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New surgical procedures can expose patients to harm and should be carefully evaluated before widespread use. The InSpace balloon (Stryker, USA) is an innovative surgical device used to treat people with rotator cuff tears that cannot be repaired. We aimed to determine the effectiveness of the InSpace balloon for people with irreparable rotator cuff tears.We conducted a double-blind, group-sequential, adaptive randomised controlled trial in 24 hospitals in the UK, comparing arthroscopic debridement of the subacromial space with biceps tenotomy (debridement only group) with the same procedure but including insertion of the InSpace balloon (debridement with device group). Participants had an irreparable rotator cuff tear, which had not resolved with conservative treatment, and they had symptoms warranting surgery. Eligibility was confirmed intraoperatively before randomly assigning (1:1) participants to a treatment group using a remote computer system. Participants and assessors were masked to group assignment. Masking was achieved by using identical incisions for both procedures, blinding the operation note, and a consistent rehabilitation programme was offered regardless of group allocation. The primary outcome was the Oxford Shoulder Score at 12 months. Pre-trial simulations using data from early and late timepoints informed stopping boundaries for two interim analyses. The primary analysis was on a modified intention-to-treat basis, adjusted for the planned interim analysis. The trial was registered with ISRCTN, ISRCTN17825590.Between June 1, 2018, and July 30, 2020, we assessed 385 people for eligibility, of which 317 were eligible. 249 (79%) people consented for inclusion in the study. 117 participants were randomly allocated to a treatment group, 61 participants to the debridement only group and 56 to the debridement with device group. A predefined stopping boundary was met at the first interim analysis and recruitment stopped with 117 participants randomised. 43% of participants were female, 57% were male. We obtained primary outcome data for 114 (97%) participants. The mean Oxford Shoulder Score at 12 months was 34·3 (SD 11·1) in the debridement only group and 30·3 (10·9) in the debridement with device group (mean difference adjusted for adaptive design -4·2 [95% CI -8·2 to -0·26];p=0·037) favouring control. There was no difference in adverse events between the two groups.In an efficient, adaptive trial design, our results favoured the debridement only group. We do not recommend the InSpace balloon for the treatment of irreparable rotator cuff tears.Efficacy and Mechanism Evaluation Programme, a Medical Research Council and National Institute for Health and Care Research partnership.

Purpose This study aims to explore how care staff working with people with learning disabilities experienced psychologist-facilitated team formulation sessions in a cognitive analytic style (contextual reformulation). Design/methodology/approach Eleven participants attended at least one contextual reformulation session regarding a client their team referred because of challenging behaviour. Post-intervention semi-structured interviews were analysed using qualitative inductive thematic analysis. Findings Five themes were developed: multiple roles and functions of sessions and clinicians; challenging behaviour in relationship; making links – understanding can be enlightening, containing and practical; the process of developing a shared understanding and approach; and caught between two perspectives. Findings suggested contextual reformulation helped staff see challenging behaviour as relational, provided them with the space to reflect on their emotions and relate compassionately to themselves and others, and ultimately helped them to focus their interventions on understanding and relationally managing rather than acting to reduce behaviour. Research limitations/implications Qualitative methodology allows no causal inferences to be made. Ten of 11 participants were female. Originality/value This qualitative study adds to the limited research base on team formulation in learning disabilities settings and specifically that using a cognitive analytic approach.

If it’s true that we learn our sense of who we are by having the views of other people reflected to us, then survivors of childhood sexual abuse are offered an utterly confusing kaleidoscope of conflicting views. Child sexual abuse is not simply what happens between the perpetrator(s) and the child, but also the stance taken by families and the prevailing political, judicial and social culture. If survivors want to make some sense of what happened, and therapists wish to help survivors thrive, both must track society’s mixed, discordant and evolving reactions. Therapeutic discourse about child sexual abuse has always been embedded in the social and political ‘zeitgeist’ when the issue was presented. Because there are dramatic and significant changes in political and social attitudes towards survivors of child sexual abuse, which are allowing previously silenced voices to express themselves, we are now able to write this chapter describing the complexities of societal and therapeutic ideas about and attitudes towards children who have been abused and their abusers. Both the authors write from a double position: one of us an NHS psychologist and the other an NHS psychotherapist, and also as survivors of child sexual abuse.

Purpose – There is little research addressing the delivery of training for health professionals who are interested in using cognitive-behaviour therapy (CBT) techniques as an adjunct to their current role. This paper describes the establishment and evaluation of a CBT training course to develop CBT skills in staff working with people with intellectual disabilities in Trust healthcare settings. The course would enable staff to learn how they could incorporate these skills into their daily practice to help them understand and work more effectively with people with intellectual disabilities. Design/methodology/approach – A CBT training course was designed to teach staff the use of a number of basic and specific CBT techniques and principles that staff could use within their current roles. Specific issues in relation to people with intellectual disabilities were included, e.g. understanding cognitive deficits as well as cognitive distortions. The course ran for six sessions on a fortnightly basis, followed by a two-month follow-up session. Participants completed a pre- and post-assessment questionnaire and kept a reflective diary. Findings – The training clearly focused on teaching skills that were feasible for staff to use in their own work settings. The evaluations, especially from the reflective diaries and the post-course questionnaires clearly demonstrated that this aim was achieved. Originality/value – This was a pilot study as there has been no previously published evidence of using this approach within intellectual disabilities services. A further training course has been planned to continue evaluating the effectiveness of this approach.

Despite possible negative effects, many children do not tell their teachers when they have been bullied. This study examined junior school pupils' ("N" = 294) reports of instrumental, emotional and validation social support received after disclosing being bullied to teachers, and associations with intentions to disclose in the future. Overall, participants reported receiving modest to high levels of social support. The three social support variables accounted for a significant proportion (16.3%) of the variance in intentions to disclose. Each of them also emerged as significant non unique predictors (i.e. not controlling for their shared variance), and validation social support did so even after controlling for the influence of the other two types. These effects were stronger for boys than for girls, and some varied by age. FINDINGS are discussed in terms of outcome- expectancy theory and practical implications. Language: en

Background: Following previous studies (Cooper et al, 1991), the department has used overnight oximetry (Minolta 300i) as a first line screening tool for Obstructive Sleep Apnoea (OSA), followed by multichannel studies (NOX T3 portable sleep monitor) on highly symptomatic patients with negative oximetry. The number of inconclusive studies requiring repeat with NOX had increased over the previous 12 month period. The aim of the study was to establish which test was most useful at baseline to reduce the number of appointments between presentation and diagnosis. Method: A retrospective service review was conducted between September 2013 and August 2014. It was registered with the hospital research department. Data was collected from patients seen for both overnight oximetry and multichannel sleep studies and the Oxygen Desaturation Index (ODI) and Apnoea Hypopnea Index (AHI) for each study was reviewed. Results: 54 patient datasets were analysed (M:29F:25). Pulse oximetry gave a mean ODI of 3.9 with multichannel studies showing a mean AHI of 11.6. 64.8% of subjects had an AHI >15 with multichannel studies, compared to 25% with oximetry. The mean increase in severity of OSA was +7.49 events/hour. Conclusion: This research indicates that multichannel studies are more sensitive at diagnosing OSA. Hospital practice was modified. Patients are now screened using multichannel sleep studies as baseline diagnostic tool. Reference: Cooper, BG, Veale, D, Griffiths, CJ, et al Value of nocturnal oxygen saturation as a screening test for sleep apnoea. Thorax 1991; 46,586-588.

Dialogical Analysis, a tool from Cognitive Analytic Therapy, is used to discover how the mindset of war silences dialogue. The savage costs of war were hidden whilst the United Kingdom government expected to attract the admiration of a grateful world. This article looks at an example of this mindset expressed through Tony Blair MP's speech to the House of Commons on 18 March 2003. The speech aimed at convincing parliament that war was inevitable, necessary and the only obvious choice. It offered an extremely narrow presentation of options available to the government, in which 'staying firm' was coupled with the case for war whilst alternative, peaceful methods of conflict resolution were identified as 'weak and feeble' and viewed as encouraging terrorists.

Nucleotide sequence polymorphism in the left domain of the control region of the mitochondrial genome of over 700 goldband snapper (Pristipomoides multidens) was surveyed using both direct sequencing and innovative restriction enzyme cleavage analysis techniques. Southeast Asian populations were sampled adjacent to western Irian Jaya, northern Papua New Guinea and western Timor. Six Australian populations were sampled from adjacent to Exmouth in western Australia to Weipa in the northern Gulf of Carpentaria. The results show that significant genetic structure occurs among Indonesian and Australian waters along national boundaries; 14% of the total molecular variance among restriction site haplotypes was due to genetic distinction between Indonesian and Australian samples. Several lines of evidence suggest that gene flow does not occur freely along the northern and western Australian coastline, particularly on the northwestern Kimberley coast. Australian fisheries managers need to be alerted to the possibility of at least one genetically distinct population of this important commercial species which should be protected from over-harvesting that may otherwise lead to localised extinction and the erosion of genetic diversity. There is no convincing biological argument for the observed genetic disjunction in the Kimberley area. It may be due to the combined effect of past sea-level changes, sampling error or patterns of exploitation. # 2002 Elsevier Science B.V. All rights reserved.

Measurement of stable isotope ratios ( 18 O/ 16 O and 13 C/ 12 C) in the sagittal otolith carbonate from assemblages of goldband snapper Pristipomoides multidens from waters off northern and western Australia revealed location-specific signatures and indicated that fish from all sites sampled within Australia (Exmouth, Rankin Bank, Broome, Vulcan Shoals, Timor Sea, Arafura Sea), Indonesia (Kupang) and Papua New Guinea (Pommern Bay) were different. The significant differences in the isotopic signatures of P. multidens demonstrated that there is unlikely to be substantial movement of fish among these distinct adult assemblages. The stable isotopic signatures for the fish from the different locations were persistent through time, and therefore it could be concluded that the fish comprise separate stocks for many of the purposes of fisheries management. The ratios of the stable oxygen isotopes in P. multidens were significantly related to sea surface temperatures (r 2 = 0.797). This study has provided further evidence that measurement of the stable isotope ratios in teleost sagittal otolith carbonate can be a valuable tool in the delineation of fishable stocks or fishery management units of adult fish where the range of distribution of the species in question covers waters with different temperature regimes.

This article describes the work of a project management nurse in improving accessibility and appropriate use of pressure-relieving equipment in an integrated (acute and community) trust. It examines key issues for future service development in the management and appropriate use of pressure-relieving equipment. The importance of education in maintaining the accuracy and process of recording pressure damage at ward level is also highlighted. One recommendation is that employing a pressure equipment assistant might improve the control and management of pressure equipment availability.

SUMMARYComparative clinical trials of live attenuated and detergent-split subunit influenza virus vaccines were undertaken with 1048 volunteers in Western Australia. Volunteers were divided into three main groups, each of which received either live virus vaccine or a saline control administered intranasally, or subunit vaccine injected subcutaneously. No differences were recorded between the three groups in their post-vaccination symptoms. Serum samples were collected at various times up to 50 weeks after vaccination, and antibody titres were measured by haemagglutination-inhibition (HI) tests and, for 231 volunteers, by virus neutralization tests. The two vaccines were almost equivalent in inducing seroconversion in vaccinees with pre-trial HI titres of 96 or less, but the subunit vaccine stimulated a higher geometric mean HI antibody titre. The longevity of the HI antibody response was greater for the live virus vaccine. The height of the response and the longevity of neutralizing antibody were the same for both vaccines. Both vaccines provided a high degree of protection against epidemic A/England/42/72 influenza, and some protection against A/Port Chalmers/1/73 influenza.

Lexical decisions about high-frequency words are faster than about low-frequency words. It has been suggested that the locus of this effect is in a verification stage in which a frequency-ordered comparison takes place that requires the continuous availability of a sensory representation of the stimulus. This proposal was tested in a series of four lexical decision studies. In the first, high- and low-frequency words and nonword stimuli remained visible until subjects responded. In the second, the stimuli were illuminated for only one retrace on a video monitor (16.7 ms), and in the third the single retrace was followed by a pattern mask 50 ms later. The latter two conditions have been suggested as manipulations that would eliminate the verification stage of recognition. Nevertheless, the effect of word frequency on decision latencies was comparable in all three studies. Data from a fourth study eliminated orthographic regularity as a factor contributing to the obtained frequency effect. The data suggest that frequency has its effects prior to verification and that the notion of verification as the sole basis for frequency effects needs to be revised.

The current study investigated the extent to which the concurrent presentation of pleasant and unpleasant odors could modulate the perceptual saliency of happy facial expressions in an emotional visual search task. Whilst a search advantage for happy faces was found in the no odor and unpleasant odor conditions, it was abolished under the pleasant odor condition. Furthermore, phasic properties of visual search performance revealed the malleable nature of this happiness advantage. Specifically, attention towards happy faces was optimized at the start of the visual search task for participants presented with pleasant odors, but diminished towards the end. This pattern was reversed for participants in the unpleasant odor condition. These patterns occur through the emotion-inducing capacities of odors and highlight the circumstances in which top-down factors can override perceptually salient facial features in emotional visual search.