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 Low-Spin Black Hole in LMC X-3

Building upon a new dynamical model for the X-ray binary LMC X-3, we measure the spin of its black hole primary via the continuum-fitting method. We consider over one thousand thermal-state RXTE X-ray spectra of LMC X-3. Using a large subset of these spectra, we constrain the spin parameter of the black hole to be spin = 0.21(+0.18,-0.22), 90% confidence. Our estimate of the uncertainty in spin takes into account a wide range of systematic errors. We discuss evidence for a correlation between a black hole's spin and the complexity of its X-ray spectrum.Comment: Submitted to ApJL, 5 pages emulateapj, 2 figures and 1 tabl

Specifying content and mechanisms of change in interventions to change professionals’ practice : an illustration from the Good Goals study in occupational therapy

PMID: 23078918 [PubMed - indexed for MEDLINE] PMCID: PMC3502268 Free PMC Article The study was funded by the Chief Scientist Office of the Scottish Government Health Directorates (ref: CZF/1/38). The views expressed in this paper are those of the authors. The funder was not involved in the conduct of the study or preparation of the manuscript.Peer reviewedPublisher PD

Identifying common health indicators from paediatric core outcome sets: a systematic review with narrative synthesis using the WHO International Classification of Functioning, Health and Disability

Background Indicators of child health have the potential to inform societal conversations, decision-making and prioritisation. Paediatric core outcome sets are an increasingly common way of identifying a minimum set of outcomes for trials within clinical groups. Exploring commonality across existing sets may give insight into universally important and inclusive child health indicators. Methods A search of the Core Outcome Measures in Effectiveness Trial register from 2008 to 2022 was carried out. Eligible articles were those reporting on core outcome sets focused on children and young people aged 0–18 years old. The International Classification of Functioning, Disability and Health (ICF) was used as a framework to categorise extracted outcomes. Information about the involvement of children, young people and their families in the development of sets was also extracted. Results 206 articles were identified, of which 36 were included. 441 unique outcomes were extracted, mapping to 22 outcome clusters present across multiple sets. Medical diagnostic outcomes were the biggest cluster, followed by pain, communication and social interaction, mobility, self-care and school. Children and young people’s views were under-represented across core outcome sets, with only 36% of reviewed studies including them at any stage of development. Conclusions Existing paediatric core outcome sets show overlap in key outcomes, suggesting the potential for generic child health measurement frameworks. It is unclear whether existing sets best reflect health dimensions important to children and young people, and there is a need for better child and young person involvement in health indicator development to address this

Learning how to understand complexity and deal with sustainability challenges : A framework for a comprehensive approach and its application in university education

Sustainability challenges such as climate change, biodiversity loss, poverty and rapid urbanization are complex and strongly interrelated. In order to successfully deal with these challenges, we need comprehensive approaches that integrate knowledge from multiple disciplines and perspectives and emphasize interconnections. In short, they aid in observing matters in a wider perspective without losing an understanding of the details. In order to teach and learn a comprehensive approach, we need to better understand what comprehensive thinking actually is. In this paper, we present a conceptual framework for a comprehensive approach, termed the GHH framework. The framework comprises three dimensions: generalism, holism, and holarchism. It contributes to the academic community's understanding of comprehensive thinking and it can be used for integrating comprehensive thinking into education. Also, practical examples of the application of the framework in university teaching are presented. We argue that an ideal approach to sustainability challenges and complexity in general is a balanced, dialectical combination of comprehensive and differentiative approaches. The current dominance of specialization, or the differentiative approach, in university education calls for a stronger emphasis on comprehensive thinking skills. Comprehensiveness should not be considered as a flawed approach, but should instead be considered as important an aspect in education as specialized and differentiative skills. (C) 2017 Elsevier B.V. All rights reserved.Peer reviewe

Syntheses, structure, reactivity and species recognition studies of oxo-vanadium(V) and -molybdenum(VI) complexes

Alkoxo-rich Schiff-bases of potentially tri-, tetra- and penta-dentate binding capacity, and their sodium tetrahydroborate-reduced derivatives, have been synthesized. Their oxo-vanadium(V) and -molybdenum(VI) complexes were synthesized and characterized using several analytical and spectral techniques including multinuclear NMR spectroscopy and single-crystal X-ray diffraction studies. Eight structurally different types of complexes possessing distorted square-pyramidal, trigonal-bipyramidal and octahedral geometries have been obtained. While (VO)-O-V exhibits dimeric Structures with 2-HOC6H4CH=NC(CH2OH)(3) and 2-HOC6H4CH2-NHC(CH2OH)(3) and related ligands through the formation of a symmetric V2O2 core as a result of bridging of one of the CH2O- groups, Mo O-VI gives only mononuclear complexes even when some unbound CH2OH groups are available and the metal center is co-ordinatively unsaturated. In all the complexes the nitrogen atom from a HC=N or H2CNH group of the ligand occupies a near trans position to the M=O bond. While the Schiff-base ligands act in a tri- and tetra-dentate manner in the vanadium(V) complexes, they are only tridentate in the molybdenum(VI) complexes. Proton NMR spectra in the region of bound CH, provides a signature that helps to differentiate dinuclear from mononuclear complexes. Carbon-13 NMR co-ordination induced shifts of the bound CH, group fit well with the charge on the oxometal species and the terminal or bridging nature of the ligand. The reactivity of the vanadium(V) complexes towards bromination of the dye xylene cyanole was studied. Transmetallation reactions of several preformed metal complexes of 2-HOC6H4CH=NC(CH2OH)(3) with VO3+ were demonstrated as was selective extraction of VO3+ from a mixture of VO(acac)(2)] and MoO2(acac)(2)] using this Schiff base. The unusual selectivity and that of related derivatives for VO3+ is supported by binding constants and the solubility of the final products, and was established through a.c. conductivity measurements. The cis-MoO22+ complexes with alkoxo binding showed an average Mo-O-alk distance of 1.926 Angstrom, a value that is close to that observed in the molybdenum(VI) enzyme dmso reductase (1.92 Angstrom). Several correlations have been drawn based on the data

Using shared goal setting to improve access and equity : a mixed methods study of the Good Goals intervention in children's occupational therapy

Peer reviewedPublisher PD

Testing the Resolving Power of 2-D K^+ K^+ Interferometry

Adopting a procedure previously proposed to quantitatively study two-dimensional pion interferometry, an equivalent 2-D chi^2 analysis was performed to test the resolving power of that method when applied to less favorable conditions, i.e., if no significant contribution from long lived resonances is expected, as in kaon interferometry. For that purpose, use is made of the preliminary E859 K^+ K^+ interferometry data from Si+Au collisions at 14.6 AGeV/c. As expected, less sensitivity is achieved in the present case, although it still is possible to distinguish two distinct decoupling geometries. The present analysis seems to favor scenarios with no resonance formation at the AGS energy range, if the preliminary K^+ K^+ data are confirmed. The possible compatibility of data with zero decoupling proper time interval, conjectured by the 3-D experimental analysis, is also investigated and is ruled out when considering more realistic dynamical models with expanding sources. These results, however, clearly evidence the important influence of the time emission interval on the source effective transverse dimensions. Furthermore, they strongly emphasize that the static Gaussian parameterization, commonly used to fit data, cannot be trusted under more realistic conditions, leading to distorted or even wrong interpretation of the source parameters!Comment: 11 pages, RevTeX, 4 Postscript figures include

Flat-band ferromagnetism in quantum dot superlattices

Possibility of flat-band ferromagnetism in quantum dot arrays is theoretically discussed. By using a quantum dot as a building block, quantum dot superlattices are possible. We consider dot arrays on Lieb and kagome lattices known to exhibit flat band ferromagnetism. By performing an exact diagonalization of the Hubbard Hamiltonian, we calculate the energy difference between the ferromagnetic ground state and the paramagnetic excited state, and discuss the stability of the ferromagnetism against the second nearest neighbor transfer. We calculate the dot-size dependence of the energy difference in a dot model and estimate the transition temperature of the ferromagnetic-paramagnetic transition which is found to be accessible within the present fabrication technology. We point out advantages of semiconductor ferromagnets and suggest other interesting possibilities of electronic properties in quantum dot superlattices.Comment: 15 pages, 7 figures (low resolution). High-resolution figures are available at http://www.brl.ntt.co.jp/people/tamura/Research/PublicationPapers.htm

Choice Architecture Cueing to Healthier Dietary Choices and Physical Activity at the Workplace:Implementation and Feasibility Evaluation

Redesigning choice environments appears a promising approach to encourage healthier eating and physical activity, but little evidence exists of the feasibility of this approach in real-world settings. The aim of this paper is to portray the implementation and feasibility assessment of a 12-month mixed-methods intervention study, StopDia at Work, targeting the environment of 53 diverse worksites. The intervention was conducted within a type 2 diabetes prevention study, StopDia. We assessed feasibility through the fidelity, facilitators and barriers, and maintenance of implementation, building on implementer interviews (n = 61 informants) and observations of the worksites at six (t1) and twelve months (t2). We analysed quantitative data with Kruskall–Wallis and Mann–Whitney U tests and qualitative data with content analysis. Intervention sites altogether implemented 23 various choice architectural strategies (median 3, range 0–14 strategies/site), employing 21 behaviour change mechanisms. Quantitative analysis found implementation was successful in 66%, imperfect in 25%, and failed in 9% of evaluated cases. These ratings were independent of the ease of implementation of applied strategies and reminders that implementers received. Researchers’ assistance in intervention launch (p = 0.02) and direct contact to intervention sites (p < 0.001) predicted higher fidelity at t1, but not at t2. Qualitative content analysis identified facilitators and barriers related to the organisation, intervention, worksite environment, implementer, and user. Contributors of successful implementation included apt implementers, sufficient implementer training, careful planning, integration into worksite values and activities, and management support. After the study, 49% of the worksites intended to maintain the implementation in some form. Overall, the choice architecture approach seems suitable for workplace health promotion, but a range of practicalities warrant consideration while designing real-world implementation