Evaluating measures to assess loneliness in autistic adults

Several measures have been developed to assess loneliness in the general population. Here, we examined if, and how accurately, widely-used measures capture the experience of loneliness in autistic adults. A total of 203 autistic participants from the UK completed an online survey, which included two widely-used loneliness questionnaires: the University of California, Los Angeles (UCLA) Loneliness Scale Version 3 and the Social and Emotional Loneliness Scale for Adults (SELSA). Participants completed the measures and provided their views on how well they captured their experiences of loneliness. A direct measure, asking participants how often they felt lonely, was also completed. Results demonstrated that scores on the UCLA and SELSA questionnaires positively correlated with the direct measure of loneliness, suggesting that these tools accurately index autistic experiences of loneliness. However, qualitative responses suggested that participants found both scales difficult to complete. Using reflexive thematic analysis, we identified three themes that encapsulated participants’ views: (1) failing to distinguish between the characteristics/experiences of loneliness and being autistic, (2) loneliness is not a static trait and (3) inappropriate wording. Given that our sample of autistic participants tended to prefer the UCLA scale to the SELSA, we provide initial recommendations around how the UCLA scale could be adapted for autistic adults

Testing the potential of mycobacteriophage endolysins fused to biodegradable nanobeads for controlling mycobacteria : a thesis presented in partial fulfilment of the requirements for the degree of Master of Natural Sciences at Massey University, Albany, New Zealand

Figures 1, 2, 3B, 4 & 5A were removed for copyright reasons but may be accessed via their sources listed in the References.10.4 million people are diagnosed with tuberculosis, worldwide, every year, according to the World Health Organisation. Mycobacterium tuberculosis is a Gram-positive bacterial pathogen that can easily be transmitted to health care professionals and people supplying aid in these nations. Fortunately, over the last 100 years, the bacteriophage has gained traction as a suitable therapeutic, antibiotic-alternative against bacterial pathogens, such as M. tuberculosis. Herein I describe my work utilising endolysins the lytic protein that bacteriophages usually employ to burst out of the cell, but instead using these proteins to lyse “from without”. In order to develop a proof-of-principle product, we used the expansive M. smegmatis bacteriophage collection and chose eight endolysin candidates for testing against M. smegmatis. These endolysins were bioinformatically analysed for active domains before being synthesised and inserted into an expression vector to produce fused biodegradable nanobeads made of polyhydroxyalkanoate. These nanobeads were tested for activity against M. smegmatis, a safe mycobacterium closely related to pathogenic tuberculosis. Four distinct tests were carried out to test the efficiency of these beads in causing cell death in different situations (45 minutes and 5 hours, across concentrations of 10mg/ml, 20mg/ml and 80mg/ml. Ultimately the nanobead fusions of endolysin Inca (lysin B) caused the most cell death at 80mg/ml after exposure to M. smegmatis for 5 hours in a standing culture, at 78.87% cell death ± 5.21. When the nanobeads were applied to filter paper to mimic application to a hospital mask as a proof-of-concept approach before spraying with a bacterial aerosol, we saw that endolysin nanobead Jaws (lysin B) caused the most cell death with 75.54% ± 3.15 at 80mg/ml. These results are promising and present a unique opportunity to take advantage of an existing natural mechanism to use as a prophylactic defense against pathogenic bacteria in hospital settings

Landscape connectivity: a key to effective habitat restoration in lowland agricultural landscapes

Landscape scale habitat restoration has the potential to reconnect habitats in fragmented landscapes. This study investigates landscape connectivity as a key to effective habitat restoration in lowland agricultural landscapes and applies these findings to transferable management recommendations. The study area is the Stonehenge World Heritage Site, UK, where landscape scale chalk grassland restoration has been implemented. Here, the ecological benefits of landscape restoration and the species, habitat and landscape characteristics that facilitate or impede the enhancement of biodiversity and landscape connectivity were investigated. Lepidoptera were used as indictors of restoration success and results showed restoration grasslands approaching the ecological conditions of the target chalk grassland habitat and increasing in biodiversity values within a decade. Restoration success is apparent for four species with a broad range of grass larval host plants (e.g. Melanargia galathea, Maniola jurtina) or with intermediate mobility (Polyommatus icarus). However, two species with specialist larval host plants and low mobility (Lysandra bellargus), are restricted to chalk grassland fragments. Studies of restoration grassland of different ages show that recent grassland restoration (1 or 2 years old) may reduce the functional isolation of chalk grassland fragments. A management experiment showed that mowing increases boundary following behaviour in two species of grassland Lepidoptera; Maniola jurtina and Zygaena filipendulae. Analysis of the landscape scale implications of the grassland restoration illustrates an increase in grassland habitat network size and in landscape connectivity, which is likely to benefit the majority of grassland associated Lepidoptera. Landscape and habitat variables can be managed to increase the success of restoration projects including the spatial targeting of receptor sites, vegetation structure and selection of seed source and management recommendations are provided that are transferrable to other species-rich grassland landscape scale restoration projects. Overall results show restoration success for some habitats and species within a decade. However, additional management is required to assist the re-colonisation of specialist species. Despite this, habitat restoration at the landscape scale can be an effective, long term approach to enhance butterfly biodiversity and landscape connectivity

Mind Your Meds: Safe Opioid Disposal Awareness

Driven by the effects of the opioid epidemic on friends, family members, students, and patients, members of the 2019 GEHLI Team “Mission Possible” are dedicated to bolstering educational awareness of safe leftover opioid disposal methods to decrease the supply of opioids in our community. On average, over 2/3 of opioid prescription medications are leftover and lead to later misuse or abuse (JAMA Survey). Despite a decrease in prescription writing for pain medication over the years, the mortality rate from overdose, and the rate of infants born to mothers with opioid abuse continues to steadily increase in Virginia (VDH). Team Mission Possible seeks to promote awareness of both the need and resources available for safe opioid disposal by educating prescribers in the VCU Health system and spreading knowledge to VCU patients, students, faculty, staff, and members of the surrounding community through: educational events on the Monroe Park and Medical campuses; teaming up with Miss Virginia’s “Mind your Meds campaign”; live Facebook interviews; and educational flyers

Observation of age-related decline in the performance of the transverse abdominis muscle

BACKGROUND. Previous research has shown that the performance of skeletal muscle declines with advancing age. Coordination of the transverse abdominis (TrA), a deep postural muscle, has been shown to be reduced in persons with low back pain. No previous research has studied the effect of age on the activation on this muscle. Objective: To assess the effect of age on TrA activation in response to rapid arm abduction. DESIGN. Cross-sectional cohort study. SETTING. University exercise physiology laboratory. PARTICIPANTS. A total of 18 adult men (aged 27 7.0 years) for the younger group and 11 older adults (5 men and 6 women, aged 59.6 4.0 years) were recruited for this study. METHOD. Participants were positioned on a treatment table and performed a series of rapid arm abduction movements with their right arm while the activation of the TrA muscle was recorded using ultrasound imaging. Onset of arm abduction was measured using surface electromyography and synchronized with the ultrasound through the ultrasound unit’s electrocardiogram channel. The mean time difference between the 2 events was calculated during post-hoc analysis. MAIN OUTCOME MEASUREMENTS. A Mann-Whitney test was performed to test for differences in the onset performance of the TrA muscle between the 2 groups. RESULTS. Results showed that the older group was significantly slower than the younger group in engaging their TrA in response to the rapid arm abduction (P ¼ .036). A separate analysis of the older group data showed that no significant differences existed between the male and female participants that could potentially have acted as a confounding factor for the main finding (P ¼ .126). CONCLUSIONS. This study shows that older adults were slower than younger adults in activating their TrA muscle in response to rapid arm abduction. This delay has the potential to lead to increased occasions when the low back is unprotected, increasing the likelihood of injury or low back pain

Interventions to promote patient utilisation of cardiac rehabilitation

Background: International clinical practice guidelines routinely recommend that cardiac patients participate in rehabilitation programmes for comprehensive secondary prevention. However, data show that only a small proportion of these patients utilise rehabilitation. Objectives: First, to assess interventions provided to increase patient enrolment in, adherence to, and completion of cardiac rehabilitation. Second, to assess intervention costs and associated harms, as well as interventions intended to promote equitable CR utilisation in vulnerable patient subpopulations. Search methods: Review authors performed a search on 10 July 2018, to identify studies published since publication of the previous systematic review. We searched the Cochrane Central Register of Controlled Trials (CENTRAL); the National Health Service (NHS) Centre for Reviews and Dissemination (CRD) databases (Health Technology Assessment (HTA) and Database of Abstracts of Reviews of Effects (DARE)), in the Cochrane Library (Wiley); MEDLINE (Ovid); Embase (Elsevier); the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCOhost); and Conference Proceedings Citation Index ‐ Science (CPCI‐S) on Web of Science (Clarivate Analytics). We checked the reference lists of relevant systematic reviews for additional studies and also searched two clinical trial registers. We applied no language restrictions. Selection criteria: We included randomised controlled trials (RCTs) in adults with myocardial infarction, with angina, undergoing coronary artery bypass graft surgery or percutaneous coronary intervention, or with heart failure who were eligible for cardiac rehabilitation. Interventions had to aim to increase utilisation of comprehensive phase II cardiac rehabilitation. We included only studies that measured one or more of our primary outcomes. Secondary outcomes were harms and costs, and we focused on equity. Data collection and analysis: Two review authors independently screened the titles and abstracts of all identified references for eligibility, and we obtained full papers of potentially relevant trials. Two review authors independently considered these trials for inclusion, assessed included studies for risk of bias, and extracted trial data independently. We resolved disagreements through consultation with a third review author. We performed random‐effects meta‐regression for each outcome and explored prespecified study characteristics. Main results: Overall, we included 26 studies with 5299 participants (29 comparisons). Participants were primarily male (64.2%). Ten (38.5%) studies included patients with heart failure. We assessed most studies as having low or unclear risk of bias. Sixteen studies (3164 participants) reported interventions to improve enrolment in cardiac rehabilitation, 11 studies (2319 participants) reported interventions to improve adherence to cardiac rehabilitation, and seven studies (1567 participants) reported interventions to increase programme completion. Researchers tested a variety of interventions to increase utilisation of cardiac rehabilitation. In many studies, this consisted of contacts made by a healthcare provider during or shortly after an acute care hospitalisation. Low‐quality evidence shows an effect of interventions on increasing programme enrolment (19 comparisons; risk ratio (RR) 1.27, 95% confidence interval (CI) 1.13 to 1.42). Meta‐regression revealed that the intervention deliverer (nurse or allied healthcare provider; P = 0.02) and the delivery format (face‐to‐face; P = 0.01) were influential in increasing enrolment. Low‐quality evidence shows interventions to increase adherence were effective (nine comparisons; standardised mean difference (SMD) 0.38, 95% CI 0.20 to 0.55), particularly when they were delivered remotely, such as in home‐based programs (SMD 0.56, 95% CI 0.37 to 0.76). Moderate‐quality evidence shows interventions to increase programme completion were also effective (eight comparisons; RR 1.13, 95% CI 1.02 to 1.25), but those applied in multi‐centre studies were less effective than those given in single‐centre studies, leading to questions regarding generalisability. A moderate level of statistical heterogeneity across intervention studies reflects heterogeneity in intervention approaches. There was no evidence of small‐study bias for enrolment (insufficient studies to test for this in the other outcomes). With regard to secondary outcomes, no studies reported on harms associated with the interventions. Only two studies reported costs. In terms of equity, trialists tested interventions designed to improve utilisation among women and older patients. Evidence is insufficient for quantitative assessment of whether women‐tailored programmes were associated with increased utilisation, and studies that assess motivating women are needed. For older participants, again while quantitative assessment could not be undertaken, peer navigation may improve enrolment. Authors' conclusions: Interventions may increase cardiac rehabilitation enrolment, adherence and completion; however the quality of evidence was low to moderate due to heterogeneity of the interventions used, among other factors. Effects on enrolment were larger in studies targeting healthcare providers, training nurses, or allied healthcare providers to intervene face‐to‐face; effects on adherence were larger in studies that tested remote interventions. More research is needed, particularly to discover the best ways to increase programme completion

A systematic review of barriers to early presentation and diagnosis with cancer among Black women

Objective: To explore barriers to early presentation and diagnosis with breast cancer among black women. Design: Systematic review. Methods: We searched multiple bibliographic databases (January 1991–February 2013) for primary research, published in English, conducted in developed countries and investigating barriers to early presentation and diagnosis with symptomatic breast cancer among black women (?18 years). Studies were excluded if they did not report separate findings by ethnic group or gender, only reported differences in time to presentation/diagnosis, or reported on interventions and barriers to cancer screening. We followed Cochrane and PRISMA guidance to identify relevant research. Findings were integrated through thematic synthesis. Designs of quantitative studies made meta-analysis impossible. Results: We identified 18 studies (6183 participants). Delay was multifactorial, individual and complex. Factors contributing to delay included: poor symptom and risk factor knowledge; fear of detecting breast abnormality; fear of cancer treatments; fear of partner abandonment; embarrassment disclosing symptoms to healthcare professionals; taboo and stigmatism. Presentation appears quicker following disclosure. Influence of fatalism and religiosity on delay is unclear from evidence in these studies. We compared older studies (?10 years) with newer ones (<10 years) to determine changes over time. In older studies, delaying factors included: inaccessibility of healthcare services; competing priorities and concerns about partner abandonment. Partner abandonment was studied in older studies but not in newer ones. Comparisons of healthy women and cancer populations revealed differences between how people perceive they would behave, and actually behave, on finding breast abnormality. Conclusions: Strategies to improve early presentation and diagnosis with breast cancer among black women need to address symptom recognition and interpretation of risk, as well as fears of the consequences of cancer. The review is limited by the paucity of studies conducted outside the USA and limited detail reported by published studies preventing comparison between ethnic groups

Exercise, science and designer doping : Traditional and emerging trends

The list of doping agents is enormous, and for the majority, any beneficial sporting effect is contentious. WADA and UK Anti-Doping have difficulty detecting the peptide hormones, Growth Hormone (GH), insulin and Erythropoietin (Epo), because they require blood analysis. Only in the last two years has an athlete been convicted of taking GH, which is still being used as a doping agent because the window for detection is so brief. This positive test was not contested, which suggests that science may be winning the war on drugs. Athletes appear to have ceased taking insulin, because of its life-threatening acute effects, and in recent years no adverse analytical findings have been reported for this drug. “Older” doping agents, which are known to enhance performance in sport, include testosterone and their derivatives, anabolic steroids. The pharmaceutical industry continues to manufacture new medicines, pushing back the boundaries in combating wasting disease states and the ageing process, but is inadvertently producing the latest generation of doping agents. This will challenge anti-doping scientists. WADA’s banned list also includes insulin-like growth factor-1, fibroblast growth factors, hepatocyte growth factor, mechano growth factors, platelet-derived growth factor, vascular-endothelial growth factor which may promote muscle, tendon or ligament development, vascularisation, energy utilisation, regenerative capacity and fibre type. Athletes will use whatever they believe works, but can only use what is available. Internet companies offer these anabolic products that but their veracity cannot be proven. There are questions that need to be answered? Are these products available to athletes, do they enhance performance, are athletes really taking them and are they so difficult to detect. The internet has made them available to anyone with a credit card and it appears that if they are cycled correctly, unless an athlete is caught in possession of them, the opportunity of proving a case of doping is almost impossible