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To establish the prevalence of obesity in an inpatient rehabilitation setting, examine its impact on hospital outcomes, and explore staff perceptions of caring for patients with obesity.A retrospective audit of inpatients admitted to a sub-acute rehabilitation hospital over 12 months. Hospital outcomes included length of stay (LOS), Functional Independence measure (FIM), and discharge destination. Linear regression models were used to determine whether obesity was associated with hospital outcomes. Staff working on rehabilitation wards were invited to complete a survey exploring their perceptions on caring for those who are obese.Of 1280 episodes of care, 359 (28%) patients were classified as obese with a body mass index ≥30 kg/mOne-third of patients admitted to inpatient subacute rehabilitation were classified as obese. Whilst obesity was not associated with poorer hospital outcomes, staff perceived that obesity negatively impacts on care requirements and LOS.Implications for rehabilitationA third of patients admitted to a public, inpatient rehabilitation setting may be classified as obese based on their body mass index.Although staff perceived that obesity negatively impacts on length of stay and functional gains, there was no evidence that obesity was associated with poorer hospital outcomes.Patients who are classified as obese were able to achieve comparable hospital outcomes including length of stay in the rehabilitation setting to those who are not obese.

This is the peer reviewed version of the following article: Oakley, L., Kinmond, K. S., Humprheys, J. & Dioum, M. (2019). Safeguarding children who are exposed to Abuse Linked to Faith or Belief. Child Abuse Review. 10.1002/car.2540, which has been published in final form at https://doi.org/10.1002/car.2540. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.

Purpose A previous publication in this journal reported the findings of a 2013 survey into people’s experiences of membership of a Christian church in the UK (author citation removed for the purposes of review). A major finding of this survey was that many people said they had been “harmed” by their experience with some labelling it as “Spiritual Abuse” (SA). Respondents in the 2013 study also stressed the importance of developing safeguarding policy and practice in this area. The purpose of this paper is to explore the findings of a more extensive survey conducted in 2017 which aims to identify people’s understanding of SA some four years after the initial work and within a context of some discussion and uncertainty around the term itself. The study also aims to assess the current status of safeguarding policy and practice in SA perpetrated against individuals in the Christian church in the UK. A secondary aim of the study is to ascertain how far understandings, policy and practice have developed since the initial survey was conducted. It is emphasised that the authors do not assert that SA is perpetrated solely in the Christian church. However, as this is their personal religious background it is the focus of this work. Design/methodology/approach A mixed methods online survey of Christians, Church attendees and members of Christian organisations was conducted in 2017. Data were analysed using descriptive statistics, inductive thematic and content analysis. Findings A clear definition of SA is required. There is an ongoing need to develop policy and practice in the area of SA in order to respond effectively to those who have these harmful experiences. Research limitations/implications This work has been conducted within the Christian faith community and thus, represents only this faith context. Accordingly, it is research with a specific group. The work would usefully be expanded to other faith contexts. Practical implications People are still being harmed by experiences in the Christian church. Safeguarding policy and practice in the area of spiritual abuse needs to be developed in the immediate future. Social implications Those working in statutory agencies, faith and community contexts need to develop an understanding of SA. Originality/value This is the largest survey conducted on the topic of SA in the Christian faith to date in the UK.

Child abuse linked to faith or belief (CALFB) is not a recent phenomenon; nor specific to any given culture or faith. This paper presents current work which articulates counsellors’ understanding, experience and training needs around CALFB. An online survey collected data from participants, seventy nine of whom identified themselves as counsellors. Seventy-nine per cent of the counsellors stated that they had heard of the term CALFB. Sixty-six per cent were confident that they understood the term. However, only 46% were confident they could identify indicators with 54% being ‘confident’ to respond. Just 34% of the counsellors had received specific training on CALFB. It is argued here that awareness raising and training around the issues of CALFB are important to include in counsellor training courses and also as Continuous Professional Development.

A rise in Advanced Persistent Threats (APTs) has introduced a need for robustness against long-running, stealthy attacks which circumvent existing cryptographic security guarantees. \(\mathsf {FlipIt}\) is a security game that models attacker-defender interactions in advanced scenarios such as APTs. Previous work analyzed extensively non-adaptive strategies in \(\mathsf {FlipIt}\), but adaptive strategies rise naturally in practical interactions as players receive feedback during the game. We model the \(\mathsf {FlipIt}\) game as a Markov Decision Process and introduce \(\mathsf {QFlip}\), an adaptive strategy for \(\mathsf {FlipIt}\) based on temporal difference reinforcement learning. We prove theoretical results on the convergence of our new strategy against an opponent playing with a Periodic strategy. We confirm our analysis experimentally by extensive evaluation of \(\mathsf {QFlip}\) against specific opponents. \(\mathsf {QFlip}\) converges to the optimal adaptive strategy for Periodic and Exponential opponents using associated state spaces. Finally, we introduce a generalized \(\mathsf {QFlip}\) strategy with composite state space that outperforms a Greedy strategy for several distributions including Periodic and Uniform, without prior knowledge of the opponent’s strategy. We also release an OpenAI Gym environment for \(\mathsf {FlipIt}\) to facilitate future research.

Purpose – The purpose of this paper is to report the findings from a study exploring the understanding of vulnerability and adult safeguarding within Christian faith-based settings. The paper concludes with recommendations for practitioners involved in safeguarding adults in faith-based Christian settings. Design/methodology/approach – The paper considers a survey (n=3,182) into understanding of vulnerability and adult safeguarding for individuals who attend Church regularly or work in a Christian organisation Findings – This study is the first to be undertaken with a UK sample and highlights a range of factors informing adult safeguarding practice within Christian organisations. This includes: complexity linked to understanding vulnerability and its role in safeguarding activity; lack of clarity about what to do with a safeguarding adult concern; and the need for safeguarding training pertinent to the particular needs of faith-based settings. Research limitations/implications – As there is currently a dearth of research in this area this paper makes a valuable contribution to the developing knowledge base around safeguarding and vulnerability within faith-based organisations. Practical implications – Professionals need to develop increased understanding of the complexities involved in safeguarding activity, and specifically how those working in the wider context of supporting vulnerable adults make sense of safeguarding processes and procedures. Social implications – It is important that all organisations, including faith-based settings, working with adults have an understanding of their roles and responsibilities with respect to safeguarding those at risk of harm. Originality/value – This paper is the first UK study to consider safeguarding adults at risk of harm in Christian faith contexts.

Purpose – The purpose of this paper is to report the findings of a ground-breaking survey into people's experiences of church and Spiritual Abuse (SA), in a context of issues of safeguarding and policy. Design/methodology/approach – The survey was delivered online between April 2011 and December 2012. Findings – The findings showed many people had encountered negative church experiences. Most respondents had very limited knowledge and understanding of SA and related support and intervention. Research limitations/implications – This survey represents the views of a small percentage of those who attend, or have attended, church and further more extensive research is required to provide a more comprehensive understanding. Additionally research is required within other faiths and cultural contexts. Practical implications – It is evident that there is clearly a need to strengthen current safeguarding policy and practice with regards to SA. Originality/value – This paper offers an initial insight into the challenges for safeguarding together with some suggested intervention strategies.

This paper reports the results of an online survey which aimed to explore practitioners' and faith community groups' awareness and understanding of child abuse linked to faith or belief (CALFB) and to identify their further training needs in this area. The survey was founded in the work of the National working group for CALFB; a multi-agency response group committed to raising knowledge and awareness of this form of child abuse. Despite the relatively small number of recorded cases, CALFB continues to be a matter of concern to professionals and faith communities in the UK and beyond. One thousand three hundred and sixty two respondents comprising of frontline practitioners, faith and community group members completed the survey. A mixed-method analysis of the survey data illustrates a wide-ranging understanding of the term CALFB and disagreement about whether this is a specific form of child abuse. The results also indicate a relationship between confidence levels in identifying and responding to CALFB and specific training in this area. There is a call for specialised training to be more readily available. Further work is needed to develop a toolkit, which identifies indicators of CALFB and effective response pathways together with research across communities. The current research is timely and important in providing a foundation on which to build more effective identification of cases, policy and intervention.

Whilst there has been some exploration of experiences of domestic violence and abuse within faith communities, understandings of spiritual abuse and how these phenomena interconnect are not yet widely understood. This chapter serves to provide a definition and understanding of spiritual abuse and how it may manifest across all faiths. Lisa Oakley and Kathryn Kinmond highlight the role and responsibility of the faith leader in shaping a positive, constructive faith discourse that condones abusive behaviour, including that which occurs in the domestic sphere. They also call for a more receptive response from mainstream domestic violence and abuse support services, with greater openness to recognising the importance of faith identity and spirituality as a tool of recovery for many victims/survivors.

Activation of seven-transmembrane region receptors typically causes their phosphorylation with consequent arrestin binding and desensitization. Arrestins also act as scaffolds, mediating signaling to Raf and ERK and, for some receptors, inhibiting nuclear translocation of ERK. GnRH receptors (GnRHRs) act via Gq/11 to stimulate the phospholipase C/Ca2+/protein kinase C (PKC) cascade and the Raf/MEK/ERK cassette. Uniquely, type I mammalian GnRHRs lack the C-tails that are found in other seven-transmembrane region receptors (including nonmammalian GnRHRs) and are implicated in arrestin binding. Here we have compared ERK signaling by human GnRHRs (hGnRHRs) and Xenopus GnRHRs (XGnRHRs). In HeLa cells, XGnRHRs underwent rapid and arrestin-dependent internalization and caused arrestin/green fluorescent protein (GFP) translocation to the membrane and endosomes, whereas hGnRHRs did not. Internalized XGnRHRs were co-localized with arrestin-GFP, whereas hGnRHRs were not. Both receptors mediated transient ERK phosphorylation and nuclear translocation (revealed by immunohistochemistry or by imaging of co-transfected ERK2-GFP), and for both, ERK phosphorylation was reduced by PKC inhibition but not by inhibiting epidermal growth factor receptor autophosphorylation. In the presence of PKC inhibitor, Δarrestin-(319-418) blocked XGnRHR-mediated, but not hGnRHR-mediated, ERK phosphorylation. When receptor number was varied, hGnRHRs activated phospholipase C and ERK more efficiently than XGnRHRs but were less efficient at causing ERK2-GFP translocation. At high receptor number, XGnRHRs and hGnRHRs both caused ERK2-GFP translocation to the nucleus, but at low receptor number, XGnRHRs caused ERK2-GFP translocation, whereas hGnRHRs did not. Thus, experiments with XGnRHRs have revealed the first direct evidence of arrestin-mediated (probably G protein-independent) GnRHR signaling, whereas those with hGnRHRs imply that scaffolds other than arrestins can determine GnRHR effects on ERK compartmentalization.

The process of SA is an important part of the story but to date a process map of this form of abuse has not been published in the UK. I have developed a process map which details the process of SA as told in each of the accounts collected and is supported by other accounts of SA. The process map was constructed to depict the key events of the abusive experience from beginning to end.

The question often raised at conferences is ‘what is spiritual abuse?’. The questioner in this context is rarely asking for an answer in the shape of a neat definition. Rather, they are seeking information about the abuse’s key features and characteristics and how it is both similar and different from other forms of abuse. This chapter will explore these issues and present a discussion of the key aspects of SA. Quotes from participants’ narratives are shown in italics and used to support the discussion.

A fundamental issue in any text on a form of abuse is definition. Yet, obtaining a clear definition is often fraught with difficulty (Yancey & Hanson, 2010). Nonetheless, it is important to identify a definition of the abuse under consideration. The impact of limited research into, and understanding of, the experience of SA has led to the current position where defining the term SA is highly problematic. Indeed Ward (2011) notes that ‘there is no consensual definition of “spiritual abuse”’. The lack of familiarity with the term SA has been illustrated during seminars and presentations on this topic at both academic and non-academic conferences (Oakley & Oakley, 2005a, 2006; Kinmond & Oakley, 2006; Oakley, 2006a, 2006b; Oakley & Kinmond, 2009).

A clear message in stories of SA is that this experience is one of real abuse. Participants described their experiences as abuse, both explicitly and implicitly. It is becoming increasingly clear that the characteristics of SA as detailed by survivors bear striking similarity to documented characteristics of other forms of abuse. This chapter will explore the parallels between SA and other forms of abuse.

Activation of seven-transmembrane region receptors typically causes their phosphorylation with consequent arrestin binding and desensitization. Arrestins also act as scaffolds, mediating signaling to Raf and ERK and, for some receptors, inhibiting nuclear translocation of ERK. GnRH receptors (GnRHRs) act via Gq/11 to stimulate the phospholipase C/Ca2+/protein kinase C (PKC) cascade and the Raf/MEK/ERK cassette. Uniquely, type I mammalian GnRHRs lack the C-tails that are found in other seven-transmembrane region receptors (including nonmammalian GnRHRs) and are implicated in arrestin binding. Here we have compared ERK signaling by human GnRHRs (hGnRHRs) and Xenopus GnRHRs (XGnRHRs). In HeLa cells, XGnRHRs underwent rapid and arrestin-dependent internalization and caused arrestin/green fluorescent protein (GFP) translocation to the membrane and endosomes, whereas hGnRHRs did not. Internalized XGnRHRs were co-localized with arrestin-GFP, whereas hGnRHRs were not. Both receptors mediated transient ERK phosphorylation and nuclear translocation (revealed by immunohistochemistry or by imaging of co-transfected ERK2-GFP), and for both, ERK phosphorylation was reduced by PKC inhibition but not by inhibiting epidermal growth factor receptor autophosphorylation. In the presence of PKC inhibitor, Deltaarrestin-(319-418) blocked XGnRHR-mediated, but not hGnRHR-mediated, ERK phosphorylation. When receptor number was varied, hGnRHRs activated phospholipase C and ERK more efficiently than XGnRHRs but were less efficient at causing ERK2-GFP translocation. At high receptor number, XGnRHRs and hGnRHRs both caused ERK2-GFP translocation to the nucleus, but at low receptor number, XGnRHRs caused ERK2-GFP translocation, whereas hGnRHRs did not. Thus, experiments with XGnRHRs have revealed the first direct evidence of arrestin-mediated (probably G protein-independent) GnRHR signaling, whereas those with hGnRHRs imply that scaffolds other than arrestins can determine GnRHR effects on ERK compartmentalization.