'One Is Too Many' preventing self-harm and suicide in military veterans: a quantitative evaluation

INTRODUCTION

In 2021, the Armed Forces Covenant Fund Trust allocated over £2 million to programmes designed to have a clear and demonstrable impact on suicide prevention. Four grant holders delivered a combination of psychotherapeutic interventions, group activities, social prescribing, peer support mentoring, life skills coaching, educational courses and practical help with housing and employment. The evaluation was completed between August 2021 and July 2023.

METHODS

A survey was completed by 503 participants at entry and 423 at exit. It captured data regarding demographic and military-specific details, health status, situational stressors, predisposing symptoms, help-seeking behaviour, social engagement, housing, living arrangements and employment status. The questionnaire included a number of validated psychometric questionnaires.

RESULTS

This evaluation revealed reductions in situational stressors, symptoms and mental health illnesses. Seventy-six per cent of participants had completed an Operational Tour, and 77% were exposed to a traumatic event during service. It was the negative impact of unresolved traumatic effects that influenced service-users to require support. Forty-nine per cent delayed seeking help, and 36% self-referred to the One Is Too Many programme which demonstrates the importance of this option. There were improvements in the participants' social networking, social activities, club membership and having people to rely on. Only 4% of participants were women which reinforces the requirement to explore initiatives to engage with female veterans.

CONCLUSIONS

Timely therapeutic and social prescribing interventions in a safe environment lowered depression, anxiety and the associated situational stressors leading to self-harming and may have reduced suicide. It presented another option to veterans and their families regarding where they can obtain support, care and therapeutic interventions. The programme provided a strong foundation for delivery organisations to forge lasting collaborative partnerships that can be extended to working with other authorities and institutes. The results highlight pathways for prevention and intervention strategies to inform policymakers, healthcare professionals and third-sector organisations.

High-Molecular-Weight Xylanase from B. pumilus US570 Strain: Purification, Characterization and Application in Banana and Orange Peels Hydrolysis and Breadmaking

New xylanase (XylUS570) was purified from the Bacillus pumilus US570 strain. It has a molecular mass of about 232 kDa. This is the first report on the highest molecular weight monomeric xylanase produced by bacteria. The optimum pH and temperature recorded for enzyme activity were 7 and 55 °C, respectively with a half-life time of 10 min at 60 °C. At 37 °C, the enzyme retains more than 50% of its activity at a pH ranging from 6 to 9.5 for 24 h. The XylUS570 exhibited a high activity on xylan, but no activity was detected for cellulosic substrates. The Vmax and Km values exhibited by the purified enzyme on beechwood xylan were 37.05 U mL-1 and 4.189 mg mL-1, respectively. The XylUS570 was used in banana and orange peels hydrolysis and showed potential efficiency to liberate reducing sugars. It could be a good candidate for bio-ethanol production from fruit waste. The purified enzyme was used also as an additive in breadmaking. A decrease in water absorption, an increase in dough rising and improvements in volume and specific volume of the bread were recorded.

Evaluation of the NHS England 'Op COURAGE' High Intensity Service for military veterans with significant mental health problems

INTRODUCTION

In November 2020, The NHS for England launched a pilot High Intensity Service (HIS) programme for treating military veterans complex mental health problems. Seven regional grants were awarded to manage the HIS, including NHS Solent, in South East England. This paper details an evaluation of the HIS, which was conducted from February 2021 to August 2022.

METHODS

This mixed-methods study gained quantitative data from a specifically designed questionnaire that included a number of validated psychometric questionnaires. These were completed by either HIS staff or beneficiaries at entry and exit from the HIS, and qualitative data were gained from semi-structured interviews with the HIS staff.

RESULTS

Data were sourced from 45 pre-questionnaires, 25 post programme questionnaires and 11 interviews. This evaluation identified reductions in situational stressors, symptoms and reported illnesses for veterans in crisis. There were reductions in depression, anxiety and post-traumatic stress disorder following programme exit. Staff reported that there was no notable changes in stress levels which appeared to remain high at programme exit. Staff interviews highlighted the importance of simultaneously understanding the social and psychological needs of veterans in mental health crisis. The benefits of integrating veteran staff members into military veteran health services were identified, demonstrating improvements in education around military culture in civilian services.

CONCLUSIONS

The importance of collaboration between clinical and veteran staff members in veteran health services was noted, demonstrating the positive impact social care provision has on veteran's overall health and well-being. Veteran engagement with the service was advocated as a result of veterans accessing the service feeling understood. This first independent evaluation of the HIS provides a positive reflection, and adds to the limited empirical evidence exploring veteran engagement in health services.

Malpractice litigation and spinal surgery in the National Health Service: a single tertiary-level centre perspective over 12 years

INTRODUCTION

Medical malpractice litigation is a major concern for all spine surgeons. Our aim was to evaluate the incidence and burden of successful litigation relating to the management of spinal disorders over 12 years within a UK NHS tertiary-level spinal unit and compare these litigation costs with those of other specialties.

METHODS

We obtained all data held by our claims department from its inception in January 2008 to December 2019. We also obtained costs for the total financial burden incurred by our Trust during this period.

RESULTS

In total, there were 83 closed claims involving spinal pathologies. Over 80% of these comprised negligent surgery (n = 28, 34%), delay to diagnose/treat (n = 25, 30%) and negligent care (n = 18, 22%). The vast majority of claims were withdrawn without incurring any cost to the hospital (n = 59, 71%) and only 24 (29%) resulted in successful litigation for the claimant. The total cost of damages for these 24 successful claims was just over £8 million, including legal costs of £2.5 million, out of total litigation costs of £381 million over this period.

DISCUSSION

Fewer than 30% of initial claims against a tertiary spinal surgical referral unit resulted in a successful financial outcome for the claimant. The total costs incurred were just over £8 million, with one-third apportioned to high legal costs, reflecting the complexity of resolving spinal litigation. Our entire legal expenses accounted for only 2% of the total legal bill paid by our hospital over a 12-year period.

Enzyme Storage and Recycling: Nanoassemblies of α-Amylase and Xylanase Immobilized on Biomimetic Magnetic Nanoparticles

Immobilization of enzymes has been extensively required in a wide variety of industrial applications as a way to ensure functionality and the potential of enzyme recycling after use. In particular, enzyme immobilization on magnetic nanoparticles (MNPs) could offer reusability by means of magnetic recovery and concentration, along with increased stability and robust activity of the enzyme under different physicochemical conditions. In the present work, microbial α-amylase (AmyKS) and xylanase (XAn11) were both immobilized on different types of MNPs [MamC-mediated biomimetic MNPs (BMNPs) and inorganic MNPs] by using two different strategies (electrostatic interaction and covalent bond). AmyKS immobilization was successful using electrostatic interaction with BMNPs. Instead, the best strategy to immobilize XAn11 was using MNPs through the hetero-crosslinker 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDC) and N-hydroxysuccinimide (NHS). The immobilization protocols were optimized by varying glutaraldehyde (GA) concentration, enzyme quantity, and reaction time. Under optimal conditions, 92% of AmyKS and 87% of XAn11 were immobilized on BMNPs and MNPs-E/N, respectively (here referred as AmyKS-BMNPs and XAn11-MNPs nanoassemblies). The results show that the immobilization of the enzymes did not extensively alter their functionality and increased enzyme stability compared to that of the free enzyme upon storage at 4 and 20 °C. Interestingly, the immobilized amylase and xylanase were reused for 15 and 8 cycles, respectively, without significant loss of activity upon magnetic recovery of the nanoassemblies. The results suggest the great potential of these nanoassemblies in bioindustry applications.

Biochemical characterization and structural insights into the high substrate affinity of a dimeric and Ca2+ independent Bacillus subtilis α-amylase

An extracellular amylase (AmyKS) produced by a newly isolated Bacillus subtilis strain US572 was purified and characterized. AmyKS showed maximal activity at pH 6 and 60°C with a half-life of 10 min at 70°C. It is a Ca²⁺ independent enzyme and able to hydrolyze soluble starch into oligosaccharides consisting mainly of maltose and maltotriose. When compared to the studied α-amylases, AmyKS presents a high affinity toward soluble starch with a K_m value of 0.252 mg ml^-1 . Coupled with the size-exclusion chromatography data, MALDI-TOF/MS analysis indicated that the purified amylase is a dimer with a molecular mass of 136,938.18 Da. It is an unusual feature of a non-maltogenic α-amylase. A 3D model and a dimeric model of AmyKS were generated showing the presence of an additional domain suspected to be involved in the dimerization process. This dimer arrangement could explain the high substrate affinity and catalytic efficiency of this enzyme.

Dental health and oral health-related quality of life in children with congenital bleeding disorders

The purpose of this study was to investigate the dental and some other aspects of oral health status of young patients with congenital bleeding disorders (CBD) and the impact of these on their quality of life (OHR-QoL) compared with controls. DMFS-dmfs (Decayed, Missed, Filled Tooth surfaces in permanent and primary teeth) scores, Simplified oral hygiene index, occurance of hypoplasia of first permanent molars, Temporomandibular joint dysfunction and occlusion of 46 CBD patients at the age range of 2-15 years and 46 of other children as control were compared, and the impact of their oral health situation on quality of life was also investigated. Data were analysed by chi-square, t-test and Pearson correlation. Patients were significantly more caries-free with less decayed teeth in primary-permanent dentition (P = 0.03, t = -2.17).The mean scores of OHR-QoL of CBD patients and controls were not significantly different. Oral Bleeding was the significant variable in relation to 'oral health-related quality of life' in CBD groups (Pearson correlation, r = -0.56, P = 0.000). OHR-QoL in the control group was related to dmfs score (r = -0.392, P = 0.011) and male gender (r = -0.329, P = 0.026). Congenital bleeding disorder CBD patients were found to have a better dental health situation in primary dentition compared with controls; however, their 'oral health-related quality of life' was similar. Oral bleeding was the only significant factor related to OHR-QoL in CBD. It shows an overall importance of development of comprehensive care centres for CBD as the main cause of this achievement.

Ischaemic posterior circulation stroke in State of Qatar

BACKGROUND

Ischaemic stroke features may show regional differences. Posterior circulation stroke (PCS) is of special interest, as symptomatology, course and outcome are usually different and complex. No significant studies or registries have reported on the characteristics and outcomes of PCS in our region.

METHODS

We prospectively collected data of 116 patients with PCS admitted from 2005 through 2008 in the only stroke admitting hospital in Qatar. Demographics, risk factors, clinical signs/symptoms, pattern of presentation, aetiology, imaging features, complications and outcome at discharge and follow-up were recorded.

RESULTS

Mean age was 53 years with 25% aged < or = 45, 85% were males. Demographically 47% were Arabs and 51% of South-Asian origin. Mean duration from onset to presentation was 29 h. Major risk factors were obesity (66%) and hypertension (61%). Minimal or fluctuating symptoms were present in 64%, while 9% had maximal deficit at onset. Thirty nine per cent had lesions in proximal territory and 23% in multiple territories. Around 41% had no occlusion, 16% had vertebro-basilar, 16% vertebral, 8% basilar occlusion. Etiologically 53% patients had large artery disease, 16% small vessel disease, and 17% cardioembolism. Seventy per cent of patients were discharged home, while 10% expired. Modified Rankin score (mRS) at discharge was < or = 2 in 53% and > or = 4 in 13% patients. At 30-day follow-up, 68% had mRS of < or = 2. Ninety-day survival status showed 89% alive with mRS < or = 2 in 73%.

CONCLUSION

The aetiology and lesion topography of PCS in this heterogeneous population differs from the pattern observed in other populations.

Complex tibial plateau fractures treated with Ilizarov external fixator with or without minimal internal fixation

We treated 30 tibial plateau fractures (Schatzker Type VI) in 29 patients, with a mean age of 41.4 (20-76) years, with the Ilizarov fixator. In 18 fractures, we combined the treatment with minimal internal fixation. All fractures were the result of high-energy trauma, and 20 patients had associated injuries. Twenty-eight fractures were available for follow-up after 27 (16-36) months. Using The Knee Society clinical rating system, 18 knees were rated as excellent, seven as good, one as fair, and two as poor. There was a direct correlation between the presence of associated injuries and the final outcome. The most significant concomitant injuries were distal femoral fractures and extensive soft-tissue injury. This study emphasizes the clinical success and low morbidity associated with the use of external fixation and minimal internal fixation.

Sensitive kinetic spectrophotometric determination of captopril and ethamsylate in pharmaceutical preparations and biological fluids

A highly sensitive kinetic spectrophotometric method was developed for the determination of captopril (CPL) and ethamsylate (ESL) in pharmaceutical preparations and biological fluids. The method is based on a catalytic acceleration of the reaction between sodium azide and iodine in an aqueous solution. Concentration range of 0.1-1.5 microg ml(-1) for CPL and 0.3-3 microg ml(-1) for ESL was determined by measuring the decrease in the absorbance of iodine at 348 nm by a fixed time method. The decrease in absorbance after 5 min was markedly correlated to the concentration. The relative standard deviations obtained were 1.30 and 1.87 for CPL and ESL, respectively, in pure forms. Correlation coefficients were 0.9997 and 0.9999 for CPL and ESL, respectively. The detection limits were determined as (S/N = 3) were 20 ng ml(-1) for CPL and 50 ng ml(-1) for ESL. The proposed procedure was successively applied for the determination of both drugs in pharmaceutical preparations and in biological fluids.

3 Tesla-MRT: Der Erfolg h�herer Feldst�rken

The recent development of 3 Tesla MRI (3T MRI) has been fueled by promise of increased signal-to-noise ratio(SNR). Many are excited about the opportunity to not only use the increased SNR for clearer images, but also the chance to exchange it for better resolution or faster scans. These possibilities have caused a rapid increase in the market for 3T MRI, where the faster scanning tips an already advantageous economic outlook in favor of the user. As a result, the global market for 3T has grown from a research only market just a few years ago to an ever-increasing clinically oriented customer base. There are, however, significant obstacles to 3T MRI presented by the physics at higher field strengths. For example, the T1 relaxation times are prolonged with increasing magnet field strength. Further, the increased RF-energy deposition (SAR), the larger the chemical shift and the stronger susceptibility effect have to be considered as challenges. It is critical that one looks at both the advantages and disadvantages of using 3T. While there are many issues to address aand a number of different methods for doing so, to properly tackle each of these concerns will take time and effort on the part od researchers and clinicians. The optimization of 3T MRI scanning will have to be a combined effort, though much of the work to date has been in neuroimaging. Multiple applications have been explored in addition to clinical anatomical imaging, where resolution is improved showing structure in the brain never seen before in human MRI. Body and cardiac imaging provide a great challenge but are also achievable at 3T. As an example, the full range of clinical applications currently achieved on today's state-of-the-art 1.5T cardiac MR scanners has also been demonstrated at 3T. In the body, the full range of contrast is available over large fields of view allowing whole liver studies in the clinic or, as needed, one may choose a smaller field of view for high-resolution imaging of the pancreas. The ability to increase resolution for musculoskeletal imaging has provided previously unseen detail. Bone structure, cartilage, and tendons and ligaments can be clearly visualized and pathology more easily detected due to an increased image quality. As the increase in field strength continues, a push to look at 7T has begun. The design philosophy is to keep the system as similar as possible, while changing only the frequency-dependent components. To date, both animal and human imaging have been performed on a whole body 7T scanner. Results show promise for both detailed imaging and functional MRI, but the road ahead is too long to be able to predict where it will end. The move toward higher field strengths is an exciting adventure in which 3T plays the role of trailblazer.

Infections in children under 5 years old and latrine cleanliness

The aim of this study is to assess the cleanliness of the latrine and its relation to occurrence of disease in children under 5 years old. A stratified random sample of 1327 households was conducted in 11 villages in Upper Egypt. It included a sub-sample of 541 children under 5 years living in households with latrines. The latrine cleanliness was assessed and its relationship to disease occurrence within a period of 2 weeks. Thirty-three percent (33.1%) of children under 5 years old with latrines in their household had infections, compared to 28.3% of those without latrines in the house. Infection with diarrhoea was found most in houses with latrine and water tap. A relation was found between latrine cleanliness score and presence of flies, house building material and maternal education, but none with occurrence of infection in children under 5 years old within a period of 2 weeks.

Echocardiographically guided pericardiocentesis - the gold standard for the management of pericardial effusion and cardiac tamponade

BACKGROUND

The conventional surgical pericardiotomy and blind needle-puncture pericardiocentesis using a subxiphoid approach have been reported to have only moderate success rates and to be associated with unacceptably high rates of morbidity and mortality. More recently, echocardiographically guided pericardiocentesis was reported to improve considerably the likelihood of success and the safety of this procedure.

OBJECTIVE

To evaluate the efficacy and safety of echocardiographically guided pericardiocentesis in the authors' institution.

PATIENTS AND METHODS

A series of consecutive patients who underwent percutaneous pericardiocentesis at the Hamilton General Hospital, Hamilton, Ontario, from June 1994 to December 1998.

RESULTS

Forty-one patients underwent a total of 46 echocardiographically guided pericardiocentesis procedures. The procedure was successful in 100% of attempts. Clinical complications occurred in two (5%) patients: one patient with known coagulopathy developed hemothorax and one patient developed purulent pericarditis several days after the procedure. There were no deaths, and no patient required urgent referral for surgical management.

CONCLUSIONS

Echocardiographically guided pericardiocentesis is safe and effective, and is the method of choice for therapeutic and diagnostic drainage of pericardial effusions. While echocardiographically guided pericardiocentesis was described originally at centres with large volumes of patients with clinically significant pericardial effusions and with extensive experience in using this technique, similar high success and low complication rates were attained at an institution with relatively low numbers of patients requiring pericardial drainage.

Antimicrobial activity of 20 plants used in folkloric medicine in the Palestinian area

Ethanolic and aqueous extracts of 20 Palestinian plant species used in folk medicine were investigated for their antimicrobial activities against five bacterial species (Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Proteus vulgaris, Pseudomonas aeruginosa) and one yeast (Candida albicans). The plants showed 90% of antimicrobial activity, with significant difference in activity between the different plants. The most antimicrobially active plants were Phagnalon rupestre and Micromeria nervosa, whereas, the least active plant was Ziziphus spina-christi. Only ten of the tested plant extracts were active against C. albicans, with the most active from M. nervosa and Inula viscosa and the least active from Ruscus aculeatus. Of all extracts the ethanolic extract of M. nervosa was the most active, whereas, the aqueous extract of Phagnalon rupestre was the most active of all aqueous extracts tested. The ethanolic extracts (70%) showed activity against both Gram positive and negative bacteria and 40% of these extracts showed anticandidal activity, whereas, 50% of the aqueous extracts showed antibacterial activity and 20% of these extracts showed anticandidal activity.