Testing the role of relative age within school year on mental health in children with neurodevelopmental vulnerability

It is important to understand the risk factors that lead some young people to develop mental health problems. The effects of potentially modifiable causal risk factors such as relative age in the school year, and their relationship with other known factors such as neurodevelopmental disorders on mental health problems throughout development were relatively unexplored epidemiologically. First, associations were examined between relative age and risk of mental health problems in childhood, adolescence, and young adulthood, in a longitudinal population cohort (ALSPAC), using general and specific measurements of mental health and depression. Young relative age was associated with poorer parent-rated general mental health in the school years (measurements taken between 7-16 years) but not before (age 4) or after (age 25). Relative age was not associated with symptoms of depression. Second, to investigate whether those with neurodevelopmental difficulties are particularly affected by relative age effects, the design was extended to test parentrated ADHD traits before school entry, and genetic risk of ADHD as moderators of associations between relative age and mental health. Relative age and ADHD risk contributed towards mental health problem risk, but there was no evidence of interactions between relative age and ADHD risk on mental health problems. Third, associations between relative age and adult (16-25 years) mental health disorder diagnoses and other related adverse clinical outcomes were investigated in cases (individuals with ADHD/ASD diagnosed in childhood) and in controls using data from a whole population electronic healthcare records cohort (SAIL databank). Relative age showed associations with outcomes in controls, but less so for cases, and there was no evidence of interactions between relative age and neurodevelopmental disorders. Relative age was associated with ADHD diagnosis. The thesis considers the implications of these findings for policy and practice, and highlights directions for future research

Relative age in the school year and risk of mental health problems in childhood, adolescence, and young adulthood

Purpose Relative age within the school year (‘relative age’) is associated with increased rates of symptoms and diagnoses of mental health disorders, including ADHD. We aimed to investigate how relative age influences mental health and behaviour before, during and after school (age range: 4–25 years). Method We used a regression discontinuity design to examine the effect of relative age on risk of mental health problems using data from a large UK population-based cohort (Avon Longitudinal Study of Parents and Children (ALSPAC); N = 14,643). We compared risk of mental health problems between ages 4 and 25 years using the parent-rated Strengths and Difficulties Questionnaire (SDQ), and depression using self-rated and parent-rated Short Mood and Feelings Questionnaire (SMFQ) by relative age. Results The youngest children in the school year have greater parent-rated risk of mental health problems, measured using parent-rated SDQ total difficulties scores. We found no evidence of differences before school entry [estimated standardised mean difference (SMD) between those born on 31 August and 1 September: .02 (−.05, .08)]. We found that estimates of effect size for a 1-year difference in relative age were greatest at 11 years [SMD: .22 (.15, .29)], but attenuated to the null at 25 years [SMD: −.02 (−.11, .07)]. We did not find consistent evidence of differences in self-rated and parent-rated depression by relative age. Conclusions Younger relative age is associated with poorer parent-rated general mental health, but not symptoms of depression

The Economics of Residential Solar and Battery Storage: Analyzing the Impact of the Joint IOU Proposal for Net Metering 3.0 in California

The California Public Utilities Commission (CPUC) is currently deciding on the structure of the next net metering program, which will determine how customers who install solar panels (and battery storage) under this new program will be compensated for excess energy that they export to the grid, and the additional fees that these solar customers will have to pay. The major investor-owned utility (IOU) companies in the state and some legislators have argued that the current net metering programs are far too generous to the customers and that they create an inequity by favoring the wealthy and causing a cost shift to the poorer non-solar customers. The IOUs have jointly proposed a set of regulations to the CPUC. In this paper, we examine the financial implications to residential customers who go solar under the new net metering program if the joint IOU proposal were to be adopted. We examine the case of a hypothetical southern California home that consumes the average amount of electricity (for that region) and estimate its electricity bills for various load profiles, assuming no solar or battery storage, with solar alone, and with solar and battery storage. For the two latter scenarios, we determine the ideal system configuration that will maximize the customer’s financial returns. In all cases, we determine that the joint IOU proposal for net metering will make residential solar panel and battery storage installations financially unattractive even in the best-case scenarios. In short, if the CPUC adopts the joint IOU proposal then residential solar installations in the state would likely come to an abrupt stop. We also analyze the economics of going off-grid (where a customer completely cuts himself off from the electrical grid) and find that it does not make sense for customers to go off-grid without being willing to cut consumption or make other compromises

Symbiosis-stimulated chitinase isoenzymes of soybean (Glycine max (L.) Merr.)

Isoforms of endochitinase in soybean were studied in relation to root symbiosis. Five selected cultivars differing in their nodulation potential were inoculated with two strains of Bradyrhizobium japonicum, the broad host-range Rhizobium sp. NGR234, and with the mycorrhizal fungus Glomus mosseae. Total chitinase activity in nodules was up to 7-fold higher than in uninoculated roots and in mycorrhizal roots. The chitinase activity in nodules varied depending on the strain-cultivar combination. On semi-native polyacrylamide gels, four acidic isoforms were identified. Two isoforms (CH 2 and CH 4) were constitutively present in all analysed tissues. The other two isoforms (CH 1 and CH 3) were strongly induced in nodules and were stimulated in mycorrhizal roots as compared to uninoculated roots. The induction of CH 1 varied in nodules depending on the soybean cultivar. This isoform was also stimulated in uninfected roots when they were treated with tri-iodobenzoic acid, rhizobial lipochitooligosaccharides (Nod factors) and chitotetraose. CH 3 was not affected by these stimuli indicating that this isoform could represent a marker for enzymes induced in later stages of the symbiotic interaction

Core Outcomes and Common Data Elements in Chronic Subdural Hematoma: A Systematic Review of the Literature Focusing on Reported Outcomes.

The plethora of studies in chronic subdural hematoma (CSDH) has not resulted in the development of an evidence-based treatment strategy, largely due to heterogeneous outcome measures that preclude cross-study comparisons and guideline development. This study aimed to identify and quantify the heterogeneity of outcome measures reported in the CSDH literature and to build a case for the development of a consensus-based core outcome set. This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and was registered with the PROSPERO international prospective register of systematic reviews (CRD42014007266). All full-text English language studies with >10 patients (prospective) or >100 patients (retrospective) published after 1990 examining clinical outcomes in CSDH were eligible for inclusion. One hundred two eligible studies were found. There were 14 (13.7%) randomized controlled trials, one single arm trial (1.0%), 25 (24.5%) cohort comparison studies, and 62 (60.8%) prospective or retrospective cohort studies. Outcome domains reported by the studies included mortality (63.8% of included studies), recurrence (94.1%), complications (48.0%), functional outcomes (40.2%), and radiological (38.2%) outcomes. There was significant heterogeneity in the definitions of the outcome measures, as evidenced by the seven different definitions of the term "recurrence," with no definition given in 19 studies. The time-points of assessment for all the outcome domains varied greatly from inpatient/hospital discharge to 18 months. This study establishes and quantifies the heterogeneity of outcome measure reporting in CSDH and builds the case for the development of a robust consensus-based core outcome set for future studies to adhere to as part of the Core Outcomes and Common Data Elements in CSDH (CODE-CSDH) project.PJH is supported by a National Institute for Health Research (NIHR) Research Professorship and the NIHR Cambridge Biomedical Research Centre

Road traffic casualties in the elderly in Europe: analysis of macroscopic and in-depth data

Road traffic casualties in the elderly in Europe: analysis of macroscopic and in-depth dat

How to do it: the neurological consultation with an autistic patient

Autism is a neurodevelopmental condition with a very heterogeneous presentation. Autistic people are more likely to have unmet healthcare needs, making it essential that healthcare professionals are ‘autism-aware’. In this article, we provide an overview of how autism presents and use case studies to illustrate how a neurological consultation in an outpatient clinic environment could prove challenging for a autistic person. We suggest how to improve communication with autistic patients in clinic and highlight the importance of a patient-centred and flexible approach

VISTA Deficiency Attenuates Antibody-induced Arthritis and Alters Macrophage Gene Expression in Response to Simulated Immune Complexes

In addition to activated T cells, the immune checkpoint inhibitor “V domain-containing Ig suppressor of T-cell activation” (VISTA) is expressed by myeloid cell types, including macrophages and neutrophils. The importance of VISTA expression by myeloid cells to antibody-induced arthritis and its potential for relevance in human disease was evaluated. Methods: VISTA was immunolocalized in normal and arthritic human synovial tissue sections and synovial tissue lysates were subjected to western blot analysis. The collagen antibody-induced arthritis model (CAIA) was performed with DBA/1 J mice treated with antibodies against VISTA and with VISTA-deficient mice (V-KO). Total mRNA from arthritic joints, spleens, and cultured macrophages was analyzed with NanoString arrays. Cytokines secreted by splenic inflammatory macrophages were determined. In-vitro chemotaxis and signal transduction assays were performed with cultured macrophages. Results: VISTA protein was localized to synovial membrane cells, neutrophils, and scattered cells in lymphocyte-rich foci and was detected by western blot analysis in normal synovium and synovium from rheumatoid arthritis patients. Deficiency of VISTA or treatment of mice with anti-VISTA monoclonal antibodies attenuated CAIA. Joint damage and MMP-3 expression were significantly reduced in V-KO mice. Surface expression of C5a receptor was reduced on monocytes, neutrophils, and cultured macrophages from V-KO. Upon Fc receptor engagement in vitro, gene expression by V-KO macrophages was altered profoundly compared to WT, including a significant induction of IL-1 receptor antagonist (IL1rn). Conclusions: VISTA expression supports immune-complex inflammation in CAIA and VISTA is expressed in human synovium. VISTA supports optimal responses to C5a and modulates macrophage responses to immune complexes

VISTA Deficiency Attenuates Antibody-induced Arthritis and Alters Macrophage Gene Expression in Response to Simulated Immune Complexes

In addition to activated T cells, the immune checkpoint inhibitor “V domain-containing Ig suppressor of T-cell activation” (VISTA) is expressed by myeloid cell types, including macrophages and neutrophils. The importance of VISTA expression by myeloid cells to antibody-induced arthritis and its potential for relevance in human disease was evaluated. Methods: VISTA was immunolocalized in normal and arthritic human synovial tissue sections and synovial tissue lysates were subjected to western blot analysis. The collagen antibody-induced arthritis model (CAIA) was performed with DBA/1 J mice treated with antibodies against VISTA and with VISTA-deficient mice (V-KO). Total mRNA from arthritic joints, spleens, and cultured macrophages was analyzed with NanoString arrays. Cytokines secreted by splenic inflammatory macrophages were determined. In-vitro chemotaxis and signal transduction assays were performed with cultured macrophages. Results: VISTA protein was localized to synovial membrane cells, neutrophils, and scattered cells in lymphocyte-rich foci and was detected by western blot analysis in normal synovium and synovium from rheumatoid arthritis patients. Deficiency of VISTA or treatment of mice with anti-VISTA monoclonal antibodies attenuated CAIA. Joint damage and MMP-3 expression were significantly reduced in V-KO mice. Surface expression of C5a receptor was reduced on monocytes, neutrophils, and cultured macrophages from V-KO. Upon Fc receptor engagement in vitro, gene expression by V-KO macrophages was altered profoundly compared to WT, including a significant induction of IL-1 receptor antagonist (IL1rn). Conclusions: VISTA expression supports immune-complex inflammation in CAIA and VISTA is expressed in human synovium. VISTA supports optimal responses to C5a and modulates macrophage responses to immune complexes