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Better End of Life survey responses
No full textDistribution of decedent characteristics in a stratified sample of deaths in England and Wales (n=3,000) identified using Office for National Statistics' mortality data compared to proxy-reported data in the survey responses received (n=1,194)
Self-aggregating <i>Lactiplantibacillus plantarum</i> enhances type-I interferon responses via the cytosolic sensors NOD2 and cGAS.
Get PDFThe gut microbiome plays a critical role in health, disease and immunity. To date, we have access to large datasets describing how the microbial diversity present in the gut correlates with many clinical conditions. However, the microbiome composition is taxonomically complex; influenced by many environmental factors; and variable between individuals and communities, thereby limiting functional and mechanistic insights into the microbiota‒host interactions. We are still unsure of the molecular mechanisms by which gut commensal microbes intrinsically possess to interact with the immune system and induce beneficial responses. This study has addressed this important question by revealing that only certain members of Lactobacillaceae, a bacterial family very well known for its probiotic properties, interact very intimately with macrophages because of their ability to simultaneously overexpress adhesive cell wall proteins and to self-aggregate, leading to significant production of type I interferon (IFN-I) cytokines. IFN-I cytokines are essential to confer protection against viral infections and auto-immune disorders. Specifically, we have proved that this enhanced IFN-I feature is strain-dependent and predominantly driven by cGAS, a molecule that activates the cytosolic sensor STING upon the recognition of bacterial DNA. Furthermore, another cytosolic sensor, NOD2, seems to be an additional stimulus to amplify IFN-I production, suggesting the involvement of successive molecular events for a prominent probiotic response. Our findings provide insight into how specific molecules of probiotic bacteria modulate or stimulate host responses, providing a better understanding of the molecular crosstalk between the microbiome and immune cells. </p
Preconception perceptions, knowledge, and behaviours of women with gestational diabetes mellitus:A qualitative study
Get PDFBackgroundGestational diabetes mellitus (GDM) is one of the most common pregnancy complications. While considerable attention has been paid to the management of GDM during pregnancy, women's perceptions of GDM, knowledge of associated risk factors and health behaviours before and between pregnancies are less well understood, despite their importance for informing diabetes prevention programmes.Aims/ObjectivesTo explore women's knowledge of GDM risk factors, perceptions of GDM and preconception health behaviours.MethodsIndividual semi-structured interviews were undertaken with 23 women with GDM in the third trimester of pregnancy. Data were analysed using a template analysis based on preconception knowledge, risk communication, and perceptions and behaviours.ResultsWomen often had limited knowledge of GDM before pregnancy, with many first learning about the condition during antenatal screening. Perceptions of risk were largely weight or BMI centred, with less recognition of other factors. Although participants commonly described intentions to improve diet quality and increase physical activity prior to conception, these intentions were rarely translated into sustained behaviours. Reported barriers included time constraints, caregiving responsibilities, financial costs and limited access to clear, culturally appropriate guidance. Pregnancy preparedness varied by parity: women approaching a first pregnancy focused on general preparation and navigating the healthcare system, whereas women with a prior GDM experience planned around potential recurrence, including early self-management and glucose monitoring.ConclusionsFindings support two priorities: (1) strengthening communication and education at the time of GDM screening and diagnosis so that results and next steps are clear, supportive and person-centred; and (2) providing universal, general preconception support delivered proportionately to need, alongside targeted interconception pathways for women at higher absolute risk, following GDM. The findings do not imply universal GDM-specific preconception education for all women; rather, they indicate a need for needs-based communication during pregnancy and targeted interconception support delivered with clear signposting to resources.Patient or Public ContributionAn advisory group of seven women has been involved in this project. Four online sessions were conducted (between October 2023 and July 2024) to develop the research question, study materials, recruitment plans, interview schedules and participant retention plan
Resisting by being invisible:Theorising infrapolitical algorithmic actions on Douyin (Chinese TikTok)
Get PDFUsers increasingly resist algorithms through subtle practices woven into everyday life. While scholarship on user resistance is growing, insufficient studies theorise such ‘invisible’ behaviours. This article develops James C. Scott’s notion of ‘infrapolitics’ to conceptualise users’ mundane tactics of resisting algorithmic power (surveillance capitalism and political censorship). Employing a video diary–interview study of Douyin users, we analyse three interrelated dimensions of infrapolitical algorithmic resistance: reflexivity (the recognition of one’s own actions as resistance based on the parallel process of developing self-understanding and awareness of algorithms), tactical immanence (using technological features for alternative purposes while still operating within platform logics) and identity-based (resisting profiling through multi-account practices and the enactment of various selves). We show that infrapolitical resistance emerges through everyday engagement with algorithms, evolving from sidestepping mismatched recommendations to subtly, reflexively and culturally situated practice that challenges the power structures embedded in algorithmic governance
Treatment satisfaction, disease severity and healthcare use in patients with axial spondyloarthritis in the United States and Europe
Get PDFFusing Data from CT Deep Learning, CT Radiomics and Peripheral Blood Immune profiles to Diagnose Lung Cancer in a Cohort of Patients Experiencing Symptoms
Get PDFBackground: Lung cancer is the leading cause of cancer-related deaths. Diagnosis at late stages is common due to the largely non-specific nature of presenting symptoms contributing to high mortality. There is a lack of specific, minimally invasive low-cost tests to screen patients ahead of the diagnostic biopsy. Methods: 344 patients experiencing symptoms from the lung clinic of Lister hospital suspected of lung cancer were recruited. Predictive covariates were successfully generated on 170 patients from Computed Tomography (CT) scans using CT Texture Analysis (CTTA) and Deep Learning Autoencoders (DLA) as well as from peripheral blood data for immunity using high depth flow-cytometry and for exosome protein components. Predictive signatures were formed by combining covariates using Bayesian regression on a randomly chosen 128-patient training set and validated on a 42-patient held-out set. Final signatures were generated by fusing the data sources at different levels. Findings: Immune, CTTA and DLA single modality signatures had overall AUCs of 0.69, 0.70 and 0.73 respectively. The final combined signature had a ROC AUC of 0.81. The overall sensitivity and specificity were 0.72 and 0.77 respectively. Interpretation: Combining immune monitoring with CT scan data is an effective approach to improving sensitivity and specificity of Lung cancer screening even in patients experiencing symptoms.<br/
Tetronic® 1307-Based Polymeric Micelles and Thermoresponsive Gels for the Co-Delivery of Pentamidine and Miltefosine
Get PDFBackground: Pentamidine isethionate (PTM) and miltefosine (MF) are clinically relevant antiparasitic agents whose use is limited by toxicity, emerging resistance, and the lack of effective co-delivery strategies. Tetronic® 1307 (T1307), an amphiphilic and thermoresponsive block copolymer, was investigated as a carrier to enable their combination therapy. Methods: PTM and MF were formulated in T1307-based micelles and thermoresponsive gels. The systems were characterized by small-angle neutron scattering (SANS), dynamic light scattering (DLS), and nuclear magnetic resonance spectroscopy (NMR). Antiparasitic activity was evaluated against Leishmania major promastigotes. Results: MF formed stable micelles that efficiently incorporated PTM, generating a “drug-in-drug” architecture. While T1307 alone showed limited PTM loading, MF promoted mixed micelle formation and enhanced PTM incorporation. At physiological temperature and adequate copolymer concentrations, drug-loaded micelles formed thermoreversible gels suitable for topical application. The combined formulations preserved drug activity and exhibited synergistic effects against L. major. Conclusions: T1307 is a promising platform for the co-delivery of PTM and MF, enabling synergistic combination therapy and thermoresponsive gel formation with potential to reduce systemic toxicity and improve treatment administration
N07 When the body tires, the mind resists:resilience as a buffer against fatigue-insights into quality of life in Crohn's disease
No full textBackground: Fatigue is one of the most burdensome and under-recognised symptoms in Crohn’s disease (CD), often persisting even in remission and profoundly affecting physical, psychological, and social functioning (Radford et al., 2021; Regueiro et al., 2023). As fatigue is only partially explained by disease activity, psychological resources such as resilience may play a crucial protective role . Resilience, defined as the ability to adapt and recover from adversity, may help mitigate the negative impact of chronic illness on health-related quality of life (HRQoL) (Jin et al., 2023). This study aimed to explore the relationships between fatigue, resilience, and HRQoL in adults living with CD.Methods: A cross-sectional survey was conducted among 50 adults with a confirmed diagnosis of CD. Three validated instruments were used: WHOQOL-BREF to assess HRQoL, the Inflammatory Bowel Disease Fatigue Scale (IBD-F) to measure fatigue, and the Resilience Scale (RS-14) to evaluate psychological resilience. Descriptive statistics and non-parametric correlations (Spearman’s rho) were performed to explore associations between variables.Results: Fatigue showed a strong negative correlation with both HRQoL and resilience. Patients reporting higher levels of fatigue experienced lower satisfaction with life, poorer psychological and social functioning, and greater difficulties in coping with daily stressors. Conversely, higher resilience scores were positively associated with HRQoL, suggesting that resilience may buffer the adverse effects of fatigue.Conclusion: Fatigue is a key determinant of reduced QoL in CD, while resilience appears to be an important adaptive resource supporting psychological well-being and daily functioning. Incorporating resilience-building interventions and psychosocial assessment into routine nursing practice could enhance patient well-being and complement medical treatment in IBD care.References:Jin, Y., Bhattarai, M., Kuo, W. C., & Bratzke, L. C. (2023). Relationship between resilience and self‐care in people with chronic conditions: A systematic review and meta‐analysis. Journal of Clinical Nursing, 32(9-10), 2041-2055. https://doi.org/10.1111/jocn.16258Radford, S. J., McGing, J., Czuber-Dochan, W., & Moran, G. (2021). Systematic review: the impact of inflammatory bowel disease-related fatigue on health-related quality of life. Frontline gastroenterology, 12(1), 11-21. 10.1136/flgastro-2019-101355Regueiro, M., Hunter, T., Lukanova, R., Shan, M., Wild, R., Knight, H., Bannikoppa, P., & Naegeli, A. N. (2023). Burden of fatigue among patients with ulcerative colitis and Crohn’s disease: results from a global survey of patients and gastroenterologists. Advances in therapy, 40(2), 474-488. 10.1007/s12325-022-02364-
The implications of the COVID-19 pandemic for clinical mental health care:MQ: Mental Health Research and Lancet Psychiatry Standing Commission on the COVID-19 Pandemic and Mental Health
No full textA Position Paper published in The Lancet Psychiatry in 2020 suggested an agenda for research about the effects of the COVID-19 pandemic on mental health, following which an interdisciplinary Lancet Psychiatry standing commission was established in 2022 to examine the emerging evidence and refine recommendations for more research. In this first Series paper from the standing commission, we focus on changes in the delivery of clinical mental health care during the COVID-19 pandemic. The second paper in the Series focuses on public mental health and policy perspectives, and the third will address neuropsychiatric consequences of infection by SARS-CoV-2. Evidence from high-quality longitudinal studies with pre-pandemic baseline data, controlled intervention trials, or systematic reviews took time to accrue. During the early months of the COVID-19 pandemic, symptoms of anxiety and depression became more prevalent, and many mental health services were compromised by pandemic-related factors; however, whether the COVID-19 pandemic accelerated pre-existing long-term trends of increasing incidence of mental health disorders, especially in children and adolescents, is unclear. Little research has been done in low-income and middle-income countries, or regarding post-COVID-19 condition (also known as long COVID), which emerged as a multisystem condition with mental health implications. Vulnerable populations, including socioeconomically disadvantaged and minoritised groups, faced disproportionate mental health impacts and limited access to care during the COVID-19 pandemic, reflecting systemic, pre-pandemic inequalities. Bold implementation of existing evidence-based mental health support for vulnerable communities, ambitious trials of novel interventions, and systematic pooling of rapidly accumulating evidence about best healh care should be priorities in future pandemics.</p