Mental health clinicians' perspectives on working with Community Treatment Orders

This research explores the beliefs and experiences of mental health clinicians working with people who are subject to a Community Treatment Order (CTO). Previous research indicates that the effectiveness of CTOs is questionable and there have been debates about the ethics of compulsory community treatment generally. The opinions of stakeholders are therefore important. Previous research with mental health clinicians has predominantly been quantitative and survey-based. Participants took part in a semi-structured interview which focused on their views about CTOs based on their clinical experiences. A Grounded Theory approach was adopted to collect and analyse the data. Two core categories were constructed from the data: ‘Factors influencing decision-making in the use of a CTO’ and ‘Impact of decisions’. The first core category contained the subcategories ‘Service user characteristics’, ‘Clinicians’ constructions of appropriate care and treatment’, ‘Clinicians’ knowledge’, ‘Pragmatic and systemic influences’ and ‘Societal influences’. The second core category contained the subcategories ‘Impact on service user’, ‘Impact on therapeutic relationship’, ‘Impact on clinician’, and ‘Impact on service delivery’. The current research is placed in the context of previous literature. The limitations of the study are described. The clinical and research implications are explored

VisGenome: visualization of single and comparative genome representations

Summary: VisGenome visualizes single and comparative representations for the rat, the mouse and the human chromosomes at different levels of detail. The tool offers smooth zooming and panning which is more flexible than seen in other browsers. It presents information available in Ensembl for single chromosomes, as well as homologies (orthologue predictions including ortholog one2one, apparent ortholog one2one, ortholog many2many) for any two chromosomes from different species. The application can query supporting data from Ensembl by invoking a link in a browser. Availability: http://www.dcs.gla.ac.uk/~asia/VisGenome Contact: [email protected]

'The ethics approval took 20 months on a trial which was meant to help terminally ill cancer patients. In the end we had to send the funding back':a survey of views on human research ethics reviews

Background: We conducted a survey to identify what types of health/medical research could be exempt from research ethics reviews in Australia. Methods: We surveyed Australian health/medical researchers and Human Research Ethics Committee (HREC) members. The survey asked whether respondents had previously changed or abandoned a project anticipating difficulties obtaining ethics approval, and presented eight research scenarios, asking whether these scenarios should or should not be exempt from ethics review, and to provide (optional) comments. Qualitative data were analysed thematically; quantitative data in R. Results: We received 514 responses. Forty-three per cent of respondents to whom the question applied, reported changing projects in anticipation of obstacles from the ethics review process; 25% reported abandoning projects for this reason. Research scenarios asking professional staff to provide views in their area of expertise were most commonly exempted from ethics review (to prioritise systematic review topics 84%, on software strengths/weaknesses 85%); scenarios involving surplus samples (82%) and N-of-1 (single case) studies (76%) were most commonly required to undergo ethics review. HREC members were 26% more likely than researchers to require ethics review. Need for independent oversight, and low risk, were most frequently cited in support of decisions to require or exempt from ethics review, respectively. Conclusions: Considerable differences exist between researchers and HREC members, about when to exempt from review the research that ultimately serves the interests of patients and the public. It is widely accepted that evaluative research should be used to reduce clinical uncertainties - the same principle should apply to ethics reviews. </p

Student feedback to tailor the card™ system for improving the immunization experience at school

Increasing the comfort of vaccine delivery at school is needed to improve the immunization experience for students. We created the CARD™ (C—Comfort, A—Ask, R—Relax and D—Distract) system to address this clinical care gap. Originally designed for grade 7 students, this study examined the perceptions of grade 9 students of CARD™. Grade 9 students who had experience with school-based immunizations, either as recipients or onlookers (n = 7; 100% females 14 years old) participated. Students answered pre–post surveys, reviewed CARD™ educational materials and participated in a semi-structured focus group discussion. The Consolidated Framework for Implementation Research (CFIR) was used as the framework for analysis of qualitative data. Participants reported positive perceptions of CARD™ educational materials and that CARD™ could fit into the school immunization process. CARD™ improved knowledge about effective coping interventions and was recommended for education of both nurses and students. The results provide preliminary evidence that CARD™ is acceptable and appropriate for implementation in grade 9 school-based immunizations

Constrained phosphine chalcogenide selenoethers supported by peri-substitution

A series of phosphorus and selenium peri-substituted acenaphthene species with the phosphino group oxidized by O, S, and Se has been isolated and fully characterized, including by single-crystal X-ray diffraction. The P(V) and Se(II) systems showed fluxional behavior in solution due to the presence of two major rotamers, as evidenced with solution NMR spectroscopy. Using Variable-Temperature NMR (VT NMR) and supported by DFT (Density Functional Theory) calculations and solid-state NMR, the major rotamers in the solid and in solution were identified. All compounds showed a loss of the through-space JPSe coupling observed in the unoxidized P(III) and Se(II) systems due to the sequestration of the lone pair of the phosphine, which has been previously identified as the major contributor to the coupling pathway.Publisher PDFPeer reviewe

Uncertainty about cellulitis and unmet patient information needs: a mixed methods study in primary and secondary care

Background: Cellulitis is a painful infection of the skin and underlying tissues, commonly affecting the lower leg: approximately a third of people experience recurrence. Patients’ ability to recover from cellulitis or prevent recurrence is likely to be influenced by their understanding of the condition.Aim: To explore patients’ perceptions of cellulitis and their information needs.Design and Setting: Mixed methods study comprising semi‐structured, face‐to‐face interviews and a cross‐sectional survey, recruiting through primary care, secondary care and advertising.Methods: Adults aged 18 or over with a history of cellulitis were invited to take part in a survey, qualitative interview, or both.Results: Thirty interviews were conducted between August 2016 and July 2017. Qualitative data highlighted: (1) low awareness of cellulitis prior to first episode, 2) uncertainty around the time of diagnosis, 3) concern/surprise at the severity of cellulitis, 4) perceived insufficient information provision. People were surprised they had never heard of cellulitis and that they had not received advice or leaflets giving self‐care information. Some sought information from the internet and found this confusing. Two hundred and forty surveys were completed (response rate 17%). These showed that, while many participants had received information on the treatment of cellulitis (60.0%, n=144), they often reported receiving no information about causes (60.8%, n=146) or prevention of recurrence (73.3%, n=176).Conclusions: There is a need to provide information for people with cellulitis, particularly around (1) the name of their condition, (2) managing acute episodes and (3) reducing risk of recurrences

Heteronuclear bimetallic complexes with 3d and 4f elements

Three heteronuclear bimetallic complexes [Cu(MeOH)(L)Ln(NO3)3] ( 1-Ce ; Ln = Ce, 1-Pr ; Ln = Pr, and 1-Nd ; Ln = Nd) were prepared using H2L (1,3-bis[(3-methoxysalicylidene)amino]-2,2-dimethylpropane) in methanol, affording the complexes as green crystalline materials. These can be prepared in a one-pot synthesis from 2,2-dimethylpropan-1,3-diamine, o-vanillin, copper(II) nitrate, and Ln(III) nitrate (Ln = Ce, Pr, Nd). X-ray crystallography, high-resolution mass spectrometry, and UV-vis spectroscopy were used to characterize the bimetallic complexes. All three complexes showed the copper center adopting a five-coordinate square pyramidal geometry and the lanthanoid cation adopting a ten-coordinate geometry.Publisher PDFPeer reviewe

The Infrared Imaging Spectrograph (IRIS) for TMT: Multi-tiered wavefront measurements and novel mechanical design

The InfraRed Imaging Spectrograph (IRIS) will be the first light adaptive optics instrument on the Thirty Meter Telescope (TMT). IRIS is being built by a collaboration between Caltech, the University of California, NAOJ and NRC Herzberg. In this paper we present novel aspects of the Support Structure, Rotator and On-Instrument Wavefront Sensor systems being developed at NRC Herzberg. IRIS is suspended from the bottom port of the Narrow Field Infrared Adaptive Optics System (NFIRAOS), and provides its own image de-rotation to compensate for sidereal rotation of the focal plane. This arrangement is a challenge because NFIRAOS is designed to host two other science instruments, which imposes strict mass requirements on IRIS. As the mechanical design of all elements has progressed, we have been tasked with keeping the instrument mass under seven tonnes. This requirement has resulted in a mass reduction of 30 percent for the support structure and rotator compared to the most recent IRIS designs. To accomplish this goal, while still being able to withstand earthquakes, we developed a new design with composite materials. As IRIS is a client instrument of NFIRAOS, it benefits from NFIRAOS’s superior AO correction. IRIS plays an important role in providing this correction by sensing low-order aberrations with three On-Instrument Wavefront Sensors (OIWFS). The OIWFS consists of three independently positioned natural guide star wavefront sensor probe arms that patrol a 2-arcminute field of view. We expect tip-tilt measurements from faint stars within the IRIS imager focal plane will further stabilize the delivered image quality. We describe how the use of On-Detector Guide Windows (ODGWs) in the IRIS imaging detector can be incorporated into the AO correction. In this paper, we present our strategies for acquiring and tracking sources with this complex AO system, and for mitigating and measuring the various potential sources of image blur and misalignment due to properties of the mechanical structure and interface