Implementation of child mental health service improvement plans in four low- and middle-income countries: stakeholders' perspectives.

Children in low- and middle-income countries (LMIC) have high levels of unmet mental health needs, especially in disadvantaged communities. To address this gap, we developed a child mental health service improvement programme. This was co-facilitated using interprofessional principles and values in four countries, South Africa, Kenya, Turkey and Brazil. Eighteen stakeholders from different professions were interviewed after six months on their perspectives on enabling factors and challenges they faced in implementing service plans. Participants valued the holistic case management approach and scaled service model that underpinned the service plans. Emerging themes on participants' priorities related to service user participation, integrated care, and different levels of capacity-building. We propose that an integrated care model in LMIC contexts can maximize available resources, engage families and mobilize communities. Implementation requires concurrent actions at micro-, meso- and macro-level.

Developing Healthcare Team Observations for Patient Safety (HTOPS): senior medical students capture everyday clinical moments.

BACKGROUND: Aviation has used a real-time observation method to advance anonymised feedback to the front-line and improve safe practice. Using an experiential learning method, this pilot study aimed to develop an observation-based real-time learning tool for final-year medical students with potential wider use in clinical practice. METHODS: Using participatory action research, we collected data on medical students' observations of real-time clinical practice. The observation data was analysed thematically and shared with a steering group of experts to agree a framework for recording observations. A sample of students (observers) and front-line clinical staff (observed) completed one-to-one interviews on their experiences. The interviews were analysed using thematic analysis. RESULTS: Thirty-seven medical students identified 917 issues in wards, theatres and clinics in an acute hospital trust. These issues were grouped into the themes of human influences, work environment and systems. Aviation approaches were adapted to develop an app capable of recording real-time positive and negative clinical incidents. Five students and eleven clinical staff were interviewed and shared their views on the value of a process that helped them learn and has the potential to advance the quality of practice. Concerns were shared about how the observational process is managed. CONCLUSION: The study developed an app (Healthcare Team Observations for Patient Safety-HTOPS), for recording good and poor clinical individual and team behaviour in acute-care practice. The process advanced medical student learning about patient safety. The tool can identify the totality of patient safety practice and illuminate strength and weakness. HTOPS offers the opportunity for collective ownership of safety concerns without blame and has been positively received by all stakeholders. The next steps will further refine the app for use in all clinical areas for capturing light noise.

An essential model for leaders to enable integrated working to flourish: a qualitative study examining leaders of Children's Centers.

Today's era of integrated working seeks to bring together different professionals to work in patient-centered teams. As a result leadership perspectives have changed. We now seek leaders who recognize the complexity of moderating across different health, social care and other public and private sector organizations for collective patient/community focussed service. This research focuses on the role of leaders in the UK who were asked to lead a range of practitioners working from Children's Centers. These centers brought together a myriad of practitioners from health, social care, and education to meet the needs of children from wide and diverse backgrounds. We share a qualitative study, exploring the experiences of Children's Center leaders, using critical theory and constructivism. The study explored how leaders enable integrated working to flourish. The research was conducted in two stages: In Stage One, five strategic Children's Center managers were interviewed to illuminate the key ingredients felt to support good leaders. Stage Two brought together 10 Children's Center leaders from across different areas of the UK, to share their experiences using Participatory Action Research. The final synthesis identified four main processes which could help leaders to enable integrated working to flourish. These were: i) Thinking Systematically; ii) Building and re-building relationships; ii) Nourishing self-actualization and; iv) Utilizing alternative approaches to problem solving. Four borderline processes were identified: Interaction, Integrity, Flow and Sensitivity. The final model articulates the skills required to lead integrated services which bring together a wide range of practitioners. The outcomes help leaders to explore new ways of leading and require further testing. The outcomes may apply to other clinical areas of integrated working.

How can nanotechnology help to combat COVID-19? Opportunities and urgent need.

Incidents of viral outbreaks have increased at an alarming rate over the past decades. The most recent human coronavirus known as COVID-19 (SARS-CoV-2) has already spread around the world and shown R0 values from 2.2 to 2.68. However, the ratio between mortality and number of infections seems to be lower in this case in comparison to other human coronaviruses (such as severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV)). These outbreaks have tested the limits of healthcare systems and have posed serious questions about management using conventional therapies and diagnostic tools. In this regard, the use of nanotechnology offers new opportunities for the development of novel strategies in terms of prevention, diagnosis and treatment of COVID-19 and other viral infections. In this review, we discuss the use of nanotechnology for COVID-19 virus management by the development of nano-based materials, such as disinfectants, personal protective equipment, diagnostic systems and nanocarrier systems, for treatments and vaccine development, as well as the challenges and drawbacks that need addressing.

Localization of Coated Iron Oxide (Fe3O4) Nanoparticles on Tomato Seeds and Their Effects on Growth.

Food demand due to the growing global population has been stretching the agriculture sector to the limit. This demands the cultivation of plants in shrinking land areas which makes the search for highly effective systems for plant nutrition and pest control important. In this context, the application of nanoparticles (NPs) in agriculture can have a transformative effect on food production techniques as it can enable the delivery of bioactive agents (including growth factors, pesticides, and fungicides) directly to plants. Herein, we report the application of unfunctionalized as well as amine-functionalized and polycaprolactone-coated Fe3O4 NPs to seed treatment in tomato (Solanum lycopersicum). The study reveals that the treatment has no side effects on plant germination and development. Furthermore, the translocation of NPs in seeds and seedlings posttreatment depends on the surface functionalization of the NPs. X-ray fluorescence spectroscopy analysis of seedlings suggested that around 66% of unfunctionalized Fe3O4 NPs were translocated in the cotyledons, while only 50% of functionalized NPs (both amine and polycaprolactone) were translocated. Our results demonstrate that all particles were taken up by the seeds, thus suggesting that the functionalized NPs can act as a versatile platform for delivering of active compounds, such as fungicides and growth factor agents.

Carvacrol and linalool co-loaded in ß-cyclodextrin-grafted chitosan nanoparticles as sustainable biopesticide aiming pest control.

Pesticides are the main tactics for pest control because they reduce the pest population very fast and their efficiency does not depend on abiotic factors. However, the indiscriminate use of these substances can speed up the development of resistant populations and causing environmental contamination. Therefore, alternative methods of pest control are sought, such as the use of botanical compounds. Nanoencapsulation of volatile compounds has been shown to be an important tool that can be used to overcome the lack of stability of these compounds. In this work, we describe the preparation and characterization of chitosan nanoparticles functionalized with ß-cyclodextrin containing carvacrol and linalool. The toxicity and biological activity were evaluated. Decreases of toxicity were observed when the compounds were nanoencapsulated. The nanoparticles presented insecticidal activity against the species Helicoverpa armigera (corn earworm) and Tetranychus urticae (spider mite). In addition, repellent activity and reduction in oviposition were observed for the mites.

Geraniol Encapsulated in Chitosan/Gum Arabic Nanoparticles: A Promising System for Pest Management in Sustainable Agriculture.

The nanoencapsulation of botanical compounds (such as geraniol) is an important strategy that can be used to increase the stability and efficiency of these substances in integrated pest management. In this study, chitosan/gum arabic nanoparticles containing geraniol were prepared and characterized. In addition, evaluation was made of the biological activity of geraniol encapsulated in chitosan/gum arabic nanoparticles toward whitefly ( Bemisia tabaci). The optimized formulation showed a high encapsulation efficiency (>90%) and remained stable for about 120 days. The formulation protected the geraniol against degradation by UV radiation, and the in vitro release was according to a diffusion mechanism that was influenced by temperature. An attraction effect was observed for Bemisia tabaci, indicating the potential of this type of system for use in pest management, especially in trap devices.

Zein Nanoparticles as Eco-Friendly Carrier Systems for Botanical Repellents Aiming Sustainable Agriculture.

Botanical repellents represent one of the main ways of reducing the use of synthetic pesticides and the contamination of soil and hydric resources. However, the poor stability and rapid degradation of these compounds in the environment hinder their effective application in the field. Zein nanoparticles can be used as eco-friendly carrier systems to protect these substances against premature degradation, provide desirable release characteristics, and reduce toxicity in the environment and to humans. In this study, we describe the preparation and characterization of zein nanoparticles loaded with the main constituents of the essential oil of citronella (geraniol and R-citronellal). The phytotoxicity, cytotoxicity, and insect activity of the nanoparticles toward target and nontarget organisms were also evaluated. The botanical formulations showed high encapsulation efficiency (>90%) in the nanoparticles, good physicochemical stability, and effective protection of the repellents against UV degradation. Cytotoxicity and phytotoxicity assays showed that encapsulation of the botanical repellents decreased their toxicity. Repellent activity tests showed that nanoparticles containing the botanical repellents were highly repellent against the Tetranychus urticae Koch mite. This nanotechnological formulation offers a new option for the effective use of botanical repellents in agriculture, reducing toxicity, protecting against premature degradation, and providing effective pest control.

Precision determination of absolute neutron flux.

A technique for establishing the total neutron rate of a highly-collimated monochromatic cold neutron beam was demonstrated using an alpha-gamma counter. The method involves only the counting of measured rates and is independent of neutron cross sections, decay chain branching ratios, and neutron beam energy. For the measurement, a target of 10B-enriched boron carbide totally absorbed the neutrons in a monochromatic beam, and the rate of absorbed neutrons was determined by counting 478 keV gamma rays from neutron capture on 10B with calibrated high-purity germanium detectors. A second measurement based on Bragg diffraction from a perfect silicon crystal was performed to determine the mean de Broglie wavelength of the beam to a precision of 0.024%. With these measurements, the detection efficiency of a neutron monitor based on neutron absorption on 6Li was determined to an overall uncertainty of 0.058%. We discuss the principle of the alpha-gamma method and present details of how the measurement was performed including the systematic effects. We also describe how this method may be used for applications in neutron dosimetry and metrology, fundamental neutron physics, and neutron cross section measurements.

Evaluation of the effects of polymeric chitosan/tripolyphosphate and solid lipid nanoparticles on germination of Zea mays, Brassica rapa and Pisum sativum.

Although the potential toxicity of many metallic and carbon nanoparticles to plants has been reported, few studies have evaluated the phytotoxic effects of polymeric and solid lipid nanoparticles. The present work described the preparation and characterization of chitosan/tripolyphosphate (CS/TPP) nanoparticles and solid lipid nanoparticles (SLN) and evaluated the effects of different concentrations of these nanoparticles on germination of Zea mays, Brassica rapa, and Pisum sativum. CS/TPP nanoparticles presented an average size of 233.6±12.1nm, polydispersity index (PDI) of 0.30±0.02, and zeta potential of +21.4±1.7mV. SLN showed an average size of 323.25±41.4nm, PDI of 0.23±0.103, and zeta potential of -13.25±3.2mV. Nanotracking analysis enabled determination of concentrations of 1.33×1010 (CS/TPP) and 3.64×1012 (SLN) nanoparticles per mL. At high concentrations, CS/TPP nanoparticles caused complete inhibition of germination, and thus negatively affected the initial growth of all tested species. Differently, SLN presented no phytotoxic effects. The different size and composition and the opposite charges of SLN and CS/TPP nanoparticles could be associated with the differential phytotoxicity of these nanomaterials. The present study reports the phytotoxic potential of polymeric CS/TPP nanoparticles towards plants, indicating that further investigation is needed on the effects of such formulations intended for future use in agricultural systems, in order to avoid damage to the environment.

Chitosan/tripolyphosphate nanoparticles loaded with paraquat herbicide: an environmentally safer alternative for weed control.

Paraquat is a fast acting nonselective contact herbicide that is extensively used worldwide. However, the aqueous solubility and soil sorption of this compound can cause problems of toxicity in nontarget organisms. This work investigates the preparation and characterization of nanoparticles composed of chitosan and sodium tripolyphosphate (TPP) to produce an efficient herbicidal formulation that was less toxic and could be used for safer control of weeds in agriculture. The toxicities of the formulations were evaluated using cell culture viability assays and the Allium cepa chromosome aberration test. The herbicidal activity was investigated in cultivations of maize (Zea mays) and mustard (Brassica sp.), and soil sorption of the nanoencapsulated herbicide was measured. The efficiency association of paraquat with the nanoparticles was 62.6 ± 0.7%. Encapsulation of the herbicide resulted in changes in its diffusion and release as well as its sorption by soil. Cytotoxicity and genotoxicity assays showed that the nanoencapsulated herbicide was less toxic than the pure compound, indicating its potential to control weeds while at the same time reducing environmental impacts. Measurements of herbicidal activity showed that the effectiveness of paraquat was preserved after encapsulation. It was concluded that the encapsulation of paraquat in nanoparticles can provide a useful means of reducing adverse impacts on human health and the environment, and that the formulation therefore has potential for use in agriculture.

Application of poly(epsilon-caprolactone) nanoparticles containing atrazine herbicide as an alternative technique to control weeds and reduce damage to the environment.

Nanoparticles of poly(epsilon-caprolactone) containing the herbicide atrazine were prepared, characterized, and evaluated in terms of their herbicidal activity and genotoxicity. The stability of the nanoparticles was evaluated over a period of three months, considering the variables: size, polydispersion index, pH, and encapsulation efficiency. Tests on plants were performed with target (Brassica sp.) and non-target (Zea mays) organisms, and the nanoparticle formulations were shown to be effective for the control of the target species. Experiments using soil columns revealed that the use of nanoparticles reduced the mobility of atrazine in the soil. Application of the Allium cepa chromosome aberration assay demonstrated that the nanoparticle systems were able to reduce the genotoxicity of the herbicide. The formulations developed offer a useful means of controlling agricultural weeds, while at the same time reducing the risk of harm to the environment and human health.

Delivering quality improvements in patient care: the application of the Leicester Model of interprofessional education.

BACKGROUND: This paper places the importance of evidence-based models of interprofessional education (IPE) within the context of a changing National Health Service (NHS). The coalition government has placed integrated care at the heart of its vision for England's health system. Its principles are to put patients at the centre of the NHS, empower clinicians to lead commissioning and change the emphasis of measurement to quality clinical outcomes. As a result, NHS services are being increasingly tendered along evidence-based care pathways and commissioners are introducing payment by results tariffs, requiring providers to achieve quality outcomes as a requirement of full payment. AIM: We argue that in preparing the health and social care workforce for outcome-based practice, the development of technical skills should be complemented with skills for effective teamworking and collaborative practice. METHODS: This paper shares the achievements of the Leicester Model of IPE which is underpinned by theoretical models of learning and implemented entirely in clinical practice; mixed research methods demonstrate that its learning potential is as relevant today as when it was first implemented in 1996. RESULTS: Our extensive research evidence demonstrates that students and healthcare professionals undertaking these programmes are enabled to perceive care pathways from service and providers perspectives; they gain valuable insights into how teams balance task- and patient-related issues, offer clarity about the team's effectiveness and gain new insights into collaborative opportunities to address patients' needs. CONCLUSION: We demonstrate that models such as ours offer evidence-based solutions which will support the achievement of quality outcomes for service providers, many of whom are reviewing their business plans to address the financial implications of payment by results. The current NHS reforms provide a hugely important lever in which IPE can come of age - in return we need to ensure that our NHS colleagues are informed of its potential.

An exploration of secondary sex ratios among women diagnosed with anxiety disorders.

BACKGROUND: Theory suggests that natural selection conserved reactivity in part because highly reactive women spontaneously abort less fit conceptuses, particularly small males. Other literature argues that high reactivity manifests clinically as anxiety disorders. If true, births to women diagnosed with anxiety disorders should exhibit a low secondary sex ratio (i.e. ratio of male to female births). We explored whether births to women diagnosed with anxiety disorders exhibit a lower sex ratio than births to women diagnosed with other psychiatric disorders, or to women without mental health diagnoses. METHODS: We performed a case-control comparison of the secondary sex ratios among groups of women categorized by mental health diagnosis using birth records linked to data from California County Mental Health system records. We compared sex ratios among 5994 deliveries to mothers diagnosed with anxiety disorders, 23 443 deliveries to mothers diagnosed with other psychiatric disorders and 1 099 198 'comparison' births. RESULTS: Although comparison births exhibited a higher sex ratio than births to women diagnosed with anxiety disorders or with other diagnoses, differences were not statistically significant. Births to African American women diagnosed with anxiety disorders, however, exhibited sex ratios significantly lower than comparison births among African Americans (OR = 0.89, P = 0.038) or births to African American women with other mental health diagnoses (OR = 0.88, P = 0.042). CONCLUSIONS: We found that infants born to African American women diagnosed with anxiety disorders exhibited a significantly lower secondary sex ratio than reference groups. We urge confirmatory tests of our findings and discuss implications of the reactivity/anxiety hypothesis for psychiatry, obstetrics and public health.

Learning from lives together: medical and social work students' experiences of learning from people with disabilities in the community.

The study aims to evaluate an interprofessional community-based learning event, focussing on disability. The learning opportunity was based on the Leicester Model of Interprofessional Education, organised around the experiences and perceptions of service users and their carers. Programme participants were drawn from medicine and social work education in Leicester, UK, bringing together diverse traditions in the care of people with disabilities. Small student groups (3-4 students) worked from one of the eight community rehabilitation hospitals through a programme of contact with people with disabilities in hospital, at home or in other community settings. The evaluation, in March 2005, used a mixed methods approach, incorporating questionnaire surveys, focus group interviews with students and feedback from service users. Responses were collated and analysed using quantitative and qualitative measures. Fifty social work and 100 medical students completed the first combined delivery of the module. The findings indicated that the merging of social work and medical perspectives appear to create some tensions, although overall the student experience was found to be beneficial. Service users (16 responses) valued the process. They were not concerned at the prospect of meeting a number of students at home or elsewhere and were pleased to think of themselves as educators. Problems and obstacles still anticipated include changing the mindset of clinicians and practising social workers to enable them to support students from each other's disciplines in practice learning. The generally positive outcomes highlight that disability focussed joint learning offers a meaningful platform for interprofessional education in a practice environment.

Preparation of educators involved in interprofessional education.

To achieve effective interprofessional learning there must be effective teaching. In this study we analyse the impact of a Masters level two day course designed to prepare teachers for their role(s) in the design development and facilitation of interprofessional student groups. Since its inception the course has run periodically each year attracting over 70 health and social care teachers from academic and practice settings. The evaluation has confirmed the original hypothesis of the course design, that in order to properly facilitate interprofessional education, teachers need tailored professional developmental opportunities. They need to consider both the underpinnings and implications of interprofessionality and the ways in which appropriate pedagogical practice can illuminate and embed truly interprofessional learning.

Early interprofessional interactions: does student age matter?

In this mixed-method evaluation we report on student responses to an introductory interprofessional learning event, accessed by ten professions within six months of commencing their chosen professional curricula. Of 898 students, 754 (84%) completed pre and post course questionnaires, and 81 took part in uni-professional focus groups. Student responses were compared with those of 14 facilitators. Younger students entering straight from school achieved more learning outcomes and were more positive about the learning than older students (e.g., undergraduate medics, range p = 0.001-0.011; graduate medics, range p = 0.001-0.819). Mature entrants valued interprofessional education, but preferred to interact with students of a similar age demanding a more challenging and relevant set of learning resources, sensitive to their prior life experience. Positive and negative stereotyping was differently constructed between younger and older students. The views of facilitators endorsed the lack of engagement of mature learners compared to their younger counterparts. The study highlights the need to consider age when bringing together large numbers of different professions for their first taste of interprofessional education.

Participation of disadvantaged parents in child care research.

AIM: To assess the level to which parents from deprived and socially dysfunctional families collaborate in complex and time-consuming research. DESIGN: Home-based study, of early physiological development in infants from a severely deprived area. Overnight continuous recordings of deep-body temperature with twice daily urine collection, parental daily diary of life-events and completion of child care social and psychological assessment by interview questionnaire. Measurements taken between age 6-12 weeks, each lasted 8-12 h per night, averaging four nights per baby. Level of parental participation assessed in relation to ongoing lifestyle pressures. Setting Home based. Inner city deprived estate. PARTICIPANTS: Random sample of mothers with newborn healthy infants. MEASUREMENTS: A total of 87 overnight deep body temperature recordings were made on 22 infants each lasting 8-12 h; 174 urine samples were taken; and 22 sets of questionnaires were completed. RESULTS: Of 62 inner city deprived parents, 39 (62%) agreed to participate. 22 (35%) completed the study. Ongoing lifestyle pressures were high including incidents of burglary, fire and family violence. Family and partner pressures and life crises overwhelmed 10 non-participations. CONCLUSIONS: Research partnerships can be developed with underprivileged families facing severe life-events. Parents were highly motivated to complete what they perceived as important infant care research.

New opportunities for nurses in medical education: facilitating valuable community learning experiences.

A new 4 week community programme, developed through a successful Department of Health Bid in partnership with the Community NHS Trust, provides a vital clinical learning block for all medical students at the Leicester/Warwick Medical school. The course owes its success to the pivotal role played by nurses. Working with an Academic co-ordinator the course was operationalised in the county's market towns and provided student access to the work of the entire front line community workforce in the care of people with life limiting diseases and disabled people. Senior nurses in each locality led the work with both community hospital and community nurses sharing their expertise with a wide range of front line health and social care professionals. The lead nurses and their teaching teams attended university training days prior to developing a locality student programme and played a key role in identifying preparing and supporting suitable patients for student learning. Students highly praised the work of the lead nurses who supported their learning throughout the course. All nurses felt the educational involvement was worthwhile, having overcome identified barriers and with funding support nurses have been able to assimilate the teaching into their annual workload.