Evidence-based policy on dietary calcium and vitamin D

Copyright © 2011 American Society for Bone and Mineral Research.Peer reviewedPostprin

Demographics of infertility and management of unexplained infertility

Peer reviewedPostprin

Energy transitions and uncertainty: creating low carbon investment opportunities in the UK electricity sector

This paper examines how actors in the UK electricity sector are attempting to deliver investment in low carbon generation. Low carbon technologies, because of their relative immaturity, capital intensity and low operational costs, do not readily fit with existing electricity markets and investment templates which were designed for fossil fuel based energy. We analyse key electricity market and infrastructure policies in the UK and highlight how these are aimed at making low carbon technologies ‘investable’ by reducing uncertainty, managing investment risks and repositioning actors within the electricity socio-technical ‘regime’. We argue that our study can inform contemporary debates on the politics and governance of sustainability transitions by empirically investigating the agency of incumbent regime actors in the face of uncertainty and by offering critical insights on the role of markets and finance in shaping socio-technical change

Whole-Exome Sequencing in the Differential Diagnosis of Primary Adrenal Insufficiency in Children.

Adrenal insufficiency is a rare, but potentially fatal medical condition. In children, the cause is most commonly congenital and in recent years a growing number of causative gene mutations have been identified resulting in a myriad of syndromes that share adrenal insufficiency as one of the main characteristics. The evolution of adrenal insufficiency is dependent on the variant and the particular gene affected, meaning that rapid and accurate diagnosis is imperative for effective treatment of the patient. Common practice is for candidate genes to be sequenced individually, which is a time-consuming process and complicated by overlapping clinical phenotypes. However, with the availability, and increasing cost effectiveness of whole-exome sequencing, there is the potential for this to become a powerful diagnostic tool. Here, we report the results of whole-exome sequencing of 43 patients referred to us with a diagnosis of familial glucocorticoid deficiency (FGD) who were mutation negative for MC2R, MRAP, and STAR the most commonly mutated genes in FGD. WES provided a rapid genetic diagnosis in 17/43 sequenced patients, for the remaining 60% the gene defect may be within intronic/regulatory regions not covered by WES or may be in gene(s) representing novel etiologies. The diagnosis of isolated or familial glucocorticoid deficiency was only confirmed in 3 of the 17 patients, other genetic diagnoses were adrenal hypo- and hyperplasia, Triple A, and autoimmune polyendocrinopathy syndrome type I, emphasizing both the difficulty of phenotypically distinguishing between disorders of PAI and the utility of WES as a tool to achieve this

Subjective experiences of compulsory treatment from a qualitative study of early implementation of the Mental Health (Care and Treatment)(Scotland) Act 2003

Compulsory psychiatric treatment is highly contested, and little research has focused specifically on direct experiences. The Mental Health (Care & Treatment) (Scotland) Act, 2003 introduced new roles and provisions including community treatment orders, and was designed to increase participation, ensure treatment was beneficial and was the ‘least restrictive’ alternative. This article draws on findings from semistructured interviews with 49 individuals who had experienced compulsion under this new legislation during 2007-08, that were part of a broader cohort study. Interviews with service users were conducted at two stages with 80% agreeing to be interviewed twice. The sample included people on a variety of compulsory orders from four Health Board areas, some of whom had been detained for the first time, while others reported ‘revolving door’ experiences. Peer researchers who were mental health service users carried out the interviews with professional researchers. The findings suggest that legislation had a limited impact on participation in the process of compulsion. Consensus was that although service users felt there was increased opportunity for their voices to be heard, this was not matched by having increased influence over professional decision-making, especially in relation to drug treatments. According to people's direct experiences, the passing of the legislation in itself had done little to change the dominant psychiatric paradigm. While providing a foundation for improving the process of compulsion, the findings suggest that as well as legislative reform, fundamental shifts in practice are needed both in terms of the nature of therapeutic relationships, and in embracing more holistic and recovery perspectives

Hughes for Senate Committee to Mr. and Mrs. James Meredith (1 October 1962)

https://egrove.olemiss.edu/mercorr_pro/1827/thumbnail.jp

Time-dependent Stochastic Modeling of Solar Active Region Energy

A time-dependent model for the energy of a flaring solar active region is presented based on a stochastic jump-transition model (Wheatland and Glukhov 1998; Wheatland 2008; Wheatland 2009). The magnetic free energy of the model active region varies in time due to a prescribed (deterministic) rate of energy input and prescribed (random) flare jumps downwards in energy. The model has been shown to reproduce observed flare statistics, for specific time-independent choices for the energy input and flare transition rates. However, many solar active regions exhibit time variation in flare productivity, as exemplified by NOAA active region AR 11029 (Wheatland 2010). In this case a time-dependent model is needed. Time variation is incorporated for two cases: 1. a step change in the rates of flare jumps; and 2. a step change in the rate of energy supply to the system. Analytic arguments are presented describing the qualitative behavior of the system in the two cases. In each case the system adjusts by shifting to a new stationary state over a relaxation time which is estimated analytically. The new model retains flare-like event statistics. In each case the frequency-energy distribution is a power law for flare energies less than a time-dependent rollover set by the largest energy the system is likely to attain at a given time. For Case 1, the model exhibits a double exponential waiting-time distribution, corresponding to flaring at a constant mean rate during two intervals (before and after the step change), if the average energy of the system is large. For Case 2 the waiting-time distribution is a simple exponential, again provided the average energy of the system is large. Monte Carlo simulations of Case~1 are presented which confirm the analytic estimates. The simulation results provide a qualitative model for observed flare statistics in active region AR 11029.Comment: 25 pages, 9 figure

A preliminary fishery quality index for Portuguese streams

There is a need to quantify the multivariate quality of a recreational fishery at the site scale to better communicate the relative quality among sites to the public and anglers. Borrowing on the general approach of multimetric indices of biotic integrity (IBIs), we developed fishery quality indices (FQIs) from species quality indices (SQIs) based on measures of fish abundance and size structure for northern and central Portuguese streams. Our FQIs showed regional patterns indicating a range in fishery quality. Higher coldwater FQI scores were mostly found in the northwestern (Minho and Lima), northeastern Douro, and northern Tagus basins. Higher warmwater FQI scores occurred in the eastern Tagus basin. The species that contributed the most to warmwater FQI scores were largemouth bass Micropterus salmoides, pumpkinseed Lepomis gibbosus, the cyprinid Luciobarbus bocagei, chubs Squalius carolitertii and S. pyrenaicus, and nases Pseudochondrostoma duriense and P. polylepis. The chubs, nases, and brown trout Salmo trutta contributed the most to coldwater FQI scores. As expected, our indices were correlated with river size and with disturbance at the catchment, segment, and site scales. Regression models for separate coldwater and warmwater FQIs were stronger than those for the individual SQIs and for an all-site FQI. The correlation was positive between the coldwater FQI and a coldwater IBI but negative between the warmwater FQI and warmwater IBIs. The proposed FQIs offer a quantitative approach for assessing relative fishery quality among sites and for making regional assessments given an appropriate study design. The component SQIs and SQI metrics of the FQIs can be disassociated to determine the population and species characteristics most affected by various environmental variables

On the relevance of the “genetics-based” approach to medicine for sociological perspectives on medical specialization

This paper draws on a study on the development of medical genetics as a medical specialism in the UK and Canada to reflect on how local and national contexts affect specialty formation. The paper begins by supporting earlier findings in the literature that stress, first, technological innovations as driving specialty formation, and, second, the domination of physicians in the division of medical labour. Beyond this, however, the paper explores the specific circumstances under which geneticists set about turning their work into a medical specialism based on a “genetics-based approach” to illness and how “medical genetics” as a specialism was assessed and configured to fit national and regional health service requirements

Anxiety, depression and swallowing disorders in patients with Parkinson’s disease

Swallowing disturbances (SDs), anxiety and depression are commonly present in Parkinson’s disease (PD) patients. We hypothesized that there is an association between the presence of SDs and the PD affective state. Sixty nine PD patients were assessed for the presence of SDs by undergoing cognitive screening with the Mini Mental State Examination (MMSE), completing three inventories: a swallowing disturbance questionnaire (SDQ), the Spielberger manual for the trait anxiety and Beck depression inventories. All patients underwent clinical swallowing evaluations by a speech and language pathologist (SLP). Patients diagnosed with SDs were also assessed by fiberoptic endoscopic evaluation of swallowing (FEES) performed by an ENT and SLP. Thirty eight patients experienced SDs, the other 31 did not. The clinical characteristics of the two groups were matched. Patients with SDs experienced increased anxiety and depression compared to patients without SDs. Comparisons between patients who scored in the two opposite ends of the anxiety and depression ranges demonstrated that the most anxious and depressed patients reported more swallowing difficulties (SDQ scores) compared with the least anxious and depressed ones. In addition, the most anxious patients had significantly increased disease severity and decreased MMSE scores compared with the least anxious patients. Disease severity was also increased in the most depressed patients compared with the least depressed ones. Advanced disease emerged as being associated with high anxiety levels and greater numbers of SDs. The contribution of anxiety or depression to the development or worsening of SDs and their role in treatment strategy warrant further investigation