Working alongside next of kin to enhance discharge: A quality improvement collaboration to co-design discharge for mental health patients.

OBJECTIVES: Mental health (MH) patients seen in the emergency department (ED) setting are often viewed in isolation, outside of the context of their loved ones, the next of kin (NOK). This is especially problematic when a patient is detained under the mental health act. This project aimed to improve this engagement. METHODS: A sense of urgency was created from a guiding coalition of the local MH and ED executive of a rural hospital. The vision was communicated to the team for action. This was then institutionally incorporated as best practice during a 3 month trial. RESULTS: NOK were engaged more frequently as a result of this quality improvement strategy, rising to 90.8% (2021) from 63.2% (2020) compared to the previous year χ2 (1, N=166) =18.75, p = .000015. Admissions for all MH patients from the emergency department fell to 28.3% (2021) from 39% (2020) χ2 (1, N=652) =8.32, p = .0039. CONCLUSIONS: Working with NOK is a best practice strategy that was embraced by clinicians when highlighted. This resulted in less restrictive practice and more community treatment. Creating a frame for the patient that is standardised, provides containment and co-designs future health care is beneficial.

Unforeseen crystal forms of the natural osmolyte floridoside.

Floridoside (2-α-O-D-galactopyranosyl glycerol) is a glycerol glycoside that is biosynthesised by most species of red algae and has been implicated as an intracellular regulator of various homeostatic functions. Here, we report the identification of two unforeseen crystal forms of the ubiquitous natural osmolyte floridoside including a seemingly unheralded second anhydrous conformational polymorph and the unambiguous description of an elusive monohydrated variant. By employing a variety of thermal and spectroscopic techniques, we begin to explore both their macro and molecular physicochemical properties, which are notably different to that of the previously reported polymorph. This work advances the characterisation of this important natural biomolecule which could aid in facilitating optimised utilisation across a variety of anthropocentric applications and improve comprehension of its role in-vivo as a preeminent compatible solute.

Quantifying the differences in structure and mechanical response of confectionery products resulting from the baking and extrusion processes.

Extrusion has potential advantages over baking in terms of throughput, asset cost and flexibility. However, it is challenging to achieve through extrusion the "light, crispy" texture of a more traditional baked confectionery. This study compares and contrasts for the first time confectionery products produced through these two processes, i.e. baking and extrusion. The microstructural differences are measured using imaging techniques, i.e. Scanning Electron Microscopy (SEM) and X-Ray Tomography (XRT) whereas mechanical characterisation is used to highlight differences in the resulting mechanical properties. Crucial information is presented which shows that the two technologies result in different mechanical properties and microstructures, even if the level of porosity in the two products is kept constant. In addition, confectionery products whether they are produced through baking or extrusion, have irregular geometries. The latter makes mechanical characterisation a real challenge. Therefore this study also presents rigorous methods for measuring true mechanical properties such that meaningful and valid comparisons may be made. The accuracy of the chosen methodologies is verified through experiments using flat and tubular extruded geometries as well as testing the products in various directions. It was concluded that the manufacturing method and, in the case of extrusion, the initial moisture content influences the microstructure and mechanics of confectionery products, both of which have an impact on consumer sensory perception.

C-Reactive Protein: Higher During Acute Psychotic Episodes and Related to Cortical Thickness in Schizophrenia and Healthy Controls.

There is increasing evidence for the role of inflammation in schizophrenia, yet the stability of increased peripheral inflammation in acute psychosis and the degree to which peripheral inflammation relates to cortical thickness, a measure of the degree of neuropathology, are unknown. In independent samples, we assessed the peripheral inflammation marker C-reactive protein (CRP) to determine the extent to which: (1) CRP was elevated and stable across admissions for acute psychosis, (2) cognition, daily function and symptom severity are characteristic of chronically ill patients with schizophrenia displaying elevated CRP, and (3) CRP levels predict cortical thickness. Study 1 assessed peripheral CRP (primary outcome) and other blood measures in 174/280 people with acute psychosis while Study 2 assessed peripheral CRP, cognition and cortical thickness (primary outcomes), symptoms, and daily function in 85/97 chronically ill patients with schizophrenia and 71/87 healthy controls. In acute psychosis, CRP and neutrophil-to-lymphocyte ratio were significantly elevated relative to a normal cutoff (with 59.8% of patients having elevated CRP) which remained elevated across admissions. CRP was significantly elevated in 43% of chronically ill patients with schizophrenia compared to 20% in controls. Elevated CRP patients displayed significantly worse working memory and CRP was inversely correlated with cortical thickness in frontal, insula, and temporal brain regions. This work supports the role of inflammation in psychotic illnesses and suggests that use of peripheral markers (e.g., CRP) in conjunction with diagnosis could be used to identify patients with more cortical neuropathology and cognitive deficits.