4,568 research outputs found

    A tailored psychological intervention for anxiety and depression management in people with chronic obstructive pulmonary disease: TANDEM RCT and process evaluation

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    Background: People with chronic obstructive pulmonary disease have high levels of anxiety and depression, which is associated with increased morbidity and poor uptake of effective treatments, such as pulmonary rehabilitation. Cognitive-behavioural therapy improves mental health of people with long-term conditions and could potentially increase uptake of pulmonary rehabilitation, enabling synergies that could enhance the mental health of people with chronic obstructive pulmonary disease. Aim: Our aim was to develop and evaluate the clinical effectiveness and cost effectiveness of a tailored cognitive-behavioural approach intervention, which links into, and optimises the benefits of, routine pulmonary rehabilitation. Design: We carried out a pragmatic multicentre randomised controlled trial using a 1.25 : 1 ratio (intervention : control) with a parallel process evaluation, including assessment of fidelity. Setting: Twelve NHS trusts and five Clinical Commissioning Groups in England were recruited into the study. The intervention was delivered in participant\u27s own home or at a local NHS facility, and by telephone. Participants: Between July 2017 and March 2020 we recruited adults with moderate/very severe chronic obstructive pulmonary disease and mild/moderate anxiety and/or depression, meeting eligibility criteria for assessment for pulmonary rehabilitation. Carers of participants were invited to participate. Intervention: The cognitive-behavioural approach intervention (i.e. six to eight 40- to 60-minute sessions plus telephone support throughout pulmonary rehabilitation) was delivered by 31 trained respiratory healthcare professionals to participants prior to commencing pulmonary rehabilitation. Usual care included routine pulmonary rehabilitation referral. Main outcome measures: Co-primary outcomes were Hospital Anxiety and Depression Scale - anxiety and Hospital Anxiety and Depression Scale - depression at 6 months post randomisation. Secondary outcomes at 6 and 12 months included health-related quality of life, smoking status, uptake of pulmonary rehabilitation and healthcare use. Results: We analysed results from 423 randomised participants (intervention, n = 242; control, n = 181). Forty-three carers participated. Follow-up at 6 and 12 months was 93% and 82%, respectively. Despite good fidelity for intervention delivery, mean between-group differences in Hospital Anxiety and Depression Scale at 6 months ruled out clinically important effects (Hospital Anxiety and Depression Scale - anxiety mean difference -0.60, 95% confidence interval -1.40 to 0.21; Hospital Anxiety and Depression Scale - depression mean difference -0.66, 95% confidence interval -1.39 to 0.07), with similar results at 12 months. There were no between-group differences in any of the secondary outcomes. Sensitivity analyses did not alter these conclusions. More adverse events were reported for intervention participants than for control participants, but none related to the trial. The intervention did not generate quality-of-life improvements to justify the additional cost (adjusted mean difference \ua3770.24, 95% confidence interval -\ua327.91 to \ua31568.39) to the NHS. The intervention was well received and many participants described positive affects on their quality of life. Facilitators highlighted the complexity of participants\u27 lives and considered the intervention to be of potential valuable; however, the intervention would be difficult to integrate within routine clinical services. Our well-powered trial delivered a theoretically designed intervention with good fidelity. The respiratory-experienced facilitators were trained to deliver a low-intensity cognitive-behavioural approach intervention, but high-intensity cognitive-behavioural therapy might have been more effective. Our broad inclusion criteria specified objectively assessed anxiety and/or depression, but participants were likely to favour talking therapies. Randomisation was concealed and blinding of outcome assessment was breached in only 15 participants. Conclusions: The tailored cognitive-behavioural approach intervention delivered with fidelity by trained respiratory healthcare professionals to people with chronic obstructive pulmonary disease was neither clinically effective nor cost-effective. Alternative approaches that are integrated with routine long-term condition care are needed to address the unmet, complex clinical and psychosocial needs of this group of patients. Trial registration: This trial is registered as ISRCTN59537391. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 13/146/02) and is published in full in Health Technology Assessment; Vol. 28, No. 1. See the NIHR Funding and Awards website for further award information.People with long-standing lung problems, such as chronic obstructive pulmonary disease, often also have anxiety and depression, which further reduces their quality of life. Two existing treatments could help. Pulmonary rehabilitation (a programme of exercise and education) improves both the physical and mental health of people with chronic obstructive pulmonary disease. Cognitive–behavioural therapy (a talking therapy) may reduce anxiety and depression. The TANDEM [Tailored intervention for Anxiety and Depression Management in chronic obstructive pulmonary disease (COPD)] intervention linked these two treatments by providing talking therapy based on cognitive–behavioural therapy during the waiting time following referral for pulmonary rehabilitation. The TANDEM treatment was delivered by respiratory healthcare professionals (e.g. nurses or physiotherapists) trained to deliver the talking therapy in six to eight weekly sessions. The sessions were conducted in the participant’s home (or another convenient location), with brief telephone support during the pulmonary rehabilitation. Of 423 participants recruited to the study, 242 participants received TANDEM talking therapy and 181 participants received usual care (including a referral to pulmonary rehabilitation). We measured mental health, quality of life, social life, attendance at pulmonary rehabilitation and healthcare use in both groups at 6 and 12 months. Forty-three carers joined the study and we assessed their mental well-being. We interviewed patients, carers and health professionals to find out their views and experience of the TANDEM treatment. We also examined whether or not the TANDEM treatment was good value for money. The TANDEM treatment did not improve the mental or the physical health of people with chronic obstructive pulmonary disease. In addition, the TANDEM treatment cost the NHS an extra \ua3770 per patient, which was not good value for money. The TANDEM treatment was well received, and many participants told us how it had helped them. Heath-care professionals noted how participants did not just have chronic obstructive pulmonary disease, but were coping with many physical, mental and social problems. The TANDEM intervention was not effective and, therefore, other strategies will be needed to help people with chronic obstructive pulmonary disease and mental health problems live with their condition

    Beam scanning by liquid-crystal biasing in a modified SIW structure

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    A fixed-frequency beam-scanning 1D antenna based on Liquid Crystals (LCs) is designed for application in 2D scanning with lateral alignment. The 2D array environment imposes full decoupling of adjacent 1D antennas, which often conflicts with the LC requirement of DC biasing: the proposed design accommodates both. The LC medium is placed inside a Substrate Integrated Waveguide (SIW) modified to work as a Groove Gap Waveguide, with radiating slots etched on the upper broad wall, that radiates as a Leaky-Wave Antenna (LWA). This allows effective application of the DC bias voltage needed for tuning the LCs. At the same time, the RF field remains laterally confined, enabling the possibility to lay several antennas in parallel and achieve 2D beam scanning. The design is validated by simulation employing the actual properties of a commercial LC medium

    Operatic Pasticcios in 18th-Century Europe

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    In Early Modern times, techniques of assembling, compiling and arranging pre-existing material were part of the established working methods in many arts. In the world of 18th-century opera, such practices ensured that operas could become a commercial success because the substitution or compilation of arias fitting the singer's abilities proved the best recipe for fulfilling the expectations of audiences. Known as »pasticcios« since the 18th-century, these operas have long been considered inferior patchwork. The volume collects essays that reconsider the pasticcio, contextualize it, define its preconditions, look at its material aspects and uncover its aesthetical principles

    In-situ dust mass distribution measurements from Giotto encounter with comet P/Halley.

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    On the night of the 13/14th of March 1986 the European Space Agency's Giotto spacecraft passed within 600km of the nucleus of comet P/Halley. On board the spacecraft was an impressive array of experiments designed to study all aspects of the cometary coma and provide high resolution images of the nucleus. The principle experiment designed to measure the coma dust mass distribution was called the Dust Impact Detection System (DIDSY). The design operation and performance of this experiment are considered and details are provided of post-mission recalibration, including the development of a software simulation to aid in the interpretation of the returned data. The faulty operation of one of the DIDSY sensors resulted in the use of ) the front end channels of the Particulate Impact Analyser Experiment (PIA) to provide information on particles of mass 10*19kg < m < 10-15kg. The techniques used to extract the required information and calibrate the sensor using encounter data and the inter-relationship between different operating modes is described. The analysis of impacts which caused multiple detection by two or more of the DIDSY sensors is described and the results from these multi-sensor events used to extend the measured mass range up to 10_5kg. A mass distribution representative of the coma passed through by Giotto was constructed and this is combined with a simple model to obtain the dust production rate and dust to gas ratio

    Elements of Ion Linear Accelerators, Calm in The Resonances, Other_Tales

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    The main part of this book, Elements of Linear Accelerators, outlines in Part 1 a framework for non-relativistic linear accelerator focusing and accelerating channel design, simulation, optimization and analysis where space charge is an important factor. Part 1 is the most important part of the book; grasping the framework is essential to fully understand and appreciate the elements within it, and the myriad application details of the following Parts. The treatment concentrates on all linacs, large or small, intended for high-intensity, very low beam loss, factory-type application. The Radio-Frequency-Quadrupole (RFQ) is especially developed as a representative and the most complicated linac form (from dc to bunched and accelerated beam), extending to practical design of long, high energy linacs, including space charge resonances and beam halo formation, and some challenges for future work. Also a practical method is presented for designing Alternating-Phase- Focused (APF) linacs with long sequences and high energy gain. Full open-source software is available. The following part, Calm in the Resonances and Other Tales, contains eyewitness accounts of nearly 60 years of participation in accelerator technology. (September 2023) The LINACS codes are released at no cost and, as always,with fully open-source coding. (p.2 & Ch 19.10)Comment: 652 pages. Some hundreds of figures - all images, there is no data in the figures. (September 2023) The LINACS codes are released at no cost and, as always,with fully open-source coding. (p.2 & Ch 19.10

    Worshipping at the Shrine of Wagner: Fandom, Media and Richard Wagner

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    Nineteenth-century opera composer Richard Wagner has long inspired passionate responses, with contemporary commentators often noting the cult-like reverence with which lovers approached his operas. In the years since, however, interest in Wagner’s art has not disappeared. In this dissertation, I explore the contours of modern Wagnerism using as my primary case study the Toronto Wagner Society, asking how members incorporate opera into their lives and what Wagner means to them. To do this, I employ a multimethodology of ethnography, an examination of Wagner’s art and rhetoric, and a consideration of the materiality of opera. These findings are analyzed through a dual lens of fan studies and cultural techniques, with which this dissertation makes two principal moves: first, to highlight how fandom of high culture is different in nature, not in kind to fandom of popular culture; second, to propose a networked model of fandom, one which conceptualizes fandom as a dynamic assemblage of audience, media and text. Chapter 1 opens by asking what is a fan, which I resolve through the introduction of cultural techniques, and subsequently, my networked model of fandom. I also consider how cultural techniques research might expand to include ethnography. Chapter 2 lays out the main findings of my interview. Particularly, I examine how aging intersects with reception, how fans re-enact the distinction between German and Italian opera, and the joy of opera as an explicitly performance art. Chapter 3 tackles the dual description of Wagner as both “work” and “overwhelming.” By taking seriously Theodor Adorno’s criticism, I illustrate how his music and rhetoric exert their agency onto fans. The final chapter studies the materiality of reception. Employing the metaphor of Michel Serres’ parasite, I analyze how the media which host opera shape reception through an examination of the role of the theatre, and by tracking mentions of Wagner in Toronto’s Globe newspaper in the years 1875–1876

    New materials for electrochemical energy storage: advanced lithium ion batteries and beyond

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    Durante la mia attività di ricerca, sono stato coinvolto nello sviluppo di materiali con proprietà auto-riparanti; la possibilità di riparare il "tessuto" che costituisce l'elettrodo e l'interfaccia elettrodo/elettrolita è il primo passo per migliorare l'affidabilità della batterie. Per quanto riguarda il compartimento anodico, i materiali attivi oggetto di ricerca sono stati nanocompositi a base di fosforo nero con carbonio e ossidi avanzati ad alta entropia con struttura tipo rock-salt. Successivamente, sono stati sviluppati materiali catodici innovativi per batterie agli ioni di litio con eccellente stabilità in un ampio intervallo di tensione ed elevate capacità specifiche. Infine, mi sono concentrato sul miglioramento della tecnologia delle batterie a litio metallico, realizzando un elettrolita gel polimerico potenziato tramite un separatore Janus con eccellenti prestazioni, ridotta perdita di capacità e abilità di intercettare la crescita dei dendriti. Un ulteriore miglioramento è dato dai collettori di corrente 3D in Cu come anodi avanzati, con buone capacità, ciclo di vita di oltre 300 ore e migliore sicurezza grazie alla maggiore area superficiale e a minori densità di corrente locali.During my PhD research activity, I was involved in the development of smart materials with self-healing functionalities, the possibility to repair the "tissue" that constitutes the electrode, and the electrode/electrolyte interface is the first step towards improve batteries reliability. Concerning the anodic compartment, the active materials subjected to research were black phosphorus-based nanocomposite with carbon and advanced high entropy oxides with rock-salt structure. Subsequently, innovative functional cathode materials were developed for application in lithium-ion batteries that exhibits excellent cycling stability in a wide voltage range and high specific capacities. During the last year I focused on improving lithium metal battery technology, by realizing an enhanced polymer gel electrolyte by means of a Janus separator that showed excellent electrochemical performance, reduced capacity loss and the ability to intercept dendrite growth. A further improvement were Cu-based 3D current collectors as advanced anodes. They showed good capacity, life cycle of more than 300 hours and enhanced safety due to the greater surface area as well as the decrease in local current densities

    Olivet Nazarene University Annual Catalog 2023-24

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    https://digitalcommons.olivet.edu/acaff_catalog/1095/thumbnail.jp

    1-D broadside-radiating leaky-wave antenna based on a numerically synthesized impedance surface

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    A newly-developed deterministic numerical technique for the automated design of metasurface antennas is applied here for the first time to the design of a 1-D printed Leaky-Wave Antenna (LWA) for broadside radiation. The surface impedance synthesis process does not require any a priori knowledge on the impedance pattern, and starts from a mask constraint on the desired far-field and practical bounds on the unit cell impedance values. The designed reactance surface for broadside radiation exhibits a non conventional patterning; this highlights the merit of using an automated design process for a design well known to be challenging for analytical methods. The antenna is physically implemented with an array of metal strips with varying gap widths and simulation results show very good agreement with the predicted performance
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