Caring in Kent: Patterns and Profiles, Evidence from the Kent Health and Lifestyle Survey, 2005

The ‘Caring in Kent’ report draws on the results of a Kent wide ‘Health and Lifestyle Survey’ conducted in 2005; this included a module on caring. This enables a picture of caring to be reported including: a general profile of carers, levels and types of care-giving, carers’ health, and the level and types of support they receive. ‘Carers provide unpaid care by looking after an ill, frail or disabled family member, friend or partner’. The increasingly recognised importance of the role of the ‘informal carer’ is - in good part - due to the rising proportion of older people in the UK population. Not only do people live longer but many experience a number of chronic conditions; these require support from family members if the older person is to remain living in the community

The effects of p27Kip1 on the in vivo development and in vitro differentiation of mesencephalic dopaminergic neurons

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Ciencias, Departamento de Biología Molecular. Fecha de lectura: 26-05-2020Dopaminergic (DA) neuron development is a complex process, combining and coordinating the precise expression of numerous molecules. The importance of understanding this process is based on the growing interest in being able to reproduce their proper differentiation in vitro, in order to provide new treatment options for Parkinson’s Disease (PD). However, obtaining DA neurons that are biologically, chemically and physiologically equivalent to those found in the brain is a complicated process, and for that reason it is important to investigate how these neurons develop in their normal physiological context. We are investigating the role of the protein p27Kip1 (p27) in the differentiation process of these neurons. p27 is a cyclin/cyclin dependent kinase inhibitor (CKI) belonging to the Cip/Kip family of proteins. p27 is best known for its function in the cell cycle, where it specifically inhibits cyclin and cyclin dependent kinases (CDKs) of the G1 phase, and it is mainly regulated through controlling its degradation. However, in recent years, p27 has also been shown to have important implications outside of the cell cycle, including promoting primary neurogenesis in the cortex, inhibiting the transcription factor Sox2 and in promoting the differentiation of DA neurospheres. In the context of the ventral mesencephalon (VM), we see that p27 deficiency appears to have a specific effect on DA neuron production, significantly decreasing the early differentiation of these neurons in vivo and in vitro. Interestingly, these differences are accompanied by an increased pool of neural precursors, increasing Sox2 and Ngn2 expression. However, despite these increases, downstream targets of Ngn2 (such as NeuroD1) necessary to promote progenitor progression towards mature DA neuronal phenotypes are diminished. We therefore suggest a novel role of p27 in regulating proper cell cycle exit to promote appropriate activation of genes involved in neurogenesis. This knowledge would allow us to better apply the use of this protein to improve current differentiation protocols of DA neurons for stem cell replacement therapies in PDEl desarrollo de las neuronas dopaminérgicas (ND) es un proceso muy complejo, que combina la expresión de varias moléculas en un contexto muy específico. La importancia de entender este proceso se basa en el interés de reproducir el proceso de diferenciación in vitro, con el fin de buscar posibles terapias para la enfermedad de Parkinson (EP). Sin embargo, la obtención de ND in vitro, equivalentes a las del cerebro en relación a su biología, química y fisiología, es un proceso muy complicado y, por lo tanto, la investigación de cómo esas neuronas se desarrollan en su entorno normal es muy importante. Estamos investigando la función de la proteína p27Kip1 (p27) en la diferenciación de ND. p27 es un inhibidor de ciclinas/ciclinas dependiente de kinasas (CDKs) que pertenece a la familia de proteínas Cip/Kip. La función más conocida de p27 es el papel que juega en el ciclo celular, donde inhibe ciclinas y CDKs de la fase G1, y su regulación está mayormente controlada a través de su degradación. No obstante, se ha visto que p27 tiene funciones importantes fuera de su papel en el ciclo celular, como promover neurogénesis en la corteza cerebral, inhibir el factor de transcripción Sox2 (marcador de precursores neurales) y promover la diferenciación de neuroesferas de ND. En el contexto del mesencéfalo ventral (MV), hemos visto que la deficiencia de p27 tiene un efecto específico en la producción de las ND, disminuyendo de manera significativa la diferenciación de estas neuronas tanto in vivo como in vitro. Estas diferencias van acompañadas con un aumento en el numero de precursores neurales, aumentando la expresión de factores como Sox2 y Ngn2. Sin embargo, a pesar de ver un incremento en el número de precursores, dianas “downstream” de Ngn2, como sería el marcador NeuroD1 (que es necesario para promover la progresión de progenitores hacía ND maduras), está disminuido. Por lo tanto, nuestro trabajo sugiere un papel nuevo de p27 en la regulación del ciclo celular para promover y activar los genes necesarios para neurogénesis. Estos resultados podrían ser importantes para ayudar a mejorar los protocolos actuales de diferenciación de ND, y para futuras terapias de reemplazo celular en la E

Synoptic multi-variable multi-glider study

Analysis and report of sustained multi-glider deployments, providing detailed methodology of the deployment strategy, piloting, and calibration process. The analysis will deliver methods for the synoptic interpretation of all ocean variables over multiple timescales

Are diabetes self-management interventions delivered in the psychiatric inpatient setting effective?: A protocol for a systematic review

Introduction: Diabetes is a major risk factor for cardiovascular disease, which is the most significant contributor to increased mortality due to natural causes in those with severe mental illness (SMI). Self-management interventions for diabetes have been shown to be effective in the general population, however, effects of these interventions in those with SMI is still unclear. Psychiatric admission could be used opportunistically to deliver interventions of this kind and help improve diabetes self-management. This review aims to assess whether interventions of this kind improve diabetes outcomes and have an effect on reducing cardiovascular risk. Methods and analysis: This review will include studies assessing diabetes self-management interventions designed to be delivered to those aged 18 and over with comorbid type 2 diabetes and SMI during admission to psychiatric inpatient settings. Databases including the Cochrane Library, Medline, Psychinfo, CINAHL, Embase, WHO’s International Clinical Trials Registry Platform, International Health Technology Assessment Database, UK Clinical Research Network and ClinicalTrials.gov will be searched from inception to September 2022. Where possible, meta-analysis of included studies will be conducted. If heterogeneity is high and meta-analysis is not possible, we will use other means of data synthesis and will include a narrative description of included studies. Ethics and dissemination: Ethical approval is not required as the systematic review will only include data from existing studies. The results will be disseminated via peer-reviewed publication and presentation at relevant national and international conferences. PROSPERO registration number: CRD4202235767

Don’t turn your back on the symptoms of psychosis : a proof-of-principle, quasi-experimental public health trial to reduce the duration of untreated psychosis in Birmingham, UK

Background: Reducing the duration of untreated psychosis (DUP) is an aspiration of international guidelines for first episode psychosis; however, public health initiatives have met with mixed results. Systematic reviews suggest that greater focus on the sources of delay within care pathways, (which will vary between healthcare settings) is needed to achieve sustainable reductions in DUP (BJP 198: 256-263; 2011). Methods/Design: A quasi-experimental trial, comparing a targeted intervention area with a ‘detection as usual’ area in the same city. A proof-of–principle trial, no a priori assumptions are made regarding effect size; key outcome will be an estimate of the potential effect size for a definitive trial. DUP and number of new cases will be collected over an 18-month period in target and control areas and compared; historical data on DUP collected in both areas over the previous three years, will serve as a benchmark. The intervention will focus on reducing two significant DUP component delays within the overall care pathway: delays within the mental health service and help-seeking delay. Discussion: This pragmatic trial will be the first to target known delays within the care pathway for those with a first episode of psychosis. If successful, this will provide a generalizable methodology that can be implemented in a variety of healthcare contexts with differing sources of delay. Trial registration: http://www.controlled-trials.com/ISRCTN45058713 Keywords: Public mental health campaign, First-episode psychosis, Early detection, Duration of untreated psychosis, Youth mental healt

Frequency and preventative interventions for non-suicidal self-injury and suicidal behaviour in primary school-age children : a scoping review protocol

Introduction: Non-suicidal self-injury (NSSI) and suicidal behaviour have been witnessed in children as young as 6–7 years of age, but while there are many reviews of preventative interventions for NSSI and suicide in adolescents, few have explored its prevalence in younger children and the potential impact of preventative interventions at this stage of life. NSSI and suicidal behaviour are an increasing concern in schools but school-based programmes can improve knowledge, attitudes and help-seeking behaviours and help prevent escalation of NSSI and later suicide. This scoping review will aim to explore the nature and extent of the evidence on the magnitude of NSSI and suicidal behaviour in primary school children, and to examine whether there are any primary school-based interventions available for the prevention of this phenomenon in 5 to 11-year-olds. Methods and analysis: A scoping review will be conducted using established methodology by Arksey and O’Malley and the Joanna Briggs Institute. Multiple bibliographic and indexing databases and grey literature will be searched using a combination of text words and index terms relating to NSSI, suicide, primary schools, frequency and intervention. Two reviewers will independently screen eligible studies for study selection and extract relevant data from included studies. A narrative summary of evidence will be conducted for all included studies with results presented in tables and/or diagrams. Inductive content analysis will be used to understand any narrative findings within the included studies. Ethics and dissemination: Ethical approval is not required for this scoping review. The results of this review will be disseminated though publication in a peer-reviewed journal and presented at relevant conferences

Highlights 2019: fresh focus on health

Contribution towardsFresh focus on health: Highlights 2019 photography competition open for submissions.Palmer J.Lancet. 2019 Jun 8;393(10188):2284-2285. doi: 10.1016/S0140-6736(19)31258-9. Epub 2019 Jun 6https://www.ncbi.nlm.nih.gov/pubmed/3118001

Overlaps and disjunctures : a cultural case study of a British Indian young woman’s experiences of Bulimia Nervosa

Eating disorder diagnoses are characterised by a pattern of disordered eating behaviour alongside symptoms such as body dissatisfaction and preoccupation with food, weight or shape (APA in Diagnostic and statistical manual of mental disorders, DSM-5, APA, Washington, DC, 2013). Incidence rates for eating disorders have increased during the last 50 years. However, epidemiological studies have suggested that such trends may not be a true representation of the occurrence of these illnesses in the general population, with figures underestimated due to reduced help seeking and poor access to care, particularly amongst ethnic minorities. This case study explores the experiences of a young British Indian woman with bulimia nervosa. Arising from an in-depth semi-structured interview, analysed with interpretative phenomenological analysis, her narrative offers a critical lens onto how diverse fragments of cultural practices and meanings come together to produce the clinical category of ‘bulimia.’ It thereby offers an alternative portrait of relationships between eating disorders and ‘culture,’ one that goes beyond a framing of these illnesses as culture inscribed on the body. Interrogating relationships between culture and the development, expression and maintenance of bulimia is suggested to be key to forging culturally-sensitive understandings of this illness; this paper begins to provide the evidence base for the design and development of appropriate support services, thereby aiming to contribute to a reduction in health inequalities and barriers to treatment

Monoenergetic proton beams accelerated by a radiation pressure driven shock

High energy ion beams (> MeV) generated by intense laser pulses promise to be viable alternatives to conventional ion beam sources due to their unique properties such as high charge, low emittance, compactness and ease of beam delivery. Typically the acceleration is due to the rapid expansion of a laser heated solid foil, but this usually leads to ion beams with large energy spread. Until now, control of the energy spread has only been achieved at the expense of reduced charge and increased complexity. Radiation pressure acceleration (RPA) provides an alternative route to producing laser-driven monoenergetic ion beams. In this paper, we show the interaction of an intense infrared laser with a gaseous hydrogen target can produce proton spectra of small energy spread (~ 4%), and low background. The scaling of proton energy with the ratio of intensity over density (I/n) indicates that the acceleration is due to the shock generated by radiation-pressure driven hole-boring of the critical surface. These are the first high contrast mononenergetic beams that have been theorised from RPA, and makes them highly desirable for numerous ion beam applications

Realistic polarizing Sagnac topology with DC readout for the Einstein Telescope

The Einstein Telescope (ET) is a proposed future gravitational wave detector. Its design is original, using a triangular orientation of three detectors and a xylophone configuration, splitting each detector into one high-frequency and one low-frequency system. In other aspects the current design retains the dual-recycled Michelson interferometer typical of current detectors, such as Advanced LIGO. In this paper, we investigate the feasibility of replacing the low-frequency part of the ET detectors with a Sagnac interferometer. We show that a Sagnac interferometer, using realistic optical parameters based on the ET design, could provide a similar level of radiation pressure noise suppression without the need for a signal recycling mirror and the extensive filter cavities. We consider the practical issues of a realistic, power-recycled Sagnac, using linear arm cavities and polarizing optics. In particular, we investigate the effects of nonperfect polarizing optics and propose a new method for the generation of a local oscillator field similar to the DC readout scheme of current detectors.Comment: 15 pages, 15 figure