What is the absolute risk of developing diabetes mellitus in patients with glucocorticoid-treated polymyalgia rheumatica and giant cell arteritis? a systematic review and meta-analysis

Background: Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are treated with glucocorticoids (GCs) but long-term GC use is associated with diabetes mellitus (DM). The absolute incidence of this serious complication in this patient group remains unclear. Objectives: To quantify the absolute risk of GC-induced DM in PMR and GCA in published literature. Methods: We identified literature from inception to February 2016 reporting diabetes following exposure to oral GC in patients with PMR and/or GCA without preexisting diabetes. A random-effects meta-analysis was performed to summarise the literature. Risk of bias was assessed using the Cochrane Collaboration tool. Results: 21 eligible publications were identified. In studies of patients with GCA, mean cumulative GC dose was almost two times higher than in studies of PMR (8.9g vs 5.0g), with slightly longer treatment duration but much longer duration of follow-up (8.8years vs 4.4years). The incidence proportion (cumulative incidence) of patients who developed new-onset DM was 6% (95% CI: 3–9%) for PMR and 12% (95% CI: 8–17%) for GCA. Heterogeneity between studies was high (I2=78.2%), as there were differences in study designs, patient population, geographical locations and treatment strategies. Based on UK data on incidence rate of DM in the general population1, the expected background incidence rate of DM over 4.4 years in PMR patients and 8.8 years in GCA patients (the duration of follow-up) would be 4.8% and 9.7%, respectively. Very little information on predictors of DM in PMR or GCA patients was found. The overall risk of bias was high for many of the observational studies, especially relating to definition and recording of outcome and prognostic variables. Conclusions: Physicians should screen patients treated for PMR/GCA for DM but it remains unclear what is the time-period of greatest risk and the influence of risk factors. Our meta-analysis produced plausible estimates of DM incidence in patients with PMR and GCA but there is insufficient published data to allow precise quantification of the DM risk or, crucially, which patients are at greatest ris

Evaluation of the Primary Care Mental Health Specialist role: Final Report

This report details an evaluation to assess the impact of the new primary care mental health specialist (PCMHS) role in Kent and Medway. The evaluation was undertaken by the Centre for Health Services Studies (CHSS) at the University of Kent and was conducted June 2013 to December 2014. The evaluation was commissioned by NHS Kent and Medway and supported by Kent and Medway Commissioning Support. The evaluation encompasses six CCG areas across Kent and Medway, with 13 PCMHS employed in these areas (see Table 1-1 for breakdown). The number of posts per CCG is dependent on the amount CCGs invest (roughly equating to population size), rather than prevalence of illness. The PCMHS have been seconded from Kent and Medway NHS and Social Care Partnership Trust (KMPT) for the duration of the pilot, and are either community psychiatric nurses (CPN) or occupational therapists (OT) by profession. The majority of PCMHS are hosted by a voluntary organisation (mcch); three are hosted by GP practices and two by a community Interest Company, Invicta CIC. The main objectives of the evaluation are: 1. To assess the impact on patients by capturing their experience of the service; 2. To assess the impact by capturing experiences of those delivering the service (i.e., PCMHS); 3. To assess the impact by capturing experiences of other professions who work alongside the service (i.e., mental health professionals in secondary care, GPs); 4. To assess the economic cost of the new service via a unit cost analysis

BOSS Ultracool Dwarfs I: Colors and Magnetic Activity of M and L dwarfs

We present the colors and activity of ultracool (M7-L8) dwarfs from the Tenth Data Release of the Sloan Digital Sky Survey (SDSS). We combine previous samples of SDSS M and L dwarfs with new data obtained from the Baryon Oscillation Sky Survey (BOSS) to produce the BOSS Ultracool Dwarf (BUD) sample of 11820 M7-L8 dwarfs. By combining SDSS data with photometry from the Two Micron All Sky Survey and the Wide-Field Infrared Sky Explorer mission, we present ultracool dwarf colors from $i-z$ to $W2-W3$ as a function of spectral type, and extend the SDSS-2MASS-WISE color locus to include ultracool dwarfs. The $i-z$, $i-J$, and $z-J$ colors provide the best indication of spectral type for M7-L3 dwarfs. We also examine ultracool dwarf chromospheric activity through the presence and strength of H$\alpha$ emission. The fraction of active dwarfs rises through the M spectral sequence until it reaches $\sim$90% at spectral type L0. The fraction of active dwarfs then declines to 50% at spectral type L5; no H$\alpha$ emission is observed in the late-L dwarfs in the BUD sample. The fraction of active L0-L5 dwarfs is much higher than previously observed. The strength of activity declines with spectral type from M7 through L3, after which the data do not show a clear trend. Using one-dimensional chromosphere models, we explore the range of filling factors and chromospheric temperature structures that are consistent with H$\alpha$ observations of M0-L7 dwarfs. M dwarf chromospheres have a similar, smoothly varying range of temperature and surface coverage while L dwarf chromospheres are cooler and have smaller filling factors.Comment: 24 pages and 13 figures, submitted to AJ. A short video describing these results can be found at https://www.youtube.com/watch?v=wwX5WkuJCU

Discovery of An Unusually Blue L Dwarf Within 10 pc of the Sun

We report the discovery of an unusually blue L5 dwarf within 10 pc of the Sun from a search of Sloan Digital Sky Survey (SDSS) spectra. A spectrophotometric distance estimate of 8.0+/-1.6 pc places SDSS J141624.08+134826.7 among the six closest known L dwarfs. SDSS 1416+13 was overlooked in infrared color-based searches because of its unusually blue J-K_S color, which also identifies it as the nearest member of the blue L dwarf subclass. We present additional infrared and optical spectroscopy from the IRTF/SpeX and Magellan/MagE spectrographs and determine UVW motions that indicate thin disk kinematics. The inclusion of SDSS 1416+13 in the 20 pc sample of L dwarfs increases the number of L5 dwarfs by 20% suggesting that the L dwarf luminosity function may be far from complete.Comment: 15 pages, 3 figures, accepted for publication in AJ; updated version includes corrected radial velocit

Microbial impacts on 99mTc migration through sandstone under highly alkaline conditions relevant to radioactive waste disposal

Geological disposal of intermediate level radioactive waste in the UK is planned to involve the use of cementitious materials, facilitating the formation of an alkali-disturbed zone within the host rock. The biogeochemical processes that will occur in this environment, and the extent to which they will impact on radionuclide migration, are currently poorly understood. This study investigates the impact of biogeochemical processes on the mobility of the radionuclide technetium, in column experiments designed to be representative of aspects of the alkali-disturbed zone. Results indicate that microbial processes were capable of inhibiting 99mTc migration through columns, and X-ray radiography demonstrated that extensive physical changes had occurred to the material within columns where microbiological activity had been stimulated. The utilisation of organic acids under highly alkaline conditions, generating H2 and CO2, may represent a mechanism by which microbial processes may alter the hydraulic conductivity of a geological environment. Column sediments were dominated by obligately alkaliphilic H2-oxidising bacteria, suggesting that the enrichment of these bacteria may have occurred as a result of H2 generation during organic acid metabolism. The results from these experiments show that microorganisms are able to carry out a number of processes under highly alkaline conditions that could potentially impact on the properties of the host rock surrounding a geological disposal facility for intermediate level radioactive waste

Benchmarking Adversarially Robust Quantum Machine Learning at Scale

Machine learning (ML) methods such as artificial neural networks are rapidly becoming ubiquitous in modern science, technology and industry. Despite their accuracy and sophistication, neural networks can be easily fooled by carefully designed malicious inputs known as adversarial attacks. While such vulnerabilities remain a serious challenge for classical neural networks, the extent of their existence is not fully understood in the quantum ML setting. In this work, we benchmark the robustness of quantum ML networks, such as quantum variational classifiers (QVC), at scale by performing rigorous training for both simple and complex image datasets and through a variety of high-end adversarial attacks. Our results show that QVCs offer a notably enhanced robustness against classical adversarial attacks by learning features which are not detected by the classical neural networks, indicating a possible quantum advantage for ML tasks. Contrarily, and remarkably, the converse is not true, with attacks on quantum networks also capable of deceiving classical neural networks. By combining quantum and classical network outcomes, we propose a novel adversarial attack detection technology. Traditionally quantum advantage in ML systems has been sought through increased accuracy or algorithmic speed-up, but our work has revealed the potential for a new kind of quantum advantage through superior robustness of ML models, whose practical realisation will address serious security concerns and reliability issues of ML algorithms employed in a myriad of applications including autonomous vehicles, cybersecurity, and surveillance robotic systems.Comment: 10 pages, 5 Figure

Colors and Kinematics of L Dwarfs From the Sloan Digital Sky Survey

We present a sample of 484 L dwarfs, 210 of which are newly discovered from the Sloan Digital Sky Survey (SDSS) Data Release 7 spectroscopic database. We combine this sample with known L dwarfs to investigate their $izJHK_S$ colors. Our spectroscopically selected sample has $\sim$0.1 magnitude bluer median $J-K_S$ colors at a given spectral type (for L0 to L4) than previously known L dwarfs, which reflects a bias towards redder L dwarfs in past selection criteria. We present photometric distance relations based on $i-z$ and $i-J$ colors and derive distances to our L dwarf sample. We combine the distances with SDSS/2MASS proper motions in order to examine the tangential velocities. For the majority of our spectroscopic sample, we measured radial velocities and present three dimensional kinematics. We also provide H$\alpha$ detections for the fraction of our sample with sufficient quality spectra. Comparison of the velocities of our L dwarf sample to a kinematic model shows evidence for both cold and hot dynamical populations, consistent with young and old disk components. The dispersions of these components are similar to those found for M dwarfs. We also show that $J-K_S$ color is correlated with velocity dispersion, confirming a relationship between $J-K_S$ color and age.Comment: 58 pages, 11 figures, 8 tables, accepted for publication in the Astronomical Journa