The cleft ion fountain

Low-energy (below approximately 50 eV) ionospheric ions, injected into the magnetosphere at the dayside cleft, are studied using data from the retarding ion mass spectrometer (RIMS) experiment on the Dynamics Explorer 1 satellite. It is concluded that upwelling ions at the cleft form an ion fountain and are blown into the polar cap by antisunward convection. At high Kp (>4), convection is generally strong enough to fill the entire polar magnetosphere with low-energy O+ ions, whereas at low kp (<2) they are largely restricted to the dayside half of the cap. Using a two-dimensional kinetic ion trajectory model, the locations where RIMS detected O+ within the cap are shown to be consistent with the spatial distributions of O+ density, predicted for an upwelling ion source at the cleft and various dawn-dusk convection electric fields. A detailed study is made of one polar pass of DE 1, during which RIMS detected He+, N+, O+, and O++ ions, the ion trajectory model being used to trace all these ions back to a common source at an observed upwelling ion event near the cleft. All observed species are deduced to be falling earthward in the nightside of the cap, as predicted from the model, indicating the dominance of gravity over upward field-aligned acceleration (such as by the ambipolar electric field). Comparison of field-aligned velocities observed for O+ and O++ ions defines a maximum limit to the upward electrostatic acceleration present within the cap which was only sufficient to eject ionospheric H+ ions, all heavier ions being supplied from the dayside by the cleft ion fountain

Upwelling O+ ion source characteristics

Recent observations from the Dynamics Explorer 1 (DE-1) spacecraft have shown that the dayside auroral zone is an important source of very low-energy superthermal O^+ ions for the polar magnetosphere. When observed at 2000- to 5000-km altitude, the core of the O^+ distribution exhibits transverse heating to energies on the order of 10 eV, significant upward heat flux, and subsonic upward flow at significant flux levels exceeding 10^8 cm^{-2}s^{-1}. The term "upwelling ions" has been adopted to label these flows, which stand out in sharp contrast to the light ion polar wind flows observed in the same altitude range in the polar cap and subauroral magnetosphere. We have chosen a typical upwelling ion event for detailed study, correlating retarding ion mass spectrometer observations of the low-energy plasma with energetic ion observations and local electromagnetic field observations. The upwelling ion signature is colocated with the magnetospheric cleft as marked by precipitating energetic magnetosheath ions. The apparent ionospheric heating is clearly linked with the magnetic field signatures of strong field-aligned currents in the vicinity of the dayside polar cap boundary. Electric field and ion plasma measurements indicate that a very strong and localized convection channel or jet exists coincident with the other signatures of this event. These observations indicate that transverse ion heating to temperatures on the order of 10^5 K in the 2000- to 5000-km ionosphere is an important factor in producing heavy ion outflows into the polar magnetosphere. This result contrasts with recent suggestions that electron heating to temperatures of order 10^4 K is the most important parameter with regard to O^+ outflow

The impact of mental health recovery narratives on recipients experiencing mental health problems: Qualitative analysis and change model.

BACKGROUND: Mental health recovery narratives are stories of recovery from mental health problems. Narratives may impact in helpful and harmful ways on those who receive them. The objective of this paper is to develop a change model identifying the range of possible impacts and how they occur. METHOD: Semi-structured interviews were conducted with adults with experience of mental health problems and recovery (n = 77). Participants were asked to share a mental health recovery narrative and to describe the impact of other people's recovery narratives on their own recovery. A change model was generated through iterative thematic analysis of transcripts. RESULTS: Change is initiated when a recipient develops a connection to a narrator or to the events descripted in their narrative. Change is mediated by the recipient recognising experiences shared with the narrator, noticing the achievements or difficulties of the narrator, learning how recovery happens, or experiencing emotional release. Helpful outcomes of receiving recovery narratives are connectedness, validation, hope, empowerment, appreciation, reference shift and stigma reduction. Harmful outcomes are a sense of inadequacy, disconnection, pessimism and burden. Impact is positively moderated by the perceived authenticity of the narrative, and can be reduced if the recipient is experiencing a crisis. CONCLUSIONS: Interventions that incorporate the use of recovery narratives, such as peer support, anti-stigma campaigns and bibliotherapy, can use the change model to maximise benefit and minimise harms from narratives. Interventions should incorporate a diverse range of narratives available through different mediums to enable a range of recipients to connect with and benefit from this material. Service providers using recovery narratives should preserve authenticity so as to maximise impact, for example by avoiding excessive editing

REFOCUS: developing a recovery focus in mental health services in England

Background: Recovery in mental health services is defined as living a satisfying, hopeful, and contributing life even with any limitations caused by illness. An evidence base for understanding and supporting recovery is needed.Objectives: To carry out a programme of linked research studies to understand how mental health services can promote recovery.Design: A two phase, mixed methods study. Phase 1 (theory) involved seven systematic reviews (develop a conceptual framework for recovery; establish its cross-cultural validity; develop a recovery practice framework; review measures of recovery measures; recovery support measures; strengths measures; staff understanding of recovery), development and evaluation of three new measures (INSPIRE for recovery support; IOM for individualised measurement of recovery; SAFE for feasibility assessment), evaluation of existing recovery measure (QPR), national survey, three qualitative studies (conceptual framework validation, staff recoveryoriented practice, black service users), and development of a new manualised REFOCUS intervention. Phase 2 involved a two-site cluster randomised controlled trial of the REFOCUS intervention, with a nested secondary outcome study, process and economic evaluation, interrupted time series analysis, sub-group analysis of black service users, and outcomes comparison. The impact of PPI on the programme was also empirically evaluated.Setting: Six mental health Trusts in England.Participants: 741 community mental health service users, 1,169 mental health staff and 54 expert stakeholders.Interventions: The manualised team-level REFOCUS intervention to increase support for personal recovery.Main outcome measures: Survey: Recovery Self Assessment (RSA). Trial: Questionnaire about the Process of Recovery (QPR), Client Satisfaction Questionnaire (CSQ).Results: Phase 1: the conceptual framework for recovery identified characteristics, stages and processes of recovery. It was cross-culturally valid and applicable to current service users. The recovery practice framework identified four domains of recovery support. INSPIRE, SAFE and IOM were developed and evaluated. The national survey identified differences between team managers (n=22), workers (n=120) and service users (n=108), and found higher recovery orientation was associated with improved recovery. The REFOCUS intervention has two elements: recovery promoting relationships and working practices. Phase 2: the 27-team trial involving 403 service users (297 at follow-up) showed no differences on primary outcomes of QPR (adjusted difference 0.63, 95%CI: -1.4 to 2.3, p=.55), but secondary outcomes of functioning (adjusted difference 5.90, 95%CI 2.6 to 9.2,

REFOCUS: developing a recovery focus in mental health services in England

Background: Recovery in mental health services is defined as living a satisfying, hopeful, and contributing life even with any limitations caused by illness. An evidence base for understanding and supporting recovery is needed. Objectives: To carry out a programme of linked research studies to understand how mental health services can promote recovery. Design: A two phase, mixed methods study. Phase 1 (theory) involved seven systematic reviews (develop a conceptual framework for recovery; establish its cross-cultural validity; develop a recovery practice framework; review measures of recovery measures; recovery support measures; strengths measures; staff understanding of recovery), development and evaluation of three new measures (INSPIRE for recovery support; IOM for individualised measurement of recovery; SAFE for feasibility assessment), evaluation of existing recovery measure (QPR), national survey, three qualitative studies (conceptual framework validation, staff recoveryoriented practice, black service users), and development of a new manualised REFOCUS intervention. Phase 2 involved a two-site cluster randomised controlled trial of the REFOCUS intervention, with a nested secondary outcome study, process and economic evaluation, interrupted time series analysis, sub-group analysis of black service users, and outcomes comparison. The impact of PPI on the programme was also empirically evaluated. Setting: Six mental health Trusts in England. Participants: 741 community mental health service users, 1,169 mental health staff and 54 expert stakeholders. Interventions: The manualised team-level REFOCUS intervention to increase support for personal recovery. Main outcome measures: Survey: Recovery Self Assessment (RSA). Trial: Questionnaire about the Process of Recovery (QPR), Client Satisfaction Questionnaire (CSQ). Results: Phase 1: the conceptual framework for recovery identified characteristics, stages and processes of recovery. It was cross-culturally valid and applicable to current service users. The recovery practice framework identified four domains of recovery support. INSPIRE, SAFE and IOM were developed and evaluated. The national survey identified differences between team managers (n=22), workers (n=120) and service users (n=108), and found higher recovery orientation was associated with improved recovery. The REFOCUS intervention has two elements: recovery promoting relationships and working practices. Phase 2: the 27-team trial involving 403 service users (297 at follow-up) showed no differences on primary outcomes of QPR (adjusted difference 0.63, 95%CI: -1.4 to 2.3, p=.55), but secondary outcomes of functioning (adjusted difference 5.90, 95%CI 2.6 to 9.2, p<.001) and staff-rated unmet need (adjusted difference -0.80, 95%CI -1·6 to -0·7, p=.03) did improve. Implementation was mixed, and higher-participating teams had higher staff-rated pro-recovery behaviour change (adjusted difference -0·4, 95%CI -0·7 to -0·2, p=·001) and patients had higher QPR Interpersonal scores (adjusted difference -1·6, 95%CI -2·7 to -0·5, p=·005) at follow-up. Intervention-group patients incurred £1,062 (95%CI -£1,103 to £3,017) lower adjusted costs. Black service users did not show improved recovery or satisfaction. Service users who experienced the intervention reported benefits. Conclusions: The REFOCUS intervention has been modified following its evaluation. The REFOCUS Programme provides a theory base for recovery research

Development of paediatric quality of inpatient care indicators for low-income countries - A Delphi study

BACKGROUND: Indicators of quality of care for children in hospitals in low-income countries have been proposed, but information on their perceived validity and acceptability is lacking. METHODS: Potential indicators representing structural and process aspects of care for six common conditions were selected from existing, largely qualitative WHO assessment tools and guidelines. We employed the Delphi technique, which combines expert opinion and existing scientific information, to assess their perceived validity and acceptability. Panels of experts, one representing an international panel and one a national (Kenyan) panel, were asked to rate the indicators over 3 rounds and 2 rounds respectively according to a variety of attributes. RESULTS: Based on a pre-specified consensus criteria most of the indicators presented to the experts were accepted: 112/137(82%) and 94/133(71%) for the international and local panels respectively. For the other indicators there was no consensus; none were rejected. Most indicators were rated highly on link to outcomes, reliability, relevance, actionability and priority but rated more poorly on feasibility of data collection under routine conditions. There was moderate to substantial agreement between the two panels of experts. CONCLUSIONS: This Delphi study provided evidence for the perceived usefulness of most of a set of measures of quality of hospital care for children proposed for use in low-income countries. However, both international and local experts expressed concerns that data for many process-based indicators may not currently be available. The feasibility of widespread quality assessment and responsiveness of indicators to intervention should be examined as part of continued efforts to improve approaches to informative hospital quality assessment

The state of the Martian climate

60°N was +2.0°C, relative to the 1981–2010 average value (Fig. 5.1). This marks a new high for the record. The average annual surface air temperature (SAT) anomaly for 2016 for land stations north of starting in 1900, and is a significant increase over the previous highest value of +1.2°C, which was observed in 2007, 2011, and 2015. Average global annual temperatures also showed record values in 2015 and 2016. Currently, the Arctic is warming at more than twice the rate of lower latitudes

A Multifaceted Intervention to Implement Guidelines and Improve Admission Paediatric Care in Kenyan District Hospitals: A Cluster Randomised Trial

Philip Ayieko and colleagues report the outcomes of a cluster-randomized trial carried out in eight Kenyan district hospitals evaluating the effects of a complex intervention involving improved training and supervision for clinicians. They found a higher performance of hospitals assigned to the complex intervention on a variety of process of care measures, as compared to those receiving the control intervention

The influence of a pre-exercise sports drink (PRX) on factors related to maximal aerobic performance

<p>Abstract</p> <p>Background</p> <p>Pre-exercise sports drinks (PRX) are commonly used as ergogenic aids in athletic competitions requiring aerobic power. However, in most cases, claims regarding their effectiveness have not been substantiated. In addition, the ingredients in PRX products must be deemed acceptable by the athletic governing bodies that regulate their use in training and competition. The purpose of this study was to examine the effects of a modified PRX formulation (known as EM·PACT™) from earlier investigations on factors related to maximal aerobic performance during a graded exercise test. The modification consisted of removing creatine to meet the compliance standards set forth by various athletic organizations that regulate the use of nutritional supplements.</p> <p>Methods</p> <p>Twenty-nine male and female college students varying in levels of aerobic fitness participated in a randomized crossover administration of PRX (containing 14 g/serving of fructose, medium-chain triglycerides, and amino acids mixed with 8 oz. of water) and placebo (PL) 30 minutes prior to performing a treadmill test with approximately one week separation between the trials. VO₂max, maximal heart rate (HR), time to exhaustion (Time), and percentage estimated non-protein fat substrate utilization (FA) during two <it>a priori </it>submaximal stages of a graded exercise testing were evaluated.</p> <p>Results</p> <p>The VO₂max mean value of the PRX trial was significantly greater than the PL trial (P < 0.01). The mean value for Time was also observed to be greater for the PRX trial compared to PL (P < 0.05). Additionally, percentage of FA during submaximal stages of the exercise test was greater for PRX trial in comparison to PL (P < 0.01).</p> <p>Conclusions</p> <p>The modified PRX formulation utilized in this investigation supports the findings of the previous investigation and its efficacy for enhancing indices of aerobic performance (specifically VO₂max, Time, & FA) during graded exercise testing.</p