Role of environment and sex differences in the development of autoimmune diseases: A roundtable meeting project

Autoimmune diseases (ADs) impose substantial health and financial burdens in the United States and in many parts of the world. Women are disproportionately affected by many of these disorders, which often contribute to lifelong disabilities. While the number of patients with some ADs appears to be rising, the complexities of conducting epidemiological studies prevent a thorough understanding of the prevalence and incidence of these various conditions. Research on environmental influences of these illnesses is limited, although they are generally hypothesized to result from the interaction of environmental agents in genetically susceptible individuals. Further, there is little known regarding the role of sex and gender in the environmentally influenced mechanisms leading to the development of AD. To address these issues, particularly the roles of environment and sex and gender in ADs and the factors that contribute to the rise in ADs, the Society for Women\u27s Health Research convened an interdisciplinary roundtable of experts from academia, medicine, and government agencies to share their expertise, address knowledge gaps in research, and propose future research recommendations

Research on post-diagnostic support for autistic young people

Autistic young people have told us that having a limited understanding of their own diagnosis makes their mental health worse, particularly during the transition to adulthood. Currently, post-diagnosis support is not widely available and many autistic young people from marginalised communities face additional barriers in accessing any support. In response, Ambitious about Autism worked with autistic young people to co-design an online peer support course called Understanding You, Discovering You (www.ambitiousaboutautism.org.uk/ post-diagnosis-peer-support). This course supports autistic young people to explore what autism is, develop a positive autistic identity, and equips young people with practical skills, with the aim to improve their mental health. We commissioned a team of researchers, led by UCL Centre for Research in Autism in Education (CRAE), to conduct research to help collate evidence linking autistic identity and wellbeing, investigate inequalities in accessing post-diagnostic support and lead an evaluation of the co-production and initial pilot of the online course. We wanted a strong research base to help us learn, inform the ongoing development of the online course, and provide us with a series of recommendations to make the course inclusive and accessible to more autistic young people. With the support of UCL CRAE and their colleagues, this research is now complete and summarised in this document. We hope by sharing our learnings and the research findings we can support more autistic young people, post-diagnosis. Full research papers are linked by QR codes in this document

Quantum Vacuum Instability Near Rotating Stars

We discuss the Starobinskii-Unruh process for the Kerr black hole. We show how this effect is related to the theory of squeezed states. We then consider a simple model for a highly relativistic rotating star and show that the Starobinskii-Unruh effect is absent.Comment: 17 Pages, (accepted by PRD), (previously incorrect header files have been corrected

Genetically modified organisms in agriculture: social and economic implications

This paper argues that whether genetic modification of crops is seen as radically different or simply a further step of ‘traditional’ breeding techniques affects the perception of the associated benefits and risks of their commercialisation and the wider context scrutinised to assess potential consequences. Current risk regulation and GM legislation is narrowly defined, and largely concerned with scientific evidence of harm to human health and the environment. This contrasts with the public disquiet and a greater concern for overarching issues such as institutional and power structures (and the way political decisions are made), the role of science in society and the social and economic impacts of new technologies in the UK and abroad. The paper shows how the debate over GM technology has been framed and reflects the broader tensions within society. First, broadly political factors are discussed, followed by economic considerations to show how socio-economic factors influence and are influenced by novel technologies. Finally, welfare impacts and issues relating to less industrially developed economies are considered

Genetically modified organisms in agriculture: social and economic implications

This paper argues that whether genetic modification of crops is seen as radically different or simply a further step of ‘traditional’ breeding techniques affects the perception of the associated benefits and risks of their commercialisation and the wider context scrutinised to assess potential consequences. Current risk regulation and GM legislation is narrowly defined, and largely concerned with scientific evidence of harm to human health and the environment. This contrasts with the public disquiet and a greater concern for overarching issues such as institutional and power structures (and the way political decisions are made), the role of science in society and the social and economic impacts of new technologies in the UK and abroad. The paper shows how the debate over GM technology has been framed and reflects the broader tensions within society. First, broadly political factors are discussed, followed by economic considerations to show how socio-economic factors influence and are influenced by novel technologies. Finally, welfare impacts and issues relating to less industrially developed economies are considered

Restoring North America’s Sagebrush Steppe Ecosystem Using Seed Enhancement Technologies

Rangelands occupy over a third of global land area, and in many cases are in less than optimum condition as a result of past land use, catastrophic wildfire and other disturbance, invasive species, or climate change. Often the only means of restoring these lands involves seeding desirable species, yet there are few cost effective seeding technologies, especially for the more arid rangeland types. The inability to consistently establish desired plants from seed may indicate that the seeding technologies being used are not successful in addressing the primary sources of mortality in the progression from seed to established plant. Seed enhancement technologies allow for the physical manipulation and application of materials to the seed that can enhance germination, emergence, and/or early seedling growth. In this article we examine some of the major limiting factors impairing seedling establishment in North America’s native sagebrush steppe ecosystem, and demonstrate how seed enhancement technologies can be employed to overcome these restoration barriers. We discuss specific technologies for: (1) increasing soil water availability; (2) enhancing seedling emergence in crusting soil; (3) controlling the timing of seed germination; (4) improving plantability and emergence of small seeded species; (5) enhancing seed coverage of broadcasted seeds; and (6) improving selectivity of pre-emergent herbicide. Concepts and technologies in this paper for restoring the sagebrush steppe ecosystem may apply generally to semi-arid and arid rangelands around the globe

The effects of supervised exercise training 12-24 months after bariatric surgery oh physical function and body composition: a randomised controlled trial

BACKGROUND: Bariatric surgery is effective for the treatment of stage II and III obesity and its related diseases, although increasing evidence is showing weight regain ~12–24 months postsurgery. Weight regain increases the risk of physical function decline, which negatively affects an individual's ability to undertake activities of daily living. The study assessed the effects of a 12-week supervised exercise intervention on physical function and body composition in patients between 12 and 24 months post bariatric surgery. METHODS: Twenty-four inactive adult bariatric surgery patients whose body mass index remained 30 kg m2 12 to 24 months post surgery were randomised to an exercise intervention (n=12) or control group (n=12). Supervised exercise consisted of three 60-min gym sessions per week of moderate intensity aerobic and resistance training for 12 weeks. Control participants received usual care. The incremental shuttle walk test (ISWT) was used to assess functional walking performance after the 12-week exercise intervention, and at 24 weeks follow-up. Measures of anthropometric, physical activity, cardiovascular and psychological outcomes were also examined. Using an intention-to-treat protocol, independent t-tests were used to compare outcome measures between groups. RESULTS: Significant improvements in the exercise group were observed for the ISWT, body composition, physical function, cardiovascular and self-efficacy measures from baseline to 12 weeks. A large baseline to 12-week change was observed for the ISWT (exercise: 325.00±117.28 m; control: 355.00±80.62 m, P<0.001). The exercise group at 24 weeks recorded an overall mean improvement of 143.3±86.6 m and the control group recorded a reduction of −32.50±75.93 m. Findings show a 5.6 kg difference between groups in body mass change from baseline to 24 weeks favouring the exercise group. CONCLUSION: A 12-week supervised exercise intervention led to significant improvements in body mass and functional walking ability post intervention, with further improvements at the 24-week follow-up

Critical Behavior of Dimensionally Continued Black Holes

The critical behavior of black holes in even and odd dimensional spacetimes is studied based on Ba\~nados-Teitelboim-Zanelli (BTZ) dimensionally continued black holes. In even dimensions it is found that asymptotically flat and anti de-Sitter Reissner-Nordstr\"om black holes present up to two second order phase transitions. The case of asymptotically anti-de-Sitter Schwarzschild black holes present only one critical transition and a minimum of temperature, which occurs at the transition. Finally, it is shown that phase transitions are absent in odd dimensions.Comment: 21 pages in Latex format, no figures, vastly improved version to appear in Phys. Rev.

Development and evaluation of a de-escalation training intervention in adult acute and forensic units: the EDITION systematic review and feasibility trial.

Containment (e.g. physical restraint and seclusion) is used frequently in mental health inpatient settings. Containment is associated with serious psychological and physical harms. De-escalation (psychosocial techniques to manage distress without containment) is recommended to manage aggression and other unsafe behaviours, for example self-harm. All National Health Service staff are trained in de-escalation but there is little to no evidence supporting training's effectiveness. Objectives were to: (1) qualitatively investigate de-escalation and identify barriers and facilitators to use across the range of adult acute and forensic mental health inpatient settings; (2) co-produce with relevant stakeholders an intervention to enhance de-escalation across these settings; (3) evaluate the intervention's preliminary effect on rates of conflict (e.g. violence, self-harm) and containment (e.g. seclusion and physical restraint) and understand barriers and facilitators to intervention effects. Intervention development informed by Experience-based Co-design and uncontrolled pre and post feasibility evaluation. Systematic reviews and qualitative interviews investigated contextual variation in use and effects of de-escalation. Synthesis of this evidence informed co-design of an intervention to enhance de-escalation. An uncontrolled feasibility trial of the intervention followed. Clinical outcome data were collected over 24 weeks including an 8-week pre-intervention phase, an 8-week embedding and an 8-week post-intervention phase. Ten inpatient wards (including acute, psychiatric intensive care, low, medium and high secure forensic) in two United Kingdom mental health trusts. In-patients, clinical staff, managers, carers/relatives and training staff in the target settings. Enhancing de-escalation techniques in adult acute and forensic units: Development and evaluation of an evidence-based training intervention (EDITION) interventions included de-escalation training, two novel models of reflective practice, post-incident debriefing and feedback on clinical practice, collaborative prescribing and ward rounds, practice changes around admission, shift handovers and the social and physical environment, and sensory modulation and support planning to reduce patient distress. Outcomes measured related to feasibility (recruitment and retention, completion of outcome measures), training outcomes and clinical and safety outcomes. Conflict and containment rates were measured via the Patient-Staff Conflict Checklist. Clinical outcomes were measured using the Attitudes to Containment Measures Questionnaire, Attitudes to Personality Disorder Questionnaire, Violence Prevention Climate Scale, Capabilities, Opportunities, and Motivation Scale, Coercion Experience Scale and Perceived Expressed Emotion in Staff Scale. Completion rates of the proposed primary outcome were very good at 68% overall (excluding remote data collection), which increased to 76% (excluding remote data collection) in the post-intervention period. Secondary outcomes had high completion rates for both staff and patient respondents. Regression analyses indicated that reductions in conflict and containment were both predicted by study phase (pre, embedding, post intervention). There were no adverse events or serious adverse events related to the intervention. Intervention and data-collection procedures were feasible, and there was a signal of an effect on the proposed primary outcome. Uncontrolled design and self-selecting sample. Definitive trial determining intervention effects. This trial is registered as ISRCTN12826685 (closed to recruitment). This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 16/101/02) and is published in full in ; Vol. 28, No. 3. See the NIHR Funding and Awards website for further award information. Conflict (a term used to describe a range of potentially unsafe events including violence, self-harm, rule-breaking, medication refusal, illicit drug and alcohol use and absconding) in mental health settings causes serious physical and psychological harm. Containment interventions which are intended to minimise harm from violence (and other conflict behaviours) such as restraint, seclusion and rapid tranquilisation can result in serious injuries to patients and, occasionally, death. Involvement in physical restraint is the most common cause of serious physical injury to National Health Service mental health staff in the United Kingdom. Violence to staff results in substantial costs to the health service in sickness and litigation payments. Containment interventions are also expensive (e.g. physical restraint costs mental health services £6.1 million and enhanced observations £88 million per annum). Despite these harms, recent findings indicate containment interventions such as seclusion and physical restraint continue to be used frequently in mental health settings. Clinical trials have demonstrated that interventions can reduce containment without increasing violence and other conflict behaviours (e.g. verbal aggression, self-harm). Substantial cost-savings result from reducing containment use. De-escalation, as an intervention to manage aggression and potential violence without restrictive practices, is a core intervention. 'De-escalation' is a collective term for a range of psychosocial techniques designed to reduce distress and anger without the need to use 'containment' interventions (measures to prevent harm through restricting a person's ability to act independently, such as physical restraint and seclusion). Evidence indicates that de-escalation involves ensuring conditions for safe intervention and effective communication are established, clarifying and attempting to resolve the patient's concern, conveyance of respect and empathy and regulating unhelpful emotions such as anxiety and anger. Despite featuring prominently in clinical guidelines and training policy domestically and internationally and being a component of mandatory National Health Service training, there is no evidence-based model on which to base training. A systematic review of de-escalation training effectiveness and acceptability conducted in 2015 concluded: (1) no model of training has demonstrated effectiveness in a sufficiently rigorous evaluation, (2) the theoretical underpinning of evaluated models was often unclear and (3) there has been inadequate investigation of the characteristics of training likely to enhance acceptability and uptake. Despite all National Health Service staff being trained in de-escalation there have been no high-quality trials evaluating the effectiveness and cost-effectiveness of training. Feasibility studies are needed to establish whether it is possible to conduct a definitive trial that can determine the clinical, safety and cost-effectiveness of this intervention

An Australian longitudinal pilot study examining health determinants of cardiac outcomes 12 months post percutaneous coronary intervention

Background Percutaneous coronary intervention (PCI) is a very common revascularisation procedure for coronary artery disease (CAD). The purpose of this study was to evaluate cardiac outcomes, health related quality of life (HRQoL), resilience and adherence behaviours in patients who have undergone a PCI at two time points (6 and 12 months) following their procedure. Methods A longitudinal pilot study was conducted to observe the cardiac outcomes across a cohort of patients who had undergone a percutaneous coronary intervention (PCI). Participants who had undergone PCI 6 months prior were invited. Those participants who met the inclusion criteria and provided consent then completed a telephone survey (time point 1). These participants were then contacted 6 months later (i.e. 12 months post-intervention, time point 2) and the measures were repeated. Results All patients (n = 51) were recorded as being alive at time point 1. The multiple model indicated that controlling for other factors, gender was significantly associated with a linear combination of outcome measures (p = 0.004). The effect was moderate in magnitude (partial-η2 = 0.303), where males performed significantly better than females 6 months after the PCI procedure physically and with mood. Follow-up univariate ANOVAs indicated that gender differences were grounded in the scale measuring depression (PHQ9) (p = 0.005) and the physical component score of the short form measuring HRQoL (SF12-PCS) (p = 0.003). Thirteen patients were lost to follow-up between time points 1 and 2. One patient was confirmed to have passed away. The pattern of correlations between outcome measures at time point 2 revealed statistically significant negative correlation between the PHQ instrument and the resilience scale (CD-RISC) (r = -0.611; p < 0.001); and the physical component score of the SF-12 instrument (r = -0.437; p = 0.054). Conclusions Men were performing better than women in the 6 months post-PCI, particularly in the areas of mood (depression) and physical health. This pilot results indicate gender-sensitive practices are recommended particularly up to 6 months post-PCI. Any gender differences observed at 6 month appear to disappear at 12 months post-PCI. Further research into the management of mood particularly for women post-PCI is warranted. A more detailed inquiry related to access/attendance to secondary prevention is also warranted