Nature of behaviours that challenge in residents living in aged care homes: implications for psychosocial interventions and service development

Background/Aims: Competing theories exist regarding the causes and nature of behaviours that challenge (BC). The present study attempted to provide better insight into these behaviours and determine whether there were any underlying relationships for people living in care homes with and without dementia. Methods: Cross sectional data for 2185 residents living in 63 UK care homes using the Challenging Behaviour Scale were collected. The incidence (i.e. presence/absence) of 25 commonly reported behaviours that challenge staff were determined using dichotomous scoring. Cluster analysis and Mokken scaling were used to examine underlying relationships. Mokken is a method of analysing data to determine whether there is a ‘latent’ structure within a data set. Results: The prevalence of reported BC was 87.5%. Cluster analysis revealed three main clusters: apathy, agitation with internal focus, agitation with active external focus. For seven of the 25 items a hierarchical model emerged, where behaviours at the bottom of the hierarchy tended to occur in the presence of those higher up. Behaviours at the bottom of the hierarchy (dangerous behaviour) were less frequently observed than the items at the top (lack of self-care, verbal aggression). Conclusion: Some common BC may occur in groups and themed clusters. This study has shown that a hierarchical structure of BC in residents may be present. The findings testify to the complexity in the aetiology and treatment of BC and hence the need for focussed high intensity bio-psychosocial interventions to be targeted towards those with high levels of ‘unmet need’. Implications for future research and practice are discussed

Mixed metal nanoparticle assembly and the effect on surface enhanced raman scattering

Here we report the assembly of mixed metal nanoparticles using an oligonucleotide-templated approach. Substitution of one of the gold nanoparticle probes with an analagous silver probe to produce a hetero-metal duplex permitted surface enhanced Raman scattering of the dye label, exploiting the improved surface enhancement properties of silver nanoparticles whilst maintaining the surface chemistry benefits of gold nanoaprticle

Viruses, dendritic cells and the lung

The interaction between viruses and dendritic cells (DCs) is varied and complex. DCs are key elements in the development of a host response to pathogens such as viruses, but viruses have developed survival tactics to either evade or diminish the immune system that functions to kill and eliminate these micro-organisms. In the present review we summarize current concepts regarding the function of DCs in the immune system, our understanding of how viruses alter DC function to attenuate both the virus-specific and global immune response, and how we may be able to exploit DC function to prevent or treat viral infections

Choose the Right Rights, Use the Data Right [Workshop Summary]

No abstract available

Assessing victim risk in cases of violent crime

Purpose: There is a body of evidence that suggests a range of psychosocial characteristics demarcate certain adults to be at an elevated risk for victimisation. To this end, the aim of the current study was to examine consistency between one police force, and a corresponding victim support service based in England, in their assessment of level of risk faced by victims of violent crime. Methodology: This study explored matched data on 869 adult victims of violent crime gathered from these two key services in Preston, namely Lancashire Constabulary and Victim Support, from which a sub-group of comparable ‘domestic violence’ cases (n=211) were selected for further examination. Findings: Data analyses revealed methodological inconsistencies in the assessment of victimisation resulting in discrepancies for recorded levels of risk in domestic violence cases across these two agencies. Practical implications: These findings provide a compelling argument for developing a more uniformed approach to victim assessment and indicate a significant training need. Value: This paper highlights areas of good practice and forwards several recommendations for improved practice that emphasises the integration of empirical research conducted by psychologists to boost the validity and reliability of risk assessment approaches and tools used

Repeat Victimisation, Retraumatisation and Victim Vulnerability

Abstract: This study explores the contribution that traumatic experiences and psychological post-traumatic stress symptoms make to predicting subsequent revictimisation in a sample of violent crime victims. In addition, the timing of first trauma exposure was also explored. Fifty-four adult victims (27 male and 27 female) of police recorded violent crime were interviewed and their traumatic exposure history, trauma symptomology, age at first trauma exposure as well as psychological and psychosocial functioning were assessed. These victims were followed longitudinally and subsequent revictimisation between six and twelve months post index victimisation measured. A greater number of types of trauma exposure was related lower emotional stability, higher trauma symptomology and revictimisation. Those victims with childhood traumatic exposure reported more trauma symptomology exposure than those without prior exposure. The implications for law enforcement and victim services are discussed

Emergency supply of prescription-only medicines to patients by community pharmacists: a mixed methods evaluation incorporating patient, pharmacist and GP perspectives

Objective To evaluate and inform emergency supply of prescription-only medicines by community pharmacists (CPs), including how the service could form an integral component of established healthcare provision to maximise adherence. Design Mixed methods. 4 phases: prospective audit of emergency supply requests for prescribed medicines (October–November 2012 and April 2013); interviews with CPs (February–April 2013); follow-up interviews with patients (April–May 2013); interactive feedback sessions with general practice teams (October–November 2013). Setting 22 community pharmacies and 6 general practices in Northwest England. Participants 27 CPs with experience of dealing with requests for emergency supplies; 25 patients who received an emergency supply of a prescribed medicine; 58 staff at 6 general practices. Results Clinical audit in 22 pharmacies over two 4-week periods reported that 526 medicines were requested by 450 patients. Requests peaked over a bank holiday and around weekends. A significant number of supplies were made during practice opening hours. Most requests were for older patients and for medicines used in long-term conditions. Difficulty in renewing repeat medication (forgetting to order, or prescription delays) was the major reason for requests. The majority of medicines were ‘loaned’ in advance of a National Health Service (NHS) prescription. Interviews with CPs and patients indicated that continuous supply had a positive impact on medicines adherence, removing the need to access urgent care. General practice staff were surprised and concerned by the extent of emergency supply episodes. Conclusions CPs regularly provide emergency supplies to patients who run out of their repeat medication, including during practice opening hours. This may aid adherence. There is currently no feedback loop, however, to general practice. Patient care and interprofessional communication may be better served by the introduction of a formally structured and funded NHS emergency supply service from community pharmacies, with ongoing optimisation of repeat prescribing

Flow and retreat of the Late Quaternary Pine Island-Thwaites palaeo-ice stream, West Antarctica

Multibeam swath bathymetry and sub-bottom profiler data are used to establish constraints on the flow and retreat history of a major palaeo-ice stream that carried the combined discharge from the parts of the West Antarctic Ice Sheet now occupied by the Pine Island and Thwaites glacier basins. Sets of highly elongated bedforms show that, at the last glacial maximum, the route of the Pine Island-Thwaites palaeo-ice stream arced north-northeast following a prominent cross-shelf trough. In this area, the grounding line advanced to within similar to 68 km of, and probably reached, the shelf edge. Minimum ice thickness is estimated at 715 m on the outer shelf, and we estimate a minimum ice discharge of similar to 108 km(3) yr(-1) assuming velocities similar to today's Pine Island glacier (similar to 2.5 km yr(-1)). Additional bed forms observed in a trough northwest of Pine Island Bay likely formed via diachronous ice flows across the outer shelf and demonstrate switching ice stream behavior. The "style" of ice retreat is also evident in five grounding zone wedges, which suggest episodic deglaciation characterized by halts in grounding line migration up-trough. Stillstands occurred in association with changes in ice bed gradient, and phases of inferred rapid retreat correlate to higher bed slopes, supporting theoretical studies that show bed geometry as a control on ice margin recession. However, estimates that individual wedges could have formed within several centuries still imply a relatively rapid overall retreat. Our findings show that the ice stream channeled a substantial fraction of West Antarctica's discharge in the past, just as the Pine Island and Thwaites glaciers do today

Introducing dip pen nanolithography as a tool for controlling stem cell behaviour: unlocking the potential of the next generation of smart materials in regenerative medicine (vol 10, pg 1662, 2010)

Correction for ‘Introducing dip pen nanolithography as a tool for controlling stem cell behaviour: unlocking the potential of the next generation of smart materials in regenerative medicine’ by Judith M. Curran et al., Lab Chip, 2010, 10, 1662–1670.</p

Interventions to improve emergency department use for mental health reasons:Protocol for a mixed-methods systematic review

BACKGROUND: Healthcare resources are limited and unnecessary, and inappropriate emergency department use is now a highly visible healthcare priority. Individuals visiting the emergency department for mental health-related reasons are often amongst the most frequent presenters. In response, researchers and clinicians have created interventions to streamline emergency department use and several primary studies describe the effects of these interventions. Yet, no consensus exists on the optimal approach, and information on the quality of development, effectiveness, acceptability, and economic considerations is hard to find. The purpose of this study is to systematically review interventions designed to improve appropriate use of the emergency department for mental health reasons. METHOD: A mixed-method systematic review using Joanna Briggs Methodology. Search combining electronic databases (EMBASE, MEDLINE, PsycINFO, CINAHL, HealthSTAR, PROQUEST, Cumulative Index to Nursing and Allied Health) and secondary searches (grey literature and hand search with consultation). Two independent reviewers will screen titles and abstracts using predetermined eligibility criteria and a third reviewer will resolve conflicts. Full texts will also be screened by two independent reviews and conflicts resolved in a consensus meeting with a third reviewer. A pilot-tested data extraction form will be used to retrieve data relevant to the study objectives. We will assess the quality and of all included studies. Data describing interventions will be summarized using logic models and reported narratively. Quality of development will be assessed using the Oxford Implementation Index. For data on intervention effectiveness, we will assess statistical heterogeneity and conduct a meta-analysis using a random effects method, if appropriate. For interventions that cannot be pooled, we will report outcomes narratively and descriptively. Qualitative data on acceptability will be synthesized using meta-aggregation and an economic evaluation of interventions will be done. The reporting of this protocol follows the PRISMA-P statement. DISCUSSION: Using a combined systematic review methodology and integrated knowledge translation plan, the project will provide decision makers with concrete evidence to support the implementation and evaluation of interventions to improve emergency department use for mental health reasons. These interventions reflect widespread priorities in the area of mental health care. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018087430