Moseley Hall Hospital

The rice blast resistance (R) genes Pi2 and Piz-t confer broad-spectrum resistance against different sets of Magnaporthe grisea isolates. We first identified the Pi2 gene using a map-based cloning strategy. The Pi2 gene is a member of a gene cluster comprising nine gene members (named Nbs1-Pi2 to Nbs9-Pi2) and encodes a protein with a nucleotide-binding site and leucine-rich repeat (LRR) domain. Fine genetic mapping, molecular characterization of the Pi2 susceptible mutants, and complementation tests indicated that Nbs4-Pi2 is the Pi2 gene. The Piz-t gene, a Pi2 allele in the rice cultivar Toride 1, was isolated based on the Pi2 sequence information. Complementation tests confirmed that the family member Nbs4-Piz-t is Piz-t. Sequence comparison revealed that only eight amino-acid changes, which are confined within three consecutive LRR, differentiate Piz-t from Pi2. Of the eight variants, only one locates within the xxLxLxx motif. A reciprocal exchange of the single amino acid between Pi2 and Piz-t did not convert the resistance specificity to each other but, rather, abolished the function of both resistance proteins. These results indicate that the single amino acid in the xxLxLxx motif may be critical for maintaining the recognition surface of Pi2 and Piz-t to their respective avirulence proteins.

Abstract Summary: The use of lignocellulosic fibers, pineapple leaf fiber (PALF) and sisal as reinforcements in thermoplastic and thermosetting resins for developing low cost and lightweight composites is an emerging field of research in polymer science and technology. Although, these biofibers have several advantages, such as low densities, low cost, nonabrasive nature, high filling level possible, low energy consumption, high specific properties, biodegradability, etc., over synthetic fibers, the absorption of moisture by untreated biofibers, poor wettability, and insufficient adhesion between the polymer matrix and fiber deteriorate the mechanical properties of composites made up of these biofibers. Therefore, the modification of these fibers is a key area of research at present to obtain optimum fiber‐matrix properties. This review article is concerned with the structure, composition and properties of PALF and sisal, the chemical modifications of these fibers and PALF/sisal‐reinforced thermosets, thermoplastics, rubber, cement, hybrids and biocomposites. Scanning electron micrograph of tensile fractured surface of alkali treated sisal fiber (magnification ×500). magnified image Scanning electron micrograph of tensile fractured surface of alkali treated sisal fiber (magnification ×500).

BACKGROUND: Postpartum haemorrhage (PPH) is the leading cause of maternal mortality worldwide. Prophylactic uterotonic drugs can prevent PPH, and are routinely recommended. There are several uterotonic drugs for preventing PPH but it is still debatable which drug is best. OBJECTIVES: To identify the most effective uterotonic drug(s) to prevent PPH, and generate a ranking according to their effectiveness and side-effect profile. SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register (1 June 2015), ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) for unpublished trial reports (30 June 2015) and reference lists of retrieved studies. SELECTION CRITERIA: All randomised controlled comparisons or cluster trials of effectiveness or side-effects of uterotonic drugs for preventing PPH.Quasi-randomised trials and cross-over trials are not eligible for inclusion in this review. DATA COLLECTION AND ANALYSIS: At least three review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We estimated the relative effects and rankings for preventing PPH ≥ 500 mL and PPH ≥ 1000 mL as primary outcomes. We performed pairwise meta-analyses and network meta-analysis to determine the relative effects and rankings of all available drugs. We stratified our primary outcomes according to mode of birth, prior risk of PPH, healthcare setting, dosage, regimen and route of drug administration, to detect subgroup effects.The absolute risks in the oxytocin are based on meta-analyses of proportions from the studies included in this review and the risks in the intervention groups were based on the assumed risk in the oxytocin group and the relative effects of the interventions. MAIN RESULTS: This network meta-analysis included 140 randomised trials with data from 88,947 women. There are two large ongoing studies. The trials were mostly carried out in hospital settings and recruited women who were predominantly more than 37 weeks of gestation having a vaginal birth. The majority of trials were assessed to have uncertain risk of bias due to poor reporting of study design. This primarily impacted on our confidence in comparisons involving carbetocin trials more than other uterotonics.The three most effective drugs for prevention of PPH ≥ 500 mL were ergometrine plus oxytocin combination, carbetocin, and misoprostol plus oxytocin combination. These three options were more effective at preventing PPH ≥ 500 mL compared with oxytocin, the drug currently recommended by the WHO (ergometrine plus oxytocin risk ratio (RR) 0.69 (95% confidence interval (CI) 0.57 to 0.83), moderate-quality evidence; carbetocin RR 0.72 (95% CI 0.52 to 1.00), very low-quality evidence; misoprostol plus oxytocin RR 0.73 (95% CI 0.60 to 0.90), moderate-quality evidence). Based on these results, about 10.5% women given oxytocin would experience a PPH of ≥ 500 mL compared with 7.2% given ergometrine plus oxytocin combination, 7.6% given carbetocin, and 7.7% given misoprostol plus oxytocin. Oxytocin was ranked fourth with close to 0% cumulative probability of being ranked in the top three for PPH ≥ 500 mL.The outcomes and rankings for the outcome of PPH ≥ 1000 mL were similar to those of PPH ≥ 500 mL. with the evidence for ergometrine plus oxytocin combination being more effective than oxytocin (RR 0.77 (95% CI 0.61 to 0.95), high-quality evidence) being more certain than that for carbetocin (RR 0.70 (95% CI 0.38 to 1.28), low-quality evidence), or misoprostol plus oxytocin combination (RR 0.90 (95% CI 0.72 to 1.14), moderate-quality evidence)There were no meaningful differences between all drugs for maternal deaths or severe morbidity as these outcomes were so rare in the included randomised trials.Two combination regimens had the poorest rankings for side-effects. Specifically, the ergometrine plus oxytocin combination had the higher risk for vomiting (RR 3.10 (95% CI 2.11 to 4.56), high-quality evidence; 1.9% versus 0.6%) and hypertension [RR 1.77 (95% CI 0.55 to 5.66), low-quality evidence; 1.2% versus 0.7%), while the misoprostol plus oxytocin combination had the higher risk for fever (RR 3.18 (95% CI 2.22 to 4.55), moderate-quality evidence; 11.4% versus 3.6%) when compared with oxytocin. Carbetocin had similar risk for side-effects compared with oxytocin although the quality evidence was very low for vomiting and for fever, and was low for hypertension. AUTHORS' CONCLUSIONS: Ergometrine plus oxytocin combination, carbetocin, and misoprostol plus oxytocin combination were more effective for preventing PPH ≥ 500 mL than the current standard oxytocin. Ergometrine plus oxytocin combination was more effective for preventing PPH ≥ 1000 mL than oxytocin. Misoprostol plus oxytocin combination evidence is less consistent and may relate to different routes and doses of misoprostol used in the studies. Carbetocin had the most favourable side-effect profile amongst the top three options; however, most carbetocin trials were small and at high risk of bias.Amongst the 11 ongoing studies listed in this review there are two key studies that will inform a future update of this review. The first is a WHO-led multi-centre study comparing the effectiveness of a room temperature stable carbetocin versus oxytocin (administered intramuscularly) for preventing PPH in women having a vaginal birth. The trial includes around 30,000 women from 10 countries. The other is a UK-based trial recruiting more than 6000 women to a three-arm trial comparing carbetocin, oxytocin and ergometrine plus oxytocin combination. Both trials are expected to report in 2018.Consultation with our consumer group demonstrated the need for more research into PPH outcomes identified as priorities for women and their families, such as women's views regarding the drugs used, clinical signs of excessive blood loss, neonatal unit admissions and breastfeeding at discharge. To date, trials have rarely investigated these outcomes. Consumers also considered the side-effects of uterotonic drugs to be important but these were often not reported. A forthcoming set of core outcomes relating to PPH will identify outcomes to prioritise in trial reporting and will inform futures updates of this review. We urge all trialists to consider measuring these outcomes for each drug in all future randomised trials. Lastly, future evidence synthesis research could compare the effects of different dosages and routes of administration for the most effective drugs.

The aim of the study was to identify the comorbidity of autistic spectrum disorders in a population of children with Down syndrome (DS). All children with DS within a defined population of South Birmingham were identified. The Asperger Syndrome Screening Questionnaire and the Child Autism Rating Scale were completed and diagnosis made according to ICD-10 criteria following interview and observation. Thirty-three of 58 identified children completed the measures, four of whom received a diagnosis of an autistic spectrum disorder. This is equivalent to a minimum comorbid rate of 7%. The questionnaire items concerning social withdrawal, restricted or repetitive interests, clumsiness, and unusual eye contact were associated with an autistic disorder. Of the remaining 29 participating children, 11 also displayed marked obsessional and ritualistic behaviours. The comorbid occurrence of autism and DS is at least 7%. It is important that these children are identified and receive appropriate education and support. A full assessment of social, language, and communication skills and behaviour is crucial, particularly in children with DS who appear different from other children with DS. Potential mechanisms accounting for this comorbidity are discussed.

A significant percentage of patients suffering from a stroke involving motor-relevant central nervous system regions will develop a spastic movement disorder. Hyperactivity of different muscle combinations forces the limbs affected into abnormal postures or movement patterns. As muscular hyperactivity can effectively and safely be treated with botulinum toxin type A (BoNT-A), we present a classification of spastic arm movement patterns to support BoNT-A therapy of arm spasticity. A few characteristic patterns can be distinguished that may be relevant for BoNT-A treatment. On the basis of a differentiated posture and arm movement analysis, five characteristic arm spasticity patterns (ASP I–V) were defined with respect to the position of the shoulder, elbow, forearm, and wrist joints. These patterns were verified using data from a worldwide noninterventional Upper Limb International Survey. By clinical observation, spastic arm postures in 94% of 665 poststroke patients could be assigned to one of these five ASPs. The most frequent pattern of arm spasticity was ASP III (41.8%) with internal rotation and adduction of the shoulder and flexion at the elbow coupled with a neutral positioning of the forearm and wrist, not the typical Wernicke–Mann position. These five different arm position patterns (ASP I–V) form the foundation of a common terminology and facilitate quick and understandable exchange of information with other physicians. Furthermore, utilization of these patterns may improve the dosing, goal setting, and outcome of the BoNT-A treatment of arm spasticity. Bei einem erheblichen Prozentsatz Patienten stellen sich nach einem Schlaganfall unter Beteiligung der für die Motorik zuständigen Regionen des zentralen Nervensystems (ZNS) spastische Bewegungsstörungen ein. Eine Hyperaktivität unterschiedlicher Muskelkombinationen ruft bei den betroffenen Extremitäten abnormale Haltungen oder Bewegungsmuster hervor. Da eine muskuläre Hyperaktivität effektiv und sicher mit Botulinumtoxin Typ A (BoNT-A) behandelt werden kann, präsentieren wir eine Klassifikation spastischer Armbewegungsmuster zur Unterstützung der BoNT-A-Therapie bei Armspastizität. Man unterscheidet einige charakteristische Muster, die für die BoNT-A-Therapie möglicherweise ausschlaggebend sind. Ausgehend von einer differenzierten Analyse der Haltung und Armbewegung wurden fünf charakteristische Muster der Armspastizität (ASP I–V) mit Bezug auf die Haltung von Schultern, Ellbogen, Unterarm und Handgelenken definiert. Diese Muster wurden mit Daten aus einer weltweiten nicht-interventionellen internationalen Umfrage zu den oberen Extremitäten belegt. Durch klinische Beobachtung konnten spastische Armhaltungen bei 94% der 665 Schlaganfallpatienten einer dieser fünf ASP zugeordnet werden. Das gängigste Muster der Armspastizität war ASP III (41.8%) mit interner Rotation und Adduktion der Schulter und Flexionshaltung des Ellbogens, kombiniert mit einer neutralen Haltung von Unterarm und Handgelenk – nicht die typische Wernicke-Mann-Haltung. Diese fünf verschiedenen Armhaltungsmuster (ASP I–V) bilden die Grundlage für eine gängige Terminologie und ermöglichen den schnellen und verständlichen gegenseitigen Informationsaustausch unter Ärzten. Außerdem kann die Nutzung dieser Muster die Dosierung, Zielsetzung und das Ergebnis der BoNT-A-Therapie der Armspastizität verbessern. Un porcentaje significativo de pacientes que han sufrido un ictus donde se han visto afectadas algunas regiones motoras del sistema nervioso central desarrollará un trastorno de movimientos espásticos. La hiperactividad de las distintas combinaciones musculares obliga a los miembros afectados a adoptar posturas o patrones de movimiento anómalos. Dado que la hiperactividad muscular puede ser tratada de forma efectiva y segura con la toxina botulínica de tipo A (BoNT-A), en este estudio se presenta una clasificación de los patrones de los movimientos espásticos del brazo con el fin de demostrar la eficacia del tratamiento con BoNT-A para la espasticidad del brazo. Es posible distinguir ciertas características que pueden ser de importancia en el tratamiento con BoNT-A. Partiendo de un análisis diferenciado de la postura y el movimiento de los brazos, se definieron cinco patrones característicos de la espasticidad de los brazos (ASP I–V) con respecto a la posición de las articulaciones del hombro, el codo, el antebrazo y las muñecas. Dichos patrones se verificaron utilizando datos procedentes de un cuestionario internacional no intervencionista de los miembros superiores. Gracias a las observaciones clínicas, se pudieron asignar las posturas espásticas del brazo del 94% de los 665 pacientes postictus a uno de los cinco ASP. El patrón más frecuente de la espasticidad del brazo fue ASP III (41,8%), que implicaba la rotación interna y la aducción del hombro, junto con la flexión del codo, combinadas con la posición neutra del antebrazo y la muñeca, es decir, no la típica actitud de Wernicke–Mann. Estos cinco patrones de las distintas posiciones del brazo (ASP I–V) forman la base de una terminología común y facilitan el intercambio rápido y comprensible de información con otros médicos. Además, el uso de estos patrones puede mejorar el establecimiento de las fases, la fijación de los objetivos y los resultados del tratamiento con BoNT-A para la espasticidad de los brazos. Un pourcentage significatif de patients atteints d'un AVC impliquant les régions du système nerveux cruciales pour les fonctions motrices développera des troubles spastiques du mouvement. L'hyperactivité de combinaisons musculaires différentes force les membres affectés dans des postures ou des déplacements anormaux. L'hyperactivité musculaire pouvant être traitée efficacement et en toute sécurité avec la toxine botulique de type A (BoNT-A), nous présentons une classification des modèles de mouvements spastiques du bras pour soutenir la thérapie de la spasticité du bras par la BoNT-A. Il est possible de distinguer plusieurs mouvements caractéristiques qui peuvent être pertinents pour le traitement par la BoNT-A. Sur la base d'une analyse des postures et des mouvements différenciés du bras, cinq mouvements caractéristiques de la spasticité du bras (ASP I–V) ont été définis par rapport à la position de l'épaule, du coude, de l'avant-bras et des articulations du poignet. Ces mouvements ont été vérifiés à l'aide de données issues d'une enquête non interventionnelle des membres supérieurs effectuée dans le monde entier. Par l'observation clinique, les postures spastiques du bras chez 94% de 665 patients post-AVC peuvent être attribuées à l'un de ces cinq ASP. Le mouvement le plus fréquent de la spasticité du bras était l'ASP III (41.8%) avec rotation et adduction internes de l'épaule et flexion au niveau du coude associée à un positionnement neutre de l'avant-bras et du poignet, autre que la position de Wernicke-Mann typique. Ces cinq mouvements différents de la position des bras (ASP I-V) constituent le fondement d'une terminologie commune et facilitent un échange rapide et compréhensible d'informations avec les autres médecins. En outre, l'utilisation de ces mouvements peut améliorer le dosage, l'établissement d'objectifs et les résultats du traitement de la spasticité du bras par la BoNT-A.

BACKGROUND: Children in the UK care system often face multiple disadvantages in terms of health, education and future employment. This is especially true of mental health where they present with greater mental health needs than other children. Although transition from care - the process of leaving the local authority as a child-in-care to independence - is a key juncture for young people, it is often experienced negatively with inconsistency in care and exacerbation of existing mental illness. Those receiving support from child and adolescent mental health services (CAMHS), often experience an additional, concurrent transfer to adult services (AMHS), which are guided by different service models which can create a care gap between services. METHOD: This qualitative study explored care-leavers' experiences of mental illness, and transition in social care and mental health services. Twelve care-leavers with mental health needs were interviewed and data analysed using framework analysis. RESULTS: Sixteen individual themes were grouped into four superordinate themes: overarching attitudes towards the care journey, experience of social care, experience of mental health services and recommendations. CONCLUSIONS: Existing social care and mental health teams can improve the care of care-leavers navigating multiple personal, practical and service transitions. Recommendations include effective Pathway Planning, multiagency coordination, and stating who is responsible for mental health care and its coordination. Participants asked that youth mental health services span the social care transition; and provide continuity of mental health provision when care-leavers are at risk of feeling abandoned and isolated, suffering deteriorating mental health and struggling to establish new relationships with professionals. Young people say that the key to successful transition and achieving independence is maintaining trust and support from services.

The Pi2/9 locus contains at least four resistance specificities to Magnaporthe grisea and belongs to a gene complex comprised of multiple genes that encode highly homologous nucleotide binding site (NBS) and leucine rich repeat (LRR) proteins. To investigate the genetic events involved in the evolution of the Pi2/9 locus, we analyzed the Pi2/9 locus at the inter- and intralocus levels in five rice cultivars. The NBS-LRR genes in the five cultivars belong to the same phylogenetic clade among rice NBS-LRR genes, and all have a phase-2 intron at the N-terminus. However, the paralogs within each haplotype show a significant sequence divergence and their N-terminal intron and 5' regulatory regions are very different. On the contrary, the orthologs from different haplotypes are highly similar, indicating an obvious orthologous relationship has been maintained during the evolution of the Pi2/9 locus. These results suggest that sequence diversification in the 5' regulatory regions and N-terminal introns of the paralogs may have led to suppression of meiotic recombination between the paralogs within each haplotype, facilitating the maintenance of the orthologous relationship among rice cultivars. Our observations provide valuable insight into the genomic dynamics and evolutionary mechanism of an NBS-LRR resistance-gene complex in rice.

BACKGROUND: Cardiovascular risk-based screening is proposed as a key intervention to reduce premature cardiovascular disease (CVD) in the UK and internationally. This study evaluated a targeted cardiovascular (CVD) assessment pilot in 23 community pharmacies in Birmingham, UK. METHODS: The CVD risk assessment service used near-patient testing and the Framingham risk equations administered by pharmacists to screen clients aged 40-70 without known CVD. Outcomes assessed included volume of activity, uptake by deprivation and ethnicity and onwards referral. RESULTS: Complete data were available for 1130 of 1141 clients; 679 (60%) male, 218 (19%) smokers and 124 (11%) had a family history of CVD. Overall, 792 (70%) of clients were referred to their general practice: 201 (18%) at CVD risk of 20% or more, remainder with individual risk factor(s). Greater representation from Black (7.4%) and Asian (24.8%) communities and from average and less deprived quintiles than the affluent and most deprived was observed. CONCLUSIONS: Community pharmacies can provide a CVD risk assessment service in a UK urban setting that can attract males and provide access for deprived communities and Black and Asian communities. A pharmacy service can support GP practices in identifying and managing the workload of around 30% of clients.

A series of three prevalence surveys were undertaken in a teaching hospital (where medical students are taught) in the West Midlands of England to identify the numbers of patients at risk of developing pressure sores and the actual number of patients with pressure sores, prior to the purchase of pressure-relieving equipment. All in-patients were assessed using the Waterlow score. Full details of all pressure sores and any pressure-relieving equipment in use was recorded. There was a mean pressure sore prevalence of 7.32%, the prevalence for each survey being 8.77%, 5.1% and 8.1% respectively. Grades 2 and 3 were the most commonly reported grades and the sacrum was the most frequent position. It was anticipated that there would be a difference in dependency between the patient populations in each of the three surveys. This was not so and, when using the Waterlow score, the numbers of patients found to be at no risk, at risk and at high risk remained remarkably stable. Only those in the very high risk category fluctuated. It is postulated that the difference between the prevalence in the three surveys is related to the difference in the numbers of patients seen to be at very high risk. These surveys have provided a basis for selecting pressure-relieving equipment and baseline information for monitoring the efficacy of the prevention programme.

We have attempted to describe the epidemiology of femoral fractures in children in the West Midlands region of the National Health Service in England. Our source of data was the Regional Hospital Episode Statistics database for the years 1991-2 to 2001-2. Cases were defined as emergency hospital admissions in patients aged under 16 years, with a diagnostic code of femoral fractures in any field, and resident in the West Midlands. Between 1991-2 and 2001-2, 3272 children aged under 16 years with femoral fractures were admitted to hospital. The crude incidence during this period decreased from 0.33 to 0.22 femoral fractures/1000/year. Those caused by traffic accidents decreased by 43%, and by falls by 29%. The peak age-gender-specific incidence (0.91/1000/year) was in two-year-old boys, and this was 50% higher than in the next highest age-gender group. In the first year of life, the incidence in boys and girls was the same. Thereafter the rate in boys exceeded that in girls, varying from 1.6 times at 11 years to 4.7 times at 14 years. Falls accounted for 49% of the fractures, varying from 77% in one-year-olds to 26% in eight-year-old children. Traffic accidents were responsible for 26% of fractures varying from 55% in ten-year-old to 2% in one-year-old children. Maltreatment was recorded in 1.3% of all cases, and in 8.5% of children under one year. Twice as many fractures were seen in May to August than in January (winter). The rates of fractures were associated with deprivation for all age-gender groups. Fractures of the shaft accounted for 58% of all fractures, varying from 70% in three-year-old to 34% in 13-year-old children. Our findings show that there has been a decrease in the incidence of femoral fractures during the 1990s and early 2000s. Two-year-old boys had twice the rate than any other single-year age-gender group. More deprived areas had much higher rates which suggests the potential for greater prevention. A relatively low rate of maltreatment was recorded compared with that in some other studies.

Background: Theoretical studies have shown that some deficits in verbal short-term/working memory can impact comprehension abilities. Clinicians often suspect that their clients are failing to understand speech because they cannot remember what has been said. Yet there are no reports of how to treat such a problem. Aims: To see if improving the short-term/working memory abilities of a person with aphasia would improve her comprehension at the sentence level. In addition, we sought to explore the issues involved in carrying out research-based therapy in a clinical environment. Methods & Procedures: The memory and language impairments of a person with aphasia were assessed. The memory impairments were then targeted in therapy by requiring the repetition of gradually more demanding sentences. Comprehension itself was not practised at all during therapy. Outcome and Results: Certain aspects of short-term and working memory improved post-therapy, notably an increase in digit span and an ability to repeat more words in sentences. There was a limited generalisation of improvement to comprehension tasks, meaning that the client could understand longer sentences and required fewer repetitions. The existence of possible additional impairments was revealed post-therapy. Conclusions: If memory limitations are causing comprehension difficulty, therapy may need to take the focus away from language and on to short-term/working memory. However, improvement may be limited. In addition, we suggest that within the context of a clinical setting, a reasonable balance between research and therapy can be struck (albeit with some difficulty) if compromises are made.

There is good evidence for effective transfer of learning from virtual to real-world environments, and this holds true even for complex spatial tasks such as route learning. However, there is little research into the simple equivalence of an individual's performance across real and virtual environments, an important topic which could support the use of virtual reality as an assessment and research tool. This pilot study compared route-learning performance in a desktop virtual town with performance around a real-world route. Participants were "driven" around a route through a virtual town and around a different (but equally complex) route through a real-world suburb, then asked to direct the driver back around each of the routes from memory. They completed strategy checklists after learning each route. Results indicated good equivalence between the real and virtual environments, with comparable error rates and no differences in strategy preferences. This demonstrates that simple desktop virtual environments may be a useful tool for assessment of and research into route learning.

OBJECTIVES: Given the importance of vision in the control of walking and evidence indicating varied practice of walking improves mobility outcomes, this study sought to examine the feasibility and preliminary efficacy of varied walking practice in response to visual cues, for the rehabilitation of walking following stroke. DESIGN: This 3 arm parallel, multi-centre, assessor blind, randomised control trial was conducted within outpatient neurorehabilitation services. PARTICIPANTS: Community dwelling stroke survivors with walking speed <0.8m/s, lower limb paresis and no severe visual impairments. INTERVENTION: Over-ground visual cue training (O-VCT), Treadmill based visual cue training (T-VCT), and Usual care (UC) delivered by physiotherapists twice weekly for 8 weeks. MAIN OUTCOME MEASURES: Participants were randomised using computer generated random permutated balanced blocks of randomly varying size. Recruitment, retention, adherence, adverse events and mobility and balance were measured before randomisation, post-intervention and at four weeks follow-up. RESULTS: Fifty-six participants participated (18 T-VCT, 19 O-VCT, 19 UC). Thirty-four completed treatment and follow-up assessments. Of the participants that completed, adherence was good with 16 treatments provided over (median of) 8.4, 7.5 and 9 weeks for T-VCT, O-VCT and UC respectively. No adverse events were reported. Post-treatment improvements in walking speed, symmetry, balance and functional mobility were seen in all treatment arms. CONCLUSIONS: Outpatient based treadmill and over-ground walking adaptability practice using visual cues are feasible and may improve mobility and balance. Future studies should continue a carefully phased approach using identified methods to improve retention. TRIAL REGISTRATION: Clinicaltrials.gov NCT01600391.

BACKGROUND: Previous studies of bereavement in primary care have tended to concentrate on the attitudes of general practitioners (GPs) to bereavement support and little has been documented on the views of patients. AIM: To establish the role, content, and value of a protocol designed to help the newly bereaved by examining the experiences and expectations of a group of bereaved patients within a single general practice, with a view to developing patient care within this area. METHOD: A qualitative approach was adopted using a semi-structured questionnaire, data collection, and analysis consistent with the principles of grounded theory. Patients were approached by letter and those who agreed to take part in the study were interviewed at home. RESULTS: Many of those interviewed expected some form of contact from their GP after bereavement, although the nature of the contact they would have liked varied. The majority would have appreciated a letter of sympathy and none would have objected to it. Over half expressed some form of dissatisfaction either with their GP or with the hospital. Quality of information giving and communication affected bereavement outcomes for some. The role of the GP was examined and patients responded positively to practical suggestions to improve bereavement care. CONCLUSIONS: Bereavement support was seen to be an important part of the GP role by the majority of those interviewed. As a result recommendations have been made for a protocol to support the newly bereaved.

Abstract Aims: On the Edge is a mental health education programme designed to support early intervention by increasing knowledge and understanding of early psychosis, reducing the stigma associated with mental health issues and improving awareness of avenues of help. The target audience was young people aged 14–22 years in schools and colleges. Methods: An interactive drama programme was developed through collaborative working across psychiatry, applied drama and those with direct experience of psychosis. A national tour engaged 2500 students in 71 performances that took place in 51 schools and colleges. The programme was evaluated against its aims with data collected both during and after the tour. Results: Quantitative and qualitative evaluation found significant gains with respect to all three aims. Thirty‐one schools developed supportive links with local mental health services. Conclusions: This programme shows the value and effectiveness of delivering health education on early psychosis through the medium of applied drama, and offers a model for a programme that can be incorporated into early intervention services. Lessons learned through delivering this programme are a valuable contribution towards future developments of mental health education programmes for schools.

Impaired route learning is a common consequence of acquired brain injury (ABI) but has received little attention in the research literature. Errorless learning may be a method of facilitating the learning of routes but this is unclear as previous studies of errorless learning have focused mainly on verbal skills and the only previous study involving route learning was based upon a pencil and paper task. In the present study we therefore use virtual reality to explore the benefits of errorless learning for routes in an ecologically valid task. Twenty people with acquired brain injury learned two routes, of equivalent difficulty, around a virtual town based upon the city of Nice. For one route, full guidance was provided throughout the learning trials in an errorless learning paradigm; the other route was learned using a procedure that allowed for trial and error. Route recall following the errorless learning condition was significantly more accurate than recall after errorful learning. This suggests that the benefits of errorless over errorful learning in acquired brain injury rehabilitation extend beyond verbal learning tasks to the practical task of route memorisation.

OBJECTIVES: Performance on neuropsychological tests can be influenced by non-cognitive factors, including deliberate underperformance, stress, the need to fulfil a sick role, depression, un-cooperativeness, fatigue and unhappiness with the evaluative situation. Tests to detect suboptimal effort are becoming widely used in clinical practice and are based on their reported insensitivity to cognitive dysfunction. A diagnosis of dementia has life-changing implications for an individual of working age. It is therefore crucial that clinicians can be confident they have obtained a valid estimate of current cognitive functioning. This study aimed to establish whether mood or cognitive functioning adversely influenced performance on symptom validity tests (SVTs) in individuals with working age dementia, who were judged to be using full effort. METHOD: Forty-two participants with dementia diagnosed before the age of 65 completed measures of emotional and cognitive functioning and six SVTs. RESULTS: There were no significant correlations between emotional functioning and measures of effort. However, cognitive functioning, in particular new learning, was significantly related to SVT performance. Participants with mild dementia performed significantly better on all six SVTs than those with moderate/severe dementia. The results also suggest that the SVTs are not equally sensitive to cognitive dysfunction. Rey's Dot Counting Test (DCT) (times criterion) achieved 100% specificity, and was the only test passed by every participant. CONCLUSION: Rey's DCT is the only SVT that can be recommended for use in those under 65 years with possible dementia at this time until further validation studies are undertaken.

We examine the challenges and developments relating to the support of ethnic minority businesses (EMBs). The challenges pertain to the distinctiveness of business support needs, the ‘mainstreaming’ of EMB support, and the dynamics of delivery. An ‘engaged scholarship’ approach is adopted, on the basis of an examination of business support providers in the West Midlands. We find considerable evidence of ‘policy learning’ in respect of these challenges. Hence, a nuanced approach to EMB support needs is in evidence, and ‘good practice’ principles are adhered to in respect of mainstreaming and EMB engagement. However, the new era of austerity imperils many of these gains.

Summary The Sexual Offences Act 2003 repealed and revamped almost all of the existing statute law in relation to sexual offences. The purpose of this was to strengthen and modernise the law in this area. Incorporated within the Act were new and specific offences providing for ‘Offences against persons with a mental disorder impeding choice’ and offences involving ‘Inducement, threat or deception to procure sexual activity with a person with a mental disorder’. Psychiatrists may be involved in such cases to provide assessment and opinion as to whether the alleged victim had a mental disorder and because of this lacked the capacity to consent to sexual activity. Knowledge of the intricacies and implementation of these offences against people with mental disorder can aid clinicians who may be asked to provide expert written and oral evidence and opinion for court cases.

The article ‘researches’ construction fragmentation from the assumption that construction projects are ‘unmanageable’ (Mintzberg, 1982) in conventional terms, in an attempt to give thematic unity to this problem. Socio‐technical analysis which underlay the Building Industry Communications Research Project (BICRP) (Higgin &amp; Jessop, 1963, 1965; TIHR, 1965; Chrichton, 1966) conducted by the Tavistock Institute for Human Relations (TIHR) from 1963 to 1965 is explored and developed, supplemented other relevant authors. The argument is conducted formally without reference to particular examples and develops the debate provoked by Connaughton (2000). Formal statement of the problem assists reinterpretation (Boyd &amp; Wild, 1999; Wild, 2001 a) of existing material and new enquiry to clarify the conditions, if any, both necessary and sufficient, for the manageability of construction.