New psychoactive substances in England: a review of the evidence.

Aims and approach: This report builds on chapter 2 of the report of the expert panel review, and provides an overview of the current available evidence on New Psychoactive Substances (NPS)1. Conclusion: • NPS is a new and developing area of study. Many innovative methodologies are being used and conventions surrounding how best to research NPS are still being established. • There is good evidence on the identification of new NPS, and evidence on the use of NPS is also well established, albeit with some limitations. • However, there are gaps in the evidence on: • the prevalence of use of NPS, and a total measure of NPS use; • the use of NPS among subgroups other than NTE participants; • the long-term health harms of NPS use; • acute health harms of NPS use; • the extent to which NPS use drives social harms; • the impact and effectiveness of legislation; • the motivations for the use of NPS other than mephedrone; • the exact factors and mechanisms that affect displacement and supplementation; and • the extent to which individuals within social groups purchase online and then distribute within their social group. This review has had a significant legislative focus. We also recognise the importance of continuing to focus on our wider, balanced approach to ensure that we invest in all strands of our Drug Strategy. This is why we asked the Panel to also consider our wider approach to prevention, treatment and information sharing

The management and cost of surgical site infection in patients undergoing surgery for spinal metastasis

Background Surgical site infection (SSI) is a serious potential complication of spinal surgery. SSI can impact significantly on in-patient hospitalisation and the costs associated with extra care. Aim To investigate the management of patients experiencing SSI following surgery for spinal metastatic tumours, and to estimate the costs associated with SSI in this context. Methods Patients experiencing SSI following spinal tumour surgery at a large spinal surgery centre between January 2009 and December 2012 were identified. Existing case notes were reviewed and patient and procedural data, details of the infection and treatment interventions were collected. A bottom-up approach to calculating costs associated with infection was used for patients experiencing SSI and compared with a quasi-random sample of similar patients without SSI. Findings The mean cost of treating patients with SSI was significantly greater than costs associated with those without SSI (p=0.019). Mean cost of in-patient hospital stay was 60% higher in patients with SSI compared to those without SSI (p=0.004). In-patient hospital stay alone accounted for 59% of total costs. Return to theatre was the second most costly intervention overall, accounting for 38% of costs, and was the most expensive single intervention involved in the treatment of SSI. Conclusion SSI significantly increases healthcare costs for patients undergoing surgery for spinal metastasis, with prolonged in-patient hospitalisation and return to theatre for wound management being major contributors. The actual total cost to society derived from SSI in this patient group is likely to be far beyond just the direct costs to healthcare providers

Survival of patients undergoing surgery for metastatic spinal tumours and the impact of surgical site infection

Background Patients with metastatic spinal tumours have a limited prognosis. Surgical complications which may result in prolonged hospitalisation or readmission are highly undesirable. Surgical site infection (SSI) is one such complication which can, in extreme cases, lead to death. Aim To assess the impact of SSI on patient survival after surgery for spinal metastases. Methods Demographic, operative and survival data were collected on 152 patients undergoing surgery for spinal metastases at Salford Royal NHS Foundation Trust. American Society of Anesthesiologists (ASA) grade and the Revised To kuhashi Score (RTS) were obtained as measures of health status at baseline. A semi-parametric Cox proportional hazards survival analysis was used to assess the relationships between covariates and survival. Results Mean age at operation was 60.5 years (standard deviation 12.9 years). Seventeen patients (11.2%) experienced SSI. At the time of last follow up, 117 patients had died. RTS score (p<0.001; hazard ratio 0.82; 95% confidence interval: 0.76-0.87) and ASA grade (p=0.022; hazard ratio 1.40; 95% confidence interval: 1.05-1.87) were significantly associated with survival, with better survival found in patients with higher RTS and lower ASA scores. Infection status was of substantive importance, with better survival in those without SSI (p=0.075). Age was not substantively related to survival (p=0.299). Overall, median survival time from operation was 262 days (95% confidence interval: 190-334 days). Conclusions Five-year survival in patients undergoing surgery for spinal metastases is approximately 23%. Either or both of RTS or ASA scores can be used as indicators of patient survival. There is insufficient evidence to conclude that the presence of SSI retards survival

Survival of patients undergoing surgery for metastatic spinal tumours and the impact of surgical site 2 infection

Summary Background Patients with metastatic spinal tumours have a limited prognosis. Surgical complications that may result in prolonged hospitalization or readmission are highly undesirable. Surgical site infection (SSI) is one such complication, which can, in extreme cases, lead to death. Aim To assess the impact of SSI on patient survival after surgery for spinal metastases. Methods Demographic, operative, and survival data were collected on 152 patients undergoing surgery for spinal metastasis at a large UK tertiary referral centre. American Society of Anesthesiologists (ASA) grade and the Revised Tokuhashi Score (RTS) were determined as measures of health status and prognosis, respectively, at baseline. A semi-parametric Cox proportional hazards survival analysis was used to assess the relationships between covariates and survival. Findings Seventeen patients (11.2%) experienced SSI. Overall, median survival time from operation was 262 days (95% confidence interval: 190–334 days) and 12-month survival was 42.1%. RTS (hazard ratio: 0.82; 95% confidence interval: 0.76–0.89; P < 0.001) and ASA grade (1.37; 1.03–1.82; P = 0.028) were significantly associated with survival, with better survival found in patients with higher RTS and lower ASA scores. Infection status was of substantive importance, with better survival in those without SSI (P = 0.075). Conclusion Twelve-month survival in patients undergoing surgery for spinal metastasis is ∼42%. RTS and ASA scores may be used as indicators of patient survival either in combination or individually. Whereas SSI has some negative impact on survival, a larger study sample would be needed to confirm whether this is statistically significan

Practical steps toward integrating economic, social and institutional elements in fisheries policy and management

While international agreements and legislation call for incorporation of four pillars of sustainability, the social (including cultural), economic and institutional aspects (the ‘human dimension’) have been relatively neglected to date. Three key impediments have been identified: a relative lack of explicit social, economic and institutional objectives; a general lack of process (frameworks, governance) for routine integration of all four pillars of sustainability; and a bias towards biological considerations. Practical integration requires a ‘systems’ approach with explicit consideration of strategic and operational aspects of management; multidisciplinary or transdisciplinary evaluations; practical objectives for the four pillars of sustainability; appropriate participation; and a governance system that is able to integrate these diverse considerations in management. We challenge all involved in fisheries to immediately take five practical steps toward integrating ecological, economic, social and institutional aspects: (1) Adopt the perspective of the fishery as a ‘system’ with interacting natural, human and management elements; (2) Be aware of both strategic and operational aspects of fisheries assessment and management; (3) Articulate overarching objectives that incorporate all four pillars of sustainability; (4) Encourage appropriate (and diverse) disciplinary participation in all aspects of research, evaluation and management; and (5) Encourage development of (or emulate) participatory governance

Scaling and Eigenmode Tests of the Improved Fat Clover Action

We test a recently proposed improved lattice-fermion action, the fat link clover action, examining indicators of pathological small-quark-mass lattice artifacts ("exceptional configurations") on quenched lattices of spacing 0.12 fm and studying scaling properties of the light hadron spectrum for lattice spacing a=0.09 and 0.16 fm. We show that the action apparently has fewer problems with pathological lattice artifacts than the conventional nonperturbatively improved clover action and its spectrum scales just as well.Comment: 15 pp RevTeX, 5 Postscript figures, submitted to Phys. Rev. Rearranged section order and added an analysis of fluctuations of the pion correlato

Handwriting speed in children with Developmental Coordination Disorder: Are they really slower?

This is the post-print version of the final paper published in Research in Developmental Disabilities. The published article is available at the link below. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. Copyright @ 2013 Elsevier B.V.Handwriting difficulties are often included in descriptions of Developmental Coordination Disorder (DCD). They are cited as the most common reason for referral to health professionals following parent and teacher concerns about slow and untidy writing. The aim of this study was to compare handwriting performance in English children with and without DCD across a range of writing tasks, to gain a better understanding of the nature of ‘slowness’ so commonly reported. Twenty-eight 8–14 year-old children with a diagnosis of DCD participated in the study, with 28 typically developing age and gender matched controls. Participants completed the four handwriting tasks from the Detailed Assessment of Speed of Handwriting (DASH) and wrote their own name; all on a digitising writing tablet. The number of words written, speed of pen movements and the time spent pausing during the tasks were calculated. The findings confirmed what many professionals report, that children with DCD produce less text than their peers. However, this was not due to slow movement execution, but rather a higher percentage of time spent pausing. Discussion centres on the understanding of the pausing phenomenon in children with DCD and areas for further research.Oxford Brookes Universit

Critical Reflections in STEM Education

The purpose of this course is to foster abilities to teach, assess, and critically reflect on STEM learning that supports authentic engagement in interdisciplinary design and inquiry. Students will engage in making connections to STEM research literature with learning and teaching practice. Field placement in a K-5 learning environment is required for this course, which is typically fulfilled through a candidate’s full time teaching position. Other arrangements are permitted but not provided. This placement is the responsibility of the candidate