Bridging the gap between pragmatic intervention design and theory: using behavioural science tools to modify an existing quality improvement programme to implement "Sepsis Six"

BACKGROUND: Sepsis has a mortality rate of 40 %, which can be halved if the evidence-based "Sepsis Six" care bundle is implemented within 1 h. UK audit shows low implementation rates. Interventions to improve this have had minimal effects. Quality improvement programmes could be further developed by using theoretical frameworks (Theoretical Domains Framework (TDF)) to modify existing interventions by identifying influences on clinical behaviour and selecting appropriate content. The aim of this study was to illustrate using this process to modify an intervention designed using plan-do-study-act (P-D-S-A) cycles that had achieved partial success in improving Sepsis Six implementation in one hospital. METHODS: Factors influencing implementation were investigated using the TDF to analyse interviews with 34 health professionals. The nursing team who developed and facilitated the intervention used the data to select modifications using the Behaviour Change Technique (BCT) Taxonomy (v1) and the APEASE criteria: affordability, practicability, effectiveness, acceptability, safety and equity. RESULTS: Five themes were identified as influencing implementation and guided intervention modification. These were:(1) "knowing what to do and why" (TDF domains knowledge, social/professional role and identity); (2) "risks and benefits" (beliefs about consequences), e.g. fear of harming patients through fluid overload acting as a barrier to implementation versus belief in the bundle's effectiveness acting as a lever to implementation; (3) "working together" (social influences, social/professional role and identity), e.g. team collaboration acting as a lever versus doctor/nurse conflict acting as a barrier; (4) "empowerment and support" (beliefs about capabilities, social/professional role and identity, behavioural regulation, social influences), e.g. involving staff in intervention development acting as a lever versus lack of confidence to challenge colleagues' decisions not to implement acting as a barrier; (5) "staffing levels" (environmental context and resources), e.g. shortages of doctors at night preventing implementation. The modified intervention included six new BCTs and consisted of two additional components (Sepsis Six training for the Hospital at Night Co-ordinator; a partnership agreement endorsing engagement of all clinical staff and permitting collegial challenge) and modifications to two existing components (staff education sessions; documents and materials). CONCLUSIONS: This work demonstrates the feasibility of the TDF and BCT Taxonomy (v1) for developing an existing quality improvement intervention. The tools are compatible with the pragmatic P-D-S-A cycle approach generally used in quality improvement work

Body mass and hibernation microclimate may predict bat susceptibility to white-nose syndrome

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Adolescents’ responses to the promotion and flavouring of e-cigarettes

Objectives The purpose of the study is to examine adolescents’ awareness of e-cigarette marketing and investigate the impact of e-cigarette flavour descriptors on perceptions of product harm and user image. Methods Data come from the 2014 Youth Tobacco Policy Survey, a cross-sectional in-home survey conducted with 11–16 year olds across the UK (n = 1205). Adolescents’ awareness of e-cigarette promotion, brands, and flavours was assessed. Perceptions of product harm, and likely user of four examples of e-cigarette flavours was also examined. Results Some participants had tried e-cigarettes (12 %) but regular use was low (2 %) and confined to adolescents who had also smoked tobacco. Most were aware of at least one promotional channel (82 %) and that e-cigarettes came in different flavours (69 %). Brand awareness was low. E-cigarettes were perceived as harmful (M = 3.54, SD = 1.19) but this was moderated by product flavours. Fruit and sweet flavours were perceived as more likely to be tried by young never smokers than adult smokers trying to quit (p < 0.001). Conclusions There is a need to monitor the impact of future market and regulatory change on youth uptake and perceptions of e-cigarettes

Diabetes status and post-load plasma glucose concentration in relation to site-specific cancer mortality: findings from the original Whitehall study

ObjectiveWhile several studies have reported on the relation of diabetes status with pancreatic cancer risk, the predictive value of this disorder for other malignancies is unclear. Methods: The Whitehall study, a 25year follow-up for mortality experience of 18,006 men with data on post-challenge blood glucose and self-reported diabetes, allowed us to address these issues. Results: There were 2158 cancer deaths at follow-up. Of the 15 cancer outcomes, diabetes status was positively associated with mortality from carcinoma of the pancreas and liver, while the relationship with lung cancer was inverse, after controlling for a range of potential covariates and mediators which included obesity and socioeconomic position. After excluding deaths occurring in the first 10years of follow-up to examine the effect of reverse causality, the magnitude of the relationships for carcinoma of the pancreas and lung was little altered, while for liver cancer it was markedly attenuated. Conclusions: In the present study, diabetes status was related to pancreatic, liver, and lung cancer risk. Cohorts with serially collected data on blood glucose and covariates are required to further examine this area

Elastic and Raman scattering of 9.0 and 11.4 MeV photons from Au, Dy and In

Monoenergetic photons between 8.8 and 11.4 MeV were scattered elastically and in elastically (Raman) from natural targets of Au, Dy and In.15 new cross sections were measured. Evidence is presented for a slight deformation in the 197Au nucleus, generally believed to be spherical. It is predicted, on the basis of these measurements, that the Giant Dipole Resonance of Dy is very similar to that of 160Gd. A narrow isolated resonance at 9.0 MeV is observed in In.Comment: 31 pages, 11 figure

Oral health behaviours of children and adolescence in England, Wales and Northern Ireland: Findings from the 2013 Child Dental Health Survey

BACKGROUND: The 2013 Children's Dental Health Survey is the fifth in a series of national surveys. AIM: To describe the oral health behaviours in children and adolescents in England, Wales and Northern Ireland. METHOD: A representative sample of children (aged 5, 8 12 and 15 years) in England, Wales and Northern Ireland were invited to participate in dental examinations. Children and parents were also invited to complete a questionnaire about oral health behaviours. RESULTS: Overall, the majority of children and young people reported good oral health behaviours. For example, more than three quarters of the 12- and 15-year-olds reported brushing their teeth twice a day or more often. However, a sizeable proportion of the sample reported less positive behaviours. Nearly 30% of 5-year-olds first started to brush their teeth after the age of one year. Among 15-year-olds, 11% were current smokers and 37% reported that they currently drank alcohol. Sixteen percent of 12-year-olds reported to consume drinks containing sugar four or more times a day. Of particular concern was the marked differences that existed by level of deprivation. Children living in lower income households (eligible for free school meals) were less likely to brush their teeth twice a day, more likely to start brushing after six months, more likely to be a smoker and more likely to consume frequent amounts of sugary drinks. CONCLUSION: Despite some encouraging overall patterns of good oral health behaviours, a sizeable proportion of children and young people reported behaviours that may lead to poorer oral and general health. Preventive support should be delivered in clinical dental settings to encourage positive oral health behaviours. Public health strategies are also needed to reduce inequalities in oral health behaviours among children and young people

Do 'good values' lead to 'good' health-behaviours? Longitudinal associations between young people's values and later substance-use

&lt;p&gt;Background: Past studies have linked certain values (traditional vs. individualistic) with adolescent substance-use. The aims of this study are to replicate cross-sectional research linking values and adolescent substance-use and to determine if such values predict future substance-use.&lt;/p&gt; &lt;p&gt;Methods: A longitudinal school-based survey of 2196 young people (age 15) followed up in early adulthood (age 18/19). Participants provided data about their beliefs and values at age 15, and their substance-use (smoking, alcohol and drug-use) at ages 15 and 18/19. In addition data were collected about their social background (gender, risk-taking, deprivation, religion, etc).&lt;/p&gt; &lt;p&gt;Results: Cross-sectionally, young people with anti-authority values were more likely to use various substances, e.g. 17-67% more likely to regularly smoke (daily), drink (most days), or use drugs (weekly) for each SD above typical levels. Adjusting for social background, associations were not substantially attenuated. However in the prospective analysis, adjusting for both background and substance-use at age 15, only two (anti-authoritarian and work ethic) values were (marginally) associated with substance-use at age 18/19.&lt;/p&gt; &lt;p&gt;Conclusions: While we replicated results found in prior cross-sectional studies, evidence from this study does not support the argument that holding certain 'pro-social' or 'good' values substantively protects against later substance-use and challenges the likely effectiveness of values-based interventions in relation to later substance-use.&lt;/p&gt

Relative Roles of Grey Squirrels, Supplementary Feeding, and Habitat in Shaping Urban Bird Assemblages

Non-native species are frequently considered to influence urban assemblages. The grey squirrel Sciurus carolinensis is one such species that is widespread in the UK and is starting to spread across Europe; it predates birds’ nests and can compete with birds for supplementary food. Using distance sampling across the urbanisation intensity gradient in Sheffield (UK) we test whether urban grey squirrels influence avian species richness and density through nest predation and competition for supplementary food sources. We also assess how urban bird assemblages respond to supplementary feeding. We find that grey squirrels slightly reduced the abundance of breeding bird species most sensitive to squirrel nest predation by reducing the beneficial impact of woodland cover. There was no evidence that grey squirrel presence altered relationships between supplementary feeding and avian assemblage structure. This may be because, somewhat surprisingly, supplementary feeding was not associated with the richness or density of wintering bird assemblages. These associations were positive during the summer, supporting advocacy to feed birds during the breeding season and not just winter, but explanatory capacity was limited. The amount of green space and its quality, assessed as canopy cover, had a stronger influence on avian species richness and population size than the presence of grey squirrels and supplementary feeding stations. Urban bird populations are thus more likely to benefit from investment in improving the availability of high quality habitats than controlling squirrel populations or increased investment in supplementary feeding

Probiotic modulation of symbiotic gut microbial–host metabolic interactions in a humanized microbiome mouse model

The transgenomic metabolic effects of exposure to either Lactobacillus paracasei or Lactobacillus rhamnosus probiotics have been measured and mapped in humanized extended genome mice (germ-free mice colonized with human baby flora). Statistical analysis of the compartmental fluctuations in diverse metabolic compartments, including biofluids, tissue and cecal short-chain fatty acids (SCFAs) in relation to microbial population modulation generated a novel top-down systems biology view of the host response to probiotic intervention. Probiotic exposure exerted microbiome modification and resulted in altered hepatic lipid metabolism coupled with lowered plasma lipoprotein levels and apparent stimulated glycolysis. Probiotic treatments also altered a diverse range of pathways outcomes, including amino-acid metabolism, methylamines and SCFAs. The novel application of hierarchical-principal component analysis allowed visualization of multicompartmental transgenomic metabolic interactions that could also be resolved at the compartment and pathway level. These integrated system investigations demonstrate the potential of metabolic profiling as a top-down systems biology driver for investigating the mechanistic basis of probiotic action and the therapeutic surveillance of the gut microbial activity related to dietary supplementation of probiotics

Comparative genomic hybridization detects many recurrent imbalances in central nervous system primitive neuroectodermal tumours in children

A series of 23 children with primitive neuroectodermal tumours (PNET) were analysed with comparative genomic hybridization (CGH). Multiple chromosomal imbalances have been detected in 20 patients. The most frequently involved chromosome was chromosome 17, with a gain of 17q (11 cases) and loss of 17p (eight cases). Further recurrent copy number changes were detected. Extra copies of chromosome 7 were present in nine patients and gains of 1q were detected in six patients. A moderate genomic amplification was detected in one patient, involving two sites on 3p and the whole 12p. Losses were more frequent, and especially involved the chromosomes 11 (nine cases), 10q (eight cases), 8 (six cases), X (six patients) and 3 (five cases), and part of chromosome 9 (five cases). These recurrent chromosomal changes may highlight locations of novel genes with an important role in the development and/or progression of PNET. © 1999 Cancer Research Campaig