Exploring changes in health visitors' knowledge, confidence and decision-making for women with perinatal mental health difficulties following a brief training package

Rationale and objective: Perinatal Mental Health (PMH) is an issue that spans the spectrum of pregnancy and childbirth and is now acknowledged to be significant on a global level. Health visitors (HVs) are increasingly expected to extend their knowledge and to understand and identify PMH in the antenatal period and across the spectrum from mild/moderate to severe. While training has been shown to enable HVs to identify post-natal depression (PND) effectively and reduce the proportion of women at risk, the mechanisms underpinning this success are unclear. This paper reports on the findings of a mixed methods study aimed at examining the impact of a single half day training session on perinatal mental health problems (PMHP) on HVs knowledge, confidence and empowerment in relation to managing PMH. Methods: Findings from data gathered by Likert Scales and focus group discussions are presented. Results: Training can empower HVs to identify PMHP beyond PND and plays a vital role in promoting confidence. Conclusions: This research highlights the potential that training of this type has on service provision and delivery. In a resource-limited service, the feasibility of a brief training package has demonstrated positive results for health visitors, childbearing women and their families

Older people's experiences of their kitchens: 2000 to 2010

Purpose – This paper aims to present the quantitative results based on a comparison and evaluation of older people's experiences, needs and wants from their current kitchens, combining and comparing the results obtained from two studies conducted in 2000 and 2010 to see what progress has been made. Design/methodology/approach – A study in 2010 investigated the life-long and contemporary experiences of kitchens of 48 people aged over 60 years of age. The research included detailed questionnaire interviews asking people about their experiences of living in their current kitchen. A previous study, conducted in 2000, asked many of the same questions of 22 people in the same age group. Findings – By combining and comparing the two sets of data it seems that only limited progress has been made in terms of kitchen design meeting the needs of older people between 2000 and 2010. Research limitations/implications – Owing to the small sizes of the samples it is not possible to compare the figures statistically or present them as fully representative of the British older population but while the two samples are limited both had similar characteristics of age and gender, so differences do show potential trends over time. Practical implications – The research refers to guidance and a computer based design tool and identifies a number of practical implications for design. Social implications – As people age their abilities and needs can change and their kitchen may no longer be as accessible or appropriate to their needs. Originality/value – This paper adds to the relevant guidance for designers, developers and managers of buildings where the continued personal use of a kitchen is important for continuing independence of older people

Modelling the delivery of low carbon energy service in residential buildings

The UK is facing a retrofit challenge due to its legacy of old homes which are poorly suited to modern expectations of indoor thermal comfort. The housing stock accounts for almost a third of total energy use and is responsible for significant CO2 emissions. There is global recognition that the current rate of greenhouse gas emissions is causing long term damage and that changes are required in all sectors in order to limit the impacts of our generation on the global climate. The energy service concept offers an alternative perspective on the energy system. It reframes our demand for energy as a desire for the service which it can provide, such as comfortable homes, illuminated spaces, warm meals and security. This thesis is an investigation of how energy efficiency technologies and measures can deliver energy services with a lower energy input and uses building modelling software as a tool to do so. Four approaches to improving energy service efficiency are compared, and these are high efficiency conversion device, improved passive system, more accurate service control and a reduced service level. These energy efficiency measures are compared based on energy savings attainable and the efficacy of energy service delivery, using the example service of heating thermal comfort. In recognition of the large influence that household occupants have on energy consumption, household behaviours are included in the analysis. Household occupancy pattern is used to define the service demanded and thus energy efficiency measures are compared for a working family, working couple and daytime-present couple occupancy pattern. The suitability of measures for different households is addressed according to elements of motivation for energy efficiency improvement and technical skills of the occupants. The results of this work show that improved passive system performed best in both energy savings and heating thermal comfort delivery for all occupancy patterns. However, combinations of lower cost measures of control and service level demonstrate an ability to deliver comparable energy savings for occupancy patterns of working couple and daytime-present couple. The findings of this thesis confirm the importance of improving the thermal performance of the housing stock, but also that increased adoption of heating controls and a readdressing of expectations of service level can deliver significant energy savings. The modelling of the delivery of thermal comfort requires an enhanced modelling approach, but offers the ability for energy efficiency recommendations to be made based on suitability for the household, which will lead to greater energy savings within the domestic sector

Bayesian modeling of differential gene expression.

We present a Bayesian hierarchical model for detecting differentially expressing genes that includes simultaneous estimation of array effects, and show how to use the output for choosing lists of genes for further investigation. We give empirical evidence that expression-level dependent array effects are needed, and explore different nonlinear functions as part of our model-based approach to normalization. The model includes gene-specific variances but imposes some necessary shrinkage through a hierarchical structure. Model criticism via posterior predictive checks is discussed. Modeling the array effects (normalization) simultaneously with differential expression gives fewer false positive results. To choose a list of genes, we propose to combine various criteria (for instance, fold change and overall expression) into a single indicator variable for each gene. The posterior distribution of these variables is used to pick the list of genes, thereby taking into account uncertainty in parameter estimates. In an application to mouse knockout data, Gene Ontology annotations over- and underrepresented among the genes on the chosen list are consistent with biological expectations

Bayesian modeling of differential gene expression.

We present a Bayesian hierarchical model for detecting differentially expressing genes that includes simultaneous estimation of array effects, and show how to use the output for choosing lists of genes for further investigation. We give empirical evidence that expression-level dependent array effects are needed, and explore different nonlinear functions as part of our model-based approach to normalization. The model includes gene-specific variances but imposes some necessary shrinkage through a hierarchical structure. Model criticism via posterior predictive checks is discussed. Modeling the array effects (normalization) simultaneously with differential expression gives fewer false positive results. To choose a list of genes, we propose to combine various criteria (for instance, fold change and overall expression) into a single indicator variable for each gene. The posterior distribution of these variables is used to pick the list of genes, thereby taking into account uncertainty in parameter estimates. In an application to mouse knockout data, Gene Ontology annotations over- and underrepresented among the genes on the chosen list are consistent with biological expectations

Group Dynamics in Organisations: A Core Literacy for Innovation Leaders in the NHS

Purpose: Individuals attempting to lead change in the NHS are often thwarted in their efforts by complex and powerful group dynamics, many of which operate seemingly unpredictably, actively resisting any alteration to the status quo. If clinicians are to succeed as innovation leaders, therefore, they need a basic literacy with which to navigate these powerful group dynamics. Developing this literacy of group dynamics is a basic building block for all clinical leaders, and without it they are set up to fail as change agents. Design/methodology/approach: We outline two theories of latent group processes that we have used to help over 120 junior doctors, participating in a postgraduate module, to understand and navigate service change successfully: Bion's theory of group mentality and analysis of organisational role. Findings: Developing a basic literacy of group dynamics enables clinicians to engage constructively with other healthcare workers and thereby to undertake service improvement projects with more confidence and success. Originality/Value: The value in this work is that it shows that if leadership programmes are to be successful, they need to prepare doctors to understand their role as change agents within an organisation, and how to work effectively with both the surface and latent dynamics of groups to bring about change. This model of leadership development challenges the current dominant model in the UK which emphasises preparation of individuals, without equivalent attention to the leaders as members of groups

Family in Rehabilitation, Empowering Carers for Improved Malnutrition Outcomes: Protocol for the FREER Pilot Study

Interventions to improve the nutritional status of older adults and the integration of formal and family care systems are critical research areas to improve the independence and health of aging communities and are particularly relevant in the rehabilitation setting.The primary outcome aimed to determine if the FREER (Family in Rehabilitation: EmpowERing Carers for improved malnutrition outcomes) intervention in malnourished older adults during and postrehabilitation improve nutritional status, physical function, quality of life, service satisfaction, and hospital and aged care admission rates up to 3 months postdischarge, compared with usual care. Secondary outcomes evaluated include family carer burden, carer services satisfaction, and patient and carer experiences. This pilot study will also assess feasibility and intervention fidelity to inform a larger randomized controlled trial.This protocol is for a mixed-methods two-arm historically-controlled prospective pilot study intervention. The historical control group has 30 participants, and the pilot intervention group aims to recruit 30 patient-carer pairs. The FREER intervention delivers nutrition counseling during rehabilitation, 3 months of postdischarge telehealth follow-up, and provides supportive resources using a novel model of patient-centered and carer-centered nutrition care. The primary outcome is nutritional status measured by the Scored Patient-Generated Subjective Global Assessment Score. Qualitative outcomes such as experiences and perceptions of value will be measured using semistructured interviews followed by thematic analysis. The process evaluation addresses intervention fidelity and feasibility.Recruitment commenced on July 4, 2018, and is ongoing with eight patient-carer pairs recruited at the time of manuscript submission.This research will inform a larger randomized controlled trial, with potential for translation to health service policies and new models of dietetic care to support the optimization of nutritional status across a continuum of nutrition care from rehabilitation to home.Australian New Zealand Clinical Trials Registry Number (ACTRN) 12618000338268; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374608&isReview=true (Archived by WebCite at http://www.webcitation.org/74gtZplU2).DERR1-10.2196/12647

Family in Rehabilitation, Empowering Carers for Improved Malnutrition Outcomes: Protocol for the FREER Pilot Study

Interventions to improve the nutritional status of older adults and the integration of formal and family care systems are critical research areas to improve the independence and health of aging communities and are particularly relevant in the rehabilitation setting.The primary outcome aimed to determine if the FREER (Family in Rehabilitation: EmpowERing Carers for improved malnutrition outcomes) intervention in malnourished older adults during and postrehabilitation improve nutritional status, physical function, quality of life, service satisfaction, and hospital and aged care admission rates up to 3 months postdischarge, compared with usual care. Secondary outcomes evaluated include family carer burden, carer services satisfaction, and patient and carer experiences. This pilot study will also assess feasibility and intervention fidelity to inform a larger randomized controlled trial.This protocol is for a mixed-methods two-arm historically-controlled prospective pilot study intervention. The historical control group has 30 participants, and the pilot intervention group aims to recruit 30 patient-carer pairs. The FREER intervention delivers nutrition counseling during rehabilitation, 3 months of postdischarge telehealth follow-up, and provides supportive resources using a novel model of patient-centered and carer-centered nutrition care. The primary outcome is nutritional status measured by the Scored Patient-Generated Subjective Global Assessment Score. Qualitative outcomes such as experiences and perceptions of value will be measured using semistructured interviews followed by thematic analysis. The process evaluation addresses intervention fidelity and feasibility.Recruitment commenced on July 4, 2018, and is ongoing with eight patient-carer pairs recruited at the time of manuscript submission.This research will inform a larger randomized controlled trial, with potential for translation to health service policies and new models of dietetic care to support the optimization of nutritional status across a continuum of nutrition care from rehabilitation to home.Australian New Zealand Clinical Trials Registry Number (ACTRN) 12618000338268; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374608&isReview=true (Archived by WebCite at http://www.webcitation.org/74gtZplU2).DERR1-10.2196/12647

Pilot study investigating the utility of a specialized online symptom management program for individuals with myalgic encephalomyelitis/chronic fatigue syndrome as compared to an online meditation program

Background: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a long-term, debilitating condition that impacts numerous areas of individuals’ lives. The two predominant treatment options for ME/CFS are cognitive behavioral therapy and graded exercise therapy; however, many people have found these techniques unacceptable or even damaging. This pilot study aimed to evaluate the utility of a specialized online symptom management program for ME/CFS in comparison to an online meditation program in an effort to ascertain whether this tool could be a further option for those with ME/CFS. Methods: This experimental design consisted of two interventions: a specialized online symptoms management program (N=19) and a control intervention based on an online meditation website (N=9). A battery of questionnaires, including measures of multidimensional fatigue, illness-specific symptoms, perceived control, and mindful awareness, were completed before the participants commenced use of the programs and following 8 weeks’ use. Results: Significant differences were found in the areas of chance and powerful others’ locus of control, and sleeping difficulties, but not in ME/CFS symptomatology overall. Conclusion: The specialized online program described in this study warrants further investigation, as it appears to influence perceived control and key ME/CFS symptoms over time