'A light in a very dark place' : The role of a voluntary organisation providing support for those affected by encephalitis

Voluntary organisations are seen as contributing to the ‘democratisation’ of health and social care. Little, however, is written about their role and this paper, by focusing on the work of The Encephalitis Society, provides insights into the challenges facing voluntary organisations as they manage twin roles as service providers and advocates, of people with neurological disorders. Two studies are presented: a review conducted by the Society, focusing on patient’s experiences of neurological services; and an external evaluation of the Society’s current provision. The first, based on a postal survey of its members affected by encephalitis (n = 339), illustrates the Society’s advocacy role. The survey provided support for the Association of British Neurologists’ recommendation for nationally agreed standards of care. The second study, a postal survey of recent contacts (n = 76) and in-depth telephone interviews (n = 22), illustrates the Society’s value role as a service provider and supports its role in helping rehabilitate affected individuals and their families. These studies provided the Society with information for policy and service development. Importantly, providing the basis of informed action and partnership with stakeholders and informing the organisation’s sense of purpose, in the changing context of welfare provision in the UK

A method of reducing the drag of transport wings

The paper describes research work that has been carried out to reduce the viscous drag of transport aircraft wings by controlling the turbulent contamination on the attachment line. Laminar leading edges will reduce the boundary layer thickness downstream and thus reduce drag. This scenario was postulated by M. Gaster in a paper presented to the AIAA Seattle conference in 2008. The effect of maintaining a laminar attachment line on the overall flow on a wing has been modeled and drag reductions calculated. These values are compared with wind tunnel measurements of viscous drag of a wing with both laminar and turbulent attachment lines

The effect of soy phytoestrogen supplementation on thyroid status and cardiovascular risk markers in patients with subclinical hypothyroidism: A randomized, double-blind, crossover study

Context: There is concern whether soy phytoestrogens may affect thyroid function. If true, soy phytoestrogens may be expected to have a greater impact in subjects with subclinical hypothyroidism. Objective: The primary aim was to determine the effect of soy phytoestrogen supplementation on thyroid function, with a secondary aim of assessing the effects on cardiovascular risk indices in patients with subclinical hypothyroidism. Design and Setting: We conducted a randomized, double-blind, crossover study in a tertiary care setting. Participants: Sixty patients with subclinical hypothyroidism participated in the study. Intervention: Patients were randomly assigned to either low-dose phytoestrogen (30 g soy protein with 2 mg phytoestrogens, representative of a Western diet) or high-dose phytoestrogen (30 g soy protein with 16 mg phytoestrogens, representative of a vegetarian diet) supplementation for 8 wk, then crossed over after an 8-wk washout period. Main Outcome Measures: The primary outcome was progression to overt hypothyroidism, with secondary outcome measures of blood pressure, insulin resistance, lipids, and highly sensitive C-reactive protein (hsCRP). Results: Six female patients in the study progressed into overt hypothyroidism with a standardized rate ratio of 3.6 (95% confidence interval, 1.9, 6.2) after 16-mg phytoestrogen supplementation. Both systolic and diastolic blood pressure decreased with 16 mg phytoestrogens, whereas systolic pressure alone decreased with 2 mg phytoestrogens. Insulin resistance (homeostasis model assessment of insulin resistance, 3.5 ± 0.09 vs. 2.6 ± 0.08; P < 0.02) and hsCRP (4.9 ± 0.04 vs. 3.9 ± 0.03; P < 0.01) decreased with 16 mg phytoestrogens. Lipid profile remained unchanged. Conclusion: There is a 3-fold increased risk of developing overt hypothyroidism with dietary supplementation of 16 mg soy phytoestrogens with subclinical hypothyroidism. However, 16-mg soy phytoestrogen supplementation significantly reduces the insulin resistance, hsCRP, and blood pressure in these patients. Copyright © 2011 by The Endocrine Society

On the Quantum Geometry of Multi-critical CDT

We discuss extensions of a recently introduced model of multi-critical CDT to higher multi-critical points. As in the case of pure CDT the continuum limit can be taken on the level of the action and the resulting continuum surface model is again described by a matrix model. The resolvent, a simple observable of the quantum geometry which is accessible from the matrix model is calculated for arbitrary multi-critical points. We go beyond the matrix model by determining the propagator using the peeling procedure which is used to extract the effective quantum Hamiltonian and the fractal dimension in agreement with earlier results by Ambjorn et al. With this at hand a string field theory formalism for multi-critical CDT is introduced and it is shown that the Dyson-Schwinger equations match the loop equations of the matrix model. We conclude by commenting on how to formally obtain the sum over topologies and a relation to stochastic quantisation.Comment: 15 pages, 2 figures, improved discussion, some new results regarding Hausdorff dimension, as publishe

Patient-reported outcomes following flexible sigmoidoscopy screening for colorectal cancer in a demonstration screening programme in the UK

&lt;p&gt;OBJECTIVES: Flexible sigmoidoscopy (FS) screening for colorectal cancer will be introduced into the National Cancer Screening Programmes in England in 2013. Patient-reported outcome measures (PROMs) from trial participants indicate high acceptability and no adverse physical or psychological consequences, but this may not generalize to routine screening in the community. This study examined PROMs in a community-based FS screening programme.&lt;/p&gt; &lt;p&gt;METHODS: Eligible adults aged 58-59 (n = 2016) registered at 34 London general practices were mailed a National Health Service-endorsed invitation to attend FS screening. Pain and side-effects were assessed in a 'morning-after' questionnaire, and satisfaction was assessed in a three-month follow-up questionnaire. Anxiety, self-rated health and colorectal symptoms were assessed at prescreening and follow-up.&lt;/p&gt; &lt;p&gt;RESULTS: In total, 1020 people attended screening and were included in the current analyses, of whom 913 (90%) returned the morning-after questionnaire, and 674 (66%) the follow-up questionnaire. The prescreening questionnaire had been completed by 751 (74%) of those who attended. The majority (87%) of respondents reported no pain or mild pain, and the most frequent side-effect (wind) was only experienced more than mildly by 16%. Satisfaction was extremely high, with 98% glad they had the test; 97% would encourage a friend to have it. From prescreening to follow-up there were no changes in anxiety or self-rated health, and the number of colorectal symptoms declined. Satisfaction and changes in wellbeing were not moderated by gender, deprivation, ethnicity or screening outcome.&lt;/p&gt; &lt;p&gt;CONCLUSIONS: PROMs indicate high acceptability of FS screening in 58-59 year olds, with no adverse effects on colorectal symptoms, health status or psychological wellbeing.&lt;/p&gt

Computing Hilbert Class Polynomials

We present and analyze two algorithms for computing the Hilbert class polynomial $H_D$ . The first is a p-adic lifting algorithm for inert primes p in the order of discriminant D < 0. The second is an improved Chinese remainder algorithm which uses the class group action on CM-curves over finite fields. Our run time analysis gives tighter bounds for the complexity of all known algorithms for computing $H_D$, and we show that all methods have comparable run times

Bedroom media, sedentary time and screen-time in children:A longitudinal analysis

Background: Having electronic media in the bedroom is cross-sectionally associated with greater screen-time in children, but few longitudinal studies exist. The aim of this study was to describe longitudinal patterns of ownership and examine cross-sectional and longitudinal associations of bedroom media with children's sedentary behaviour. Methods: Data are from the Sport, Physical activity and Eating behaviour: Environmental Determinants in Young people (SPEEDY) study, collected at 3 time-points: baseline (2007, T0; age 10.3 ± 0.3 years), 1-year (T1y) and 4-year (T4y) follow-up. For each assessment, 1512 (44.9% male), 715 (41.0% male), and 319 (48.3% male) participants provided valid accelerometer data. Outcome variables were accelerometer-assessed sedentary time and self-reported screen-time. The presence of a television or computer in the bedroom was self-reported by participants and a combined bedroom media score calculated as the sum of such items. Cross-sectional and longitudinal associations between bedroom media and each outcome were examined using multi-level linear regression. Results: Bedroom TV ownership fell from 70.9% at T0 to 42.5% at T4y. Having a TV in the bedroom (beta; 95% CI*100, T0: -1.17; -1.88, -0.46. T1y: -1.68; -2.67, -0.70) and combined bedroom media (T0: -0.76; -1.26, -0.27. T1y: -0.79; -1.51, -0.07) were negatively associated with objectively measured weekly sedentary time at T0 and T1y. Having a computer in the bedroom (beta; 95% CI, T0: 0.15; 0.02, 0.29. T4y: 0.35; 0.10, 0.60) and combined bedroom media (T0: 0.09: 0.01, 0.18. T4y: 0.20; 0.05, 0.34) were positively associated with screen-time at T0 and T4y. Relative to participants without a computer throughout the study, children that had a computer in their bedroom at T0 but not at T4y (beta; 95% CI for change in screen-time: -8.02; -12.75, -3.29) reported smaller increases in screen-time. Conclusions: The bedroom media environment changes with age and exhibits a complex relationship with children's sedentary behaviour. Modifying children's bedroom media environment may impact upon screen-time but appears unlikely to influence overall sedentary time

Patient perspectives on discussing alcohol as part of medicines review in community pharmacies.

BACKGROUND: This paper reports on a qualitative study which formed part of the intervention development phase of a five year research programme (Community pharmacy: Highlighting Alcohol use in Medication aPpointments; CHAMP-1). OBJECTIVES: To better understand patient views on the appropriateness of alcohol as a subject for discussion in medication reviews in community pharmacy. METHODS: Semi-structured interviews were conducted with a sample of 25 people eligible for medication reviews whose AUDIT-C screening scores identified them as likely risky drinkers. Transcripts were analysed using a modified framework method with a constructionist thematic analysis approach. RESULTS: Most patients interviewed said they were open to the idea of a medication and alcohol linked discussion with a pharmacist if this was routine, well-conducted and confidential. Such a discussion was thought less personally relevant for those who viewed the proposed intervention through the prism of a particular set of ideas about the nature of alcohol problems, which distanced them from thinking about alcohol in terms of their everyday life and possible impacts on their health. Study findings attest to some of the sensitivities involved in discussion of alcohol, and the complexities inherent in helping people to talk about their own drinking, medicine use and health. CONCLUSIONS: Patients were open to the idea of discussing alcohol with community pharmacists in the context of a medicines review if this was sensitively done and the relevance was clear to them

Halving Balls in Deterministic Linear Time

Let \D be a set of $n$ pairwise disjoint unit balls in $\R^d$ and $P$ the set of their center points. A hyperplane \Hy is an \emph{$m$-separator} for \D if each closed halfspace bounded by \Hy contains at least $m$ points from $P$. This generalizes the notion of halving hyperplanes, which correspond to $n/2$-separators. The analogous notion for point sets has been well studied. Separators have various applications, for instance, in divide-and-conquer schemes. In such a scheme any ball that is intersected by the separating hyperplane may still interact with both sides of the partition. Therefore it is desirable that the separating hyperplane intersects a small number of balls only. We present three deterministic algorithms to bisect or approximately bisect a given set of disjoint unit balls by a hyperplane: Firstly, we present a simple linear-time algorithm to construct an $\alpha n$-separator for balls in $\R^d$, for any $0<\alpha<1/2$, that intersects at most $cn^{(d-1)/d}$ balls, for some constant $c$ that depends on $d$ and $\alpha$. The number of intersected balls is best possible up to the constant $c$. Secondly, we present a near-linear time algorithm to construct an $(n/2-o(n))$-separator in $\R^d$ that intersects $o(n)$ balls. Finally, we give a linear-time algorithm to construct a halving line in $\R^2$ that intersects $O(n^{(5/6)+\epsilon})$ disks. Our results improve the runtime of a disk sliding algorithm by Bereg, Dumitrescu and Pach. In addition, our results improve and derandomize an algorithm to construct a space decomposition used by L{\"o}ffler and Mulzer to construct an onion (convex layer) decomposition for imprecise points (any point resides at an unknown location within a given disk)