A pedagogic evaluation comparing face to face and online formats of a Multi-Professional Offender Personality Disorder (OPD) Higher Education Training programme

Purpose – The aim of this paper is to provide an overview of a novel offender personality disorder (OPD) higher education programme and the research evaluation results collected over a three-year period. Data from phase 1 was collected from a face-to-face mode of delivery, and phase 2 data collected from the same programme was from an online mode of delivery due to the Covid-19 pandemic. Design/methodology/approach – In phase 1 three modules were developed and delivered in a fully face-to-face format before the pandemic in 2019-20 (n=52 student participants). In 2020-2021 (n=66 student participants) training was adapted into a fully online mode of delivery in phase 2. This mixed methods study evaluated participant confidence, and compassion. Pre, post, and six months follow up questionnaires were completed. Qualitative interviews were conducted across both phases to gain in-depth feedback on this programme (Phase 1 N=7 students, Phase 2 N=2 students N= 5 Leaders). Data from phase one (face to face) and phase 2 (online) are synthesised for comparison. Findings –In phase 1 (N=52) Confidence in working with people with personality disorder or associated difficulties improved significantly, whilst compassion did not change. In phase 2 (N=66) these results were replicated, with statistically significant improvements in confidence reported.. Compassion however in phase 2 reduced at six month follow up. Results have been integrated and have assisted in shaping the future of modules to meet learning needs of students. Originality – This paper provides a comparison of a student evaluated training programme thus providing insights into the impact of delivering a relational focussed training programme in both face to face and online distant learning delivery modes. From this pedagogic research evaluation, we were able to derive unique insights into the outcomes of this programme. Research Implications – Further research into the impact of different modes of delivery are important for the future of education in a post pandemic digitalised society. Comparisons of blended learning approaches were not covered but would be beneficial to explore and evaluate in the future. Practical Implications - This comparison provided informed learnings for consideration within the development of non-related educational programmes and hence of use to other educational providers

AKT1 Loss Correlates with Episomal HPV16 in Vulval Intraepithelial Neoplasia

Anogenital malignancy has a significant association with high-risk mucosal alpha-human papillomaviruses (alpha-PV), particularly HPV 16 and 18 whereas extragenital SCC has been linked to the presence of cutaneous beta and gamma–HPV types. Vulval skin may be colonised by both mucosal and cutaneous (beta-, mu-, nu- and gamma-) PV types, but there are few systematic studies investigating their presence and their relative contributions to vulval malignancy. Dysregulation of AKT, a serine/threonine kinase, plays a significant role in several cancers. Mucosal HPV types can increase AKT phosphorylation and activity whereas cutaneous HPV types down-regulate AKT1 expression, probably to weaken the cornified envelope to promote viral release. We assessed the presence of mucosal and cutaneous HPV in vulval malignancy and its relationship to AKT1 expression in order to establish the corresponding HPV and AKT1 profile of normal vulval skin, vulval intraepithelial neoplasia (VIN) and vulval squamous cell carcinoma (vSCC). We show that HPV16 is the principle HPV type present in VIN, there were few detectable beta types present and AKT1 loss was not associated with the presence of these cutaneous HPV. We show that HPV16 early gene expression reduced AKT1 expression in transgenic mouse epidermis. AKT1 loss in our VIN cohort correlated with presence of high copy number, episomal HPV16. Maintained AKT1 expression correlated with low copy number, an increased frequency of integration and increased HPV16E7 expression, a finding we replicated in another untyped cohort of vSCC. Since expression of E7 reflects tumour progression, these findings suggest that AKT1 loss associated with episomal HPV16 may have positive prognostic implications in vulval malignancy

Doxycycline versus prednisolone as an initial treatment strategy for bullous pemphigoid: a pragmatic non-inferiority randomised controlled trial

Background: Bullous pemphigoid (BP) is a blistering skin disorder with increased mortality. We tested whether a strategy of starting treatment with doxycycline conveys acceptable short-term blister control whilst conferring long-term safety advantages over starting treatment with oral corticosteroids. Methods: Pragmatic multi-centre parallel-group randomised controlled trial of adults with BP (≥3 blisters ≥2 sites and linear basement membrane IgG/C3) plus economic evaluation. Participants were randomised to doxycycline (200 mg/day) or prednisolone (0·5 mg/kg/day). Localised adjuvant potent topical corticosteroids (<30 g/week) was permitted weeks 1-3. The non-inferiority primary effectiveness outcome was the proportion of participants with ≤3 blisters at 6 weeks. We assumed that doxycycline would be 25% less effective than corticosteroids with a 37% acceptable margin of noninferiority. The primary safety outcome was the proportion with severe, life-threatening or fatal treatment-related adverse events by 52 weeks. Analysis used a regression model adjusting for baseline disease severity, age and Karnofsky score, with missing data imputed. Results: 132 patients were randomised to doxycycline and 121 to prednisolone from 54 UK and 7 German dermatology centres. Mean age was 77·7 years and 68.4% had moderate to severe baseline disease. For those starting doxycycline, 83/112 (74·1%) had ≤3 blisters at 6 weeks compared with 92/101 (91·1%) for prednisolone, a difference of 18·6% favouring prednisolone (upper limit of 90% CI, 26·1%, within the predefined 37% margin). Related severe, life-threatening and fatal events at 52 weeks were 18·5% for those starting doxycycline and 36·6% for prednisolone (mITT analysis), an adjusted difference of 19·0% (95% CI, 7·9%, 30·1%, p=0·001). Conclusions: A strategy of starting BP patients on doxycycline is non-inferior to standard treatment with oral prednisolone for short-term blister control and significantly safer long-term

Health, education, and social care provision after diagnosis of childhood visual disability

Aim: To investigate the health, education, and social care provision for children newly diagnosed with visual disability.Method: This was a national prospective study, the British Childhood Visual Impairment and Blindness Study 2 (BCVIS2), ascertaining new diagnoses of visual impairment or severe visual impairment and blindness (SVIBL), or equivalent vi-sion. Data collection was performed by managing clinicians up to 1-year follow-up, and included health and developmental needs, and health, education, and social care provision.Results: BCVIS2 identified 784 children newly diagnosed with visual impairment/SVIBL (313 with visual impairment, 471 with SVIBL). Most children had associated systemic disorders (559 [71%], 167 [54%] with visual impairment, and 392 [84%] with SVIBL). Care from multidisciplinary teams was provided for 549 children (70%). Two-thirds (515) had not received an Education, Health, and Care Plan (EHCP). Fewer children with visual impairment had seen a specialist teacher (SVIBL 35%, visual impairment 28%, χ2p < 0.001), or had an EHCP (11% vs 7%, χ2p < 0 . 01).Interpretation: Families need additional support from managing clinicians to access recommended complex interventions such as the use of multidisciplinary teams and educational support. This need is pressing, as the population of children with visual impairment/SVIBL is expected to grow in size and complexity.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited

Commercial relationships between intermediaries and harvesters of the mangrove crab Ucides cordatus (Linnaeus, 1763) in the Mamanguape River estuary, Brazil, and their socio-ecological implications

The large mangrove crab Ucides cordatus (“caranguejo-uçá”) is a key fisheries resource in Brazil, critical for the sustenance of livelihoods of thousands of people in coastal rural areas. Today's crab populations suffer from habitat degradation, disease, and increasing fishing pressure. Crabs are sold alive on local and regional markets, or traded as processed meat and the market chains typically involve intermediaries (i.e. traders). The present study examined the relationship between crab harvesters and the intermediaries, and the socio-ecological implications thereof. The research was performed between September 2013 and October 2014 in the Mamanguape River estuary, northeastern Brazil. Socioeconomic information and data regarding the catch (sex and carapace width of the crabs), the processing of U. cordatus meat and the commercial relationship between harvesters and intermediaries were obtained through structured (questionnaires) and semi-structured interviews and direct observations. The crab harvesters exist under precarious socioeconomic conditions that place them at the edge of society and therefore often seek loans offered by the intermediaries, generating loyalty and dependence that guarantees the intermediaries a stable supply of crabs needed to supply an avid market.Within this relationship, the intermediaries create pressure on natural crab populations by stimulating non-selective captures, as they buy specimens below the legal size limit (6 cm wide carapace) for meat processing. During crab meat processing, the intermediaries themselves report that the meat is often mixed with cooked and shredded of other marine vertebrates, such as spotted eagle ray (Aetobatus narinari) and nurse shark (Ginglymostoma cirratum), to increase the weight of the final product. As with the crab harvesters, the women involved in processing the crabmeat often accept loans, resulting in the same type of dependence and loyalty to the intermediaries. The intermediaries, with their strong influence on the crab harvesting, are directly linked to the commercial, social and ecological implications of these harvesting activities, together with the crab harvesters themselves. Hence, to ensure sustainability of the U. cordatus fishery and maintain (better improve) dependant livelihoods, all actors involved in the production chain of U. cordatus must be considered when developing management strategies, rather than the current approach of considering the crab harvesters only. We advise the development and implementation of fisheries associations to give the crab harvesters (and regulating bodies) greater control over and capital gains from their catches

Bionic bodies, posthuman violence and the disembodied criminal subject

This article examines how the so-called disembodied criminal subject is given structure and form through the law of homicide and assault. By analysing how the body is materialised through the criminal law’s enactment of death and injury, this article suggests that the biological positioning of these harms of violence as uncontroversial, natural, and universal conditions of being ‘human’ cannot fully appreciate what makes violence wrongful for us, as embodied entities. Absent a theory of the body, and a consideration of corporeality, the criminal law risks marginalising, or altogether eliding, experiences of violence that do not align with its paradigmatic vision of what bodies can and must do when suffering its effects. Here I consider how the bionic body disrupts the criminal law’s understanding of human violence by being a body that is both organic and inorganic, and capable of experiencing and performing violence in unexpected ways. I propose that a criminal law that is more receptive to the changing, technologically mediated conditions of human existence would be one that takes the corporeal dimensions of violence more seriously and, as an extension of this, adopts an embodied, embedded, and relational understanding of human vulnerability to violence

SONIC: Evaluations from students using web based resources

The growth of electronic learning (e-learning) is fully supported by many stakeholders such as universities and their client bases. Increasingly the evidence shows that students are turning to technology for information before other sources. This paper will discuss the advantages and disadvantages of using electronic information to support students undertaking problem-based learning by presenting an evaluation of one such web-based project – the Students Online in Nursing Integrated Curricula (SONIC) project. The project was nationally funded and whilst the partners were situated in Nursing, a key issue for the team was collaborating with other health care professionals in formulating an on-line framework for scenarios, and building on resources already available. Accessibility to online materials was one of the prime considerations of the project, and a significant amount of development went into ensuring compliance with the standards for best practice. The team were also keen to enable students to be engaged in a variety of relevant learning activities. The scenarios and the accompanying questions allow for this with some activities being information giving, whilst others such as the self-test quizzes, are interactive. The evaluation process took place in three stages: evaluation of a pilot study with one scenario available online; an evaluation across the project partnership when all the scenarios were available; an overall evaluation involving a total of 242 students and 19 facilitators from across ten Higher Education Institutions. Facilitators observed and took field notes whilst the students were using the SONIC website for the first time, and reported that students were generally able to navigate their way around the site. Facilitators commented that students liked the ‘fast click’ of the mouse and virtually instant access to certain information. The SONIC resources have been designed to support learning and a flexible website which did not require a password, except on campus, was well received by the students. During the evaluations facilitators noted that some students only wished to engage with the technology at a superficial level. However the SONIC resources are able to support a number of different learning styles and future work may indicate whether or not students used the resources at a later date and for what purpose. Having 24/7 access to the resources was regarded as a very positive aspect and students liked the flexibility of access from home as well as on campus. However, not all students have broadband on their home computers, which could be costly for study in terms of the amount of time spent using the computer and possibly downloading information. The number of students with reported disabilities was not known, but some students did report that the help page on how to change font size etc. was very useful. The evaluation did not specifically elicit information about what the students had learned and understood specific to the resources, but does suggest that the students valued them as supplemental to their learning, rather than a substitution for teaching in general. Students found navigating around the site to be straightforward and 26 students reported an increase in confidence with their computer skills. Albion and Gibson (1998) point out that resources such as these, can work against deep learning as users are encouraged to skim and sample content, so may unwittingly miss crucial components. However they also contend that using such a resource with PBL will help to promote deep learning, because of the emphasis on finding good quality information to meet learning need

Seclusion of children and adolescents: Psychopathological and family factors

This paper describes the use of seclusion in a child and adolescent inpatient unit, including precipitating events, management strategies, details of seclusion episodes and individual and family risk factors. Inpatient ward documentation of seclusion episodes, demographic data and measures of individual psychopathology and impairment, parent mental health, life events and family functioning were used to compare secluded, non-secluded and outpatient groups. Secluded individuals had elevated psychopathology compared with non-secluded inpatients and outpatients. Their families reported poorer parental mental health and family functioning and more recent stressful life events. The results indicate that seclusion is most common among high-risk inpatients