GSCC targeted inspections of Approved Mental Health Professionals (AMHP) courses in England (2011-12)

The General Social Care Council (GSCC) has duties under Section 19 of the Mental Health Act 2007 to approve Approved Mental Health Profession (AMHP) training. This function will transfer to the Health Professions Council on 31 July 2012. The GSCC carried out a targeted inspection between March 2011 and February 2012 of all 22 AMHP programmes across England. This was to ensure at the point of transfer all courses were sufficiently meeting standards. There had been a number of issues and concerns raised about inconsistencies in the quality of AMHP programmes. The inspection process involved consulting all stakeholders concerned in delivering and using the programmes, including AMHP candidates, service users and carers. Each programme has their inspection report on the GSCC website. The key findings of these inspections are that the majority of the 22 programmes are meeting the standards expected and where they are not, action has been taken to ensure that prior to transfer of the GSCC’s AMHP inspection function, all programmes will meet the standards and not require regulatory intervention. There is inconsistency in the length and attached credit of each AMHP programme, although this did not seem to impair the threshold standard required for being competent in the AMHP role. This composite report features the overall outputs from the inspections

Addressing the needs of the children’s integrated workforce: A method for developing collaborative practice through joint learning

The delivery of welfare, health and educational provision to the majority of children aged 0–18 in England is primarily led by local authorities via their children’s integrated service. In 2004 the children’s integrated service model was launched and it promised the benefits of an integrated and collaborative system of working, regarding flexibility and responsiveness to national policy, local development and capacity building (Robinson et al, 2008). However, the implementation and emergence of this model has been characterised by competing local and national agendas, practitioner misunderstanding and lack of trust, a lack of strong leadership and also financial restrictions. It can therefore be contended that conceptually children’s integrated services are not operating fully with a collaborative and integrated workforce. As a possible solution to the current situation, it is proposed that joint learning, along with a combined continual professional development (CPD) framework, be made available as a valuable starting point for such organisations. Learning and working together has benefits for children and practitioners, and especially, as this article will argue, for playwork practitioners

Inhibition of succinate dehydrogenase dysregulates histone modification in mammalian cells

Remodelling of mitochondrial metabolism is a hallmark of cancer. Mutations in the genes encoding succinate dehydrogenase (SDH), a key Krebs cycle component, are associated with hereditary predisposition to pheochromocytoma and paraganglioma, through mechanisms which are largely unknown. Recently, the jumonji-domain histone demethylases have emerged as a novel family of 2-oxoglutarate-dependent chromatin modifiers with credible functions in tumourigenesis. Using pharmacological and siRNA methodologies we show that increased methylation of histone H3 is a general consequence of SDH loss-of-function in cultured mammalian cells and can be reversed by overexpression of the JMJD3 histone demethylase. ChIP analysis revealed that the core promoter of IGFBP7, which encodes a secreted protein upregulated after loss of SDHB, showed decreased occupancy by H3K27me3 in the absence of SDH. Finally, we provide the first evidence that the chief (type I) cell is the major methylated histone-immunoreactive constituent of paraganglioma. These results support the notion that loss of mitochondrial function alters epigenetic processes and might provide a signature methylation mark for paraganglioma

Developing a CPD Framework in a time of organizational cultural conflict

The need for continual organisational improvement is of critical importance for organisations like that of children’s integrated services where there is both a legal and moral authority to safeguard and promote the welfare of all children. However, the implementation of children’s integrated services since 2004 has produced a series of challenges in the forms of contextual barriers, changing political climates, organisational change and cultural issues (Robinson et al., 2008). A perennial challenge for children’s services has been the ability to meet the CPD needs of the various professions that constitute its workforce without seemingly destabilising the wider organisational norms and beliefs. This paper specifically focuses on the current development of a CPD framework for an entire children’s integrated workforce, and the impact the organisational culture, as well as the professional sub-cultures are having. Reference will be made to members of the workforce being cultural carriers and the role of leaders in relation to organisational change (Schein, 1993 and Lucas and Kline, 2008). In seeking to answer the real world problem of developing a CPD framework for multiple professions within a single organisation, the paper will identify the factors that need to be taken into account

Taking advantage of dissonance: a CPD framework

Purpose: To communicate the findings of an empirical research project based on a real world problem that involved the development of a Continuous Professional Development (CPD) framework for a children’s integrated service workforce. In addition, to give attention to the notion that children’s integrated services have not necessarily been viewed from the perspective of conflict management and that this has meant ensuing conflicts that characterise such organisations are more often than not ignored. Design/Methodology/Approach: A case study approach involving a mixed methodology consisting of semi-structured interviews for senior managers and service leads; a quantitative survey for frontline practitioners and focus groups for service users, carers and children. Findings: Rather than the service being fully integrated, services were aligned, and this was reflected in the conflict between professional cultures, reinforcing an ‘us and them’ culture. This culture had seemingly permeated all aspects of the organisation including the senior management team. It was also noted that certain systems and processes, as well as bureaucracy, within the service were seen as hindering integrated working and was in effect a catalyst for conflict. Originality/Value: Through the application of conflict management theory it will be illustrated how conflict could be used to effectively steer children integrated services towards creativity and productivity through an organisational wide framework that not only embraces dissonance, but also promotes a learning environment that takes advantage of such dissonance to incorporate a hybrid of professional practice and expertise

A phase I/II study of intrathecal idursulfase-IT in children with severe mucopolysaccharidosis II

Approximately two-thirds of patients with the lysosomal storage disease mucopolysaccharidosis II have progressive cognitive impairment. Intravenous (i.v.) enzyme replacement therapy does not affect cognitive impairment because recombinant iduronate-2-sulfatase (idursulfase) does not penetrate the blood-brain barrier at therapeutic concentrations. We examined the safety of idursulfase formulated for intrathecal administration (idursulfase-IT) via intrathecal drug delivery device (IDDD). A secondary endpoint was change in concentration of glycosaminoglycans in cerebrospinal fluid. Sixteen cognitively impaired males with mucopolysaccharidosis II who were previously treated with weekly i.v. idursulfase 0.5 mg/kg for ≥6 months were enrolled. Patients were randomized to no treatment or 10-mg, 30-mg, or 1-mg idursulfase-IT monthly for 6 months (four patients per group) while continuing i.v. idursulfase weekly. No serious adverse events related to idursulfase-IT were observed. Surgical revision/removal of the IDDD was required in 6 of 12 patients. Twelve total doses were administrated by lumbar puncture. Mean cerebrospinal fluid glycosaminoglycan concentration was reduced by approximately 90% in the 10-mg and 30-mg groups and approximately 80% in the 1-mg group after 6 months. These preliminary data support further development of investigational idursulfase-IT in MPS II patients with the severe phenotype who have progressed only to a mild-to-moderate level of cognitive impairment.Genet Med advance online publication 02 April 2015Genetics in Medicine (2015); doi:10.1038/gim.2015.36

A novel formulation of inhaled sodium cromoglicate (PA101) in idiopathic pulmonary fibrosis and chronic cough: a randomised, double-blind, proof-of-concept, phase 2 trial

Background Cough can be a debilitating symptom of idiopathic pulmonary fibrosis (IPF) and is difficult to treat. PA101 is a novel formulation of sodium cromoglicate delivered via a high-efficiency eFlow nebuliser that achieves significantly higher drug deposition in the lung compared with the existing formulations. We aimed to test the efficacy and safety of inhaled PA101 in patients with IPF and chronic cough and, to explore the antitussive mechanism of PA101, patients with chronic idiopathic cough (CIC) were also studied. Methods This pilot, proof-of-concept study consisted of a randomised, double-blind, placebo-controlled trial in patients with IPF and chronic cough and a parallel study of similar design in patients with CIC. Participants with IPF and chronic cough recruited from seven centres in the UK and the Netherlands were randomly assigned (1:1, using a computer-generated randomisation schedule) by site staff to receive PA101 (40 mg) or matching placebo three times a day via oral inhalation for 2 weeks, followed by a 2 week washout, and then crossed over to the other arm. Study participants, investigators, study staff, and the sponsor were masked to group assignment until all participants had completed the study. The primary efficacy endpoint was change from baseline in objective daytime cough frequency (from 24 h acoustic recording, Leicester Cough Monitor). The primary efficacy analysis included all participants who received at least one dose of study drug and had at least one post-baseline efficacy measurement. Safety analysis included all those who took at least one dose of study drug. In the second cohort, participants with CIC were randomly assigned in a study across four centres with similar design and endpoints. The study was registered with ClinicalTrials.gov (NCT02412020) and the EU Clinical Trials Register (EudraCT Number 2014-004025-40) and both cohorts are closed to new participants. Findings Between Feb 13, 2015, and Feb 2, 2016, 24 participants with IPF were randomly assigned to treatment groups. 28 participants with CIC were enrolled during the same period and 27 received study treatment. In patients with IPF, PA101 reduced daytime cough frequency by 31·1% at day 14 compared with placebo; daytime cough frequency decreased from a mean 55 (SD 55) coughs per h at baseline to 39 (29) coughs per h at day 14 following treatment with PA101, versus 51 (37) coughs per h at baseline to 52 (40) cough per h following placebo treatment (ratio of least-squares [LS] means 0·67, 95% CI 0·48–0·94, p=0·0241). By contrast, no treatment benefit for PA101 was observed in the CIC cohort; mean reduction of daytime cough frequency at day 14 for PA101 adjusted for placebo was 6·2% (ratio of LS means 1·27, 0·78–2·06, p=0·31). PA101 was well tolerated in both cohorts. The incidence of adverse events was similar between PA101 and placebo treatments, most adverse events were mild in severity, and no severe adverse events or serious adverse events were reported. Interpretation This study suggests that the mechanism of cough in IPF might be disease specific. Inhaled PA101 could be a treatment option for chronic cough in patients with IPF and warrants further investigation

Habitat Assessment of Non-Wadeable Rivers in Michigan

Habitat evaluation of wadeable streams based on accepted protocols provides a rapid and widely used adjunct to biological assessment. However, little effort has been devoted to habitat evaluation in non-wadeable rivers, where it is likely that protocols will differ and field logistics will be more challenging. We developed and tested a non-wadeable habitat index (NWHI) for rivers of Michigan, where non-wadeable rivers were defined as those of order ≥5, drainage area ≥1600 km 2 , mainstem lengths ≥100 km, and mean annual discharge ≥15 m 3 /s. This identified 22 candidate rivers that ranged in length from 103 to 825 km and in drainage area from 1620 to 16,860 km 2 . We measured 171 individual habitat variables over 2-km reaches at 35 locations on 14 rivers during 2000–2002, where mean wetted width was found to range from 32 to 185 m and mean thalweg depth from 0.8 to 8.3 m. We used correlation and principal components analysis to reduce the number of variables, and examined the spatial pattern of retained variables to exclude any that appeared to reflect spatial location rather than reach condition, resulting in 12 variables to be considered in the habitat index. The proposed NWHI included seven variables: riparian width, large woody debris, aquatic vegetation, bottom deposition, bank stability, thalweg substrate, and off-channel habitat. These variables were included because of their statistical association with independently derived measures of human disturbance in the riparian zone and the catchment, and because they are considered important in other habitat protocols or to the ecology of large rivers. Five variables were excluded because they were primarily related to river size rather than anthropogenic disturbance. This index correlated strongly with indices of disturbance based on the riparian (adjusted R 2 = 0.62) and the catchment (adjusted R 2 = 0.50), and distinguished the 35 river reaches into the categories of poor (2), fair (19), good (13), and excellent (1). Habitat variables retained in the NWHI differ from several used in wadeable streams, and place greater emphasis on known characteristic features of larger rivers.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41269/1/267_2004_Article_141.pd