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Developing practice research in mental health: experiences in adult recovery and specialist child and adolescent settings
No full textPurpose – A long-standing agenda in the field of health is developing practice-based evidence, with research driven by applied research questions and led by practitioner experts. The purpose of this paper is to contribute to a growing literature addressing this type of practice research in mental health by presenting the authors’ experiences embedding practice-based evaluation and research activity in an English NHS context. Design/methodology/approach – Efforts in two multidisciplinary settings in a single mental health trust are detailed: a specialist child and adolescent mental health service team and an adult rehabilitation and recovery pathway. This work, developed to inform the meaningful integration of research-based knowledge with care delivery, is described by reference to experiences over a four-year period in which research activity was particularly productive in output compared to other periods. Findings – A reflective account is provided in which conditions that animate practice research activity are considered, particularly collaboration with wider professional networks, including academic colleagues, and the involvement of junior and trainee clinicians. Originality/value – The reflections presented in the paper provide insights into the “doing” of practice research activity in NHS mental health service provision and virtuous cycles of activity to embed this activity in a local context. Though based on experiences from one specific trust, this paper may have the implication of illustrating a prototype for embedding practice research in other settings across similar provider trusts in the UK
Cost-effectiveness of risk-stratified blood test monitoring strategies for adults with inflammatory conditions
No full textObjectivesTo assess the cost-effectiveness of extending the interval between monitoring blood tests beyond 3-monthly intervals during established treatment of adults prescribed low-dose weekly MTX (≤25 mg/week), LEF or SSZ.MethodsPublished prognostic models that estimated the risk of stopping treatment due to abnormal blood test results during 5 years of established treatment were incorporated into a cost-effectiveness model. The consequences of having an extended monitoring period and a delay in stopping treatment was estimated by clinicians as the probability of someone having 1 of the 11 adverse events (AEs) that could be avoided with monitoring. The clinicians erred towards overestimating the risks. The costs and quality-adjusted life year loss of the AEs were sourced from recent National Institute of Health and Care Excellence appraisals or from targeted searches. Incremental net monetary benefit (iNMB) of 6-, 12- and 24-monthly monitoring, compared with three monthly monitoring was calculated for each drug conditional on risk decile.ResultsOur analyses show that extending the duration between monitoring appointments is cost-effective in all scenarios, even in a pessimistic analysis, where the risks of all AEs were tripled, and the costs of some AEs were increased. In the base case, biennial monitoring was often most cost-effective although the iNMB between annual and biennial monitoring was often small.ConclusionExtending the interval between monitoring blood tests appears to be cost-effective with annual monitoring producing consistently good results regardless of assumptions related to risks of AEs, risk decile or treatment
Bandwidth characteristics optimisation and matching for surface texture measurement of ultra-precision diamond turned structured surfaces
Get PDFUltra-precision diamond turning facilitates flexible fabrication of functional structured surfaces with nanometric surface texture. However, due to its complex multi-scale generation mechanism, optimisation and matching of bandwidth characteristics are still challenging for surface texture measurement. In this work, simulation analysis of single-/dual-scale sine waves was first designed to reveal and optimise bandwidth characteristics for surface texture measurement. Next, the cumulative power spectral density (CPSD) scale threshold method at 90% was proposed for bandwidth matching. Next, a series of ultra-precision machining experiments were conducted on end-face turning of polycrystalline aluminium and oxygen-free copper, as well as slow-tool-servo turning of multi-scale micro-structured surfaces. Finally, ultra-precision surface measurements at various bandwidths were carried out with two different white-light interferometers (WLIs). Surface texture characterisation was performed by height parameters (Sq and Sz) according to ISO 25178-2. The results indicated that the experiments were consistent with the simulations for optimising the bandwidth characteristics of surface texture measurement. In addition, bandwidth characteristics matching for multi-scale micro-structured surfaces verified the proposed CPSD scale threshold method. Under the scale limitation by zero-order Gaussian regression filter, the relative deviations of scale and surface texture parameters were less than 5% and 6%, respectively, for the two WLIs used in this work. From the perspective of surface texture metrology, this work provides guidance on bandwidth characteristics optimisation and matching for ultra-precision diamond turning
Chronic Kidney Disease Progression Mechanisms: Why They Matter in an Era of Novel Kidney Protective Therapies
Get PDFResearch over several decades has identified multiple factors that contribute to a complex pathway of mechanisms that drive the progression of chronic kidney disease (CKD) across all etiologies. These include glomerular hypertension and hyperfiltration, proteinuria and tubulointerstitial fibrosis. These endeavours identified multiple therapeutic targets for achieving kidney protection, starting with Angiotensin II, which led to the development of renin-angiotensin aldosterone system inhibitors as the first effective kidney protective therapies. Following a long period of stagnation, several additional kidney protective drug classes have been developed including sodium glucose cotransporter 2 inhibitors, non-steroidal mineralocorticoid antagonists and glucagon-like peptide-1 receptor agonists. The effects of all of these drugs can readily be understood within the framework of previously described CKD progression mechanisms. The development of additional novel kidney protective drug classes has been informed by our understanding of progression mechanisms and include endothelin receptor antagonists, soluble guanylate cyclase stimulators or activators and aldosterone synthase inhibitors. This review of novel therapies in the light of CKD progression mechanisms highlights the importance of ongoing research to identify new therapeutic targets as we seek to achieve the complete arrest and even reversal of CKD progression
Neural activations and representations during episodic versus semantic memory retrieval
Get PDFAlthough the distinction between episodic and semantic memory is supported by numerous neuropsychological studies, neuroimaging data have shown considerable overlap between regions that are activated during semantic and episodic remembering. This might indicate similar or shared mechanisms but might also result from inadequate task designs or poor functional magnetic resonance imaging signal coverage. Here we compared neural activations and representations associated with successful retrieval of episodic and semantic memories, using tasks that are more closely matched. A total of n = 40 participants recalled pairings between logos and brand names, where the pairings corresponded to real-world knowledge (semantic task) or were learned in an initial study phase (episodic task). Neither a priori-defined networks nor clusters generally activated by our task provided evidence for any difference between successful semantic and episodic retrieval, with the Bayes factor for the a priori networks supporting the null hypothesis of no difference. Protocol registration The Stage 1 protocol for this Registered Report was accepted in principle on 15 September 2021. The protocol, as accepted by the journal, can be found at https://osf.io/dm47y/
Dicta Domini Rectoris: Najraniji troškovi dubrovačkoga Kneževa dvora kao glazbenopovijesni izvor (1543. – 1589.) The Earliest Expenses of Ragusan Rector’s Palace as a Source for Music History (1543-1589)
Get PDFCroatian State Archive in Dubrovnik keeps a series of account books of the Rector’s Palace (HR-DADU-29, Dicta Domini Rectoris – Detta) that contain expenses of the Palace from 1543 to 1808. The books track all ongoing costs of the Palace, including soldier payments, foodstuff, and salt, but also alms for monasteries, Masses, and extraordinary payments to musicians. The plethora of latter makes the account books a valuable source for the history of Croatian music, but we lack their detailed and systematic analysis. Based on the entries from the earliest account books, through a deep reading and a quantitative analysis supported by the methodology of auditory history, this article contains an analysis of Ragusan auditory environment and performance practice. The analysis is based on the earliest records found in four account books that cover the period from 1543 to 1589, and uses other archival and secondary sources in the contextualisation of sound events. The detailed analysis uncovered the densest layer that includes sung Masses, followed by a smaller layer of instrumental music. The costs of sung Masses reveal a clear weekly pulse with Friday and Saturday Masses, a monthly and annual rhythm with temporal and sanctoral sung Masses, and temporary with votive ad hoc Masses. Although rarer, payments to the civic ensemble (piffari, musici di Pallazzo) map a ceremonially charged layer. The musicians performed before the Rector’s loggia on state holidays, accompanied processions, and include a single appearance by three Ottoman players. The 927 entries document how music and sound were woven into Ragusan political and devotional practice, forming an audible counterpart to the Republic’s visual representation. The regular entries confirm a stable corpus of clerics able to sing, and a carefully maintained civic band, both underwritten directly from the Rector’s account. Finally, the study demonstrates that account books can be read as sonic artefacts: interrogated through the lens of auditory history, the expenses uncover urban auditory experiences and open new directions for Croatian and Adriatic music and sound historiography
A △-Source DC Circuit Breaker for Microgrid Protection
Get PDFConventional Z-source type circuit breakers exhibit inherent drawbacks such as such as non-common ground, significant source-side fault currents, and a narrow autonomous breaking range causing misoperation. To address these issues, this paper proposes a novel bidirectional △-source circuit breaker topology. The △-source circuit breaker utilizes a three winding coupled inductor, which can generate a higher coupled current at the instant of a short-circuit, thereby achieving a faster turn-off speed. Moreover, △-source circuit breaker has a special topology structure that can flexibly reconfigure the circuit breaker structure through the opening of any winding, enabling more adaptable adjustment of its autonomous breaking range. Additionally, this paper analyzes the operational principle of the circuit breaker, develops a stage-by-stage model, and establishes a model for defining its autonomous breaking range. Finally, through theoretical analysis, comparative studies, and experimental validation, this paper verifies the △-source circuit breaker's ability to achieve microsecond-level fault interruption and bidirectional breaking performance, and demonstrates the accuracy of the model for its autonomous breaking range
Influence of film formation kinetics on the dispersion of colloidal quantum dots in organic small molecule matrices
Get PDFImproving the dispersion of colloidal quantum dots (QDs) within organic semiconductor (OSC) matrices remains critical for advancing hybrid nanocomposite optoelectronic technologies. This study investigates how film-deposition kinetics influence the morphology of TIPS-tetracene (TIPS-Tc):PbS QD blends, comparing spin-coating and blade coating for QDs ligated with either native oleic acid (OA) or a matched carboxylic acid functionalised tetracene analogue (TET-CA). Films spun-cast at low spin speeds form highly crystalline TIPS-Tc domains with highly aggregated QDs. Increased spin speed induces a deeper solvent quench, driving rapid TIPS-Tc nucleation while kinetically arresting QD diffusion, which improves QD dispersion within the crystalline matrix. TIPS-Tc:PbS-OA blends typically exhibit poor QD dispersibility due to poor matching between the OA ligands and the TIPS-Tc matrix. This work demonstrates that through employing high spin speeds QD dispersibilities may be significantly enhanced, even for PbS-OA, a significant step demonstrating that QD-OSC surface chemistries may not have to be fully matched to attain desired, well-dispersed morphologies. In contrast, blade-coating proceeds under slower solvent removal, resulting in weakly crystalline TIPS-Tc and extensive QD aggregation due to extended diffusion and delayed nucleation. These findings reveal the critical role of processing kinetics in directing OSC-QD self-assembly, essential for the optimisation of nanocomposite morphologies for next-generation optoelectronic devices
Sustainable School Leadership: Final Report
Get PDFThis report presents findings from the Sustainable School Leadership project, a three-year mixed methods study which explored the training, supply, retention, and wider sustainability of senior school leadership across England, Northern Ireland and Scotland. The ESRC-funded research addressed two questions: 1. How does each nation recruit, train, and retain school leaders, particularly headteachers? 2. How well do these approaches account for individual, local, and systemic needs, including the sustainability of leadership supply, diversity, equity, quality and fitness for the future? The study examined these questions through two interconnected lenses: i) The sustainability of leadership (i.e. supply and succession planning) ii) Leadership for sustainability (i.e. meeting present needs without compromising future needs). The study included five main strands: 1) Evidence review - reviewed 159 articles, 67 for England, 32 for Northern Ireland, 51 for Scotland, and 9 for UK overall2) Expert interviews - interviewed 17 international and UK experts 3) Secondary data - analysis of workforce census data in England and Scotland and public statistics in Northern Ireland 4) Locality case studies - 132 interviewees across 7 localities (3 in England, 2 each in Northern Ireland and Scotland) 5) Survey – 1623 respondents from across the UK. The report outlines an original conceptual framework for sustainable leadership, comprising four overlapping 'petals': leadership, identity, place and an ethic of education and care.The report sets out six UK-wide themes: 1. The nature of school leadership is widely seen to have changed in recent years – COVID as a hinge point 2. Schools and leaders are often working beyond their ‘education’ remit – limited time for instructional leadership - an ethic of education and care 3. It’s not a pipeline crisis (yet) – it’s a sustainability crisis4. Diversity – a problem that no-one really owns 5. Preparing for headship – the importance of developmental experience 6. One-size-fits-all policy does not fit all – place & the need for local solutions
Similar Outcomes for Fixation of Undisplaced Intracapsular Hip Fractures with Either Cannulated Screws or Dynamic Hip Screws in 255 Patients: A Comparison of Propensity-Matched Groups
Get PDFPurpose: Internal fixation of undisplaced intracapsular hip fractures is typically achieved using either cannulated screws (CS) or a 2-hole dynamic hip screw (DHS). However, there is a lack of consensus on which of these is more effective clinically. Whilst several biomechanical analyses of cadaveric hips show a higher construct stability of DHS fixation, there is a paucity of large clinical studies investigating patient outcomes.Materials and Methods: Data from 2,705 patients at a single institution, including 322 internal fixations, were analysed retrospectively. Propensity scores were calculated to mitigate for the impact of covariates such as age, sex, Charlson comorbidity index and Nottingham Hip Fracture Score, producing an eligible group of 255 patients.Results: The CS group included 204 patients (mean age, 82.5±7.5 years; female, 90.7%), the DHS group included 51 patients (mean age, 82.4±8.0 years; female, 90.2%). There were no differences between groups after propensity matching. There were no significant differences in outcomes between CS and DHS groups for reoperation rate (CS 5.9% vs. DHS 5.9%, P>0.999), death 0.999), length of stay (CS 11.5 days vs. DHS 14.0 days, P=0.294) and hours to surgery (CS 31:03 hours vs. DHS 29:23 hours, P=0.618). However, operation time was significantly shorter for CS (CS 39.0 minutes vs. DHS 44.0 minutes, P=0.013), an 11% reduction.Conclusion: There is no difference in clinical outcomes between CS and DHS fixation of intracapsular hip fractures. However, in this cohort the operating time was approximately 5 minutes shorter in CS fixation
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