Student interprofessional mental health simulation (SIMHS): evaluating the impact on medical and nursing students, and clinical psychology trainees

Purpose: Mental health simulation is the educational practice of recreating clinical situations in safe environments using actors, followed by structured debriefing, to foster professional development and improve care. Although evidence outlines the benefits of simulation, few studies have examined the impact of interprofessional mental health simulation on healthcare trainees, which is more reflective of clinical care. The purpose of this paper is to evaluate the impact of mental health simulation training on students’ confidence, attitudes, knowledge and perceived professional development and anticipated clinical practice. Design/methodology/approach: Participants (n=56) were medical (41 per cent) and mental health nursing students (41 per cent), and clinical psychology trainees (18 per cent). Six simulated scenarios, involving one to three trainees, were followed by structured debriefs with trained facilitators. Scenarios, using actors, reflected patient journeys through emergency, medical and psychiatric settings. Participants’ confidence, knowledge and attitudes were measured quantitatively using pre- and post-course self-report questionnaires. Perceptions of impact on professional development and clinical practice were assessed using thematic analysis of post-course questionnaire responses. Findings: Knowledge, confidence and attitudes scores showed statistically significant increases, with large effect sizes. Thematic analyses highlighted themes of: interprofessionalism, communication skills, reflective practice, personal resilience, clinical skills and confidence. Research limitations/implications: Further research should clarify the impact of interprofessional simulation training on mental health practice in the context of other training received. Practical implications: Simulation training may begin to influence participants’ professional development and future clinical practice and subsequently care delivered, supporting its increased use in mental health. Originality/value: This study adds to nascent understandings of the use and potential of interprofessional mental health simulation, outlining innovative training, its positive outcomes and implications

Pretreatment health measures and complications after surgical management of elderly women with breast cancer

Elderly patients with breast cancer are less likely to be offered surgery, partly owing to co-morbidities and reduced functional ability. However, there is little consensus on how best to assess surgical risk in this patient group.The ability of pretreatment health measures to predict complications was investigated in a prospective cohort study of a consecutive series of women aged at least 70 years undergoing surgery for operable (stage I-IIIa) breast cancer at 22 English breast units between 2010 and 2013. Data on treatment, surgical complications, health measures and tumour characteristics were collected by case-note review and/or patient interview. Outcome measures were all complications and serious complications within 30 days of surgery.The study included 664 women. One or more complications were experienced by 41·0 per cent of the patients, predominantly seroma or primary/minor infections. Complications were serious in 6·5 per cent. More extensive surgery predicted a higher number of complications, but not serious complications. Older age did not predict complications. Several health measures were associated with complications in univariable analysis, and were included in multivariable analyses, adjusting for type/extent of surgery and tumour characteristics. In the final models, pain predicted a higher count of complications (incidence rate ratio 1·01, 95 per cent c.i. 1·00 to 1·01; P = 0·004). Fatigue (odds ratio (OR) 1·02, 95 per cent c.i. 1·01 to 1·03; P = 0·004), low platelet count (OR 4·19, 1·03 to 17·12: P = 0·046) and pulse rate (OR 0·96, 0·93 to 0·99; P = 0·010) predicted serious complications.The risk of serious complications from breast surgery is low for older patients. Surgical decisions should be based on patient fitness rather than age. Health measures that predict surgical risk were identified in multivariable models, but the effects were weak, with 95 per cent c.i. close to unity.This paper presents independent research funded by theBreast Cancer Campaign (2008NOVPR35), a NationalInstitute for Health Research (NIHR) Programme Grantfor Applied Research (RP-PG-0608-10168) and researcharising from a Post Doctoral Fellowship supported by theNIHR (PDF/01/2008/027). The views expressed in thispublication are those of the authors and not necessarilythose of the NHS, the NIHR or the Department of Health

Using the NPSS Environment to Model an Altitude Test Facility

An altitude test facility was modeled using Numerical Propulsion System Simulation (NPSS). This altitude test facility model represents the most detailed facility model developed in the NPSS architecture. The current paper demonstrates the use of the NPSS system to define the required operating range of a component for the facility. A significant number of additional component models were easily developed to complete the model. Discussed in this paper are the additional components developed and what was done in the development of these components

Meson Structure Functions in Valon Model

Parton distributions in a {\it{valon}} in the next-to-leading order is used to determine the patron distributions in pion and kaon. The validity of the valon model is tested and shown that the partonic content of the valon is universal and independent of the valon type. We have evaluated the valon distribution in pion and kaon, and in particular it is shown that the results are in good agreement with the experimental data on pion structure in a wide range of $x=[10^{-4},1]$Comment: 13 pages with 7 figures included, The manuscript is revised, figures are added and some errors are corrected. Accepted for publication in Physical Review

Young adults' perceptions of using wearables, social media and other technologies to detect worsening mental health: A qualitative study

BACKGROUND: Technological interventions may help support and improve mental health. However young peoples' perspectives on using different technologies to detect deteriorating mental health in those already diagnosed with a mental health condition is lacking. The study aim was to explore the perspectives of young patients on the feasibility and acceptability of using wearables, social media and technologies to detect mental health deterioration. METHODS: The study was co-produced with young adults with past mental health difficulties. Semi-structured interviews were conducted with young adults with a severe mental health condition in a private room at a community mental health site. Data was triangulated by comparing codes and ideas across the two co-researchers and two researchers over two virtual meetings. Themes were finalised and presented in a thematic map. RESULTS: Sixteen participants were interviewed (81% female). There were four main themes: dealing with mental health symptoms, signs of mental health deterioration, technology concerns and technological applications to identify worsening mental health. Wearables and mobile apps were considered acceptable and feasible to detect mental health deterioration in real-time if they could measure changes in sleep patterns, mood or activity levels as signs of deterioration. Getting help earlier was deemed essential particularly in reference to dissatisfaction with the current non-technological mental health services. However, patients identified issues to consider before implementation including practicality, safeguarding and patient preference. CONCLUSION: Wearables and mobile apps could be viable technological options to help detect deterioration in young people in order to intervene early and avoid delay in accessing mental health services. However, immediate action following detection is required for the patient to trust and use the intervention

Charges in Gauge Theories

In this article we investigate charged particles in gauge theories. After reviewing the physical and theoretical problems, a method to construct charged particles is presented. Explicit solutions are found in the Abelian theory and a physical interpretation is given. These solutions and our interpretation of these variables as the true degrees of freedom for charged particles, are then tested in the perturbative domain and are demonstrated to yield infra-red finite, on-shell Green's functions at all orders of perturbation theory. The extension to collinear divergences is studied and it is shown that this method applies to the case of massless charged particles. The application of these constructions to the charged sectors of the standard model is reviewed and we conclude with a discussion of the successes achieved so far in this programme and a list of open questions.Comment: 47 pages, LaTeX, 14 figures, uses feynmp, necessary Metapost files included. Review to appear in Pramana, Journal of Physics. Minor LaTeX change to make page numbers visible on "Letter" paper forma

Squeezed gluon vacuum and the global colour model of QCD

We discuss how the vacuum model of Celenza and Shakin with a squeezed gluon condensate can explain the existence of an infrared singular gluon propagator frequently used in calculations within the global colour model. In particular, it reproduces a recently proposed QCD-motivated model where low energy chiral parameters were computed as a function of a dynamically generated gluon mass. We show how the strength of the confining interaction of this gluon propagator and the value of the physical gluon condensate may be connected.Comment: 13 pages, LaTe

Symmetry breaking, conformal geometry and gauge invariance

When the electroweak action is rewritten in terms of SU(2) gauge invariant variables, the Higgs can be interpreted as a conformal metric factor. We show that asymptotic flatness of the metric is required to avoid a Gribov problem: without it, the new variables fail to be nonperturbatively gauge invariant. We also clarify the relations between this approach and unitary gauge fixing, and the existence of similar transformations in other gauge theories.Comment: 11 pages. Version 2: typos corrected, discussion of Elitzur's theorem added. Version to appear in J.Phys.

Reflections, impact and recommendations of a co-produced qualitative study with young people who have experience of mental health difficulties

Background: There is limited evidence of genuine equal partnership where power is shared with young people with mental health difficulties throughout all research stages, particularly in data collection and analysis. Objective: To describe how our qualitative study, exploring young peoples’ perceptions on the feasibility of using technology to detect mental health deterioration, was co- produced using principles of co-production, whilst reflecting on impact, challenges and recommendations. Methods: Young people with experience of mental health difficulties were appointed and then worked with researchers throughout all research stages. The study was evaluated against the five principles of co-production. Reflections from researchers and young people were collected throughout. Results: Seven young people formed an initial Young People's Advisory Group (YPAG); three became co-researchers. Reflection was key throughout the process. Sharing power became easier and more evident as trust, confidence and mutual re- spect grew over time, particularly after a safe space was established. The safe space was crucial for open discussions, and our WhatsApp group enabled continual com- munication, support and shared decision-making. The resulting co-produced topic guide, coding framework, thematic map, papers and presentations demonstrated significant impact. Conclusions: To our knowledge, this is the first qualitative mental health study to be co-produced using the principles of co-production. Our rigorous assessment can be utilized as an informative document to help others to produce meaningful co- produced future research. Although co-production takes time, it makes significant impact to the research, researchers and co-researchers. Flexible funding for spon- taneous suggestions from co-researchers and more time for interview training is recommended