Evaluation of a novel co‐designed and co‐delivered training package to de‐escalate violence and aggression in UK acute inpatient, PICU and forensic mental health settings

Background Evidence suggests a discrepancy between recommended and routine practice in de-escalation in mental health settings, suggesting a lack of impact of existing training. Aim To investigate the acceptability and perceived impact of a co-designed/delivered training intervention on a trauma-informed approach to de-escalation on mental health wards. Methods Trainees were invited to complete the Training Acceptability Rating Scale (TARS) post-training. Responses to the quantitative items were summarized using descriptive statistics, and open-text responses were coded using content analysis. Results Of 214 trainees, 211 completed the TARS. The trainees rated the training favourably (median overall TARS = 55/63), as acceptable (median 33/36) and impactful (median 23/27). There were five qualitative themes: modules of interest; multiple perspectives; modes of delivery; moulding to context; and modifying other elements. Discussion The EDITION training was found to be acceptable and impactful, with trainees particularly valuing the co-delivery model. Trainees suggested several ways in which the training could be improved, particularly around the need for further moulding of the intervention to the specific ward contexts/teams. Implications for Practice We recommend co-designing and co-delivering staff training to mental health professionals that tackles restrictive practices. Relevance Statement This research is relevant to lived experience practitioners who want to be involved in training mental health professionals around restrictive practices, demonstrating the value and importance of their voice. It is relevant to current providers of de-escalation training, and to staff receiving training, outlining a novel, but acceptable and impactful, form of training on a key area of mental health practice. It is relevant to anyone with an interest in reducing restrictive practice via co-delivered training

Health-related quality of life in children with perceived and diagnosed food hypersensitivity

The few studies measuring health-related quality of life (HRQL) in food hypersensitivity (FHS) have found significantly reduced HRQL in patients and their families, particularly in the areas of family and social activities, emotional issues and family economy. One aspect that has not been studied is the effect of suspected FHS (food allergy/intolerance) vs. diagnosed FHS [based on a food challenge or a positive skin prick test (SPT) and good clinical history] on HRQL. Therefore, the aim of this study was to investigate the HRQL in children with a proven diagnosis of FHS vs. those with reported FHS.MethodsWe have utilized the 10-yr old follow-up cohort of the Food Allergy and Intolerance Research (FAIR) study from the Isle of Wight and assessed the child's HRQL with the Food Allergy Quality of Life Questionnaire – Parent form (FAQLQ-PF) which measures HRQL using four domains: food anxiety, emotional impact, social and dietary limitation.ResultsWhen comparing the two groups of children (proven FHS vs. perceived FHS), no difference in HRQL was found, although food anxiety showed a p-value of (p = 0.062). This was also the case when correcting for all confounding factors identified.ConclusionWe have found that having a clear diagnosis of FHS is not an independent predictor of HRQL. Future studies are required comparing two more similar groups. We also need to focus more on the effect of continuous input from the multidisciplinary team on HRQL and which particular factors of FHS management affect HRQL

Cancer incidence near municipal solid waste incinerators in Great Britain.

By use of the postcoded database held by the Small Area Health Statistic Unit, cancer incidence of over 14 million people living near 72 municipal solid waste incinerators in Great Britain was examined from 1974-86 (England), 1974-84 (Wales) and 1975-87 (Scotland). Numbers of observed cases were compared with expected numbers calculated from national rates (regionally adjusted) after stratification by a deprivation index based on 1981 census small area statistics. Observed-expected ratios were tested for decline in risk with distance up to 7.5 km. The study was conducted in two stages: the first involved a stratified random sample of 20 incinerators; the second the remaining 52 incinerators. Over the two stages of the study was a statistically significant (P<0.05) decline in risk with distance from incinerators for all cancers combined, stomach, colorectal, liver and lung cancer. Among these cancers in the second stage, the excess from 0 to 1 km ranged from 37% for liver cancer (0.95) excess cases 10(-5) per year to 5% for colorectal cancer. There was evidence of residual confounding near the incinerators, which seems to be a likely explanation of the finding for all cancers, stomach and lung, and also to explain at least part of the excess of liver cancer. For this reason and because of a substantial level of misdiagnosis (mainly secondary tumours) found among registrations and death certificates for liver cancer, further investigation, including histological review of the cases, is to be done to help determine whether or not there is an increase in primary liver cancer in the vicinity of incinerators

Binaries in the Kuiper Belt

Binaries have played a crucial role many times in the history of modern astronomy and are doing so again in the rapidly evolving exploration of the Kuiper Belt. The large fraction of transneptunian objects that are binary or multiple, 48 such systems are now known, has been an unanticipated windfall. Separations and relative magnitudes measured in discovery images give important information on the statistical properties of the binary population that can be related to competing models of binary formation. Orbits, derived for 13 systems, provide a determination of the system mass. Masses can be used to derive densities and albedos when an independent size measurement is available. Angular momenta and relative sizes of the majority of binaries are consistent with formation by dynamical capture. The small satellites of the largest transneptunian objects, in contrast, are more likely formed from collisions. Correlations of the fraction of binaries with different dynamical populations or with other physical variables have the potential to constrain models of the origin and evolution of the transneptunian population as a whole. Other means of studying binaries have only begun to be exploited, including lightcurve, color, and spectral data. Because of the several channels for obtaining unique physical information, it is already clear that binaries will emerge as one of the most useful tools for unraveling the many complexities of transneptunian space.Comment: Accepted for inclusion in "The Kuiper Belt", University of Arizona Press, Space Science Series Corrected references in Table

Contribution of Baobab Production Activities to Household Livelihoods.

IES Working paper.Baobab production activities play a crucial role in contributing to the livelihoods of rural households. In the face of increasing village populations, commercial use of baobab has been steadily increasing to the point where currently, 43% of sampled households participate in baobab production activities. Commercial use of baobab products is especially important to the poorer households arid women. In terms of contributing to household livelihoods, baobab activities are ranked second only to some kinds of agricultural production. Numerical estimates of contribution to livelihoods bear out this result with cash income of approximately Z$5000 per annum received for each participating person, well above the official minimum wage. Opportunity costs of labour make up about four-fifths of this value, leaving one-fifth of the cash income accruing as economic rent. The rent available to households seems to vary widely, as there are households that are well located close to baobab trees, which greatly reduces production costs and increases economic rents captured. The importance of baobabs to livelihoods, combined with the potential ecological importance of these trees in contributing to biodiversity, makes the sustainability of this resource vital. Accordingly, if current use rates are not sustainable (see Romero et al., (in prep) there is scope for investigations into policies and management options that could foster sustainable use

Enabling Personalized Composition and Adaptive Provisioning of Web Services

The proliferation of interconnected computing devices is fostering the emergence of environments where Web services made available to mobile users are a commodity. Unfortunately, inherent limitations of mobile devices still hinder the seamless access to Web services, and their use in supporting complex user activities. In this paper, we describe the design and implementation of a distributed, adaptive, and context-aware framework for personalized service composition and provisioning adapted to mobile users. Users specify their preferences by annotating existing process templates, leading to personalized service-based processes. To cater for the possibility of low bandwidth communication channels and frequent disconnections, an execution model is proposed whereby the responsibility of orchestrating personalized processes is spread across the participating services and user agents. In addition, the execution model is adaptive in the sense that the runtime environment is able to detect exceptions and react to them according to a set of rules

Real-time analysis of gene regulation by glucocorticoid hormones

There is increasing evidence that temporal factors are important in allowing cells to gain additional information from external factors, such as hormones and cytokines. We sought to discover how cell responses to glucocorticoids develop over time, and how the response kinetics vary according to ligand structure and concentration, and hence have developed a continuous gene transcription measurement system, based on an interleukin-6 (IL-6) luciferase reporter gene. We measured the time to maximal response, maximal response and integrated response, and have compared these results with a conventional, end point glucocorticoid bioassay. We studied natural glucocorticoids (corticosterone and cortisol), synthetic glucocorticoids (dexamethasone) and glucocorticoid precursors with weak, or absent bioactivity. We found a close correlation between half maximal effective concentration (EC50) for maximal response, and for integrated response, but with consistently higher EC50 for the latter. There was no relation between the concentration of ligand and the time to maximal response. A comparison between conventional end point assays and real-time measurement showed similar effects for dexamethasone and hydrocortisone, with a less effective inhibition of IL-6 seen with corticosterone. We profiled the activity of precursor steroids, and found pregnenolone, progesterone, 21-hydroxyprogesterone and 17-hydroxyprogesterone all to be ineffective in the real-time assay, but in contrast, progesterone and 21-hydroxyprogesterone showed an IL-6 inhibitory activity in the end point assay. Taken together, our data show how ligand concentration can alter the amplitude of glucocorticoid response, and also that a comparison between real-time and end point assays reveals an unexpected diversity of the function of glucocorticoid precursor steroids, with implications for human disorders associated with their overproduction