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Damaging dichotomies and confounding contradictions in mental health inpatient nursing: Lessons learned from Orwell’s 1984
Get PDFPurpose: Our discursive paper considers the use of restrictive practices in mental health inpatient settings and how these are often prioritised over relational approaches, especially where the diagnostic label of personality disorder intersects with risk.
Approach: Key concepts from Orwell’s 1984 are studied for their pertinence to mental health inpatient settings, supporting our argument that restrictive practices arise from dichotomous thinking and externalised fears.
Findings: Drawing upon Orwellian themes of power, social control, and digital surveillance from 1984, we highlight the role of fear in perpetuating restrictive practices under a guise of benevolent care in mental health inpatient settings, especially for those who are diagnosed with a personality disorder. A lack of preparedness to work with complexity in such environments, coupled with a deficit in self-reflexivity and critical thinking, can exacerbate challenges.
Originality/value: We use Orwell’s novel to support a critical discourse around those damaging dichotomies and inherent contradictions that contribute to restrictive practice in contemporary mental health settings and to question whose interests’ these restrictive practices serve.
Implications: To transcend damaging dichotomies and reduce restrictive practices in inpatient settings, we make the argument for the adequate preparation and education of the mental health nurse and authentic, collaborative, user-involved care
CSP2023: 441 A series of single-case experiments exploring cryotherapy interventions in semi-professional football players with medial collateral ligament injuries
No full textPurpose: Knee injuries continue to be a common site of injury in sport, affecting people of all ages. Medial Collateral Ligament (MCL) injuries are one of the most prevalent knee injuries in football. Cryotherapy and compression are advised in clinical guidelines for knee injury management. However, optimal compressive-cryotherapy protocols have not yet been defined. This highlights the need for exploration into the effectiveness of different cryotherapy interventions on a range of injuries. This series of single-case experiments aimed to explore the effects of two cryotherapy interventions on pain, swelling and stability in football players with an MCL injury, in order to inform the development of evidence-based interventions for knee injury management.
Methods: Five semi-professional football players with an MCL injury (age: 24.8 ± 3.8 yrs.; n=1 females, n=4 males; injury severity: n=4 grade 1, n=1 grade 3) were recruited. An alternating-treatment design was adopted, over a series of five single-case experiments, exploring two 20-minute interventions (A) wetted ice (400g ice, 400ml water) and (B) ProMOTION EV1 compressive-cryotherapy device (10°C with 50mmHg compression). The order of intervention was randomised (ABABAB or BABABA). Each intervention was applied once a day for three consecutive days, with a minimum of two hours in between. Three outcome measures were recorded pre- and post-intervention: i) Swelling using a standard tape measure, ii) Pain using the 11-point numeric pain rating scale, iii) Stability on an 11-point scale (very unstable – very stable). The data was analysed using visual analysis of graphical data individually and collectively. All outcome measures were assessed for the clinical relevance using minimal clinically important changes.
Results: Eighty percent of players reported a reduction in pain on days 1, 2 and 3 for both interventions; 75% of which reported clinically important reductions in pain (≥1 point). Both interventions achieved the same number of clinically important pain reductions in total (8 out of 15 sessions). Both interventions illustrated small effect sizes for pain reduction each day (ice: d=0.2-0.4, EV1: d=0.2-0.3). Clinically important swelling reductions were recorded in all 5 players following compressive-cryotherapy using ProMOTION EV1, and in 20% of players using ice. Interestingly, both interventions recorded the largest effect on swelling on day 1 (ice: d=0.2, EV1: d=0.4). However, both interventions had limited effect on patient-perceived stability, only 6% of compressive-cryotherapy interventions and 0% of ice interventions observed clinically important increases. Individual analysis of the total number of clinically important changes showed that compressive-cryotherapy was the most effective intervention for all 5 semi-professional football players.
Conclusion(s): There is a significant lack of evidence-based cryotherapy interventions for knee injury management. Using compression and cryotherapy simultaneously, using ProMOTION EV1, reduced swelling more effectively than the current standard clinical treatment, in semi-professional football players with an MCL injury. The findings show that combining compression and cryotherapy could offer a greater therapeutic effect than cryotherapy alone. Further research is recommended to continue to develop evidence-based cryotherapy interventions for injury management.
Impact: Establishing evidence-based interventions to alleviate knee injury symptoms could help clinicians to advise individual compressive-cryotherapy interventions and optimise individuals’ ability to self-manage symptoms
Introduction to Appreciative Inquiry: A case study of maternity services
Get PDFAI was first developed by Cooperrider and Srivastva1 and sits within action research approaches that aims to create practical and collaborative change. It has a distinctive and deliberate strengths-based approach to achieve emancipatory learning and change, rooted in the experiences of stakeholders. AI has a strong theoretical base drawing on social constructionism, neuroscience, and positive psychology. Its assumptions include that: every society, organisation or group/team have strengths or things that work well and can be elaborated and expanded; our realities can be co-created through the quality of language, relationships, interactions and actions with one another.
The original model uses a four step or ‘4-D process’ (Fig. 1) to take participants through an in-depth exploration of their organisation, team or individual roles. Starting with discovering and appreciating best experiences (discovery), imagining the ideal - how it would be if those valued experiences happened most of the time (dream), defining the dream more clearly and discussing steps towards realising it (design), to wide ranging actions, improvisation, learning, adjustments (destiny). Deciding what to study, or the ‘affirmative topic’, is important because ‘human systems move in the direction of what they study’. Hence, some have added an extra step, ‘definition’ (see Figure 1).
Appreciative Inquiry was undertaken in an NHS maternity unit in England. This AI approach aimed to provide a space for participants to reflect on meaning in their work. It has the potential to generate novel insights, encapsulate creativity, and co-create change. AI was particularly appropriate during the COVID-19 pandemic as taking part could offer a therapeutic effect.
Thirty-nine individual interviews were conducted with a broad range of clinical staff including midwives of all grades, an obstetrician, trainee doctors, student midwives, and maternity support workers. Four group discussions were also held with mixed professional groups. Staff were asked to reflect on what made a good day and what made a difference to their wellbeing. Interviews were digitally recorded, transcribed, initially analysed thematically by the research team but then analysed further by the maternity team. Feedback was provided to management and staff through clinical governance meetings, social media, newsletters, and informal conversations. Various changes were initiated by staff and supported by management.
We contributed to the book Appreciating Health and Care: A Practical Appreciative Inquiry Resource for the Health & Social Care Sector.4-5 Rachel Arnold is the lead author of our contribution ‘Let’s get messy! Where to start with using Appreciative Inquiry’. Here we explain how we adapted and overcame some of the challenges, strategies that worked, and practical ideas for anyone interested in using Appreciative Inquiry in health or social care
Best practice for the selection, design and implementation of UK Kidney Association guidelines: a modified Delphi consensus approach
Get PDFBackground: Despite research into how to effectively implement evidence-based recommendations into clinical practice, a lack of standardisation in the commissioning and development of clinical practice guidelines can lead to inconsistencies and gaps in implementation. This research aimed to ascertain how topics in kidney care worthy of guideline development within the UK should be chosen, prioritised, designed and implemented. Methods: Following a modified Delphi methodology, a multi-disciplinary panel of experts in kidney healthcare from across the UK developed 35 statements on the issues surrounding the selection, development and implementation of nephrology guidelines. Consensus with these statements was determined by agreement using an online survey; the consensus threshold was defined as 75% agreement. Results: 419 responses were received. Of the 364 healthcare practitioners (HCPs), the majority had over 20 years of experience in their role (n=123) and most respondents were nephrologists (n=95). Of the 55 non-clinical respondents, the majority were people with kidney disease (n=41) and the rest were their carers or family. Participants were from across England, Northern Ireland, Scotland and Wales. Consensus between HCPs was achieved in 32/35 statements, with 28 statements reaching ≥90% agreement. Consensus between patients and patient representatives was achieved across all 20 statements, with 13/20 reaching ≥90% agreement. Conclusions: The current results have provided the basis for six recommendations to improve the selection, design and implementation of guidelines. Actioning these recommendations will help improve the accessibility of, and engagement with, clinical guidelines, contributing to the continuing development of best practice in UK kidney care
Development of an Autonomous, Self-Optimising Machine Learning Framework for use in Manufacturing Applications
Get PDFTraditionally manufacturing processes have used a wide variety of sensors to provide process control, quality and productivity metrics. Industry 4.0 introduces the concept of combining and analysing sensor derived production data to offer greater insights into all aspects of manufacturing operations. A key area of advancement is the ability to process and analyse large volumes of data, in real-time, to provide to process control. The objective of this thesis is to define a framework that enables adaptive, optimised production control via the use of automated machine learning algorithm selection.
The complete framework is capable of adaptively processing streamed production data directly from manufacturing processes along with other appropriate sources. To achieve this, a second longer term channel is used to autonomously evaluate and optimise competing algorithms and data strategies to select the most appropriate solution for near real-time control. A series of experiments demonstrates that the framework is suitable for production control applications which benefit from a focus on single or multiple accuracy metrics.
The framework can automatically switch algorithms via a supervisory mode. This allows it to take into account additional factors such as concept drift, production changes, computational complexity and algorithm stability. Algorithm switching is based on a flexible optimisation strategy for algorithm performance over variable time periods. Experimental results are provided for two optimisation methodologies.
Further development of the framework will involve full automation of the real-time algorithm selection method. This will remove the need for specialist data processing knowledge and hence allow the framework to be deployed in a wide range of existing manufacturing companies
Visual Depictions and Narrative Functions of Achilles’ Death in Homer’s The Iliad
Get PDFThis paper explores the narrative strategies and symbolic significance of Achilles’ death in Homer’s The Iliad, focusing on how Homer employs visual depictions to enhance the hero’s image and convey the theme of mortality. Through a detailed analysis of textual foreshadowing, character reactions, and symbolic imagery, the study reveals how Achilles’ death serves as a central motif that underscores the epic’s themes of heroism and the inevitability of death. Additionally, the paper examines ancient Greek art, such as vase paintings and sculptures, to provide a visual complement to the literary narrative. These artistic representations capture key moments that highlight Achilles’ heroic status and the divine interventions that seal his fate, aligning closely with the literary themes of destiny and mortality. The research also considers the cultural and philosophical concerns of ancient Greek society, reflecting on how the interplay between literary and visual depictions reinforces the cultural belief in the power of fate and the transient nature of human life. By integrating textual and visual analyses, this paper offers a comprehensive understanding of the enduring legacy of Achilles and the thematic depth of The Iliad
False memory-guided eye movements: insights from a DRM-Saccade paradigm
Get PDFThe Deese-Roediger and McDermott (DRM) paradigm and visually guided saccade tasks are both prominent research tools in their own right. This study introduces a novel DRM-Saccade paradigm, merging both methodologies. We used rule-based saccadic eye movements whereby participants were presented with items at test and were asked to make a saccade to the left or right of the item to denote a recognition or non-recognition decision. We measured old/new recognition decisions and saccadic latencies. Experiment 1 used a pro/anti saccade task to a single target. We found slower saccadic latencies for correct rejection of critical lures, but no latency difference between correct recognition of studied items and false recognition of critical lures. Experiment 2 used a two-target saccade task and also measured corrective saccades. Findings corroborated those from Experiment 1. Participants adjusted their initial decisions to increase accurate recognition of studied items and rejection of unrelated lures but there were no such corrections for critical lures. We argue that rapid saccades indicate cognitive processing driven by familiarity thresholds. These occur before slower source-monitoring is able to process any conflict. The DRM-Saccade task could effectively track real-time cognitive resource use during recognition decisions
First Very Long Baseline Interferometry Detections at 870 μ m
Get PDFThe first very long baseline interferometry (VLBI) detections at 870 μm wavelength (345 GHz frequency) are reported, achieving the highest diffraction-limited angular resolution yet obtained from the surface of the Earth and the highest-frequency example of the VLBI technique to date. These include strong detections for multiple sources observed on intercontinental baselines between telescopes in Chile, Hawaii, and Spain, obtained during observations in 2018 October. The longest-baseline detections approach 11 Gλ, corresponding to an angular resolution, or fringe spacing, of 19 μas. The Allan deviation of the visibility phase at 870 μm is comparable to that at 1.3 mm on the relevant integration timescales between 2 and 100 s. The detections confirm that the sensitivity and signal chain stability of stations in the Event Horizon Telescope (EHT) array are suitable for VLBI observations at 870 μm. Operation at this short wavelength, combined with anticipated enhancements of the EHT, will lead to a unique high angular resolution instrument for black hole studies, capable of resolving the event horizons of supermassive black holes in both space and time
Alzheimer disease and Glioblastoma
Get PDFAlzheimer’s disease (AD) is characterised by progressive impairments in memory and cognitive process and contributes to 50 – 70% of dementia cases. Alzheimer’s predominantly presents in people over 65 while brain cancer incidence is similarly seen in the elderly. Glioblastoma (GBM) is the most aggressive form of primary malignant brain tumour with life expectancy only 15 months following diagnosis. A relationship between the two neurological diseases was first suggested when patients with AD were found to be less likely to die from cancer compared to AD patients who died from other diseases. Meta-analysis has confirmed that cancer patients have a 50% reduced risk of developing AD with a general consensus of inverse comorbidity. Beta amyloid exists in two main forms Aβ40 and Aβ42 and has long been at the centre of AD pathogenesis. Our preliminary data suggests it to also be present in glioma. However, the full role of beta amyloid or its associated proteins have not been fully explored in GBM.
Immortalised cell lines U87-mg (human grade IV GBM), SVGp12 (human foetal glial cell) and 1321N1 (human low-grade astrocytoma) were used throughout.
ELISA assay was able to confirm presence of both Aβ40 and Aβ42 in U87-mg, 1321N1 and SVGp12 cell lysates with no significant difference between the different cell lines. Pharmacological inhibition of beta amyloid similarly had no significant effect on cell proliferation in the glioma cell lines.
Bioinformatic exploration of beta amyloid associated genes was undertaken to identify novel targets to study in the glioma cell lines. BRCA2 and BCHE genes showed different expression in LGG and GBM compared to normal tissue. BRCA2 expression was confirmed in cell lysates by western blot with less BRCA2 in U-87mg and SVGp12 compared to 1321N1.
BRCA2 has been long implicated in other cancers, however the role BRCA2 may have in glioma brain tumours remain unknown. BRCA2 may therefore be an interesting protein for further study and a potential strategy in GBM
Development of plant extracts loaded lipid nanoparticles for potential glioblastoma treatment.
No full textGlioblastoma (GB) is a form of malignant brain tumours with extremely poor prognosis due to the difficulty in bypassing the blood brain barrier (BBB). Phytochemicals have shown potential for positive anti-cancer activity with two showing a promising potential for research those being epigallocatechin gallate (EPGC) and curcumin. Difficulties arose in delivery due to the BBB preventing entry to tumour sites in the brain. Nanostructured lipid carriers (NLC) show intrigue due to their ability in crossing the BBB. Encapsulation of these compounds inside NLC formulations was explored for their potential toxicity against GB cells U87MG and was compared to a control non-cancerous cell line (SVG P12).
A novel HPLC method was developed and optimised following ICH guidelines for curcumin and EPGC quantification. The methods showed accuracy ranging from 90-108% representing the high sensitivity of each method. The NLCs were optimised following a set of process and product parameters which include, increasing sonication time, and the inclusion of Solutol. Curcumin was optimized from F1 Cur-NLC to F2 Cur-NLC, to achieve a particle size of 132.9nm ± 22.2 and PDI of 0.181 ± 0.052, and zeta potential of -47.8mV ± 2.1. F2 Cur-NLC TD was 67.3% ± 4.4 and EE of 92% ± 1.2. F1 EPGC-NLC was characterised with a particle size of 148.3nm ± 6.5 with a uniform distribution of 0.209 ± 0.012. They also exhibited a zeta potential of -43.1mV ± 4.9. TGA and DSC highlighted the possibility that EPGC and Curcumin were embedded in NLCs in an amorphous state. FTIR showed encapsulation of curcumin inside the NLC, whilst the EPGC fingerprint region overlapped with peaks found in the formulation. All developed NLCs remained stable for up to 14 days, in a suspension form at ambient temperatures.
Data obtained from the In vitro studies suggested a reduced toxicity to SVG P12 cells lines between the phytochemical encapsulated NLC and the phytochemical alone at both 24 and 48 hours of treatment. This toxicity was reflected also on the scratch/wound assay data with F2 Cur-NLC showing an increased ability to inhibit the migration of U87MG cell lines when compared against both the control and the phytochemical alone. No change in cell cycle was observed in any of the U87MG cells treated with the chosen samples (F2 Blank-NLC, Curcumin, F2 Cur-NLC and EPGC) and followed a similar expression of G1, S and G2/M phase. While curcumin and EPGC exhibited a decrease in G1 phase when SVG P12 cells were tested. TNF-α was measured for both U87MG and SVG P12 cells with F2 cur-NLC inhibiting TNF-α to a significant degree when compared to the phytochemical alone.
The results presented in this project highlighted the potential benefits of using both curcumin and EPGC as a form of compounds loaded into a carrier system to improve BBB permeability and be used for GBs treatments