Mark my words! Service User and Carer Involvement in Social Work Academic Assessment

This paper discusses the involvement of service users in academic assessment as part of a second year module for social work undergraduate students at Canterbury Christ Church University in the UK. The three main tasks undertaken in partnership are detailed: designing an assessment form, assessment of student group presentations and assessment of a written reflective essay. The paper starts by identifying key questions raised by the assessor team before providing a critical commentary on the process, and identifying challenges and learning points. The experience emphasises the need for a more critical and searching approach towards service user involvement in social work education in academic assessment. Moreover, the team's experience suggests that such work is best achieved in the context of collaborative working relationships based on trust, with opportunities for team reflection and supported by training in academic assessment

It’s not all about control: Challenging mainstream framing of eating disorders

Background: The concept of control has long been suggested as a central factor in eating disorder ( aetiology. The concept is now so mainstream that it risks being used in a potentially reductionist, stigmatising or otherwise harmful manner. In this we explore and discuss our positions on the use of control related terminologyfor EDs. Methods: The authors of this auto ethnographic position paper include academic researchers, individuals with lived experience and clinicians not mutually exclusive) In sharing our experiences and observations, we aim to raise awareness of the wider impacts that control framing can have on ED perceptions, treatment, recovery and individuals’ lived experience. Results We argue that although control can play a role in some ED experiences, an overemphasis upon this factor to the exclusion of other conceptualisations is not beneficial. Conclusions: To mitigate against pathologisation of an individual, it is important to challenge a discourse that can lead to EDs being perceived as something ‘ with the individual, rather than a consequence of life events or other environmental influences We identify priorities for the future for researchers, clinicians, policy makers and the wider public

Barriers and facilitators to the implementation of individual placement and support (IPS) for patients with offending histories in the community: The United Kingdom experience

IntroductionWe aimed to identify the barriers and facilitators to the implementation of a high fidelity individual placement and support service in a community forensic mental health setting.MethodIn-depth interviews were conducted with clinical staff (n = 11), patients (n = 3), and employers (n = 5) to examine barriers and facilitators to implementation of a high fidelity individual placement and support service. Data was analysed using thematic analysis, and themes were mapped onto individual placement and support fidelity criteria.ResultsBarriers cited included competing interests between employment support and psychological therapies, perceptions of patients’ readiness for work, and concerns about the impact of returning to work on welfare benefits. Facilitators of implementation included clear communication of the benefits of individual placement and support, inter-disciplinary collaboration, and positive attitudes towards the support offered by the individual placement and support programme among stakeholders. Offences, rather than mental health history, were seen as a key issue from employers’ perspectives. Employers regarded disclosure of offending or mental health history as important to developing trust and to gauging their own capacity to offer support.ConclusionsImplementation of individual placement and support in a community mental health forensic setting is complex and requires robust planning. Future studies should address the barriers identified, and adaptations to the individual placement and support model are needed to address difficulties encountered in forensic settings

Does Council Tax Valuation Band (CTVB) correlate with Under-Privileged Area 8 (UPA8) score and could it be a better 'Jarman Index'?

BACKGROUND: Widespread scepticism persists on the use of the Under-Privileged Area (UPA8) score of Jarman in distributing supplementary resources to so-attributed 'deprived' UK general practices. The search for better 'needs' markers continues. Having already shown that Council Tax Valuation Band (CTVB) is a predictor of UK GP workload, we compare, here, CTVB of residence of a random sample of patients with their respective 'Jarman' scores. METHODS: Correlation coefficient is calculated between (i) the CTVB of residence of a randomised sample of patients from an English general practice and (ii) the UPA8 scores of the relevant enumeration districts in which they live. RESULTS: There is a highly significant correlation between the two measures despite modest study size of 478 patients (85% response). CONCLUSIONS: The proposal that CTVB is a marker of deprivation and of clinical demand should be examined in more detail: it correlates with 'Jarman', which is already used in NHS resource allocation. But unlike 'Jarman', CTVB is simple, objective, and free of the problems of Census data. CTVB, being household-based, can be aggregated at will

Mutation of von Hippel–Lindau Tumour Suppressor and Human Cardiopulmonary Physiology

BACKGROUND: The von Hippel–Lindau tumour suppressor protein–hypoxia-inducible factor (VHL–HIF) pathway has attracted widespread medical interest as a transcriptional system controlling cellular responses to hypoxia, yet insights into its role in systemic human physiology remain limited. Chuvash polycythaemia has recently been defined as a new form of VHL-associated disease, distinct from the classical VHL-associated inherited cancer syndrome, in which germline homozygosity for a hypomorphic VHL allele causes a generalised abnormality in VHL–HIF signalling. Affected individuals thus provide a unique opportunity to explore the integrative physiology of this signalling pathway. This study investigated patients with Chuvash polycythaemia in order to analyse the role of the VHL–HIF pathway in systemic human cardiopulmonary physiology. METHODS AND FINDINGS: Twelve participants, three with Chuvash polycythaemia and nine controls, were studied at baseline and during hypoxia. Participants breathed through a mouthpiece, and pulmonary ventilation was measured while pulmonary vascular tone was assessed echocardiographically. Individuals with Chuvash polycythaemia were found to have striking abnormalities in respiratory and pulmonary vascular regulation. Basal ventilation and pulmonary vascular tone were elevated, and ventilatory, pulmonary vasoconstrictive, and heart rate responses to acute hypoxia were greatly increased. CONCLUSIONS: The features observed in this small group of patients with Chuvash polycythaemia are highly characteristic of those associated with acclimatisation to the hypoxia of high altitude. More generally, the phenotype associated with Chuvash polycythaemia demonstrates that VHL plays a major role in the underlying calibration and homeostasis of the respiratory and cardiovascular systems, most likely through its central role in the regulation of HIF

Yalanji-Warranga Kaban: Yalanji people of the rainforest fire management book

The tropical rainforest, beaches, reefs, and mountain ranges stretching along the coast between Mossman and the Annan River are the homelands of Eastern Yalanji people (bama). We have been here since the beginning in the dreaming. Stories of the lives of past generations of Eastern Yalanji bama are held in every mangrove inlet, in the roaring torrents and giant mountain boulders, and in the silent sliding streams. We Yalanji bama are still here today and hold strongly to our Law, culture and language in building for the future. "Kulu-Yanlanji" literally means speakers of Yalanji language. There are several dialects within this language. Yalanji bama are related to each other and to different parts of out lands through out customary law. Only those people with the right connections to a particular place can speak for that country, for that place. The tract of country belonging to our particular family group is known as our "clan estate". To know your role and your place in Yalanji society, you must know your country, your clan estate and your kin

Genetic loci inherited from hens lacking maternal behaviour both inhibit and paradoxically promote this behaviour

International audienceBackground A major step towards the success of chickens as a domesticated species was the separation between maternal care and reproduction. Artificial incubation replaced the natural maternal behaviour of incubation and, thus, in certain breeds, it became possible to breed chickens with persistent egg production and no incubation behaviour; a typical example is the White Leghorn strain. Conversely, some strains, such as the Silkie breed, are prized for their maternal behaviour and their willingness to incubate eggs. This is often colloquially known as broodiness.ResultsUsing an F2 linkage mapping approach and a cross between White Leghorn and Silkie chicken breeds, we have mapped, for the first time, genetic loci that affect maternal behaviour on chromosomes 1, 5, 8, 13, 18 and 19 and linkage group E22C19W28. Paradoxically, heterozygous and White Leghorn homozygous genotypes were associated with an increased incidence of incubation behaviour, which exceeded that of the Silkie homozygotes for most loci. In such cases, it is likely that the loci involved are associated with increased egg production. Increased egg production increases the probability of incubation behaviour occurring because egg laying must precede incubation. For the loci on chromosomes 8 and 1, alleles from the Silkie breed promote incubation behaviour and influence maternal behaviour (these explain 12 and 26 % of the phenotypic difference between the two founder breeds, respectively).ConclusionsThe over-dominant locus on chromosome 5 coincides with the strongest selective sweep reported in chickens and together with the loci on chromosomes 1 and 8, they include genes of the thyrotrophic axis. This suggests that thyroid hormones may play a critical role in the loss of incubation behaviour and the improved egg laying behaviour of the White Leghorn breed. Our findings support the view that loss of maternal incubation behaviour in the White Leghorn breed is the result of selection for fertility and egg laying persistency and against maternal incubation behaviour

Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial

Objective: The HOME BP (Home and Online Management and Evaluation of Blood Pressure) trial aimed to test a digital intervention for hypertension management in primary care by combining self-monitoring of blood pressure with guided self-management. Design: Unmasked randomised controlled trial with automated ascertainment of primary endpoint. Setting: 76 general practices in the United Kingdom. Participants: 622 people with treated but poorly controlled hypertension (>140/90 mm Hg) and access to the internet. Interventions: Participants were randomised by using a minimisation algorithm to self-monitoring of blood pressure with a digital intervention (305 participants) or usual care (routine hypertension care, with appointments and drug changes made at the discretion of the general practitioner; 317 participants). The digital intervention provided feedback of blood pressure results to patients and professionals with optional lifestyle advice and motivational support. Target blood pressure for hypertension, diabetes, and people aged 80 or older followed UK national guidelines. Main outcome measures: The primary outcome was the difference in systolic blood pressure (mean of second and third readings) after one year, adjusted for baseline blood pressure, blood pressure target, age, and practice, with multiple imputation for missing values. Results: After one year, data were available from 552 participants (88.6%) with imputation for the remaining 70 participants (11.4%). Mean blood pressure dropped from 151.7/86.4 to 138.4/80.2 mm Hg in the intervention group and from 151.6/85.3 to 141.8/79.8 mm Hg in the usual care group, giving a mean difference in systolic blood pressure of −3.4 mm Hg (95% confidence interval −6.1 to −0.8 mm Hg) and a mean difference in diastolic blood pressure of −0.5 mm Hg (−1.9 to 0.9 mm Hg). Results were comparable in the complete case analysis and adverse effects were similar between groups. Within trial costs showed an incremental cost effectiveness ratio of £11 ($15, €12; 95% confidence interval £6 to £29) per mm Hg reduction. Conclusions: The HOME BP digital intervention for the management of hypertension by using self-monitored blood pressure led to better control of systolic blood pressure after one year than usual care, with low incremental costs. Implementation in primary care will require integration into clinical workflows and consideration of people who are digitally excluded. Trial registration: ISRCTN13790648

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification

Indigenous knowledge and governance in protected areas in Australia and Sweden

Indigenous peoples live in, manage and own large areas of land that are often rich in biodiversity. Their management is based on Indigenous knowledge systems that have sustained their societies over millennia, and carry insights critical for sustainability. Indigenous peoples and communities across the world maintain traditional and cultural connections amongst and within their own societies, and to their traditional lands. Many of these connections support Indigenous ways of life, identity and cultural belief systems that form the basis of knowledge systems. Indigenous people's governance systems influence the application of Indigenous knowledge, and therefore the management of landscapes, including protected areas. For protected areas, the cornerstone of biodiversity conservation, understanding how Indigenous knowledge is recognised and supported by Indigenous governance is vital. Therefore, this research examines the conditions under which Indigenous governance systems recognise and support the application of Indigenous knowledge, through a comparative analysis between two world heritage areas, one in Australia and one in Sweden. Analysis of different concepts of Indigenous knowledge and models of Indigenous governance systems, within Australia and Sweden, is central to addressing key policy and practice issues in Indigenous land management for biodiversity conservation outcomes. Furthermore, investigation of the interrelationship between Indigenous governance and Indigenous knowledge, through an Indigenous lens, focusing on Indigenous epistemology, ontology and worldview, provides Indigenous perspectives and insights. The research also embeds me, an Aboriginal woman from the Wet Tropics World Heritage Area, in the research, allowing incorporation of critical understandings and perspectives that reflect Indigenous lived and shared experiences. I developed an 'Empowering Indigenous Lens' methodology, embedding Indigenous worldviews, ontologies and epistemologies to undertake this research. The Empowering Indigenous Lens recognises Indigenous knowledges in a place-based context, so emphasis can be drawn from the shared lives, experiences and knowledges of the Indigenous peoples from that place, informing and influencing the methodology. Practical application of the Empowering Indigenous Lens methodology is guided by its "Walking Together" approach. Five key stages to the "Walking Together" approach include: invitation; conversation and interview; analysis; feedback; and reinterpretation. This approach reflects fundamental Indigenous cultural protocols of 'giving back' to Indigenous peoples and communities. Further, the practice of shared experiences through "Walking Together" remains in effect throughout the research process, therefore implementing the Empowering Indigenous Lens. To enable effective application of the Indigenous lens, a case study methodology was adopted. A case approach best supported this research as it supports culturally-sensitive investigation of contemporary phenomena within a real-world context. Qualitative data collection methods and analysis based on interviews, documentary analysis and context mapping underpin the case study approach. The comparative analysis identified the nexus between Indigenous governance systems and three major influences on Indigenous knowledge application. These include: Indigenous Peoples' arrangements to express sovereignty of governance; arrangements of nation-state sovereignty that support and/or influence Indigenous Peoples' governance; and shared governance arrangements. Indigenous Peoples' sovereignty of governance in turn depends on conditions that enable Indigenous self-determination, empowerment and leadership. This research, and its Indigenous methodology, highlights previously invisible aspects of governance that support Indigenous knowledge application in protected areas, and carry implications for management and research