Blaming the victim, all over again: Waddell and Aylward's biopsychosocial (BPS) model of disability

The biopsychosocial (BPS) model of mental distress, originally conceived by the American psychiatrist George Engel in the 1970s and commonly used in psychiatry and psychology, has been adapted by Gordon Waddell and Mansell Aylward to form the theoretical basis for current UK Government thinking on disability. Most importantly, the Waddell and Aylward version of the BPS has played a key role as the Government has sought to reform spending on out-of- work disability benefits. This paper presents a critique of Waddell and Aylward’s model, examining its origins, its claims and the evidence it employs. We will argue that its potential for genuine inter-disciplinary cooperation and the holistic and humanistic benefits for disabled people as envisaged by Engel are not now, if they ever have been, fully realized. Any potential benefit it may have offered has been eclipsed by its role in Coalition/Conservative government social welfare policies that have blamed the victim and justified restriction of entitlements

AQUIFER Nano-Electrofuel Energy Economy and Powered Aircraft Operations

The Aqueous, QUick-charging battery Integration For Electric flight Research project is explained and the major subsystems are described, including nano-electric fluid, rim-driven motors, and integration concepts. The nano-electric fluid concept is a new type of aqueous flow battery that could reduce or retire the fire and explosion hazards of conventional batteries and fuel cells. The nano-electric fluid itself could enable energy storage and increased available energy per fuel weight ratios. The rim-driven motor is being developed to improve propulsion system safety and stability and to reduce noise. The rim-driven motor concept could enable motors that are more efficient both electrically and aerodynamically. The Energy Economy of the project concept is presented as a potential renewable or green energy sustainment for utilizing in-place infrastructure. The nano-electric fluid energy charge-use-recharge cycle is presented using renewable energy input from solar, wind, and hydroelectricity. Powered aircraft operations are presented, and the logistics of the new nano-electric fluid technology are explored. Powered aircraft operations topics include weight and balance, fueling, recharging, safety, and derivative considerations

The influence of 'significant others' on persistent back pain and work participation: a qualitative exploration of illness perceptions

Background Individual illness perceptions have been highlighted as important influences on clinical outcomes for back pain. However, the illness perceptions of 'significant others' (spouse/partner/close family member) are rarely explored, particularly in relation to persistent back pain and work participation. The aim of this study was to initiate qualitative research in this area in order to further understand these wider influences on outcome. Methods Semi-structured interviews based on the chronic pain version of the Illness Perceptions Questionnaire-Revised were conducted with a convenience sample of UK disability benefit claimants, along with their significant others (n=5 dyads). Data were analysed using template analysis. Results Significant others shared, and perhaps further reinforced, claimants' unhelpful illness beliefs including fear of pain/re-injury associated with certain types of work and activity, and pessimism about the likelihood of return to work. In some cases, significant others appeared more resigned to the permanence and negative inevitable consequences of the claimant's back pain condition on work participation, and were more sceptical about the availability of suitable work and sympathy from employers. In their pursuit of authenticity, claimants were keen to stress their desire to work whilst emphasising how the severity and physical limitations of their condition prevented them from doing so. In this vein, and seemingly based on their perceptions of what makes a 'good' significant other, significant others acted as a 'witness to pain', supporting claimants' self-limiting behaviour and statements of incapacity, often responding with empathy and assistance. The beliefs and responses of significant others may also have been influenced by their own experience of chronic illness, thus participants lives were often intertwined and defined by illness. Conclusions The findings from this exploratory study reveal how others and wider social circumstances might contribute both to the propensity of persistent back pain and to its consequences. This is an area that has received little attention to date, and wider support of these findings may usefully inform the design of future intervention programmes aimed at restoring work participation

Antimicrobial treatment improves mycobacterial survival in nonpermissive growth conditions

Antimicrobials targeting cell wall biosynthesis are generally considered inactive against nonreplicating bacteria. Paradoxically, we found that under nonpermissive growth conditions, exposure of Mycobacterium bovis BCG bacilli to such antimicrobials enhanced their survival. We identified a transcriptional regulator, RaaS (for regulator of antimicrobial-assisted survival), encoded by bcg1279 (rv1219c) as being responsible for the observed phenomenon. Induction of this transcriptional regulator resulted in reduced expression of specific ATP-dependent efflux pumps and promoted long-term survival of mycobacteria, while its deletion accelerated bacterial death under nonpermissive growth conditions in vitro and during macrophage or mouse infection. These findings have implications for the design of antimicrobial drug combination therapies for persistent infectious diseases, such as tuberculosis

Investigating the implementation of SMS and mobile messaging In Population Screening (The SIPS Study): Protocol for a Delphi Study

Background The use of mobile messaging including Short Message Service (SMS) and Web-based messaging in healthcare has grown significantly. Using messaging to facilitate patient communication has been advocated in several circumstances including population screening. These programmes, however, pose unique challenges to mobile communication, as messaging is often sent from a central hub to a diverse population with differing needs. Despite this, there is a paucity of robust frameworks to guide implementation. Objective This protocol describes the methods that will be used to develop a guide for the principles of use of mobile messaging for population screening programmes in England. Methods This modified Delphi study will be conducted in two parts: evidence synthesis and consensus generation. The former will incorporate a literature review of publications from 1st January 2000 to the present. This will elicit key themes to inform an online scoping questionnaire posed to a group of experts from academia, clinical medicine, industry and public health. Thematic analysis of free-text responses by two independent authors will elicit items to be used in the consensus generation. Patient and Public Involvement groups will be convened to ensure that a comprehensive item list is generated, which represents the public’s perspective. Each item will then be anonymously voted upon by experts as to its importance and feasibility of implementation in screening, during three rounds of a Delphi process. Consensus will be defined a priori at 70%, with items considered important and feasible eligible for inclusion into the final recommendation. A list of desirable items (important, but not currently feasible) will be developed to guide future work. Results The Institutional Review Board at Imperial College London has granted ethical approval (20IC6088). Results are expected to involve a list of recommendations to screening services with findings made available to screening services through Public Health England. This study will thus provide a formal guideline for the use of mobile messaging in screening services and provide future directions in this field. Discussion The use of mobile messaging has grown significantly across healthcare services, especially given the COVID-19 pandemic, but its implementation in screening programmes remains challenging. this modified Delphi approach with leading experts, will provide invaluable insights to facilitate incorporating messaging in these programmes, and create awareness of future developments in this area

Comparison between resistive and collisionless double tearing modes for nearby resonant surfaces

The linear instability and nonlinear dynamics of collisional (resistive) and collisionless (due to electron inertia) double tearing modes (DTMs) are compared with the use of a reduced cylindrical model of a tokamak plasma. We focus on cases where two q = 2 resonant surfaces are located a small distance apart. It is found that regardless of the magnetic reconnection mechanism, resistivity or electron inertia, the fastest growing linear eigenmodes may have high poloidal mode numbers m ~ 10. The spectrum of unstable modes tends to be broader in the collisionless case. In the nonlinear regime, it is shown that in both cases fast growing high-m DTMs lead to an annular collapse involving small magnetic island structures. In addition, collisionless DTMs exhibit multiple reconnection cycles due to reversibility of collisionless reconnection and strong ExB flows. Collisionless reconnection leads to a saturated stable state, while in the collisional case resistive decay keeps the system weakly dynamic by driving it back towards the unstable equilibrium maintained by a source term.Comment: 15 pages, 9 figure

Clinical features and survival among children with retinoblastoma in Uganda

AIMS: To characterise the clinical features, treatment and outcome of children diagnosed with retinoblastoma in Uganda. METHODS: The study comprised a 6-year nationwide enrolment with follow-up. RESULTS: In total, 282 cases were enrolled, 26% (72) were bilateral; 6% were lost to follow-up. Almost all diagnoses in the first affected eye were International Classification of Retinoblastoma group E or worse. Histology was available for 92%; of those, 45%, had extraocular tumour at diagnosis. Enucleation of the first eye was done for 271; 94 received radiotherapy to the socket and in the last 2 years, 70 children received chemotherapy. At close of study, 139 children had died. Survival, as determined in a proportional hazards model adjusted for age, sex, laterality and treatment era (pre or post introduction of chemotherapy), varied by extent of the tumour (p<0.001); children with only intraocular involvement were 80% less likely to die (HR=0.21, 95% CI 0.12 to 0.35) compared with children with extraocular involvement. CONCLUSIONS: Diagnostic delay results in relatively high mortality among children with retinoblastoma in Uganda. There is an urgent need for more effective treatment modalities, particularly chemotherapy, and nationwide efforts to encourage earlier access to medical care

Clinical features and survival among children with retinoblastoma in Uganda

AIMS: To characterise the clinical features, treatment and outcome of children diagnosed with retinoblastoma in Uganda. METHODS: The study comprised a 6-year nationwide enrolment with follow-up. RESULTS: In total, 282 cases were enrolled, 26% (72) were bilateral; 6% were lost to follow-up. Almost all diagnoses in the first affected eye were International Classification of Retinoblastoma group E or worse. Histology was available for 92%; of those, 45%, had extraocular tumour at diagnosis. Enucleation of the first eye was done for 271; 94 received radiotherapy to the socket and in the last 2 years, 70 children received chemotherapy. At close of study, 139 children had died. Survival, as determined in a proportional hazards model adjusted for age, sex, laterality and treatment era (pre or post introduction of chemotherapy), varied by extent of the tumour (p<0.001); children with only intraocular involvement were 80% less likely to die (HR=0.21, 95% CI 0.12 to 0.35) compared with children with extraocular involvement. CONCLUSIONS: Diagnostic delay results in relatively high mortality among children with retinoblastoma in Uganda. There is an urgent need for more effective treatment modalities, particularly chemotherapy, and nationwide efforts to encourage earlier access to medical care

New Mechanics of Spinal Injury

The prediction and prevention of spinal injury is an important aspect of preventive health science. The spine, or vertebral column, represents a chain of 26 movable vertebral bodies, joint together by transversal viscoelastic intervertebral discs and longitudinal elastic tendons. This paper proposes a new locally-coupled loading-rate hypothesis}, which states that the main cause of both soft- and hard-tissue spinal injury is a localized Euclidean jolt, or SE(3)-jolt, an impulsive loading that strikes a localized spine in several coupled degrees-of-freedom simultaneously. To show this, based on the previously defined covariant force law, we formulate the coupled Newton-Euler dynamics of the local spinal motions and derive from it the corresponding coupled SE(3)-jolt dynamics. The SE(3)-jolt is the main cause of two basic forms of spinal injury: (i) hard-tissue injury of local translational dislocations; and (ii) soft-tissue injury of local rotational disclinations. Both the spinal dislocations and disclinations, as caused by the SE(3)-jolt, are described using the Cosserat multipolar viscoelastic continuum model. Keywords: localized spinal injury, coupled loading-rate hypothesis, coupled Newton-Euler dynamics, Euclidean jolt dynamics, spinal dislocations and disclinationsComment: 14 pages, 1 figure, Late