Understanding Why People Experiencing a Mental Health Crisis Leave the Emergency Department Before Care: A Qualitative Interpretive Study.

A number of people experiencing a mental health crisis who present to a hospital emergency department (ED) do not wait (DNW) for assessment or care and leave. This phenomenon is poorly understood and offers an opportunity to enhance quality of care. We sought to understand the characteristics and reasons of those who DNW for assessment or care, and what happens after leaving the ED.

Qualitative evaluation of rapid implementation of remote blood pressure self-monitoring in pregnancy during Covid-19.

In March 2020, the World Health Organisation named the severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2), which causes corona virus disease 2019 (COVID -19), as a pandemic. Pregnant women were considered at increased risk of developing severe COVID-19 after viral infection. In response maternity services reduced face-to-face consultations with high-risk pregnant women by supplying blood pressure monitors for supported self-monitoring.

National lockdowns in England: The same restrictions for all, but do the impacts on COVID-19 mortality risks vary geographically?

Quantifying the impact of lockdowns on COVID-19 mortality risks is an important priority in the public health fight against the virus, but almost all of the existing research has only conducted macro country-wide assessments or limited multi-country comparisons. In contrast, the extent of within-country variation in the impacts of a nation-wide lockdown is yet to be thoroughly investigated, which is the gap in the knowledge base that this paper fills. Our study focuses on England, which was subject to 3 national lockdowns between March 2020 and March 2021.

Review and Consultations of Canadian Financial Education Programs for Individuals with Disabilities.

Individuals or persons who live with a disability (PWD) can experience unique financial occupation challenges. Financial education programs can address some challenges. The aim of this study was to describe and critically appraise current financial education programs for PWD in Canada.

Ultrasound-guided, minimally invasive looped thread fasciotomy for chronic exertional compartment syndrome of the lower leg: A cadaveric feasibility study.

Background: - Chronic exertional compartment syndrome (CECS) is an exertional pain syndrome that typically affects the lower legs of participants involved in high-intensity running or marching activities. Surgical open fasciotomy is the standard treatment for recalcitrant cases of CECS. Alternative, minimally invasive fasciotomy techniques are emerging which may reduce rates of procedural complications and expedite recovery.

GP trainee responses to using SHERPA for multimorbidity consultations.

UK general practitioner (GP) trainees are taught a consultation model which elicits the patients' main reason for consulting 'today'. This approach will often miss important issues for the increasing number of patients with multimorbidity. We developed the SHERPA model as a person-centred biopsychosocial framework for consulting patients with multimorbidity to address this.

Embracing complexity with systems thinking in general practitioners' clinical reasoning helps handling uncertainty.

Clinical reasoning in general practice is increasingly challenging because of the rise in the number of patients with multimorbidity. This creates uncertainty because of unpredictable interactions between the symptoms from multiple medical problems and the patient's personality, psychosocial context and life history. Case analysis may then be more appropriately managed by systems thinking than by hypothetic-deductive reasoning, the predominant paradigm in the current teaching of clinical reasoning.

Evaluation of the presence and distribution of leptomeningeal inflammation in SIDS/SUDI cases and comparison with a hospital-based cohort.

Introduction: Prior research demonstrates that leptomeninges of infants and late-term fetuses derived from a non-traumatic, hospital-based cohort contain a surprisingly large number of inflammatory cells and stainable iron. These were present irrespective of the findings from the general autopsy, the neuropathologic examination, and the mode of delivery.

Materials And Methods: We applied a similar methodology to a sudden infant death syndrome/sudden unexpected death in infancy (SIDS/SUDI) cohort.

Estimating the changing nature of Scotland's health inequalities by using a multivariate spatiotemporal model.

Health inequalities are the unfair and avoidable differences in people's health between different social groups. These inequalities have a huge influence on people's lives, particularly those who live at the poorer end of the socio-economic spectrum, as they result in prolonged ill health and shorter lives. Most studies estimate health inequalities for a single disease, but this will give an incomplete picture of the overall inequality in population health.

An exploration of the perceptions of caring held by students entering nursing programmes in the United Kingdom: A longitudinal qualitative study phase 1.

In a climate of intense international scrutiny of healthcare and nursing in particular, there is an urgent need to identify, foster and support a caring disposition in student nurses worldwide. Yet relatively little is known about how core nursing values are shaped during education programmes and this warrants further investigation. This longitudinal study commencing in February 2013 examines the impact of an innovative nursing curriculum based on a humanising framework (Todres et al.

The associations between objectively-determined and self-reported urban form characteristics and neighborhood-based walking in adults.

Background: Self-reported and objectively-determined neighborhood built characteristics are associated with physical activity, yet little is known about their combined influence on walking. This study: 1) compared self-reported measures of the neighborhood built environment between objectively-determined low, medium, and high walkable neighborhoods; 2) estimated the relative associations between self-reported and objectively-determined neighborhood characteristics and walking and; 3) examined the extent to which the objectively-determined built environment moderates the association between self-reported measures of the neighborhood built environment and walking.

Methods: A random cross-section of 1875 Canadian adults completed a telephone-interview and postal questionnaire capturing neighborhood walkability, neighborhood-based walking, socio-demographic characteristics, walking attitudes, and residential self-selection.

The inflammatory cellular constituents of foetal and infant leptomeninges: a survey of hospital-based autopsies without trauma.

Objectives: Notwithstanding the lack of definitive evidence from studies conducted to date, inflammatory infiltrates and iron deposition in the leptomeninges are routinely used as forensic markers of traumatic brain injury. We investigated the presence of these forensic markers of trauma in neonates and infants, with the objective of determining their suitability for use in forensic cases.

Methods: Leptomeninges derived from non-traumatic deaths were studied.

Pre-oxygenation in healthy volunteers: a comparison of the supine and 45° seated positions*.

Pre-oxygenation in the seated (sitting) position has been associated with better oxygenation. This randomised, cross over study compared oxygenation in the supine position with that in the 45° seated position in 40 young, healthy volunteers. Oxygen was administered through a circle system and tight fitting facemask.

Promoting leadership: the development of a nurse executive team in an acute hospital trust.

Aim: The purpose of this study was to evaluate how an executive nursing team, within an acute hospital trust in the south of England, developed their leadership characteristics through the use of a professional development programme.

Background: This paper offers an insight into how this team worked together to clarify their views of their new role and how the role would be enacted.

Method: A questionnaire using quantitative and qualitative measures was used to explore the group's leadership style and evaluate the professional development programme.

Structural insights into the polymorphism of amyloid-like fibrils formed by region 20-29 of amylin revealed by solid-state NMR and X-ray fiber diffraction.

Many unrelated proteins and peptides can assemble into amyloid or amyloid-like nanostructures, all of which share the cross-beta motif of repeat arrays of beta-strands hydrogen-bonded along the fibril axis. Yet, paradoxically, structurally polymorphic fibrils may derive from the same initial polypeptide sequence. Here, solid-state nuclear magnetic resonance (SSNMR) analysis of amyloid-like fibrils of the peptide hIAPP 20-29, corresponding to the region S (20)NNFGAILSS (29) of the human islet amyloid polypeptide amylin, reveals that the peptide assembles into two amyloid-like forms, (1) and (2), which have distinct structures at the molecular level.

Cardiovascular changes after achieving constant effect site concentration of propofol.

Target controlled infusions of propofol use a pharmacokinetic/pharmacodynamic model to calculate an effect site concentration of the drug. We assessed the cardiovascular stability of 10 healthy patients using non-invasive thoracic bioimpedance and their 'depth' of anaesthesia using the Bispectral index after they had been anaesthetised to a constant effect site concentration of propofol (6.5 min from starting).

Membrane interactions of peptides representing the polybasic regions of three Rho GTPases are sensitive to the distribution of arginine and lysine residues.

Rho GTPases are a multifunctional family of proteins that are localized at cellular membranes via an isoprenyl group covalently linked to a C-terminal cysteine. Close to this primary site of membrane anchoring there is often found an additional polybasic region (PBR), which plays a secondary role in membrane binding and targeting of the complex. Here, peptides derived from the PBRs of the Rho family proteins Rac1 (K(183)KRKRK), TCL (K(198)KKKKR) and Cdc42 (P(182)KKSRR) were prepared with hexalysine (K(6)) and hexaarginine (R(6)) to study their interactions with multilamellar vesicles of phosphatidylglycerol (DOPG) and headgroup-deuterated dimyristoylphosphatidylcholine (DMPC-d(4)) using (2)H and (31)P NMR.

Apolipoprotein E-derived antimicrobial peptide analogues with altered membrane affinity and increased potency and breadth of activity.

Host-derived anti-infective proteins represent an important source of sequences for designing antimicrobial peptides (AMPs). However such sequences are often long and comprise diverse amino acids with uncertain contribution to biological effects. Previously, we identified a simple highly cationic peptide derivative of human apolipoprotein E (apoEdp) that inhibited a range of microorganisms.

Consistent with dopamine supersensitivity, RGS9 expression is diminished in the amphetamine-treated animal model of schizophrenia and in postmortem schizophrenia brain.

It is known that RGS9-2 gene knockout mice show supersensitivity to DA and have a marked elevation in the proportion of DA D2 receptors in the high-affinity state for DA (D2(High) receptors). As this is a similar profile to that observed in the CNS from subjects with schizophrenia, we examined whether postmortem CNS tissue from subjects with the disorder and brain striata from an animal model of psychosis or schizophrenia (the amphetamine-sensitized rat) had altered levels of RGS9-2. The mRNA for RGS9-2 in 29 control hippocampi was 0.

The risk of vertebral canal complications in 2837 cardiac surgery patients with thoracic epidurals.

Background: Recent communications in the medical press have suggested that the rate of vertebral canal complications following epidural catheter placement is increasing in frequency, in particular the incidence of epidural abscess (Hearn M. Epidural abscess complicating insertion of epidural catheters. Br J Anaesth 2003; 90 (5): 706-7; Govasi C, Bland D, Poddar R, Horst C.

Angiotensin-converting enzyme genotype predicts cardiac and autonomic responses to prolonged exercise.

Objectives: The purpose of this study was to investigate the phenomenon of left ventricular (LV) dysfunction after ultraendurance exercise.

Background: Subclinical LV dysfunction in response to endurance exercise up to 24 h duration has been described, but its mechanism remains elusive.

Methods: We tested 86 athletes before and after the Adrenalin Rush Adventure Race using echocardiography, impedance cardiography, and plasma immunoassay.