Implementation of the Crisis Resolution Team model in adult mental health settings: a systematic review.

Crisis Resolution Teams (CRTs) aim to offer an alternative to hospital admission during mental health crises, providing rapid assessment, home treatment, and facilitation of early discharge from hospital. CRTs were implemented nationally in England following the NHS Plan of 2000. Single centre studies suggest CRTs can reduce hospital admissions and increase service users' satisfaction: however, there is also evidence that model implementation and outcomes vary considerably. Evidence on crucial characteristics of effective CRTs is needed to allow team functioning to be optimised. This review aims to establish what evidence, if any, is available regarding the characteristics of effective and acceptable CRTs

Cultures of caste and rural development in the social network of a south Indian village

Cultures of caste in much of rural India have become entangled with institutions of rural development. In community-driven development, emphasis on “local resource persons” and “community spokespersons” has created new opportunities for brokerage and patronage within some villages, which interact with existing forms of authority and community afforded by caste identity and intra-caste headmanship. In this article, we study how these entangled cultures of caste and development translate into social network structures using data on friendship ties from a south Indian village. We find that although caste continues to be important in shaping community structures and leadership in the village’s network, its influence varies across different communities. This fluidity of caste’s influence on community network structures is argued to be the result of multiple distinct yet partially overlapping cultural-political forces, which include sharedness afforded by caste identity and new forms of difference and inequality effected through rural development

Disulfonated tetraphenyl chlorin (TPCS2a)–induced photochemical internalisation of bleomycin in patients with solid malignancies: A first-in-man phase I dose escalation clinical trial

BACKGROUND: Photochemical internalisation, a novel minimally invasive treatment, has shown promising preclinical results in enhancing and site-directing the effect of anticancer drugs by illumination, which initiates localised chemotherapy release. We assessed the safety and tolerability of a newly developed photosensitiser, disulfonated tetraphenyl chlorin (TPCS2a), in mediating photochemical internalisation of bleomycin in patients with advanced and recurrent solid malignancies. METHODS: In this phase 1, dose-escalation, first-in-man trial, we recruited patients (aged ≥18 to <85 years) with local recurrent, advanced, or metastatic cutaneous or subcutaneous malignancies who were clinically assessed as eligible for bleomycin chemotherapy from a single centre in the UK. Patients were given TPCS2a on day 0 by slow intravenous injection, followed by a fixed dose of 15 000 IU/m2 bleomycin by intravenous infusion on day 4. After 3 h, the surface of the target tumour was illuminated with 652 nm laser light (fixed at 60 J/cm2). The TPCS2a starting dose was 0·25 mg/kg and was then escalated in successive dose cohorts of three patients (0·5, 1·0, and 1·5 mg/kg). The primary endpoints were safety and tolerability of TPCS2a; other co-primary endpoints were dose-limiting toxicity and maximum tolerated dose. The primary analysis was per protocol. This study is registered with ClinicalTrials.gov, number NCT00993512, and has been completed. FINDINGS: Between Oct 3, 2009, and Jan 14, 2014, we recruited 22 patients into the trial. 12 patients completed the 3-month follow-up period. Adverse events related to photochemical internalisation were either local, resulting from the local inflammatory process, or systemic, mostly as a result of the skin-photosensitising effect of TPCS2a. The most common grade 3 or worse adverse events were unexpected higher transient pain response (grade 3) localised to the treatment site recorded in nine patients, and respiratory failure (grade 4) noted in two patients. One dose-limiting toxicity was reported in the 1·0 mg/kg cohort (skin photosensitivity [grade 2]). Dose-limiting toxicities were reported in two of three patients at a TPCS2a dose of 1·5 mg/kg (skin photosensitivity [grade 3] and wound infection [grade 3]); thus, the maximum tolerated dose of TPCS2a was 1·0 mg/kg. Administration of TPCS2a was found to be safe and tolerable by all patients. No deaths related to photochemical internalisation treatment occurred. INTERPRETATION: TPCS2a-mediated photochemical internalisation of bleomycin is safe and tolerable. We identified TPCS2a 0·25 mg/kg as the recommended treatment dose for future trials. FUNDING: PCI Biotech

Plant growth responses to vesticular-arbuscular mycorrhiza (VAM XIIISpread of an introduced VA endophyte in the field and residual growth effects of inoculation in the second year

RESP-842

Factors affecting student motivation for STEM study

Background The decrease in student participation in STEM at a tertiary level has been acknowledged across Australia and is most marked in rural and regional areas. One way to attempt to understand this trend is to explore the motivations of students who have chosen to study science and engineering at a tertiary level. Aims This project aims to determine what factors influenced student choice to undertake science or engineering in a small regional university. The outcomes from this study will help regional universities to design targeted outreach activities and to identify who to target in these interventions (students/parents/teachers). Design and methods Students enrolled in science and engineering courses at the Gippsland campus of Federation University Australia took part in a study to explore what influenced their choice to study science or engineering. 80 undergraduate and post-graduate students were surveyed during semester 2, 2014 about the importance of specific experiences and people in influencing their choice of study STEM, both within the school environment, at home and cultural factors. Student experiences in school and how they impacted on their perceptions of science and likelihood to continue studying in a STEM discipline were further explored in focus groups. Results Students identified a number of key factors which influenced their choice to study science or engineering at FedUni Gippsland campus, including the geographic location, their interest in science, success in science subjects at school, and influence of others including teachers and parents. Parents had the greatest influence on students’ choices, and interest in science and future employment were also very important factors in their choice to continue studying STEM disciplines. Students identified factors such as inspirational teachers, university open days, outreach activities and work experience as positive influences on their choice to study STEM at university. Conclusions This presentation will give an overview of the results of this study and highlight the role of school, family and cultural factors in students choices to study STEM at university. Recommendations will be made regarding the focus of university outreach

Recorded lectures don’t replace the ‘real thing’: What the students say

Many face-to-face lecture programs are supplemented by recorded lectures. In this study on-campus students were surveyed regarding their experiences of face-to-face and recorded lectures. The majority of students favoured face-to-face lectures due to the ability to interact with lecturers and other students and the ability to ask questions in real time. Recorded lectures were seen to be useful for clarification and revision, due to the ability to rewind, pause and review

How does conformational flexibility influence key structural features involved in activation of anaplastic lymphoma kinase?

Anaplastic Lymphoma Kinase (ALK) plays a major role in developing tumor processes and therefore has emerged as a validated therapeutic target. Applying atomistic molecular dynamics simulations on the wild type enzyme and the nine most frequently occurring and clinically important activation mutants we revealed important conformational effects on key interactions responsible for the activation of the enzyme

Cathepsin B-degradable, NIR-responsive nanoparticulate platform for target-specific cancer therapy

Stimuli-responsive anticancer formulations can promote drug release and activation within the target tumour, facilitate cellular uptake, as well as improve the therapeutic efficacy of drugs and reduce off-target effects. In the present work, indocyanine green (ICG)-containing polyglutamate (PGA) nanoparticles were developed and characterized. Digestion of nanoparticles with cathepsin B, a matrix metalloproteinase overexpressed in the microenvironment of advanced tumours, decreased particle size and increased ICG cellular uptake. Incorporation of ICG in PGA nanoparticles provided the NIR-absorbing agent with time-dependent altered optical properties in the presence of cathepsin B. Having minimal dark toxicity, the formulation exhibited significant cytotoxicity upon NIR exposure. Combined use of the formulation with saporin, a ribosome-inactivating protein, resulted in synergistically enhanced cytotoxicity attributed to the photo-induced release of saporin from endo/lysosomes. The results suggest that this therapeutic approach can offer significant therapeutic benefit in the treatment of superficial malignancies, such as head and neck tumours

Embedding patient and public involvement: managing tacit and explicit expectations

Background: Evidencing well-planned and implemented patient and public involvement (PPI) in a research project is increasingly required in funding bids and dissemination activities. There is a tacit expectation that involving people with experience of the condition under study will improve the integrity and quality of the research. This expectation remains largely unproblematised and unchallenged. Objective: To critically evaluate the implementation of PPI activity, including co-research in a programme of research exploring ways to enhance the independence of people with dementia. Design: Using critical cases we make visible and explicate theoretical and moral challenges of PPI. Results: Case 1 explores the challenges of undertaking multiple PPI roles in the same study making explicit different responsibilities of being a co-applicant, PPI advisory member and a co-researcher. Case 2 explores tensions which arose when working with carer co-researchers during data collection; here the co-researcher’s wish to offer support and advice to research participants, a moral imperative, was in conflict with assumptions about the role of the objective interviewer. Case 3 defines and examines co-research data coding and interpretation activities undertaken with people with dementia; reporting the theoretical outputs of the activity and questioning whether this was co-researcher analysis or PPI validation. Conclusion: PPI activity can empower individual PPI volunteers and improve relevance and quality of research but it is a complex activity which is socially constructed in flexible ways with variable outcomes. It cannot be assumed to be simple or universal panacea for increasing the relevance and accessibility of research to the public