Olfactory Acuity in Chronic Migraine: A Cross-Sectional Study.

OBJECTIVE/BACKGROUND: This study aims to measure olfactory acuity in chronic migraine subjects, at baseline and on migraine days, and compare to age- and sex-matched controls. Olfactory impairment is common in neurological disorders. While smell hypersensitivity has been established with chronic migraine, olfactory acuity has not been well studied. METHODS: We recruited 50 subjects with chronic migraine from the Jefferson Headache Center and 50 age- and sex-matched controls. Using the University of Pennsylvania Smell Identification Test (UPSIT), a validated test of olfaction, olfactory acuity was measured at baseline and during a migraine for subjects, and compared to controls at baseline and at home 2 weeks later. All subjects were additionally screened for odor sensitivity and allodynia. RESULTS: The mean UPSIT score for migraine subjects was 34.5 on non-migraine days and 34.7 on migraine days (mean difference = -0.4, 95% confidence interval [CI; -1.3, 0.6] P = .45). Controls had a mean of 35.9 and 36.1 for each test day (mean difference = -0.1, 95% CI [-0.9, 0.7] P = .87). On average, migraineurs performed worse than their matched control counterparts in both test sittings (test 1: P = .047; test 2: P = .01). The great majority of subjects were allodynic (42/50) compared with only 9 of 50 controls, and the majority of subjects (41/50) found more than one listed odor to be bothersome, compared with only 10/50 controls. On non-migraine days, 18/48 chronic migraine subjects had abnormal olfaction and on migraine days 14/42 had abnormal olfaction, compared with only 9/50 controls who had abnormal olfaction on their first UPSIT. CONCLUSIONS: While chronic migraine patients do not appear to have a significant change in olfactory acuity between migrainous and non-migrainous periods, they do appear to be more likely to have abnormal olfactory acuity at baseline compared to age- and sex-matched controls

Embedding effective depression care: using theory for primary care organisational and systems change

Background: depression and related disorders represent a significant part of general practitioners (GPs) daily work. Implementing the evidence about what works for depression care into routine practice presents a challenge for researchers and service designers. The emerging consensus is that the transfer of efficacious interventions into routine practice is strongly linked to how well the interventions are based upon theory and take into account the contextual factors of the setting into which they are to be transferred. We set out to develop a conceptual framework to guide change and the implementation of best practice depression care in the primary care setting.Methods: we used a mixed method, observational approach to gather data about routine depression care in a range of primary care settings via: audit of electronic health records; observation of routine clinical care; and structured, facilitated whole of organisation meetings. Audit data were summarised using simple descriptive statistics. Observational data were collected using field notes. Organisational meetings were audio taped and transcribed. All the data sets were grouped, by organisation, and considered as a whole case. Normalisation Process Theory (NPT) was identified as an analytical theory to guide the conceptual framework development.Results: five privately owned primary care organisations (general practices) and one community health centre took part over the course of 18 months. We successfully developed a conceptual framework for implementing an effective model of depression care based on the four constructs of NPT: coherence, which proposes that depression work requires the conceptualisation of boundaries of who is depressed and who is not depressed and techniques for dealing with diffuseness; cognitive participation, which proposes that depression work requires engagement with a shared set of techniques that deal with depression as a health problem; collective action, which proposes that agreement is reached about how care is organised; and reflexive monitoring, which proposes that depression work requires agreement about how depression work will be monitored at the patient and practice level. We describe how these constructs can be used to guide the design and implementation of effective depression care in a way that can take account of contextual differences.Conclusions: ideas about what is required for an effective model and system of depression care in primary care need to be accompanied by theoretically informed frameworks that consider how these can be implemented. The conceptual framework we have presented can be used to guide organisational and system change to develop common language around each construct between policy makers, service users, professionals, and researchers. This shared understanding across groups is fundamental to the effective implementation of change in primary care for depressio

What support do frontline workers want? A qualitative study of health and social care workers' experiences and views of psychosocial support during the COVID-19 pandemic

Background: The COVID-19 pandemic has placed a significant burden on the mental health and wellbeing of frontline health and social care workers. The need to support frontline staff has been recognised. However, there is to date little research specifically on how best to support the mental health needs of frontline workers, and none on their own experiences and views about what might be most helpful. Aims: We set out to redress this research gap by qualitatively exploring UK frontline health and social care workers’ own experiences and views of psychosocial support during the pandemic. Method: Frontline health and social care workers were recruited purposively through social media and by snowball sampling via healthcare colleagues. Workers who volunteered to take part in the study were interviewed remotely following a semi-structured interview guide. Transcripts of the interviews were analysed by the research team following the principles of Reflexive Thematic Analysis. Results: We conducted 25 interviews with frontline workers from a variety of professional groups working in health and social care settings across the UK. Themes derived from our analysis showed that workers’ experiences and views about psychosocial support were complex. Peer support was many workers’ first line of support but could also be experienced as a burden. Workers were ambivalent about support shown by organisations, media and the public. Whilst workers valued psychological support services, there were many disparities in provision and barriers to access. Conclusions: The results of this study show that frontline health and social care workers are likely to need a flexible system of support including peer, organisational and professional support. More research is needed to fully unpack the structural, systemic and individual barriers to accessing psychosocial support. Greater collaboration, consultation and co-production of support services and their evaluation is warranted

Interaction of preimplantation factor with the global bovine endometrial transcriptome

Preimplantation factor (PIF) is an embryo derived peptide which exerts an immune modulatory effect on human endometrium, promoting immune tolerance to the embryo whilst maintaining the immune response to invading pathogens. While bovine embryos secrete PIF, the effect on the bovine endometrium is unknown. Maternal recognition of pregnancy is driven by an embryo-maternal cross talk, however the process differs between humans and cattle. As many embryos are lost during the early part of pregnancy in cattle, a greater knowledge of factors affecting the embryo-maternal crosstalk, such as PIF, is needed to improve fertility. Therefore, for the first time, we demonstrate the effect of synthetic PIF (sPIF) on the bovine transcriptome in an ex vivo bovine endometrial tissue culture model. Explants were cultured for 30h with sPIF (100nM) or in control media. Total RNA was analysed via RNA-sequencing. As a result of sPIF treatment, 102 genes were differentially expressed compared to the control (Padj<0.1), although none by more than 2-fold. The majority of genes (78) were downregulated. Pathway analysis revealed targeting of several immune based pathways. Genes for the TNF, NF-κB, IL-17, MAPK and TLR signalling pathways were down-regulated by sPIF. However, some immune genes were demonstrated to be upregulated following sPIF treatment, including C3. Steroid biosynthesis was the only over-represented pathway with all genes upregulated. We demonstrate that sPIF can modulate the bovine endometrial transcriptome in an immune modulatory manner, like that in the human endometrium, however, the regulation of genes was much weaker than in previous human work

Olfactory function in migraine both during and between attacks.

INTRODUCTION: People with migraine often report being osmophobic, both during and between acute migraine attacks. It is not clear, however, whether such reports are associated with changes in olfaction such as hyperosmia, as measured by psychophysical testing. In this case-control study we quantitatively assessed olfactory identification ability, which correlates with threshold tests of olfactory acuity, in patients with migraine at baseline (no headache), during migraine episodes, and after a treated attack and compared the test scores to those of matched control subjects. METHODS: Fifty episodic migraine subjects and 50 and sex- and age-matched controls without headache were tested. All completed the University of Pennsylvania Smell Identification Test (UPSIT), a standardized and well-validated olfactory test. RESULTS: At baseline, the UPSIT scores did not differ significantly between the migraine and control study groups (median paired score difference: -1, p = 0.18). During migraine attacks, a minority of migraine subjects (eight of 42) developed microsmia (i.e. lower test scores by at least four points), suggesting that, as compared to their matched controls, olfactory acuity was somewhat impaired during migraine attacks (p = 0.02). This difference was less pronounced and not statistically significant after a successfully treated attack (p = 0.15). DISCUSSION: People with episodic migraine were found to have similar olfactory function as age- and sex-matched controls, but a minority exhibit microsmia or hyposmia during acute attacks. The cause of this dysfunction is unknown, but could relate to autonomic symptoms, limbic system activation, or disorders of higher order sensory processing

Exploring the psychological rewards of a familiar semirural landscape: connecting to local nature through a mindful approach

This study analyses a 53,000 word diary of a year engaging with nature through over 200 trips to a semi-rural landscape. Thematic analysis revealed two themes; the transition from observer to nature connectedness and the ways in which the natural environment was experienced once a connection was made. These themes are discussed in relation to theories that seek to explain the positive effect of nature and nature connectedness. The findings are important as they suggest that repeated engagement with local semi-rural countryside can lead to a mindful approach and psychological rewards that do not require travel into the wilderness. The work informs further research into outcomes and processes of nature based interventions such as: trip frequency, duration and diary keeping

On finite pp-groups whose automorphisms are all central

An automorphism $\alpha$ of a group $G$ is said to be central if $\alpha$ commutes with every inner automorphism of $G$. We construct a family of non-special finite $p$-groups having abelian automorphism groups. These groups provide counter examples to a conjecture of A. Mahalanobis [Israel J. Math., {\bf 165} (2008), 161 - 187]. We also construct a family of finite $p$-groups having non-abelian automorphism groups and all automorphisms central. This solves a problem of I. Malinowska [Advances in group theory, Aracne Editrice, Rome 2002, 111-127].Comment: 11 pages, Counter examples to a conjecture from [Israel J. Math., {\bf 165} (2008), 161 - 187]; This paper will appear in Israel J. Math. in 201

The roles of specialist provision for children with specific speech and language difficulties in England and Wales: a model for inclusion?

Children with specific speech and language difficulties pose a challenge to the education and health systems. In addition to their language difficulties they are also at risk of literacy and social, emotional and behavioural difficulties. The main support for children with more severe difficulties has been enhanced provision in mainstream schools (language units or integrated resources) and special schools. The move to an inclusive education system challenges this tradition. The present paper reports the results of interviews with heads of language units/integrated resources and headteachers of special schools (n=57) as part of a larger study within England and Wales. Their views are considered with reference to criteria for entry to specialist provision, the development of collaborative practice between teachers, teaching assistants and speech and language therapists, and the implications for inclusive education

Density and P‐wave velocity structure beneath the Paraná Magmatic Province: Refertilization of an ancient lithospheric mantle

We estimate density and P‐wave velocity perturbations in the mantle beneath the southeastern South America plate from geoid anomalies and P‐wave traveltime residuals to constrain the structure of the lithosphere underneath the Paraná Magmatic Province (PMP) and conterminous geological provinces. Our analysis shows a consistent correlation between density and velocity anomalies. The P‐wave speed and density are 1% and 15 kg/m3 lower, respectively, in the upper mantle under the Late Cretaceous to Cenozoic alkaline provinces, except beneath the Goiás Alkaline Province (GAP), where density (+20 kg/m3) and velocity (+0.5%) are relatively high. Underneath the PMP, the density is higher by about 50 kg/m3 in the north and 25 kg/m3 in the south, to a depth of 250 − 300 km. These values correlate with high‐velocity perturbations of +0.5% and +0.3%, respectively. Profiles of density perturbation versus depth in the upper mantle are different for the PMP and the adjacent Archean São Francisco (SFC) and Amazonian (AC) cratons. The Paleoproterozoic PMP basement has a high‐density root. The density is relatively low in the SFC and AC lithospheres. A reduction of density is a typical characteristic of chemically depleted Archean cratons. A more fertile Proterozoic and Phanerozoic subcontinental lithospheric mantle has a higher density, as deduced from density estimates of mantle xenoliths of different ages and composition. In conjunction with Re‐Os isotopic studies of the PMP basalts, chemical and isotopic analyses of peridodite xenoliths from the GAP in the northern PMP, and electromagnetic induction experiments of the PMP lithosphere, our density and P‐wave speed models suggest that the densification of the PMP lithosphere and flood basalt generation are related to mantle refertilization. Metasomatic refertilization resulted from the introduction of asthenospheric components from the mantle wedge above Proterozoic subduction zones, which surrounded the Paraná lithosphere. The high‐density PMP lithosphere is presently gravitationally unstable and prone to delamination.Key Points:Density and P‐wave velocity in the lithospheric mantle beneath the Paraná Magmatic Province are highHigh density precludes a depleted cratonic lithosphere and indicates refertilized lithospheric mantleBasalt magmatism suggests refertilized mantle with asthenospheric components from mantle wedgePeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134193/1/ggge21079-sup-0003-2016GC006369-fs02.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134193/2/ggge21079-sup-0004-2016GC006369-fs03.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134193/3/ggge21079-sup-0002-2016GC006369-fs01.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134193/4/ggge21079_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134193/5/ggge21079.pd