9,045 research outputs found

    Challenges and opportunities of the COVID-19 pandemic for perinatal mental health care: a mixed-methods study of mental health care staff

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    The aim of this study was to explore staff perceptions of the impact of the COVID-19 pandemic on mental health service delivery and outcomes for women who were pregnant or in the first year after birth ('perinatal' women). Secondary analysis was undertaken of an online mixed-methods survey open to all mental health care staff in the UK involving 363 staff working with women in the perinatal period. Staff perceived the mental health of perinatal women to be particularly vulnerable to the impact of stressors associated with the pandemic such as social isolation (rated by 79.3% as relevant or extremely relevant; 288/363) and domestic violence and abuse (53.3%; 192/360). As a result of changes to mental health and other health and social care services, staff reported feeling less able to assess women, particularly their relationship with their baby (43.3%; 90/208), and to mobilise safeguarding procedures (29.4%; 62/211). While 42% of staff reported that some women engaged poorly with virtual appointments, they also found flexible remote consulting to be beneficial for some women and helped time management due to reductions in travel time. Delivery of perinatal care needs to be tailored to women's needs; virtual appointments are perceived not to be appropriate for assessments but may be helpful for some women in subsequent interactions. Safeguarding and other risk assessment procedures must remain robust in spite of modifications made to service delivery during pandemics

    High-dimensional simplexes for supermetric search

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    In a metric space, triangle inequality implies that, for any three objects, a triangle with edge lengths corresponding to their pairwise distances can be formed. The n-point property is a generalisation of this where, for any (n+1) objects in the space, there exists an n-dimensional simplex whose edge lengths correspond to the distances among the objects. In general, metric spaces do not have this property; however in 1953, Blumenthal showed that any semi-metric space which is isometrically embeddable in a Hilbert space also has the n-point property. We have previously called such spaces supermetric spaces, and have shown that many metric spaces are also supermetric, including Euclidean, Cosine, Jensen-Shannon and Triangular spaces of any dimension. Here we show how such simplexes can be constructed from only their edge lengths, and we show how the geometry of the simplexes can be used to determine lower and upper bounds on unknown distances within the original space. By increasing the number of dimensions, these bounds converge to the true distance. Finally we show that for any Hilbert-embeddable space, it is possible to construct Euclidean spaces of arbitrary dimensions, from which these lower and upper bounds of the original space can be determined. These spaces may be much cheaper to query than the original. For similarity search, the engineering tradeoffs are good: we show significant reductions in data size and metric cost with little loss of accuracy, leading to a significant overall improvement in exact search performance

    Categorical dilemmas: challenges for HIV prevention among men who have sex with men and transgender women in Vietnam

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    In Vietnam, HIV continues disproportionately to affect men who have sex with men and transgender women, and the increase in HIV prevalence in these populations may be related to a lack of tailoring of current prevention approaches, which often fail to address social diversity within these populations. To effectively respond to HIV in Vietnam, it is imperative to identify sub-populations within the broad category of ‘men who have sex with men’ (MSM), a term which in Vietnam as in many other sites frequently subsumes transgender women. In this paper, we document the different categories used to describe people who engage in same-sex sexual practices and/or non-normative gender performances drawing on data collected via in-depth interviews and focus groups with a total of 79 participants in Hanoi. We identified over 40 different categories used to describe men who have sex with men and/or transgender women. These categories could be described as behaviourally-based, identity-based, or emic, and each carried different meanings, uses (based on age and geography) and levels of stigma. The categories shine light on the complexity of identities among men who have sex with men and transgender women and have utility for future research and programming to more comprehensively address HIV in Vietnam

    Young children's cognitive achievement: home learning environment, language and ethnic background

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    For decades, research has shown differences in cognitive assessment scores between White and minority ethnic group(s) learners as well as differences across different minority ethnic groups. More recent data have indicated that the home learning environment and languages spoken can impact cognitive assessment and other corollary outcomes. This study uses the Millennium Cohort Study to jointly assess how minority ethnic group, home learning environment and home languages predict child cognitive assessment scores. Regression analyses were conducted using two assessment measures. The following is hypothesised: (1) cognitive achievement scores vary by minority ethnic group, (2) more home learning environment in early childhood leads to higher cognitive development scores and (3) English only in the home yields the highest cognitive scores while no English in the home yields the lowest. Findings reveal that there are differences in cognitive scores along ethnic group categories although there are also some unexpected findings. Home learning environment does not play as large a role as was predicted in raising the assessment scores overall for learners while speaking English in the home does, irrespective of ethnic background

    The impact of SARS-CoV-2 vaccination in Dravet Syndrome: A UK survey

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    Background: The COVID-19 pandemic led to the urgent need for accelerated vaccine development. Approved vaccines have proved to be safe and well tolerated across millions of people in the general population. Dravet Syndrome (DS) is a severe, early onset, developmental and epileptic encephalopathy. Vaccination is a precipitating factor for seizures. Whilst there is no evidence that vaccine-precipitated seizures lead to adverse outcomes in people with DS, fear surrounding vaccination can remain for caregivers of people with DS, in some cases resulting in rejection of recommended vaccinations, leaving individuals more vulnerable to the relevant infections. A greater understanding of the safety profile of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination in this vulnerable group will help provide guidance for caregivers and clinicians when considering vaccination. / Methods: A cross‐sectional survey regarding COVID-19 and SARS-CoV-2 vaccine, in people with DS, was conducted by Dravet Syndrome UK (DSUK). Concomitantly, a review of individuals with DS who had recently received the SARS-CoV-2 vaccine, and who are resident at the Chalfont Centre for Epilepsy (CCE), or attend epilepsy clinics at the National Hospital for Neurology and Neurosurgery (NHNN), was undertaken. / Results: 38 people completed the DSUK survey. 37% of caregivers reported being concerned about someone with DS receiving the SARS-CoV-2 vaccine; with some reporting that they would decline a vaccine when offered. 77% had not received any advice from a health care professional about the SARS-CoV-2 vaccination. 18/38 were eligible for SARS-CoV-2 vaccination, of whom nine had received their first vaccine dose. Combining the results of the DSUK survey and the review of individuals monitored at CCE or NHNN, fifteen people with DS had received their first dose of the SARS-CoV-2 vaccine. 11/15 (73%) reported at least one side effect, the most common being fatigue (6/15; 40%) and fever (6/15; 40%). Three individuals (20%) reported an increase in seizure frequency after the first vaccine dose. No increase in seizure frequency or duration was reported after the second dose. / Conclusion: Overall, these results suggest that SARS-CoV-2 vaccines are safe and well tolerated in individuals with DS, as they are in most people without DS. In most people with DS, SARS-CoV-2 vaccine does not appear to be associated with an increase in the frequency or duration of seizures, even in those who develop fever post-vaccination. Many caregivers are concerned about a person with DS receiving a SARS-CoV-2 vaccine, with some reporting that they would decline a SARS-CoV-2 vaccine when offered. It is crucial that healthcare professionals are proactive in providing accurate information regarding the risks and benefits of vaccination in this population, given the potential for serious outcomes from infection

    Quantifying the Efficiency and Equity Implications of Power Plant Air Pollution Control Strategies in the United States

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    BACKGROUND: In deciding among competing approaches for emissions control, debates often hinge on the potential tradeoffs between efficiency and equity. However, previous health benefits analyses have not formally addressed both dimensions. OBJECTIVES: We modeled the public health benefits and the change in the spatial inequality of health risk for a number of hypothetical control scenarios for power plants in the United States to determine optimal control strategies. METHODS: We simulated various ways by which emission reductions of sulfur dioxide (SO(2)), nitrogen oxides, and fine particulate matter (particulate matter < 2.5 μm in diameter; PM(2.5)) could be distributed to reach national emissions caps. We applied a source–receptor matrix to determine the PM(2.5) concentration changes associated with each control scenario and estimated the mortality reductions. We estimated changes in the spatial inequality of health risk using the Atkinson index and other indicators, following previously derived axioms for measuring health risk inequality. RESULTS: In our baseline model, benefits ranged from 17,000–21,000 fewer premature deaths per year across control scenarios. Scenarios with greater health benefits also tended to have greater reductions in the spatial inequality of health risk, as many sources with high health benefits per unit emissions of SO(2) were in areas with high background PM(2.5) concentrations. Sensitivity analyses indicated that conclusions were generally robust to the choice of indicator and other model specifications. CONCLUSIONS: Our analysis demonstrates an approach for formally quantifying both the magnitude and spatial distribution of health benefits of pollution control strategies, allowing for joint consideration of efficiency and equity

    PB.23: Effect of detector type on cancer detection in digital mammography

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    This work measured the effect that image quality associated with different detectors has on cancer detection in mammography using a novel method for changing the appearance of images.\ud \ud A set of 270 mammography cases (one view, both breasts) was acquired using five Hologic Selenias and two Hologic Dimensions X-ray units: 80 normal, 80 with simulated inserted subtle calcification clusters, 80 with subtle real noncalcification malignant lesions and 30 with benign lesions (biopsy proven). These 270 cases (Arm 1) were converted to appear as if they had been acquired on two other imaging systems: needle image plate computed radiography (CR) (Arm 2) and powder phosphor CR (Arm 3). Three experienced mammography readers marked the location of suspected cancers in the images and classified whether each lesion would require further investigation and the confidence in that decision. Performance was calculated as the area under curve (AUC) of the alternative free-response receiver operating characteristic curv

    Fast field-cycling magnetic resonance detection of intracellular ultra-small iron oxide particles in vitro: Proof-of-concept.

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    PurposeInflammation is central in disease pathophysiology and accurate methods for its detection and quantification are increasingly required to guide diagnosis and therapy. Here we explored the ability of Fast Field-Cycling Magnetic Resonance (FFC-MR) in quantifying the signal of ultra-small superparamagnetic iron oxide particles (USPIO) phagocytosed by J774 macrophage-like cells as a proof-of-principle.MethodsRelaxation rates were measured in suspensions of J774 macrophage-like cells loaded with USPIO (0-200 μg/ml Fe as ferumoxytol), using a 0.25 T FFC benchtop relaxometer and a human whole-body, in-house built 0.2 T FFC-MR prototype system with a custom test tube coil. Identical non-imaging, saturation recovery pulse sequence with 90° flip angle and 20 different evolution fields selected logarithmically between 80 μT and 0.2 T (3.4 kHz and 8.51 MHz proton Larmor frequency [PLF] respectively). Results were compared with imaging flow cytometry quantification of side scatter intensity and USPIO-occupied cell area. A reference colorimetric iron assay was used.ResultsThe T1 dispersion curves derived from FFC-MR were excellent in detecting USPIO at all concentrations examined (0-200 μg/ml Fe as ferumoxytol) vs. control cells, p ≤ 0.001. FFC-NMR was capable of reliably detecting cellular iron content as low as 1.12 ng/µg cell protein, validated using a colorimetric assay. FFC-MR was comparable to imaging flow cytometry quantification of side scatter intensity but superior to USPIO-occupied cell area, the latter being only sensitive at exposures ≥ 10 µg/ml USPIO.ConclusionsWe demonstrated for the first time that FFC-MR is capable of quantitative assessment of intra-cellular iron which will have important implications for the use of USPIO in a variety of biological applications, including the study of inflammation
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