scholarly journals Self-guided CcARM pogramme-COVID 19-March 2020. Complex case and recovery management framework (the CcARM*) - a quality improvement project

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S191-S192
Author(s):  
Syeda Hasan ◽  
Mark Spurrell
Keyword(s):  
Learning Disability ◽  
Complex Case ◽  
List Type ◽  
Service Users ◽  
Online Environment ◽  
Management Framework ◽  
Complex Needs ◽  
Pdsa Cycle ◽  
Recovery Management ◽  
The Impact

AimsDuring the recent lockdown, it was difficult for those with complex needs associated with learning disability and autism to source timely support. Despite the challenges posed by the COVID-19 epidemic, several resourceful initiatives were implemented, across the clinical landscapeThe Self-guided CCaRM Programme was developed as a format for on-line workshops with those concerned. The expectation was to reframe support already there, and streamline further support to best effect.MethodThis programme evolved from the Complex Case and Recovery Management Framework (The CCaRM*), developed within Merseycare Specialist LD Services. This value-based platform was being used by the Specialist Support Team (SST) to support people in the community with LD and Autism with complex needs. With lockdown constraints, the service became reliant on working indirectly through family and carers.Primary Driver: 1:The priority during the lockdown was to make sure how quickly to carry on functioning ,when everyone was distant from each other, and not been able to see people who have Learning Disability & Autism with complex needs.2: Bringing CCARM to the people as a internet based intervention as CcARM was successfully practice with specialist services.3: To provide a format for service users and then career to better review and reframe the care needs, to better effect for themselvesDuring the recent lockdown, for those with complex needs associated with learning disability and autism:It was difficult for people to source timely support for themselves.It was difficult for specialist teams to reach them with useful adviceSecondary Drivers: 1:To reframe support already there and to streamline farther support to best effect.2:Increase Engagement:3:Ensure Accessibility4:Continuing workshops through COVID-Pandemic with no gaps in between-in first PDSA cycleChange Ideas 1: The approach to counter the impact of Lockdown in a critical area2: To adapt the CCARM framework to the online environment.3: Simplification to improve over all engagement within the processA skype-based workshop was convened for all relevant parties. In advance, attendees reviewed concerns using the 6 self-guided CCaRM headings, in line with the original CCaRM, as follows: Having a good circle of supportHaving a good shared understandingHaving clear problem areas thought aboutSocial Participation and Living a Good LifeKeeping people safe and wellMaking progressFor each theme, areas of strengths, concerns, and possible fresh approaches were explored. Subsequently, collaborative care plans were refreshed accordingly.ResultThere were 8 such workshops conducted in first PDSA cycle . Participants included support staff and family members, though no service users in this period. All gave positive feedback: that the experience helped with understanding and confidence in roles, and generated fresh ideas to try.Conclusion•This approach helped counter the impact of lockdown in a critical area.•It was interesting to adapt the CCaRM framework to the online environment.•The perforce simplification seemed to improve the engagement of carers•Further work needs to explore potential service user involvement also, and to evaluate the approach longer term.

FC20-04 -’Who is on my side?’ - qualitative analysis of ethnic minorities experiences of mental health related stigma and discrimination

2011 ◽  
Vol 26 (S2) ◽  
pp. 1924-1924
Author(s):  
G. Shefer ◽  
C. Henderson ◽  
D. Rose ◽  
S. Evans-Lacko
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Ethnic Minority ◽  
Minority Groups ◽  
List Type ◽  
Service Users ◽  
Ethnic Minority Groups ◽  
Minority Communities ◽  
Wide Range ◽  
The Impact

IntroductionThe Time to Change (TTC) anti-stigma campaign, launched in January 2009 in England, intends to make fundamental improvements across England in: public knowledge, attitudes and discriminatory behaviour in relation to people with mental illness. To be effective and valid the campaign must reach a wide range of diverse audiences. This study explores attitudes of people from ethnic minority communities in relation to mental health.ObjectivesThe study investigates:1)General attitudes and perceptions about mental illness in ethnic minority communities2)How we might increase awareness about mental wellbeing and decrease stigma in ethnic minority communities.MethodsTen focus groups with members of ethnic minority groups were conducted. Five groups consisted of service users and five were composed of non-service users. Two groups comprised participants from an Indian origin, two Somali origin, two Afro-Caribbean origin and the other groups were mixed.ResultsWe will present findings regarding the ways in which traditional perceptions of mental health and personal experiences of ethnic minority service users affect their perceptions of sources of support such as family, friends, medical staff and religion and how this feedback could inform ant-stigma interventions.ConclusionThe study suggests that in order to maximise the impact of anti-stigma campaigns, attention should be given to sources of discrimination and traditional perceptions of mental illness which are emphasised by ethnic minority groups. When planning anti-stigma campaigns it is important to incorporate experiences and perceptions from a wide range of audiences.

Changes in rehabilitation actors’ mental health literacy and support to employers: An evaluation of the SEAM intervention

Work ◽  
2021 ◽  
pp. 1-9
Author(s):  
Annika Lexén ◽  
Maria Emmelin ◽  
Lars Hansson ◽  
Bengt Svensson ◽  
Susann Porter ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Literacy ◽  
Return To Work ◽  
Mental Health Literacy ◽  
Mental Health Problems ◽  
Health Problems ◽  
Service Users ◽  
Rehabilitation Professionals ◽  
Knowledge And Beliefs ◽  
The Impact

BACKGROUND: Lack of mental health literacy among rehabilitation professionals and employers in the return-to-work of persons with mental health problems resulted in the development of a three-day group training program, the Support to Employers from rehabilitation Actors about Mental health (SEAM) intervention. OBJECTIVE: To evaluate the impact of SEAM on rehabilitation professionals’ knowledge and beliefs, attitudes, and supporting behaviors towards people with mental health problems and employers as part of the return-to-work process. METHODS: In this longitudinal study, 94 rehabilitation professionals were included. Data were collected prior to (T1), immediately after (T2) and 6 months after SEAM training (T3) using knowledge and attitude scales and a questionnaire on supporting behaviors. SEAM includes training in Mental Health First Aid, presentations and discussions on current research on work and mental health, and strategies and communication guidelines to use when meeting service users and employers as part of the return-to-work of persons with mental health problems. SEAM also includes a homepage with targeted employer information. Data were analyzed using non-parametric statistics. RESULTS: SEAM significantly increased rehabilitation professionals’ knowledge of mental health (T1-T2: z = –2.037, p = 0.042; T2-T3: z = –5.093, p = 0.001), and improved their attitudes towards persons with mental health problems (T1-T2: z = 4.984, p = 0.001). Professionals (50–60%) also estimated that they had increased their use of supporting strategies towards service users and employers. CONCLUSIONS: The study suggests that SEAM can increase mental health literacy among rehabilitation professionals and lead to a greater focus on service users’ resources and work ability, as well as on employers’ support needs.

scholarly journals Using Satellite Data for CBRN (Chemical, Biological, Radiological, and Nuclear) Threat Detection, Monitoring, and Modelling

2021 ◽  
Author(s):  
Gary Sutlieff ◽  
Lucy Berthoud ◽  
Mark Stinchcombe
Keyword(s):  
Satellite Data ◽  
Meteorological Data ◽  
Atmospheric Composition ◽  
Chemical Detection ◽  
List Type ◽  
Data Types ◽  
Wide Range ◽  
Future Technologies ◽  
The Impact ◽  
Near Future

Abstract CBRN (Chemical, Biological, Radiological, and Nuclear) threats are becoming more prevalent, as more entities gain access to modern weapons and industrial technologies and chemicals. This has produced a need for improvements to modelling, detection, and monitoring of these events. While there are currently no dedicated satellites for CBRN purposes, there are a wide range of possibilities for satellite data to contribute to this field, from atmospheric composition and chemical detection to cloud cover, land mapping, and surface property measurements. This study looks at currently available satellite data, including meteorological data such as wind and cloud profiles, surface properties like temperature and humidity, chemical detection, and sounding. Results of this survey revealed several gaps in the available data, particularly concerning biological and radiological detection. The results also suggest that publicly available satellite data largely does not meet the requirements of spatial resolution, coverage, and latency that CBRN detection requires, outside of providing terrain use and building height data for constructing models. Lastly, the study evaluates upcoming instruments, platforms, and satellite technologies to gauge the impact these developments will have in the near future. Improvements in spatial and temporal resolution as well as latency are already becoming possible, and new instruments will fill in the gaps in detection by imaging a wider range of chemicals and other agents and by collecting new data types. This study shows that with developments coming within the next decade, satellites should begin to provide valuable augmentations to CBRN event detection and monitoring. Article Highlights There is a wide range of existing satellite data in fields that are of interest to CBRN detection and monitoring. The data is mostly of insufficient quality (resolution or latency) for the demanding requirements of CBRN modelling for incident control. Future technologies and platforms will improve resolution and latency, making satellite data more viable in the CBRN management field

scholarly journals Impact of an integrated community-based model of care for older people with complex conditions on hospital emergency presentations and admissions: a step-wedged cluster randomized trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jennifer Mann ◽  
Fintan Thompson ◽  
Robyn McDermott ◽  
A. Esterman ◽  
Edward Strivens
Keyword(s):  
Older People ◽  
Older Persons ◽  
Hospital Admissions ◽  
Community Dwelling ◽  
Trial Registration ◽  
Significant Finding ◽  
Complex Needs ◽  
Primary Practice ◽  
The Impact ◽  
Open Arch

Abstract Background Health systems must reorient towards preventative and co-ordinated care to reduce hospital demand and achieve positive and fiscally responsible outcomes for older persons with complex needs. Integrated care models can improve outcomes by aligning primary practice with the specialist health and social services required to manage complex needs. This paper describes the impact of a community-facing program that integrates care at the primary-secondary interface on the rate of Emergency Department (ED) presentation and hospital admissions among older people with complex needs. Methods The Older Persons Enablement and Rehabilitation for Complex Health Conditions (OPEN ARCH) study is a multicentre randomised controlled trial with a stepped wedge cluster design. General practitioners (GPs; n = 14) in primary practice within the Cairns region are considered ‘clusters’ each comprising a mixed number of participants. 80 community-dwelling persons over 70 years of age if non-Indigenous and over 50 years of age if Indigenous were included at baseline with no new participants added during the study. Clusters were randomly assigned to one of three steps that represent the time at which they would commence the OPEN ARCH intervention, and the subsequent intervention duration (3, 6, or 9 months). Each participant was its own control. GPs and participants were not blinded. The primary outcomes were ED presentations and hospital admissions. Data were collected from Queensland Health Casemix data and analysed with multilevel mixed-effects Poisson regression modelling to estimate the effectiveness of the OPEN ARCH intervention. Data were analysed at the cluster and participant levels. Results Five clusters were randomised to steps 1 and 2, and 4 clusters randomised to step 3. All clusters (n = 14) completed the trial accounting for 80 participants. An effect size of 9% in service use (95% CI) was expected. The OPEN ARCH intervention was found to not make a statistically significant difference to ED presentations or admissions. However, a stabilising of ED presentations and a trend toward lower hospitalisation rates over time was observed. Conclusions While this study detected no statistically significant change in ED presentations or hospital admissions, a plateauing of ED presentation and admission rates is a clinically significant finding for older persons with complex needs. Multi-sectoral integrated programs of care require an adequate preparation period and sufficient duration of intervention for effectiveness to be measured. Trial registration The OPEN ARCH study received ethical approval from the Far North Queensland Human Research Ethics Committee, HREC/17/QCH/104–1174 and is registered on the Australian and New Zealand Trials Registry, ACTRN12617000198325p.

scholarly journals Does agricultural intensification cause tipping points in ecosystem services?

2021 ◽  
Author(s):  
Stephen C. L. Watson ◽  
Adrian C. Newton ◽  
Lucy E. Ridding ◽  
Paul M. Evans ◽  
Steven Brand ◽  
...  
Keyword(s):  
Ecosystem Services ◽  
Agricultural Intensification ◽  
Spatial Dynamics ◽  
Policy Option ◽  
List Type ◽  
Tipping Points ◽  
Software Models ◽  
Non Linear ◽  
Study Interval ◽  
The Impact

Abstract Context Agricultural intensification is being widely pursued as a policy option to improve food security and human development. Yet, there is a need to understand the impact of agricultural intensification on the provision of multiple ecosystem services, and to evaluate the possible occurrence of tipping points. Objectives To quantify and assess the long-term spatial dynamics of ecosystem service (ES) provision in a landscape undergoing agricultural intensification at four time points 1930, 1950, 1980 and 2015. Determine if thresholds or tipping points in ES provision may have occurred and if there are any detectable impacts on economic development and employment. Methods We used the InVEST suite of software models together with a time series of historical land cover maps and an Input–Output model to evaluate these dynamics over an 85-year period in the county of Dorset, southern England. Results Results indicated that trends in ES were often non-linear, highlighting the potential for abrupt changes in ES provision to occur in response to slight changes in underlying drivers. Despite the fluctuations in provision of different ES, overall economic activity increased almost linearly during the study interval, in line with the increase in agricultural productivity. Conclusions Such non-linear thresholds in ES will need to be avoided in the future by approaches aiming to deliver sustainable agricultural intensification. A number of positive feedback mechanisms are identified that suggest these thresholds could be considered as tipping points. However, further research into these feedbacks is required to fully determine the occurrence of tipping points in agricultural systems.

128 Development of an M1-polarized, non-viral chimeric antigen receptor macrophage (CAR-M) platform for cancer immunotherapy

2020 ◽  
Vol 8 (Suppl 3) ◽  
pp. A141-A141
Author(s):  
Yumi Ohtani ◽  
Kayleigh Ross ◽  
Aditya Dandekar ◽  
Rashid Gabbasov ◽  
Michael Klichinsky
Keyword(s):  
Cancer Immunotherapy ◽  
Chimeric Antigen Receptor ◽  
Scale Up ◽  
Antigen Receptor ◽  
Innate Immune ◽  
List Type ◽  
M1 Phenotype ◽  
The Impact ◽  
Anti Tumor Activity ◽  
Immunosuppressive Factors

BackgroundWe have previously developed CAR-M as a novel cell therapy approach for the treatment of solid tumors.1 CAR-M have the potential to overcome key challenges that cell therapies face in the solid tumor setting – tumor infiltration, immunosuppression, lymphocyte exclusion – and can induce epitope spreading to overcome target antigen heterogeneity. While macrophages transduced with the adenoviral vector Ad5f35 (Ad CAR-M) traffic to tumors, provide robust anti-tumor activity, and recruit and activate T cells, we sought to identify a robust non-viral method of macrophage engineering in order to reduce the cost of goods, manufacturing complexity, and potential immunogenicity associated with viral vectors.MethodsAs innate immune cells, macrophages detect exogenous nucleic acids and respond with inflammatory and apoptotic programs. Thus, we sought to identify a means of mRNA delivery that avoids recognition by innate immune sensors. We screened a broad panel of mRNA encoding an anti-HER2 CAR comprising multiplexed 5’Cap and base modifications using an optimized and scalable electroporation approach and evaluated the impact of interferon-β priming on CAR-M phenotype and function.ResultsWe identified the optimal multiplexed mRNA modifications that led to maximal macrophage viability, transfection efficiency, intensity of CAR expression, and duration of expression. Non-viral HER2 CAR-M phagocytosed and killed human HER2+ tumor cells. Unlike Ad CAR-M, mRNA CAR-M were not skewed toward an M1 state by mRNA electroporation. Priming non-viral CAR-M with IFN-β induced a durable M1 phenotype, as shown by stable upregulation of numerous M1 markers and pathways. IFN-β priming significantly enhanced the anti-tumor activity of CAR but not control macrophages. IFN-β primed mRNA CAR-M were resistant to M2 conversion, maintaining an M1 phenotype despite challenge with various immunosuppressive factors, and converted bystander M2 macrophages toward M1. Interestingly, priming mRNA CAR-M with IFN-β significantly enhanced the persistence of CAR expression, overcoming the known issue of rapid mRNA turnover. RNA-seq analysis revealed that IFN-β priming affected pathways involved in increasing translation and decreasing RNA degradation in human macrophages.ConclusionsWe have established a novel, optimized non-viral CAR-M platform based on chemically modified mRNA and IFN-β priming. IFN-β priming induced a durable M1 phenotype, improved CAR expression, improved CAR persistence, led to enhanced anti-tumor function, and rendered resistance to immunosuppressive factors. This novel platform is amenable to scale-up, GMP manufacturing, and represents an advance in the development of CAR-M.ReferenceKlichinsky M, Ruella M, Shestova O, et al. Human chimeric antigen receptor macrophages for cancer immunotherapy. Nat Biotechnol 2020;38(8):947–953.

scholarly journals Research on the impact of ship traffic flow on the restricted channel segment of the middle Yangtze River based on traffic wave theory

2021 ◽  
Vol 3 (8) ◽  
Author(s):  
Ting Liu ◽  
Gabriel Lodewijks
Keyword(s):  
Traffic Flow ◽  
Flow Rate ◽  
Flow Simulation ◽  
Wave Theory ◽  
Flow Density ◽  
List Type ◽  
Ship Traffic ◽  
Traffic Wave ◽  
The Impact ◽  
Channel Segment

Abstract Abstract On the basis of the influence of dry season on ship traffic flow, the gathering and dissipating process of ship traffic flow was researched with Greenshields linear flow—density relationship model, the intrinsic relationship between the ship traffic congestion state and traffic wave in the unclosed restricted channel segment was emphatically explored when the ship traffic flow in a tributary channel inflows, and the influence law of multiple traffic waves on the ship traffic flow characteristics in unclosed restricted segment is revealed. On this basis, the expressions of traffic wave speed and direction, dissipation time of queued ships and the number of ships affected were provided, and combined with Monte Carlo method, the ship traffic flow simulation model in the restricted channel segment was built. The simulation results show that in closed restricted channel segment the dissipation time of ships queued is mainly related to the ship traffic flow rate of segments A and C, and the total number of ships affected to the ship traffic flow rate of segment A. And in unclosed restricted channel segment, the dissipation time and the total number of ships affected are also determined by the meeting time of the traffic waves in addition to the ship traffic flow rate of segments. The research results can provide the theoretical support for further studying the ship traffic flow in unclosed restricted channel segment with multiple tributaries Article Highlights The inflow of tributaries' ship traffic flows has an obvious impact on the traffic conditions in the unenclosed restricted channel segment. The interaction and influence between multiple ship traffic waves and the mechanism of generating new traffic waves are explained. The expression of both dissipation time of queued ships and the total number of ships affected in the closed and unclosed restricted channel segment are given.

scholarly journals The potential for person-centred planning to support the community participation of adults with an intellectual disability

2021 ◽  
pp. 174462952110221
Author(s):  
Darren McCausland ◽  
Esther Murphy ◽  
Mary McCarron ◽  
Philip McCallion
Keyword(s):  
Intellectual Disability ◽  
Mixed Methods ◽  
Community Participation ◽  
Social Inclusion ◽  
Mixed Methods Approach ◽  
Complex Needs ◽  
Qualitative Case Studies ◽  
Quantitative Analyses ◽  
The Right ◽  
The Impact

Person-centred planning (PCP) puts individuals with an intellectual disability at the centre of service and support planning, identifying how individuals wish to live their lives and what is needed to make that possible. PCP has been identified as having the potential to facilitate improved social inclusion and community participation. A mixed-methods approach combined quantitative analyses with qualitative case studies of individuals with severe-profound intellectual disability to assess the impact of PCP on community participation for adults with an intellectual disability at a disability service in Dublin. We conclude that PCP may provide a good basis to plan community participation and, with the right supports in place, may provide opportunities for people with complex needs to improve their community participation. Supports including familiar staff and family are critical to the success of PCP for people with complex needs, and their absence may undermine the best intentions of PCP for this population.

scholarly journals Antibiotics at birth and later antibiotic courses: effects on gut microbiota

2021 ◽  
Author(s):  
Sofia Ainonen ◽  
Mysore V Tejesvi ◽  
Md. Rayhan Mahmud ◽  
Niko Paalanne ◽  
Tytti Pokka ◽  
...  
Keyword(s):  
Gut Microbiota ◽  
Control Group ◽  
List Type ◽  
Antibiotic Exposure ◽  
Microbiota Composition ◽  
Long Term Effects ◽  
The Impact ◽  
Antibiotic Courses ◽  
Gut Microbiota Composition

Abstract Background Intrapartum antibiotic prophylaxis (IAP) is widely used, but the evidence of the long-term effects on the gut microbiota and subsequent health of children is limited. Here, we compared the impacts of perinatal antibiotic exposure and later courses of antibiotic courses on gut microbiota. Methods This was a prospective, controlled cohort study among 100 vaginally delivered infants with different perinatal antibiotic exposures: control (27), IAP (27), postnatal antibiotics (24), and IAP and postnatal antibiotics (22). At 1 year of age, we performed next-generation sequencing of the bacterial 16S ribosomal RNA gene of fecal samples. Results Exposure to the perinatal antibiotics had a clear impact on the gut microbiota. The abundance of the Bacteroidetes phylum was significantly higher in the control group, whereas the relative abundance of Escherichia coli was significantly lower in the control group. The impact of the perinatal antibiotics on the gut microbiota composition was greater than exposure to later courses of antibiotics (28% of participants). Conclusions Perinatal antibiotic exposure had a marked impact on the gut microbiota at the age of 1 year. The timing of the antibiotic exposure appears to be the critical factor for the changes observed in the gut microbiota. Impact Infants are commonly exposed to IAP and postnatal antibiotics, and later to courses of antibiotics during the first year of life. Perinatal antibiotics have been associated with an altered gut microbiota during the first months of life, whereas the evidence regarding the long-term impact is more limited. Perinatal antibiotic exposure had a marked impact on the infant’s gut microbiota at 1 year of age. Impact of the perinatal antibiotics on the gut microbiota composition was greater than that of the later courses of antibiotics at the age of 1 year.

scholarly journals Anomalous Laterally Stressed Kinetically Trapped DNA Surface Conformations

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Valery V. Prokhorov ◽  
Nikolay A. Barinov ◽  
Kirill A. Prusakov ◽  
Evgeniy V. Dubrovin ◽  
Maxim D. Frank-Kamenetskii ◽  
...  
Keyword(s):  
Electrostatic Interaction ◽  
Mechanical Response ◽  
Persistence Length ◽  
Strong Impact ◽  
List Type ◽  
Surface Charges ◽  
Monomolecular Films ◽  
Chain Approximation ◽  
The Impact ◽  
Positively Charged

Highlights DNA kinking is inevitable for the highly anisotropic 1D–1D electrostatic interaction with the one-dimensionally periodically charged surface. The double helical structure of the DNA kinetically trapped on positively charged monomolecular films comprising the lamellar templates is strongly laterally stressed and extremely perturbed at the nanometer scale. The DNA kinetic trapping is not a smooth 3D—> 2D conformational flattening but is a complex nonlinear in-plane mechanical response (bending, tensile and unzipping) driven by the physics beyond the scope of the applicability of the linear worm-like chain approximation. Abstract Up to now, the DNA molecule adsorbed on a surface was believed to always preserve its native structure. This belief implies a negligible contribution of lateral surface forces during and after DNA adsorption although their impact has never been elucidated. High-resolution atomic force microscopy was used to observe that stiff DNA molecules kinetically trapped on monomolecular films comprising one-dimensional periodically charged lamellar templates as a single layer or as a sublayer are oversaturated by sharp discontinuous kinks and can also be locally melted and supercoiled. We argue that kink/anti-kink pairs are induced by an overcritical lateral bending stress (> 30 pNnm) inevitable for the highly anisotropic 1D-1D electrostatic interaction of DNA and underlying rows of positive surface charges. In addition, the unexpected kink-inducing mechanical instability in the shape of the template-directed DNA confined between the positively charged lamellar sides is observed indicating the strong impact of helicity. The previously reported anomalously low values of the persistence length of the surface-adsorbed DNA are explained by the impact of the surface-induced low-scale bending. The sites of the local melting and supercoiling are convincingly introduced as other lateral stress-induced structural DNA anomalies by establishing a link with DNA high-force mechanics. The results open up the study in the completely unexplored area of the principally anomalous kinetically trapped DNA surface conformations in which the DNA local mechanical response to the surface-induced spatially modulated lateral electrostatic stress is essentially nonlinear. The underlying rich and complex in-plane nonlinear physics acts at the nanoscale beyond the scope of applicability of the worm-like chain approximation.

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