Improving safety in care homes:protocol for evaluation of the Walsall and Wolverhampton care home improvement programme

Abstract Background Improving safety in care homes is becoming increasingly important. Care home residents typically have multiple physical and/or cognitive impairments, and adverse events like falls often lead to hospital attendance or admission. Developing a safety culture is associated with beneficial impacts on safety outcomes, but the complex needs of care home residents, coupled with staffing pressures in the sector, pose challenges for positive safety practices to become embedded at the individual and organisational levels. Staff training and education can positively enforce safety culture and reduce the incidence of harms, but improvement initiatives are often short lived and thorough evaluation is uncommon. This protocol outlines an evaluation of a large-scale care home improvement programme in the West Midlands. Methods The programme will run in 35 care homes across Walsall and Wolverhampton over 24\ua0months, and we anticipate that 30 care homes will participate in the evaluation ( n \u2009=\u20091500 staff). The programme will train staff and managers in service improvement techniques, with the aim of strengthening safety culture and reducing adverse safety event rates. The evaluation will use a pre-post design with mixed methods. Quantitative data will focus on: care home manager and staff surveys administered at several time points and analysis of adverse event rates. Data on hospital activity by residents at participating care homes will be compared to matched controls. Qualitative data on experience of training and the application of learning to practice will be collected via semi-structured interviews with staff ( n \u2009=\u200948 to 64) and programme facilitators ( n \u2009=\u20096), and staff focus groups ( n \u2009=\u200936 to 48 staff). The primary outcome measure is the change in mean score on the safety climate domain of the Safety Attitudes Questionnaire between baseline and programme end. Discussion This mixed methods evaluation of a large-scale care home improvement programme will allow a substantial amount of qualitative and quantitative data to be collected. This will enable an assessment of the extent to which care home staff training can effectively improve safety culture, lower the incidence of adverse safety events such as falls and pressure ulcers, and potentially reduce care home resident\u2019s use of acute services

Collecting Data on Charismatic Mini-Fauna: Public Participation and the Dragonfly Mercury Project

The Dragonfly Mercury Project (DMP) engages citizen scientists in collection of drag­onfly larvae for mercury analysis in national parks, allowing for national-scale assess­ment of this neurotoxic pollutant. DMP goals for citizen scientist engagement are to (1) provide opportunity for biodiversity discovery; (2) connect people to parks; and (3) provide a vehicle for mercury education and outreach. Over 90 parks and 3,000 citizen scientists have participated in the project. Here we summarize information about citizen groups who participated in 2014–2016. High school students (20%), interns and youth groups (24%), and local community groups (15%) comprised the majority of partici­pants. Park liaisons reported that the project achieved internal and external communica­tion that otherwise would not have occurred. Opportunities for improvement included further curriculum and workforce development. Ultimately, citizen scientists gained new perspectives and practiced civic skills while project scientists and resource managers gained data and insights on mercury in foodwebs

Hyperinsulinemic hypoglycemia in children and adolescents: Recent advances in understanding of pathophysiology and management

Hyperinsulinemic hypoglycemia (HH) is characterized by unregulated insulin release, leading to persistently low blood glucose concentrations with lack of alternative fuels, which increases the risk of neurological damage in these patients. It is the most common cause of persistent and recurrent hypoglycemia in the neonatal period. HH may be primary, Congenital HH (CHH), when it is associated with variants in a number of genes implicated in pancreatic development and function. Alterations in fifteen genes have been recognized to date, being some of the most recently identified mutations in genes HK1, PGM1, PMM2, CACNA1D, FOXA2 and EIF2S3. Alternatively, HH can be secondary when associated with syndromes, intra-uterine growth restriction, maternal diabetes, birth asphyxia, following gastrointestinal surgery, amongst other causes. CHH can be histologically characterized into three groups: diffuse, focal or atypical. Diffuse and focal forms can be determined by scanning using fluorine-18 dihydroxyphenylalanine-positron emission tomography. Newer and improved isotopes are currently in development to provide increased diagnostic accuracy in identifying lesions and performing successful surgical resection with the ultimate aim of curing the condition. Rapid diagnostics and innovative methods of management, including a wider range of treatment options, have resulted in a reduction in co-morbidities associated with HH with improved quality of life and long-term outcomes. Potential future developments in the management of this condition as well as pathways to transition of the care of these highly vulnerable children into adulthood will also be discussed.This article is freely available via Open Access. Click on the Publisher URL to access it via the publisher's site.Nick Oliver is supported by the NIHR BRC at Imperial College Healthcare NHS Trust. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. The other authors have no funding to declare. Sarah Flanagan is supported by a Sir Henry Dale Fellowship jointly funded by the Wellcome Trust and the Royal Society (105,636/Z/14/Z). The other authors are not supported by grants or fellowships.published version, accepted version (12 month embargo

Social capital and burnout among mental healthcare providers

Background: Provider burnout is a critical problem in mental health services. Contributing factors have been explicated across three domains: personal, job and organizational characteristics. Of these, organizational characteristics, including workplace environment, appear to be particularly important given that most interventions addressing burnout via the other domains (e.g. bolstering personal coping skills) have been modestly effective at best. Aims: This study builds on previous research by using social capital as a framework for the experience of work social milieu, and aims to provide a richer understanding of how workplace social environment might impact burnout and help create more effective ways to reduce burnout. Methods: Providers (n = 40) taking part in a larger burnout intervention study were randomly selected to take part in interviews regarding their workplace environment and burnout. Participant responses were analyzed thematically. Results: Workplace social milieu revolved around two primary themes: workplace social capital in provider burnout and the protective qualities of social capital in cohesive work teams that appear to mitigate burnout. Conclusions: These results imply that work environments where managers support collaboration and social interaction among work teams may reduce burnout

Intracranial abscess secondary to dental infection

We report a case of Aggregatibacter actinomycetemcomitans (A.actinomycetemcomitans) bacteraemia and secondary brain abscess in a patient where periodontal disease was implicated as the probable source

A Retrospective Pre-Post Treatment Study of Occupational Therapy Intervention for Children with Sensory Processing Challenges

Background: This study investigated the impact of an intensive, short-term program that incorporates the principles of sensory integration and relationship-based therapies with extensive parent collaboration. The goals were to identify measures sensitive to change and explore the relation between sensory modulation characteristics and change in behavior after intervention. Method: A retrospective chart review examined routine clinical data pre-post intervention from 179 children identified with sensory processing challenges without comorbid autism. Change in measures of adaptive behavior, emotional functioning, sensory-related behaviors, and motor functioning were evaluated. Relations between sensory modulation and behavior were explored. Results: Improvements were noted from pretreatment to postreatment on all measures of adaptive behavior, problem behaviors, sensory-related functions, and measures of motor function. Sensory craving symptoms were associated with a significant reduction in externalizing and behavior problems after intervention. Conclusion: This study provides preliminary support for the effectiveness of a novel treatment approach

Elucidating the Genomic Signatures of Selection Using Theoretical and Empirical Approaches

Selection acts on phenotypes, but it is important to understand how its effects on the genome result in evolutionary change. Population genomics has provided several methods for detecting the form of selection acting on populations (e.g. positive or balancing), but current techniques are limited in their ability to identify the type of selection acting on traits (e.g. natural or sexual). Selection components analysis detects the types of selection acting in a population by comparing allele frequencies at different life history stages. In my dissertation, I used both population genomics analyses and selection components analysis to identify signatures of selection in natural populations. I first conducted a traditional population genomics study to determine the population structure of multiple populations throughout the Gulf of Mexico and Atlantic Ocean in Gulf pipefish (Syngnathus scovelli). I also identified genome-wide loci that were differentiated between populations due to local adaptation. Although the results suggest that population divergence is driven by a variety of factors in S. scovelli, including neutral processes and selection on multiple traits, this population genetics approach could not differentiate among sexual or natural selective processes. Next, I developed an individual-based simulation model to test the power of a selection components analysis approach with genome-wide data that mimicked next-generation sequencing datasets. The model showed that quantitative trait loci can be identified with relatively high power if selection was strong, sample sizes were large, and there were few loci underlying the trait. Finally, I implemented the genome-wide selection components analysis in one population of Gulf pipefish and identified loci significantly associated with sexual selection and differential viability selection between males and females. Together, these studies allowed to me identify several signatures of selection at the genomic level in pipefish, which provides a better understanding of the relationship between selection and the genome. The genomic signatures of selection identified here can be integrated with other studies for a better understanding of broad-scale evolutionary patterns at the genomic level