Planetary explorer liquid propulsion study

An analytical evaluation of several candidate monopropellant hydrazine propulsion system approaches is conducted in order to define the most suitable configuration for the combined velocity and attitude control system for the Planetary Explorer spacecraft. Both orbiter and probe-type missions to the planet Venus are considered. The spacecraft concept is that of a Delta launched spin-stabilized vehicle. Velocity control is obtained through preprogrammed pulse-mode firing of the thrusters in synchronism with the spacecraft spin rate. Configuration selection is found to be strongly influenced by the possible error torques induced by uncertainties in thruster operation and installation. The propulsion systems defined are based on maximum use of existing, qualified components. Ground support equipment requirements are defined and system development testing outlined

Governing researchers through public involvement

This paper focuses on recent developments in UK health research policy, which place new pressures on researchers to address issues of accountability and impact through the implementation of patient and public involvement (PPI). We draw on an in-depth interview study with 20 professional researchers, and we analyse their experiences of competing for research funding, focusing on PPI as a process of professional research governance. We unearth dominant professional narratives of scepticism and alternative identifications in their enactment of PPI policy. We argue that such narratives and identifications evidence a resistance to ways in which patient involvement has been institutionalised and to the resulting subject-positions researchers are summoned to take up. We show that the new subjectivities emerging in this landscape of research governance as increasingly disempowered, contradictory and fraught with unresolved tensions over the ethical dimensions of the researchers' own professional identities

Patient outcomes up to 15 years after stroke: survival, disability, quality of life, cognition and mental health

BACKGROUND: The global epidemiological shift of disease burden towards long-term conditions means understanding long-term outcomes of cardiovascular disease is increasingly important. More people are surviving stroke to experience its long-term consequences, but outcomes in people living more >10 years after stroke have not been described in detail. METHODS: Data were collected for the population-based South London Stroke Register, with participants followed up annually until death. Outcomes were survival, disability, activity, cognitive impairment, quality of life, depression and anxiety. FINDINGS: Of 2625 people having first-ever stroke, 262 (21%) survived to 15 years. By 15 years, 61% (95% CI 55% to 67%) of the survivors were male, with a median age of stroke onset of 58 years (IQR 48-66). 87% of the 15-year survivors were living at home and 33.8% (26.2% to 42.4%) had mild disability, 14.3% (9.2% to 21.4%) moderate disability and 15.0% (9.9% to 22.3%) severe disability. The prevalence of disability increased with time but 1 in 10 of the 15-year survivors had lived with moderate-severe disability since their stroke. At 15 years, the prevalence of cognitive impairment was 30.0% (19.5% to 43.1%), depression 39.1% (30.9% to 47.9%) and anxiety 34.9% (27.0% to 43.8%), and survivors reported greater loss of physical than mental quality of life. CONCLUSIONS: One in five people live at least 15 years after a stroke and poor functional, cognitive and psychological outcomes affect a substantial proportion of these long-term survivors. As the global population of individuals with cardiovascular long-term conditions grows, research and health services will need to increasingly focus on preventing and managing the long-term consequences of stroke

Low grade glioma: An Update for Radiologists

With the recent publication of a new World Health Organization (WHO) brain tumour classification that reflects increased understanding of glioma tumour genetics there is a need for radiologists to understand the changes and their implications for patient management. There has also been an increasing trend for adopting earlier, more aggressive surgical approaches to low grade glioma treatment. We will summarise these changes, give some context to the increased role of tumour genetics and discuss the associated implications for radiologists of their adoption. We will discuss the earlier and more radical surgical resection of low grade gliomas and what it means for imaging patients

Patient, carer and public involvement in major system change in acute stroke services: The construction of value

BACKGROUND: Patient and public involvement is required where changes to care provided by the UK National Health Service are proposed. Yet involvement is characterized by ambiguity about its rationales, methods and impact. AIMS: To understand how patients and carers were involved in major system changes (MSCs) to the delivery of acute stroke care in 2 English cities, and what kinds of effects involvement was thought to produce. METHODS: Analysis of documents from both MSC projects, and retrospective in-depth interviews with 45 purposively selected individuals (providers, commissioners, third-sector employees) involved in the MSC. RESULTS: Involvement was enacted through consultation exercises; lay membership of governance structures; and elicitation of patient perspectives. Interviewees' views of involvement in these MSCs varied, reflecting different views of involvement per se, and of implicit quality criteria. The value of involvement lay not in its contribution to acute service redesign but in its facilitation of the changes developed by professionals. We propose 3 conceptual categories-agitation management, verification and substantiation-to identify types of process through which involvement was seen to facilitate system change. DISCUSSION: Involvement was seen to have strategic and intrinsic value. Its strategic value lay in facilitating the implementation of a model of care that aimed to deliver evidence-based care to all; its intrinsic value was in the idea of citizen participation in change processes as an end in its own right. The concept of value, rather than impact, may provide greater traction in analyses of contemporary involvement practices

How is the audit of therapy intensity influencing rehabilitation in inpatient stroke units in the UK? An ethnographic study.

OBJECTIVES: Occupational therapy, physiotherapy and speech and language therapy are central to rehabilitation after a stroke. The UK has introduced an audited performance target: that 45 min of each therapy should be provided to patients deemed appropriate. We sought to understand how this has influenced delivery of stroke unit therapy. DESIGN: Ethnographic study, including observation and interviews. The theoretical framework drew on the work of Lipsky and Power, framing therapists as 'street level bureaucrats' in an 'audit society'. SETTING: Stroke units in three English hospitals. PARTICIPANTS: Forty-three participants were interviewed, including patients, therapists and other staff. RESULTS: There was wide variation in how therapy time was recorded and in decision-making regarding which patients were 'appropriate for therapy' or auditable. Therapists interpreted their roles differently in each stroke unit. Therapists doubted the validity of the audit results and did not believe their results reflected the quality of services they provided. Some assumed their audit results would inform commissioning decisions. Senior therapy leaders shaped priorities and practices in each therapy team. Patients were inactive outside therapy sessions. Patients differed regarding the quantity of therapy they felt they needed but consistently wanted to be more involved in decisions and treated as individuals

Patient experience of centralised acute stroke care pathways

Background: In 2010, Greater Manchester (GM) and London centralized acute stroke care services into a reduced number of hyperacute stroke units, with local stroke units providing on‐going care nearer patients’ homes. / Objective: To explore the impact of centralized acute stroke care pathways on the experiences of patients. / Design: Qualitative interview study. Thematic analysis was undertaken, using deductive and inductive approaches. Final data analysis explored themes related to five chronological phases of the centralized stroke care pathway. / Setting and participants: Recruitment from 3 hospitals in GM (15 stroke patients/8 family members) and 4 in London (21 stroke patients/9 family members). / Results: Participants were impressed with emergency services and initial reception at hospital: disquiet about travelling further than a local hospital was allayed by clear explanations. Participants knew who was treating them and were involved in decisions. Difficulties for families visiting hospitals a distance from home were raised. Repatriation to local hospitals was not always timely, but no detrimental effects were reported. Discharge to the community was viewed less positively. / Discussion and conclusions: Patients on the centralized acute stroke care pathways reported many positive aspects of care: the centralization of care pathways can offer patients a good experience. Disadvantages of travelling further were perceived to be outweighed by the opportunity to receive the best quality care. This study highlights the necessity for all staff on a centralized care pathway to provide clear and accessible information to patients, in order to maximize their experience of care

How is the audit of therapy intensity influencing rehabilitation in inpatient stroke units in the UK? An ethnographic study.

OBJECTIVES: Occupational therapy, physiotherapy and speech and language therapy are central to rehabilitation after a stroke. The UK has introduced an audited performance target: that 45 min of each therapy should be provided to patients deemed appropriate. We sought to understand how this has influenced delivery of stroke unit therapy. DESIGN: Ethnographic study, including observation and interviews. The theoretical framework drew on the work of Lipsky and Power, framing therapists as 'street level bureaucrats' in an 'audit society'. SETTING: Stroke units in three English hospitals. PARTICIPANTS: Forty-three participants were interviewed, including patients, therapists and other staff. RESULTS: There was wide variation in how therapy time was recorded and in decision-making regarding which patients were 'appropriate for therapy' or auditable. Therapists interpreted their roles differently in each stroke unit. Therapists doubted the validity of the audit results and did not believe their results reflected the quality of services they provided. Some assumed their audit results would inform commissioning decisions. Senior therapy leaders shaped priorities and practices in each therapy team. Patients were inactive outside therapy sessions. Patients differed regarding the quantity of therapy they felt they needed but consistently wanted to be more involved in decisions and treated as individuals