Residential school placements for children and young people with intellectual disabilities: their use and implications for adult social care

Out of area residential placements are associated with a range of poor outcomes for adults with intellectual disabilities and behaviours that challenge. In recent years there has been an increased drive to reduce such placements at as early a stage as possible. In this context the current review collates research and policy regarding use of residential schools for children and young people with intellectual disabilities and transition from these settings to adult services. The review highlights that relatively little is known about both use of, and transition from, residential schooling for children and young people with intellectual disabilities in the UK. Thirteen articles are identified: 7 examining the child or families’ experiences before placement, 4 examining outcomes during the placement, and 4 examining the process of transitioning from the placement and longer term outcomes. The methodological quality of articles was often limited. A lack of control groups, independent samples, or adequate sample sizes was particularly notable. Results are discussed in relation to factors that lead to a child’s placement in a residential school, children and families’ experiences of the placement, and outcomes following placement, including the transition process. A number of research priorities are highlighted based on gaps in the literature. Examples of alternative forms of support from clinical practice are provided, with recognition that a multi-element model is likely to be needed to provide high quality support to this group of young people

The relationship between radiological OA severity or body weight and outcomes following a structured education and exercise therapy program (GLA:D®) for people with knee osteoarthritis

BackgroundClinicians may presume people with higher bodyweight or greater OA severity do not respond to exercise therapy for knee osteoarthritis (OA), but few studies have examined this.ObjectiveTo examine the relationship between radiographical OA severity or bodyweight and pain and functional outcomes following a structured education and exercise therapy program (Good Life with OsteoArthritis from Denmark: GLA:D®).Methods33 participants with knee OA were assessed at baseline and week 8 following GLA:D®. Outcomes were pain (Visual analogue scale (VAS) 0–100), Knee Injury and Osteoarthritis Outcome Score-12 (KOOS-12 total), 40 m-fast-paced walk and 30-s chair stand. Multilevel models were used to define the severity of OA in medial, lateral and patellofemoral compartments using the Kellgren-Lawrence (KL) system and to examine the relationship between compartment severity, bodyweight and outcomes.ResultsNo meaningful relationships between bodyweight and response to GLA:D® were found for any outcome measures. Greater medial OA compartment severity was related to less improvement in pain, KOOS-12 and chair stand repetitions. However, all levels of lateral compartment severity had similar improvements, and greater patellofemoral compartment severity was related to more improvement for KOOS-12 and pain.ConclusionBodyweight may have little influence on a person's response to a structured education and exercise therapy program. While people with greater medial compartment severity were less likely to improve following the program, OA severity in the PF and lateral compartments was not a barrier to improvement

The local bisection hypothesis for twisted groupoid C*-algebras

In this note, we present criteria that are equivalent to a locally compact Hausdorff groupoid $G$ being effective. One of these conditions is that $G$ satisfies the "C*-algebraic local bisection hypothesis"; that is, that every normaliser in the reduced twisted groupoid C*-algebra is supported on an open bisection. The semigroup of normalisers plays a fundamental role in our proof, as does the semigroup of normalisers in cyclic group C*-algebras.Comment: 11 pages. This version matches the version in Semigroup Foru

Physical rehabilitation approaches for the recovery of function and mobility following stroke

Background: Various approaches to physical rehabilitation to improve function and mobility are used after stroke. There is considerable controversy around the relative effectiveness of approaches, and little known about optimal delivery and dose. Some physiotherapists base their treatments on a single approach; others use components from several different approaches. Objectives: Primary objective: To determine whether physical rehabilitation is effective for recovery of function and mobility in people with stroke, and to assess if any one physical rehabilitation approach is more effective than any other approach. Secondary objective: To explore factors that may impact the effectiveness of physical rehabilitation approaches, including time after stroke, geographical location of study, intervention dose/duration, intervention provider, and treatment components. Stakeholder involvement: Key aims were to clarify the focus of the review, inform decisions about subgroup analyses, and co-produce statements relating to key implications. Search methods: For this update, we searched the Cochrane Stroke Trials Register (last searched November 2022), CENTRAL (2022, Issue 10), MEDLINE (1966 to November 2022), Embase (1980 to November 2022), AMED (1985 to November 2022), CINAHL (1982 to November 2022), and the Chinese Biomedical Literature Database (to November 2022). Selection criteria: Inclusion criteria: Randomised controlled trials (RCTs) of physical rehabilitation approaches aimed at promoting the recovery of function or mobility in adult participants with a clinical diagnosis of stroke. Exclusion criteria: RCTs of upper limb function or single treatment components. Primary outcomes: measures of independence in activities of daily living (IADL) and motor function. Secondary outcomes: balance, gait velocity, and length of stay. Data collection and analysis: Two independent authors selected studies according to pre-defined eligibility criteria, extracted data, and assessed the risk of bias in the included studies. We used GRADE to assess the certainty of evidence. Main results: In this review update, we included 267 studies (21,838 participants). Studies were conducted in 36 countries, with half (133/267) in China. Generally, studies were heterogeneous, and often poorly reported. We judged only 14 studies in meta-analyses as at low risk of bias for all domains and, on average, we considered 33% of studies in analyses of primary outcomes at high risk of bias. Is physical rehabilitation more effective than no (or minimal) physical rehabilitation?. Compared to no physical rehabilitation, physical rehabilitation may improve IADL (standardised mean difference (SMD) 1.32, 95% confidence interval (CI) 1.08 to 1.56; 52 studies, 5403 participants; low-certainty evidence) and motor function (SMD 1.01, 95% CI 0.80 to 1.22; 50 studies, 5669 participants; low-certainty evidence). There was evidence of long-term benefits for these outcomes. Physical rehabilitation may improve balance (MD 4.54, 95% CI 1.36 to 7.72; 9 studies, 452 participants; low-certainty evidence) and likely improves gait velocity (SMD 0.23, 95% CI 0.05 to 0.42; 18 studies, 1131 participants; moderate-certainty evidence), but with no evidence of long-term benefits. Is physical rehabilitation more effective than attention control?. The evidence is very uncertain about the effects of physical rehabilitation, as compared to attention control, on IADL (SMD 0.91, 95% CI 0.06 to 1.75; 2 studies, 106 participants), motor function (SMD 0.13, 95% CI -0.13 to 0.38; 5 studies, 237 participants), and balance (MD 6.61, 95% CI -0.45 to 13.66; 4 studies, 240 participants). Physical rehabilitation likely improves gait speed when compared to attention control (SMD 0.34, 95% CI 0.14 to 0.54; 7 studies, 405 participants; moderate-certainty evidence). Does additional physical rehabilitation improve outcomes?. Additional physical rehabilitation may improve IADL (SMD 1.26, 95% CI 0.82 to 1.71; 21 studies, 1972 participants; low-certainty evidence) and motor function (SMD 0.69, 95% CI 0.46 to 0.92; 22 studies, 1965 participants; low-certainty evidence). Very few studies assessed these outcomes at long-term follow-up. Additional physical rehabilitation may improve balance (MD 5.74, 95% CI 3.78 to 7.71; 15 studies, 795 participants; low-certainty evidence) and gait velocity (SMD 0.59, 95% CI 0.26 to 0.91; 19 studies, 1004 participants; low-certainty evidence). Very few studies assessed these outcomes at long-term follow-up. Is any one approach to physical rehabilitation more effective than any other approach?. Compared to other approaches, those that focus on functional task training may improve IADL (SMD 0.58, 95% CI 0.29 to 0.87; 22 studies, 1535 participants; low-certainty evidence) and motor function (SMD 0.72, 95% CI 0.21 to 1.22; 20 studies, 1671 participants; very low-certainty evidence) but the evidence in the latter is very uncertain. The benefit was sustained long-term. The evidence is very uncertain about the effect of functional task training on balance (MD 2.16, 95% CI -0.24 to 4.55) and gait velocity (SMD 0.28, 95% CI -0.01 to 0.56). Compared to other approaches, neurophysiological approaches may be less effective than other approaches in improving IADL (SMD -0.34, 95% CI -0.63 to -0.06; 14 studies, 737 participants; low-certainty evidence), and there may be no difference in improving motor function (SMD -0.60, 95% CI -1.32 to 0.12; 13 studies, 663 participants; low-certainty evidence), balance (MD -0.60, 95% CI -5.90 to 6.03; 9 studies, 292 participants; low-certainty evidence), and gait velocity (SMD -0.17, 95% CI -0.62 to 0.27; 16 studies, 630 participants; very low-certainty evidence), but the evidence is very uncertain about the effect on gait velocity. For all comparisons, the evidence is very uncertain about the effects of physical rehabilitation on adverse events and length of hospital stay. Authors' conclusions: Physical rehabilitation, using a mix of different treatment components, likely improves recovery of function and mobility after stroke. Additional physical rehabilitation, delivered as an adjunct to 'usual' rehabilitation, may provide added benefits. Physical rehabilitation approaches that focus on functional task training may be useful. Neurophysiological approaches to physical rehabilitation may be no different from, or less effective than, other physical rehabilitation approaches. Certainty in this evidence is limited due to substantial heterogeneity, with mainly small studies and important differences between study populations and interventions. We feel it is unlikely that any studies published since November 2022 would alter our conclusions. Given the size of this review, future updates warrant consensus discussion amongst stakeholders to ensure the most relevant questions are explored for optimal decision-making.</p

Characterisation of the SARS-CoV-2 pandemic in healthcare workers within the United Kingdom: risk factors for infection during four successive waves

BackgroundHealthcare workers were at a high risk of infection early in the SARS-CoV-2 pandemic. It is uncertain to what extent occupational, household and community factors contributed, and how this changed over time. We aimed to characterise the risk factors for infection over four successive waves of the pandemic in a large, UK healthcare worker cohort (SIREN).MethodsParticipants underwent fortnightly SARS-CoV-2 PCR testing and symptom/exposure questionnaire. Attack rates and adjusted OR of infection were calculated according to participant characteristics and exposures for each wave between 1st October 2020 and 30th August 2022.Findings19,427 participants were included in the second wave, 20,260 in the third, 11,937 in the fourth, and 6503 in the fifth. The attack rates of infection were 9.1% (alpha), 6.6% (delta), 36.6% (omicron BA.1/2) and 15.9% (omicron BA.4/5), respectively.Occupational risk factors were only apparent in the second wave, during which significant social distancing measures were in place. These were identified as working as a healthcare assistant, nurse or bedside therapist, and working on an inpatient ward. Occupational exposure requiring personal protective equipment was also a risk.In subsequent waves, without social restrictions, occupational characteristics were not risk factors. Instead, living with others compared to living alone was a risk, particularly children. During the third wave (winter 2021–2022), having a colleague with COVID-19 was identified as a risk for the first time.InterpretationOur findings highlight clinical areas and occupational groups in which there may be scope to prevent healthcare-associated infections, particularly during winter pressures. Prospective studies targeting these are essential to establish which interventions are most effective. This study also underscores the importance of community circulation and exposures when considering healthcare workforce protection.<br/

Pre-conception self-harm, maternal mental health and mother-infant bonding problems:a 20-year prospective cohort study

Background: Self-harm in young people is associated with later problems in social and emotional development. However, it is unknown whether self-harm in young women continues to be a marker of vulnerability on becoming a parent. This study prospectively describes the associations between pre-conception self-harm, maternal depressive symptoms and mother&ndash;infant bonding problems.MethodsThe Victorian Intergenerational Health Cohort Study (VIHCS) is a follow-up to the Victorian Adolescent Health Cohort Study (VAHCS) in Australia. Socio-demographic and health variables were assessed at 10 time-points (waves) from ages 14 to 35, including self-reported self-harm at waves 3&ndash;9. VIHCS enrolment began in 2006 (when participants were aged 28&ndash;29 years), by contacting VAHCS women every 6 months to identify pregnancies over a 7-year period. Perinatal depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale during the third trimester, and 2 and 12 months postpartum. Mother&ndash;infant bonding problems were assessed with the Postpartum Bonding Questionnaire at 2 and 12 months postpartum.ResultsFive hundred sixty-four pregnancies from 384 women were included. One in 10 women (9.7%) reported pre-conception self-harm. Women who reported self-harming in young adulthood (ages 20&ndash;29) reported higher levels of perinatal depressive symptoms and mother&ndash;infant bonding problems at all perinatal time points [perinatal depressive symptoms adjusted &beta; = 5.40, 95% confidence interval (CI) 3.42&ndash;7.39; mother&ndash;infant bonding problems adjusted &beta; = 7.51, 95% CI 3.09&ndash;11.92]. There was no evidence that self-harm in adolescence (ages 15&ndash;17) was associated with either perinatal outcome.ConclusionsSelf-harm during young adulthood may be an indicator of future vulnerability to perinatal mental health and mother&ndash;infant bonding problems.</jats:sec

Providing personalised care for people with tuberculosis: an evaluation of enhanced case management in a UK TB Network 2013 to 2021

Objectives: Evaluating the outcomes of enhanced case management (ECM) for patients with tuberculosis (TB) in the North Central London TB Service (NCLTBS). // Design: Retrospective cohort study. // Setting: The NCLTBS provides care for persons diagnosed with TB across north and central London. Management involves both medical and psychosocial support, leading to the implementation ECM to provide additional non-clinical assistance to patients at risk of treatment non-completion. However, there has been limited evaluation of its outcomes. // Participants: All adults with TB notified to NCLTBS between January 2013 and June 2021. // Main outcome measures: Descriptive socio-economic and clinical characteristics grouped by binary ECM status (yes/no) and level (0–3). Clinical outcomes at 12 months (completed treatment, death, lost-to-follow-up, continuing on treatment) were compared using multivariable logistic regression. // Results: Totally, 2437 patients were included (57.2% male, 79.1% born outside the UK). Overall, 82.3% completed treatment and 4.1% died. Factors associated with mortality included older age (over 70 years odds ratio (OR) 3.3), inpatient diagnosis (OR 4.4), and mental health issues (OR 2.2). 52.8% received ECM, with the proportion increasing over time, and 76% of this group successfully competed treatment. // Conclusions: This comprehensive evaluation of ECM in a diverse London population indicates high treatment completion rates even among those with multiple social risk factors. However, ECM needs of patients has increased over time, with a particular rise in patients requiring the highest support level. Given the small difference between standard care and ECM categories 1 and 2, there may be scope to simplify the system

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Reflecting back, looking forward: the challenges for location-based learning

This final section of the report has been reproduced from “D3.1 The STELLAR Rendez-Vous I report and white papers”, published in 2009 by the STELLAR Network of Excellence. It is included here for completeness; we, as co-authors, felt that it was important to look back at the main contributions to theworkshop and also where the challenges lie for the future. This chapter addresses two critical questions: - What has been learned from this workshop, especially in respect to the STELLAR Grand Challenges (“Connecting learners”, “Orchestration” and “Contextualisation”)? - What are the new research questions and issues for location-based learning, with respect to the Grand Challenges (“Connecting learners”, “Orchestration”and “Contextualisation”)