Using Multiple Sequential Functional Analysis (MSFA) to identify potential developmental pathways of Non-Epileptic Attack Disorder (NEAD)

Background. Non-epileptic attack disorder (NEAD) is one of the most common differential diagnoses to epilepsy. Due to the impact of misdiagnosis, research has focused on improving differential diagnosis by identifying factors distinguishing the two populations. These factors, though non-specific and common place comprise much of the understanding of the aetiology of NEAD. Theories which adequately explain the processes by which attacks develop and are maintained are lacking. Although it is agreed that psychological processes underpin NEAD, therapeutic approaches targeting specific processes are under developed. In light of the limitations of currently employed structural approaches, a functional approach may improve understanding of possible mechanisms underpinning NEAD development and maintenance. Aim. This study aimed to use Multiple Sequential Functional Analysis to explore whether behavioural principles of learning, applied to detailed life histories, can be used to understand the developmental pathway of non-epileptic attacks. Method. Three adult participants were recruited from outpatient Neurology clinics in the East Midlands, UK. Clinical interviews were conducted using a biographical format to collate detailed information around all aspects of the participant’s histories, current situation, and non-epileptic attacks. To improve the hypotheses made, interview data was triangulated with data from an interview with a relative and a file review. The MSFA was conducted according to the principles of radical behaviourism and applied functional analysis. Data was utilised in the analysis based on the pragmatic truth criterion of functional contextualism. Results. The results are three detailed functional analytic case studies that track the development of non-epileptic attacks for each participant from formative experiences to their current attack experiences. The results demonstrate that functional analytic principles can be used to understand the developmental pathway of NEAD in these three adults. Though the participants had very different experiences and presentations, an across-case analysis identifies that attacks have similar functional values for these people. Issues including avoiding/reducing stress and emotional suppression appear to be important factors in the development and maintenance of the behaviour. Discussion. The findings that non-epileptic attacks hold functional value for this group of people, supports the theorised roles of avoidance and secondary gain in the developmental process. The findings have important implications for future research. A strength of the present methodology is that it identifies subtle differences in the learning histories, which has implications for the development of assessment and treatment approaches for those with NEAD. Page 2 of 248 Acknowledgement

Close companions to Brightest Cluster Galaxies: Support for minor mergers and downsizing

We identify close companions of Brightest Cluster Galaxies (BCGs) for the purpose of quantifying the rate at which these galaxies grow via mergers. By exploiting deep photometric data from the CFHTLS, we probe the number of companions per BCG (Nc) with luminosity ratios down to those corresponding to potential minor mergers of 20:1. We also measure the average luminosity in companions per galaxy (Lc). We find that Nc and Lc rise steeply with luminosity ratio for both the BCGs, and a control sample of other bright, red, cluster galaxies. The trend for BCGs rises more steeply, resulting in a larger number of close companions. For companions within 50kpc of a BCG, Nc= 1.38+/-0.14 and Lc=(2.14+/-0.31)x10^(10)L_sun and for companions within 50kpc of a luminosity matched control sample of non-BCGs, Nc=0.87+/-0.08 and Lc=(1.48+/-0.20)x10^(10)L_sun. This suggests that the BCGs are likely to undergo more mergers compared to otherwise comparable luminous galaxies. Additionally, compared to a local sample of luminous red galaxies, the more distant sample presented in this study (with redshifts between 0.15-0.39,) shows a higher Nc, suggesting the younger and smaller BCGs are still undergoing hierarchical formation. Using the Millennium Simulations we model and estimate the level of contamination due to unrelated cluster galaxies. The contamination by interloping galaxies is 50% within projected separations of 50kpc, but within 30kpc, 60% of identified companions are real physical companions. We conclude that the luminosity of bound merger candidates down to luminosity ratios of 20:1 could be adding as much as 10% to the mass of a typical BCG over 0.5Gyr at redshifts of z~0.3.Comment: 10 pages, 7 figures. Accepted and to be published in MNRA

Enquiring About Tolerance (EAT) study: Feasibility of an early allergenic food introduction regimen.

BACKGROUND: The influence of early exposure to allergenic foods on the subsequent development of food allergy remains uncertain. OBJECTIVE: We sought to determine the feasibility of the early introduction of multiple allergenic foods to exclusively breast-fed infants from 3 months of age and the effect on breastfeeding performance. METHODS: We performed a randomized controlled trial. The early introduction group (EIG) continued breastfeeding with sequential introduction of 6 allergenic foods: cow's milk, peanut, hard-boiled hen's egg, sesame, whitefish (cod), and wheat; the standard introduction group followed the UK infant feeding recommendations of exclusive breastfeeding for around 6 months with no introduction of allergenic foods before 6 months of age. RESULTS: One thousand three hundred three infants were enrolled. By 5 months of age, the median frequency of consumption of all 6 foods was 2 to 3 times per week for every food in the EIG and no consumption for every food in the standard introduction group (P < .001 for every comparison). By 6 months of age, nonintroduction of the allergenic foods in the EIG was less than 5% for each of the 6 foods. Achievement of the stringent per-protocol consumption target for the EIG proved more difficult (42% of evaluable EIG participants). Breastfeeding rates in both groups significantly exceeded UK government data for equivalent mothers (P < .001 at 6 and at 9 months of age). CONCLUSION: Early introduction, before 6 months of age, of at least some amount of multiple allergenic foods appears achievable and did not affect breastfeeding. This has important implications for the evaluation of food allergy prevention strategies

Multiple novel prostate cancer susceptibility signals identified by fine-mapping of known risk loci among Europeans

Genome-wide association studies (GWAS) have identified numerous common prostate cancer (PrCa) susceptibility loci. We have fine-mapped 64 GWAS regions known at the conclusion of the iCOGS study using large-scale genotyping and imputation in 25 723 PrCa cases and 26 274 controls of European ancestry. We detected evidence for multiple independent signals at 16 regions, 12 of which contained additional newly identified significant associations. A single signal comprising a spectrum of correlated variation was observed at 39 regions; 35 of which are now described by a novel more significantly associated lead SNP, while the originally reported variant remained as the lead SNP only in 4 regions. We also confirmed two association signals in Europeans that had been previously reported only in East-Asian GWAS. Based on statistical evidence and linkage disequilibrium (LD) structure, we have curated and narrowed down the list of the most likely candidate causal variants for each region. Functional annotation using data from ENCODE filtered for PrCa cell lines and eQTL analysis demonstrated significant enrichment for overlap with bio-features within this set. By incorporating the novel risk variants identified here alongside the refined data for existing association signals, we estimate that these loci now explain ∼38.9% of the familial relative risk of PrCa, an 8.9% improvement over the previously reported GWAS tag SNPs. This suggests that a significant fraction of the heritability of PrCa may have been hidden during the discovery phase of GWAS, in particular due to the presence of multiple independent signals within the same regio

Protocol for a systematic review of the diagnostic test accuracy of tests for IgE-mediated food allergy

Background: The European Academy of Allergy and Clinical Immunology (EAACI) is in the process of updating the guidelines on the diagnosis and management of food allergy. The existing guidelines are based on a systematic review of the literature until 30 September 2012. Therefore, a new systematic review must be undertaken to inform the new guidelines. This systematic review aims to assess the accuracy of index tests to support the diagnosis of IgE-mediated food allergy. Methods: The databases Cochrane CENTRAL (Trials), MEDLINE (OVID) and Embase (OVID) will be searched for diagnostic test accuracy studies from 1 October 2012 to 30 June 2021. Inclusion and exclusion criteria will be used to select appropriate studies. Data from these studies will be extracted and tabulated, and then reviewed for risk of bias and applicability using the QUADAS-2 tool. All evaluations will be done in duplicate. Studies with a high risk of bias and low applicability will be excluded. Meta-analysis will be performed if there are three or more studies of the same index test and food. Results: A protocol for the systematic review and meta-analyses is presented and was registered using Prospero prior to commencing the literature search. Discussion: Oral food challenges are the reference standard for diagnosis but involve considerable risks and resources. This protocol for systematic review aims to assess the accuracy of various tests to diagnose food allergy, which can be useful in both clinical and research settings

Iodine and Selenium Intakes of Postmenopausal Women in New Zealand

Iodine and selenium are required for thyroid function. This study investigated iodine and selenium intakes in healthy, women aged 50–70 years (n = 97) from three cities in the North Island of New Zealand, after mandatory fortification of bread with iodised salt. Iodine and selenium concentrations were determined in 24-h urine samples; daily intakes were extrapolated from amounts in urine (90% and 55% of daily intake, respectively). Three day diet diaries (3DDD) also estimated selenium and iodine (excluding iodised salt) intake. Median urinary iodine concentration (UIC) was 57 (41, 78) µg/L, indicating mild iodine deficiency. Estimated median iodine intake based on urine was 138 (100, 172) µg/day, below Recommended Dietary Intake (RDI) (150 µg/day) with 25% below Estimated Average Requirement (EAR) (100 µg/day). Estimated median selenium intake was 50 (36, 71) µg/day based on urine and 45 (36, 68) µg/day using 3DDD, below RDI (60 µg/day) with 49%–55% below EAR (50 µg/day). Median bread intakes were low at 1.8 (1.1, 2.7) serves/day; 25% consumed ≤1 serve/day. Although population iodine intakes improved following mandatory fortification, some had low intakes. Selenium intakes remain low. Further research should investigate thyroid function of low consumers of iodine fortified bread and/or selenium in New Zealand

Connecting design and health professionals for skin cancer prevention : A novel, sustainable approach in Queensland, Australia.

This unique project addresses the need for collaborative action between health and design sectors to improve the incorporation of sun protective elements into apparel and built environment design in settings where Queenslanders live, work, play and learn..

Shade and age-friendly outdoor spaces : A handy guide

This booklet provides handy tips to protect your skin from the sun and to choose shade and age friendly locations when out and about in Queensland

Micronutrients Intake and Status during Pregnancy and Lactation

Optimal nutrition is important during pregnancy and lactation for the health of both the mother and infant. Chronic deficiencies of both macronutrients and micronutrients are well established in developing countries. Although in developed countries overconsumption of macronutrients is a major issue, micronutrient deficiencies which occur concomitantly are no less of a concern. Furthermore in developed countries there is also the risk of excessive micronutrient intake from dietary supplements. Micronutrients have a role in fetal and neonatal health and also health in later life. Micronutrient deficiency or toxicity during pregnancy or early life can permanently affect developing tissues, resulting in adverse growth and development of the infant which is associated with chronic diseases in adulthood. An aberrant micronutrient intake during pregnancy or lactation can also have detrimental effect on the mother both in the neonatal period and in later life

Re-think, Re-generate, Re-envisage fashionable sun-safe apparel

Design is a way of thinking and working that systematically can create immense societal change. In particular, fashion design is one of the most progressively forward-looking creative and commercial generators that can envisage and initiate meaningful visual and social transformation. If we look back in time at the authority of fashion, many trends have significantly induced visual norms aligning glamour and health with tanned skin - numerous examples exist, including Vogue magazine proclaiming (front-cover) that ‘The 1929 girl must be tanned’. Indeed, in a contemporary landscape, fashion trends continue to re-generate apparel that, in-the-main, has limited design resolution connected to sun safety, and surprisingly many designers elect to ignore this vital and potentially lucrative market segment. In a context with soaring skin cancer rates, how can this powerful design medium of fashion make a positive difference to sun protection; what is the untapped potential for young design talent to connect with the health sector for skin cancer prevention; and, how can fashion designers be swayed to design and produce fashionable sun-safe apparel, that address pertinent issues including heat build up, comfort and transformability? Through a case study approach, examining emergent fashion designers, this paper will propose that astute and novel avenues exist for fashion to re-think sun protective apparel, including: generation of crucial design standards for sun-safe apparel, exploration of co-branding opportunities, advancement of fashion forecasting to connect modesty of body coverage to fashion trends and alignment of the market segment to re-envisage a critical mass for fashionable sun-safe apparel