An initial investigation into the effectiveness of group therapeutic puppetry with adults with severe mental illness

Section A explores the role of creative arts therapies (CATs) in assisting recovery from severe mental illness (SMI). It examines the congruence of CATs with recovery models, and critically reviews evidence for the effectiveness of art and drama therapy with adults with mental health problems. It then examines one form of CAT which combines art and drama therapy – therapeutic puppetry. Underlying theoretical models and the existing evidence base with adults with SMI are outlined and critiqued. The review concludes with a summary of proposed arguments and research recommendations. Section B reports on a pilot investigation of group therapeutic puppetry with people with SMI. Background: Therapeutic puppetry is the use of puppets to aid emotional healing. There is no published research investigating the effectiveness of therapeutic puppetry with people with SMI. Aims: A pilot investigation of group therapeutic puppetry with people with SMI tested the hypotheses that this intervention results in improvements in mental wellbeing, self-esteem, and body connection. It also investigated mechanisms of change, and service user acceptability and experience. Method: This mixed methodology study utilised five single AB design case studies with time series data analysed using simulation modelling analysis. Qualitative data was collected via participant observation and participant interviews and analysed using thematic analysis. Results: Three participants experienced statistically and clinically significant changes in either positive or negative directions during the intervention, with all participants describing therapeutic puppetry as powerful and beneficial. Conclusions: Therapeutic puppetry is a potentially powerful medium which could be utilised by various mental health professionals. Service users find therapeutic puppetry acceptable and beneficial despite it being an occasionally difficult and intense experience. Section C is a critical appraisal of the conducted research, examining lessons learnt, identified training needs, changes to clinical practice and future research directions.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial.

BACKGROUND: Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection. METHODS: In this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants. FINDINGS: Between Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18-45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference -1·4%, 95% CI -7·0 to 4·3; hazard ratio 0·96, 0·68-1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3-4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005). INTERPRETATION: Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia. FUNDING: UK National Institute for Health Research Health Technology Assessment

Simulating future climate change impacts on snow- and ice-related driving hazards in Arctic-boreal regions

As Arctic and boreal regions rapidly warm, the frequency and seasonal timing of hazardous driving conditions on all-season Arctic-boreal roads are likely to change. Because these roads link remote Arctic areas to the rest of the North American road system, climate change may substantially affect safety and quality of life for northern residents and commercial enterprises. To gain insight into future hazardous driving conditions, we built Random Forest models that predict the occurrence of hazardous driving conditions by linking snow, ice, and weather simulated by a spatially explicit modeling system (SnowModel) to archived road condition reports from two highly trafficked all-season northern roads: the Dalton Highway (Alaska, USA) and Dempster Highway (Yukon, Canada). We applied these models to downscaled future climate trajectories for the study period of 2006–2100. We estimated future trends in the frequency and timing of icy, wet-icy, and snowy road surfaces, blowing and drifting snow, and high winds. We found that as the climate warms, and the portion of the year when snow and ice occur becomes shorter, overall frequency of snow storms and ice- and snow-related driving hazards decreased. For example, the mean number of days per year when roads are covered in snow or ice decreased by 51 d (−21%) on the Dalton Highway between the 2006–2020 and 2081–2100 time periods. However, the intensity of storms was predicted to increase, resulting in higher mean annual storm wind speeds (Dalton +0.56 m s ^−1 [+17%]) and snowfall totals (Dalton +0.3 cm [+36%]). Our models also predicted increasing frequency of wet-icy driving conditions during November, December, January, and February, when daylength is short and hazardous conditions may be more difficult to perceive. Our findings may help road managers and drivers adapt their expectations and behaviors to minimize accident risk on Arctic-boreal roads in the future

ACKNOWLEDGEMENTS

Health promotion, inequalities and young people’s health A systematic review of researc