Comparing early years and childhood experiences and outcomes in Scotland, England and three city-regions: a plausible explanation for Scottish ‘excess’ mortality?

Background Negative early years and childhood experiences (EYCE), including socio-economic circumstances, parental health and parenting style, are associated with poor health outcomes both in childhood and adulthood. It has also been proposed that EYCE were historically worse in Scottish areas, especially Glasgow and the Clyde Valley, compared to elsewhere in the UK and that this variation can provide a partial explanation for the excess of ill health and mortality observed among those Scottish populations. Methods Multiple logistic regression analysis was applied to two large, representative, British birth cohorts (the NCDS58 and the BCS70), to test the independent association of area of residence at ages 7 and 5 with risk of behavioural problems, respiratory problems and reading/vocabulary problems at the same age. Cohort members resident in Scotland were compared with those who were resident in England, while those resident in Glasgow and the Clyde Valley were compared with those resident in Merseyside and Greater Manchester. Results After adjustment for a range of relevant variables, the risk of adverse childhood outcomes was found to be either no different, or lower, in the Scottish areas. At a national level, the study reinforces the combined association of socio-economic circumstances, parental health (especially maternal mental health) and parenting with child health outcomes. Conclusion Based on these samples, the study does not support the hypothesis that EYCE were worse in Scotland and Glasgow and the Clyde Valley. It seems, therefore (based on these data), less likely that the roots of the excess mortality observed in the Scottish areas can be explained by these factors.</p

Novel synchronous DPSK optical regenerator based on a feed-forward based carrier extraction scheme

We experimentally demonstrate a novel synchronous 10.66Gbit/s DPSK OEO regenerator which uses a feed-forward carrier extraction scheme with an injection-locked laser to synchronize the regenerated signal wavelength to the incoming signal wavelength. After injection-locking, a low-cost DFB laser used at the regenerator exhibited the same linewidth characteristics as the narrow line-width transmitter laser. The phase regeneration properties of the regenerator were evaluated by emulating random Gaussian phase noise applied to the DPSK signal before the regenerator using a phase modulator driven by an arbitrary waveform generator. The overall performance was evaluated in terms of electrical eye-diagrams, BER measurements, and constellation diagrams

HST/COS Observations of the Ly alpha Forest toward the BL Lac Object 1ES1553+113

We present new far-ultraviolet spectra from the Cosmic Origins Spectrograph (HST/COS) of the BL Lac object 1ES1553+113 covering the wavelength range 1135-1795 A. The data show a smooth continuum with a wealth of narrow absorption features arising in the ISM and IGM. These features include 41 Lya absorbers at 0<z<0.43, fourteen of which are detected in multiple Lyman lines and six in one or more metal lines. We analyze a metal-rich triplet of Lya absorbers at z=0.188 in which OVI, NV, and CIII absorption is detected. Silicon ions (SiIII/IV) are not detected to fairly strong upper limits, and we use the measured SiIII/CIII upper limit to derive an abundance limit [C/Si]>0.6 for the strongest component of the absorber complex. Galaxy redshift surveys show a number of massive galaxies at approximately the same redshift as this absorption complex, suggesting that it arises in a large-scale galaxy filament. As one of the brightest extragalactic X-ray and gamma-ray sources, 1ES1553+113 is of great interest to the high-energy astrophysics community. With no intrinsic emission or absorption features, 1ES1553+113 has no direct redshift determination. We use intervening Lya absorbers to place a direct limit on the redshift: z_em>0.395 based on a confirmed Lya+OVI absorber and z_em>0.433 based on a single-line detection of Lya. COS/FUV data are only sensitive to Lya absorbers at z<0.47, but we present statistical arguments that z_em<0.58 based on the non-detection of any Lyb absorbers at z>0.4.Comment: ApJ submitted: 11 pages, 7 figure

Silent Harm. A training manual for service providers and interpreters who work with deaf, refugee, and migrant women and girls who have experienced gender-based violence

Introduction: The handbook presented here is one of the results of the Justisigns2 project, which was developed to address an important interpreter-mediated communications gap, namely: the need to share information about how to communicate effectively, via interpretation, with deaf and migrant women, refugees or asylum-seekers, victims/survivors of gender-based violence (DSGBV) who use languages other than the official languages of their host states. This gave rise to an analysis of need on the part of service providers and the creation of resources to support service providers working with victims/survivors across a range of sectors (e.g.police-court, social-health and NGO settings) and the interpreters who mediate the communicative exchanges with these victims/survivors. The Justisigns2 project was funded by the Erasmus+program (ref. 2019-1-IE01-KA202-051558) and was carried out by the following project partners: Interesource Group (Ireland), European Union of the Deaf, Trinity College Dublin, Dublin Rape Crisis Centre, An Garda Síochána,Heriot-Watt University and the Universidade de Vigo, with support from a number of organisations and individuals (associate partners). This handbook builds on the results of a survey that was conducted in 2021 (Napier et al. 2022) that invited engagement from interpreters and a broad range of service providers working with deaf or migrant DSGBV victims. This yielded extensive and varied data on the needs of such groups in the three countries surveyed (Ireland, Spain and the United Kingdom). For the purposes of this publication, the focus is on violence against women and girls. It is important to acknowledge that DSGBV is violence directed against a person because of that person’s gender or violence that affects persons of a particular gender disproportionately. Given that sociolinguistic contexts and legislative frameworks vary in the different project partner countries, a general definition of DSGBV is first provided and then the differences that exist in the 3 countries surveyed (Ireland, UK and Spain) are discussed. For example, the term gender-based violence is not widely used in the UK where the term Violence against Women and Girls (VAWG) is in use. As a result, the term Domestic, Sexual and Gender-based violence (DSGBV) is used here

Language and social/emotional problems identified at a universal developmental assessment at 30 months

Non peer reviewedPublisher PD

Trial of healthy relationship initiatives for the very early years (THRIVE), evaluating Enhanced Triple P for Baby and Mellow Bumps additional social and care needs during pregnancy and their infants who are at higher risk of maltreatment : study protocol for a randomised controlled trial

THRIVE was funded by the National Institute for Health Research Public Health Research Programme (PHR Project: 11/3002/01). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Intervention Subvention Funding was provided by the CSO and Scottish Government (GN12KH589 THRIVE). Neither the trial funders nor Sponsor (NHS Greater Glasgow & Clyde Health Board (Reference GN12KH589)) will have any involvement in the implementation of the study design or the analysis of the data. The Sponsor will, however, play an active role in the delivery of the interventions, through employing and managing group facilitators. The Sponsor will also be the grant holder of the subvention funding, granted by the CSO and the Scottish Government to deliver the groups. Approval for all documentation to be used with the trial must be granted by the Sponsor as it will be delivered to NHS patients. Likewise, permission must be sought from the trial funders prior to any public engagement regarding the trial including conference presentations or academic articles.Peer reviewedPublisher PD

Daily functioning and self-management in patients with chronic low back pain after an intensive cognitive behavioral programme for pain management

Chronic low back pain (CLBP) is associated with persistent or recurrent disability which results in high costs for society. Cognitive behavioral treatments produce clinically relevant benefits for patients with CLBP. Nevertheless, no clear evidence for the most appropriate intervention is yet available. The purpose of this study is to evaluate the mid-term effects of treatment in a cohort of patients with CLBP participating in an intensive pain management programme. The programme provided by RealHealth-Netherlands is based on cognitive behavioral principles and executed in collaboration with orthopedic surgeons. Main outcome parameters were daily functioning (Roland and Morris Disability Questionnaire and Oswestry Disability Questionnaire), self-efficacy (Pain Self-Efficacy Questionnaire) and quality of life (Short Form 36 Physical Component Score). All parameters were measured at baseline, last day of residential programme and at 1 and 12 months follow-up. Repeated measures analysis was applied to examine changes over time. Clinical relevance was examined using minimal clinical important differences (MCID) estimates for main outcomes. To compare results with literature effect sizes (Cohen’s d) and Standardized Morbidity Ratios (SMR) were determined. 107 patients with CLBP participated in this programme. Mean scores on outcome measures showed a similar pattern: improvement after residential programme and maintenance of results over time. Effect sizes were 0.9 for functioning, 0.8 for self-efficacy and 1.3 for physical functioning related quality of life. Clinical relevancy: 79% reached MCID on functioning, 53% on self-efficacy and 80% on quality of life. Study results on functioning were found to be 36% better and 2% worse when related to previous research on, respectively, rehabilitation programmes and spinal surgery for similar conditions (SMR 136 and 98%, respectively). The participants of this evidence-based programme learned to manage CLBP, improved in daily functioning and quality of life. The study results are meaningful and comparable with results of spinal surgery and even better than results from less intensive rehabilitation programmes

CD1a promotes systemic manifestations of skin inflammation

Inflammatory skin conditions are increasingly recognised as being associated with systemic inflammation. The mechanisms connecting the cutaneous and systemic disease are not well understood. CD1a is a virtually monomorphic major histocompatibility complex (MHC) class I-like molecule, highly expressed by skin and mucosal Langerhans cells, and presents lipid antigens to T-cells. Here we show an important role for CD1a in linking cutaneous and systemic inflammation in two experimental disease models. In human CD1a transgenic mice, the toll-like receptor (TLR)7 agonist imiquimod induces more pronounced splenomegaly, expansion of the peripheral blood and spleen T cell compartments, and enhanced neutrophil and eosinophil responses compared to the wild-type, accompanied by elevated skin and plasma cytokine levels, including IL-23, IL-1α, IL-1β, MCP-1 and IL-17A. Similar systemic escalation is shown in MC903-induced skin inflammation. The exacerbated inflammation could be counter-acted by CD1a-blocking antibodies, developed and screened in our laboratories. The beneficial effect is epitope dependent, and we further characterise the five best-performing antibodies for their capacity to modulate CD1a-expressing cells and ameliorate CD1a-dependent systemic inflammatory responses. In summary, we show that a therapeutically targetable CD1a-dependent pathway may play a role in the systemic spread of cutaneous inflammation

The Lung Screen Uptake Trial (LSUT): protocol for a randomised controlled demonstration lung cancer screening pilot testing a targeted invitation strategy for high risk and ‘hard-to-reach’ patients

Background Participation in low-dose CT (LDCT) lung cancer screening offered in the trial context has been poor, especially among smokers from socioeconomically deprived backgrounds; a group for whom the risk-benefit ratio is improved due to their high risk of lung cancer. Attracting high risk participants is essential to the success and equity of any future screening programme. This study will investigate whether the observed low and biased uptake of screening can be improved using a targeted invitation strategy. Methods/design A randomised controlled trial design will be used to test whether targeted invitation materials are effective at improving engagement with an offer of lung cancer screening for high risk candidates. Two thousand patients aged 60–75 and recorded as a smoker within the last five years by their GP, will be identified from primary care records and individually randomised to receive either intervention invitation materials (which take a targeted, stepped and low burden approach to information provision prior to the appointment) or control invitation materials. The primary outcome is uptake of a nurse-led ‘lung health check’ hospital appointment, during which patients will be offered a spirometry test, an exhaled carbon monoxide (CO) reading, and an LDCT if eligible. Initial data on demographics (i.e. age, sex, ethnicity, deprivation score) and smoking status will be collected in primary care and analysed to explore differences between attenders and non-attenders with respect to invitation group. Those who attend the lung health check will have further data on smoking collected during their appointment (including pack-year history, nicotine dependence and confidence to quit). Secondary outcomes will include willingness to be screened, uptake of LDCT and measures of informed decision-making to ensure the latter is not compromised by either invitation strategy. Discussion If effective at improving informed uptake of screening and reducing bias in participation, this invitation strategy could be adopted by local screening pilots or a national programme. Trial registration This study was registered with the ISRCTN (International Standard Registered Clinical/soCial sTudy Number : ISRCTN21774741) on the 23rd September 2015 and the NIH ClinicalTrials.gov database (NCT0255810) on the 22nd September 2015

Comparative costs and activity from a sample of UK clinical trials units

Background: The costs of medical research are a concern. Clinical Trials Units (CTUs) need to better understand variations in the costs of their activities. Methods: Representatives of ten CTUs and two grant-awarding bodies pooled their experiences in discussions over 1.5 years. Five of the CTUs provided estimates of, and written justification for, costs associated with CTU activities required to implement an identical protocol. The protocol described a 5.5-year, nonpharmacological randomized controlled trial (RCT) conducted at 20 centres. Direct and indirect costs, the number of full time equivalents (FTEs) and the FTEs attracting overheads were compared and qualitative methods (unstructured interviews and thematic analysis) were used to interpret the results. Four members of the group (funding-body representatives or award panel members) reviewed the justification statements for transparency and information content. Separately, 163 activities common to trials were assigned to roles used by nine CTUs; the consistency of role delineation was assessed by Cohen's κ. Results: Median full economic cost of CTU activities was £769,637 (range: £661,112 to £1,383,323). Indirect costs varied considerably, accounting for between 15% and 59% (median 35%) of the full economic cost of the grant. Excluding one CTU, which used external statisticians, the total number of FTEs ranged from 2.0 to 3.0; total FTEs attracting overheads ranged from 0.3 to 2.0. Variation in directly incurred staff costs depended on whether CTUs: supported particular roles from core funding rather than grants; opted not to cost certain activities into the grant; assigned clerical or data management tasks to research or administrative staff; employed extensive on-site monitoring strategies (also the main source of variation in non-staff costs). Funders preferred written justifications of costs that described both FTEs and indicative tasks for funded roles, with itemised non-staff costs. Consistency in role delineation was fair (κ = 0.21-0.40) for statisticians/data managers and poor for other roles (κ < 0.20). Conclusions: Some variation in costs is due to factors outside the control of CTUs such as access to core funding and levels of indirect costs levied by host institutions. Research is needed on strategies to control costs appropriately, especially the implementation of risk-based monitoring strategies