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Many male prisoners have significant mental health problems, including anxiety and depression. High proportions struggle with homelessness and substance misuse.
This study aims to evaluate whether the Engager intervention improves mental health outcomes following release.
The design is a parallel randomised superiority trial that was conducted in the North West and South West of England (ISRCTN11707331). Men serving a prison sentence of 2 years or less were individually allocated 1:1 to either the intervention (Engager plus usual care) or usual care alone. Engager included psychological and practical support in prison, on release and for 3–5 months in the community. The primary outcome was the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), 6 months after release. Primary analysis compared groups based on intention-to-treat (ITT).
In total, 280 men were randomised out of the 396 who were potentially eligible and agreed to participate; 105 did not meet the mental health inclusion criteria. There was no mean difference in the ITT complete case analysis between groups (92 in each arm) for change in the CORE-OM score (1.1, 95% CI –1.1 to 3.2, P = 0.325) or secondary analyses. There were no consistent clinically significant between-group differences for secondary outcomes. Full delivery was not achieved, with 77% (108/140) receiving community-based contact.
Engager is the first trial of a collaborative care intervention adapted for prison leavers. The intervention was not shown to be effective using standard outcome measures. Further testing of different support strategies for prison with mental health problems is needed.
Previously, we showed that disinfection of sink drains is effective at decreasing bacterial loads. Here, we report our evaluation of the ideal frequency of sink-drain disinfection and our comparison of 2 different hydrogen peroxide disinfectants.
For over 120 years, the shell middens of western Scotland and the series of open-air sites on Oronsay have been the focus of debate in European Mesolithic studies. This paper challenges the significance of Oronsay in light of results from the geophysical survey and test-excavation of a new limpet and periwinkle shell midden dated to the late 5th or start of the 4th millennium cal bc at Port Lobh, Colonsay that offers fresh evidence to re-evaluate critically the role of Oronsay and coastal resources in island settlement models ahead of the Mesolithic–Neolithic transition. Test excavations recovered a marine molluscan assemblage dominated by limpet and periwinkle shells together with crab, sea urchin, a fishbone assemblage composed mainly of Gadidae, some identifiable bird and mammal bone, carbonised macroplant remains, and pumice as well as a bipolar lithic assemblage and coarse stone implements. Novel seasonality studies of saithe otolith thin-sections suggest wintertime tidal fishing practices. At least two activity events may be discerned, dating from the late 5th millennium cal bc. The midden could represent a small number of rapidly deposited assemblages or maybe the result of stocastic events within a more extended timeframe. We argue that alternative research questions are needed to advance long-standing debates about seasonal inter-island mobility versus island sedentism that look beyond Oronsay to better understand later Mesolithic occupation patterns and the formation and date of Oronsay middens. We propose alternative methodological strategies to aid identification of contemporaneous sites using geophysical techniques and lithic technological signatures.
Describe the epidemiological and molecular characteristics of an outbreak of Klebsiella pneumoniae carbapenemase (KPC)–producing organisms and the novel use of a cohorting unit for its control.
A 566-room academic teaching facility in Milwaukee, Wisconsin.
Solid-organ transplant recipients.
Infection control bundles were used throughout the time of observation. All KPC cases were intermittently housed in a cohorting unit with dedicated nurses and nursing aids. The rooms used in the cohorting unit had anterooms where clean supplies and linens were placed. Spread of KPC-producing organisms was determined using rectal surveillance cultures on admission and weekly thereafter among all consecutive patients admitted to the involved units. KPC-positive strains underwent pulsed-field gel electrophoresis and whole-genome sequencing.
A total of 8 KPC cases (5 identified by surveillance) were identified from April 2016 to April 2017. After the index patient, 3 patients acquired KPC-producing organisms despite implementation of an infection control bundle. This prompted the use of a cohorting unit, which immediately halted transmission, and the single remaining KPC case was transferred out of the cohorting unit. However, additional KPC cases were identified within 2 months. Once the cohorting unit was reopened, no additional KPC cases occurred. The KPC-positive species identified during this outbreak included Klebsiella pneumoniae, Enterobacter cloacae complex, and Escherichia coli. blaKPC was identified on at least 2 plasmid backbones.
A complex KPC outbreak involving both clonal and plasmid-mediated dissemination was controlled using weekly surveillances and a cohorting unit.
We examined if and when English-learning 17-month-olds would accommodate Japanese forms as labels for novel objects. In Experiment 1, infants (n = 22) who were habituated to Japanese word–object pairs looked longer at switched test pairs than familiar test pairs, suggesting that they had mapped Japanese word forms to objects. In Experiments 2 (n = 44) and 3 (n = 22), infants were presented with a spoken passage prior to habituation to assess whether experience with a different language would shift their perception of Japanese word forms. Here, infants did not demonstrate learning of Japanese word–object pairs. These findings offer insight into the flexibility of the developing perceptual system. That is, when there is no evidence to the contrary, 17-month-olds will accommodate forms that vary from their typical input but will efficiently constrain their perception when cued to the fact that they are not listening to their native language.
In 2018, the Clostridium difficile LabID event methodology changed so that hospitals doing 2-step tests, nucleic acid amplification test (NAAT) plus enzyme immunofluorescence assay (EIA), had their adjustment modified to EIA-based tests, and only positive final tests (eg, EIA) were counted in the numerator. We report the immediate impact of this methodological change at 3 Milwaukee hospitals.
Little is known about what motivates people to enroll in research registries. The purpose of this study is to identify facilitators of registry enrollment among diverse older adults.
Participants completed an 18-item Research Interest Assessment Tool. We used logistic regression analyses to examine responses across participants and by race and gender.
Participants (N=374) were 58% black, 76% women, with a mean age of 68.2 years. All participants were motivated to maintain their memory while aging. Facilitators of registry enrolled varied by both race and gender. Notably, blacks (estimate=0.71, p<0.0001) and women (estimate=0.32, p=0.03) were more willing to enroll in the registry due to home visits compared with whites and men, respectively.
Researchers must consider participant desire for maintaining memory while aging and home visits when designing culturally tailored registries.
The burden of tuberculosis (TB) among adolescents and young adults in endemic settings is poorly characterised. This study aimed to review published and unpublished estimates of the incidence and prevalence of bacteriologically confirmed TB among young people aged 10–24 years. We searched PubMed and World Health Organization archives for publications and unpublished data from population-based epidemiologic studies reporting confirmed pulmonary TB among young people, conducted from January 2000 onwards. We identified 27 publications and unpublished data from two national surveys, representing a total of 26 studies in 19 countries. The prevalence of bacteriologically confirmed TB ranged from 45 to 799 per 100 000 in the Asia-Pacific region and from 160 to 462 per 100 000 in African settings. We did not identify any epidemiologic studies of confirmed TB among adolescents living with human immunodeficiency virus (HIV). Many studies were excluded due to absent or inadequately reported age-specific data. Adolescents and young adults living in many endemic settings appear to be at substantial risk of developing active TB. There is a pressing need to improve the routine reporting of age in epidemiologic studies of TB, and to generate high-quality epidemiologic data regarding TB among adolescents living with HIV.
Speech disfluencies can guide the ways in which listeners interpret spoken language. Here, we examined whether three-year-olds, five-year-olds, and adults use filled pauses to anticipate that a speaker is likely to refer to a novel object. Across three experiments, participants were presented with pairs of novel and familiar objects and heard a speaker refer to one of the objects using a fluent (“Look at the ball/lep!”) or disfluent (“Look at thee uh ball/lep!”) expression. The salience of the speaker's unfamiliarity with the novel referents, and the way in which the speaker referred to the novel referents (i.e., a noun vs. a description) varied across experiments. Three- and five-year-olds successfully identified familiar and novel targets, but only adults’ looking patterns reflected increased looks to novel objects in the presence of a disfluency. Together, these findings demonstrate that adults, but not young children, use filled pauses to anticipate reference to novel objects.
Patrick Griffin, University of Melbourne,
Narelle English, Research Fellow, lecturer in assessment and doctoral candidate at the Assessment Research Centre, University of Melbourne.,
Nives Nibali, teacher and researcher currently working on a PhD and on the ‘Realising the Potential of Australia's High Capacity Students’ Project.,
Susan-Marie Harding, Research Fellow at the Assessment Research Centre, University of Melbourne.,
Lorraine Graham, Professor of Learning Intervention at the Melbourne Graduate School of Education, University of Melbourne.
• understand the importance of self-regulation for both teacher and student
• use evidence of learning to assess and support SRL strategies.
This chapter introduces the concept of student self-regulated learning (SRL). It is included in this book about assessment for teaching because the student must be part-teacher and part-student. It is also included because the rubrics written using the approach in this book complement students’ SRL skills by articulating the competencies they need to assess, monitor and reflect on in their learning. The teacher also has to be part-student. The role of the teacher is less of a transmitter and more of a co-facilitator. The teacher, using the approach of this book and understanding the elements of SRL presented in this chapter, can help the student to take a more active role in SRL. The student becomes dependent on self-assessment and on assessing peers in collaborative arrangements. Now the teacher has two roles: one in facilitating learning and the other in helping students understand the self-assessments that will govern the development of their SRL competency.
In earlier chapters of this book we described assessment as the search for evidence of learning. In normal circumstances the search tends to be conducted or managed by the teacher. Student self-assessment may also be defined as students’ search for evidence of their own learning. But is it a search? Do students understand how to produce evidence of what they are learning? How do teachers and students work together to identify learning outcomes, the strategies that lead to those outcomes, and the evidence of having reached or attained those outcomes? Increasingly the role of the teacher is changing, from transmitter to more a facilitator of knowledge.
In this book we emphasise the role of developmental teaching and learning and assessment as key in dealing with the phenomenon of SRL. Both the teacher and the student can follow the student's growth and development if the road map is clear. This is discussed extensively in Chapter 10. For now, we will focus on the ideas of developmental teaching and learning where both the teacher and the student need to understand the developmental pathway the student is following.
Maternal vitamin B12 (B12) status has been inversely associated with adverse pregnancy outcomes and positively with fetal growth and infant development. South Asians, Canada’s largest ethnic minority, are prone to B12 deficiency. Yet, data are lacking on B12 status in South Asian pregnant women in North America. We sought to determine B12 status, using multiple biomarkers, in 1st and 2nd trimester pregnant women of South Asian and, for comparison, European ethnicity living in Vancouver, Canada. In this retrospective cohort study, total B12, holotranscobalamin (holoTC), methylmalonic acid (MMA), and total homocysteine concentrations were quantified in two routinely collected (mean gestational week: 11·5 (range 8·3–13·9) and 16·5 (range 14·9–20·9)), banked serum samples of 748 healthy pregnant South Asian (n 371) and European (n 377) women. South Asian pregnant women had significantly lower B12 status than European pregnant women at both time points, as indicated by lower serum total B12 and holoTC concentrations, and higher MMA concentrations (all P≤0·001). The largest difference, which was substantial (Cohen’s d≥0·5), was observed in mean serum total B12 concentrations (1st trimester: 189 (95 % CI 180, 199) v. 246 (95 % CI 236, 257) pmol/l; 2nd trimester: 176 (95 % CI 168, 185) v. 226 (95 % CI 216, 236) pmol/l). Further, South Asian ethnicity was a significant negative predictor of B12 status during pregnancy. South Asian women living in Vancouver have substantially lower B12 status during early pregnancy. Future research identifying predictors and health consequences of this observed difference is needed to allow for targeted interventions.
Regulatory impact analyses (RIAs) weigh the benefits of regulations against the burdens they impose and are invaluable tools for informing decision makers. We offer 10 tips for nonspecialist policymakers and interested stakeholders who will be reading RIAs as consumers.
1. Core problem: Determine whether the RIA identifies the core problem (compelling public need) the regulation is intended to address.
2. Alternatives: Look for an objective, policy-neutral evaluation of the relative merits of reasonable alternatives.
3. Baseline: Check whether the RIA presents a reasonable “counterfactual” against which benefits and costs are measured.
4. Increments: Evaluate whether totals and averages obscure relevant distinctions and trade-offs.
5. Uncertainty: Recognize that all estimates involve uncertainty, and ask what effect key assumptions, data, and models have on those estimates.
6. Transparency: Look for transparency and objectivity of analytical inputs.
7. Benefits: Examine how projected benefits relate to stated objectives.
8. Costs: Understand what costs are included.
9. Distribution: Consider how benefits and costs are distributed.
10. Symmetrical treatment: Ensure that benefits and costs are presented symmetrically.
Substantial policy, communication and operational gaps exist between mental health services and the police for individuals with enduring mental health needs.
To map and cost pathways through mental health and police services, and to model the cost impact of implementing key policy recommendations.
Within a case-linkage study, we estimated 1-year individual-level healthcare and policing costs. Using decision modelling, we then estimated the potential impact on costs of three recommended service enhancements: street triage, Mental Health Act assessments for all Section 136 detainees and outreach custody link workers.
Under current care, average 1-year mental health and police costs were £10 812 and £4552 per individual respectively (n = 55). The cost per police incident was £522. Models suggested that each service enhancement would alter per incident costs by between −8% and +6%.
Recommended enhancements to care pathways only marginally increase individual-level costs.
When linguistic information alone does not clarify a speaker's intended meaning, skilled communicators can draw on a variety of cues to infer communicative intent. In this paper, we review research examining the developmental emergence of preschoolers’ sensitivity to a communicative partner's perspective. We focus particularly on preschoolers’ tendency to use cues both within the communicative context (i.e. a speaker's visual access to information) and within the speech signal itself (i.e. emotional prosody) to make on-line inferences about communicative intent. Our review demonstrates that preschoolers’ ability to use visual and emotional cues of perspective to guide language interpretation is not uniform across tasks, is sometimes related to theory of mind and executive function skills, and, at certain points of development, is only revealed by implicit measures of language processing.
We investigated 16- and 20-month-olds' flexibility in mapping phonotactically illegal words to objects. Using an associative word-learning task, infants were presented with a training phase that either highlighted or did not highlight the referential status of a novel label. Infants were then habituated to two novel objects, each paired with a phonotactically illegal Czech word. When referential cues were provided, 16-, but not 20-month-olds, formed word–object mappings. In the absence of referential cues, infants of both ages failed to map the novel words. These findings illustrate the complex interplay between infants' developing sound system and their word learning abilities.
The effects of fish oil (FO) supplementation on glycaemic control are unclear, and positive effects may occur only when the phospholipid content of tissue membranes exceeds 14 % as n-3 PUFA. Subjects (n 36, thirty-three completed) were paired based on metabolic parameters and allocated into a parallel double-blind randomised trial with one of each pair offered daily either 6 g of FO (3·9 g n-3 PUFA) or 6 g of maize oil (MO) for 9 months. Hyperinsulinaemic–euglycaemic–euaminoacidaemic (HIEGEAA) clamps (with [6,6 2H2 glucose]) were performed at the start and end of the intervention. Endogenous glucose production (EGP) and whole-body protein turnover (WBPT) were each measured after an overnight fast. The primary outcome involved the effect of oil type on insulin sensitivity related to glycaemic control. The secondary outcome involved the effect of oil type on WBPT. Subjects on FO (n 16) had increased erythrocyte n-3 PUFA concentrations >14 %, whereas subjects on MO (n 17) had unaltered n-3 PUFA concentrations at 9 %. Type of oil had no effect on fasting EGP, insulin sensitivity or total glucose disposal during the HIEGEAA clamp. In contrast, under insulin-stimulated conditions, total protein disposal (P=0·007) and endogenous WBPT (P=0·001) were both increased with FO. In an associated pilot study (n 4, three completed), although n-3 PUFA in erythrocyte membranes increased to >14 % with the FO supplement, the enrichment in muscle membranes remained lower (8 %; P<0·001). In conclusion, long-term supplementation with FO, at amounts near the safety limits set by regulatory authorities in Europe and the USA, did not alter glycaemic control but did have an impact on WBPT.