The effects of a thermal discharge on the macroinvertebrate community of a large British river: implications for climate change

Anthropogenic changes to the temperature regimes of rivers, whether through thermal pollution, removal of shade, or climate change, could affect community stability and cause phenological changes in aquatic species. This study examines the impact of a thermal discharge from a power station on the diversity and composition of the aquatic macroinvertebrate community in the River Severn, UK. Daily temperatures up to 2 km downstream of the thermal discharge averaged 4.5°C above ambient. Abundance and taxon richness metrics were reduced at a site approximately 0.5 km downstream of the power station outfall, but were largely unaffected at a second site about 2 km downstream. The majority of the macroinvertebrate taxa observed were recorded at both control and heated sites, suggesting species were below their thermal tolerance threshold or had developed adaptations to survive increased temperatures. However, indicator species analysis suggests certain taxa were associated with particular sites; abundances of Musculium lacustre, Simulium reptans, and Orthocladiinae were greater at the unheated control site, whereas more pollution-tolerant species such Asellus aquaticus and Erpobdella octoculata were more common in the thermally impacted reaches. Overall, the results provide an indication of potential species and community response to future warming under climate change scenarios

Efficient chemical synthesis of human complement protein C3a

We report the total chemical synthesis of human C3a by one-pot native chemical ligation of three unprotected peptide segments, followed by efficient in vitro folding that yielded the anaphylatoxin C3a in high yield and excellent purity. Synthetic C3a was fully active and its crystal structure at 2.1 Å resolution showed 3 helices and a C-terminal turn motif

Group Singing as a Resource for the Development of a Healthy Public

A growing body of evidence points to a wide range of benefits arising from participation in group singing. Group singing requires participants to engage with each other in a simultaneous musical dialogue in a pluralistic and emergent context, creating a coherent cultural expression through the reflexive negotiation of (musical) meaning manifest in the collective power of the human voice. As such, group singing might be taken – both literally and figuratively – as a potent form of ‘healthy public’, creating an ‘ideal’ community which participants can subsequently mobilise as a positive resource for everyday life. The experiences of a group of singers (n=78) who had participated in an outdoor singing project were collected and analysed using a three-layer research design consisting of: distributed data generation and interpretation, considered against comparative data from other singing groups (n=88); a focus group workshop (n=11); an unstructured interview (n=2). The study confirmed an expected perception of the social bonding effect of group singing, highlighting affordances for interpersonal attunement and attachment alongside a powerful individual sense of feeling ‘uplifted’. This study presents a novel perspective on group singing, highlighting the importance of participant experience as a means of understanding music as a holistic and complex adaptive system. It validates findings about group singing from previous studies - in particular the stability of the social bonding effect as a less variant characteristic in the face of environmental and other situational influences, alongside its capacity for mental health recovery. It establishes a subjective sociocultural and musical understanding of group singing, by expanding on these findings to centralise the importance of individual experience, and the consciousness of that experience as descriptive self-awareness. The ways in which participants describe and discuss their experiences of group singing and its benefits points to a complex interdependence between a number of musical, neurobiological and psychosocial mechanisms which might be independently and objectively analysed. An emerging theory is that at least some of the potency of group singing is as a resource where people can rehearse and perform ‘healthy’ relationships, further emphasising its potential as a resource for healthy publics

Anaphylatoxin C3a receptors in asthma

The complement system forms the central core of innate immunity but also mediates a variety of inflammatory responses. Anaphylatoxin C3a, which is generated as a byproduct of complement activation, has long been known to activate mast cells, basophils and eosinophils and to cause smooth muscle contraction. However, the role of C3a in the pathogenesis of allergic asthma remains unclear. In this review, we examine the role of C3a in promoting asthma. Following allergen challenge, C3a is generated in the lung of subjects with asthma but not healthy subjects. Furthermore, deficiency in C3a generation or in G protein coupled receptor for C3a abrogates allergen-induced responses in murine models of pulmonary inflammation and airway hyperresponsiveness. In addition, inhibition of complement activation or administration of small molecule inhibitors of C3a receptor after sensitization but before allergen challenge inhibits airway responses. At a cellular level, C3a stimulates robust mast cell degranulation that is greatly enhanced following cell-cell contact with airway smooth muscle (ASM) cells. Therefore, C3a likely plays an important role in asthma primarily by regulating mast cell-ASM cell interaction

Targeting IL-1β and IL-17A driven inflammation during influenza-induced exacerbations of chronic lung inflammation.

For patients with chronic lung diseases, such as chronic obstructive pulmonary disease (COPD), exacerbations are life-threatening events causing acute respiratory distress that can even lead to hospitalization and death. Although a great deal of effort has been put into research of exacerbations and potential treatment options, the exact underlying mechanisms are yet to be deciphered and no therapy that effectively targets the excessive inflammation is available. In this study, we report that interleukin-1β (IL-1β) and interleukin-17A (IL-17A) are key mediators of neutrophilic inflammation in influenza-induced exacerbations of chronic lung inflammation. Using a mouse model of disease, our data shows a role for IL-1β in mediating lung dysfunction, and in driving neutrophilic inflammation during the whole phase of viral infection. We further report a role for IL-17A as a mediator of IL-1β induced neutrophilia at early time points during influenza-induced exacerbations. Blocking of IL-17A or IL-1 resulted in a significant abrogation of neutrophil recruitment to the airways in the initial phase of infection or at the peak of viral replication, respectively. Therefore, IL-17A and IL-1β are potential targets for therapeutic treatment of viral exacerbations of chronic lung inflammation

Identifying Key Factors Associated with Aggression on Acute Inpatient Psychiatric Wards

Aggressive behaviour is a critical issue for modern acute psychiatric services, not just because of the adverse impact it has on patients and staff, but also because it puts a financial strain on service providers. The aim of this study was to assess the relationship of patient violence to other variables: patient characteristics, features of the service and physical environment, patient routines, staff factors, the use of containment methods, and other patient behaviours. A multivariate cross sectional design was utilised. Data were collected for a six month period on 136 acute psychiatric wards in 26 NHS Trusts in England. Multilevel modelling was conducted to ascertain those factors most strongly associated with verbal aggression, aggression toward objects, and physical aggression against others. High levels of aggression were associated with a high proportion of patients formally detained under mental health legislation, high patient turnover, alcohol use by patients, ward doors being locked, and higher staffing numbers (especially qualified nurses). The findings suggest that the imposition of restrictions on patients exacerbates the problem of violence, and that alcohol management strategies may be a productive intervention. Insufficient evidence is available to draw conclusions about the nature of the link between staffing numbers and violence

Exploring the potential of virtual reality technology to investigate the health and well being benefits of group singing

There is a growing body of academic research aiming to quantify and understand the associated health and well being benefits of group singing. The social interaction is known to strongly contribute to perceived improvements to mental and physical health but there are also indications that singing together elicits better well being outcomes that other community activities. This paper introduces the Vocal Interaction in an Immersive Virtual Acoustic (VIIVA) system, which allows the user to take part in a group singing activity in 360 degree virtual reality, hearing themselves in the recorded venue alongside the other singers. The VIIVA is intended to make group singing accessible to those unable to attend real community choirs but also as a tool for experimental research into the health and well being benefits of group singing. This paper describes the system and presents a number of methodologies and applications which are discussed in relation to three ongoing research projects. Preliminary work indicates that the VIIVA system and the devised setups provide a promising tool with which to study the health and well being benefits of group singing, and in particular to control for the social interactions inherent in real group singing activities

Exercise versus usual care after non-reconstructive breast cancer surgery (UK PROSPER): multicentre randomised controlled trial and economic evaluation

Objective To evaluate whether a structured exercise programme improved functional and health related quality of life outcomes compared with usual care for women at high risk of upper limb disability after breast cancer surgery. Design Multicentre, pragmatic, superiority, randomised controlled trial with economic evaluation. Setting 17 UK National Health Service cancer centres. Participants 392 women undergoing breast cancer surgery, at risk of postoperative upper limb morbidity, randomised (1:1) to usual care with structured exercise (n=196) or usual care alone (n=196). Interventions Usual care (information leaflets) only or usual care plus a physiotherapy led exercise programme, incorporating stretching, strengthening, physical activity, and behavioural change techniques to support adherence to exercise, introduced at 7-10 days postoperatively, with two further appointments at one and three months. Main outcome measures Disability of Arm, Hand and Shoulder (DASH) questionnaire at 12 months, analysed by intention to treat. Secondary outcomes included DASH subscales, pain, complications, health related quality of life, and resource use, from a health and personal social services perspective. Results Between 26 January 2016 and 31 July 2017, 951 patients were screened and 392 (mean age 58.1 years) were randomly allocated, with 382 (97%) eligible for intention to treat analysis. 181 (95%) of 191 participants allocated to exercise attended at least one appointment. Upper limb function improved after exercise compared with usual care (mean DASH 16.3 (SD 17.6) for exercise (n=132); 23.7 (22.9) usual care (n=138); adjusted mean difference 7.81, 95% confidence interval 3.17 to 12.44; P=0.001). Secondary outcomes favoured exercise over usual care, with lower pain intensity at 12 months (adjusted mean difference on numerical rating scale −0.68, −1.23 to −0.12; P=0.02) and fewer arm disability symptoms at 12 months (adjusted mean difference on Functional Assessment of Cancer Therapy-Breast+4 (FACT-B+4) −2.02, −3.11 to −0.93; P=0.001). No increase in complications, lymphoedema, or adverse events was noted in participants allocated to exercise. Exercise accrued lower costs per patient (on average −£387 (€457; $533) (95% confidence interval −£2491 to £1718; 2015 pricing) and was cost effective compared with usual care. Conclusions The PROSPER exercise programme was clinically effective and cost effective and reduced upper limb disability one year after breast cancer treatment in patients at risk of treatment related postoperative complications

Demographic, clinical, and service-use characteristics related to the clinician’s recommendation to transition from child to adult mental health services

Purpose: The service configuration with distinct child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) may be a barrier to continuity of care. Because of a lack of transition policy, CAMHS clinicians have to decide whether and when a young person should transition to AMHS. This study describes which characteristics are associated with the clinicians’ advice to continue treatment at AMHS. Methods: Demographic, family, clinical, treatment, and service-use characteristics of the MILESTONE cohort of 763 young people from 39 CAMHS in Europe were assessed using multi-informant and standardized assessment tools. Logistic mixed models were fitted to assess the relationship between these characteristics and clinicians’ transition recommendations. Results: Young people with higher clinician-rated severity of psychopathology scores, with self- and parent-reported need for ongoing treatment, with lower everyday functional skills and without self-reported psychotic experiences were more likely to be recommended to continue treatment. Among those who had been recommended to continue treatment, young people who used psychotropic medication, who had been in CAMHS for more than a year, and for whom appropriate AMHS were available were more likely to be recommended to continue treatment at AMHS. Young people whose parents indicated a need for ongoing treatment were more likely to be recommended to stay in CAMHS. Conclusion: Although the decision regarding continuity of treatment was mostly determined by a small set of clinical characteristics, the recommendation to continue treatment at AMHS was mostly affected by service-use related characteristics, such as the availability of appropriate services