Understanding and controlling the ingress of driven rain through exposed, solid wall masonry structures

Long term performance of historic buildings can be affected by many environmental factors, some of which become more apparent as the competence of the fabric deteriorates. Many tall historic buildings suffer from water ingress when exposed to driving rain conditions, particularly church towers in the south west of England. It is important to recognise that leakage can occur not only through flaws in the roof of a building but also through significant thicknesses of solid masonry. Identification of the most appropriate intervention requires an understanding of the way in which water might enter the structure and the assessment of potential repair options. While the full work schedule used an integrated assessment involving laboratory, field and archival work to assess the repairs which might be undertaken on these solid wall structures, this paper focuses on the laboratory work done to inform the writing of a Technical Advice Note on the effects of wind driven rain and moisture movement in historic structures (English Heritage, 2012). The laboratory work showed that grouting and rendering was effective at reducing water penetration without retarding drying rates, but that use of internal plastering also had a very beneficial effect

State-of-the-art in studies of glacial isostatic adjustment for the British Isles: a literature review

Understanding the effects of glacial isostatic adjustment (GIA) of the British Isles is essential for the assessment of past and future sea-level trends. GIA has been extensively examined in the literature, employing different research methods and observational data types. Geological evidence from palaeo-shorelines and undisturbed sedimentary deposits has been used to reconstruct long-term relative sea-level change since the Last Glacial Maximum. This information derived from sea-level index points has been employed to inform empirical isobase models of the uplift in Scotland using trend surface and Gaussian trend surface analysis, as well as to calibrate more theory-driven GIA models that rely on Earth mantle rheology and ice sheet history. Furthermore, current short-term rates of GIA-induced crustal motion during the past few decades have been measured using different geodetic techniques, mainly continuous GPS (CGPS) and absolute gravimetry (AG). AG-measurements are generally employed to increase the accuracy of the CGPS estimates. Synthetic aperture radar interferometry (InSAR) looks promising as a relatively new technique to measure crustal uplift in the northern parts of Great Britain, where the GIA-induced vertical land deformation has its highest rate. This literature review provides an in-depth comparison and discussion of the development of these different research approaches

Cumulative mutagenesis of the basic residues in the 201-218 region of insulin-like growth factor (IGF)-binding protein-5 results in progressive loss of both IGF-I binding and inhibition of IGF-I biological action

We have reported previously that mutation of two conserved nonbasic amino acids (G203 and Q209) within the highly basic 201–218 region in the C-terminal domain of IGF-binding protein-5 (IGFBP-5) decreases binding to IGFs. This study reveals that cumulative mutagenesis of the 10 basic residues in this region, to create the C-Term series of mutants, ultimately results in a 15-fold decrease in the affinity for IGF-I and a major loss in heparin binding. We examined the ability of mutants to inhibit IGF-mediated survival of MCF-7 cells and were able to demonstrate that this depended not only upon the affinity for IGF-I, but also the kinetics of this interaction, because IGFBP-5 mutants with similar affinity constants (KD) values, but with different association (Ka) and dissociation (Kd) rate values, had markedly different inhibitory properties. In contrast, the affinity for IGF-I provided no predictive value in terms of the ability of these mutants to enhance IGF action when bound to the substratum. Instead, these C-Term mutants appeared to enhance the actions of IGF-I by a combination of increased dissociation of IGF-IGFBP complexes from the substratum, together with dissociation of IGF-I from IGFBP-5 bound to the substratum. These effects of the IGFBPs were dependent upon binding to IGF-I, because a non-IGF binding mutant (N-Term) was unable to inhibit or enhance the actions of IGF-I. These results emphasize the importance of the kinetics of association/dissociation in determining the enhancing or inhibiting effects of IGFBP-5 and demonstrate the ability to generate an IGFBP-5 mutant with exclusively IGF-enhancing activity

A comparison of course-related stressors in undergraduate problem-based learning (PBL) versus non-PBL medical programmes

Background: Medical students report high levels of stress related to their medical training as well as to other personal and financial factors. The aim of this study is to investigate whether there are differences in course-related stressors reported by medical students on undergraduate problem-based learning (PBL) and non-PBL programmes in the UK. Method: A cross-sectional study of second-year medical students in two UK medical schools (one PBL and one non-PBL programme) was conducted. A 16-question self-report questionnaire, derived from the Perceived Medical Student Stress Scale and the Higher Education Stress Inventory, was used to measure course-related stressors. Following univariate analysis of each stressor between groups, multivariate logistic regression was used to determine which stressors were the best predictors of each course type, while controlling for socio-demographic differences between the groups. Results: A total of 280 students responded. Compared to the non-PBL students (N = 197), the PBL students (N = 83) were significantly more likely to agree that: they did not know what the faculty expected of them (Odds Ratio (OR) = 0.38, p = 0.03); there were too many small group sessions facilitated only by students resulting in an unclear curriculum (OR = 0.04, p < 0.0001); and that there was a lack of opportunity to explore academic subjects of interest (OR = 0.40, p = 0.02). They were significantly more likely to disagree that: there was a lack of encouragement from teachers (OR = 3.11, p = 0.02); and that the medical course fostered a sense of anonymity and feelings of isolation amongst students (OR = 3.42, p = 0.008). Conclusion: There are significant differences in the perceived course-related stressors affecting medical students on PBL and non-PBL programmes. Course designers and student support services should therefore tailor their work to minimise, or help students cope with, the specific stressors on each course type to ensure optimum learning and wellbeing among our future doctors

Text Mining the History of Medicine

Historical text archives constitute a rich and diverse source of information, which is becoming increasingly readily accessible, due to large-scale digitisation efforts. However, it can be difficult for researchers to explore and search such large volumes of data in an efficient manner. Text mining (TM) methods can help, through their ability to recognise various types of semantic information automatically, e.g., instances of concepts (places, medical conditions, drugs, etc.), synonyms/variant forms of concepts, and relationships holding between concepts (which drugs are used to treat which medical conditions, etc.). TM analysis allows search systems to incorporate functionality such as automatic suggestions of synonyms of user-entered query terms, exploration of different concepts mentioned within search results or isolation of documents in which concepts are related in specific ways. However, applying TM methods to historical text can be challenging, according to differences and evolutions in vocabulary, terminology, language structure and style, compared to more modern text. In this article, we present our efforts to overcome the various challenges faced in the semantic analysis of published historical medical text dating back to the mid 19th century. Firstly, we used evidence from diverse historical medical documents from different periods to develop new resources that provide accounts of the multiple, evolving ways in which concepts, their variants and relationships amongst them may be expressed. These resources were employed to support the development of a modular processing pipeline of TM tools for the robust detection of semantic information in historical medical documents with varying characteristics. We applied the pipeline to two large-scale medical document archives covering wide temporal ranges as the basis for the development of a publicly accessible semantically-oriented search system. The novel resources are available for research purposes, while the processing pipeline and its modules may be used and configured within the Argo TM platform

“Accumulating harm and waiting for crisis”: Parents’ perspectives of accessing Child and Adolescent Mental Health Services for their autistic child experiencing mental health difficulties

BackgroundAutistic children and young people are at increased risk of mental health difficulties, but often face barriers when seeking help from Child and Adolescent Mental Health Services (CAMHS). The present study aimed to 1) explore the experiences of parents/carers seeking help from CAMHS for their autistic child’s mental health difficulties, and 2) gain parents’ perceptions of the accessibility of CAMHS for their child.MethodsA mixed-methods survey design was used. 300 parents/carers took part from across the United Kingdom. Quantitative data were analysed using descriptive statistics, and qualitative data using qualitative content analysis.ResultsFindings demonstrated ongoing struggles that parents/carers faced when seeking help from CAMHS. Those who were referred reported a lack of reasonable adjustments and offers of ineffective or inappropriate therapies. Ultimately, parents felt their child’s mental health difficulties either did not improve or declined to the point of crisis. However, there was a recognition that some professionals were kind and compassionate.ConclusionsThere is a need for a more neuro-inclusive and personalised approach in CAMHS. Further research, funding, and training are urgently needed to ensure support is accessible, timely, and effective for autistic young people. <br/

Phenotypic Characterization of EIF2AK4 Mutation Carriers in a Large Cohort of Patients Diagnosed Clinically With Pulmonary Arterial Hypertension.

BACKGROUND: Pulmonary arterial hypertension (PAH) is a rare disease with an emerging genetic basis. Heterozygous mutations in the gene encoding the bone morphogenetic protein receptor type 2 (BMPR2) are the commonest genetic cause of PAH, whereas biallelic mutations in the eukaryotic translation initiation factor 2 alpha kinase 4 gene (EIF2AK4) are described in pulmonary veno-occlusive disease/pulmonary capillary hemangiomatosis. Here, we determine the frequency of these mutations and define the genotype-phenotype characteristics in a large cohort of patients diagnosed clinically with PAH. METHODS: Whole-genome sequencing was performed on DNA from patients with idiopathic and heritable PAH and with pulmonary veno-occlusive disease/pulmonary capillary hemangiomatosis recruited to the National Institute of Health Research BioResource-Rare Diseases study. Heterozygous variants in BMPR2 and biallelic EIF2AK4 variants with a minor allele frequency of <1:10 000 in control data sets and predicted to be deleterious (by combined annotation-dependent depletion, PolyPhen-2, and sorting intolerant from tolerant predictions) were identified as potentially causal. Phenotype data from the time of diagnosis were also captured. RESULTS: Eight hundred sixty-four patients with idiopathic or heritable PAH and 16 with pulmonary veno-occlusive disease/pulmonary capillary hemangiomatosis were recruited. Mutations in BMPR2 were identified in 130 patients (14.8%). Biallelic mutations in EIF2AK4 were identified in 5 patients with a clinical diagnosis of pulmonary veno-occlusive disease/pulmonary capillary hemangiomatosis. Furthermore, 9 patients with a clinical diagnosis of PAH carried biallelic EIF2AK4 mutations. These patients had a reduced transfer coefficient for carbon monoxide (Kco; 33% [interquartile range, 30%-35%] predicted) and younger age at diagnosis (29 years; interquartile range, 23-38 years) and more interlobular septal thickening and mediastinal lymphadenopathy on computed tomography of the chest compared with patients with PAH without EIF2AK4 mutations. However, radiological assessment alone could not accurately identify biallelic EIF2AK4 mutation carriers. Patients with PAH with biallelic EIF2AK4 mutations had a shorter survival. CONCLUSIONS: Biallelic EIF2AK4 mutations are found in patients classified clinically as having idiopathic and heritable PAH. These patients cannot be identified reliably by computed tomography, but a low Kco and a young age at diagnosis suggests the underlying molecular diagnosis. Genetic testing can identify these misclassified patients, allowing appropriate management and early referral for lung transplantation

Stakeholder priorities for multi-functional coastal defence developments and steps to effective implementation

To fulfil international conservation commitments, governments have begun to recognise the need for more proactive marine planning policies, advocating sensitive engineering design that can deliver secondary benefits above and beyond the primary purpose of developments. In response, there is growing scientific interest in novel multi-functional coastal defence structures with built-in secondary ecological and/or socio-economic benefits. To ensure research efforts are invested effectively, it is first necessary to determine what secondary benefits can potentially be built-in to engineered coastal defence structures, and further, which of these benefits would be most desirable. It is unlikely that secondary benefits are perceived in the same way across different stakeholder groups. Further, their order of priority when evaluating different options is unlikely to be consistent, since each option will present a suite of compromises and trade-offs. The aim of this study was to investigate stakeholder attitudes towards multi-functional coastal defence developments across different sector groups. A preliminary questionnaire indicated unanimous support for implementing multi-functional structures in place of traditional single-purpose ones. This preliminary survey informed the design of a Delphi-like study, which revealed a more nuanced and caveated level of support from a panel of experts and practitioners. The study also elicited a degree of consensus that the most desirable secondary benefits that could be built-in to developments would be ecological ones – prioritised over social, economic and technical benefits. This paper synthesises these findings, discusses the perceived barriers that remain, and proposes a stepwise approach to effective implementation of multi-functional coastal defence developments

“Constantly overwhelmed and desperate for help”: Parents’ experiences of supporting their autistic child with mental health difficulties in the United Kingdom

Autistic children and young people are at increased risk of experiencing mental health difficulties, but often face delays or barriers to accessing support. While evidence exists regarding parents’ experiences of supporting an autistic child, there is a lack of focus on parenting autistic children who are also experiencing mental health difficulties. This is despite the high likelihood of co-occurrence, the increased complexity this can bring, and the potential impact on the parents and their children. Thus, the present study aimed to explore parents’ experiences of supporting their autistic child with mental health difficulties in the United Kingdom (UK). Mixed-methods surveys were completed by 300 parents/carers of autistic children who had previously sought help for their child’s mental health difficulties. Qualitative data were extracted from open-text questions pertaining to parents’ perceived impact of their children’s mental health difficulties on all aspects of their life. Data were analysed using reflexive thematic analysis. Three themes, along with associated subthemes, were identified, namely 1) Deteriorating parental wellbeing, 2) The knock-on effect on the whole family, and 3) A lack of support. Findings underscore the significant challenges faced by parents, as they were often left to manage their child’s deteriorating mental health without sufficient professional support. The emotional and physical toll on parents was thought to be exacerbated by long waiting times, inadequate support services, and a lack of understanding of autism within healthcare and educational systems. There is an urgent need for more neuroaffirmative, personalised approaches to supporting autistic children and their families, along with timely access to effective interventions. By ensuring earlier intervention and reducing systemic barriers, both the mental health of children and the wellbeing of their families can be significantly improved, ultimately fostering better outcomes for all involved