Best Interests Assessor Role: An Opportunity or a ‘Dead End’ for Adult Social Workers?

© 2017 British Association of Social Workers. This opinion article explores the significance of the Best Interests Assessor role in England and Wales for social workers working with adults. It considers the challenges of the role following the Supreme Court’s Cheshire West (2014) judgement and the implications for BIAs of the Law Commission’s 2017 plans for replacing DoLS with the ‘Liberty Protection Safeguards’. The author explains why they consider the BIA role to be a valuable one for the status of adult social work as well as for people who may lack capacity to uphold their human rights, with some reservations about the risk of diluting the safeguards the current role represents for those vulnerable people

Structural Studies of a Circularly Permuted Human Hemoglobin Containing Low O₂-affinity Mutations

Our research is focused on the production of a hemoglobin-based oxygen carrier (HBOC) which can be used as a therapeutic in the event of acute blood loss. The administration of cell-free hemoglobin is associated with severe adverse effects due to dissociation of the tetrameric α₂β₂ complex into αβ heterodimers. Our approach to designing an effective HBOC is based on a recombinant circularly permuted human hemoglobin in which all of the subunits are linked in a single-chain fashion. This design would prevent the dissociation of the tetramer and allow for the biosynthesis of polymeric hemoglobins of defined mass. Preliminary ligand binding data with our permuted hemoglobins indicates that they prefer the high O₂-affinity R-state conformation over the low O₂-affinity T state. The βN108K and αV96W mutations were introduced to restore T state stability. Preliminary studies of the mutants have shown that while the βN108K mutation improved T-state stability, the αV96W mutation displays an unexpected destabilizing effect on the T state. We would like to understand the molecular basis for the surprising results. We intend to determine the X-ray crystal structure of the αV96W mutant as well as the βN108K mutant and the αV96W + βN108K double mutant to gain an atomic-level picture of protein structural differences that could explain these results

Progress Toward Structural Studies of a Circularly Permuted Human Hemoglobins Containing T-State Stabilizing Mutations

Our research is focused on the production of a hemoglobin based oxygen carrier (HBOC) which can be used as a therapeutic in the event of acute blood loss. The administration of cell-free hemoglobin is associated with severe adverse effects due to dissociation of the tetrameric α₂β₂ complex into αβ heterodimers. Our approach to the design of an effective HBOC, is based on a recombinant circularly permuted human hemoglobin in which all of the subunits are linked in a single-chain fashion. This design would prevent the dissociation of the tetramer and allow for the biosynthesis of polymeric hemoglobins of defined mass. Preliminary ligand binding data with our permuted hemoglobins indicate that they prefer the high O₂-affinity R-state conformation over the low O₂-affinity T state. The βN108K and αV96W mutations were introduced to restore T state stability. Preliminary studies of the mutants have shown that while the βN108K mutation improved T-state stability, the αV96W mutation, in the context of the permuted hemoglobin backbone, displays an unexpected destabilizing effect on the T state. We have inserted the βN108K mutation into our single chain hemoglobin in order to obtain structural and functional data however it was discovered that this change significantly decreases expression yield. We would like to utilize X-ray crystallography to gain an atomic-level picture of protein structural differences that could explain the results from our αV96W mutants. Crystallization trials are underway for the αV96W mutant as well as the βN108K mutant and a αV96W + βN108K double mutant. To date no crystals have been obtained that diffract X-rays

Gait Variability and Energy Cost of Oveground Walking in Persons With Multiple Sclerosis: A Cross-Sectional Study

Objective: This study examined the associations between gait variability based on common spatiotemporal parameters and energetic cost of walking in persons with multiple sclerosis. Design: Eighty-six persons with multiple sclerosis underwent the 6-min walk while wearing a portable metabolic unit. The cost of walking was generated by dividing the net steady-state VO2 (milliliter per kilogram per minute) by walking speed during the 6-min walk. Participants further completed two trials of walking on the GAITRite mat at a self-selected pace for measuring spatiotemporal parameters. Variability of step length, step time, stride length, swing time, stance time, stride velocity, and single- and double-support time was indexed by the coefficient of variation. Results: Variability in the spatiotemporal variables and Expanded Disability Status Scale scores were significantly correlated with cost of walking (i.e., [rho] = 0.25-0.36). Multivariate analysis revealed that disability (Expanded Disability Status Scale: [beta] = 0.186), stance time variability ([beta] = 1.446), and step length variability ([beta] = -1.216) explained significant variance (R2 = 0.38, P \u3c 0.001) in cost of walking. Conclusions: We provide evidence of the positive association between gait variability and cost of walking during overground walking in persons with multiple sclerosis. The findings highlight the need for interventions aiming to reduce gait variability, thereby reducing the energetic demands of walking in this population

Gyrotactic swimmer dispersion in pipe flow: testing the theory

Suspensions of microswimmers are a rich source of fascinating new fluid mechanics. Recently we predicted the active pipe flow dispersion of gyrotactic microalgae, whose orientation is biased by gravity and flow shear. Analytical theory predicts that these active swimmers disperse in a markedly distinct manner from passive tracers (Taylor dispersion). Dispersing swimmers display non-zero drift and effective diffusivity that is non-monotonic with Péclet number. Such predictions agree with numerical simulations, but hitherto have not been tested experimentally. Here, to facilitate comparison, we obtain new solutions of the axial dispersion theory accounting both for swimmer negative buoyancy and a local nonlinear response of swimmers to shear, provided by two alternative microscopic stochastic descriptions. We obtain new predictions for suspensions of the model swimming alga Dunaliella salina, whose motility and buoyant mass we parametrise using tracking video microscopy. We then present a new experimental method to measure gyrotactic dispersion using fluorescently stained D. salina and provide a preliminary comparison with predictions of a non-zero drift above the mean flow for each microscopic stochastic description. Finally, we propose further experiments for a full experimental characterisation of gyrotactic dispersion measures and discuss the implications of our results for algal dispersion in industrial photobioreactors

The Health Wagon Partners with the Virginia Department of Health to Provide COVID-19 Testing in Rural Southwest Virginia

The Health Wagon has been providing care for the rural population of southwest Virginia for the past 40 years. The mission of the Health Wagon is to provide quality health care to the medically underserved people in the mountains of Appalachia. It has expanded to two stationary clinics, three mobile units, and a mobile dental unit, logging over 19,000 patients encounters in the past year

The change in weight perception of weight status among the overweight: comparison of NHANES III (1988–1994) and 1999–2004 NHANES

<p>Abstract</p> <p>Objectives</p> <p>This study seeks to determine whether perception of weight status among the overweight has changed with the increasing overweight/obesity prevalence.</p> <p>Methods</p> <p>The perception of weight status was compared between overweight participants (BMI between 25.0–29.9 kg/m²) from NHANES III (1988–1994) and overweight participants from NHANES 1999–2004. Perception of weight status was assessed by asking participants to classify their weight as about the right weight, underweight or overweight. Comparisons were made across age groups, genders, race/ethnicities and various income levels.</p> <p>Results</p> <p>Fewer overweight people during the NHANES 1999–2004 survey perceived themselves as overweight when compared to overweight people during the NHANES III survey. The change in distortion between the survey periods was greatest among persons with lower income, males and African-Americans.</p> <p>Conclusion</p> <p>The increase in overweight/obesity between the survey years (NHANES III and NHANES 1999–2004 has been accompanied with fewer overweight people perceiving themselves as overweight.</p

First trimester exposure to anxiolytic and hypnotic drugs and the risks of major congenital anomalies: a United Kingdom population-based cohort study.

BACKGROUND: Despite their widespread use the effects of taking benzodiazepines and non-benzodiazepine hypnotics during pregnancy on the risk of major congenital anomaly (MCA) are uncertain. The objectives were to estimate absolute and relative risks of MCAs in children exposed to specific anxiolytic and hypnotic drugs taken in the first trimester of pregnancy, compared with children of mothers with depression and/or anxiety but not treated with medication and children of mothers without diagnosed mental illness during pregnancy. METHODS: We identified singleton children born to women aged 15-45 years between 1990 and 2010 from a large United Kingdom primary care database. We calculated absolute risks of MCAs for children with first trimester exposures of different anxiolytic and hypnotic drugs and used logistic regression with a generalised estimating equation to compare risks adjusted for year of childbirth, maternal age, smoking, body mass index, and socioeconomic status. RESULTS: Overall MCA prevalence was 2.7% in 1,159 children of mothers prescribed diazepam, 2.9% in 379 children with temazepam, 2.5% in 406 children with zopiclone, and 2.7% in 19,193 children whose mothers had diagnosed depression and/or anxiety but no first trimester drug exposures. When compared with 2.7% in 351,785 children with no diagnosed depression/anxiety nor medication use, the adjusted odds ratios were 1.02 (99% confidence interval 0.63-1.64) for diazepam, 1.07 (0.49-2.37) for temazepam, 0.96 (0.42-2.20) for zopiclone and 1.27 (0.43-3.75) for other anxiolytic/hypnotic drugs and 1.01 (0.90-1.14) for un-medicated depression/anxiety. Risks of system-specific MCAs were generally similar in children exposed and not exposed to such medications. CONCLUSIONS: We found no evidence for an increase in MCAs in children exposed to benzodiazepines and non-benzodiazepine hypnotics in the first trimester of pregnancy. These findings suggest that prescription of these drugs during early pregnancy may be safe in terms of MCA risk, but findings from other studies are required before safety can be confirmed

Associations of functional connectivity and walking performance in multiple sclerosis

Background Persons with multiple sclerosis (MS) often demonstrate impaired walking performance, and neuroimaging methods such as resting state functional connectivity (RSFC) may support a link between central nervous system damage and disruptions in walking. Objectives This study examined associations between RSFC in cortical networks and walking performance in persons with MS. Methods 29 persons with MS underwent 3-T brain magnetic resonance imaging (MRI) and we computed RSFC among 68 Gy matter regions of interest in the brain. Participants completed the Timed 25-foot Walk as a measure of walking performance. We examined associations using partial Pearson product-moment correlation analyses (r), controlling for age. Results There were eight cortical brain regions that were significantly associated with the T25FW, including the left parahippocampal gyrus and transverse temporal gyrus, and the right fusiform gyrus, inferior temporal gyrus, lingual gyrus, pericalcarine cortex, superior temporal gyrus, and transverse temporal gyrus. Conclusions We provide novel evidence that RSFC can be a valuable tool to monitor the motor and non-motor networks impacted in MS that relate to declines in motor impairment. RSFC may identify critical nodes involved in a range of motor tasks such as walking that can be more sensitive to disruption by MS

Maternal depression, antidepressant prescriptions, and congenital anomaly risk in offspring: a population-based cohort study

OBJECTIVE: To estimate risks of major congenital anomaly (MCA) among children of mothers prescribed antidepressants during early pregnancy or diagnosed with depression but without antidepressant prescriptions. DESIGN: Population-based cohort study. SETTING: Linked UK maternal–child primary care records. POPULATION: A total of 349 127 singletons liveborn between 1990 and 2009. METHODS: Odds ratios adjusted for maternal sociodemographics and comorbidities (aORs) were calculated for MCAs, comparing women with first-trimester selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants (TCAs) and women with diagnosed but unmedicated depression, or women without diagnosed depression. MAIN OUTCOME MEASURES: Fourteen system-specific MCA groups classified according to the European Surveillance of Congenital Anomalies and five specific heart anomaly groups. RESULTS: Absolute risks of MCA were 2.7% (95% confidence interval, 95% CI, 2.6–2.8%) in children of mothers without diagnosed depression, 2.8% (95% CI 2.5–3.2%) in children of mothers with unmedicated depression, and 2.7% (95% CI 2.2–3.2%) and 3.1% (95% CI 2.2–4.1%) in children of mothers with SSRIs or TCAs, respectively. Compared with women without depression, MCA overall was not associated with unmedicated depression (aOR 1.07, 95% CI 0.96–1.18), SSRIs (aOR 1.01, 95% CI 0.88–1.17), or TCAs (aOR 1.09, 95% CI 0.87–1.38). Paroxetine was associated with increased heart anomalies (absolute risk 1.4% in the exposed group compared with 0.8% in women without depression; aOR 1.78, 95% CI 1.09–2.88), which decreased marginally when compared with women with diagnosed but unmedicated depression (aOR 1.67, 95% CI 1.00–2.80). CONCLUSIONS: Overall MCA risk did not increase with maternal depression or with antidepressant prescriptions. Paroxetine was associated with increases of heart anomalies, although this could represent a chance finding from a large number of comparisons undertaken