Assertive outreach treatment versus care as usual for the treatment of high-need, high-cost alcohol related frequent attenders: study protocol for a randomised controlled trial

Background: Alcohol-related hospital admissions have doubled in the last ten years to >1.2m per year in England. High-need, high-cost (HNHC) alcohol-related frequent attenders (ARFA) are a relatively small subgroup of patients, having multiple admissions or attendances from alcohol during a short time period. This trial aims to test the effectiveness of an assertive outreach treatment (AOT) approach in improving clinical outcomes for ARFA, and reducing resource use in the acute setting. Methods: One hundred and sixty ARFA patients will be recruited and following baseline assessment, randomly assigned to AOT plus care as usual (CAU) or CAU alone in equal numbers. Baseline assessment includes alcohol consumption and related problems, physical and mental health comorbidity and health and social care service use in the previous 6 months using standard validated tools, plus a measure of resource use. Follow-up assessments at 6 and 12months after randomization includes the same tools as baseline plus standard measure of patient satisfaction. Outcomes for CAU+AOT and CAU at 6 and 12months will be compared, controlling for pre-specified baseline measures. Primary outcome will be percentage of days abstinent at 12months. Secondary outcomes include emergency department (ED) attendance, number and length of hospital admissions, alcohol consumption, alcohol-related problems, other health service use, mental and physical comorbidity 6 and 12months post intervention. Health economic analysis will estimate the economic impact of AOT from health, social care and societal perspectives and explore cost-effectiveness in terms of quality adjusted life years and alcohol consumption at 12-month follow-up. Discussion: AOT models piloted with alcohol dependent patients have demonstrated significant reductions in alcohol consumption and use of unplanned National Health Service (NHS) care, with increased engagement with alcohol treatment services, compared with patients receiving CAU. While AOT interventions are costlier per case than current standard care in the UK, the rationale for targeting HNHC ARFAs is because of their disproportionate contribution to overall alcohol burden on the NHS. No previous studies have evaluated the clinical and costeffectiveness of AOT for HNHC ARFAs: this randomized controlled trial (RCT) targeting ARFAs across five South London NHS Trusts is the first. Trial registration: International standard randomized controlled trial number (ISRCTN) registry: ISRCTN67000214, retrospectively registered 26/11/2016

Assessment of cognitive self-statements during marital problem solving: A comparison of two methods

Twenty maritally distressed couples (DC) and 20 nondistressed couples (NDC) were recruited and asked to undertake 10 minutes of problem-solving discussions, which were videotaped. Each individual partner’s cognitive self-statements during the interaction were assessed using two methods: video-assisted recall (VR) and thought listing (TL). Reported cognitions from each method were content- analysed and classified into five categories: partner- referent positive, partner- referent negative, self-referent positive, self- referent negative, and other. Proportions of reported cognitions falling into each category were analysed in two separate two-way MANOVAs (marital distress/ nondistress x sex) for the VR and TL measures. Results of each MANOVA indicated a highly significant effect of marital distress on cognitions, and a significant effect of sex on the VR but not the TL measure. Discriminant analyses showed that the VR and TL methods both discriminated between DC and NDC groups. Post hoc univariate ANOVAs indicated that DC had significantly higher proportions of negative partner- referent cognitions, and lower proportions of positive partner- referent cognitions, than NDC while problem solving. The relative merits of each cognitive assessment method, and their potential use in increasing marital therapy effectiveness, are discussed

Hydrodynamic interactions in colloidal ferrofluids: A lattice Boltzmann study

We use lattice Boltzmann simulations, in conjunction with Ewald summation methods, to investigate the role of hydrodynamic interactions in colloidal suspensions of dipolar particles, such as ferrofluids. Our work addresses volume fractions $\phi$ of up to 0.20 and dimensionless dipolar interaction parameters $\lambda$ of up to 8. We compare quantitatively with Brownian dynamics simulations, in which many-body hydrodynamic interactions are absent. Monte Carlo data are also used to check the accuracy of static properties measured with the lattice Boltzmann technique. At equilibrium, hydrodynamic interactions slow down both the long-time and the short-time decays of the intermediate scattering function $S(q,t)$, for wavevectors close to the peak of the static structure factor $S(q)$, by a factor of roughly two. The long-time slowing is diminished at high interaction strengths whereas the short-time slowing (quantified via the hydrodynamic factor $H(q)$) is less affected by the dipolar interactions, despite their strong effect on the pair distribution function arising from cluster formation. Cluster formation is also studied in transient data following a quench from $\lambda = 0$; hydrodynamic interactions slow the formation rate, again by a factor of roughly two

One-Step Purification of Recombinant Human Amelogenin and Use of Amelogenin as a Fusion Partner

Amelogenin is an extracellular protein first identified as a matrix component important for formation of dental enamel during tooth development. Lately, amelogenin has also been found to have positive effects on clinical important areas, such as treatment of periodontal defects, wound healing, and bone regeneration. Here we present a simple method for purification of recombinant human amelogenin expressed in Escherichia coli, based on the solubility properties of amelogenin. The method combines cell lysis with recovery/purification of the protein and generates a >95% pure amelogenin in one step using intact harvested cells as starting material. By using amelogenin as a fusion partner we could further demonstrate that the same method also be can explored to purify other target proteins/peptides in an effective manner. For instance, a fusion between the clinically used protein PTH (parathyroid hormone) and amelogenin was successfully expressed and purified, and the amelogenin part could be removed from PTH by using a site-specific protease

The New ‘Hidden Abode’: Reflections on Value and Labour in the New Economy

In a pivotal section of Capital, volume 1, Marx (1976: 279) notes that, in order to understand the capitalist production of value, we must descend into the ‘hidden abode of production’: the site of the labour process conducted within an employment relationship. In this paper we argue that by remaining wedded to an analysis of labour that is confined to the employment relationship, Labour Process Theory (LPT) has missed a fundamental shift in the location of value production in contemporary capitalism. We examine this shift through the work of Autonomist Marxists like Hardt and Negri, Lazaratto and Arvidsson, who offer theoretical leverage to prize open a new ‘hidden abode’ outside employment, for example in the ‘production of organization’ and in consumption. Although they can open up this new ‘hidden abode’, without LPT's fine-grained analysis of control/resistance, indeterminacy and structured antagonism, these theorists risk succumbing to empirically naive claims about the ‘new economy’. Through developing an expanded conception of a ‘new hidden abode’ of production, the paper demarcates an analytical space in which both LPT and Autonomist Marxism can expand and develop their understanding of labour and value production in today's economy. </jats:p

Generation tourism: towards a common identity

The purpose of this article is to highlight the implications of the indiscipline of tourism academia for a new generation of tourism academics. Generation Tourism is characterised by scholars with a multi-disciplinary education associated with a broad field of study and commonly considered to lack the advantages of a discipline-focused education with its strong theoretical and methodological foundations. The problem this article addresses relates to how new generations of scholars and their views on knowledge creation achieve ascendancy in ways that move on from existing paradigms and earlier cohorts of scholars. Our main argument is that Generation Tourism scholars would benefit from a more clearly developed and common academic identity. To begin the critical conversation around the identity of Generation Tourism we outline five possible points of departure. These points are: (1) learning from historical developments in parent disciplines; (2) spearheading inter-disciplinary scholarship; (3) working towards theoretical developments; (4) embracing mediating methodologies and (5) forming tourism nodes and networks. Recognising these as starting points rather than final statements, we hope that the conversation about Generation Tourism identity will continue in other forums

Education, Personality and Separation: The Distribution of Relationship Skills Across Society

The reasons why the lower educated divorce more than the higher educated in many societies today are poorly understood. Distinct divorce risks by education could be caused by variation in pressures to the couple, commitment, or relationship skills. We concentrate on the latter explanation by looking at the distribution of personality traits across society and its impact on the educational gradient in divorce in Germany. Using data on married couples from the German Socio Economic Panel (N = 9 417) we first estimate the effect of several personality traits on divorce: the tendency to forgive, negative reciprocity, positive reciprocity, and the Big Five. We also account for and find non-linear effects of several personality traits on divorce risk, which is relevant for future research on the effects of personality. In addition, effects differ by level of education. We find personality traits that affect divorce risk to be unevenly distributed over educational groups, but contrary to expectation to favor the lower educated. Once taking into account personality the educational gradient in divorce becomes more negative. This is due to especially high scores on openness to experience for the higher educated, which is a very significant predictor of divorce risk. Overall, we find no support for the hypothesis that the lower educated have less relationship skills in Germany