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Perhaps due to the complexities of the problem of aggression and violence, and to ethical issues relating to the mental health areas where much of the work is focused, it is the perspective of staff working in those areas that is most commonly sought in research studies. In contrast, tools to examine the patient's view are rare. In this paper Joy Duxbury describes the piloting and development of a new tool, which aimed to survey the views of both patients and staff about the broader approaches used to manage patient aggression. This became the 'Management of Aggression and Violence Attitude Scale' (MAVAS), and the testing of this tool is the focus of this paper. [ABSTRACT FROM AUTHOR]

Introduction: The use of restrictive practices has significant adverse effects on the individual, care providers and organisations. This review will describe how, why, for whom, and in what circumstances approaches used by healthcare organisations work to prevent and reduce the use of restrictive practices on adults with learning disabilities., Methods and Analysis: Evidence from the literature will be synthesised using a realist review approach - an interpretative, theory-driven approach to understand how complex healthcare approaches work in reducing the use of restrictive practices in these settings. In step 1, existing theories will be located to explore what approaches work by consulting with key topic experts, holding consultation workshops with healthcare professionals, academics, and experts by experience, and performing an informal search to help develop an initial programme theory. A systematic search will be performed in the second step in electronic databases. Further searches will be performed iteratively to test particular subcomponents of the initial programme theory, which will also include the use of the CLUSTER approach. Evidence judged as relevant and rigorous will be used to test the initial programme theory. In step three, data will be extracted and coded inductively and deductively. The final step will involve using a realist logic of analysis to refine the initial programme theory in light of evidence. This will then provide a basis to describe and explain what key approaches work, why, how and in what circumstances in preventing and reducing the use of restrictive practices in adults with learning disabilities in healthcare settings., Results: Findings will be used to provide recommendations for practice and policymaking., Registration: In accordance with the guidelines, this realist review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 4th December 2019 (CRD42019158432)., Competing Interests: The authors have declared that no competing interests exist.

Background: The use of physical restraint on vulnerable people with learning disabilities and mental health problems is one of the most controversial and criticised forms of restrictive practice. This paper reports on the implementation of an organisational approach called "No Force First" within a large mental health organisation in England, UK. The aim was to investigate changes in violence/aggression, harm, and physical restraint following implementation., Methods: The study used a pretest-posttest quasi-experimental design. Recorded incidents of violence/aggression from 44 inpatient mental health and learning disabilities (including forensic) wards were included ( n = 13,599). Two study groups were created for comparison: the "intervention" group comprising all incidents on these wards during the 24 months post-implementation (2018-2019) ( n = 6,551) and the "control" group comprising all incidents in the 24 months preceding implementation (2015-2016) ( n = 7,048). Incidents recorded during implementation (i.e., 2017) were excluded ( n = 3,705). Incidence rate ratios (IRR) were calculated with 95% confidence intervals (95% CI). Multivariate regression models using generalised estimating equations were performed to estimate unadjusted and adjusted prevalence ratios (aPR) of physical restraint and harm, using type of wards, incident, and violence/aggression as key covariates., Results: A significant 17% reduction in incidence of physical restraint was observed [IRR = 0.83, 95% CI 0.77-0.88, p < 0.0001]. Significant reductions in rates of harm sustained and aggression/violence were also observed, but not concerning the use of medication during restraint. The prevalence of physical restraint was significantly higher in inpatients on forensic learning disability wards than those on forensic mental health wards both pre- (aPR = 4.26, 95% CI 2.91-6.23) and post-intervention (aPR = 9.09, 95% CI 5.09-16.23), when controlling for type of incident and type of violence/aggression. Physical assault was a significantly more prevalent risk factor of restraint use than other forms of violence/aggression, especially that directed to staff (not to other patients)., Conclusions: This is a key study reporting the positive impact that organisational models and guides such as "No Force First" can have on equipping staff to focus more on primary and secondary prevention as opposed to tertiary coercive practices such as restraint in mental health and learning disabilities settings., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Haines-Delmont, Goodall, Duxbury and Tsang.)

Objectives: The aim of the project was to examine the acceptability and feasibility of a mobile phone application-based intervention 'TechCare', for individuals with psychosis in the North West of England. The main objectives were to determine whether appropriate individuals could be identified and recruited to the study and whether the TechCare App would be an acceptable intervention for individuals with psychosis., Methods: This was a mixed methods feasibility study, consisting of a test-run and feasibility evaluation of the TechCare App intervention., Setting: Early Intervention Services (EIS) for psychosis, within an NHS Trust in the North West of England., Participants: Sixteen participants (test-run n=4, feasibility study n=12) aged between 18 and 65 years recruited from the East, Central and North Lancashire EIS., Intervention: A 6-week intervention, with the TechCare App assessing participants' symptoms and responses in real-time and providing a personalised-guided self-help-based psychological intervention based on the principles of Cognitive Behaviorual Therapy (CBT)., Results: A total of 83.33% (n=10) of participants completed the 6-week feasibility study, with 70% of completers achieving the set compliance threshold of ≥33% engagement with the TechCare App system. Analysis of the qualitative data suggested that participants held the view that the TechCare was both an acceptable and feasible means of delivering interventions in real-time., Conclusion: Innovative digital clinical technologies, such as the TechCare App, have the potential to increase access to psychological interventions, reduce health inequality and promote self-management with a real-time intervention, through enabling access to mental health resources in a stigma-free, evidence-based and time-independent manner., Trial Registration Number: ClinicalTrials.gov Identifier: NCT02439619., Competing Interests: Competing interests: IBC and NH have given lectures and advice to Eli Lilly, Bristol Myers Squibb, Lundbeck, Astra Zeneca and Janssen Pharmaceuticals, for which they or their employing institution have been reimbursed. IBC and NH were previously trustees of the Pakistan Institute of Learning and Living. NH is Chair of the board of trustees of the Manchester Global Foundation. CDJT reports grants from UK National Institute for Health Research (NIHR) Research Fellowship award (DRF-2012-05-211), delivers psychological therapy in the UK National Health Service and personal fees from providing occasional workshops on CBT, outside the submitted work. The other authors have no competing interests to declare., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)

The relative burden of mental health disorders is increasing globally, in terms of prevalence and disability. There is limited data available to guide treatment choices for clinicians in low resourced settings, with mHealth technologies being a potentially beneficial avenue to bridging the large mental health treatment gap globally. The aim of the review was to search the literature systematically for studies of mHealth interventions for psychosis globally, and to examine whether mHealth for psychosis has been investigated. A systematic literature search was completed in Embase, Medline, PsychINFO and Evidence Based Medicine Reviews databases from inception to May 2016. Only studies with a randomised controlled trial design that investigated an mHealth intervention for psychosis were included. A total of 5690 records were identified with 7 studies meeting the inclusion criteria. The majority of included studies, were conducted across Europe and the United Sates with one being conducted in China. The 7 included studies examined different parameters, such as Experiential Sampling Methodology (ESM), medication adherence, cognitive impairment, social functioning and suicidal ideation in veterans with schizophrenia. Considering the increasing access to mobile devices globally, mHealth may potentially increase access to appropriate mental health care. The results of this review show promise in bridging the global mental health treatment gap, by enabling individuals to receive treatment via their mobile phones, particularly for those individuals who live in remote or rural areas, areas of high deprivation and for those from low resourced settings., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

Objectives: Technological advances in healthcare have shown promise when delivering interventions for mental health problems such as psychosis. The aim of this project is to develop a mobile phone intervention for people with psychosis and to conduct a feasibility study of the TechCare App., Methods: The TechCare App will assess participant's symptoms and respond with a personalised guided self-help-based psychological intervention with the aim of exploring feasibility and acceptability. The project will recruit 16 service users and 8-10 health professionals from the Lancashire Care NHS Foundation Trust Early Intervention Service., Results: In strand 1 of the study, we will invite people to discuss their experience of psychosis and give their opinions on the existing evidence-based treatment (cognitive behavioural therapy) and how the mobile app can be developed. In strand 2, we will complete a test run with a small number of participants (n = 4) to refine the mobile intervention (TechCare). Finally, in strand 3 of the study, the TechCare App will be examined in a feasibility study with 12 participants., Conclusion: It has been suggested that there is a need for a rapid increase in the efforts to develop the evidence base for the clinical effectiveness of digital technologies, considering mHealth research can potentially be helpful in addressing the demand on mental health services globally., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Background: A study of involvement initiatives within secure mental health services across one UK region, where these have been organized to reflect alliances between staff and service users. There is little previous relevant international research, but constraints upon effective involvement have been noted., Objective: To explore and evaluate involvement initiatives in secure mental health settings., Design: A case study design with thematic analysis of qualitative interviews and focus groups., Setting and Participants: Data collection was carried out between October 2011 and February 2012 with 139 staff and service users drawn from a variety of secure mental health settings., Findings: Our analysis offers four broad themes, titled: safety and security first?; bringing it all back home; it picks you up; it's the talk. The quality of dialogue between staff and services users was deemed of prime importance. Features of secure environments could constrain communication, and the best examples of empowerment took place in non-secure settings., Discussion: Key aspects of communication and setting sustain involvement. These features are discussed with reference to Jurgen Habermas's work on communicative action and deliberative democracy., Conclusions: Involvement initiatives with service users resident in secure hospitals can be organized to good effect and the active role of commissioners is crucial. Positive outcomes are optimized when care is taken over the social space where involvement takes place and the process of involvement is appreciated by participants. Concerns over risk management are influential in staff support. This is germane to innovative thinking about practice and policy in this field., (© 2014 The Authors Health Expectations Published by John Wiley & Sons Ltd.)

Rice consumption is one of the major pathways for As intake in populations that depend on a rice diet in several countries of South and South-east Asia. Pot experiments were undertaken to investigate the effects of water management (WM), arsenic (As) contaminated soil-water and Phosphorus (P) rates on As uptake in rice plants. There were 18 treatments comprising of three each of As rates (0, 20 and 40 mg kg(-1) soil) and P rates (0, 12.5 and 25 mg kg(-1) soil) and two WM (aerobic and anaerobic) strategies on winter (boro var. BRRI dhan 29) and monsoon (aman var. BRRI dhan 32) rice at the Wheat Research Center (WRC), Nashipur, Dinajpur, Bangladesh. Arsenic concentrations in rice grain and straw increased significantly (P ≤ 0.01) with the increasing As rates in the soil. Arsenic availability in soil pore-water solution was less (58%) under aerobic WM (redox potential-Eh=+135 to +138 mV; pH-6.50 at 24.3 °C) as compared to anaerobic WM (flooded: Eh=-41 to -76 mV; pH-6.43 at 23 °C). The highest total grain As content 2.23 ± 0.12 mg kg(-1) and 0.623 ± 0.006 mg kg(-1) was found in T(6) (P(12.5)As(40)-anaerobic) and T(9) (P(25)As(40)-anaerobic) in BRRI dhan 29 and BRRI dhan 32, respectively, which was significantly higher (41-45%) than in the same As and P treatments for pots under aerobic WM. The As content in rice straw (up to 24.7 ± 0.49 ppm in BRRI dhan 29, 17.3 ± 0.49 mg kg(-1) in BRRI dhan 32 with the highest As level) suggested that As can more easily be translocated to the shoots under anaerobic conditions than aerobic condition. BRRI dhan 29 was more sensitive to As than BRRI dhan 32. Under aerobic WM, P soil amendments reduced As uptake by rice plants. The study demonstrated that aerobic water management along with optimum P amendment and selection of arsenic inefficient rice varieties are appropriate options that can be applied to minimize As accumulation in rice which can reduce effects on human and cattle health risk as well as soil contamination., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Spatial distribution of arsenic (As) concentrations of irrigation water, soil and plant (rice) in a shallow tube-well (STW) command area (8 ha), and their relationship with Fe, Mn and P were studied. Arsenic concentrations of water in the 110 m long irrigation channel clearly decreased with distance from the STW point, the range being 68-136 microg L(-1). Such decreasing trend was also noticed with Fe and P concentrations, but the trend for Mn concentrations was not remarkable. Concerning soil As, the concentration showed a decreasing tendency with distance from the pump. The NH(4)-oxalate extractable As contributed 36% of total As and this amount of As was associated with poorly crystalline Fe-oxides. Furthermore only 22% of total As was phosphate extractable so that most of the As was tightly retained by soil constituents and was not readily exchangeable by phosphate. Soil As (both total and extractable As) was significantly and positively correlated with rice grain As (0.296+/-0.063 microg g(-1), n=56). Next to drinking water, rice could be a potential source of As exposure of the people living in the As affected areas of Bangladesh.

The impact of Meloidogyne graminicola on growth and yield of lowland rainfed rice was assessed with and without carbofuran in a rice-wheat rotation area of northwestern Bangladesh. The experiment was conducted on farmer fields and at a research station, with experimental plots arranged in a randomized complete block design. Prior to transplanting, rice seedling height and dry weight were greater (P

Objectives: Link traditional agricultural production disciplines to the food sciences and the various disciplines concerned with human nutrition and health in order to find sustainable solutions to malnutrition., Design: Develop a new integrated program area within a university by forging explicit linkages within a wide array of disciplines concerned with food systems and human health., Setting: The College of Agriculture and Life Sciences, the College of Human Ecology, the Division of Nutrition, and the Cornell International Institute for Food, Agriculture, and Development at Cornell University, Ithaca, New York, USA., Interventions: Use food-based, system approaches to meet human nutrition goals. Current focus is on the provision of micronutrients (especially iron, vitamin A and iodine) for people globally., Results: A new program area 'Food Systems for Health' has been developed at Cornell University. The program fosters effective interdisciplinary research, teaching and extension activities directed towards sustainable improvements in human nutrition and health., Conclusions: The old paradigms of agriculture, human nutrition, and public health must be shifted from current linear approaches to integrated and interactive approaches if effective long-term, food-based solutions to micronutrient malnutrition are to be found.

An enzyme preparation from 2,4-dichlorophenoxyacetate-grown Arthrobacter sp. converted cis,cis-2,4-dichloromuconate to chloromaleylacetate. The enzyme lactonizing the dichloromuconate to yield 2-chloro-4-carboxymethylene but-2-enolide was separated from the butenolide-delactonizing enzyme.