Trends in drop out, drug free discharge and rates of re-presentation: a retrospective cohort study of drug treatment clients in the North West of England

Background: Governments aim to increase treatment participation by problematic drug users. In the UK this has been achieved by fiscal investment, an expanded workforce, reduced waiting times and coercive measures (usually criminal justice (CJ) led). No assessment of these measures on treatment outcomes has been made. Using established monitoring systems we assessed trends in 'dropped out' and 'discharged drug free' (DDF), since the launch of the national drug strategy, and rates of treatment re-presentation for these cohorts. Methods: A longitudinal dataset of drug users (1997 to 2004/05, n = 26,415) was used to identify people who dropped out of, and were DDF from, services for years 1998 to 2001/02, and representations of these people in years to 2004/05. Trends in drop out and DDF, baseline comparisons of those DDF and those who dropped out and outcome comparisons for those referred from the CJ system versus other routes of referral were examined using chi square. Logistic regression analyses identified variables predicting drop out versus DDF and subsequent representation versus no re-presentation. Results: The proportion of individuals dropping out has increased from 7.2% in 1998 to 9.6% in 2001/02 (P < 0.001). The proportion DDF has fallen from 5.8% to 3.5% (P < 0.001). Drop out was more likely in later years, by those of younger age and by CJ referrals. The proportion re-presenting to treatment in the following year increased from 27.8% in 1998 to 44.5% in 2001/02 (P < 0.001) for those DDF, and from 22.9% to 48.6% (P < 0.001) for those who dropped out. Older age and prior treatment experience predicted re-presentation. Outcome (drop out or DDF) did not predict re-presentation. Conclusion: Increasing numbers in treatment is associated with an increased proportion dropping out and an ever-smaller proportion DDF. Rates of drop out are significantly higher for those coerced into treatment via the CJ system. Rates of re-presentation are similar for those dropping out and those DDF. Encouragingly, those who need to re-engage with treatment, particularly those who drop out, are doing so more quickly. The impact of coercion on treatment outcomes and the appropriateness of aftercare provision require further consideration

Identifying factors associated with the success and failure of terrestrial insect translocations

Translocation is increasingly used as a management strategy to mitigate the effects of human activity on biodiversity. Based on the current literature, we summarised trends in terrestrial insect translocations and identified factors associated with success and failure. As the authors’ definitions of success and failure varied according to the individual sets of goals and objectives in each project, we adopted a standardised species-specific definition of success. We applied generalised linear models and information-theoretic model selection to identify the most important factors associated with translocation success. We found literature documenting the translocation of 74 terrestrial insect species to 134 release sites. Of the translocations motivated by conservation, 52% were considered successful, 31% were considered to have failed and 17% were undetermined. Our results indicate that the number of individuals released at a translocation site was the most important factor associated with translocation success, despite this being a relatively infrequent perceived cause of failure as reported by authors. Factors relating to weather and climate and habitat quality were the most commonly perceived causes of translocation failure by authors. Consideration of these factors by managers during the planning process may increase the chance of success in future translocation attempts of terrestrial insects

The influence of climate on past, present, and future conservation translocations

A large proportion of conservation translocations fail to establish viable populations. Managers often attribute translocation failure to environmental conditions at recipient sites, however, no study has attempted to quantify the importance of environmental conditions, such as climate, in determining past translocation outcomes. In this thesis, I investigate the potential effects of recent and future climatic conditions on translocated populations of ectothermic vertebrate and invertebrate taxa across the globe. Using species distribution modelling techniques, I contrast predicted climate suitability between sites of successful and unsuccessful translocation programmes. I find that the probability of translocation success increases as predicted climate suitability increases. Furthermore, when contrasting the effect of climate suitability against five other variables often considered in the peer-reviewed literature as important to translocation outcome, climate suitability exerted the strongest effect and explained the most variation in translocation outcome. While these results highlight the potential of predicted climate suitability to inform translocation management, the rapidly changing climate means that matching species climatic preferences to existing conditions will be insufficient to secure the long-term viability of translocated populations. I demonstrate this by projecting species distribution models (SDMs) onto scenarios of future climate change for species that have been successfully established through translocation. SDMs project that at least 74% of recipient sites will decline in suitability in the future, and alarmingly, this percentage is based on an optimistic scenario of greenhouse-gas emissions for the near-future (2021-2040). The final data-chapter of this thesis applies the findings and methodologies of the preceding chapters to support conservation decision-making in an ongoing translocation programme in the North West of England, by using SDM outputs to facilitate the prioritisation of translocation efforts towards species with the greatest likelihood of establishing long-term populations under climate change. My findings call for greater integration of the spatiotemporal properties of climate into translocation management planning and suggest that SDMs offer an effective tool for achieving this

Conserving temperate montane birds under climate change: an assessment of potential management options

Montane species are particularly vulnerable to the threats posed by climate change. As temperatures increase, their climatic niche will shift upwards – and species must either adapt to warmer conditions, or migrate to avoid extinction. In the first section of this thesis, I assessed the feasibility of management strategies available to conservation practitioners for conserving montane bird species under climate change. I integrated the dimensions of vulnerability outlined in previous research with management strategies relevant to the conservation of montane birds in order to specify the most appropriate strategy for species that display certain elements of vulnerability. I also outline the specific data and research needs that would allow conservation practitioners to more rigorously assess the management strategy for their focal montane species. It is evident that for some highly specialised species – such as alpine birds that are restricted to habitats above the treeline – conservation practitioners will be more limited in their choice of management approach. Assisted colonisation (AC) has been proposed as a strategy for mountaintop species with nowhere left to go. However, this strategy is reliant on the identification of suitable sites elsewhere. In the second section of this thesis, I focused on the identification and assessment of potential AC sites for European alpine birds. My results highlight the severe threat posed by climate change, with European alpine birds projected to lose 57-80% of their climatically suitable area by 2080. I identified promising AC sites that will sustain suitable conditions under climate change for the majority of species considered. My findings are useful for guiding conservation practitioners to the most suitable AC sites for alpine birds under climate change, as well as for identifying the most suitable source populations for translocating individuals to those sites, the latter of which represents a novel approach

Harms from other people's drinking: an international survey of their occurrence, impacts on feeling safe and legislation relating to their control.

OBJECTIVE: To examine factors associated with suffering harm from another person's alcohol consumption and explore how suffering such harms relate to feelings of safety in nightlife. DESIGN: Cross-sectional opportunistic survey (Global Drug Survey) using an online anonymous questionnaire in 11 languages promoted through newspapers, magazines and social media. SUBJECTS: Individuals (participating November 2014-January 2015) aged 18-34 years, reporting alcohol consumption in the past 12 months and resident in a country providing ≥250 respondents (n=21 countries; 63 725 respondents). MAIN OUTCOME MEASURES: Harms suffered due to others' drinking in the past 12 months, feelings of safety on nights out (on the way out, in bars/pubs, in nightclubs and when travelling home) and knowledge of over-serving laws and their implementation. RESULTS: In the past 12 months, >40% of respondents suffered at least one aggressive (physical, verbal or sexual assault) harm and 59.5% any harm caused by someone drunk. Suffering each category of harm was higher in younger respondents and those with more harmful alcohol consumption patterns. Men were more likely than women to have suffered physical assault (9.2% vs 4.7; p<0.001), with women much more likely to suffer sexual assault or harassment (15.3% vs 2.5%; p<0.001). Women were more likely to feel unsafe in all nightlife settings, with 40.8% typically feeling unsafe on the way home. In all settings, feeling unsafe increased with experiencing more categories of aggressive harm by a drunk person. Only 25.7% of respondents resident in countries with restrictions on selling alcohol to drunks knew about such laws and 75.8% believed that drunks usually get served alcohol. CONCLUSIONS: Harms from others' drinking are a threat to people's health and well-being. Public health bodies must ensure that such harms are reflected in measures of the societal costs of alcohol, and must advocate for the enforcement of legislation designed to reduce such harms

Optimization procedure for electric propulsion engines

This thesis addresses the optimization of all types of space electrical propulsion thrusters. From the Langmuir-Irving payload mass fraction formulation, a "dual-optimum" solution is defined, yielding a minimum overall mass for a specified payload consistent with minimum transfer time. This solution fixes the ideal payload mass ratio (m(pl / m(o)) at a value of 0.45, establishing the ratios of effective exhaust velocity (v / V(c)) and incremental change of vehicle velocity (deltau / V(c)) to characteristic velocity at 0.820 and 0.327 respectively. The characteristic velocity (V(c)) includes thrust time as well as engine efficiency (eta(t)) and specific power (alpha). A range of mass ratios from 0.35 to 0.55 is used in order to allow the system designer some flexibility while remaining close to optimal. Nine examples are presented which demonstrate that mission profiles can be optimized by profile-to-thruster matching. A comprehensive list of currently available electric propulsion engines is provided. This list details important parameters such as the specific power, which "sizes" an engine in terms of power provided to the thruster at the cost of additional mass. Allowance is, also made for a fuel tank mass penalty, and examples show that this can also noticeably influence the optimum design.http://archive.org/details/optimizationproc1094513424U.S. Navy (U.S.N.) author.Approved for public release; distribution is unlimited

Reaction Time of a Group of Physics Students

The reaction time of a group of students majoring in Physics is reported here. Strong co-relation between fatigue, reaction time and performance have been seen and may be useful for academicians and administrators responsible of working out time-tables, course structures, students counsellings etc.Comment: 10 pages, 4 figure

Growth hormone prescribing and initial BMI SDS: Increased biochemical adverse effects and costs in obese children without additional gain in height

BACKGROUND: Recombinant human growth hormone (rhGH) treatment in children is usually prescribed using actual body weight. This may result in inappropriately high doses in obese children. METHODS: Retrospective audit of all paediatric patients treated with rhGH 2010-14 at a tertiary paediatric hospital in the UK. Change in height SDS and IGF-I SDS during the first year of treatment was stratified by initial BMI SDS in a mixed cohort, and a subgroup of GH deficient (GHD) patients. Alternative doses for those BMI SDS ≥2.0 (Obese) were calculated using BSA, IBW and LBW. RESULTS: 354 patients (133 female) received rhGH, including 213 (60.2%) with GHD. Obesity was present in 40 patients (11.3%) of the unselected cohort, and 32 (15.0%) of the GHD cohort. For GHD patients, gain in height SDS was directly related to BMI SDS, except in obese patients (p<0.05). For both the entire cohort, and GHD patients only, IGF-1 SDS was significantly higher in obese patients (p<0.0001 for both groups). Cross sectional data identified 265 children receiving rhGH, 81 (30.5%) with a BMI-SDS ≥1.75. Alternate prescribing strategies for rhGH prescribing in obese patients suggest a saving of 27% - 38% annually. CONCLUSIONS: Gain in IGF-I SDS is greater in obese children, and is likely to be related to relatively higher doses of rhGH. Additional gain in height was not achieved at the higher doses administered to obese children. Alternative dosing strategies in the obese patient population should be examined in rigorous clinical trials

Holidays, celebrations, and commiserations: measuring drinking during feasting and fasting to improve national and individual estimates of alcohol consumption

BACKGROUND: Accurate measures of alcohol consumption are critical in assessing health harms caused by alcohol. In many countries, there are large discrepancies between survey-based measures of consumption and those based on alcohol sales. In England, surveys measuring typical alcohol consumption account for only around 60% of alcohol sold. Here, using a national survey, we measure both typical drinking and atypical/special occasion drinking (i.e., feasting and fasting) in order to develop more complete measures of alcohol consumption. METHODS: A national random probability telephone survey was implemented (May 2013 to April 2014). Inclusion criteria were resident in England and aged 16 years or over. Respondents (n = 6,085) provided information on typical drinking (amounts per day, drinking frequency) and changes in consumption associated with routine atypical days (e.g., Friday nights) and special dinking periods (e.g., holidays) and events (e.g., weddings). Generalized linear modelling was used to identify additional alcohol consumption associated with atypical/special occasion drinking by age, sex, and typical drinking level. RESULTS: Accounting for atypical/special occasion drinking added more than 120 million UK units of alcohol/week (~12 million bottles of wine) to population alcohol consumption in England. The greatest impact was seen among 25- to 34-year-olds with the highest typical consumption, where atypical/special occasions added approximately 18 units/week (144 g) for both sexes. Those reporting the lowest typical consumption (≤1 unit/week) showed large relative increases in consumption (209.3%) with most drinking associated with special occasions. In some demographics, adjusting for special occasions resulted in overall reductions in annual consumption (e.g., females, 65 to 74 years in the highest typical drinking category). CONCLUSIONS: Typical drinking alone can be a poor proxy for actual alcohol consumption. Accounting for atypical/special occasion drinking fills 41.6% of the gap between surveyed consumption and national sales in England. These additional units are inevitably linked to increases in lifetime risk of alcohol-related disease and injury, particularly as special occasions often constitute heavy drinking episodes. Better population measures of celebratory, festival, and holiday drinking are required in national surveys in order to adequately measure both alcohol consumption and the health harms associated with special occasion drinking