The views of psychiatrists on proposed changes to the England and Wales Mental Health Act 1983 legislation for people with intellectual disability: A national study

BACKGROUND: The Draft Mental Health Bill proposes removal of both intellectual disability and autism from Section 3 of the Mental Health Act for England and Wales (MHA). This would lead to people with intellectual disability (PwID) and/or autism could not be detained beyond 28 days, in the absence of diagnosed co-occurring mental illness. AIM: To obtain views of psychiatrists working with PwID in England and Wales regarding the proposed MHA changes. This study focusses specifically on the impact on PwID. METHODS: A cross-sectional online mixed methodology survey of Likert and free-text response questions was developed, to ascertain perceptions of proposed legislative changes to the MHA. A non-discriminatory exponential snowballing technique leading to non-probability sampling was used to disseminate the survey. Quantitative data was analysed using descriptive statistics, Mann-Whitney and Fisher's exact tests. Thematic analysis was conducted on free text responses. RESULTS: A total of 82 psychiatrists (33%) from approximately 250 eligible completed the survey. Nearly two-thirds (64%) reported good awareness of the proposed changes, with over half (55%) reporting disagreement with the changes. Psychiatrists working in inpatient settings for PwID reported increased awareness of the changes, less agreement with the reforms, and increased expectations of the reforms having negative unintended consequences, compared to their peers working exclusively in the community. Consultants reported greater disagreement with the changes compared to their non-consultant peers. Qualitative analysis identified five main themes: impact on diagnosis and treatment, seeking alternative options, introducing inequities, resources, and meeting holistic care goals through the Care, Education and Treatment Reviews (CETR) process. CONCLUSION: Psychiatrists working with PwID report widespread disagreement with the proposed changes to the MHA for PwID, with greater levels of disagreement among those working in inpatient services. Caution with respect to the proposed changes, and monitoring of the impact of the changes if implemented, is advised

Validation of Risk Prediction Models to Inform Clinical Decisions After Acute Kidney Injury

Wellcome Trust Research Training Fellowship: 102729/Z/13/Z Academy of Medical Sciences Starter Grant for Clinical Lecturers: SGL020\1076 We acknowledge the support of the Grampian Data Safe Haven (DaSH) facility within the Aberdeen Centre for Health Data Science and the associated financial support of the University of Aberdeen, and NHS Research Scotland (through NHS Grampian investment in DaSH). More information is available at the DaSH website: http://www.abdn.ac.uk/iahs/facilities/grampian-data-safe-haven.phpPeer reviewedPublisher PD

Locally Up-regulated Lymphotoxin α, Not Systemic Tumor Necrosis Factor α, Is the Principle Mediator of Murine Cerebral Malaria

Cerebral malaria (CM) causes death in children and nonimmune adults. TNF-α has been thought to play a key role in the development of CM. In contrast, the role of the related cyto-kine lymphotoxin α (LTα) in CM has been overlooked. Here we show that LTα, not TNFα, is the principal mediator of murine CM. Mice deficient in TNFα (B6.TNFα−/−) were as susceptible to CM caused by Plasmodium berghei (ANKA) as C57BL/6 mice, and died 6 to 8 d after infection after developing neurological signs of CM, associated with perivascular brain hemorrhage. Significantly, the development of CM in B6.TNFα−/− mice was not associated with increased intracellular adhesion molecule (ICAM)-1 expression on cerebral vasculature and the intraluminal accumulation of complement receptor 3 (CR3)-positive leukocytes was moderate. In contrast, mice deficient in LTα (B6.LTα−/−) were completely resistant to CM and died 11 to 14 d after infection with severe anemia and hyperparasitemia. No difference in blood parasite burden was found between C57BL/6, B6.TNFα−/−, and B6.LTα−/− mice at the onset of CM symptoms in the two susceptible strains. In addition, studies in bone marrow (BM) chimeric mice showed the persistence of cerebral LTα mRNA after irradiation and engraftment of LTα-deficient BM, indicating that LTα originated from a radiation-resistant cell population

Methods for modifying cell contact with a surface

Described herein is a multi-functional polymeric material for use in inhibiting adhesion and immune recognition between cells and cells, cells and tissues, and tissues and tissues. One component of the polymeric material adsorbs well to cells or tissue, and the other component of the polymeric material does not adsorb well to tissues. A water-soluble polymer that does not bear charge (polynonion) is used as the non-binding component, and a water soluble polymer that is positively charged at physiological pH (polycation) is used as the tissue binding component. When the bi-functional polymeric material contacts a tissue, the tissue-binding component binds and thus immobilizes the attached non-binding component, which will then extend generally away from the tissue surface and sterically block the attachment of other tissues. The method and compositions are useful in inhibiting formation of post-surgical adhesions, protecting damaged blood vessels from thrombosis and restenosis, and decreasing the extent of metastasis of attachment-dependent tumor cells.Board of Regents, University of Texas Syste

An Assessment of Surface Properties and Moisture Uptake of Nonwoven Fabrics from Ginning By-products

Greige (raw) cotton by-products resulting from cotton ginning and mill processes have long been bleached for use in absorbent nonwoven products. The potential to use greige cotton by-products as an economical source for absorbent nonwoven blends is explored. The nonwoven hydroentanglement of greige cotton lint with cotton gin motes and comber noils blends was analyzed for fiber surface polarity, swelling, and absorbance to assess properties with potential usefulness in absorbent nonwovens. The electrokinetic analysis of the fabric surface gives a composite picture of the relative hydrophilic/hydrophobic polarity absorbency and swelling properties. Nonwoven fabrics made with cleaned greige cotton lint separately blended with comber noils and ginning motes at 40:60 and 60:40 blend ratios demonstrated charge, swell, and percent moisture uptake profiles that are characteristic of the fabrics’ crystalline/amorphous cellulosic content with some variance in swelling properties. However, cellulose crystallite size varied. X-ray diffraction patterns of the three different cotton constituents displayed similar crystalline cellulose compositions. An electrochemical double-layer analysis of charge based on a pH titration (ζplateau) was employed to measure the relative fiber and fabric surface polarity which varied slightly between -21 and -29 mV. A relationship of fiber swelling (∆ζ) and percent moisture content is apparent when greige cotton lint and other fibers are blended. The blended nonwoven materials possess absorbent properties characterized by similar moisture uptake (7.1-9.5 %) and fiber polarity, but some variation in swelling is based on the by-product additive and its percent content. The crystallinity, electrokinetic, and water binding properties of the nonwoven by-product materials are discussed in the context of the molecular features water, cellulose, and greige cotton components that enhance potential uses as absorbent nonwoven end-use products

Myeloid Sarcoma: A Mediastinal Masquerader

Mediastinal Myeloid Sarcoma is a rare entity. Here we present a case of a 28-year-old gentleman, who first presented with a mediastinal mass and was clinically considered lymphoblastic lymphoma. He was diagnosed initially as having T lymphoblastic lymphoma on a mediastinal trucut biopsy. After one month patient was diagnosed with Acute myeloid leukemia on peripheral smear and bone marrow examination and was confirmed with the help of flow cytometry. The biopsy slides from the mediastinal mass were reviewed and based on the smear findings additional immunohistochemical markers were added and diagnosed as Myeloid Sarcoma. Keywords: Myeloid sarcoma, Mediastinum, Acute myeloid leukemi

Using the Revised Cardiac Risk Index to predict major postoperative events for people with kidney failure : An external validation and update

Funding Information: T.G.H. is supported by a Kidney Research Scientist Core Education and National Training Program postdoctoral fellowship (cosponsored by the Kidney Foundation of Canada and Canadian Institutes of Health Research) and the Clinician Investigator Program at the University of Calgary. These funding sources had no role in study design, data collection, analysis, reporting, or the decision to submit for publication. Funding Information: Ethics Statement: We followed the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) checklist19 for prediction-model validation (Supplemental Table S1) and were granted ethics approval by the University of Calgary and the University of Alberta.Preoperative risk-prediction tools that are used to predict risk of perioperative death and CV events, and are supported by North American guidelines, include the revised cardiac risk index (RCRI),5 the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) tool,6,7 and the National Surgical Quality Improvement Program Myocardial Infarction or Cardiac Arrest (NSQIP MICA) tool.8 The RCRI has been recommended over others for use in Canada for all adults over the age of 45 years, and for those aged 18-45 years with CV disease, who are undergoing elective, noncardiac surgery.3 The RCRI incorporates 6 criteria based on surgical and comorbidity characteristics of the patient and derives an estimated probability of postoperative myocardial infarction, cardiac arrest, or death.5 Additionally, the RCRI is used to guide perioperative decision-making.3The Alberta Kidney Disease Network database includes person-level linkages of administrative health data, laboratory data, prescription information, and kidney disease-specific data from the province of Alberta, Canada.17 Alberta has approximately 4.4 million residents, and with universal public health insurance, health data capture is near complete.17,18 From this database, we derived a retrospective cohort of adults with kidney failure who underwent ambulatory or inpatient surgery. We used this cohort to externally validate and examine the performance of the RCRI for this population. We followed the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) checklist19 for prediction-model validation (Supplemental Table S1) and were granted ethics approval by the University of Calgary and the University of Alberta.Peer reviewedPublisher PD

Delay factors in construction of healthcare infrastructure projects: a comparison amongst developing countries

Creation of large healthcare infrastructure facilities involves complex construction projects. These complex projects face the risk of poor delivery in terms of time adherence and end up in delays. Identification of sector-specific factors of delay at a regional level can help with timely delivery of projects. This paper intends to investigate the challenges in the construction of hospitals in India. The study was based on a qualitative approach and used content analysis to investigate the factors responsible for the delay. Semi-structured interviews were carried out to collect the data from project managers, architects, site engineers, service consultants, and administrative heads. A list of the six most critical factors of the delay was derived. The delay factors in the Indian healthcare construction were compared with the findings of similar investigations conducted in other developing countries. The findings of the study can benefit the project managers and organizations to efficiently manage the construction of similar projects and help in the reduction of instances of delay. The learnings from the study apply to healthcare projects in the regions with similar challenges. Furthermore, the subject demands region-specific investigations

Biomarkers for assessing acute kidney injury for people who are being considered for admission to critical care : a systematic review and cost-effectiveness analysis

This study is registered as PROSPERO CRD42019147039. Funding This project was funded by the National Institute for Health Research (NIHR) Evidence Synthesis programme and will be published in full in Health Technology Assessment; Vol. 26, No. 7. See the NIHR Journals Library website for further project information.Peer reviewedPublisher PD

Cost-effectiveness and value of information analysis of NephroCheck and NGAL tests compared to standard care for the diagnosis of acute kidney injury

Acknowledgements We are grateful to Thomas Walker and Rebecca Albrow at NICE for their thoughtful comments on earlier versions of the economic model and to the NICE Diagnostic Committee for their critical review of our identifed evidence. We are also grateful for the advice and clinical guidance received from the NICE Specialist Advisory Group for DG19 and to Peter S Hall and Alison F Smith (on behalf of the team) for providing early versions of their economic model that was instrumental in the development and structuring of the model used in this study. A big thank goes also to Lara Kemp for her secretarial support and patience throughout the study. The results presented in this paper have not been published previously in any academic journals, nor have they been submitted elsewhere. This work has informed the development of NICE guidance for diagnostic testing for AKI (https://www.nice.org.uk/guidance/dg39) and a full report to the funder describing the totality of this work will be published in the NIHR, HTA mono‑ graph series in due course. Funding The fndings presented in this manuscript are part of a broader research project funded by the National Institute for Health Research (NIHR) and com‑missioned through the NICE Diagnostic Assessment Programme (project no 12/88/97). The views expressed are those of the authors and not necessarily those of NICE, the NHS, the NIHR or the Department of Health. The Health Economics Research Unit and the Health Services Research Unit, University of Aberdeen, are funded by the Chief Scientist Ofce of the Scottish Government Health and Social Care Directorates.Peer reviewedPublisher PD