Challenges and solutions for autism in academic geosciences

Researcher diversity promotes research excellence. But academia is widely perceived as inaccessible to those who work in non-stereotypical ways, and disabled researchers are consequently chronically under-represented within higher education. The barriers that academia presents to the inclusion and success of disabled individuals must therefore be understood and removed in order to enhance researcher diversity and improve the quality and quantity of research. Autism is a disability that is particularly under-represented within higher education, despite many autistic individuals having attributes that are conducive to research excellence. With a focus on geosciences, we use the experiences of an autistic PhD student to evaluate why academia can be inaccessible, and propose simple strategies that can reduce and remove barriers to academic success. We suggest that minor changes to communication, the academic environment and better disability awareness can make significant differences to the inclusion of disabled researchers, particularly those with autism. These changes would also benefit the wider scientific community and promote research and teaching excellence

Spectacular Shells in the Host Galaxy of the QSO MC2 1635+119

We present deep HST/ACS images and Keck spectroscopy of MC2 1635+119, a QSO hosted by a galaxy previously classified as an undisturbed elliptical. Our new images reveal dramatic shell structure indicative of a merger event in the relatively recent past. The brightest shells in the central regions of the host are distributed alternately in radius, with at least two distinct shells on one side of the nucleus and three on the other, out to a distance of ~13 kpc. The light within the five shells comprises ~6% of the total galaxy light. Lower surface brightness ripples or tails and other debris extend out to a distance of ~65 kpc. A simple N-body model for a merger reproduces the inner shell structure and gives an estimate for the age of the merger between ~30 Myr and ~1.7 Gyr, depending on a range of reasonable assumptions. While the inner shell structure is suggestive of a minor merger, the total light contribution from the shells and extended structures are more indicative of a major merger. The spectrum of the host galaxy is dominated by a population of intermediate age (~1.4 Gyr), indicating a strong starburst episode that may have occurred at the time of the merger event. We speculate that the current QSO activity may have been triggered in the recent past by either a minor merger, or by debris from an older (~Gyr) major merger that is currently ``raining'' back into the central regions of the merger remnant.Comment: 14 pages, 5 figures. Accepted for publication in the Astrophysical Journa

Reducing failure to rescue rates in a paediatric in‐patient setting: A 9‐year quality improvement study

Aim: To identify and quantify Failure to Rescue (FtR) episodes from emergency events at a large children’s hospital and understand the impact of targeted interventions on reducing FtR. Methods: A quality improvement approach was adopted. From 2011 – 2019 all emergency event calls were systematically reviewed prospectively to identify FtR episodes. Root-cause analysis was performed to identify practice deficiencies. The Plan-Do-Study-Act fundamentals were used. Results: A total of 520 (100%) emergency events were reviewed, with yearly mean of 58 events (SD 13, range 41- 81). Cardiac arrest events were the most common 132 (25.8%). Out of the total 132 (100%) cardiac arrest events, 116 (88%) occurred in paediatric critical care unit and only 16 (12%) occurred in general paediatric wards. Three hundred and twelve (60%) of the events were observed in children who had been inpatient for > 48 hours. Observed FtR figures over the nine years was characterised by high rate of 23.6% in 2011 when the project commenced followed subsequently by a sharp decrease after interventions and remained at 2.5% or below for the last six years.Conclusion: Identifying rates of FtR events from routinely collected emergency events data can be used as a patient safety measure to identify emergency concerns. This enables progressive dynamic problem solving through delivery of strategic targeted interventions. The proposed interventions outlined in this quality improvement study have application to critical care nursing as mechanisms for reducing in-hospital unplanned admissions to paediatric critical care

Mixed methods study of clinicians' perspectives on barriers to implementation of treat to target in psoriatic arthritis

Objectives: In treat to target (T2T), the patient is treated to reach and maintain specified and sequentially measured goals, such as remission or low disease activity. T2T in psoriatic arthritis (PsA) has demonstrated improved clinical and patient-reported outcomes and is recommended in European guidelines. However, most clinicians do not use T2T in PsA. This study examined the barriers and enablers to implementation in practice. Methods: Sequential mixed methods comprising a qualitative design (interviews and focus group) to inform a quantitative design (survey). Qualitative data were analysed thematically, and quantitative statistics were analysed descriptively. Results: Nineteen rheumatology clinicians participated in telephone interviews or a face-to-face focus group. An overarching theme 'Complexity' (including 'PsA vs Rheumatoid Arthritis', 'Measurement' and 'Resources') and an underpinning theme 'Changes to current practice' (including 'Reluctance due to organisational factors' and 'Individual determination to make changes') were identified. 153 rheumatology clinicians responded to an online survey. Barriers included limited clinical appointment time to collect outcome data (54.5%) and lack of training in assessing skin disease (35%). Enablers included provision of a protocol (86.4%), a local implementation lead (80.9%), support in clinic to measure outcomes (83.3%) and training in T2T (69.8%). The importance of regular audit with feedback, specialist PsA clinics and a web-based electronic database linked to hospital/national information technology (IT) systems were also identified as enablers. Conclusions: Implementation of T2T in PsA requires an integrated approach to address the support, training and resource needs of individual clinicians, rheumatology teams, local IT systems and service providers to maximise success

Making the most of the Mogi model: Size matters

Magma movements are almost universally associated with volcanic deformation. The Mogi (1958) and McTigue (1987) models link observed surface displacements to behaviour within inaccessible magmatic plumbing systems. Mogi and McTigue models are well-used due to their computational simplicity and ease of application, but both models are limited by their assumptions about the deformation source and its embedding domain. Domain assumptions, including elasticity, homogeneity, and flat topography, have been previously described and corrected for. Whilst recognising the limits of these models, their frequent use in the literature requires an objective assessment of their utility against more sophisticated Finite Element (FE) models, their operational limits (radius-to-depth ratio, ε) and their relative merits in the light of limited field data. Here, we relax the source assumption of a small ε. We simulate volcanic deformation using Mogi, McTigue and FE models - the latter unrestricted by ε - to validate the maximum ε for which the analytical models can be applied, and to compare analytical and FE interpretations of deformation data from Kīlauea Volcano, Hawai'i. We find that analytical and FE models correspond for deformation sources with a range of ε that is wider than previously suggested limits. The differences between simulated surface displacements (forward modelling) and estimated deformation source parameters (inverse modelling) are less than 5% when ε < 0.37 (Mogi) or ε < 0.59 (McTigue). Misfits between analytical and FE models depend on whether radial or vertical displacements are considered simultaneously or independently, and on the values of source radius and depth - not only their ratio, as was assumed previously. There is little or no difference between best-fitting source parameters inferred using Mogi, McTigue and FE models at Kīlauea Volcano, despite the high ε of the system geometry, but sometimes poor correspondences between model results and GNSS observations. Our results demonstrate that Mogi and McTigue models can be applied to volcanoes with a wider range of magma reservoir radii and depths than was hitherto supposed, but previously-established corrections for domain simplifications are necessary to accurately interpret volcanic deformation

Personal non-commercial use only

ABSTRACT. Objective. The central strategy for effective gout management is longterm urate-lowering therapy to maintain the serum urate at a level below 0.36 mmol/l. We sought to determine the prevalence of gout and the quality of care in a national Australian general practice population. Methods. Data were from general practice point-of-care electronic records over a 5-year period (n = 1,479,449). Information was collected on patients with gout according to a validated definition. All patients who visited the same general practices over the study period formed the denominator group. We determined the estimated prevalence of gout, the frequency of allopurinol prescription, and serum urate testing, and the percentage of patients achieving a target serum urate level. Results. The crude prevalence of gout in this general practice population was 1.54% (95% CI 1.52-1.56). Prevalence in men was 2.67% and in women 0.53%. Prevalence increased with age in both men and women (4.90%, 95% CI 4.82-4.99, in men &gt; 65 yrs). Allopurinol was prescribed to 57% of patients with gout during the 5 years of the study. Only 55% of patients with gout had their serum urate tested at any time during the 5-year study period. A target serum urate concentration of &lt; 0.36 mmol/l at any time during the 5-year study period was documented in 22.4% of all people with gout. Conclusion. Gout is managed poorly in Australian primary care, with low levels of allopurinol prescribing and serum urate testing. Collectively, these factors probably contribute to low achievement of serum urate targets

Personal non-commercial use only

ABSTRACT. Objective. The central strategy for effective gout management is longterm urate-lowering therapy to maintain the serum urate at a level below 0.36 mmol/l. We sought to determine the prevalence of gout and the quality of care in a national Australian general practice population. Methods. Data were from general practice point-of-care electronic records over a 5-year period (n = 1,479,449). Information was collected on patients with gout according to a validated definition. All patients who visited the same general practices over the study period formed the denominator group. We determined the estimated prevalence of gout, the frequency of allopurinol prescription, and serum urate testing, and the percentage of patients achieving a target serum urate level. Results. The crude prevalence of gout in this general practice population was 1.54% (95% CI 1.52-1.56). Prevalence in men was 2.67% and in women 0.53%. Prevalence increased with age in both men and women (4.90%, 95% CI 4.82-4.99, in men &gt; 65 yrs). Allopurinol was prescribed to 57% of patients with gout during the 5 years of the study. Only 55% of patients with gout had their serum urate tested at any time during the 5-year study period. A target serum urate concentration of &lt; 0.36 mmol/l at any time during the 5-year study period was documented in 22.4% of all people with gout. Conclusion. Gout is managed poorly in Australian primary care, with low levels of allopurinol prescribing and serum urate testing. Collectively, these factors probably contribute to low achievement of serum urate targets

Effect of mineralocorticoid receptor antagonists on proteinuria and progression of chronic kidney disease: a systematic review and meta-analysis

Background: Hypertension and proteinuria are critically involved in the progression of chronic kidney disease. Despite treatment with renin angiotensin system inhibition, kidney function declines in many patients. Aldosterone excess is a risk factor for progression of kidney disease. Hyperkalaemia is a concern with the use of mineralocorticoid receptor antagonists. We aimed to determine whether the renal protective benefits of mineralocorticoid antagonists outweigh the risk of hyperkalaemia associated with this treatment in patients with chronic kidney disease. Methods: We conducted a meta-analysis investigating renoprotective effects and risk of hyperkalaemia in trials of mineralocorticoid receptor antagonists in chronic kidney disease. Trials were identified from MEDLINE (1966–2014), EMBASE (1947–2014) and the Cochrane Clinical Trials Database. Unpublished summary data were obtained from investigators. We included randomised controlled trials, and the first period of randomised cross over trials lasting ≥4 weeks in adults. Results: Nineteen trials (21 study groups, 1 646 patients) were included. In random effects meta-analysis, addition of mineralocorticoid receptor antagonists to renin angiotensin system inhibition resulted in a reduction from baseline in systolic blood pressure (−5.7 [−9.0, −2.3] mmHg), diastolic blood pressure (−1.7 [−3.4, −0.1] mmHg) and glomerular filtration rate (−3.2 [−5.4, −1.0] mL/min/1.73 m2). Mineralocorticoid receptor antagonism reduced weighted mean protein/albumin excretion by 38.7 % but with a threefold higher relative risk of withdrawing from the trial due to hyperkalaemia (3.21, [1.19, 8.71]). Death, cardiovascular events and hard renal end points were not reported in sufficient numbers to analyse. Conclusions: Mineralocorticoid receptor antagonism reduces blood pressure and urinary protein/albumin excretion with a quantifiable risk of hyperkalaemia above predefined study upper limit

High resolution 16S rRNA gene Next Generation Sequencing study of brain areas associated with Alzheimer’s and Parkinson’s disease

IntroductionAlzheimer’s (AD) and Parkinson’s disease (PD) are neurodegenerative conditions characterized by incremental deposition of β-amyloid (Aβ) and α-synuclein in AD and PD brain, respectively, in relatively conserved patterns. Both are associated with neuroinflammation, with a proposed microbial component for disease initiation and/or progression. Notably, Aβ and α-synuclein have been shown to possess antimicrobial properties. There is evidence for bacterial presence within the brain, including the oral pathobiont Porphyromonas gingivalis, with cognitive impairment and brain pathology being linked to periodontal (gum) disease and gut dysbiosis.MethodsHere, we use high resolution 16S rRNA PCR-based Next Generation Sequencing (16SNGS) to characterize bacterial composition in brain areas associated with the early, intermediate and late-stage of the diseases.Results and discussionThis study reveals the widespread presence of bacteria in areas of the brain associated with AD and PD pathology, with distinctly different bacterial profiles in blood and brain. Brain area profiles were overall somewhat similar, predominantly oral, with some bacteria subgingival and oronasal in origin, and relatively comparable profiles in AD and PD brain. However, brain areas associated with early disease development, such as the locus coeruleus, were substantially different in bacterial DNA content compared to areas affected later in disease etiology