A qualitative study of older adults’ experiences of transitioning from secure forensic services – The TOPS Study

This was presented at the Faculty of Medicine, Health and Social Care Lunchtime Research Seminar. The presentation discusses the current findings of Phase 1 and 2 of the TOPS study

Restarting a prisoner's life onto a supportive path leading to RESETtlement in the community: The RESET Study

Executive Summary The potential of not having secure accommodation upon release from prison is a major problem for prisoners with mental health needs. This study focused on evaluating an intervention that supported prisoners upon their release from prison with the primary objective being to support them in finding accommodation release from prison service. In September, 2019 there were 83,518 prisoners detained in England and Wales (Her Majesty’s Prison and Probation Service, 2019). The period of transition from prison to the community has been acknowledged as a confusing and chaotic experience for many which is intensified by being homeless. A recent survey ascertained that 36% of people found rough sleeping had previously been in prison (CHAIN, 2018). Being homeless is viewed as a major factor in the likelihood of reoffending (Homeless Link, 2018) and not engaging with support services (health services, GP services, welfare benefits) (Williamson, 2007). It has been estimated that over 90% of prisoners have one or more psychiatric disorders (psychosis, neurosis, personality disorder, hazardous drinking and drug dependency). The period directly before and following release from prison is a highly stressful and isolating experience that exacerbates mental health problems (Theurer & Lovell, 2008; The Mental Welfare Commission for Scotland, 2017). Hopkins & Thornicroft (2014) have also reported that prisoners with mental health problems have twenty-nine times the rate of all-cause mortality during the first two weeks after release compared to the general population and are 8.3 times more likely to commit suicide in the twelve months following release from prison compared to the general population. Hancock et al (2018) has proposed that secure housing is the most important factor in ensuring a positive transition from prison to the community for people with mental health problems due to: • It is impossible to address mental health support and treatment before a person has stable accommodation • without housing they are lost to care. If someone does not have a fixed address, they are difficult to locate and connect with which makes it hard to provide support • housing helps break a cycle of returning to poor previous relationships and routines Providing support for prisoners with mental health needs upon their release has the potential to be an important factor in helping reintegrate this cohort into the community through helping to find secure accommodation, improving health and wellbeing, engaging with services, re-establishing contacts with family and friends and reducing reoffending. The Bradley Report (2009) noted if prisoners receive the support they need inside prisons, they were more likely to engage with services outside prison. The report added for the resettlement of prisoners with mental health needs into the community to be successful, it was important to ensure that the engagement that had started in prisons continued once prisoners leave the prison gate. However, the evidence for the effectiveness of existing services approaches is limited. Hopkin et al (2018) undertook a systematic review examining interventions for prisoners with diagnosed mental health conditions that targeted the transition period between prison and the community. Thirteen studies were found (with only two in the UK). The conclusions drawn were that there was some evidence that the interventions examined could improve contact between service users and mental health and other services. However, evidence that it reduced reoffending was equivocal and none on of the studies had examined whether the intervention improved access to secure accommodation. During the period of the study, the standard care package offered to prisoners upon their release was based on the government’s Transforming Rehabilitation strategy aimed to reduce reoffending and to provide a seamless transition between prison and the community by developing “Through the Gate” services (Ministry of Justice, 2013). The Through the Gate service was delivered by the newly commissioned local Community Rehabilitation Companies (CRCs) to help prisoners maintain or find accommodation; aid with finance, benefits and debt; and to support them to enter education, training and employment. It has been noted that prisoners with mental health needs present different challenges, have multiple and complex needs and require a more focused approach than the support provided by the CRCs. In addition, limitations in the amount of support and assistance offered to prisoners with mental health needs and, in particular, the lack of planning and arrangements for suitable accommodation were identified by Her Majesty’s Inspectorate of Probation reports (HMIP, 2019). To provide intensive support to those who had offended but also have identified mental health needs, Oxleas NHS Foundation Trust commissioned Clarion Housing (at the time known as Centra) and Nacro to provide a resettlement service for prisoners with mental health needs upon their release; the Supporting Prisoners upon Release Service (RESET) Intervention service. Clarion Housing worked from HMP Elmley, HMP Rochester and HMP Stamford Hill, while Nacro and Clarion Housing operated in London from HMP ISIS, HMP Belmarsh and HMP Thameside. The threshold for meeting the criteria for receiving support was that service users must have had limited community support in place, high rates of reoffending, and meet at least step 3 on the Oxleas stepped care model. The RESET service was based on the principles of the Critical Time Intervention (CTI) approach. CTI is a structured, time limited intervention developed in the USA in the 1990s to prevent recurrent homelessness in transient individuals with severe and mental illness moving from hospital care into the community. In CTI, case managers provided support for up to nine months to strengthen times with family, friends and service providers and to provide practical and emotional support during the transition in to the community. Studies had found significantly reduced number of homelessness for those users receiving CTI (Susser et al, 1997). The main elements of the RESET service were: • A short-term (12 week) support service to prisoners with an identified level of mental health need • The focus was in obtaining appropriate safe and secure accommodation, access to welfare benefits, re-engagement with health services and strengthening links with family and community support services • Referrals to the service were made through the Mental Health Inreach team at each prison • Work began before release to develop rapport with service user, to try to secure accommodation, and start to fill out necessary paperwork • On the day of release, the support co-ordinator would meet the service user at the gate • The main aim in first day is to ensure the individual has some form of housing • Any released prisoner would be escorted to all crucial appointments on the day, such as probation and local authority housing • Support was provided to ensure that the service users had all the essentials for the first few days i.e. correct medication, scripts and planned appointments • The support co-ordinator worked intensively during the first week of service users release and then gradually reduced their level of contact The overall aim of this study was to evaluate the impact of the RESET service. The specified objectives were to examine the: • Participants’ housing situation • Rate of reoffending • Number of hospital admissions • Number on maintained benefits • Number of contacts with mental health and GP services • Level of engagement with services • Number in employment or education • The service user’s views of the RESET servic

A single session of submaximal grip strength training with or without high-definition anodal-TDCS produces no cross-education of maximal force

BACKGROUND: Previous studies suggest that cross-education of strength may be modulated by increased corticospinal excitability of the ipsilateral primary motor cortex (M1) due to cross-activation. However, no study has examined the influence of bilateral TDCS of both M1 and how it affects corticospinal excitability, cross-activation and cross-education of muscle strength.METHOD: Twelve participants underwent three conditions in a randomized crossover design: (1) submaximal grip training and single-site unilateral-high definition-TDCS (2) submaximal grip training and bilateral anodal-high definition-TDCS, and (3) submaximal grip training and sham-high definition-TDCS. Submaximal gripping task involved a single-session of unilateral training which was squeezing the transducer at 70% of maximum voluntary isometric contraction (MVIC) grip force and performing four sets of 10 isometric contractions. Anodal-high definition-TDCS was applied for 15 min at 1.5 mA over right M1 or left and right M1s, and in a sham condition. Participants were pseudorandomized to receive either single-site or bilateral M1 stimulation with each session separated by one-week. Before and after each session, MVIC force of ipsilateral and contralateral gripping, ipsilateral stimulus-response curve, short-interval intracortical inhibition, cortical silent period, intracortical facilitation, long-interval intracortical inhibition, and cross-activation were measured.RESULTS: MVIC of the trained arm decreased by 43% (P=0.04) after training. We observed no changes in MVIC of the untrained hand and in any of the TMS measures (all P>0.05).CONCLUSION: A single session of submaximal grip training with or without anodal-high definition-TDCS produces no cross-education of maximal grip force nor does it affect the excitability of the ipsilateral M1

Caffeine ingestion compromises thermoregulation and does not improve cycling time to exhaustion in the heat among males

Purpose Caffeine is a commonly used ergogenic aid for endurance events; however, its efficacy and safety have been questioned in hot environmental conditions. The aim of this study was to investigate the effects of acute caffeine supplementation on cycling time to exhaustion and thermoregulation in the heat. Methods In a double-blind, randomised, cross-over trial, 12 healthy caffeine-habituated and unacclimatised males cycled to exhaustion in the heat (35 \ub0C, 40% RH) at an intensity associated with the thermoneutral gas exchange threshold, on two separate occasions, 60 min after ingesting caffeine (5 mg/kg) or placebo (5 mg/kg). Results There was no effect of caffeine supplementation on cycling time to exhaustion (caffeine; 28.5 \ub1 8.3 min vs. placebo; 29.9 \ub1 8.8 min, P = 0.251). Caffeine increased pulmonary oxygen uptake by 7.4% (P = 0.003), heat production by 7.9% (P = 0.004), whole-body sweat rate by 21% (P = 0.008), evaporative heat transfer by 16.5% (P = 0.006) and decreased estimated skin blood flow by 14.1% (P < 0.001) compared to placebo. Core temperature was higher by 0.6% (P = 0.013) but thermal comfort decreased by -18.3% (P = 0.040), in the caffeine condition, with no changes in rate of perceived exertion (P > 0.05). Conclusion The greater heat production and storage, as indicated by a sustained increase in core temperature, corroborate previous research showing a thermogenic effect of caffeine ingestion. When exercising at the pre-determined gas exchange threshold in the heat, 5 mg/kg of caffeine did not provide a performance benefit and increased the thermal strain of participants

Motivation toward Physical Activity: Effect of Social Media Community on Exercise Adherence

The purpose of this study was to provide information regarding a venue for exercise adherence motivation toward physical activity via social media support. The five themes identified that positively affected participants' intrinsic and extrinsic motivation to adhere to exercise through a social media fitness application were: accountability matters; support is crucial for a sedentary population beginning exercise; recognition of gains positively affects motivation; social media creates positive fitness competition; and fitness is a lifestyle

Optimised force-velocity training during pre-season enhances physical performance in professional rugby league players

The effectiveness of 8-week force-velocity optimised training was assessed in highly trained professional rugby league (RL) athletes. Players (age 24 ± 3 years; body mass 94.9 ± 21.6 kg; height 181.3 ± 6.0 cm) were strength-matched and assigned to a force-velocity optimised group (OP; n=15) or a general strength-power group (GP; n=14). Tests conducted pre-and post-training included 10-m, 20-m sprints, 3 repetition-maximum (3RM) squat and squat jumps (SJ) over five load conditions to ascertain vertical force-velocity relationship. ANCOVA revealed there was a group effect for force-velocity deficit (P<0.001), with the OP two-fold greater than the GP group (OP pre: 51.13 ± 31.42%, post: 62.26 ± 31.45%, GP pre: 33.00 ± 19.60%, post: 31.14 ± 31.45%, P<0.001). There were further group effects for 3RM squat (OP pre: 151.17 ± 22.95kg, post: 162.17 ± 24.16kg, GP pre: 156.43 ± 25.07kg, post: 163.39 ± 25.39kg, P<0.001), peak power (OP pre: 3195 ± 949W, post: 3552 ± 1033W, GP pre: 3468 ± 911W, post: 3591 ± 936W, P<0.001), and SJ (OP pre: 39.79 ± 7.80cm, post: 42.69 ± 7.83cm, GP pre: 40.44 ± 6.23cm, post: 41.14 ± 5.66cm, P<0.001). Prescribing F-V deficit training is superior for improving physical performance within highly trained RL players

Reliability and validity of velocity measures and regression methods to predict maximal strength ability in the back-squat using a novel linear position transducer

The purpose of this study was to examine the reliability of load-velocity profiles (LVPs) and validity of 1-repetition maximum (1-RM) prediction methods in the back-squat using the novel Vitruve linear position transducer (LPT). Twenty-five men completed a back-squat 1-RM assessment followed by 2 LVP trials using five incremental loads (20%–40%–60%–80%–90% 1-RM). Mean propulsive velocity (MPV), mean velocity (MV) and peak velocity (PV) were measured via a (LPT). Linear and polynomial regression models were applied to the data. The reliability and validity criteria were defined a priori as intraclass correlation coefficient (ICC) or Pearson correlation coefficient (r) . 0.70, coefficient of variation (CV) 410%, and effect size (ES) \0.60. Bland Altman analysis and heteroscedasticity of errors (r2) were also assessed. The main findings indicated MPV, MV and PV were reliable across 20%–90% 1-RM (CV \ 8.8%). The secondary findings inferred all prediction models had acceptable reliability (CV \ 8.0%). While the MPV linear and MV linear models demonstrated the best estimation of 1-RM (CV \ 5.9%), all prediction models displayed unacceptable validity and a tendency to overestimate or underestimate 1-RM. Mean systematic bias (27.29 to 2.83 kg) was detected for all prediction models, along with little to no heteroscedasticity of errors for linear (r2 \ 0.04) and polynomial models (r2 \ 0.08). Furthermore, all 1-RM estimations were significantly different from each other (p \ 0.03). Concludingly, MPV, MV and PV can provide reliable LVPs and repeatable 1-RM predictions. However, prediction methods may not be sensitive enough to replace direct assessment of 1-RM. Polynomial regression is not suitable for 1-RM prediction

Unilateral Strength Training Imparts a Cross-Education Effect in Unilateral Knee Osteoarthritis Patients

Background: Worldwide, 86 million individuals over the age of 20 were diagnosed with knee osteoarthritis (KOA) in 2020. Hallmark features of KOA are the loss in knee extensor strength, increasing knee pain severity, and deficits in functional performance. There is a critical need for the investigation into potential cost-effective therapeutic interventions in the treatment of KOA. A potential therapeutic option is the cross-education phenomenon. Methods: This was a non-blinded randomized control trial, with a 4-week intervention, with a pre, post and follow-up assessment (3 months post intervention). Outcome measures of isometric knee extensor strength, rectus femoris muscle thickness and neuromuscular activation were assessed at all-time points. Results: Compared to age-matched KOA controls, 4 weeks of unilateral strength training in end-stage KOA patients increased strength of the untrained affected KOA limb by 20% (p &lt; 0.05) and reduced bilateral hamstring co-activation in the KOA intervention group compared to the KOA control group (p &lt; 0.05). Conclusions: A 4-week-long knee extensor strength training intervention of the contralateral limb in a cohort with diagnosed unilateral KOA resulted in significant improvements to knee extensor strength and improved neuromuscular function of the KOA limb. Importantly, these results were maintained for 3 months following the intervention

Garden varieties: how attractive are recommended garden plants to butterflies?

One way the public can engage in insect conservation is through wildlife gardening, including the growing of insect-friendly flowers as sources of nectar. However, plant varieties differ in the types of insects they attract. To determine which garden plants attracted which butterflies, we counted butterflies nectaring on 11 varieties of summer-flowering garden plants in a rural garden in East Sussex, UK. These plants were all from a list of 100 varieties considered attractive to British butterflies, and included the five varieties specifically listed by the UK charity Butterfly Conservation as best for summer nectar. A total of 2659 flower visits from 14 butterfly and one moth species were observed. We performed a principal components analysis which showed contrasting patterns between the species attracted to Origanum vulgare and Buddleia davidii. The “butterfly bush” Buddleia attracted many nymphalines, such as the peacock, Inachis io, but very few satyrines such as the gatekeeper, Pyronia tithonus, which mostly visited Origanum. Eupatorium cannibinum had the highest Simpson’s Diversity score of 0.75, while Buddleia and Origanum were lower, scoring 0.66 and 0.50 respectively. No one plant was good at attracting all observed butterfly species, as each attracted only a subset of the butterfly community. We conclude that to create a butterfly-friendly garden, a variety of plant species are required as nectar sources for butterflies. Furthermore, garden plant recommendations can probably benefit from being more precise as to the species of butterfly they attract

Reliability of the Coach’s Eye Goniometer Application during Squat Exercise

This study examined the test re-test, intrarater and interrater reliability of joint kinematics from the Coach’s Eye smartphone application. Twenty-two males completed a 1-repetition maximum (1-RM) assessment followed by 2 identical sessions using 5 incremental loads (20%-40%-60%-80%-90% 1-RM). Peak flexion angles at the hip, knee, and ankle joints were assessed using 1 experienced practitioner and 1 inexperienced practitioner. The acceptable reliability thresholds were defined as intraclass correlation coefficient (ICC) (r) > 0.70 and coefficient of variation (CV) ≤ 10%. The test re-test reliability of peak hip and knee flexion were reliable across 20-90% 1-RM (r > 0.64; CV 0.70; CV 0.11). The intrarater reliability was near perfect (r > 0.90) except for peak ankle flexion (r > 0.85). The interrater reliability was nearly perfect (r > 0.91) except for hip flexion at 80% 1-RM and ankle flexion at 20% (r > 0.77). Concludingly, the Coach’s Eye application can produce repeatable assessments of joint kinematics using either a single examiner or 2 examiners, regardless of experience level. The Coach’s Eye can accurately monitor squat depth