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Purpose Many referrals to our mental health of learning disability service focus on concerns about behaviours that present risks to the referred person and to those around them, including support workers. If the referred person has good verbal ability, psychological therapy may be requested and offered, but the person may find it too difficult to engage for a number of reasons. Even when they do engage in therapy, the authors recognise the importance of helping staff better understand their attachment needs. This paper aims to demonstrate an innovative approach to helping staff provide Trauma-Informed Care (TIC). Design/methodology/approach The authors developed a training programme for support workers using psychodynamic concepts, such as splitting, transference and counter-transference, to help them develop insight into the processes that get enacted during their work. In this paper the authors have generally used the term “care staff”, recognising that an important aspect of the role of those staff is to provide care within an attachment framework; as well as support to maximise independence. Findings The feedback from staff who have attended has been very positive, both at the time and later. Staff who have attended have talked to multidisciplinary colleagues about the impact their learning has had on their ability to work with service users who present great challenges, in the context of their trauma histories. Originality/value The importance of providing TIC is gaining traction across varied settings. The authors are in the process of developing both qualitative and quantitative research programmes to evaluate this approach to increasing TIC for adults with learning disabilities, reducing staff burn out and placement breakdown.

Antibody tests for SARS-CoV-2, the virus that causes COVID-19, are widely available. This living review summarizes the evidence on the prevalence, levels, and durability of detectable antibodies after SARS-CoV-2 infection and whether antibodies to SARS-CoV-2 confer protective immunity. The review will be updated as more evidence becomes available., Background: The clinical significance of the antibody response after SARS-CoV-2 infection remains unclear. Purpose: To synthesize evidence on the prevalence, levels, and durability of detectable antibodies after SARS-CoV-2 infection and whether antibodies to SARS-CoV-2 confer natural immunity. Data Sources: MEDLINE (Ovid), Embase, CINAHL, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, World Health Organization global literature database, and Covid19reviews.org from 1 January through 15 December 2020, limited to peer-reviewed publications available in English. Study Selection: Primary studies characterizing the prevalence, levels, and duration of antibodies in adults with SARS-CoV-2 infection confirmed by reverse transcriptase polymerase chain reaction (RT-PCR); reinfection incidence; and unintended consequences of antibody testing. Data Extraction: Two investigators sequentially extracted study data and rated quality. Data Synthesis: Moderate-strength evidence suggests that most adults develop detectable levels of IgM and IgG antibodies after infection with SARS-CoV-2 and that IgG levels peak approximately 25 days after symptom onset and may remain detectable for at least 120 days. Moderate-strength evidence suggests that IgM levels peak at approximately 20 days and then decline. Low-strength evidence suggests that most adults generate neutralizing antibodies, which may persist for several months like IgG. Low-strength evidence also suggests that older age, greater disease severity, and presence of symptoms may be associated with higher antibody levels. Some adults do not develop antibodies after SARS-CoV-2 infection for reasons that are unclear. Limitation: Most studies were small and had methodological limitations; studies used immunoassays of variable accuracy. Conclusion: Most adults with SARS-CoV-2 infection confirmed by RT-PCR develop antibodies. Levels of IgM peak early in the disease course and then decline, whereas IgG peaks later and may remain detectable for at least 120 days. Primary Funding Source: Agency for Healthcare Research and Quality. (PROSPERO: CRD42020207098)

This article discusses the justification for inclusive education in Australia, whilst being cognizant of the wider international landscape. Separate educational provision is increasing in many countries, including Australia. Inclusive education has plateaued to a degree with demand increasing for non-inclusive settings. There are three main components to the argument for and against inclusive education and these are the educational, social, and the economic justification. There is clear evidence that inclusive education in Australia can be justified across these areas. There is a dearth of evidence that inclusive education is less than beneficial for all students in mainstream schools. In fact, studies show that there is an economic advantage to being fully inclusive, but this should not be seen as an opportunity for cost saving in the education sector but rather as proper deployment of resources to ensure effective education for all students no matter what their background. The evidence for social and educational benefits is vast with both parents and students reporting positive outcomes. Inclusive education can be fraught with difficulties, but this article clearly shows the positive justification for inclusive educational environments.

Inclusive education can be viewed as an ongoing active process or journey that is impacted by changes in policy, practices, and values (Anderson & Boyle, 2020). This “journey toward inclusion” is not always an easy undertaking, but rather a progression that requires modification to systems, structures, and functioning in schools. Nauru, a small Pacific republic situated in the Micronesian central Pacific Ocean, has worked in partnership with Australian education providers since 2011 to improve educational learning experiences for all Nauruan students. More recently, initiatives by the Nauru Government resulted in the commissioning of a national project to develop a Nauru policy on inclusive education and also to deliver professional development for teachers that would be needed to support inclusion. Inclusive education staff at the University of England, Australia, guided the development of the project which culminated in the Nauru Inclusive Education Policy and Guidelines (2017) (Page, 2018). From this policy, a series of workshops were delivered on unpacking the policy directions, guidelines, and roles and responsibilities for teaching staff in Nauru. This chapter describes the university staff who are working in collaboration with Nauruan teachers in order to develop their capacity to create inclusive classrooms. In doing so, we embraced approaches that incorporated culturally responsive practices into our work, using the framework of Ekereri (educational approaches that embody the core values of Nauruan culture) into our practices. With this chapter, we hope to further the understanding of how contextual factors influence the collaboration and implementation of educational partnerships between culturally distinctive groups of people.

Purpose The purpose of this review is to assess maternal explanations for early breastfeeding cessation in economically developed countries. Study design and methods The electromic databases EBSCO, CINAHL, Child Development & Adolescent Studies, PsycInfo, Health Source: Nursing/Academic Edition, Nursing and Allied Health; ProQuest databases: Family Health Database, Health and Medical Collection, Nursing and Allied Health, Psychology Database, and Public Health Databases were searched using the terms breastfeeding, cessation, stop, discontinuation, early weaning, quit*, early termination, and six months. Inclusion criteria included infants born at least 37 weeks gestation, single birth, and infant birthweight > 2,500 g. Results Initial literature search yielded 117 studies; 10 studies met inclusion criteria. The two most common reasons for early breastfeeding cessation were perceived inadequate milk supply and maternal breast or nipple pain. Conclusion Research on maternal reasons for early breastfeeding cessation is limited. Reasons for early breastfeeding cessation are varied; however, the most common themes were perceived inadequate supply and breast or nipple pain. Nurses should tailor assessment of each breastfeeding mother-baby couplet and associated interventions based on these findings.

Over the first few months of 2020, the schooling sector shifted to distance education as governments moved to bring the virus, COVID-19, under control. Education sectors rapidly developed online en...

Introduction Incidence of colorectal cancer (CRC) increases with age, with older patients having a worse prognosis than younger patients. The underlying molecular features which lead to these age-related differences are unclear, but possible reasons include immune senescence or cellular senescence. Characterisation of differences in gene expression in cancers of older and younger patients, particularly genes driving the immune response to cancer, will contribute to our understanding of the differences between early- and late-presenting tumours and inform treatment strategies. Methods RNA was extracted from tumour cells and lymph nodes from three cohorts of patients with rectal cancer (n=47), stage 2 CRC (n=72) and stage 3 CRC (n=69). For the stage 3 CRC cohort, RNA was extracted from the primary tumour. After RNA-Sequencing, differential gene expression data was generated between older and younger patients in the Stage 3 cohort, with ‘old’ patients being one standard deviation (SD) above the median, and ‘young’ patients one SD below the median (median=72 years). Results were validated with a second cohort of Stage 3 CRC samples (n=78). Results In primary tumour samples from the stage 3 cohort, there were 581 genes differentially expressed between older and younger patients at p-adj Conclusions Our results have shown that there are detectable differences in tumour and lymph node gene expression between older and younger patients; such findings may further enhance age-dependent personalised therapy. We have chosen to focus on age-related differential gene expression, but differences between other tumour phenotypes may also be investigated and likely to further enhance our biological understanding of cancer biology.

Inclusive education ( IE) is a term that has been part of the educational discourse in Australia for almost two decades. While there is no overarching definition under which IE operates in that country, it is accepted that the meaning behind the term has shifted from being exclusively about students with a disability to now encompassing the delivery of a high-quality education to all students. The public education system is carrying the burden of an increasingly diverse student population ( Gonski et al., 2011), and as such, each of the eight educational jurisdictions responsible for the schools within their borders have developed policies and increased funding levels in the name of IE ( Graham, in press). Despite this, there are currently no standards or guidelines provided at the state or federal level to measure the success (or not) of IE practices within Australian educational sectors. This article aims to do just that, by providing a 'report card' on IE in Australia. An extensive review of the current literature and related educational policies and reports was conducted, and Loreman's (2014) three guides for measuring IE - student participation, student achievement and post-school options - were adopted to evaluate the performance of Australia's public education system. The findings indicate that, despite operating under the same national legislative acts, the eight educational jurisdictions in Australia are managing and enacting IE in different ways, leading to inconsistent levels of access and educational outcomes for students. Rates of segregation and exclusion (through both the provision of education in 'alternative' settings and disciplinary action) are on the increase, with disproportionate representation of students from minority groups. This has been exacerbated by the inception of a national testing regime, which some have argued is in breach of the Disability Discrimination Act as it excludes participation by particular groups of students. On the flip side, for the first time Australia has a consistent curriculum that has provided a set of outcomes for all students, and the gap between Indigenous and non-Indigenous students in the areas of literacy and numeracy is on the decrease, albeit a slow decrease. However, there is still a long way to go, and this paper discusses the need for a national approach to IE to enable the continued development of effective schooling for all students across Australia. [ABSTRACT FROM AUTHOR]

District general hospital scanners have historically been linked to regional neuroscience units for specialist opinions on scans and to make decisions on transfer of patients requiring neurosurgical management. The implementation of digital picture archiving and communication systems (PACS) in all hospitals in the UK has disrupted these dedicated links and technical and information governance issues have delayed reprovision of electronic transfer of images for rapid expert decision making in this group of patients. We studied improvement in image transfer to acute neurosurgery units over a 4-year period.Four-year sequential review of national provision of image transfer facilities into neurosurgery units; observational study of delays associated with image transfer modalities in one representative tertiary referral centre.During the 4 years of study, all hospitals nationally have implemented digital PACS systems for image viewing. Remote image viewing facilities have gradually changed with dedicated image links being replaced by remote PACS access. However, a minority of referrals (12%) still require images to be physically transferred between hospitals using couriers for CD-ROMs. The detailed study within our own unit shows that this adds a mean delay of 5.8 h to decision making.Image transfer in neuroscience has been neglected following the shift to PACS servers. The recommendations of the 2004 Neuroscience Critical Care Report are unmet and patient safety is being threatened by a continued failure to implement a coordinated solution to this problem.

e15595Background: Metastasis is a key hallmark of cancer and the principal cause of death of patients with colorectal cancer (CRC). Lymph node metastatic tumour deposits (LNMTD) are of interest as ...

The study's objective was to identify systemic facilitators and barriers of transferring young adults (ages 17-21) with eating disorders from pediatric to adult health and mental health services. Qualitative interviews were conducted and three themes emerged: (a) difficulties navigating care during the transfer period; (b) challenges achieving and maintaining recovery due to systemic barriers after the transfer of care;and (c) recommendations for facilitating the transfer between systems of care. From the perspective of young adults with eating disorders our study shows that the transition to adult care services may be improved with increased coordination, communication, and collaborative partnerships between pediatric and adult providers.

Globally, student populations in government-run schools are becoming increasingly diverse (see Gonski, 2011; Rashid & Tikly, 2010; Voltz, Sims & Nelson, 2010). Simultaneously, students are being excluded from schools, or placed into segregated educational settings in increasing numbers. Both the social and economic costs of disengagement and exclusion from, and inequalities within, education systems have been well documented (see OECD, 2010; Snow & Powell, 2012; Wilkinson & Pickett, 2010).