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An analysis of the acceptability, feasibility, and utility of the Global Mental Health Assessment Tool for Primary Care (GMHAT/PC) in a UK primary healthcare setting: a practice-based mixed methods study
Get PDFIntroduction: Published evidence shows that at least one in four people at any one time have mental health symptoms, most commonly of anxiety and depression. This is set against a background where the evidence demonstrates that primary care in general is poorly equipped to identify, diagnose and manage mental health disorders. The effect of these disorders affects the individual’s physical and social wellbeing and has an impact at all levels of Society. This study investigates the acceptability and feasibility of the Global Mental Health Assessment Tool for primary care (GMHAT/PC), and the impact of using it on the confidence and self-rated competence of healthcare workers.
The Global Mental Health Assessment Tool for primary care (GMHAT/PC) is a computerised semi-structured interview tool to support a healthcare worker in the assessment of patients presenting with mental health symptoms. While single diagnosis tools are now more widely used in UK general practice, semi-structured mental health interview tools are not. GMHAT/PC was developed in the UK using resources from both community mental health services and primary care. Used in clinical practice, GMHAT/PC guides a healthcare worker through a comprehensive mental health assessment and its greater use has the potential to increase their diagnostic accuracy. With diagnostic accuracy comes more appropriate patient management.
Method: The study deploys mixed methods research strategies in a UK general medical practice setting. Fifty-five healthcare workers were trained in the use of GMHAT/PC. They provided pre- and post-training self-ratings and participated in semi-structured interviews to provide views of the feasibility of the tool and its impact on their confidence and self-rated competence in mental health assessments. After training, the healthcare workers interviewed 198 patients with mental health symptoms using GMHAT/PC. The patients completed a questionnaire exploring their views of the time taken for the interview, whether it addressed their symptoms and whether they found it acceptable. Seventeen patients were also interviewed to further explore their opinions.
Results: Ninety-nine per cent (99%) of the patient participants found the use of GMHAT/PC in their clinical assessment either “somewhat acceptable” or “very acceptable” (2 (1) = 6.636, N = 198, p = .010). Most healthcare workers identified time as a barrier to GMHAT/PC’s feasibility but viewed its use as feasible, provided that additional time was available for the assessment, such as extra appointment time, arranging an appointment at the end of a consulting session, or delegating the assessment to another healthcare worker with less time pressures.
There was a statistically significant improvement in the self-rated competence (T = 253, z = 4.221, p < .001) and confidence (T = 378, z = 4.560, p < .001) of healthcare workers still in undergraduate training. For healthcare workers working under the supervision of a fully qualified general practitioner, statistically significant improvements were also seen in self-rated competence (T = 73, z = 2.801, p = .005) and confidence (T = 150, z = 3.491, p < .001). There was no statistically significant change in the confidence and self-rated competence of fully certified practitioners.
Conclusion: The results show that the use of GMHAT/PC is highly acceptable to patients. Its use is feasible provided additional time is made available for the interview. There were improvements in the confidence and self-rated competence of undergraduate healthcare workers and those working under supervision. This research is important because it shows how the use of a tool such as GMHAT/PC could support healthcare workers in their practice, facilitating more accurate diagnoses and hopefully reducing the burden of mental health disorders for the individual and their societal settings.
Future research should assess the value of semi-structured interview tools, such as GMHAT/PC, in developing trainee healthcare workers’ skills in mental health assessments, most particularly for common mental health disorders which cause significant disability for a large proportion of Society. Healthcare workers were concerned about the additional consultation time required for the GMHAT/PC interview. Future research could assess the impact of a semi-structured mental health interview on the patient’s subsequent consulting patterns
Non-territorial GPS-tagged golden eagles Aquila chrysaetos at two Scottish wind farms: avoidance influenced by preferred habitat distribution, wind speed and blade motion status
Get PDFWind farms can have two broad potential adverse effects on birds via antagonistic processes: displacement from the vicinity of turbines (avoidance), or death through collision with rotating turbine blades. These effects may not be mutually exclusive. Using detailed data from 99 turbines at two wind farms in central Scotland and thousands of GPS-telemetry data from dispersing golden eagles, we tested three hypotheses. Before-and-after-operation analyses supported the hypothesis of avoidance: displacement was reduced at turbine locations in more preferred habitat and with more preferred habitat nearby. After-operation analyses (i.e. from the period when turbines were operational) showed that at higher wind speeds and in highly preferred habitat eagles were less wary of turbines with motionless blades: rejecting our second hypothesis. Our third hypothesis was supported, since at higher wind speeds eagles flew closer to operational turbines; especially – once more – turbines in more preferred habitat. After operation, eagles effectively abandoned inner turbine locations, and flight line records close to rotor blades were rare. While our study indicated that whole-wind farm functional habitat loss through avoidance was the substantial adverse impact, we make recommendations on future wind farm design to minimise collision risk further. These largely entail developers avoiding outer turbine locations which are in and surrounded by swathes of preferred habitat. Our study illustrates the insights which detailed case studies of large raptors at wind farms can bring and emphasises that the balance between avoidance and collision can have several influences
Characterization of microwave and terahertz dielectric properties of single crystal La2Ti2O7 along one single direction
Get PDFNew generation wireless communication systems require characterisations of dielectric permittivity and loss tangent at microwave and terahertz bands. La2Ti2O7 is a candidate material for microwave application. However, all the reported microwave dielectric data are average value from different directions of a single crystal, which could not reflect its anisotropic nature due to the layered crystal structure. Its dielectric properties at the microwave and terahertz bands in a single crystallographic direction have rarely been reported. In this work, a single crystal ferroelectric La2Ti2O7 was prepared by floating zone method and its dielectric properties were characterized from 1 kHz to 1 THz along one single direction. The decrease in dielectric permittivity with increasing frequency is related to dielectric relaxation from radio frequency to microwave then to terahertz band. The capability of characterizing anisotropic dielectric properties of a single crystal in this work opens the feasibility for its microwave and terahertz applications
The ‘Teacher Research Group’ as a collaborative model of professional learning
Get PDFThis is an Accepted Manuscript of an article published by Taylor & Francis in Educational Action Research on 10/08/2021, available online: https://doi.org/10.1080/09650792.2021.1960577In this study, we adopted a Teacher Research Group model, a collaborative approach to teacher education that draws on the principles of numerous action research models of enquiry. More specifically, a teacher educator worked alongside an experienced physical education teacher over a three-month period to plan, teach and evaluate a series of classroom-based lessons. The Teacher Research Group adopted five teaching strategies that were thought to be significantly related to optimal learning and then refined their use in response to an evaluation of pupils’ learning in the classroom. This article outlines the context for this model, describes its application and finally reviews its value as a means of promoting shared professional learning. Adopting the Teacher Research Group model did lead to changes in teaching strategies and improvements in pupils’ learning outcomes. Moreover, the model was an effective approach to shared professional learning, one that could lead to desirable change among education professionals elsewhere
Trichuris muris infection drives cell-intrinsic IL4R alpha independent colonic RELMα+ macrophages
Get PDFFrom PLOS via Jisc Publications RouterHistory: received 2021-02-23, accepted 2021-06-29, collection 2021-07, epub 2021-07-30Publication status: PublishedFunder: Medical Research Council; funder-id: http://dx.doi.org/10.13039/501100000265; Grant(s): MR/N022661/1Funder: wellcome trust; funder-id: http://dx.doi.org/10.13039/100004440; Grant(s): 106898/A/15/ZThe intestinal nematode parasite Trichuris muris dwells in the caecum and proximal colon driving an acute resolving intestinal inflammation dominated by the presence of macrophages. Notably, these macrophages are characterised by their expression of RELMα during the resolution phase of the infection. The RELMα+ macrophage phenotype associates with the presence of alternatively activated macrophages and work in other model systems has demonstrated that the balance of classically and alternatively activated macrophages is critically important in enabling the resolution of inflammation. Moreover, in the context of type 2 immunity, RELMα+ alternatively activated macrophages are associated with the activation of macrophages via the IL4Rα. Despite a breadth of inflammatory pathologies associated with the large intestine, including those that accompany parasitic infection, it is not known how colonic macrophages are activated towards an alternatively activated phenotype. Here, we address this important knowledge gap by using Trichuris muris infection, in combination with transgenic mice (IL4Rαfl/fl.CX3CR1Cre) and IL4Rα-deficient/wild-type mixed bone marrow chimaeras. We make the unexpected finding that education of colonic macrophages towards a RELMα+, alternatively activated macrophage phenotype during T. muris infection does not require IL4Rα expression on macrophages. Further, this independence is maintained even when the mice are treated with an anti-IFNγ antibody during infection to create a strongly polarised Th2 environment. In contrast to RELMα, PD-L2 expression on macrophages post infection was dependent on IL4Rα signalling in the macrophages. These novel data sets are important, revealing a surprising cell-intrinsic IL4R alpha independence of the colonic RELMα+ alternatively activated macrophage during Trichuris muris infection
‘Every partnership [… is] an emotional experience’: Towards a model of partnership support for addressing the emotional challenges of student-staff partnerships
Get PDFThis is an Accepted Manuscript of an article published by Taylor & Francis in Teaching in Higher Education on 10/01/2022, available online: https://doi.org/10.1080/13562517.2021.2021391The practice of student-staff partnerships is fundamentally about relationships. As new partnerships are formed, and existing power relations challenged, people experience a range of emotions. Despite their importance, there are few studies that have systematically researched the emotional challenges of student-staff partnership. Through a humanistic approach focused on analysing participants experiences of partnership we found that varying degrees of hope, pride, anxiety, and frustration, were experienced by both students and staff in a curriculum development partnership project. We argue that effective partnership practices should recognise and support the emotional wellbeing of student and staff partners. Drawing upon the effective characteristics of partnership support found in this research and the broader literature, we propose a flexible support model drawing on: 1) peer support, 2) mentoring, and 3) independent reflective writing. Partnership practice that actively supports the emotions involved in working in partnership may encourage more partnerships in the future
Mirror self-recognition in gorillas (Gorilla gorilla gorilla): A review and evaluation of mark test replications and variants
Get PDFThe version of record of this article, first published in [Animal Cognition], is available online at Publisher’s website: http://dx.doi.org/10.1007/s10071-021-01592-3Mirror self-recognition (MSR), widely regarded as an indicator of self-awareness, has not been demonstrated consistently in gorillas. We aimed to examine this issue by setting out a method to evaluate gorilla self-recognition studies that is objective, quantifiable, and easy to replicate. Using Suarez and Gallup’s (1981) study as a reference point, we drew up a list of 15 methodological criteria and assigned scores to all published studies of gorilla MSR for both methodology and outcomes. Key features of studies finding both mark-directed and spontaneous self-directed responses included visually inaccessible marks, controls for tactile and olfactory cues, subjects who were at least five years old, and clearly distinguishing between responses in front of versus away from the mirror. Additional important criteria include videotaping the tests, having more than one subject, subjects with adequate social rearing, reporting post-marking observations with mirror absent, and giving mirror exposure in a social versus individual setting. Our prediction that MSR studies would obtain progressively higher scores as procedures and behavioural coding practices improved over time was supported for methods, but not for outcomes. These findings illustrate that methodological rigour does not guarantee stronger evidence of self-recognition in gorillas; methodological differences alone do not explain the inconsistent evidence for MSR in gorillas. By implication, it might be suggested that, in general, gorillas do not show compelling evidence of MSR. We advocate that future MSR studies incorporate the same criteria to optimize the quality of attempts to clarify the self-recognition abilities of gorillas as well as other species
The Competing Values of Elim Leaders in Northern Ireland: A Theological and Practical Response
Get PDFThis thesis identifies how competing values divided transgenerational leaders from the Elim Movement in Northern Ireland (NI) over the last four decades. Divisions increased between leaders with competing values after changes to long-held beliefs and practices, which they never openly discussed until this research. This thesis also uses theological reflection to suggest how the situation may improve for leaders with competing values if they unite relationally to limit divisions and embrace their diversity.
As an Elim leader, the researcher’s position allowed access to interview ten colleagues from NI for a qualitative investigation into their competing values in a field ready for extensive doctoral research. The “four voices of theology” model provided the structure for focused engagement with literature and empirical research to systematically examine four areas where leaders’ values competed: core principles, perspectives, differences and changes.
The researcher reflected theologically on the field results to justify a unifying model that was always available but never intentionally prioritised. This model includes unifying values from the Apostles’ Doctrine and Fellowship in Acts 2:42 that leaders can prioritise in future collaboration. This thesis shows that it is apposite for Elim leaders to unite in closer relationships to embrace their diversity. Moreover, as a collaborative critique, this thesis hopes to contribute to practical theology by determining how Elim leaders’ competing values in NI are inevitable and can stop or stimulate progress for future practitioners and researchers
Aircraft Electrical Propulsion for High-Speed Flight: Rim Driven Fan (RDF) Technology
Get PDFThe aim of this programme of studies is to research and develop electrical Rim Driven Fan (RDF) technology for high-speed aircraft propulsion and to provide knowledge to support Society’s efforts to combat climate change using zero-emission technologies.
The objectives were to conduct research into the state-of-the-art of aircraft electrical propulsion, to estimate the performance of single and dual stage contra-rotating fans over a range of diameters, to provide a methodology to enable the aerodynamic design and detailed Computational Fluid Dynamic (CFD) analyses of small contra-rotating fans and to create a conceptual design for an RDF device suitable to power an unmanned aircraft. In completing this work, literature reviews were carried out on electrically powered propulsion for aircraft, electrical motor technologies and rim drive technology for aircraft propulsion. Original research was undertaken in the form of aerodynamic analyses, using derived numerical and CFD techniques, to determine the optimum performance of single and dual stage (contrarotating) rim driven fans for high-speed electric aircraft applications. Original research was also undertaken in the form of electrical analyses using Motor-CAD finite element software to
analyse the feasibility of novel rim-drive concepts such as slotless stator designs, aluminium windings and iron-less rotors with Halbach magnet arrays in an RDF context. The results of these studies have contributed new knowledge that has been peer-reviewed and internationally published. An original RDF design concept, suitable to power an unmanned aircraft, was devised and a UK patent application filed. The main findings of this work are that RDF technology offers a viable means of high-speed aircraft propulsion with a dual-stage contrarotating, air-cooled fan arrangement. That optimum RDF power density is achieved with slotless windings and iron-less rotors configured with Halbach magnet arrays which reduce their rotating mass. These findings have enabled a feasible novel RDF design to be created which is a significant contribution in the field of electrical aircraft propulsion. The results of this work also contribute the significant new knowledge that dual stage contra-rotating RDF
configurations provide the potential for an increase in thrust per frontal area, and higher exhaust-air velocities, when compared with existing hub-driven fan technologies. This work has established a novel fan design technique, that can be used by technologists to analyse and design future electrical fan concepts, and offers a significant contribution towards Society’s efforts to combat climate change with zero-emission technologies. Opportunities for further areas of study in this field are in the analyses of large diameter high thrust versions of RDFs suitable for large manned aircraft and hovercraft applications
An exploration of the impact of diversity and culture on the journey of faith and spirituality of the counsellor who is a Christian
Get PDFAim: The purpose of this study was to explore the impact of diversity and culture on the journey of faith and spirituality of the counsellor who is a Christian. This is an under-researched area. Method: The study explored the experiences of eight experienced counsellors who were also Christian. It was conducted by means of semi-structured qualitative interviews. Data were analysed using interpretative phenomenological analysis. Results: Analysis of data identified five superordinate themes: 1)
thoughts on motivations; 2) perspectives on training; 3) experiences in supervision; 4) experiences of faith and spirituality; 5) experiences of diversity and culture. Discussion: The data revealed that participants believed their faith to be a vital part of their
desire to become a counsellor. In spite of this, they received little preparation for the diverse clients they were to meet and found little support in the areas of diversity and culture, or faith and spirituality, in training or supervision. They also faced challenges to their own faith and spirituality. This has, however, resulted in what participants believe
is a broader and deeper faith. A move to a new stage of faith, which they may not have reached had they not become counsellors, was also identified. Conclusion/Implications: Gaps in training and supervision were highlighted, and areas for further research are identified
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