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Recently the NHS has expanded the provision of liaison mental health services (LMHS) to ensure that every acute hospital with an emergency department in England has a liaison psychiatry service. Little work has been undertaken to explore first-hand experiences of these services. The aim of this study was to capture service users’ experiences of LMHS in both emergency departments and acute inpatient wards in the UK, with a view to adapt services to better meet the needs of its users.
This cross-sectional internet survey was initially advertised from May-July 2017 using the social media platform Facebook. Due to a paucity of male respondents, it was re-run from November 2017-February 2018, specifically targeting this demographic group. 184 people responded to the survey, of which 147 were service users and 37 were service users’ accompanying partners, friends or family members. The survey featured a structured questionnaire divided into three categories: the profile of the respondent, perceived professionalism of LMHS, and overall opinion of the service. Space was available for free-text comments in each section. Descriptive analysis of quantitative data was undertaken with R statistical software V.3.2.2. Qualitative data from free-text comments were transcribed and interpreted independently by three researchers using framework analysis; familiarisation with the data was followed by identification of a thematic framework, indexing, charting, mapping and interpretation.
Opinions of the service were mixed but predominantly negative. 31% of service users and 27% of their loved ones found their overall contact with LMHS useful. Features most frequently identified as important were the provision of a 24/7 service, assessment by a variety of healthcare professionals and national standardisation of services. Respondents indicated that the least important feature was the provision of a separate service for older people. They also expressed that a desirable LMHS would include faster assessments following referral from the parent team, clearer communication about next steps and greater knowledge of local services and third sector organisations.
Our survey identified mixed responses, however service users and their loved ones perceived LMHS more frequently as negative than positive. This may be attributed to the recent governmental drive to assess, treat and discharge 95% of all patients seen in emergency departments within four hours of initial attendance. Additionally, dissatisfied service users are more likely to volunteer their opinions. The evaluation and adaptation of LMHS should be prioritised to enhance their inherent therapeutic value and improve engagement with treatment and future psychiatric care.
We have found a class of circular radio objects in the Evolutionary Map of the Universe Pilot Survey, using the Australian Square Kilometre Array Pathfinder telescope. The objects appear in radio images as circular edge-brightened discs, about one arcmin diameter, that are unlike other objects previously reported in the literature. We explore several possible mechanisms that might cause these objects, but none seems to be a compelling explanation.
Non-alcoholic fatty liver disease (NAFLD) is an increasing cause of chronic liver disease that accompanies obesity and the metabolic syndrome. Excess fructose consumption can initiate or exacerbate NAFLD in part due to a consequence of impaired hepatic fructose metabolism. Preclinical data emphasized that fructose-induced altered gut microbiome, increased gut permeability, and endotoxemia play an important role in NAFLD, but human studies are sparse. The present study aimed to determine if two weeks of excess fructose consumption significantly alters gut microbiota or permeability in humans.
We performed a pilot double-blind, cross-over, metabolic unit study in 10 subjects with obesity (body mass index [BMI] 30–40 mg/kg/m2). Each arm provided 75 grams of either fructose or glucose added to subjects’ individual diets for 14 days, substituted isocalorically for complex carbohydrates, with a 19-day wash-out period between arms. Total fructose intake provided in the fructose arm of the study totaled a mean of 20.1% of calories. Outcome measures included fecal microbiota distribution, fecal metabolites, intestinal permeability, markers of endotoxemia, and plasma metabolites.
Routine blood, uric acid, liver function, and lipid measurements were unaffected by the fructose intervention. The fecal microbiome (including Akkermansia muciniphilia), fecal metabolites, gut permeability, indices of endotoxemia, gut damage or inflammation, and plasma metabolites were essentially unchanged by either intervention.
In contrast to rodent preclinical findings, excess fructose did not cause changes in the gut microbiome, metabolome, and permeability as well as endotoxemia in humans with obesity fed fructose for 14 days in amounts known to enhance NAFLD.
To assess the contribution of different food groups to total salt purchases and to evaluate the estimated reduction in salt purchases if mandatory maximum salt limits in South African legislation were being complied with.
This study conducted a cross-sectional analysis of purchasing data from Discovery Vitality members. Data were linked to the South African FoodSwitch database to determine the salt content of each food product purchased. Food category and total annual salt purchases were determined by summing salt content (kg) per each unit purchased across a whole year. Reductions in annual salt purchases were estimated by applying legislated maximum limits to product salt content.
The study utilised purchasing data from 344 161 households, members of Discovery Vitality, collected for a whole year between January and December 2018.
Vitality members purchased R12·8 billion worth of food products in 2018, representing 9562 products from which 264 583 kg of salt was purchased. The main contributors to salt purchases were bread and bakery products (23·3 %); meat and meat products (19 %); dairy (12·2 %); sauces, dressings, spreads and dips (11·8 %); and convenience foods (8·7 %). The projected total quantity of salt that would be purchased after implementation of the salt legislation was 250 346 kg, a reduction of 5·4 % from 2018 levels.
A projected reduction in salt purchases of 5·4 % from 2018 levels suggests that meeting the mandatory maximum salt limits in South Africa will make a meaningful contribution to reducing salt purchases.
Late Pleistocene and Early Holocene aeolian deposits in Tasmania are extensive in the present subhumid climate zone but also occur in areas receiving >1000 mm of rain annually. Thermoluminescence, optically stimulated luminescence, and radiocarbon ages indicate that most of the deposits formed during periods of cold climate. Some dunes are remnants of longitudinal desert dunes sourced from now-inundated continental shelves which were previously semi-arid. Others formed near source, often in the form of lunettes east of seasonally-dry lagoons in the previously semi-arid Midlands and southeast of Tasmania, or as accumulations close to floodplains of major rivers, or as sandsheets in exposed areas. Burning of vegetation by the Aboriginal population after 40 ka is likely to have influenced sediment supply. A key site for determining climate variability in southern Tasmania is Maynes Junction which records three periods of aeolian deposition (at ca. 90, 32 and 20 ka), interspersed with periods of hillslope instability. Whether wind speeds were higher than at present during the last glacial period is uncertain, but shells in the Mary Ann Bay sandsheet near Hobart and particle size analysis of the Ainslie dunes in northeast Tasmania suggest stronger winds during the last glacial period than at present.
Human rights are a pillar of the United Nations that emerged as a formative principle of that body in 1945 and that are evident in the Universal Declaration of Human Rights (adopted in 1948) and other subsequent major international instruments affirming the dignity and equality of all. While the United Nations is primarily a stage for member governments to make agreements, non-governmental organizations (NGOs), including those comprised of psychologists, can be accredited by two bodies, namely the Economic and Social Council and the Department of Global Communications, to advocate on behalf of their issues. This chapter presents a historical narrative of more than seventy years of engagement by psychologists who represent such NGOs on issues of human rights and social justice. Five sections cover individual psychologists who pioneered interactions with the United Nations; the varied activities and contexts in which psychologists interact with UN bodies; contributions of selected psychology organizations at the United Nations that have been active in the protection and advancement of human rights; new ways psychologists are collaborating in human rights efforts at the United Nations; and challenges and the way forward for such professionals in their contributions to human rights on the world stage.
We examine shifts in British income inequality and their causes from 1911–1949. Using newly rediscovered Inland Revenue income distribution estimates, we show that Britain had an unusually high concentration of personal incomes in 1911 compared to other industrial nations. We also find that Britain’s substantial inequality reduction over the next four decades was largely driven by a collapse in top capital incomes. This parallels findings for France, the United States, and other western countries, that reduced inequality was mainly caused by declining top unearned incomes, owing to economic shocks, policy responses, and non-market mechanisms associated with the retreat from globalization.
Indigenous health research in Canada has a chequered past and has been identified as problematic and lacking in appropriate collaboration with Indigenous people. The Tri-Council Policy Statement on Ethical Conduct for Research Involving Humans, Chapter 9 describes ethical conduct of research regarding First Nations, Inuit, and Métis Peoples. First Nations Ownership, Control, Access, and Possession (OCAP®) Principles highlight the necessity of Indigenous engagement and governance. To ensure that the aims and activities of the research being developed are in full and meaningful partnership with Indigenous peoples and communities, community-based participatory research (CBPR) methods provide a process in which full engagement is possible. Research utilizing secondary data sets, such as routinely collected health administrative data, should no longer be excluded from this approach. Our aim was to describe how our research team of academic researchers and a national Indigenous health organization adapted CBPR methods in a research project using previously collected data to examine end-of-life health care service delivery gaps for Indigenous people in Ontario. We describe the process of how we developed our research partnership and how grounding principles and Indigenous ways of knowing guided our work together. Through the adaptation of CBPR methods, our research partnership illustrates a process of engagement that can guide others hoping to conduct Indigenous health research using previously collected data. We also present a transparent research agreement negotiated equally by a national Indigenous health organization and research scientists, which can also be used as a framework for others wishing to establish similar research partnerships. Ensuring that Indigenous perspectives are central to and reflected in the research process is essential when using health administrative data.
Commentary on the introduction of the Australian Curriculum (AC) has reflected a tension for educators of students with disabilities (SWD) between in-principle support for a curriculum that is inclusive of all students and the challenge of translating a general framework into relevant, individualised learning experiences appropriate for all SWD. In this paper, we report on findings from the second part of a national online survey in which we explored the perceptions and practices of 151 educators of SWD in specialist settings (special schools, disability units co-located at mainstream schools, special classes within mainstream schools) in relation to the AC. Specifically, these findings relate to the professional learning (PL) experiences and perceived needs of educators of SWD related to the AC and their advice to policymakers about the AC for SWD. Consistent with previous research, participants expressed a preference for PL experiences delivered on site, facilitated by content experts over extended periods, with opportunities for demonstration and targeted feedback, and in the context of collegial learning communities. In addition, participants raised concerns about the extent to which the AC is fully inclusive of all SWD. Implications for policy, practice, and future research are discussed.
Despite aspirations to be a world-class national curriculum, the Australian Curriculum (AC) has been criticised as ‘manifestly deficient’ (Australian Government Department of Education and Training, 2014 p. 5) as an inclusive curriculum, failing to meet the needs of all students with disabilities (SWD) and their teachers. There is a need for research into the daily attempts of educators to navigate the tension between a ‘top-down’ system-wide curriculum and a ‘bottom-up’ regard for individual student needs, with a view to informing both policy and practice. This article is the first of two research papers in which we report the findings from a national online Research in Special Education (RISE) Australian Curriculum Survey of special educators in special schools, classes, and units regarding their experience using the AC to plan for and teach SWD. Survey results indicated (a) inconsistent use of the AC as the primary basis for developing learning objectives and designing learning experiences, (b) infrequent use of the achievement standards to support assessment and reporting, and (c) considerable supplementation of the AC from other resources when educating SWD. Overall, participants expressed a lack of confidence in translating the AC framework into a meaningful curriculum for SWD. Implications for policy, practice, and future research are discussed.
There is limited empirical information on service-level outcome domains and indicators for the large number of people with intellectual disabilities being treated in forensic psychiatric hospitals.
This study identified and developed the domains that should be used to measure treatment outcomes for this population.
A systematic review of the literature highlighted 60 studies which met eligibility criteria; they were synthesised using content analysis. The findings were refined within a consultation and consensus exercises with carers, patients and experts.
The final framework encompassed three a priori superordinate domains: (a) effectiveness, (b) patient safety and (c) patient and carer experience. Within each of these, further sub-domains emerged from our systematic review and consultation exercises. These included severity of clinical symptoms, offending behaviours, reactive and restrictive interventions, quality of life and patient satisfaction.
To index recovery, services need to measure treatment outcomes using this framework.
Urban slums provide suitable conditions for infestation by rats, which harbour and shed a wide diversity of zoonotic pathogens including helminths. We aimed to identify risk factors associated with the probability and intensity of infection of helminths of the digestive tract in an urban slum population of Rattus norvegicus. Among 299 rats, eleven species/groups of helminths were identified, of which Strongyloides sp., Nippostrongylus brasiliensis and, the human pathogen, Angiostrongylus cantonensis were the most frequent (97, 41 and 39%, respectively). Sex interactions highlighted behavioural differences between males and females, as eg males were more likely to be infected with N. brasiliensis where rat signs were present, and males presented more intense infections of Strongyloides sp. Moreover, rats in poor body condition had higher intensities of N. brasiliensis. We describe a high global richness of parasites in R. norvegicus, including five species known to cause disease in humans. Among these, A. cantonensis was found in high prevalence and it was ubiquitous in the study area – knowledge which is of public health importance. A variety of environmental, demographic and body condition variables were associated with helminth species infection of rats, suggesting a comparable variety of risk factors for humans.
Particle Image Velocimetry (PIV) has been used to study the complex flowfield created by simulated battle damage to a two-dimensional wing. Computational Fluid Dynamics (CFD) predictions have also been used for validation of internal cavity flow. Two damage cases were selected for the study; both cases were simulated using a single hole with diameters equal to 20% and 40% of the chord, located at the wing half-chord. Wind-tunnel tests were conducted at a Reynolds number of 500,000 over a range of incidences from 0 to 10° with two-component PIV measurements made on three chordwise and three spanwise planes. The PIV data were analysed and compared to CFD data of the same damage cases. The PIV data have shown lower velocity ratios and lower vorticity in the jet compared to past Jet in Cross-Flow experiments and CFD was used to describe the flow features inside the cavity of the wing. It was seen that the wing cavity has large effects on the external flow features, particularly for the 20% damage case. Finally, the flow field data have been related to force balance data. At higher incidence angles, the larger force coefficient increments in both lift and drag can be attributed to the larger wakes and higher jet strengths.
We describe the design and performance of the Engineering Development Array, which is a low-frequency radio telescope comprising 256 dual-polarisation dipole antennas working as a phased array. The Engineering Development Array was conceived of, developed, and deployed in just 18 months via re-use of Square Kilometre Array precursor technology and expertise, specifically from the Murchison Widefield Array radio telescope. Using drift scans and a model for the sky brightness temperature at low frequencies, we have derived the Engineering Development Array’s receiver temperature as a function of frequency. The Engineering Development Array is shown to be sky-noise limited over most of the frequency range measured between 60 and 240 MHz. By using the Engineering Development Array in interferometric mode with the Murchison Widefield Array, we used calibrated visibilities to measure the absolute sensitivity of the array. The measured array sensitivity matches very well with a model based on the array layout and measured receiver temperature. The results demonstrate the practicality and feasibility of using Murchison Widefield Array-style precursor technology for Square Kilometre Array-scale stations. The modular architecture of the Engineering Development Array allows upgrades to the array to be rolled out in a staged approach. Future improvements to the Engineering Development Array include replacing the second stage beamformer with a fully digital system, and to transition to using RF-over-fibre for the signal output from first stage beamformers.
We examine a classic “wheel of retailing” episode: the abandonment of the five-and-dime pricing formula by American variety chains. The variety chains switched from a conventional product lifecycle, focusing on cost reduction through standardization, to a reverse path up the “service cost–unit value” continuum. We show that, rather than reflecting deteriorating managerial acumen, this shift was a response to the continued imperative for growth following retail format saturation. Firm-specific (rather than format-specific) competitive advantages were too weak for any chain to be confident it could win a within-format price war, making interformat competition through raising price points more attractive.
Since the War and particularly during the last ten years there has been a revolution in the chief factors governing retail trade. The balance of spending power has moved swiftly from one class to another, improved social services and increased wages have brought millions of people into the orbit of the retailer's influence whose standard of living was formerly so low that except for foodstuffs they were of little importance … ‘Fashion’ is now the keynote of appeal and knows no barriers either of class, age, or sex. Mass production of many fashion articles at extremely moderate prices has been developed to meet the ever-widening market for these goods and new forms of distribution to handle them.
Francesca's later work focused on how consumer goods with fashion and status connotations were made available to progressively wider sections of the population; the resulting impacts on class differentials in lifestyles and consumption patterns; and the mediation of these processes between producers, retailers and consumers. This chapter explores these themes in the context of the expansion of mass retailers in Britain during the 1920s and 1930s.
The above quotation by Frank Chitham (a director of Harrods) sums up the profound changes in the relationship between the leaders of the retail trade and the mass of the British people over the quarter century after 1914. On the eve of the First World War working-class families had remained sharply segregated from the rest of society, not only in their work and housing, but in their access to such mundane ‘public’ spaces as shops and places of refreshment. This segregation was sometimes overt, such as the intimidating presence of the floor-walker at the entrance to the department store – one of whose principal tasks was to keep out ‘undesirables’. More commonly it was invisible, but no less effective, operating through such subtle screening mechanisms as the need to negotiate any purchase with the sales clerk and without being able to physically view all goods stocked, or knowing their prices. Even the outward appearance of a ‘middle class’ emporium was usually enough to signal which sections of society were, and were not, welcome.
We examine the early marketing and distribution of entertainment radio sets. Manufacturers used distribution networks to both maximize profits and create barriers to entry. Lacking the market power of auto manufacturers, they developed cooperative strategies with authorized distributors and dealers. Dealers often complained about the costly activities manufacturers required of them. However, these underpinned the dominant quality and branding competition model of the 1920s, while the Depression-era switch to a simpler radio format, sold on price, proved catastrophic for the specialist retailer.