Increasing powers to reject licences to sell alcohol: Impacts on availability, sales and behavioural outcomes from a novel natural experiment evaluation.

Excessive alcohol consumption leads to negative health and social impacts at individual and population levels. Interventions that aim to limit the density of alcohol retail premises (including cumulative impact policies (CIPs)) have been associated with decreases in alcohol-related crime and alcohol-related hospital admissions. We evaluated the quantitative impact of introducing a new alcohol licensing policy that included a comprehensive Cumulative Impact Policy (CIP) enforced in seven Cumulative Impact Zones (CIZs) in one English Local Authority in 2013. We used time series analysis to assess immediate and longer term impacts on licensing decisions and intermediate outcomes, including spatial and temporal alcohol availability, crime, alcohol-related ambulance call-outs and on-licence alcohol retail sales across the Local Authority and in CIZs and non-CIZs during the period 2008 to 2016. We found no impact on licence application rates but post-intervention applications involved fewer trading hours. Application approvals declined initially but not over the longer term. Longer term, small reductions in units of alcohol sold in bars (-2060, 95% confidence interval (CI) = -3033, -1087) were observed in areas with more intensive licensing policies ('Cumulative Impact Zones' (CIZs)). Significant initial declines in overall crime rates (CIZs = -12.2%, 95% CI = -18.0%, -6.1%; non-CIZs = -8.0%, 95% CI = -14.0%, -1.6%) were only partially reversed by small, longer term increases. Ambulance callout rates did not change significantly. The intervention was partially successful but a more intensive and sustained implementation may be necessary for longer term benefits.

Stimulus specific cortical activity associated with ignoring distraction during working memory encoding and maintenance.

Distraction disrupts Working Memory (WM) performance, but how the brain filters distraction is not known. One possibility is that neural activity associated with distractions is suppressed relative to a baseline/passive task (biased competition). Alternatively, distraction may be denied access to WM, with no suppression. Furthermore, behavioural work indicates separate mechanisms for ignoring distractions which occur (1) while we put information into WM (Encoding Distraction, ED) and (2) while we maintain already encoded information during the WM delay period (Delay Distraction, DD). Here we used fMRI in humans to measure category-sensitive cortical activity and probe the extent to which ED/DD mechanisms involve enhancement/suppression during a WM task. We observed significant enhancement of task-relevant activity, relative to a passive view task, which did not differ according to whether or when distractors appeared. For both ED and DD we found no evidence of suppression, but instead a robust increase in stimulus specific activity in response to additional stimuli presented during the passive view task, which was not seen for the WM task, when those additional stimuli were to be ignored. The results indicate that ED/DD resistance does not necessarily involve suppression of distractor-related activity. Rather, a rise in distractor-associated activity is prevented when distractors are presented, supporting models of input gating, and providing a potential mechanism by which input-gating might be achieved.

Lateralization of lateral displays in convict cichlids.

We examine lateralization of lateral displays in convict cichlids, Amatitlania nigrofasciata, and show a population level preference for showing the right side. This enables contesting pairs of fish to align in a head-to-tail posture, facilitating other activities. We found individuals spent a shorter mean time in each left compared with each right lateral display. This lateralization could lead to contesting pairs using a convention to align in a predictable head-to-tail arrangement to facilitate the assessment of fighting ability. It has major implications for the common use of mirror images to study fish aggression, because the 'opponent' would never cooperate and would consistently show the incorrect side when the real fish shows the correct side. With the mirror, the 'normal' head-to-tail orientation cannot be achieved.

Quantifying the contribution of leading causes of death to mortality decline among older people in England, 1991-2005.

BACKGROUND: This paper quantifies the contribution of leading causes of death to mortality change between 1991 and 2005 for people aged 50 years and over in England. Between 1971 and 2005 the life expectancy of men aged 50 years increased by more than in the whole of the rest of the 20(th) century. The ageing population has not only had an important impact on health and social services, but was responsible for sparking the pensions crisis affecting both the public and commercial sector. METHODS: A cross-sectional analysis was used to quantify trends in cause-specific mortality in terms of absolute and relative change between 1991 and 2005 in the population aged 50 and over. Absolute change is quantified in terms of the numbers of deaths prevented or postponed (or conversely, increased or brought-forward) in a year compared to deaths in the baseline year. The percentage change in age-standardised rates was used to identify relative change in causes of death. RESULTS: Between 1991 and 2005 there was a continuous decline in overall all-cause death rates for people aged 50 and over. Age-standardised mortality declined by 30 per cent for men, from 3,216 per 100,000 men to 2,267 per 100,000. This resulted in 86,477 fewer male deaths in 2005 than would have occurred had 1991 rates persisted. For women the age-standardised mortality rate declined by 20 per cent from 2,032 per 100,000 to 1,626 per 100,000, resulting in 48,406 deaths postponed (or fewer deaths) in 2005.Of the total numbers of deaths postponed in 2005, ischaemic heart disease contributed the largest share for both men (45,244 deaths - 52.3 per cent) and women (33,601 - 69.4 per cent).The greatest decline in the mortality rate was observed for influenza, for which age-standardised rates fell by 89 per cent for men and 93 per cent for women. However the proportion of deaths in which influenza was the underlying cause was extremely small and so did not contribute a large proportion in terms of the total fall in numbers of deaths.Mortality rates from some conditions increased. Liver disease rates demonstrated some of the largest increases for both men and women aged 50 and over. For men the age-standardised mortality rate from liver disease increased by 104 per cent, resulting in 1,434 more deaths in 2005 than in 1991. CONCLUSIONS: The trends of decreasing mortality rates from ischaemic heart disease and stroke have continued into the 21(st) century, however both causes continue to be the biggest killers in England. They are projected to remain so, and consequently, to contribute significantly to the burden of disease in the population.The steady increase in liver disease mortality identified highlights the importance of tackling alcohol misuse as a public health priority.

DIAMOND (DIgital Alcohol Management ON Demand): a feasibility RCT and embedded process evaluation of a digital health intervention to reduce hazardous and harmful alcohol use recruiting in hospital emergency departments and online.

BACKGROUND: The harmful use of alcohol is a causal factor in more than 200 disease and injury conditions and leads to over 3 million deaths every year worldwide. Relatively few problem alcohol users access treatment due to stigma and lack of services. Alcohol-specific digital health interventions (DHI) may help them, but trial data comparing DHI with face-to-face treatment are lacking. METHODS: We conducted a feasibility RCT of an alcohol DHI, testing recruitment, online data-collection and randomisation processes, with an embedded process evaluation. Recruitment ran from October 2015 for 12 months. Participants were adults, drinking at hazardous and harmful levels, recruited from hospital emergency departments (ED) in London or recruited online. Participants were randomised to HeLP-Alcohol, a six module DHI with weekly reminder prompts (phone, email or text message), or to face-to-face treatment as usual (TAU). Participants were invited to take part in qualitative interviews after the trial. RESULTS: The trial website was accessed 1074 times: 420 people completed online eligibility questionnaires; 350 did not meet eligibility criteria, 51 declined to participate, and 19 were recruited and randomised. Follow-up data were collected from three participants (retention 3/19), and four agreed to be interviewed for the process evaluation. The main themes of the interviews were:Participants were not at equipoise. They wanted to try the website and were disappointed to be randomised to face-to-face, so they were less engaged and dropped out.Other reasons for drop out included not accepting that they had a drink problem; problem drinking interfering with their ability to take part in a trial or forgetting appointments; having a busy life and being randomised to TAU made it difficult to attend appointments. CONCLUSIONS: This feasibility RCT aimed to test recruitment, randomisation, retention, and data collection methods, but recruited only 19 participants. This illustrates the importance of undertaking feasibility studies prior to fully powered RCTs. From the qualitative interviews we found that potential recruits were not at equipoise for recruitment. An alternative methodology, for example a preference RCT recruiting from multiple locations, needs to be explored in future trials. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number: ISRCTN31789096.

Comparing the effectiveness of virtual reality and video modelling as an intervention strategy for individuals with Autism Spectrum Disorder: Brief report.

The increasing numbers of individuals diagnosed with Autism Spectrum Disorder (ASD) has foreshadowed a greater need for effective intervention procedures to aid learning. PURPOSE: This study compared the effectiveness of video modelling (VM) and virtual reality (VR) for teaching adults with ASD. METHODS: Using an alternating treatments design without baseline two participants completed paper folding projects of varying difficulty following exposure to either VM or VR task modelling. The rate of learning (ROL) determined treatment effectiveness. RESULTS: One participant reached mastery criterion for the intermediate project on the 5th trial with both VR and VM (i.e. equal ROL). The other achieved mastery by the 6th trial of VM, but did not attain mastery in VR. Both participants reported enjoying both procedures. CONCLUSIONS: The results suggest that VM was more effective than VR in facilitating learning. Implications for future research are discussed.

DIAMOND (DIgital Alcohol Management ON Demand): a mixed methods feasibility RCT and embedded process evaluation of a digital health intervention to reduce hazardous and harmful alcohol use.

BACKGROUND: Alcohol is a major risk factor for preventable illness, with huge cost to healthcare economies. There is a role for alcohol-specific digital health interventions (DHI), but there have been few randomised controlled trials (RCT) comparing DHI with face-to-face treatment. Such trials are complex and face obstacles in recruitment and retention. METHODS: Mixed-methods feasibility RCT of an alcohol DHI, testing recruitment, online data-collection and randomisation processes, with an embedded process evaluation. Recruitment ran from October 2014 for 9 months. Participants were adults drinking at hazardous and harmful levels, attending four community drug and alcohol services (CDAS) in London. Participants completed baseline demographic, alcohol-related and other psychological questionnaires online and were randomised to HeLP-Alcohol, a six-module DHI with weekly reminder prompts (phone, email or text message), which mirrors face-to-face treatment, or to face-to-face treatment at CDAS. Alcohol counsellors took part in qualitative interviews at the end of the study. RESULTS: Alcohol counsellors screened 1253 patients. One thousand one hundred eighty-nine did not meet inclusion criteria so were excluded: 579 were dependent drinkers, 548 had health conditions that made them ineligible to take part and 62 were ineligible for other reasons including homelessness. Of the 64 patients who were eligible to take part, 54 declined to participate, with 36 stating a preference for face-to-face treatment, 13 gave no reason, and 5 gave other reasons including not wanting to use a computer. Ten consented but then 3 changed their minds, so we were able to randomise 7 participants to the study (11% of eligible). Five alcohol counsellors agreed to be interviewed for the process evaluation and provided the following feedback: Although most of their colleagues were enthusiastic about the trial, some were not at equipoise in recruiting; potential participants also declared strong preference to intervention arm from the outset. These factors affected recruitment. Counsellors also lacked time to undertake the data inputting and follow-up of participants in addition to their everyday work. CONCLUSIONS: This feasibility study aimed to test recruitment, randomisation, retention and data collection methods but recruited only 7 participants so these aims were not fully achieved. This illustrates to all researchers of complex interventions the importance of conducting feasibility studies and is generalisable to areas other than alcohol research. CDAS were seeing larger numbers of non-dependent drinkers with complex additional problems than alcohol commissioners expected. CDAS clients and some counsellors were not at equipoise for recruitment. Alternative settings for recruitment need to be explored in future trials. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number: ISRCTN31789096, DOI 10.1186/ISRCTN31789096.

How effective are brief interventions in reducing alcohol consumption: do the setting, practitioner group and content matter? Findings from a systematic review and metaregression analysis.

BACKGROUND: While the efficacy and effectiveness of brief interventions for alcohol (ABI) have been demonstrated in primary care, there is weaker evidence in other settings and reviews do not consider differences in content. We conducted a systematic review to measure the effect of ABIs on alcohol consumption and how it differs by the setting, practitioner group and content of intervention. METHODS: We searched MEDLINE, EMBASE, PsycINFO; CINAHL, Social Science Citation Index, Cochrane Library and Global Health up to January 2015 for randomised controlled trials that measured effectiveness of ABIs on alcohol consumption. We grouped outcomes into measures of quantity and frequency indices. We used multilevel meta-analysis to estimate pooled effect sizes and tested for the effect of moderators through a multiparameter Wald test. Stratified analysis of a subset of quantity and frequency outcomes was conducted as a sensitivity check. RESULTS: 52 trials were included contributing data on 29 891 individuals. ABIs reduced the quantity of alcohol consumed by 0.15 SDs. While neither the setting nor content appeared to significantly moderate intervention effectiveness, the provider did in some analyses. Interventions delivered by nurses had the most effect in reducing quantity (d=-0.23, 95% CI (-0.33 to -0.13)) but not frequency of alcohol consumption. All content groups had statistically significant mean effects, brief advice was the most effective in reducing quantity consumed (d=-0.20, 95% CI (-0.30 to -0.09)). Effects were maintained in the stratified sensitivity analysis at the first and last assessment time. CONCLUSIONS: ABIs play a small but significant role in reducing alcohol consumption. Findings show the positive role of nurses in delivering interventions. The lack of evidence on the impact of content of intervention reinforces advice that services should select the ABI tool that best suits their needs.

DIgital Alcohol Management ON Demand (DIAMOND) feasibility randomised controlled trial of a web-based intervention to reduce alcohol consumption in people with hazardous and harmful use versus a face-to-face intervention: protocol.

BACKGROUND: "Hazardous and harmful" drinkers make up approximately 23 % of the adult population in England. However, only around 10 % of these people access specialist care, such as face-to-face extended brief treatment in community alcohol services. This may be due to stigma, difficulty accessing services during working hours, a shortage of trained counsellors and limited provision of services in many places. Web-based alcohol treatment programmes may overcome these barriers and may better suit people who are reluctant or unable to attend face-to-face services, but there is a gap in the evidence base for the acceptability, effectiveness and cost-effectiveness of these programmes compared with treatment as usual (TAU) in community alcohol services. This study aims investigate the feasibility of all parts of a randomised controlled trial (RCT) of a psychologically informed web-based alcohol treatment programme called Healthy Living for People who use Alcohol (HeLP-Alcohol) versus TAU in community alcohol services, e.g. recruitment and retention, online data collection methods, and the use and acceptability of the intervention to participants. METHODS: A feasibility RCT delivered in north London community alcohol services, comparing HeLP-Alcohol with TAU. Potential participants are aged ≥18 years referred or self-referred for hazardous and harmful use of alcohol, without co-morbidities or other complex problems. The main purpose of this study is to demonstrate the feasibility of recruiting participants to the study and will test online methods for collecting baseline demographic and outcome questionnaire data, randomising participants and collecting 3-month follow-up data. The acceptability of this intervention will be measured by recruitment and retention rates, automated log-in data collection and an online service satisfaction questionnaire. The feasibility of using tailored text message, email or phone prompt to maintain engagement with the intervention will also be explored. Results of the study will inform a definitive Phase 3 RCT. RESULTS: Recruitment started on 26 September 2014 and will run for 1 year. CONCLUSION: The proposed trial will provide data to inform a fully powered non-inferiority effectiveness and cost-effectiveness RCT comparing HeLP-Alcohol with TAU. TRIAL REGISTRATION: ISRCTN31789096.

Is preparedness for CBRN incidents important to general practitioners in East London?

General practitioners (GPs) have an important role in public health response to CBRN incidents, including disseminating information to worried patients and undertaking risk assessments of patients. The authors undertook the first known UK survey of GPs' CBRN preparedness to assess knowledge and attitudes towards CBRN preparedness among GPs in East London, in the area of the Olympic Park. A questionnaire was developed, focusing on GPs' self-preparedness for, and perceived roles in CBRN incidents, and GPs' access to resources and policies for dealing with such incidents. Of 157 GPs, 56 responded, although some responded collectively for their practice. The majority of respondents recognised roles for themselves in CBRN incidents, including recognition of illness, supporting decontamination, and appropriate reporting. However, 79 per cent of GPs also felt unprepared for such incidents. The most popular topic for training to address this was clinical presentation of CBRN exposures. Most practices had no policy for dealing with suspect packages and white powder incidents. Since this survey, guidance and training has been made available to local GPs. As the UK will host more events like the 2012 Olympics, preparedness for GPs will continue to be an important consideration in the UK.

Social variations in access to hospital care for patients with colorectal, breast, and lung cancer between 1999 and 2006: retrospective analysis of hospital episode statistics.

OBJECTIVES: To determine the extent to which type of hospital admission (emergency compared with elective) and surgical procedure varied by socioeconomic circumstances, age, sex, and year of admission for colorectal, breast, and lung cancer. DESIGN: Repeated cross sectional study with data from individual patients, 1 April 1999 to 31 March 2006. SETTING: Hospital episode statistics (HES) dataset. PARTICIPANTS: 564 821 patients aged 50 and over admitted with a diagnosis of colorectal, breast, or lung cancer. MAIN OUTCOME MEASURES: Proportion of patients admitted as emergencies, and the proportion receiving the recommended surgical treatment. RESULTS: Patients from deprived areas, older people, and women were more likely to be admitted as emergencies. For example, the adjusted odds ratio for patients with breast cancer in the least compared with most deprived fifth of deprivation was 0.63 (95% confidence interval 0.60 to 0.66) and the adjusted odds ratio for patients with lung cancer aged 80-89 compared with those aged 50-59 was 3.13 (2.93 to 3.34). There were some improvements in disparities between age groups but not for patients living in deprived areas over time. Patients from deprived areas were less likely to receive preferred procedures for rectal, breast, and lung cancer. These findings did not improve with time. For example, 67.4% (3529/5237) of patients in the most deprived fifth of deprivation had anterior resection for rectal cancer compared with 75.5% (4497/5959) of patients in the least deprived fifth (1.34, 1.22 to 1.47). Over half (54.0%, 11 256/20 849) of patients in the most deprived fifth of deprivation had breast conserving surgery compared with 63.7% (18 445/28 960) of patients in the least deprived fifth (1.21, 1.16 to 1.26). Men were less likely than women to undergo anterior resection and lung cancer resection and older people were less likely to receive breast conserving surgery and lung cancer resection. For example, the adjusted odds ratio for lung cancer patients aged 80-89 compared with those aged 50-59 was 0.52 (0.46 to 0.59). Conclusions Despite the implementation of the NHS Cancer Plan, social factors still strongly influence access to and the provision of care.