Now showing items 1-20 of 608

    • Interaction between Metabolic Genetic Risk Score and Dietary Fatty Acid Intake on Central Obesity in a Ghanaian Population

      Alsulami, Sooad; Nyakotey, David; Dudek, Kamila; Bawah, Abdul-Malik; Lovegrove, Julie; Annan, Reggie; Ellahi, Basma; Karani, Santhanakrishnan Vimaleswaran; University of Reading, University of Chester and Kumasi University
      Obesity is a multifactorial condition arising from the interaction between genetic and lifestyle factors. We aimed to assess the impact of lifestyle and genetic factors on obesity-related traits in 302 healthy Ghanaian adults. Dietary intake and physical activity were assessed using a 3 day repeated 24 h dietary recall and global physical activity questionnaire, respectively. Twelve single nucleotide polymorphisms (SNPs) were used to construct 4-SNP, 8-SNP and 12-SNP genetic risk scores (GRSs). The 4-SNP GRS showed significant interactions with dietary fat intakes on waist circumference (WC) (Total fat, Pinteraction = 0.01; saturated fatty acids (SFA), Pinteraction = 0.02; polyunsaturated fatty acids (PUFA), Pinteraction = 0.01 and monounsaturated fatty acids (MUFA), Pinteraction = 0.01). Among individuals with higher intakes of total fat (>47 g/d), SFA (>14 g/d), PUFA (>16 g/d) and MUFA (>16 g/d), individuals with ≥3 risk alleles had a significantly higher WC compared to those with <3 risk alleles. This is the first study of its kind in this population, suggesting that a higher consumption of dietary fatty acid may have the potential to increase the genetic susceptibility of becoming centrally obese. These results support the general dietary recommendations to decrease the intakes of total fat and SFA, to reduce the risk of obesity, particularly in individuals with a higher genetic predisposition to central obesity.
    • Social Care Workers’ Experiences of Assessing Parents with Learning Disabilities: An Interpretative Phenomenological Analysis Study Based in the Northwest of England.

      Lovell, Andrew; Constance, Lyndsey J. (University of Chester, 2020-06-26)
      Aims: Qualitative research has identified a number of issues when working with parents with learning disabilities. Pre-conceived ideas, professional discrimination and a high percentage of children living away from the family home have featured heavily in the literature. However, less is known about the assessment process, and how practitioners adapt their skills to assess this parental group. The current study therefore aimed to gain an in-depth understanding of the assessment process, utilising a qualitative approach. The study focused upon the experiences of social care assessors from children’s and adult services, and sought to explore the following: the approach social care workers adopt when assessing parents with learning disabilities; if appropriate knowledge is embedded into practice to assess competently; experiences of the application of the PAMS 4.0; multi-disciplinary approach to assessment, and how this exhibits in practice. Method: Semi-structured interviews were carried out with fourteen frontline social care practitioners from children’s and adult services who had direct experience of assessing parents with learning disabilities. The transcripts of the interviews were analysed using Interpretative Phenomenological Analysis (IPA). Results: The analysis produced four master themes. These were; inadequate knowledge to understand complexities; hierarchy; reasonable adjustments; assessing parental ability. An analysis of these master themes and the related super-ordinate themes is presented. Discussion: The results are considered in light of the experiences of the participants, and how this impacts on the assessment of parents with learning disabilities. The study finds that whilst there is evidence the participants hold pre-conceived ideas, a lack of relevant skills and knowledge as well as an unstructured implementation of the Parenting Assessment Manual 4.0, are both contributing factors. Furthermore, problematic multi-agency working and managerial influences impact on the overall outcomes for parents with learning disabilities and their families.
    • Stigma: the representation of anorexia nervosa in UK newspaper Twitter feeds.

      Bowen, Matt; Lovell, Andrew; Waller, Rhian; University of Chester
      Background There is evidence that the representation of mental health in newspapers has an influence on readers’ attitudes, however, relatively little is known about how the industry presents accounts of anorexia nervosa. Further, the industry increasingly uses Twitter as a medium for reaching readers and this remains an under-examined area of research. Aims To explore the representation of anorexia nervosa in the UK national press’ Twitter feeds. Method Frame analysis was used to examine the manner in which anorexia nervosa was represented in the Twitter feeds of all national UK newspapers between 2009-2019 (n=332). This qualitative approach used Braun and Clarke’s stages of thematic analysis, while drawing on Van Gorp’s use of a frame matrix to support the definition of the news frames. Results The analysis identified four news frames: social model, illness model, stress-recovery model and clickbait model. Conclusions The newspapers drew on a range of perspectives in their representation of anorexia nervosa, which typically were not stigmatising in their accounts. However, there was a pattern of using sensationalistic images in some of the tweets, which may encourage readers to view people with anorexia nervosa as Other, and as a consequence contribute to stigmatisation.
    • The value of embedded secondary-care-based psychology services in rheumatology: an exemplar for long-term conditions

      Barnes, Theresa; Taylor, Lou; Eost-Telling, Charlotte; Joy, Thomas; Countess of Chester Hospital; University of Chester; University of Chester; Cheshire and Wirral Partnership (Royal College of Physicians, 2020-02-29)
      Rheumatoid arthritis is an exemplar long term condition, complicated by pain, disability, co-morbidities and long term medication use. It has significant effects on mobility, work performance, social role, sexual function and relationships. It is commonly associated with fatigue and mood disturbance as a result of complex interactions of physical (disease related) and psychosocial factors. NICE guidance recommends the availability of psychological support for these patients. We have implemented a psychology service for our patients with chronic rheumatological conditions. This study was set up to capture the value of this service.
    • Exploring the staff development needs of junior academic middle managers in a Faculty of Health and Social Care during organisational change: A Bourdieusian perspective.

      Evers, Jean L (University of ChesterUniversity of Chester, 2019-12)
      The aim of this study was to gain an in-depth understanding of the personal and professional staff development needs of junior academic middle managers in a Faculty of Health and Social Care during a period of change. The research was undertaken in the North West of England in a post-1992 University, following a reorganisation of the Faculty of Health and Social Care and introduction of new roles. The study adopted an action research methodology and a co-operative inquiry method, which consisted of a co-operative inquiry group of junior academic middle managers who were also co-researchers. The nature of co-operative inquiry is for co -researchers to engage in repeated cycles of reflection and action that generate changes to their professional practice. The study was conducted over a period of one year and during this time multiple data collection methods were utilised to triangulate the evidence. The research findings identified that multiple identities caused conflict between professional and academic roles, negatively impacting on junior academic middle managers during periods of change. During transition, some participants reported difficulty in adapting to complex political reforms, which caused dissonance between their actual and perceived roles in the field. The junior academic middle managers reported that the safe and trusting environment of the co-operative inquiry group enhanced their confidence and enabled them to learn in action and acquire a reflexive approach when undertaking their roles in the newly structured organisation. The study contributes to the existing literature regarding role identity of professional academics in higher education and offers new insights into transition during complex organisational change.
    • Association of apolipoprotein E gene polymorphisms with blood lipids and their interaction with dietary factors

      Shatwan, Israa M.; Winther, Kristian H.; Ellahi, Basma; Elwood, Peter; Ben-Shlomo, Yoav; Givens, Ian; Rayman, Margaret P.; Lovegrove, Julie A.; Vimaleswaran, Karani S.; Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research (ICMR), Department of Food and Nutritional Sciences, University of Reading, Reading, UK, RG6 6AP, UK; Food and Nutrition Department, Faculty of Home Economics, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Endocrinology and Metabolism Odense University Hospital Denmark; Faculty of Health and Social Care, University of Chester, Chester, CH1 1SL, UK; Department of Epidemiology, Statistics and Public Health, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK; Population Health Sciences, University of Bristol, Bristol, BS8 2PS, UK; Institute for Food, Nutrition and Health, University of Reading, Earley Gate, Reading RG6 6AR, UK; Department of Nutritional Sciences Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK. (BMC, 2018-04-30)
      Abstract Background: Several candidate genes have been identified in relation to lipid metabolism, and among these, lipoprotein lipase (LPL) and apolipoprotein E (APOE) gene polymorphisms are major sources of genetically determined variation in lipid concentrations. This study investigated the association of two single nucleotide polymorphisms (SNPs) at LPL, seven tagging SNPs at the APOE gene, and a common APOE haplotype (two SNPs) with blood lipids, and examined the interaction of these SNPs with dietary factors. Methods: The population studied for this investigation included 660 individuals from the Prevention of Cancer by Intervention with Selenium (PRECISE) study who supplied baseline data. The findings of the PRECISE study were further replicated using 1,238 individuals from the Caerphilly Prospective cohort (CaPS). Dietary intake was assessed using a validated food-frequency questionnaire (FFQ) in PRECISE and a validated semi-quantitative FFQ in the CaPS. Interaction analyses were performed by including the interaction term in the linear regression model adjusted for age, body mass index, sex and country. Results: There was no association between dietary factors and blood lipids after Bonferroni correction and adjustment for confounding factors in either cohort. In the PRECISE study, after correction for multiple testing, there was a statistically significant association of the APOE haplotype (rs7412 and rs429358; E2, E3, and E4) and APOE tagSNP rs445925 with total cholesterol (P=4x10-4 and P=0.003, respectively). Carriers of the E2 allele had lower total cholesterol concentration (5.54± 0.97 mmol/L) than those with the E3 (5.98± 1.05 mmol/L) (P=0.001) and E4 (6.09± 1.06 mmol/L) (P=2x10-4) alleles. The association of APOE haplotype (E2, E3, and E4) and APOE SNP rs445925 with total cholesterol (P=2x10-6 and P=3x10-4, respectively) was further replicated in the CaPS. Additionally, significant association was found between APOE haplotype and APOE SNP rs445925 with low density lipoprotein cholesterol in CaPS (P=4x10-4 and P=0.001, respectively). After Bonferroni correction, none of the cohorts showed a statistically significant SNP-diet interaction with lipid outcomes. Conclusion: In summary, our findings from the two cohorts confirm that genetic variations at the APOE locus influence plasma total cholesterol concentrations, however, the gene-diet interactions on lipids require further investigation in larger cohorts.
    • A genetic approach to examine the relationship between vitamin B12 status and metabolic traits in a South Asian population

      Surendran, S; Alsulami, S; Lankeshwara, R; Jayawardena, R; Wetthasinghe, K; Sarkar, S; Ellahi, B; Lovegrove, JA; Anthony, D; Vimaleswaran, KS; et al.
      Background: Observational studies in South Asian populations have suggested an association between vitamin B12 status and metabolic traits; however, the findings have been inconclusive. Hence, the aim of the present study was to use a genetic approach to explore the relationship between metabolic traits and vitamin B12 status in a Sri Lankan population and to investigate whether these relationships were modified by dietary intake. Methods: A total of 109 Sinhalese adults (61 men and 48 women aged 25-50 years), from Colombo city underwent anthropometric, biochemical, dietary intake analysis and genetic tests. Genetic risk scores (GRS) based on 10 metabolic single nucleotide polymorphisms (SNPs) (metabolic-GRS) and 10 vitamin B12 SNPs (B12-GRS) were constructed. Results: The B12-GRS was significantly associated with serum vitamin B12 (P=0.008), but not with metabolic traits (P>0.05); whereas, the metabolic-GRS had no effect on metabolic traits (P>0.05) and vitamin B12 concentrations (P>0.05). An interaction was observed between B12-GRS and protein energy intake (%) on waist circumference (P=0.002). Interactions were also seen between the metabolic-GRS and carbohydrate energy intake (%) on waist to hip ratio (P=0.015). Conclusion: Our findings suggest that a genetically lowered vitamin B12 concentration may have an impact on central obesity in the presence of a dietary influence; however, our study failed to provide evidence for an impact of metabolic-GRS on lowering B12 concentrations. Given that our study has a small sample size, further large studies are required to confirm our findings.
    • Stay Well in Wales Super Profiles: Who thinks what about the nation's health

      Sharp, Catherine A.; Hughes, Karen; Bellis, Mark; Di Lemma, Lisa; Public Health Collaborating Unit Bangor University; Public Health Wales; University of Chester
      Using a household and online survey, the views of 3,310 individuals in Wales (aged 16+ years) on 19 public health statements were gathered. Eight demographic and five health-related behaviour super profiles were created to explore differences in opinions across population groups.
    • Event-related and readiness potentials when preparing to approach and avoid alcohol cues following cue avoidance training in heavy drinkers.

      Stancak, Andrej; Soto, Vicente; Fallon, Nick; Di Lemma, Lisa; University of Chester; University of Liverpool; Universidad Adolfo Ibáñez; University of Sheffield.
      Rationale Cue avoidance training (CAT) reduces alcohol consumption in the laboratory. However, the neural mechanisms that underlie the effects of this intervention are poorly understood. Objectives The present study investigated the effects of a single session of CAT on event-related and readiness potentials during preparation of approach and avoidance movements to alcohol cues. Methods Heavy drinking young adults (N = 60) were randomly assigned to complete either CAT or control training. After training, we recorded participants’ event-related and motor readiness potentials as they were preparing to respond. Results In the CAT group, N200 amplitude was higher when preparing to approach rather than avoid alcohol pictures. In the control group, N200 amplitudes did not differ for approach and avoidance to alcohol pictures. Regarding the late positive potential (LPP), in the CAT group, the negativity of this was blunted when preparing to avoid alcohol pictures relative to when preparing to avoid control pictures. In the control group, the negativity of the LPP was blunted when preparing to approach alcohol pictures relative to when preparing to approach control pictures. There were no effects on motor readiness potentials. Behavioural effects indicated short-lived effects of training on reaction times during the training block that did not persist when participants were given time to prepare their motor response before executing it during the EEG testing block. Conclusions After a single session of CAT, the enhanced N200 when approaching alcohol cues may indicate the engagement of executive control to overcome the associations learned during training. These findings clarify the neural mechanisms that may underlie the effects of CAT on drinking behaviour.
    • Responding to Adverse Childhood Experiences: An evidence review of interventions to prevent and address adversity across the life course.

      Ford, Kat; Di Lemma, Lisa; Gray, Benjamin; Hughes, Karen; University of Chester; Public Health Collaborating Unit Bangor University; Public Health Wales.
      Adverse childhood experiences (ACEs) are stressful events during childhood that can have a profound impact on an individual’s present and future health (Section 1.3). Growing up in the face of such adversities is recognised as an important public health concern in Wales and internationally (Welsh Government, 2017a; World Health Organization [WHO], 2014). Actions to prevent and mitigate ACEs and their associated harms are essential to improve population health for present and future generations (Bethell et al., 2017; Pachter et al., 2017). In Wales, many sectors are working to identify and respond to adversity in order to improve outcomes for those who have experienced ACEs. Whilst a number of evidence-based interventions target specific types of adversity (e.g. domestic violence), we know that ACEs are strongly correlated (e.g. individuals exposed to adversity are often exposed to more than one type; Hughes et al., 2017). Thus, complex adversity requires a response which extends across sectors including health, social care, policing, education, community and others, and across the life course from early childhood through to adulthood. To support innovation in addressing ACEs we have undertaken a review of evidence on common approaches to prevent ACEs and/or mitigate their negative impacts. Over 100 interventions were identified and collated across four common approaches: supporting parenting; building relationships and resilience; early identification of adversity; and, responding to trauma and specific ACEs (Chapter 3). Whilst the interventions vary in type, the review identified cross-cutting themes, which could be used to inform a whole system approach (spanning individual, family and community levels) to tackle ACEs across the life course, supporting the development of an ACE-informed approach (Chapter 4). The report concludes by highlighting current gaps in the evidence and suggests key areas for further work to tackle ACEs for our future generations (Chapter 5). The report is not an exhaustive systematic evidence review of the interventions for specific ACE types, nor does it advocate any specific intervention, rather it seeks to present a summary of the research evidence and information on common approaches across the prevention of ACEs and mitigation of their impact. We hope the report will be a useful resource for service planners, practitioners and commissioners to support innovation and development towards an ACE-free future.
    • Public acceptability of public health policy to improve population health: A population‐based survey

      Bellis, Mark A.; Hughes, Karen; Di Lemma, Lisa; Public Health Collaborating Unit, School of Health Sciences, Bangor University, Wrexham; Public Health Wales; University of Chester
      Background: For public health policies to be effective, it is critical that they are acceptable to the public as acceptance levels impact success rate. Objective: To explore public acceptance of public health statements and examine differences in acceptability across socio-demographics, health behaviours (physical activity, diet, binge drinking and smoking), health status and well-being. Method: A cross-sectional survey was conducted with a nationally representative sample (N = 1001) using a random stratified sampling method. Face-to-face interviews were conducted at homes of residents in Wales aged 16+ years. Individuals reported whether they agreed, had no opinion, or disagreed with 12 public health statements. Results: More than half of the sample were supportive of 10 out of 12 statements. The three statements with the greatest support (>80% agreement) reflected the importance of: a safe and loving childhood to becoming a healthy adult, schools teaching about health, and healthier foods costing less. Individuals who engaged in unhealthy behaviours were less likely to agree with some of the statements (eg 39.8% of binge drinkers agreed alcohol adverts should be banned compared to 57.6% of those who never binge drink; P < .001). Conclusions: Findings show an appetite for public health policies among the majority of the public. The relationship between supporting policies and engaging in healthy behaviours suggests a feedback loop that is potentially capable of shifting both public opinion and the opportunities for policy intervention. If a nation becomes healthier, this could illicit greater support for stronger policies which could encourage more people to move in a healthier direction.
    • Retention and sustained viral suppression in HIV patients transferred to community refill centres in Kinshasa, DRC

      Moudachirou, Ramsia; Van Cutsem, G; Chuy, R; Tweya, H; Senkoro, Mbazi; Mabhala, Mzwandile; Zolfo, Maria; University of Chester
      Background The adoption of the UNAIDS 90-90-90 targets acceleration plan and the implementation of ‘test and treat’ strategy has resulted in a significant increase in the number of people living with HIV/AIDS (PLWHA) receiving lifelong antiretroviral therapy (ART). To improve and sustain ART retention in care and virologic suppression, innovative service delivery models are needed. In 2010, Médecins Sans Frontières (MSF) set-up decentralized community ART refill centres (“poste de distribution communautaire”, PODI) for follow-up of stable ART patients from Kabinda Hospital (CHK), in Kinshasa, Democratic Republic of Congo. Objective To assess retention in care and virologic suppression on ART after transfer to the three main PODIs in Kinshasa. Methods A retrospective cohort study was conducted using routine program data for PLWH aged >15 years and stable on ART transferred from CHK to a PODI between January 2015 and June 2017. Kaplan-Meier analysis was used to estimate retention in care. Viral load (VL) suppression was defined as a VL ≤ 1000 copies/ml. Results A total of 337 patients were transferred to a PODI. Of these, 306 (91%) patients were on ART 12 months after transfer to PODI and were eligible for the 12-month routine VL testing. A total of 118 (39%) had VL done at 12 months; VL suppression was 93% (n=110). Median time from enrolment into PODI to 12-month routine VL was 14.6 months [IQR: 12.2-20.8]. Overall, 189 (62%) patients had at least one VL load test done during follow-up. Retention in PODI at 6, 12 and 18 months was 96%, 92% and 88% respectively. Retention at 18 months was statistically different between PODIs; 91%, 88% and 78% in PODI East, PODI West and PODI Central respectively, (p=0.0349). Conclusion Retention and VL suppression in community-based ART refill centers were high, although VL coverage was low. HIV programs need to scale–up VL testing services PLWHA receiving ART in PODIs.
    • The perceived psychological stressors and coping behaviours in university students, on a pre-registration programme.

      Mitchell, Andrew E. P.; University of Chester (Emerald Publishing, 2020-05-20)
      The purpose was to investigate perceived stressors and coping behaviours in student nurses on a pre-registration programme of study. Stress in student nurses has been identified with decreased emotional well-being and poor academic achievement. The significance of stress and coping behaviours in students during training has implications for education and practice. The present study recruited eighty seven pre-registration student nurses in a cross sectional design. Bivariate and multivariate analyses assessed the differences in field and year of study and the students’ perceived stress and coping behaviours. The findings showed that stress is a significant issue in nurse training. Fifty-three percent of the participants had levels higher than the mean. Interestingly, the present study found that high perceived stress was associated with avoidance behaviours. The most common type of perceived stress and ranked by highest factor were from written assignments and a lack of professional skills and knowledge. Their peer group and everyday life activities were shown as potential ways of coping with stressors. Thus, it seems reasonable to focus support on decreasing avoidant and enhancing stress-reducing behaviours. Psychological stress and coping behaviours must be considered together as perceived stress is bound by the ability to ameliorate stress by managing helpful and unhelpful behaviours. The findings may suggest that a potential benefit could come from the provision of helpful strategies such as peer group support and reduction of avoidant behaviours. Also, there seems to be a need for greater mental health literacy in dealing with stress during training.
    • Understanding minimum and ideal factor levels for participation in physical activities by people with haemophilia: An expert elicitation exercise.

      Martin, Antony P; orcid: 0000-0003-4383-6038; Burke, Tom; Asghar, Sohaib; Noone, Declan; Pedra, Gabriel; orcid: 0000-0002-2023-5224; O'Hara, Jamie (2020-04-08)
      The benefits of physical activity (PA) for people with haemophilia (PWH) may include improvements in joint, bone and muscle health. However, the factor VIII activity level required to avoid a bleeding episode associated with PA is unknown. To elicit the opinion of clinical experts on the minimum level and ideal factor VIII activity ('level') required to avoid a bleeding episode during participation in different types of PA for PWH. Based on the 2017 National Hemophilia Foundation PA descriptions, clinical experts estimated a minimally acceptable and an ideal factor level at which a bleed could be avoided. The uncertainty around estimates was quantified using an approach to construct a probability distribution to represent expert opinion. Minimum and ideal factor level increased with higher risk PA, whether or not joint morbidity was present, as did the experts' uncertainty in their estimates (ie the range between lowest and highest estimates for minimum and ideal levels). Mean minimum levels ranged from 4% to 48% for low to high risk for people without joint morbidity, and from 7% to 47% for those with joint morbidity. For ideal factor levels, corresponding figures were 9%-52% and 12%-64%, respectively. To support a patient-centric outcome, expert opinion indicates that the clinical norm of 0.01 IU/mL (1%) trough level is insufficient. It is anticipated that introducing a more targeted approach to meet the needs of patients who are increasingly physically active will benefit patients further in addition to recent treatment advances. [Abstract copyright: © 2020 John Wiley & Sons Ltd.]
    • Assessment and treatment of cutaneous leishmaniasis in the emergency department.

      McGhee, Stephen; Finnegan, Alan; Unversity of Miami; University of Chester
      Cutaneous leishmaniasis is endemic in more than 70 countries worldwide. It is a non-fatal disease caused by the Leishmania parasite that is transmitted to humans via bites of infected female sandflies. Cutaneous leishmaniasis causes skin lesions on areas of exposed skin, such as the face and limbs, which often produce scarring and atrophy. If untreated, cutaneous leishmaniasis can develop into mucocutaneous leishmaniasis, which is potentially life-threatening. Furthermore, patients with cutaneous leishmaniasis commonly experience psychosocial issues such as anxiety, distress, stigma and rejection. Cutaneous leishmaniasis is spreading outside of its traditional endemic areas because of the effects of environmental changes such as urbanisation and climate change. In the UK, healthcare professionals may encounter the disease in migrants from endemic areas, members of the armed forces, tourists and expatriates. Therefore, emergency nurses need to be able to assess and support patients who present with symptoms suggestive of cutaneous leishmaniasis. This article provides an overview of the epidemiology, aetiology, pathophysiology, clinical presentation, diagnosis, treatment and prevention of the disease.
    • Educating nurses to deliver optimum care to military veterans and their families

      Finnegan, Alan; Di Lemma, Lisa; McGhee, Stephen; University of Miami; University of Chester
      The aim of the project was to help prepare the future nursing workforce to provide optimum care for the Armed Forces Community. Structured evidenced-based educational sessions were designed and then delivered at two Universities in England. This educational model included a flipped approach, didactic classroom teaching, blended learning, and information technology. Educational sessions were provided to 468 first year Bachelor of Nursing undergraduate students in 2017 and 2018. A mixed methods evaluation included a quasi-experiential design with pre and post-test data followed by research interviews conducted by student nurses and analysed using a modified Grounded Theory. Post session evaluation demonstrated a significant improvement in students' knowledge. 93% agreed that the training was useful, 95% felt that nurses should be aware of the healthcare needs of the Armed Forces Community, and 89% indicated that the subject matter should be included in the undergraduate curriculum. A qualitative theoretical model was built from four major clusters: the military community; student's identity, clinical engagement, and future practice. These educational sessions are being introduced into a growing number of United Kingdom Universities to create future nursing leaders with a better insight into the large and diverse Armed Forces Community.
    • A Research Portfolio: Transformational change by nursing, midwifery and care staff across health and care.

      Finnegan, Alan; Aitkenhead, Susan; NHS England & NHS Improvement
      It is widely accepted that nursing research is paramount to help address the challenges facing the international nursing workforce in caring for a growing and ageing population. Nursing, midwifery and care staff make up the largest proportion of the workforce across the NHS. In the UK, there are over 693,000 registered nurses and midwives (Nursing and Midwifery Council, 2018), all striving to prevent and tackle health inequalities and improve the care experience for patients, individuals and populations. The role that nursing, midwifery and care staff play should not be underestimated and specifically in this editorial, we describe a new research portfolio which signposts to examples of nursing, midwifery and care staff led research to demonstrate the significant academic contribution of these professions to transformational change across the health and care system. The Research Portfolio (NHS England, 2019a) showcases examples of research studies that demonstrate leadership in research and practice, all aligned to the key priorities outlined in the NHS Long Term Plan (LTP) (NHS England, 2019b). Evidence underpins so much of what we do and there is a huge opportunity to quantifiably demonstrate the contribution staff bring to the LTP, harnessing intelligence in closing gaps and addressing unwarranted variation in health and care.
    • Responding to nerve agent poisoning: A guide for emergency nurses. Part 2

      Mcgee, Stephen; Clochesy, John; Finnegan, Alan P.; McGhee, Stephen; University of Miami
      The release of chemical agents can cause loss of life and result in major incidents. Chemical agent-related major incidents require a modified response by emergency services due to the chemicals’ transmissibility, lethality, latency and persistence. In general, modifications to casualty flow, triage and treatment are made to reduce transmissibility, and lethality of chemical hazards. This article, the second of a two-part series on nerve agents, describes the adapted response and explains how emergency nurses must be familiar with principles of care including incident and casualty management.
    • Nerve agents: A guide for emergency nurses. Part 1

      McGhee, Stephen; Finnegan, Alan P.; Clochesy, John; University of Miami; University of Chester
      Recent incidents in the UK and the alleged chemical attacks in Syria by the Bashar al-Assad regime have brought the subject of chemical weapons back into the public domain. To date these types of event have been relatively rare because terrorist plans to harm large numbers of people have mostly been thwarted. This is the first part of a two-part article on nerve agents. Part one gives an overview of these agents, their historical background and manufacture, and how the agents affect physiology. Part two, which will appear in the next issue, considers the pre-hospital response to the use of nerve agents, including effective triage and decontamination, and in-hospital treatment.
    • Making sense of complexity: a qualitative investigation into forensic learning disability nurses' interpretation of the contribution of personal history to offending behaviour

      Skellern, Joanne; Lovell, Andrew; University of Chester; University of Derby
      Background: There is growing recognition that an individual’s personal history can be extremely influential in shaping his/her future experience, though there has been limited exploration in the context of learning disability and offending behaviour. Method: Research questions related to participant interpretation of offending behaviour and individual and service responses. A series of focus groups comprising learning disability forensic nurses were conducted across all secure settings, high, medium and low. Results: Three themes were produced: interpreting offending behaviour; the impact of personal history; responding therapeutically. The difficulties relating to understanding the relationship between offending behaviour and personal history significantly informed the construction of the most effective therapeutic relationships. Conclusions: An increased focus on the impact of someone’s background might inform nursing as it seeks to deliver care to individuals with increasingly complex needs in a time of service transition.