Developing a framework to guide the evaluation of training in research skills for health and care professionals

Background

Delivering research skills training to health professionals through short, applied sessions outside a formal higher education program, can help fill gaps in training and build research capacity in clinical settings. This has been the endeavor of some of the Applied Research Collaborations funded by the National Institute for Health and Care Research in England since 2014. How to evaluate this type of training in terms of the wider impact it may have, has not featured heavily in the literature and methods have largely borrowed from more generic approaches to training evaluation which can over-simplify outcomes and ignore longer-term impacts.

Methods

We developed the framework in four stages: mapping potential impacts of our research skills training courses to identify key concepts; shaping into three domains in which impact could be expected, informed by established definitions of research capacity building; testing the initial framework and adapting wording of impacts; refining the framework into a practical tool.

Results

The final framework specifies types of impact in three domains of influence - individual, group/organization and health system, and maps these against key questions to guide inquiry, as well as suggested methods for capturing the impact and expected timeframe for each type of impact.

Discussion

The framework provides a structure for guiding the evaluation of research training as well as a focus on medium-longer term impacts, encouraging a broader and continuous approach to evaluation. It is hoped this will support educators in other contexts and fields, in the planning of a wider range of training evaluation activities, to capture impact more fully.

Exploring the role of exposure to green and blue spaces in preventing anxiety and depression among young people aged 14-24 years living in urban settings: A systematic review and conceptual framework

Despite the growing problem of anxiety and depression amongst young people aged 14-24 years living in urban settings, reviews about the role of exposure to green and blue spaces or nature in preventing anxiety and depression tend to focus on children, adults or sometimes adolescents. This review aims to explore whether exposure to green and blue spaces reduces the risk of anxiety and depression among young people aged 14-24 years living in urban settings and provide a conceptual framework. The academic databases CINAHL plus, Global Health, MEDLINE, ProQuest: Dissertations and Theses, PsycINFO, Scopus and OpenGrey were searched for research published in English between January 2000 and June 2020. All study designs were eligible. All included studies were assessed for quality. Searches identified 9208 sources with 48 meeting the inclusion criteria for the review. Experimental studies provided evidence that walking or being in a green space improves mood and state anxiety immediately following the intervention. Non-randomised evaluations and observational studies suggest that social interaction, physical activity, and mindfulness mediate the relationship between exposure to green space and mental health. We propose that the absence of noise and restorative qualities of green spaces promotes mindfulness and interrupt rumination, which in turn reduce the risk of anxiety disorders and depression. This review and the resulting conceptual framework provide evidence to healthcare professionals about the value of contact with nature and green social prescribing. For policymakers, it provides evidence about the value of bringing the benefits of forests, vegetation and nature into cities, and ensuring that these spaces are accessible and safe for young people to use.

Exposure to Green and Historic Urban Environments and Mental Well-Being: Results from EEG and Psychometric Outcome Measures

Previous studies have identified the benefits of exposure to green or historic environments using qualitative methods and psychometric measures, but studies using a combination of measures are lacking. This study builds on current literature by focusing specifically on green and historic urban environments and using both psychological and physiological measures to investigate the impact of virtual exposure on well-being. Results from the psychological measures showed that the presence of historic elements was associated with a significantly stronger recuperation of hedonic tone (p = 0.01) and reduction in stress (p = 0.04). However, the presence of greenness had no significant effect on hedonic tone or stress. In contrast, physiological measures (EEG) showed significantly lower levels of alpha activity (p < 0.001) in occipital regions of the brain when participants viewed green environments, reflecting increased engagement and visual attention. In conclusion, this study has added to the literature by showing the impact that historic environments can have on well-being, as well as highlighting a lack of concordance between psychological and physiological measures. This supports the use of a combination of subjective and direct objective measures in future research in this field.

Exposure to Green, Blue and Historic Environments and Mental Well-Being: A Comparison between Virtual Reality Head-Mounted Display and Flat Screen Exposure

Improving the mental health of urban residents is a global public health priority. This study builds on existing work that demonstrates the ability of virtual exposure to restorative environments to improve population mental health. It compares the restorative effects of green, blue and historic environments delivered by both flat screen and immersive virtual reality technology, and triangulates data from psychological, physiological and qualitative sources. Results from the subjective measure analyses showed that exposures to all the experimental videos were associated with self-reported reduced anxiety and improved mood, although the historic environment was associated with a smaller reduction of anxiety (p < 0.01). These results were supported by the qualitative accounts. For two of the electroencephalography (EEG) frequency bands, higher levels of activity were observed for historic environments. In relation to the mode of delivery, the subjective measures did not suggest any effect, while for the EEG analyses there was evidence of a significant effect of technology across three out of four frequency bands. In conclusion, this study adds to the evidence that the benefits of restorative environments can be delivered through virtual exposure and suggests that virtual reality may provide greater levels of immersion than flat screen viewing.

Systematic Review of the Health and Equity Impacts of Remediation and Redevelopment of Contaminated Sites

(1) Background: Globally there is a vast legacy of contaminated sites from past industrial, commercial and military activity, waste disposal, and mineral extraction. This review examined the extent to which the remediation of contaminated sites reduces health risks to new and existing populations. (2) Methods: Standard academic databases were searched for papers that reported on health-related outcomes in humans following remediation and redevelopment of contaminated sites. Title/abstract screening, followed by full-text screening identified sixteen papers that met the eligibility criteria. (3) Results: Most studies were set in the United States of America and reported changes in blood lead concentrations in children, following soil remediation and, in some cases, public health campaigns to reduce exposure. Two further studies examined the impacts of remediation on soil contaminated with chromium and sediments contaminated with polychlorinated biphenyls (PCBs). (4) Conclusions: Overall, the evidence suggests that remediation via removal, capping, and replacing soil, and planting vegetation is effective at reducing concentrations of lead and chromium in blood and urine in children. There is also evidence that sediment dredging can reduce PCB concentrations in umbilical cords in infants. Study designs are relatively weak and some recommendations are provided for those wishing to examine the health impacts of remediation.

All-Order Full-Coulomb Quantum Spectral Line-Shape Calculations

Understanding how atoms interact with hot dense matter is essential for astrophysical and laboratory plasmas. Interactions in high-density plasmas broaden spectral lines, providing a rare window into interactions that govern, for example, radiation transport in stars. However, up to now, spectral line-shape theories employed at least one of three common approximations: second-order Taylor treatment of broadening operator, dipole-only interactions between atom and plasma, and classical treatment of perturbing electrons. In this Letter, we remove all three approximations simultaneously for the first time and test the importance for two applications: neutral hydrogen and highly ionized magnesium and oxygen. We found 15%-50% change in the spectral line widths, which are sufficient to impact applications including white-dwarf mass determination, stellar-opacity research, and laboratory plasma diagnostics.

Measuring the effectiveness of catch-up MMR delivered by school nurses compared to signposting to general practice on improving MMR coverage

BACKGROUND

This study assesses whether increased coverage of the measles, mumps and rubella (MMR) vaccination differs between areas where school nurses deliver catch-up MMR doses to adolescents in school settings, compared to signposting to general practice.

METHODS

A retrospective cohort study was conducted using Child Health Information Services records within the NHS England South (South Central) commissioning boundary. The sample population included children born 1 September 2000-31 August 2001, in school year 9 during the 2014-15 academic year.

RESULTS

The primary outcome findings show an increase in coverage of at least one dose of MMR by 1.6% (n = 334) in the cohort receiving catch-up MMR, compared to 0.2% (n = 12) in the cohort signposted to general practice. Over time, the difference in increase between the two cohorts was 1.4%, analysed using the chi-squared comparison of proportions test, providing strong evidence (P < 0.0001) that school nurse delivery of catch-up MMR is effective at increasing coverage. The findings also suggest that school nurse delivery of catch-up MMR may benefit Black, Asian and minority ethnic children and those from more deprived backgrounds.

CONCLUSIONS

It is recommended that commissioners of school-aged immunization services incorporate the delivery of catch-up MMR doses in their contracts with school nurses.

Exposure to green space and prevention of anxiety and depression among young people in urban settings: a global scoping review

Purpose

There is a mental health crisis, particularly among young people. Despite many young people living in urban settings, reviews about the association between exposure to green or natural environments and mental health tend to focus on either children or adults. The aim of this review is to examine the scope of the global literature for this age group, to inform a systematic review on the role of exposure to green space in preventing anxiety and depression amongst young people aged 14–24 years.

Design/methodology/approach

Seven databases were searched for quantitative and qualitative sources published from January 2000 to June 2020. This identified 201 sources and their characteristics are described here. Gaps in the literature are also highlighted.

Findings

The number of relevant studies published per year has increased over time. Most studies are set in North America (28%) or Europe (39%). The most common study designs were observational (34%) or experimental (28%). A wide range of exposures and interventions are described.

Research limitations/implications

This review included literature from predominantly high-income countries and has shown the under-representation of low-middle income countries and lack of ethnic diversity in study populations. It has also highlighted the lack of clinical measures of anxiety and depression as outcomes.

Originality/value

This inter-disciplinary review has contributed to the field by describing the geographic distribution of the literature and the broad range of exposures to green spaces being reported. Unlike previous scoping reviews, this review focused specifically on young people and on measures of anxiety and depression and their pre-cursers.

Body dissatisfaction predicts the onset of depression among adolescent females and males: a prospective study

RATIONALE

Body dissatisfaction is prevalent in mid-adolescence and may be associated with the onset of depression.

OBJECTIVE

The study assessed the influence of body dissatisfaction on the occurrence of later depressive episodes in a population-based sample of British adolescents.

METHOD

Participants were 2078 females and 1675 males from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort. Logistic regression was used to test if body dissatisfaction at 14 years old predicted the onset of depressive episodes at 18 years old, controlling for baseline depression.

RESULTS

Among females, body dissatisfaction predicted mild (OR=1.63, 95% CI=1.31, 2.04), moderate (OR=1.67, 95% CI=1.28, 2.18) and severe depressive episodes (OR=1.84, 95% CI=1.09, 3.12). Among males, body dissatisfaction predicted mild (OR=1.50, 95% CI=1.00, 2.25) and severe depressive episodes (OR=2.85, 95% CI=1.18, 6.87) at 18 years of age.

CONCLUSIONS

This is the first prospective study to demonstrate that body dissatisfaction in adolescence predicts the occurrence of later depressive episodes in a cohort born in the early 1990s. The findings highlight that body dissatisfaction is a public health concern.

Coronavirus disease 2019 mortality: a multivariate ecological analysis in relation to ethnicity, population density, obesity, deprivation and pollution

BACKGROUND

There is emerging evidence about characteristics that may increase the risk of coronavirus disease 2019 (COVID-19) mortality, but they are highly correlated.

METHODS

An ecological analysis was used to estimate associations between these variables and age-standardised COVID-19 mortality rates at the local authority level.

RESULTS

Ethnicity, population density and overweight/obesity were all found to have strong independent associations with COVID-19 mortality, at the local authority level.

DISCUSSION

This analysis provides some preliminary evidence about which variables are independently associated with COVID-19 mortality and suggests that others (deprivation and pollution) are not directly linked. It highlights the importance of multivariate analyses to understand the factors that increase vulnerability to COVID-19.

Prospective Pathways to Depressive Symptoms and Disordered Eating in Adolescence: A 7-Year Longitudinal Cohort Study

Eating pathology and depressive symptoms increase during adolescence, yet predictive pathways remain predominantly unexplored, despite their implications for prevention. The present study aimed to identify shared risk factors for eating pathology and depressive symptoms by evaluating an adapted Dual-Pathway Model of disordered eating, which postulated that higher BMI would predict disordered eating and depressive symptoms via pathways between body dissatisfaction, later BMI, depressive symptoms, and visible indicators of puberty (breast development for girls, height for boys). The participants were 8915 children (49% girls) from the Avon Longitudinal Study of Parents and Children, a population-based cohort study of British children, who were assessed at different intervals between the age of 7 to 14 years. Path analyses revealed that, for girls, childhood BMI exerted indirect effects on disordered eating via body dissatisfaction, depressive symptoms, and more advanced breast development, with indirect pathways identified to depressive symptoms via earlier depressive symptoms and more advanced breast development. For boys, childhood BMI had indirect effects on disordered eating via later BMI and body dissatisfaction, while only earlier depressive symptoms were found to have an independent and direct effect on adolescent depressive symptoms. This study reveals shared and independent risk factors for eating pathology and depressive symptoms in adolescence and suggests targets for preventative interventions, including higher BMI, body dissatisfaction, and depressive symptoms, in addition to advanced breast development, for girls.

Effect of Electron Capture on Spectral Line Broadening in Hot Dense Plasmas

Accurate calculation of spectral line broadening is important for many hot, dense plasma applications. However, calculated line widths have significantly underestimated measured widths for Δn=0 lines of Li-like ions, which is known as the isolated-line problem. In this Letter, scrutinization of the line-width derivation reveals that the commonly used expression neglects a potentially important contribution from electron-capture. Line-width calculations including this process are performed with two independent codes, both of which removed the discrepancies at temperatures below 10 eV. The revised calculations also suggest the remaining discrepancy scales more strongly with electron temperature than the atomic number as was previously suggested.

Weight gain in mid-childhood and its relationship with the fast food environment

Background

Childhood obesity is a serious public health issue. Understanding environmental factors and their contribution to weight gain is important if interventions are to be effective.

Aims

The purpose of this research was to assess the relationship between weight gain in children and accessibility of fast-food outlets.

Methods

A longitudinal sample of 1577 children was created using two time points from the National Child Measurement Programme in South Gloucestershire (2006/7 and 2012/13). A spatial analysis was conducted using a weighted accessibility score on the number of fast-food outlets within a 1-km network radius of each child's residence to quantify access to fast food.

Results

The mean accessibility score for all children was 0.73 (standard deviation: 1.14). Fast-food outlets were more prevalent in areas of deprivation. A moderate association was found between deprivation score and accessibilty score (r = 0.4, P < 0.01). Children who had greater access to fast-food outlets were more likely (odds ratio = 1.89, P = 0.04) to gain significant weight (>50 percentile points) compared to children who had no access to fast-food outlets.

Conclusions

This paper supports previous research that fast-food outlets are more prevalent in areas of deprivation and presents new evidence on fast-food outlets as a potential contributor towards weight gain in mid-childhood.

Adolescent body dissatisfaction and disordered eating: Predictors of later risky health behaviours

RATIONALE

Body dissatisfaction is prevalent among teenagers, and may influence the uptake of risky health behaviours.

OBJECTIVE

The study assessed the influence of body dissatisfaction on smoking, cannabis use, drug use, self-harm, gambling, and drinking and the mediating role of disordered eating in a population-based sample of British adolescents.

METHOD

Participants were 2634 females and 1684 males from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort. Logistic regression was used to test if body dissatisfaction at 14 years old predicted the onset of risky health behaviours at 21 years old. Mediation analysis tested the mediating role of disordered eating at 16 years old on each risky health behaviour.

RESULTS

Among females, body dissatisfaction predicted smoking (OR = 1.40, 95% CI = 1.15, 1.72), cannabis use (OR = 1.20, 95% CI = 1.00, 1.43), drug use (OR = 1.51, 95% CI = 1.20, 1.90), self-harm (OR = 1.44, 95% CI = 1.13, 1.84) and high-risk drinking (OR = 1.41, 95% CI = 1.10, 1.80). Disordered eating symptoms had mediating effects on some behaviours. Among males, body dissatisfaction predicted smoking (OR = 1.44, 95% CI = 1.14, 1.81) and no effect of disordered eating was found on any risky health behaviour.

CONCLUSIONS

This is the first prospective study to demonstrate that body dissatisfaction in adolescence predicts the occurrence of several risky health behaviours, and elucidates the mediating role of disordered eating. The findings highlight that body dissatisfaction is a public health concern. Early interventions to promote body satisfaction may reduce the prevalence of later risky health behaviours.

Effects of city-wide 20 mph (30km/hour) speed limits on road injuries in Bristol, UK

Twenty miles per hour (32 km/hour) or 30 km/hour speed limits represent a potential strategy to reduce urban road injuries and are becoming increasingly widespread. However, no study has conducted a robust evaluation of the effects of city-wide 20 mph speed limits on road injuries. This study reports the effects of such an intervention, based on a natural experiment that took place in Bristol, UK. Based on a stepped-wedge design using count data, negative binomial regressions showed that between 2008 and 2016, the 20 mph speed limit intervention was associated with a city-level reduction of fatal injuries of around 63% (95% CI 2% to 86%), controlling for trends over time and areas. There was also a general trend of reduction of the total number of injuries at city level and in 20 mph roads. These findings highlight the potential benefits of city-wide 20 mph speed limits. We hypothesise that this city-wide approach may encourage a general behaviour change in drivers that, in turn, may contribute to reducing injuries across the city.

Recommended electron-impact excitation and ionization cross sections for Be I

Analytic fits to the recommended electron-impact excitation and ionization cross sections for Be I are presented. The lowest 19 terms of configurations 2snl (n ≤ 4) and 2p ² terms below the first ionization limit are considered. The fits are based on the accurate calculations with the convergent close coupling (CCC) method as well as the B-spline R-matrix (BSR) approach. The fitted cross sections provide rate coefficients that are believed to approximate the original data within 10% with very few exceptions. The oscillator strengths for the dipole-allowed transitions between all the considered states are calculated with the relativistic multi-configuration Dirac-Hartree-Fock (MCDHF) approach and compared with the CCC and BSR results. This comparison shows a very good agreement except for a handful of cases with likely strong cancellations.

Near-Threshold Cross Sections for Electron and Positron Impact Ionization of Atomic Hydrogen

Using classical arguments Wannier [Phys. Rev. 90, 817 (1953)PHRVAO0031-899X10.1103/PhysRev.90.817] proposed an electron-impact ionization cross section for neutral atoms to behave as E^{1.127}, where E is the excess energy above threshold. Using similar arguments Klar [J. Phys. B 14, 4165 (1981)JPAMA40022-370010.1088/0022-3700/14/21/027] obtained E^{2.65} to be the corresponding threshold law for positron impact. Recently, Babij et al. [Phys. Rev. Lett. 120, 113401 (2018)PRLTAO0031-900710.1103/PhysRevLett.120.113401] measured near-threshold positron-impact breakup behavior to be similar to that expected for electrons. Using the convergent close-coupling method for the atomic hydrogen target, we examine cross sections at near-threshold energies for electron and positron impact. Contrary to the experiment, the calculated cross sections are found to behave differently for the two projectiles and consistently with the aforementioned threshold laws, despite the entirely quantum nature of these problems. For electron impact, the threshold behavior holds while the total electron spin asymmetry remains constant, whereas for positron scattering the threshold law holds for breakup while the positronium-formation component of the ionization cross section remains constant.

Promoting positive body image and tackling overweight/obesity in children and adolescents: A combined health psychology and public health approach

This article draws attention to the dual global problems of disordered eating and overweight/obesity among children and adolescents. It is well recognised that the main risk factor for disordered eating is body dissatisfaction, yet public health messages to tackle overweight/obesity are likely to increase body dissatisfaction. This tension between key public health messages and a health psychology approach is examined, with the goal of seeking a common way forward. We focus on the UK as a case study, where there is currently no statutory education in schools on body image. Since more prescriptive guidance on the curriculum covering personal/social/health issues is soon to be introduced, it is timely to consider the content, and in particular its impact on body image as well as overweight/obesity. Having reviewed current interventions and policy, we argue for a more holistic approach to the obesity problem, using a whole school approach to create a body confident culture.

Proximity to overhead power lines and childhood leukaemia: an international pooled analysis

BACKGROUND

Although studies have consistently found an association between childhood leukaemia risk and magnetic fields, the associations between childhood leukaemia and distance to overhead power lines have been inconsistent. We pooled data from multiple studies to assess the association with distance and evaluate whether it is due to magnetic fields or other factors associated with distance from lines.

METHODS

We present a pooled analysis combining individual-level data (29,049 cases and 68,231 controls) from 11 record-based studies.

RESULTS

There was no material association between childhood leukaemia and distance to nearest overhead power line of any voltage. Among children living < 50 m from 200 + kV power lines, the adjusted odds ratio for childhood leukaemia was 1.33 (95% CI: 0.92-1.93). The odds ratio was higher among children diagnosed before age 5 years. There was no association with calculated magnetic fields. Odds ratios remained unchanged with adjustment for potential confounders.

CONCLUSIONS

In this first comprehensive pooled analysis of childhood leukaemia and distance to power lines, we found a small and imprecise risk for residences < 50 m of 200 + kV lines that was not explained by high magnetic fields. Reasons for the increased risk, found in this and many other studies, remains to be elucidated.

A physiologically relevant 3D collagen-based scaffold-neuroblastoma cell system exhibits chemosensitivity similar to orthotopic xenograft models

3D scaffold-based in vitro cell culturing is a recent technological advancement in cancer research bridging the gap between conventional 2D culture and in vivo tumours. The main challenge in treating neuroblastoma, a paediatric cancer of the sympathetic nervous system, is to combat tumour metastasis and resistance to multiple chemotherapeutic drugs. The aim of this study was to establish a physiologically relevant 3D neuroblastoma tissue-engineered system and explore its therapeutic relevance. Two neuroblastoma cell lines, chemotherapeutic sensitive Kelly and chemotherapeutic resistant KellyCis83 were cultured in a 3D in vitro model on two collagen-based scaffolds containing either glycosaminoglycan (Coll-GAG) or nanohydroxyapatite (Coll-nHA) and compared to 2D cell culture and an orthotopic murine model. Both neuroblastoma cell lines actively infiltrated the scaffolds and proliferated displaying >100-fold increased resistance to cisplatin treatment when compared to 2D cultures, exhibiting chemosensitivity similar to orthotopic xenograft in vivo models. This model demonstrated its applicability to validate miRNA-based gene delivery. The efficacy of liposomes bearing miRNA mimics uptake and gene knockdown was similar in both 2D and 3D in vitro culturing models highlighting the proof-of-principle for the applicability of 3D collagen-based scaffolds cell system for validation of miRNA function. Collectively, this data shows the successful development and characterisation of a physiologically relevant, scaffold-based 3D tissue-engineered neuroblastoma cell model, strongly supporting its value in the evaluation of chemotherapeutics, targeted therapies and investigation of neuroblastoma pathogenesis. While neuroblastoma is the specific disease being focused upon, the platform may have multi-functionality beyond this tumour type.

STATEMENT OF SIGNIFICANCE

Traditional 2D cell cultures do not completely capture the 3D architecture of cells and extracellular matrix contributing to a gap in our understanding of mammalian biology at the tissue level and may explain some of the discrepancies between in vitro and in vivo results. Here, we demonstrated the successful development and characterisation of a physiologically relevant, scaffold-based 3D tissue-engineered neuroblastoma cell model, strongly supporting its value in the evaluation of chemotherapeutics, targeted therapies and investigation of neuroblastoma pathogenesis. The ability to test drugs in this reproducible and controllable tissue-engineered model system will help reduce the attrition rate of the drug development process and lead to more effective and tailored therapies. Importantly, such 3D cell models help to reduce and replace animals for pre-clinical research addressing the principles of the 3Rs.

Quantum suppression of antihydrogen formation in positronium-antiproton scattering

The interaction of antiprotons with low-energy positronium atoms is a fundamental three-body problem whose significance is its utility for formation of antihydrogen. Particular importance resides in understanding processes involving excited positronium states. Until recently such studies were performed using classical techniques. However, they become inapplicable in the low-energy domain. Here we report the results of comprehensive quantum calculations, which include initial excited positronium states with principal quantum numbers up to n i = 5. Contrary to expectation from earlier work, there are only muted increases in the cross-sections for antihydrogen formation for n i > 3. We interpret this in terms of quantum suppression of the reaction at higher angular momenta. Furthermore, the cross-sections for elastic scattering are around two orders of magnitude higher, which we attribute to the degeneracy of the positronium states. We outline some experimental consequences of our results.

A randomised controlled trial of student nurse performance of cardiopulmonary resuscitation in a simulated family-witnessed resuscitation scenario

This randomized controlled trial, conducted in a UK University nursing department, compared student nurses' performance during a simulated cardiac arrest. Eighteen teams of four students were randomly assigned to one of three scenarios: 1) no family witness; 2) a "quiet" family witness; and 3) a family witness displaying overt anxiety and distress. Each group was assessed by observers for a range of performance outcomes (e.g. calling for help, timing to starting cardiopulmonary resuscitation), and simulation manikin data on the depth and timing of three cycles of compressions. Groups without a distressed family member present performed better in the early part of the basic life support algorithm. Approximately a third of compressions assessed were of appropriate pressure. Groups with a distressed family member present were more likely to perform compressions with low pressure. Groups with no family member present were more likely to perform compressions with too much pressure. Timing of compressions was better when there was no family member present. Family presence appears to have an effect on subjectively and objectively measured performance. Further study is required to see how these findings translate into the registered nurse population, and how experience and education modify the impact of family member presence.

Antiproton stopping power data for radiation therapy simulations

Stopping powers of H, He, H₂, and H₂O targets for antiprotons have been calculated using a convergent close-coupling method. For He and H₂ targets electron-electron correlations are fully accounted for using a multiconfiguration approximation. Two-electron processes are included using an independent-event model. The water molecule is described using a neon-like structure model with a pseudo-spherical potential. Results are tabulated for the purpose of Monte Carlo simulations to model antiproton transport through matter for radiation therapy.

Family presence during resuscitation: Validation of the risk–benefit and self-confidence scales for student nurses

Background. There is increasing debate about the advantages and disadvantages of family-witnessed resuscitation. Research about the views of healthcare providers depends upon reliable tools to measure their perceptions. Two tools have been developed for use with nurses (26-item cost-benefit tool, 17-item self-confidence tool). Objectives. Firstly, to validate these tools for use with student nurses in the UK. Secondly, to report on the perceived risks and benefits reported by student nurses, and their self-confidence in dealing with this situation. Methods. A sample of 79 student nurses were invited to complete the tools. Item-total correlations and Cronbach’s α were used to determine internal consistency. Factor analysis was computed to assess construct validity. The correlation between the two scales was explored. Results. 69 students completed a questionnaire. Very few had experience of family-witnessed resuscitation. Mean total scores were 3.16 (standard deviation 0.37; range 2.04–4.12) on the risk-benefit scale and 3.14 (standard deviation 0.66; range 1.94–4.82) on the self-confidence scale. Four of the original items were removed from the risk-benefit scale (Cronbach's α 0.86; 95% confidence interval ≥0.82). None were removed from the self-confidence scale (Cronbach's α 0.93; 95% confidence interval ≥0.91). There was a significant correlation between the two scales ( r = 0.37, p = 0.002). Conclusions. There is growing evidence that these tools are valid and reliable for measuring student nurses’ perceptions about family-witnessed resuscitation.

A randomised controlled trial comparing opt-in and opt-out home visits for tracing lost participants in a prospective birth cohort study

BACKGROUND

Attrition is an important problem in cohort studies. Tracing cohort members who have moved or otherwise lost contact with the study is vital. There is some debate about the acceptability and relative effectiveness of opt-in versus opt-out methods of contacting cohort members to re-engage them in this context. We conducted a randomised controlled trial to compare the two approaches in terms of effectiveness (tracing to confirm address and consenting to continue in the study), cost-effectiveness and acceptability.

METHODS

Participants in this trial were individuals (young people and mothers) recruited to the Avon Longitudinal Study of Parents and Children (ALSPAC), who had not engaged with the study in the previous 5 years and for whom mail had been returned from their last known address. The sampling frame was restricted to those for whom database searching led to a potential new address being found in the Bristol area. 300 participants were randomly selected and assigned using stratified randomisation to the opt-in or opt-out arm. A tailored letter was sent to the potential new address, either asking participants to opt in to a home visit, or giving them the option to opt out of a home visit. Fieldworkers from Ipsos MORI conducted home visits to confirm address details.

RESULTS

The proportion who were traced was higher in the opt-out arm (77/150 = 51 %) than the opt-in arm (6/150 = 4 %), as was the proportion who consented to continue in ALSPAC (46/150 = 31 % v 4/150 = 3 %). The mean cost per participant was £8.14 in the opt-in arm and £71.93 in the opt-out arm. There was no evidence of a difference in acceptability between the opt-in and opt-out approaches.

CONCLUSION

Since the opt-in approach yielded very low response rates, and there were no differences in terms of acceptability, we conclude that the opt-out approach is the most effective method of tracing disengaged study members. The gains made in contacting participants must be weighed against the increase in cost using this methodology.

Antihydrogen Formation via Antiproton Scattering with Excited Positronium

Utilizing the two-center convergent close-coupling method, we find a several order of magnitude enhancement in the formation of antihydrogen via antiproton scattering with positronium in an excited state over the ground state. The effect is greatest at the lowest energies considered, which encompass those achievable in experiment. This suggests a practical approach to creating neutral antimatter for testing its interaction with gravity and for spectroscopic measurements.

Changes in objectively measured BMI in children aged 4-11 years: data from the National Child Measurement Programme

BACKGROUND

This study looked at the degree of weight gain between the first (Reception) and last year (Year 6) of primary school and how weight status in Reception predicts becoming overweight/obese by Year 6.

METHODS

A longitudinal sample of 1863 children was created using two time points (2006/7, 2012/13) from the National Child Measurement Programme (NCMP) in South Gloucestershire. T-test and logistic regression were used to test the difference between the BMI z-scores and BMI percentiles, and predict the probability of being overweight (BMI ≥ 85th) or obese (≥95th) at Year 6 based on BMI percentile in Reception.

RESULTS

Of those children who were obese at Reception age, 68% were obese at Year 6. Compared with children with a BMI in the 2nd to 49th percentile range, children between the 75th and 84th percentiles of BMI at Reception age were 10 times more likely (odds ratio (OR) = 10.18, P < 0.01), and those with a BMI between the 85th and 94th percentiles were 13 times more likely (OR = 13.38, P < 0.01), to become obese by Year 6. Boys were more likely than girls to revert to a healthy weight.

CONCLUSIONS

This is the first study to link data from the NCMP. It provides estimates of prevalence and offers new evidence on obesity emergence and gender differences.

Target structure-induced suppression of the ionization cross section for low-energy antiproton-molecular hydrogen collisions: theoretical confirmation

Theoretical confirmation of the experimentally observed phenomenon [Knudsen et al., Phys. Rev. Lett. 105, 213201 (2010)] of target structure-induced suppression of the ionization cross section for low-energy antiproton-molecular hydrogen collisions is given. To this end a novel time-dependent convergent close-coupling approach to the scattering problem that accounts for all possible orientations of the molecular target, has been developed. The approach is applied to study single ionization of molecular hydrogen on the wide energy range from 1 keV to 2 MeV with a particular emphasis on low energies. Results for the orientation-averaged total single ionization cross section are compared with available experimental data and good agreement is found at low (<20 keV) and high (>90 keV) energies. A minor discrepancy is found within a small energy gap near the maximum of the cross section.

Ejection of quasi-free-electron pairs from the helium-atom ground state by single-photon absorption

We investigate the single-photon double ionization of helium at photon energies of 440 and 800 eV. We observe doubly charged ions with close to zero momentum corresponding to electrons emitted back to back with equal energy. These slow ions are the unique fingerprint of an elusive quasifree photon double ionization mechanism predicted by Amusia et al. nearly four decades ago [J. Phys. B 8, 1248 (1975)]. It results from the nondipole part of the electromagnetic interaction. Our experimental data are supported by calculations performed using the convergent close-coupling and time-dependent close-coupling methods.

Smoking prevalence amongst UK Armed Forces recruits: changes in behaviour after 3 years follow-up and factors affecting smoking behaviour

OBJECTIVES: The purpose of this study was to investigate smoking prevalence of Tri-Service recruits, and changes in smoking behaviour at 3-year follow-up, by trade group and gender. Associations with educational attainment and deprivation were also assessed. METHODS: Analysis of a survey into the health behaviours of 10 531 recruits in 1998/1999. A follow-up 3 years later measured changes in behaviour. Correlation and multiple regression was used to investigate the relationship between smoking prevalence in each trade group and both educational attainment and deprivation, using Index of Multiple Deprivation 2004 (IMD 2004) scores. RESULTS: Army recruits exhibited a significantly higher smoking prevalence (45%) than Royal Navy recruits (34%) and Royal Air Force (RAF) recruits (31%). There were marked differences between smoking levels amongst officer cadets (12%, 20% and 10% in the Navy, Army and RAF, respectively) and other rank trade groups (24-56%), with the exception of the Marines (13%). At follow up, smoking had generally increased, and in some parts of the infantry had risen to 66%. There was a clear correlation between smoking at enlistment and both educational attainment (correlation coefficient=0.7, p<0.005) and deprivation score (correlation coefficient=0.8, p<0.005). CONCLUSIONS: There were clear differences between Services, rank and trade groups in smoking prevalence at recruitment. Smoking levels increased in the 3 years after recruitment to the Armed Forces. Deprivation was more important than educational attainment in determining the smoking status of recruits.

Signature of two-electron interference in angular resolved double photoionization of Mg

The double photoionization of Mg has been studied experimentally and theoretically in a kinematic where the two photoelectrons equally share the excess energy. The observation of a symmetrized gerade amplitude, which strongly deviates from the Gaussian ansatz, is explained by a two-electron interference predicted theoretically, but never before observed experimentally. Similar to the Cooper minima in the single photoionization cross section, the effect finds its origin in the radial extent and oscillation of the target wave function.

MicroRNAs 10a and 10b are potent inducers of neuroblastoma cell differentiation through targeting of nuclear receptor corepressor 2

MicroRNAs function as negative regulators of posttranscriptional gene expression, having major roles in cellular differentiation. Several neuroblastoma cell lines can be induced to undergo differentiation by all-trans-retinoic acid (ATRA) and are used for modeling signaling pathways involved in this process. To identify miRNAs contributing to differentiation, we profiled 364 loci following ATRA treatment of neuroblastoma cell lines and found miR-10a and miR-10b to be highly overexpressed in SK-N-BE, LAN5 and SHSY-5Y. Ectopic overexpression of these miRNAs led to a major reprogramming of the transcriptome and a differentiated phenotype that was similar to that induced by ATRA in each of these cell lines. One of the predicted downregulated miR-10a/b targets was nuclear receptor corepressor 2 (NCOR2), a corepressor of gene transcription, which is known to suppress neurite outgrowth. NCOR2 was experimentally validated as a direct target of miR-10a/b, and siRNA-mediated inhibition of this mRNA alone resulted in neural cell differentiation. Moreover, induction of differentiation could be blocked by ectopic upregulation of NCOR2 using an expression construct lacking the miR-10a/b 3' untranslated region target site. We conclude that miR-10a/b has major roles in the process of neural cell differentiation through direct targeting of NCOR2, which in turn induces a cascade of primary and secondary transcriptional alterations, including the downregulation of MYCN.

Suicide after leaving the UK armed forces--a cohort study

BACKGROUND

Few studies have examined suicide risk in individuals once they have left the military. We aimed to investigate the rate, timing, and risk factors for suicide in all those who had left the UK Armed Forces (1996-2005).

METHODS AND FINDINGS

We carried out a cohort study of ex-Armed Forces personnel by linking national databases of discharged personnel and suicide deaths (which included deaths receiving either a suicide or undetermined verdict). Comparisons were made with both general and serving populations. During the study period 233,803 individuals left the Armed Forces and 224 died by suicide. Although the overall rate of suicide was not greater than that in the general population, the risk of suicide in men aged 24 y and younger who had left the Armed Forces was approximately two to three times higher than the risk for the same age groups in the general and serving populations (age-specific rate ratios ranging from 170 to 290). The risk of suicide for men aged 30-49 y was lower than that in the general population. The risk was persistent but may have been at its highest in the first 2 y following discharge. The risk of suicide was greatest in males, those who had served in the Army, those with a short length of service, and those of lower rank. The rate of contact with specialist mental health was lowest in the age groups at greatest risk of suicide (14% for those aged under 20 y, 20% for those aged 20-24 y).

CONCLUSIONS

Young men who leave the UK Armed Forces were at increased risk of suicide. This may reflect preservice vulnerabilities rather than factors related to service experiences or discharge. Preventive strategies might include practical and psychological preparation for discharge and encouraging appropriate help-seeking behaviour once individuals have left the services.

Self-harm in UK armed forces personnel: descriptive and case-control study of general hospital presentations

BACKGROUND

Little is known about self-harm in the armed forces.

AIMS

To investigate the characteristics of armed forces personnel presenting to a general hospital following self-harm and compare these with matched controls who had self-harmed.

METHOD

Investigation of armed forces personnel presenting to hospital between 1989 and 2003 following self-harm and case-control comparison with people in the general population who had self-harmed.

RESULTS

One hundred and sixty-six armed forces personnel presented with self-harm during the study period, of whom 72.3% (120) were male. Nearly two-thirds (62.7%) were aged under 25 years. Relationship problems (62.0%), employment problems (43.9%) and alcohol misuse (40.5%) were common. Fewer armed forces personnel than controls had evidence of current or past psychiatric disorders or treatment or a prior history of self-harm, and their suicidal intent was lower (males only). Of 64 people in the armed forces who presented during the first 9 years of the study period, 1 had died (from natural causes) by the end of 2000, compared with 9 (5.1%) of the controls, 6 by probable suicide.

CONCLUSIONS

Self-harm by armed forces personnel may often be a response to interpersonal and employment problems complicated by alcohol misuse, with relatively low suicide intent.

Physical mechanisms and scaling laws of K-shell double photoionization

We report on the photon energy dependence of the K-shell double photoionization (DPI) of Mg, Al, and Si. The DPI cross sections were derived from high-resolution measurements of x-ray spectra following the radiative decay of the K-shell double vacancy states. Our data evince the relative importance of the final-state electron-electron interaction to the DPI. By comparing the double-to-single K-shell photoionization cross-section ratios for neutral atoms with convergent close-coupling calculations for He-like ions, the effect of outer shell electrons on the K-shell DPI process is assessed. Universal scaling of the DPI cross sections with the effective nuclear charge for neutral atoms is revealed.

Coulomb breakup problem

We formulate scattering theory in the framework of a surface-integral approach utilizing analytically known asymptotic forms of the three-body wave functions. This formulation is valid for both short-range and Coulombic potentials. The post and prior forms of the breakup amplitude are derived without any reference to renormalization procedures.

The operational emergency department attendance register (OPEDAR): a new epidemiological tool

AIM

To determine the number, status and nature of emergency department attendances to deployed field hospitals.

POPULATION

All attendances to the emergency department (ED) of deployed field hospitals in support of Operation TELIC (Iraq) from initial entry war fighting to enduring operations.

METHODS

Analysis of hand written and electronic registers ED attendance registers and validation with four other data sources.

RESULTS

Validation of data held on OpEDAR against 4 other data sources shows that OpEDAR is accurate, but that accuracy can be further improved. 26,746 ED attendances recorded on OP TELIC from 19 March 2003 to 11 November 2006. 21,112 (78.9%) were UK military. Overall, 43.5% were admitted from ED. Attendances peaked during TELIC phases 2 (422.9 per 1,000 troops deployed), but have settled to around 200 per 1,000 troops deployed in the more recent phases. Ophthalmology rates peaked in TELIC 2 to 20.72 per 1,000 and have since reduced to a consistent 10 to 15 per 1,000. This suggests that preventative measures introduced for eye injury are incompletely effective or incompletely utilised.

CONCLUSIONS

OpEDAR is a clinical tool to inform manning, equipment and training requirements for enduring and new operations, focused on the requirements of the emergency department. Multivariate quality control models applied in industry could be applied to OpEDAR to produce a dynamic epidemiological tool that identifies emerging case clusters and facilitates deployed commanders to take preventative action.

Near-threshold positron-impact ionization of atomic hydrogen

We consider the positron-impact ionization (breakup) of atomic hydrogen utilizing the full and S-wave model calculations, concentrating on the near-threshold energy region. Unlike the corresponding electron-impact case, the S-wave model does support the Wannier-like threshold law predicted by Ihra et al. [Phys. Rev. Lett. 78, 4027 (1997)10.1103/PhysRevLett.78.4027]. It is found that convergent S-wave model cross sections are obtained only if complete expansions are utilized on both the atomic and the positronium centers. Furthermore, we suggest that, in the model and full calculations, the separate contributions to the breakup cross section from both centers become equal at threshold.

Advanced paternal age: how old is too old?

Average paternal age in the UK is increasing. The public health implications of this trend have not been widely anticipated or debated. This commentary aims to contribute to such a debate. Accumulated chromosomal aberrations and mutations occurring during the maturation of male germ cells are thought to be responsible for the increased risk of certain conditions with older fathers. Growing evidence shows that the offspring of older fathers have reduced fertility and an increased risk of birth defects, some cancers, and schizophrenia. Adverse health outcomes should be weighed up against advantages for children born to older parents, mindful that these societal advantages are likely to change over time.

Increase in schizophrenia incidence rates: findings in a Canadian cohort born 1975-1985

BACKGROUND

Results from previous studies on the incidence rates for schizophrenia are inconsistent, with some showing a declining rate [e.g., Suvisaari et al. (1999) Arch Gen Psychiatry 56:733-740] and others showing an increasing rate [e.g., Boydell et al. (2003) Br J Psychiatry 182:45-49].

OBJECTIVE

This study examines (1) whether incidence rates are changing, (2) relationships amongst changing incidence rates and age, period and cohort effects, and (3) the impact of rate changes on rate projections.

DESIGN

A care-based cohort study carried out in British Columbia, Canada, 1989-1998. Bayesian statistical analyses were used to estimate rates and describe secular effects. Classical tests of significance were used to assess the relative importance of age, period and cohort effects.

RESULTS

Between 1989 and 1998, median rates per 100,000 persons changed from 77.1 (90% credible interval (CI): 42.1-137.7) to 89.9 (90% CI: 80.1-100.1) in females, and from 66.6 (90% CI: 38.8-113.3) to 119.6 (90% CI: 107.4-132.4) in males. Age effects were active for both males and females. Period and cohort effects were stronger for males than females.

CONCLUSIONS

In contrast to most previous studies, we found an increasing incidence of schizophrenia. Precise projections of schizophrenia incidence beyond 5 years require large sample sizes over prolonged periods of follow-up.

Suicide rates, life satisfaction and happiness as markers for population mental health

OBJECTIVE

To examine the association of variables from survey data on well-being with suicide rates and other markers of population mental health in Europe.

DESIGN

Ecological study correlating (Spearman's rank correlation) life satisfaction and happiness (European Values Survey 1999/2000) in 32 countries with suicide rates (WHO Mortality Database), rates of hospital discharge for mental and behavioural disorders and prevalence of mental disorders based on registered mental patients (WHO Regional Office for Europe) and Mental Health Index (MHI)-5 survey data (European Opinion Research Group).

RESULTS

An inverse association exists between suicide rates and life satisfaction (r=-0.44; 95% CI: -0.68, -0.11) and happiness (r=-0.42; 95% CI: -0.67, -0.08). Similar though weaker associations were seen with hospital discharge data and MHI-5 data but not with the prevalence of mental disorders. The association between suicide rates and life satisfaction was weaker amongst 15-44 year olds (r=-0.31; 95% CI: -0.59, 0.04) than amongst 45-64 year olds (r=-0.47; 95% CI: -0.70, -0.14). It was strongest in the 65+ age group (r=-0.54; 95% CI: -0.75, -0.23). A similar pattern was observed for the association with happiness. In a subgroup analysis, the association between suicide and life satisfaction in Eastern Europe was similar to that in the whole dataset (r=-0.35) but a positive association was seen in Western Europe (r=0.47).

CONCLUSIONS

Life satisfaction and happiness were modestly associated with other indicators of population mental health. Since all such markers have their limitations, surveys of well-being may be useful indicators of population mental health.

Associations of childhood and adulthood height and the components of height with insulin-like growth factor levels in adulthood: a 65-year follow-up of the Boyd Orr cohort

CONTEXT

Taller individuals with longer legs have a higher risk of cancer but a lower risk of coronary heart disease.

OBJECTIVE

We investigated whether childhood height and its components are associated with the IGF system in adulthood.

DESIGN AND PARTICIPANTS

We analyzed data from 429 participants of the Boyd Orr cohort, for whom height measured in childhood (mean age, 7.4 yr) in 1937-1939 could be related to levels of IGF-I, IGF-II, IGF binding protein (IGFBP)-2, and IGFBP-3 in adulthood (mean age, 71.1 yr). In 385 participants, measured height in adulthood could be related to IGF levels.

RESULTS

In fully adjusted models (controlling for age, sex, socioeconomic factors, lifestyle, and body mass index), childhood height and its components were not associated with adult circulating IGF-I, IGF-II, or IGFBP-2 levels. IGFBP-3 was 85.5 ng/ml higher (95% confidence interval, -11.6 to 182.5; P = 0.08) per sd increase in childhood trunk length and 83.6 ng/ml lower (95% confidence interval, -10.3 to 177.5; P = 0.08) per sd increase in childhood leg/trunk ratio. Height in adulthood was not associated with IGF-I, IGF-II, or IGFBP-3 and was inversely associated with IGFBP-2 (P = 0.05) after additionally controlling for childhood height.

CONCLUSION

There was no evidence that associations of childhood height with cancer and coronary heart disease risk are mediated by IGF-I in adulthood. The anthropometric associations with IGFBP-2 and IGFBP-3 could be chance findings but warrant additional investigation. IGF levels in childhood may be more important determinants of long-term disease risk than adult levels.