Stroke units: The implementation of a complex intervention

This article reports on selected findings from an action research study that looked at the lessons learnt from setting up a new in-patient stroke service in a London teaching hospital. Key participants in the design and evaluation of this 2-year study included members of the multi-professional stroke team and support staff within the unit, the hospital management team and representatives of patients and carers. Mixed methods (focus groups, indepth interviews, audits, documentary analysis, participant observation field notes) were used to generate data. Findings demonstrated positive change overtime with four main themes emerging from the process: building a team; developing practice-based knowledge and skills in stroke; valuing the central role of the nurse in stroke care; and creating an organisational climate for supporting change. The interplay of these non-linear, but interrelated factors is supported by complexity theory, which includes exploration of how the sum of a whole can be more than its constituent parts. Findings are likely to be of interest to practitioners, managers and policy makers interested in supporting change in a learning organisation

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Developing theory and practice: Creation of a Community of Practice through Action Research produced excellence in stroke care

Much emphasis is placed on expert knowledge such as evidence based stroke guidelines, but not enough attention is paid to the processes that are required to translate this into delivery of everyday good care. This paper highlights the worth of creating a Community of Practice (CoP) as a means to achieve this. Drawing on findings from a study conducted 2000 - 2002 of the processes involved in establishment of a nationally lauded high quality Stroke Unit, it demonstrates how successful development of a new service was linked to creation of a CoP. Recent literature suggests CoPs have a key role in the implementation of evidence-based practice; this study supports this claim whilst revealing for the first time the practical knowledge and skills required to develop this style of working. Findings also indicate that the participatory and democratic characteristics of Action Research are congruent with the collaborative approach required for the development of a CoP. The study is an exemplar of how practitioner researchers can capture learning from changing practice, thus contributing to evidence-based healthcare with theoretical as well as practical knowledge. Findings are relevant to those developing stroke services globally but also to those interested in evidence-based practice. (198

Design and Early In-flight Performance of the Tropical Rainfall Measuring Mission (TRMM) Power Subsystem

Maryland built the spacecraft in-house with four U.S. instruments and one Japanese instrument, the first space flown Precipitation Radar (PR). The TRMM Observatory was successfully launched from Tanegashima Space Center in Japan on an H-2 Expendable Launch Vehicle on November 27, 1997. This paper presents an overview of the TRMM Power System including its design, testing, and in flight performance for the first 70 days. Finally, key lessons learned are presented. The TRMM power system consists of an 18.1 square meter deployed solar array fabricated by TRW with Tecstar GaAs/Ge cells, two (2) Hughes 50 Ampere-Hour (Ah) Super NiCd' batteries, each with 22 Eagle-Picher cells, and three (3) electronics boxes designed to provide power regulation, battery charge control, and command and telemetry interface

A Serpin shapes the extracellular environment to prevent influenza A virus maturation

Interferon-stimulated genes (ISGs) act in concert to provide a tight barrier against viruses. Recent studies have shed light on the contribution of individual ISG effectors to the antiviral state, but most have examined those acting on early, intracellular stages of the viral life cycle. Here, we applied an image-based screen to identify ISGs inhibiting late stages of influenza A virus (IAV) infection. We unraveled a directly antiviral function for the gene SERPINE1, encoding plasminogen activator inhibitor 1 (PAI-1). By targeting extracellular airway proteases, PAI-1 inhibits IAV glycoprotein cleavage, thereby reducing infectivity of progeny viruses. This was biologically relevant for IAV restriction in vivo. Further, partial PAI-1 deficiency, attributable to a polymorphism in human SERPINE1, conferred increased susceptibility to IAV in vitro. Together, our findings reveal that manipulating the extracellular environment to inhibit the last step in a virus life cycle is an important mechanism of the antiviral response

On generation-integrated energy storage

Generation-integrated energy storage (GIES) systems store energy at some point along the transformation between the primary energy form and electricity. Instances exist already in natural hydro power, biomass generation, wave power, and concentrated solar power. GIES systems have been proposed for wind, nuclear power and they arise naturally in photocatalysis systems that are in development. GIES systems can compare very favourably in both performance and total cost against equivalent non-integrated systems comprising both generation and storage. Despite this, they have not hitherto been recognised as a discrete class of systems. Consequently policy decisions affecting development or demonstration projects and policy approaches concerning low-carbon generation are not fully informed. This paper highlights that policy structures exist militating against the development and introduction of GIES systems-probably to the detriment of overall system good

Maternal dietary selenium intake during pregnancy and neonatal outcomes in the norwegian mother, father, and child cohort study

Properly working antioxidant defence systems are important for fetal development. One of the nutrients with antioxidant activity is selenium. Increased maternal selenium intake has been associated with reduced risk for being small for gestational age and preterm delivery. Based on the Norwegian Mother, Father, and Child Cohort Study and the Medical Birth Registry of Norway, we in-vestigated the association of maternal selenium intake from food and dietary supplements during the first half of pregnancy (n = 71,728 women) and selenium status in mid-pregnancy (n = 2628 women) with neonatal health, measured as two composite variables (neonatal morbidity/mortality and neonatal intervention). Low maternal dietary selenium intake (<30 \ub5g/day) was associated with increased risk for neonatal morbidity/mortality (adjusted odds ratio (adjOR) 1.36, 95% confidence interval (95% CI) 1.08–1.69) and neonatal intervention (adjOR 1.16, 95% CI 1.01–1.34). Using continuous variables, there were no associations between maternal selenium intake (from diet or supplements) or whole-blood selenium concentration and neonatal outcome in the adjusted models. Our findings suggest that sufficient maternal dietary selenium intake is associated with neonatal outcome. Adher-ing to the dietary recommendations may help ensure an adequate supply of selenium for a healthy pregnancy and optimal fetal development

Phosphorylation of serine-893 in CARD11 suppresses the formation and activity of the CARD11-BCL10-MALT1 complex in T and B cells

CARD 11 acts as a gatekeeper for adaptive immune responses after T cell or B cell antigen receptor (TCR/BCR) ligation on lymphocytes. PKC theta/beta-catalyzed phosphorylation of CARD11 promotes the assembly of the CARD11-BCL10-MALT1 (CBM) complex and lymphocyte activation. Here, we demonstrated that PKC theta/beta-dependent CARD11 phosphorylation also suppressed CARD11 functions in T or B cells. Through mass spectrometry-based proteomics analysis, we identified multiple constitutive and inducible CARD11 phosphorylation sites in T cells. We demonstrated that a single TCR- or BCR-inducible phosphorylation on Ser 893 in the carboxyl terminus of CARD1 1 prevented the activation of the transcription factor NF-kappa B, the kinase JNK, and the protease MALT1. Moreover, CARD11 Ser(893) phosphorylation sensitized BCR-addicted lymphoma cells to toxicity induced by Bruton's tyrosine kinase (BTK) inhibitors. Phosphorylation of Ser 893 in CARD11 by PKCO controlled the strength of CARD11 scaffolding by impairing the formation of the CBM complex. Thus, PKCO simultaneously catalyzes both stimulatory and inhibitory CARD11 phosphorylation events, which shape the strength of CARD11 signaling in lymphocytes

The need for early referral to palliative care especially for Black, Asian and minority ethnic groups in a COVID-19 pandemic:Findings from a service evaluation

Background: Palliative care services face challenges in adapting and responding to the COVID-19 pandemic. Understanding how palliative care needs and outcomes have changed during the pandemic compared to before the pandemic is crucial to inform service planning and research initiatives. Aim: To evaluate the impact of COVID-19 on symptoms, clinical characteristics, and outcomes for patients referred to a hospital-based palliative care service in a district general hospital in London, UK. Design: A retrospective service evaluation. Data were extracted from the electronic patient records. Setting/participants: The first 60 inpatients with confirmed COVID-19 infection, referred to the hospital palliative care service between 1 March 2020 and 23 April 2020, and another 60 inpatients, referred to the hospital palliative care service between 11 March 2019 and 23 April 2019, were included from a district general hospital in East London, UK. Results: Patients with COVID-19 have lower comorbidity scores, poorer performance status, and a shorter time from referral to death compared to patients without COVID-19. Breathlessness, drowsiness, agitation, and fever are the most prevalent symptoms during COVID-19 compared to pain and drowsiness pre-COVID-19. Time from admission to referral to palliative care is longer for Black, Asian and minority ethnic patients, especially during COVID-19. Conclusion: Early referral to palliative care is essential in COVID-19, especially for Black, Asian and minority ethnic groups. There is urgent need to research why Black, Asian and minority ethnic patients are referred late; how palliative care services have changed; and possible solutions to setting up responsive, flexible, and integrated services

Adult Social Work and High Risk Domestic Violence Cases

Summary This article focuses on adult social work’s response in England to high-risk domestic violence cases and the role of adult social workers in Multi-Agency Risk and Assessment Conferences. (MARACs). The research was undertaken between 2013-2014 and focused on one city in England and involved the research team attending MARACs, Interviews with 20 adult social workers, 24 MARAC attendees, 14 adult service users at time T1 (including follow up interviews after six months, T2), focus groups with IDVAs and Women’s Aid and an interview with a Women’s Aid service user. Findings The findings suggest that although adult social workers accept the need to be involved in domestic violence cases they are uncertain of what their role is and are confused with the need to operate a parallel domestic violence and adult safeguarding approach, which is further, complicated by issues of mental capacity. MARACS are identified as overburdened, under-represented meetings staffed by committed managers. However, they are in danger of becoming managerial processes neglecting the service users they are meant to protect. Applications The article argues for a re-engagement of adult social workers with domestic violence that has increasingly become over identified with child protection. It also raises the issue whether MARACS remain fit for purpose and whether they still represent the best possible response to multi-agency coordination and practice in domestic violence