Search

Introduction: There is a national movement to reduce restrictive interventions due to the harm and distress they can cause which has been reflected in NHS trust policies and practices. NHS trust policies state that all in-patients who may require restrictive interventions must have a Positive Behaviour Support Plan (PBSP) based on a functional analysis of what drives and triggers their behaviour. A PBSP is intended to facilitate understanding and help manage behaviours that challenge by teaching new skills and ways to communicate a person's needs. Previous research on the use of PBSPs on adult acute mental health wards is limited but research on PICU wards has shown PBSPs have not been implemented into mental health care as intended. Objectives: Trust policies identify that PBSPs should be implemented to reduce the use of restrictive interventions. However, it is unknown whether PBSPs are being used as part of routine practice on the acute mental health ward. The degree to which staff are aware of patients PBSPs and how they use them to guide their practice is unclear. The service evaluation aims to understand the perspectives, attitudes, and experiences of staff who are responsible for using and implementing PBSPs on the ward. The evaluation aims to investigate how PBSP informs practice and to identify the barriers and facilitators to implementing PBSPs on the ward. Methods: A volunteer sample of clinical staff members (including Doctors, Nurses, Psychotherapists, Occupational Therapists, and Clinical Support Workers) who are responsible for implementing PBSPs on an acute mental health ward in the East of England took part in a focus group which lasted up to an hour. There were four focus groups with between two and four participants per group. A total of thirteen staff members participated in the focus groups. The focus groups lasted up to one hour and were guided by a topic guide. Two members of the project team facilitated the group. Focus groups were audio recorded. Results: Thematic synthesis will be the overarching approach used to synthesise the qualitative data from the focus groups. The audio recordings will be transcribed. Analysis will be conducted on a within-case basis prior to cross-case analysis aimed to identify common themes. Two evaluators will work together to code, analyse, and synthesise the extracted data. Conclusions: Based on the results, training may be developed to improve the understanding and implementation of the PBSPs on the ward. The findings may also result in changes to the way PBSPs are used. The results will be presented to the trust chief executives and used to inform how to best support individuals who may be at risk of requiring restrictive interventions. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

Abstract Background Following Helicobacter pylori eradication in idiopathic parkinsonism (IP), hypokinesia improved but flexor-rigidity increased. Small intestinal bacterial-overgrowth (SIBO) is a candidate driver of the rigidity: hydrogen-breath-test-positivity is common in IP and case histories suggest that Helicobacter keeps SIBO at bay. Methods In a surveillance study, we explore relationships of IP-facets to peripheral immune/inflammatory-activation, in light of presence/absence of Helicobacter infection (urea-breath- and/or stool-antigen-test: positivity confirmed by gastric-biopsy) and hydrogen-breath-test status for SIBO (positivity: >20 ppm increment, 2 consecutive 15-min readings, within 2h of 25G lactulose). We question whether any relationships found between facets and blood leukocyte subset counts stand in patients free from anti-parkinsonian drugs, and are robust enough to defy fluctuations in performance consequent on short t½ therapy. Results Of 51 IP-probands, 36 had current or past Helicobacter infection on entry, 25 having undergone successful eradication (median 3.4 years before). Thirty-four were hydrogen-breath-test-positive initially, 42 at sometime (343 tests) during surveillance (2.8 years). Hydrogen-breath-test-positivity was associated inversely with Helicobacter-positivity (OR 0.20 (95% CI 0.04, 0.99), p In 38 patients (untreated (17) or on stable long-t½ IP-medication), the higher the natural-killer count, the shorter stride, slower gait and greater flexor-rigidity (by mean 49 (14, 85) mm, 54 (3, 104) mm.s-1, 89 (2, 177) Nm.10-3, per 100 cells.μl-1 increment, p=0.007, 0.04 & 0.04 respectively, adjusted for patient characteristics). T-helper count was inversely associated with flexor-rigidity before (p=0.01) and after adjustment for natural-killer count (-36(-63, -10) Nm.10-3 per 100 cells.μl-1, p=0.007). Neutrophil count was inversely associated with tremor (visual analogue scale, p=0.01). Effect-sizes were independent of IP-medication, and not masked by including 13 patients receiving levodopa (except natural-killer count on flexor-rigidity). Cellular associations held after allowing for potentially confounding effect of hydrogen-breath-test or Helicobacter status. Moreover, additional reduction in stride and speed (68 (24, 112) mm & 103 (38, 168) mm.s-1, each p=0.002) was seen with Helicobacter-positivity. Hydrogen-breath-test-positivity, itself, was associated with higher natural-killer and T-helper counts, lower neutrophils (p=0.005, 0.02 & 0.008). Conclusion We propose a rigidity-associated subordinate pathway, flagged by a higher natural-killer count, tempered by a higher T-helper, against which Helicobacter protects by keeping SIBO at bay.

Abstract The two-stage neuroinflammatory process, containment and progression, proposed to underlie neurodegeneration may predicate on systemic inflammation arising from the gastrointestinal tract. Helicobacter infection has been described as one switch in the pathogenic-circuitry of idiopathic parkinsonism (IP): eradication modifies disease progression and marked deterioration accompanies eradication-failure. Moreover, serum Helicobacter-antibody-profile predicts presence, severity and progression of IP. Slow gastrointestinal-transit precedes IP-diagnosis and becomes increasingly-apparent after, predisposing to small-intestinal bacterial-overgrowth (SIBO). Although IP is well-described as a systemic illness with a long prodrome, there has been no comprehensive overview of the blood profile. Here, it is examined in relation to Helicobacter status and lactulose-hydrogen-breath-testing for SIBO. A robust finding of reduced lymphocyte count in 126 IP-probands and 79 spouses (without clinically-definite IP), compared with that in 381 controls (p < 0.001 in each case), was not explained by Helicobacter-status or breath-hydrogen. This complements a previous report that spouses were 'down-the-pathway' to 'clinically-definite' disease. In 205 other controls without clinically-definite IP, there were strong associations between sporadic cardinal features and immunoglobulin class concentration, not explained by Helicobacter-status. Premonitory states for idiopathic parkinsonism associated with relative lymphopenia, higher serum immunoglobulin concentrations and evidence of enteric-nervous-system damage may prove viral in origin. Although only 8% of the above 79 spouses were urea-breath-test-positive for Helicobacter, all 8 spouses with clinically-definite IP were (p < 0.0001). Transmission of a 'primer' to a Helicobacter-colonised recipient might result in progression to the diagnostic threshold. Twenty-five percent of the 126 probands were seropositive for anti-nuclear autoantibody. In 20 probands, monitored before and serially after anti-Helicobacter therapy, seropositivity marked a severe hypokinetic response (p = 0.03). It may alert to continuing infection, even at low-density. Hyperhomocysteinemia is a risk factor for dementia and depression. Serum homocysteine exceeded the target in 43% of the 126 IP-probands. It was partially explained by serum B12 (12% variance, p < 0.001), but not by Helicobacter-status (gastric-atrophy uncommon in IP) or levodopa treatment. Immune-inflammatory activation increases homocysteine production. Since an estimated 60% of probands are hydrogen-breath-test positive, SIBO, with its increased bacterial utilisation of B12, is a likely cause. Thus, two prognostic indicators in established IP fit with involvement of Helicobacter and SIBO.

Carbon export out of the surface ocean via the biological pump is a critical sink for atmospheric carbon dioxide. This process transports organic carbon to the deep ocean through sinking particulate organic carbon (POC) and the downward transport of suspended POC and dissolved organic carbon (DOC). Changes in the relative contribution of each pathway can significantly affect the magnitude and efficiency of carbon export to depth. Net community production (NCP), an analog of carbon export under steady state assumptions, is typically estimated using budgets of biologically important chemical tracers in the upper ocean constrained by ship‐board or autonomous platform observations. In this study, we use measurements from biogeochemical profiling floats, the Ocean Station Papa mooring, and recently developed algorithms for carbonate system parameters to constrain budgets for three tracers (nitrate, dissolved inorganic carbon, and total alkalinity) and estimate NCP in the Northeast Pacific from 2009 to 2017. Using our multiple‐tracer approach, and constraining end‐member nutrient ratios of the POC and DOC produced, we not only calculate regional NCP throughout the annual cycle and across multiple depth horizons, but also partition this quantity into particulate and dissolved portions. We also use a particle backscatter‐based approach to estimate POC attenuation with depth and present a new method to constrain particle export across deeper horizons and estimate in situ export efficiency. Our results agree well with previously published estimates of regional carbon export annually and suggest that the approaches presented here could be used to assess the magnitude and efficiency of carbon export in other regions of the world's oceans. Plain Language Summary: "Carbon export" refers to the amount of carbon dioxide that is removed from the atmosphere by organisms in the surface ocean and subsequently transported into the deep sea, either through sinking particles (more efficient process) or downward mixing (less efficient process), making the ocean a natural sink for atmospheric carbon dioxide and significantly influencing ocean chemistry. The relative proportion of export through each pathway significantly affects the overall efficiency of this process and has implications for the pattern of carbon export globally. Measuring carbon export throughout the year traditionally requires persistent ship‐based observations, which can be costly and perilous for researchers. Instead, carbon export is often estimated by budgeting nutrient distributions and changes through time, as they are also controlled by the same processes. These measurements can now be made remotely using autonomous biogeochemical profiling floats. Here, we present a new approach utilizing multiple chemical budgets to estimate carbon export over a decade in the Northeast Pacific, which can be combined to partition export occurring through sinking particles and downward mixing. Our results are supported by previously published estimates of carbon export and suggest that this method has the potential to be applied to other parts of the ocean. Key Points: We use publicly available nitrate and inorganic carbon data from profiling floats to solve tracer budgets for net community productionOur estimates of seasonal and annual net community production agree well with previously published resultsUsing multiple budgets, we are able to differentiate the dissolved and particulate organic, and particulate inorganic, carbon export pools [ABSTRACT FROM AUTHOR]

As a hormone-sensitive condition with no single identifiable cause, breast cancer is a major health problem. It is characterized by a wide range of contributing factors and exposures occurring in different combinations and strengths across a lifetime that may be amplified during periods of enhanced developmental susceptibility and impacted by reproductive patterns and behaviours. The vast majority of cases are oestrogen-receptor positive and occur in women with no family history of the disease suggesting that modifiable risk factors are involved. A substantial body of evidence now links oestrogen-positive breast cancer with environmental exposures. Synthetic chemicals capable of oestrogen mimicry are characteristic of industrial development and have been individually and extensively assessed as risk factors for oestrogen-sensitive cancers. Existing breast cancer risk assessment tools do not take such factors into account. In the absence of consensus on causation and in order to better understand the problem of escalating incidence globally, an expanded, integrated approach broadening the inquiry into individual susceptibility breast cancer is proposed. Applying systems thinking to existing data on oestrogen-modulating environmental exposures and other oestrogenic factors characteristic of Westernisation and their interactions in the exposure, encompassing social, behavioural, environmental, hormonal and genetic factors, can assist in understanding cancer risks and the pursuit of prevention strategies. A new conceptual framework based on a broader understanding of the "system" that underlies the development of breast cancer over a period of many years, incorporating the factors known to contribute to breast cancer risk, could provide a new platform from which government and regulators can promulgate enhanced and more effective prevention strategies. [ABSTRACT FROM AUTHOR]

Nitrite (NO2-) is a substrate for both oxidative and reductive microbial metabolism. NO2- accumulates at the base of the euphotic zone in oxygenated, stratified open-ocean water columns, forming a feature known as the primary nitrite maximum (PNM). Potential pathways of NO2- production include the oxidation of ammonia (NH3) by ammonia-oxidizing bacteria and archaea as well as assimilatory nitrate (NO3-) reduction by phytoplankton and heterotrophic bacteria. Measurements of NH3 oxidation and NO3- reduction to NO2- were conducted at two stations in the central California Current in the eastern North Pacific to determine the relative contributions of these processes to NO2- production in the PNM. Sensitive (< 10 nmol L-1), precise measurements of [NH4+] and [NO2-] indicated a persistent NH maximum overlying the PNM at every station, with concentrations as high as 1.5 µmol L-1. Within and just below the PNM, NH3 oxidation was the dominant NO2- producing process, with rates of NH3 oxidation to NO2- of up to 31 nmol L-1 d-1, coinciding with high abundances of ammonia-oxidizing archaea. Though little NO2- production from NO3- was detected, potentially nitrate-reducing phytoplankton (photosynthetic picoeukaryotes, Synechococcus, and Prochlorococcus) were present at the depth of the PNM. Rates of NO2- production from NO3- were highest within the upper mixed layer (4.6 nmol L-1 d-1 ) but were either below detection limits or 10 times lower than NH3 oxidation rates around the PNM. One-dimensional modeling of water column NO2- production agreed with production determined from 15N bottle incubations within the PNM, but a modeled net biological sink for NO2- just below the PNM was not captured in the incubations. Residence time estimates of NO2- within the PNM ranged from 18 to 470 days at the mesotrophic station and was 40 days at the oligotrophic station. Our results suggest the PNM is a dynamic, rather than relict, feature with a source term dominated by ammonia oxidation. [ABSTRACT FROM AUTHOR]

Background: We examine the effect of eradicating Helicobacter in idiopathic parkinsonism (IP). Marked deterioration, where eradication-therapy failed, prompted an interim report in the first 20 probands to reach de-blinding. The null-hypothesis, “eradication has no effect on principal outcome, mean stride length at free-walking speed,” was rejected. We report on study completion in all 30 who had commenced post-treatment assessments. Methods: This is a randomized, placebo-controlled, parallel-group efficacy study of eradicating biopsy-proven (culture and/or organism on histopathology) Helicobacter pylori infection on the time course of facets of IP, in probands taking no, or stable long- t½, anti-parkinsonian medication. Persistent infection at de-blinding (scheduled 1-year post-treatment) led to open active eradication-treatment. Results: Stride length improved (73 (95% CI 14–131) mm/year, p = .01) in favor of “successful” blinded active over placebo, irrespective of anti-parkinsonian medication, and despite worsening upper limb flexor rigidity (237 (57–416) Nm × 10−3/year, p = .01). This differential effect was echoed following open active, post-placebo. Gait did not deteriorate in year 2 and 3 post-eradication. Anti-nuclear antibody was present in all four proven (two by molecular microbiology only) eradication failures. In the remainder, it marked poorer response during the year after eradication therapy, possibly indicating residual “low-density” infection. We illustrate the importance of eradicating low-density infection, detected only by molecular microbiology, in a proband not receiving anti-parkinsonian medication. Stride length improved (424 (379–468) mm for 15 months post-eradication, p = .001), correction of deficit continuing to 3.4 years. Flexor rigidity increased before hydrogen-breath-test positivity for small intestinal bacterial overgrowth (208 (28–388) Nm × 10−3, p = .02), increased further during (171 (67–274), p = .001) (15–31 months), and decreased (136 (6–267), p = .04) after restoration of negativity (32–41 months). Conclusion: Helicobacter is an arbiter of progression, independent of infection-load. [ABSTRACT FROM AUTHOR]

Epithelial-mesenchymal transition (EMT) is a process occurring during both embryogenesis and early stages of invasive cancer. Epithelial cells that undergo EMT become more migratory and invasive with a mesenchymal morphology. Herein we assess EMT induction in a mouse mammary epithelial cell line driven by Msx2, a homeobox-containing transcription factor important during mammary gland development. NMuMG cells, a normal mouse mammary epithelial cell line, stably transfected with a Msx2 cDNA showed downregulation of an epithelial marker E-cadherin and upregulation of the mesenchymal markers vimentin and N-cadherin. Furthermore, overexpression of Cripto-1, a member of the epidermal growth factor-CFC protein family already known to be involved in EMT, was detected in Msx2-transfected cells. The expression of Cripto-1 was accompanied by activation of the tyrosine kinase c-Src pathway and an increase in the invasive ability of the cells. Functional assays also demonstrated inhibition of the invasive behavior of the Msx2-transfected cells by a c-Src specific inhibitor. Moreover, immunohistochemistry of human infiltrating breast carcinomas showed positive staining for Msx2 only in the infiltrating tumor cells while the non-infiltrating tumor cells were negative. These results suggest that Msx2 may play a significant role in promoting EMT in epithelial cells that acquire properties involved in tumor invasion. J. Cell. Physiol. 219: 659–666, 2009. Published 2009 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Stream-sediment geochemistry is commonly used to provide a regionally averaged, background composition against which may be judged the anomalies caused by unusual geology, mineralisation or pollution. Its interpretation may be based on assumptions of relative compositional uniformity within broad categories of bedrock lithology. This approach is undermined by the dramatic variations in stream-sediment chemistry that occur over some large areas of superficially homogeneous geology. In these cases, regional geochemistry may pickout subtle compositional variations in bedrock that are not otherwise apparent. Thick greywacke sequences present a particular problem of geological interpretation by virtue of their general uniformity, with a good example provided by the Southern Uplands terrane. There, some stratigraphical variations in greywacke composition, reflecting changes in sedimentary provenance, are known from petrographic and analytical work but are not visible macroscopically. However, contoured stream sediment geochemistry maps, supplemented by cross-strike element abundance profiles, reveal a remarkable level of detailed variation pertinent to stratigraphical sub-division and a much-improved provenance interpretation. Of particular value are the transition metals Cr-Ni-Mg-V and the feldspar-related elements Sr-Rb-K-Ba, the latter defining a major structural break within the terrane. An important corollary to the improved geological understanding arising from regional geochemical survey is the parallel improvement in understanding of the surface processes influencing element distribution in the stream-sediment environment. [ABSTRACT FROM AUTHOR]

The variation of baseline levels of uranium in soil and stream sediments over Europe is described, based on new data prepared by the Forum of European Geological Surveys (FOREGS). The samples have been collected and analysed according to the protocols established for the International Union of Geological Sciences/International Association of Geochemistry and Cosmochemistry (IUGS/IAGC) Working Group on Global Geochemical Baselines. The baseline levels of U vary between 0·21 to 53 mg kg[sup -1] in topsoils, 0·19 to 30 mg kg[sup -1] in subsoils and < 1 to 59 mg kg[sup -1] in stream sediments. There is generally good agreement between the levels of U in the three sample types, and the median concentration in all three media is approximately 2 mg kg[sup -1]. The most anomalous baseline levels occur over the Variscan orogen, especially areas into which late postorogenic radiothermal high heat production (HHP) granites were emplaced. Spiderdiagrams based on trace element levels and rare earth element (REE) plots, confirm the association between the highest U anomalies and evolved radiothermal granites. High values are also associated with parts of the Alpine terrain especially in Slovenia, where there are historical U workings, and Southern Italy, where high values of U reflect contemporary volcanism. In contrast, much of the Caledonides of North West Europe and the Precambrian of the Baltic Shield and East European craton and its overlying sedimentary cover have very low values, generally < 4 mg kg[sup -1]. The results suggest that the main concern for the environment and human health from U, and the Th and K with which it is generally associated, is the naturally occurring total gamma radiation and radon potential associated with radiothermal granites. This is likely to be especially important where the granites are mineralised and have been worked historically, for example in the North West of the Iberian Peninsula where U and its decay products are likely to be more dispersed in the surface environment. The study also indicates the value of multielement data in distinguishing between anthropogenic and naturally occurring anomalies. [ABSTRACT FROM AUTHOR]

Introduces a series of articles about public policy on transportation in the U.S.