Developing a suicide prevention implementation plan for older adults in Kent and Medway

This document sets out the findings from a ten week student internship project focussing on the development of a suicide prevention implementation plan for older adults in Kent and Medway. The Canterbury Christ Church Student Internship Scheme allows students to work with academic staff on real research projects. Academics can apply for a research intern to work with them on a relevant and clearly defined project, creating capacity to carry out research in areas that are likely to result in tangible outputs. The author of this report is a second year BSc Psychology student at Canterbury Christ Church University who carried out a paid research intern role researching suicide prevention in older adults for the Kent and Medway Suicide Prevention Steering Group over a 10 week period from May to July 2014

Grieving in the workplace: How do grieving employees perceive their experience of workplace support from management?

To explore what bereaved employees consider as helpful support from their managers. An online questionnaire was completed by 40 participants from various occupations in the United Kingdom who had been bereaved of their spouse. The data were analysed using a qualitative thematic approach. Two key superordinate themes were found: Acknowledgement’ and ‘Response’. This study supports the growing initiative to set informal support for grieving employees thereby enhancing the provision of impactful and timely bereavement support in the workplace. These findings suggest that managers were considered to be supportive when they ‘acknowledged’ the bereaved employees’ situation and their reactions to grief. Additionally, managers were thought to be supportive when they responded in offering specific support depending on the individual’s circumstances and provided sufficient time and space for them to grieve. ‘Acknowledging’ and ‘responding’ appeared to promote understanding and instil a sense of being valued rather than the feeling of being just another number within the organisation. All participants were English speakers and a higher proportion were women, which may influence the generalisability of the findings

How employers respond to employees who return to the workplace after experiencing the death of a loved one? A review of the literature

In order to provide insight for employers in maintaining a mentally healthy and productive workforce, it is essential to understand how bereaved employees experience workplace support. A global literature search was conducted between February 2018 and April 2018, resulting in 15 papers directly matching stipulated inclusion and exclusion criteria. Three common themes emerged from the data namely; Instrumental Support, Informational Support and Emotional Support. Findings suggest that while various employers endeavoured to show sympathy and flexibility to bereaved employees, others were found to be less responsive with certain areas of workplace support being reported as insufficient

The Scherk-Schwarz mechanism as a flux compactification with internal torsion

The aim of this paper is to make progress in the understanding of the Scherk-Schwarz dimensional reduction in terms of a compactification in the presence of background fluxes and torsion. From the eleven dimensional supergravity point of view, we find that a general E6(6) S-S phase may be obtained by turning on an appropriate background torsion, together with suitable fluxes, some of which can be directly identified with certain components of the four-form field-strength. Furthermore, we introduce a novel (four dimensional) approach to the study of dualities between flux/torsion compactifications of Type II/M-theory. This approach defines the action that duality should have on the background quantities, in order for the E7(7) invariance of the field equations and Bianchi identities to be restored also in the presence of fluxes/torsion. This analysis further implies the interpretation of the torsion flux as the T-dual of the NS three-form flux.Comment: Version published on J. High Energy Phy

Investigating the potential clinical benefit of Selumetinib in resensitising advanced iodine refractory differentiated thyroid cancer to radioiodine therapy (SEL-I-METRY): protocol for a multicentre UK single arm phase II trial

Background Thyroid cancer is the most common endocrine malignancy. Some advanced disease is, or becomes, resistant to radioactive iodine therapy (refractory disease); this holds poor prognosis of 10% 10-year overall survival. Whilst Sorafenib and Lenvatinib are now licenced for the treatment of progressive iodine refractory thyroid cancer, these treatments require continuing treatment and can be associated with significant toxicity. Evidence from a pilot study has demonstrated feasibility of Selumetinib to allow the reintroduction of I-131 therapy; this larger, multicentre study is required to demonstrate the broader clinical impact of this approach before progression to a confirmatory trial. Methods SEL-I-METRY is a UK, single-arm, multi-centre, two-stage phase II trial. Participants with locally advanced or metastatic differentiated thyroid cancer with at least one measureable lesion and iodine refractory disease will be recruited from 8 NHS Hospitals and treated with 4-weeks of oral Selumetinib and assessed for sufficient I-123 uptake (defined as any uptake in a lesion with no previous uptake or 30% or greater increase in uptake). Those with sufficient uptake will be treated with I-131 and followed for clinical outcomes. Radiation absorbed doses will be predicted from I-123 SPECT/CT and verified from scans following the therapy. 60 patients will be recruited to assess the primary objective of whether the treatment schedule leads to increased progression-free survival compared to historical control data. Discussion The SEL-I-METRY trial will investigate the effect of Selumetinib followed by I-131 therapy on progression-free survival in radioiodine refractory patients with differentiated thyroid cancer showing increased radioiodine uptake following initial treatment with Selumetinib. In addition, information on toxicity and dosimetry will be collected. This study presents an unprecedented opportunity to investigate the role of lesional dosimetry in molecular radiotherapy, leading to greater personalisation of therapy. To date this has been a neglected area of research. The findings of this trial will be useful to healthcare professionals and patients alike to determine whether further study of this agent is warranted. It is hoped that the development of the infrastructure to deliver a multicentre trial involving molecular radiotherapy dosimetry will lead to further trials in this field. Trial registration SEL-I-METRY is registered under ISRCTN17468602, 02/12/2015

Objective comparison of lesion detectability in low and medium-energy collimator iodine-123 mIBG images using a channelized Hotelling observer.

Iodine-123 mIBG imaging is widely regarded as a gold standard for diagnostic studies of neuroblastoma and adult neuroendocrine cancer although the optimal collimator for tumour imaging remains undetermined. Low-energy (LE) high-resolution (HR) collimators provide superior spatial resolution. However due to septal penetration of high-energy photons these provide poorer contrast than medium-energy (ME) general-purpose (GP) collimators. LEGP collimators improve count sensitivity. The aim of this study was to objectively compare the lesion detection efficiency of each collimator to determine the optimal collimator for diagnostic imaging. The septal penetration and sensitivity of each collimator was assessed. Planar images of the patient abdomen were simulated with static scans of a Liqui-Phil™ anthropomorphic phantom with lesion-shaped inserts, acquired with LE and ME collimators on 3 different manufacturers' gamma camera systems (Skylight (Philips), Intevo (Siemens) and Discovery (GE)). Two-hundred normal and 200 single-lesion abnormal images were created for each collimator. A channelized Hotelling observer (CHO) was developed and validated to score the images for the likelihood of an abnormality. The areas under receiver-operator characteristic (ROC) curves, Az, created from the scores were used to quantify lesion detectability. The CHO ROC curves for the LEHR collimators were inferior to the GP curves for all cameras. The LEHR collimators resulted in statistically significantly smaller Azs (p  123I mIBG image lesion detectability over LEHR collimators that provided better spatial resolution

InfuShield: a shielded enclosure for administering therapeutic radioisotope treatments using standard syringe pumps.

The administration of radionuclide therapies presents significant radiation protection challenges. The aim of this work was to develop a delivery system for intravenous radioisotope therapies to substantially moderate radiation exposures to staff and operators. A novel device (InfuShield) was designed and tested before being used clinically. The device consists of a shielded enclosure which contains the therapeutic activity and, through the hydraulic action of back-to-back syringes, allows the activity to be administered using a syringe pump external to the enclosure. This enables full access to the pump controls while simultaneously reducing dose to the operator. The system is suitable for use with all commercially available syringe pumps and does not require specific consumables, maximising both the flexibility and economy of the system. Dose rate measurements showed that at key stages in an I mIBG treatment procedure, InfuShield can reduce dose to operators by several orders of magnitude. Tests using typical syringes and infusion speeds show no significant alteration in administered flow rates (maximum of 1.2%). The InfuShield system provides a simple, safe and low cost method of radioisotope administration