65 g/d; 99 % CI 61, 69 in Scotland v. 58 g/day; 99 % CI 57, 60 in England, P<0·001, but similar in the highest-income quintile (58 g/d; 99 % CI 54, 61 v. 59 g/d; 99 % CI 58, 60, respectively). A poorer diet in Scotland compared with England, particularly among disadvantaged groups, may contribute to differences in excess mortality between countries.
To date, Ireland has been a leading light in the provision of youth mental health services. However, cognisant of the efforts of governmental and non-governmental agencies working in youth mental health, there is much to be done. Barriers into care as well as discontinuity of care across the spectrum of services remain key challenges. This editorial provides guidance for the next stage of development in youth mental care and support that will require significant national engagement and resource investment.
The diagnosis and control of Mycobacterium bovis infection (bovine tuberculosis: TB) continues to present huge challenges to the British cattle industry. A clearer understanding of the magnitude and duration of immune response to M. bovis infection in the European badger (Meles meles) – a wildlife maintenance host – may assist with the future development of diagnostic tests, and vaccination and disease management strategies. Here, we analyse 5280 diagnostic test results from 550 live wild badgers from a naturally-infected population to investigate whether one diagnostic test (a gamma interferon release [IFNγ] assay, n = 550 tests) could be used to predict future positive results on two other tests for the same disease (a serological test [n = 2342 tests] and mycobacterial culture [n = 2388 tests]) and hence act as an indicator of likely bacterial excretion or disease progression. Badgers with the highest IFNγ optical density (OD) values were most likely to subsequently test positive on both serological and culture tests, and this effect was detectable for up to 24 months after the IFNγ test. Furthermore, the higher the original IFNγ OD value, the greater the chance that a badger would subsequently test positive using serology. Relationships between IFNγ titres and mycobacterial culture results from different types of clinical sample suggest that the route of infection may affect the magnitude of immune response in badgers. These findings identify further value in the IFNγ test as a useful research tool, as it may help us to target studies at animals and groups that are most likely to succumb to more progressive disease.
In this study the onset of stress-free Boussinesq thermal convection in rotating spherical shells with aspect ratio η = rinner/router = 0.9, Prandtl numbers Pr ∈ [10−4, 10−1], and Taylor numbers Ta ∈ [104, 1012] is considered. We focus on the form of the convective cell pattern that develops, and on its time scales, since this may have observational consequences for thermonuclear burning and the development of burst oscillations in the exploding oceans of accreting neutron stars (Watts (2012)).
Superburst oscillations are high frequency X-ray variations observed during hours’ long superbursts on accreting neutron stars. We investigate a potential mechanism to explain these observations; a buoyant r-mode, excited in the ocean layers of the star. These modes are affected by ash composition in the ocean so are a good probe of nuclear burning processes. The phenomenon could be used in pulse profile modelling as a way of measuring neutron star mass and radius, and so the dense matter equation of state.
Rates of premature mortality have been higher in Scotland than in England since the 1970s. Given the known association of diet with chronic disease, the study objective was to identify and synthesise evidence on current and historical differences in food and nutrient intakes in Scotland and England.
A rapid review of the peer-reviewed and grey literature was carried out. After an initial scoping search, Medline, CINAHL, Embase and Web of Science were searched. Relevant grey literature was also included. Inclusion criteria were: any date; measures of dietary intake; representative populations; cross-sectional or observational cohort studies; and English-language publications. Study quality was assessed using the Quality Assessment Tool for Observational Cohort and Cross-sectional Studies. A narrative synthesis of extracted information was conducted.
Fifty publications and reports were included in the review. Results indicated that children and adults in Scotland had lower intakes of vegetables and vitamins compared with those living in England. Higher intakes of salt in Scotland were also identified. Data were limited by small Scottish samples, difficulty in finding England-level data, lack of statistical testing and adjustment for key confounders.
Further investigation of adequately powered and analysed surveys is required to examine more fully dietary differences between Scotland and England. This would provide greater insight into potential causes of excess mortality in Scotland compared with England and suitable policy recommendations to address these inequalities.
Introduction: Mild traumatic brain injury (mTBI) is the most common emergency department (ED) brain injury presentation in Canada; however, an evidence-practice gap in mTBI management exists among ED physicians, evidenced by significant practice variation. This review aimed to identify mTBI education and training directed at ED physicians and its relationship with practice patterns and physician knowledge. Methods: A comprehensive literature search of four bibliographic databases and the grey literature was performed using the keywords: concussion, mTBI, medical education, and continuing medical education. Included studies were required to report on mTBI education received by practicing ED physicians. Two independent reviewers screened unique citations for relevance and reviewed the full-texts of relevant articles. Two independent reviewers assessed methodological quality using the Methodological Index for Non-Randomized Studies. Data were extracted in duplicated onto standardized forms. Throughout the review process, discrepancies were adjudicated by an independent third party. Results: A total of 409 unique results were retrieved, and five studies were included. None of the included studies were of high methodological quality. Included studies assessed mTBI educational toolkits (n=3), conference presentations and academic journal articles (n=1), and pediatric fellowship training (n=1). Training primarily occurred after residency (i.e., continuing professional development) and focused on awareness and management of mTBI. Three studies measured ED physicians self-reported knowledge uptake and retention, and all three studies reported positive changes in knowledge uptake including self-reported increases in appropriate return-to-school and return-to-play recommendations. An increase in appropriate return-to-school/sports recommendations was reported in one study, measured by surveying parents of children diagnosed with mTBI. Conclusion: After a systematic and comprehensive search, few studies on mTBI education or training targeting ED physicians were identified and focused on process change rather than outcomes, highlighting an evidence-practice gap that needs to be addressed to improve mTBI patient care. Existing mTBI knowledge translation, including EDP education, needs to be optimized to effectively disseminate evidence-based best-practices for mTBI management in the ED.
Dietary mycoprotein decreases energy intake in lean individuals. The effects in overweight individuals are unclear, and the mechanisms remain to be elucidated. This study aimed to investigate the effect of mycoprotein on energy intake, appetite regulation, and the metabolic phenotype in overweight and obese volunteers. In two randomised-controlled trials, fifty-five volunteers (age: 31 (95 % CI 27, 35) years), BMI: 28·0 (95 % CI 27·3, 28·7) kg/m2) consumed a test meal containing low (44 g), medium (88 g) or high (132 g) mycoprotein or isoenergetic chicken meals. Visual analogue scales and blood samples were collected to measure appetite, glucose, insulin, peptide tyrosine-tyrosine (PYY) and glucagon-like peptide-1 (GLP-1). Ad libitum energy intake was assessed after 3 h in part A (n 36). Gastric emptying by the paracetamol method, resting energy expenditure and substrate oxidation were recorded in part B (n 14). Metabonomics was used to compare plasma and urine samples in response to the test meals. Mycoprotein reduced energy intake by 10 % (280 kJ (67 kcal)) compared with chicken at the high content (P=0·009). All mycoprotein meals reduced insulin concentrations compared with chicken (incremental AUClow (IAUClow): −8 %, IAUCmedium: −12 %, IAUChigh: −21 %, P=0·004). There was no significant difference in glucose, PYY, GLP-1, gastric emptying rate and energy expenditure. Following chicken intake, paracetamol-glucuronide was positively associated with fullness. After mycoprotein, creatinine and the deamination product of isoleucine, α-keto-β-methyl-N-valerate, were inversely related to fullness, whereas the ketone body, β-hydroxybutyrate, was positively associated. In conclusion, mycoprotein reduces energy intake and insulin release in overweight volunteers. The mechanism does not involve changes in PYY and GLP-1. The metabonomics analysis may bring new understanding to the appetite regulatory properties of food.
Accurate detection of infection with Mycobacterium bovis in live badgers would enable targeted tuberculosis control. Practical challenges in sampling wild badger populations mean that diagnosis of infection at the group (rather than the individual) level is attractive. We modelled data spanning 7 years containing over 2000 sampling events from a population of wild badgers in southwest England to quantify the ability to correctly identify the infection status of badgers at the group level. We explored the effects of variations in: (1) trapping efficiency; (2) prevalence of M. bovis; (3) using three diagnostic tests singly and in combination with one another; and (4) the number of badgers required to test positive in order to classify groups as infected. No single test was able to reliably identify infected badger groups if <90% of the animals were sampled (given an infection prevalence of 20% and group size of 15 badgers). However, the parallel use of two tests enabled an infected group to be correctly identified when only 50% of the animals were tested and a threshold of two positive badgers was used. Levels of trapping efficiency observed in previous field studies appear to be sufficient to usefully employ a combination of two existing diagnostic tests, or others of similar or greater accuracy, to identify infected badger groups without the need to capture all individuals. To improve on this, we suggest that any new diagnostic test for badgers would ideally need to be >80% sensitive, at least 94% specific, and able to be performed rapidly in the field.
Complex oxides and semiconductors exhibit distinct yet complementary properties
owing to their respective ionic and covalent natures. By electrically coupling
oxides to semiconductors within epitaxial heterostructures, enhanced or novel
functionalities beyond those of the constituent materials can potentially be
realized. Key to electrically coupling oxides to semiconductors is controlling
the physical and electronic structure of semiconductor – crystalline
oxide heterostructures. Here we discuss how composition of the oxide can be
manipulated to control physical and electronic structure in
Ba1-xSrxTiO3/ Ge and
SrZrxTi1-xO3/Ge heterostructures. In the
case of the former we discuss how strain can be engineered through composition
to enable the re-orientable ferroelectric polarization to be coupled to carriers
in the semiconductor. In the case of the latter we discuss how composition can
be exploited to control the band offset at the semiconductor - oxide interface.
The ability to control the band offset, i.e. band-gap engineering, provides a
pathway to electrically couple crystalline oxides to semiconductors to realize a
host of functionalities.
The two Pan-STARRS telescopes, located on Haleakala, Maui, Hawaii, are 1.8-meter diameter telescopes equipped with 1.4 Gigapixel cameras that deliver 7 square degree fields-of-view. The first of these telescopes, Pan-STARRS1, is conducting a search for Near Earth Objects, and is currently the leading discoverer of Near Earth Objects. The second telescope, Pan-STARRS2, is nearing the end of its commissioning, and is becoming more productive.
Pan-STARRS has become the leading survey for Near Earth Objects, responsible for approximately half of the NEO discoveries to date in 2015. Pan-STARRS is also the leading discoverer of new comets.
Mental health literacy is increasingly referenced as a goal of mental health policy. However, the current definition of this concept has a relatively narrow focus on mental disorders. The objectives of this study were to explore mental health literacy through the use of vignettes and to begin to articulate a broader definition.
Six groups of young people (n=42) aged between 16 and 25 years old responded to open-ended questions about vignettes depicting fictional characters with diagnosable mental health problems. The responses were analysed using Foucault’s governmentality theory.
The responses to the vignettes highlighted a range of determinants of our mental health. The young people suggested informal mental health-promoting techniques and highlighted the importance of talking. Ambiguity was reported in relation to the types of knowledge that are important in responding to mental health need. Finally, the responses were reflective of young people who are empathetic and view mental health from the perspective of our shared humanity, rather than as a marginal issue.
As mental health literacy is increasingly becoming a goal of mental health policy, it is timely that a shared understanding of this important concept is articulated. The current definition of mental health literacy is narrow in its focus on the recognition of mental disorders. A more broad-based definition of mental health literacy should be adopted by policy makers, reflecting the full range of determinants of mental health and recognising the importance of mental wellbeing.
In recent years, there has been a renewed interest in the role of dietary fibre in obesity management. Much of this interest stems from animal and human studies which suggest that an increased intake of fermentable fibre can suppress appetite and improve weight management. A growing number of reports have demonstrated that the principal products of colonic fermentation of dietary fibre, SCFA, contribute to energy homeostasis via effects on multiple cellular metabolic pathways and receptor-mediated mechanisms. In particular, over the past decade it has been identified that a widespread receptor system exists for SCFA. These G-protein-coupled receptors, free fatty acid receptor (FFAR) 2 and FFAR3 are expressed in numerous tissue sites, including the gut epithelium and adipose tissue. Investigations using FFAR2- or FFAR3-deficient animal models suggest that SCFA-mediated stimulation of these receptors enhances the release of the anorectic hormones peptide tyrosine tyrosine and glucagon-like peptide-1 from colonic L cells and leptin from adipocytes. In addition, the SCFA acetate has recently been shown to have a direct role in central appetite regulation. Furthermore, the SCFA propionate is a known precursor for hepatic glucose production, which has been reported to suppress feeding behaviour in ruminant studies through the stimulation of hepatic vagal afferents. The present review therefore proposes that an elevated colonic production of SCFA could stimulate numerous hormonal and neural signals at different organ and tissue sites that would cumulatively suppress short-term appetite and energy intake.