Use of co-production to explore food insecurity in adults with severe mental illness living in Northern England: a mixed-methods study.

BACKGROUND: People living with severe mental illness experience premature mortality from diet-related preventable illnesses. Yet, little research focuses on food insecurity with adults with severe mental illness. This coproduced study aimed to understand the experiences of adults with severe mental illness and food insecurity and strategies to help. METHODS: Following a pragmatism philosophical foundation, we undertook a mixed-methods study involving a survey (online and paper versions) and one-to-one semi-structured interviews (online and telephone) during March 7 to Dec 16, 2022. We recruited participants via existing severe mental illness service user groups and social media in Northern England. Eligible participants were adults (≥18 years) self-reporting a diagnosis of severe mental illness. Ethics approval was obtained from Teesside University and the Health Research Authority (Reference: 22/NR/0010; IRAS ID: 306281), with informed consent given. The target sample size, accounting for a typical survey response rate for people with severe mental illness of 10-20%, was 135. A target sample of 20 interviews was agreed to capture a range of views. Food insecurity was defined as the lack of financial resources needed to ensure someone has reliable access to enough food to meet their dietary, nutritional, and social needs. It is sometimes called food poverty. Quantitative data were analysed using descriptive statistics and binary logistic regression and qualitative data using thematic analysis. FINDINGS: 135 participants completed the survey (mean age 44·67 years [SD 14·1]). Participants were predominantly male (53%, n=72), white (87%, n=117), and from the Yorkshire region (50%, n=68). Overall, prevalence of food insecurity was 50·4% (n=68). Discussion across 13 interviews found food insecurity being a long-rooted experience, including familial and intergenerational experiences of food insecurity: "I grew up… with this insecurity around food" (P002). Recommendations for tackling food insecurity centred on food banks, increasing accessibility, and reducing stigma: "I would like to get more information on where the centres are..." (P006) and "I was referred to, erm, a foodbank … but it's still the stigma that's attached to it." (P002). INTERPRETATION: We found a higher prevalence of food insecurity in this study than in the general population (being 15%), yet limited research with adults with severe mental illness perpetuates food insecurity intergenerational injustices. Food insecurity should be eliminated. However, in the meanwhile, there should be widespread easy access to food banks offering nutritional foods. Limitations of this research include not reaching target sample size and a lack of ethnic diversity. FUNDING: National Institute of Health and Care Research (NIHR) Research for Patient Benefit.

Identifying the neural correlates of anticipatory postural control: A novel fMRI paradigm.

Altered postural control in the trunk/hip musculature is a characteristic of multiple neurological and musculoskeletal conditions. Previously it was not possible to determine if altered cortical and subcortical sensorimotor brain activation underlies impairments in postural control. This study used a novel fMRI-compatible paradigm to identify the brain activation associated with postural control in the trunk and hip musculature. BOLD fMRI imaging was conducted as participants performed two versions of a lower limb task involving lifting the left leg to touch the foot to a target. For the supported leg raise (SLR) the leg is raised from the knee while the thigh remains supported. For the unsupported leg raise (ULR) the leg is raised from the hip, requiring postural muscle activation in the abdominal/hip extensor musculature. Significant brain activation during the SLR task occurred predominantly in the right primary and secondary sensorimotor cortical regions. Brain activation during the ULR task occurred bilaterally in the primary and secondary sensorimotor cortical regions, as well as cerebellum and putamen. In comparison with the SLR, the ULR was associated with significantly greater activation in the right premotor/SMA, left primary motor and cingulate cortices, primary somatosensory cortex, supramarginal gyrus/parietal operculum, superior parietal lobule, cerebellar vermis, and cerebellar hemispheres. Cortical and subcortical regions activated during the ULR, but not during the SLR, were consistent with the planning, and execution of a task involving multisegmental, bilateral postural control. Future studies using this paradigm will determine mechanisms underlying impaired postural control in patients with neurological and musculoskeletal dysfunction.

Novel use of oral chloramphenicol for treatment-resistant Mycoplasma genitalium.

We describe the novel use of oral chloramphenicol for treatment-resistant Mycoplasma genitalium (M. genitalium) infection in a 20-year-old heterosexual cisgender male presenting with recurrent symptomatic non-gonococcal urethritis. M. genitalium urethritis is an increasingly common clinical conundrum in sexual health clinics and in cases of second-line treatment failure (such as moxifloxacin), UK and international guidelines struggle to make recommendations for third-line treatments. As shown in our case, the evidence base for third-line treatments is lacking, with poor success rates, and may be poorly tolerated. Here we demonstrate the novel use of a well-tolerated oral antimicrobial, chloramphenicol, resulting in rapid microbiological and clinical cure in treatment-resistant M. genitalium urethritis.

Weight management interventions for adults living with overweight or obesity and severe mental illness: a systematic review and meta-analysis.

When compared with the general population, people living with severe mental illness (SMI) are 1·8 times more likely to have obesity while in adult mental health secure units, rates of obesity are 20 % higher than the general population. In England, there are currently 490 000 people living with SMI. The aim of this systematic review was to collate and synthesise the available quantitative and qualitative evidence on a broad range of weight management interventions for adults living with SMI and overweight or obesity. Primary outcomes were reductions in BMI and body weight. Following sifting, eighteen papers were included in the final review, which detailed the results of nineteen different interventions; however, there was a lack of qualitative evidence. Pooled results for three studies (MD - 3·49, 95 % CI - 6·85, -0·13, P = 0·04) indicated a small effect in terms of body weight reduction but no effect on BMI for four studies (MD - 0·42, 95 % CI - 1·27, 0·44, P = 0·34). Key recommendations for future research included integration of qualitative methodology into experimental study design, a review of outcome measures and for study authors to follow standardised guidelines for reporting to facilitate complete and transparent reporting.

Modelling the deactivation of Escherichia coli in Nigerian soils amended with differently treated manures.

AIM: This study aimed to simulate deactivation of Escherichia coli in soils amended with cattle manure after burning, anaerobic digestion, composting, or without treatment. METHOD AND RESULTS: The Weibull survival function was used to describe deactivation of E. coli. Parameters for each treatment were determined using E. coli measurements from manure-amended soils and evaluated against measurements at different application rates. A statistically significant correlation and high coincidence between the simulated and measured values were obtained. The simulations revealed that although anaerobic digestion or burning of cattle manure effectively reduced the E. coli loads to background levels, burning retained very little nitrogen, so the ash residue was ineffective as an organic fertilizer. Anaerobic digestion was most effective at reducing E. coli levels while retaining a high proportion of N in the bioslurry residue, but the persistence of E. coli was higher than in compost. CONCLUSION: The results from this study suggest that the safest method for production of organic fertilizer would involve anaerobic digestion to reduce E. coli, followed by composting to reduce its persistence.

Investigating 'treat culture' in a secure care service: a study of inpatient NHS staff on their views and opinions on weight gain and treat giving for patients in a forensic secure care service.

BACKGROUND: Obesity is a significant health inequality within forensic secure care mental health/learning disability inpatient settings. Patients may be at increased risk of developing preventable long-term conditions/premature death. This study investigated staff views on patient weight gain, how it affects patients and how to better manage patient weight in this setting. Furthermore, the research explored the culture of food being used as a 'treat' and the perceived impact of 'treats' on weight. METHODS: A two-phase mixed methods approach was taken to explore staff views on patient weight gain and the 'treat' culture on adult forensic secure care inpatient wards in one NHS Mental Health Trust in the north-east of England. Phase one was an online survey, and phase two consisted of semi-structured qualitative interviews. The quantitative survey data were analysed using descriptive statistics. Thematic analysis was used for the open-ended survey questions and interview data. RESULTS: The survey had 49 responses out of a possible 380 (13%). Ninety-two per cent of staff participants viewed patient weight gain as an area for concern, citing a range of reasons for weight gain. Weight gain was considered a risk to developing long-term health conditions and poor mental health. Nine participants were interviewed. Six themes were identified suggesting why patients might gain weight in forensic secure care, for example, patient history, staff behaviours, the surrounding 'treat' culture in this environment, along with suggestions of what could be improved to manage patient weight. CONCLUSIONS: People detained in forensic secure care may be more at risk of weight gain due to their history, the secure care environment and the 'treat' culture adopted in these environments.

Classifying Unstable and Stable Walking Patterns Using Electroencephalography Signals and Machine Learning Algorithms.

Analyzing unstable gait patterns from Electroencephalography (EEG) signals is vital to develop real-time brain-computer interface (BCI) systems to prevent falls and associated injuries. This study investigates the feasibility of classification algorithms to detect walking instability utilizing EEG signals. A 64-channel Brain Vision EEG system was used to acquire EEG signals from 13 healthy adults. Participants performed walking trials for four different stable and unstable conditions: (i) normal walking, (ii) normal walking with medial-lateral perturbation (MLP), (iii) normal walking with dual-tasking (Stroop), (iv) normal walking with center of mass visual feedback. Digital biomarkers were extracted using wavelet energy and entropies from the EEG signals. Algorithms like the ChronoNet, SVM, Random Forest, gradient boosting and recurrent neural networks (LSTM) could classify with 67 to 82% accuracy. The classification results show that it is possible to accurately classify different gait patterns (from stable to unstable) using EEG-based digital biomarkers. This study develops various machine-learning-based classification models using EEG datasets with potential applications in detecting unsteady gait neural signals and intervening by preventing falls and injuries.

Investigating the challenges of biogas provision in water limited environments through laboratory scale biodigesters.

The potential for biogas provision through household-scale anaerobic digestion in rural sub-Saharan Africa is limited due to perceived water shortages. The most common substrate is animal dung diluted 1:1 with water. Two experimental methods tested the potential of reducing water demand. The first experiment compared the chemical oxygen demand (COD) and volatile solid removal of four cow dung dilutions ranging from 3.5-10.6% total solids. In the second experiment, bioslurry filtrate was recirculated back into the fresh substrate at different concentrations. The highest COD removal rate of 28.3% was obtained from mixing equal volumes of dung with filtrate (mean total solids 7.4%) while the highest methane production rate of 0.40 g/L/day, calculated from COD balance, was obtained from undiluted cow dung (total solids 10.6%). Results suggest the potential for a 75-100% reduction in water demand.

Impacts of different treatment methods for cattle manure on the spread of faecal indicator organisms from soil to lettuce in Nigeria.

AIM: This study investigated impacts of different organic waste treatment methods on reduction and spread of faecal indicator organisms to food crops in a developing country. METHODS AND RESULTS: Fresh cattle manure was subjected to three different treatments; anaerobic digestion, burning and composting. Escherichia coli, coliforms and nitrogen content of cattle manure were measured before and after treatment in the amended soil and harvested lettuce. All treatments significantly reduced E. coli and coliform counts but differed in the ratio of E. coli or coliforms to nitrogen. Application of the recommended nitrogen dose of 120 kg ha-1 as bioslurry resulted in significantly lower E. coli and coliform contamination of soil than the same nitrogen rate applied as compost or ash. The E. coli content of lettuces grown on soil amended with treated wastes at recommended rates did not differ between treatments but was significantly lower than in lettuces grown on soil amended with untreated manure. CONCLUSIONS: Treatment of manure before use as an organic fertilizer significantly reduces potential contamination of both soil and food crops with E. coli and coliforms. To best reduce the spread of E. coli from organic fertilizers, manures should be treated by anaerobic digestion. SIGNIFICANCE AND IMPACT OF THE STUDY: Information from this study quantifies potential risks associated with use of manures in growing food crops by determining the ratio between pathogen content and required nitrogen application rate.

Assessing soil carbon dioxide and methane fluxes from a Scots pine raised bog-edge-woodland.

Scots pine bog edge woodland is a type of habitat typical on raised bogs where trees cohabitate with bog vegetation to form a low-density stand. Even though nowadays this habitat does not cover large areas, in a future scenario it is possible that this environment will expand, either naturally (drier climate) or anthropogenically, as the result of the application of new restoration strategies that could increase net landscape carbon benefits from both peatland and woodland environments. This study is the first reported investigation in Scotland exploring carbon flux dynamics from sparse woodlands on raised bogs. We examined how Scots pine trees directly or indirectly affected soil temperature and moisture, ground vegetation, and consequently carbon dioxide (CO2) and methane (CH4) soil fluxes. Soil CO2 and CH4 were measured at different distance from the tree and thereafter assessed for both spatial and temporal variability. Our results showed that these low-density trees were able to modify the ground vegetation composition, had no effect on soil temperature, but did affect the soil moisture, with soils close to tree roots significantly drier (0.25 ± 0.01 m3 m-3) than those on open bog (0.39 ± 0.02 m3 m-3). Soil CO2 fluxes were significantly higher in the vicinity of trees (34.13 ± 3.97 µg CO2 m-2 s-1) compared to the open bog (24.34 ± 2.86 µg CO2 m-2 s-1). On the opposite, CH4 effluxes were significantly larger in the open bog (0.07 ± 0.01 µg CH4 m-2 s-1) than close to the tree (0.01 ± 0.00 µg CH4 m-2 s-1). This suggests that Scots pine trees on bog edge woodland may affect soil C fluxes in their proximity primarily due to the contribution of root respiration, but also as a result of their effects on soil moisture, enhancing soil CO2 emissions, while reducing the CH4 fluxes. There is, however, still uncertainty about the complete greenhouse gas assessment, and further research would be needed in order to include the quantification of soil nitrous oxide (N2O) dynamics together with the analysis of complete gas exchanges at the tree-atmosphere level.

Evaluating a trait-based approach to compare natural enemy and pest communities in agroforestry vs. arable systems.

Diversified farming systems, for example those that incorporate agroforestry elements, have been proposed as a solution that could maintain and improve multiple ecosystem services. However, habitat diversification in and around arable fields has complex and inconsistent effects on invertebrate crop pests and their natural enemies. This hinders the development of policy recommendations to promote the adoption of such management strategies for the provision of natural pest control services. Here, for the first time, we conducted a trait-based approach to investigate the effect of farming system on plant, invertebrate herbivore, and invertebrate natural enemy communities. We then evaluated this approach by comparing the results to those generated using a traditional taxonomic approach. At each of three working farms, we sampled within an agroforestry field (a diverse farming system comprising alleys of arable crops separated by tree rows), and within a paired non-diversified area of the farm (arable control field). Each of 96 sample points was sampled between 8 and 10 times, yielding 393,318 invertebrate specimens from 344 taxonomic groups. Diet specialization or granivory, lack of a pupal stage, and wing traits in invertebrates, along with late flowering, short flowering duration, creeping habit, and perenniality in plants, were traits more strongly associated with agroforestry crop alleys than the arable control fields. We hypothesize that this is a result of reduced habitat disturbance and increased habitat complexity in the agroforestry system. Taxonomic richness and diversity were higher in the agroforestry crop alleys compared to the arable control fields, but these effects were stronger at lower trophic levels. However, functional trait diversity of natural enemies was significantly higher in the agroforestry crop alleys than the arable control fields, suggesting an improved level of biocontrol, which was not detected by traditional diversity metrics. Of eight key pest taxa, three were significantly suppressed in the agroforestry system, while two were more abundant, compared to the arable control fields. Trait-based approaches can provide a better mechanistic understanding of farming system effects on pests and their natural enemies, therefore we recommend their application and testing in future studies of diversified farming systems.

Agricultural methane emissions and the potential formitigation.

Agriculture is the largest anthropogenic source of methane (CH4), emitting 145 Tg CH4 y-1 to the atmosphere in 2017. The main sources are enteric fermentation, manure management, rice cultivation and residue burning. There is significant potential to reduce CH4 from these sources, with bottom-up mitigation potentials of approximately 10.6, 10, 2 and 1 Tg CH4 y-1 from rice management, enteric fermentation, manure management and residue burning. Other system-wide studies have assumed even higher potentials of 4.8-47.2 Tg CH4 y-1 from reduced enteric fermentation, and 4-36 Tg CH4 y-1 from improved rice management. Biogas (a methane-rich gas mixture generated from the anaerobic decomposition of organic matter and used for energy) also has the potential to reduce unabated CH4 emissions from animal manures and human waste. In addition to these supply side measures, interventions on the demand-side (shift to a plant-based diet and a reduction in total food loss and waste by 2050) would also significantly reduce methane emissions, perhaps in the order of greater than 50 Tg CH4 y-1. While there is a pressing need to reduce emissions of long-lived greenhouse gases (CO2 and N2O) due to their persistence in the atmosphere, despite CH4 being a short-lived greenhouse gas, the urgency of reducing warming means we must reduce any GHG emissions we can as soon as possible. Because of this, mitigation actions should focus on reducing emissions of all the three main anthropogenic greenhouse gases, including CH4. This article is part of a discussion meeting issue 'Rising methane: is warming feeding warming? (part1)'.

Reliability of a Barre-Mounted Dynamometer-Stabilizing Device in Measuring Dance-Specific Muscle Performance.

BACKGROUND: Hand-held dynamometry is considered an efficient, effective, and portable means of objectively measuring lower extremity strength; however, it has yet to be studied specific to dance-relevant muscle performance. Also, dynamometry is often criticized for variability in results based on tester strength and sex. Use of an external stabilizing device has been suggested to minimize differences in outcomes between male and female testers by reducing variability associated with tester strength limitations. Therefore, this study used a barre-mounted, portable dynamometer stabilizing device to improve consistency of results among different testers for assessing hip and lower extremity muscle performance in dance-relevant positions. OBJECTIVE: To assess the intra and inter-rater reliability of a barre-mounted dynamometer stabilizing device in measuring muscle performance in common dance maneuvers. METHODS: Two testers assessed muscle performance of three common dance maneuvers--développé en avant, à la secondé, and arabesque--on 11 pre-professional and professional dancers on two separate occasions to establish intra- and inter-rater reliability of the barre-mounted dynamometer stabilizing device. RESULTS: Intra-rater reliability was moderate to high and inter-rater reliability of the device was excellent, with intraclass correlation coefficients ranging from 0.527-0.851 and 0.834-0.953, respectively, for all positions. CONCLUSIONS: The barre-mounted stabilizing device shows promise in mitigating tester strength or fatigue in assessing muscle performance of dancers. Initial assessment of the device suggests further study may be indicated to improve generalizability to applications of larger-scale muscle performance screening and assessment in dancers or other athletic populations who engage in movements that require extensive hip range of motion and multi-joint stability. CLINICAL RELEVANCE: Using a portable, barre-mounted stabilizing device in assessing multi-joint lower extremity muscle performance in dancers improves consistency of testing results. Application of this testing device into wider scale screenings could assist in developing normative data for a population that is lacking.

IMPlementation of An online Relatives' Toolkit for psychosis or bipolar (IMPART study): iterative multiple case study to identify key factors impacting on staff uptake and use.

BACKGROUND: Despite the potential of digital health interventions to improve the delivery of psychoeducation to people with mental health problems and their relatives, and substantial investment in their development, there is little evidence of successful implementation into clinical practice. We report the first implementation study of a digital health intervention: Relatives Education And Coping Toolkit (REACT), into routine mental healthcare. Our main aim was to identify critical factors affecting staff uptake and use of this online self-management tool for relatives of people with psychosis or bipolar. METHODS: A mixed-methods, theory-driven (Normalisation Process Theory), iterative multiple case study approach using qualitative analysis of interviews with staff and quantitative reporting of uptake. Carer researchers were part of the research team. RESULTS: In all, 281 staff and 159 relatives from Early Intervention teams across six catchment areas (cases) in England registered on REACT; 129 staff took part in qualitative interviews. Staff were positive about REACT helping services improve support and meet clinical targets. Implementation was hindered by: high staff caseloads and difficulties prioritising carers; perception of REACT implementation as research; technical difficulties using REACT; poor interoperability with trust computer systems and care pathways; lack of access to mobile technology and training; restricted forum populations; staff fears of risk, online trolling, and replacement by technology; and uncertainty around REACT's long-term availability. CONCLUSIONS: Digital health interventions, such as REACT, should be iteratively developed, evaluated, adapted and implemented, in partnership with the services they aim to support, and as part of a long term national strategy to co-develop integrated technology-enabled mental healthcare. Implementation strategies must instil a sense of ownership for staff and ensure they have adequate IT training, appropriate governance protocols for online working, and adequate mobile technologies. Wider contextual factors including adequate funding for mental health services and prioritisation of carer support, also need to be addressed for successful implementation of carer focussed digital interventions. TRIAL REGISTRATION: Study registration: ISCTRN 16267685.

Bridging barriers to advance multisector approaches to improve food security, nutrition and population health in Nepal: transdisciplinary perspectives.

BACKGROUND: Understanding stakeholders' perceptions is crucial to the development and implementation of any intervention. However, a structured approach to eliciting stakeholder insights into complex, multisector issues of food security, household environment and health is lacking in many low and middle-income countries. This qualitative, workshop-based participatory study explores stakeholders' experiences of developing and implementing multisector interventions to provide transdisciplinary lessons for future developments in low and middle-income countries. METHODS: Participants were purposely selected based on their involvement in, or exposure to, the multisector intervention. Participants with interests in agriculture, nutrition, household air-quality, drinking water-quality and health from academic institutes, government and developmental organisations were brought together at a one-day workshop to participate in a series of discussions on issues relating to food security, nutrition, household environment and health in Nepal. All group discussions were audio-recorded and transcribed, and a thematic qualitative analysis performed to identify relevant themes. RESULTS: The government's ongoing Multisector Nutrition Plan, stakeholders' willingness to work together, availability of local infrastructure for cross-institutional inputs and increasing global movement towards transdisciplinary approaches were identified by the 33 workshop participants, representing 23 organisations as key factors determining success of transdisciplinary work. Fragmentation, lack of research-based and practice-based evidence, limited transdisciplinary knowledge amongst sectoral stakeholders, short-term funding and lack of knowledge-sharing mechanisms were identified as barriers, often creating systematic problems for successful implementation. Stakeholders suggested methods to bring about success included: improved knowledge, both amongst policy-makers and implementers, of food security and its linkage with nutrition, household environments, health and hygiene; investment in collaborative practice-based research and evidence-based practice; and strengthened transdisciplinary collaboration between multi-stakeholders, such as researchers, implementers and beneficiaries, throughout the intervention development and implementation process. CONCLUSIONS: This study suggests that multisector approach needs to adapt to take into account the experiences and views of the stakeholders concerned. The paper offers recommendations for successful development and implementation of future multisector interventions in Nepal that can be extrapolated to other low and middle-income countries, and lays foundations for future transdisciplinary working to support realisation of the recommendations.

Anticipatory postural adjustments and spatial organization of motor cortex: evidence of adaptive compensations in healthy older adults.

During anticipated postural perturbations induced by limb movement, the central nervous system generates anticipatory postural adjustments (APAs) in the trunk and hip musculature to minimize disturbances to equilibrium. Age-related changes in functional organization of the nervous system may contribute to changes in APAs in healthy older adults. Here we examined if altered APAs of trunk/hip musculature in older adults are accompanied by changes in the representation of these muscles in motor cortex. Twelve healthy older adults, 5 with a history of falls and 7 nonfallers, were compared with 13 young adults. APAs were assessed during a mediolateral arm raise task in standing. Temporal organization of postural adjustments was quantified as latency of APAs in the contralateral external oblique, lumbar paraspinals, and gluteus medius relative to activation of the deltoid. Spatial organization was quantified as extent of synergistic coactivation between muscles. Volume and location of the muscle representations in motor cortex were mapped using transcranial magnetic stimulation. We found that older adults demonstrated significantly delayed APAs in the gluteus medius muscle. Spatial organization of the three muscles in motor cortex differed between groups, with the older adults demonstrating more lateral external oblique representation than the other two muscles. Separate comparisons of the faller and nonfaller subgroups with young adults indicated that nonfallers had the greatest delay in gluteus medius APAs and a reduced distance between the representational areas of the lumbar paraspinals and gluteus medius. This study indicates that altered spatial organization of motor cortex accompanies altered temporal organization of APA synergies in older adults. NEW & NOTEWORTHY Anticipatory postural adjustments are a critical component of postural control. Here we demonstrate that, in healthy older adults with and without a history of falls, delayed anticipatory postural adjustments in the hip musculature during mediolateral perturbations are accompanied by altered organization of trunk/hip muscle representation in motor cortex. The largest adaptations are evident in older adults with no history of falls.

'I didn't think you were allowed that, they didn't mention that.' A qualitative study exploring women's perceptions of home birth.

BACKGROUND: Evidence suggests that home birth is as safe as hospital birth for low risk multiparous women, and is associated with reduced intervention rates and increased rates of normal birth. However the home birth rate in the UK is low, and few women choose this option. The aims of this study were to identify what influences multiparous women's choice of birth place, and to explore their views of home birth. METHODS: Five focus groups were conducted with multiparous women (n = 28) attending mother and baby groups in a city in the UK with a diverse multi-ethnic population. Data were analysed thematically using the Framework Method, combining deductive and inductive approaches to the data. RESULTS: Several themes were developed from the data, these were: the expectation that birth would take place in an Obstetric Unit; perceptions of birth as a 'natural' event; lack of knowledge of what home birth looked like; and a lack of confidence in the reliability of the maternity service. Two themes emerged regarding the influences on women's choices: clear information provision, particularly for those from ethnic minority groups, and the role of health care professionals. A final theme concerned women's responses to the offer of choice. CONCLUSIONS: There are gaps in women's knowledge about the reality and practicalities of giving birth at home that have not been previously identified. Other findings are consistent with existing evidence, suggesting that many women still do not receive consistent, comprehensive information about home birth. The findings from this research can be used to develop approaches to meet women's information and support needs, and facilitate genuine choice of place of birth.

The motor cortical representation of a muscle is not homogeneous in brain connectivity.

Functional connectivity patterns of the motor cortical representational area of single muscles have not been extensively mapped in humans, particularly for the axial musculature. Functional connectivity may provide a neural substrate for adaptation of muscle activity in axial muscles that have both voluntary and postural functions. The purpose of this study was to combine brain stimulation and neuroimaging to both map the cortical representation of the external oblique (EO) in primary motor cortex (M1) and supplementary motor area (SMA), and to establish the resting-state functional connectivity associated with this representation. Motor-evoked potentials were elicited from the EO muscle in stimulation locations encompassing M1 and SMA. The coordinates of locations with the largest motor-evoked potentials were confirmed with task-based fMRI imaging during EO activation. The M1 and SMA components of the EO representation demonstrated significantly different resting-state functional connectivity with other brain regions: the SMA representation of the EO muscle was significantly more connected to the putamen and cerebellum, and the M1 representation of the EO muscle was significantly more connected to somatosensory cortex and the superior parietal lobule. This study confirms the representation of a human axial muscle in M1 and SMA, and demonstrates for the first time that different parts of the cortical representation of a human axial muscle have resting-state functional connectivity with distinct brain regions. Future studies can use the brain regions of interest we have identified here to test the association between resting-state functional connectivity and control of the axial muscles.

Type and extent of trans-disciplinary co-operation to improve food security, health and household environment in low and middle income countries: systematic review.

BACKGROUND: Although linkages have been found between agricultural interventions and nutritional health, and the development of clean fuels and improved solid fuel stoves in reducing household air pollution and adverse health effects, the extent of the potential of combined household interventions to improve health, nutrition and the environment has not been investigated. A systematic review was conducted to identify the extent and type of community-based agricultural and household interventions aimed at improving food security, health and the household environment in low and middle income countries. METHODS: A systematic search of Ovid MEDLINE, PUBMED, EMBASE and SCOPUS databases was performed. Key search words were generated reflecting the "participants, interventions, comparators, outcomes and study design" approach and a comprehensive search strategy was developed following "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" recommendations. Any community-based agricultural and/or household interventions were eligible for inclusion if the focus was to improve at least one of the outcome measures of interest. All relevant study designs employing any of these interventions (alone/in combination) were included if conducted in Low and middle income countries. Review articles, and clinical and occupational studies were excluded. RESULTS: A total of 123 studies were included and grouped into four intervention domains; agricultural (n = 27), air quality (n = 34), water quality (n = 32), and nutritional (n = 30). Most studies were conducted in Asia (39.2 %) or Africa (34.6 %) with the remaining 26.1 % in Latin America. Very few studies (n = 11) combined interventions across more than one domain. The majority of agricultural and nutritional studies were conducted in Africa and Asia, whereas the majority of interventions to improve household air quality were conducted in Latin America. CONCLUSIONS: It is clear that very little trans-disciplinary research has been done with the majority of studies still being discipline specific. It also appears that certain low and middle income countries seem to focus on domain-specific interventions. The review emphasizes the need to develop holistic, cross-domain intervention packages. Further investigation of the data is being conducted to determine the effectiveness of these interventions and whether interdisciplinary interventions provide greater benefit than those that address single health or community problems.

Layers of listening: qualitative analysis of the impact of early intervention services for first-episode psychosis on carers' experiences.

BACKGROUND: Early intervention services (EIS) comprise low-stigma, youth-friendly mental health teams for young people undergoing first-episode psychosis (FEP). Engaging with the family of the young person is central to EIS policy and practice.AimsBy analysing carers' accounts of their daily lives and affective challenges during a relative's FEP against the background of wider research into EIS, this paper explores relationships between carers' experiences and EIS. METHOD: Semi-structured longitudinal interviews with 80 carers of young people with FEP treated through English EIS. RESULTS: Our data suggest that EIS successfully aid carers to support their relatives, particularly through the provision of knowledge about psychosis and medications. However, paradoxical ramifications of these user-focused engagements also emerge; they risk leaving carers' emotions unacknowledged and compounding an existing lack of help-seeking. CONCLUSIONS: By focusing on EIS's engagements with carers, this paper draws attention to an urgent broader question: as a continuing emphasis on care outside the clinic space places family members at the heart of the care of those with severe mental illness, we ask: who can, and should, support carers, and in what ways?