Evaluation of the Primary Care Mental Health Specialist role: Final Report

This report details an evaluation to assess the impact of the new primary care mental health specialist (PCMHS) role in Kent and Medway. The evaluation was undertaken by the Centre for Health Services Studies (CHSS) at the University of Kent and was conducted June 2013 to December 2014. The evaluation was commissioned by NHS Kent and Medway and supported by Kent and Medway Commissioning Support. The evaluation encompasses six CCG areas across Kent and Medway, with 13 PCMHS employed in these areas (see Table 1-1 for breakdown). The number of posts per CCG is dependent on the amount CCGs invest (roughly equating to population size), rather than prevalence of illness. The PCMHS have been seconded from Kent and Medway NHS and Social Care Partnership Trust (KMPT) for the duration of the pilot, and are either community psychiatric nurses (CPN) or occupational therapists (OT) by profession. The majority of PCMHS are hosted by a voluntary organisation (mcch); three are hosted by GP practices and two by a community Interest Company, Invicta CIC. The main objectives of the evaluation are: 1. To assess the impact on patients by capturing their experience of the service; 2. To assess the impact by capturing experiences of those delivering the service (i.e., PCMHS); 3. To assess the impact by capturing experiences of other professions who work alongside the service (i.e., mental health professionals in secondary care, GPs); 4. To assess the economic cost of the new service via a unit cost analysis

A water-soluble Manganese complex for selective electrocatalytic CO2 reduction to CO

Relatively few solution electrocatalysts for CO2 reduction in aqueous solutions are reported. However to be sustainable, electrocatalytic CO2 reduction is likely to be coupled to water oxidation in a complete device. Here we report a water-soluble Mn polypyridyl complex for the electrocatalytic reduction of CO2 to CO. This complex shows activity across a broad pH range and an excellent selectivity at pH 9 (3.8:1, CO:H2). Cyclic voltammetry indicates activity across a range of different electrode materials (Boron doped diamond, glassy carbon and Hg/Au amalgams)

Water quality effects of intermittent water supply in Arraiján, Panama

Intermittent drinking water supply is common in low- and middle-income countries throughout the world and can cause waterquality to degrade in the distribution system.In this study,we characterized waterquality in one study zone with continuous supply and three zoneswith intermittentsupply in the drinking waterdistribution network in Arraija!n,Panama.Low orzero pressuresoccurred in allzones,and negative pressuresoccurred in the continuouszone and two ofthe intermittentzones.Despite hydraulic conditions that created risks for backflow and contaminant intrusion, only four of 423 (0.9%) grab samplescollected atrandom timeswere positive fortotalcoliform bacteria and only one waspositive for E.coli.Only nine of 496 (1.8%) samples had turbidity >1.0 NTU and all samples had !0.2 mg/L free chlorine residual.In contrast,water quality was often degraded during the first-flush period (when supply first returned after an outage).Still, routine and first-flush water quality under intermittent supply was much better in Arraija!n than that reported in a previous study conducted in India.Better waterquality in Arraija!n could be due to betterwaterquality leaving the treatmentplant,shortersupply outages,highersupply pressures,a more consistentand higherchlorine residual,and fewercontaminant sourcesnearpipes.The resultsillustrate thatintermittentsupply and itseffectson waterquality can vary greatly between and within distribution networks.The study also demonstrated thatmonitoring techniques designed specifically for intermittentsupply,such as continuous pressure monitoring and sampling the firstflush,can detectwaterquality threats and degradation thatwould notlikely be detected with conventionalmonitoring.Intermittent drinking water supply is common in low- and middle-income countries throughout the world and can cause waterquality to degrade in the distribution system.In this study,we characterized waterquality in one study zone with continuous supply and three zoneswith intermittentsupply in the drinking waterdistribution network in Arraija!n,Panama.Low orzero pressuresoccurred in allzones,and negative pressuresoccurred in the continuouszone and two ofthe intermittentzones.Despite hydraulic conditions that created risks for backflow and contaminant intrusion, only four of 423 (0.9%) grab samplescollected atrandom timeswere positive fortotalcoliform bacteria and only one waspositive for E.coli.Only nine of 496 (1.8%) samples had turbidity >1.0 NTU and all samples had !0.2 mg/L free chlorine residual.In contrast,water quality was often degraded during the first-flush period (when supply first returned after an outage).Still, routine and first-flush water quality under intermittent supply was much better in Arraija!n than that reported in a previous study conducted in India.Better waterquality in Arraija!n could be due to betterwaterquality leaving the treatmentplant,shortersupply outages,highersupply pressures,a more consistentand higherchlorine residual,and fewercontaminant sourcesnearpipes.The resultsillustrate thatintermittentsupply and itseffectson waterquality can vary greatly between and within distribution networks.The study also demonstrated thatmonitoring techniques designed specifically for intermittentsupply,such as continuous pressure monitoring and sampling the firstflush,can detectwaterquality threats and degradation thatwould notlikely be detected with conventionalmonitoring

Metal-organic conjugated microporous polymer containing a carbon dioxide reduction electrocatalyst

A metal-organic conjugated micorporous polymer (CMP) containing a manganese carbonyl electrocatalyst for CO2 reduction has been synthesised and electrochemically characterised. Incorporation in a rigid framework changes the behavior of the catalyst, preventing reductive dimerization. These initial studies demonstrate the feasibility of CMP electrodes that can provide both high local CO2 concentrations and well defined electrocatalytic sites

Equity of access to treatment on the Cancer Drugs Fund:A missed opportunity for cancer research?

AbstractUsing mixed-methods, we investigated the CDF in the South West of England (3193 cancer patients treated through the CDF, April 1st 2011–March 31st 2013) for evidence of: (1) equitable access across socioeconomic groups, age groups, sex, and Cancer Network; (2) time-to-treatment by socioeconomic group; and (3) the perception of the CDF as fair, using semi-structured interviews with oncology consultants.There was no evidence of inequitable access to anti-cancer therapy for those in more deprived areas. For all cancer types, there was a lower proportion of women in the CDF cohort than in the Cancer Registry reference population (e.g., melanoma, CDF 36.8% female, reference population 48.7%; difference 11.9%, 95% CI 3.1–20.7%). There was a lower proportion of older patients in the CDF compared with the reference population (e.g., colorectal cancer, CDF 6.9% ≥80 years, reference population 30.1%; difference 23.2%, 95% CI 20.2–26.2%). Interviewed oncologists felt differences in performance status, not age, influenced referral to the CDF, with neither deprivation, nor gender contributing.Our study suggests that the CDF has differential access by age and sex, but not by deprivation. The absence of high quality CDF data represents a missed opportunity to fully evaluate equity of access and the real-world costs and outcomes of novel anti-cancer drugs

Directing the mechanism of CO2 reduction by a Mn catalyst through surface immobilization

Immobilization of a Mn polypyridyl CO2 reduction electrocatalyst on nanocrystalline TiO2 electrodes yields an active heterogeneous system and also significantly triggers a change in voltammetric and catalytic behaviour, relative to in solution. A combination of spectroelectrochemical techniques are presented here to elucidate the mechanism of the immobilised catalyst in-situ

Collaboration and contestation in further and higher education partnerships in England: a Bourdieusian field analysis

Internationally, ‘College for All’ policies are creating new forms of vocational higher education (HE), and shifting relationships between HE and further education (FE) institutions. In this paper, we consider the way in which this is being implemented in England, drawing on a detailed qualitative case study of a regional HE–FE partnership to widen participation. We focus on the complex mix of collaboration and contestation that arose within it, and how these affected socially differentiated groups of students following high- and low-status routes through its provision. We outline Bourdieu’s concept of ‘field’ as a framework for our analysis and interpretation, including its theoretical ambiguities regarding the definition and scale of fields. Through hermeneutic dialogue between data and theory, we tentatively suggest that such partnerships represent bridges between HE and FE. These bridges are strong between higher-status institutions, but highly contested between lower-status institutions competing closely for distinction. We conclude that the trajectories and outcomes for socially disadvantaged students require attention and collective action to address the inequalities they face, and that our theoretical approach may have wider international relevance beyond the English case

Early conscious prone positioning in patients with COVID-19 receiving continuous positive airway pressure: A retrospective analysis

The global pandemic of COVID-19 has challenged the management of hypoxaemic respiratory failure and strained intensive care unit resources. While prone positioning (PP) is an established therapy in mechanically ventilated patients with acute respiratory distress syndrome (ARDS), its role in conscious patients is less well defined. We retrospectively reviewed our experience of implementing early PP in a cohort of 24 patients with acute hypoxaemic respiratory failure due to COVID-19 who required support with continuous positive airway pressure (CPAP). The use of PP alongside CPAP significantly increased both the ROX index and arterial oxygen pressure:fractional inspired oxygen (PaO 2:FiO 2) ratio from baseline values (ROX index: 7.0±2.5 baseline vs 11.4±3.7 CPAP+PP,

The long-term impact of folic acid in pregnancy on offspring DNA methylation : follow-up of the Aberdeen folic acid supplementation trial (AFAST)

Funding This work was supported by the NIHR Bristol Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health. R.C.R., G.C.S., N.K., T.G., G.D.S. and C.L.R. work in a unit that receives funds from the University of Bristol and the UK Medical Research Council (MC_UU_12013/1, MC_UU_12013/2 and MC_UU_12013/8). This work was also supported by CRUK (grant number C18281/A19169) and the ESRC (grant number ES/N000498/1). C.M.T. is supported by a Wellcome Trust Career Re-entry Fellowship (grant number 104077/Z/14/Z).Peer reviewedPublisher PD

Improving the efficiency of electrochemical CO2 reduction using immobilized manganese complexes

Immobilization of [Mn(bpy)(CO)3Br], (1) and [Mn(bpy(tBu)2)(CO)3Br] (2, where (bpy(tBu)2) = 4,4′-di-tert-butyl-2,2′-bipyridine) in Nafion/multi-walled carbon nanotubes (MWCNT) on glassy carbon yielded highly active electrodes for the reduction of CO2 to CO in aqueous solutions at pH 7. Films incorporating 2 have significantly improved selectivity towards CO2, with CO : H2 ∼ 1 at −1.4 V vs. SCE, exceeding that for the previously reported 1/MWCNT/Nafion electrode. Furthermore, we report the synthesis and subsequent electrochemical characterization of two new substituted Mn(i) bipyridine complexes, [Mn(bpy(COOH)2)(CO)3Br] (3) and [Mn(bpy(OH)2)(CO)3Br] (4) (where (bpy(COOH)2) = 4,4′-di-carboxy-2,2′-bipyridine and (bpy(OH)2) = 4,4′-di-hydroxy-2,2′-bipyridine). Both 3 and 4 were found to have some activity towards CO2 in acetonitrile solutions; however once immobilized in Nafion membranes CO2 reduction was found to not occur at significant levels.</p