The Leeds Evaluation of Efficacy of Detoxification Study (LEEDS) prisons project pilot study: protocol for a randomised controlled trial comparing dihydrocodeine and buprenorphine for opiate detoxification

Background In the United Kingdom (UK), there is an extensive market for the class 'A' drug heroin. Many heroin users spend time in prison. People addicted to heroin often require prescribed medication when attempting to cease their drug use. The most commonly used detoxification agents in UK prisons are buprenorphine, dihydrocodeine and methadone. However, national guidelines do not state a detoxification drug of choice. Indeed, there is a paucity of research evaluating the most effective treatment for opiate detoxification in prisons. This study seeks to address the paucity by evaluating routinely used interventions amongst drug using prisoners within UK prisons. Methods/Design The Leeds Evaluation of Efficacy of Detoxification Study (LEEDS) Prisons Pilot Study will use randomised controlled trial methodology to compare the open use of buprenorphine and dihydrocodeine for opiate detoxification, given in the context of routine care, within HMP Leeds. Prisoners who are eligible and give informed consent will be entered into the trial. The primary outcome measure will be abstinence status at five days post detoxification, as determined by a urine test. Secondary outcomes during the detoxification and then at one, three and six months post detoxification will be recorded

Theory of mind in utterance interpretation: the case from clinical pragmatics

The cognitive basis of utterance interpretation is an area that continues to provoke intense theoretical debate among pragmatists. That utterance interpretation involves some type of mind-reading or theory of mind (ToM) is indisputable. However, theorists are divided on the exact nature of this ToM-based mechanism. In this paper, it is argued that the only type of ToM-based mechanism that can adequately represent the cognitive basis of utterance interpretation is one which reflects the rational, intentional, holistic character of interpretation. Such a ToM-based mechanism is supported on conceptual and empirical grounds. Empirical support for this view derives from the study of children and adults with pragmatic disorders. Specifically, three types of clinical case are considered. In the first case, evidence is advanced which indicates that individuals with pragmatic disorders exhibit deficits in reasoning and the use of inferences. These deficits compromise the ability of children and adults with pragmatic disorders to comply with the rational dimension of utterance interpretation

The UK needs an open data portal dedicated to coastal flood and erosion hazard risk and resilience

In the UK, coastal flooding and erosion are two of the primary climate-related hazards to communities, businesses, and infrastructure. To better address the ramifications of those hazards, now and into the future, the UK needs to transform its scattered, fragmented coastal data resources into a systematic, integrated portal for quality-assured, publicly accessible open data. Such a portal would support analyses of coastal risk and resilience by hosting, in addition to data layers for coastal flooding and erosion, a diverse array of spatial datasets for building footprints, infrastructure networks, land use, population, and various socio-economic measures and indicators derived from survey and census data. The portal would facilitate novel combinations of spatial data layers to yield scientifically, societally, and economically beneficial insights into UK coastal systems

Transitions in modes of coastal adaptation: addressing blight, engagement and sustainability

Coastal defences have long provided protection from erosion and flooding to cities, towns and villages. In many parts of the world, continued defence is being questioned due to both environmental, sustainability and economic considerations. This is exemplified in England and Wales, where strategic Shoreline Management Plans envisage realignment of many protected coasts, often with low population densities, over the coming decades. The policy transition from protection to realignment is often resisted by affected communities and can have high political costs. Whilst some preparations for such transitions have been made, the communities affected are often not fully aware of the implications of policy change, and this brings the potential for blight. In this paper, we investigate the challenges of implementing transitions in coastal policy within England and Wales. The analysis is based on data obtained from three workshops held in 2019 that were attended by council members, engineers, planners, scientists and other relevant professionals. Five conditions are found to promote contention: (i) policy actors with competing priorities and different decision making time frames (immediate to decadal to a century); (ii) divergence between regulations and ad hoc political decisions (e.g. in relation to the demand for new housing); (iii) limited or non-existent funding to support policy transition; (iv) community expectation that protection is forever; and (v) a disconnection between people and ongoing coastal change. Our research indicates that transitions can be better supported through: (1) integrated multi-scalar preparedness for coastal change; (2) an accessible evidence base and future vision to nurture political confidence in adaptation; and (3) defined, time-bound and accessible diverse funding streams to achieve transitions. Critically, these generic actions need to be embedded within the local political and planning system to facilitate transition to more sustainable coasts and their communities

Developing a dynamic approach to water budgeting for the Emirate of Abu Dhabi: final report

Water demand in the Emirate of Abu Dhabi has increased significantly over the last decades. The largest demand sectors are agriculture, forests and parks followed by the residential and government sectors. According to previous studies, the main driving forces are population growth, economic development and changes in lifestyle that have increased the water demand for irrigation, human consumption and industrial processes. Several public policies intensified this water demand. Some of these are the expansion of agriculture with a view to protecting the rural heritage and making Abu Dhabi less dependent on imported food; desert greening policies with a view to providing a habitat for wild animals and stabilizing the sand around roads; development of public parks to enhance the aesthetic value of outdoor spaces; residential and commercial megaprojects with a view to catering for the local population and a growing tourism industry; and industrialization driven by the government’s diversification effort into non-oil industries. This report provides a comprehensive assessment of the current state of water sources and demands in Emirate of Abu Dhabi prepared through a rigorous analysis of the data gained from a literature review of published research articles, reports and through discussions during stakeholders’ workshops. Brief description of the developed model and its sensitivity to different inputs and calibration of demands drivers are then presented. The ultimate aim of the developed model is to help inform better management of the scarce water resources by identifying potential reductions in demands from various interventions assuming constant supply for a series of scenarios for the Emirate until 2050. The work reported here involves three stages. First stage involves development of the static baseline for supply and demand of the Abu Dhabi water budget. The second stage involves development of the dynamic water budget including the identification and engagement of data sources and dissemination of the model. The third stage considers the development of scenarios framework and assessment of future needs as per the projected conditions of demands and supply

Identifying and tracking key climate adaptation actors in the UK

To understand how climate adaptation planning and decision-making will progress, a better understanding is needed as to which organisations are expected to take on key responsibilities. Methodological challenges have impeded efforts to identify and track adaptation actors beyond the coarse scale of nation states. Yet, for effective adaptation to succeed, who do national governments need to engage, support and encourage? Using the UK as a case study, we conducted a systematic review of official government documents on climate adaptation, between 2006 and 2015, to understand which organisations are identified as key to future adaptation efforts and tracked the extent to which these organisations changed over time. Our unique longitudinal dataset found a very large number of organisations (n = 568). These organisations varied in size (small-medium enterprises to large multinationals), type (public, private and not-for-profit), sector (e.g. water, energy, transport and health), scale (local, national and international), and roles and responsibilities (policymaking, decision-making, knowledge production, retail). Importantly, our findings reveal a mismatch between official government policies that repeatedly call on private organisations to drive adaptation, on the one hand, and a clear dominance of the public sector on the other hand. Yet, the capacity of organisations to fulfil the roles and responsibilities assigned to them, particularly in the public sector, is diminishing. Unless addressed, climate adaptation actions could be assigned to those either unable, or unwilling, to implement them

Role-play for medical students learning about communication: Guidelines for maximising benefits

BACKGROUND: Role-play is widely used as an educational method for learning about communication in medical education. Although educational theory provides a sound rationale for using this form of simulation, there is little published evidence for its effectiveness. Students' prior experiences of role-play may influence the way in which they engage in this method. This paper explores students' experiences with the aim of producing guidelines for maximising the benefits of role-play within this learning context. METHODS: First-year undergraduate medical students participated in a role-play session as part of their communication programme. Before and after the session, students completed questionnaires. In the pre-session questionnaire, students were asked about their experiences of role-play and asked to identify helpful and unhelpful elements. Immediately after the session, students answered similar questions in relation to the role-play activity they had just completed. Descriptive statistics were used to analyse quantitative data and qualitative data was thematically analysed. RESULTS: 284 students completed evaluation forms. Although 63 (22.2%) had prior unhelpful experiences, most students (n = 274; 96.5%) found this experience helpful. Summary findings were that students reported the key aspects of helpful role-play were opportunities for observation, rehearsal and discussion, realistic roles and alignment of roles with other aspects of the curriculum. Unhelpful aspects were those that evoked strong negative emotional responses and factors that contributed to a lack of realism. CONCLUSION: Role-play was valued by students in the acquisition of communication skills even though some had prior unhelpful experiences. Guidelines for effective role-play include adequate preparation, alignment of roles and tasks with level of practice, structured feedback guidelines and acknowledgment of the importance of social interactions for learning

The Leeds Evaluation of Efficacy of Detoxification Study (LEEDS) prisons project: a randomised controlled trial comparing dihydrocodeine and buprenorphine for opiate detoxification

<p>Abstract</p> <p>Background</p> <p>Many opiate users entering British prisons require prescribed medication to help them achieve abstinence. This commonly takes the form of a detoxification regime. Previously, a range of detoxification agents have been prescribed without a clear evidence base to recommend a drug of choice. There are few trials and very few in the prison setting. This study compares dihydrocodeine with buprenorphine.</p> <p>Methods</p> <p>Open label, pragmatic, randomised controlled trial in a large remand prison in the North of England. Ninety adult male prisoners requesting an opiate detoxification were randomised to receive either daily sublingual buprenorphine or daily oral dihydrocodeine, given in the context of routine care. All participants gave written, informed consent. Reducing regimens were within a standard regimen of not more than 20 days and were at the discretion of the prescribing doctor. Primary outcome was abstinence from illicit opiates as indicated by a urine test at five days post detoxification. Secondary outcomes were collected during the detoxification period and then at one, three and six months post detoxification. Analysis was undertaken using relative risk tests for categorical data and unpaired t-tests for continuous data.</p> <p>Results</p> <p>64% of those approached took part in the study. 63 men (70%) gave a urine sample at five days post detoxification. At the completion of detoxification, by intention to treat analysis, a higher proportion of people allocated to buprenorphine provided a urine sample negative for opiates (abstinent) compared with those who received dihydrocodeine (57% vs 35%, RR 1.61 CI 1.02–2.56). At the 1, 3 and 6 month follow-up points, there were no significant differences for urine samples negative for opiates between the two groups. Follow up rates were low for those participants who had subsequently been released into the community.</p> <p>Conclusion</p> <p>These findings would suggest that dihydrocodeine should not be routinely used for detoxification from opiates in the prison setting. The high relapse rate amongst those achieving abstinence would suggest the need for an increased emphasis upon opiate maintenance programmes in the prison setting.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN07752728</p

Mutations in the Beta Propeller WDR72 Cause Autosomal-Recessive Hypomaturation Amelogenesis Imperfecta

Healthy dental enamel is the hardest and most highly mineralized human tissue. Though acellular, nonvital, and without capacity for turnover or repair, it can nevertheless last a lifetime. Amelogenesis imperfecta (AI) is a collective term for failure of normal enamel development, covering diverse clinical phenotypes that typically show Mendelian inheritance patterns. One subset, known as hypomaturation AI, is characterised by near-normal volumes of organic enamel matrix but with weak, creamy-brown opaque enamel that fails prematurely after tooth eruption. Mutations in genes critical to enamel matrix formation have been documented, but current understanding of other key events in enamel biomineralization is limited. We investigated autosomal-recessive hypomaturation AI in a consanguineous Pakistani family. A whole-genome SNP autozygosity screen identified a locus on chromosome 15q21.3. Sequencing candidate genes revealed a point mutation in the poorly characterized WDR72 gene. Screening of WDR72 in a panel of nine additional hypomaturation AI families revealed the same mutation in a second, apparently unrelated, Pakistani family and two further nonsense mutations in Omani families. Immunohistochemistry confirmed intracellular localization in maturation-stage ameloblasts. WDR72 function is unknown, but as a putative β propeller is expected to be a scaffold for protein-protein interactions. The nearest homolog, WDR7, is involved in vesicle mobilization and Ca2+-dependent exocytosis at synapses. Vesicle trafficking is important in maturation-stage ameloblasts with respect to secretion into immature enamel and removal of cleaved enamel matrix proteins via endocytosis. This raises the intriguing possibility that WDR72 is critical to ameloblast vesicle turnover during enamel maturation