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IntroductionIn the UK there are 3500 individuals detained in medium secure forensic psychiatry units. Service users in such settings have complex and serious mental illness (SMI), often with co-morbid physical health problems and a life expectancy of at least 10 years shorter than the general population. They often have low levels of physical activity. There is little evidence about physical activity interventions for medium secure service users in the United Kingdom.ObjectivesOur objective is to co-produce, with medium secure service users, the content and delivery of an intervention to increase physical activity. We shall assess feasibility, acceptability, and pilot data collection methods for outcomes relevant for a future randomised controlled trial.MethodsThis is a 30-month mixed-methods project that will follow the Medical Research Council (MRC) framework Developing and Evaluating Complex Interventions. The study has 4 phases. Phases 1-2 will gather information required to co-develop an evidence-based intervention in Phase 3. Phase 4 will assess the intervention in a feasibility study, evaluating and testing the intervention for a future pilot study.Study settings: Two NHS Medium Secure In-Patient Psychiatric Hospitals in the UK.ResultsThis paper presents the preliminary findings from Phase 4 and also offers a highlight into the results from the Women’s Services from both study sites. A total of thirty-three service users from both study sites participated in Phase 4 of the study and twenty-six completed the physical activity intervention, known as the IMPACT Intervention. Between both study sites, there were two Women’s Standard Medium Secure Services and one Women’s Enhanced Medium Secure Service, involved in this study. A total of nine female service users participated in Phase 4.ConclusionsThe preliminary findings of Phases 4 are allowing the team to move forward and evaluate the effect of the IMPACT Intervention.Disclosure of InterestNone Declared

\"Although 'grassroots' conjures up images of independent citizen organizing, much mass participation today is sponsored by elite consultants working for corporations and powerful interest groups. This book pulls back the curtain to reveal a lucrative industry of consulting firms that incentivize public activism as a marketable service. Edward Walker illustrates how, spurred by the post-sixties advocacy explosion and rising business political engagement, elite consultants have deployed new technologies to commercialize mass participation. Using evidence from interviews, surveys and public records, Grassroots for Hire paints a detailed portrait of these consultants and their clients. Today, Fortune 500 firms hire them to counter-mobilize against regulation, protest or controversy. Ironically, some advocacy groups now outsource organizing to them. Walker also finds that consultants are reshaping both participation and policymaking, but unethical 'astroturf' strategies are often ineffective. This pathbreaking book calls for a rethinking of interactions between corporations, advocacy groups, and elites in politics\"-- Provided by publisher.

IntroductionIn the UK there are 3500 individuals detained in medium secure forensic psychiatry units. Service users in such settings have complex and serious mental illness (SMI), often with co-morbid physical health problems and a life expectancy of at least 10 years shorter than the general population. They often have low levels of physical activity. There is little evidence about physical activity interventions for medium secure service users in the United Kingdom.ObjectivesOur objective is to co-produce, with medium secure service users, the content and delivery of an intervention to increase physical activity. We shall assess feasibility, acceptability and pilot data collection methods for outcomes relevant for a future randomised controlled trial.MethodsThis is a 24-month mixed-methods project that will follow the Medical Research Council (MRC) framework Developing and Evaluating Complex Interventions. The study has 4 phases.- Phases 1-2 will gather information required to co-develop an evidence based intervention in Phase 3.- Phase 4 will assess the intervention in a feasibility study, evaluating and testing the intervention for a future pilot study.Study settings: Two NHS Medium Secure In-Patient Psychiatric Hospitals in the UK.ResultsThis paper presents the findings from the Phase 1 questionnaire and focus groups with service users and hospital staff that identified the barriers and facilitators to physical activity in such settings. The results are then discussed in relation to the Phase 2 qualitative results that explored stakeholders’ and service users’ opinions into how to increase physical activity among medium secure service users by identifying potential elements for inclusion in a physical activity intervention, to gain insight into how we can establish engagement of this group with the intervention, maintain commitment, avoid drop-out and develop the intervention design. All findings are presented using the Capability, Opportunity, and Motivation Model of Behaviour (COM-B model), which is widely used to identify what needs to change for a behaviour change intervention to be effective.ConclusionsThe findings of Phases 1-2 are allowing the team to move forward with Phase 3 that is currently developing an intervention to increase physical activity for adult inpatient service users in the medium secure units. This phase will be guided by the MRC framework and the COM-B model to define the target behaviours and select the most suitable intervention components (functions and techniques) and implementation approach.Disclosure of InterestNone Declared

Environmental justice and social movements scholarship demonstrates how not-in-my-backyard activism by more privileged communities leaves the disadvantaged with “locally unwanted land uses.” Yet it overlooks instances of local support for risky industries. Our ethnographic case shows how a rural, white, mixed-income Pennsylvania community adopted a please-in-my-backyard stance toward shale gas extraction (fracking). Residents invited development on their land and supported it through quiet mobilization. While landowners prioritized benefits over risks, economics cannot fully explain their enthusiasm. Consistent with public opinion research, partisan identities and community obligations undergirded industry support even when personal benefits were limited. Devotion to self-reliance and property rights led residents to defend landowners’ freedom to lease their land. Cynicism toward government precluded endorsing environmental regulation, and the perception of antifracking activists as “liberal” outsiders linked support for fracking with community solidarity. This case illustrates why communities may champion risky industries and complicates theories of nonmobilization.

Engineered living materials (ELMs) based on bacterial cellulose (BC) offer a promising avenue for cheap-to-produce materials that can be programmed with genetically encoded functionalities. Here we explore how ELMs can be fabricated in a modular fashion from millimetre-scale biofilm spheroids grown from shaking cultures of Komagataeibacter rhaeticus . Here we define a reproducible protocol to produce BC spheroids with the high yield bacterial cellulose producer K. rhaeticus and demonstrate for the first time their potential for their use as building blocks to grow ELMs in 3D shapes. Using genetically engineered K. rhaeticus , we produce functionalized BC spheroids and use these to make and grow patterned BC-based ELMs that signal within a material and can sense and report on chemical inputs. We also investigate the use of BC spheroids as a method to regenerate damaged BC materials and as a way to fuse together smaller material sections of cellulose and synthetic materials into a larger piece. This work improves our understanding of BC spheroid formation and showcases their great potential for fabricating, patterning and repairing ELMs based on the promising biomaterial of bacterial cellulose. Bacterial cellulose is a promising cheap-to-produce programmable engineered living material. Here the authors present a method for production of spheroids for use as engineerable building blocks able to sense and respond to chemical inputs.

In the face of rapidly changing data, a range of case fatality ratio estimates for coronavirus disease 2019 (COVID-19) have been produced that differ substantially in magnitude. We aimed to provide robust estimates, accounting for censoring and ascertainment biases. We collected individual-case data for patients who died from COVID-19 in Hubei, mainland China (reported by national and provincial health commissions to Feb 8, 2020), and for cases outside of mainland China (from government or ministry of health websites and media reports for 37 countries, as well as Hong Kong and Macau, until Feb 25, 2020). These individual-case data were used to estimate the time between onset of symptoms and outcome (death or discharge from hospital). We next obtained age-stratified estimates of the case fatality ratio by relating the aggregate distribution of cases to the observed cumulative deaths in China, assuming a constant attack rate by age and adjusting for demography and age-based and location-based under-ascertainment. We also estimated the case fatality ratio from individual line-list data on 1334 cases identified outside of mainland China. Using data on the prevalence of PCR-confirmed cases in international residents repatriated from China, we obtained age-stratified estimates of the infection fatality ratio. Furthermore, data on age-stratified severity in a subset of 3665 cases from China were used to estimate the proportion of infected individuals who are likely to require hospitalisation. Using data on 24 deaths that occurred in mainland China and 165 recoveries outside of China, we estimated the mean duration from onset of symptoms to death to be 17·8 days (95% credible interval [CrI] 16·9–19·2) and to hospital discharge to be 24·7 days (22·9–28·1). In all laboratory confirmed and clinically diagnosed cases from mainland China (n=70 117), we estimated a crude case fatality ratio (adjusted for censoring) of 3·67% (95% CrI 3·56–3·80). However, after further adjusting for demography and under-ascertainment, we obtained a best estimate of the case fatality ratio in China of 1·38% (1·23–1·53), with substantially higher ratios in older age groups (0·32% [0·27–0·38] in those aged <60 years vs 6·4% [5·7–7·2] in those aged ≥60 years), up to 13·4% (11·2–15·9) in those aged 80 years or older. Estimates of case fatality ratio from international cases stratified by age were consistent with those from China (parametric estimate 1·4% [0·4–3·5] in those aged <60 years [n=360] and 4·5% [1·8–11·1] in those aged ≥60 years [n=151]). Our estimated overall infection fatality ratio for China was 0·66% (0·39–1·33), with an increasing profile with age. Similarly, estimates of the proportion of infected individuals likely to be hospitalised increased with age up to a maximum of 18·4% (11·0–37·6) in those aged 80 years or older. These early estimates give an indication of the fatality ratio across the spectrum of COVID-19 disease and show a strong age gradient in risk of death. UK Medical Research Council.