The ergonomics and design of an inclusive best-fit solution to workbenches

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.In a time when the developed world, is trying to reduce the human and economic costs of musculo-skeletal disorders (MSDs), any contribution to such an endeavour would be welcome. These economic costs are estimated to be in the tens of billions of Euro in the EU countries and similarly in the USA, the cost in human pain has not been measured. It may surprise many that in spite of all the advancements in science and technology, that two generations of people, who are very significantly taller than the people of a century ago, are still working in industry and in education at benches, which have not changed, either in height or design in centuries. Some, like wheelchair users do not have the opportunity to work at a bench at all. At the outset this research project, had the primary objective of determining an ergonomic best-fit, for a broad range of users of workbenches. These included the young school going population (12-13 year olds), the senior students (16 plus years old), adults, and a cohort of surrogate wheelchair users. The research also endeavoured to determine if adolescents, who were of the same stature as adults, had the same workbench ergonomics requirements. The secondary objective, which was completely dependant on the first, was to design a bench, which would suit the ergonomic requirements of this diverse group. The research has identified the best-fit workbench heights for the total cohort, while recognising the individual differences in relation to bench height ergonomics, for each of the sub-groups tested. The findings of the research have shown, that using surrogate wheelchair users to determine ergonomic data for this type of activity is fully justified. In combining the raw data for a similar number of wheelchair users, a best-fit bench height has been confirmed at 100 mm above knee height. There are no significant differences between the ergonomic requirements for males and females at workbenches. Body part discomfort has been reduced significantly, for the wheelchair users, at the identified height and endurance has been extended. Importantly the career options for wheelchair users have been extended, empowering them to make broader career choices. The outcomes of the research relating to three groups making up the able-bodied cohort have shown that an ergonomic best-fits possible, which suits the needs of this diverse group. A height of 150 mm under elbow height has been identified as best-fit, and this reduces the discomfort considerably while extending endurance. Robust working heights have been identified, but the female working heights at workbenches, are not as robust as for the males. For all groups it has been shown that bench height has a significant effect on body part discomfort and endurance, and while there were differences in efficiency, which were not quite significant, it is suggested that working in an ergonomically compromising position must, in the long term, in addition to increasing the risk of MSDs, likely also influence productivity, and quality of work. An inclusive test-workbench has been designed and built which satisfies the ergonomic needs of the diverse user group described above

Remission and recovery from first-episode psychosis in adults: systematic review and meta-analysis of long-term outcome studies

Background: Remission and recovery rates for people with first-episode psychosis (FEP) remain uncertain. Aims: To assess pooled prevalence rates of remission and recovery in FEP and to investigate potential moderators. Method: We conducted a systematic review and meta-analysis to assess pooled prevalence rates of remission and recovery in FEP in longitudinal studies with more than 1 year of follow-up data, and conducted meta-regression analyses to investigate potential moderators. Results: Seventy-nine studies were included representing 19072 patients with FEP. The pooled rate of remission among 12301 individuals with FEP was 58% (60 studies, mean follow-up 5.5 years). Higher remission rates were moderated by studies from more recent years. The pooled prevalence of recovery among 9642 individuals with FEP was 38% (35 studies, mean follow-up 7.2 years). Recovery rates were higher in North America than in other regions. Conclusions: Remission and recovery rates in FEP may be more favourable than previously thought. We observed stability of recovery rates after the first 2 years, suggesting that a progressive deteriorating course of illness is not typical. Although remission rates have improved over time recovery rates have not, raising questions about the effectiveness of services in achieving improved recovery

Optical sensing system based on wireless paired emitter detector diode device and ionogels for lab-on-a-disc water quality analysis

This work describes the first use of a wireless paired emitter detector diode device (PEDD) as an optical sensor for water quality monitoring in a lab-on-a-disc device. The microfluidic platform, based on an ionogel sensing area combined with a low-cost optical sensor is applied for pH (quantitative) and qualitative turbidity monitoring of water samples at the point-of-need. The autonomous capabilities of the PEDD system, combined with the portability and wireless communication of the full device, provide the flexibility needed for on-site water testing. Water samples from local fresh and brackish sources were successfully analysed using the device, showing very good correlation with standard bench-top systems

Sodium valproate and clozapine induced neutropenia: A case control study using register data

BACKGROUND: The use of clozapine is limited due to the occurrence of neutropenia, and the rare but life threatening adverse event of agranulocytosis. There is little epidemiological research into clinical factors that may impact on this risk. We conducted a case control study examining the clinical risk factors for neutropenia patients treated with clozapine. METHOD: A case-control study was conducted within a database of anonymised electronic clinical records. All patients who discontinued clozapine due to a neutropenic event were included as cases. Matched controls were selected from patients with a documented clozapine exposure at the time of the clozapine neutropenic event of the case patient, matched by duration of clozapine treatment. RESULTS: 136 cases and 136 controls were included. In multivariable analysis, the concurrent use of sodium valproate was associated with neutropenia (Odds Raito (OR) 2.28, 95%CI: 1.27–4.11, p = 0.006). There was a dose-response effect, with greater associations for higher doses. Patients who discontinued clozapine due to neutropenia were more likely to be of black ethnicity (OR 2.99, p < 0.001), were younger (t = 5.86, df = 267, p < 0.001), and received lower doses of clozapine (t = − 2.587, p = 0.01) than those who did not develop neutropenia. CONCLUSION: We identified an association between the concurrent use of sodium valproate and an increased risk of clozapine associated neutropenia. These results, taken in combination with the results from previous case series, suggest that the risk of clozapine associated neutropenia could be reduced by avoiding concurrent valproate treatment

Inequalities in glycemic management in people living with type 2 diabetes mellitus and severe mental illnesses: cohort study from the UK over 10 years

Introduction Using data from a a primary care pay-for-performance scheme targeting quality indicators, the objective of this study was to assess if people living with type 2 diabetes mellitus (T2DM) and severe mental illnesses (SMI) experienced poorer glycemic management compared with people living with T2DM alone, and if observed differences varied by race/ethnicity, deprivation, gender, or exclusion from the scheme. Research design and methods Primary care data from a cohort of 56 770 people with T2DM, including 2272 people with T2DM and SMI, from London (UK), diagnosed between January 17, 2008 and January 16, 2018, were used. Adjusted mean glycated hemoglobin (HbA1c) and HbA1c differences were assessed using multilevel regression models. Results Compared with people with T2DM only, people with T2DM/SMI were more likely to be of an ethnic minority background, excluded from the pay-for-performance scheme and residing in more deprived areas. Across the sample, mean HbA1c was lower in those with T2DM and SMI (mean HbA1c: 58 mmol/mol; 95% CI 57 to 59), compared with people with T2DM only (mean HbA1c: 59 mmol/mol; 95% CI 59 to 60). However, HbA1c levels were greater in Bangladeshi, Indian, Pakistani, and Chinese people compared with the White British reference in the T2DM/SMI group. People with T2DM/SMI who had been excluded from the pay-for-performance scheme, had HbA1c levels which were +7 mmol/mol (95% CI 2 to 11) greater than those with T2DM/SMI not excluded. Irrespective of SMI status, increasing deprivation and male gender were associated with increased HbA1c levels. Conclusions Despite a pay-for-performance scheme to improve quality standards, inequalities in glycemic management in people with T2DM and SMI persist in those excluded from the scheme and by gender, ethnicity, and area-level deprivation

Clinical correlates of vitamin D deficiency in established psychosis

Background Suboptimal vitamin D levels have been identified in populations with psychotic disorders. We sought to explore the relationship between vitamin D deficiency, clinical characteristics and cardiovascular disease risk factors among people with established psychosis. Methods Vitamin D levels were measured in 324 community dwelling individuals in England with established psychotic disorders, along with measures of mental health, cardiovascular risk and lifestyle choices. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D (25-OHD) levels below 10 ng/ml (equivalent to 50 nmol/L). Results The mean 25-OHD serum level was 12.4 (SD 7.3) ng/ml, (range 4.0-51.7 ng/ml). Forty nine percent (n = 158) were vitamin D deficient, with only 14 % (n = 45) meeting criteria for sufficiency. Accounting for age, gender, ethnicity and season of sampling, serum 25-OHD levels were negatively correlated with waist circumference (r = −0.220, p < 0.002), triglycerides (r = −0.160, p = 0.024), total cholesterol (r = −0.144, p = 0.043), fasting glucose (r = −0.191, p = 0.007), HbA1c (r = −0.183, p = 0.01), and serum CRP levels (r = −0.211, p = 0.003) and were linked to the presence of metabolic syndrome. Conclusions This is the largest cross sectional study of serum 25-OHD levels in community dwelling individuals with established psychosis, indicating a high level of vitamin D deficiency. Lower vitamin D levels are associated with increased cardiovascular disease risk factors and in particular metabolic syndrome. Further research is needed to define appropriate protocols for vitamin D testing and supplementation in practice to see if this can improve cardiovascular disease risk

Vitamin D and the risk of treatment-resistant and atypical depression: A Mendelian randomization study

Observational evidence has implicated vitamin D levels as a risk factor in major depressive disorder (MDD). Confounding or reverse causation may be driving these observed associations, with studies using genetics indicating little evidence of an effect. However, genetic studies have relied on broad definitions of depression. The genetic architecture of different depression subtypes may vary since MDD is a highly heterogenous condition, implying potentially diverging requirements in therapeutic approaches. We explored the associations between vitamin D and two subtypes of MDD, for which evidence of a causal link could have the greatest clinical benefits: treatment-resistant depression (TRD) and atypical depression (AD). We used a dual approach, combining observational data with genetic evidence from polygenic risk scores (PRS) and two-sample Mendelian randomization (MR), in the UK Biobank. There was some evidence of a weak association between vitamin D and both incident TRD (Ncases = 830) and AD (Ncases = 2366) in observational analyses, which largely attenuated when adjusting for confounders. Genetic evidence from PRS and two-sample MR, did not support a causal link between vitamin D and either TRD (Ncases = 1891, OR = 1.01 [95%CI 0.78, 1.31]) or AD (Ncases = 2101, OR = 1.04 [95%CI 0.80, 1.36]). Our comprehensive investigations indicated some evidence of an association between vitamin D and TRD/AD observationally, but little evidence of association when using PRS and MR, mirroring findings of genetic studies of vitamin D on broad depression phenotypes. Results do not support further clinical trials of vitamin D in these MDD subtypes but do not rule out that small effects may exist that require larger samples to detect

Gene-expression analysis of clozapine treatment in whole blood of patients with psychosis

OBJECTIVES: Clozapine is an atypical antipsychotic primarily prescribed for treatment-resistant schizophrenia. We tested the specific effect of clozapine versus other drug treatments on whole-blood gene expression in a sample of patients with psychosis from the UK. METHODS: A total of 186 baseline whole-blood samples from individuals receiving treatment for established psychosis were analysed for gene expression on Illumina HumanHT-12.v4 BeadChips. After standard quality-control procedures, 152 samples remained, including 55 from individuals receiving clozapine. In a within-case study design, weighted gene correlation network analysis was used to identify modules of coexpressed genes. The influence of mood stabilizers, lithium carbonate/lithium citrate and sodium valproate was studied to identify their possible roles as confounders. RESULTS: Individuals receiving clozapine as their only antipsychotic (clozapine monotherapy) had a nominal association with one gene-expression module, whereas no significant change in gene expression was found for other drugs. CONCLUSION: Overall, this study does not provide evidence that clozapine treatment induces medium to large different gene-expression patterns in human whole blood versus other antipsychotic treatments. This does not rule out the possibility of smaller effects as observed for other common antipsychotic treatments

Minocycline and the risk of acute psychiatric events in adolescence: A self-controlled case series

BACKGROUND: Minocycline has neurological anti-inflammatory properties and has been hypothesised to have antipsychotic effects. AIM: The aim of this study was to investigate, using routinely collected United Kingdom primary health care data, whether adolescent men and women are more or less likely to receive an urgent psychiatric referral during treatment for acne with minocycline compared with periods of non-treatment. METHOD: A self-controlled case series using United Kingdom Clinical Practice Research Datalink to calculate the incidence rate ratio of urgent psychiatric referrals for individuals, comparing periods during which minocycline was prescribed with unexposed periods, adjusted for age. RESULTS: We found 167 individuals who were at the time exposed to minocycline for a mean of 99 days and who received an urgent psychiatric referral. There was no difference in psychiatric referral risk during periods of exposure compared with periods of non-exposure: incidence rate ratio first 6 weeks of exposure 1.96, 95% confidence interval 0.82-4.71, p=0.132; incidence rate ratio remaining exposure period=1.97, 95% confidence interval 0.86-4.47, p=0.107. CONCLUSIONS: We found no evidence in support of a protective effect of minocycline against severe psychiatric symptoms in adolescence

Ethnicity and cardiovascular health inequalities in people with severe mental illnesses: protocol for the E-CHASM study

“The final publication is available at Springer via http://dx. doi.10.1007/s00127-016-1185-8JD is funded by the Health Foundation working with the Academy of Medical Sciences. CM is supported by a European Research Council Consolidator Award (Ref: ERC-CoG- 2014-Proposal 648837, REACH). RS is funded by the NIHR Spe- cialist Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust and Institute of Psy- chiatry, King’s College London. GT and FG are supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South London at King’s College London Foundation Trust. GT acknowledges financial support from the Department of Health via the National Institute for Health Research (NIHR) Biomedical Research Centre and Dementia Unit awarded to South London and Maudsley NHS Foundation Trust in partnership with King’s College London and King’s College Hospital NHS Foundation Trust. GT is supported by the European Union Seventh Framework Programme (FP7/2007–2013) Emerald project. AR is funded by the European Union Horizon 2020 pro- gramme OpenMinTeD and KConnect projects, by the National Institute for Health Research (NIHR) Biomedical Research Centre and Dementia Biomedical Research Unit at South London and Maudsley NHS Foundation Trust and King’s College London, and by QBurs