Coercive containment measures for the management of self-cutting versus general disturbed behaviour:differences in use and attitudes among mental health nursing staff

Self-harm is common in mental health facilities, and coercive containment measures are sometimes used to manage it. Nurses' attitudes towards these measures have been investigated in relation to disturbed behaviour in general, but rarely to self-harm specifically. We therefore investigated mental health nurses' use of and attitudes towards coercive measures (seclusion, restraint, intermittent and constant observations, forced intramuscular medication, and PRN medication) for self-cutting management compared with for disturbed behaviours in general using a cross-sectional, repeated measures survey design. Participants were N = 164 mental health nursing staff. Data collection was via a questionnaire comprising validated attitudinal measures. The study is reported in line with STROBE guidelines. Physical restraint (36.6%), forced intramuscular medication (32.3%) and seclusion (48.2%) had reportedly been used by individuals for self-cutting management. Respondents disapproved of using each coercive measure for self-cutting more than they did for disturbed behaviour in general with the exception of PRN medication. Attitudes to coercive measures differed across target behaviours. Hence, nurses who had used each measure for managing self-cutting disapproved of it less for that purpose than those who had not. Nurses who had used coercive techniques for self-cutting management had less desirable attitudes to their use. We cannot say whether prior use of these techniques led to increased approval or whether greater approval led to an increased willingness to use them. Reducing the use of coercive techniques for self-harm will require attitudes that support its use to be challenged. Less coercive techniques should be encouraged. Harm reduction techniques offer one such alternative

A single site for N-linked glycosylation in the envelope glycoprotein of feline immunodeficiency virus modulates the virus-receptor interaction

Feline immunodeficiency virus (FIV) targets helper T cells by attachment of the envelope glycoprotein (Env) to CD134, a subsequent interaction with CXCR4 then facilitating the process of viral entry. As the CXCR4 binding site is not exposed until CD134-binding has occurred then the virus is protected from neutralising antibodies targeting the CXCR4-binding site on Env. Prototypic FIV vaccines based on the FL4 strain of FIV contain a cell culture-adapted strain of FIV Petaluma, a CD134-independent strain of FIV that interacts directly with CXCR4. In addition to a characteristic increase in charge in the V3 loop homologue of FIV<sub>FL4</sub>, we identified two mutations in potential sites for N-linked glycosylation in the region of FIV Env analogous to the V1-V2 region of HIV and SIV Env, T271I and N342Y. When these mutations were introduced into the primary GL8 and CPG41 strains of FIV, the T271I mutation was found to alter the nature of the virus-CD134 interaction; primary viruses carrying the T271I mutation no longer required determinants in cysteine-rich domain (CRD) 2 of CD134 for viral entry. The T271I mutation did not confer CD134-independent infection upon GL8 or CPG41, nor did it increase the affinity of the CXCR4 interaction, suggesting that the principal effect was targeted at reducing the complexity of the Env-CD134 interaction

Human Ecology Economics (HEE) and Strategic Management

Human Ecology Economics (HEE) draws on evolutionary and complex systems processes by incorporating interdisciplinary material from the humanities and sciences. Lessons for strategic managers follow from this HEE perspective with examples from the banking industry. HEE can nurture a broad environmental perspective among strategic managers and an ontological understanding of their organization within its dynamic ecology. Reconciliation is attempted between the chaotic dualities inherent in strategic management (SM)

Anger, Quality of Life and Mood in Multiple Sclerosis

This research was funded by The Multiple Sclerosis Society (UK).Peer reviewedPublisher PD

Neutralization of feline immunodeficiency virus by antibodies targeting the V5 loop of Env

Neutralising antibodies (NAbs) play a vital role in vaccine-induced protection against infection with feline immunodeficiency virus (FIV). However, little is known about the appropriate presentation of neutralisation epitopes in order to induce NAbs effectively; the majority of the antibodies that are induced are directed against non-neutralising epitopes. Here, we demonstrate that a subtype B strain of FIV, designated NG4, escapes autologous NAbs but may be rendered neutralisation-sensitive following the insertion of two amino acids, Lysine and Threonine, at positions 556-557 in the fifth hypervariable (V5) loop of the envelope glycoprotein (Env). Consistent with the contribution of this motif to virus neutralisation, an additional three subtype B strains retaining both residues at the same position were also neutralised by the NG4 serum and serum from an unrelated cat (TOT1) targeted the same sequence in V5. Moreover, when the V5-loop of subtype B isolate KNG2, an isolate that was moderately resistant to neutralisation by NG4 serum, was mutated to incorporate the K-T motif, the virus was rendered sensitive to neutralisation. These data suggest that even in a polyclonal sera derived from FIV infected cats following natural infection, the primary determinant of virus neutralising activity may be represented by a single, dominant epitope in V5

Security management education online

This paper describes the philosophy and pedagogy informing the design and development of Security Science online units. The Physical Security unit is used to illustrate the development of the online learning strategies and interactive activities. Learning materials developed for this course have unique attributes as they were specifically designed to provide simulations and interactivity in the learning process. Field scenarios have been developed for the activities to make the learning experiences as realistic as possible. Simulations and graphics provide these experiences, together with security site images for actual security barriers, systems and technologies. Features of units in the course include graphics, simulations, and video clips to present learning aspects of security that are not normally available to students

Restoration of a floodplain meadow in Wiltshire, UK through application of green hay and conversion from pasture to meadow management

In July 2010 green hay from a species-rich donor field was used to diversify a species-poor floodplain meadow (the receiver field), which had previously been managed as a pasture. The receiver site was prepared through harrowing. Green hay was then collected from the donor site and spread on the receiver site using a bale shredder and spreader. It was then managed as a hay meadow, with an annual hay cut in July or August, followed by aftermath grazing. The vegetation in the receiver field was monitored from 2010-2017, as was an adjacent species-rich meadow, which was used as a target reference site. Over this period, the receiver field moved towards a species-rich sward, similar to the target Alopecurus pratensis-Sansguisorba officinalis floodplain community. In 2011, 12 months after the green hay application and change of management, species richness had increased significantly, as had the goodness-of-fit to the target floodplain-meadow community. The transformation from species-poor eutrophicated grassland to a more herb-rich floodplain meadow continued over the following six years, with further increases in the frequency and cover of target species

Patient and carer experiences of pain care in an Australian regional comprehensive cancer care setting: a qualitative study.

INTRODUCTION: Pain is a common and distressing symptom in people living with cancer that requires a patient-centred approach to management. Since 2010, the Australian Government has invested heavily in developing regional cancer centres to improve cancer outcomes. This study explored patient and carer experiences of care from a regional cancer centre with specific reference to cancer pain management. METHODS: A qualitative approach was used with semi-structured telephone interviews. Participants were outpatients at a regional cancer centre in New South Wales who had reported worst pain of 2 or more on a 0-10 numerical rating scale, and their carers. Questions explored experiences of pain assessment and management, and perceptions of how these were affected by the regional setting. Researchers analysed data using a deductive approach, using Mead and Bower's (2000) framework of factors influencing patient-centred care. RESULTS: Eighteen telephone interviews were conducted with 13 patients and 5 carers. Participants perceived that living in a regional setting conferred advantages to the patient-centredness of care via influences at the levels of professional context, the doctor-patient relationship, and consultation. These influences included established and ongoing relationships with a smaller number of care providers who were members of the community, and heightened accessibility in terms of travel/parking, flexible appointments, and ample time spent with each patient. The first of these factors was also perceived to contribute to continuity of care between specialist and primary care providers. However, one negative case reported disagreement between providers and a difficulty accessing specialist pain services. Several participants also reported a preference, and unmet need, for non-pharmacological rather than pharmacological pain management. CONCLUSION: While much research has focused on lack of services and poorer outcomes for people with cancer in rural areas, the Australian regional setting may offer benefits to the patient-centredness of cancer pain management and continuity of care. More research is needed to better understand the benefits and trade-offs of cancer care in regional versus urban settings, and how each can learn from the other. An unmet need for non-pharmacological rather than pharmacological pain management is among the most consistent findings of qualitative studies of patient/carer preferences across settings

Genetic diversity of Brazilian isolates of feline immunodeficiency virus

We isolated Feline immunodeficiency virus (FIV) from three adult domestic cats, originating from two open shelters in Brazil. Viruses were isolated from PBMC following co-cultivation with the feline T-lymphoblastoid cell line MYA-1. All amplified env gene products were cloned directly into pGL8MYA. The nucleic acid sequences of seven clones were determined and then compared with those of previously described isolates. The sequences of all of the Brazilian virus clones were distinct and phylogenetic analysis revealed that all belong to subtype B. Three variants isolated from one cat and two variants were isolated from each of the two other cats, indicating that intrahost diversity has the potential to pose problems for the treatment and diagnosis of FIV infection

Selective expansion of viral variants following experimental transmission of a reconstituted feline immunodeficiency virus quasispecies

Following long-term infection with virus derived from the pathogenic GL8 molecular clone of feline immunodeficiency virus (FIV), a range of viral variants emerged with distinct modes of interaction with the viral receptors CD134 and CXCR4, and sensitivities to neutralizing antibodies. In order to assess whether this viral diversity would be maintained following subsequent transmission, a synthetic quasispecies was reconstituted comprising molecular clones bearing envs from six viral variants and its replicative capacity compared in vivo with a clonal preparation of the parent virus. Infection with either clonal (Group 1) or diverse (Group 2) challenge viruses, resulted in a reduction in CD4+ lymphocytes and an increase in CD8+ lymphocytes. Proviral loads were similar in both study groups, peaking by 10 weeks post-infection, a higher plateau (set-point) being achieved and maintained in study Group 1. Marked differences in the ability of individual viral variants to replicate were noted in Group 2; those most similar to GL8 achieved higher viral loads while variants such as the chimaeras bearing the B14 and B28 Envs grew less well. The defective replication of these variants was not due to suppression by the humoral immune response as virus neutralising antibodies were not elicited within the study period. Similarly, although potent cellular immune responses were detected against determinants in Env, no qualitative differences were revealed between animals infected with either the clonal or the diverse inocula. However, in vitro studies indicated that the reduced replicative capacity of variants B14 and B28 in vivo was associated with altered interactions between the viruses and the viral receptor and co-receptor. The data suggest that viral variants with GL8-like characteristics have an early, replicative advantage and should provide the focus for future vaccine development