Brain natriuretic peptide and NT-proBNP levels reflect pulmonary artery systolic pressure in trekkers at high altitude.

Our objective was to evaluate the utility of the natriuretic peptides BNP (brain natriuretic peptide) and NT-proBNP as markers of pulmonary artery systolic pressure (PASP) in trekkers ascending to high altitude (HA). 20 participants had BNP and NT-proBNP assayed and simultaneous echocardiographic assessment of PASP performed during a trek to 5150 m. PASP increased significantly (p=0.006) with ascent from 24+/-4 to 39+/-11 mm Hg at 5150 m. At 5150 m those with a PASP>/=40 mm Hg (n=8) (versus those with PASP/=400 pg/ml) rise in NT-proBNP at 5150 m (n=4) PASP was significantly higher: 45.9+/-7.5 vs. 32.2+/-6.2 mm Hg (p=0.015). BNP and NT-proBNP may reflect elevated PASP, a central feature of high altitude pulmonary oedema, at HA

Neutrophil gelatinase-associated lipocalin: its response to hypoxia and association with acute mountain sickness.

Acute Mountain Sickness (AMS) is a common clinical challenge at high altitude (HA). A point-of-care biochemical marker for AMS could have widespread utility. Neutrophil gelatinase-associated lipocalin (NGAL) rises in response to renal injury, inflammation and oxidative stress. We investigated whether NGAL rises with HA and if this rise was related to AMS, hypoxia or exercise. NGAL was assayed in a cohort (n = 22) undertaking 6 hours exercise at near sea-level (SL); a cohort (n = 14) during 3 hours of normobaric hypoxia (FiO2 11.6%) and on two trekking expeditions (n = 52) to over 5000 m. NGAL did not change with exercise at SL or following normobaric hypoxia. During the trekking expeditions NGAL levels (ng/ml, mean ± sd, range) rose significantly (P < 0.001) from 68 ± 14 (60-102) at 1300 m to 183 ± 107 (65-519); 143 ± 66 (60-315) and 150 ± 71 (60-357) at 3400 m, 4270 m and 5150 m respectively. At 5150 m there was a significant difference in NGAL between those with severe AMS (n = 7), mild AMS (n = 16) or no AMS (n = 23): 201 ± 34 versus 171 ± 19 versus 124 ± 12 respectively (P = 0.009 for severe versus no AMS; P = 0.026 for mild versus no AMS). In summary, NGAL rises in response to prolonged hypobaric hypoxia and demonstrates a relationship to the presence and severity of AMS

Managing Minds at Work: development of a digital line manager training programme

Background Mental ill health is the leading cause of sickness absence with high economic burden. Workplace interventions aimed at supporting employers with prevention of mental ill-health in the workforce are urgently required. Managing Minds at Work (MMW) is a digital intervention targeting support for line managers in any work setting to promote better mental health at work through a preventative approach. Objectives To describe the design and development of the MMW digital training programme, prior to feasibility testing. We adopted a collaborative participatory design involving co-design (users as partners) and principles of user-centred design (pilot and usability testing). Agile methodology was used to co-create intervention content with a stakeholder community of practice. Development processes were mapped to core elements of the Medical Research Council (MRC) framework for developing and evaluating complex interventions. Results The program covers five broad areas: (i) promoting self-care techniques among line managers; (ii) designing work to prevent work-related stress; (iii) management competencies to prevent and reduce stress; (iv) having conversations with employees about mental health; (v) building a psychologically safe work environment. Pilot and usability testing (n = 37 surveys) aligned with the Technology Acceptance Model (TAM) demonstrated that MMW was perceived to be useful, relevant, and easy to use by managers across sectors, organization types and sizes. We identified positive impacts on manager attitudes and behavioural intentions related to preventing mental ill-health and promoting good mental well-being at work. Conclusions MMW is a digital training programme for line managers that has been co-created using rigorous development processes and aims to support employers with primary prevention in mental health. The next step is to explore the feasibility and acceptability of this intervention with line managers in diverse employment settings. Key message

Challenging school reform from below: is leadership the missing link in mobilization theory?

This article presents research relating to the experiences of union and community-based campaigns that have sought to challenge the establishment of academy and free schools in England. Such schools are removed from local government control and are seen as a defining element of the neoliberal restructuring of public education. The research draws on social-movement literature, and particularly mobilization theory, to better understand the dynamics of such campaigns and the contexts in which they can either thrive or wither. In the article, I argue that mobilization theory provides a useful framework for such analysis but that it fails to adequately reflect the importance of individual agency and the role of leadership at a local level. Leadership of such campaigns is often assumed by individuals reluctantly, and often defies traditional descriptions of “leadership,” but must be recognized if mobilization theory is to avoid being overly deterministic

Work-life balance in the police: the development of a self-management competency framework

Purpose Addressing a gap in the current work–life balance (WLB) literature regarding individual-focused approaches to inform interventions, we elicited behaviors used to self-manage WLB to draw up a competency-based WLB framework for relevant learnable knowledge, skills, and abilities (KSAs; Hoffmann, Eur J Ind Train 23:275–285, 1999) and mapping this against extant WLB frameworks. Design/Methodology/Approach Our participants were from a major UK police force, which faces particular challenges to the work–life interface through job demands and organizational cutbacks, covering a range of operational job roles, including uniformed officers and civilian staff. We took a mixed methods approach starting with semi-structured interviews to elicit 134 distinct behaviors (n = 20) and used a subsequent card sort task (n = 10) to group these into categories into 12 behavioral themes; and finally undertook an online survey (n = 356) for an initial validation. Findings Item and content analysis reduced the behaviors to 58, which we analyzed further. A framework of eight competencies fits the data best; covering a range of strategies, including Boundary Management, Managing Flexibility, and Managing Expectations. Implications The WLB self-management KSAs elicited consist of a range of solution-focused behaviors and strategies, which could inform future WLB-focused interventions, showing how individuals may negotiate borders effectively in a specific environment. Originality/Value A competence-based approach to WLB self-management is new, and may extend existing frameworks such as Border Theory, highlighting a proactive and solution-focused element of effective behaviors

Employer's management of employees affected by cancer

Return to work (RTW) following treatment can be problematic for cancer survivors. Although some people affected by cancer are able to continue working, a greater proportion of these survivors end up unemployed, retire early or change jobs than those without a diagnosis of cancer. One of the reasons for not returning to work is the lack of understanding and support from employers and supervisors. Currently, it is not clear what factors are likely to influence the employer’s management of employees recovering from cancer. This article reports the outcome from a review of the published literature on factors related to the current employer management of employed cancer survivors

Usefulness and engagement with a guided workbook intervention (WorkPlan) to support work related goals among cancer survivors

Background: Returning to work after cancer is associated with improved physical and psychological functioning, but managing this return can be a challenging process. A workbook based intervention (WorkPlan) was developed to support return-to-work among cancer survivors. The aim of this study was to explore how participants using the workbook engaged with the intervention and utilised the content of the intervention in their plan to return-to-work. Methods: As part of a feasibility randomised controlled trial, 23 participants from the intervention group were interviewed 4-weeks post intervention. Interviews focussed on intervention delivery and data was analysed using Framework analysis. Results: Participants revealed a sense of empowerment and changes in their outlook as they transitioned from patient to employee, citing the act of writing as a medium for creating their own return-to-work narrative. Participants found the generation of a return-to-work plan useful for identifying potential problems and solutions, which also served as a tool for aiding discussion with the employer on return-to-work. Additionally, participants reported feeling less uncertain and anxious about returning to work. Timing of the intervention in coordination with ongoing cancer treatments was crucial to perceived effectiveness; participants identified the sole or final treatment as the ideal time to receive the intervention. Conclusions: The self-guided workbook supports people diagnosed with cancer to build their communication and planning skills to successfully manage their return-to-work. Further research could examine how writing plays a role in this process

5C analysis of the Epidermal Differentiation Complex locus reveals distinct chromatin interaction networks between gene-rich and gene-poor TADs in skin epithelial cells

YesMammalian genomes contain several dozens of large (>0.5 Mbp) lineage-specific gene loci harbouring functionally related genes. However, spatial chromatin folding, organization of the enhancer-promoter networks and their relevance to Topologically Associating Domains (TADs) in these loci remain poorly understood. TADs are principle units of the genome folding and represents the DNA regions within which DNA interacts more frequently and less frequently across the TAD boundary. Here, we used Chromatin Conformation Capture Carbon Copy (5C) technology to characterize spatial chromatin interaction network in the 3.1 Mb Epidermal Differentiation Complex (EDC) locus harbouring 61 functionally related genes that show lineage-specific activation during terminal keratinocyte differentiation in the epidermis. 5C data validated by 3D-FISH demonstrate that the EDC locus is organized into several TADs showing distinct lineage-specific chromatin interaction networks based on their transcription activity and the gene-rich or gene-poor status. Correlation of the 5C results with genome-wide studies for enhancer-specific histone modifications (H3K4me1 and H3K27ac) revealed that the majority of spatial chromatin interactions that involves the gene-rich TADs at the EDC locus in keratinocytes include both intra- and inter-TAD interaction networks, connecting gene promoters and enhancers. Compared to thymocytes in which the EDC locus is mostly transcriptionally inactive, these interactions were found to be keratinocyte-specific. In keratinocytes, the promoter-enhancer anchoring regions in the gene-rich transcriptionally active TADs are enriched for the binding of chromatin architectural proteins CTCF, Rad21 and chromatin remodeler Brg1. In contrast to gene-rich TADs, gene-poor TADs show preferential spatial contacts with each other, do not contain active enhancers and show decreased binding of CTCF, Rad21 and Brg1 in keratinocytes. Thus, spatial interactions between gene promoters and enhancers at the multi-TAD EDC locus in skin epithelial cells are cell type-specific and involve extensive contacts within TADs as well as between different gene-rich TADs, forming the framework for lineage-specific transcription.This study was supported by the grants 5R01AR064580 and 1RO1AR071727 to VAB, TKS and AAS, as well as by the grants from MRC (MR/ M010015/1) and BBSRC (BB/K010050/1) to VAB

Development of inclusive education in England: Impact on children with special educational needs and disabilities

This is an accepted manuscript of a book chapter published by Springer Routledge in the Handbook on Promoting Social Justice in Education, available online: https://doi.org/10.1007/978-3-319-74078-2_151-1 The accepted version of the publication may differ from the final published version. Please refer to the publisher's terms and conditions for re-use.This chapter considers a historical account of the development of inclusion in England and the changes made to the education of children with SEND since the 1940s. The chapter details the development of inclusive education, the complexity of defining inclusion, and what inclusion has come to mean in current practice. This historical account is considered alongside the development and dominance of the standards agenda. In considering inclusion in this manner, the original intentions of its agenda are questioned against the practical implementation of inclusive education in current practice. The chapter concludes by proposing that significant progress has not been made with inclusion because it has not been possible to accommodate it within the competing political agendas replete in England’s education system