Does chronic caregiving stress accelerate T cell immunosenescence?

First paragraph: It is now well understood that the human immune system undergoes considerable changes, termed immunosenescence, as part of the ageing process, resulting in an increased rate of infections and inflammation. The impact of stress is often studied in the context of such age-related changes, as detailed in this issue by Prather et al. (2018). In the innate immune system, immunosenescence changes include increased levels of inflammatory cytokines and markers such as CRP, accompanied by decreased anti-inflammatory cytokines; a skewing toward myeloid cell differentiation of haematopoietic stem cells; decreased phagocytosis, intracellular killing and dysregulated chemotaxis in neutrophils and macrophages/monocytes, increased NK and NKT cells but decreased cytotoxicity (Bosch et al., 2013). In the adaptive immune system, these alterations encompass decreased production of naïve T cells, especially cytotoxic CD8+ T cells, due to thymus involution and CMV exposure, decreases in T cell activation, reduced numbers of naïve B cells, and a switch towards accumulation of memory and effector T and B cells (Bosch et al., 2013). Chronic stress is known to exacerbate these changes further and affect a range of immune cells and immune processes such as slower wound healing and reduced antibody response to vaccination (Segerstrom and Miller, 2004)

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Assessing the feasibility and impact of an adapted resistance training intervention, aimed at improving the multi-dimensional health and functional capacity of frail older adults in residential care settings: protocol for a feasibility study

Background Frailty is a common and clinically significant condition in older adults, predominantly due to its association with adverse health outcomes such as hospitalisation, disability and mortality. Exercise interventions have been shown to be a beneficial treatment for frail older adults. However, more high-quality studies are needed within this area to assess the feasibility and impact of these interventions in frail geriatric populations within different settings, and with regards to their impact on broader aspects of health and wellbeing. Methods This study will utilise an interventional, randomised, controlled research design in order to assess the feasibility (acceptability, demand, implementation, practicality, adaptation, integration, expansion) and potential impact (limited-efficacy testing) of a specially adapted resistance training intervention; aimed at improving the multi-dimensional health and functional capacity of frail geriatric care home residents. Discussion The most immediate implication of this research from a scientific perspective is informing the feasibility, and potential efficacy, of a proposed future clinical trial within this setting. Additionally, if the study proves feasible, and the limited-efficacy testing proves positive, this study also has the potential to lead to advancement in the care for frail geriatric populations within residential care settings; and the ability to measurably improve various aspects of health and functional capacity within this population. This study has been granted a favourable ethical opinion by the London Harrow NHS Research Ethics Committee and is sponsored by the University of Birmingham. The findings of this study will be disseminated through publication in open access scientific journals, public engagement events, online via social media, conference presentations and directly to study participants

Microaggressions & Bystander Training for Tutors and SPs: Providing a safe environment for Year 3 & 4 MB BS student to discuss and role play dealing with microaggressions personally or as a bystander in Communication Masterclasses

Presentation Objectives: To develop awareness of HYMS innovative Microaggression/Bystander Training delivered to our Communication Masterclass tutors & SPs to improve their skills and confidence in providing an opportunity for students to discuss and role play dealing with microaggressions either personally or as bystanders.To consider feedback and reflections from Communication Masterclass Tutors & SPs regarding discussion and role play of microaggressions in HYMS Communication Masterclasses

Oral 13. Unconscious Bias Training for our Simulated Patients: Showcasing a new and innovative workshop

Oral Presentation objectives1) To develop awareness of our innovative workshop delivered to our Simulated Patients to increase their understanding of unconscious biases, how these might impact their work as Simulated Patients in our teaching and assessments and to equip them with skills to challenge and interrogate their automatic thinking. 2) To consider Simulated patient feedback and reflections and my own critical reflections on the Workshop.3) To share best practice with delegates regarding their own experiences of developing Unconscious Bias training to Simulated Patients / other groups in their own institutions

PC030. Unconscious Bias Training for our Simulated Patients: Showcasing a new and innovative workshop

Background:Unconscious biases are beliefs, attitudes and stereotypes that can affect our understanding and decisions in a way that we're not aware of. If steps aren't taken to avoid acting on such biases, it can lead to unfair treatments and discriminatory practices (General Medical Council).At the Hull York Medical School, we are committed to ensuring an inclusive environment and developing a culture of cultural competence which includes raising awareness of unconscious bias. We are fortunate to have a large pool of highly trained Simulated Patients (SPs) who can both simulate patient scenarios and deliver specific, descriptive and non-judgmental feedback in teaching sessions across all five years of the curriculum. Since the arrival of the covid pandemic, Simulated Patients have played a crucial role in the delivery of teaching and assessments across all five years of our MBBS programme. We are aware that, despite ongoing efforts, our Simulated Patient pool is less diverse than both our student and staff cohorts. This workshop is part of a wider school commitment to raise awareness of the impact of Unconscious Bias on our interactions with students, patients and staff. This training was informed by the adaptation of Bennett’s intercultural competency model1 by Teal et al2

Fusion of heart rate variability and salivary cortisol for stress response identification based on adverse childhood experience

Adverse childhood experiences have been suggested to cause changes in physiological processes and can determine the magnitude of the stress response which might have a significant impact on health later in life. To detect the stress response, biomarkers that represent both the Autonomic Nervous System (ANS) and Hypothalamic-Pituitary-Adrenal (HPA) axis are proposed. Among the available biomarkers, Heart Rate Variability (HRV) has been proven as a powerful biomarker that represents ANS. Meanwhile, salivary cortisol has been suggested as a biomarker that reflects the HPA axis. Even though many studies used multiple biomarkers to measure the stress response, the results for each biomarker were analyzed separately. Therefore, the objective of this study is to propose a fusion of ANS and HPA axis biomarkers in order to classify the stress response based on adverse childhood experience. Electrocardiograph, blood pressure (BP), pulse rate (PR), and salivary cortisol (SCort) measures were collected from 23 healthy participants; 11 participants had adverse childhood experience while the remaining 12 acted as the no adversity control group. HRV was then computed from the ECG and the HRV features were extracted. Next, the selected HRV features were combined with the other biomarkers using Euclidean distance (ed) and serial fusion, and the performance of the fused features was compared using Support Vector Machine. From the result, HRV-SCort using Euclidean distance achieved the most satisfactory performance with 80.0% accuracy, 83.3% sensitivity, and 78.3% specificity. Furthermore, the performance of the stress response classification of the fused biomarker, HRV-SCort, outperformed that of the single biomarkers: HRV (61% Accuracy), Cort (59.4% Accuracy), BP (78.3% accuracy), and PR (53.3% accuracy). From this study, it was proven that the fused biomarkers that represent both ANS and HPA (HRV-SCort) able to demonstrate a better classification performance in discriminating the stress response. Furthermore, a new approach for classification of stress response using Euclidean distance and SVM named as ed-SVM was proven to be an effective method for the HRV-SCort in classifying the stress response from PASAT. The robustness of this method is crucial in contributing to the effectiveness of the stress response measures and could further be used as an indicator for future health

Undiagnosed Obstructive Sleep Apnea and Physical Activity in Older Manual Workers

First paragraph: Sleep is essential for life and integral to health and well-being (Roehrs, 2000). However, during the aging process, sleep patterns become disrupted, which leads to sleep deprivation (Stanley, 2005). Inadequate sleep has adverse effects on the body, including the production of higher cortisol (stress hormone) levels, which causes wear and tear physiologically, and further contributes to wakefulness (Stanley, 2005)

Transient landscape and stratigraphic responses to drainage integration in the actively extending central Italian Apennines

Drainage networks in continental rifts are generally reported as dynamic features that produce transitions between endorheic and exorheic conditions. While this is of major importance for landscape development, sediment dispersal, and basin stratigraphy, the controls of drainage network evolution across an array of normal fault bounded basins are still not well understood. In this study we use the central Italian Apennines – an area that has been affected by active normal faulting and regional uplift over the last ~3 Myrs – to determine the controls on drainage network evolution and its impact on transient landscape evolution and basin stratigraphy. We compile previously published stratigraphic and fault-related data with new geomorphological constraints for the Aterno River system (~1300 km2), for which a wealth of data has been collected following the destructive L'Aquila earthquake in 2009. We use this compilation to demonstrate how the different basins along the river system were initially isolated during the Early Pleistocene but became fluvially integrated with one another and the Adriatic coast between ca. 1.2 and 0.65 Ma. We conclude that the spatial and temporal pattern of drainage integration is mostly explained by a long-term increase in sediment and water supply relative to basin subsidence due to the Early to Middle Pleistocene climatic transition, the progressive increase in fault-related topography, and the transport of sediment and water down-system as drainage integration occurred. Overall we conclude that rates of sedimentation and basin subsidence in the central Apennines are well-matched, allowing tipping points between over- and under-filled conditions to be easily reached. We also show that consecutive drainage integration events produce discrete waves of river incision and terrace formation, and conclude that drainage integration is of major importance, at least equivalent to tectonics and climate, in controlling transient landscape evolution and rift basin stratigraphy.publishedVersio