Coronary artery calcification on routine CT has prognostic and treatment implications for all ages

Aims: Guidelines have recommended reporting coronary artery calcification (CAC) if present on chest CT imaging regardless of indication. This study assessed CAC prevalence, prognosis and the potential clinical impact of its reporting. Methods: We performed a single-centre retrospective analysis (January-December 2015) of 1400 chest CTs (200 consecutive within each age group: &lt;40, 40-49, 50-59, 60-69, 70-79, 80-89, ≥90). CTs were re-reviewed for CAC presence and severity and excluded if prior coronary intervention. Comorbidities, statin prescription and clinical outcomes (myocardial infarction [MI], stroke, all-cause mortality) were recorded. The impact of reporting CAC was assessed against pre-existing statin prescriptions. Results: 1343 patients were included (mean age 63±20 years, 56% female). Inter- and intra-observer variability for CAC presence at re-review was almost perfect (κ 0.89, p &lt; 0.001; κ 0.90, p &lt; 0.001) and for CAC grading was substantial and almost perfect (κ 0.68, p &lt; 0.001; κ 0.91, p &lt; 0.001). CAC was observed in 729/1343 (54%), more frequently in males (p &lt; 0.001) and rising age (p &lt; 0.001). A high proportion of patients with CAC in all age groups had no prior statin prescription (range: 42% [80-89] to 100% [&lt;40]). The ‘number needed to report’ CAC presence to potentially impact management across all ages was 2. 689 (51%) patients died (median follow-up 74-months). CAC presence was associated with risk of MI, stroke and all-cause mortality (p &lt; 0.001). After adjusting for confounders, severe calcification predicted risk of all-cause mortality (HR 1.8 [1.2-2.5], p = 0.002). Conclusion: Grading of CAC was reproducible, and although prevalence rose with age, prognostic and treatment implications were maintained in all ages.</p

Thinking about Later Life: Insights from the Capability Approach

A major criticism of mainstream gerontological frameworks is the inability of such frameworks to appreciate and incorporate issues of diversity and difference in engaging with experiences of aging. Given the prevailing socially structured nature of inequalities, such differences matter greatly in shaping experiences, as well as social constructions, of aging. I argue that Amartya Sen’s capability approach (2009) potentially offers gerontological scholars a broad conceptual framework that places at its core consideration of human beings (their values) and centrality of human diversity. As well as identifying these key features of the capability approach, I discuss and demonstrate their relevance to thinking about old age and aging. I maintain that in the context of complex and emerging identities in later life that shape and are shaped by shifting people-place and people-people relationships, Sen’s capability approach offers significant possibilities for gerontological research

Invited to labour or participate: intra- and inter-generational distinctions and the role of capital in children’s invited participation

This paper applies aspects of Bourdieu’s conceptual toolkit related to capital, and analyses inter- and intra-generational relations of influence. Applying Bourdieu’s concepts to examples of case studies from a children’s parliament in Finland, and with reference to an adult resident forum, moments of continuity and disruption in the relatively stable patterns of distinction between children and adults emerge. Children in school councils (at times) are labourers for agendas set by teachers, but the children at the top of the structure’s hierarchy can benefit from cultural capital and a functional capital that enables them to set agendas and direct the work of others. The political capital of the person presenting views from the participation sphere and the dominant symbolic capital of market logics appear to have a greater impact than generation on the influence participants achieve. Unquestioned acceptance of this differentiation suggests that new approaches to invited participation structures are needed

Health Visiting and School Nursing Programmes: supporting implementation of the new service model No.5: Domestic Violence and Abuse – Professional Guidance

Guidance created by an expert working group at the Department of Healt

The stigmatisation of source isolation: a literature review

Background: Isolation precautions in patients with multi-drug-resistant bacteria and other communicable infectious agents can be associated with adverse effects. Patients’ perspectives of isolation suggest that the imposed environment and procedures create barriers to their physical, social and emotional needs.Aims: The purpose of this paper is to review the literature to uncover any reliable evidence supporting the assertion that stigma is a significant characteristic of the experience of source isolation in healthcare settings.Methods: The methodological framework of Arksey and O’Malley was applied to this review. A total of 14 papers identified from 189 abstracts screened were included in the review.Results: The research reviewed suggests a clear association between stigmatisation and isolation in which stigma does have a direct negative effect on patients placed in hospital isolation. None of the studies found evidence to the contrary.Conclusions: The implications of this literature review for policy-makers and healthcare professionals suggest that when isolation or other forms of constraint are implemented and in use, patients must be provided with strengthened forms of support, including social and emotional support, and given access to healthcare of optimal quality to prevent the associated adverse effects of isolation as much as possibl

iDAH Research Software Engineering (RSE) Steering Group working paper

This is the final version. Available from the iDAH Research Software Engineering (RSE) Steering Group via the DOI in this record. Our purpose was to convene a broad and representative group from the UK Research Software Engineering (RSE) community to discuss opportunities for and barriers to the development of Arts & Humanities (AH) RSE capability, with a specific focus on contributing to the AHRC Infrastructure for Digital Innovation and Curation in Arts and Humanities (iDAH) project and a wider remit to consider longer term strategic priorities and opportunities for alignment with UKRI and EU initiatives. The discussion was intended to be foundational, inclusive, and broad-ranging, involving a wide stakeholder group encouraged to engage in ‘blue-sky’ thinking over short, medium, and long-term time horizons. The analysis contained in this working paper should be read in that context, as a reflection of early stage discussions intended to provide a platform for future more focused activity. Additional discussion and analysis is needed to produce substantive actionable conclusions

Placebo and other psychological interactions in headache treatment

We present a theory according which a headache treatment acts through a specific biological effect (when it exists), a placebo effect linked to both expectancy and repetition of its administration (conditioning), and a non-specific psychological effect. The respective part of these components varies with the treatments and the clinical situations. During antiquity, suggestions and beliefs were the mainstays of headache treatment. The word placebo appeared at the beginning of the eighteenth century. Controversies about its effect came from an excessive interpretation due to methodological bias, inadequate consideration of the variation of the measure (regression to the mean) and of the natural course of the disease. Several powerful studies on placebo effect showed that the nature of the treatment, the associated announce, the patients’ expectancy, and the repetition of the procedures are of paramount importance. The placebo expectancy is associated with an activation of pre-frontal, anterior cingular, accumbens, and periacqueducal grey opioidergic neurons possibly triggered by the dopaminergic meso-limbic system. In randomized control trials, several arms design could theoretically give information concerning the respective part of the different component of the outcome and control the natural course of the disease. However, for migraine and tension type headache attacks treatment, no three arm (verum, placebo, and natural course) trial is available in the literature. Indirect evidence of a placebo effect in migraine attack treatment, comes from the high amplitude of the improvement observed in the placebo arms (28% of the patients). This figure is lower (6%) when using the harder criterium of pain free at 2 h. But these data disregard the effect of the natural course. For prophylactic treatment with oral medication, the trials performed in the last decades report an improvement in 21% of the patients in the placebo arms. However, in these studies the duration of administration was limited, the control of attacks uncertain as well as the evolution of the co-morbid psycho-pathology. Considering the reviews and meta-analysis of complex prophylactic procedures, it must be concluded that their effect is mostly linked to a placebo and non-specific psychological effects. Acupuncture may have a slight specific effect on tension type headache, but not on migraine. Manual therapy studies do not exhibit difference between manipulation, mobilization, and controls; touch has no proven specific effect. A comprehensive efficacy review of biofeedback studies concludes to a small specific effect on tension type headache but not on migraine. A review of behavioral treatment conclude to an interesting mean improvement but did not demonstrated a specific effect with the exception of a four arm study including a pseudo meditation control group. Expectation-linked placebo, conditioning, and non-specific psychological effects vary according clinical situations and psychological context; likely low in RCT, high after anempathic medical contact, and at its maximum with a desired charismatic healer. The announcements of doctors strongly influence the beliefs of patients, and in consequence their pain and anxiety sensibilities; this modulates the amplitude of the placebo and the non-specific psychological effects and is therefore a major determinant of the therapeutic success. Furthermore, any repetitive contact, even through a placebo, may interfere positively with the psychopathological co-morbidity. One has to keep in mind that the non-specific psychological interactions play a major role in the improvement of the majority of the headache sufferers