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A Pilot Qualitative Study to Better Understand the Factors Related to Suicides and Inform Public Health Action Across a Predominantly Coastal and Rural Area: Cornwall, Southwest of England: International Journal of Environmental Research and Public Health
No full textBackground: Better understanding factors leading to suicide and prevention opportunities is a global public health priority. This qualitative pilot study tested whether reviewing inquest recordings could generate insights during COVID-19 and inform public health prevention programmes across a predominantly rural and coastal area where there are significant health inequalities. Methods: Fifty-five inquest recordings reached a suicide conclusion between March 2020 and January 2021. Stratified sampling was used to obtain two samples from each month. Template analysis was employed to thematically analyse data from 30 inquests. Results: Risk factors during this period were social isolation, anxiety, difficulty in routine creation and maintenance, low mood and economic impact. Remote working in a more rural/coastal area impacted both healthcare service users and staff. Lockdown and other multiple risk factors impacted those at increased risk of poor mental health and suicide. Conclusions: There is a need to identify those at risk and with deteriorating mental health. All age trauma-informed approaches are needed to prevent individuals from reaching crisis along with more equitable services and community support due to the complex nature of suicide. This requires consideration of digital access/exclusion, training, continuity of care and enhanced care of those with additional needs and multiple vulnerabilities
IL-1 Signal Inhibition in Alcohol-Related Hepatitis: A Randomized, Double-Blind, Placebo-Controlled Trial of Canakinumab
No full textBackground and Aims: Short-term mortality in alcohol-related hepatitis (AH) is high, and no current therapy results in durable benefit. A role for interleukin (IL)-1β has been demonstrated in the pathogenesis of alcohol-induced steatohepatitis. This study explored the safety and efficacy of canakinumab (CAN), a monoclonal antibody targeting IL-1β, in the treatment of patients with AH. Methods: Participants with biopsy-confirmed AH and discriminant function ≥32 but Model for End-Stage Liver Disease ≤27 were randomly allocated 1:1 to receive either CAN 3 mg/kg or placebo (PBO). Liver biopsies were taken before and 28 days after treatment. The primary endpoint was the overall histological improvement in inflammation analyzed by the modified intention-to-treat principle. Results: Fifty-seven participants were randomized: 29 to CAN and 28 to PBO. Two participants had histology that did not corroborate the clinical diagnosis. Of the remaining 55 participants, paired histology data were evaluable from 48 participants. In CAN-treated participants, 14 (58%) of 24 demonstrated histological improvement compared with 10 (42%) of 24 in the PBO group (P = .25). There was no improvement in prognostic scores of liver function. Four (7%) of the 55 participants died within 90 days, 2 in each group. The number of serious adverse events was similar between CAN vs PBO. In post hoc exploratory analyses after adjustment for baseline prognostic factors, CAN therapy was associated with overall histological improvement (P = .04). Conclusions: CAN therapy in severe AH participants with Model for End-Stage Liver Disease ≤27 did not alter biochemical or clinical outcomes compared with PBO. Nonsignificant histological improvements did not translate into clinical benefit. EudraCT, Number: 2017-003724-79; ClinicalTrials.gov, Number: NCT03775109
Multiple oceanic sources of alkylamines in Southern Ocean atmospheres
No full textMeasurements of pre-industrial conditions are of paramount importance for understanding historical climate change. The Southern Ocean and Antarctic continent are some of the least polluted environments on planet Earth. Alkylamines can rapidly partition into aerosols, increasing their mass, as well as form new particles altogether. We demonstrate the importance of pelagic “open ocean” (OO) and sympagic “sea ice” (SI) regions in supplying distinct organic nitrogen aerosol components. In the aerosol phase, dimethylamine (DMA) and trimethylamine (TMA) are both secondary, though DMA likely originates mainly from pelagic regions, while TMA is associated mainly with sympagic regions. Parallel measurements in ice and surface waters reveal that melting sea ice contains a factor of four more TMA than coastal Antarctic Peninsula waters; and seventeen times more TMA than OO regions - suggesting additional coastal Antarctic sources. To better interpret future climate change, we recommend employing regional atmospheric chemistry models to understand these diverse aerosol sources
Optimising adherence to inpatient rehabilitation trial protocols: A mixed-methods systematic review
No full textBackground:The results of rehabilitation clinical trials can be negatively affected by adherence to trial protocols. Adherence is multi-factorial, but studies often look at adherence factors separately. Therefore, a systematic review to appraise and synthesise the evidence is warranted to determine the barriers, facilitators and predictors associated with adherence to inpatient rehabilitation trial protocols, whether and how factors interact with one another, and how adherence to rehabilitation protocols can be optimised.Methods:A mixed-methods systematic review was conducted and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Databases searched were PubMed (Ovid), EMBASE (Ovid), MEDLINE (Ovid), CINAHL (Ovid), PsycINFO (Ovid), Cochrane Library, Health Technology Assessment Database, Web of Science and grey literature up to April 2024. A cohesive, integrated methodology was employed, leveraging the Consolidated Framework for Implementation Research (CFIR) 2.0, to transform, synthesise and integrate data from various methodologies to address the review objectives.Results:Twenty-seven studies met the inclusion criteria (randomised controlled trials, qualitative studies related to randomised controlled trials or mixed-methods). Most of the studies were in stroke (n = 17), but other studies included neurological, respiratory, cardiovascular, post-surgical, osteoarthritis and elderly medical. Multiple factors affecting adherence protocols were identified. Adherence was measured in various ways, and setting pre-specified adherence levels was uncommon.Conclusion:Adherence to inpatient rehabilitation trial protocols is multi-dimensional and multi-factorial. Consensus of adherence measurement and interpretation of adherence levels is needed to make meaningful comparisons between trials. A standardised approach, including adopting a traffic light system, would enable trialists to implement changes mid-trial or stop the trial to avoid research waste. Adopting approaches from behavioural science in the design and conduct of inpatient rehabilitation trials may overcome some of the behavioural barriers identified and optimise adherence for those delivering and receiving the intervention.Review registration:Prospective Register of Systematic Reviews, registration number CRD42021270121
Investigating the potential for first year residential field courses to facilitate the establishment of teacher-student relationships in biological sciences undergraduate degrees
No full textTeacher-student relationships (TSRs) in higher education impact many aspects of the student experience, including engagement and performance. However, relatively little is known about the mechanisms of establishment of TSRs, and in particular how these are influenced by specific learning environments and contexts. Here, we undertake an exploratory investigation using first year biological sciences undergraduate residential field courses to examine how this teaching context affected the frequency and nature of teacher student interactions, and consequently the development of TSRs. Data were collected from teacher and student participants using questionnaires and focus groups. We found that interactions during fieldwork took place frequently and tended to be more positive than on campus. At the end of the field course, we found a statistically significant increase in students’ perceptions of their teachers as supportive and honest, which may be attributable to teachers providing immediate feedback on student work. Findings also indicate that positive effects may persist beyond the fieldwork with students being more comfortable approaching teachers back on campus. These findings have important implications for the value of experiential learning environments such as fieldwork for the development of positive TSRs
How have Mediterranean peatlands changed in response to human influence during the Late Holocene? A case study from the Gölbaşı peatlands, Türkiye
No full textThe eastern Mediterranean is a landscape that has been shaped by thousands of years of climatic shifts, cultural change and extensive human land use. However, late Holocene landscape change in the peatlands of southeastern Anatolia is currently not well understood. This environment is important to protect as a valuable carbon sink with many endemic plant species and a rich biodiversity. This study, which was carried out in the Gölbaşı depression in southeastern Anatolia, aimed to investigate vegetation changes during the Late Holocene and to evaluate human impact on the landscape. Late Holocene studies conducted in Anatolia have demonstrated an increase in aridity especially in continental regions and that this was a warmer period in general. Palaeovegetation studies indicate that the effects of human activities on vegetation in Anatolia have been considerably more pronounced during the last two millennia of the Late Holocene. In this study we have investigated how human activities have influenced vegetation change during the Late Holocene in the Gölbaşı basin, which is one of the eighteen largest peatlands in Anatolia, and located in a transition area between Mediterranean and continental climate regions. A sediment core (GLBS21) was taken from the Gölbaşı peatlands region and analysed for fossil pollen as a proxy for vegetation change. The arboreal pollen (AP) to non-arboreal (NAP) pollen ratio in the study area is 56 % AP and 44 % NAP indicating a semi-open landscape. According to the fossil pollen record, Pinus, Cedrus, Juniperus, Quercus cerris types are the most common tree species, and Artemisia, Asteraceae, Amaranthaceae, Poaceae and Plantago are common herbaceous pollen types. The high representation of non-arboreal pollen known to be associated with human impacts, such as Artemisia, Plantago, and Cerealia type, and the presence of arboreal pollen associated with cultivation, such as Castanea, Juglans, and Pistacia, indicate that human land use has played an important role in shaping this landscape. The record from Gölbaşı highlights the sensitivity of this region to changing human activity, for example, reforestation is evident following abandonment associated with plague that affected Anatolia in the 14th-15th century. The record also reveals continued agricultural activity during periods of conflict. The fossil pollen record emphasizes the resilience and changing character of this landscape
Older Adults\u27 Experiences of Telephone-Delivered Behavioral Activation with Mental Imagery as a Treatment for Depression During the COVID-19 Pandemic: A Qualitative Study
No full textThe COVID-19 pandemic prompted the use of telehealth interventions for treating depression in older adults. We conducted a pilot study of a telephone-based brief psychological intervention, Behavioral Activation with Mental Imagery (BA-MI), for the treatment of depression in isolated older adults during the COVID-19 pandemic. We achieved promising results regarding a reduction in depressive symptoms. The purpose of the present study was to investigate the participants\u27 experiences of the intervention and provide insight into how the intervention could be improved. Fourteen participants aged 67-85 years that completed the BA-MI intervention were purposively selected and interviewed. The interviews were analyzed using thematic analysis with a descriptive phenomenological approach. BA was experienced as a good way of increasing activities and improving mood, but the opinions on MI were divided. Telephone delivery reduced barriers due to pandemic restrictions but felt less personal and lacking non-verbal communication. Being recognized and talking to a therapist every week was described as healing. When using manual-based psychological interventions, one should aim to make them as person-centered as possible by making room for the patients as individuals with both a past and a present, rather than just focusing on intervention delivery
Get remimazolam off the bench and into the game
No full textIn a high-level sporting fixture, the introduction of a skilled player from the reserve bench can be a game changer. The introduction of propofol into clinical anaesthesia practice was a pharmacological game changer [1]. The drug rapidly assumed dominance over other intravenous options for induction of anaesthesia in children. Propofol use for maintenance does not yet rival that of the inhalational agent, sevoflurane, but acceptance is increasing [2] even in areas such as neonatal anaesthesia and intensive care sedation. None of the other hypnotic drugs available or investigated have competed with propofol in adults or children [3], although remimazolam is a recent competitor
The current clinical practice and experiences in buccal midazolam prescribing in community for status epilepticus termination in the United Kingdom: The Rescue Epilepsy Medication and Training (REMIT) study
Get PDFBackground: Epilepsy is one of the commonest neurological conditions worldwide and confers a significant mortality risk, partly driven by status epilepticus (SE). Terminating SE is the goal of pharmaceutical rescue therapies. This survey evaluates UK-based healthcare professionals’ clinical practice and experience in community-based rescue therapy prescribing. Methods: A cross-sectional, 21 item questionnaire composed of Likert-style and free-text based questions was administered online. It was distributed through a non-discriminative snow-balling methodology to members of the Epilepsy Specialist Nurses’ Association (ESNA) and the British International League Against Epilepsy (ILAE). Quantitative analysis used Chi-squared, Fishers’ exact and Mann-Whitney tests. Qualitative data were analysed through NVivo 14 software, following Braun and Clarke methodology. Results: 86 participants comprising of nurses (n = 64) and doctors (n = 21) responded. Participants’ responses reflected guideline-concordant use of emergency management plans and buccal midazolam (BM) as a first-choice therapy for terminating tonic-clonic seizures in SE. However, significant variation (P \u3c 0.05) was found between doctors and nurses in prescribing practices of BM including maximum dose prescribed/day, withdrawal plans and the use in multimorbid patients. Eight themes were identified with some suggestive of concerns of overuse, misuse and abuse of BM by patients/carers. Conclusion: This is the first study to give insights to community management of SE using rescue therapies particularly BM. Further evidence-based guidelines are needed for BM use in multimorbid patients and for its deprescribing. Robust safeguarding protocols and vigilance is needed to regulate BM\u27s misuse and abuse potential. Oncoming community-based technology could provide objective assurance for evidencing utility of rescue medications