A review of cultural competence training in UK mental health settings

Background: Cultural competence is key to high-quality mental health care and is a required competency for professionals. However, there is little to guide practitioners on the content, format, implementation or effectiveness of cultural competence training. Aims: This review aimed to identify the evidence base for cultural competence training in UK mental health settings and to summarise definitions, theoretical models, contents and measures of effectiveness used in such training. Methods: A systematic search and narrative synthesis of the literature on cultural competence training was conducted. Results: A literature search generated seven articles that met the inclusion criteria, which reported five original studies. There were no randomised controlled trials. Only two studies described training that was underpinned by an explicit definition or model of cultural competence. Three studies reported service user involvement. Conclusions: There literature on cultural competence training in mental health settings in the UK is surprisingly limited. There is insufficient evidence on which to base recommendations for clinical practice. Research is required to develop theoretically informed cultural competence training and evaluate its effectivenes

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

An interdisciplinary assessment of climate engineering strategies

Author Posting. © Ecological Society of America, 2014. This article is posted here by permission of Ecological Society of America for personal use, not for redistribution. The definitive version was published in Frontiers in Ecology and the Environment 12 (2014): 280–287, doi:10.1890/130030.Mitigating further anthropogenic changes to the global climate will require reducing greenhouse-gas emissions (“abatement”), or else removing carbon dioxide from the atmosphere and/or diminishing solar input (“climate engineering”). Here, we develop and apply criteria to measure technical, economic, ecological, institutional, and ethical dimensions of, and public acceptance for, climate engineering strategies; provide a relative rating for each dimension; and offer a new interdisciplinary framework for comparing abatement and climate engineering options. While abatement remains the most desirable policy, certain climate engineering strategies, including forest and soil management for carbon sequestration, merit broad-scale application. Other proposed strategies, such as biochar production and geological carbon capture and storage, are rated somewhat lower, but deserve further research and development. Iron fertilization of the oceans and solar radiation management, although cost-effective, received the lowest ratings on most criteria. We conclude that although abatement should remain the central climate-change response, some low-risk, cost-effective climate engineering approaches should be applied as complements. The framework presented here aims to guide and prioritize further research and analysis, leading to improvements in climate engineering strategies.NSF grant #1103575 supported KRMM

Collembolan transcriptomes highlight molecular evolution of hexapods and provide clues on the adaptation to terrestrial life

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