Why do they fail? A qualitative follow up study of 1000 recruits to the British Army Infantry to understand high levels of attrition

BACKGROUND: The British Army has over 100 career employment groups to which recruits may apply. The Infantry is one of these career employment groups; it accounts for 25% of the overall strength. It is of concern that Infantry recruit attrition within the first 12 weeks of training remains consistently above 30%. Poor selection methods that lead to the enlistment of unsuitable recruits have negative financial and personal consequences, but little is known about the personal experiences of those who fail. OBJECTIVE: The aim of this research was to understand why infantry recruits choose to leave and explore the personal experiences of those that fail. METHODS: This study draws on qualitative data from the second phase of a larger mixed method study. The foci of this paper are the findings directly related to the responses of recruits in exit interviews and their Commanding Officers' training reports. An exploratory qualitative, inductive method was used to generate insights, explanations and potential solutions to training attrition. RESULTS: What the data describes is a journey of extreme situational demands that the recruits experience throughout their transition from civilian life to service in the British Infantry. It is the cumulative effect of the stressors, combined with the recruit being dislocated from their established support network, which appears to be the catalyst for failure among recruits. CONCLUSION: There are clearly defined areas where either further research or changes to current practice may provide a better understanding of, and ultimately reduce, the current attrition rates experienced by the Infantry Training Centre

How do potentially inappropriate medications and polypharmacy affect mortality in frail and non-frail cognitively impaired older adults?:A cohort study

OBJECTIVES: To test whether the use of potentially inappropriate central nervous system acting medications, proton pump inhibitors (PPIs) or polypharmacy are associated with mortality in cognitively impaired older adults and whether frailer people are at greater risk of harm. SETTING: A cohort study nested within the Cognitive Function and Ageing Study II, a population representative cohort study of the older population in Cambridgeshire, Nottingham and Newcastle, UK. PARTICIPANTS: A total of 1154 cognitively impaired participants, aged 65 years or older. EXPOSURES: Any use of antipsychotics, antidepressants, other anticholinergic medication, benzodiazepines or PPIs, polypharmacy (5-9) and hyperpolypharmacy (≥10 reported medications) were ascertained at baseline. Frailty was assessed using the Fried criteria. PRIMARY OUTCOME: Mortality up to 8 years follow-up. HRs associated with potentially inappropriate medication (PIM), frailty and their interaction were estimated adjusting for covariates. RESULTS: Within the sample, 44% were taking one or more PIM. Apart from antipsychotics (adjusted HR=3.24, 95% CI 1.83 to 5.73), use of specific PIM was not associated with greater subsequent mortality. Polypharmacy (HR=1.17, 95% CI 0.95 to 1.45) and hyperpolypharmacy were associated with mortality (HR=1.60, 95% CI 1.16 to 2.22). Being frail (HR=1.90, 95% CI 1.32 to 2.72) or prefrail (HR=1.56, 95% CI 1.10 to 2.20) was associated with increased mortality. There was some evidence that the HR for polypharmacy on mortality was lower among frailer individuals, but the overall polypharmacy by frailty interaction was not statistically significant (p=0.102). CONCLUSIONS: For those with cognitive impairment, greater concern should be afforded to the number of medications than the prescription of specific classes. Frailer individuals may have a lower relative risk of mortality associated with polypharmacy than less frail individuals

Research that supports nursing teams 2: learning opportunities that help staff to deliver better care.

This article, the second in a four-part series about using research evidence to support nursing teams, discusses the learning opportunities generated from four studies that followed the two Francis inquiries into care failings at Mid Staffordshire NHS Foundation Trust. We discuss how four different interventions, directly or indirectly use learning to enable nursing teams to optimise care in acute hospital settings. We argue that the profound impact of the Covid-19 pandemic may have overshadowed the need for measures to support nursing staff learning at a time when care quality is more important than ever

Research that supports nursing teams 1: how research can improve patient care and nurse wellbeing

This article, the first in a four-part series about using research evidence to inform the delivery of nursing care, discusses four studies that were funded following the two Francis inquiries into care failings at Mid Staffordshire NHS Foundation Trust. Each study examined a different intervention method in acute hospital settings aiming to improve patient care and protect the wellbeing of nursing staff: a team-based practice development programme, a relational care training intervention for healthcare assistants, a regular bedside ward round (intentional rounding), and monthly group meetings during which staff discussed the emotional challenges of care. The remaining articles in this series will explore the results of the studies and how they can be applied to nursing care during and after the coronavirus pandemic

Mountains of Maize, Persistent Poverty

The past two years are a tribute to Zambian farmers; they have responded admirably to government efforts to promote maize production. But ironically, rural poverty remains stubbornly high despite the fact that the government has spent over 2% of the nation’s gross domestic product in supporting maize production and subsidizing inputs for farmers. Why is it that maize production has increased so impressively without making a serious dent in rural poverty? And what are the lessons for the new government?maize, poverty, Zambia, Agricultural and Food Policy, Food Security and Poverty,

Identifying British Army infantry recruit population characteristics using biographical data

Background: The infantry accounts for more than a quarter of the British Army but there is a lack of data about the social and educational background of its recruits population. Aims: The current study uses biographical data tTo provide an insight into British Army Iinfantry rRecruits’ personal, social and educational background prior to enlistment. Methods: The study sample consisted of 1000 Iinfantry recruits who enlisted into the British Army School of Infantry. Each recruit completed a 95 item biographical questionnaire. Descriptive statistics were used to describe the whole study sample in terms of demographics, physical, personal, social, and educational attributes. Results: The study sample consisted of 1000 male recruits. Over half of the recruits were consuming alcohol at a hazardous or harmful level prior to enlistment and 60% of recruits had used cannabis prior to joining the Army. Academic attainment was low, with the majority of recruits achieving GCSE grade C and below in most subjects, with 15% not taking any examinations. Over half the recruits had been in trouble with the police and either been suspended or expelled from school. Conclusions: Substance misuse and poor behaviour are highly prevalent among recruits prior to enlistment. Taken alongside existing evidence that some of these problems are commonplace among personnel in regular service, the assumption that the British Army iInfantry is, in itself, a cause of these behaviours should be questioned

Análisis de las propiedades de un concreto permeable con fibras de polipropileno para una resistencia de 210 kg/cm2 en la ciudad de Huancayo-Junín

La presente investigación planteo como problema general: ¿Cuáles serían los resultados al adicionar las fibras de polipropileno en las propiedades de un concreto permeable para una resistencia de 210 kg/cm2 en la ciudad de Huancayo-Junín?, el objetivo general fue: Determinar los resultados al adicionar las fibras de polipropileno en las propiedades de un concreto permeable para una resistencia de 210 kg/cm2 . El método de investigación fue científico, el tipo de investigación fue aplicada, el nivel de investigación fue explicativo y el diseño de investigación fue experimental, la población estuvo conformada por 72 probetas y 36 vigas de concreto, la muestra fue la asignación de porcentajes de fibras de polipropileno de un 0.04%,0.08% y 0.12%. Se concluye que al adicionar 0.08% de fibras de polipropileno mejoran el comportamiento del concreto permeable incrementando su resistencia a compresión y flexión, cumpliendo con los parámetros de coeficiente de permeabilidad

The effect of hypoglycaemia during hospital admission on health-related outcomes for people with diabetes: a systematic review and meta-analysis

Aims: To assess the health-related outcomes of hypoglycaemia for people with diabetes admitted to hospital; specifically, hospital length of stay and mortality.Methods: We conducted a systematic review and meta-analysis of studies relating to inpatient hypoglycaemia (<4 mmol/L) for hospitalised adults (≥16 years) with diabetes reporting the primary outcomes of interest, hospital length of stay or mortality. Final papers for inclusion were reviewed in duplicate and the adjusted results of each were pooled, using a random effects model then undergoing further prespecified subgroup analysis.Results: 15 studies were included in the meta-analysis. The pooled mean difference in length of stay for ward-based inpatients exposed to hypoglycaemia was 4.1 days longer (95% confidence interval [CI], 2.36-5.79; IÇ = 99%) compared to inpatients without hypoglycaemia. This association remained robust across the pre-specified subgroup analyses. The pooled relative risk (RR) of in-hospital mortality was greater for inpatients exposed to hypoglycaemia 2.09 (95% CI, 1.64 to 2.67; IÇ = 94%, n=7 studies) but not in intensive care unit mortality RR 0.75 (0.49 to 1.16; IÇ =0%, n=2 studies).Conclusion: There is an association between inpatient hypoglycaemia and longer length of stay and greater in-hospital mortality. Studies examining this association were heterogenous in terms of both clinical populations and effect size, but the overall direction of the association was consistent. Therefore, glucose concentration should be considered a potential tool to aid the identification of patients at risk of poor health-related outcomes

Antidepressant use and risk of adverse outcomes in people aged 20–64 years: cohort study using a primary care database

Background: Antidepressants are one of the most commonly prescribed medications in young and middle-aged adults, but there is relatively little information on their safety across a range of adverse outcomes in this age group. This study aimed to assess associations between antidepressant treatment and several adverse outcomes in people aged 20–64 years diagnosed with depression. Methods: We conducted a cohort study in 238,963 patients aged 20–64 years registered with practices across the UK contributing to the QResearch primary care database. Only patients with a first diagnosis of depression were included. Outcomes were falls, fractures, upper gastrointestinal bleed, road traffic accidents, adverse drug reactions and all-cause mortality recorded during follow-up. Cox proportional hazards models were used to estimate hazard ratios associated with antidepressant exposure adjusting for potential confounding variables. Results: During 5 years of follow-up, 4651 patients had experienced a fall, 4796 had fractures, 1066 had upper gastrointestinal bleeds, 3690 had road traffic accidents, 1058 had experienced adverse drug reactions, and 3181 patients died. Fracture rates were significantly increased for selective serotonin reuptake inhibitors (adjusted hazard ratio 1.30, 95% CI 1.21–1.39) and other antidepressants (1.28, 1.11–1.48) compared with periods when antidepressants were not used. All antidepressant drug classes were associated with significantly increased rates of falls. Rates of adverse drug reactions were significantly higher for tricyclic and related antidepressants (1.54, 1.25–1.88) and other antidepressants (1.61, 1.22–2.12) compared with selective serotonin reuptake inhibitors. Trazodone was associated with a significantly increased risk of upper gastrointestinal bleed. All-cause mortality rates were significantly higher for tricyclic and related antidepressants (1.39, 1.22–1.59) and other antidepressants (1.26, 1.08–1.47) than for selective serotonin reuptake inhibitors over 5 years but not 1 year, and were significantly reduced after 85 or more days of treatment with selective serotonin reuptake inhibitors. Mirtazapine was associated with significantly increased mortality rates over 1 and 5 years of follow-up. Conclusions: Selective serotonin reuptake inhibitors had higher rates of fracture than tricyclic and related antidepressants but lower mortality and adverse drug reaction rates than the other antidepressant drug classes. The association between mirtazapine and increased mortality merits further investigation. These risks should be carefully considered and balanced against potential benefits for individual patients when the decision to prescribe an antidepressant is made

Antidepressant use and risk of suicide and attempted suicide or self harm in people aged 20 to 64: cohort study using a primary care database

Objective To assess the associations between different antidepressant treatments and the rates of suicide and attempted suicide or self harm in people with depression. Design Cohort study. Setting Patients registered with UK general practices contributing data to the QResearch database. Participants 238 963 patients aged 20 to 64 years with a first diagnosis of depression between 1 January 2000 and 31 July 2011, followed up until 1 August 2012. Exposures Antidepressant class (tricyclic and related antidepressants, selective serotonin reuptake inhibitors, other antidepressants), dose, and duration of use, and commonly prescribed individual antidepressant drugs. Cox proportional hazards models were used to calculate hazard ratios adjusting for potential confounding variables. Main outcome measures Suicide and attempted suicide or self harm during follow-up. Results During follow-up, 87.7% (n=209 476) of the cohort received one or more prescriptions for antidepressants. The median duration of treatment was 221 days (interquartile range 79-590 days). During the first five years of follow-up 198 cases of suicide and 5243 cases of attempted suicide or self harm occurred. The difference in suicide rates during periods of treatment with tricyclic and related antidepressants compared with selective serotonin reuptake inhibitors was not significant (adjusted hazard ratio 0.84, 95% confidence interval 0.47 to 1.50), but the suicide rate was significantly increased during periods of treatment with other antidepressants (2.64, 1.74 to 3.99). The hazard ratio for suicide was significantly increased for mirtazapine compared with citalopram (3.70, 2.00 to 6.84). Absolute risks of suicide over one year ranged from 0.02% for amitriptyline to 0.19% for mirtazapine. There was no significant difference in the rate of attempted suicide or self harm with tricyclic antidepressants (0.96, 0.87 to 1.08) compared with selective serotonin reuptake inhibitors, but the rate of attempted suicide or self harm was significantly higher for other antidepressants (1.80, 1.61 to 2.00). The adjusted hazard ratios for attempted suicide or self harm were significantly increased for three of the most commonly prescribed drugs compared with citalopram: venlafaxine (1.85, 1.61 to 2.13), trazodone (1.73, 1.26 to 2.37), and mirtazapine (1.70, 1.44 to 2.02), and significantly reduced for amitriptyline (0.71, 0.59 to 0.85). The absolute risks of attempted suicide or self harm over one year ranged from 1.02% for amitriptyline to 2.96% for venlafaxine. Rates were highest in the first 28 days after starting treatment and remained increased in the first 28 days after stopping treatment. Conclusion Rates of suicide and attempted suicide or self harm were similar during periods of treatment with selective serotonin reuptake inhibitors and tricyclic and related antidepressants. Mirtazapine, venlafaxine, and trazodone were associated with the highest rates of suicide and attempted suicide or self harm, but the number of suicide events was small leading to imprecise estimates. As this is an observational study the findings may reflect indication biases and residual confounding from severity of depression and differing characteristics of patients prescribed these drugs. The increased rates in the first 28 days of starting and stopping antidepressants emphasise the need for careful monitoring of patients during these period