The introduction of an holistic design approach through a teaching company scheme

Traditional design approaches separate the various functions of design such as material selection, performance modelling and tolerance specification into discrete entities. Whilst this allows more focused methods to be used at each stage, areas of conflict or benefit may be overlooked, and the designer is left to bring the loose ends together. This paper looks at a synthesis approach that draws upon a number of current design themes. The design process is considered along with various aspects such as product development, design-for-`X' methodologies and material selection. The need for the preservation of design knowledge and reasoning, the so called wh-? questions, within the process are considered along with various models of the design process. The paper draws these various aspects together to form a more holistic approach to design. The application of this technique within the Teaching Company Scheme is briefly discussed

Fault tolerant motor drive system with redundancy for critical applications

Some of the recent research activities in the area of electric motor drives for critical applications (such as aerospace and nuclear power plants) are focused on looking at various motor and drive topologies. This paper presents a motor drive system, which provides an inverter topology for three-phase motors, and also proposes an increased redundancy. The paper develops a simulation model for the complete drive system including synthetic faults. In addition, the hardware details including the implementation of DSP based motor controller, inverter module, and brushless PM motor system are provided and some experimental results are presented.N. Ertugrul, W. Soong, G. Dostal and D. Saxo

The Contribution of Therapist Effects to Patient Dropout and Deterioration in the Psychological Therapies

BACKGROUND: In the psychological therapies, patient outcomes are not always positive. Some patients leave therapy prematurely (dropout), while others experience deterioration in their psychological well-being. METHODS: The sample for dropout comprised patients (n = 10 521) seen by 85 therapists, who attended at least the initial session of one-to-one therapy and completed a Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) at pre-treatment. The subsample for patient deterioration comprised patients (n = 6405) seen by the same 85 therapists but who attended two or more sessions, completed therapy and returned a CORE-OM at pre-treatment and post-treatment. Multilevel modelling was used to estimate the extent of therapist effects for both outcomes after controlling for patient characteristics. RESULTS: Therapist effects accounted for 12.6% of dropout variance and 10.1% of deterioration variance. Dropout rates for therapists ranged from 1.2% to 73.2%, while rates of deterioration ranged from 0% to 15.4%. There was no significant correlation between therapist dropout rate and deterioration rate (Spearman's rho = 0.07, p = 0.52). CONCLUSIONS: The methods provide a reliable means for identifying therapists who return consistently poorer rates of patient dropout and deterioration compared with their peers. The variability between therapists and the identification of patient risk factors as significant predictors has implications for the delivery of safe psychological therapy services. Copyright © 2016 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE: Therapists play an important role in contributing to patient dropout and deterioration, irrespective of case mix. Therapist effects on patient dropout and deterioration appear to act independently. Being unemployed as a patient was the strongest predictor of both dropout and deterioration. Patient risk to self or others was also an important predictor

Oral diabetes medication monotherapy and short-term mortality in individuals with type 2 diabetes and coronary artery disease

Objective To determine whether sulfonylurea use, compared with non-sulfonylurea oral diabetes medication use, was associated with 2-year mortality in individuals with well-controlled diabetes and coronary artery disease (CAD). Research design and methods We studied 5352 US veterans with type 2 diabetes, obstructive CAD on coronary angiography, hemoglobin A1c ≤7.5% at the time of catheterization, and taking zero or one oral diabetes medication (categorized as no medications, non-sulfonylurea medication, or sulfonylurea). We estimated the association between medication category and 2-year mortality using inverse probability of treatment-weighted (IPW) standardized mortality differences and IPW multivariable Cox proportional hazards regression. Results 49%, 35%, and 16% of the participants were on no diabetes medications, non-sulfonylurea medications, and sulfonylureas, respectively. In individuals on no medications, non-sulfonylurea medications, and sulfonylureas, the unadjusted mortality rates were 6.6%, 5.2%, and 11.9%, respectively, and the IPW-standardized mortality rates were 5.9%, 6.5%, and 9.7%, respectively. The standardized absolute 2-year mortality difference between non-sulfonylurea and sulfonylurea groups was 3.2% (95% CI 0.7 to 5.7) (p=0.01). In Cox proportional hazards models, the point estimate suggested that sulfonylurea use might be associated with greater hazard of mortality than non-sulfonylurea medication use, but this finding was not statistically significant (HR 1.38 (95% CI 1.00 to 1.93), p=0.05). We did not observe significant mortality differences between individuals on no diabetes medications and non-sulfonylurea users. Conclusions Sulfonylurea use was common (nearly one-third of those taking medications) and was associated with increased 2-year mortality in individuals with obstructive CAD. The significance of the association between sulfonylurea use and mortality was attenuated in fully adjusted survival models. Caution with sulfonylurea use may be warranted for patients with well-controlled diabetes and CAD, and metformin or newer diabetes medications with cardiovascular safety data could be considered as alternatives when individualizing therapy

Quantifying the relationship between mechanical loading and the skeletal response in pre- and early-pubertal girls

PURPOSEBefore exercise prescription for bone health can be recommended, the relationship between mechanical loading characteristics and the skeletal response need to be quantified. We asked i) does moderate impact exercise result in a greater gain in BMC than low impact exercise, ii) what are the loading characteristics associated with a moderate and low impact exercise program and does this differ from non-structured play?, and iii) does loading history affect the osteogenic response to a moderate or low impact program? METHODSSixty-eight pre- and early-pubertal girls (aged 8.9 +/- 0.2 yrs) were randomized to take part in a moderate or low impact exercise program 3 times/wk for 8.5 mnths. The number and type of loads associated with the exercise classes and non-structured play (recess) were assessed from video footage. The magnitude of load was assessed using a pedar in-sole mobile system. Hours of moderate and high impact organized sport were assessed from a physical activity questionnaire. RESULTSThe moderate and low impact exercise programs consisted of -400 impacts per class, but the jumping, hopping and dynamic activities performed during the moderate impact program produced forces ranging from 2 to 4 times body weight (BW) compared to -1 BW for the low impact program. Moderate impact exercise resulted in a 2.7% greater gain in BMC at the tibia compared to the low impact exercise. The moderate impact exercise program consisted of fewer low impacts (1-2 BW) and a higher number of moderate impacts (2-4BW) compared to those typically performed during non-structured play. There were greater gains in BMC in subjects participating in the moderate versus the low impact exercise programs who participated in 2 to 3 hours of moderate impact sports outside school (2.5% to 4.5%, p CONCLUSIONApproximately 400 impacts ranging 2-4 BW, 3 times/wk was enough stimuli to result in an osteogenic response in normally active girls; even in those actively involved in moderate impact sports outside school.<br /

Exact results for `bouncing' Gaussian wave packets

We consider time-dependent Gaussian wave packet solutions of the Schrodinger equation (with arbitrary initial central position, x_0, and momentum, p_0, for an otherwise free-particle, but with an infinite wall at x=0, so-called bouncing wave packets. We show how difference or mirror solutions of the form psi(x,t)-psi(-x,t) can, in this case, be normalized exactly, allowing for the evaluation of a number of time-dependent expectation values and other quantities in closed form. For example, we calculate _t explicitly which illustrates how the free-particle kinetic (and hence total) energy is affected by the presence of the distant boundary. We also discuss the time dependence of the expectation values of position, _t, and momentum, _t, and their relation to the impulsive force during the `collision' with the wall. Finally, the x_0,p_0 --> 0 limit is shown to reduce to a special case of a non-standard free-particle Gaussian solution. The addition of this example to the literature then expands on the relatively small number of Gaussian solutions to quantum mechanical problems with familiar classical analogs (free particle, uniform acceleration, harmonic oscillator, unstable oscillator, and uniform magnetic field) available in closed form.Comment: 14 pages, 1 embedded .eps figur

The comparative effectiveness and efficiency of cognitive behaviour therapy and generic counselling in the treatment of depression: evidence from the 2(nd) UK National Audit of psychological therapies.

BACKGROUND: Cognitive Behaviour Therapy (CBT) is the front-line psychological intervention for step 3 within UK psychological therapy services. Counselling is recommended only when other interventions have failed and its effectiveness has been questioned. METHOD: A secondary data analysis was conducted of data collected from 33,243 patients across 103 Improving Access to Psychological Therapies (IAPT) services as part of the second round of the National Audit of Psychological Therapies (NAPT). Initial analysis considered levels of pre-post therapy effect sizes (ESs) and reliable improvement (RI) and reliable and clinically significant improvement (RCSI). Multilevel modelling was used to model predictors of outcome, namely patient pre-post change on PHQ-9 scores at last therapy session. RESULTS: Counselling received more referrals from patients experiencing moderate to severe depression than CBT. For patients scoring above the clinical cut-off on the PHQ-9 at intake, the pre-post ES (95% CI) for CBT was 1.59 (1.58, 1.62) with 46.6% making RCSI criteria and for counselling the pre-post ES was 1.55 (1.52, 1.59) with 44.3% of patients meeting RCSI criteria. Multilevel modelling revealed a significant site effect of 1.8%, while therapy type was not a predictor of outcome. A significant interaction was found between the number of sessions attended and therapy type, with patients attending fewer sessions on average for counselling [M = 7.5 (5.54) sessions and a median (IQR) of 6 (3-10)] than CBT [M = 8.9 (6.34) sessions and a median (IQR) of 7 (4-12)]. Only where patients had 18 or 20 sessions was CBT significantly more effective than counselling, with recovery rates (95% CIs) of 62.2% (57.1, 66.9) and 62.4% (56.5, 68.0) respectively, compared with 44.4% (32.7, 56.6) and 42.6% (30.0, 55.9) for counselling. Counselling was significantly more effective at two sessions with a recovery rate of 34.9% (31.9, 37.9) compared with 22.2% (20.5, 24.0) for CBT. CONCLUSIONS: Outcomes for counselling and CBT in the treatment of depression were comparable. Research efforts should focus on factors other than therapy type that may influence outcomes, namely the inherent variability between services, and adopt multilevel modelling as the given analytic approach in order to capture the naturally nested nature of the implementation and delivery of psychological therapies. It is of concern that half of all patients, regardless of type of intervention, did not show reliable improvement

Prevalence and characteristics of gastrointestinal infections in men who have sex with men diagnosed with rectal chlamydia infection in the UK: an 'unlinked anonymous' cross-sectional study.

INTRODUCTION: Gastrointestinal infections (GII) can cause serious ill health and morbidity. Although primarily transmitted through faecal contamination of food or water, transmission through sexual activity is well described, especially among men who have sex with men (MSM). METHODS: We investigated the prevalence of GIIs among a convenience sample of MSM who were consecutively diagnosed with rectal Chlamydia trachomatis (CT) at 12 UK genitourinary medicine clinics during 10 weeks in 2012. Residual rectal swabs were coded, anonymised and tested for Shigella, Campylobacter, Salmonella, shiga toxin-producing Escherichia coli and enteroaggregative E. coli (EAEC) using a real-time PCR. Results were linked to respective coded and anonymised clinical and demographic data. Associations were investigated using Fisher's exact tests. RESULTS: Of 444 specimens tested, overall GII prevalence was 8.6% (95% CI 6.3% to 11.6%): 1.8% (0.9% to 3.6%) tested positive for Shigella, 1.8% (0.9% to 3.6%) for Campylobacter and 5.2% (3.5% to 7.7%) for EAEC. No specimens tested positive for Salmonella or other diarrhoeagenic E. coli pathotypes. Among those with any GII, 14/30 were asymptomatic (2/7 with Shigella, 3/6 with Campylobacter and 9/17 with EAEC). Shigella prevalence was higher in MSM who were HIV-positive (4.7% (2.1% to 10.2%) vs 0.5%(0.1% to 3.2%) in HIV-negative MSM; p=0.01). CONCLUSIONS: In this small feasibility study, MSM with rectal CT appeared to be at appreciable risk of GII. Asymptomatic carriage may play a role in sexual transmission of GII

Healthcare students’ perceptions about their role, confidence and competence to deliver brief public health interventions and advice

Background Public health improvement has long been an important focus for the United Kingdom Department of Health. The Allied Health Professions (AHP) Federation has 84,000 members, such a large number of AHP professionals should play a role in public health initiatives, but it is not clear if they or the AHP students who will be the future healthcare workforce feel themselves equipped to do so. Our aim was to understand the perceptions of AHP students about their role in delivering public health advice. Methods AHP students were recruited in one teaching university from different departments. Participants were final year AHP students who had completed all clinical placements related to their course. All students were emailed an invitation to participate, and those interested were asked to contact the researchers to participate in one of several focus groups. Data were recorded, transcribed, and analysed using framework analysis by two independent researchers. Results Nineteen students were recruited and participated in four focus groups. The main themes produced by the data analysis were: understanding of public health issues, perceptions of their role in this, challenges and opportunities to develop a public health role, and preparation for a public health role. Conclusions AHP students felt that they had a role in public health advice-giving, but barriers to providing this advice included their own lack of confidence and knowledge, time, and the environment of the clinical placement. They considered that there should be more teaching on public health issues, and that these should feature in both the curriculum and on clinical placement

Analytic results for Gaussian wave packets in four model systems: II. Autocorrelation functions

The autocorrelation function, A(t), measures the overlap (in Hilbert space) of a time-dependent quantum mechanical wave function, psi(x,t), with its initial value, psi(x,0). It finds extensive use in the theoretical analysis and experimental measurement of such phenomena as quantum wave packet revivals. We evaluate explicit expressions for the autocorrelation function for time-dependent Gaussian solutions of the Schrodinger equation corresponding to the cases of a free particle, a particle undergoing uniform acceleration, a particle in a harmonic oscillator potential, and a system corresponding to an unstable equilibrium (the so-called `inverted' oscillator.) We emphasize the importance of momentum-space methods where such calculations are often more straightforwardly realized, as well as stressing their role in providing complementary information to results obtained using position-space wavefunctions.Comment: 18 pages, RevTeX, to appear in Found. Phys. Lett, Vol. 17, Dec. 200