The GREAT triggerless total data readout method

Recoil decay tagging (RDT) is a very powerful method for the spectroscopy of exotic nuclei. RDT is a delayed coincidence technique between detectors usually at the target position and at the focal plane of a spectrometer. Such measurements are often limited by dead time. This paper describes a novel triggerless data acquisition method, which is being developed for the Gamma Recoil Electron Alpha Tagging (GREAT) spectrometer, that overcomes this limitation by virtually eliminating dead time. Our solution is a total data readout (TDR) method where all channels run independently and are associated in software to reconstruct events. The TDR method allows all the data from both target position and focal plane to be collected with practically no dead-time losses. Each data word is associated with a timestamp generated from a global 100-MHz clock. Events are then reconstructed in real time in the event builder using temporal and spatial associations defined by the physics of the experimen

Large scale shell model calculations for odd-odd 58−62^{58-62}Mn isotopes

Large scale shell model calculations have been carried out for odd-odd $^{58-62}$Mn isotopes in two different model spaces. First set of calculations have been carried out in full $\it{fp}$ shell valence space with two recently derived $\it{fp}$ shell interactions namely GXPF1A and KB3G treating $^{40}$Ca as core. The second set of calculations have been performed in ${fpg_{9/2}}$ valence space with the $fpg$ interaction treating $^{48}$Ca as core and imposing a truncation by allowing up to a total of six particle excitations from the 0f$_{7/2}$ orbital to the upper $\it{fp}$ orbitals for protons and from the upper $\it{fp}$ orbitals to the 0g$_{9/2}$ orbital for neutron. For low-lying states in $^{58}$Mn, the KB3G and GXPF1A both predicts good results and for $^{60}$Mn, KB3G is much better than GXPF1A. For negative parity and high-spin positive parity states in both isotopes $fpg$ interaction is required. Experimental data on $^{62}$Mn is sparse and therefore it is not possible to make any definite conclusions. More experimental data on negative parity states is needed to ascertain the importance of 0g$_{9/2}$ and higher orbitals in neutron rich Mn isotopes.Comment: 5 pages, 4 figures, Submitted to Eur. Phys. J.

Gender differences in experiences and expectations of haemodialysis in a frail and seriously unwell patient population

Introduction Surprisingly few studies have explored the experiences of seriously unwell people with kidney disease on haemodialysis therapy: we conducted a mixed-methods study to investigate gender differences in illness experience, symptom burden, treatment considerations or expectations in this cohort. Methods Seriously unwell people on haemodialysis (1-year mortality risk of >20%) at three hospital-based units were invited to take part in a structured interview or to complete the same questions independently via a questionnaire. 54 people took part (36 males, 18 females); data analysis was undertaken using a thematic approach. Results ‘Desire to keep living’ is the most important and basic thought process when starting dialysis. Fear also predominates influencing risk assessment and decision-making. Once fear is managed, there are physical, social, practical and emotional issues to rationalise, but choice only seems possible if shared decision-making is part of the consultation. Gender differences were seen in perceived hopes and expectations of treatment. Males were more likely to prioritise achievement of physical goals, with females prioritising a wish to feel well. Both genders reported significantly higher symptom scores than their healthcare provider perceived, however this difference was more marked in females. Dialysis regret existed in >50% of participants and 6/54 (11%) stated that they would have chosen no dialysis at all. Females were more likely to report feeling depressed (P=0.001). Conclusion Different genders approach treatment decisions and prioritise treatment expectations differently. Recognising this will allow personalised care plans to be developed and improve the experiences of seriously unwell people with kidney disease

Gender Differences in Experiences and Expectations of Hemodialysis in a Frail and Seriously Unwell Patient Population.

Surprisingly few studies have explored the experiences of seriously unwell people with kidney disease on hemodialysis therapy: we conducted a mixed-methods study to investigate gender differences in illness experience, symptom burden, treatment considerations or expectations in this cohort. Seriously unwell people on hemodialysis (1-year mortality risk of >20%) at 3 hospital-based units were invited to take part in a structured interview or to complete the same questions independently via a questionnaire. A total of 54 people took part (36 males, 18 females); data analysis was undertaken using a thematic approach. "Desire to keep living" is the most important and basic thought process when starting dialysis. Fear also predominates influencing risk assessment and decision-making. Once fear is managed, there are physical, social, practical and emotional issues to rationalize, but choice only seems possible if shared decision-making is part of the consultation.Gender differences were seen in perceived hopes and expectations of treatment. Males were more likely to prioritize achievement of physical goals, with females prioritizing a wish to feel well. Both genders reported significantly higher symptom scores than their health care provider perceived, however this difference was more marked in females. Dialysis regret existed in >50% of participants and 6 out of 54 (11%) stated that they would have chosen no dialysis at all. Females were more likely to report feeling depressed (  = 0.001). Different genders approach treatment decisions and prioritize treatment expectations differently. Recognizing this will allow personalized care plans to be developed and improve the experiences of seriously unwell people with kidney disease. [Abstract copyright: © 2022 International Society of Nephrology. Published by Elsevier Inc.

Methodological challenges in online trials: an update and insights from the REACT trial

There has been a growth in the number of web-based trials of web-based interventions, adding to an increasing evidence base for their feasibility and effectiveness. However, there are challenges associated with such trials, which researchers must address. This discussion paper follows the structure of the Down Your Drink trial methodology paper, providing an update from the literature for each key trial parameter (recruitment, registration eligibility checks, consent and participant withdrawal, randomization, engagement with a web-based intervention, retention, data quality and analysis, spamming, cybersquatting, patient and public involvement, and risk management and adverse events), along with our own recommendations based on designing the Relatives Education and Coping Toolkit randomized controlled trial for relatives of people with psychosis or bipolar disorder. The key recommendations outlined here are relevant for future web-based and hybrid trials and studies using iterative development and test models such as the Accelerated Creation-to-Sustainment model, both within general health research and specifically within mental health research for relatives. Researchers should continue to share lessons learned from conducting web-based trials of web-based interventions to benefit future studies

IMPlementation of an Online Relatives’ Toolkit for Psychosis or Bipolar (IMPART Study): Iterative Multiple Case Study to Identify Key Factors Impacting on Staff Uptake and Use

Background: Despite the potential of digital health interventions to improve the delivery of psychoeducation to people with mental health problems and their relatives, and substantial investment in their development, there is little evidence of successful implementation into clinical practice. We report the first implementation study of a digital health intervention: Relatives Education And Coping Toolkit (REACT), into routine mental healthcare. Our main aim was to identify critical factors affecting staff uptake and use of this online self-management tool for relatives of people with psychosis or bipolar. Methods: A mixed-methods, theory-driven (Normalisation Process Theory), iterative multiple case study approach using qualitative analysis of interviews with staff and quantitative reporting of uptake. Carer researchers were part of the research team. Results: In all, 281 staff and 159 relatives from Early Intervention teams across six catchment areas (cases) in England registered on REACT; 129 staff took part in qualitative interviews. Staff were positive about REACT helping services improve support and meet clinical targets. Implementation was hindered by: high staff caseloads and difficulties prioritising carers; perception of REACT implementation as research; technical difficulties using REACT; poor interoperability with trust computer systems and care pathways; lack of access to mobile technology and training; restricted forum populations; staff fears of risk, online trolling, and replacement by technology; and uncertainty around REACT’s long-term availability

Spectroscopy of the N=Z-2 nucleus Cr46 and mirror energy differences

Excited states in Cr46 were sought using the C12(Ar36,2n) reaction. Gamma rays were detected with the Gammasphere array, and the Z value of the reaction products was determined with an ionization chamber located at the focal plane of the Fragment Mass Analyzer. In addition to the ground-state band observed up to IÏ€=10+ (tentatively 12+), five states are proposed to belong to the 3- band. The mirror energy differences with the analog states in Ti46 present a pronounced staggering effect between the odd and even spin members that is reproduced well by shell-model calculations incorporating the different Coulomb contributions, monopole, multipole, and single-particle effects together with an isospin-nonconserving interaction that accounts for the so-called J=2 anomaly. Dramatically different E1 decay patterns for members of the 3- band between the Cr46 and Ti46 mirrors are also observed

An online supported self-management toolkit for relatives of people with psychosis or bipolar experiences: the IMPART multiple case study

Background Digital health interventions have the potential to improve the delivery of psychoeducation to people with mental health problems and their relatives. Despite substantial investment in the development of digital health interventions, successful implementation into routine clinical practice is rare. Objectives Use the implementation of the Relatives’ Education And Coping Toolkit (REACT) for psychosis/bipolar disorder to identify critical factors affecting uptake and use, and develop an implementation plan to support the delivery of REACT. Design This was an implementation study using a mixed-methods, theory-driven, multiple case study approach. A study-specific implementation theory for REACT based on normalisation process theory was developed and tested, and iterations of an implementation plan to address the key factors affecting implementation were developed. Setting Early-intervention teams in six NHS mental health trusts in England (three in the north and three in the south). Participants In total, 281 staff accounts and 159 relatives’ accounts were created, 129 staff and 23 relatives took part in qualitative interviews about their experiences, and 132 relatives provided demographic data, 56 provided baseline data, 21 provided data at 12 weeks’ follow-up and 20 provided data at 24 weeks’ follow-up. Interventions REACT is an online supported self-management toolkit, offering 12 evidence-based psychoeducation modules and support via a forum, and a confidential direct messaging service for relatives of people with psychosis or bipolar disorder. The implementation intervention was developed with staff and iteratively adapted to address identified barriers. Adaptations included modifications to the toolkit and how it was delivered by teams. Main outcome measures The main outcome was factors affecting implementation of REACT, assessed primarily through in-depth interviews with staff and relatives. We also assessed quantitative measures of delivery (staff accounts and relatives’ invitations), use of REACT (relatives’ logins and time spent on the website) and the impact of REACT [relatives’ distress (General Health Questionnaire-28), and carer well-being and support (Carer Well-being and Support Scale questionnaire)]. Results Staff and relatives were generally positive about the content of REACT, seeing it as a valuable resource that could help services improve support and meet clinical targets, but only within a comprehensive service that included face-to-face support, and with some additional content. Barriers to implementation included high staff caseloads and difficulties with prioritising supporting relatives; technical difficulties of using REACT; poor interoperability with trust information technology systems and care pathways; lack of access to mobile technology and information technology training; restricted forum populations leading to low levels of use; staff fears of managing risk, online trolling, or replacement by technology; and uncertainty around REACT’s long-term availability. There was no evidence that REACT would reduce staff time supporting relatives (which was already very low), and might increase it by facilitating communication. In all, 281 staff accounts were created, but only 57 staff sent relatives invitations. In total, 355 relatives’ invitations were sent to 310 unique relatives, leading to the creation of 159 relatives’ accounts. The mean number of logins for relatives was 3.78 (standard deviation 4.43), but with wide variation from 0 to 31 (median 2, interquartile range 1–8). The mean total time spent on the website was 40.6 minutes (standard deviation 54.54 minutes), with a range of 0–298 minutes (median 20.1 minutes, interquartile range 4.9–57.5 minutes). There was a pattern of declining mean scores for distress, social dysfunction, depression, anxiety and insomnia, and increases in relatives’ well-being and eHealth literacy, but no changes were statistically significant. Conclusions Digital health interventions, such as REACT, should be iteratively developed, evaluated, adapted and implemented, with staff and service user input, as part of a long-term strategy to develop integrated technology-enabled services. Implementation strategies must instil a sense of ownership for staff and ensure that they have adequate training, risk protocols and resources to deliver the technology. Cost-effectiveness and impact on workload and inequalities in accessing health care need further testing, along with the generalisability of our findings to other digital health interventions. Limitations REACT was offered by the same team running the IMPlementation of A Relatives’ Toolkit (IMPART) study, and was perceived by staff and relatives as a time-limited research study rather than ongoing clinical service, which affected engagement. Access to observational data was limited. Trial registration Current Controlled Trials ISRCTN16267685. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 37. See the NIHR Journals Library website for further project information