The effect of using NHS number as the unique identifier for patients who self-harm: a multi-centre descriptive study

BACKGROUND: Processing personal data for research purposes and the requirement of anonymity has been the subject of recent debate. We aimed to determine the proportion of individuals who present to emergency departments with non-fatal suicidal behavior where an NHS number has been successfully traced and to investigate the characteristics of patients associated with non-capture. METHOD: This was a descriptive study of people attending after self-harm using allocation of NHS numbers as main outcome measurement. Data from the Multicentre Monitoring of Self-Harm Project from 3 centres in England were used to identify consecutive patients (N = 3000) who were treated in six emergency departments in Oxford, Manchester and Leeds in 2004 and 2005 following self-harm. RESULTS: NHS number was available between 55-73% of individuals across centres. Characteristics associated with non-recording of NHS number in more than one centre included those from ethnic minority groups (Oxford: chi-squared statistic = 13.6, df = 3, p = 0.004; Manchester: chi-squared statistic = 13.6, df = 3,

The effect of beta-adrenergic receptor antagonists on the temporal accommodative response

In this thesis a modified Canon IR optometer was used to record static and continuous responses of accommodation during sustained visual tasks. The instrument was assessed with regard to the ocular exit pupil used, its frequency response and noise levels. Experimental work concerned essentially the temporal characteristics and neurological basis of the accommodative mechanism. In the absence of visual stimuli, the accommodative system assumes a resting or tonic accommodative (TA) position, which may be modified by periods of sustained fixation. The rate of regression from a near task to TA in darkness has exhibited differences between regression rates for enunetropes (EMMs) compared with late-onset myopes (WMs). The rate of accommodative regression from a task set at 3D above TA was examined for a group of 10 EMMs and 10 LOMs for 3 conditions: saline, timolol and betaxolol. Timolol retarded the regression to TA for a sub-group of EMMs. The patterns of regression for the remaining emmetropes mirrored that for the LOMs, the drugs showing no difference in rate of regression compared with the saline condition. This provides support for the conjecture that LOMs and certain EMMs appear to be deficient in a sympathetic inhibitory component to the ciliary muscle which may attenuate adaptational changes in tonus and which leave them susceptible to the development of LOM. It is well established that the steady-state accommodative response is characterised by temporal changes in lens power having 2 dominant frequency components: a low frequency component (LFC: < 0.6Hz) and a high frequency component (HFC: 1.0-2.2Hz). This thesis investigates various aspects of these microfluctuations of accommodation.The HFC of accommodative fluctuations was shown to be present in central and peripheral lens zones, although the magnitude of the rms of accommodative microfluctuations was found to be reduced in the lens periphery. These findings concur with the proposal that the lens capsule acts as a force distributor, transmitting the tension from the zonules evenly over the whole of the lens surface.An investigation into the correlation between arterial pulse and the HFC of accommodative fluctuations showed that the peak frequency of the HFC was governed by the arterial pulse frequency. It was proposed that the microflucutations comprised a combination of neurological control (LFC) and physiological variations (HFC).The effect of timolol maleate on the steady-state accommodative response for a group of 10 emmetropes showed that timolol reduced significantly the rms of accommodative microfluctuations in treated but not untreated eyes. Consequently, the effect was considered to be locally, rather than systemically induced.The influence of the sympathetic system on within-task measurements of accommodation was examined by recording the accommodative response of 3 subjects to a sinusoidally moving target at 6 temporal frequencies from 0.05Hz to 0.5Hz for 3 drug conditions: saline, timolol and betaxolol. Timolol caused a reduced gain for frequencies below 0.3 whereas betaxolol reduced accommodative gain for all frequencies. It was proposed that the results for timolol were consistent with temporal response characteristics of sympathetic innervation of the ciliary muscle whereas the betaxolol results were thought to be a manifestation of fatigue resulting from the CNS depressant effect of the drug

Rail Reform Strategies: The Australian Experience

Widely different approaches to rail reform are evident across countries and within Australia. Reforms have involved structural separation (both vertical and horizontal) and varying degrees of private sector involvement. Evidence from Australian experience suggests that no one size fits all. The characteristics of rail networks - namely the degree of market power, the strength of intermodel competition, competition in downstream markets and traffic density would all influence the approach adopted. These differ for urban passenger, regional freight (general and bulk) and long distance networks. The potential implications for future rail reform are outlined.

KidsMatter Primary Evaluation Final Report

KidsMatter is an approach to the promotion of good mental health, the prevention of mental illness, and early intervention where problems arise. It requires a whole-of-school approach and has four key components – a positive school community; social and emotional learning for students; parenting support and education and early intervention for students with mental health difficulties. Based on approaches already tested by the World Health Organization and the American Collaborative for Academic, Social and Emotional Learning, it has been adapted to suit Australian conditions.KidsMatter Primary and KidsMatter Early Childhood are being conducted in collaboration between beyondblue: the national depression initiative, which is contributing funding of $3.5 million, the Australian Psychological Society, Principals Australia and Early Childhood Australia

Evaluating parent implementation on differential reinforcement without escape extinction on compliance during nail clipping

Many young children diagnosed with autism spectrum disorder (ASD) are resistant to tolerating a variety of personal hygiene tasks performed by caregivers or health professionals, leading to poor hygiene and overall health. Previous research conducted by Schmuamcher and Rapp (2001), Bishop et al. (2013) and Dowdy et al. (2018) evaluated hygiene tolerance interventions which included compliant-contingent positive reinforcement without escape extinction. The purpose of the current study was (1) to evaluate a differential reinforcement for alternative behavior (DRA) without escape extinction and (2) to evaluate behavioral skills training (BST) with two child-parent dyads to assess the effectiveness of the DRA without escape extinction procedure on increasing compliance to nail clipping routines. The results of this study indicated that the DRA procedure without escape extinction was an effective procedure for increasing compliance during nail clipping routines for one of the two participants. For the second participant, results also indicated that implementing BST with caregivers over the DRA procedures was an effective method to train parents to complete nail clipping routines.Includes bibliographical references

The relationship between parent and child dysfunctional beliefs about sleep and child sleep

Cognitive theories emphasise the role of dysfunctional beliefs about sleep in the development and maintenance of sleep-related problems (SRPs). The present research examines how parents' dysfunctional beliefs about children's sleep and child dysfunctional beliefs about sleep are related to each other and to children's subjective and objective sleep. Participants were 45 children aged 11 -12 years and their parents. Self-report measures of dysfunctional beliefs about sleep and child sleep were completed by children, mothers and fathers. Objective measures of child sleep were taken using actigraphy. The results showed that child dysfunctional beliefs about sleep were correlated with father (r=.43, p<.05) and mother (r=.43, p<.05) reported child SRPs, and with Sleep Onset Latency (r=.34, p<.05). Maternal dysfunctional beliefs about child sleep were related to child SRPs as reported by mothers (r=.44, p<.05), and to child dysfunctional beliefs about sleep (r=.37, p<.05). Some initial evidence was found for a mediation pathway in which child dyfunctional beliefs mediate the relationship between parent dysfunctional beliefs and child sleep. The results support the cognitive model of SRPs and contribute to the literature by providing the first evidence of familial aggregation of dysfunctional beliefs about sleep

HDAC6 Regulates Mitochondrial Transport in Hippocampal Neurons

Background: Tubulin is a major substrate of the cytoplasmic class II histone deacetylase HDAC6. Inhibition of HDAC6 results in higher levels of acetylated tubulin and enhanced binding of the motor protein kinesin-1 to tubulin, which promotes transport of cargoes along microtubules. Microtubule-dependent intracellular trafficking may therefore be regulated by modulating the activity of HDAC6. We have shown previously that the neuromodulator serotonin increases mitochondrial movement in hippocampal neurons via the Akt-GSK3b signaling pathway. Here, we demonstrate a role for HDAC6 in this signaling pathway. Methodology/Principal Findings: We found that the presence of tubacin, a specific HDAC6 inhibitor, dramatically enhanced mitochondrial movement in hippocampal neurons, whereas niltubacin, an inactive tubacin analog, had no effect. Compared to control cultures, higher levels of acetylated tubulin were found in neurons treated with tubacin, and more kinesin-1 was associated with mitochondria isolated from these neurons. Inhibition of GSK3b decreased cytoplasmic deacetylase activity and increased tubulin acetylation, whereas blockade of Akt, which phosphorylates and down-regulates GSK3b, increased cytoplasmic deacetylase activity and decreased tubulin acetylation. Concordantly, the administration of 5-HT, 8-OH-DPAT (a specific 5-HT1A receptor agonist), or fluoxetine (a 5-HT reuptake inhibitor) increased tubulin acetylation. GSK3b was found to co-localize with HDAC6 in hippocampal neurons, and inhibition of GSK3b resulted in decrease

Characterisation of EphA1 and its potential role in Alzheimer’s Disease

Recent genetic evidence has identified the EphA1 gene as a susceptibility locus in Alzheimer’s disease with targeted sequencing identifying a nonsynonymous variant (P460L) within intron 1 (Vardarajan et al., 2015). EphA1 encodes the type-I transmembrane protein EphA1, a member of the Eph family of receptor tyrosine kinases. Eph receptors and their surface associated ligands, ephrins, play a role in immunity and inflammation, with inflammatory mechanisms a central component of AD neuropathology. This study aimed to characterise the WT EphA1 molecule as a means to understand the pathological potential of P460L EphA1