Alcohol and injuries in the accident and emergency department: a national perspective.

The purpose of this study was to examine the role of alcohol and injuries, with a specific focus in the A & E Departments in acute hospitals. The six hospitals were selected to achieve a wide geographic and demographic distribution across the country - Mater Misercordiae University Hospital in Dublin , Beaumont Hospital in Dublin, University College Hospital Galway, Sligo General Hospital, Letterkenny General Hospital and Waterford Regional Hospital. Data was collected using a standard 25 minute questionnaire, which included the type and cause of the presenting injury, drinking in the six hours prior to the injury, quantity and frequency of usual drinking habits, frequency of high consumption times during the last year, indicators of alcohol problems and alcohol dependency and demographic characteristics

The outcomes of secure care in Scotland

This paper describes the findings of a three year study of the use and effectiveness of secure accommodation in Scotland. Data were collected on 53 young people shortly after their admission to secure accommodation. Most young people were admitted because they were a danger to themselves and/or they were likely to abscond; a third were considered a danger to others. Secure accommodation was considered to have benefits in relation to keeping young people safe and addressing health issues. On other dimensions, such as behaviour or family relationships, signs of benefit were more ambiguous. Thirty-three young people were considered to have clearly benefited from placement. At follow-up, after two years, outcomes were assessed as: 'good' - 14 (26%); 'medium'- 24 (45 %); and 'poor' - 15 (28%). The research highlighted the importance of effectively managing the transition from secure care. Social workers attributed a good outcome more to an appropriate placement and education being offered when the young person left secure rather than simply the placement itself. A gradual 'step-down' approach from the structure and supervision of the secure setting was also linked to better outcomes. Young people respond well when offered continuity and the opportunity to develop relationships with one or more reliable adults who can help with problems as they arise

Secure Accommodation in Scotland: Its Role and Relationship with ‘Alternative’ Services - Summary

This research was carried out between November 2002 - 2005 to increase understanding of the use and effectiveness of secure accommodation in relation to young people placed on the authority of a children's hearing. It also examined the circumstances in which open residential or community-based services might provide an ‘alternative' to secure placement

After the reforms: An analysis of the factors associated with the use of legal services in child welfare proceedings in Ireland

Against the backdrop of austerity measures and public sector reforms in Ireland, this paper examined legal costs incurred in child welfare proceedings by the State Child and Family Agency - Tusla, using a need-based allocation model. The direct financial costs of engaging with legal services, necessitated by the adversarial nature of child welfare proceedings, were scrutinized to determine if resources were allocated based on need. Adopting a cross-sectional research design, secondary data (obtained from the organization’s financial billing system. n =1032) were employed in an econometric analysis examining the factors influencing variations in Tusla’s legal expenditure. The dependent variable was total amount billed by legal firm per observation and the independent variables included type of legal activity involved (a proxy for need), geographical location and type of legal personnel (supply factor). Type of legal personnel, volume and type of legal activity have significant positive effects on legal spend. Administrative area does not significantly affect spending on legal services. We found that engagement with legal services, demanded by the adversarial nature of child welfare proceedings, has considerable cost implications; however, does seem to be allocated on the basis of need. The findings can be employed to increase the organization’s awareness of costs

Analysis of Campylobacter jejuni infection in the gnotobiotic piglet and genome-wide identification of bacterial factors required for infection

To investigate how Campylobacter jejuni causes the clinical symptoms of diarrhoeal disease in humans,use of a relevant animal model is essential. Such a model should mimic the human disease closely in terms of host physiology, incubation period before onset of disease, clinical signs and a comparable outcome of disease. In this study, we used a gnotobiotic piglet model to study determinants of pathogenicity of C. jejuni. In this model, C. jejuni successfully established infection and piglets developed an increased temperature with watery diarrhoea, which was caused by a leaky epithelium and reduced bile re-absorption in the intestines. Further, we assessed the C. jejuni genes required for infection of the porcine gastrointestinal tract utilising a transposon (Tn) mutant library screen. A total of 123 genes of which Tn mutants showed attenuated piglet infection were identified. Our screen highlighted a crucial role for motility and chemotaxis, as well as central metabolism. In addition, Tn mutants of 14 genes displayed enhanced piglet infection. This study gives a unique insight into themechanisms of C. jejuni disease in terms of host physiology and contributing bacterial factors

Walking groups for women with breast cancer: mobilising therapeutic assemblages of walk, talk and place

Walking is widely accepted as a safe and effective method of promoting rehabilitation and a return to physical activity after a cancer diagnosis. Little research has considered the therapeutic qualities of landscape in relation to understanding women’s recovery from breast cancer, and no study has considered the supportive and therapeutic benefits that walking groups might contribute to their wellbeing. Through a study of a volunteer-led walking group intervention for women living with and beyond breast cancer (Best Foot Forward) we address this gap. A mixed-methods design was used including questionnaires with walkers (n=35) and walk leaders (n=13); telephone interviews with walkers (n=4) and walk leaders (n=13); and walking interviews conducted outdoors and on the move with walkers (n=15) and walk leaders (n=4). Questionnaires were analysed descriptively. Interviews were audio-recorded, transcribed verbatim, and analysed thematically. Our study found that the combination of walking and talking enabled conversations to roam freely between topics and individuals, encouraging everyday and cancer-related conversation that created a form of ‘shoulder-to-shoulder support’ that might not occur in sedentary supportive care settings. Walking interviews pointed to three facets of the outdoor landscape – as un/natural, dis/placed and im/mobile – that walkers felt imbued it with therapeutic qualities. ‘Shoulder-to-shoulder support’ was therefore found to be contingent on the therapeutic assemblage of place, walk and talk. Thus, beyond the physical benefits that walking brings, it is the complex assemblage of walking and talking in combination with the fluid navigation between multiple spaces that mobilises a therapeutic assemblage that promotes wellbeing in people living with and beyond breast cancer

In vivo laboratory practicals in research-led teaching: An example using glucose tolerance tests in lean and obese mice

The use of animal models is an essential part of medical research and drug development. The essential skills required to be able to do such research includes experimental design, statistical analysis and the actual handling and treating of the animals (in vivo skills). The number of students in the U.K. receiving training in handling and experimenting on animals has declined rapidly in the last few decades which has led to initiatives to increase numbers of students with these skills to meet demand. Within the Department of Pharmacology and Therapeutics at King's College London, we run a course for 2nd year undergraduates entitled “Animal models of disease and injury”. This course not only covers the theoretical and ethical aspects of using animals in research, but also contains practical laboratory classes in which students get hands-on experience using animals. One of the laboratory classes we run is a glucose tolerance test in obese and lean mice. This is an example of research-led teaching which aims to develop research skills through engaging students in research like activities. In this paper, we outline the methodology of the glucose tolerance practical and highlight some of the skills we and the students think they gain by research-led teaching such as this

A segmental approach from molecular profiling to medical imaging to study bicuspid aortic valve aortopathy

Bicuspid aortic valve (BAV) patients develop ascending aortic (AAo) dilation. The pathogenesis of BAV aortopathy (genetic vs. haemodynamic) remains unclear. This study aims to identify regional changes around the AAo wall in BAV patients with aortopathy, integrating molecular data and clinical imaging. BAV patients with aortopathy (n = 15) were prospectively recruited to surgically collect aortic tissue and measure molecular markers across the AAo circumference. Dilated (anterior/right) vs. non-dilated (posterior/left) circumferential segments were profiled for whole-genomic microRNAs (next-generation RNA sequencing, miRCURY LNA PCR), protein content (tandem mass spectrometry), and elastin fragmentation and degeneration (histomorphometric analysis). Integrated bioinformatic analyses of RNA sequencing and proteomic datasets identified five microRNAs (miR-128-3p, miR-210-3p, miR-150-5p, miR-199b-5p, and miR-21-5p) differentially expressed across the AAo circumference. Among them, three miRNAs (miR-128-3p, miR-150-5p, and miR-199b-5p) were predicted to have an effect on eight common target genes, whose expression was dysregulated, according to proteomic analyses, and involved in the vascular-endothelial growth-factor signalling, Hippo signalling, and arachidonic acid pathways. Decreased elastic fibre levels and elastic layer thickness were observed in the dilated segments. Additionally, in a subset of patients n = 6/15, a four-dimensional cardiac magnetic resonance (CMR) scan was performed. Interestingly, an increase in wall shear stress (WSS) was observed at the anterior/right wall segments, concomitantly with the differentially expressed miRNAs and decreased elastic fibres. This study identified new miRNAs involved in the BAV aortic wall and revealed the concomitant expressional dysregulation of miRNAs, proteins, and elastic fibres on the anterior/right wall in dilated BAV patients, corresponding to regions of elevated WSS

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

‘It Means We are Not Safe’: Understanding and Learning from Household Experiences of Water Scarcity, Flood and Fire in Marginalized Settlements in the Cape Flats, South Africa

As climate change-related extreme weather events such as flooding and droughts increase in frequency and severity in most cities worldwide, there is a need to deepen understanding of disaster risks and adaptive capacities. A significant percentage of the urban population in most low- and middle-income countries live in informal settlements. Due to poor quality housing, dense settlement patterns and lack of risk reducing infrastructure e.g., drainage systems, informal settlements have been identified as being least prepared and at higher risk for climate change issues and therefore serve as important sites for understanding these risks and capacities. Marginalized communities in settlements in the Cape Flats region of South Africa face a range of environmental hazards including recurrent large-scale fires, localised flooding and water supply shortages. This paper presents findings from a household survey with 600 participants from three economically marginalised township settlements in this region. The aim of the survey was to understand the lived experiences, coping mechanisms and resilience attributes of the residents faced with localised flooding, fires and water shortages – locally salient environmental risks and hazards. The paper explores how different forms of capital come into play in the shaping of these experiences and responses and uses these to consider power structures and the creation of particular types of habitus amongst settlement residents. Insights from this study further enhance knowledge of community resilience that could potentially inform policy development and institutional disaster risk reduction strategies for climate change resilience of cities in low- and middle-income countries