Implementing screening and brief alcohol interventions in primary care : views from both sides of the consultation

Excessive drinking is a global health problem which is responsible for a wide range of both chronic and acute illness, and which costs the UK National Health Service (NHS) £1.7 billion annually. Current health policy aims to reduce alcohol-related problems by promoting early identification of risk followed by brief intervention to facilitate positive changes in drinking level or patterns of consumption. However, practical and philosophical barriers concerning screening and brief alcohol intervention have so far impeded its uptake in routine primary care. This qualitative study aimed to simultaneously explore and compare health professionals’ and patients’ views on the acceptability and feasibility of screening and brief alcohol intervention in primary care. Focus groups were held with (a) four primary care teams, (b) two general practitioner (GP) and two nurse groups and (c) six patient groups in the north-east of England. A thematic framework approach was used to analyse audio-taped data via transcripts. Both health professionals and patients reported that raising and discussing alcohol-related risk was acceptable in primary care, when combined with other lifestyle issues or linked to relevant health conditions. Targeted rather than universal screening was the most acceptable method of identifying alcohol-related risk and would fit well with existing practice. However, there was uncertainty among health professionals about the effectiveness of brief alcohol interventions and some disagreement with patients concerning who was best placed to deliver them. Health professionals felt that nurses were best placed for such work whilst patients reported that they would initially raise the subject with GPs. There was broad acceptance of brief intervention approaches but a lack of support and specific incentives for this work impeded its delivery in routine practice

The investigation of a recombinant GalNAc binding protein from bacillus thuringiensis as a tool for glycan analysis and detection

Changes in the structures of glycans on the surfaces of eukaryotic cells can be important biomarkers for developmental or disease states. Improved methods are needed for the detection and analysis of alterations in glycan structures. Carbohydrate binding proteins such as lectins have potential for the recognition of changes in glycan structure. Host-pathogen interactions frequently involve the recognition of host carbohydrates by proteins of bacteria or viruses. Many bacterial toxins have evolved to interact with host cell receptors or with a specific tissue due to lectin like properties. The toxins from Bacillus thuringiensis have been shown to have carbohydrate binding abilities, in particular N-Acetylgalactosamine (GalNAc) has been shown to inhibit the binding of the toxin Cry1Ac. GalNAc has been shown to be an important marker in many diseases such as breast cancer and colon carcinogenesis. Moreover, changes in GalNAc glycosylation have been identified in many disorders such as cystic fibrosis, neuromuscular disorders and nephropathy. Here we describe the purification of a GalNAc binding protein of bacterial origin that may have potential in the development of diagnostic assays

Regions of the Cry1Ac toxin predicted to be under positive selection are shown to be the carbohydrate binding sites and can be altered in their glycoprotein target specificity

The cry gene family, is a large family of homologous genes from Bacillus thuringiensis. Studies have examined the structural and functional relationships of the Cry proteins. They have revealed several residues in domains II and III that are important for target recognition and receptor attachment. In 2007 Wu, Jin-Yu et al employed a maximum likelihood method to detect evidence of adaptive evolution in Cry proteins. They identified positively selected residues, which are all located in Domain II or III. Figure 1 shows a protein sequence alignment between domain II and III of Cry1Ac and Cry1Aa. This highlights the areas which are thought to be under positive selection. Cry1Ac and Cry1Aa are structurally very similar and they both bind to a variety of N-aminopeptidases (APN’s) in different insect species. However Cry1Aa has a higher specificity for the cadherin like receptor HevCalP and Cry1Ac binds to N-acetylgalactosamine (GalNAc) on the surface of APN’s. Differences in the binding of the two toxins has been shown in an in-direct toxin-binding assay where GalNAc completely abolished toxin binding of Cry1Ac but had no effect on the binding of Cry1Aa. The binding site has been shown to be located in the third domain of Cry1Ac. Some of these sites correlate with the positively selected residues found by Wu et al 2007 in Cry1Aa. Our aim was to use the comparison of the toxins to analyse the potential to alter the binding specificity of Cry1Ac and its domains. In this work we identified critical amino acid residues for this objective

Dietary flavonoid intakes and CVD incidence in the Framingham Offspring Cohort

This study examines the relationship between long-term intake of six flavonoid classes and incidence of CVD and CHD, using a comprehensive flavonoid database and repeated measures of intake, while accounting for possible confounding by components of a healthy dietary pattern. Flavonoid intakes were assessed using a FFQ among the Framingham Offspring Cohort at baseline and three times during follow-up. Cox proportional hazards regression was used to characterise prospective associations between the natural logarithms of flavonoid intakes and CVD incidence using a time-dependent approach, in which intake data were updated at each examination to represent average intakes from previous examinations. Mean baseline age was 54 years, and 45 % of the population was male. Over an average 14·9 years of follow-up among 2880 participants, there were 518 CVD events and 261 CHD events. After multivariable adjustment, only flavonol intake was significantly associated with lower risk of CVD incidence (hazard ratios (HR) per 2·5-fold flavonol increase = 0·86, Ptrend = 0·05). Additional adjustment for total fruit and vegetable intake and overall diet quality attenuated this observation (HR = 0·89, Ptrend = 0·20 and HR = 0·92, Ptrend = 0·33, respectively). There were no significant associations between flavonoids and CHD incidence after multivariable adjustment. Our findings suggest that the observed association between flavonol intake and CVD risk may be a consequence of better overall diet. However, the strength of this non-significant association was also consistent with relative risks observed in previous meta-analyses, and therefore a modest benefit of flavonol intake on CVD risk cannot be ruled out

Emergent pedagogy: learning to enjoy the uncontrollable—and make it productive

This essay reflects the shared experiences of four college faculty members (a biologist, a psychologist, a computer scientist, and a feminist literary scholar) working together with K-12 teachers to explore a new perspective on educational practice. It offers a novel rationale for independent thinking and learning, one that derives from rapidly developing interdisciplinary and transdisciplinary inquiries in the sciences and social sciences into what are known as “complex” or “emergent” systems. Using emergent systems as a model of teaching and learning makes at least three significant contributions to our thinking bout teaching, in three very different dimensions. It invites us into an awareness that the brains of individual students and teachers operate as emergent systems that are neither possible nor desirable to control fully. It invites us to appreciate as well that the activities and benefits of a classroom are not all individual interactions between teacher and student. Interactions among students and teachers are collectively contributing to a somewhat unpredictable project with an insistently social dimension, which is in turn crucial to the individual achievements of all involved. Finally, emergent pedagogy encourages us to consider more carefully the relations between the individual classroom and the larger educational community of which it is a component, including a challenge to rethink the matter of assessment

Emergent pedagogy: learning to enjoy the uncontrollable—and make it productive

This essay reflects the shared experiences of four college faculty members (a biologist, a psychologist, a computer scientist, and a feminist literary scholar) working together with K-12 teachers to explore a new perspective on educational practice. It offers a novel rationale for independent thinking and learning, one that derives from rapidly developing interdisciplinary and transdisciplinary inquiries in the sciences and social sciences into what are known as “complex” or “emergent” systems. Using emergent systems as a model of teaching and learning makes at least three significant contributions to our thinking bout teaching, in three very different dimensions. It invites us into an awareness that the brains of individual students and teachers operate as emergent systems that are neither possible nor desirable to control fully. It invites us to appreciate as well that the activities and benefits of a classroom are not all individual interactions between teacher and student. Interactions among students and teachers are collectively contributing to a somewhat unpredictable project with an insistently social dimension, which is in turn crucial to the individual achievements of all involved. Finally, emergent pedagogy encourages us to consider more carefully the relations between the individual classroom and the larger educational community of which it is a component, including a challenge to rethink the matter of assessment

Gibbs Sampling with Low-Power Spiking Digital Neurons

Restricted Boltzmann Machines and Deep Belief Networks have been successfully used in a wide variety of applications including image classification and speech recognition. Inference and learning in these algorithms uses a Markov Chain Monte Carlo procedure called Gibbs sampling. A sigmoidal function forms the kernel of this sampler which can be realized from the firing statistics of noisy integrate-and-fire neurons on a neuromorphic VLSI substrate. This paper demonstrates such an implementation on an array of digital spiking neurons with stochastic leak and threshold properties for inference tasks and presents some key performance metrics for such a hardware-based sampler in both the generative and discriminative contexts.Comment: Accepted at ISCAS 201

The Development of a Prison Mental Health Unit in England: Understanding Realist Context(s).

A pragmatic solution for the provision of care for prisoners with serious mental illness, who are often subject to delays in hospital transfer, is the creation of specialist prison units. This paper analyses the development of a prison unit in England for prisoners with ‘serious mental illness’. The unit was developed within over-lapping health and justice contexts, including expectations, pressures and priorities, which impacted on the outcomes expected and achieved. The methodology included attendance at Steering group meetings, analysis of a minimum dataset, and interviews with key stakeholders. A number of key sites of contestation are analyzed including: admission criteria; aims; activities; staffing; the physical environment; and discharge

Development of a readiness ruler for use with alcohol brief interventions

Background A quick method of assessing readiness to change was needed for a major study of implementing screening and alcohol brief intervention in England. For this purpose, a Readiness Ruler that had been validated among a sample of male college students in the USA was adapted and applied to a sample of excessive drinkers in a general medical practice located in a deprived area of Gateshead, England. Methods 72 participants identified as excessive drinkers by health professionals completed a single-item Readiness Ruler, the 12-item Readiness to Change Questionnaire (RCQ) and the AUDIT questionnaire. Results In terms of concurrent validity, the relationships between the Readiness Ruler, on the one hand, and either stage of change allocation or a dimensional score derived from the RCQ, on the other hand, were highly significant but weaker than expected. When patients who endorsed the “maintenance” point on the Readiness Ruler were excluded from the analysis, the above relationships were considerably strengthened for reasons that are discussed. On this basis and with another small change, a final Readiness Ruler was developed. Conclusion If the validity of the Readiness Ruler is confirmed in subsequent research, a quick and simple way of measuring readiness to change will be available for research or clinical work with alcohol brief interventions