They're NICE and neat, but are they useful?: a grounded theory of clinical psychologists' beliefs about, and use of NICE guidelines.

There is a growing research interest into investigating why NICE (National Institute for Health and Care Excellence) guidelines are not consistently followed in UK mental health services. The current study utilised grounded theory methodology to investigate clinical psychologists’ use of NICE guidelines. Eleven clinical psychologists working in routine practice in the NHS were interviewed. A theoretical framework was produced conceptualising the participants’ beliefs, decision making processes and clinical practices. The overall emerging theme was “considering NICE guidelines to have benefits but to be fraught with dangers”. Participants were concerned that guidelines can create an unhelpful illusion of neatness. They managed the tension between the helpful and unhelpful aspects of guidelines by relating to them in a flexible manner. The participants reported drawing on specialist skills such as idiosyncratic formulation and integration. However, as a result of pressure, and also the rewards that follow from being seen to comply with NICE guidelines, they tended to practice in ways that prevent these skills from being recognised. This led to fears that their professional identity was threatened, which impacted upon perceptions of the guidelines. This is the first theoretical framework that attempts to explain why NICE guidelines are not consistently utilised in UK mental health services. Attention is drawn to the proposed benefits and limitations of guidelines and how these are managed. This study highlights the importance of clinical psychologists articulating and advertising their specialist skills. The findings are integrated with existing theory and research, and clinical and research implications are presented

Jimsphere wind and turbulence exceedance statistic

Exceedance statistics of winds and gusts observed over Cape Kennedy with Jimsphere balloon sensors are described. Gust profiles containing positive and negative departures, from smoothed profiles, in the wavelength ranges 100-2500, 100-1900, 100-860, and 100-460 meters were computed from 1578 profiles with four 41 weight digital high pass filters. Extreme values of the square root of gust speed are normally distributed. Monthly and annual exceedance probability distributions of normalized rms gust speeds in three altitude bands (2-7, 6-11, and 9-14 km) are log-normal. The rms gust speeds are largest in the 100-2500 wavelength band between 9 and 14 km in late winter and early spring. A study of monthly and annual exceedance probabilities and the number of occurrences per kilometer of level crossings with positive slope indicates significant variability with season, altitude, and filter configuration. A decile sampling scheme is tested and an optimum approach is suggested for drawing a relatively small random sample that represents the characteristic extreme wind speeds and shears of a large parent population of Jimsphere wind profiles

Systematic review of SGLT2 receptor inhibitors in dual or triple therapy in type 2 diabetes

Background Despite the number of medications for type 2 diabetes, many people with the condition do not achieve good glycaemic control. Some existing glucose-lowering agents have adverse effects such as weight gain or hypoglycaemia. Type 2 diabetes tends to be a progressive disease, and most patients require treatment with combinations of glucose-lowering agents. The sodium glucose co-transporter 2 (SGLT2) receptor inhibitors are a new class of glucose-lowering agents. Objective To assess the clinical effectiveness and safety of the SGLT2 receptor inhibitors in dual or triple therapy in type 2 diabetes. Data sources MEDLINE, Embase, Cochrane Library (all sections); Science Citation Index; trial registries; conference abstracts; drug regulatory authorities; bibliographies of retrieved papers. Inclusion criteria Randomised controlled trials of SGLT2 receptor inhibitors compared with placebo or active comparator in type 2 diabetes in dual or combination therapy. Methods Systematic review. Quality assessment used the Cochrane risk of bias score. Results Seven trials, published in full, assessed dapagliflozin and one assessed canagliflozin. Trial quality appeared good. Dapagliflozin 10 mg reduced HbA1c by −0.54% (weighted mean differences (WMD), 95% CI −0.67 to −0.40) compared to placebo, but there was no difference compared to glipizide. Canagliflozin reduced HbA1c slightly more than sitagliptin (up to −0.21% vs sitagliptin). Both dapagliflozin and canagliflozin led to weight loss (dapagliflozin WMD −1.81 kg (95% CI −2.04 to −1.57), canagliflozin up to −2.3 kg compared to placebo). Limitations Long-term trial extensions suggested that effects were maintained over time. Data on canagliflozin are currently available from only one paper. Costs of the drugs are not known so cost-effectiveness cannot be assessed. More data on safety are needed, with the Food and Drug Administration having concerns about breast and bladder cancers. Conclusions Dapagliflozin appears effective in reducing HbA1c and weight in type 2 diabetes, although more safety data are needed

The combustion characteristics and stable carbon isotopic compositions of irradiated organic matter: implications for terrestrial and extraterrestrial sample analysis

Exposure to ionizing radiation causes the mean combustion temperature of naturally occurring, solid, terrestrial organic matter, derived from the radiation-induced polymerization of methane, to increase

Mathematical wind profiles

Augmented Fourier polynomials for mathematical representation of vertical profiles for horizontal wind velocitie

A quantitative study of quasiparticle traps using the single-Cooper-pair-transistor

We use radio-frequency reflectometry to measure quasiparticle tunneling rates in the single-Cooper-pair-transistor. Devices with and without quasiparticle traps in proximity to the island are studied. A $10^2$ to $10^3$-fold reduction in the quasiparticle tunneling rate onto the island is observed in the case of quasiparticle traps. In the quasiparticle trap samples we also measure a commensurate decrease in quasiparticle tunneling rate off the island.Comment: 4 pages, 4 fig

Mathematical wind profiles, parts 1, 2, 3, 4

Fourier holograph representation of wind velocity over Cape Kenned

A study of jimsphere wind profiles as related to space vehicle design and operations

Winds aloft and wind shear analysis from jimsphere wind sensor balloon-radar dat

A further study of Jimsphere wind profiles as related to space vehicle design and operations

Statistical characteristics of wind profiles from Jimsphere balloon sensors for space vehicle desig

They’re NICE and neat, but are they useful? A grounded theory of clinical psychologists’ beliefs about, and use of NICE guidelines

Guidelines are ubiquitous but inconsistently used in UK mental health services. Clinical psychologists are often influential in guideline development and implementation, but opinion within the profession is divided. This study utilised grounded theory methodology to examine clinical psychologists’ beliefs about, and use of NICE guidelines. Eleven clinical psychologists working in the NHS were interviewed. The overall emerging theme was; NICE guidelines are considered to have benefits but to be fraught with dangers. Participants were concerned that guidelines can create an unhelpful illusion of neatness. They managed the tension between the helpful and unhelpful aspects of guidelines by relating to them in a flexible manner. The participants reported drawing on specialist skills such as idiosyncratic formulation and integration. However, due to the pressures and dominant discourses within services they tended to practice in ways that prevent these skills from being recognised. This led to fears that their professional identity was threatened, which impacted upon perceptions of the guidelines. To our knowledge, the theoretical framework presented in this paper is the first that attempts to explain why NICE guidelines are not consistently utilised in UK mental health services. The current need for services to demonstrate ‘NICE compliance’ may be leading to a perverse incentive for clinical psychologists in particular to do one thing but say another and for specialist skills to be obscured. If borne out by future studies, this represents a threat to continued quality improvement and also to the profession