Understanding the role of allied health professional support workers with exercise qualifications in the delivery of the NHS Long Term Plan within allied health professional services in England

Demand modelling for the allied health professionals (AHPs) workforce showed that significant expansion would be needed to successfully deliver on the National Health Service (NHS) Long Term Plan. The aim was to explore the use of AHP support workers with exercise qualifications in AHP services and to understand their current and potential role in NHS commissioned AHP services in England. The project had two phases and took place between October 2020 and January 2021. In phase one, an electronic survey was carried out to identify the scope and variation of exercise professionals working in AHP support roles in NHS commissioned services. Semi-structured interviews were conducted in phase two to gain further understanding about the experiences of those involved in AHP commissioned services. Survey data were analysed using descriptive statistics and interview data were qualitatively analysed using thematic analysis. Recorded interviews were transcribed and initially coded. Coding was then refined and themes were identified. Support workers with exercise qualifications made a valued contribution to AHP services and were considered cost-effective in delivering a specialised exercise intervention. AHP support workers contributed to a range of tasks relating to clinical exercise prescription. Collated data highlighted inconsistency in the way AHP support workers with exercise qualifications identified themselves, despite similar roles. Variation existed in the level of autonomy for AHP support workers with exercise qualifications, even within the same NHS Agenda for Change band. Attempts to manage this disparity involved numerous governance processes to ensure safe, high-quality healthcare in the context of delegation to support workers. Limited training and development opportunities and the lack of career progression for support workers were consistently acknowledged as a source of frustration and hindrance to individuals fulfilling their potential. AHP support workers with exercise qualifications have potential to positively impact service delivery providing added value to the NHS workforce

Lagrangian Time Series Models for Ocean Surface Drifter Trajectories

This paper proposes stochastic models for the analysis of ocean surface trajectories obtained from freely-drifting satellite-tracked instruments. The proposed time series models are used to summarise large multivariate datasets and infer important physical parameters of inertial oscillations and other ocean processes. Nonstationary time series methods are employed to account for the spatiotemporal variability of each trajectory. Because the datasets are large, we construct computationally efficient methods through the use of frequency-domain modelling and estimation, with the data expressed as complex-valued time series. We detail how practical issues related to sampling and model misspecification may be addressed using semi-parametric techniques for time series, and we demonstrate the effectiveness of our stochastic models through application to both real-world data and to numerical model output.Comment: 21 pages, 10 figure

Temporal Variability of Diapycnal Mixing in Shag Rocks Passage

Diapycnal mixing rates in the oceans have been shown to have a great deal of spatial variability, but the temporal variability has been little studied. Here we present results from a method developed to calculate diapycnal diffusivity from moored Acoustic Doppler Current Profiler (ADCP) velocity shear profiles. An 18-month time series of diffusivity is presented from data taken by a LongRanger ADCP moored at 2400 m depth, 600 m above the sea floor, in Shag Rocks Passage, a deep passage in the North Scotia Ridge (Southern Ocean). The Polar Front is constrained to pass through this passage, and the strong currents and complex topography are expected to result in enhanced mixing. The spatial distribution of diffusivity in Shag Rocks Passage deduced from lowered ADCP shear is consistent with published values for similar regions, with diffusivity possibly as large as 90 × 10-4 m2 s-1 near the sea floor, decreasing to the expected background level of ~ 0.1 × 10-4 m2 s-1 in areas away from topography. The moored ADCP profiles spanned a depth range of 2400 to 1800 m; thus the moored time series was obtained from a region of moderately enhanced diffusivity. The diffusivity time series has a median of 3.3 × 10-4 m2 s-1 and a range of 0.5 × 10-4 m2 s-1 to 57 × 10-4 m2 s-1. There is no significant signal at annual or semiannual periods, but there is evidence of signals at periods of approximately fourteen days (likely due to the spring-neaps tidal cycle), and at periods of 3.8 and 2.6 days most likely due to topographically-trapped waves propagating around the local seamount. Using the observed stratification and an axisymmetric seamount, of similar dimensions to the one west of the mooring, in a model of baroclinic topographically-trapped waves, produces periods of 3.8 and 2.6 days, in agreement with the signals observed. The diffusivity is anti-correlated with the rotary coefficient (indicating that stronger mixing occurs during times of upward energy propagation), which suggests that mixing occurs due to the breaking of internal waves generated at topography

Povodom puštanja u pogon nove Gradske mljekare u Zagrebu

Dne 2. kolovoza 1952. godine u 8 sati svečano je puštena u pogon nova Centralna Gradska Mljekara u Zagrebu na Žitnjaku. Svečanom činu otvorenja mljekare prisustvovali su u ime Međunarodne organizacije za pomoć djeci Unicef-a gg. Julius Perstein, šef glavnog centra Unicef-a u Parizu, G. I. R. Cooper, šef odjela za izgradnju mljekara u Evropi i na Bliskom Istoku, gdja Helen Glassey, šef misije za Jugoslaviju i g. J. L. Vinck, član Unicefa u Parizu

A Novel Copper Chelate Modulates Tumor Associated Macrophages to Promote Anti-Tumor Response of T Cells

At the early stages of carcinogenesis, the induction of tumor specific T cell mediated immunity seems to block the tumor growth and give protective anti-tumor immune response. However, tumor associated macrophages (TAMs) might play an immunosuppressive role and subvert this anti tumor immunity leading to tumor progression and metastasis.The Cu (II) complex, (chelate), copper N-(2-hydroxy acetophenone) glycinate (CuNG), synthesized by us, has previously been shown to have a potential usefulness in immunotherapy of multiple drug resistant cancers. The current study demonstrates that CuNG treatment of TAMs modulates their status from immunosuppressive to proimmunogenic nature. Interestingly, these activated TAMs produced high levels of IL-12 along with low levels of IL-10 that not only allowed strong Th1 response marked by generation of high levels of IFN-gamma but also reduced activation induced T cell death. Similarly, CuNG treatment of peripheral blood monocytes from chemotherapy and/or radiotherapy refractory cancer patients also modulated their cytokine status. Most intriguingly, CuNG treated TAMs could influence reprogramming of TGF-beta producing CD4(+)CD25(+) T cells toward IFN-gamma producing T cells.Our results show the potential usefulness of CuNG in immunotherapy of drug-resistant cancers through reprogramming of TAMs that in turn reprogram the T cells and reeducate the T helper function to elicit proper anti-tumorogenic Th1 response leading to effective reduction in tumor growth

Masks and minstrels of new Germany,

Mode of access: Internet

Vagabond journeys; the human comedy at home and abroad,

Humor and humanity at sea.--Egypt ruined for a tourist holiday.--Vandalism in modern Florence.--Munich.--A typical cure resort.--Paris.--Berlin.--London.Mode of access: Internet

Their day in court,

pt. 1. Women, womanists and manners.--pt. 2. Men and manners.--pt. 3. Criticism.Mode of access: Internet

Understanding the role of exercise professionals in the delivery of the NHS long term plan within AHP services in England

Keywords: Support worker, Exercise, NHS Long Term PlanPurpose: To explore the use of exercise professionals in AHP services and to understand their current and potential role in AHP NHS commissioned services.Methods: The project had three phases. In phase one an expert panel was established to guide the project. In phase two, an electronic survey was carried out to identify the scope and variation of exercise professionals working in AHP support roles in NHS commissioned services. The survey was piloted and distributed in October 2020 to relevant stakeholders including registered healthcare and exercise professionals using the Qualtrics® online survey tool. Data were analysed using descriptive statistics. In phase three semi-structured interviews were conducted to gain further understanding about the experiences of those involved in AHP commissioned services. Topic guides were developed with input from the expert panel and informed by the survey findings. Interviews took place between November 2020 and January 2021. Data were transcribed and initially coded. Coding was then refined, and themes identified.Results: The expert panel consisted of AHPs (n = 4), academics (n = 4), service users (n = 3), a representative from the Chartered Society of Physiotherapy (n = 1) and members of fitness industry institutions (n = 5). The survey was completed by 67 individuals (n = 7 service leads, n = 36 AHPs and n = 24 AHP support workers) and interviews were carried out with 11 individuals (n = 5 AHPs and n = 6 AHP support worker with exercise qualifications). Overall findings suggested that support workers with exercise qualifications made a valued contribution to AHP services and were considered cost-effective in delivering a specialised intervention, although there were no objective data available to verify these accounts. AHP support workers contributed to a range of tasks which included delivering, monitoring, progressing exercise programmes, onward referral, baseline assessment, designing programmes and discharge. Collated data highlighted inconsistency in the way AHP support workers with exercise qualifications identified themselves, despite similar roles. Variation existed in the level of autonomy for AHP support workers with exercise qualifications, even within the same NHS Agenda for Change band. Attempts to manage this disparity involved numerous governance processes to ensure safe, high quality health care in the context of delegation to support workers. Limited training and development opportunities and the lack of career progression for support workers was consistently acknowledged as a source of frustration and hindrance to individuals fulfilling their potential.Conclusion(s): The findings suggest that routine data collection is necessary to verify the important role that support workers with exercise qualifications potentially have within AHP services including the specific contribution that they make to the NHS Long Term Plan. Further work is also needed to develop the professional identity of AHP support workers with exercise qualifications, standardising the qualification requirements in general and specific to a range of settings. Finally, there needs to be clear continuing professional development opportunities and a career development pathway for AHP support workers with exercise qualifications to ensure that their skills are optimised.Impact: AHP support workers with exercise qualifications potentially have a positive impact on service users lives and offer added-value to the NHS workforce.Funding acknowledgements: This project was commissioned by the CSP as part of a Health Education England funded project