Immunology of choriodecidua and onset of labour

Introduction: Labour is a well-orchestrated process associated with inflammation; its onset is a poorly understood retrospective diagnosis. Immunology of pregnancy and labour is an area of wide interest; however, knowledge is lacking in what occurs at the maternal-fetal interface, the decidua. The aim of this thesis was to better understand the role of decidual immune cells in preterm birth and term labour while associating metabolites with immune cells that may be pivotal in labour. Methodology: Multiple cytokine assays were used to quantify cytokines/chemokines in choriodecidua/placenta. Flow cytometry was used to identify immune cells in decidua, placenta, maternal and cord blood. Mass spectrometry was used to quantify urinary metabolites. Results: Study one showed that choriodecidua was the most inflammatory gestational tissue analysed. Cytokines/chemokines indicated that NK cells, monocytes, T cells and neutrophils may play a significant role in preterm birth. Increased IL-8 in choriodecidua was associated with worse neonatal outcomes. Study two revealed a shift from predominantly CD56bright NK cells to a predominant subset of CD56+CD16+ NK cells with onset of term labour in decidua. Decidual NKbright cells and Tregs work together to maintain uterine quiescence at term, which is lost with labour. CD4+ Tregs and CD8+ Tregs were significantly higher in decidua than placenta/blood at term. Decidual monocytes, T cells and neutrophils did not alter with the onset of labour. Study three did not identify a signature urinary metabolic profile that is associated with the onset of labour. It highlighted that factors such as diet and lifestyle may cause inter-personal variability. Conclusions: This thesis highlights that the tolerant immune cells and their interaction with cytokines/chemokines maintain an immunological equilibrium in the decidua. This is altered with the onset of labour. Urinary metabolites inconsistently altered with the onset of labour, there was no signature urinary metabolic profile associated with labour.Open Acces

An empirical analysis of the twin deficits evidence from Sri Lanka

This paper explores the empirical relationship between budget and current account deficits in the case of a small developing country, Sri Lanka for the period of 1960-2010. The data are collected from annual reports, Centra! Bank, Sri Lanka. The econometric methods used in this study are cointegration technique, Error correction modeling and Granger causality analysis. The empirical results are consistent with conventional view. Our empirical results clearly suggest that there exist statistically significant long-run positive relationship between the trade deficit and the budget deficit in Sri Lanka. The Granger causality test shows that the direction of causality runs from the budget deficit to the trade deficit and the relationship is positive and statistically significant. '••The empirical analysis in this study partially supports the Keynesian view that there is a linkage between the trade deficit and the budget deficit and the direction of causality is correct but the Ricardian equivalence hypothesis is not valid for Sri Lankan economy during the study period

Empirical investigation of the dynamic relationship between government expenditure and Economic growth in Sri Lanka

This study examines the long run dynamic relationship between government expenditures and economic growth for Sri Lankan economy during the period from 1977-2009. The study tests the validity of the Keynesian view and Wagner's law in the case of Sri Lankan economy. The empirical evidence has been acquired through the co-integration, error correction model and the Granger causality tests. The empirical findings clearly suggest that there is a statistically significant positive long run relationship between government expenditure and economic growth in Sri Lanka during the sample period. The Granger causality test shows that causality runs from government expenditure to economic growth and vice versa, the relationship is positive and statistically significant. The empiridcal results of this study support the Keynesian view and Wagnerian law and the direction of causality is valid for Sri Lankan economy during the study period. These results have important policy implications for both domestic policy makers and the development partners working in Sri Lanka

Violence in England and Wales in 2017: An Accident and Emergency perspective

Executive Summary • Serious violence levels and trends in England and Wales were studied based on data from a structured sample of 94 Emergency Departments (EDs), Minor Injury Units (MIUs) and Walk-in Centres. All are certified members of the National Violence Surveillance Network (NVSN). • Overall, an estimated 190,747 people attended EDs in England and Wales for treatment following violence in 2017, 1942 more than in 2016; a 1% increase. Falls or no change in overall violence levels in England and Wales according to this public health measure over the past decade were maintained in 2017. • In 2017, males (4.6 per 1,000 residents) were more than twice as likely as females (1.9 per 1,000 residents) to be treated in EDs following injury in violence. • Increases in violent injury among those aged 0-10 years (11%), 31-50 years (4.6%) and those aged 51 years and over (2.1%) were offset by the 1.8% decrease in violence among those aged 18-30 years. Due to small numbers, NVSN is unable to provide reliable violence trends for those aged 0-10 years. • Implementation of the new Emergency Care Data Set (ECDS) in Type 1 EDs in England led to increases in violence recording in the three months, October to December 2017. • Those most at risk of violence-related injury were males and those aged 18 to 30. Violence-related ED attendance was most frequent on Saturdays and Sundays

Preventing violence-related injuries in England and Wales: A panel study examining the impact of on-trade and off-trade alcohol prices

Objective To examine the influence of real on-trade and off-trade alcohol prices and socioeconomic and environmental factors on rates of violence-related emergency department (ED) attendances in England and Wales over an 8-year period. Methods Anonymised injury data which included attendance date, age and gender of patients aged over 18 years who reported injury in violence were collected from a structured sample of 100 EDs across England and Wales between 1 January 2005 and 31 December 2012. Alcohol prices and socioeconomic measures were obtained from the UK Office for National Statistics. Panel techniques were used to derive a statistical model. Results Real on-trade (β=−0.661, p<0.01) and off-trade (β=−0.277, p<0.05) alcohol prices were negatively related with rates of violence-related ED attendance among the adult population of England and Wales, after accounting for the effects of regional poverty, income inequality, youth spending power and seasonal effects. It is estimated that over 6000 fewer violence-related ED attendances per year in England and Wales would result from a 1% increase in both on-trade and off-trade alcohol prices above inflation. Of the variables studied, changes in regional poverty and income inequality had the greatest effect on violence-related ED attendances in England and Wales. Conclusions Small increases in the price of alcohol, above inflation, in both markets, would substantially reduce the number of patients attending EDs for treatment of violence-related injuries in England and Wales. Reforming the current alcohol taxation system may be more effective at reducing violence-related injury than minimum unit pricing

Oral surgery referrals at a UK dental hospital in the context of a managed vlinical network: a mixed-methods study

Background and aims: To inform the first Welsh OS Managed Clinical Network (MCN), a mixed-methods study investigated existing patterns, quality, suitability and reasons for referral to secondary care at the University Dental Hospital in Wales. Materials and methods: A random sample of 298 OS referrals were studied over a six-month period. Data recording proforma included details on referral practitioner, patient and referral diagnosis. Referrals were categorised by Levels of complexity (Levels 1, 2 and 3) and face-to-face, semi-structured and audio-recorded interviews were conducted with five frequent referrers. Results: The age range of patients was between 1 and 92 years, with over 58% (n=174) female. Majority of referrals (80%) were from GDPs. Top six practices accounted for a fifth (21%) of referrals, with three of these practices were corporate dental chains. Approximately, a third of referrals were categorised as Level 1 (37%), Level 2 (33%) and Level 3 (30%) complexity. 16% provided no medical history, and only 13% included supporting radiographs. Five themes emerged as reasons for oral surgery referrals: contract limitations, perception that new graduates lack OS practical skills, communication, practice resources and risk. Conclusions: Priorities for the Wales OS MCN are to reduce inappropriate referrals to secondary care and to ensure quality referrals. Introduction of the pan-Wales electronic Referral Management System in May 2019 is welcome in this context. The newly formed Health Education and Improvement Wales, with lead roles in education, training and shaping the healthcare workforce, will form a vital part in tackling barriers for safe OS in primary care

Environment, alcohol intoxication and overconfidence: evidence from a lab-in-the-field experiment

Alcohol has long been known as the demon drink; an epithet owed to the numerous social ills it is associated with. Our lab-in-the-field experiment assesses the extent to which changes in intoxication and an individual's environment lead to changes in overconfidence or cognitive ability that are, in turn, often linked to problematic behaviours. Results indicate that it is the joint effect of being intoxicated in a bar, rather than simply being intoxicated, that matters. Subjects systematically underestimated the magnitude of their behavioural changes, suggesting that they cannot be held fully accountable for their actions