The impact of a night confinement policy on patients in a high secure inpatient mental health service.

Purpose – From 2012, all high-secure forensic mental health services in England began operating a policy of confining patients to their locked bedrooms overnight to increase service efficiency and reduce costs. The purpose of this paper is to assess the views of staff and patients concerning the policy and examine the specific impact of the policy on patients. Design/methodology/approach – Measures of patients’ sleep hygiene, patients’ behaviour, ward atmosphere, engagement with therapy and adverse incidents were taken both before and after the night confinement (NC) policy was implemented. Both patients and staff also expressed their views of the impact of the NC policy. Findings – Results provide converging evidence that the impact of the NC policy on patients is negligible. There were no consistent negative effects of confining patients overnight. Rather, patients and staff were broadly positive about the impact that the practice had on patients. Practical implications – Confining patients to locked bedrooms overnight does not exert any consistent influence, positive or negative, on patients’ sleep hygiene, behaviour or engagement with therapy, and patients expressed a broadly positive view of the practice of NC. Thus, a NC policy may have a contribution to make to the provision an effective high-secure mental health service. Originality/value – The study provides convincing evidence that secure inpatient mental health services that are considering the adoption of a NC policy may do so without fear of a negative impact on patients

Using technology to encourage critical thinking

As technology continues to change educators must be willing to make adjustments in their teaching strategies and make an effort to make technology a permanent part of the curriculum. Critical thinking consists of organizing knowledge in a meaningful manner so it can easily be used by the learner. Those applying critical thinking are more motivated and perform at a higher level of performance than students using lower level thinking skills. Technology continues to become a bigger part of education and teachers need to use databases, spreadsheets, and concept maps as tools to facilitate critical thinking. Educators need to be aware of the barriers to technology integration such as the lack of training and lack of administrative support. This review will demonstrate how technology can be used as mindtools and how using technology in this manner will benefit students

From Competition to Collaboration: What it Takes to Lead Across the Converging Healthcare Ecosystem - Lessons from the Field

Leaders from all sectors of the healthcare industry are being tasked with developing strategies to improve health outcomes while reducing costs. These strategies require leaders from diverse sectors to expand beyond their organization’s four walls and consider strategic partnerships with others to generate and advance innovative solutions. Our session focuses on the leadership requirements for converging across the health ecosystem and considers best practices in cross-sector collaboration from the field. Learning Objectives: List practical examples of how various sectors work collaboratively to achieve the intended outcomes of population health Discuss the essential competencies of health ecosystem leadership Explain the biggest obstacles, both for leaders and for organizations, in working collaboratively and how to overcome barriers Agenda Why an ecosystem approach? Perspectives on leading within and across the health ecosystem Building capabilities to lead in the health ecosystem Q&A Presentation: 48:0

EXPRESSION OF HUMAN PROTEIN C IN MAMMARY TISSUE OF TRANSGENIC MAMMALS

Recombinant protein C characterized by a high percentage of active protein can be obtained in the milk of transgenic mammals that incorporate DNAs according to the present invention. Transgenic mammals of the present invention are produced by introducing into developing embryos DNA that encodes protein C, such that the DNA is stably incorporated in the DNA of germ line cells of the mature mammals and inherited in normal, mendelian fashion

Coping, Mental Health, and Subjective Well-being among Mental Health Staff working in Secure Forensic Psychiatric Settings: Results from a Workplace Health Assessment

Given raised rates of patient suicide and violence in secure psychiatric facilities, staff in such settings are arguably at increased risk for burnout and reduced mental health. The present paper responds to the recent UK National Institute for Health and Care Excellence (NICE) call to assess workforce well-being. This paper held the following aims: (1) to quantify existing levels of mental health (i.e., depression, anxiety, distress, and post-traumatic stress) and subjective well-being (i.e., job satisfaction, life satisfaction, and four domains of burnout), and (2) to evaluate Coping Self-Efficacy (CSE) and Need for Affect (NFA) as factors associated with staff mental health and subjective well-being. We conducted a voluntary cross-sectional health needs assessment of forensic mental health staff (N=170) between 2017 and 2018 from one National Health Service (NHS) Trust. Descriptive findings suggest staff possessed non-clinical average ranges of mental health symptoms. Subjective well-being findings showed burnout was relatively low, whereas job and life satisfaction were modest. Regression models demonstrated that: (a) thought/emotion stopping beliefs were negatively associated with psychological exhaustion; (b) social support beliefs were positively associated with life satisfaction and job enthusiasm; (c) NFA Avoidance was linked with poor mental health and burnout, and; (d) NFA Approach was positively associated with two health subjective well-being indicators. Overall, assessment results suggest NHS forensic mental health staff reported relatively good health. Cognitive- and emotion-focused coping beliefs demonstrate promise as content for prevention programming. Using Emotional Labour Theory, we offer psychological services-based recommendations for future prevention programming and research

CD44 Promotes Intoxication by the Clostridial Iota-Family Toxins

International audienceVarious pathogenic clostridia produce binary protein toxins associated with enteric diseases of humans and animals. Separate binding/translocation (B) components bind to a protein receptor on the cell surface, assemble with enzymatic (A) component(s), and mediate endocytosis of the toxin complex. Ultimately there is translocation of A component(s) from acidified endosomes into the cytosol, leading to destruction of the actin cytoskeleton. Our results revealed that CD44, a multifunctional surface protein of mammalian cells, facilitates intoxication by the iota family of clostridial binary toxins. Specific antibody against CD44 inhibited cytotoxicity of the prototypical Clostridium perfringens iota toxin. Versus CD44(+) melanoma cells, those lacking CD44 bound less toxin and were dose-dependently resistant to C. perfringens iota, as well as Clostridium difficile and Clostridium spiroforme iota-like, toxins. Purified CD44 specifically interacted in vitro with iota and iota-like, but not related Clostridium botulinum C2, toxins. Furthermore, CD44 knockout mice were resistant to iota toxin lethality. Collective data reveal an important role for CD44 during intoxication by a family of clostridial binary toxins

A qualitative study of ambulance personnel, care staff and service users’ experiences and perceptions of emergency care in care homes

Background Medical emergencies in care homes are common and costly, often resulting in calls to emergency services, ambulance attendance, conveyance, and hospital admissions. Over half of emergency transfers to hospital could be prevented with better ongoing care, access to primary care and training of staff. Our aim was to explore ambulance staff experiences of emergencies in care homes. Methods We employed a qualitative design. The study involved semi-structured interviews with ambulance staff working at the East Midlands Ambulance Service NHS Trust. Data were analysed thematically using a framework approach. Results We interviewed 15 ambulance staff (including paramedics, technicians, urgent care assistants). Preliminary analysis showed that although good communication with care home staff was considered important, experiences were varied. The importance of good, adequate resident information ready for ambulance staff upon arrival was highlighted. Regarding the decision-making process, participants reported consulting with everyone involved (care home staff, residents, relatives) and making final decisions based on various factors, including the resident/their family’s wishes, medical history, ReSPECT forms, alternative pathways to A&E, and what they considered the most appropriate course of action for the resident. Care home-related factors (access/egress issues; staff training; policies and procedures; and overall quality of care) and Emergency Medical Services-related factors (current pressures on the service; better training needed on working with people with dementia, end-of-life care, etc.; having access to an on-call geriatrician), which impact those who experience emergencies in care homes, were also discussed. Conclusion This study highlights the main challenges and facilitators that ambulance staff are faced with when dealing with emergencies in care homes. These data present findings of one staff group and triangulation with care home staff, resident and family perspectives would generate further insights. The findings will inform the development of interventions to improve outcomes and experiences of emergencies in care homes

The next generation of training for arabidopsis researchers: Bioinformatics and Quantitative Biology

It has been more than 50 years since Arabidopsis (Arabidopsis thaliana) was first introduced as a model organism to understand basic processes in plant biology. A well-organized scientific community has used this small reference plant species to make numerous fundamental plant biology discoveries (Provart et al., 2016). Due to an extremely well-annotated genome and advances in high-throughput sequencing, our understanding of this organism and other plant species has become even more intricate and complex. Computational resources, including CyVerse,3 Araport,4 The Arabidopsis Information Resource (TAIR),5 and BAR,6 have further facilitated novel findings with just the click of a mouse. As we move toward understanding biological systems, Arabidopsis researchers will need to use more quantitative and computational approaches to extract novel biological findings from these data. Here, we discuss guidelines, skill sets, and core competencies that should be considered when developing curricula or training undergraduate or graduate students, postdoctoral researchers, and faculty. A selected case study provides more specificity as to the concrete issues plant biologists face and how best to address such challenges

Social Class

Discussion of class structure in fifth-century Athens, historical constitution of theater audiences, and the changes in the comic representation of class antagonism from Aristophanes to Menander