Care planning for aggression management in a specialist secure mental health service:user involvement

This paper describes an audit of prevention and management of violence and aggression care plans and incident reporting forms which aimed to: (i) report the compliance rate of completion of care plans; (ii) identify the extent to which patients contribute to and agree with their care plan; (iii) describe de-escalation methods documented in care plans; and (iv) ascertain the extent to which the de-escalation methods described in the care plan are recorded as having been attempted in the event of an incident. Care plans and incident report forms were examined for all patients in men's and women's mental health care pathways who were involved in aggressive incidents between May and October 2012. In total, 539 incidents were examined, involving 147 patients and 121 care plans. There was no care plan in place at the time of 151 incidents giving a compliance rate of 72%. It was documented that 40% of patients had contributed to their care plans. Thematic analysis of de-escalation methods documented in the care plans revealed five de-escalation themes: staff interventions, interactions, space/quiet, activities and patient strategies/skills. A sixth category, coercive strategies, was also documented. Evidence of adherence to de-escalation elements of the care plan was documented in 58% of incidents. The reasons for the low compliance rate and very low documentation of patient involvement need further investigation. The inclusion of coercive strategies within de-escalation documentation suggests that some staff fundamentally misunderstand de-escalation

Mental health nurses' emotions, exposure to patient aggression, attitudes to and use of coercive measures:cross sectional questionnaire study

BackgroundMental health nurses are exposed to patient aggression, and required to manage and de-escalate aggressive incidents; coercive measures such as restraint and seclusion should only be used as a last resort. An improved understanding of links between nurses’ exposure to aggression, attitudes to, and actual involvement in, coercive measures, and their emotions (anger, guilt, fear, fatigue, sadness), could inform preparation and education for prevention and management of violence.ObjectivesTo identify relationships between mental health nurses’ exposure to patient aggression, their emotions, their attitudes towards coercive containment measures, and their involvement in incidents involving seclusion and restraint.DesignCross-sectional, correlational, observational study.SettingsLow and medium secure wards for men and women with mental disorder in three secure mental health hospitals in England.ParticipantsN = 68 Mental health nurses who were designated keyworkers for patients enrolled into a related study.MethodsParticipants completed a questionnaire battery comprising measures of their exposure to various types of aggression, their attitudes towards seclusion and restraint, and their emotions. Information about their involvement in restraint and/or restraint plus seclusion incidents was gathered for the three-month period pre- and post- their participation. Linear and logistic regression analyses were performed to test study hypotheses.ResultsNurses who reported greater exposure to a related set of aggressive behaviours, mostly verbal in nature, which seemed personally derogatory, targeted, or humiliating, also reported higher levels of anger-related provocation. Exposure to mild and severe physical aggression was unrelated to nurses’ emotions. Nurses’ reported anger was significantly positively correlated with their endorsement of restraint as a management technique, but not with their actual involvement in restraint episodes. Significant differences in scores related to anger and fatigue, and to fatigue and guilt, between those involved/not involved in physical restraint and in physical restraint plus seclusion respectively were detected. In regression analyses, models comprising significant variables, but not the variables themselves, predicted involvement/non-involvement in coercive measures.ConclusionsVerbal aggression which appears targeted, demeaning or humiliating is associated with higher experienced anger provocation. Nurses may benefit from interventions which aim to improve their skills and coping strategies for dealing with this specific aggressive behaviour. Nurse-reported anger predicted approval of coercive violence management interventions; this may have implications for staff deployment and support. However, anger did not predict actual involvement in such incidents. Possible explanations are that nurses experiencing anger are sufficiently self-aware to avoid involvement or that teams are successful in supporting colleagues who they perceive to be ‘at risk’. Future research priorities are considered

Experimental manipulation of breakfast in normal and overweight/obese participants is associated with changes to nutrient and energy intake consumption patterns

The effect of breakfast and breakfast omission on daily food intake in normal and overweight participants was investigated. 37 participants were recruited for this experimental study and assigned to one of four groups on the basis of their body mass index (BMI) (normal weight BMI 25 kg/m2) and breakfast habits (breakfast eater or breakfast omitter). All participants were requested to eat breakfast for an entire week, and then following a washout period, omit breakfast for an entire week, or vice versa. Seven-day food diaries reporting what was consumed and the timing of consumption were completed for each breakfast condition. Overall more energy was consumed during the breakfast than the no breakfast week. The present study revealed significant effects of timing on energy intakes; more energy was consumed during the afternoon in the no breakfast week compared to the breakfast week. Overweight participants consumed greater amounts of energy than normal weight participants in the early evening. Breakfast omitters consumed more than did breakfast eaters later in the evening. All groups consumed significantly less energy, carbohydrate and fibre in the no breakfast week; however, overweight participants increased their sugar intakes. Consumption of the micronutrients iron and folate was reduced in the no breakfast week. The findings highlight that the timing of food intake and habitual breakfast eating behaviour are important factors when investigating why breakfast consumption may be associated with BMI.This study was supported by Kellogg's Ltd.Published versio

insights from a bio-behavioural survey in thirteen cities

Publisher Copyright: © 2020 Author(s) (or their employer(s)). No commercial re-use. See rights and permissions. Published by BMJ.Objectives: This paper aims to estimate the percentage of European men who have sex with men (MSM) who may benefit from pre-exposure prophylaxis (PrEP), applying the three most widely used HIV risk indices for MSM (MSM Risk Index, Menza score, San Diego Early Test (SDET) score) and drawing on a large-scale multisite bio-behavioural survey (Sialon II). Methods: The Sialon II study was a bio-behavioural survey among MSM implemented in 13 European cities using either time-location sampling or respondent-driven sampling. Biological and behavioural data from 4901 MSM were collected. Onlybehavioural data of HIV-negative individuals were considered. Three widely used risk indices to assess HIV acquisition risk among MSM were used to estimate individual HIV risk scores and PrEP eligibility criteria. Results: 4219 HIV-negative MSM were considered. Regardless the HIV risk score used and the city, percentages of MSM eligible for PrEP were found to range between 5.19% and 73.84%. Overall, the MSM Risk Index and the Menza score yielded broadly similar percentages, whereas the SDETIndex provided estimates constantly lower across all cities. Although all the three scores correlated positively (r>0.6), their concordance was highly variable (0.01<CCC<0.62). Conclusion: Our findings showed the impact of different scoring systems on the estimation of the percentage of MSM who may benefit from PrEP in European cities. Although our primary aim was not to compare the performance of different HIV risk scores, data show that a considerable percentage of MSM in each city should be offered PrEP in order to reduce HIV infections. As PrEP is highly effective at preventing HIV among MSM, our findings provide useful, practical guidance for stakeholders in implementingPrEP at city level to tackle HIV infections in Europe.publishersversionpublishe

Assessment and optimisation of normalisation methods for dual-colour antibody microarrays

<p>Abstract</p> <p>Background</p> <p>Recent advances in antibody microarray technology have made it possible to measure the expression of hundreds of proteins simultaneously in a competitive dual-colour approach similar to dual-colour gene expression microarrays. Thus, the established normalisation methods for gene expression microarrays, e.g. loess regression, can in principle be applied to protein microarrays. However, the typical assumptions of such normalisation methods might be violated due to a bias in the selection of the proteins to be measured. Due to high costs and limited availability of high quality antibodies, the current arrays usually focus on a high proportion of regulated targets. Housekeeping features could be used to circumvent this problem, but they are typically underrepresented on protein arrays. Therefore, it might be beneficial to select invariant features among the features already represented on available arrays for normalisation by a dedicated selection algorithm.</p> <p>Results</p> <p>We compare the performance of several normalisation methods that have been established for dual-colour gene expression microarrays. The focus is on an invariant selection algorithm, for which effective improvements are proposed. In a simulation study the performances of the different normalisation methods are compared with respect to their impact on the ability to correctly detect differentially expressed features. Furthermore, we apply the different normalisation methods to a pancreatic cancer data set to assess the impact on the classification power.</p> <p>Conclusions</p> <p>The simulation study and the data application demonstrate the superior performance of the improved invariant selection algorithms in comparison to other normalisation methods, especially in situations where the assumptions of the usual global loess normalisation are violated.</p

Leading-order determination of the gluon polarisation from semi-inclusive deep inelastic scattering data

Using a novel analysis technique, the gluon polarisation in the nucleon is re-evaluated using the longitudinal double-spin asymmetry measured in the cross section of semi-inclusive single-hadron muoproduction with photon virtuality $Q^2>1~({\rm GeV}/c)^2$. The data were obtained by the COMPASS experiment at CERN using a 160 GeV/$c$ polarised muon beam impinging on a polarised $^6$LiD target. By analysing the full range in hadron transverse momentum $p_{\rm T}$, the different $p_{\rm T}$-dependences of the underlying processes are separated using a neural-network approach. In the absence of pQCD calculations at next-to-leading order in the selected kinematic domain, the gluon polarisation $\Delta g/g$ is evaluated at leading order in pQCD at a hard scale of $\mu^2= \langle Q^2 \rangle = 3 ({\rm GeV}/c)^2$. It is determined in three intervals of the nucleon momentum fraction carried by gluons, $x_{\rm g}$, covering the range $0.04 \!<\! x_{ \rm g}\! <\! 0.28$~ and does not exhibit a significant dependence on $x_{\rm g}$. The average over the three intervals, $\langle \Delta g/g \rangle = 0.113 \pm 0.038_{\rm (stat.)}\pm 0.036_{\rm (syst.)}$ at $\langle x_{\rm g} \rangle \approx 0.10$, suggests that the gluon polarisation is positive in the measured $x_{\rm g}$ range.Comment: 14 pages, 6 figure

Genome Expression Pathway Analysis Tool – Analysis and visualization of microarray gene expression data under genomic, proteomic and metabolic context

<p>Abstract</p> <p>Background</p> <p>Regulation of gene expression is relevant to many areas of biology and medicine, in the study of treatments, diseases, and developmental stages. Microarrays can be used to measure the expression level of thousands of mRNAs at the same time, allowing insight into or comparison of different cellular conditions. The data derived out of microarray experiments is highly dimensional and often noisy, and interpretation of the results can get intricate. Although programs for the statistical analysis of microarray data exist, most of them lack an integration of analysis results and biological interpretation.</p> <p>Results</p> <p>We have developed GEPAT, Genome Expression Pathway Analysis Tool, offering an analysis of gene expression data under genomic, proteomic and metabolic context. We provide an integration of statistical methods for data import and data analysis together with a biological interpretation for subsets of probes or single probes on the chip. GEPAT imports various types of oligonucleotide and cDNA array data formats. Different normalization methods can be applied to the data, afterwards data annotation is performed. After import, GEPAT offers various statistical data analysis methods, as hierarchical, k-means and PCA clustering, a linear model based t-test or chromosomal profile comparison. The results of the analysis can be interpreted by enrichment of biological terms, pathway analysis or interaction networks. Different biological databases are included, to give various information for each probe on the chip. GEPAT offers no linear work flow, but allows the usage of any subset of probes and samples as a start for a new data analysis. GEPAT relies on established data analysis packages, offers a modular approach for an easy extension, and can be run on a computer grid to allow a large number of users. It is freely available under the LGPL open source license for academic and commercial users at <url>http://gepat.sourceforge.net</url>.</p> <p>Conclusion</p> <p>GEPAT is a modular, scalable and professional-grade software integrating analysis and interpretation of microarray gene expression data. An installation available for academic users can be found at <url>http://gepat.bioapps.biozentrum.uni-wuerzburg.de</url>.</p

Longitudinal double spin asymmetries in single hadron quasi-real photoproduction at high pTp_T

We measured the longitudinal double spin asymmetries $A_{LL}$ for single hadron muo-production off protons and deuterons at photon virtuality $Q^2$ < 1(GeV/$\it c$)$^2$ for transverse hadron momenta $p_T$ in the range 0.7 GeV/$\it c$ to 4 GeV/$\it c$ . They were determined using COMPASS data taken with a polarised muon beam of 160 GeV/$\it c$ or 200 GeV/$\it c$ impinging on polarised $\mathrm{{}^6LiD}$ or $\mathrm{NH_3}$ targets. The experimental asymmetries are compared to next-to-leading order pQCD calculations, and are sensitive to the gluon polarisation $\Delta G$ inside the nucleon in the range of the nucleon momentum fraction carried by gluons $0.05 < x_g < 0.2$