The Individual Recovery Outcomes Counter:preliminary validation of a personal recovery measure

Aims and methodThe Individual Recovery Outcomes Counter (I.ROC) is to date the only recovery outcomes instrument developed in Scotland. This paper describes the steps taken to initially assess its validity and reliability, including factorial analysis, internal consistency and a correlation benchmarking analysis.ResultsThe I.ROC tool showed high internal consistency. Exploratory factor analysis indicated a two-factor structure comprising intrapersonal recovery (factor 1) and interpersonal recovery (factor 2), explaining between them over 50% of the variance in I.ROC scores. There were no redundant items and all loaded on at least one of the factors. The I.ROC significantly correlated with widely used existing instruments assessing both personal recovery and clinical outcomes.Clinical implicationsI.ROC is a valid and reliable measure of recovery in mental health, preferred by service users when compared with well-established instruments. It could be used in clinical settings to map individual recovery, providing feedback for service users and helping to assess service outcomes.</p

Exploring the role of the Tissue Viability Nurse

Aim: To explore the role and identify key responsibilities of the Tissue Viability Nurse (TVN) in the UK. Methods: Mixed methodology using questionnaires distributed via SurveyMonkey and semi-structured interviews. Results: 261 respondents completed the online questionnaire and seven participated in semi-structured interviews. Of the 261 respondents to the questionnaire, 63.7% were employed as TVNs. Almost all respondents claimed to have access to a tissue viability service and the mean TVN team size was 4.7. Some 81.9% of respondents stated they had a team vision, with 75.9% stating that their service had set criteria for referrals. Analysis showed a statistical significance (χ2 (1)=16.6; p<0.001) between TVNs’ and non-TVNs’ knowledge of the referral criteria, with the latter being more aware. There was a variety of other titles used for the role, with interviewees affirming this was poorly understood by patients. Discussion: The results of this study identified that there is no national job title for the TVN role. Data identified that patients do not fully understand the title ‘Tissue Viability Nurse’. The TVN role is complex and not just about the management of a wound. However, what is also clear from the analysis of the data is that there are no clear criteria, or educational level, for the role. Data also suggest that review of current service provision, including partnership working with the multidisciplinary team and industry, is required to develop national competencies, guidance and quality assurance measures

Reviews

Review of Low pay and the minimum wage, Labour relations in the public service: developing countries, Public employment law: the role of the contract of employment in Australia and Britain, The system of industrial relations in New Zealan

An Enquiry into Using Supplementary Bioscience Resources in Health

The learning and teaching of bioscience subjects has been recognised to be problematic for well over 20-30 years. Various reasons have been suggested but it is evident that better support for learning at least is required. Various strategies have been tried and effective online support looks promising, especially as an aid to help those students who struggle with science and for whom English is not their first language. This project sought to introduce an online module designed to support student self-efficacy on the basics of science that are fundamental to gaining an understanding of more advanced bioscience processes. The module went ‘live’ in February 2013 as a voluntary adjunct to curriculum teaching. Though designed with students in mind the subsequent access has been disappointing and raises questions about the willingness of some students to voluntarily access extracurricular material. This might be a focus for further exploration

An electro-hydrostatic actuator for hybrid active-passive vibration isolation

The concept, design, modelling and testing of a novel electro-hydrostatic actuator (EHA) intended for active vibration isolation is described. The EHA consists of a brushless DC motor integrated with a bidirectional gear pump, controlling oil flow to a double-ended hydraulic cylinder. The permanent magnet rotor runs in oil, the motor and pump forming a pressure vessel pre-charged to a mean system pressure (about 80 bar). This arrangement means no pump case drain and refeeding circuit is required. The actuator is designed to cancel the force transmitted through a flexible vibration mount, with dominant vibration frequency of around 20Hz. The particular motivation is to provide isolation between a helicopter fuselage and the vibrating rotor hub, and would be integrated into the flexible strut connecting the two. The inertia of the EHA is tuned to provide a degree of passive vibration isolation at the dominant frequency, and hence is termed a Resonant EHA. Active control of the motor extends the isolation performance of the passive device by compensating for losses (which give damping), and extend the frequency of isolation away from the resonant frequency. A 7kN prototype has been built and extensively tested, demonstrating a reduction by a factor of four in the root-mean-square transmitted force and a near elimination at the fundamental frequency. The advantage of the Resonant EHA is a wider range of operating frequencies than a purely passive system, and a lower power consumption than a purely active system

Emergency department referral patterns of Australian general practitioner registrars: A cross-sectional analysis of prevalence, nature and associations

Objective: Limited international evidence suggests general practice registrars' emergency department (ED) referral rates exceed those of established general practitioners (GPs). The aim of the present study was to fill an evidence gap by establishing the prevalence, nature and associations of Australian GP registrar ED referrals. Methods: A cross-sectional analysis was performed of the Registrar Clinical Encounters in Training (ReCEnT) cohort study of GP registrars' consultation experiences, between 2010 and 2015. The outcome factor in logistic regression analysis was referral to an ED. Independent variables included patient-level, registrar-level, practice-level and consultation-level factors. Results: In all, 1161 GP registrars (response rate 95.5%) contributed data from 166 966 consultations, comprising 258 381 individual problems. Based on responses, 0.5% of problems resulted in ED referral, of which nearly 25% comprised chest pain, abdominal pain and fractures. Significant (P 34 years, the patient being new to the registrar, one particular regional training provider (RTP), in-consultation information or assistance being sought and learning goals being generated. Outer regional-, remote-or very remote-based registrars made significantly fewer ED referrals than more urban registrars. Of the problems referred to the ED, 45.5% involved the seeking of in-consultation information or assistance, predominantly from supervisors. Conclusions: Registrars' ED referral rates are nearly twice those of established GPs. The findings of the present study suggest acute illnesses or injuries present registrars with clinical challenges and real learning opportunities, and highlight the importance of continuity of care, even for acute presentations

The Impact of Li Grain Size on Coulombic Efficiency in Li Batteries

One of the most promising means to increase the energy density of state-of-the-art lithium Li-ion batteries is to replace the graphite anode with a Li metal anode. While the direct use of Li metal may be highly advantageous, at present its practical application is limited by issues related to dendrite growth and low Coulombic efficiency, CE. Here operando electrochemical scanning transmission electron microscopy (STEM) is used to directly image the deposition/stripping of Li at the anode-electrolyte interface in a Li-based battery. A non-aqueous electrolyte containing small amounts of H2O as an additive results in remarkably different deposition/stripping properties as compared to the “dry” electrolyte when operated under identical electrochemical conditions. The electrolyte with the additive deposits more Li during the first cycle, with the grain sizes of the Li deposits being significantly larger and more variable. The stripping of the Li upon discharge is also more complete, i.e., there is a higher cycling CE. This suggests that larger grain sizes are indicative of better performance by leading to more uniform Li deposition and an overall decrease in the formation of Li dendrites and side reactions with electrolyte components, thus potentially paving the way for the direct use of Li metal in battery technologies

Energy supply of countryside based on geothermal deposit

Meiosis is a specialized eukaryotic cell division that generates haploid gametes required for sexual reproduction. During meiosis, homologous chromosomes pair and undergo reciprocal genetic exchange, termed crossover (CO). Meiotic CO frequency varies along the physical length of chromosomes and is determined by hierarchical mechanisms, including epigenetic organization, for example methylation of the DNA and histones. Here we investigate the role of DNA methylation in determining patterns of CO frequency along Arabidopsis thaliana chromosomes. In A. thaliana the pericentromeric regions are repetitive, densely DNA methylated, and suppressed for both RNA polymerase-II transcription and CO frequency. DNA hypomethylated methyltransferase1 (met1) mutants show transcriptional reactivation of repetitive sequences in the pericentromeres, which we demonstrate is coupled to extensive remodeling of CO frequency. We observe elevated centromere-proximal COs in met1, coincident with pericentromeric decreases and distal increases. Importantly, total numbers of CO events are similar between wild type and met1, suggesting a role for interference and homeostasis in CO remodeling. To understand recombination distributions at a finer scale we generated CO frequency maps close to the telomere of chromosome 3 in wild type and demonstrate an elevated recombination topology in met1. Using a pollen-typing strategy we have identified an intergenic nucleosome-free CO hotspot 3a, and we demonstrate that it undergoes increased recombination activity in met1. We hypothesize that modulation of 3a activity is caused by CO remodeling driven by elevated centromeric COs. These data demonstrate how regional epigenetic organization can pattern recombination frequency along eukaryotic chromosomes