Inter-agency adult support and protection practice:a realistic evaluation with police, health and social care professionals

Purpose: Collaborative inter-agency working is of paramount importance for the public protection agenda worldwide. The purpose of this paper is to disseminate the findings from a research study on the inter-agency working within adult support and protection (ASP) roles in the police, health and social care.Design/methodology/approach: This realistic evaluation study with two inter-related phases was funded by the Scottish Institute for Policing Research. This paper reports on Phase 1 which identified existing gaps in the implementation of effective inter-agency practice by reviewing the “state of play” in inter-agency collaboration between the police and health and social care professionals. In total, 13 focus groups comprising representatives from Police Scotland (n¼52), Social Care (n¼31) and Health (n¼18), engaged in single profession and mixed profession groups addressing issues including referral and information exchange.Findings: On analysing context-mechanism-outcome (CMO), gaps in joint working were identified and attributed to the professionals’ own understanding of inter-agency working and the expectations of partner agencies. It recommended the need for further research and inter-agency training on public protection. Research limitations/implications – This unique Scottish study successfully identified the inter-agency practices of health, social services and police. By means of a modified realistic evaluation approach, it provides an in-depth understanding of the challenges that professionals face on a day-to-day basis when safeguarding adults and informed strategic recommendations to overcome the barriers to good practices in organisational working. The methods used to determine CMO could benefit other researchers to develop studies exploring the complexities of multi-causal effects of cross-boundary working. The use of the same case study in each focus group helped to neutralise bias. However, the voluntary nature of participation could have resulted in biased perceptions. The limited numbers of health professionals may have resulted in less representation of health sector views.Practical implications: Collaborative inter-agency working is of paramount importance for public protection worldwide. This paper reports on a Scottish study that focussed on the coordinated and integrated practices amongst the police, health and social services’ professionals who support and protect adult members of society at risk of harm.Social implications: Whilst the focus of this study has been on ASP, the conclusions and recommendations are transferable to public protection issues in many other contexts.Originality/value: Studies on the joint-working practices amongst police and health and social services’ professionals who support and protect adult members of society at risk of harm are uncommon. This  study investigated professionals’ perceptions of gaps and concerns pertaining to integrated working by means of a realistic evaluation approach. It recommended the need for further research and inter-agency training on public protection

Interagency adult support and protection practice of police and health and social care professionals: a realistic evaluation approach.

The purpose of this project was to investigate the interagency Adult Support and Protection practices of police, health and social care professionals in Scotland by means of a Realistic Evaluation Approach. The study comprised of two specific phases. The first phase sought to establish the 'state of play' for cross boundary working by: identifying the gaps in interagency practice; evaluating the education and training needs of professionals working in the area of adult support and protection, and identifying information sharing practices. Focus groups with members of the police and health and social care professionals were conducted in each of the three Police Scotland Command areas. Thirteen focus groups were conducted, with 101 professionals participating. Nine key themes were identified: Information sharing; relationships; people and processes; lessons from child protection; environment; implementation of the act; regional variations and training; rights of the service users. The second phase will inform the development and evaluation of future interprofessional training resources and identify key performance indicators (KPIs). These KPIs will enable subsequent evaluation and monitoring of practice for all professionals involved in adult support and protection

Proceedings of Abstracts Engineering and Computer Science Research Conference 2019

© 2019 The Author(s). This is an open-access work distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. For further details please see https://creativecommons.org/licenses/by/4.0/. Note: Keynote: Fluorescence visualisation to evaluate effectiveness of personal protective equipment for infection control is © 2019 Crown copyright and so is licensed under the Open Government Licence v3.0. Under this licence users are permitted to copy, publish, distribute and transmit the Information; adapt the Information; exploit the Information commercially and non-commercially for example, by combining it with other Information, or by including it in your own product or application. Where you do any of the above you must acknowledge the source of the Information in your product or application by including or linking to any attribution statement specified by the Information Provider(s) and, where possible, provide a link to this licence: http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/This book is the record of abstracts submitted and accepted for presentation at the Inaugural Engineering and Computer Science Research Conference held 17th April 2019 at the University of Hertfordshire, Hatfield, UK. This conference is a local event aiming at bringing together the research students, staff and eminent external guests to celebrate Engineering and Computer Science Research at the University of Hertfordshire. The ECS Research Conference aims to showcase the broad landscape of research taking place in the School of Engineering and Computer Science. The 2019 conference was articulated around three topical cross-disciplinary themes: Make and Preserve the Future; Connect the People and Cities; and Protect and Care

Biomarkers of coagulation, endothelial function, and fibrinolysis in critically ill patients with COVID-19: A single-center prospective longitudinal study

Background: Immunothrombosis and coagulopathy in the lung microvasculature may lead to lung injury and disease progression in coronavirus disease 2019 (COVID-19). We aim to identify biomarkers of coagulation, endothelial function, and fibrinolysis that are associated with disease severity and may have prognostic potential. Methods: We performed a single-center prospective study of 14 adult COVID-19(+) intensive care unit patients who were age- and sex-matched to 14 COVID-19(−) intensive care unit patients, and healthy controls. Daily blood draws, clinical data, and patient characteristics were collected. Baseline values for 10 biomarkers of interest were compared between the three groups, and visualized using Fisher\u27s linear discriminant function. Linear repeated-measures mixed models were used to screen biomarkers for associations with mortality. Selected biomarkers were further explored and entered into an unsupervised longitudinal clustering machine learning algorithm to identify trends and targets that may be used for future predictive modelling efforts. Results: Elevated D-dimer was the strongest contributor in distinguishing COVID-19 status; however, D-dimer was not associated with survival. Variable selection identified clot lysis time, and antigen levels of soluble thrombomodulin (sTM), plasminogen activator inhibitor-1 (PAI-1), and plasminogen as biomarkers associated with death. Longitudinal multivariate k-means clustering on these biomarkers alone identified two clusters of COVID-19(+) patients: low (30%) and high (100%) mortality groups. Biomarker trajectories that characterized the high mortality cluster were higher clot lysis times (inhibited fibrinolysis), higher sTM and PAI-1 levels, and lower plasminogen levels. Conclusions: Longitudinal trajectories of clot lysis time, sTM, PAI-1, and plasminogen may have predictive ability for mortality in COVID-19

Hyperoxia Avoidance: A Comparison of Prehospital Oxygen Initiated at High Flow versus Titration to Target Range; a Retrospective Cohort Analysis

Problem: Exposure to high flow oxygen for even short periods of time has been independently linked to increased risk of poor patient outcomes. Evidence supports hypothesis that high flow oxygen may do more harm than good. Cognitive link between hyperoxia and related risk is deficient among prehospital providers. Implementation of hyperoxia avoidance education and evidence based updates to Mesa County, Colorado EMS protocol are predicted to improve provider comprehension and compliance, as well as, reduce patient risk for harm. Purpose: The purpose of this study is to evaluate whether informal introduction to hyperoxia avoidance presented to EMS providers in August 2013 resulted in greater number of patients whose prehospital oxygen was titrated to evidence based range versus high flow. The null hypothesis projects there is no difference between pre-and post-group analysis. Methods: A retrospective review of prehospital patient records was performed utilizing comparative data to analyze difference between independent groups in application of evidence based protocol, number of patients titrated to > 96 percent SpO2, and mean of highest recorded SpO2. Results: Analysis resulted no statistically significant difference between pre-and post-groups for initiation of evidence based oxygen guidelines, (p = .0697). Although SpO2 > 96 percent was common in both groups, the post group resulted a reduction in patients titrated to hyperoxia, (p = .024). Sample population mean of high recorded SpO2 was 97.3 percent with mean difference between groups of 0.5 percent, (p < 0.05). Conclusion: Study outcomes substantiate need for hyperoxia focused education within Mesa County Emergency Medical Services, as well as, indication of protocol generalizability. This manuscript will comprehensively discuss identified problem, study protocol, implication for advanced nursing practice, and areas of future study

5-Aryl-2-(naphtha-1-yl)sulfonamido-thiazol-4(5H)-ones as clathrin inhibitors

The development of a (Z)-5-((6,8-dichloro-4-oxo-4H-chromen-3-yl)methylene)-2-thioxothiazolidin-4-one (2), rhodanine-based lead that led to the Pitstop® 2 family of clathrin inhibitors is described herein. Head group substitution and bioisosteric replacement of the rhodanine core with a 2-aminothiazol-4(5H)-one scaffold eliminated off target dynamin activity. A series of N-substituents gave first phenylglycine (20, IC50 ∼ 20 μM) then phenyl (25, IC50 ∼ 7.1 μM) and 1-napthyl sulfonamide (26, Pitstop® 2 compound, IC50 ∼ 1.9 μM) analogues with good activity, validating this approach. A final library exploring the head group resulted in three analogues displaying either slight improvements or comparable activity (33, 38, and 29 with IC50 ∼ 1.4, 1.6 and 1.8 μM respectively) and nine others with IC50 < 10 μM. These results were rationalized using in silico docking studies. Docking studies predicted enhanced Pitstop® 2 family binding, not a loss of binding, within the Pistop® groove of the reported clathrin mutant invalidating recent assumptions of poor selectivity for this family of clathrin inhibitors

An extensive antigenic footprint underpins immunodominant TCR adaptability against a hypervariable viral determinant

Mutations in T cell epitopes are implicated in hepatitis C virus (HCV) persistence and can impinge on vaccine development. We recently demonstrated a narrow bias in the human TCR repertoire targeted at an immunodominant, but highly mutable, HLAB 0801-restricted epitope (HSKKKCDEL [HSK]). To investigate if the narrow TCR repertoire facilitates CTL escape, structural and biophysical studies were undertaken, alongside comprehensive functional analysis of T cells targeted at the natural variants of HLA-B∗0801-HSK in different HCV genotypes and quasispecies. Interestingly, within the TCR-HLA-B∗0801-HSK complex, the TCR contacts all available surface-exposed residues of the HSK determinant. This broad epitope coverage facilitates cross-genotypic reactivity and recognition of common mutations reported in HCV quasispecies, albeit to a varying degree. Certain mutations did abrogate T cell reactivity; however, natural variants comprising these mutations are reportedly rare and transient in nature, presumably due to fitness costs. Overall, despite a narrow bias, the TCR accommodated frequent mutations by acting like a blanket over the hypervariable epitope, thereby providing effective viral immunity. Our findings simultaneously advance the understanding of anti-HCV immunity and indicate the potential for cross-genotype HCV vaccines

Antigen-driven patterns of TCR bias are shared across diverse outcomes of human hepatitis C virus infection

Hepatitis C virus (HCV) infection causes significant morbidity and mortality worldwide. T cells play a central role in HCV clearance; however, there is currently little understanding of whether the disease outcome in HCV infection is influenced by the choice of TCR repertoire. TCR repertoires used against two immunodominant HCV determinants--the highly polymorphic, HLA-B*0801 restricted ¹³⁹⁵HSKKKCDEL¹⁴⁰³ (HSK) and the comparatively conserved, HLA-A*0101-restricted, ¹⁴³⁵ATDALMTGY¹⁴⁴³ (ATD)--were analyzed in clearly defined cohorts of HLA-matched, HCV-infected individuals with persistent infection and HCV clearance. In comparison with ATD, TCR repertoire selected against HSK was more narrowly focused, supporting reports of mutational escape in this epitope, in persistent HCV infection. Notwithstanding the Ag-driven divergence, T cell repertoire selection against either Ag was comparable in subjects with diverse disease outcomes. Biased T cell repertoires were observed early in infection and were evident not only in persistently infected individuals but also in subjects with HCV clearance, suggesting that these are not exclusively characteristic of viral persistence. Comprehensive clonal analysis of Ag-specific T cells revealed widespread use of public TCRs displaying a high degree of predictability in TRBV/TRBJ gene usage, CDR3 length, and amino acid composition. These public TCRs were observed against both ATD and HSK and were shared across diverse disease outcomes. Collectively, these observations indicate that repertoire diversity rather than particular Vβ segments are better associated with HCV persistence/clearance in humans. Notably, many of the anti-HCV TCRs switched TRBV and TRBJ genes around a conserved, N nucleotide-encoded CDR3 core, revealing TCR sequence mosaicism as a potential host mechanism to combat this highly variant virus