The role of training in IBA implementation beyond primary health care settings in the UK

There has been a considerable drive to encourage a wide range of professional groups to incorporate alcohol screening (or identification) and brief advice (IBA) into their everyday practice. This article aims to examine the role of training in promoting IBA delivery in contexts outside primary care and other health settings. The data are drawn mainly from a structured online survey supplemented by illustrative material from nine qualitative interviews and insights from an expert workshop. Findings support the results from other research that issues relating to role relevance and role security continue to act as barriers to professional change. Furthermore, issues of organisational commitment and organisational barriers are insufficiently addressed in strategy to promote wider use of IBA. The article concludes that development of appropriate training for alcohol IBA needs to take account of the role of IBA within a complex interactive system of related services and help seeking pathways and consider how training can contribute to changing both professional attitudes and behaviours and organisational approaches to implementing and sustaining IBA in everyday professional practice

Delivering alcohol IBA: is there a case for mainstreaming? Insights from an expert workshop and from the published literature

Identification and brief advice (IBA) has been widely advocated as a cost effective intervention to address problem drinking. Evidence for the effectiveness of IBA comes largely from primary care studies. Research in pharmacies, educational settings and criminal justice settings has indicated the possibilities for successful delivery of IBA but there is little solid evidence to support mainstreaming IBA beyond core medical facilities. Furthermore, even in primary health care settings there are continuing difficulties around implementing IBA (see: Thom et al., 2014) and continuing debate about the research findings (Heather, 2014). A number of key questions around the drive towards wider implementation of IBA were debated at an expert workshop in Birmingham in November 2014. The questions debated were: 1. What are the challenges and barriers to broadening the contexts in which alcohol IBA is delivered? 2. How can these challenges and barriers be addressed? 3. Should delivery of alcohol IBA in wider contexts (mainstreaming) be a policy goal? This monograph provides insights from this expert workshop and from the published literature on theses questions

The Magnetic Ordering of the 3d Wigner Crystal

Using Path Integral Monte Carlo, we have calculated exchange frequencies as electrons undergo ring exchanges of 2, 3 and 4 electrons in a ``clean'' 3d Wigner crystal (bcc lattice) as a function of density. We find pair exchange dominates and estimate the critical temperature for the transition to antiferromagnetic ordering to be roughly $1 \times 10^{-8}$Ry at melting. In contrast to the situation in 2d, the 3d Wigner crystal is different from the solid bcc 3He in that the pair exchange dominates because of the softer interparticle potential. We discuss implications for the magnetic phase diagram of the electron gas

Delivering alcohol identification and brief advice (IBA) in housing settings: a step too far or opening doors?

Within the UK, there is a drive to encourage the delivery of alcohol screening (or identification) and brief advice (IBA) in a range of contexts beyond primary care and hospitals where the evidence is strongest. However, the evidence base for effectiveness in non-health contexts is not currently established. This paper considers the case of housing provided by social landlords, drawing on two research studies which were conducted concurrently. One study examined the feasibility of delivering alcohol IBA in housing settings and the other the role of training in delivering IBA in non-health contexts including housing. This paper draws mainly on the qualitative data collected for both studies to examine the appropriateness and feasibility of delivering IBA in a range of social housing settings by the housing workforce. Findings suggest that while it is feasible to deliver IBA in housing settings, there are similar challenges and barriers to those already identified in relation to primary care. These include issues around role inadequacy, role legitimacy and the lack of support to work with people with alcohol problems. Results indicate that the potential may lie in focusing training efforts on specific roles to deliver IBA rather than it being expected of all staff

Delivering information and brief advice on alcohol (IBA) in social work and social care settings: an exploratory study

Social workers and practitioners working in social care are potentially key players in the prevention of alcohol-related harm and harm reduction for people using services and their carers. This requires attention to workforce development alongside the selection of appropriate tools to support prevention strategies. We report findings from a UK exploratory study into the potential of using Identification and Brief Advice (IBA) as a tool for screening and prevention in social work and social care settings. Thirty-six social workers and social care practitioners attended one of two training workshops on IBA in the South East of England. Pre and post-workshop surveys (n = 35 and n = 20, respectively) and four post-workshop focus groups (n = 36) were conducted with participants to explore the application of IBA taking into account the paradigmatic shift towards prevention and holistic approaches indicated in recent UK legislation and policy. Four themes emerged from the findings: (1) perceptions of the social work/social care role in responding to alcohol problems, (2) ethical concerns, (3) time conflicts and problems of delivering IBA and (4) the role of training. Further studies are needed to evaluate the effectiveness of motivational techniques and tools that social workers can use to promote preventative practise for alcohol-related harm. Different strategies are required to engage and support those working in social care to increase proactive engagement with problematic alcohol use in everyday practise settings

Partnerships: survey respondents' perceptions of inter-professional collaboration to address alcohol-related harms in England

Tackling alcohol-related harms crosses agency and professional boundaries, requiring collaboration between health, criminal justice, education and social welfare institutions. It is a key component of most multicomponent programmes in the United States, Australia and Europe. Partnership working, already embedded in service delivery structures, is a core mechanism for delivery of the new UK Government Alcohol Strategy. This article reports findings from a study of alcohol partnerships across England. The findings are based on a mix of open discussion interviews with key informants and on semi-structured telephone interviews with 90 professionals with roles in local alcohol partnerships. Interviewees reported the challenges of working within a complex network of interlinked partnerships, often within hierarchies under an umbrella partnership, some of them having a formal duty of partnership. The new alcohol strategy has emerged at a time of extensive reorganisation within health, social care and criminal justice structures. Further development of a partnership model for policy implementation would benefit from consideration of the incompatibility arising from required collaboration and from tensions between institutional and professional cultures. A clearer analysis of which aspects of partnership working provide ‘added value’ is needed

Transcriptome profiling reveals significant changes in the gastric muscularis externa with obesity that partially overlap those that occur with idiopathic gastroparesis

BACKGROUND: Gastric emptying is impaired in patients with gastroparesis whereas it is either unchanged or accelerated in obese individuals. The goal of the current study was to identify changes in gene expression in the stomach muscularis that may be contributing to altered gastric motility in idiopathic gastroparesis and obesity. METHODS: Quantitative real time RT-PCR and whole transcriptome sequencing were used to compare the transcriptomes of lean individuals, obese individuals and either lean or obese individuals with idiopathic gastroparesis. RESULTS: Obesity leads to an increase in mRNAs associated with muscle contractility whereas idiopathic gastroparesis leads to a decrease in mRNAs associated with PDGF BB signaling. Both obesity and idiopathic gastroparesis were also associated with similar alterations in pathways associated with inflammation. CONCLUSIONS: Our findings show that obesity and idiopathic gastroparesis result in overlapping but distinct changes in the gastric muscularis transcriptome. Increased expression of mRNAs encoding smooth muscle contractile proteins may be contributing to the increased gastric motility observed in obese subjects, whereas decreased PDGF BB signaling may be contributing to the impaired motility seen in subjects with idiopathic gastroparesis

Modeling of nutation-precession: very long baseline interferometry results

Analysis of over 20 years of very long baseline interferometry data (VLBI) yields estimates of the coefficients of the nutation series with standard deviations ranging from 5 microseconds of arc (μas) for the terms with periods <400 days to 38 µas for the longest-period terms. The largest deviations between the VLBI estimates of the amplitudes of terms in the nutation series and the theoretical values from the Mathews-Herring-Buffett (MHB2000) nutation series are 56 ± 38 μas (associated with two of the 18.6 year nutations). The amplitudes of nutational terms with periods <400 days deviate from the MHB2000 nutation series values at the level standard deviation. The estimated correction to the IAU-1976 precession constant is -2.997 ± 0.008 mas yr-1 when the coefficients of the MHB2000 nutation series are held fixed and is consistent with that inferred from the MHB2000 nutation theory. The secular change in the obliquity of the ecliptic is estimated to be -0.252 ± 0.003 mas yr-1. When the coefficients of the largest-amplitude terms in the nutation series are estimated, the precession constant correction and obliquity rate are estimated to be -2.960 ± 0.030 and -0.237 ± 0.012 mas yr-1. Significant variations in the freely excited retrograde free core nutation mode are observed over the 20 years. During this time the amplitude has decreased from -300 ± 50 μas in the mid-1980s to nearly zero by the year 2000. There is evidence that the amplitude of the mode in now increasing again