The other side of the wall

The closure of CrossReach's last remaining residential school, Ballikinrain, marks an important stage in the evolution of the charity's care for young people. CrossReach (the operating name for The Church of Scotland's Social Care Council) began opening large residential schools following World War II. It has now moved to family-style living in local communities for its children and young people, a process in which Scotland's changing legislation and CrossReach's own knowledge and experience have interacted to underpin a nuanced understanding of child centred care. Changes in practice at Ballikinrain, informed by academic and psychological consultation, legislative changes and recommendations from Scottish Government reports are described, together with a growing understanding of the local community's role in supporting cared for young people and necessary collaboration in the elimination of stigmatisation. This evolution is illustrated by statements from former pupils, and the particular example of one boy and his key worker, whose metaphor of driver and navigator suggests a fruitful way of viewing relationships at every level of the residential care system. We argue that the trajectory towards child-centred practice and legislation, exemplified by The Promise, supports the residential childcare system to enable our children and young people to influence national policy

Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial

Background Results of small trials indicate that fluoxetine might improve functional outcomes after stroke. The FOCUS trial aimed to provide a precise estimate of these effects. Methods FOCUS was a pragmatic, multicentre, parallel group, double-blind, randomised, placebo-controlled trial done at 103 hospitals in the UK. Patients were eligible if they were aged 18 years or older, had a clinical stroke diagnosis, were enrolled and randomly assigned between 2 days and 15 days after onset, and had focal neurological deficits. Patients were randomly allocated fluoxetine 20 mg or matching placebo orally once daily for 6 months via a web-based system by use of a minimisation algorithm. The primary outcome was functional status, measured with the modified Rankin Scale (mRS), at 6 months. Patients, carers, health-care staff, and the trial team were masked to treatment allocation. Functional status was assessed at 6 months and 12 months after randomisation. Patients were analysed according to their treatment allocation. This trial is registered with the ISRCTN registry, number ISRCTN83290762. Findings Between Sept 10, 2012, and March 31, 2017, 3127 patients were recruited. 1564 patients were allocated fluoxetine and 1563 allocated placebo. mRS data at 6 months were available for 1553 (99·3%) patients in each treatment group. The distribution across mRS categories at 6 months was similar in the fluoxetine and placebo groups (common odds ratio adjusted for minimisation variables 0·951 [95% CI 0·839–1·079]; p=0·439). Patients allocated fluoxetine were less likely than those allocated placebo to develop new depression by 6 months (210 [13·43%] patients vs 269 [17·21%]; difference 3·78% [95% CI 1·26–6·30]; p=0·0033), but they had more bone fractures (45 [2·88%] vs 23 [1·47%]; difference 1·41% [95% CI 0·38–2·43]; p=0·0070). There were no significant differences in any other event at 6 or 12 months. Interpretation Fluoxetine 20 mg given daily for 6 months after acute stroke does not seem to improve functional outcomes. Although the treatment reduced the occurrence of depression, it increased the frequency of bone fractures. These results do not support the routine use of fluoxetine either for the prevention of post-stroke depression or to promote recovery of function. Funding UK Stroke Association and NIHR Health Technology Assessment Programme

Approximate formulae for the average one sided specific radiation wave impedance of a finite rectangular panel

ABSTRACT The authors have previously published approximate formulae for the average one sided specific radiation wave impedance of a finite rectangular panel mounted in a rigid infinite baffle. The panel's transverse vibration was due to a (possibly forced) two dimensional bending plane wave propagating in the panel without reflection at the edges of the panel. The average was over all the surface area of the panel and over all possible azimuthal angles of propagation direction. The radiation from waves propagating in different directions was assumed to be uncorrelated. These approximate formulae were derived from the 1982 research of Thomasson whose approximate formulae only covered the high and low frequency regions and not the mid frequency region. This paper presents more accurate versions of some of the approximate formulae. When the bending wave number is larger than the wave number of sound, the real part of the impedance is smaller than that for the case studied by Maidanik and Leppington. This is because correlated reflections are not included the case analyzed in this paper. When the bending wave number is smaller than or equals the wave number of sound, the real part of the impedance is the same for both cases

New candidate planetary nebulae in the IPHAS survey : The case of planetary nebulae with ISM interaction

Copyright © Astronomical Society of Australia 2010We present the results of the search for candidate Planetary Nebulae interacting with the interstellar medium (PNISM) in the framework of the INT Photometric H Survey (IPHAS) and located in the right ascension range 1820 h. The detection capability of this new Northern survey, in terms of depth and imaging resolution, has allowed us to overcome the detection problem generally associated to the low surface brightness inherent to PNe-ISM. We discuss the detection of 21 IPHAS PNISM candidates. Thus, different stages of interaction were observed, implying various morphologies i.e. from the unaffected to totally disrupted shapes. The majority of the sources belong to the so-called WZO2 stage which main characteristic is a brightening of the nebula's shell in the direction of motion. The new findings are encouraging as they would be a first step into the reduction of the scarcity of observational data and they would provide new insights into the physical processes occurring in the rather evolved PNe.Peer reviewe

Feasibility of reporting results of large randomised controlled trials to participants:experience from the Fluoxetine or Control under supervision (FOCUS) trial

Objectives Informing research participants of the results of studies in which they took part is viewed as an ethical imperative. However, there is little guidance in the literature about how to do this. The Fluoxetine Or Control Under Supervision trial randomised 3127 patients with a recent acute stroke to 6 months of fluoxetine or placebo and was published in the Lancet on 5 December 2018. The trial team decided to inform the participants of the results at exactly the same time as the Lancet publication, and also whether they had been allocated fluoxetine or placebo. In this report, we describe how we informed participants of the results.Design In the 6-month and 12-month follow-up questionnaires, we invited participants to provide an email address if they wished to be informed of the results of the trial. We re-opened our trial telephone helpline between 5 December 2018 and 31 March 2019.Setting UK stroke services.Participants 3127 participants were randomised. 2847 returned 6-month follow-up forms and 2703 returned 12-month follow-up forms; the remaining participants had died (380), withdrawn consent or did not respond.Results Of those returning follow-up questionnaires, a total of 1845 email addresses were provided and a further 50 people requested results to be sent by post. Results were sent to all email and postal addresses provided; 309 emails were returned unrecognised. Seventeen people replied, of whom three called the helpline and the rest responded by email.Conclusion It is feasible to disseminate results of large trials to research participants, though only around 60% of those randomised wanted to receive the results. The system we developed was efficient and required very little resource, and could be replicated by trialists in the future.Trial registration number ISRCTN83290762; Post-results