London Health Research Articles

S221. QUANTITATIVE SYSTEMS PHARMACOLOGY AS AN ALTERNATIVE TO CHLORPROMAZINE EQUIVALENTS: PREDICTIVE VALIDATION FROM A CRIS DATABASE EXPERIMENT

BackgroundPolypharmacy is common in real clinical practice and in pharma-sponsored clinical trials. Chlorpromazine equivalents do not take into account pharmacodynamic interactions of drug combinations. If there is a sufficiently deep calibration set available, bio-informatics approaches can build classifiers for clinical phenotypes. However, this is not always the case which severely limits the generalizability of the predictions.MethodsWe applied a mechanism-based computer model of a cortico-striatal-thalamocortical loop of the dorsal motor circuit that has been calibrated with clinical data on the prevalence of extrapyramidal symptoms after antipsychotic treatment in schizophrenia patients and therapeutic interventions in Parkinson’s patients[1]. The Quantitative Systems Pharmacology (QSP) model is based on the appropriate connections between basal ganglia regions and consists of 220 neurons (8 different cell types), 3500 synapses and implementations of 32 CNS active targets, based on their unique locations and coupling with intracellular pathways. Modulation of the various CNS targets were calculated on simulating the competition between the endogenous neurotransmitter and the two drugs at their appropriate concentrations and affinity.The model was challenged to blindly predict the extrapyramidal symptoms liability of 1,124 patients prescribed two antipsychotics for six or more months (772 unique combinations). Anonymized data were derived from South London and Maudsley NHS Foundation Trust (SLAM) electronic health records (EHR). Extrapyramidal side effects were captured and identified using a combination of Natural Language Processing and a bespoke algorithm [2]. Only names and doses of the two drugs were made available without any calibration set.ResultsBlind prediction of the outcomes using a Receiver Operating Characteristic curve with the QSP model resulted in an Area-Under-the Curve of 0.64 (p<0.01), compared to an AUC of 0.52 for the sum of the chlorpromazine equivalents, 0.53 for the sum of affinity constants or the sum of D2R occupancies of the individual antipsychotics (AUC=0.52).DiscussionQSP is a powerful approach to predict PD-PD interactions in the absence of any calibration set or with limited and unique data and is superior to chlorpromazine equivalents for predicting EPS liability. A major application is the simulation of pharmacodynamic interactions of comedications in clinical trials with novel compounds leading to possible better balance between the different treatment arms

PAM Day: Department of Performing Arts Medicine, University College London, 17 June 2017.

On 17 June 2017 the first PAM DAY was launched at the Institute of Sport Exercise and Health in London. This was organised by the Department of Performing Arts Medicine which is part of the Division of Surgery and Interventional Science at University College London. The Department runs a Master’s Programme in Performing Arts Medicine, and faculty and graduates of the course put together an event to bring awareness of Performing Arts Medicine to the medical profession, the performance educators, and the professionals in the arts.

Functional Recovery in Critically Ill Children, the "WeeCover" Multicenter Study.

To evaluate functional outcomes and evaluate predictors of an unfavorable functional outcome in children following a critical illness. Prospective observational longitudinal cohort study. Two tertiary care, Canadian PICUs: McMaster Children's Hospital and London Health Sciences. Children 12 months to 17 years old, admitted to PICU for at least 48 hours with one or more organ dysfunction, were eligible. Patients not expected to survive, direct transfers from neonatal ICU and patients in whom long-term follow-up would not be able to be conducted, were excluded. None. The primary endpoint was functional outcome up to 6 months post PICU discharge, measured using the Pediatric Evaluation of Disabilities Inventory Computer Adaptive Test. Secondary outcomes included predictors of unfavorable functional outcome, caregiver stress, health-related quality-of-life, and clinical outcomes such as mortality, length of stay, and PICU-acquired complications. One hundred eighty-two patients were enrolled; 78 children (43.6%) had functional limitations at baseline and 143 (81.5%) experienced functional deterioration following critical illness. Ninety-two (67.1%) demonstrated some functional recovery by 6 months. Higher baseline function and a neurologic insult at PICU admission were the most significant predictors of functional deterioration. Higher baseline function and increasing age were associated with slower functional recovery. Different factors affect the domains of functioning differently. Preexisting comorbidities and iatrogenic PICU-acquired morbidities were associated with persistent requirement for caregiver support (responsibility function) at 6 months. The degree of functional deterioration after critical illness was a significant predictor of increased hospital length of stay. This study provides new information regarding functional outcomes and the factors that influence meaningful aspects of functioning in critically ill children. Identifying patients at greatest risk and modifiable targets for improvement in PICU care guides us in developing strategies to improve functional outcomes and tailor to the rehabilitation needs of these patients and their families.

The Swetenesse of Confection: A Recipe for Spiritual Health in London, British Library, Additional MS 61823, The Book of Margery Kempe

The Swetenesse of Confection: A Recipe for Spiritual Health in London, British Library, Additional MS 61823, The Book of Margery Kempe

The Impact of Industrialization on London Health

The Impact of Industrialization on London Health

32. Demographic and Clinical Predictors of Duration of Untreated Psychosis

Background: A shorter duration of untreated psychosis (DUP) is associated with better outcomes following first-episode psychosis (FEP; Power et al., 2007; Birchwood et al., 2013; McGorry et al., 2008). However, the evidence on social and clinical factors that may predict to DUP is inconsistent. Aims: To investigate the association between DUP and social and clinical factors. Methods: A retrospective incidence study design was employed, using the Biomedical Research Centre (BRC) clinical record interactive search (CRIS) system. In brief, CRIS is a regional case register based in South London containing a large data set of anonymous clinical data of over 250 000 patient records derived from the South London and Maudsley NHS Foundation Trust (SLaM) electronic health record system. All patients presenting to SLaM adult mental health services for the first time with a psychotic disorder between May 2010 and April 2012 and in the catchment area served by SLaM were screened for inclusion. Data relating to DUP, sociodemographic characteristics, mode of contact, and source of referral were collated from clinical records. Individuals were included as cases if they were: resident in the London boroughs of Lambeth or Southwark (served by SLaM); aged 18–64 years (inclusive), experienced psychotic symptoms of at least one day duration, and were making their first contact for psychosis with mental health services. Results: A total of 558 individuals with first-episode psychosis were identified. Individuals who were unemployed (68.5%) experienced longer DUP (median = 119; interquartile range= 28–492) compared to people who were employed (19.6%; median =45; interquartile range= 6–426, P < .001). Living alone (29.7%) was also associated with longer DUP (median = 116; interquartile range = 30–531) compared to living with family/relative (median = 90; interquartile range = 14–370, P = .04). Further, an insidious mode of onset of psychosis (37.5%) was associated with longer DUP (median = 608; interquartile range = 360–1918) compared to acute onset (20.7%; median = 4; interquartile range = 2–6.5, P < .001). Similarly, individuals accessing care via accident and emergency departments (AE interquartile range = 6–295) compared with those referred by their general practitioner (GP 35.1%; Median=184.5; interquartile range = 46.5–821.5, P < .001). Conclusion: Findings from this sample of FEP patients suggest that indicators of social isolation were associated with DUP. Clinically, pathways into care were also strongly associated with DUP prior to help seeking. Our results are consistent with previous findings.

London health and care devolution plans to be finalised by end of year

London health and care devolution plans to be finalised by end of year

Topic - 'Health Justice Partnerships (HJP) Research, Evaluations and Findings, and 'How to.'' Presentation Slides, Panel of the Legal Education Foundation UK &amp; Allen &amp; Overy, 12 September 2016, London, UK

There is a growing evidence base demonstrating positive outcomes from the provision of legal advice in healthcare settings. In the US and Australia there are national centres that promote and co-ordinate this work, where they are respectively known as medical-legal partnerships and health justice partnerships. There are also multiple examples of good practice in the UK, captured by reports such as the Low Commission’s 2015 paper The Role of Advice Services in Health Outcomes. The Legal Education Foundation is keen to see the expansion of partnerships between health funders and providers and social welfare legal advice. There have been discussions about how to convert the isolated good practice into a more cohesive national system of health justice partnerships. This event was a workshop, which heard from Dr Liz Curran, a leading academic in this field who has been involved in Health Justice Partnerships in Australia and Steven Schulman, a partner at Akin Gump who has worked on Medical-Legal Partnerships in the US. Professor Dame Hazel Genn with a UK perspective as a leading authority on access to civil and administrative justice and her work to develop a pioneering student law clinic based at the Guttman Health and Well-being Centre in east London. The workshop was designed to be participatory so as to hear about UK-based examples of best practice and to explore how best to build upon the work going on in the UK.

Testosterone and cardiovascular disease – what is the story?

Testosterone therapy was thought to be good for the cardiovascular system until a couple of papers put the cat among the pigeons in 2013. In this article, based on a talk he gave at the UK National Congress of Men's Health in London in June, Professor Morgentaler discusses why he believes the negative papers were flawed and describes the evidence that points to positive cardiovascular benefits.

Now Hunt's back in the job, here's the top issues he needs to address.

Jeremy Hunt is back in his office at Richmond House, home of the Department of Health in London, for the foreseeable future - and against expectations. Even he must have thought that his time was up. Attention will now focus on what he should do next given his new lease of life, so here's what Nursing Standard would like him to tackle first.

THE DEVELOPMENT OF THE HOARD QUESTIONNAIRE: A SCREENING INSTRUMENT FOR HOARDING DISORDER.

abstract Aims and hypothesis The aim of this study was to conduct preliminary validation of a self-administered five item screening questionnaire for Hoarding Disorder. Background Hoarding disorder has been estimated to affect 2-5% of adults during their lifetime. It is a chronic condition which tends to manifest as a clinical problem later in life, yet it has been established that certain characteristics could begin in early adulthood. It is defined as acquisition and failure to discard objects of little value or use. This results in heavily cluttered living spaces, making them unusable. This condition is very disabling and accidental fatalities have occurred due to unsafe accumulations of objects. Although there are instruments which measure the severity of Hoarding Disorder, there is a lack of a simple- self-administered screening questionnaire for the condition. This study therefore chose to conduct preliminary validation on the HOARD Questionnaire, which is a five-item, binary response, screening questionnaire for Hoarding Disorder. It has been developed at the National and Trustwide OCD/BDD Service, South West London and St George's Mental Health NHS Trust. Methods Patients treated by the National and Trustwide Service for OCD/BDD, were asked to complete the HOARD questionnaire. All patients’ responses were compared with their diagnosis of Hoarding Disorder which was made following observation and interviews in their home by specialist mental health workers. Results Fifty-two patients completed the questionnaire, five of whom, had significant Hoarding Disorder on clinical assessment. Using a score of 3/5, the HOARD identified three of these five patients (false positive result in 13/52) (sensitivity 60.0% and specificity 72.3%). Conclusions Further investigation with a larger number of subjects is necessary before the use of the HOARD can be advocated widely. This preliminary investigation suggests it is an easy to use, sensitive and specific tool, which may have a future role in early identification of individuals at a risk of developing Hoarding Disorder.

Digital Media and Humanities

Digital Media and Humanities Graham Mooney Website Review: London’s Pulse http://wellcomelibrary.org/moh/ London’s Pulse is a digitized collection of London Medical Officer of Health (MOH) Reports covering the period 1848–1972. Starting with Sir John Simon’s first report for the City of London and ending with the major reorganization of English local government in the mid-1970s, London’s Pulse provides digitized coverage of the annual reports issued for each of the capital’s succession of local authorities: parishes and district boards, metropolitan boroughs, and boroughs. All told, the collection contains more than 5,500 reports. MOH reports are a mainstay of historical research into public health, social services, and human welfare at the local level. The existence of London’s Pulse ensures that this will continue. The website has a handy guide on how to use the reports, and short contextual essays not only on the reports themselves, but also covering topics such as the health of Londoners, the professional role of the MOH, and the changing face of London over time. The accompanying timeline, “The Health of London” is well presented, but it is far from exhaustive: here may lie an opportunity for encouraging user contributions and involvement. For most historical researchers of a certain vintage (myself included), the availability of digitized content such as London’s Pulse induces a micro-weep for all the tedious hours spent poring over content lists, indexes, and tables, and manually extracting narratives and statistical information. The user can still do this if desired: the reports can be browsed and selected by borough or decade and, as with the best digitization projects, the embedded document viewer means that the pages of any report can be leafed through elegantly and at leisure. However, as one would expect, the power of this website is in what lies waiting to be unearthed from these fully searchable documents. One neat aspect is the way in which the return on a search identifies textual from tabular data. In the latter case, a table’s column headings are also provided in the search results. The user can also elect whether to view only results containing tables. Charts are not separately listed, which is a shame for those interested in the visualization of data, though the word “Chart” can at least be used a search term. While the full text of any report can be downloaded—indeed the full corpus of the reports can be had as a 215 MB raw text file—most stunning is the availability of around 275,000 tables that have been extracted from the reports as individual files. These can be downloaded in a variety of formats (CSV, HTML, XML, and TEXT) to be manipulated by the user (the text and data can be reused under a Creative Commons license CC-BY 4.0). For these two things alone, London’s Pulse is a truly remarkable online [End Page 314] resource that I expect will be consulted very heavily by all kinds of users beyond the community of professional historians. Despite its many strengths, there are some aspects of the site that could be improved or enriched. The uninitiated user needs additional guidance on how the multiple local jurisdictions succeeded and superseded one another. To do this for the period covered would be something of a daunting and complex task, but the following example illustrates why it is necessary. The “Browse Boroughs” function on the home page allows the user to bring up the historical reports for each district falling under a borough’s boundary as it was constituted by the Local Government Act 1963. Select “Southwark,” for example, and the annual reports at various dates are returned for Bermondsey, St George Southwark, Camberwell, St Giles (Camberwell), Rotherhithe, St Saviour’s (Southwark), Newington, and Southwark. Without a great deal of sleuthing, the user can not know which of these reports belongs to a single parish, a vestry district board, a Metropolitan Borough (from 1901), or a Greater London Borough (from 1965). Nor would they know if Southwark (or any of the places that eventually made up the district “Southwark”) had consistent boundaries. This makes handling information for even a...

Bacterial Transformation and the Origins of Epidemics in the Interwar Period: The Epidemiological Significance of Fred Griffith's "Transforming Experiment".

Frederick Griffith (1879-1941) was an English bacteriologist at the Pathological Laboratory of the Ministry of Health in London who believed that progress in the epidemiology and control of infectious diseases would come only with more precise knowledge of the identity of the causative microorganisms. Over the years, Griffith developed and expanded a serological technique for identifying pathogenic microorganisms, which allowed the tracing of the sources of infectious disease outbreaks: slide agglutination. Yet Griffith is not remembered for his contributions to the biology and epidemiology of infectious diseases so much as for discovering the phenomenon known as 'transformation'. Griffith's discovery, for many, was a pure case of serendipity whose biological relevance had also largely escaped him. In this paper, I argue that the key to understanding the significance of bacterial transformation - and the scientific legacy of Fred Griffith - rests not only on it initiating a cascade of events leading to molecular genetics but also on its implications for epidemiology based on the biology of host-parasite interactions. Looking at Griffith's entire career, instead of focusing only on the transformation study, we can better appreciate the place of the latter within Griffith's overall contributions. Presented in this way, Griffith's experiment on bacterial transformation also ceases to appear as an anomaly, which in turn leads us to rethink some of the most prevalent historical conceptions about his work.

Meteorology, Air Quality, and Health in London: The ClearfLo Project

Abstract Air quality and heat are strong health drivers, and their accurate assessment and forecast are important in densely populated urban areas. However, the sources and processes leading to high concentrations of main pollutants, such as ozone, nitrogen dioxide, and fine and coarse particulate matter, in complex urban areas are not fully understood, limiting our ability to forecast air quality accurately. This paper introduces the Clean Air for London (ClearfLo; www.clearflo.ac.uk) project’s interdisciplinary approach to investigate the processes leading to poor air quality and elevated temperatures. Within ClearfLo, a large multi-institutional project funded by the U.K. Natural Environment Research Council (NERC), integrated measurements of meteorology and gaseous, and particulate composition/loading within the atmosphere of London, United Kingdom, were undertaken to understand the processes underlying poor air quality. Long-term measurement infrastructure installed at multiple levels (street and elevated), and at urban background, curbside, and rural locations were complemented with high-resolution numerical atmospheric simulations. Combining these (measurement–modeling) enhances understanding of seasonal variations in meteorology and composition together with the controlling processes. Two intensive observation periods (winter 2012 and the Summer Olympics of 2012) focus upon the vertical structure and evolution of the urban boundary layer; chemical controls on nitrogen dioxide and ozone production—in particular, the role of volatile organic compounds; and processes controlling the evolution, size, distribution, and composition of particulate matter. The paper shows that mixing heights are deeper over London than in the rural surroundings and that the seasonality of the urban boundary layer evolution controls when concentrations peak. The composition also reflects the seasonality of sources such as domestic burning and biogenic emissions.

Health and social care partnership improves lives

The coordination of health and social care services in south London is helping older people to stay healthy and independent for longer. Liam Benison reports

Online health Access for patients - How can London's health practices offer healthcare on demand?

Online health Access for patients - How can London's health practices offer healthcare on demand?

Female doctors are increasingly seeking help for eating disorders, Gerada says

More female doctors are seeking help for eating disorders, Clare Gerada, former chair of the Royal College of General Practitioners, has said. Gerada is medical director of the Practitioner Health Programme, a confidential London based health service for doctors and dentists.1 Speaking at the International Conference on Physician Health in London on Monday 15 September, …

EPA-1412 – Ethnic or social variation of the psychosis incidence in UK? results from EUGEI project - UK

Introduction Studies have reported high rates of schizophrenia and other psychoses in the Black Caribbean population in the UK, between two and 14 times higher than for the White population (Sharpley et al., 2001; Cantor-Graae & Selten, 2005; Fearon et al. 2006). We sought to clarify whether social adversity may contribute to the higher risk of psychosis in the Black Caribbean population. Method To address this question we used preliminary data from the ongoing EU-GEI study of first episode psychosis being conducted in London, UK. Socio-demographic information and data on social adversity were collected from 227 cases presenting with a first episode of psychosis to the South London & Maudsley National Health Service (NHS) Foundation Trust and from 199 controls representative of the local population. Logistic regression and odds ratios were calculated using Stata 11. Results 67% (n=150) of cases, compared with 25% (n=49) of controls, reported two or more markers of social adversity at admission. Compared with White British, Black Caribbean patients were 3.7 times more likely to experience adversity (i.e., being unemployed, living alone and being single) in adulthood (OR 3.7; 95%CI 1.2-10.7 p≤ 0.001). Interestingly, the same pattern was not evident for the other ethnic minority groups (Asian, Black African, Non British White and other minority). Conclusion These initial findings suggest that social adversity may be contributing to the high rates of psychosis observed in the Black Caribbean population in the UK.

The emergence of an ‘ethnic economy’? The spatial relationships of migrant workers in London's health and hospitality sectors

This paper examines how the globalized nature of London's service sector redefines spatial relationships for recent migrants working in the health and hospitality industries. Findings from the qualitative data demonstrate that recent temporary migrants to the UK employ broader strategies to secure employment than accounted for by current theories. The migrants in our case studies overwhelmingly utilized global and local recruitment and employment agencies, as well as sought employment in industries already established as ‘ethnic economies’. We suggest that this might be attributed to a lack of interaction with established co-ethnic immigrant communities; temporary migration trajectories; and living arrangements with co-migrants. We conclude by emphasizing the need to broaden our understanding of ethnic economies and social networks in light of these changing spatial relationships that have emerged through the globalization of the service sector in the UK.

Striving to excel

Joan Myers is an expert in motivation, inspired by the pioneering nurse Mary Seacole. A nurse consultant in community children’s nursing at Whittington Health in London, Joan set up a community nurse-led eczema clinic and has extensive clinical, collaborative, management and lecturing experience. She was recognised in this year’s Queen’s birthday honours with an OBE