Effects of restrictions to Income Support on health of lone mothers in the UK: a natural experiment study

Background: In the UK, lone parents must seek work as a condition of receiving welfare benefits once their youngest child reaches a certain age. Since 2008, the lower age limit at which these Lone Parent Obligations (LPO) apply has been reduced in steps. We used data from a nationally representative, longitudinal, household panel study to analyse the health effects of increased welfare conditionality under LPO. Methods: From the Understanding Society survey, we used data for lone mothers who were newly exposed to LPO when the age cutoff was reduced from 7 to 5 years in 2012 (intervention group 1) and from 10 to 7 years in 2010 (intervention group 2), as well as lone mothers who remained unexposed (control group 1) or continuously exposed (control group 2) at those times. We did difference-in-difference analyses that controlled for differences in the fixed characteristics of participants in the intervention and control groups to estimate the effect of exposure to conditionality on the health of lone mothers. Our primary outcome was the difference in change over time between the intervention and control groups in scores on the Mental Component Summary (MCS) of the 12-item Short-Form Health Survey (SF-12). Findings: The mental health of lone mothers declined in the intervention groups compared with the control groups. For intervention group 1, scores on the MCS decreased by 1·39 (95% CI −1·29 to 4·08) compared with control group 1 and by 2·29 (0·00 to 4·57) compared with control group 2. For intervention group 2, MCS scores decreased by 2·45 (−0·57 to 5·48) compared with control group 1 and by 1·28 (−1·45 to 4·00) compared with control group 2. When pooling the two intervention groups, scores on the MCS decreased by 2·13 (0·10 to 4·17) compared with control group 1 and 2·21 (0·30 to 4·13) compared with control group 2. Interpretation: Stringent conditions for receiving welfare benefits are increasingly common in high-income countries. Our results suggest that requiring lone parents with school-age children toseek work as a condition of receiving welfare benefits adversely affects their mental health. Funding: UK Medical Research Council, Scottish Government Chief Scientist Office, and National Health Service Research Scotland

Strategic design of service orientated web-based supply chain infrastructure

The traditional \u27make and sell\u27 attitude of industrial manufacturing organisations has now almost entirely given way to customer orientated \u27sense and respond\u27 service philosophies to the extent where this has become a major competitive key success factor in a global manufacturing industry. In order to become service orientated, manufacturing industry is increasingly dependent on efficient and effective supply relationships. This trend is compounded by needs for waste avoidance, minimal inventory, cost efficiency and appropriate service to the customer. This paper considers the strategic opportunities for large engineering project firms that have identified a need to establish advantages over their competitors by designing and implementing novel service orientated supply chain strategies, using internet technology. Rather than relying on functional hierarchy and command and control governance where a chain of commitments are poorly connected and difficult to reconfigure, this paper proposes more flexible strategic process designs around a \u27state of the art\u27 service based architecture. Complexity reduction is traditionally a philosophy widely used by industrial engineers that thus far has been also applied in attempts to enable efficient supply chain relationships between different manufacturing supply partners. However, in this work, those traditional industrial engineering ideas are challenged. When a supply chain is simplified, it is inevitable that it will not offer optimum performance, especially in terms of customer service because the complex nature of customer requirements is not reflected in its entirety. The architecture developed by the authors and demonstrated here explores ideas of complexity absorption. The architecture is built on the premise that necessary complexity absorption creates an organisation that is strategically superior because it becomes a complex adaptive system that is unique to a group of organisations that constitute a supply chain or supply network. A case study will be presented based on a major industrial gas pipeline procuring organisation that illustrates an application consisting of Manufacturing Portal and Service Orientated Architecture. This model is internet-based, has three main constituents of Web Services, Portal and Client Services and is described in detail in this paper. The authors conclude by discussing the unique competitive advantages that are achievable by designing unique, responsive and adaptive supply chain architecture in this way

The Attitudes about Complex Therapy Scale (ACTS) in Type 2 Diabetes and Cardiovascular Disease: Development, Validity and Reliability

Background: Type 2 diabetes is associated with cardiovascular disease, and patients with both conditions are prescribed complex medication regimens. Aim: The aim was to develop a reliable and valid measure of attitudes associated with the prescription and management of multiple medicines in patients with Type 2 diabetes and cardiovascular disease. Methods: Principal component analysis (PCA) and Cronbach alpha assessed the reliability of the Attitudes about Complex Therapy Scale (ACTS). Examinations of relationships with related measures inform concurrent validity. Questionnaires were sent to a cross-sectional sample of 480 people prescribed multiple medicines for co-morbid Type 2 diabetes. Results: Cronbach alpha was 0.76, indicating the scale had good internal reliability. PCA rotated a four factor model accounting for 37% of the variance. Four subscales identified; 1. Concerns about multiple medicines and increasing numbers of medicines; 2.Anxiety over missed medicines; 3. Desires to substitute medicines and reduce the number of medicines prescribed and; 4. Perceptions related to organising and managing complex therapy. The ACTS showed significant relationships with measures of anxiety, depression, general beliefs about medicines and self-efficacy. Also, the ACTS significantly correlated with adherence to medicines, showing good predictive validity. Conclusion: The ACTS was designed to assess negative attitudes towards complex therapy and multiple medication management. This tool could aid prescribing decisions and may identify people who are intentionally non-adherent to all or some of their medicines

Disassembly sequence generation in recycling based on parts accessibility and end-of-life strategy

Nowadays, global sustainability is the central issue in recycling and, increasingly, in manufacturing. Recycling used products can save energy, natural resources, and landfill space, and can reduce air pollution. It can give used products new lives. The study of disassembly is needed in order to make recycling economical, and disassembly sequence generation (DSG) plays an important role. An appropriate disassembly process plan can minimize the cost spent on the disassembly processes and maximize the benefits coming from the reused components. In the current paper, a new approach using Petri net modelling to generate an optimal disassembly sequence (ODS), based on accessibility and end-of-life (EOL) strategy, is described. The different life spans of the reusable components affect the disassembly order, especially in destructive disassembly, and the influence of components with different life spans on DSG is analysed. First, AND/OR graphs are used to generate all feasible disassembly sequences, and then AND/OR graphs are transferred into Petri net graphs while accessibility values and life span values of components are taken into account to obtain the ODS. A program using Microsoft Cþþ is developed to generate the ODS. The disassembly of a C-clamp is used as a trial example

Sensitivity to wheat, gluten and FODMAPs in IBS: Facts or fiction?

IBS is one of the most common types of functional bowel disorder. Increasing attention has been paid to the causative role of food in IBS. Food ingestion precipitates or exacerbates symptoms, such as abdominal pain and bloating in patients with IBS through different hypothesised mechanisms including immune and mast cell activation, mechanoreceptor stimulation and chemosensory activation. Wheat is regarded as one of the most relevant IBS triggers, although which component(s) of this cereal is/are involved remain(s) unknown. Gluten, other wheat proteins, for example, amylase-trypsin inhibitors, and fructans (the latter belonging to fermentable oligo-di-mono-saccharides and polyols (FODMAPs)), have been identified as possible factors for symptom generation/exacerbation. This uncertainty on the true culprit(s) opened a scenario of semantic definitions favoured by the discordant results of double-blind placebo-controlled trials, which have generated various terms ranging from non-coeliac gluten sensitivity to the broader one of non-coeliac wheat or wheat protein sensitivity or, even, FODMAP sensitivity. The role of FODMAPs in eliciting the clinical picture of IBS goes further since these short-chain carbohydrates are found in many other dietary components, including vegetables and fruits. In this review, we assessed current literature in order to unravel whether gluten/wheat/FODMAP sensitivity represent 'facts' and not 'fiction' in IBS symptoms. This knowledge is expected to promote standardisation in dietary strategies (gluten/wheat-free and low FODMAP) as effective measures for the management of IBS symptoms

Thermoresponsive, well-defined, poly(vinyl alcohol) co-polymers

Thermoresponsive polymers have attracted huge interest as adaptable biomaterials based on their reversible solubility behaviour which can be exploited for controlled drug delivery or cellular uptake. The most famous and successful of these is poly(ethylene glycol) (PEG), but the thermal transition temperatures that are practically accessible are not physiologically useful. There are some notable examples of synthetic, responsive, polymers that are highly tunable over a physiologically relevant range, but there is still a need for these to be clinically validated in terms of toxicology and immunogenity for in vivo usage, in addition to their widely used in vitro applications. Poly(vinyl alcohol), PVA, is an appealing biocompatible polymer which is already used for a huge range of biomedical applications. Here, PVA is shown to be a highly tunable, thermoresponsive polymer scaffold. RAFT/MADIX polymerization is used to obtain a library of well-defined polymers between 8 and 50 kDa. Selective alkanoylation of the obtained PVA enabled the effect of side-chains, end-groups and molecular weight on the observable transition temperatures to be studied by turbidimetry. It was found that increasingly hydrophobic side chains (acetyl, propanoyl, butanoyl), or increasing their density led to corresponding decreases in cloud point. PVA with just 10 mol% butanoylation was shown to have a thermal transition temperature close to physiological temperatures (37 °C), compared to 70 mol% for acetylation, with temperatures in between accessible by controlling both the relative degree of functionalization, or by altering the chain length. Finally, a secondary response to esterase enzymes was demonstrated as a route to ‘turn off’ the responsive behaviour on demand. This study suggests that PVA-derived polymers may be a useful platform for responsive biomaterials

Functional gastrointestinal symptoms in patients with inflammatory bowel disease: A clinical challenge

Description The purpose of this clinical practice update review is to describe key principles in the diagnosis and management of functional gastrointestinal (GI) symptoms in patients with inflammatory bowel disease (IBD). Methods The evidence and best practices summarized in this manuscript are based on relevant scientific publications, systematic reviews, and expert opinion where applicable. Best practice advice 1 A stepwise approach to rule-out ongoing inflammatory activity should be followed in IBD patients with persistent GI symptoms (measurement of fecal calprotectin, endoscopy with biopsy, cross-sectional imaging). Best practice advice 2 In those patients with indeterminate fecal calprotectin levels and mild symptoms, clinicians may consider serial calprotectin monitoring to facilitate anticipatory management. Best practice advice 3 Anatomic abnormalities or structural complications should be considered in patients with obstructive symptoms including abdominal distention, pain, nausea and vomiting, obstipation or constipation. Best practice advice 4 Alternative pathophysiologic mechanisms should be considered and evaluated (small intestinal bacterial overgrowth, bile acid diarrhea, carbohydrate intolerance, chronic pancreatitis) based on predominant symptom patterns. Best practice advice 5 A low FODMAP diet may be offered for management of functional GI symptoms in IBD with careful attention to nutritional adequacy. Best practice advice 6 Psychological therapies (cognitive behavioural therapy, hypnotherapy, mindfulness therapy) should be considered in IBD patients with functional symptoms. Best practice advice 7 Osmotic and stimulant laxative should be offered to IBD patients with chronic constipation. Best practice advice 8 Hypomotility agents or bile-acid sequestrants may be used for chronic diarrhea in quiescent IBD. Best practice advice 9 Antispasmodics, neuropathic-directed agents, and anti-depressants should be used for functional pain in IBD while use of opiates should be avoided. Best practice advice 10 Probiotics may be considered for treatment of functional symptoms in IBD. Best practice advice 11 Pelvic floor therapy should be offered to IBD patients with evidence of an underlying defecatory disorder. Best practice advice 12 Until further evidence is available, fecal microbiota transplant should not be offered for treatment of functional GI symptoms in IBD. Best practice advice 13 Physical exercise should be encourage in IBD patients with functional GI symptoms. Best practice advice 14 Until further evidence is available, complementary and alternative therapies should not be routinely offered for functional symptoms in IBD

Structural behaviour of copper chloride catalysts during the chlorination of CO to phosgene

The interaction of CO with an attapulgite-supported Cu(II)Cl2 catalyst has been examined in a micro-reactor arrangement. CO exposure to the dried, as-received catalyst at elevated temperatures leads to the formation of CO2 as the only identifiable product. However, phosgene production can be induced by a catalyst pre-treatment where the supported Cu(II)Cl2 sample is exposed to a diluted stream of chlorine. Subsequent CO exposure at ~ 370°C then leads to phosgene production. In order to investigate the origins of this atypical set of reaction characteristics, a series of x-ray absorption experiments were performed that were supplemented by DFT calculations. XANES measurements establish that at the elevated temperatures connected with phosgene formation, the catalyst is comprised of Cu+ and a small amount of Cu2+. Moreover, the data show that unique to the chlorine pre-treated sample, CO exposure at elevated temperature results in a short-lived oxidation of the copper. On the basis of calculated CO adsorption energies, DFT calculations indicate that a mixed Cu+/Cu2+ catalyst is required to support CO chemisorption

Mitochondrial ROS cause motor deficits induced by synaptic inactivity:implications for synapse pruning

Developmental synapse pruning refines burgeoning connectomes. The basic mechanisms of mitochondrial reactive oxygen species (ROS) production suggest they select inactive synapses for pruning: whether they do so is unknown. To begin to unravel whether mitochondrial ROS regulate pruning, we made the local consequences of neuromuscular junction (NMJ) pruning detectable as motor deficits by using disparate exogenous and endogenous models to induce synaptic inactivity en masse in developing Xenopus laevis tadpoles. We resolved whether: (1) synaptic inactivity increases mitochondrial ROS; and (2) antioxidants rescue synaptic inactivity induced motor deficits. Regardless of whether it was achieved with muscle (α-bugarotoxin), nerve (α-latrotoxin) targeted neurotoxins or an endogenous pruning cue (SPARC), synaptic inactivity increased mitochondrial ROS in vivo. The manganese porphyrins MnTE-2-PyP5+ and/or MnTnBuOE-2-PyP5+ blocked mitochondrial ROS to significantly reduce neurotoxin and endogenous pruning cue induced motor deficits. Selectively inducing mitochondrial ROS—using mitochondria-targeted Paraquat (MitoPQ)—recapitulated synaptic inactivity induced motor deficits; which were significantly reduced by blocking mitochondrial ROS with MnTnBuOE-2-PyP5+. We unveil mitochondrial ROS as synaptic activity sentinels that regulate the phenotypical consequences of forced synaptic inactivity at the NMJ. Our novel results are relevant to pruning because synaptic inactivity is one of its defining features

A Randomized Dietary Intervention to Increase Colonic and Peripheral Blood Short-Chain Fatty Acids Modulates the Blood B- and T-cell Compartments in Healthy Humans

BACKGROUND: Short-chain fatty acids (SCFA) have immune-modulating effects in animal models of disease. However, there is limited evidence that this may occur in humans. OBJECTIVES: This study aimed to determine the effects of increased exposure to SCFA via dietary manipulation on colonic fermentation and adaptive immune cells. METHODS: Twenty healthy, young adults (18-45 years of age) underwent a blinded, randomized, cross-over dietary intervention, consuming a high-SCFA producing diet and matched low-SCFA diet for 21 days with 21-day wash-out in between. SCFA were provided through resistant starch, inulin and apple cider vinegar. Blood and 3-day total fecal output were collected at baseline and at the end of each diet. Gas chromatography was used to measure fecal and plasma SCFA. Flow cytometry was used for peripheral blood immuno-phenotyping. RESULTS: High-SCFA diet was associated with significantly (paired samples Wilcoxon test) higher median [IQR] fecal SCFA concentrations (86.6 [59.0] vs 75.4 [56.2] µmol/g, P = 0.02) and significantly lower median fecal ammonia concentrations (26.2 [14.7] vs 33.4 [18.5] µmol/g, P = 0.04) than the low-SCFA diet. Plasma propionate (9.87 [12.3] vs 4.72 [7.6] µmol/L, P = 0.049) and butyrate (2.85 [1.35] vs 2.02 [1.29] µmol/L, P = 0.03) were significantly higher after high-SCFA diet than after low-SCFA diet. Blood total B cells (184 [112] vs 199 [143] cells/µL, P = 0.04), naive B cells (83 [66] vs 95 [89] cells/µL, P = 0.02), Th1 cells (22 [19] vs 29 [16] cells/µL, P = 0.03) and mucosal-associated invariant T (MAIT) cells (62 [83] vs 69 [114] cells/µL, P = 0.02) were significantly lower after high-SCFA diet than low-SCFA diet. CONCLUSION: Increasing colonic and peripheral blood SCFA has discrete effects on circulating immune cells in healthy humans following 3-week intervention. Further studies, e.g., in patients with inflammatory disease, are necessary to determine if these changes have immunomodulatory effects, whether these are therapeutically beneficial, and whether prolonged intake might be required. Clinical trial registry: Australian New Zealand Clinical trials registry: ACTRN12618001054202.