Targeted youth support: Rapid Evidence Assessment of effective early interventions for youth at risk of future poor outcomes

This report describes the findings and methods of a systematic rapid evidence assessment (REA) of research relevant to interventions of interest to Targeted Youth Support. It was commissioned by the Department for Children, Schools and Families (DCSF) to inform the development of policy and practice in relation to this initiative

And Ye Shall Know the Wrath of God: An Analysis of American Religion Violence

Since the early 1970’s, religious violence and terrorism have become salient topics in American political and social discourse. The growing prominence of religious violence underscores the need to understand these acts of terror and violence. This study will explore the modern-day effects of religious violence, leading up to the attacks in New York City and Washington DC on September 11, 2001. In order to demonstrate the broader and wider effects of 9/11 on American society and thought, this research paper will touch on the psychological and sociological constructs behind religious terrorism, as well as the American perception of religion and “freedom of religion.” This essay will argue that the tragic events of September 11 were part of a growing pattern of religious violence, from the Christian Identity Movement to the 1993 siege of the Branch Davidian compound in Waco, Texas that have increased in number and brutality in the United States since the 1970s

Return to work after stroke: recording, measuring, and describing occupational therapy intervention

Introduction: Existing research on vocational rehabilitation following stroke has been criticised for not describing intervention in sufficient detail for replication or clinical implementation. The purpose of this study was to test the feasibility of recording and measuring the content of an early stroke-specific vocational rehabilitation intervention delivered to participants in a feasibility randomized controlled trial, using a proforma previously developed for a study of vocational rehabilitation following traumatic brain injury. Method: The proforma was adapted for use in stroke with input from an expert panel and was used to record intervention content, in 10-minute units, following each intervention session. Findings: Twenty-five people, working or in education at the time of stroke, participated in the study. Two thirds of the therapists' time was spent in face-to-face contact (43%) and liaison with the patient and others (20%). Intervention mainly focused on work preparation (21%) and the return to work process (24%). The remaining time was consumed by administration (19%) and travel (18%). Conclusion: The proforma was quick and easy to use and captured the main focus of intervention. This study suggests that it can be used to record stroke-specific vocational rehabilitation intervention content and has potential for wider use in research and clinical practice

Characterisation of MYB and TRKB as candidate targets in CYLD cutaneous syndrome

PhD ThesisCYLD cutaneous syndrome is a rare, autosomal dominant inherited disease in which an individual is predisposed to developing multiple cutaneous tumours; namely cylindromas, spiradenomas and trichoepitheliomas, due to germline mutations in the tumour suppressor gene CYLD. However at present there are no curative treatments other than repetitive surgery to control tumour burden. Therefore, an overarching theme of this thesis was to identify potential therapeutic targets that could possibly translate into treatment strategies in the clinic. The first strategic target, c-MYB, was explored, as overexpression of c-MYB was previously shown in sporadic cylindromas due to the presence of the fusion protein MYB-NFIB. It was demonstrated that inherited cylindromas did not express the MYBNFIB fusion protein. However, using immunohistochemistry c-MYB was shown to be overexpressed in inherited tumours and that gene silencing of MYB caused a reduction in cell viability. A novel finding, transcriptomic and protein analysis also revealed that keratinocytes expressed the alternate MYB 9B isoform. A second strategic target, Trk, was explored using RNA-seq of CYLD defective tumours. Exploration of Trk signalling in these tumour cells found that the truncated TrkB.T1 isoform of the TrkB receptor is overexpressed in the tumours, alongside the receptors cognate ligand BDNF. Overexpression of TrkB.T1 in the HaCaT, keratinocyte cell line, indicated that TrkB.T1 increased cell survival. BDNF stimulation of TrkB.T1 overexpressing cells caused Stat3 phosphorylation, and in primary cylindroma tumour cells BDNF stimulation increased the nuclear localisation of Stat3. Finally, a three-dimensional spheroid cell culture method was established and characterised using immunofluorescence, as 3D in vitro models better reflect the in vivo environment. The cultures were found to have an expression pattern similar to their in vivo counterparts and were shown to be sensitive to inhibitory Stat3 targeting, supporting the translational relevance of this work in the hope of bringing targeted therapies for CYLD cutaneous syndrome to the clinic

Health professionals' perceptions of the barriers and facilitators to providing smoking cessation advice to women in pregnancy and during the post-partum period : a systematic review of qualitative research

Background: Reducing smoking in pregnancy is a policy priority in many countries and as a result there has been a rise in the development of services to help pregnant women to quit. A wide range of professionals are involved in providing these services, with midwives playing a particularly pivotal role. Understanding professionals' experiences of providing smoking cessation support in pregnancy can help to inform the design of interventions as well as to improve routine care. Methods: A synthesis of qualitative research of health professionals' perceptions of the barriers and facilitators to providing smoking cessation advice to women in pregnancy and the post-partum period was conducted using meta-ethnography. Searches were undertaken from 1990 to January 2015 using terms for maternity health professionals and smoking cessation advisors, pregnancy, post-partum, smoking, and qualitative in seven electronic databases. The review was reported in accordance with the 'Enhancing transparency in reporting the synthesis of qualitative research' (ENTREQ) statement. Results: Eight studies reported in nine papers were included, reporting on the views of 190 health professionals/ key informants, including 85 midwives and health visitors. The synthesis identified that both the professional role of participants and the organisational context in which they worked could act as either barriers or facilitators to an individual's ability to provide smoking cessation support to pregnant or post-partum women. Underpinning these factors was an acknowledgment that the association between maternal smoking and social disadvantage was a considerable barrier to addressing and supporting smoking cessation Conclusions: The review identifies a role for professional education, both pre-qualification and in continuing professional development that will enable individuals to provide smoking cessation support to pregnant women. Key to the success of this education is recognising the centrality of the professional-client/patient relationship in any interaction. The review also highlights a widespread professional perception of the barriers associated with helping women give up smoking in pregnancy, particularly for those in disadvantaged circumstances. Improving the quality and accessibility of evidence on effective healthcare interventions, including evidence on 'what works' to support smoking cessation in disadvantaged groups, should therefore be a priority

Describing return to work after stroke : a feasibility trial of 12-month outcomes

Objective: Stroke is the greatest cause of disability in adults. A quarter of strokes in the UK affect people of working age, yet under half of them return to work after stroke. There has been little investigation into what constitutes “return to work” following stroke. The aim of this study is to describe the work metrics of stroke survivor participants in a feasibility randomized controlled trial of an early stroke specific vocational rehabilitation intervention. Methods: Retrospective analysis of trial data. Metrics on work status, working hours, workplace accommodations and costs were extracted from trial out - comes gathered by postal questionnaire at 3, 6, and 12 months’ post-randomization for 46 stroke participants in a feasibility randomized controlled trial. Participants were randomized to receive vocational rehabilitation (intervention) or usual care (control). Results: Two-thirds ( n = 29; 63%) of participants re - turned to work at some point in the 12 months following stroke. Participants took a mean of 90 days to return to work. Most returned to the same role with an existing employer. Only one-third of participants who were employed full-time at stroke onset were working full-time at 12 months post-stroke. Most participants experienced a reduction in pre-stroke earnings. Workplace accommodations were more common among intervention group participants. More intervention participants than control participants reported satisfaction with work at both 6 and 12 months post-randomization. Conclusion: This study illustrates the heterogeneous nature of return to work and the dramatic impact of stroke on work status, working hours and income. Longitudinal research should explore the socioeconomic legacy of stroke and include clear definitions of work and accurate measures of working hours and income from all sources

Impact of personal alcohol consumption on aspects of medical student alcohol-related competencies

AimAs part of the prevention and management of alcohol-related harms, health professionals need to be competent to assess the level of alcohol use in patients. In this study, we explored how medical students’ own alcohol consumption impacts on their familiarity with alcohol brands, strengths and alcohol-related harms.MethodsAs part of a wider study investigating the concept of ‘alcohol health literacy’, this study combined an anonymous online survey, linked to an electronic alcohol ‘brand’ recognition game. Participants were medical students in their first clinical year. The survey recorded demographics, self-reported alcohol consumption (using the AUDIT-C), a visual test of relative alcohol concentrations of wine, beer and spirits, and a free-text response asking them to list alcohol-related harms. Participants then completed the brand recognition game recording accuracy and reaction time for identifying alcohol drink brands.ResultsOne hundred and fifty students participated. There was a significant effect of ethnicity on drinking status, with 48% of non-white participants scoring zero on the AUDIT-C. Students who reported any alcohol consumption were more likely to correctly assess relative alcohol concentrations and were faster and more accurate at recognizing alcohol brands, which was dose dependent. Overall, only 45% correctly recognized relative alcohol strengths of drinks presented.ConclusionsAmong third-year medical students, ability to correctly identify relative strengths of alcoholic drinks is low. As might be expected, students who drink alcohol tend to identify brands and strengths more accurately. This has implications for how best to tailor the delivery of teaching and training about alcohol to ensure similar levels of clinical confidence in dealing with future patients regardless of personal experience

A scoping review of determinants of performance in dressage

As a first step in achieving an evidence-based classification system for the sport of Para Dressage, there is a clear need to define elite dressage performance. Previous studies have attempted to quantify performance with able-bodied riders using scientific methods; however, definitive measures have yet to be established for the horse and/or the rider. This may be, in part, due to the variety of movements and gaits that are found within a dressage test and also due to the complexity of the horse-rider partnership. The aim of this review is therefore to identify objective measurements of horse performance in dressage and the functional abilities of the rider that may influence them to achieve higher scores. Five databases (SportDiscuss, CINAHL, MEDLINE, EMBASE, VetMed) were systematically searched from 1980 to May 2018. Studies were included if they fulfilled the following criteria: (1) English language; (2) employ objective, quantitative outcome measures for describing equine and human performance in dressage; (3) describe objective measures of superior horse performance using between-subject comparisons and/or relating outcome measures to competitive scoring methods; (4) describe demands of dressage using objective physiological and/or biomechanical measures from human athletes and/or how these demands are translated into superior performance. In total, 773 articles were identified. Title and abstract screening resulted in 155 articles that met the eligibility criteria, 97 were excluded during the full screening of articles, leaving 58 included articles (14 horse, 44 rider) involving 311 equine and 584 able-bodied human participants. Mean ± sd (%) quality scores were 63.5 ± 15.3 and 72.7 ± 14.7 for the equine and human articles respectively. Significant objective measures of horse performance (n = 12 articles) were grouped into themes and separated by gait/movement. A range of temporal variables that indicated superior performance were found in all gaits/movements. For the rider, n = 5 articles reported variables that identified significant differences in skill level, which included the postural position and ROM of the rider’s pelvis, trunk, knee and head. The timing of rider pelvic and trunk motion in relation to the movement of the horse emerged as an important indicator of rider influence. As temporal variables in the horse are consistently linked to superior performance it could be surmised that better overall dressage performance requires minimal disruption from the rider whilst the horse maintains a specific gait/movement. Achieving the gait/movement in the first place depends upon the intrinsic characteristics of the horse, the level of training achieved and the ability of the rider to apply the correct aid. The information from this model will be used to develop an empirical study to test the relative strength of association between impairment and performance in able-bodied and Para Dressage riders