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Methadone as an adjuvant analgesicMethadone as an 'adjuvant' has proven to be effective and safe to be used in conjunction with opioids. Generally, only a low dose is required to improve pain control. [Abstract copyright: © Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.]
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Non-tuberculous mycobacterial pulmonary disease (NTM-PD): Epidemiology, diagnosis and multidisciplinary managementNon-tuberculous mycobacteria (NTM) are ubiquitous environmental organisms that can cause significant disease in both immunocompromised and immunocompetent individuals. The incidence of NTM pulmonary disease (NTM-PD) is rising globally. Diagnostic challenges persist and treatment efficacy is variable. This article provides an overview of NTM-PD for clinicians. We discuss how common it is, who is at risk, how it is diagnosed and the multidisciplinary approach to its clinical management. [Abstract copyright: Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.]
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ISRA9PHL0474 Monad & Kimud Shoals FactsheetMonad & Kimud Shoals are located southeast of Malapascua Island in the Central Visayan Sea, central Philippines. The Visayan Sea is a relatively shallow area with frequent wind- driven vertical mixing due to its shallow nature, and land-based nutrient run-off which play an important role in supplementing the overall primary production. Monad & Kimud Shoals are shallow seamounts, 7 km apart. The top of the seamounts forms a plateau at 15 to 25 m depth. This area overlaps with the Sulu-Sulawesi Marine Ecoregion an Ecologically and Biologically Significant Marine Area (EBSA), and two marine protected areas. Within this area there are: threatened species and distinctive attributes (Pelagic Thresher Alopias pelagicus).
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Who is at risk? Adults with intellectual disability at risk of admission to mental health inpatient careBackground: NHS England's Transforming Care agenda aims to reduce the number of adults with intellectual disabilities and autistic adults in mental health hospitals. The aim was to understand the demographic and clinical characteristics of those most at risk of admission.MethodA cohort, retrospective study of adults using community intellectual disability services in the North West of England from 2018 to 2022 was undertaken.ResultsWe compared 211 adults at imminent risk of admission to a mental health hospital and 249 at significant (but not imminent) risk on a validated risk stratification tool. Individuals at significant risk were more likely to have moderate intellectual disability. Individuals at imminent risk were more likely to have diagnoses of mild intellectual disability, autism, personality disorder, or psychosis.ConclusionBy furthering our understanding of the clinical characteristics of those most at risk of admission, the findings inform more appropriate targeting of resources.
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Optimal omegas – barriers and novel methods to narrow omega-3 gaps. A narrative reviewDietary intakes of omega-3 long chain polyunsaturated fatty acids (O3LC-PUFAs) such as eicosapentaenoic and docosahexaenoic acid are central to development and health across the life course. O3LC-PUFAs have been linked to neurological development, maternal and child health and the etiology of certain non-communicable diseases including age-related cognitive decline, cardiovascular disease, and diabetes. However, dietary inadequacies exist in the United Kingdom and on a wider global scale. One predominant dietary source of O3LC-PUFAs is fish and fish oils. However, growing concerns about overfishing, oceanic contaminants such as dioxins and microplastics and the trend towards plant-based diets appear to be acting as cumulative barriers to O3LC-PUFAs from these food sources. Microalgae are an alternative provider of O3LC-PUFA-rich oils. The delivery of these into food systems is gaining interest. The present narrative review aims to discuss the present barriers to obtaining suitable levels of O3LC-PUFAs for health and wellbeing. It then discusses potential ways forward focusing on innovative delivery methods to utilize O3LC-PUFA-rich oils including the use of fortification strategies, bioengineered plants, microencapsulation, and microalgae.
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An Examination of the Field-Based Training Practices in European Super League’s first Quadruple Winning ChampionsUsing a case study approach, the primary aim of this thesis was to develop an understanding of field-based training practices of a successful professional rugby league team. The research findings were applied to inform the coaching practices of the club but also offered insight that might be of interest more widely given the success of the team over an extended period. Chapter 4 quantified the types of training used during a preseason by the team. There was a 4-week increase in external load, followed by a “regeneration week” in week 5 before an increase in load during week 6. A weekly cycle also emerged with Monday primarily comprising Rugby Skill drills and Speed drills, Tuesday largely Rugby Skill based alongside Conditioning and Game-Based Training, Thursday was a mix of training types with Friday primarily consisting of Game-Based Training that also coincided with the week’s highest values for total distance, high-speed running, and high metabolic distance. Chapter 5 examined the associations between the types of training in preseason and improvements in intermittent running performance (i.e., prone Yo-Yo IR1). The intensity (r = 0.61; 95% CI 0.18, 0.84) and PlayerLoadTM (r = 0.44; 95% CI -0.05, 0.76) during Game-Based Training and high-speed running (r = 0.61; 95% CI 0.18, 0.84) in Conditioning had positive associations with the mean change in prone Yo-Yo IR1 performance (200 ± 143 m [18.1 ± 13.5%]). Total duration of Game-Based Training had a negative association with change in prone Yo-Yo IR1 performance (r = -0.57; 95% CI -0.82, -0.12). These data enable the manipulation of training practices to target specific external metrics (e.g., intensity, PlayerLoadTM, high-speed running) when improvements in intermittent running capacity of professional rugby league players is the desired goal. Chapter 6 examined the differences in external and internal load of field-based training between the three different in-season match-day microcycles and assessed the differences in external demands of matches between the microcycles. Game-Based Training contributed the most to external (total distance, high metabolic distance and PlayerLoadTM) and internal load (highest HRmax, time spent in HR band 5 and HR band 6) for the main training day in long (MD-5), medium (MD-4), and short (MD-2) turnarounds. Both short (86.7 ± 7.9 m.min-1) and medium (86.5 ± 10.9 m.min-1) turnaround matches resulted in lower intensity values than long turnarounds (89.5 ± 7.6m.min-1; P < 0.05). No other differences in external demands were observed between the 3 different match-day microcycles. The consistency in match-day external demands is a desirable outcome as the training week has effectively prepared athletes to perform in match. Additionally, the extensive use of Game-Based Training allowed for the maintenance of physical qualities whilst technically and tactically developing and preparing players for competition. Chapter 7 examined the effect altering match rules (because of COVID-19) had on the external demands of match play. There were increases in whole team high-speed running (r = 0.09; 95% CI 0.02, 0.15 c.f. r = 0.29; 95% CI 0.20, 0.38) and an increased ball-in-play time (52.16 ± 5.01 min c.f. 55.58 ± 4.04 min). These changes highlight the impact of rule changes on the movement demands of professional rugby league matches and the implications for the design of appropriate training practices to better prepare players. Chapter 8 assessed the effects altering the area size per-person of Game-Based Training and the length of Conditioning drills has on key external load metrics. The study showed that increasing the area of Game-Based Training by 10 m2 per-person resulted in athletes covering greater distance (539.3 ± 49.6 m c.f. 500.9 ± 62.9 m & 555.4 ± 55.9 m c.f. 491.4 ± 40.1 m), higher intensities (132.1 ± 12.1 m.min-1 c.f. 122.4 ± 15.4 m.min-1 & 136.8 ± 13.8 m.min-1 c.f. 121.4 ± 9.9 m.min-1), and greater high metabolic distances (122.4 ± 32.0 m c.f. 81.8 ± 22.9 m & 153.0 ± 33.0 m c.f. 120.3 ± 27.1 m). However, the smaller area Game-Based Training showed significantly greater cognitive load (dRPE-C; 73.2 ± 7.8 c.f. 56.3 ± 17.9 AU), possibly due to increased technical/tactical involvements. Increasing the length of conditioning drills resulted in an increase in all external metrics for the shuttle runs, with the linear run experiencing an increase in intensity but a reduction in total distance and PlayerLoadTM. Chapter 8 also found that the coefficient of variation (%CV) between-players during Game-Based Training was higher than previously reported in soccer, with high-speed distance found to have the highest level of variability (23 – 58%), whereas linear running Conditioning drills had much lower variability (4 – 5 %). Game-Based Training is an effective training method, however the variability experienced could leave players under or over trained if this method was solely used, highlighting the importance of using it as a part of balanced programme.
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Myotonic dystrophy type 1: palliative care guidelinesPalliative care for adults with neuromuscular conditions is an emerging field. Previous guidelines regarding myotonic dystrophy and palliative care have only mentioned end-of-life care and little else. The following guidelines have been written using national experts as a description of best practice as part of the Dystrophia Myotonica National Care Guidelines Consortium. [Abstract copyright: © Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.]
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Do sociodemographic and clinical characteristics affect mortality rates in people with intellectual disability and dysphagia who have a percutaneous endoscopic gastrostomy? A cohort study between 2000 and 2022Background: People with intellectual disability frequently have eating, drinking and swallowing difficulties (dysphagia) and are at greater risk of premature mortality, particularly from aspiration and respiratory infections. The insertion of a percutaneous endoscopic gastrostomy (PEG), as part of a multidisciplinary management plan, may help to maintain and improve nutrition. This study included people with intellectual disability who had ever had a PEG inserted and who presented to the specialist Speech and Language Therapy team in one Greater Manchester borough between 2000 and 2022 and assessed the risk of death and sociodemographic and clinical factors associated with this. Methods: This was a cohort study using secondary data. Kaplan–Meier estimates were used to construct the probability of mortality curves. Cox proportional hazards were used to compare death rates in the different sociodemographic and clinical characteristic groups and were presented as hazard ratios and 95% confidence intervals. Findings: Of 42 people included in the study, 18 (43%) died from the point of PEG insertion to the end of the study (December 2022). The median (interquartile range) time to death from PEG insertion was 5 (2–10) years, with four people (10%) dying in the first year. Aspiration pneumonia and unspecified pneumonia were responsible for seven (39%) deaths. No significant associations were found between sociodemographic and clinical factors and risk of death. Conclusion: In persons with intellectual disability and a PEG who were followed up between 2000 and 2022, the mortality was around 40% with deaths occurring in the first year and respiratory conditions being an important cause. The lack of association with sociodemographic and clinical characteristics may have been due to a limited sample size. Further research is needed with larger samples and more variables, including quality of life data, to help understand and improve clinical practice in this area.
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Pain in SheepPain in sheep can occur for a variety of reasons, including disease, injury, and naturally through parturition. Sheep, as a prey species, do not overtly express pain making it challenging for owners and veterinarians to recognise and thus effectively treat pain. By observing facial expressions, it is possible to recognise and quantify the pain a sheep may be experiencing. This enables the provision of treatment and the prevention of any further suffering. Information © The Author 2024
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Development of Edible Food Wrappers: An Eco-Friendly Approach Towards SustainabilityEdible food wrappers are safe packaging systems that can be consumed with food. Edible packaging developed using natural renewable resources come under the category of bio-based and biodegradable packaging. The main components of edible wrappers include a biopolymer solubilized in a solvent to form film casting solution and certain additives to improve functional characteristics of packaging. Biopolymers are frequently used in food packaging applications due to their flexibility in film formation and biodegradability. The development of green packaging materials utilizing discarded edible materials will be beneficial to confront the challenges associated with traditional packaging systems, attaining sustainability, and fostering recycling in the food industry. Edible food wrappers present a number of benefits over synthetic materials. These packaging systems can replace and possibly strengthen the outside layers of packed items in order to elude moisture loss, flavors, and bioactive components from the foods as well as between them.
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The efficacy and safety of ketamine for depression in patients with cancer: A systematic reviewManagement of depression in the oncology population includes supportive psychotherapeutic interventions with or without psychotropic medication, which take time to demonstrate effectiveness. Fast-acting interventions, like ketamine, can provide a rapid antidepressant effect; however, there has been limited research on effects of ketamine among cancer patients. The objective of this review is to provide an overview of research on the efficacy and safety of ketamine on depression in patients with cancer. We reviewed the published literature in MEDLINE® (via PubMed®), EMBASE, and Scopus from 1 January 1982 to 20 October 2022. We screened the retrieved abstracts against inclusion criteria and conducted a full-text review of eligible studies. Following extraction of data from included studies, we used a framework analysis approach to summarize the evidence on using ketamine in patients with cancer. All 5 included studies were randomized clinical trials conducted in inpatient settings in China. In all included studies ketamine was administered intravenously. Three studies used only racemic ketamine, and two studies used both S-ketamine and racemic ketamine. All included studies reported ketamine a tolerable and effective drug to control depression symptoms. Included studies showed administration of sub-anesthesia ketamine significantly improves postoperative depression among patients with cancer. [Abstract copyright: © 2023 The Author(s).]
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The Influence of Polycystic Ovary Syndrome (PCOS) and Other Related Factors upon Health-Related Quality of Life in Women of Reproductive Age: A Case-Control StudyThis study aimed to assess the impact of a polycystic ovary syndrome (PCOS) diagnosis and other factors on health-related quality of life (HRQoL) in women of reproductive age. Online questionnaires were completed and study groups compared. Potential causal relationships were evaluated using path analysis. Analyses revealed that a PCOS diagnosis alongside BMI had the largest effect on HRQoL. Higher levels of physical activity (PA) were not associated with greater HRQoL, and PA was not directly affected by any other outcome. However, reduced self-esteem was identified as a key factor in the promotion of physical and mental health.
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Development of a novel dietary assessment tool for vitamin D and the in vivo and in vitro effects of supplementation on asthmaVitamin D is a secosteroid hormone with the essential role of maintaining calcium and phosphorus homeostasis to support bone metabolism. Furthermore, vitamin D has also been shown to have important immunomodulatory functions, which have been linked to inflammatory diseases such as asthma. In the UK, 18.8% of the general population are vitamin D deficient during the winter. In 2016, SACN proposed recommendations that adults in the UK consume 400 IU (10 μg) vitamin D day-1. Health and disease are linked to diet and nutrition therefore, assessing food intake is crucial. A food frequency questionnaire (FFQ) captures habitual food intake with a lower participant burden compared to alternative methods. Validation of a FFQ requires comparison of nutrient biomarkers with another method of dietary assessment. The first study in this thesis recruited 50 healthy volunteers to assess the agreement between a four-day food diary and a newly designed vitamin FFQ to measure dietary intake of vitamin D. Participants provided a blood sample for plasma analysis of 25(OH)D concentrations. Results of this study showed a strong correlation between vitamin D intake recorded by the FFQ and the food diary (r = 0.609, p < 0.0001) within 95% limits of agreement. Our analysis suggested that this FFQ is a useful and rapid tool for researchers and health professionals to assess vitamin D dietary intakes in UK adults. Vitamin D deficiency is linked to asthma in adults and associated with reduced lung function. Clinical trials investigating the effect of vitamin D supplementation have mainly focussed on asthmatic children and trials carried out in adults have used bolus dosing. The aim of chapter 3 was to conduct a 12-week randomised placebo-controlled trial investigating the effect of daily 5000 IU vitamin D supplementation on lung function and inflammation in 32 adults with mild to moderate asthma. The intervention resulted in a significant increase in the mean (± SD) ratio of FEV1: FVC from baseline (week 0) to post-intervention (week 12) in the vitamin D group (+ 0.05 ± 0.06) compared to the placebo group (+ 0.006 ± 0.04, p = 0.04). This dosing strategy at a level above current UK recommendations may be a useful adjunct to existing asthma control strategies. The Calu-3 cell line has been used as a model of asthma and the aim of chapter 4 was to investigate the effect of calcitriol and 25(OH)D treatment of Calu-3 cell cultures on cell proliferation and secretion of inflammatory biomarkers. Incubation of cultures for 24 and 72 hours respectively, with 50nM (p = 0.002; p < 0.0001), 100nM (p = 0.004; p = 0.007) and 200nM (p = 0.002; p < 0.0001) 25(OH)D resulted in significantly decreased proliferation compared to an untreated control. No effect was observed with calcitriol treatment. To our knowledge, this is the first in vitro study using the Calu-3 cell line to show differing effects of vitamin D metabolites. The findings from this thesis are clinically relevant in the UK in a population that is at increased risk of vitamin D deficiency during the winter months. The new tool designed and validated will facilitate easier measurement of vitamin D dietary intakes and the clinical trial and in vitro work have provided novel insights to patient outcomes and underlying mechanisms of the benefit of vitamin D supplementation to asthma patients.
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Novel lactoferrin-conjugated gallium complex to treat Pseudomonas aeruginosa wound infectionPseudomonas aeruginosa is one of the leading causes of opportunistic infections such as chronic wound infection that could lead to multiple organ failure and death. Gallium (Ga3+) ions are known to inhibit P. aeruginosa growth and biofilm formation but require carrier for localized controlled delivery. Lactoferrin (LTf), a two-lobed protein, can deliver Ga3+ at sites of infection. This study aimed to develop a Ga-LTf complex for the treatment of wound infection. The characterisation of the Ga-LTf complex was conducted using differential scanning calorimetry (DSC), Infra-Red (FTIR) and Inductive Coupled Plasma Optical Emission Spectrometry (ICP-OES). The antibacterial activity was assessed by agar disc diffusion, liquid broth and biofilm inhibition assays using the colony forming units (CFUs). The healing capacity and biocompatibility were evaluated using a P.aeruginosa infected wound in a rat model. DSC analyses showed thermal transition consistent with apo-lactoferrin; FTIR confirmed the complexation of gallium to lactoferrin. ICP-OES confirmed the controlled local delivery of Ga3+. Ga-LTf showed a 0.57 log10 CFUs reduction at 24 h compared with untreated control in planktonic liquid broth assay. Ga-LTf showed the highest antibiofilm activity with a 2.24 log10 CFUs reduction at 24 h. Furthermore, Ga-LTf complex is biocompatible without any adverse effect on brain, kidney, liver and spleen of rats tested in this study. Ga-LTf can be potentially promising novel therapeutic agent to treat pathogenic bacterial infections.
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How Useful Are Existing Protocols in the Quick Assessment of the Welfare of Semi-Feral Horses? Pilot Study on Konik Polski Horses Living in the Forest SanctuaryScientifically validated and standardised methods for the evaluation of the welfare of free-living horses are urgently needed by both the owners and managers of these populations and those responsible for implementing national welfare legislation. The aim of the study was to test the feasibility and usefulness of two welfare protocols that could be applied to semi-feral populations: a prototype of welfare assessment template (WAT) for Carneddau semi-feral ponies and the IFCE/INRAE Horse Welfare Protocol. Additionally, the body condition scale designed by Henneke (BCS-H) was employed. The study took place in July/August 2022 and April 2023 to evaluate the welfare of a pilot population of nineteen semi-feral Konik polski horses. The horses scored high or satisfactory under indicators across both protocols; only body condition scores were significantly lower in early spring (BCS-WAT: 1.11 ± 0.57; BCS-H: 3.84 ± 1.17) than in the summer (BCS-WAT: 1.58 ± 0.61; BCS-H: 5.63 ± 1.01). Our study confirmed the feasibility of utilising most of the WAT and IFCE/INRAE welfare indicators in semi-feral horses. Some adaptations, such as considering validation of scales, positive welfare indicators and animals’ free-choice of conditions, have been suggested for future in-field application.
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A formative investigation assessing menstrual health literacy in professional women’s footballThe aim of this study was to assess and compare menstrual health literacy in professional women’s football. A three-section questionnaire was completed by professional players (n = 25), development players (n = 22) and staff (n = 19). The mean total knowledge score (out of 19) was lower for development players (5.4 ± 2.9) than professional players (7.8 ± 3.2) and staff (9.1 ± 4.8) (p < 0.001). No group achieved >50% correct answers. For each group, knowledge of the menstrual cycle (MC) was greater than knowledge of hormonal contraceptives (HC) (p < 0.001). Previous MC and HC education did not correspond to higher knowledge scores in professional players (p = 0.823) or development players (p = 0.274). In professional and development players, comfort of communication was influenced by the sex of whom they were communicating with (p < 0.001), with a preference for females. In conclusion, results from the present study suggest refined education strategies and new approaches are required for both players and staff to improve menstrual health literacy in professional women’s football.
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Lifelong dietary protein restriction accelerates skeletal muscle loss and reduces muscle fibre size by impairing proteostasis and mitochondrial homeostasisThe early life environment significantly affects the development of age-related skeletal muscle disorders. However, the long-term effects of lactational protein restriction on skeletal muscle are still poorly defined. Our study revealed that male mice nursed by dams fed a low-protein diet during lactation exhibited skeletal muscle growth restriction. This was associated with a dysregulation in the expression levels of genes related to the ribosome, mitochondria and skeletal muscle development. We reported that lifelong protein restriction accelerated loss of type-IIa muscle fibres and reduced muscle fibre size by impairing mitochondrial homeostasis and proteostasis at 18 months of age. However, feeding a normal-protein diet following lactational protein restriction prevented accelerated fibre loss and fibre size reduction in later life. These findings provide novel insight into the mechanisms by which lactational protein restriction hinders skeletal muscle growth and includes evidence that lifelong dietary protein restriction accelerated skeletal muscle loss in later life.
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A comprehensive review on the risks assessment and treatment options for Sarcopenia in people with diabetesThis comprehensive review aims to examine the reciprocal interplay between Type 2 diabetes mellitus (T2DM) and sarcopenia, identify prevailing research gaps, and discuss therapeutic approaches and measures to enhance healthcare practices within hospital settings. A thorough literature review was conducted to gather relevant studies and articles on the relationship between T2DM and sarcopenia. Various databases were searched, including Google Scholar, PubMed, Scopus, and Science Direct databases. The search terms included T2DM, sarcopenia, inflammation, insulin resistance, advanced glycation end products, oxidative stress, muscle dimensions, muscle strength, muscle performance, aging, nutrition, hormone levels, and physical activity. The collected articles were critically analysed to extract key findings and identify gaps in current research. The prevalence and incidence of metabolic and musculoskeletal disorders, notably T2DM and sarcopenia, have surged in recent years. T2DM is marked by inflammation, insulin resistance, accumulation of advanced glycation end products, and oxidative stress, while sarcopenia involves a progressive decline in skeletal muscle mass and function. The review underscores the age-related correlation between sarcopenia and adverse outcomes like fractures, falls, and mortality. Research gaps regarding optimal nutritional interventions for individuals with T2DM and sarcopenia are identified, emphasizing the necessity for further investigation in this area. The reciprocal interplay between T2DM and sarcopenia holds significant importance. Further research is warranted to address knowledge gaps, particularly in utilizing precise measurement tools during clinical trials. Lifestyle modifications appear beneficial for individuals with T2DM and sarcopenia. Additionally, practical nutritional interventions require investigation to optimize healthcare practices in hospital settings. The online version contains supplementary material available at 10.1007/s40200-023-01262-w. [Abstract copyright: © The Author(s), under exclusive licence to Tehran University of Medical Sciences 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.]
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Coupled information networks drive honeybee (Apis mellifera) collective foragingCollective behaviour by eusocial insect colonies is typically achieved through multiple communication networks that produce complex behaviour at the group level but often appear to provide redundant or even competing information. A classic example occurs in honeybee (Apis mellifera) colonies, where both the dance communication system and robust scent‐based mechanisms contribute to the allocation of a colony's workforce by regulating the flow of experienced foragers among known food sources. Here we analysed social connectivity patterns during the reactivation of experienced foragers to familiar feeding sites to show that these social information pathways are not simply multiple means to achieve the same end but intersect to play complementary roles in guiding forager behaviour. Using artificial feeding stations, we mimicked a natural scenario in which two forager groups were simultaneously collecting from distinct patches containing different flowering species. We then observed the reactivation of these groups at their familiar feeding sites after interrupting their foraging. Social network analysis revealed that temporarily unemployed individuals interacted more often and for longer with foragers that advertised a familiar versus unfamiliar foraging site. Due to such resource‐based assortative mixing, network‐based diffusion analysis estimated that reactivation events primarily resulted from interactions among bees that had been trained to the same feeding station and less so from different‐feeder interactions. Both scent‐ and dance‐based interactions strongly contributed to reactivation decisions. However, each bout of dance‐following had an especially strong effect on a follower's likelihood of reactivation, particularly when dances indicated locations familiar to followers. Our findings illustrate how honeybee foragers can alter their social connectivity in ways that are likely to enhance collective outcomes by enabling foragers to rapidly access up‐to‐date information about familiar foraging sites. In addition, our results highlight how reliance on multiple communication mechanisms enables social insect workers to utilise flexible information‐use strategies that are robust to variation in the availability of social information.