High willingness to use drug consumption rooms among people who inject drugs in Scotland: findings from a national bio-behavioural survey among people who inject drugs

Background To address rising drug-related harms (including significant transmission of HIV) among people who inject drugs (PWID) in Glasgow, officials have proposed the introduction of the UK's first drug consumption room (DCR) in Glasgow city centre. Using a nationally representative sample, this study aimed to determine willingness to use a DCR among PWID nationally, in Glasgow city centre (the proposed DCR location), other Scottish city centres (excluding Glasgow) and the rest of Scotland (excluding city centres). Methods Bio-behavioural survey, of 1469 current PWID (injected in last 6 months) across Scotland during 2017-18. Willingness to use DCRs was examined by drug-related risk behaviours and harms overall in Scotland, and then stratified by Glasgow city centre (n = 219), other Scottish city centres (n = 226) and the rest of Scotland (n = 1024). Results The majority of PWID overall in Scotland (75%) were willing to use a DCR; willingness was higher among those recruited in Glasgow city centre (83%) and other Scottish city centres (83%), compared to the rest of Scotland (72%) (p < 0.001). Willingness was greater among PWID who reported (compared to those who did not report) injecting heroin (76%, p = 0.002), cocaine injecting (79%, p = 0.014), homelessness (86%, p < 0.001), public injecting (87%, p < 0.001) and an overdose (80%, p = 0.026). Willingness was found to be associated with a cumulative multiple risk variable: increased from 66% among those with a score of zero to 85% with a score of at least three (p < 0.001). Conclusions The vast majority of PWID at greatest risk of drug-related harm in Glasgow and elsewhere in Scotland would be willing to use a DCR, supporting proposals for the introduction of DCRs nationally

Pedagogies for the 'dis‐engaged': diverse experiences of the young people’s Arts Award programme

Art education is often praised for its engaging programmes and inclusive pedagogies, with many initiatives created with the intention of widening access for those who are deemed to be lacking. This article investigates one such programme – the young people’s Arts Award, which is a nationally recognised qualification for young people aged 11–25. I call upon a range of pedagogies in order to critique the Arts Award within the context of informal and alternative education settings in the United Kingdom. Drawing on a 12‐month ethnographic study, the research was conducted across five diverse programmes which included youth work projects and alternative provision. I present two cases – ‘learning to be an artist’ and ‘learning to behave’ – which demonstrate a hierarchy of pedagogy in the application of this programme across these particular contexts. Artists’ Signature Pedagogies are used as an analytical framework to explore the affordances of working with artists through the programme. Further, I engage with the Pedagogy of Poverty to demonstrate that young people who were classified as ‘dis‐engaged’ were more likely to receive lower quality programmes, low‐level work and over‐regulated teaching. I argue that despite changes to the ways that young people access art education, there continues to be unequal opportunities. This finding is significant for not only creative practitioners and youth arts workers, but also arts education policy makers and programmers

Cross-sectional survey of a sample of UK primary care dental professionals' experiences of sharps injuries and perception of access to occupational health support

Background: The 2013 Sharps Regulations were introduced to minimise the risk of sharps injuries and blood borne virus transmission throughout healthcare. Occupational health (OH) services are pivotal for helping employers implement these regulations. Despite this, no research has been conducted on the prevalence of sharps injuries, underreporting of injuries or access to OH among primary care dental professionals in the UK since 2013. Aim: To estimate the prevalence of sharps injuries, the level of underreporting and of self-reported access to an OH service both for the care of sharps injuries and for general health and wellbeing. Method: A cross-sectional survey was administered at the 2017 British Dental Association (BDA) Conference and Exhibition in Manchester, and at the 2017 BDA Scottish Conference and Exhibition in Glasgow. The survey covered questions relating to sharps injuries and OH support. Statistical analyses were conducted using SPSS Version 22 (IBM Corp., 2013). Results: A total of 796 delegates participated, of whom 166 (20.8%) had experienced a sharps injury in the past year and 58 (35%) did not report the incident. Of the participants, 190 (23.9%) reported no, or uncertain, access to OH support. Most respondents' practices had a sharps safety policy (771; 96.9%), but fewer (611; 76.8%) had received training on the prevention of sharps injuries and neither policy nor training were associated with incident reporting. Conclusion: Despite the introduction of the sharps regulations, sharps injuries and underreporting of injuries remain prevalent among those practising in primary dental care. Our results also suggest that there are significant shortfalls in OH support, at a time when changes to guidance on health clearance and management of BBV infected healthcare workers, in addition to sharps injury management, increase the need for such services

A pragmatic harm reduction approach to manage a large outbreak of wound botulism in people who inject drugs, Scotland 2015

Abstract Background People who inject drugs (PWID) are at an increased risk of wound botulism, a potentially fatal acute paralytic illness. During the first 6 months of 2015, a large outbreak of wound botulism was confirmed among PWID in Scotland, which resulted in the largest outbreak in Europe to date. Methods A multidisciplinary Incident Management Team (IMT) was convened to conduct an outbreak investigation, which consisted of enhanced surveillance of cases in order to characterise risk factors and identify potential sources of infection. Results Between the 24th of December 2014 and the 30th of May 2015, a total of 40 cases were reported across six regions in Scotland. The majority of the cases were male, over 30 and residents in Glasgow. All epidemiological evidence suggested a contaminated batch of heroin or cutting agent as the source of the outbreak. There are significant challenges associated with managing an outbreak among PWID, given their vulnerability and complex addiction needs. Thus, a pragmatic harm reduction approach was adopted which focused on reducing the risk of infection for those who continued to inject and limited consequences for those who got infected. Conclusions The management of this outbreak highlighted the importance and need for pragmatic harm reduction interventions which support the addiction needs of PWID during an outbreak of spore-forming bacteria. Given the scale of this outbreak, the experimental learning gained during this and similar outbreaks involving spore-forming bacteria in the UK was collated into national guidance to improve the management and investigation of future outbreaks among PWID

The use of technology to enable school governors to participate remotely in meetings: A solution to skilled governor shortages in schools?

Governor recruitment is increasingly difficult, with schools in remote locations struggling to recruit skilled governors. This paper evaluates Lloyds Banking Group’s (LBG) ‘e-governor’ concept – volunteer LBG employees who attend governing board meetings remotely. Interview data collected from five e-governors as well as key school stakeholders is analysed and showed that schools often value e-governor contributions more than the e-governors did themselves. This was due to the difficulties of building relationships with their schools with technology and outdated governing body practices exacerbating this problem. We conclude by recommending a model of ‘flexi-governance’ as a potential solution to skilled governor recruitment shortages

Politische Dimensionen von Militärübungen und Manövern – ein Projektbericht

Die virtuellen Kriege und Operationen, die in Militärübungen gespielt und geprobt werden, können entweder der Abschreckung dienen oder aber Angriffe vorbereiten bzw. zur Maskierung tatsächlicher Angriffe dienen. Für Beobachter ist es vielfach nicht offensichtlich, um welche Art von Militärübung es sich handelt. Die Ergebnisse eines vierjährigen internationalen Projektes zu politischen Dimensionen von Militärübungen richten das Schlaglicht insbesondere auf Missverständnisse und deren ungewollte politische Auswirkungen, die im Extremfall unbeabsichtigt zum Krieg führen können

Phagocytosis of Streptococcus pyogenes by all-trans retinoic acid-differentiated HL-60 cells: roles of azurophilic granules and NADPH oxidase.

BACKGROUND: New experimental approaches to the study of the neutrophil phagosome and bacterial killing prompted a reassessment of the usefulness of all-trans retinoic acid (ATRA)-differentiated HL-60 cells as a neutrophil model. HL-60 cells are special in that they possess azurophilic granules while lacking the specific granules with their associated oxidase components. The resulting inability to mount an effective intracellular respiratory burst makes these cells more dependent on other mechanisms when killing internalized bacteria. METHODOLOGY/PRINCIPAL FINDINGS: In this work phagocytosis and phagosome-related responses of ATRA-differentiated HL-60 cells were compared to those earlier described in human neutrophils. We show that intracellular survival of wild-type S. pyogenes bacteria in HL-60 cells is accompanied by inhibition of azurophilic granule-phagosome fusion. A mutant S. pyogenes bacterium, deficient in M-protein expression, is, on the other hand, rapidly killed in phagosomes that avidly fuse with azurophilic granules. CONCLUSIONS/SIGNIFICANCE: The current data extend our previous findings by showing that a system lacking in oxidase involvement also indicates a link between inhibition of azurophilic granule fusion and the intraphagosomal fate of S. pyogenes bacteria. We propose that differentiated HL-60 cells can be a useful tool to study certain aspects of neutrophil phagosome maturation, such as azurophilic granule fusion

Using the value creation framework to capture knowledge co-creation and pathways to impact in a transnational community of practice in autism education

Although theories around Communities of Practice have gained significant ground in recent years and have become an important focus for organizational development, there is a gap in studies that investigate what members gain from participation in these communities. This paper explains how the value creation framework was implemented in a transnational research and development project in autism education by examining cycles of value creation and drawing on two types of data identified by Wenger and colleagues. The value creation framework is a theoretically driven framework to assess social learning in communities. Participants involved in the learning space were co-researchers engaged in a process of investigating, sharing and reflecting on their practice. The paper discusses the methodological challenges and strengths of using the value creation framework, with a particular focus on how insights and interactions led to subsequent changes in the practice of the participants. This work has the potential to make an important contribution to methods and analysis in assessing social learning and pathways to impact in participatory research and development projects more broadly

Climate-Smart Agricultural Value Chains: Risks and Perspectives

Extreme weather is causing significant problems for smallholder farmers and others who depend on agricultural value chains in developing countries. Although value-chain analysis can help untangle the complex relationships within agricultural systems, it often has failed to take into account the effects of climate change. Climate-change assessments, meanwhile, often focus on the production node while neglecting other components of the value chain. In response to these shortcomings, the International Center for Tropical Agriculture (CIAT), in collaboration with the Government of Kenya, developed the climate risk profiles (CRP) approach. Using a case study from Nyandarua County in Kenya, we illustrate how this approach (i) supports identification of major climate risks and their impacts on the value chain, (ii) identifies adaptation interventions, and (iii) promotes the mainstreaming of climate-change considerations into development planning at the subnational level. Our results show that the magnitude of a climate risk varies across value chains. At the input and production stage, strategies for supporting climate-smart value chains include the following: improving access to input markets, supporting diversification and value addition, provision of climate-smart production technologies, dissemination of climate information services, and making financial and insurance services available. At the harvesting, processing and marketing stages, useful interventions would include strengthening farmer organization, investing in climate-proofed infrastructure including roads and facilities for storage, processing and improving access to output markets. Finally, climate-change adaptation along the value chain would be improved by strengthening existing institutions, exploring public-private partnerships and adopting coherent local policies

Modeling the TNFα-Induced Apoptosis Pathway in Hepatocytes

The proinflammatory cytokine TNFα fails to provoke cell death in isolated hepatocytes but has been implicated in hepatocyte apoptosis during liver diseases associated with chronic inflammation. Recently, we showed that TNFα is able to sensitize primary murine hepatocytes cultured on collagen to Fas ligand-induced apoptosis and presented a mathematical model of the sensitizing effect. Here, we analyze how TNFα induces apoptosis in combination with the transcriptional inhibitor actinomycin D (ActD). Accumulation of reactive oxygen species (ROS) in response to TNFR activation turns out to be critical for sustained activation of JNK which then triggers mitochondrial pathway-dependent apoptosis. In addition, the amount of JNK is strongly upregulated in a ROS-dependent way. In contrast to TNFα plus cycloheximide no cFLIP degradation is observed suggesting a different apoptosis pathway in which the Itch-mediated cFLIP degradation and predominantly caspase-8 activation is not involved. Time-resolved data of the respective pro- and antiapoptotic factors are obtained and subjected to mathematical modeling. On the basis of these data we developed a mathematical model which reproduces the complex interplay regulating the phosphorylation status of JNK and generation of ROS. This model was fully integrated with our model of TNFα/Fas ligand sensitizing as well as with a published NF-κB-model. The resulting comprehensive model delivers insight in the dynamical interplay between the TNFα and FasL pathways, NF-κB and ROS and gives an example for successful model integration