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Stratifying areas at risk of housing insecurity among families with children: a multidimensional index for the improvement of policy interventions in England
Get PDFBackground
Housing insecurity resulting from multiple, involuntary residential moves is detrimental to the health and wellbeing of families with children. Policy makers seeking to mitigate these negative effects require a measure of risk of housing insecurity. Here we present the development of a novel risk index for England.
Methods
We undertook a literature review to select drivers of housing insecurity and identify relevant metrics. We recruited a practitioner panel to rank and weight these metrics using a Likert survey. The weighted metrics were summed for each small area (Lower Super Output Area) in England to produce the overall risk score. The score was then stratified into five levels, from very low to very high, linked to geographical units for data mapping. The final index (called the “Families at Risk of Housing Insecurity Index”) was made available on a public data platform.
Results
Eight drivers of housing insecurity were identified from the literature review as follows, (variable type and weight shown in brackets): primary school pupils eligible for free school meals (%, 0.5); income deprivation affecting children (%, 0.5); residential mobility (decile, 0.4); lone parent households (%, 0.3); pre-1919 dwellings (%, 0.3); households in fuel poverty (%, 0.3); households with dependent children in which the reference person is of Asian or Asian British, Black, Black British, or Caribbean ethnicity (%, 0.2); mental health (Small Area Mental Health Index; decile, 0.1).Analysis of the index indicated a highly varied distribution of risk across England. Two noteworthy findings were the greater proportion of very high risk areas in Greater London, possibly indicating the impact of higher living costs in the capital city region. The index also suggested there were areas at higher risk in generally more affluent settings, possibly due to a greater proportion of older housing stock in these locations.
Conclusion
The Families at Risk of Housing Insecurity Index (FRoHII) was composed of metrics from public datasets at the small area level. The index provides a public resource to help identify areas where families with children might be at risk of housing insecurity. The index constitutes a tool and resource for professionals seeking to provide support to families within their catchment areas
Envisioning the Future of Work: From Ideas to Reforms
Get PDFTwo different theoretical perspectives concerning technology and the future of work are examined. One is linked to mainstream economics, whereas the other is associated with critical (‘post-work’) discourse. Ideas about work—its nature and impacts on well-being—matter in both perspectives. Indeed, they shape visions of a ‘better’ or ‘ideal’ future. They also influence policy responses to new technology. A critique is presented of the ways that work and its possible futures are understood. This critique is used to develop a different set of ideas about how technology might be harnessed to reduce the burden and raise the quality of work. The ability of ideas to effect reforms in and of work—ideas that have currency now and possible radical alternatives—is also assessed
Residual lung abnormality following COVID-19 hospitalisation is characterised by biomarkers of epithelial injury
Get PDFBackground
Long term respiratory symptoms are reported following recovery of acute COVID-19 infection and residual lung abnormalities (RLA) on follow-up thoracic computed tomography (CT) after COVID-19 hospitalisation have been observed. It is unknown whether RLA are associated with epithelial lung injury.
Methods
Plasma was sampled from the observational Post HOSPitalisation-COVID cohort at five months post-hospitalisation. Epithelial injury biomarkers Krebs von den Lungen-6 (KL-6), matrix metalloproteinase 7 (MMP-7), surfactant protein-D (SP-D) and surfactant protein-A (SP-A) were assayed. In those without follow-up CT, RLA at-risk was defined by percent predicted DLCO <80% and/or abnormal chest X-ray, otherwise they were considered low-risk. Follow-up CT RLA was defined as combined involvement of ground glass opacity and reticulation ≥10%.
Findings
A total of 957 people were included, 846 people with no CT (at-risk n = 103; 12.2%), 111 people with follow-up CT (RLA ≥10% n = 85; 76.6%). All epithelial injury biomarkers were significantly elevated in people at-risk of RLA compared with low-risk. KL-6 and MMP-7 were significantly higher in people with ≥10% RLA than those with <10%, SP-D and SP-A did not reach significance. SP-D and SP-A were associated with percent involvement of reticulation (3.22%, 95% CI 1.19–5.24; 3.03%, 95% CI 0.76–5.30, respectively).
Interpretation
RLA after acute COVID-19 infection were consistent with elevated epithelial injury biomarkers and pro-fibrotic signalling. Future studies should address the temporal association between fibrotic biomarkers and resolution or progression of radiological involvement.
Funding
MRC-UK Research and Innovation and National Institute for Health Research (NIHR) rapid response panel to tackle COVID-19 (MR/V027859/1; COV0319; MR/W006111/1)
Region Embedding With Adaptive Correlation Discovery for Predicting Urban Socioeconomic Indicators
Get PDFA recent trend in urban computing involves utilizing multi-modal data for urban region embedding, which can be further expanded in a variety of downstream urban sensing tasks. Many previous studies rely on multi-graph embedding techniques and follow a two-stage paradigm: first building a k-nearest neighbor graph based on fixed region correlations for each view, and then blending multi-view information in a posterior stage to learn region representations. However, multi-graph construction and multi-graph representation learning are not associated in most existing two-stage studies, and the relationship between them is not leveraged, which can provide complementary information to each other. In this paper, we unify these two stages into one by constructing learnable weighted complete graphs of regions and propose a new one-stage Region Embedding method with Adaptive region correlation Discovery (READ). Specifically, READ comprises three modules, including a disentangled region feature learning module utilizing a city-context Transformer to encode regions’ semantic and mobility features, and an adaptive weighted multi-graph construction module that builds multiple complete graphs with learnable weights based on disentangled features of regions. In addition, we propose a multi-graph representation learning module to yield effective region representations that integrate information from multiple graphs. We conduct thorough experiments on three downstream tasks to assess READ. Experimental results demonstrate that READ considerably outperforms state-of-the-art baseline methods in urban region embedding
Predicting the formation of mud cracks in Li-ion battery electrodes during the drying process with in situ X-ray computed tomography
Get PDFDrying of slurry cast electrodes is amongst the most energy intensive unit operations in battery manufacture. In spite of this, the optimisation of drying processes has been highly empirical, and there remains limited understanding of the interplay between drying dynamics and resulting microstructure. In this work, we used synchrotron X-ray computed microtomography in order to study the formation of mud cracks during the drying process, and evaluate their impact on the electrode microstructure. This was achieved by applying a reduced drying rate, which proved to be an effective means of studying the drying mechanism with a greater resolution and image contrast than otherwise possible. The rate of crack growth is measured, and the differing crack morphology resultant from changes in thickness (between 300 and 800 µm doctor blade gaps) and the presence of air bubbles in the slurry is demonstrated. Digital volume correlation is utilised to identify the specific location of crack formation before these cracks were visible, suggesting image correlation methods as an appropriate tool for process feedback in order to control or eliminate mud cracking. This new approach which enables direct quantification of the evolving microstructure during dynamic drying, in 3D, is therefore transformative in our understanding of the underlying physical processes and will guide rational optimisation of this industrially significant process
Myosin 7a is required for maintaining the transducing stereocilia and for force transmission to the MET channel during cochlear hair cell development
Get PDFShaker-1 mice carry a spontaneous missense mutation in Myo7a (Myo7aSh1) that interferes with the motor function of MYO7A. Mutation in the orthologous gene in humans causes syndromic (Usher 1B) or non-syndromic forms of deafness. In hair cells, MYO7A is expressed throughout the stereocilia, where it has been implicated in tip-link tensioning required for gating the mechanoelectrical transducer (MET) channel and setting its resting open probability (Po). The Myo7aSh1 mutation progressively dysregulated the height of shorter stereocilia rows from the end of the first postnatal week onwards, associated with reduced MET current amplitude and hearing loss. Noise exposure exacerbated stereocilia dysfunction in Myo7aSh1/Sh1 mice. Following the onset of maturation, hair cells from Myo7aSh1/Sh1 mice showed normal resting Po and calcium sensitivity of the MET channel. In immature Myo7aSh1/Sh1 hair cells, the resting Po was very small or absent in comparison to control cells, but it was restored by changing the membrane lipid bilayer fluidity or thickness by depleting cholesterol or PIP2. Bundle stiffness in immature IHCs was not affected by the absence of functional MYO7A but decreased after their onset of maturation in both genotypes. Expression of a subset of genes was affected similarly in immature Myo7aSh1/Sh1 mice and in adult Myo7a conditional knockout mice, indicating a common response pathway in Myo7a-deficient mice. This study reveals that MET channel gating might differ depending on hair cell developmental stage, and MYO7A is likely to influence, albeit indirectly, force transmission via the lipid bilayer to the MET channel and maintenance of the shorter rows of transducing stereocilia.
Key points
Shaker-1 mice carry a spontaneous missense mutation in the shaker-1 gene (Myo7aSh1) that interferes with the motor function of MYO7A, a protein expressed in hair-cell stereocilia.
The absence of functional MYO7A (Myo7aSh1/Sh1 mice) caused a progressive dysregulation in the height of the shortest two rows of stereocilia and the consequent loss of mechanoelectrical transduction (MET) current.
Although immature hair cells from Myo7aSh1/Sh1 mice exhibited a markedly reduced resting open probability of their MET channels, this was restored upon maturation or following depletion of cholesterol or PIP2 from the lipid bilayer.
Hair-bundle stiffness was affected in immature inner hair cells from Myo7aSh1/Sh1 mice, suggesting that MYO7A is not required for establishing the resting tension of the tip links gating the MET channels.
We conclude that MYO7A is crucial for the structural integrity of the MET complex and transport of key proteins required to transfer forces efficiently from the lipid bilayer to the MET channel
‘Public opinion in England is seriously roused’: popular attitudes and national stereotypes during the Metropolitan-Vickers crisis of 1933
Get PDFWhen six British engineers working in the Soviet Union, along with several local contractors, were arrested, interrogated and tried for the crimes of sabotage, bribery and espionage in March 1933, British people reacted indignantly against the Soviet ‘other’, defending their own sense of the national persona against the seemingly alien ideology of Bolshevik rule. The Metropolitan-Vickers crisis was therefore charged with symbolic importance. The case created an opportunity to override self-doubt and revivify historical grandeur in the diplomatic arena, thereby suppressing a widespread sense of uncertainty about Britain’s place in the world, not least over its economic performance, political model and continued imperial hegemony. Newspapers and periodicals facilitate consideration of the popular mood, revealing how idealised versions of the British character—often in competition contingent on one’s opinion about Britain’s global role—were projected onto the engineers and their relatives in Britain. Equally, the case was used to reaffirm competing arguments about the Soviet experiment: the backwardness of Communism versus emotional investment in its objectives irrespective of practical reality. When Soviet figures were denounced as ‘Oriental’ or ‘Asiatic’, this offered an obvious contrast with the grandiosity of constructed British identities, providing a comforting act of national reassurance. This article opens a new historiographical angle on the politics of the crisis, as well as on the broader tenor of Anglo-Soviet relations in the inter-war period
Analysis of familial exudative vitreoretinopathy (FEVR) cases in the UK 100 000 genomes project increases diagnostic rate and implicates heterozygous CTNND1 mutations in FEVR
No full textBackground
Familial exudative vitreoretinopathy (FEVR) is an inherited eye disease characterised by the incomplete development of the retinal vasculature. Over 10 genes have been associated with FEVR, but there are still a substantial number of genetically unsolved cases. The aim of this study was to analyse whole genome sequencing (WGS) data from the FEVR cases in the Genomics England (GEL) 100 000 genomes project to identify the causative variants.
Methods
WGS was performed by GEL and accessed within the GEL Research Environment. FEVR cases were identified using LabKey and candidate variants were extracted using the ‘gene-variant workflow’ and ‘CNV/SV workflow’ and by using BCFtools in unfiltered VCF files.
Results
Fifty-nine FEVR probands were submitted to GEL. We found six novel and eight previously reported pathogenic variants in six genes known to underlie FEVR (TSPAN12, LRP5, FZD4, CTNNB1, KIF11 and NDP), as well as structural variants in TSPAN12 and KIF11. These accounted for 15/59 (25.4%) of FEVR cases. We also found candidate heterozygous variants in CTNND1 in three unsolved FEVR cases. Expanding the list of genes examined to include all genes reported to be mutated in ocular disorders likely solved a further four cases, indicating that these individuals may be misclassified as FEVR in GEL.
Conclusion
By performing bespoke reanalysis of the FEVR GEL cohort, this study has highlighted additional heterozygous variants in CTNND1 in FEVR cases and increased the diagnostic yield from 20% solved by the GEL analysis pipeline to 37% (22/59), but the majority of FEVR cases remain without a molecular diagnosis
Home-based extended rehabilitation for older people with frailty (HERO): a multicentre randomised controlled trial with health economic analysis and process evaluation.
No full textBackground: Half of older people in hospital have frailty and are at increased risk of re-admission or death following discharge. Although short-term rehabilitation can reduce early re-admissions, benefits are attenuated over time. It is unknown whether extended rehabilitation for older people with frailty can improve outcomes.
Trial design: Pragmatic, multicentre, individually randomised controlled parallel-group superiority trial with economic evaluation and embedded process evaluation.
Methods: Participants: Eligible participants were 65 years or older with mild/moderate/severe frailty (score of 5-7 on Clinical Frailty Scale) admitted to hospital with acute illness or injury, then discharged home directly or from intermediate care (post-acute care) rehabilitation services. People with significant cognitive impairment and care home residents were among those ineligible. Recruitment took place from December 2017 to August 2021, with follow-up till August 2022. Interventions: Participants were randomly assigned (1.28 : 1) to the Home-based Older People's Exercise programme - a 24-week home-based manualised, progressive exercise intervention delivered by National Health Service therapists as extended rehabilitation, or usual care (control). Randomisation occurred after the participant had been discharged from hospital or intermediate care. Participants were not masked to allocation. Main outcome measures: The primary outcome was physical health-related quality of life, measured using the physical component score of the modified Short Form 36-item health questionnaire at 12 months. Secondary outcomes at 6 and 12 months included physical and mental health-related quality of life, functional independence, death, hospitalisations and care home admissions. Researchers involved in data collection were masked to allocation. Data sources: Primary and secondary outcomes were obtained via self-report questionnaire at 6 and 12 months. Hospitalisations and deaths were collected from routine healthcare data.
Results: We randomised 740 participants (410 Home-based Older People's Exercise, 330 control) across 15 sites. Four hundred and seventy-nine (64.7%) participants completed 12-month follow-up. One hundred and eighty-eight Home-based Older People's Exercise participants (45.9%) completed 24 weeks of intervention delivery. Over half of participants completed more than 75% of prescribed exercises. Intention-to-treat analyses (258 Home-based Older People's Exercise participants, 208 control participants for primary outcome) showed no evidence that Home-based Older People's Exercise was superior to control for 12-month physical component score (adjusted mean difference -0.22, 95% confidence interval -1.47 to 1.03; p = 0.73). There was some evidence of a higher rate of all-cause hospitalisations in the control arm (incidence rate ratio 1.12, 95% confidence interval 1.00 to 1.25; p = 0.05), but no evidence of differences in other outcomes. The process evaluation found the intervention was largely delivered as intended and proved acceptable to most participants. The economic analysis showed incremental costs of Home-based Older People's Exercise plus usual care of GB£1401 (mean per participant), compared with usual care alone. There was a 0.024 quality-adjusted life-year improvement in Home-based Older People's Exercise compared to control. The incremental cost-effectiveness ratio was £58,375.
Limitations: This trial was delivered during especially challenging circumstances that included the COVID-19 pandemic. We examined outcomes taking account of this but detected no difference in primary or secondary outcomes, providing reassurance that COVID-19 was unlikely to have influenced trial results.
Conclusions: Based on our findings, we do not recommend routine commissioning of extended rehabilitation for older people with frailty after discharge home from hospital or intermediate care, following an acute admission with illness or injury.
Future work: Future work should consider how existing core intermediate care and community rehabilitation services should be best organised and delivered to ensure that older people with frailty feel ready for discharge from rehabilitation, and are enabled to maintain their independence.
Funding: This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 15/43/07
Dynamics of car consumption and attitudes towards car characteristics: Insights from a large-scale panel model in the United Kingdom
Get PDFThe current study aims to understand the dynamics between the importance people place on different car characteristics when purchasing a car (labelled as car-related attitudes in this study) and their car consumption (car use and the number of cars owned) over time. Using data from the UK Household Longitudinal Study (UKHLS), we conceptualize bidirectional effects between car-related attitudes, the number of cars owned, and car use among those who access at least a car in their households and test how and which element comes first in impacting the other elements over time. Employing a two-wave cross-lagged panel model with a two-year lag on a large-scale sample (n = 17,198), and considering covariates, the results reveal existence of bidirectional but asymmetric effects between these three elements. Interestingly, the number of cars has the greatest effect on the two other elements. Car consumption influences car-related attitudes larger than the reverse effect. In particular, over time, a higher number of cars and higher levels of car use more strongly affect declines in the weight individuals place on environmental considerations when purchasing a car (e.g., engine size, CO2 emissions, or electric propulsion). This effect is larger than that of environmental considerations on shedding cars or reducing car use
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