Using shared goal setting to improve access and equity: a mixed methods study of the Good Goals intervention

Background: Access and equity in children’s therapy services may be improved by directing clinicians’ use of resources toward specific goals that are important to patients. A practice-change intervention (titled ‘Good Goals’) was designed to achieve this. This study investigated uptake, adoption, and possible effects of that intervention in children’s occupational therapy services. Methods: Mixed methods case studies (n = 3 services, including 46 therapists and 558 children) were conducted. The intervention was delivered over 25 weeks through face-to-face training, team workbooks, and ‘tools for change’. Data were collected before, during, and after the intervention on a range of factors using interviews, a focus group, case note analysis, routine data, document analysis, and researchers’ observations. Results: Factors related to uptake and adoptions were: mode of intervention delivery, competing demands on therapists’ time, and leadership by service manager. Service managers and therapists reported that the intervention: helped therapists establish a shared rationale for clinical decisions; increased clarity in service provision; and improved interactions with families and schools. During the study period, therapists’ behaviours changed: identifying goals, odds ratio 2.4 (95% CI 1.5 to 3.8); agreeing goals, 3.5 (2.4 to 5.1); evaluating progress, 2.0 (1.1 to 3.5). Children’s LoT decreased by two months [95% CI −8 to +4 months] across the services. Cost per therapist trained ranged from £1,003 to £1,277, depending upon service size and therapists’ salary bands. Conclusions: Good Goals is a promising quality improvement intervention that can be delivered and adopted in practice and may have benefits. Further research is required to evaluate its: (i) impact on patient outcomes, effectiveness, cost-effectiveness, and (ii) transferability to other clinical contexts

The eta-prime propagator in quenched QCD

The calculation of the eta-prime hairpin diagram is carried out in the modified quenched approximation (MQA) in which the lattice artifact which causes exceptional configurations is removed by shifting observed poles at kappa<kappa_c in the quark propagators to the critical value of hop ping parameter. By this method, the eta-prime propagator can be accurately calculated even for very light quark mass. A determination of the topological susceptibility for quenched QCD is also obtained, using the fermionic method of Smit and Vink to calculate winding numbers.Comment: 3 pages, 3 postscript figure

Can fundamental movement skill mastery be increased via a six week physical activity intervention to have positive effects on physical activity and physical self-perception?

Previous research has suggested a positive relationship between fundamental movement skills (FMS) mastery and physical activity (PA) level. Research conducted on interventions to improve FMS mastery is equivocal and further research is needed.An intervention group of 82 children (35 boys and 47 girls) and a control group of 83 children (42 boys and 41 girls) were recruited from Years 4 and 5 (mean age ± SD = 8.3 ± 0.4 years) of two schools in Central England. The intervention included a combination of circuits and dancing to music. Pre and post intervention tests were conducted. Tests included: subjective assessment of eight FMS; objective measurement of two FMS; four day pedometer step count recording; height and mass for Body Mass Index (BMI); and the completion of Harter et al.'s (1982) self-perception questionnaire.Following a two (pre to post) by two (intervention and control group) mixed-model ANOVA it was highlighted that the intervention group improved mastery in all eight FMS, and increased both daily steps and physical self-perception.It can be concluded that focussing one Physical Education (PE) lesson per week on the development of FMS has had a positive benefit on FMS, PA level and physical self-perception for the children in this study

Getting the best outcomes from epilepsy surgery.

Neurosurgery is an underutilized treatment that can potentially cure drug-refractory epilepsy. Careful, multidisciplinary presurgical evaluation is vital for selecting patients and to ensure optimal outcomes. Advances in neuroimaging have improved diagnosis and guided surgical intervention. Invasive electroencephalography allows the evaluation of complex patients who would otherwise not be candidates for neurosurgery. We review the current state of the assessment and selection of patients and consider established and novel surgical procedures and associated outcome data. We aim to dispel myths that may inhibit physicians from referring and patients from considering neurosurgical intervention for drug-refractory focal epilepsies. Ann Neurol 2018;83:676-690

The determination of the electrical resistance of the human body under conditions to be met within underground mining

The use of electric wires in mines for power purposes is dangerous to human life. Deaths occur every year from electric shocks, and in most cases these accidents could have been prevented if some precaution had been taken by the victims, or if some care had been taken to protect them from coming in contact with live wires. Most workingmen accustomed to working around electric wires become careless and a lack of knowledge of the danger involved gives rise to the many accidents that occur each year...The object of this investigation is to determine just what resistance the human body would offer to an electric current under all the conditions met with in mines --page 1 -2

Unquenched QCD with Light Quarks

We present recent results in unquenched lattice QCD with two degenerate light sea quarks using the truncated determinant approximation (TDA). In the TDA the infrared modes contributing to the quark determinant are computed exactly up to some cutoff in quark off-shellness (typically 2$\Lambda_{QCD}$). This approach allows simulations to be performed at much lighter quark masses than possible with conventional hybrid MonteCarlo techniques. Results for the static energy and topological charge distributions are presented using a large ensemble generated on very coarse (6$^4$) but physically large lattices. Preliminary results are also reported for the static energy and meson spectrum on 10$^3$x20 lattices (lattice scale $a^{-1}$=1.15 GeV) at quark masses corresponding to pions of mass $\leq$ 200 MeV. Using multiboson simulation to compute the ultraviolet part of the quark determinant the TDA approach becomes an exact with essentially no increase in computational effort. Some preliminary results using this fully unquenched algorithm are presented.Comment: LateX, 39 pages, 16 eps figures, 1 ps figur

Observationally derived transport diagnostics for the lowermost stratosphere and their application to the GMI chemistry and transport model

International audienceTransport from the surface to the lowermost stratosphere (LMS) can occur on timescales of a few months or less, making it possible for short-lived tropospheric pollutants to influence stratospheric composition and chemistry. Models used to study this influence must demonstrate the credibility of their chemistry and transport in the upper troposphere and lower stratosphere (UT/LS). Data sets from satellite and aircraft instruments measuring CO, O3, N2O, and CO2 in the UT/LS are used to create a suite of diagnostics for the seasonally-varying transport into and within the lowermost stratosphere, and of the coupling between the troposphere and stratosphere in the extratropics. The diagnostics are used to evaluate a version of the Global Modeling Initiative (GMI) Chemistry and Transport Model (CTM) that uses a combined tropospheric and stratospheric chemical mechanism and meteorological fields from the GEOS-4 general circulation model. The diagnostics derived from N2O and O3 show that the model lowermost stratosphere has realistic input from the overlying high latitude stratosphere in all seasons. Diagnostics for the LMS show two distinct layers. The upper layer begins ~30 K potential temperature above the tropopause and has a strong annual cycle in its composition. The lower layer is a mixed region ~30 K thick near the tropopause that shows no clear seasonal variation in the degree of tropospheric coupling. Diagnostics applied to the GMI CTM show credible seasonally-varying transport in the LMS and a tropopause layer that is realistically coupled to the UT in all seasons. The vertical resolution of the GMI CTM in the UT/LS, ~1 km, is sufficient to realistically represent the extratropical tropopause layer. This study demonstrates that the GMI CTM has the transport credibility required to study the impact of tropospheric emissions on the stratosphere

Capturing learning from public involvement with people experiencing homelessness to help shape new physiotherapy research: Utilizing a reflective model with an under-served, vulnerable population

INTRODUCTION: People experiencing homelessness (PEH) have poorer health than housed people but face barriers accessing care and being involved in research. As an often-ignored group, their contribution to help shape research that is for and about them is essential, as it can strengthen the research proposal, in turn facilitating research and outcomes that are relevant to this vulnerable group. METHODS: Six people with experience of homelessness attended a PPI consultation aided by Pathway, a UK homeless peer advocacy charity, which coordinates an 'Experts by Experience' group. We present reflections on conducting PPI with PEH that informed the development of a physiotherapy research proposal. Kolb's Experiential Learning Cycle guided reflections across four stages: (1) describing the PPI experience; (2) reviewing and reflecting on the PPI experience; (3) learning from the PPI experience; and (4) planning and trying out learning. RESULTS: Reflections highlighted the importance of: working closely with an advocacy organisation and leader to reach under-served people; the diversity of experiences; using familiar venues, contingency and budget planning; flexibility and 'allowing time; talking less; listening more'; planning for early and ongoing PPI, and the potential of mobile 'one-off' PPI outreach models to reach vulnerable groups. CONCLUSION: Kolb's Experiential Learning Cycle aided team reflection on feedback from PEH, which helped refine and strengthen a physiotherapy research proposal. The project was unfunded. However, a reflective model helped maximize learning and impact including for future PPI and research. The novel application of Kolb's Experiential Learning Cycle provided structure, facilitated reflection and enhanced individual and collective learning and may benefit capturing learning from PPI with other vulnerable populations. PATIENT OR PUBLIC CONTRIBUTION: We highlight how a PPI consultation with people with experience of homelessness helped shape a funding proposal. Additionally, the reflections of the experts by experience team leader are included

Model for self-tuning the cosmological constant

The vanishing cosmological constant in the four dimensional space-time is obtained in a 5D Randall-Sundrum model with a brane (B1) located at $y=0$. The matter fields can be located at the brane. For settling any vacuum energy generated at the brane to zero, we need a three index antisymmetric tensor field $A_{MNP}$ with a specific form for the Lagrangian. For the self-tuning mechanism, the bulk cosmological constant should be negative.Comment: LaTeX file of 4 pages, to appear in Phys. Rev. Let