The impact of an assessment toolkit on use of objective measurement tools in stroke rehabilitation.

Objective: To evaluate the impact of a toolkit of psychometrically robust measurement tools, the Greater Manchester Assessment for Stroke Rehabilitation (G-MASTER) toolkit, on the use of measurement tools during stroke rehabilitation Design: Mixed methods cohort design using non-participant observation of multi-disciplinary team meetings and semi-structured interviews with members of the team over three months before and three months after implementation of the assessment toolkit. Development and implementation of the toolkit are also described. Setting: Ten in-patient stroke services in a large UK city. Subjects: Members of the participating multi-disciplinary stroke teams. Results: Before implementation standardised measures were seldom used in team meetings. After implementation, use of all measurement tools significantly increased (36% to 81% of occasions, P&lt;0.000). Staff were generally positive about the toolkit and felt it enabled more accurate problem identification, effective progress monitoring, timely decision-making, communication and promoted inter-team relationships. Conclusions: A toolkit of standardised measurement tools can be feasibly and acceptably implemented into stroke rehabilitation. It increases the use of measurement tools by the multi-disciplinary team and improves the processes and quality of care. </jats:sec

Multi-discliplinary team meetings in stroke rehabilitation: An observation study

Objective: To explore how multi-disciplinary team meetings operate in stroke rehabilitation. Design: Non-participant observation of multi-disciplinary team meetings and semi-structured interviews with attending staff. Setting and participants: Twelve meetings were observed (at least one at each site) and 18 staff (one psychologist, one social worker; four nurses; four physiotherapists four occupational therapists, two speech and language therapists, one stroke co-ordinator and one stroke ward manager) were interviewed in eight in-patient stroke rehabilitation units. Results: Multi-disciplinary team meetings in stroke rehabilitation were complex, demanding and highly varied. A model emerged which identified the main inputs to influence conduct of the meetings were personal contributions of the members and structure and format of the meetings. These were mediated by the team climate and leadership skills of the chair. The desired outputs; clinical decisions and the attributes of apparently effective meetings were identified by the staff. A notable difference between the meetings that staff considered effective and those that were not, was their structure and format. Successful meetings tended to feature a set agenda, structured documentation; formal use of measurement tools; pre-meeting preparation and skilled chairing. These features were often absent in meetings perceived to be ineffective. Conclusions: The main features of operation of multi-disciplinary team meetings have been identified which will enable assessment tools and interventions to improve effectiveness to be developed. </jats:sec

'The drugs did for me what I couldn’t do for myself’: A qualitative exploration of the relationship between mental health and amphetamine-type stimulant (ATS) use

Substance use and mental ill health constitute a major public health burden, and a key global policy priority is to reduce illicit and other harmful substance use. Amphetamine-type stimulants (ATS) are the second most used class of illicit drugs and a range of mental health issues have been documented amongst users. This paper explores the relationship between mental health and ATS use, through a thematic analysis of qualitative interviews with n=18 current and former ATS users in England. The findings are presented by trajectory point of; (1) Initiation of ATS use; (2) continued and increased ATS use; and (3) decreased and remitted ATS use. This work helps to develop understanding around the complex and bidirectional relationship between ATS use and mental health. Many ATS users lead chaotic lives and engage in multiple risk behaviours; however, there is a need to better understand and conceptualise the dynamic interaction between different individual, social, environment and cultural factors that determine individuals’ mental health and substance use. There is no ‘one size fits all’ approach to prevention and treatment, and these findings highlight the need for more joined-up, tailored, and holistic approaches to intervention development

The NIRSPEC Brown Dwarf Spectroscopic Survey II: High-Resolution J-Band Spectra of M, L and T Dwarfs

We present a sequence of high resolution (R~20,000 or 15 km/s) infrared spectra of stars and brown dwarfs spanning spectral types M2.5 to T6. Observations of 16 objects were obtained using eight echelle orders to cover part of the J-band from 1.165-1.323 micron with NIRSPEC on the Keck II telescope. By comparing opacity plots and line lists, over 200 weak features in the J-band are identified with either FeH or H2O transitions. Absorption by FeH attains maximum strength in the mid-L dwarfs, while H2O absorption becomes systematically stronger towards later spectral types. Narrow resolved features broaden markedly after the M to L transition. Our high resolution spectra also reveal that the disappearance of neutral Al lines at the boundary between M and L dwarfs is remarkably abrupt, presumably because of the formation of grains. Neutral Fe lines can be traced to mid-L dwarfs before Fe is removed by condensation. The neutral potassium (K I) doublets that dominate the J-band have pressure broadened wings that continue to broaden from ~50 km/s (FWHM) at mid-M to ~500 km/s at mid-T. In contrast however, the measured pseudo-equivalent widths of these same lines reach a maximum in the mid-L dwarfs. The young L2 dwarf, G196-3B, exhibits narrow potassium lines without extensive pressure-broadened wings, indicative of a lower gravity atmosphere. Kelu-1AB, another L2, has exceptionally broad infrared lines, including FeH and H2O features, confirming its status as a rapid rotator. In contrast to other late T objects, the peculiar T6 dwarf 2MASS 0937+29 displays a complete absence of potassium even at high resolution, which may be a metallicity effect or a result of a cooler, higher-gravity atmosphere.Comment: 53 pages, 21 figures, data will be available at http://www.astro.ucla.edu/~mclean/BDSSarchive

Identifying Young Brown Dwarfs Using Gravity-Sensitive Spectral Features

We report the initial results of the Brown Dwarf Spectroscopic Survey Gravity Project, to study gravity sensitive features as indicators of youth in brown dwarfs. Low-resolution (R~2000) J-band and optical (R~1000) observations using NIRSPEC and LRIS at the W.M. Keck Observatory reveal transitions of TiO, VO, K I, Na I, Cs I, Rb I, CaH, and FeH. By comparing these features in late-type giants and in old field dwarfs we show that they are sensitive to the gravity (g = GM/R^2) of the object. Using low-gravity spectral signatures as age indicators, we observed and analyzed J-band and optical spectra of two young brown dwarfs, G 196-3B (20-300 Myr) and KPNO Tau-4 (1-2 Myr), and two possible low mass brown dwarfs in the sigma Orionis cluster (3-7 Myr). We report the identification of the phi bands of TiO near 1.24 microns and the A-X band of VO near 1.18 microns together with extremely weak J-band lines of K I in KPNO-Tau4. This is the first detection of TiO and VO in the J-band in a sub-stellar mass object. The optical spectrum of KPNO-Tau4 exhibits weak K I and Na I lines, weak absorption by CaH, and strong VO bands, also signatures of a lower gravity atmosphere. G 196-3B shows absorption features in both wavelength regions like those of KPNO-Tau4 suggesting that its age and mass are at the lower end of published estimates. Whereas sigma Ori 51 appears to be consistent with a young sub-stellar object, sigma Ori 47 shows signatures of high gravity most closely resembling an old L1.5/L0, and can not be a member of the sigma Orionis cluster.Comment: 14 pages, 4 figures. To appear in the January 10, 2004 issue of the Astrophysical Journa

The NIRSPEC Brown Dwarf Spectroscopic Survey. I. Low-Resolution Near-Infrared Spectra

We present the first results of a near-infrared (0.96-2.31 micron) spectroscopic survey of M, L, and T dwarfs obtained with NIRSPEC on the Keck II telescope. Our new survey has a resolving power of R = 2000 and is comprised of two major data sets: 53 J-band (1.14-1.36 micron) spectra covering all spectral types from M6 to T8 with at least two members in each spectral subclass (wherever possible), and 25 flux-calibrated spectra from 1.14 to 2.31 microns for most spectral classes between M6 and T8. Sixteen of these 25 objects have additional spectral coverage from 0.96-1.14 microns to provide overlap with optical spectra. Spectral flux ratio indexes for prominent molecular bands are derived and equivalent widths (EWs) for several atomic lines are measured. We find that a combination of four H2O and two CH4 band strengths can be used for spectral classification. Weak (EW~1-2 angstrom) atomic lines of Al I and Ca I disappear at the boundary between M and L types.Comment: 60 pages, 25 figures. To appear in the Astrophysical Journal Vol 596. Received 2003 March 31; accepted 2003 June 20. Web site at http://www.astro.ucla.edu/~mclean/BDSSarchiv

The Opioid Antagonist Naltrexone Improves Murine Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is a condition of the intestine with significant morbidity. Although hereditary, environmental, immunologic, and bacterial factors have been implicated, the etiology of IBD remains unknown. Since opioid peptides modulate inflammatory cytokine production and opioid antagonists promote tissue growth and repair, we hypothesized the opioid antagonist naltrexone could reduce inflammation of the bowel. Using a chemically-induced mouse model of IBD, C57BL/6J mice received either untreated drinking water or water containing 2% dextran sulfate sodium (DSS) in two parallel regimens modeling moderate and severe colitis. After colitis was established, animals in the moderate colitis study were administered either saline (control) or naltrexone (NTX; 8 or 400 μ g/kg) daily, while those in the severe colitis study received 0.1 or 10 mg/kg NTX. DSS-treated animals had significant weight loss (p = 0.006) and higher disease activity index (DAI) scores (p \u3c 0.001) compared to water controls. However, NTX treatment of mice with moderate colitis resulted in less weight loss, lower DAI scores, and less histologic evidence of inflammation compared to controls. Significantly, elevated levels of colonic RNA for pro-inflammatory cytokines interleukin (IL)-6 and IL-12 were also decreased toward normal with NTX. Similar to patients with severe and unresponsive disease, animals in the severe colitis study did not significantly respond to treatment. Thus, NTX therapy reverses physical symptoms, histologic evidence, and molecular markers of inflammation in moderate colitis. The mechanism by which NTX acts to reverse colitis is related in part to the decreased expression of pro-inflammatory cytokines