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 ${\it Spitzer}$-MIPS ${\rm 24\mu m}$ and ${\it Herschel}$-PACS ${\rm 70\mu m}$ images, and by comparing to MIR ${\it Spitzer}$-IRAC $3$--${\rm 8\mu m}$ 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 ${\it Spitzer}$-IRS (14 to ${\rm 38\mu m}$) 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 $\sim{\rm 12\mu m}$ and $\sim{\rm 35\mu m}$ 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

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