Natural convection in a vertical slot: accurate solution of the linear stability equations

The linear stability of natural convection in a fluid between vertical hot and cold walls was studied using a collocation method. Seven figure accurate results for monotonic disturbances were obtained by Ruth (1979) using numerical power series, but this method is intrinsically limited and failed for Pr ? 10 . In contrast, Chebyshev collocation converges more rapidly and allows the computation of results at higher Pr for which oscillatory disturbances dominate. Accurate results are now obtained across the entire Prandtl number range. These match the zero and infinite Pr asymptotes which are also refined here

Application and Effectiveness of Telehealth to Support Severe Mental Illness Management: Systematic Review

Background: It is important that people with SMI receive early interventions to prevent mental health deterioration or relapse. Telecommunications and other technologies are increasingly used to assist healthcare delivery (‘telehealth’) , providing service users with immediate real-time information to improve the management of chronic health conditions. Telehealth has been found to be successful in improving management and symptoms across a number of health conditions, whilst also being acceptable to users. Initial findings suggest technology could improve quality of life in people with SMI. Objectives: This systematic review aimed to identify the variety of uses and efficacy of teleheal th technology for SMI. Methods: We systematically searched electronic databases from inception to March 2016 (MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, AMED, He alth Techno logy Assessment, CINAHL plus and NHS EED ) for randomised controlled trials (RCTs) evaluating telehealth for adults with SMI , published in English. Additional literature was identified by searching reference lists of key articles. The articles meeting the inclusion criteria were systematically reviewed and assessed for quality and risk of bias. Results: The search identified 31 eligible articles, describing 29 trials. The included studies evaluated the use of computers to deliver cognitive rehabilitation (1 5 trials), patient education (3 trials), online self- management interventions (2 trials), and to support consultations (1 trial). Virtual reality (VR) was used to simulate work and social sit uations (2 trials ) and to deliver cognitive training (1 trial). Telephones were used to prompt medication use (3 trials ) and report SMI symptoms to healthcare teams (1 trial ). Remote sensors were used to monitor medication use (1 trial). Telephone support was found effective for improving medication adherence and reducing symptom severity and inpatient days. Computer assisted cognitive rehabilitation was effective in improving cognitive function. The impact of telehealth on other outcomes was inconsistent. Few studies evaluated the 3 use of remote medication telemonitoring, VR, online self-management and computer -mediated consultations, suggesting these are novel technologies for managing SMI, although all were found effective for improving psycho social and behavioural outcomes. The results of this review should be taken in the context of varied quality in study design, with only five studies demonstrating a low risk of bias. Conclusions : A growing variety of telehealth technologies are used to support SMI. Specific types of technology have been found to be effective for som e outcomes, for example telephone prompts for medication adherence, while other types of telehealth had no benefit over traditional methods and were less acceptable to patients. Few studies found benefits for telehealth on quality of life, except for novel technologies with a limited number of trials. Further research is warranted to establish the full potential benefits of telehealth for improving quality of life in SMI, acceptability from the service user perspective, and cost-effectivenes

The Experiences of People Who Quit Khat and the Health Care Professionals Who Support them

Background: This study aimed to explore the barriers and enablers to quitting khat from the perspective of users and the barriers and enablers to supporting users to quit from the healthcare professional (HCP) perspective. Methods: A qualitative study using semi-structured interviews and the Theoretical Domains Framework (TDF) to collect and analyse data. Results: Overall 10 khat users and 3 professionals were interviewed. Beliefs about the consequences of continued use facilitated user’s decisions to quit. Social influences were a barrier and enabler. For professionals, the social influence of other colleagues and working together was key in enabling them to support clients. Social / professional role and identity was also an important enabler, as professionals saw supporting users to quit as an integral part of their role. A range of behaviour change techniques was identified as potential ways in which quit attempts could be more successful, from the user and professionals perspective. Conclusions: The study reveals the complexity of khat chewing and quitting from the perspective of khat users, such as the varied influence of family and friends. It also identifies the many barriers and enablers that professionals experience when supporting individuals to quit, such as working with other professionals. There is little evidence for the effectiveness of current quit khat services or little information outlining how they were developed. Current services would benefit from evaluating the effectiveness of the interventions using established methodology. Recommendations for practice in the field of substance misuse have been identified

Clinician and patients’ views about self-management support in arthritis: a cross-sectional UK survey

Objective The overall aims of the study are to (a) establish receipt and provision of self-management support for patients with inflammatory arthritis in the UK; and (b) establish if receipt of selfmanagement support is associated with patient’s knowledge, skills and confidence to selfmanage. Methods Questionnaire for patients and healthcare professionals were sent to members and associates of the National Rheumatoid Arthritis Society (NRAS). Patients completed the Patient Activation Measure (PAM), and questions about receipt of self-management support. Healthcare professionals completed the Clinician Support PAM and questions about provision of self-management support. Results A total of 886 patients and 117 healthcare professionals completed a questionnaire. Only 15% of patients had attended a structured self-management programme. Over half of patients reported having the skills, confidence and knowledge to self-manage and this was associated with receipt of self-management support embedded in routine care. All healthcare professionals felt that patients should be actively involved in their own care, however, 60% were unable to offer structured self-management support. Healthcare professionals reported engaging in more embedded self-management support than patients reported receiving in routine care

The impact of mobile monitoring technologies on glycosylated hemoglobin in diabetes: a systematic review

Background: A new development in the field of telehealth is the use of mobile health technologies (mhealth) to help patients record and track medical information. Mhealth appears particularly advantageous for conditions that require intense and ongoing monitoring, such as diabetes, and where people are of working age and not disabled. This review aims to evaluate the evidence for the effectiveness of mhealth interventions in diabetes management on glycosylated hemoglobin. Method: A comprehensive search strategy was developed and applied to eight electronic databases to identify studies that investigated the clinical effectiveness of mobile-based applications that allowed patients to record and send their blood glucose readings to a central server. The eligibility of 8543 papers was assessed against the selection criteria, and 24 papers were reviewed. All studies reviewed were assessed for quality using a standardized quality assessment tool. Results: Results for patients with type 1 and type 2 diabetes were examined separately. Study variability and poor reporting made comparison difficult, and most studies had important methodological weaknesses. Evidence on the effectiveness of mhealth interventions for diabetes was inconsistent for both types of diabetes and remains weak

Three ways to compute multiport inertance

International audienceThe immediate impulse-response of a confined incompressible fluid is characterized by inertance. For a vessel with inlet and outlet, this is a single quantity; for multiple ports the generalization is a singular reciprocal inertance matrix, acting on the port-impulses to give the corresponding inflows. The coefficients are defined by the boundary-fluxes of potential flows. Green's identity converts these to domain integrals of kinetic energy. If the system is discretized with finite elements, a third method is proposed which requires only the stiffness matrix and the solution vectors and no numerical differentiation

Qualitative research using realist evaluation to explain preparedness for doctors' memorable 'firsts'

CONTEXT: Doctors must be competent from their first day of practice if patients are to be safe. Medical students and new doctors are acutely aware of this, but describe being variably prepared. OBJECTIVES: This study aimed to identify causal chains of the contextual factors and mechanisms that lead to a trainee being capable (or not) of completing tasks for the first time. METHODS: We studied three stages of transition: anticipation; lived experience, and post hoc reflection. In the anticipation stage, medical students kept logbooks and audio diaries and were interviewed. Consenting participants were followed into their first jobs as doctors, during which they made audio diaries to capture the lived experiences of transition. Reflection was captured using interviews and focus groups with other postgraduate trainee doctors. All materials were transcribed and references to first experiences ('firsts') were analysed through the lens of realist evaluation. RESULTS: A total of 32 medical students participated. Eleven participants were followed through the transition to the role of doctor. In addition, 70 postgraduate trainee doctors from three local hospitals who were graduates of 17 UK medical schools participated in 10 focus groups. We identified three categories of firsts (outcomes): firsts that were anticipated and deliberately prepared for in medical school; firsts for which total prior preparedness is not possible as a result of the step change in responsibility between the student and doctor identities, and firsts that represented experiences of failure. Helpful interventions in preparation (context) were opportunities for rehearsal and being given responsibility as a student in the clinical team. Building self-efficacy for tasks was an important mechanism. During transition, the key contextual factor was the provision of appropriate support from colleagues. CONCLUSIONS: Transition is a step change in responsibility for which total preparedness is not achievable. This transition is experienced as a rite of passage when the newly qualified doctor first makes decisions alone. This study extends the existing literature by explaining the mechanisms involved in preparedness for firsts

A patient-initiated DMARD selfmonitoring service for people with rheumatoid or psoriatic arthritis on methotrexate: a randomised controlled trial

Objective: To determine the effectiveness of a patient-initiated DMARD self-monitoring service for people with rheumatoid (RA) or psoriatic arthritis (PsA) on methotrexate. Methods: A two-arm, single centre, randomised controlled trial assessing superiority in relation to healthcare utilisation, clinical and psychosocial outcomes. Participants were 100 adults with either RA or PsA on a stable dose of methotrexate, randomly assigned to usual care or the patient-initiated service. Intervention participants were trained how to understand and interpret their blood tests and use this information to initiate care from their clinical nurse specialist (CNS). The primary outcome was the number of outpatient visits to the CNS during the trial period. Differences between groups were analysed using Poisson regression models. Secondary outcomes were collected at baseline and after the 3rd and 6th blood tests. Disease activity was measured using either the DAS28 or PsARC, pain and fatigue using a visual numeric scale and the HAQII, HADS and SF12 were completed to assess disability, mood and quality of life, respectively. Differences between groups over time on secondary outcomes were analysed using multi-level models. Results: The patient-initiated DMARD self-monitoring service was associated with 54.55% fewer visits to the CNS (p<0.0001), 6.80% fewer visits to the rheumatologist (p=0.23) and 38.80% fewer visits to the GP (p=0.07), compared with control participants. There was no association between trial arm and any of the clinical or psychosocial outcomes. Conclusions: The results suggest that a patient-initiated service that incorporates patients self-monitoring DMARD therapy can lead to significant reductions in healthcare utilisation, whilst maintaining clinical and psychosocial well-being

Characterisation of Low Reynolds Number Fountain behaviour

Experimental evidence for previously unreported fountain behaviour is presented. It has been found that the first unstable mode of a wall bounded three dimensional round fountain is a laminar flapping motion that can grow to a circling or multi-modal flapping motion. With increasing Froude and Reynolds numbers, fountain behaviour becomes more disorderly, exhibiting a laminar bobbing motion. The transition between steady behaviour, the initial flapping modes and the laminar bobbing flow can be approximately described by a function C =FrRe 2/3. The transition to turbulence occurs at Re > 120, independent of Froude number. For Fr > 20 and Re 120 these instabilities cause the fountain to intermittently breakdown into turbulent jet like flow. A regime map of the fountain behaviour for 0:7 < Fr < 55 and 15 < Re < 1100 is presented and the underlying mechanisms for the observed behaviour are proposed