Diagnosing coeliac disease in the elderly: a United Kingdom cohort study

Aim: To assess the outcomes for an elderly population with coeliac disease and to compare with younger adults with CD. Background: Coeliac disease in the elderly has been underdiagnosed due to the heterogeneity of presentation as well as lack of physicians' awareness of CD in this population. However, the benefits of diagnosing CD in the elderly may be contentious. Methods: Newly diagnosed CD patients were prospectively recruited from the Coeliac Specialist Clinic at the Royal Hallamshire Hospital, Sheffield, between 2008 and 2017. All patients had villous atrophy (VA) on biopsy with positive coeliac serology. Additionally, the patients were retrospectively recruited from 1990 to 2008 to determine the trend in elderly CD diagnostic frequency over time. Results: A total of 1605 patients with CD were recruited (n=644 prospectively, n=961 retrospectively). Of these, 208 patients (13.0%) were diagnosed over the age of 65 years between 1990 and 2017. The proportion of elderly CD diagnoses increased from 0% in 1990-1991 to 18.7% in 2016-2017 (p<0.001). Younger patients more commonly presented with fatigue (p<0.001) and gastrointestinal symptoms including diarrhoea (p=0.005), abdominal pain (p=0.019), and IBS-type symptoms (p=0.008), while older people more frequently presented with B12 deficiency (p=0.037). Conclusion: The prevalence of CD in the elderly has significantly increased over the last two decades, but elderly patients tend to present with fewer symptoms. Further research is required to determine whether a strict gluten-free diet in these patients is a necessity or a burden

On the spin-statistics connection in curved spacetimes

The connection between spin and statistics is examined in the context of locally covariant quantum field theory. A generalization is proposed in which locally covariant theories are defined as functors from a category of framed spacetimes to a category of $*$-algebras. This allows for a more operational description of theories with spin, and for the derivation of a more general version of the spin-statistics connection in curved spacetimes than previously available. The proof involves a "rigidity argument" that is also applied in the standard setting of locally covariant quantum field theory to show how properties such as Einstein causality can be transferred from Minkowski spacetime to general curved spacetimes.Comment: 17pp. Contribution to the proceedings of the conference "Quantum Mathematical Physics" (Regensburg, October 2014

A Feasibility Study Of Administering The Electronic Research And Development Culture Index To The Multidisciplinary Workforce In A UK Teaching Hospital.

Purpose: The study aims were: (i) to convert the Research and Development Culture Index (a validated rating instrument for assessing the strength of organizational Research and Development culture) into electronic format (eR&DCI), and (ii) to test the format and assess the feasibility of administering it to the multidisciplinary (allied health professionals, doctors and nurses) workforce in a National Health Service Hospital (NHS) in the United Kingdom (UK) by trialing it with the workforce of the tertiary Children's Hospital within the organization. Population and methods: The eR&DCI was emailed to all professional staff (n=907) in the Children's Hospital. Data were analyzed using IBM SPSS Statistics 22. Results: The eR&DCI was completed by 155 respondents (doctors n=38 (24.52%), nurses n=79 (50.96%) and allied health professionals (AHPs) n=38 (24.52%)). The response rate varied by professional group: responses were received from 79 out of 700 nurses (11%); 38 out of 132 doctors (29%) and 38 out of 76 AHPs (50%). Index scores demonstrated a positive research culture within the multidisciplinary workforce. Survey responses demonstrated differences between the professions related to research training and engagement in formal research activities. Conclusion: This is the first study to assess the feasibility of assessing the strength of an organization's multidisciplinary workforce research and development (R&D) culture by surveying that workforce using the eR&DCI. We converted the index to "Online Surveys" and successfully administered it to the entire multidisciplinary workforce in the Children's Hospital. We met our criteria for feasibility: ability to administer the survey and a response rate comparable with similar studies. Uptake could have been increased by also offering the option of the paper-based index for self-administration. Results of the survey are informing delivery of the research strategy in the Children's Hospital. This methodology has potential application in other healthcare contexts

Deformations of quantum field theories on spacetimes with Killing vector fields

The recent construction and analysis of deformations of quantum field theories by warped convolutions is extended to a class of curved spacetimes. These spacetimes carry a family of wedge-like regions which share the essential causal properties of the Poincare transforms of the Rindler wedge in Minkowski space. In the setting of deformed quantum field theories, they play the role of typical localization regions of quantum fields and observables. As a concrete example of such a procedure, the deformation of the free Dirac field is studied.Comment: 35 pages, 3 figure

Dark mammoth trunks in the merging galaxy NGC 1316 and a mechanism of cosmic double helices

NGC 1316 is a giant, elliptical galaxy containing a complex network of dark, dust features. The morphology of these features has been examined in some detail using a Hubble Space Telescope, Advanced Camera for Surveys image. It is found that most of the features are constituted of long filaments. There also exist a great number of dark structures protruding inwards from the filaments. Many of these structures are strikingly similar to elephant trunks in H II regions in the Milky Way Galaxy, although much larger. The structures, termed mammoth trunks, generally are filamentary and often have shapes resembling the letters V or Y. In some of the mammoth trunks the stem of the Y can be resolved into two or more filaments, many of which showing signs of being intertwined. A model of the mammoth trunks, related to a recent theory of elephant trunks, is proposed. Based on magnetized filaments, the model is capable of giving an account of the various shapes of the mammoth trunks observed, including the twined structures.Comment: Accepted for publication in Astrophysics & Space Scienc

Multiorder coherent Raman scattering of a quantum probe field

We study the multiorder coherent Raman scattering of a quantum probe field in a far-off-resonance medium with a prepared coherence. Under the conditions of negligible dispersion and limited bandwidth, we derive a Bessel-function solution for the sideband field operators. We analytically and numerically calculate various quantum statistical characteristics of the sideband fields. We show that the multiorder coherent Raman process can replicate the statistical properties of a single-mode quantum probe field into a broad comb of generated Raman sidebands. We also study the mixing and modulation of photon statistical properties in the case of two-mode input. We show that the prepared Raman coherence and the medium length can be used as control parameters to switch a sideband field from one type of photon statistics to another type, or from a non-squeezed state to a squeezed state and vice versa.Comment: 12 pages, 7 figures, to be published in Phys. Rev.

Dynamical locality and covariance: What makes a physical theory the same in all spacetimes?

The question of what it means for a theory to describe the same physics on all spacetimes (SPASs) is discussed. As there may be many answers to this question, we isolate a necessary condition, the SPASs property, that should be satisfied by any reasonable notion of SPASs. This requires that if two theories conform to a common notion of SPASs, with one a subtheory of the other, and are isomorphic in some particular spacetime, then they should be isomorphic in all globally hyperbolic spacetimes (of given dimension). The SPASs property is formulated in a functorial setting broad enough to describe general physical theories describing processes in spacetime, subject to very minimal assumptions. By explicit constructions, the full class of locally covariant theories is shown not to satisfy the SPASs property, establishing that there is no notion of SPASs encompassing all such theories. It is also shown that all locally covariant theories obeying the time-slice property possess two local substructures, one kinematical (obtained directly from the functorial structure) and the other dynamical (obtained from a natural form of dynamics, termed relative Cauchy evolution). The covariance properties of relative Cauchy evolution and the kinematic and dynamical substructures are analyzed in detail. Calling local covariant theories dynamically local if their kinematical and dynamical local substructures coincide, it is shown that the class of dynamically local theories fulfills the SPASs property. As an application in quantum field theory, we give a model independent proof of the impossibility of making a covariant choice of preferred state in all spacetimes, for theories obeying dynamical locality together with typical assumptions.Comment: 60 pages, LaTeX. Version to appear in Annales Henri Poincar

Chronic exposure to KATP channel openers results in attenuated glucose sensing in hypothalamic GT1-7 neurons

Individuals with Type 1 diabetes (T1D) are often exposed to recurrent episodes of hypoglycaemia. This reduces hormonal and behavioural responses that normally counteract low glucose in order to maintain glucose homeostasis, with altered responsiveness of glucose sensing hypothalamic neurons implicated. Although the molecular mechanisms are unknown, pharmacological studies implicate hypothalamic ATP-sensitive potassium channel (KATP) activity, with KATP openers (KCOs) amplifying, through cell hyperpolarization, the response to hypoglycaemia. Although initial findings, using acute hypothalamic KCO delivery, in rats were promising, chronic exposure to the KCO NN414 worsened the responses to subsequent hypoglycaemic challenge. To investigate this further we used GT1-7 cells to explore how NN414 affected glucose-sensing behaviour, the metabolic response of cells to hypoglycaemia and KATP activity. GT1-7 cells exposed to 3 or 24 h NN414 exhibited an attenuated hyperpolarization to subsequent hypoglycaemic challenge or NN414, which correlated with diminished KATP activity. The reduced sensitivity to hypoglycaemia was apparent 24 h after NN414 removal, even though intrinsic KATP activity recovered. The NN414-modified glucose responsiveness was not associated with adaptations in glucose uptake, metabolism or oxidation. KATP inactivation by NN414 was prevented by the concurrent presence of tolbutamide, which maintains KATP closure. Single channel recordings indicate that NN414 alters KATP intrinsic gating inducing a stable closed or inactivated state. These data indicate that exposure of hypothalamic glucose sensing cells to chronic NN414 drives a sustained conformational change to KATP, probably by binding to SUR1, that results in loss of channel sensitivity to intrinsic metabolic factors such as MgADP and small molecule agonists.We thank Novo Nordisk for providing NN414. This study was funded by grants from Diabetes UK (to MLJA, RJM) and the Juvenile Diabetes Research Foundation (postdoctoral fellowship 3-576-2010 to CB and 1-2008-728 to RJM)

On the spin-statistics connection in curved spacetimes

The connection between spin and statistics is examined in the context of locally covariant quantum field theory. A generalization is proposed in which locally covariant theories are defined as functors from a category of framed spacetimes to a category of ∗-algebras. This allows for a more operational description of theories with spin, and for the derivation of a more general version of the spin-statistics connection in curved spacetimes than previously available. The proof involves a "rigidity argument" that is also applied in the standard setting of locally covariant quantum field theory to show how properties such as Einstein causality can be transferred from Minkowski spacetime to general curved spacetimes