‘Blocked at every level’: criminal justice system professionals’ experiences of including people with intellectual disabilities within a targeted magistrates’ court

This is an accepted manuscript of an article published by Emerald in Journal of Intellectual Disabilities and Offending Behaviour on 28/03/2020, available online: https://doi.org/10.1108/JIDOB-07-2019-0014 The accepted version of the publication may differ from the final published version.Purpose: Mental health courts (MHCs) may enable better support for people with intellectual disabilities (ID) within the criminal justice system (CJS) but little evaluative empirical evidence is available regarding their operation. This study explores professional perceptions of the challenges of including people with ID in a Targeted Services Court (TSC) designed for people with mental health issues and ID. Methodology: Information was gathered, via interviews and focus groups, from 46 professionals working with people with mental health issues and ID within the TSC. Data were analysed using thematic network analysis. Findings: Findings highlight the neglect and lack of inclusion of people with ID within the TSC processes, with challenges in identifying people with ID, stakeholder awareness, inconsistent adapting of practices for people with ID and information transfer underpinned by the involvement of numerous organisations with differing agendas. Implications: Although valued, development of a TSC including people with ID was a challenging endeavour and may reflect societal and institutional neglect of people with ID, recommendations are provided. Originality: This study adds to the few investigations have considered the process of including people with ID in a TSC from the perspective of those working in the criminal justice system

Homotopic Coupling in Persons with Epilepsy using Movie-driven and Resting-state fMRI

For the 30-40% of persons with epilepsy (PWE) with refractory epilepsy, seizure freedom following surgery is affected by the localization of the epileptogenic zone (EZ). However, functional abnormalities can exist at a distance from the EZ, which may contribute to variable outcomes after surgery. Considering epilepsy as a network disorder (Pittau & Vulliemoz, 2015), and evaluating functional coupling among homotopic brain areas, may help predict cognitive outcomes. Homotopic areas are well connected anatomically and undoubtedly work synchronously to generate cognition. We evaluated 22 persons with focal epilepsy and 24 neurologically healthy controls using fMRI at rest and while watching a brief and engaging audiovisual film clip. The Glasser parcellation (Glasser et al., 2016), a surface-based atlas that divides each hemisphere into 180 cortical regions and 22 functionally distinct sections, was applied and a baseline distribution of homotopic connectivity between pairs of regions and sections was established based on a subset of controls. Regional distribution of homotopic coupling activity was investigated as well as the relationship with performance on neuropsychological measures. We demonstrate the combined utility of resting-state and movie-driven fMRI for detecting homotopic functional coupling abnormalities in persons with refractory temporal lobe epilepsy. In addition, we find evidence of patient-specific and widespread abnormal homotopic functional coupling in PWE within and outside the temporal lobe. Finally, we show that the relationship between homotopic coupling at rest and performance on neuropsychological assessments shows group differences. Our findings supplement evidence of altered functional connectivity in epilepsy using resting-state fMRI and demonstrate how the engaged brain is altered in focal epilepsy

Police officers’ perceptions of their role in a mental health Magistrates’ court pathway

Although common in the USA, Mental Health Courts are relatively new to the UK and their effectiveness here is not yet fully understood. Referral to these courts is largely reliant upon early identification of mental health problems, a task commonly undertaken by police in the custody suite. Little is known about police perceptions of their role in working with offenders with mental health system in the UK. This exploratory study therefore investigates police views of a pilot Mental Health Courts and their role within the pathway to these. Semi-structured interviews were conducted with six members of a large police force involved in a pilot Mental Health Court. Data-led thematic analysis was used to identify the recurrent themes emerging. Three main themes were identified: ‘Benefits of a Mental Health Court’, ‘Police as Gatekeepers’ and ‘Barriers to Identification’. The introduction of Mental Health Courts in the UK was viewed as being reflective of changes in approaches to criminal justice. Whilst feeling responsibility for referrals to the Mental Health Court, time, training and multiagency working were seen as hindering this. The findings suggest the success of Mental Health Courts is dependent upon ‘getting it right’ from the start of the pathway; recommendations are provided

Internet Access by People with Intellectual Disabilities: Inequalities and Opportunities

This review gives an overview of the societal inequalities faced by people with intellectual disabilities, before focusing specifically on challenges people face accessing the Internet. Current access will be outlined along with the societal, support and attitudinal factors that can hinder access. Discussion of carer views of Internet use by people with intellectual disabilities will be covered incorporating consideration of the tension between protection, self-determination and lifestyle issues and gaining Internet access. We will address how impairment related factors may impede access and subsequently discuss how supports may be used to obfuscate impairments and facilitate access. We will move on from this to critically describe some of the potential benefits the Internet could provide to people with intellectual disabilities, including the potential for self-expression, advocacy and developing friendships. Finally, strategies to better include people with intellectual disabilities online will be given along with future research suggestions

The British HIV Association national clinical audit 2021: Management of HIV and hepatitis C coinfection

Objectives: We aimed to describe clinical policies for the management of people with HIV/hepatitis C virus (HCV) coinfection and to audit routine monitoring and assessment of people with HIV/HCV coinfection attending UK HIV care. Methods: This was a clinic survey and retrospective case-note review. HIV clinics in the UK participated in the audit from May to July 2021 by completing an online questionnaire regarding their clinic's policies for the management of people with HIV/HCV coinfection, and by contributing to a case-note review of people living with HIV with detectable HCV RNA who were under the care of their service. Results: Ninety-five clinics participated in the clinic survey; of these, 15 (15.8%) were regional specialist centres, 19 (20.0%) were HIV services with their own coinfection clinics, 40 (42.1%) were HIV services that referred coinfected individuals to a local hepatology service and 20 (21.1%) were HIV services that referred to a regional specialist centre. Eighty-one clinics provided full caseload estimates; of the approximately 3951 people with a history of HIV/HCV coinfection accessing their clinics, only 4.9% were believed to have detectable HCV RNA, 3.15% of whom were already receiving or approved for direct-acting antiviral (DAA) treatment. In total, 29 (30.5%) of the clinics reported an impact of COVID-19 on coinfection care, including delays or reductions in the frequency of services, monitoring, treatment initiation and appointments, and changes to the way that treatment was dispensed. Case-note reviews were provided for 283 people with detectable HCV RNA from 74 clinics (median age 42 years, 74.6% male, 56.2% HCV genotype 1, 22.3% HCV genotype 3). Overall, 56% had not received treatment for HCV, primarily due to lack of engagement in care (54.7%) and/or being uncontactable (16.4%). Conclusions: Our findings show that the small number of people with HIV with detectable HCV RNA in the UK should mean that it is possible to achieve HCV micro-elimination. However, more work is needed to improve engagement in care for those who are untreated for HCV

Progressing the care, husbandry and management of ageing mice used in scientific studies

Driven by the longer lifespans of humans, particularly in Westernised societies, and the need to know more about ‘healthy ageing’, ageing mice are being used increasingly in scientific research. Many departments and institutes involved with ageing research have developed their own systems to determine intervention points for potential refinements and to identify humane end points. Several good systems are in use, but variations between them could contribute to poor reproducibility of the science achieved. Working with scientific and regulatory communities in the UK, we have reviewed the clinical signs observed in ageing mice and developed recommendations for enhanced monitoring, behaviour assessment, husbandry and veterinary interventions. We advocate that the default time point for enhanced monitoring should be 15 months of age, unless prior information is available. Importantly, the enhanced monitoring should cause no additional harms to the animals. Where a mouse strain is well characterised, the onset of age-related enhanced monitoring may be modified based on knowledge of the onset of an expected age-related clinical sign. In progeroid models where ageing is accelerated, enhanced monitoring may need to be brought forward. Information on the background strain must be considered, as it influences the onset of age-related clinical signs. The range of ageing models currently used means that there will be no ‘one-size fits all’ solution. Increased awareness of the issues will lead to more refined and consistent husbandry of ageing mice, and application of humane end points will help to reduce the numbers of animals maintained for longer than is scientifically justified

Reactive Attachment Disorder in maltreated young children in foster care

Reactive attachment disorder (RAD) is one of the least researched and most poorly understood psychiatric disorders. Very little is known about the prevalence and stability of RAD symptoms over time. Until recently it has been difficult to investigate RAD due to limited tools for informing a diagnosis. Utilising a newly developed observational tool along with the Disturbances of Attachment Interview. this short-term prospective longitudinal study explored RAD symptoms in maltreated young children in Scotland (n=100, age range =12-62 months) over 12 months. Children were recruited as part of The Best Services Trial (BeST ), in which all infants who came in to the care of the local authority in Glasgow due to child protection concerns were invited to participate. Prevalence of RAD was found to be 5.0% (n=5, 95% CI [0.7-9.3]) when children were first placed in to foster care. Following at least 1 year of improved care conditions, prevalence in the 76 children remaining in the study was 2.1% (n=2, 95% CI [below 0-4.7]). RAD was associated with some mental health and cognitive difficulties. While levels of carer-reported RAD symptoms decreased significantly over time, observed symptoms did not. Findings suggest that RAD resolved in a small majority of cases but further exploration in larger samples would be invaluable

NK cell function is markedly impaired in patients with chronic lymphocytic leukaemia but is preserved in patients with small lymphocytic lymphoma

Chronic lymphocytic leukemia (B-CLL) and small lymphocytic lymphoma (SLL) are part of the same disease classification but are defined by differential distribution of tumor cells. B-CLL is characterized by significant immune suppression and dysregulation but this is not typical of patients with SLL. Natural killer cells (NK) are important mediators of immune function but have been poorly studied in patients with B-CLL/SLL. Here we report for the first time the NK cell phenotype and function in patients with B-CLL and SLL alongside their transcriptional profile. We show for the first time impaired B-CLL NK cell function in a xenograft model with reduced activating receptor expression including NKG2D, DNAM-1 and NCRs in-vitro. Importantly, we show these functional differences are associated with transcriptional downregulation of cytotoxic pathway genes, including activating receptors, adhesion molecules, cytotoxic molecules and intracellular signalling molecules, which remain intact in patients with SLL. In conclusion, NK cell function is markedly influenced by the anatomical site of the tumor in patients with B-CLL/SLL and lymphocytosis leads to marked impairment of NK cell activity. These observations have implications for treatment protocols which seek to preserve immune function by limiting the exposure of NK cells to tumor cells within the peripheral circulation

Metal β-diketoiminate precursor use in aerosol assisted chemical vapour deposition of gallium- and aluminium-doped zinc oxide

Aerosol assisted chemical vapour deposition (AACVD) has been used to deposit thin films of ZnO from the single-source precursor [Zn(OC(Me)CHC(Me)N(iPr))2] (1) affording highly transparent (>80%) and conductive films (sheet resistance ∼70 KΩ/sq). Extension of this AACVD method whereby related precursors of the type, [R2M(OC(Me)CHC(Me)N(iPr))] (R = Et, M = Al (2); R = Me, M = Ga (3)), isolated as oils, were added to the precursor solution allowed for the deposition of aluminium- and gallium-doped ZnO (AZO and GZO) films, respectively. Complexes 1–3 were characterised by elemental analysis, NMR and mass spectrometry. Films were deposited in under 30 min at 400 °C, from CH2Cl2/toluene solutions with a N2 carrier gas. Herein we report the bulk resistivity, ρ, of AZO (0.252 Ω cm) and GZO (0.756 Ω cm) films deposited from this novel approach. All the films transparency exceeded 80% in the visible, X-ray diffraction (XRD) showed all films to crystallise in the wurtzite phase whilst X-ray photoemission spectroscopy (XPS) confirmed the presence of the Al and Ga dopants in the films, and highlighted the low C-contamination (<5%) this route offers. Investigation of a mechanism analogous to the Kirkendall effect confirmed that heating of GZO films at 1000 °C produced the spinel structure GaZn2O4