Kent and Medway acute mental health services review

An independent analysis of the public response to a consultation on ‘achieving excellent care in a mental health crisis’ by the Centre for Nursing and Healthcare Research at the University of Greenwich. Background: This document presents the results of an analysis of the responses to the formal public consultation on Acute Mental Health Crisis Care services which took place over a 13 week period from 26 July 2012 to 26 October 2012. The consultation was conducted by NHS Kent and Medway working in partnership with Kent and Medway NHS and Social Care Partnership Trust, and the data gathered was analysed independently by the Centre for Nursing and Healthcare Research at the University of Greenwich

Bacterial inactivation, photoreactivation and dark repair post flow-through pulsed UV disinfection

Pulsed UV (PUV) technology is accepted commercially for disinfection within the food packaging industry, but has yet to be deployed by the water/wastewater sector. This is partly due to a lack of robust, independently validated data for submerged or flow-through treatment applications. This study evaluated the efficacy of PUV for water disinfection under flow-through conditions. Bacterial pathogens of interest in the food and water/wastewater sector, namely Escherichia coli, Staphylococcus aureus and Listeria innocua (surrogate for L. monocytogenes) were used to investigate the potential for photoreactivation and/or dark repair post PUV flow-through disinfection. A continuous-flow low-pressure UV was also analysed under similar experimental conditions. Bacterial inactivation via flow-through PUV was dependant on energy output with E. coli exhibiting greatest sensitivity to PUV treatment (5.3 log 10 inactivation after treatment at 1539 mJ/cm 2 - output in UV range < 300 nm); L. innocua exhibited the highest PUV resistance (3.0 log 10 inactivation after treatment at 1539 mJ/cm 2 – output in UV range < 300 nm) under similar treatment conditions. Greater photoreactivation occurred at lower PUV outputs for both S. aureus and E. coli after flow-through PUV treatment. Thus exposure of treated bacteria to natural light, immediately post flow-through PUV treatment, should be avoided to minimise photoreactivation. The LPUV demonstrated inactivation of all bacteria below the limit of detection (1 CFU/mL) and inhibited the occurrence of photoreactivation. This study highlights the importance of considering bacterial repair potential and the need for further development of PUV technology for such applicationsThe authors would like to acknowledge the Department of Agriculture, Food and the Marine of Ireland (Ref: 13-F-507) for funding this research. Dr. Val del Rio was supported by the Spanish Government (CTM2014-55397-JIN project co-funded by FEDER) and Xunta de Galicia postdoctoral fellowshipS

Microbiology and ecology are vitally important to premedical curricula

Despite the impact of the human microbiome on health, an appreciation of microbial ecology is yet to be translated into mainstream medical training and practice. The human microbiota plays a role in the development of the immune system, in the development and function of the brain, in digestion, and in host defense, and we anticipate that many more functions are yet to be discovered. We argue here that without formal exposure to microbiology and ecology—fields that explore the networks, interactions and dynamics between members of populations of microbes—vitally important links between the human microbiome and health will be overlooked. This educational shortfall has significant downstream effects on patient care and biomedical research, and we provide examples from current research highlighting the influence of the microbiome on human health. We conclude that formally incorporating microbiology and ecology into the premedical curricula is invaluable to the training of future health professionals and critical to the development of novel therapeutics and treatment practices

Differential effect of regional drug pressure on dihydrofolate reductase and dihydropteroate synthetase mutations in southern Mozambique.

The prevalence and frequency of the dihydrofolate reductase (dhfr) and dihydropteroate synthetase (dhps) mutations associated with sulfadoxine-pyrimethamine (SP) resistance at 13 sentinel surveillance sites in southern Mozambique were examined regularly between 1999 and 2004. Frequency of the dhfr triple mutation increased from 0.26 in 1999 to 0.96 in 2003, remaining high in 2004. The dhps double mutation frequency peaked in 2001 (0.22) but declined to baseline levels (0.07) by 2004. Similarly, parasites with both dhfr triple and dhps double mutations had increased in 2001 (0.18) but decreased by 2004 (0.05). The peaking of SP resistance markers in 2001 coincided with a SP-resistant malaria epidemic in neighboring KwaZulu-Natal, South Africa. The decline in dhps (but not dhfr) mutations corresponded with replacement of SP with artemether-lumefantrine as malaria treatment policy in KwaZulu-Natal. Our results show that drug pressure can exert its influence at a regional level rather than merely at a national level

Semantics of a Typed Algebraic Lambda-Calculus

Algebraic lambda-calculi have been studied in various ways, but their semantics remain mostly untouched. In this paper we propose a semantic analysis of a general simply-typed lambda-calculus endowed with a structure of vector space. We sketch the relation with two established vectorial lambda-calculi. Then we study the problems arising from the addition of a fixed point combinator and how to modify the equational theory to solve them. We sketch an algebraic vectorial PCF and its possible denotational interpretations

An Interprofessional End of Life Simulation Using a Movie/Discussion Format

An Interprofessional End of Life Simulation Using a Movie/Discussion Format Sigma Theta Tau International Nursing Research Congress Cape Town, South Africa July 25, 2016 Mary Val Palumbo, DNP, MSN, BS, APRN, GNP-BC1 Christina S. Melvin, MS, BS, PHCNS, BC, CHPN1 Nancy P. LeMieux, MSN, BSEd, RN1 Deborah A. O\u27Rouke, PhD, MA, MClSc, BSc, PT2 Jean Beatson, EdD, MS, RN3 Patricia A. Prelock, PhD, MA, BS, CCC-SLP, BCS-CL4 Kelly A. Melekis, PhD, MSW, LMSW5 Mary Alice Favro, MA, BS, CCC-SLP6 Vicki Hart, PhD7 (1)Department of Nursing, University of Vermont, Burlington, VT (2)Dept. of Rehabilitation and Movement Science, University of Vermont, Burlington, VT (3)Vermont Interdisciplinary Leadership Education for Health Professionals Program, University Of Vermont, Burlington, VT (4)Department of Communication Sciences & Disorders, University of Vermont, Burlington, VT (5)Department of Social Work, University of Vermont, Burlington, VT (6)Department of Communication Sciences and Disorders, University of Vermont, Burlington, VT, VT (7)Office of Health Promotion Research, University of Vermont, Burlington, VT Purpose: The interprofessional team’s role in end of life care provides a unique opportunity for an educational simulation. Novel ways to teach this content to a large number of students were needed. This research evaluated a palliative care interprofessional educational activity for healthcare students from six disciplines using an in-person movie/discussion format. Methods: Healthcare provider assessment visits and a death scene were pilot tested in actual simulations using twenty four students with standardized patients portraying a patient with ALS and his husband. Scripts were written from recordings of these simulations and were used in the dialogue of the movie which had standardized patient actors playing the patient, husband, sister and the student healthcare providers. The movie portrayed a patient with ALS and his husband in five scenes: assessment of patient and family needs by nursing, physical therapy, social work and speech language pathology; and a death scene. The movie was then edited to be used for discussion by large student groups. An evaluation survey was developed with 14 questions scored on a Likert scale and related to Interprofessional Competency Domains of 1. Values/Ethics, 2. Roles/Responsibilities, 3. Interprofessional communication, and 4. Teams/teamwork. These competencies provided a structure for the evaluation questions, and a review by faculty in each discipline also provided content validity. Reliability of the survey instrument was not tested or established. Graduate nurse practitioner, medical, communication sciences and disorders, social work and physical therapy students as well as undergraduate nursing students participated together in end of life movie discussions in four sessions held in a classroom equipped with tables of six. Survey responses were compared across disciplines and across the four interprofessional competency domains using a Chi-square test and adjusting for multiple comparisons. Significant differences were established at p Results: Student evaluations of the end of life simulations were consistently positive. Eighty percent of the participants (n=162) strongly agreed that they recognize the necessity of utilizing a healthcare team when providing care for patients at the end of life. All participants agreed that they would continue to forge relationships with other healthcare professionals to improve care for elders. Physical therapy students were consistently had the most positive responses; however, significant differences were only observed in three of the 14 questions. There were no significant differences between disciplines across the four interprofessional competency domains. A summary of qualitative data from the open ended questions will be also be presented. Conclusion: Interprofessional end of life care can be simulated in a carefully planned activity. The value of the experience was expressed by all students. Nurse practitioner students valued being able to practice supervising a palliative care team and facilitating the team discussion. Other students appreciated a safe place to discuss how to care for a dying patient and their family. Regarding the evaluation, small sample sizes in some disciplines may have limited the ability to detect significant differences between groups. Production of a movie and the discussion of the different scenes helped lower the cost of the simulation and scale up the activity for use with large groups of students. Interprofessional education requires innovative pedagogy that must be evaluated and disseminated. Consistent evaluation of interprofessional practice competency domains must be included in all educational activities

Stable conditional expression and effect of C/EBPβ-LIP in adipocytes using the pSLIK system

Murine 3T3-L1 adipocytes are widely used as a cellular model of obesity. However, whereas transfection of 3T3-L1 preadipocytes is straightforward, ectopic gene expression in mature 3T3-L1 adipocytes has proved challenging. Here, we used the pSLIK vector system to generate stable doxycycline-inducible expression of the liver-enriched inhibitor protein isoform of CCAAT/enhancer binding protein (C/EBP) {beta} (C/EBP{beta}-LIP) in fully differentiated 3T3-L1 adipocytes. Because overexpression of C/EBP{beta}-LIP impairs adipocyte differentiation, the C/EBP{beta}-LIP construct was first integrated in 3T3-L1 preadipocytes but expression was induced only when adipocytes were fully differentiated. Increased C/EBP{beta}-LIP in mature adipocytes down-regulated C/EBP{beta} target genes including 11{beta}-hydroxysteroid dehydrogenase type 1, phosphoenolpyruvate carboxykinase and fatty acid binding protein 4, but had no effect on asparagine synthetase, demonstrating that transcriptional down-regulation by C/EBP{beta}-LIP in 3T3-L1 adipocytes is not a general effect. Importantly, these genes were modulated in a similar manner in adipose tissue of mice with genetically increased C/EBP{beta}-LIP levels. The use of the pSLIK system to conditionally express transgenes in 3T3-L1 cells could be a valuable tool to dissect adipocyte physiology

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy