Values and behaviours: using the Ten Essential Shared Capabilities to support policy reform in mental health practice

This paper will review aspects of current policy in mental health with specific reference to policy that has a values focus. In this context, values refers to the standards and expectations we hold and which we use to guide aspects of practice performance. Service users state that core values that support, respect choice, collaboration, and customer service are critical foundation stones of a trusting therapeutic relationship. Attending to these foundations for practice has merit in ensuring the quality of care delivery in mental health. This paper will analyse what this means for the mental health workforce in their engagement with service users and delivery of policy priorities. Finally, the paper will explore resources, such as the Ten Essential Shared Capabilities (see Appendix 1), which support engagement and ongoing promotion of person-centred mental health care

Isolation of Salmonella spp. and bacteriophage active against Salmonella spp. from commercial swine

Bacteriophage are viruses that prey on bacteria and may be a potential strategy to reduce foodborne pathogemc bactena in the gastromtestlnal tract of food animals Phages are fairly common in the gastrointestinal microbial ecosystem of mammals, but the incidence is unknown. If phage are to be an intervention strategy, we must understand their role in the microbial ecology of the gut. From a regulatory perspective, knowing incidence of phage is crucial. Therefore the current study was designed to determine the incidence of phage active against Salmonella spp in the feces of commercial finishing swine in the United States. Fecal samples (n=60) were collected from each of six commercial swine finishing operations. Samples were collected from 10 randomly selected pens throughout each operation. Total number of fecal samples collected in this study was n=360 Salmonella spp were found in 66% of the fecal samples Salmonella spp. were isolated from only 2 farms and the serotypes represented were Schwarzengrund, Anatum, Ohio and Heidelberg Bacteriophages were isolated from fecal sample through 2 parallel methods, 1) initlal enrichment in Salmonella Typhimunum, or 2) initial ennchment in E. colt B (a strain very sensitive to phages), followed by direct spot-testing against Salmonella Typhimurium Bacteriophages active against Salmonella Typhimunum were isolated from 1.1% 4/360) of the individual fecal samples when initially enriched in Salmonella Typhimurium, but E coli S-killing phages were 1solated from 43.8% (158/360) of the fecal samples but only 2 of these Isolates were capable of k1ll1ng Salmonella Typhimunum. Our results mdicate that bactenophage capable of killing Salmonella Typh1murium are fairly w1despread across commercial swine production facilities but may be present at relatively low populat1ons These results md1cate that phage (predator) populations may vary along w1th Salmonella (prey) populations and that phage could potentially be used as a food safety pathogen reduction strategy

IRIS Guidelines: Early Intervention in Psychosis IRIS Guidelines Update September 2012

Revision of the original 1998 IRIS Guidelines

Isolation of Salmonella spp. and bacteriophage active against Salmonella spp. from commercial swine

Abstract Bactenophage are viruses that prey on bacteria and may be a poten tial strategy to reduce foodborne pathogemc bactena in the gastromtestlnal tract of food ammals Phages are fa1rly common m the gastrointestinal m1crob1al ecosystem of mammals, but the incidence is unknown. If phage are to be an intervention strategy, we must understand the1r role in the m1crobial ecology of the gut From a regulatory perspective, knowmg mc1dence of phage 1s cruc1al Therefore the current study was designed to determine the incidence of phage active against Salmonella spp 1n the feces of commercial finishmg swine m the Umted States Fecal samples (n=60) were collected from each of s1x commerc1al swme fimshmg operations Samples were collected from 10 randomly selected pens throughout each operation Total number of fecal samples collected m th1s study was n=360 Salmonella spp were found 1n 6 6% of the fecal samples Salmonella spp. were ISOlated from only 2 farms and the serotypes represented were Schwarzengrund, Anatum, Ohio and Heidelberg Bacteriophages were isolated from fecal sample through 2 parallel methods, 1) in1tlal enrichment m Salmonella Typh1munum, or 2) 1n1t1al ennchment 1n E. colt B (a stram very sensitive to phages), followed by direct spot-testing against Salmonella Typhimurium Bactenophages active against Salmonella Typhimunum were Isolated from 1 1% (4/360) of the individual fecal samples when initially enriched m Salmonella Typhimurium, but E coli S-killing phages were 1solated from 43.8% (158/360) of the fecal samples but only 2 of these Isolates were capable of k1ll1ng Salmonella Typhimunum. Our results mdicate that bactenophage capable of killing Salmonella Typh1murium are fairly w1despread across commercial swine production facilities but may be present at relatively low populat1ons These results md1cate that phage (predator) populations may vary along w1th Salmonella (prey) populations and that phage could potentially be used as a food safety pathogen reduction strateg

Antibiotic Resistance Genes in the Bacteriophage DNA Fraction of Environmental Samples

Antibiotic resistance is an increasing global problem resulting from the pressure of antibiotic usage, greater mobility of the population, and industrialization. Many antibiotic resistance genes are believed to have originated in microorganisms in the environment, and to have been transferred to other bacteria through mobile genetic elements. Among others, β-lactam antibiotics show clinical efficacy and low toxicity, and they are thus widely used as antimicrobials. Resistance to β-lactam antibiotics is conferred by β-lactamase genes and penicillin-binding proteins, which are chromosomal- or plasmid-encoded, although there is little information available on the contribution of other mobile genetic elements, such as phages. This study is focused on three genes that confer resistance to β-lactam antibiotics, namely two β-lactamase genes (blaTEM and blaCTX-M9) and one encoding a penicillin-binding protein (mecA) in bacteriophage DNA isolated from environmental water samples. The three genes were quantified in the DNA isolated from bacteriophages collected from 30 urban sewage and river water samples, using quantitative PCR amplification. All three genes were detected in the DNA of phages from all the samples tested, in some cases reaching 104 gene copies (GC) of blaTEM or 102 GC of blaCTX-M and mecA. These values are consistent with the amount of fecal pollution in the sample, except for mecA, which showed a higher number of copies in river water samples than in urban sewage. The bla genes from phage DNA were transferred by electroporation to sensitive host bacteria, which became resistant to ampicillin. blaTEM and blaCTX were detected in the DNA of the resistant clones after transfection. This study indicates that phages are reservoirs of resistance genes in the environment

Endophytic fungi from the roots of horseradish (Armoracia rusticana) and their interactions with the defensive metabolites of the glucosinolate myrosinase – isothiocyanate system

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What makes Early Intervention in Psychosis services effective?: A Case Study

A number of studies have demonstrated that Early Intervention in Psychosis (EIP) services can produce improved outcomes for service users. However, the essential elements that produce these results remain elusive. This paper considers a number of hypotheses, with a particular focus on one service in the UK, which was designed according to policy guidance. It concludes that the structure of EIP services allows for the effective implementation of evidence based psychosocial interventions, which often fail to be implemented successfully within standard mental health services

A national survey of psychosocial intervention training and skills in early intervention services in England

This study aimed to determine the level of training in psychosocial interventions among staff in the 119 early intervention in psychosis (EIP) teams that were established at the time. A brief questionnaire was sent to each of the teams asking for details of the composition of the team, and for details of any training in psychosocial interventions (PSI) the members of the team had undergone. Fifty-two questionnaires were returned (44%). Over half of the teams had input from social workers, clinical psychologists and occupational therapists to compliment the nursing provision, though less than 50% employed support workers or had specific psychiatry input. All but two of the teams returning the questionnaire had members of staff trained in PSI though the type of training tended to reflect availability of local training provision. The results are discussed and practical recommendations are made to ensure evidencebased care is implemented within EIP

Predictors of Outcome in Brief Cognitive Behaviour Therapy for Schizophrenia

Antipsychotic medications, while effective, often leave patients with ongoing positive and negative symptoms of schizophrenia. Guidelines recommend using cognitive behavior therapy (CBT) with this group. Clearly, mental health professionals require training and supervision to deliver CBT-based interventions. This study tested which antipsychotic-resistant patients were most likely to respond to brief CBT delivered by psychiatric nurses. Staff were trained over 10 consecutive days with ongoing weekly supervision. Training for carers in the basic principles of CBT was also provided. This article represents the secondary analyses of completer data from a previously published randomized controlled trial (Turkington D, Kingdon D, Turner T. Effectiveness of a brief cognitive-behavioural therapy intervention in the treatment of schizophrenia. Br J Psychiatry. 2002;180:523–527) (n = 354) to determine whether a number of a priori variables were predictive of a good outcome with CBT and treatment as usual. Logistic regression was employed to determine whether any of these variables were able to predict a 25% or greater improvement in overall symptoms and insight. In the CBT group only, female gender was found to strongly predict a reduction in overall symptoms (P = .004, odds ratio [OR] = 2.39, 95% confidence interval [CI] = 1.33, 4.30) and increase in insight (P = .04, OR = 1.84, 95% CI = 1.03, 3.29). In addition, for individuals with delusions, a lower level of conviction in these beliefs was associated with a good response to brief CBT (P = .02, OR = 0.70, 95% CI = 0.51, 0.95). Women with schizophrenia and patients with a low level of conviction in their delusions are most likely to respond to brief CBT and should be offered this routinely alongside antipsychotic medications and other psychosocial interventions

Pervasive developmental disorder and early intervention in psychosis services: a survey of care coordinators' experiences

Aim: To evaluate the experience of care coordinators encountering clients with co-morbid diagnoses or features of pervasive development disorder (PDD) in an Early Intervention in Psychosis (EIP) service. Methods: A cross-sectional survey was conducted using a semi-structured face-to-face interview schedule. Results: Thirty-three care coordinators were interviewed. One-third of the care coordinators had previously encountered at least one client with a co-morbid diagnosis of PDD, with the majority feeling confident that they could recognize the features of the syndrome. The estimated reported prevalence of diagnosed PDD in this group was around 4–5%, although social and communication impairments were regularly encountered in clients by at least a quarter of the clinicians interviewed. Conclusions: Social and communication problems are commonly observed by clinicians in this population and some may represent the presence of a co-morbid PDD. Further efforts should be made to better identify and support this sub-population of EIP clients