Capturing the value of peer support : measuring recovery-oriented services

Purpose: The purpose of this paper is to examine the gap between recovery-oriented processes and clinical outcomes in peer support, an exemplar of recovery-oriented services, and offer suggestions for bridging this gap. Design/methodology/approach: This viewpoint is a brief review of literature on peer support services and gaps in outcome measurement towards building an evidence base for recovery-oriented services. Findings: Clinical outcomes like hospitalizations or symptoms remain a focus of research, practice and policy in recovery-oriented services and contribute to a mixed evidence base for peer support services, in which recovery-oriented outcomes like empowerment, self-efficacy and hopefulness have more evidentiary support. One approach is to identify the theoretical underpinnings of peer support services and the corresponding change mechanisms in models that would make these recovery-oriented outcomes mediators or process outcomes. A better starting point is to consider which outcomes are valued by the people who use services and develop an evaluation approach according to those stated goals. User driven measurement approaches and more participatory types of research can improve both the quality and impact of health and mental health services. Originality/value: This viewpoint provides a brief review of peer support services and the challenges of outcome measurement in establishing an evidence base and recommends user driven measurement as a starting point in evaluation of recovery-oriented services

Bimodal release ondansetron for acute gastroenteritis among adolescents and adults: A randomized clinical trial

Importance: Vomiting resulting from acute gastroenteritis is commonly treated with intravenous antiemetics in acute care settings. If oral treatment were beneficial, patients might not need intravenous administered hydration or medication. Furthermore, a long-acting treatment could provide sustained relief from nausea and vomiting. Objective: To determine whether an experimental long-acting bimodal release ondansetron tablet decreases gastroenteritis-related vomiting and eliminates the need for intravenous therapy for 24 hours after administration. Design, Setting, and Participants: This placebo-controlled, double-blind, randomized clinical trial included patients from 19 emergency departments and 2 urgent care centers in the United States from December 8, 2014, to February 17, 2017. Patients 12 years and older with at least 2 vomiting episodes from presumed gastroenteritis in the previous 4 hours and symptoms with less than 36 hours\u27 duration were randomized using a 3:2 active to placebo ratio. Analyses were performed on an intent-to-treat basis and conducted from June 1, 2017, to November 1, 2017. Intervention: Bimodal release ondansetron tablet containing 6 mg of immediate release ondansetron and 18 mg of a 24-hour release matrix for a total of 24 mg of ondansetron. Main Outcomes and Measures: Treatment success was defined as no further vomiting, no need for rescue medication, and no intravenous hydration for 24 hours after bimodal release ondansetron administration. Results: Analysis included 321 patients (mean [SD] age, 29.0 [11.1] years; 195 [60.7%] women), with 192 patients in the bimodal release ondansetron group and 129 patients in the placebo group. Treatment successes were observed in 126 patients in the bimodal release ondansetron group (65.6%) compared with 70 patients in the placebo group (54.3%), with an 11.4% (95% CI, 0.3%-22.4%) absolute probability difference. The proportion of treatment success was 21% higher among patients who received bimodal release ondansetron compared with those who received a placebo (relative risk, 1.21; 95% CI, 1.00-1.46; P = .04). In an analysis including only patients with a discharge diagnosis of acute gastroenteritis and no major protocol violations, there were 123 treatment successes (69.5%) in the bimodal release ondansetron group compared with 67 treatment successes (54.9%) in the placebo group (relative risk, 1.27; 95% CI, 1.05-1.53; P = .01). Adverse effects were infrequent and similar to the known safety profile of ondansetron. Conclusions and Relevance: This randomized clinical trial found that a long-acting bimodal release oral ondansetron tablet was an effective antiemetic among adolescents and adults with moderate to severe vomiting from acute gastroenteritis. The drug benefits extended to 24 hours after administration. Bimodal release ondansetron may decrease the need for intravenous access and emergency department care to manage acute gastroenteritis. Trial Registration: ClinicalTrials.gov identifier: NCT02246439

Ovarian leydig cell hyperplasia: an unusual case of virilization in a postmenopausal woman.

Objective. To report an unusual case of ovarian Leydig cell hyperplasia resulting in virilization in a postmenopausal woman. Methods. Patient\u27s medical history and pertinent literature were reviewed. Results. A 64-year-old woman presented with virilization with worsening hirsutism, deepening of her voice, male musculature, and male pattern alopecia. Her pertinent past medical history included type 1 diabetes, hyperlipidemia, and hypertension. Her pertinent past surgical history included hysterectomy due to fibroids. On further work-up, her serum total testosterone was 506 ng/dL (nl range: 2-45) and free testosterone was 40 pg/mL (nl range: 0.1-6.4). After ruling out adrenal causes, the patient underwent an empiric bilateral oophorectomy that showed Leydig cell hyperplasia on pathology. Six weeks postoperatively, serum testosterone was undetectable with significant clinical improvement. Conclusion. Postmenopausal hyperandrogenism can be the result of numerous etiologies ranging from normal physiologic changes to ovarian or rarely adrenal tumors. Our patient was found to have Leydig cell hyperplasia of her ovaries, a rarely reported cause of virilization

An analytic model of the Gruneisen parameter at all densities

We model the density dependence of the Gruneisen parameter as gamma(rho) = 1/2 + gamma_1/rho^{1/3} + gamma_2/rho^{q}, where gamma_1, gamma_2, and q>1 are constants. This form is based on the assumption that gamma is an analytic function of V^{1/3}, and was designed to accurately represent the experimentally determined low-pressure behavior of gamma. The numerical values of the constants are obtained for 20 elemental solids. Using the Lindemann criterion with our model for gamma, we calculate the melting curves for Al, Ar, Ni, Pd, and Pt and compare them to available experimental melt data. We also determine the Z (atomic number) dependence of gamma_1. The high-compression limit of the model is shown to follow from a generalization of the Slater, Dugdale-MacDonald, and Vashchenko-Zubarev forms for the dependence of the Gruneisen parameter.Comment: 14 Pages, LaTeX, 5 eps figues; changes in the tex

Complex, but not quite complex enough : The turn to the complexity sciences in evaluation scholarship

This document is the Accepted Manuscript version of the following article: Chris Mowles, ‘Complex, but not quite complex enough: The turn to the complexity sciences in evaluation scholarship’. The final, definitive version of this paper has been published in Evaluation, Vol. 20 (2): 160-175, April 2014, doi: https://doi.org/10.1177/1356389014527885 , published by SAGE Publishing. All rights reserved.This article offers a critical review of the way in which some scholars have taken up the complexity sciences in evaluation scholarship. I argue that there is a tendency either to over-claim or under-claim their importance because scholars are not always careful about which of the manifestations of the complexity sciences they are appealing to, nor do they demonstrate how they understand them in social terms. The effect is to render ‘complexity’ just another volitional tool in the evaluator’s toolbox subsumed under the dominant understanding of evaluation, as a logical, rational activity based on systems thinking and design. As an alternative I argue for a radical interpretation of the complexity sciences, which understands human interaction as always complex and emergent. The interweaving of intentions in human activity will always bring about outcomes that no one has intended including in the activity of evaluation itself.Peer reviewe

The effect of the electric field on lag phase, β-galactosidase production and plasmid stability of a recombinant Saccharomyces cerevisiae strain growing on lactose

Ethanol and β-galactosidase production from cheese whey may significantly contribute to minimise environmental problems while producing value from lowcost raw materials. In this work, the recombinant Saccharomyces cerevisiae NCYC869-A3/pVK1.1 flocculent strain expressing the lacA gene (coding for β-galactosidase) of Aspergillus niger under ADHI promoter and terminator was used. This strain shows high ethanol and β-galactosidase productivities when grown on lactose. Batch cultures were performed using SSlactose medium with 50 gL−1 lactose in a 2-L bioreactor under aerobic and microaerophilic conditions. Temperature was maintained at 30 °C and pH 4.0. In order to determine the effect of an electric field in the fermentation profile, titanium electrodes were placed inside the bioreactor and different electric field values (from 0.5 to 2 Vcm−1) were applied. For all experiments, β-galactosidase activity, biomass, protein, lactose, glucose, galactose and ethanol concentrations were measured. Finally, lag phase duration and specific growth rate were calculated. Significant changes in lag phase duration and biomass yield were found when using 2 Vcm−1. Results show that the electric field enhances the early stages of fermentation kinetics, thus indicating that its application may improve industrial fermentations’ productivity. The increase in electric field intensity led to plasmid instability thus decreasing β-galactosidase production.The authors gratefully acknowledge Fundacao para a Ciencia e a Tecnologia (Portugal) for the scholarships SFRH/BD/11230/2002 and SFRH/BDP/63831/2009 granted to authors I. Castro and C. Oliveira, respectively

Family stories, public silence: Irish identity construction amongst the second-generation Irish in England

Formal narratives of history, especially that of colonial oppression, have been central to the construction of national identities in Ireland. But the Irish diasporic community in Britain has been cut off from the reproduction of these narratives, most notably by their absence from the curriculum of Catholic schools, as result of the unofficial 'denationalisation' pact agreed by the Church in the 19th century (Hickman, 1995). The reproduction of Irish identities is largely a private matter, carried out within the home through family accounts of local connections, often reinforced by extended visits to parent/s 'home' areas. Recapturing a public dimension has often become a personal quest in adulthood, 'filling in the gaps'. This paper explores constructions of narratives of nation by a key diasporic population, those with one or two Irish-born parents. It places particular emphasis on varying regional/national contexts within which such constructions take place, drawing on focus group discussions and interviews for the ESRC-funded Irish 2 Project in five locations — London, Glasgow, Manchester, Coventry and Banbury

Photon Dominated Regions in NGC 3603

Aims: We aim at deriving the excitation conditions of the interstellar gas as well as the local FUV intensities in the molecular cloud surrounding NGC 3603 to get a coherent picture of how the gas is energized by the central stars. Methods: The NANTEN2-4m submillimeter antenna is used to map the [CI] 1-0, 2-1 and CO 4-3, 7-6 lines in a 2' x 2' region around the young OB cluster NGC 3603 YC. These data are combined with C18O 2-1 data, HIRES-processed IRAS 60 and 100 micron maps of the FIR continuum, and Spitzer/IRAC maps. Results: The NANTEN2 observations show the presence of two molecular clumps located south-east and south-west of the cluster and confirm the overall structure already found by previous CS and C18O observations. We find a slight position offset of the peak intensity of CO and [CI], and the atomic carbon appears to be further extended compared to the molecular material. We used the HIRES far-infrared dust data to derive a map of the FUV field heating the dust. We constrain the FUV field to values of \chi = 3 - 6 \times 10^3 in units of the Draine field across the clouds. Approximately 0.2 to 0.3 % of the total FUV energy is re-emitted in the [CII] 158 {\mu}m cooling line observed by ISO. Applying LTE and escape probability calculations, we derive temperatures (TMM1 = 43 K, TMM2 = 47 K), column densities (N(MM1) = 0.9 \times 10^22 cm^-2, N(MM2) = 2.5 \times 10^22 cm^-2) and densities (n(MM1) = 3 \times 10^3 cm^-3, n(MM2) = 10^3 -10^4 cm^-3) for the two observed molecular clumps MM1 and MM2. Conclusions: The cluster is strongly interacting with the ambient molecular cloud, governing its structure and physical conditions. A stability analysis shows the existence of gravitationally collapsing gas clumps which should lead to star formation. Embedded IR sources have already been observed in the outskirts of the molecular cloud and seem to support our conclusions.Comment: 13 pages, 10 figures, accepted for publication by A&