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Criminal sanctions including court orders, prosecution and imprisonment persist as responses to suicidality in the UK even where there is no public danger. Their prevalence, the level of clinical involvement and outcomes are unclear. There is an urgent need to examine the national picture of harms, benefits and the responsibilities of mental health professionals.

This study examines the opportunities presented to high school chemistry studentsthrough argument driven inquiry (ADI) and how these opportunities led to changes in studentunderstanding. Lesson plans and videos were analyzed to determine how much time studentsspent arguing from evidence including constructing and argument board, discussing with resultswith other groups, and writing arguments. Students in an on level high school chemistry classparticipated in three ADI activities throughout the semester. Their understanding of the sciencepractice of arguing from evidence was evaluated prior to participation and after participation ineach activity through individual interviews. Student understanding was rated as low, medium orhigh based on the thoroughness and correctness of their argument. Changes in studentunderstanding were determined and linked back to the various features of ADI. Most studentsmade gains in their ability to argue from evidence after participating in an individual ADIactivity. The key features of ADI that lead to changes in student understanding were the socialconstruction of the argument boards, participation in the round robin presentation sessions, andtime spent creating individual written arguments. ADI is the only argumentation format thatincorporates all three of these features and asks students to build knowledge through socialconstructivism and writing to learn. This research shows that teacher use of ADI in the highschool chemistry classroom can be an effective method for developing student understanding ofthe science practice of arguing from evidence.

Purpose The purpose of this paper is to examine the value of utilising future studies to explore citizenship for people with mental health challenges. Design/methodology/approach This paper critiques the discipline of future studies and considers it in the context of the citizenship and mental health literature. It explores how future studies can be utilised to promote marginalised voices, such as those of people with mental health challenges. Findings Technology is leading to rapid change in society including what it means to be a citizen (Isin and Nielsen, 2008; Isin and Ruppert, 2015). Whilst citizenship has been promoted within mental health for a long time, change has been slow (Rowe and Davidson, 2016). In order to create inclusive opportunities for people with mental health challenges, any focus on citizenship in mental health needs to not only address the present time but to anticipate and influence future technological directions. Originality/value This paper is original in bringing together mental health and the future impact on society of new technologies. It stands to offer a new perspective to discussions on citizenship.

Introduction: UK Integrated community care teams ICCT have been encouraged by policy initiatives and legislation 1, 2 to establish and provide better methods of integrating care IC across health and social care; reducing duplication of provision, improving efficiency and service experiences 3.A UK IC partnership identified the need for a set of core competencies for ICCT. This team supports people in their community to develop independence and self-management skills, and offers diverse health and social care input to improved mental and physical health. An initial literature review indicated few UK publications about ICCT competencies.Practice Change Implemented: Implementation of core professional competencies for ICCT.Aim and Theory of Change: The project is based upon the quality improvement model of Plan Do Study Act 4.Targeted Population and Stakeholders: The population served by the ICCT have complex multiple mental and physical health and social care needs.Stakeholder within the project included service users, ICCT including care navigators, nurses, OT's, psychologists, physiotherapists, and social worker and and the health and social care partnership organisations.Highlights: Core competencies for ICCT were developed through review of the international literature, telephone interviews with the stakeholders, analysis of international competency guidance and job descriptions/ competencies for all professional groups within the ICCT.The competencies were revised through focus groups and piloted with the ICCT. Feedback on the competencies was obtained.Principles from the international competency documents on integrated care were combined to produce a UK ICCT core competency document.ICCT found potential utilisation across the professionals and at all levels.ICCT found them useful in considering their collective understanding of IC and in facilitating their understanding of other professionals' roles within the ICCT.ICCT could see the value of them in assessing and developing their IC competence.Comments on Sustainability: The development led to a document containing eight core competency themes. The PDSA model requires continued adoption and adaptation the ICCT core competencies.Comments on Transferability: The competencies should be transferable and adaptable across the UK utilisng the PDSA model.Due to the incorporation of the published international competencies for integrated care the ICCT core competencies may have use internationally.Conclusion: Identification of ICCT Core Competencies that were acceptable to a wide range of professionals was possible. A variety of practical usages were identified. The ICCT Core Competencies have national and international potential.Lessons Learned: Wider evaluation of this primary care service improvement initiative is required.Gaining a shared understanding of ICCT is key to efficient working.References:1- DH 2010 Equity and Excellence: Liberating the NHS. London: DH.2- Care Act 2014, Availble from: http://www.legislation.gov.uk/ukpga/2014/23/contents/enacted3- Shaw, S; et al An overview of integrated health care in the NHS. Evidence for better Health Care. What is integrated care? Nuffield Trust. 2011 Available from: https://www.nuffieldtrust.org.uk/research/what-is-integrated-care .4- HQIP 2015 A guide to quality improvement methods. Available from: https://www.hqip.org.uk/resources/guide-to-quality-improvement-methods/

This chapter describes the importance of liaison mental health services (LMHS) in acute healthcare settings as a means of ensuring that mental health and wellbeing are addressed alongside acute and/or longterm physical problems. People living with longterm physical conditions often experience mental health problems, and conversely people living with mental health problems often experience serious physical health problems. Thus there is a need to ensure that any mental health problems of people using physical health services are identified and not left untreated, and also that the physical problems of those using mental healthcare services are identified and addressed. This chapter describes the value of LHMS, the process of LMHS provision, competencies for liaison mental health nursing, and how to work with specific physical and psychosomatic disorders. The contribution of LMHS to the provision of integrated healthcare is also considered.

As of 1st June 2020, the US Centres for Disease Control and Prevention reported 104,232 confirmed or probable COVID-19-related deaths in the US. This was more than twice the number of deaths reported in the next most severely impacted country. We jointly model the US epidemic at the state-level, using publicly available death data within a Bayesian hierarchical semi-mechanistic framework. For each state, we estimate the number of individuals that have been infected, the number of individuals that are currently infectious and the time-varying reproduction number (the average number of secondary infections caused by an infected person). We use changes in mobility to capture the impact that non-pharmaceutical interventions and other behaviour changes have on the rate of transmission of SARS-CoV-2. We estimate that R t was only below one in 23 states on 1st June. We also estimate that 3.7% [3.4%–4.0%] of the total population of the US had been infected, with wide variation between states, and approximately 0.01% of the population was infectious. We demonstrate good 3 week model forecasts of deaths with low error and good coverage of our credible intervals. High numbers of COVID-19-related deaths have been reported in the United States, but estimation of the true numbers of infections is challenging. Here, the authors estimate that on 1 June 2020, 3.7% of the US population was infected with SARS-CoV-2, and 0.01% was infectious, with wide variation by state.

Background: It has been suggested that probiotics may improve gastrointestinal discomfort. Not all probiotics exhibit the same effects and consequently meta-analyses on probiotics should be confined to well-defined strains or strain combinations. The aim of this study was to evaluate the effectiveness of a probiotic fermented milk (PFM) that includes Bifidobacterium lactis (B. lactis) CNCM I-2494 and lactic acid bacteria on gastrointestinal discomfort in the general adult population. Methods: Double-blind randomized controlled trials in the general adult population comparing PFM with a control dairy product for at least 4 weeks were searched from multiple literature databases (up to February 2015). Meta-analyses using random-effects models, with individual participant data were undertaken to calculate an odds ratio (OR) or standard mean difference (SMD), with a 95% confidence interval (CI). Results: The search strategy identified 12,439 documents. Overall, three trials with a total of 598 adults (female = 96.5%) met the inclusion criteria. Consumption of the PFM product was associated with a significant improvement in overall gastrointestinal discomfort compared with the control product (OR = 1.48; 95% CI 1.07–2.05), with a number needed to treat (NNT) of 10.24 (95% CI 5.64–55.93). PFM was also superior to the control in reducing digestive symptoms, as measured using a composite score (SMD = −0.21; 95% CI −0.37 to −0.05). Sensitivity analyses produced similar results, and the heterogeneity between studies was minimal. Conclusions: This meta-analysis shows that the consumption of PFM with B. lactis CNCM I-2494 and lactic acid bacteria is associated with a modest but consistent and significant improvement of outcomes related to gastrointestinal discomfort in healthy adults.

Background: Since early March 2020, the COVID-19 epidemic across the United Kingdom has led to a range of social distancing policies, which have resulted in reduced mobility across different regions. Crowd level data on mobile phone usage can be used as a proxy for actual population mobility patterns and provide a way of quantifying the impact of social distancing measures on changes in mobility. Methods: Here, we use two mobile phone-based datasets (anonymised and aggregated crowd level data from O2 and from the Facebook app on mobile phones) to assess changes in average mobility, both overall and broken down into high and low population density areas, and changes in the distribution of journey lengths. Results: We show that there was a substantial overall reduction in mobility, with the most rapid decline on the 24th March 2020, the day after the Prime Minister’s announcement of an enforced lockdown. The reduction in mobility was highly synchronized across the UK. Although mobility has remained low since 26th March 2020, we detect a gradual increase since that time. We also show that the two different datasets produce similar trends, albeit with some location-specific differences. We see slightly larger reductions in average mobility in high-density areas than in low-density areas, with greater variation in mobility in the high-density areas: some high-density areas eliminated almost all mobility. Conclusions: These analyses form a baseline from which to observe changes in behaviour in the UK as social distancing is eased and inform policy towards the future control of SARS-CoV-2 in the UK.

Background: It has been suggested that probiotics may improve gastrointestinal discomfort. Not all probiotics exhibit the same effects and consequently meta-analyses on probiotics should be confined to well-defined strains or strain combinations. The aim of this study was to evaluate the effectiveness of a probiotic fermented milk (PFM) that includes Bifidobacterium lactis ( B. lactis ) CNCM I-2494 and lactic acid bacteria on gastrointestinal discomfort in the general adult population. Methods: Double-blind randomized controlled trials in the general adult population comparing PFM with a control dairy product for at least 4 weeks were searched from multiple literature databases (up to February 2015). Meta-analyses using random-effects models, with individual participant data were undertaken to calculate an odds ratio (OR) or standard mean difference (SMD), with a 95% confidence interval (CI). Results: The search strategy identified 12,439 documents. Overall, three trials with a total of 598 adults (female = 96.5%) met the inclusion criteria. Consumption of the PFM product was associated with a significant improvement in overall gastrointestinal discomfort compared with the control product (OR = 1.48; 95% CI 1.07–2.05), with a number needed to treat (NNT) of 10.24 (95% CI 5.64–55.93). PFM was also superior to the control in reducing digestive symptoms, as measured using a composite score (SMD = −0.21; 95% CI −0.37 to −0.05). Sensitivity analyses produced similar results, and the heterogeneity between studies was minimal. Conclusions: This meta-analysis shows that the consumption of PFM with B. lactis CNCM I-2494 and lactic acid bacteria is associated with a modest but consistent and significant improvement of outcomes related to gastrointestinal discomfort in healthy adults.