Selective patient and public involvement: The promise and perils of pharmaceutical intervention for autism

This is the final version of the article. Available from Wiley via the DOI in this record.BACKGROUND: Guidelines suggest the patient community should be consulted from the outset when designing and implementing basic biomedical research, but such patient communities may include conflicting views. We examined how engagement occurred in one such instance. OBJECTIVE: Our objective was to scrutinize patient and public involvement (PPI) by a pan-European biomedical consortium working to develop drugs to treat autism. We aimed to use this as an example to illustrate how PPI has been utilized in biomedical research. SETTING, PARTICIPANTS AND ANALYSIS: Two public events, one in the UK and one in Denmark were conducted as part of the consortium's on-going PPI activities in 2014 and 2015. Sixty-six individuals submitted written comments on the consortium's research after these events. The textual data produced were analysed using a thematic approach. Approximately 71% of respondents reported themselves to be adults on the autism spectrum or parents of children with autism. RESULTS: The themes identified illustrated major differences between some community concerns and the biomedical research agenda. While treating autism per se. was seen as problematic by some, treating specific co-occurring problems was seen as helpful in some circumstances. The biomedical consortium selected PPI with a limited user viewpoint at its outset and more widely once basic research was on-going. DISCUSSION: This case illustrates what we term "selective PPI" where only a sympathetic and/or limited patient viewpoint is included. Findings highlight the perils of using selective PPI to legitimise scientific endeavours, and the possibilities for constructive dialogue.This work was supported by EU-AIMS (European Autism Interventions), which receives support from the Innovative Medicines Initiative Joint Undertaking under grant agreement no. 115300, the resources of which are composed of financial contributions from the European Union’s Seventh Framework Programme (grant FP7/2007-2013); The first author's work was specifically funded by the Wellcome Trust, Grant number 108676/Z/15/Z

Frequency Locking in Spatially Extended Systems

A variant of the complex Ginzburg-Landau equation is used to investigate the frequency locking phenomena in spatially extended systems. With appropriate parameter values, a variety of frequency-locked patterns including flats, $\pi$ fronts, labyrinths and $2\pi/3$ fronts emerge. We show that in spatially extended systems, frequency locking can be enhanced or suppressed by diffusive coupling. Novel patterns such as chaotically bursting domains and target patterns are also observed during the transition to locking

Order Parameter Equations for Front Transitions: Planar and Circular Fronts

Near a parity breaking front bifurcation, small perturbations may reverse the propagation direction of fronts. Often this results in nonsteady asymptotic motion such as breathing and domain breakup. Exploiting the time scale differences of an activator-inhibitor model and the proximity to the front bifurcation, we derive equations of motion for planar and circular fronts. The equations involve a translational degree of freedom and an order parameter describing transitions between left and right propagating fronts. Perturbations, such as a space dependent advective field or uniform curvature (axisymmetric spots), couple these two degrees of freedom. In both cases this leads to a transition from stationary to oscillating fronts as the parity breaking bifurcation is approached. For axisymmetric spots, two additional dynamic behaviors are found: rebound and collapse.Comment: 9 pages. Aric Hagberg: http://t7.lanl.gov/People/Aric/; Ehud Meron: http://www.bgu.ac.il/BIDR/research/staff/meron.htm

People should be allowed to do what they like’: Autistic adults’ views and experiences of stimming

This is the final version. Available from the publisher via the DOI in this record.Data from participants who consented will be deposited in the UK Data Service, in 2019.‘Stereotyped or repetitive motor movements’ are characterised as core features in the diagnosis of autism, yet many autistic adults (and the neurodiversity movement) have reclaimed them as ‘stimming’. Supported by a growing body of scientific research, autistic adults argue that these behaviours may serve as useful coping mechanisms, yet little research has examined stimming from the perspective of autistic adults. Through interviews and focus groups, we asked 32 autistic adults to share their perceptions and experiences of stimming, including the reasons they stim, any value doing so may hold for them and their perceptions of others’ reactions to stimming. Using thematic analysis, we identified two themes: stimming as (1) a self-regulatory mechanism and (2) lacking in social acceptance, but can become accepted through understanding. Autistic adults highlighted the importance of stimming as an adaptive mechanism that helps them to soothe or communicate intense emotions or thoughts and thus objected to treatment that aims to eliminate the behaviour.Wellcome TrustLeverhulme Trus

Multistable Pulse-like Solutions in a Parametrically Driven Ginzburg-Landau Equation

It is well known that pulse-like solutions of the cubic complex Ginzburg-Landau equation are unstable but can be stabilised by the addition of quintic terms. In this paper we explore an alternative mechanism where the role of the stabilising agent is played by the parametric driver. Our analysis is based on the numerical continuation of solutions in one of the parameters of the Ginzburg-Landau equation (the diffusion coefficient $c$), starting from the nonlinear Schr\"odinger limit (for which $c=0$). The continuation generates, recursively, a sequence of coexisting stable solutions with increasing number of humps. The sequence "converges" to a long pulse which can be interpreted as a bound state of two fronts with opposite polarities.Comment: 13 pages, 6 figures; to appear in PR

Open-label, cluster randomised controlled trial and economic evaluation of a brief letter from a GP on unscheduled medical contacts associated with the start of the school year: the PLEASANT trial

BACKGROUND: Asthma is seasonal with peaks in exacerbation rates in school-age children associated with the return to school following the summer vacation. A drop in prescription collection in August is associated with an increase in the number of unscheduled contacts after the school return. OBJECTIVE: To assess whether a public health intervention delivered in general practice reduced unscheduled medical contacts in children with asthma. DESIGN: Cluster randomised trial with trial-based economic evaluation. Randomisation was at general practice level, stratified by size of practice. The intervention group received a letter from their general practitioner (GP) in late July outlining the importance of (re)taking asthma medication before the return to school. The control group was usual care. SETTING: General practices in England and Wales. PARTICIPANTS: 12 179 school-age children in 142 general practices (70 randomised to intervention). MAIN OUTCOME: Proportion of children aged 5-16 years who had an unscheduled contact in September. Secondary endpoints included collection of prescriptions in August and medical contacts over 12 months (September-August). Economic endpoints were quality-adjusted life-years gained and health service costs. RESULTS: There was no evidence of effect (OR 1.09; 95% CI 0.96 to 1.25 against treatment) on unscheduled contacts in September. The intervention increased the proportion of children collecting a prescription in August by 4% (OR 1.43; 95% CI 1.24 to 1.64). The intervention also reduced the total number of medical contacts between September-August by 5% (incidence ratio 0.95; 95% CI 0.91 to 0.99).The mean reduction in medical contacts informed the health economics analyses. The intervention was estimated to save £36.07 per patient, with a high probability (96.3%) of being cost-saving. CONCLUSIONS: The intervention succeeded in increasing children collecting prescriptions. It did not reduce unscheduled care in September (the primary outcome), but in the year following the intervention, it reduced the total number of medical contacts. TRIAL REGISTRATION NUMBER: ISRCTN03000938; Results

Breathing Spots in a Reaction-Diffusion System

A quasi-2-dimensional stationary spot in a disk-shaped chemical reactor is observed to bifurcate to an oscillating spot when a control parameter is increased beyond a critical value. Further increase of the control parameter leads to the collapse and disappearance of the spot. Analysis of a bistable activator-inhibitor model indicates that the observed behavior is a consequence of interaction of the front with the boundary near a parity breaking front bifurcation.Comment: 4 pages RevTeX, see also http://chaos.ph.utexas.edu/ and http://t7.lanl.gov/People/Aric

Stable periodic waves in coupled Kuramoto-Sivashinsky - Korteweg-de Vries equations

Periodic waves are investigated in a system composed of a Kuramoto-Sivashinsky - Korteweg-de Vries (KS-KdV) equation, which is linearly coupled to an extra linear dissipative equation. The model describes, e.g., a two-layer liquid film flowing down an inclined plane. It has been recently shown that the system supports stable solitary pulses. We demonstrate that a perturbation analysis, based on the balance equation for the field momentum, predicts the existence of stable cnoidal waves (CnWs) in the same system. It is found that the mean value U of the wave field u in the main subsystem, but not the mean value of the extra field, affects the stability of the periodic waves. Three different areas can be distinguished inside the stability region in the parameter plane (L,U), where L is the wave's period. In these areas, stable are, respectively, CnWs with positive velocity, constant solutions, and CnWs with negative velocity. Multistability, i.e., the coexistence of several attractors, including the waves with several maxima per period, appears at large value of L. The analytical predictions are completely confirmed by direct simulations. Stable waves are also found numerically in the limit of vanishing dispersion, when the KS-KdV equation goes over into the KS one.Comment: a latex text file and 16 eps files with figures. Journal of the Physical Society of Japan, in pres

Controlling domain patterns far from equilibrium

A high degree of control over the structure and dynamics of domain patterns in nonequilibrium systems can be achieved by applying nonuniform external fields near parity breaking front bifurcations. An external field with a linear spatial profile stabilizes a propagating front at a fixed position or induces oscillations with frequency that scales like the square root of the field gradient. Nonmonotonic profiles produce a variety of patterns with controllable wavelengths, domain sizes, and frequencies and phases of oscillations.Comment: Published version, 4 pages, RevTeX. More at http://t7.lanl.gov/People/Aric

Prediction of reservoir permeability from petrography characterization

see Abstract Volum