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9 results

  • Practical guide to climate change for general insurance practitioners

  • M. Rothwell, M. Earle, C. H. Ooi, J. Orr, S. Shroff, J. Siew
  • Journal:
    British Actuarial Journal / Volume 25 / 2020
    Published online by Cambridge University Press:
    01 January 2020, e18
    • Article
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  • Climate change is one of the biggest challenges facing the world. Scientific research points out that it is predominately driven by human activity. There are three different types of risks that arise from this change. These have been broadly grouped into physical, transition and liability risks. These risks can impact general insurers to different degrees, depending on their business areas and investment strategies. These may pose different strategic, investment, market, operational and reputational risks. This paper provides General Insurance Practitioners with an overview of different aspects of insurance operations that may be affected by climate change. It highlights the impact of these risks on pricing and underwriting, reserving, reinsurance, catastrophe modelling, investment, risk management and capital management processes.

  • Multidimensional Treatment Foster Care for Adolescents in English care: randomised trial and observational cohort evaluation

  • J. M. Green, N. Biehal, C. Roberts, J. Dixon, C. Kay, E. Parry, J. Rothwell, A. Roby, D. Kapadia, S. Scott, I. Sinclair
  • Journal:
    The British Journal of Psychiatry / Volume 204 / Issue 3 / March 2014
    Published online by Cambridge University Press:
    02 January 2018, pp. 214-221
    Print publication:
    March 2014
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  • Background

    Children in care often have poor outcomes. There is a lack of evaluative research into intervention options.

    Aims

    To examine the efficacy of Multidimensional Treatment Foster Care for Adolescents (MTFC-A) compared with usual care for young people at risk in foster care in England.

    Method

    A two-arm single (assessor) blinded randomised controlled trial (RCT) embedded within an observational quasi-experimental case–control study involving 219 young people aged 11–16 years (trial registration: ISRCTN 68038570). The primary outcome was the Child Global Assessment Scale (CGAS). Secondary outcomes were ratings of educational attendance, achievement and rate of offending.

    Results

    The MTFC-A group showed a non-significant improvement in CGAS outcome in both the randomised cohort (n = 34, adjusted mean difference 1.3, 95% CI −7.1 to 9.7, P = 0.75) and in the trimmed observational cohort (n = 185, adjusted mean difference 0.95, 95% CI −2.38 to 4.29, P = 0.57). No significant effects were seen in secondary outcomes. There was a possible differential effect of the intervention according to antisocial behaviour.

    Conclusions

    There was no evidence that the use of MTFC-A resulted in better outcomes than usual care. The intervention may be more beneficial for young people with antisocial behaviour but less beneficial than usual treatment for those without.

  • 20 - Sites and mechanisms of IL-1 action in ischemic and excitotoxic brain damage

  • from Part VI - Inflammation
    • By Stuart M. Allan, School of Biological Sciences, University of Manchester, Manchester, England, Robert I. Grundy, School of Biological Sciences, University of Manchester, Manchester, England, Lisa C. Parker, School of Biological Sciences, University of Manchester, Manchester, England, Nancy J. Rothwell, School of Biological Sciences, University of Manchester, Manchester, England
  • Edited by Pak H. Chan, Stanford University, California
  • Book:
    Cerebrovascular Disease
    Published online:
    02 November 2009
    Print publication:
    28 March 2002, pp 237-246

  • Summary

    Cytokines and ischemic brain damage

    Cytokines are polypeptides that include the families of interleukins (IL-1), tumor necrosis factors (TNF), interferons and growth factors with diverse actions on development, inflammation, tissue injury and repair in almost all cells in the body. The past decade has witnessed increasing interest in the functions and importance of cytokines in central nervous system biology and pathology.

    Most cytokines are produced at low levels in healthy adult brains, but many are upregulated rapidly in response to injury, infection or inflammation in the brain including cerebral ischemia. The influence of cytokines on ischemic brain damage appears to be diverse and complex. While several cytokines have clearly identified neurotrophic or neuroprotective effects (e.g., IL-6, insulin-like growth factor (IGF), nerve growth factor (NGF), fibroblast growth factor (FGF), transforming growth factor-β (TGF-β)), others have been implicated as mediators of cell damage (most notably IL-1), while for some (such as TNF-α) both neuroprotective and neurotoxic effects have been identified. This review will focus on the actions of IL-1 on ischemic brain damage and recent findings about its mechanisms of action.

    IL-1 expression in stroke

    IL-1, IL-1α and IL-1β, and IL-1 receptor antagonist (IL-1ra) are all rapidly produced in response to experimental stroke and excitotoxic and traumatic brain injury in rodents. Temporal studies on expression indicate that IL-1β is produced most extensively and rapidly, initially by microglia and meningeal macrophages and later by astrocytes and invading immune cells.

  • Reliability of the Salford Needs Assessment Schedule for Adolescents

  • L. KROLL, A. WOODHAM, J. ROTHWELL, S. BAILEY, C. TOBIAS, R. HARRINGTON, M. MARSHALL
  • Journal:
    Psychological Medicine / Volume 29 / Issue 4 / July 1999
    Published online by Cambridge University Press:
    01 July 1999, pp. 891-902
    Print publication:
    July 1999

  • Background. For adolescents, there is no specific needs assessment instrument that assesses significant problems that can benefit from specified interventions. A new instrument (S.NASA) was developed by incorporating and adapting three well established adult needs assessment instruments. The S.NASA covers 21 areas of functioning including social, psychiatric, educational and life skills.

    Method. Client and carer interviews were conducted by different researchers. A week later the interviews were repeated using a crossover design. Significant (cardinal) problems were generated from the clinical interviews using a pre-defined algorithm. Final need status (three categories) was made by clinicians assessing the cardinal problems against defined interventions. The interventions were generated from discussions with clinicians and a survey of appropriate professionals working with adolescents.

    Results. Pre-piloting led to the final version being administered to 40 adolescents from secure units, forensic psychiatric and adolescent psychiatric services. There were 25 males and 15 females, mean age 15·5 years. Overall there were moderate to good inter-rater and test–retest reliability coefficients, the test–retest reliability coefficients for the total scores on the needs assessment interviews ranged from 0·73 to 0·85. Consensual and face validity was good, the adolescents and staff finding the instrument useful and helpful.

    Conclusions. This new needs assessment instrument shows acceptable psychometric properties. It should be of use in research projects assessing the needs and the provision of services for adolescents with complex and chronic problems.