The development of a theory-based intervention to promote appropriate disclosure of a diagnosis of dementia

Background: The development and description of interventions to change professional practice are often limited by the lack of an explicit theoretical and empirical basis. We set out to develop an intervention to promote appropriate disclosure of a diagnosis of dementia based on theoretical and empirical work. Methods: We identified three key disclosure behaviours: finding out what the patient already knows or suspects about their diagnosis; using the actual words 'dementia' or 'Alzheimer's disease' when talking to the patient; and exploring what the diagnosis means to the patient. We conducted a questionnaire survey of older peoples' mental health teams (MHTs) based upon theoretical constructs from the Theory of Planned Behaviour (TPB) and Social Cognitive Theory (SCT) and used the findings to identify factors that predicted mental health professionals' intentions to perform each behaviour. We selected behaviour change techniques likely to alter these factors. Results: The change techniques selected were: persuasive communication to target subjective norm; behavioural modelling and graded tasks to target self-efficacy; persuasive communication to target attitude towards the use of explicit terminology when talking to the patient; and behavioural modelling by MHTs to target perceived behavioural control for finding out what the patient already knows or suspects and exploring what the diagnosis means to the patient. We operationalised these behaviour change techniques using an interactive 'pen and paper' intervention designed to increase intentions to perform the three target behaviours. Conclusion : It is feasible to develop an intervention to change professional behaviour based upon theoretical models, empirical data and evidence based behaviour change techniques. The next step is to evaluate the effect of such an intervention on behavioural intention. We argue that this approach to development and reporting of interventions will contribute to the science of implementation by providing replicable interventions that illuminate the principles and processes underlying change.This project is funded by UK Medical Research Council, Grant reference number G0300999. Jeremy Grimshaw holds a Canada Research Chair in Health Knowledge Transfer and Uptake. Jill Francis is funded by the Chief Scientist Office of the Scottish Government Health Directorate. The views expressed in this study are those of the authors

Improving the delivery of care for patients with diabetes through understanding optimised team work and organisation in primary care

Peer reviewedPublisher PD

Ethical issues in implementation research: a discussion of the problems in achieving informed consent

Background: Improved quality of care is a policy objective of health care systems around the world. Implementation research is the scientific study of methods to promote the systematic uptake of clinical research findings into routine clinical practice, and hence to reduce inappropriate care. It includes the study of influences on healthcare professionals' behaviour and methods to enable them to use research findings more effectively. Cluster randomized trials represent the optimal design for evaluating the effectiveness of implementation strategies. Various codes of medical ethics, such as the Nuremberg Code and the Declaration of Helsinki inform medical research, but their relevance to cluster randomised trials in implementation research is unclear. This paper discusses the applicability of various ethical codes to obtaining consent in cluster trials in implementation research. Discussion: The appropriate application of biomedical codes to implementation research is not obvious. Discussion of the nature and practice of informed consent in implementation research cluster trials must consider the levels at which consent can be sought, and for what purpose it can be sought. The level at which an intervention is delivered can render the idea of patient level consent meaningless. Careful consideration of the ownership of information, and rights of access to and exploitation of data is required. For health care professionals and organizations, there is a balance between clinical freedom and responsibility to participate in research. Summary: While ethical justification for clinical trials relies heavily on individual consent, for implementation research aspects of distributive justice, economics, and political philosophy underlie the debate. Societies may need to trade off decisions on the choice between individualized consent and valid implementation research. We suggest that social sciences codes could usefully inform the consideration of implementation research by members of Research Ethics Committees

Stability of Nonlinear Control Systems by the Second Method of Liapunov

This report investigates the stability of autonomous closed-loop control systems containing nonlinear elements. An n-th order nonlinear autonomous system is described by a set of n first order differential equations of the type dxi/dt=xi(x1, x2, …xn) i=1,2,…n. Liapunov\u27s second (direct) method is used in the stability analysis of such systems. This method enables one to prove that a system is stable (or unstable) if a function V=V (x1, x2, … xn) can be found which, together with its time derivative, satisfies the requirements of Liapunov\u27s stability (or instability) theorems. At the present time, there are no generally applicable straight forward procedures available for constructing these Liapunov\u27s functions. Several Liapunov\u27s functions, applicable to systems described in the canonic form of differential equations, have been reported in the literature. In this report, it is shown that any autonomous closed-loop system containing a single nonlinear element can be described by canonic differential equations. The stability criteria derived from the Liapunov\u27s functions for canonic systems give sufficient and not necessary conditions for stability. It is known that these criteria reject many systems which are actually stable. The reasons why stable systems are sometimes rejected by these simplified stability criteria are investigated in the report. It is found that a closed-loop system will always be rejected by these simplified stabi1ity criteria if the root locus of the transfer function G(s), representing the linear portion of the system, is not confined to the left-half of the s-plane for all positive values of the loop gain. A pole-shifting technique and a zero-shifting technique, extending -the applicability of the simplified stability criteria to systems that are stable for sufficiently high and/or sufficiently low values of the loop gain, are proposed in this report. New simplified stability criteria have been developed which incorporate the changes in the canonic form of differential equations caused by the application of the zero-shifting technique. Other methods of constructing Liapunov\u27s functions for nonlinear control systems are presented in Chapter III, These include the work of Pliss, Aizerman and Krasovski. Numerous other procedures, which have been reported in literature, apply to only very special cases of automatic control systems. No attempt has been made to account for all of these special cases and the presentation of methods of constructing Liapunov’s functions is limited to only those which are more generally applicable. A pseudo-canonic transformation has been developed which enables one to find stability criteria of canonic systems without the use of complex variables. The results of this research indicate that the second method of Liapunov is a very powerfuI tool of exact stability analysis of nonlinear systems. Additional research, especially in the direction of the methods of construction of Liapunov’s functions, will not only yield new analysis and synthesis procedures, but also will aid in arriving at a set of meaningful performance specifications for nonlinear control systems

Specification and Data Presentation in Linear Control Systems-Part Two

This is the second part of a 2 volume report on the specification and data presentation in linear control systems. This volume deals with Sample Data Systems, Linear Time Variable Parameter Systems, and Performance Indices, which are respectively Chapter II, III, and IV of the volume. Since these subjects are somewhat unrelated, a separate abstract is given at the beginning of each chapter, with the exception of the introductory Chapter I. The separate chapter abstracts are repeated here for the convenience of the reader. Abstract - Linear Sampled Data Control Systems The specifications recommended, for use with sampled data control systems are those recommended for linear, continuous systems [1]. These specifications must be supplemented, as is dictated by the requirements of a particular system, by compatibility considerations that are detailed in the following sections. Abstract - The Specification of Linear Time Variable Parameter Systems Linear time variable parameter (LTVP) systems are defined and subdivided into those systems with fast or slow variations and/or large or small variations. The methods of analysis of such systems are reviewed, and the following recommendations are made. Specifications 1) Time Domain Specifications (a) LTVP systems with fast variation of parameters. Simulated unfrozen system step function responses should all lie within a prescribed envelope. Whenever possible, the actual system response should be obtained. (b) LTVP systems with slow variation of parameters. Simulated or actual frozen or unfrozen system step function responses should all lie within a prescribed envelope. 2) Frequency Domain Specifications (a) LTVP system with fast variation of parameters. Frequency domain specifications are not recommended. (b) LTFP system with slow variation of parameters. The family of frequency response curves of the system frozen at different instants should all lie within a predetermined envelope. Data Presentation It is recommended that the region of variation of closed loop poles of the frozen system be exhibited on the complex plane. Thus, for example, if the only varying parameter is an open loop gain, then the region of variation of the closed loop poles will correspond to the root loci over the total range of variation of gain. It is also recommended that a family of Nyquist diagrams corresponding to the system frozen at different instants be displayed in the case of system with slow variations of parameters. Abstract - Performance Index This study was undertaken to determine whether or not Performance Indices should be used to evaluate and specify control systems* It is recommended that they not be used at this time by the Air Force for the stated purpose. A performance index is defined and detailed discussions are presented for the various performance indices. Analytical methods for evaluating performance indices are presented

Inadequate reporting of research ethics review and informed consent in cluster randomized trials : review of random sample of published trials

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How to humiliate and shame: A reporter's guide to the power of the mugshot

This is an Author's Accepted Manuscript of an article published in Social Semiotics, 24(1), 56-87, 2014, copyright Taylor & Francis, available online at: http://www.tandfonline.com/The judicial photograph – the “mugshot” – is a ubiquitous and instantly recognisable form, appearing in the news media, on the internet, on book covers, law enforcement noticeboards and in many other mediums. This essay attempts to situate the mugshot in a historical and theoretical context to explain the explicit and implicit meaning of the genre as it has developed, focussing in particular on their use in the UK media in late modernity. The analysis is based on the author's reflexive practice as a journalist covering crime in the national news media for 30 years and who has used mugshots to illustrate stories for their explicit and specific content. The author argues that the visual limitations of the standardised “head and shoulders” format of the mugshot make it a robust subject for analysing the changing meaning of images over time. With little variation in the image format, arguments for certain accreted layers of signification are easier to make. Within a few years of the first appearance of the mugshot form in the mid-19th century, it was adopted and adapted as a research tool by scientists and criminologists. While the positivist scientists claimed empirical objectivity we can now see that mugshots played a part in the construction of subjective notions of “the other”, “the lesser” or “sub-human” on the grounds of class, race and religion. These dehumanising ideas later informed the theorists and bureaucrats of National Socialist ideology from the 1920s to 1940s. The author concludes that once again the mugshot has become, in certain parts of the media, a signifier widely used to exclude or deride certain groups. In late modernity, the part of the media that most use mugshots – the tabloid press and increasingly tabloid TV – is part of a neo-liberal process that, in a conscious commercial appeal to the paying audience, seeks to separate rather than unify wider society

Tunable Oscillations in the Purkinje Neuron

In this paper, we study the dynamics of slow oscillations in Purkinje neurons in vitro, and derive a strong association with a forced parametric oscillator model. We demonstrate the precise rhythmicity of the oscillations in Purkinje neurons, as well as a dynamic tunability of this oscillation using a photo-switchable compound. We show that this slow oscillation can be induced in every Purkinje neuron, having periods ranging between 10-25 seconds. Starting from a Hodgkin-Huxley model, we also demonstrate that this oscillation can be externally modulated, and that the neurons will return to their intrinsic firing frequency after the forced oscillation is concluded. These results signify an additional functional role of tunable oscillations within the cerebellum, as well as a dynamic control of a time scale in the brain in the range of seconds.Comment: 12 pages, 5 figure

Non-destructive evaluation of cement-based materials from pressure-stimulated electrical emission - Preliminary results

This is the post-print version of the final paper published in Construction and Building Materials. The published article is available from the link below. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. Copyright @ 2010 Elsevier B.V.This paper introduces the possibility of in situ assessment of loading and remaining strength in concrete structures by means of measuring discharge of electric current from loaded specimens. The paper demonstrates that the techniques have been applied to other rock-like materials, but that for the first time they are applied to cement-based materials and a theoretical model is proposed in relation to the appearance of electrical signals during sample loading and up to fracture. A series of laboratory experiments on cement mortar specimens in simple uniaxial compression, and subsequently in bending – hence displaying both tension and compression – are described and show clear correlations between resulting strains and currents measured. Under uniaxial loading there is a well-defined relationship between the pressure-stimulated current (PSC) as a result of a monotonic mechanical loading regime. Similar results are observed in the three-point bending tests where a range of loading regimes is studied, including stepped changes in loading. While currents can be measured at low strains, best results seem to be obtained when strains approach and exceed yield stress values. This technique clearly has immense potential for structural health monitoring of cement-based structures. Both intermittent and continuous monitoring becomes possible, and given an ongoing campaign of monitoring, remaining strength can be estimated