Understanding the social inclusion needs of people living in mental health supported accommodation

Objectives: To identify the social inclusion needs that were (i) most commonly identified and (ii) most and least commonly prioritised as support planning goals for mental health service users living in supported accommodation, using the online Social Inclusion Questionnaire User Experience (SInQUE). We qualitatively examined mental health supported accommodation staff and servicer users’ views on barriers to offering support with two less commonly prioritised areas: help finding a partner and feeling less lonely. // Methods: Anonymous SInQUE data were collected during a completed study in which we developed and tested the online SInQUE. Four focus groups were conducted with mental health supported accommodation staff (N = 2) and service users (N = 2). // Results: The most common social inclusion needs identified by service users (N = 31) were leisure activities, finding transport options, and feeling less lonely. Of the needs identified, those that service users and staff least frequently prioritised as support planning goals were having company at mealtimes, getting one’s own furniture, feeling less lonely, help with finances, and help finding a partner. In the focus groups, staff and service users identified barriers to helping with loneliness and finding a partner which related to staff and service users themselves, supported accommodation services, and wider societal factors

The Very Low Albedo of WASP-12b From Spectral Eclipse Observations with Hubble\textit{Hubble}

We present an optical eclipse observation of the hot Jupiter WASP-12b using the Space Telescope Imaging Spectrograph on board the Hubble Space Telescope. These spectra allow us to place an upper limit of $A_g < 0.064$ (97.5% confidence level) on the planet's white light geometric albedo across 290--570 nm. Using six wavelength bins across the same wavelength range also produces stringent limits on the geometric albedo for all bins. However, our uncertainties in eclipse depth are $\sim$40% greater than the Poisson limit and may be limited by the intrinsic variability of the Sun-like host star --- the solar luminosity is known to vary at the $10^{-4}$ level on a timescale of minutes. We use our eclipse depth limits to test two previously suggested atmospheric models for this planet: Mie scattering from an aluminum-oxide haze or cloud-free Rayleigh scattering. Our stringent nondetection rules out both models and is consistent with thermal emission plus weak Rayleigh scattering from atomic hydrogen and helium. Our results are in stark contrast with those for the much cooler HD 189733b, the only other hot Jupiter with spectrally resolved reflected light observations; those data showed an increase in albedo with decreasing wavelength. The fact that the first two exoplanets with optical albedo spectra exhibit significant differences demonstrates the importance of spectrally resolved reflected light observations and highlights the great diversity among hot Jupiters.Comment: 8 pages, 4 figures, 1 table, published in ApJL, in pres

Impact of patient and public involvement on enrolment and retention in clinical trials: Systematic review and meta-analysis

© Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to. Objective To investigate the impact of patient and public involvement (PPI) on rates of enrolment and retention in clinical trials and explore how this varies with the context and nature of PPI. Design Systematic review and meta-analysis. Data sources Ten electronic databases, including Medline, INVOLVE Evidence Library, and clinical trial registries. Eligibility criteria Experimental and observational studies quantitatively evaluating the impact of a PPI intervention, compared with no intervention or non-PPI intervention(s), on participant enrolment and/or retention rates in a clinical trial or trials. PPI interventions could include additional non-PPI components inseparable from the PPI (for example, other stakeholder involvement). Data extraction and analysis Two independent reviewers extracted data on enrolment and retention rates, as well as on the context and characteristics of PPI intervention, and assessed risk of bias. Random effects meta-analyses were used to determine the average effect of PPI interventions on enrolment and retention in clinical trials: main analysis including randomised studies only, secondary analysis adding non-randomised studies, and several exploratory subgroup and sensitivity analyses. Results 26 studies were included in the review; 19 were eligible for enrolment meta-analysis and five for retention meta-analysis. Various PPI interventions were identified with different degrees of involvement, different numbers and types of people involved, and input at different stages of the trial process. On average, PPI interventions modestly but significantly increased the odds of participant enrolment in the main analysis (odds ratio 1.16, 95% confidence interval and prediction interval 1.01 to 1.34). Non-PPI components of interventions may have contributed to this effect. In exploratory subgroup analyses, the involvement of people with lived experience of the condition under study was significantly associated with improved enrolment (odds ratio 3.14 v 1.07; P=0.02). The findings for retention were inconclusive owing to the paucity of eligible studies (odds ratio 1.16, 95% confidence interval 0.33 to 4.14), for main analysis). Conclusions These findings add weight to the case for PPI in clinical trials by indicating that it is likely to improve enrolment of participants, especially if it includes people with lived experience of the health condition under study. Further research is needed to assess which types of PPI work best in particular contexts, the cost effectiveness of PPI, the impact of PPI at earlier stages of trial design, and the impact of PPI interventions specifically targeting retention. Systematic review registration PROSPERO CRD42016043808

Home monitoring of physiology and symptoms to detect interstitial lung disease exacerbations and progression:a systematic review

Background: Acute exacerbations (AEs) and disease progression in interstitial lung disease (ILD) pose important challenges to clinicians and patients. AEs of ILD are variable in presentation but may result in rapid progression of ILD, respiratory failure and death. However, in many cases AEs of ILD may go unrecognised so that their true impact and response to therapy is unknown. The potential for home monitoring to facilitate early, and accurate, identification of AE and/or ILD progression has gained interest. With increasing evidence available, there is a need for a systematic review on home monitoring of patients with ILD to summarise the existing data. The aim of this review was to systematically evaluate the evidence for use of home monitoring for early detection of exacerbations and/or progression of ILD. Method: We searched Ovid-EMBASE, MEDLINE and CINAHL using Medical Subject Headings (MeSH) terms in accordance with the PRISMA guidelines (PROSPERO registration number CRD42020215166). Results: 13 studies involving 968 patients have demonstrated that home monitoring is feasible and of potential benefit in patients with ILD. Nine studies reported that mean adherence to home monitoring was &gt;75%, and where spirometry was performed there was a significant correlation (r=0.72–0.98, p&lt;0.001) between home and hospital-based readings. Two studies suggested that home monitoring of forced vital capacity might facilitate detection of progression in idiopathic pulmonary fibrosis. Conclusion: Despite the fact that individual studies in this systematic review provide supportive evidence suggesting the feasibility and utility of home monitoring in ILD, further studies are necessary to quantify the potential of home monitoring to detect disease progression and/or AEs.</p

Vascular Health in American Football Players: Cardiovascular Risk Increased in Division III Players

Studies report that football players have high blood pressure (BP) and increased cardiovascular risk. There are over 70,000 NCAA football players and 450 Division III schools sponsor football programs, yet limited research exists on vascular health of athletes. This study aimed to compare vascular and cardiovascular health measures between football players and nonathlete controls. Twenty-three athletes and 19 nonathletes participated. Vascular health measures included flow-mediated dilation (FMD) and carotid artery intima-media thickness (IMT). Cardiovascular measures included clinic and 24 hr BP levels, body composition, VO2 max, and fasting glucose/cholesterol levels. Compared to controls, football players had a worse vascular and cardiovascular profile. Football players had thicker carotid artery IMT (0.49 ± 0.06 mm versus 0.46 ± 0.07 mm) and larger brachial artery diameter during FMD (4.3 ± 0.5 mm versus 3.7 ± 0.6 mm), but no difference in percent FMD. Systolic BP was significantly higher in football players at all measurements: resting (128.2 ± 6.4 mmHg versus 122.4 ± 6.8 mmHg), submaximal exercise (150.4 ± 18.8 mmHg versus 137.3 ± 9.5 mmHg), maximal exercise (211.3 ± 25.9 mmHg versus 191.4 ± 19.2 mmHg), and 24-hour BP (124.9 ± 6.3 mmHg versus 109.8 ± 3.7 mmHg). Football players also had higher fasting glucose (91.6 ± 6.5 mg/dL versus 86.6 ± 5.8 mg/dL), lower HDL (36.5±11.2 mg/dL versus 47.1±14.8 mg/dL), and higher body fat percentage (29.2±7.9% versus 23.2±7.0%). Division III collegiate football players remain an understudied population and may be at increased cardiovascular risk

Carers' perspectives on the presentation of community-acquired pneumonia and empyema in children: a case series

Objective To describe carers’ perceptions of the development and presentation of community-acquired pneumonia or empyema in their children. Design Case series. Setting Seven hospitals with paediatric inpatient units in South Wales, UK. Participants Carers of 79 children aged 6 months to 16 years assessed in hospital between October 2008 and September 2009 with radiographic, community-acquired pneumonia or empyema. Methods Carers were recruited in hospital and participated in a structured face-to-face or telephone interview about the history and presenting features of their children's illnesses. Responses to open questions were initially coded very finely and then grouped into common themes. Cases were classified into two age groups: 3 or more years and under 3 years. Results The reported median duration of illness from onset until the index hospital presentation was 4 days (IQR 2–9 days). Pain in the torso was reported in 84% of cases aged 3 or more years and was the most common cause for carer concern in this age group. According to carer accounts, clinicians sometimes misjudged the origin of this pain. Almost all carers reported something unusual about the index illness that had particularly concerned them—mostly non-specific physical symptoms and behavioural changes. Conclusions Pain in the torso and carer concerns about unusual symptoms in their child may provide valuable additional information in a clinician's assessment of the risk of pneumonia in primary care. Further research is needed to confirm the diagnostic value of these features

Deep Chandra X-ray Imaging of a Nearby Radio Galaxy 4C+29.30: X-ray/Radio Connection

We report results from our deep Chandra X-ray observations of a nearby radio galaxy, 4C+29.30 (z=0.0647). The Chandra image resolves structures on sub-arcsec to arcsec scales, revealing complex X-ray morphology and detecting the main radio features: the nucleus, a jet, hotspots, and lobes. The nucleus is absorbed (N(H)=3.95 (+0.27/-0.33)x10^23 atoms/cm^2) with an unabsorbed luminosity of L(2-10 keV) ~ (5.08 +/-0.52) 10^43 erg/s characteristic of Type 2 AGN. Regions of soft (<2 keV) X-ray emission that trace the hot interstellar medium (ISM) are correlated with radio structures along the main radio axis indicating a strong relation between the two. The X-ray emission beyond the radio source correlates with the morphology of optical line-emitting regions. We measured the ISM temperature in several regions across the galaxy to be kT ~ 0.5 with slightly higher temperatures (of a few keV) in the center and in the vicinity of the radio hotspots. Assuming these regions were heated by weak shocks driven by the expanding radio source, we estimated the corresponding Mach number of 1.6 in the southern regions. The thermal pressure of the X-ray emitting gas in the outermost regions suggest the hot ISM is slightly under-pressured with respect to the cold optical-line emitting gas and radio-emitting plasma, which both seem to be in a rough pressure equilibrium. We conclude that 4C+29.30 displays a complex view of interactions between the jet-driven radio outflow and host galaxy environment, signaling feedback processes closely associated with the central active nucleus.Comment: ApJ in pres

C2D Spitzer-IRS spectra of disks around T Tauri stars: I. Silicate emission and grain growth

Infrared ~5--35 um spectra for 40 solar-mass T Tauri stars and 7 intermediate-mass Herbig Ae stars with circumstellar disks were obtained using the Spitzer Space Telescope as part of the c2d IRS survey. This work complements prior spectroscopic studies of silicate infrared emission from disks, which were focused on intermediate-mass stars, with observations of solar-mass stars limited primarily to the 10 um region. The observed 10 and 20 um silicate feature strengths/shapes are consistent with source-to-source variations in grain size. A large fraction of the features are weak and flat, consistent with um-sized grains indicating fast grain growth (from 0.1--1.0 um in radius). In addition, approximately half of the T Tauri star spectra show crystalline silicate features near 28 and 33 um indicating significant processing when compared to interstellar grains. A few sources show large 10-to-20 um ratios and require even larger grains emitting at 20 um than at 10 um. This size difference may arise from the difference in the depth into the disk probed by the two silicate emission bands in disks where dust settling has occurred. The 10 um feature strength vs. shape trend is not correlated with age or Halpha equivalent width, suggesting that some amount of turbulent mixing and regeneration of small grains is occurring. The strength vs. shape trend is related to spectral type, however, with M stars showing significantly flatter 10 um features (larger grain sizes) than A/B stars. The connection between spectral type and grain size is interpreted in terms of the variation in the silicate emission radius as a function of stellar luminosity, but could also be indicative of other spectral-type dependent factors (e.g, X-rays, UV radiation, stellar/disk winds, etc.).Comment: 17 pages, 13 figures, accepted for publication by ApJ, formatted with emulateapj using revtex4 v4.

A Spitzer Survey of Protoplanetary Disk Dust in the Young Serpens Cloud: How do Dust Characteristics Evolve with Time?

We present Spitzer IRS mid-infrared (5-35 micron) spectra of a complete flux-limited sample (> 3 mJy at 8 micron) of young stellar object (YSO) candidates selected on the basis of their infrared colors in the Serpens Molecular Cloud. Spectra of 147 sources are presented and classified. Background stars (with slope consistent with a reddened stellar spectrum and silicate features in absorption), galaxies (with redshifted PAH features) and a planetary nebula (with high ionization lines) amount to 22% of contamination in this sample, leaving 115 true YSOs. Sources with rising spectra and ice absorption features, classified as embedded Stage I protostars, amount to 18% of the sample. The remaining 82% (94) of the disk sources are analyzed in terms of spectral energy distribution shapes, PAHs and silicate features. The presence, strength and shape of these silicate features are used to infer disk properties for these systems. About 8% of the disks have 30/13 micron flux ratios consistent with cold disks with inner holes or gaps, and 3% of the disks show PAH emission. Comparison with models indicates that dust grains in the surface of these disks have sizes of at least a few \mu\m. The 20 micron silicate feature is sometimes seen in absence of the 10 micron feature, which may be indicative of very small holes in these disks. No significant difference is found in the distribution of silicate feature shapes and strengths between sources in clusters and in the field. Moreover, the results in Serpens are compared with other well-studied samples: the c2d IRS sample distributed over 5 clouds and a large sample of disks in the Taurus star-forming region. The remarkably similar distributions of silicate feature characteristics in samples with different environment and median ages - if significant - imply that the dust population in the disk surface results from an equilibrium between dust growth and destructive collision processes that are maintained over a few million years for any YSO population irrespective of environment.Comment: accepted by Ap

The Influence of HIV on the Evolution of Mycobacterium tuberculosis.

HIV significantly affects the immunological environment during tuberculosis coinfection, and therefore may influence the selective landscape upon which M. tuberculosis evolves. To test this hypothesis whole genome sequences were determined for 169 South African M. tuberculosis strains from HIV-1 coinfected and uninfected individuals and analyzed using two Bayesian codon-model based selection analysis approaches: FUBAR which was used to detect persistent positive and negative selection (selection respectively favoring and disfavoring nonsynonymous substitutions); and MEDS which was used to detect episodic directional selection specifically favoring nonsynonymous substitutions within HIV-1 infected individuals. Among the 25,251 polymorphic codon sites analyzed, FUBAR revealed that 189-fold more were detectably evolving under persistent negative selection than were evolving under persistent positive selection. Three specific codon sites within the genes celA2b, katG, and cyp138 were identified by MEDS as displaying significant evidence of evolving under directional selection influenced by HIV-1 coinfection. All three genes encode proteins that may indirectly interact with human proteins that, in turn, interact functionally with HIV proteins. Unexpectedly, epitope encoding regions were enriched for sites displaying weak evidence of directional selection influenced by HIV-1. Although the low degree of genetic diversity observed in our M. tuberculosis data set means that these results should be interpreted carefully, the effects of HIV-1 on epitope evolution in M. tuberculosis may have implications for the design of M. tuberculosis vaccines that are intended for use in populations with high HIV-1 infection rates