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Secondary analysis of the Game of Stones trial for men with obesity: examining moderator effects and exploratory outcomes
Get PDFObjective:
To explore whether socio-economic, health and behavioural characteristics moderate effectiveness of a text message intervention with or without financial incentives versus a control group, and to examine differences in exploratory outcomes.
Methods:
Three-group randomized trial including 585 men with obesity comparing daily automated behavioural text messages for 12-months alongside financial incentives; text messages alone; or a waiting list control. Moderator analyses examined percent weight change after 12 months for 9 socio-economic and 11 health factors. Exploratory outcomes included: self-reported physical activity, sedentary behaviour, smoking and alcohol behaviours, engagement in 15 weight management strategies, and weight-management related confidence.
Results:
No moderator effects were found by any factors for either comparison versus control. There were no differences between groups for health behaviours. The texts with incentives group had higher levels of engagement in six strategies including weight goals, food changes and self-weighing, and higher levels of confidence compared to controls.
Conclusion:
The Game of Stones interventions were equally effective across various sub-groups based on socio-economic, health or wellbeing status. Texts with financial incentive group participants showed better engagement for some intervention elements. The implementation of Game of Stones is unlikely to increase health inequalities. Future studies should focus on increasing engagement
Participatory-deliberative processes in UK policy making related to income insecurity as a determinant of health: a scoping review
Get PDFBackground:
Deepening democratic engagement in socio-economic policy domains is of increasing interest to the health inequalities research community. However, there is a recognised gap between theory and the practical application of public participation. Viewing income security as a fundamental determinant of health, this article investigates how, when and where participatory-deliberative processes (PDPs) were applied in policy making connected to income, in the UK, from January 2007 to June 2022.
Methods:
The review applied the PRIMSA-ScR checklist. Searches were conducted in: EconLit, SOC Index, Sociological Abstracts, MedLine; and grey literature sources: BASE database, government, non-governmental organisation websites for articles related to PDPs in income-related policy making in the UK, published after 1 January 2007. Articles were synthesised through a conceptual framework combining Whitehead’s typology of actions to tackle health inequalities and Smith’s categorisation of democratic goods.
Findings:
The review found 20 articles relating to 13 PDPs. A majority of PDPs took place in Scottish Government/ Parliament or at Local Authority/NHS Trust level in England and Wales. A variety of types of PDPs were used by policy-making institutions across a range of socio-economic domains, with varying degrees of information provided about participants and policy outcomes.
Discussion and conclusions:
Findings demonstrate a multitude of disconnects between participatory rhetoric and reality. There is no evidence of PDPs influencing macro socio-economic policy making, with participatory decision-making instead dispersed across less empowered, downstream spaces. Democratising socio-economic policy domains requires critical reflection on the fractured nature of participatory policy making, the locus of decision-making power and how inclusion is realised in participation spaces
Variable rates of SARS-CoV-2 evolution in chronic infections
Get PDFAn important feature of the evolution of the SARS-CoV-2 virus has been the emergence of highly mutated novel variants, which are characterised by the gain of multiple mutations relative to viruses circulating in the general global population. Cases of chronic viral infection have been suggested as an explanation for this phenomenon, whereby an extended period of infection, with an increased rate of evolution, creates viruses with substantial genetic novelty. However, measuring a rate of evolution during chronic infection is made more difficult by the potential existence of compartmentalisation in the viral population, whereby the viruses in a host form distinct subpopulations. We here describe and apply a novel statistical method to study within-host virus evolution, identifying the minimum number of subpopulations required to explain sequence data observed from cases of chronic infection, and inferring rates for within-host viral evolution. Across nine cases of chronic SARS-CoV-2 infection in hospitalised patients we find that non-trivial population structure is relatively common, with five cases showing evidence of more than one viral population evolving independently within the host. The detection of non-trivial population structure was more common in severely immunocompromised individuals (p = 0.04, Fisher’s Exact Test). We find cases of within-host evolution proceeding significantly faster, and significantly slower, than that of the global SARS-CoV-2 population, and of cases in which viral subpopulations in the same host have statistically distinguishable rates of evolution. Non-trivial population structure was associated with high rates of within-host evolution that were systematically underestimated by a more standard inference method
Reflecting on a Triple Helix Transdisciplinary Collaboration for Postgraduate Course Development
Get PDFSkills provision within MSc programmes has historically been delivered by academic teaching staff with limited input from external partners. However, courses which foster knowledge exchange between university academics and industry professionals, are more relevant. Despite postgraduate student numbers increasing to record levels, here in the UK, there is a widely accepted “graduate skills gap”. Students that have obtained sought after transferable skills or have undertaken industry-relevant experience will likely be more valued by employers. Working and learning are no longer considered as two distinct entities and when real-world perspectives are brought into teaching, they enrich student learning. As educators, we need to support the employability of our students by including training from both within and outside academia. Partnering with third-space industry professionals to create authentic experiences and assessment, better support students in their future careers.
In this paper, we reflect on our transdisciplinary triple helix approach which involves expert university academics, professional industrial partners, and training by an accredited government body. This model was used to create an optional post-graduate in vivo research skills course which was offered to students for the first time this year. This course embeds two authentic real-world assessments which have been developed with industry partners. Students can obtain an additional accredited qualification in the field of animal experimentation since the UK Home Office personal licence certification is part of the assessment. In addition, students take part in an experimental design assessment which was created by an industry expert and is highly applicable in animal research. Not only do these assessments reinforce the relevance of the work-based activities but align education outcomes with employer expectations.
Here, we reflect on our personal experience of using transdisciplinary collaboration to foster authentic work-related learning and assessment. We examine our perceived achievements and challenges, and our perception of transdisciplinary learning on the student experience. We believe that this critical self-examination allows us to exchange our knowledge and experience with other academics wishing to incorporate a similar triple helix approach
Weighing in on obesity and psoriatic arthritis – time to move beyond association to robust randomised trials
Get PDFAlmost one in two individuals with psoriatic arthritis (PsA) are now living with obesity. Obesity increases the risk of developing PsA, worsens disease activity, pain and fatigue, impairs treatment response, and amplifies the risk of many cardiometabolic comorbidities already more prevalent in PsA. Despite the increasing evidence for the pathogenic role of obesity in PsA, current treatment focuses on immune mediated therapies, with limited attention to tackling excess adiposity. Residual pain and disease activity in PsA can in turn adversely impact physical activity, leading to a cycle of further weight gain and worse disease activity. Preliminary evidence from dietary interventions in patients with PsA and obesity suggests weight loss of ≥5% body weight can improve disease activity, holding promise for potentially even better improvements with newer pharmacological anti-obesity therapies, such as incretin-based weight loss medicines, which result in average weight losses of 15-20%. In this narrative review, we provide an overview of the adverse impacts of obesity in PsA and discuss weight loss therapies now available to help address this. We highlight the urgent need for robust randomised controlled trials of weight loss therapies in patients with PsA and obesity to determine their clinical and cost effectiveness in PsA management and to inform where these are best implemented in the disease course and treatment pathway
Occupational differences in COVID-19 hospital admission and mortality risks between women and men in Scotland: a population-based study using linked administrative data
Get PDFObjectives: Occupations vary with respect to workplace factors that influence exposure to COVID-19, such as ventilation, social contacts and protective equipment. Variations between women and men may arise because they have different occupational roles or behavioural responses. We estimated occupational differences in COVID-19 hospital admission and mortality risks by sex.
Methods: We combined (1) individual-level data from 2011 Census with (2) health records and (3) household-level information from residential identifiers, using a Scottish cohort of 1.7 million adults aged 40–64 years between 1 March 2020 and 31 January 2021. We estimated age-standardised COVID-19 hospital admission and mortality rates, stratified by sex and occupation. Cox proportional hazards models were adjusted for pre-pandemic health and occupational exposure factors, including interaction effects between occupation and sex.
Results: Women had lower age-standardised COVID-19 hospital admission and mortality rates than men. Among women, adjusted death risks were lowest for health professionals, and those in associate professional and technical occupations (paramedics and medical technicians), with the latter supported by results from the interaction model. Among men, elevated adjusted admission and death risks were observed for large vehicle and taxi drivers. Additionally, admission risks remained high among men in caring personal services (including home and care workers), while elevated risks were observed among women in customer service occupations (call centre operators) and process, plant and machine operative roles (assemblers and sorters).
Conclusions: Occupational differences in COVID-19 hospital admission and mortality risks between women and men highlight the need to account for sex differences when developing interventions to reduce infections among vulnerable occupational groups
The use of complainers’ sexual history and character evidence in Scottish rape and attempted rape trials
No full textThis article presents findings from an empirical project reviewing the operation of the Scottish ‘rape shield’ provisions. It provides much-needed data on the current application of the rape shield in adult rape and attempted rape cases. Through in-depth interviews, observations of pre-trial and trial hearings and case file analysis, our study provides insights into shifts in the interpretation and enforcement of the rape shield, as well as a broader understanding of the attitudes of police, defence counsel, judges, Rape Crisis advocacy workers, and complainers, about how the regime has been designed, reformed and operationalised. While we found clear examples of good practice, and an increased participatory role for complainers in the process, we also saw significant variability in the interpretation and implementation of the rape shield provisions, indicating that ongoing efforts are needed to ensure the legislation is working as intended to protect the interests of all parties. We conclude that, notwithstanding improvements, variable practice and the adversarial nature of rape trials continue to present challenges in delivering trauma-informed criminal justice processes for complainers
Bendable substrates of cellulose nanocrystals for triboelectric nanogenerators
Get PDFTriboelectric nanogenerators (TENGs) effectively convert mechanical energy to electric power or signals. In the presented work, films of sulfated cellulose nanocrystals (CNC) in combination with additives, triethanolamine (TEOA), and methylimidazole (MI) were turned into a tribo-positive layer in combination with polyethylene terephthalate (PET) (tribo-negative layer) to develop CNC-PET TENG. The additives improved the bendability of the formed films. Under optimized additive concentrations, cellulose nanocrystals (CNC) film with 4 wt % TEOA and 4.5 wt % MI shows tensile strength of 68 MPa with 4.8% elongation at break values in comparison to 47 MPa strength and 1% elongation at break values for neat CNC films. The CNC-PET film-based vertical contact-separation TENG device shows output voltages of 80 and 123 V at frequencies of 4 and 8 Hz, respectively. The TENG based on modified CNC films was stable for 4000 contact-separation cycles. Unlike TENG based on CNF and other nanocellulose composites, in this work, CNC films consist of more than 90 wt % cellulose and show good electromechanical performance, which makes them promising candidates as substrates for flexible electronics with recyclability over earlier published reports on cellulose composite with synthetic additives described in the introduction section
Genetic diversity of Toscana virus glycoproteins affects the kinetics of virus entry and the infectivity of newly produced virions
Get PDFToscana virus (TOSV) is a pathogenic and transmissible Phlebovirus of the Bunyavirales order. To date, two principal genetic lineages (A and B) have been identified and the impact of TOSV genetic diversity on its biology is still unknown. We used a reverse genetic approach based on two TOSV strains belonging to lineage A or B (i.e., TOSV-A and TOSV-B) and displaying different in vitro replicative fitness. Our results demonstrate that the sequences of Gn and Gc glycoproteins are responsible for the differences in replicative fitness between the two TOSV strains. Moreover, our data show that TOSV-A and TOSV-B display different entry kinetics and that newly-produced virions have different infectivity. This comparative approach demonstrates that the genetic diversity of TOSV can significantly impact viral properties and highlights the need for better molecular characterisation of the genomes of circulating TOSV strains, with a particular focus on the viral Gn and Gc glycoproteins
Making a case for an autism-specific multimorbidity index: a comparative cohort study
Get PDFAutistic people experience challenges in healthcare, including disparities in health outcomes and multimorbidity patterns distinct from the general population. This study investigated the efficacy of existing multimorbidity indices in predicting COVID- 19 mortality among autistic adults and proposes a bespoke index, the ASD-MI, tailored to their specific health profile. Using data from the CVD-COVID-UK/COVID-IMPACT Consortium, encompassing England’s entire population, we identified 1,027 autistic adults hospitalized for COVID- 19, among whom 62 died due to the virus. Predictors were selected using logistic regression with fivefold cross-validation, comparing AUCs amongst multimorbidity indices. Diabetes, coronary heart disease, and thyroid disorders were selected as predictors for the ASD-MI, outperforming the Quan Index, a general population-based measure, with an AUC of 0.872 versus 0.828, respectively. Notably, the ASD-MI exhibited better model fit (pseudo-R2 0.25) compared to the Quan Index (pseudo-R2 0.20). These findings underscore the need for tailored indices in predicting mortality risks among autistic individuals. However, caution is warranted in interpreting results, given the limited understanding of morbidity burden in this population. Further research is needed to refine autism-specific indices and elucidate the complex interplay between long-term conditions and mortality risk, informing targeted interventions to address health disparities in autistic adults. This study highlights the importance of developing healthcare tools tailored to the unique needs of neurodivergent populations to improve health outcomes and reduce disparities
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