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Road traffic noise, noise sensitivity, noise annoyance, psychological and physical health and mortality
No full textBackground
Both physical and psychological health outcomes have been associated with exposure to environmental noise. Noise sensitivity could have the same moderating effect on physical and psychological health outcomes related to environmental noise exposure as on annoyance but this has been little tested.
Methods
A cohort of 2398 men between 45 and 59 years, the longitudinal Caerphilly Collaborative Heart Disease study, was established in 1984/88 and followed into the mid-1990s. Road traffic noise maps were assessed at baseline. Psychological ill-health was measured in phase 2 in 1984/88, phase 3 (1989/93) and phase 4 (1993/7). Ischaemic heart disease was measured in clinic at baseline and through hospital records and records of deaths during follow up. We examined the longitudinal associations between road traffic noise and ischaemic heart disease morbidity and mortality using Cox Proportional Hazard Models and psychological ill-health using Logistic Regression; we also examined whether noise sensitivity and noise annoyance might moderate these associations. We also tested if noise sensitivity and noise annoyance were longitudinal predictors of ischaemic heart disease morbidity and mortality and psychological ill-health.
Results
Road traffic noise was not associated with ischaemic heart disease morbidity or mortality. Neither noise sensitivity nor noise annoyance moderated the effects of road traffic noise on ischaemic heart disease morbidity or mortality. High noise sensitivity was associated with lower ischaemic heart disease mortality risk (HR = 0.74, 95%CI 0.57, 0.97). Road traffic noise was associated with Phase 4 psychological ill-health but only among those exposed to 56-60dBA (fully adjusted OR = 1.82 95%CI 1.07, 3.07). Noise sensitivity moderated the association of road traffic noise exposure with psychological ill-health. High noise sensitivity was associated longitudinally with psychological ill-health at phase 3 (OR = 1.85 95%CI 1.23, 2.78) and phase 4 (OR = 1.65 95%CI 1.09, 2.50). Noise annoyance predicted psychological ill-health at phase 4 (OR = 2.47 95%CI 1.00, 6.13).
Conclusions
Noise sensitivity is a specific predictor of psychological ill-health and may be part of a wider construct of environmental susceptibility. Noise sensitivity may increase the risk of psychological ill-health when exposed to road traffic noise. Noise annoyance may be a mediator of the effects of road traffic noise on psychological ill-health
Expression of the cancer-associated DNA polymerase ε P286R in fission yeast leads to translesion synthesis polymerase dependent hypermutation and defective DNA replication
No full textSomatic and germline mutations in the proofreading domain of the replicative DNA polymerase ε (POLE-exonuclease domain mutations, POLE-EDMs) are frequently found in colorectal and endometrial cancers and, occasionally, in other tumours. POLE-associated cancers typically display hypermutation, and a unique mutational signature, with a predominance of C > A transversions in the context TCT and C > T transitions in the context TCG. To understand better the contribution of hypermutagenesis to tumour development, we have modelled the most recurrent POLE-EDM (POLE-P286R) in Schizosaccharomyces pombe. Whole-genome sequencing analysis revealed that the corresponding pol2-P287R allele also has a strong mutator effect in vivo, with a high frequency of base substitutions and relatively few indel mutations. The mutations are equally distributed across different genomic regions, but in the immediate vicinity there is an asymmetry in AT frequency. The most abundant base-pair changes are TCT > TAT transversions and, in contrast to human mutations, TCG > TTG transitions are not elevated, likely due to the absence of cytosine methylation in fission yeast. The pol2-P287R variant has an increased sensitivity to elevated dNTP levels and DNA damaging agents, and shows reduced viability on depletion of the Pfh1 helicase. In addition, S phase is aberrant and RPA foci are elevated, suggestive of ssDNA or DNA damage, and the pol2-P287R mutation is synthetically lethal with rad3 inactivation, indicative of checkpoint activation. Significantly, deletion of genes encoding some translesion synthesis polymerases, most notably Pol κ, partially suppresses pol2-P287R hypermutation, indicating that polymerase switching contributes to this phenotype
The changing epidemiology of Plasmodium vivax: insights from conventional and novel surveillance tools
No full text
Evaluation of a digital system to predict unplanned admissions to the intensive care unit: A mixed-methods approach
No full textBackground
We have developed the Hospital Alerting Via Electronic Noticeboard (HAVEN) which aims to identify hospitalised patients most at risk of reversible deterioration. HAVEN combines patients’ vital-sign measurements with laboratory results, demographics and comorbidities using a machine learnt algorithm.
Objectives
The aim of this study was to identify variables or concepts that could improve HAVEN predictive performance.
Methods
This was an embedded, mixed methods study. Eligible patients with the five highest HAVEN scores in the hospital (i.e., ‘HAVEN Top 5′) had their medical identification details recorded. We conducted a structured medical note review on these patients 48 hours post their identifiers being recorded. Methods of constant comparison were used during data collection and to analyse patient data.
Results
The 129 patients not admitted to ICU then underwent constant comparison review, which produced three main groups. Group 1 were patients referred to specialist services (n = 37). Group 2 responded to ward-based treatment, (n = 38). Group 3 were frail and had documented treatment limitations (n = 47).
Conclusions
Digital-only validation methods code the cohort not admitted to ICU as ‘falsely positive’ in sensitivity analyses however this approach limits the evaluation of model performance. Our study suggested that coding for patients referred to other specialist teams, those with treatment limitations in place, along with those who are deteriorating but then respond to ward-based therapies, would give a more accurate measure of the value of the scores, especially in relation to cost-effectiveness of resource utilisation
Mental health professionals’ experiences of working with parents with psychosis and their families: a qualitative study
No full textBackground
Healthcare service users who are parents with psychosis form part of the caseload of most community mental health teams. Mental health professionals can experience uncertainty about how to work with and ask about the children of these parents, and often report difficulties when collaborating with other agencies. This study focused on professionals’ experiences of working with parents with psychosis and their families to gain an understanding of these parents’ needs from a service-level perspective, and to identify barriers that professionals may experience in meeting those needs.
Methods
Qualitative focus groups were conducted with four to eight mental health professionals per group. Data were analysed using reflexive thematic analysis. JR familiarised herself with the transcripts and then coded each salient unit within the text. Themes were then identified and discussed amongst all authors until there was agreement.
Results
We developed two overarching themes: 1) Diversity of need in parents with psychosis and 2) Role boundaries. The first explored mental health professionals’ perceived range of experiences that parents with psychosis and their families have, and the range of potential effects of parental psychosis on a child. The second theme described how some mental health professionals emphasised the importance of supporting service users in terms of their parenting status and others felt it was more critical to treat the person’s symptomatic expression. This theme also included issues with communication both with their service users and with other agencies.
Conclusions
Mental health professionals identified that the needs of parents with psychosis were diverse and reflected significant variation in the experiences of service users. Mental health professionals across different types of team (early intervention and community mental health) expressed contrasting viewpoints about how achievable it was to respond to a service user’s parenting status in an adult mental health setting. Future research should aim to determine where training is needed to enhance mental health professionals’ ability to work holistically with families in an adult mental health setting, and how to enhance collaboration with other agencies
Exploring interactions between trust, anthropomorphism, and relationship development in voice assistants
No full textModern conversational agents such as Alexa and Google Assistant represent significant progress in speech recognition, natural language processing, and speech synthesis. But as these agents have grown more realistic, concerns have been raised over how their social nature might unconsciously shape our interactions with them. Through a survey of 500 voice assistant users, we explore whether users' relationships with their voice assistants can be quantified using the same metrics as social, interpersonal relationships; as well as if this correlates with how much they trust their devices and the extent to which they anthropomorphise them. Using Knapp's staircase model of human relationships, we find that not only can human-device interactions be modelled in this way, but also that relationship development with voice assistants correlates with increased trust and anthropomorphism
Is comprehensive geriatric assessment admission avoidance hospital at home an alternative to hospital admission for older persons? A randomized trial
No full textBackground:
Delivering hospital-level care with comprehensive geriatric assessment (CGA) in the home is one approach to deal with the increased demand for bed-based hospital care, but clinical effectiveness is uncertain.
Objective:
To assess the clinical effectiveness of admission avoidance hospital at home (HAH) with CGA for older persons.
Design:
Multisite randomized trial. (ISRCTN registry number: ISRCTN60477865)
Setting:
9 hospital and community sites in the United Kingdom.
Patients:
1055 older persons who were medically unwell, were physiologically stable, and were referred for a hospital admission.
Intervention:
Admission avoidance HAH with CGA versus hospital admission with CGA when available using 2:1 randomization.
Measurements:
The primary outcome of living at home was measured at 6 months. Secondary outcomes were new admission to long-term residential care, death, health status, delirium, and patient satisfaction.
Results:
Participants had a mean age of 83.3 years (SD, 7.0). At 6-month follow-up, 528 of 672 (78.6%) participants in the CGA HAH group versus 247 of 328 (75.3%) participants in the hospital group were living at home (relative risk [RR], 1.05 [95% CI, 0.95 to 1.15]; P = 0.36); 114 of 673 (16.9%) versus 58 of 328 (17.7%) had died (RR, 0.98 [CI, 0.65 to 1.47]; P = 0.92); and 37 of 646 (5.7%) versus 27 of 311 (8.7%) were in long-term residential care (RR, 0.58 [CI, 0.45 to 0.76]; P < 0.001).
Limitation:
The findings are most applicable to older persons referred from a hospital short-stay acute medical assessment unit; episodes of delirium may have been undetected.
Conclusion:
Admission avoidance HAH with CGA led to similar outcomes as hospital admission in the proportion of older persons living at home as well as a decrease in admissions to long-term residential care at 6 months. This type of service can provide an alternative to hospitalization for selected older persons.
Primary Funding Source:
The National Institute for Health Research Health Services and Delivery Research Programme (12/209/66)
Improved detection of intestinal helminth infections with a formalin ethyl-acetate-based concentration technique compared to a crude formalin concentration technique
No full textIntestinal helminth infections are the most prevalent neglected tropical diseases, predominantly affecting rural and marginalised populations. The mainstay of diagnosis is the microscopic examination of faecal samples to detect parasites in the form of eggs, larvae and cysts. In an effort to improve the standard of care, the comparative accuracy in detecting helminth infections of the hitherto used formalin-based concentration method (FC) was compared to a previously developed formalin ethyl-acetate-based concentration technique (FECT), prior to the systematic deployment of the latter at a research and humanitarian unit operating on the Thailand–Myanmar border. A total of 693 faecal samples were available for the comparison of the two diagnostic methods. The FECT was superior in detecting hookworm, Trichuris trichiura and small liver flukes. Interestingly, there was no significant difference for Ascaris lumbricoides, possibly due to the high observed egg density. Despite the minor increase in material cost and the fact that the FECT is somewhat more time consuming, this method was implemented as the new routine technique
On Gilgamesh and Homer: Ishtar, Aphrodite and the meaning of a parallel
No full textThis article reconsiders the similarities between Aphrodite's ascent to Olympus and Ishtar's ascent to heaven in Iliad Book 5 and the Standard Babylonian Gilgamesh Tablet VI respectively. The widely accepted hypothesis of an Iliadic reception of the Mesopotamian poem is questioned, and the consonance explained as part of a vast stream of tradition encompassing ancient Near Eastern and early Greek narrative poetry. Compositional and conceptual patterns common to the two scenes are first analyzed in a broader early Greek context, and then across further Sumerian, Akkadian, Ugaritic and Hurro-Hittite sources. The shared compositional techniques at work in Mesopotamia and the Eastern Mediterranean can be seen as a function of the largely performative nature of narrative poetry. This contributes to explaining literary transmission within the Near East and onto Greece