A complexity-informed in-depth case study into the sustainability and impact of a culture of health:The TR14ers community youth dance group

Funding: This study was funded by the NIHR Rapid Funding Scheme (NIHR127482 to KW, AJW and LP, https://www.nihr.ac.uk/funding/public-health-research-programme-rapid-funding-scheme/20247). This paper is independent research and KMW is supported by the National Institute for Health Research Applied Research Collaboration South West Peninsula.There are calls for researchers to study existing community assets and activities that appear to improve health and have achieved longevity. The TR14ers Community Dance Charity Limited is a community youth dance group that has been running since 2005 providing free weekly sessions for children and adolescents in an economically disadvantaged town in the UK. An in-depth case study employing qualitative, quantitative and participatory methods was undertaken with the TR14ers (current participants and those who have left, co-ordinators and families) over 6 months with the aim of understanding the sustainable processes and impact of the Group. The 12 complex systems’ leverage points described by Meadows and the five domains of adolescent wellbeing developed by the United Nations H6+ Technical Working Group on Adolescent Health and Well-Being were used as frameworks to recognise the complexity of community assets like the TR14ers. The quantitative and qualitative data indicated that being part of the TR14ers contributed to multiple health and wellbeing outcomes. The positive experiences of being a TR14er led members to actively recruit others through word of mouth and public performances. Central to the TR14ers is a commitment to children’s rights, which is communicated formally and informally throughout the membership informing how and what the Group does, leading to the structure and delivery of the Group evolving over time. Members sought to ensure the sustainability of the Group after they had left and were keen to mentor younger members to develop and become the leaders. Based on the insights from this case study we suggest that efforts to develop cultures of health, like the TR14ers, should focus on the core values of the activity or intervention that underpin what it does and how within the local context.Publisher PDFPeer reviewe

Weight of Shell Must Tell : A Lanchestrian reappraisal of the Battle of Jutland

We re-analyse the 1916 Battle of Jutland (German: Skagerrak), the major naval engagement of the First World War, in the light of the understanding of dreadnought fleet tactics developed over the decade leading up to it. In particular, we consider the interaction of the calculus of Lanchester’s Square Law with fleet geometry and the commanders’ decisions that determined it, and with the shipbuilding decisions associated with the Lanchestrian trade-off between quality and quantity. We re-examine the behaviour of the commanders in the light of this tactical analysis, and conclude that the outcome of Jutland, in spite of apparent British tactical and technological failings, was the culmination of a decade of consistent and professionally insightful decision-making by the Royal Navy, which built and correctly wielded its decisive weapon, the Grand Fleet, to achieve the required strategic victory

Regional analysis of UK primary care prescribing and adult service referrals for young people with attention-deficit hyperactivity disorder.

BACKGROUND: Approximately 20% of children with attention-deficit hyperactivity disorder (ADHD) experience clinical levels of impairment into adulthood. In the UK, there is a sharp reduction in ADHD drug prescribing over the period of transition from child to adult services, which is higher than expected given estimates of ADHD persistence, and may be linked to difficulties in accessing adult services. Little is currently known about geographical variations in prescribing and how this may relate to service access. AIMS: To analyse geographic variations in primary care prescribing of ADHD medications over the transition period (age 16-19 years) and adult mental health service (AMHS) referrals, and illustrate their relationship with UK adult ADHD service locations. METHOD: Using a Clinical Practice Research Datalink cohort of people with an ADHD diagnosis aged 10-20 in 2005 (study period 2005-2013; n = 9390, 99% diagnosed <18 years), regional data on ADHD prescribing over the transition period and AMHS referrals, were mapped against adult ADHD services identified in a linked mapping study. RESULTS: Differences were found by region in the mean age at cessation of ADHD prescribing, range 15.8-17.4 years (P<0.001), as well as in referral rates to AMHSs, range 4-21% (P<0.001). There was no obvious relationship between service provision and prescribing variation. CONCLUSIONS: Clear regional differences were found in primary care prescribing over the transition period and in referrals to AMHSs. Taken together with service mapping, this suggests inequitable provision and is important information for those who commission and deliver services for adults with ADHD

Better health through better infrastructure

Welcome to HaCIRIC’s 2009 Progress Report. Better Health through Better Infrastructure offers a chance to reflect on both the achievements of our short history and on the strategy for going forward. The Centre is now in its third year since foundation. In that time, we have taken enormous strides and have begun to fulfill the imagination and foresight of our funders. We are starting to make a real, measurable impact on the health and care sectors and their supply chains. We have also grown to understand much better the main issues facing our stakeholders and to fashion four key areas upon which to focus our future activity. HaCIRIC, as Patricia Leahy of the National Audit Office says, is ‘bringing innovative, rigorous analysis to the field’. She highlights the useful outputs that are now emerging from all the universities involved. Our mission – to improve health outcomes through innovative thinking about infrastructure – is bold and creative. It is helping, as Professor Duane Passman of Brighton and Sussex University Hospitals NHS Trust, suggests, ‘to take us back to being world class researchers in infrastructure and the built environment’. This goal is absolutely right for the times, as governments all over the world struggle to create greater value out of tighter budgets. As is clear from this report, HaCIRIC understands the real needs of the sector. It has created the capacity, the vision and the drive to deliver what is needed

Dietary nitrate increases arginine availability and protects mitochondrial complex I and energetics in the hypoxic rat heart

This is the final version. It was first published by Wiley in The Journal of Physiology at http://onlinelibrary.wiley.com/doi/10.1113/jphysiol.2014.275263/abstract.Hypoxic exposure is associated with impaired cardiac energetics in humans and altered mitochondrial function, with suppressed complex I-supported respiration, in rat heart. This response might limit reactive oxygen species (ROS) generation, but at the cost of impaired electron transport chain (ETC) activity. Dietary nitrate supplementation improves mitochondrial efficiency and can promote tissue oxygenation by enhancing blood flow. We therefore hypothesised that ETC dysfunction, impaired energetics and oxidative damage in the hearts of rats exposed to chronic hypoxia could be alleviated by sustained administration of a moderate dose of dietary nitrate. Male Wistar rats (n=40) were given water supplemented with 0.7 mmol/L NaCl (as control) or 0.7 mmol/L NaNO3, elevating plasma nitrate levels by 80%, and were exposed to 13% O2 (hypoxia) or normoxia (n=10 per group) for 14 days. Respiration rates, ETC protein levels, mitochondrial density, ATP content and protein carbonylation were measured in cardiac muscle. Complex I respiration rates and protein levels were 33% lower in hypoxic/NaCl rats compared with normoxic/NaCl controls. Protein carbonylation was 65% higher in hearts of hypoxic rats compared with controls, indicating increased oxidative stress, whilst ATP levels were 62% lower. Respiration rates, complex I protein and activity, protein carbonylation and ATP levels were all fully protected in the hearts of nitrate-supplemented hypoxic rats. Both in normoxia and hypoxia, dietary nitrate suppressed cardiac arginase expression and activity and markedly elevated cardiac L-arginine concentrations, unmasking a novel mechanism of action by which nitrate enhances tissue NO bioavailability. Dietary nitrate therefore alleviates metabolic abnormalities in the hypoxic heart, improving myocardial energetics

Health and Care Infrastructure Research and Innovation Centre final report 2014

Improving healthcare, while containing costs, demands sophisticated understanding of three core elements in healthcare systems: infrastructure, technology and services. Their tripartite relationship is extremely complex, not least because the pace of change for each is different. That creates considerable challenges in planning for future needs and makes the management of innovation and change difficult. [Continues.

Cognitive Fatigue Influences Time-On-Task during Bodyweight Resistance Training Exercise

Prior investigations have shown measurable performance impairments on continuous physical performance tasks when preceded by a cognitively fatiguing task. However, the effect of cognitive fatigue on bodyweight resistance training exercise task performance is unknown. In the current investigation 18 amateur athletes completed a full body exercise task preceded by either a cognitive fatiguing or control intervention. In a randomized repeated measure design, each participant completed the same exercise task preceded by a 52 minute cognitively fatiguing intervention (vigilance) or control intervention (video). Data collection sessions were separated by 1 week. Participants rated the fatigue intervention as being significantly more mentally demanding than the control intervention (p .05). There was no statistical difference for heart rate or metabolic expenditure as a function of fatigue intervention during exercise. Cognitively fatigued athletes have decreased time-on-task in bodyweight resistance training exercise tasks

Characterizing the Cool KOIs. VI. H- and K-band Spectra of Kepler M Dwarf Planet-Candidate Hosts

We present H- and K-band spectra for late-type Kepler Objects of Interest (the "Cool KOIs"): low-mass stars with transiting-planet candidates discovered by NASA's Kepler Mission that are listed on the NASA Exoplanet Archive. We acquired spectra of 103 Cool KOIs and used the indices and calibrations of Rojas-Ayala et al. to determine their spectral types, stellar effective temperatures and metallicities, significantly augmenting previously published values. We interpolate our measured effective temperatures and metallicities onto evolutionary isochrones to determine stellar masses, radii, luminosities and distances, assuming the stars have settled onto the main-sequence. As a choice of isochrones, we use a new suite of Dartmouth predictions that reliably include mid-to-late M dwarf stars. We identify five M4V stars: KOI-961 (confirmed as Kepler 42), KOI-2704, KOI-2842, KOI-4290, and the secondary component to visual binary KOI-1725, which we call KOI-1725 B. We also identify a peculiar star, KOI-3497, which has a Na and Ca lines consistent with a dwarf star but CO lines consistent with a giant. Visible-wavelength adaptive optics imaging reveals two objects within a 1 arc second diameter; however, the objects' colors are peculiar. The spectra and properties presented in this paper serve as a resource for prioritizing follow-up observations and planet validation efforts for the Cool KOIs, and are all available for download online using the "data behind the figure" feature.Comment: Accepted for publication in the Astrophysical Journal Supplement Series (ApJS). Data and table are available in the sourc

How long do revised and multiply revised knee replacements last?:A retrospective observational study of the National Joint Registry

Background Knee replacements are common and effective operations but patients that undergo this intervention are at risk of needing subsequent costly and often complex revision surgery with poorer outcomes than primary surgery. The treatment pathway over the life of the patient in terms of risk of revision and re-revisions is poorly described. We aim to provide detailed information on the longevity of revision surgery. Methods We did a retrospective observational registry-based study of the National Joint Registry in England and Wales, UK. Knee replacement revision procedures linked to a primary episode were included; duplicates, records with missing information, and records with an unknown sequence of revision procedures were not included. Kaplan-Meier estimates were used to determine the cumulative probability of revision and subsequent re-revisions following primary knee replacement. Analyses were stratified by age and gender, and the influence of time from first to second revision on the risk of further revision was explored. Findings Between April 1, 2003, and Dec 31, 2018, 33 292 revision knee replacements were linked with a primary episode. Revision rates of revision knee replacements were higher in males than females at 10 years (20·0% [95% CI 19·0–21·0] vs 14·8% [13·9–15·6]) and higher in younger patients at 10 years (females younger than 55 years 21·0% [18·6–23·5] vs females aged 75–79 years 8·3% [6·8–10·2]; males younger than 55 years 26·6% [23·9–29·5] vs males aged 75–79 years 13·6% [10·6–17·5]). 19·9% (18·3–21·5) of first revisions were revised again within 13 years, 20·7% (19·1–22·4) of second revisions were revised again within 5 years, and 20·7% (17·1–24·9) of third revisions were revised again within 3 years. A shorter time between revision episodes was associated with earlier subsequent revision. Interpretation Males and younger patients are at higher risk of multiple revisions. Patients who undergo a revision have a steadily increasing risk of further revision the more procedures they undergo, and each subsequent revision lasts for approximately half the time of the previous one. Although knee replacements are effective for improving pain and function and usually last a remarkably long time, if they are revised, successive revisions are progressively and markedly less successfu

DarkCarb: An Innovative Approach to Infrared Imaging

DarkCarb is a pioneering Earth observation (EO) satellite, under development at SSTL, designed to acquire high resolution Mid Wave Infrared (MWIR) imagery and video from low Earth orbit. The mission will set a precedent in IR performance from a small and capable satellite platform while maintaining the SSTL cost effective approach thereby enabling a spacecraft price which makes building constellations, capable of delivering rapid re-visit and wide area coverage, an attractive and worthwhile commercial investment. The DarkCarb satellite features an innovative low mass and volume MWIR imager which, when combined with the implementation of novel image enhancement algorithms, will achieve high quality 3.5m GSD imagery. The instrument is assembled using COTS devices and components fabricated using standard industry processes, optimised for production and rapid delivery of multiple instruments to meet constellation needs. The high spatial resolution DarkCarb MWIR imagery will deliver provides several key and complementary differentiators to visible imagery and therefore has the potential to become a high value data product for the EO market. MWIR imagery provides the capability to differentiate between objects and surfaces of different temperature and emissivity. As the detectable signal is only dependent on the temperature of the scene, DarkCarb also has the ability to extend imaging opportunities into the night. The video capability allows information on highly dynamic features in scenes to be provided and will be of key interest for applications relating to human activity. The DarkCarb mission is therefore a highly innovative development which has the potential to seriously disrupt the status quo of the commercial satellite imagery market by providing affordable high quality and high resolution MWIR data which will address a range of applications. With the DarkCarb Imager currently in production this paper will showcase the development to date with initial results from recent airborne flight trials and further explain the details of the unique payload which has been designed to meet the market need for responsive delivery at the right price