48,884 research outputs found
Inpatients’ perspectives of occupational therapy in acute mental health
Background
Research into service users’ views of occupational therapy in acute mental health is extremely limited. This collaborative study between South West London and St George’s Mental Health NHS Trust and Brunel University (UK) obtained inpatients’ perspectives of occupational therapy.
Methods
Service users and occupational therapists were involved in designing a self-report questionnaire and, following training, in recruiting participants and collecting data.
Results
Sixty-four (28.6%) inpatients responded and most had met an occupational therapist who had explained the purpose of their intervention. The most frequent group interventions were arts and crafts, relaxation, community meetings, cookery, sports and gym, with the latter two rated as most beneficial. There was much less choice about individual goals and interventions. A highly significant and positive correlation was found between occupational therapy meeting the needs of individuals and it improving their daily functioning and quality of their admission.
Conclusions
Occupational therapists need to provide more individual interventions and more fully involve inpatients in deciding on individual goals. Group interventions, which are meaningful, relevant and with an occupational focus, are most beneficial. Further research examining the effectiveness of cookery and sport and gym and establishing the benefits of engaging in group and individual intervention on acute wards is warranted
Spectroscopic infrared extinction mapping as a probe of grain growth in IRDCs
We present spectroscopic tests of MIR to FIR extinction laws in IRDC
G028.36+00.07, a potential site of massive star and star cluster formation. Lim
& Tan (2014) developed methods of FIR extinction mapping of this source using
-MIPS and -PACS
images, and by comparing to MIR -IRAC --
extinction maps, found tentative evidence for grain growth in the highest mass
surface density regions. Here we present results of spectroscopic infrared
extinction (SIREX) mapping using -IRS (14 to )
data of the same IRDC. These methods allow us to first measure the SED of the
diffuse Galactic ISM that is in the foreground of the IRDC. We then carry out
our primary investigation of measuring the MIR to FIR opacity law and searching
for potential variations as a function of mass surface density within the IRDC.
We find relatively flat, featureless MIR-FIR opacity laws that lack the
and features associated with the thick
water ice mantle models of Ossenkopf & Henning (1994). Their thin ice mantle
models and the coagulating aggregate dust models of Ormel et al. (2011) are a
generally better match to the observed opacity laws. We also find evidence for
generally flatter MIR to FIR extinction laws as mass surface density increases,
strengthening the evidence for grain and ice mantle growth in higher density
regions.Comment: 12 pages, 12 Figures, 1 Table, Accepted to be published to Ap
The clinical effectiveness and cost-effectiveness of inhaler devices used in the routine management of chronic asthma in older children: a systematic review and economic evaluation
Background:
This review examines the clinical effectiveness and
cost-effectiveness of hand-held inhalers to deliver
medication for the routine management of chronic
asthma in children aged between 5 and 15 years.
Asthma is a common disease of the airways, with a
prevalence of treated asthma in 5–15-year-olds of
around 12% and an actual prevalence in the community
as high as 23%. Treatment for the condition
is predominantly by inhalation of medication. There
are three main types of inhaler device, pressurised
metered dose, breath actuated, and dry powder, with
the option of the attachment of a spacer to the first
two devices under some prescribed circumstances.
Two recent reviews have examined the clinical and
cost-effectiveness evidence on inhaler devices, but
one was for children aged under 5 years and the
comparison in the second was made between pressurised
metered dose inhalers and other types only.
Objectives:
This review examines the clinical effectiveness and
cost-effectiveness of manual pressurised metered
dose inhalers, breath-actuated metered dose
inhalers, and breath-actuated dry powder inhalers,
with and without spacers as appropriate, to deliver
medication for the routine management of chronic
asthma in children aged between 5 and 15 years.
Methods:
Two previous HTA reviews have compared the
effectiveness of inhaler devices, one focusing on
asthma in children aged under 5 years and the
other on asthma and chronic obstructive airways
disease in all age groups. For the current review, a
literature search was carried out to identify all
evidence relating to the use of inhalers in older
children with chronic asthma. A search of in-vitro
studies undertaken for one of the previous reviews
was also updated.
The data sources used were: 15 electronic bibliographic
databases; the reference lists of one of the
previous HTA reports and other relevant articles;
health services research-related internet resources;
and all sponsor submissions.
Studies were selected according to strict inclusion
and exclusion criteria, and relevant information
concerning effectiveness and patient compliance
and preference was extracted directly on to an
extraction/evidence table. Quality assurance
was monitored.
Economic evaluation was undertaken by reviewing
existing cost-effective evidence. Further economic
modelling was carried out, and tables constructed
to determine device cost-minimisation and
incremental quality-adjusted life-year (QALY)
thresholds between devices.
Results:
Number and quality of studies, and
direction of evidence:
Fourteen randomised controlled studies were
identified relating to the clinical effectiveness of
inhaler devices for delivering β2-agonists. A further
five were on devices delivering corticosteroids and
one concerned the delivery of cromoglicate.
Overall, there were no differences in clinical
efficacy between inhaler devices, but a pressurised
metered dose inhaler with a spacer would appear
to be more effective than one without. These
findings endorse those of a previous HTA review
but extend them to other inhaler devices.
Seven randomised controlled trials examined the
impact on clinical effectiveness of using a nonchlorofluorocarbon
(CFC) propellant in place of
a CFC propellant in metered dose inhalers, both
pressurised and breath activated, although only one
study considered the latter type. No differences were
found between inhalers containing either propellant.
A further 30 studies of varying quality, from 12 randomised
controlled trials to non-controlled studies,
were identified that concerned the impact of use
by, and preference for, inhaler type, and treatment
adherence in children. Differences between the
studies, and limitations in comparative data between
various inhaler device types, make it difficult to draw
any firm conclusions from this evidence.
Summary of benefits:
No obvious benefits for one inhaler device type
over another for use in children aged 5–15 years
were identified.
Costs and cost per quality-adjusted
life-year:
Two approaches have been taken: cost-minimisation
and QALY threshold. In the QALY threshold
approach, additional QALYs that each device must
produce compared with a cheaper device to achieve
an acceptable cost per QALY were calculated. Using
the cheapest and most expensive devices for delivering
200 μg of beclometasone per day, assuming no
cost offset for any device, and a threshold of £5000,
the largest QALY needed was 0.00807. With such
a small QALY increase, no intervention can be
categorically rejected as not cost-effective.
Conclusions:
Generalisability of findings:
On the available evidence there are no obvious
benefits for one inhaler device over another
when used by children aged 5–15 years with
chronic asthma. However, the evidence, in the
majority of cases, was compiled on children
with mild to moderate asthma and restricted
to a limited number of drugs. Therefore the
findings may not be generalisable to those at
the more severe end of the spectrum of the
disease or to inhaler devices delivering some
of the drugs used in the management of asthma.
Need for further research:
Many of the previous studies are likely to
have been underpowered. Further clinical
trials with a robust methodology, sufficient
power and qualitative components are needed
to demonstrate any differences in clinical
resource use and patients’ asthma symptoms.
Further studies should also include the
behavioural aspects of patients towards their
medication and its delivery mechanisms.
It is acknowledged that sufficient power may
prove impractical owing to the large numbers
of patients required
Two Projects
The public telephone has seen the many vicissitudes of life in the late twentieth century. Its unrivalled distribution in almost every city of the world makes it the ideal forum for disseminating services and information
Supersymmetry in gauge theories with extra dimensions
We show that a quantum-mechanical N=2 supersymmetry is hidden in 4d mass
spectrum of any gauge invariant theories with extra dimensions. The N=2
supercharges are explicitly constructed in terms of differential forms. The
analysis can be extended to extra dimensions with boundaries, and for a single
extra dimension we clarify a possible set of boundary conditions consistent
with 5d gauge invariance, although some of the boundary conditions break 4d
gauge symmetries.Comment: 18 page
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Microwave Heating of Lunar Simulants JSC-1A and NU-LHT-3M: Experimental And Theoretical Analysis
Widely separated binary systems of very low mass stars
In this paper we review some recent detections of wide binary brown dwarf
systems and discuss them in the context of the multiplicity properties of very
low-mass stars and brown dwarfs.Comment: 2 pages, 1 figure (new version with minor corrections); to appear in
the proceedings of the workshop "Ultra-low mass star formation and
evolution", to be published in A
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