Accidental injury, risk-taking behaviour and the social circumstances in which young people (aged 12-24) live: a systematic review

In industrialised countries such as England and Wales, unintended injury (which ranges from sprains in sport to hospitalisation and death due to drugs or transport crashes) is the leading cause of death in children aged 0 to 14 years, and a major cause of death in young adults aged 15 to 24. It is also a major cause of ill health and disability in these age groups. There is a large body of research on young people and their perceived propensity to take risks. Common sense suggests that an increased willingness to place oneself at risk will result an increased likelihood of physical injury. However, given that pathways to injury are complex and not always well understood, the UK Department of Health commissioned a large systematic review to examine this multifaceted issue. Drug use • The review found that the use of drugs is associated with an increased risk of accidental death among young people and that 12–24 year olds are less at risk than those immediately older. However, risk of death increases with length of drug use, so there is value in targeting interventions at this age group. • Many more young men than women die from drug overdoses, because more men take drugs, but those women who do use drugs are at higher risk. Certain other groups of young people are more at risk than others. These include young people in deprived areas and men who have recently been released from prison. • There was a clear disjunction of views between young people who used drugs and those who did not. The young people who did not take drugs regarded them as risky and stated that media images about possible negative consequences dissuaded them from trying them, while those who did tended not to believe ‘official’ messages about possible harms and did not perceive taking drugs as being dangerous. Cannabis in particular was singled out as possibly being good for you, with some young people believing it to be cheaper than alcohol. The recent reclassification of cannabis and the subsequent debate may have helped to reinforce this view. • The burden of the more serious injuries – as demonstrated by the mortality statistics – is carried by young people in the lower socio-economic groups. • In road injuries, drugs are found in the bloodstream of more young fatal accident victims than older age groups; however, it is difficult to assess whether drugs actually contributed to the accident. • Driving on cannabis was thought to be more acceptable than drink-driving and not thought to be dangerous. Alcohol use • Almost everyone admitted to hospital for alcohol poisoning is aged between 11 and 17. After a sharp peak among 14 and 15 year olds, hospital admissions for injuries with alcohol involvement decline slowly between the ages of 16 and 30. • Correlational studies have shown that alcohol puts the drinker at an increased risk of injury, that young people are more likely to have injuries than older people, and that young men are more at risk than young women. In the one study that examined ethnicity, minority ethnic status did not increase alcohol-related injuries, and may in fact have had a protective association. • Views studies found that young people say that they do not commonly mix alcohol and other drugs. Most young people reported that drinking places them at greater risk of injury, though some did not. The younger teenagers – 14 and 15 year olds – felt most in danger of injury when drinking. Young people felt that they learned to manage their drinking through experience and that unsupervised, outdoor drinking was the most dangerous and was more common among younger teenagers (with injuries being considered less common in licensed venues). Peers encourage both drinking and drunken pranks, but also protect one another when they have become more vulnerable as a result of drink. Young people felt that drinking reduces their perceptions of danger and some stated that injury as a result was inevitable. Most young people were cautious about getting very drunk, though being sick as a result of drinking is common and not regarded as serious. Bad experiences – whether to self or someone else – might change behaviour in the short- but not long-term. • One study which examined attempts to reduce alcohol-related injuries found some evidence that motivational interviews in A&E departments are more effective than information handouts. Drink-driving • Drink-driving was generally considered dangerous and not socially acceptable, whereas driving on cannabis was more acceptable and not thought to be dangerous. Some young people stated that a lack of public transport (or alternatives, such as taxis) made it more likely that they would drink and drive. • Interventions based on models of behaviour change to reduce drink-driving are ineffective or have a negative effect. Combining different approaches has more effect than using a single approach. Education or skills training has either negative or no effects on driver behaviour and subsequent accidents, possibly because these approaches lead to over-confidence or early licensing. • Legislation and enforcement on reducing drink-driving has been found to be effective

The Neurophysiology of Tone: The Role of the Muscle Spindle and the Stretch Reflex

The excitability of the stretch reflex is used as a measure of tone. The muscle spindle is the receptor for the stretch reflexes which may be phasic or tonic in nature. This paper provides a theoretical background through an overview of published studies as a basis for the under-standing of the contribution of the muscle spindle to both the phasic and tonic stretch reflexes

Integrated care : the presence, nature and development of integrated care in community health services in England and Ireland

Background: Integrated care is a policy imperative in health and social care services globally, and yet there are reported difficulties in defining, developing and sustaining this way of working. Research Question: This research explores staff views and experiences of the presence, nature and development of integrated care in two programmes of community services. Method: A case study approach was adopted using secondary analysis of qualitative data from staff questionnaires using themed content analysis and pattern matching, with findings triangulated with documentary sources. The study considers the presence and nature of integrated care using the conceptual framework “to what extent integrated care is for everyone (inclusive) and not just for some (exclusive)” as interpreted from the literature. The development of integrated care was explored using systems theory for the management of change in a complex environment. Findings: A meta-analysis of the two case studies demonstrated that integration was present in all 66 services within the two programmes. The nature of integrated care varied and was demonstrated as multiple types (in community hospitals) and processes (in community services). The most frequently reported type was multidisciplinary working. The processes most teams chose to develop were information sharing systems. The development of integration within the case studies was affected by a number of factors, such as commitment and staffing. Conclusion: This study provides new evidence of the presence, nature and development of integration within a wide range of established services spanning all ages. From this and other measures, the extent to which integrated care is presented as “exclusive” can be questioned. These findings have informed the development of a framework of five principles, reflecting whether integrated care is: for everyone, extensive, enduring, can be enabled and essential. The implications and application of this research for policy, service development and training are discussed, and proposals for further research include testing the applicability of this framework and widening this study

High spectral resolution mass spectrometry imaging of three-dimensional cell culture

Three-dimensional (3D) cell culture combines the simplicity of two-dimensional (2D) cell culture systems with the complex interplay of factors resembling the multifaceted physiology of tissues in vivo. These microscale spherical cell clusters – known as multicellular tumour spheroids (MTS) – replicate the oxygen, nutrient, and waste gradients observed within tumours, and provide useful model systems to improve our understanding of cancer biology. Matrix-assisted laser desorption/ionisation (MALDI) mass spectrometry imaging (MSI) is an analytical technique that permits broad spectral and label-free analysis to observe the distribution of compounds without requiring any significant prior knowledge. MALDI-MSI can be used as a global untargeted approach to elucidate the various microenvironments within MTS at high spatial resolution. Here, method development for MALDI-MSI of MTS will be reported. Breast cancer (MCF-7) and prostate cancer (PC3) spheroids were grown to diameters of approximately 500 μm using the hanging drop method. For MALDI imaging, the spheroids were embedded in gelatin, cryosectioned, and coated with a matrix. Using the optimised protocol, up to eight spheroids were embedded in a gelatin block, and up to 100 spheroid sections were mounted onto a slide. To discern the ionisable metabolome of an MCF-7 spheroid, MALDI mass spectrometry (MS) analysis was employed to compile a list of tentative metabolite identifications. Using various matrices in both polarities, over 760 tentative formulae were assigned at sub-ppm errors. A targeted MALDI-MSI approach suggested that adenosine triphosphate (ATP), adenosine diphosphate (ADP), and glutathione can be used as metabolite markers to indicate regions of increased oxidative stress and hypoxia. ATP was found to be primarily localised to the outer region, whereas ADP was more uniformly distributed, suggesting there is a decreasing oxygen gradient through the spheroid. Subsequently, an untargeted approach of discriminatory analysis tentatively identified the metabolites that colocalised to these areas. The assignments were used to investigate the regional flux through specific metabolic branch pathways. The hexosamine biosynthetic pathway (HBP) was found to be upregulated in the regions of the spheroid with greater access to oxygen, whereas there was greater glycolytic flux within the regions limited by hypoxia. MALDI-MSI is useful for elucidating the absorption, distribution, metabolism, and excretion (ADME) of drugs within MTS. Therefore, the developed protocol was employed to observe the time-dependent distribution of the hypoxia marker pimonidazole within PC3 spheroids. Due to the low signal-to-noise (S/N) of pimonidazole and its metabolites, continual accumulation of ions (CASI) was used to effectively lower the limit of detection and increase the signal intensities. Over 24 hours, pimonidazole was distributed throughout the spheroid and underwent reduction. Furthermore, its reduction derivatives showed a central localisation throughout the time course, suggestive of a hypoxic core. Finally, a 3D printer and other parts commonly found in an analytical chemistry lab were employed as a low-cost alternative to commercial sprayers for matrix deposition. Using printed rhodamine B microarrays and fluorescence imaging, matrix application conditions were optimised to effectively reduce delocalisation from 403% to 9.4%. Subsequently, MALDI-MSI of MTS was used to compare the optimised conditions of the home-built sprayer to a commercially available matrix application platform. Using this system, robust and reproducible distributions of endogenous metabolite distributions with a high spatial resolution were observed

Midwives' competence : is it affected by working in a rural location?

Introduction: Rising health care costs and the need to consolidate expertise in tertiary services have led to the centralisation of services. In the UK, the result has been that many rural maternity units have become midwife-led. A key consideration is that midwives have the skills to competently and confidently provide maternity services in rural areas, which may be geographically isolated and where the midwife may only see a small number of pregnant women each year. Our objective was to compare the views of midwives in rural and urban settings, regarding their competence and confidence with respect to ‘competencies’ identified as being those which all professionals should have in order to provide effective and safe care for low-risk women. Method: This was a comparative questionnaire survey involving a stratified sample of remote and rural maternity units and an ad hoc comparison group of three urban maternity units in Scotland. Questionnaires were sent to 82 midwives working in remote and rural areas and 107 midwives working in urban hospitals with midwife-led units. Results: The response rate from midwives in rural settings was considerably higher (85%) than from midwives in the urban areas (60%). Although the proportion of midwives who reported that they were competent was broadly similar in the two groups, there were some significant differences regarding specific competencies. Midwives in the rural group were more likely to report competence for breech delivery (p = 0.001), while more urban midwives reported competence in skills such as intravenous fluid replacement (p <0.001) and initial and discharge examination of the newborn (p <0.001). Both groups reported facing barriers to continuing professional development; however, more of the rural group had attended an educational event within the last month (p <0.001). Lack of time was a greater barrier for urban midwives (p = 0.02), whereas distance to training was greater for rural midwives (p = 0.009). Lack of motivation or interest was significantly higher in urban units (p = 0.006). Conclusion: It is often assumed that midwives in rural areas where there are fewer deliveries, will be less competent and confident in their practice. Our exploratory study suggests that the issue of competence is far more complex and deserves further attention.NHS Education Scotlan

Structure–property insights into nanostructured electrodes for Li-ion batteries from local structural and diffusional probes

Microwave heating presents a faster, lower energy synthetic methodology for the realization of functional materials. Here, we demonstrate for the first time that employing this method also leads to a decrease in the occurrence of defects in olivine structured LiFe1−xMnxPO4. For example, the presence of antisite defects in this structure precludes Li+ diffusion along the b-axis leading to a significant decrease in reversible capacities. Total scattering measurements, in combination with Li+ diffusion studies using muon spin relaxation (μ+SR) spectroscopy, reveal that this synthetic method generates fewer defects in the nanostructures compared to traditional solvothermal routes. Our interest in developing these routes to mixed-metal phosphate LiFe1−xMnxPO4 olivines is due to the higher Mn2+/3+ redox potential in comparison to the Fe2+/3+ pair. Here, single-phase LiFe1−xMnxPO4 (x = 0, 0.25, 0.5, 0.75 and 1) olivines have been prepared following a microwave-assisted approach which allows for up to 4 times faster reaction times compared to traditional solvothermal methods. Interestingly, the resulting particle morphology is dependent on the Mn content. We also examine their electrochemical performance as active electrodes in Li-ion batteries. These results present microwave routes as highly attractive for reproducible, gram-scale syntheses of high quality nanostructured electrodes which display close to theoretical capacity for the full iron phase

Orbital Dimer Model for Spin-Glass State in Y2_2Mo2_2O7_7

The formation of a spin glass usually requires both structural disorder and frustrated magnetic interactions. Consequently, the origin of spin-glass behaviour in Y$_2$Mo$_2$O$_7$ $-$ in which magnetic Mo$^{4+}$ ions occupy a frustrated pyrochlore lattice with minimal compositional disorder $-$ has been a longstanding question. Here, we use neutron and X-ray pair-distribution function (PDF) analysis to develop a disorder model that resolves apparent incompatibilities between previously-reported PDF, EXAFS and NMR studies and provides a new and physical mechanism for spin-glass formation. We show that Mo$^{4+}$ ions displace according to a local "2-in/2-out" rule on each Mo$_4$ tetrahedron, driven by orbital dimerisation of Jahn-Teller active Mo$^{4+}$ ions. Long-range orbital order is prevented by the macroscopic degeneracy of dimer coverings permitted by the pyrochlore lattice. Cooperative O$^{2-}$ displacements yield a distribution of Mo$-$O$-$Mo angles, which in turn introduces disorder into magnetic interactions. Our study demonstrates experimentally how frustration of atomic displacements can assume the role of compositional disorder in driving a spin-glass transition.Comment: 6 pages, 3 figure