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Background: Specialist Community Practitioner (SCP) and Specialist Community Public Health Nurse (SCPHN) students are required to evidence their competency by the use of reflective practice as part of the NMC proficiencies. A reflective café trilogy comprising of three reflective teaching sessions was developed and introduced into a university programme to support and encourage alternative methods for deeper reflection within this student group. Aim: It was important for educators to evaluate if a reflective café met the student’s needs and understand the usefulness of a ‘reflective café’ as a technique to support the process of reflecting on practice. Methods: Evaluation was undertaken using an online questionnaire. Findings: Students evaluated if the reflective café was useful for their own development and identified that the number of sessions met their developmental needs. Conclusion: The potential to develop alternative methods to reflect was recognised and the team plan to develop other reflective processes to support students in the future.

Purpose Existing algorithms for predicting suicide risk rely solely on data from electronic health records, but such models could be improved through the incorporation of publicly available socioeconomic data – such as financial, legal, life event and sociodemographic data. The purpose of this study is to understand the complex ethical and privacy implications of incorporating sociodemographic data within the health context. This paper presents results from a survey exploring what the general public’s knowledge and concerns are about such publicly available data and the appropriateness of using it in suicide risk prediction algorithms. Design/methodology/approach A survey was developed to measure public opinion about privacy concerns with using socioeconomic data across different contexts. This paper presented respondents with multiple vignettes that described scenarios situated in medical, private business and social media contexts, and asked participants to rate their level of concern over the context and what factor contributed most to their level of concern. Specific to suicide prediction, this paper presented respondents with various data attributes that could potentially be used in the context of a suicide risk algorithm and asked participants to rate how concerned they would be if each attribute was used for this purpose. Findings The authors found considerable concern across the various contexts represented in their vignettes, with greatest concern in vignettes that focused on the use of personal information within the medical context. Specific to the question of incorporating socioeconomic data within suicide risk prediction models, the results of this study show a clear concern from all participants in data attributes related to income, crime and court records, and assets. Data about one’s household were also particularly concerns for the respondents, suggesting that even if one might be comfortable with their own being used for risk modeling, data about other household members is more problematic. Originality/value Previous studies on the privacy concerns that arise when integrating data pertaining to various contexts of people’s lives into algorithmic and related computational models have approached these questions from individual contexts. This study differs in that it captured the variation in privacy concerns across multiple contexts. Also, this study specifically assessed the ethical concerns related to a suicide prediction model and determining people’s awareness of the publicness of select data attributes, as well as which of these data attributes generated the most concern in such a context. To the best of the authors’ knowledge, this is the first study to pursue this question.

This chapter interrogates homegrown extremism in the context of political community. Identifying the common threads of disparate attacks, the chapter argues that acts of homegrown extremism are by definition committed by a member of a political community against other members in a way that is incommensurate with membership in that community. Adopting a Bourdieusian approach, the chapter argues that such acts exhibit symbolic as well as material violence, heightening their impact and shaping their use as a terrorist tactic. The chapter identifies and analyses homegrown extremism’s evolution as a jihadi strategy in the post-9/11 era, from Al-Qaeda to Islamic State.

This chapter presents a history of legislative attempts to address the issue of citizen terrorists in the United States. The chapter begins with relevant provisions in the PATRIOT Act 2001 that establish the framework through which the relationship between the citizen and the state is viewed in the context of post-9/11 counterterrorism. The chapter moves on to the failed Violent Radicalization and Homegrown Terrorism Prevention Act 2007 and tracks provisions dealing with citizen terrorists in the National Defense Authorization Acts (NDAAs) 2012–2016, and the Enemy Expatriation Act 2011. In tracing this history, the chapter argues that legislative attempts to deal explicitly with the problem of homegrown extremism clearly show the link between the concept of radicalization as a problem and the application of American values as its solution.

Discourses about “American values” pervade American CVE policy. This chapter interrogates the meaning of “American values” in three ways. First, it provides a brief history of US citizenship and integration policies—the means by which immigrants are encouraged to become American. Second, it outlines the history of US citizen violence against the state and pre-9/11 responses to it, from the Alien and Sedition Acts of 1798 to the Antiterrorism and Effective Death Penalty Act of 1996. Third, it gives a brief history of the emergence of the threat of homegrown extremism in the post-9/11 era, prior to the introduction of federal CVE programs.

This chapter provides a global survey of counterradicalization policies. The chapter begins by examining efforts to develop counterradicalization policies at the multilateral level, especially the UN Counter-Terrorism Implementation Task Force. It shows that in the post 9-11 era agreement between states, especially Muslim minority and Muslim majority states, on counterterrorism definitions and policies is fraught. The chapter continues by examining policies in a broad range of states and drawing out similarities between them. It finds that the primary similarity is an implicit framing of the problem of homegrown extremism as one of political community and a shared commitment to preemptive integration of radicalized and potentially radicalized individuals as a solution.

This chapter traces the UK’s legislative approach to the relationship between citizens and the state in the context of homegrown extremism, showing that such legislation addresses the problem within a broader framework of political community. It examines three types of legislative measures: those which establish the framework through which the relationship between citizen and state is viewed in the context of post-9/11 counterterrorism; those which seek to prevent “citizen terrorism” directly; and those which respond to homegrown extremism via immigration and citizenship legislation. Doing so offers a timeline of legislative activity and provides insights into the way that the problem and response are framed in the UK, showing that the concept of political community is key.

This chapter provides a brief history of US CVE and identifies the persistence of ideas about informal political community in these policies, despite the absence of conclusive evidence as to their efficacy. The chapter shows that ideas about a strong informal political community as a valid response to the problem of homegrown extremism appear in much of the thinking behind counterradicalization measures in the United States. These measures consistently frame tightening the borders of informal political community as a response to the problem of radicalization, via an emphasis on community engagement with the agencies of government and on community cohesion against agents of radicalization.

This chapter summarizes the arguments made in the book. The bulk of the chapter is dedicated to outlining the argument that both counterradicalization and homegrown extremism are concerned with ideas of political community. In particular, counterradicalization policies are concerned with integration as a counterradicalization measure and with persuasive rather than coercive approaches. The chapter goes on to summarize similarities and differences between UK and US approaches to the issue, situating the analysis in the context of constructivist counterterrorism literature. It ends by integrating broader literatures on transnationalism and citizenship theory and by briefly offering lessons for policymakers.

This chapter considers ideas of Britishness and British values that pervade much of Britain’s counterradicalization policy and asks what it means to be British and what British values entail, by providing a history of British citizenship and integration policies—the means by which immigrants are encouraged to become British. The chapter places this analysis in the context of a history of citizen violence against the British state and state responses to it. In doing so, it establishes the background against which post-9/11 counterradicalization policies emerge.

This chapter introduces the puzzle underpinning this book’s analysis. It identifies counterradicalization measures as different to traditional counterterrorism measures in that they are concerned with integration and persuasion rather than coercion. It highlights the fact that these types of policies exist in a range of different states, and asks why such measures appear to have emerged in the post-9/11 era. The chapter goes on to define key terms used in the book, including radicalization, homegrown extremism, and political community, and symbolic power. It also outlines relevant literatures and theoretical frameworks, including constructivist counterterrorism studies, citizenship theory, transnationalism, and critical terrorism studies.

Holding Your Friends Close: Countering Radicalization in Britain and America examines counterradicalization policies in the UK and United States, informed by both history and theory. The book traces the evolution of the threat of jihadi homegrown extremism and outlines a history of the counterradicalization policies that emerged globally in response. It takes the UK and United States as case studies within this broader analysis and provides a detailed policy history for each jurisdiction, interrogating policy measures, legislation, and the policies’ broader historical and political context. The book situates counterradicalization policies and homegrown extremism itself in the context of citizenship theory, transnationalism, and the concept of political community.

Summary Objective Our objective was to describe the characteristics of patients admitted, discharged and readmitted, due to COVID-19, to a central London acute-care hospital during the second peak, in particular in relation to corticosteroids use. Methods We reviewed patients admitted from the community to University College Hospital (UCH) with COVID-19 as their primary diagnosis between 1st-31st December 2020. Re-attendance and readmission data were collected for patients who re-presented within 10 days following discharge. Data were retrospectively collected. Results 196 patients were admitted from the community with a diagnosis of COVID-19 and discharged alive in December 2020. Corticosteroids were prescribed in hospital for a median of 5 days (IQR 3–8). 20 patients (10.2%) were readmitted within 10 days. 11/20 received corticosteroids in the first admission of which 10 had received 1–3 days of corticosteroids. Readmission rate in those receiving 1–3 days of corticosteroids was 25%. Conclusions Most international guidelines have recommended providing up to 10 days of corticosteroids for severe COVID-19 but stopping on discharge. Our findings show shorter courses of corticosteroids during admission are associated with an increased risk of being readmitted and support continuing the course of corticosteroids after hospital discharge monitored in the virtual ward setting.

Between 7 and 25 May, 86 monkeypox cases were confirmed in the United Kingdom (UK). Only one case is known to have travelled to a monkeypox virus (MPXV) endemic country. Seventy-nine cases with information were male and 66 reported being gay, bisexual, or other men who have sex with men. This is the first reported sustained MPXV transmission in the UK, with human-to-human transmission through close contacts, including in sexual networks. Improving case ascertainment and onward-transmission preventive measures are ongoing.

Pressure on acute medical services in the pandemic mandated an assertive emergency department (ED) discharge policy. Given the potential for subsequent deterioration and growing appreciation of complications relating to COVID-19 infection, this follow up study was instigated to provide clinical reassurance that discharged patients had followed a safe clinical course. 199 patients discharged from the ED of our central London hospital were identified over a 20-day period at the height of the pandemic in April 2020. 44 had already reattended ED and 12 had been admitted. At 2-week telephone follow-up, 14 patients were identified who required urgent recall for assessment. At 4-week telephone follow-up, 87 patients were identified with persistent symptoms requiring face to face review. A COVID-19 follow-up clinic was therefore established to provide multi-professional review and diagnostics. 65 patients attended for this assessment. This is the first report on outcomes in COVID-19 infected patients discharged from an ED. It highlights the importance of safety-netting after discharge, the difficulty in predicting which patients might deteriorate and the need for appropriate follow up services.

The COVID-19 pandemic has necessitated rapid adaptation of healthcare providers to new clinical and logistical challenges. Following identification of high levels of emergency department (ED) reattendance among patients with suspected COVID-19 at our centre, we piloted a rapid remote follow-up service for this patient group. We present our service framework and evaluation of our pilot cohort of 192 patients. We followed up patients by telephone within 36 hours of their ED attendance. Pulse oximetry was used for remote monitoring of a subset of patients. Patients required between one and six consecutive telephone assessments, dependent on illness severity, and 23 patients were recalled for in-person assessment. Approximately half of patients with confirmed or probable COVID-19 required onward referral for respiratory follow-up. This framework reduced unplanned ED reattendances in comparison with a retrospective comparator cohort (4.7% from 22.6%). We reproduced these findings in a validation cohort with a high prevalence of acute COVID-19, managed through the clinic in September–October 2020, where we identified an unplanned ED reattendance rate of 5.2%. We propose that rapid remote follow-up is a mechanism by which ambulatory patients can be clinically supported during the acute phase of illness, with benefits both to patient care and to health service resilience.

Information sharing has become a central concern for security agencies since 9/11. Previous research has identified a number of barriers to information sharing among agencies: a combination of legal or policy constraints, interagency rivalry and mistrust, and technology. Drawing on ideas from the sociology of information and trust, this article conceptualises the sharing/withholding of information between agencies as dependent on rules as a system of trust. Adapting Richard Ericson’s framework of the different contexts of rule-following and making use of an Australian case study, the article demonstrates how law, culture and technology are intertwined in constraining or enabling access to information. The implications of this model for legal and policy interventions are discussed.

We describe the London community testing programme developed for COVID-19, audit its effectiveness and report patient acceptability and patient adherence to isolation guidance, based upon a survey conducted with participants. Any patients meeting the Public Health England (PHE) case definition for COVID-19 who did not require hospital admission were eligible for community testing. 2,053 patients with suspected COVID-19 were tested in the community between January and March 2020. Of those tested, 75 (3.6%) were positive. 88% of patients that completed a patient survey felt safe and 82% agreed that community testing was preferable to hospital admission. 97% were able to remain within their own home during the isolation period but just 41% were able to reliably isolate from other members of their household. The London community testing programme allowed widespread testing for COVID-19 while minimising patient transport, hospital admissions and staff exposures. Community testing was acceptable to patients and preferable to admission to hospital. Patients were able to reliably isolate in their home but not from household contacts. The authors believe in the importance, feasibility and acceptability of community testing for COVID-19 as a part of a package of interventions to mitigate a second wave of infection.

IntroductionPost-COVID-19 complications require simultaneous characterisation and management to plan policy and health system responses. We describe the 12-month experience of the first UK dedicated post-COVID-19 clinical service to include hospitalised and non-hospitalised patients.MethodsIn a single-centre, observational analysis, we report the demographics, symptoms, comorbidities, investigations, treatments, functional recovery, specialist referral and rehabilitation of 1325 individuals assessed at the University College London Hospitals post-COVID-19 service between April 2020 and April 2021, comparing by referral route: posthospitalised (PH), non-hospitalised (NH) and post emergency department (PED). Symptoms associated with poor recovery or inability to return to work full time were assessed using multivariable logistic regression.Results1325 individuals were assessed (PH: 547, 41.3%; PED: 212, 16%; NH: 566, 42.7%). Compared with the PH and PED groups, the NH group were younger (median 44.6 (35.6–52.8) years vs 58.3 (47.0–67.7) years and 48.5 (39.4–55.7) years), more likely to be female (68.2%, 43.0% and 59.9%), less likely to be of ethnic minority (30.9%, 52.7% and 41.0%) or seen later after symptom onset (median (IQR): 194 (118–298) days, 69 (51–111) days and 76 (55–128) days; all pConclusionPost-COVID-19 symptoms were significant in PH and NH patients, with significant ongoing healthcare needs and utilisation. Trials of interventions and patient-centred pathways for diagnostic and treatment approaches are urgently required.

A young previously healthy patient presented with sepsis and cavitating pneumonia. Campylobacter rectus was isolated from blood cultures and subsequent CT neck showed an internal jugular vein thrombosis. Treatment was with antibiotics, anticoagulation and supportive management. Lemierre’s syndrome is an infectious thrombophlebitis of the internal jugular vein. Although a rare diagnosis since the use of penicillin for treatment of acute pharyngitis, it is being reported with increasing frequency. Usually associated with Fusobacterium spp, we believe that this is the first reported case of Lemierre’s caused by C. rectus—an anaerobic member of the human oral cavity flora, usually associated with localised periodontal disease. The bacillus was isolated from blood during the acute presentation.

BackgroundComplications following SARS-CoV-2 infection require simultaneous characterisation and management to plan policy and health system responses. We describe the 12-month experience of the first UK dedicated Post-COVID clinical service to include both hospitalised and non-hospitalised patients.MethodsIn a single-centre, observational analysis, we report outcomes for 1325 individuals assessed in the University College London Hospitals NHS Foundation Trust Post-COVID service between April 2020 and April 2021. Demography, symptoms, comorbidities, investigations, treatments, functional recovery, specialist referral and rehabilitation were compared by referral route (“post hospitalisation”, PH; “non-hospitalised”, NH; and “post emergency department”, PED). Symptoms associated with poor recovery or inability to return to work full-time were assessed using multivariable logistic regression.Findings1325 individuals were assessed (PH 547 [41.3%], PED 212 [16%], NH 566 [42.7%]. Compared with PH and PED groups, NH were younger (median 44.6 [35.6-52.8] vs 58.3 [47.0-67.7] and 48.5 [39.4-55.7] years), more likely to be female (68.2%, 43.0% and 59.9%), less likely to be from an ethnic minority (30.9%, 52.7% and 41.0%) and seen later after symptom onset (median [IQR]:194 [118-298], 69 [51-111] and 76 [55-128] days) (all pInterpretationSymptoms following SARS-CoV-2 infection were significant in both post- and non-hospitalised patients, with significant ongoing healthcare needs and utilisation. Trials of interventions and patient-centred pathways for diagnostic and treatment approaches are urgently required.FundingUCLH/UCL BRCResearch in contextPrevious evidenceLong COVID and post-COVID syndrome were first identified in April 2020. We searched PubMed and medrxiv for articles published up to April 30th, 2021, using the keywords “long COVID”, “post-COVID syndrome”, “persistent symptoms”, “hospitalised”, “community” and “non-hospitalised”. We identified 17 articles and 7 systematic reviews. Fifteen studies have considered symptoms, multi-organ or functional impairment but only one study to-date has considered all these variables in non-hospitalised COVID patients. No studies have compared symptom burden and management between non-hospitalised and hospitalised individuals as systematically assessed and managed in a dedicated post-COVID service.Added value of this studyFor the first time, we report the baseline characteristics, investigation and outcomes of initial assessment of all eligible patients in a dedicated multi-professional post-COVID service, including 547 post-hospitalisation, 566 non-hospitalised and 212 patients discharged from emergency department. Despite relatively low comorbidity and risk factor burden in non-hospitalised patients, we show that both non-hospitalised and hospitalised patients presenting with persistent symptoms after SARS-CoV2 infection have high rates of functional impairment, specialist referral and rehabilitation, even 6-12 months after the acute infection. These real-world data will inform models of care during and beyond the pandemic.Implications of all the available evidenceThe significant, long-lasting health and social consequences of SARS-CoV-2 infection are not confined to those who required hospitalisation. As with other long-term conditions, care of patients experiencing Long COVID or specific end-organ effects require consistent, integrated, patient-centred approaches to investigation and management. At public health and policy level, burden of post-COVID morbidity demands renewed focus on effective infection suppression for all age groups.

The OVIVA study demonstrated noninferiority for managing bone and joint infections (BJIs) with oral antibiotics. We report that 79.7% of OPAT patients being treated for BJIs at our center would be eligible for oral antibiotics, saving a median (IQR) 19.5 IV-antibiotic days (8.5–37) and GBP 1234 (569–2594) per patient.

For the Fall 2020 semester, the University of New Haven (UNewHaven) joined over a third of colleges and universities across the country in offering in-person courses and reopening its campus. Allowing the campus community to safely return was a challenging endeavor, particularly for those at the University’s School of Health Sciences, which offers both non-clinical and clinical courses. In order to create learning environments that adhered to continuously-changing guidelines, our team at the School of Health Sciences was forced to develop and implement innovative strategies. In this article, we share our experiences in fulfilling our roles as faculty, staff, and students at a School of Health Sciences offering in-person, non-clinical and clinical courses during the COVID-19 pandemic. We reflect upon our challenges and share the lessons learned, which we hope will serve as guidance for our collective community in higher education, including those working within schools of public health and health sciences. Our lessons learned are presented in following three themes: 1) preparation for in-person classes; 2) the emotional state of faculty, staff, and students; and 3) innovative practices. Should colleges and universities ever find themselves in similar, yet unprecedented times, our lessons and recommendations may serve as a starting point to assist them in navigating through such tumultuous moments.

Pioneering firms have the potential to achieve significant social and economic benefits in fragile and conflict‑affected settings. However, these contexts involve higher risks and costs, which dissuades pioneers and investors. In this policy paper, we argue that the public good these firms provide warrants the use of public funds to offset the costs of pioneering in these settings.

Maternal alcohol exposure during pregnancy can substantially impact the development of the fetus, causing a range of symptoms, known as fetal alcohol spectrum disorders (FASDs), such as cognitive dysfunction and psychiatric disorders, with the pathophysiology and mechanisms largely unknown. Recently developed human cerebral organoids from induced pluripotent stem cells are similar to fetal brains in the aspects of development and structure. These models allow more relevant in vitro systems to be developed for studying FASDs than animal models. Modeling binge drinking using human cerebral organoids, we sought to quantify the downstream toxic effects of alcohol (ethanol) on neural pathology phenotypes and signaling pathways within the organoids. The results revealed that alcohol exposure resulted in unhealthy organoids at cellular, subcellular, bioenergetic metabolism, and gene expression levels. Alcohol induced apoptosis on organoids. The apoptotic effects of alcohol on the organoids depended on the alcohol concentration and varied between cell types. Specifically, neurons were more vulnerable to alcohol-induced apoptosis than astrocytes. The alcohol-treated organoids exhibit ultrastructural changes such as disruption of mitochondria cristae, decreased intensity of mitochondrial matrix, and disorganized cytoskeleton. Alcohol exposure also resulted in mitochondrial dysfunction and metabolic stress in the organoids as evidenced by (1) decreased mitochondrial oxygen consumption rates being linked to basal respiration, ATP production, proton leak, maximal respiration and spare respiratory capacity, and (2) increase of non-mitochondrial respiration in alcohol-treated organoids compared with control groups. Furthermore, we found that alcohol treatment affected the expression of 199 genes out of 17,195 genes analyzed. Bioinformatic analyses showed the association of these dysregulated genes with 37 pathways related to clinically relevant pathologies such as psychiatric disorders, behavior, nervous system development and function, organismal injury and abnormalities, and cellular development. Notably, 187 of these genes are critically involved in neurodevelopment, and/or implicated in nervous system physiology and neurodegeneration. Furthermore, the identified genes are key regulators of multiple pathways linked in networks. This study extends for the first time animal models of binge drinking-related FASDs to a human model, allowing in-depth analyses of neurotoxicity at tissue, cellular, subcellular, metabolism, and gene levels. Hereby, we provide novel insights into alcohol-induced pathologic phenotypes, cell type-specific vulnerability, and affected signaling pathways and molecular networks, that can contribute to a better understanding of the developmental neurotoxic effects of binge drinking during pregnancy.

The advent of human-induced pluripotent stem cell (iPSC)-derived three-dimensional (3D) cerebral organoids provides unprecedented opportunities of modeling human brains in states of health and disorder. Emerging data supports that cerebral organoids allow for more relevant in vitro systems for studying the human brain system and diseases than the current widely used 2D monolayer cell culture. Thus, the ability to isolate, culture, and maintain human brain cells from cerebral organoids is highly needed, particularly for studies on organoid-derived cell-type-specific signaling and their electrophysiological properties. Here we present a protocol to isolate and culture brain cells from 2-month human iPSC-derived cerebral organoids. The dissociation and plating of cells from organoids takes 3-4 h. The dissociated cells can be maintained in culture for up to at least 3 weeks. Some cells expressed the neuron-specific marker microtubule-associated protein 2 and exhibited spontaneous action potentials.

Infective endocarditis caused by Proteus mirabilis is strikingly rare. Here, we describe the case of an 86-year old man with five recurrent septic episodes over a period of three months associated with Proteus mirabilis bacteraemia secondary to underlying Proteus endocarditis. The final diagnosis was made based on clinical findings, blood culture results and transoesophageal echocardiogram. The patient was treated medically with 6 weeks of ceftriaxone and long-term oral ciprofloxacin. On completion of intravenous therapy the patient remained well. We performed a literature review and found this to be only the fourth confirmed case of Proteus mirabilis endocarditis successfully treated with antibiotic therapy alone. This case highlights an important but rare cause of endocarditis, reinforcing the need to consider this diagnosis in recurrent Gram-negative bacteraemia even if by an atypical organism.