What is the impact of nature on human health? A scoping review of the literature.

Background: The burden of non-communicable diseases (including poor mental health) is increasing, and some practitioners are turning to nature to provide the solution. Nature-based interventions (NBIs) could offer cost-effective solutions by reconnecting individuals with nature, but the success of these interventions depends partially on the way in which people engage with blue and green spaces.

Methods: We conducted a scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and Cochrane guidelines to establish the evidence base for treating poor mental and physical health with NBIs.

Utilising quality of life outcome trajectories to aid patient decision making in pelvic exenteration.

Background: Shared decision-making in pelvic exenteration is a complex and detailed process, which must balance clinical, oncological and patient-reported outcomes (PROs), whilst addressing and valuing the patient priorities. Communicating patient-centred information on quality of life (QoL) and functional outcomes is an essential component of this. The aim of this systematic review was to understand the impact of pelvic exenteration on QoL PROs over a longitudinal period and to develop QoL trajectories to support decision-making in this context.

Current costs of dialysis modalities: A comprehensive analysis within the United Kingdom.

Background: Previous evidence suggests home-based dialysis to be more cost-effective than unit-based or hospital-based dialysis. However, previous analyses to quantify the costs of different dialysis modalities have used varied perspectives, different methods, and required assumptions due to lack of available data. The National Institute for Health and Care Excellence reports uncertainty about the differences in costs between home-based and unit-based dialysis.

Early palliative interventions for improving outcomes in people with a primary malignant brain tumour and their carers.

Background: Primary malignant brain tumours can have an unpredictable course, but high-grade gliomas typically have a relentlessly progressive disease trajectory. They can cause profound symptom burden, affecting physical, neurocognitive, and social functioning from an early stage in the illness. This can significantly impact on role function and on the experiences and needs of informal caregivers.

Healthy eating and lifestyle in pregnancy (HELP): a cluster randomised trial to evaluate the effectiveness of a weight management intervention for pregnant women with obesity on weight at 12 months postpartum.

Objective: To assess whether a weight management intervention for pregnant women with obesity was effective in reducing body mass index (BMI) 12 months after giving birth.

Methods: Pragmatic, cluster randomised controlled trial (RCT) with embedded cost-effectiveness analysis. 598 women with a BMI of ≥30 kg/m (between 12 and 20 weeks gestation) were recruited from 20 secondary care maternity units in England and Wales.

Antibodies to the Caspr1/contactin-1 complex in chronic inflammatory demyelinating polyradiculoneuropathy.

Previous studies have described the clinical, serological and pathological features of patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and antibodies directed against the paranodal proteins neurofascin-155, contactin-1 (CNTN1), contactin-associated protein-1 (Caspr1), or nodal forms of neurofascin. Such antibodies are useful for diagnosis and potentially treatment selection. However, antibodies targeting Caspr1 only or the Caspr1/CNTN1 complex have been reported in few patients with CIDP.

Clinical management and mortality risk in those with eating disorders and self-harm: e-cohort study using the SAIL databank.

Background: Individuals with eating disorders who self-harm are a vulnerable group characterised by greater pathology and poorer outcomes.

Aims: To explore healthcare utilisation and mortality in those with a record of: self-harm only; eating disorders only; and both co-occurring.

Method: We conducted a retrospective whole population e-cohort study of individuals aged 10-64 years from 2003 to 2016.

X Chromosome Contribution to the Genetic Architecture of Primary Biliary Cholangitis.

Background & Aims: Genome-wide association studies in primary biliary cholangitis (PBC) have failed to find X chromosome (chrX) variants associated with the disease. Here, we specifically explore the chrX contribution to PBC, a sexually dimorphic complex autoimmune disease.

Methods: We performed a chrX-wide association study, including genotype data from 5 genome-wide association studies (from Italy, United Kingdom, Canada, China, and Japan; 5244 case patients and 11,875 control individuals).

Validation of Risk Prediction Models to Inform Clinical Decisions After Acute Kidney Injury.

Rationale & Objective: There is limited evidence to guide follow-up after acute kidney injury (AKI). Knowledge gaps include which patients to prioritize, at what time point, and for mitigation of which outcomes. In this study, we sought to compare the net benefit of risk model-based clinical decisions following AKI.

Expecting the unexpected: measures, outcomes and dying trajectories for expected and unexpected death in adults with intellectual disabilities in social care settings in the UK.

Background: Considerable attention is rightly paid to preventable deaths in adults with intellectual disabilities. The pattern of these deaths and the implications for services have been less considered.

Method: This paper forms part of a larger cross-sectional study of deaths in a defined population of adults with intellectual disabilities.

Improving access to the treatment of hepatitis C in low- and middle-income countries: evaluation of a patient assistance programme.

Background Modern antiviral treatments have high cure rates against the hepatitis C virus however, the high cost associated with branded medicines and diagnostic tests, have resulted in poor access for many low-income patients residing in low-and-middle-income countries. Objective This study aimed to evaluate the role of a patient assistance programme and generic medicines in improving access to treatment of low-income hepatitis C patients in a low-and-middle-income country. Setting A major teaching public hospital in Islamabad, Pakistan.

Multimorbidity in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: Results From a Longitudinal, Multicenter Data Linkage Study.

Objective: Antineutrophil cytoplasmic antibody-associated vasculitis (AAV) is considered a chronic, relapsing condition. To date, no studies have investigated multimorbidity in AAV nationally. This study was undertaken to characterize temporal trends in multimorbidity and report excess health care expenditures associated with multimorbidities in a national AAV cohort from Scotland.

Emotional modulation of the pupil in psychopathy: A test of the Response Modulation Hypothesis.

Some aspects of psychopathy may be underpinned by a deficit in processing emotional information, although there is evidence that this impairment only emerges when the affective cues are not central to ongoing goal-directed behaviour. However, this hypothesis has not been explored previously in relation to autonomic reactivity to emotional stimuli. The current study investigated this in a large (N = 174) community sample by examining changes in pupil diameter, a measure of autonomic nervous system activity, while participants viewed images that were either neutral in content or contained highly arousing/emotional content.

Prostate Cancer Risk by BRCA2 Genomic Regions.

A BRCA2 prostate cancer cluster region (PCCR) was recently proposed (c.7914 to 3') wherein pathogenic variants (PVs) are associated with higher prostate cancer (PCa) risk than PVs elsewhere in the BRCA2 gene. Using a prospective cohort study of 447 male BRCA2 PV carriers recruited in the UK and Ireland from 1998 to 2016, we estimated standardised incidence ratios (SIRs) compared with population incidences and assessed variation in risk by PV location.

Prognostic prediction tools and clinician communication: a qualitative study of the effect of the STUMBL tool on clinical practice.

Background: In recent years, researchers and clinicians have been developing prognostic prediction tools (PPTs) as a way of identifying patients at risk of deterioration. The use of PPTs in the clinical environment not only impacts the risk of adverse outcomes for patients, but the use of these tools also effect clinical practice. Much attention has been paid to the clinical performance of PPTs.

Incidence of postpartum haemorrhage defined by quantitative blood loss measurement: a national cohort.

Background: Visual estimation of blood loss following delivery often under-reports actual bleed volume. To improve accuracy, quantitative blood loss measurement was introduced for all births in the 12 hospitals providing maternity care in Wales. This intervention was incorporated into a quality improvement programme (Obstetric Bleeding Strategy for Wales, OBS Cymru).

Management of Parkinson's Disease During Pregnancy: Literature Review and Multidisciplinary Input.

Background: There are no standardized clinical guidelines for the management of Parkinson's disease (PD) during pregnancy. Increasing maternal age would suggest that the incidence of pregnancy in women diagnosed with PD is likely to increase.

Objective: To evaluate the evidence for the treatment of PD during pregnancy and to canvass opinion from patients and clinical teams as to the optimum clinical management in this setting.

An Analytical Approach for Improving Patient-centric Delivery of Dialysis Services.

In this paper, we report on the development of an analytical model and a decision support tool for meeting the complex challenge of scheduling dialysis patients. The tool has two optimization objectives: First, waiting times for the start of the dialysis after the patients' arrivals must be minimized. Second, the minimization of lateness after the scheduled finish time, which is relevant for transport services, are pursued.

Designing and implementing an all Wales postpartum haemorrhage quality improvement project: OBS Cymru (the Obstetric Bleeding Strategy for Wales).

Background: Postpartum haemorrhage (PPH) contributes to substantial maternal morbidity. Research into PPH has led to improvements in care which have been incorporated into the Obstetric Bleeding Strategy for Wales.

Intervention: A national quality improvement team supported local teams in implementing multiple interventions including risk assessment, objective measurement of blood loss, multiprofessional assessment (at the bedside at 1000 mL blood loss) and point-of-care (POC) testing of coagulation to guide blood product resuscitation during PPH.

Prevalence and outcome of dual aortic stenosis and cardiac amyloid pathology in patients referred for transcatheter aortic valve implantation.

Aims: Cardiac amyloidosis is common in elderly patients with aortic stenosis (AS) referred for transcatheter aortic valve implantation (TAVI). We hypothesized that patients with dual aortic stenosis and cardiac amyloid pathology (AS-amyloid) would have different baseline characteristics, periprocedural and mortality outcomes.

Methods And Results: Patients aged ≥75 with severe AS referred for TAVI at two sites underwent blinded bone scintigraphy prior to intervention (Perugini Grade 0 negative, 1-3 increasingly positive).

Spontaneous spondylodiscitis in an elderly lady.

A 76-year-old woman presented following two episodes of unexplained falls at home. Blood cultures were positive for and following investigations she was diagnosed with L4/L5 spondylodiscitis confirmed on spine MRI. She was initially treated with intravenous metronidazole and flucloxacillin prior to switching to ceftriaxone with good results.

Characterizing infection in anti-neutrophil cytoplasmic antibody-associated vasculitis: results from a longitudinal, matched-cohort data linkage study.

Objectives: Infection exerts a major burden in ANCA-associated vasculitis (AAV), however, its precise extent and nature remains unclear. In this national study we aimed to longitudinally quantify, characterize and contextualize infection risk in AAV.

Methods: We conducted a multicentre matched cohort study of AAV.

Impact of HIV and chronic kidney disease comorbidities on hepatitis C treatment choices, drug-drug interactions and hepatitis C cure.

Background Human immunodeficiency virus (HIV) co-infection and chronic kidney disease add challenges to hepatitis C virus treatment. Objective To conduct a comparative study of treatment choices, drug-drug interactions and clinical outcomes in hepatitis C mono-infected patients, or those with HIV or chronic kidney disease comorbidities. Setting Hepatitis C treatment centers of West Midlands England, United Kingdom.

Self-Esteem, Narcissism, and Aggression: Different Types of Self-Esteem Predict Different Types of Aggression.

The aim of this study was to examine the relationship between self-esteem, narcissism, and measures of proactive and reactive aggression in two large community samples of young adults from two countries (the United Kingdom and Malaysia). Self-esteem and narcissism were measured through the Multidimensional Self-Esteem Inventory and the Narcissistic Personality Inventory, whereas aggression was measured by the Reactive-Proactive Aggression Questionnaire in 501 young adults with approximately equal numbers of men and women. In both countries, low levels of self-esteem were associated with reactive aggression while high levels of narcissism were associated with proactive aggression.