Body image dissatisfaction in patients with inflammatory bowel disease:a systematic review protocol

Abstract Background Inflammatory bowel disease (IBD) is a debilitating chronic disease characterised by inflammation and ulceration of the gastrointestinal tract. It is associated with a range of debilitating symptoms and reduced quality of life. People living with IBD may also be at risk of body image dissatisfaction (BID). BID is a distorted and negative view of the physical self, which in turn can adversely affect mental health and quality of life. To date, there have been no systematic reviews of the evidence on BID in IBD patients. Therefore, the aim of this systematic review is to clarify the evidence base on BID in *IBD patients including (i) the tools used to measure BID, (ii) the prevalence and severity of BID, (iii) the risk factors associated with BID and (iv) the relationship between BID and quality of life. Methods Bibliographic databases (EMBASE, MEDLINE, PsycINFO, Cochrane CENTRAL) will be searched using a sensitive search strategy aiming to identify any quantitative study reporting on body image in the context of IBD. This will be supplemented by searches of ongoing trials registers and checking of reference lists. Studies will be assessed for eligibility using predetermined selection criteria for each question. Data will be extracted using a predefined data extraction form, and risk of bias (quality) of included studies will be assessed based on checklists appropriate to the study designs identified. Key methodological steps will be undertaken in duplicate to minimise bias and error. Synthesis will be undertaken separately for the different systematic review sub-questions. Given the anticipated heterogeneity of evidence on each question, it is likely that synthesis will be mostly narrative. Discussion To the best of our knowledge, this will be the first systematic review to collate the existing evidence on BID in IBD patients. Understanding the impact of BID, its relationship with quality of life, and which patients may be at greater risk, may ultimately lead to the development of interventions to prevent or treat BID and to better patient care. Any gaps in the identified evidence will help to inform the research agenda in this area. Systematic review registration PROSPERO: (CRD42018060999)

The Clinical Teaching Fellow role:exploring expectations and experiences

BackgroundMany UK junior doctors are now taking a year out of the traditional training pathway, usually before specialty training, and some choose to work as a clinical teaching fellow (CTF). CTFs primarily have responsibility for delivering hospital-based teaching to undergraduate medical students. Only a very small amount of literature is available regarding CTF posts, none of which has explored why doctors choose to undertake the role and their expectations of the job. This study aimed to explore the expectations and experiences of CTFs employed at NHS hospital Trusts in the West Midlands.MethodsCTFs working in Trusts in the West Midlands region registered as students on the Education for Healthcare Professionals Post Graduate Certificate course at the University of Birmingham in August 2019 took part in a survey and a focus group.ResultsTwenty-eight CTFs participated in the survey and ten participated in the focus group. In the survey, participants reported choosing a CTF role due to an interest in teaching, wanting time out of training, and being unsure of which specialty to choose. Expectations for the year in post were directly related to reasons for choosing the role with participants expecting to develop teaching skills, and have a break from usual clinical work and rotations. The focus group identified five main themes relating to experiences starting their job, time pressures and challenges faced in post, how CTF jobs differed between Trusts, and future career plans. Broadly, participants reported enjoying their year in a post at a mid-year point but identified particular challenges such as difficulties in starting the role and facing time pressures in their day-to-day work.ConclusionThis study has provided a valuable insight into the CTF role and why doctors choose a CTF post and some of the challenges experienced, adding to the sparse amount of literature. Understanding post holders’ experiences may contribute to optimisation of the role. Those employing CTFs should consider ensuring a formal handover process is in place between outgoing and incoming CTFs, having a lead person at their Trust responsible for evaluating changes suggested by CTFs, and the balance of contractual duties and personal development time

Predicting repeated self-harm or suicide in adolescents and young adults using risk assessment scales/tools:a systematic review protocol

Abstract Background Self-harm and suicide have been identified as serious public health problems in children, adolescents, and young people across the world. Suicide is a major cause of mortality in this population and is commonly preceded by self-harm. Both suicide and self-harm are difficult to predict, and several risk scales and tools are in use for this purpose. Currently, there is only a small amount of evidence available regarding their predictive ability in clinical practice, and no consensus as to which is the most suitable for particular populations or settings. The aim of this review is to evaluate the ability of risk scales to predict future episodes of suicide or self-harm in adolescents and young adults presenting to clinical services with attempted suicide or an episode of self-harm. Methods A comprehensive search of electronic databases (MEDLINE, EMBASE, CINAHL, and PsycINFO) from inception will be conducted to identify studies that look at the ability of risk scales to predict suicide or future episodes of self-harm in adolescents and young adults presenting to clinical services with attempted suicide or an episode of self-harm. Two authors will independently carry out key methodological steps such as study screening and selection and data extraction. Quality assessment will be carried out using a checklist developed from the QUIPS and QUADAS-2 tools. Data will be grouped by tool and a narrative synthesis undertaken. For each tool, meta-analysis will be undertaken for ability to predict suicide or repeat self-harm where clinical and methodological homogeneity exists. Discussion This systematic review will be the first to explore the use of assessment scales/tools in an adolescent population and will help to inform current practice regarding scales/tools with higher predictive ability. There is currently no evidence specifically for this population and a clear need with a high prevalence of self-harm and suicide in adolescents. Additionally, this review will help guide future research into suicide and self-harm prediction and prevention. Systematic review registration PROSPERO CRD4201705868

Knowledge Distillation for Anomaly Detection

Unsupervised deep learning techniques are widely used to identify anomalous behaviour. The performance of such methods is a product of the amount of training data and the model size. However, the size is often a limiting factor for the deployment on resource-constrained devices. We present a novel procedure based on knowledge distillation for compressing an unsupervised anomaly detection model into a supervised deployable one and we suggest a set of techniques to improve the detection sensitivity. Compressed models perform comparably to their larger counterparts while significantly reducing the size and memory footprint

To what extent has COVID-19 impacted hard-to-reach energy audiences?

Energy users who don’t participate in efficiency and conservation programmes despite ongoing outreach are often referred to as ‘Hard-to-Reach’ (HTR). These individuals or organisations can include, e.g., low income or vulnerable households; renters; and small businesses. More effectively engaging HTR audiences is key to ensuring everyone benefits equitably from low-carbon energy transitions and related (policy) interventions. This is even more so the case in light of the COVID-19 pandemic, and the ongoing implications for energy use and affordability for the most vulnerable (and newly-vulnerable) members of our society.Within this context, the main purpose of this paper is to explore the extent to which HTR energy audiences have been impacted by COVID-19. Our primary method for this work was a comprehensive, critical literature review and a compilation of official statistics. We also collected survey, interview and focus group data during 2020 COVID-19 pandemic responses in the U.S., UK, NZ and Sweden. The geographical scope is determined by a 3-year project focusing on HTR energy users and implemented in partnership with the User-Centred Energy Systems Technology Collaboration Programme (Users TCP) by the International Energy Agency (IEA). Key findings we highlight and discuss in this paper:● Sweden has taken a different approach to manage COVID-19, yet when it comes to mobility, declines in demand (~25%) have shown relatively similar patterns to countries with stricter measures. ● In the UK, energy debt is growing due to higher domestic consumption arising from lockdown measures and the reduced income of many households. Most households (72%) have increased their energy (monthly gas and electricity bills are up £32) use. In response, 36% are turning thermostats down and 27% limiting lighting.● In the U.S., a survey of 1,000 energy customers found that more than 50% are using more energy, and monitoring their energy use less; 15% reported postponing a utility bill. ● NZ’s model COVID-19 “elimination” response has included housing, financial support, and specific energy payments to date, though unhealthy and unaffordable housing remains a major issue.Whereas the pandemic has exacerbated several elements of the HTR policy discourse (e.g. impacts on vulnerable and/or low-income households), our findings also reveal several opportunities and critical aspects for policy makers, researchers and utilities to identify and engage HTR energy users