291 research outputs found
Quantum Gravity Phenomenology and Lorentz Violation
If quantum gravity violates Lorentz symmetry, the prospects for observational
guidance in understanding quantum gravity improve considerably. This article
briefly reviews previous work on Lorentz violation (LV) and discusses aspects
of the effective field theory framework for parametrizing LV effects. Current
observational constraints on LV are then summarized, focusing on effects in QED
at order E/M_Planck.Comment: 16 pages, Expanded version of a lecture by T. Jacobson, to be
published in Particle Physics and the Universe, Proceedings of the 9th
Adriatic Meeting, eds. J.Trampetic and J.Wess (Springer-Verlag, 2004
Violations of Lorentz invariance in the neutrino sector: an improved analysis of anomalous threshold constraints
Recently there has been a renewed activity in the physics of violations of
Lorentz invariance in the neutrino sector. Flavor dependent Lorentz violation,
which generically changes the pattern of neutrino oscillations, is extremely
tightly constrained by oscillation experiments. Flavor independent Lorentz
violation, which does not introduce new oscillation phenomena, is much more
weakly constrained with constraints coming from time of flight and anomalous
threshold analyses. We use a simplified rotationally invariant model to
investigate the effects of finite baselines and energy dependent dispersion on
anomalous reaction rates in long baseline experiments and show numerically that
anomalous reactions do not necessarily cut off the spectrum quite as sharply as
currently assumed. We also present a revised analysis of how anomalous
reactions can be used to cast constraints from the observed atmospheric high
energy neutrinos and the expected cosmogenic ones.Comment: v1: 8 pages, 2 figures. v2: Rate for neutrino splitting corrected,
other minor adjustments for clarity and context. Comment added on recent
Icarus results. v3: Accepted for publication in JCAP. Significantly revised
version after OPERA withdrew the superluminal results. Our original
unpublished comments on those results can be found in v
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A qualitative study of experiences of NHS mental healthcare workers during the Covid-19 pandemic.
BackgroundThe Covid-19 pandemic has imposed extraordinary strains on healthcare workers. But, in contrast with acute settings, relatively little attention has been given to those who work in mental health settings. We aimed to characterise the experiences of those working in English NHS secondary mental health services during the first wave of the pandemic.MethodsThe design was a qualitative interview-based study. We conducted semi-structured, remote (telephone or online) interviews with 35 members of staff from NHS secondary (inpatient and community) mental health services in England. Analysis was based on the constant comparative method.ResultsParticipants reported wide-ranging changes in the organisation of secondary mental health care and the nature of work in response to the pandemic, including pausing of all services deemed to be "non-essential", deployment of staff across services to new and unfamiliar roles, and moves to remote working. The quality of participants' working life was impaired by increasing levels of daily challenge associated with trying to provide care in trying and constrained circumstances, the problems of forging new ways of working remotely, and constraints on ability to access informal support. Participants were confronted with difficult dilemmas relating to clinical decision-making, prioritisation of care, and compromises in ability to perform the therapeutic function of their roles. Other dilemmas centred on trying to balance the risks of controlling infection with the need for human contact. Many reported features of moral injury linked to their perceived failures in providing the quality or level of care that they felt service users needed. They sometimes sought to compensate for deficits in care through increased advocacy, taking on additional tasks, or making exceptions, but this led to further personal strain. Many experienced feelings of grief, helplessness, isolation, distress, and burnout. These problems were compounded by sometimes poor communication about service changes and by staff feeling that they could not take time off because of the potential impact on others. Some reported feeling poorly supported by organisations.ConclusionsMental health workers faced multiple adversities during the pandemic that were highly consequential for their wellbeing. These findings can help in identifying targets for support
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Remote care for mental health:qualitative study with service users, carers and staff during the COVID-19 pandemic
Objectives: To explore the experiences of service users, carers and staff seeking or providing secondary mental health services during the COVID-19 pandemic.
Design: Qualitative interview study, co-designed with mental health service users and carers.
Methods: We conducted semi-structured, telephone or online interviews with a purposively constructed sample; a lived experience researcher conducted and analysed interviews with service users. Analysis was based on the constant comparison method.
Setting: NHS secondary mental health services in England between June and August 2020.
Participants: Of 65 participants, 20 had either accessed or needed to access English secondary mental healthcare during the pandemic; 10 were carers of people with mental health difficulties; 35 were members of staff working in NHS secondary mental health services during the pandemic.
Results: Experiences of remote care were mixed. Some service users valued the convenience of remote methods in the context of maintaining contact with familiar clinicians. Most participants commented that a lack of non-verbal cues and the loss of a therapeutic ‘safe space’ challenged therapeutic relationship building, assessments, and identification of deteriorating mental wellbeing. Some carers felt excluded from remote meetings and concerned that assessments were incomplete without their input. Like service users, remote methods posed challenges for clinicians who reported uncertainty about technical options and a lack of training. All groups expressed concern about intersectionality exacerbating inequalities and the exclusion of some service user groups if alternatives to remote care are lost.
Conclusions: Though remote mental healthcare is likely to become increasingly widespread in secondary mental health services, our findings highlight the continued importance of a tailored, personal approach to decision-making in this area. Further research should focus on which types of consultations best suit face-to-face interaction, and for whom and why, and which can be provided remotely and by which medium.This research was funded by The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge. THIS Institute is supported by the Health Foundation, an independent charity committed to bringing about better health and healthcare for people in the UK. Grant number not applicable. All contracted parties contributed to the study under agreements through the same funding. PBJ is supported by the NIHR Applied Research Collaboration East of England and by RP-PG-0161-20003. Mary Dixon-Woods is an NIHR Senior Investigator (NF-SI-0617-10026)
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Qualitative study of candidacy and access to secondary mental health services during the COVID-19 pandemic.
Funder: The Health FoundationCandidacy, a construct describing how people's eligibility for care is negotiated between themselves and services, has received limited attention in the context of mental health care. In addition, candidacy research has only rarely studied the views of carers and health professionals. In this article, we use concepts relating to candidacy to enable a theoretically informed examination of experiences of access to secondary mental health services during the first wave of the COVID-19 pandemic in England. We report a qualitative study of the views and experiences of service users, carers, and healthcare professionals. Analysis of 65 in-depth interviews was based on the constant comparative method. We found that wide-ranging service changes designed to address the imperatives of the pandemic were highly consequential for people's candidacy. Macro-level changes, including increased emphasis on crisis and risk management and adapted risk assessment systems, produced effects that went far beyond restrictions in the availability of services: they profoundly re-structured service users' identification of their own candidacy, including perceptions of what counted as a problem worthy of attention and whether they as individuals needed, deserved, and were entitled to care. Services became less permeable, such that finding a point of entry to those services that remained open required more work of service users and carers. Healthcare professionals were routinely confronted by complex decisions and ethical dilemmas about provision of care, and their implicit judgements about access may have important implications for equity. Many of the challenges of access exposed by the pandemic related to pre-existing resource deficits and institutional weaknesses in care for people living with mental health difficulties. Overall, these findings affirm the value of the construct of candidacy for explaining access to mental healthcare, but also enable deepened understanding of the specific features of candidacy, offering enduring learning and implications for policy and practice.This project was funded by THIS Institute’s grant from the Health Foundation. The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK. All contracted parties contributed to the study under agreements through the same funding. PBJ is supported by the NIHR Applied Research Collaboration East of England and by RP-PG-0161-20003. Mary Dixon-Woods is an NIHR Senior Investigator (NF-SI-0617-10026). The views expressed in this article are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care
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Transcranial direct current stimulation (tDCS) in the treatment of depression: Systematic review and meta-analysis of efficacy and tolerability
BACKGROUND
Transcranial direct current stimulation (tDCS) is a potential alternative treatment option for major depressive episodes (MDE).
OBJECTIVES
We address the efficacy and safety of tDCS in MDE.
METHODS
The outcome measures were Hedges' g for continuous depression ratings, and categorical response and remission rates.
RESULTS
A random effects model indicated that tDCS was superior to sham tDCS (k=11, N=393, g=0.30, 95% CI=[0.04, 0.57], p=0.027). Adjunctive antidepressant medication and cognitive control training negatively impacted on the treatment effect. The pooled log odds ratios (LOR) for response and remission were positive, but statistically non-significant (response: k=9, LOR=0.36, 95% CI[-0.16, 0.88], p=0.176, remission: k=9, LOR=0.25, 95% CI [-0.42, 0.91], p=0.468). We estimated that for a study to detect the pooled continuous effect (g=0.30) at 80% power (alpha=0.05), a total N of at least 346 would be required (with the total N required to detect the upper and lower bound being 49 and 12,693, respectively).
CONCLUSIONS
tDCS may be efficacious for treatment of MDE. The data do not support the use of tDCS in treatment-resistant depression, or as an add-on augmentation treatment. Larger studies over longer treatment periods are needed
Ítems de referencia para publicar Revisiones Sistemáticas y Metaanálisis: La Declaración PRISMA
Original citation: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med. 2009;6:e1000097. The original authors have not revised and verified the Spanish translation, and not necessary endorse it. Los autores originales no han revisado ni verificado la traducción del manuscrito al español, y no necesariamente están de acuerdo con su contenido. Original article published: July 21, 2009 Copyright: © 2009 Moher et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Provenance: Not commissioned; externally peer reviewed. In order to encourage dissemination of the PRISMA Statement, this article is freely accessible on the PLoS Medicine Web site (http://medicine.plosjournals.org/) and will be also published in the Annals of Internal Medicine, BMJ, Journal of Clinical Epidemiology, and Open Medicine. The authors jointly hold the copyright of this article. For details on further use, see the PRISMA Web site (http://www.prisma-statement.org/). Spanish translation: Mercedes Sotos-Prieto, Johana Prieto, Maria Manera, Eduard Baladia, Rodrigo Martínez-Rodríguez y Julio Basulto. Corresponding author of the spanish translation: Mercedes Sotos-Prieto ([email protected])Artículo original: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med. 2009;6:e1000097.The original authors have not revised and verified the Spanish translation, and not necessary endorse it. Los autores originales no han revisado ni verificado la traducción del manuscrito al español, y no necesariamente están de acuerdo con su contenido.Publicación del artículo original: 21 Julio 2009 Derechos: © 2009 Moher et al. Este es un artículo de acceso abierto distribuido bajo las condiciones de The Creative Commons Attribution License, que permite el uso ilimitado, su distribución y reproducción en cualquier medio, siempre y cuando se acredite el autor y su fuente original.Procedencia: No comisionado; revisión científica externa. Para promover la publicación de la Declaración PRISMA, el artículo se ha publicado como acceso abierto y se puede encontrar en la página web de PLoS Medicine (http://medicine.plosjournals.org/) y también se ha publicado en Annals of Internal Medicine, BMJ, Journal of Clinical Epidemiology, y Open Medicine. Los autores tienen unánimemente los derechos de este artículo. Para más detalles de su uso ver la página web de PRISMA (http://www.prisma-statement.org/).Traducción y adaptación al español: Mercedes Sotos-Prieto, Johana Prieto, Maria Manera, Eduard Baladia, Rodrigo Martínez-Rodríguez y Julio Basulto.Autor de correspondencia de la traducción: Mercedes Sotos-Prieto ([email protected]
Compliance of clinical trial registries with the World Health Organization minimum data set: a survey
BACKGROUND: Since September 2005 the International Committee of Medical Journal Editors has required that trials be registered in accordance with the World Health Organization (WHO) minimum dataset, in order to be considered for publication. The objective is to evaluate registries' and individual trial records' compliance with the 2006 version of the WHO minimum data set. METHODS: A retrospective evaluation of 21 online clinical trial registries (international, national, specialty, pharmaceutical industry and local) from April 2005 to February 2007 and a cross-sectional evaluation of a stratified random sample of 610 trial records from the 21 registries. RESULTS: Among 11 registries that provided guidelines for registration, the median compliance with the WHO criteria were 14 out of 20 items (range 6 to 20). In the period April 2005-February 2007, six registries increased their compliance by six data items, on average. None of the local registry websites published guidelines on the trial data items required for registration. Slightly more than half (330/610; 54.1%, 95% CI 50.1% - 58.1%) of trial records completed the contact details criteria while 29.7% (181/610, 95% CI 26.1% - 33.5%) completed the key clinical and methodological data fields. CONCLUSION: While the launch of the WHO minimum data set seemed to positively influence registries with better standardisation of approaches, individual registry entries are largely incomplete. Initiatives to ensure quality assurance of registries and trial data should be encouraged. Peer reviewers and editors should scrutinise clinical trial registration records to ensure consistency with WHO's core content requirements when considering trial-related publications
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