Metabolic theories of Whipple disease

Whipple disease is a rare, infectious, disease first described from a single case by Whipple in 1907. As well as characterising the clinical and pathological features of the condition, Whipple made two suggestions regarding its aetiology. These were either than the disease was caused by an infectious agent, or that it was of metabolic origin. As the disease is now thought to be caused by infection with the bacterium Tropheryma whipplei, historical reviews of the history of the disease typically mention only the first of these suggestions. In this paper, we therefore revisit Whipple’s other theory. We argue that a diverse and often successful research programme was developed around this mechanism of disease causation which gave rise to many useful findings on the condition. In the later parts of this article, we then turn to discuss the surprising neglect of this period of Whipple disease research in the current literature, and conclude by offering a brief reconstruction of this early history suitable for use in a technical context

Host movement dominates the predicted effects of climate change on parasite transmission between wild and domestic mountain ungulates

Climate change is shifting the transmission of parasites, which is determined by host density, ambient temperature and moisture. These shifts can lead to increased pressure from parasites, in wild and domestic animals, and can impact the effectiveness of parasite control strategies. Understanding the interactive effects of climate on host movement and parasite life histories will enable targeted parasite management, to ensure livestock productivity and avoid additional stress on wildlife populations. To assess complex outcomes under climate change, we applied a gastrointestinal nematode transmission model to a montane wildlife–livestock system, based on host movement and changes in abiotic factors due to elevation, comparing projected climate change scenarios with the historic climate. The wildlife host, Alpine ibex (Capra ibex ibex), undergoes seasonal elevational migration, and livestock are grazed during the summer for eight weeks. Total parasite infection pressure was more sensitive to host movement than to the direct effect of climatic conditions on parasite availability. Extended livestock grazing is predicted to increase parasite exposure for wildlife. These results demonstrate that movement of different host species should be considered when predicting the effects of climate change on parasite transmission, and can inform decisions to support wildlife and livestock health.<br/

Higher Mediterranean diet score is associated with longer time between relapses in Australian females with multiple sclerosis

A higher Mediterranean diet score has been associated with lower likelihood of multiple sclerosis. However, evidence regarding its association with disease activity and progression is limited. Using data from the AusLong Study, we tested longitudinal associations (over 10 years follow-up) between the alternate Mediterranean diet score (aMED) and aMED-Red (including moderate consumption of unprocessed red meat) and time between relapses and disability measured by Expanded Disability Status Scale (EDSS) (n=132; 27 males, 105 females). We used covariate-adjusted survival analysis for time between relapses, and time series mixed-effects negative binomial regression for EDSS. After adjusting for covariates, both higher aMED (aHR=0.94, 95%CI: 0.90, 0.99, p=0.009) and higher aMED-Red (aHR=0.93, 95%CI: 0.89, 0.97, p=0.001) were associated with significantly longer time between relapses in females. Whether specific dietary components of a Mediterranean diet are important in relation to relapses merits further study.Comment: Original article, Brief communication, 13 pages, 2 tables (one main table and one supplementary table

The benefits of being a near-peer teacher

Background: Near-peer teaching is used in anatomy education because of its benefits to the learner, teacher and faculty. Despite the range of reports focusing on the learner, the advantages for the teacher, which are thought to include communication skills, subject knowledge and employability, are only beginning to be explored. Method: A questionnaire was distributed to the teachers involved in anatomy near-peer teaching at the University of Southampton and Brighton and Sussex Medical School. This questionnaire was designed using 0-10 rating scales to assess teacher perspectives on their level of knowledge, teaching skills and enjoyment of teaching. Free text responses determined the teachers’ motivation and perceived benefits from the teaching. Results: Twenty-eight questionnaires were gathered (54.9% response rate) including 20 from Southampton and 8 from BSMS. Long term knowledge retention and better understanding of the material were rated 8.1 and 7.9 out of 10 respectively. Eight responses were from currently practising doctors, who rated how much they now use their teaching skills as doctors as 8.9 out of 10. Of the 8 doctors, 7 gained points for their foundation programme applications as a direct result of near-peer teaching. The most common motivator for engaging in teaching was to improve subject matter knowledge and the most common benefit was improved communication skills. Discussion: There are numerous advantages to being a near-peer teacher in medical school, which include knowledge improvement, transferrable professional skills and employability. These initial results support the hypothesised benefits to the teachers and provide a foundation for further longitudinal studies

Campsbourne Community-Based Research: Pilot project report

Campsbourne Estate lies in the heart of Haringey (North London). Despite its location towards the more affluent end of the borough, its rich architectural heritage, diverse population and proximity to green space and good schools/health centres, the estate is home to significant deprivation with some of the worst rates in England, particularly in terms of ‘housing and services’ and ‘income deprivation affecting the elderly’. Haringey Labour Party Manifesto 2022-26 pledged to empower local communities to make change, putting residents at the heart of decision-making. In 2021 residents were awarded a Civic Fellowship from the Institute of Community Studies (Young Foundation) to pilot a 6- month community-based research and training project on the estate. Grounded in Community-Based Participatory Research and a feminist ethics of care, the training was structured around three modules, each of which included a short period of data collection: i) understanding ourselves (autoethnographic research); ii) understanding our peers (peer research); and understanding our community (action research). A diverse cohort of 10 community researchers was recruited including 6 individuals and 2 family teams. The entirety of the research grant was spent on compensating the community researchers for their participation in both the training and data collection at London Living Wage. Autoethnographic research (through multimodal journaling) revealed positive and negative examples of lived experience and started to map the meaningful places on the estate, identifying the need for a community hub. Peer research (through informal interviews with family and neighbours, and a formal survey administered to residents) considered difference and representation, expanding the map of meaningful spaces, identifying those that felt inaccessible and exploring what different groups would look for in a community hub and what might prevent their engagement. Action research (through organisational case studies and a workshop with Haringey Council) built on the research findings to develop three proposals that were shared with councillors and other stakeholders: i) council to rent the Kurdish Advice Centre one day a week as a space for information sharing, advice sessions, classes and socialising; ii) council to work with a team of young people to co-design an outside sports facility; iii) council to work with a representative residents group to map accessibility and safety on the estate and consider appropriate actions. It was stressed that budgets must include fair compensation for participants and the agreement of tangible outcomes. Next steps include: i) supporting the council to implement recommendations fairly and responsibly; ii) continuing to strengthen relationships with the key organisation in the estate (iii) expanding the network; iv) seeking funding for further research and development work; and v) exploring implications for other participatory processes

Cognitive therapy compared with CBT for social anxiety disorder in adolescents: a feasibility study

Background: Social anxiety disorder (SAD) is common, typically starts in adolescence and has a low natural recovery rate. Existing psychological treatments for adolescent SAD are only moderately effective. It is possible that recovery rates for adolescents could be substantially improved by adapting a psychological therapy that is highly effective among adults with SAD. Objectives: To train child and adolescent mental health services (CAMHS) therapists to deliver cognitive therapy for SAD in adolescents (CT-SAD-A) and assess therapist competence. To estimate the costs to the NHS of training therapists to deliver CT-SAD-A and the mean cost per adolescent treated. To examine the feasibility of a randomised controlled trial (RCT) to compare CT-SAD-A with the general form of cognitive-behavioural therapy that is more commonly used. Design: During the training phase of the study, it became clear that the RCT would not be feasible because of high staff turnover and unfilled posts within CAMHS and changes in the nature of referrals, which meant that few young people with primary SAD were accessing some of the participating services. The study design was altered to comprise the following: a training case series of CT-SAD-A delivered in routine CAMHS, an estimate of the cost to the NHS of training therapists to deliver CT-SAD-A and of the mean cost per adolescent treated, and qualitative interviews with participating young people, parents, therapists and service managers/leads. Setting: Five CAMHS teams within Berkshire Healthcare and Oxford Health NHS Foundation Trusts. Participants: Eight therapists received training in CT-SAD-A. Twelve young people received CT-SAD-A, delivered by six therapists. Six young people, six parents, seven therapists and three managers participated in qualitative interviews. Interventions: Cognitive therapy for social anxiety disorder in adolescents (CT-SAD-A). Main outcome measures: Measured outcomes included social anxiety symptoms and diagnostic status, comorbid symptoms of anxiety and depression, social and general functioning, concentration in class and treatment acceptability. Patient level utilisation of the intervention was collected using clinicians’ logs. Results: Nine out of 12 participants achieved good outcomes across measures (r ≥ 0.60 across social anxiety measures). The estimated cost of delivering CT-SAD-A was £1861 (standard deviation £358) per person. Qualitative interviews indicated that the treatment was acceptable to young people, parents and therapists, but therapists and managers experienced challenges when implementing the training and treatment within the current CAMHS context. Limitations: Findings were based on a small, homogeneous sample and there was no comparison arm. Conclusions: CT-SAD-A is a promising treatment for young people with SAD, but the current CAMHS context presents challenges for its implementation

Homo sapiens in Arabia by 85,000 years ago.

Understanding the timing and character of the expansion of Homo sapiens out of Africa is critical for inferring the colonization and admixture processes that underpin global population history. It has been argued that dispersal out of Africa had an early phase, particularly ~130-90 thousand years ago (ka), that reached only the East Mediterranean Levant, and a later phase, ~60-50 ka, that extended across the diverse environments of Eurasia to Sahul. However, recent findings from East Asia and Sahul challenge this model. Here we show that H. sapiens was in the Arabian Peninsula before 85 ka. We describe the Al Wusta-1 (AW-1) intermediate phalanx from the site of Al Wusta in the Nefud desert, Saudi Arabia. AW-1 is the oldest directly dated fossil of our species outside Africa and the Levant. The palaeoenvironmental context of Al Wusta demonstrates that H. sapiens using Middle Palaeolithic stone tools dispersed into Arabia during a phase of increased precipitation driven by orbital forcing, in association with a primarily African fauna. A Bayesian model incorporating independent chronometric age estimates indicates a chronology for Al Wusta of ~95-86 ka, which we correlate with a humid episode in the later part of Marine Isotope Stage 5 known from various regional records. Al Wusta shows that early dispersals were more spatially and temporally extensive than previously thought. Early H. sapiens dispersals out of Africa were not limited to winter rainfall-fed Levantine Mediterranean woodlands immediately adjacent to Africa, but extended deep into the semi-arid grasslands of Arabia, facilitated by periods of enhanced monsoonal rainfall

Long-Lived Antibody and B Cell Memory Responses to the Human Malaria Parasites, Plasmodium falciparum and Plasmodium vivax

Antibodies constitute a critical component of the naturally acquired immunity that develops following frequent exposure to malaria. However, specific antibody titres have been reported to decline rapidly in the absence of reinfection, supporting the widely perceived notion that malaria infections fail to induce durable immunological memory responses. Currently, direct evidence for the presence or absence of immune memory to malaria is limited. In this study, we analysed the longevity of both antibody and B cell memory responses to malaria antigens among individuals who were living in an area of extremely low malaria transmission in northern Thailand, and who were known either to be malaria naïve or to have had a documented clinical attack of P. falciparum and/or P. vivax in the past 6 years. We found that exposure to malaria results in the generation of relatively avid antigen-specific antibodies and the establishment of populations of antigen-specific memory B cells in a significant proportion of malaria-exposed individuals. Both antibody and memory B cell responses to malaria antigens were stably maintained over time in the absence of reinfection. In a number of cases where antigen-specific antibodies were not detected in plasma, stable frequencies of antigen-specific memory B cells were nonetheless observed, suggesting that circulating memory B cells may be maintained independently of long-lived plasma cells. We conclude that infrequent malaria infections are capable of inducing long-lived antibody and memory B cell responses

Radical Response exhibition in partnership with the International Association of Design Research (IASDR) Conference

Radical Response exhibition in partnership with the International Association of Design Research (IASDR) Conferenc