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Clinical and cost-effectiveness of a standardised diagnostic assessment for children and adolescents with emotional difficulties: the STADIA multi-centre RCT
No full textBackground: Emotional disorders are common in children and young people and can significantly impair their quality of life. Evidence-based treatments require a timely and appropriate diagnosis. The utility of standardised diagnostic assessment tools may aid the detection of emotional disorders, but there is limited evidence of their clinical value. Objectives: To assess the clinical effectiveness and cost effectiveness of a standardised diagnostic assessment for children and young people with emotional difficulties referred to Child and Adolescent Mental Health Services. A nested qualitative process evaluation aimed to identify the barriers and facilitators to using a standardised diagnostic assessment tool in Child and Adolescent Mental Health Services. Design: A United Kingdom, multicentre, two-arm, parallel-group randomised controlled trial with a nested qualitative process evaluation. Setting: Eight National Health Service Trusts providing multidisciplinary specialist Child and Adolescent Mental Health Services. Participants: Children and young people aged 5-17 years with emotional difficulties referred to Child and Adolescent Mental Health Services, excluding emergency/urgent referrals that required an expedited assessment. In the qualitative process evaluation, 15 young people aged 16-17 years, 38 parents/carers and 56 healthcare professionals participated in semistructured interviews. Interventions: Participants were randomly assigned (1 : 1) following referral receipt to intervention (the development and well-being assessment) and usual care, or usual care only. Main outcome measures: Primary outcome was a clinician-made diagnosis decision about the presence of an emotional disorder within 12 months of randomisation, collected from Child and Adolescent Mental Health Services clinical records. Secondary outcomes collected from clinical records included referral acceptance, time to offer and start treatment/interventions and discharge. Data were also self-reported from participants through online questionnaires at baseline, 6 and 12 months post randomisation, and the cost effectiveness of the intervention was investigated. Results: One thousand two hundred and twenty-five (1225) children and young people were randomly assigned (1 : 1) to study groups between 27 August 2019 and 17 October 2021; 615 were assigned to the intervention and 610 were assigned to the control group. Adherence to the intervention (full/partial completion of the development and well-being assessment) was 80% (494/615). At 12 months, 68 (11%) participants in the intervention group received an emotional disorder diagnosis versus 72 (12%) in the control group [adjusted risk ratio 0.94 (95% confidence interval 0.70 to 1.28); p = 0.71]. Child and Adolescent Mental Health Services acceptance of the index referral [intervention 277 (45%) vs. control 262 (43%); risk ratio: 1.06 (95% confidence interval: 0.94 to 1.19)] or any referral by 18 months [intervention 374 (61%) vs. control 352 (58%); risk ratio: 1.06 (95% confidence interval: 0.97 to 1.16)] was similar between groups. There was no evidence of any differences between groups for any other secondary outcomes. The qualitative nested process evaluation identified a number of barriers and facilitators to the use of the development and well-being assessment during the trial, particularly at the assessment and diagnosis stages of the Child and Adolescent Mental Health Services pathway. Limitations: It was not possible to mask participants, clinicians or site researchers collecting source data to treatment allocation. Conclusions: We found no evidence that completion of the development and well-being assessment aided the detection of emotional disorders in this study. Using the development and well-being assessment in this way cannot be recommended for clinical practice. Future research: To determine longer-term service use outcomes and to investigate whether receipt of a clinical diagnosis makes a difference to clinical outcomes and care/intervention receipt. Funding: This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 16/96/09
Facilitators and barriers to participation of patients with treatment resistant depression in a randomised controlled trial of two forms of personalised magnetic resonance imaging targeted transcranial magnetic stimulation (the BRIGhTMIND trial)
Get PDFBackgroundMagnetic resonance imaging (MRI) can personalise the site of transcranial magnetic stimulation (TMS) delivered as a course of 20 sessions for treatment-resistant depression (TRD). Facilitators and barriers to a randomised controlled trial (RCT) of MRI personalised TMS is understudied.AimQualitative analysis to explore facilitators and barriers behind RCT participants’ experience of personalised MRI-targeted TMS in people with TRD.MethodsNineteen participants from the BRIGhTMIND RCT of two forms of MRI personalised TMS, completed semi-structured interviews exploring the reasons behind the uptake and experience of TMS. The sample included fifteen participants who completed the treatment course and four who declined to proceed before randomisation. Interviews were analysed using thematic analysis, co-produced between researchers and patients and public involvement contributors.ResultsFacilitators were “hope” regarding the treatment itself, the influence of research staff, interest in a new treatment, and altruism. Barriers were concerns about their ability to commit to the trial and the nature of the TMS itself. Throughout the themes, clinicians and researchers made a difference by explaining and setting realistic expectations of the treatment and building rapport through daily patient contact.ConclusionThe study highlights the importance of understanding patients’ concepts and experiences of TMS. The provision of optimal information to patients twinned with offering TMS outside office hours and the most efficacious, acceptable regimes of TMS delivery may maximise participation (Trial registration number ISRCTN19674644, registered on 01/10/2018).Trial RegistrationTrial registration: ISRCTN19674644||http://www.isrctn.org/) registered on 01/10/2018.Trial Identifying numbers: CPMS 39297, IRAS 245025
Sexism and Feminist Conspiracy Beliefs: Hostile Sexism Moderates the Link Between Feminist Conspiracy Beliefs and Rape Myth Acceptance
Get PDFThis research examined the effect of belief in feminist conspiracy theories and sexist ideology on endorsing rape myths. Study 1 (N = 201) uncovered that the relationship between feminist conspiracy beliefs and rape myth acceptance was conditional on higher levels of hostile sexism. Study 2 (N = 552) demonstrated that for those with higher hostile sexism, exposure to feminist conspiracy theories (vs control) increased feminist conspiracy beliefs, which were then associated with rape myths. The current research suggests that the link between feminist conspiracy beliefs and rape myths could result from such beliefs upholding a hostile sexist view of women
Identifying neonatal transport research priorities: a modified Delphi consensus
Get PDFObjectives: With increasing advances in neonatal transport, a focused research strategy is required to increase the evidence base towards providing optimal care. We aimed to identify the most important neonatal transport research questions as prioritised by parents and healthcare professionals (HCPs).Design: Key stakeholders participated in a modified three-stage Delphi consensus process. Research questions were identified and submitted through two survey stages before the final priority setting workshop.Participants: Parents of babies who received neonatal care, neonatal HCPs and stakeholders.Outcome: Identify the top 10 research priorities for neonatal transport.Results: Overall, 269 survey responses from HCPs/stakeholders (n=161) and parents (n=108) were analysed from two survey rounds. Consensus was reached on 22 of 43 research priorities for the final priority setting workshop. The agreed top research priorities covered the domains of: (1) Pain assessment and management, (2) Long-term neurological outcomes, (3) Impact of transfer on birth-related brain injury, (4) Investigating risk of transport, (5) Safety restraints for infants, (6) Optimal temperature management, (7) Respiratory management and outcomes, (8) Benchmarking of important of transport measures, (9) Understanding transport environmental exposures, (10) Mental health and burden of transfer on families.Conclusion: We have identified the top research questions for neonatal transport through an extensive process actively engaging parents, HCPs and key stakeholders. Targeted funding and research resources, directed towards addressing these prioritised research areas, will inform evidence-based practices and international frameworks specific to neonatal transport, helping minimise research waste and ultimately improve outcomes for these high-risk infants and their families
Breathing space amidst the permanence of racism in the academy
Get PDFThis paper presents evidence that sheds light on both the limitations and the possibilities of race-focused staff forums that have formed across UK higher education as part of a response to equality legislation. Based on interviews conducted with thirteen staff of color across two universities, this paper foregrounds critical race theory presenting evidence that these staff forums are often performative and fail to address needed structural changes. Despite this, there is also evidence of agency among members to struggle for an anti-racist university. This paper reveals varying perceptions and meanings to these forums, highlighting a tension. On the one hand, staff recognize the performativity of these initiatives. On the other, they also often value them as spaces of respite. The paper concludes that further examination of the perspectives and situated knowledge of members of these forums can offer valuable insights that can impact the creation and implementation of such spaces
Investigation on a Class of 2D Profile Amplified Stroke Dielectric Elastomer Actuators
No full textDielectric elastomer actuators (DEAs) have been widely studied in soft robotics due to their muscle-like movements. Linear DEAs are typically tensioned using compression springs with positive stiffness or weights directly attached to the flexible film of the DEA. In this paper, a novel class of 2D profile linear DEAs (butterfly-and X-shaped linear DEAs) with compact structure is introduced, which, employing negative-stiffness mechanisms, can largely increase the stroke of the actuators. Then, a dynamic model of the proposed amplified-stroke linear DEAs (ASL-DEAs) is developed and used to predict the actuator stroke. The fabrication process of linear DEAs is presented. This, using compliant joints, 3D-printed links, and dielectric elastomer, allows for rapid and affordable production. The experimental validation of the butterfly-and X-shaped linear DEAs proved capable of increasing the stroke up to 32.7% and 24.0%, respectively, compared with the conventional design employing springs and constant weights. Finally, the dynamic model is validated against the experimental data of stroke amplitude and output force; errors smaller than 10.5% for a large stroke amplitude (60% of maximum stroke) and 10.5% on the output force are observed
Advances in euglenoid genomics: unravelling the fascinating biology of a complex clade
Get PDFEuglenids have long been studied due to their unique physiology and versatile metabolism, providing underpinnings for much of our understanding of photosynthesis and biochemistry, and a growing opportunity in biotechnology. Until recently there has been a lack of genetic studies due to their large and complex genomes, but recently new technologies have begun to unveil their genetic capabilities. Whilst much research has focused on the model organism Euglena gracilis, other members of the euglenids have now started to receive due attention. Currently only poor nuclear genome assemblies of E. gracilis and Rhabdomonas costata are available, but there are many more plastid genome sequences and an increasing number of transcriptomes. As more assemblies become available, there are great opportunities to understand the fundamental biology of these organisms and to exploit them for biotechnology
Unlocking the full potential of restorative justice: Lessons for a thicker peace in Colombia’s transitional justice framework
Get PDFThis policy brief critically examines the role of the Special Jurisdiction for Peace (JEP) in Colombia as a mechanism for restorative justice within the broader framework of transitional justice established by the 2016 Peace Agreement. The JEP’s structure and processes are assessed in relation to promoting social healing, reconciliation, and accountability for macro-criminality. The policy brief highlights the institution’s operational independence, collaborative efforts with other bodies, and the meetings between ‘accredited victims’ and ‘appearing parties’ as strengths of the JEP’s structure. Yet, the analysis also identifies the limitations of the JEP’s restorative potential, particularly in its reliance on an adversarial legal framework that may overshadow restorative aims. Drawing on theoretical frameworks, this policy brief proposes a holistic approach that encompasses three lenses—encounter, reparative, and transformative—suggesting that bridging capital between adversary’s, restitution, and the dismantling of oppressive structures are essential for achieving lasting peace. Recommendations are made at conceptual, strategic, and practical levels to enhance the JEP's engagement with communities, foster inclusive dialogue, and address systemic inequalities. Ultimately, this policy brief advocates for a reimagined model of restorative justice that empowers local actors, integrates traditional practices, and fosters long-term societal transformation in Colombia
Suppression of flow separation of a high-lift wing with active flow control
Get PDFFlow separation caused by the integration of a leading edge slat cut-out to accommodate an ultra-high bypass ratio engine reduces the maximum lift coefficient. In this study, an active flow control approach including 88 pulsed jet nozzles near the leading edge is used to control flow separation over a multi-element high-lift aerofoil. A hybrid large-eddy simulation (LES) and stress-blended eddy simulation (SBES) method is deployed to analyze flow physics and wind tunnel tests are also performed for the flow with/without control. The results show that severe flow separation is observed for the clean case by visualizing the streamlines on the airfoil's surface via numerical and experimental methods. Compared with the clean case, the stall angle is delayed by around 4°, and the maximum lift coefficient is increased by more than 15% after deploying the active flow control. Meanwhile, when the active flow control is imposed, a lift enhancement region caused by the vortex shedding downstream of the jet nozzles is formed adjacent to the leading edge, and its scale becomes larger along the spanwise direction
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