The trajectory to diagnosis with pulmonary arterial hypertension: a qualitative study

Objectives To investigate the patient's experience of the trajectory to receiving a diagnosis of pulmonary arterial hypertension (PAH) and inform the provision of care for this patient group. Design Qualitative study using in-depth one-to-one interviews and pictorial representations. Data were analysed using thematic analysis. Setting Participants were interviewed in their own homes across England. Participants 30 patients with a diagnosis of pulmonary hypertension (18 participants were women, mean age 56 and range 26-80 02years and time since diagnosis ranged from a few months to more than 12 02years) participated. Results All participants, regardless of the time since diagnosis, vividly described the process from manifestation of symptoms to receiving a confirmed diagnosis. The authors present data using three major themes: (i) making sense of symptoms, (ii) process of elimination and (iii) being diagnosed with PAH. Making sense of symptoms represented an early period of perseverance 14people tried to carry-on as usual despite 18unexplained breathlessness 19. As time progressed, this period was punctuated by critical events that triggered seeking medical advice. Once medical contact had been made, patients described a period of 18elimination 19 and convoluted contact with the medical profession. Dyspnoea misdiagnosis was a key factor that delayed the PAH diagnosis. Diagnosis disclosure by some medical professionals was also viewed as lacking empathy. More positive experiences were relayed when the medical team disclosing the diagnosis acknowledged previous limitations. Conclusions A lack of awareness of this illness from both the sufferer themselves and the medical profession emerged as a central theme and led to prolonged periods of being misdiagnosed. The application of a diagnostic pathway for unexplained dyspnoea that alerts practitioners to rare conditions could expedite the process of correct diagnosis

Learning to facilitate arts-in-health programmes: a case study of musicians facilitating creative interventions for mothers with symptoms of postnatal depression

There is growing research documenting the effects of arts-in-health interventions on diverse participant groups. However, the impact of interventions on facilitators remains largely lacking. Drawing on a case study project, this article reports on a qualitative study to understand the practices, challenges, enablers and impacts for musicians of facilitating creative interventions for women with symptoms of postnatal depression. Thematic analysis revealed that the musicians used specific practices to successfully facilitate their activities, relying on a balance of forward-planning with the need to retain flexibility and provide women with autonomy and opportunities for social bonding. Key challenges included coping with the emotional impact of the project as well as facilitating different types of creative activities, while a strong sense of team and the structure of the interventions supported delivery. Finally, the project enabled the development of both generic and context-specific creative facilitation skills, and also contributed to the facilitators’ wellbeing. The logistical, educational and support implications for other practitioners seeking to establish such interventions are considered within the context of arts-in-health and musicians’ education

How group singing facilitates recovery from the symptoms of postnatal depression: a comparative qualitative study

Background: Previous research has demonstrated that making music can enhance positive emotions as well as support positive psychological functioning. However, studies tend to be limited by lack of comparison with other psychosocial interventions. This study builds on a three-arm randomised controlled trial (RCT) that demonstrated that group singing for mothers and babies, but not group creative play, can lead to faster recovery from moderate-severe symptoms of postnatal depression than usual care. The aim was to elucidate the mechanisms of the group singing intervention in order to account for its recovery properties. Methods: Qualitative research was conducted with 54 mothers who had experienced symptoms of postnatal depression. Mothers completed a 10-week programme of either group singing or group creative play as part of the wider RCT study. Data were collected via a series of 10 semi-structured focus groups conducted at the end of each 10-week programme. These were designed to elicit subjective and constructed experiences of the singing and play interventions and were analysed inductively for emergent themes. Results: Five distinctive features of the group singing emerged: (i) providing an authentic, social and multicultural creative experience, (ii) ability to calm babies; (iii) providing immersive ‘me time’ for mothers; (iv) facilitating a sense of achievement and identity; (v) enhancing mother-infant bond. Conclusions: Community group singing interventions may reduce symptoms of postnatal depression through facilitating a functional emotional response rooted in the needs of new motherhood. These features are of relevance to others seeking to implement creative interventions for maternal mental health. Trial registration: NCT02526407. Registered 18 August 2015

Characterizing the velocity field in hydrodynamical simulations of low-mass star formation using spectral line profiles

When low-mass stars form, the collapsing cloud of gas and dust goes through several stages which are usually characterized by the shape of their spectral energy distributions. Such classification is based on the cloud morphology only and does not address the dynamical state of the object. In this paper we investigate the initial cloud collapse and subsequent disk formation through the dynamical behavior as reflected in the sub-millimeter spectral emission line profiles. If a young stellar object is to be characterized by its dynamical structure it is important to know how accurately information about the velocity field can be extracted and which observables provide the best description of the kinematics. Of particular interest is the transition from infalling envelope to rotating disk, because this provides the initial conditions for the protoplanetary disk, such as mass and size. We use a hydrodynamical model, describing the collapse of a core and formation of a disk, to produce synthetic observables which we compare to calculated line profiles of a simple parameterized model. Because we know the velocity field from the hydrodynamical simulation we can determine in a quantitative way how well our best-fit parameterized velocity field reproduces the original. We use a molecular line excitation and radiation transfer code to produce spectra of both our hydro dynamical simulation as well as our parameterized model. We find that information about the velocity field can reasonably well be derived by fitting a simple model to either single-dish lines or interferometric data, but preferentially by using a combination of the two. Our result shows that it is possible to establish relative ages of a sample of young stellar objects using this method, independently of the details of the hydrodynamical model.Comment: 12 pages, 11 figures, accepted for publication in A&A on June 1

Certainty Closure: Reliable Constraint Reasoning with Incomplete or Erroneous Data

Constraint Programming (CP) has proved an effective paradigm to model and solve difficult combinatorial satisfaction and optimisation problems from disparate domains. Many such problems arising from the commercial world are permeated by data uncertainty. Existing CP approaches that accommodate uncertainty are less suited to uncertainty arising due to incomplete and erroneous data, because they do not build reliable models and solutions guaranteed to address the user's genuine problem as she perceives it. Other fields such as reliable computation offer combinations of models and associated methods to handle these types of uncertain data, but lack an expressive framework characterising the resolution methodology independently of the model. We present a unifying framework that extends the CP formalism in both model and solutions, to tackle ill-defined combinatorial problems with incomplete or erroneous data. The certainty closure framework brings together modelling and solving methodologies from different fields into the CP paradigm to provide reliable and efficient approches for uncertain constraint problems. We demonstrate the applicability of the framework on a case study in network diagnosis. We define resolution forms that give generic templates, and their associated operational semantics, to derive practical solution methods for reliable solutions.Comment: Revised versio

Pan-European grading scales: lessons from national systems and the ECTS

This article assesses the impact of the Bologna Process on the grading schemes of EU member countries. In light of some problems regarding the implementation of the European Credit Transfer system (ECTS), the author proposes further reforms and offers some elements of a unified grading system for European higher education. The author explores the variation among Europe’s grading systems and the resulting lessons learned are shared here. Lastly, this article also argues that principles of justice and fairness, deemed central to academic freedom, are best upheld by the use of a unified grading system at national and European levels

VLA observations of candidate high-mass protostellar objects at 7 mm

We present radio continuum observations at 7 mm made using the Very Large Array towards three massive star forming regions thought to be in very early stages of evolution selected from the sample of Sridharan et al. (2002). Emission was detected towards all three sources (IRAS 18470-0044, IRAS 19217+1651 and IRAS 23151+5912). We find that in all cases the 7 mm emission corresponds to thermal emission from ionized gas. The regions of ionized gas associated with IRAS 19217+1651 and IRAS 23151+5912 are hypercompact with diameters of 0.009 and 0.0006 pc, and emission measures of 7.0 x 10^8 and 2.3 x 10^9 pc cm^(-6), respectively.Comment: 17 pages, 5 figures, accepted by The Astronomical Journa

How do Current Economic and Cultural Criteria for Assessing the Effectivity of the Liverpool Biennial Impact Upon its Planning, Strategies, and Resourcing?

This thesis focuses on the evolution of the Liverpool Biennial through the use of their evaluation methodologies. Throughout, I will show how evaluation and impact research has shaped the development of the Biennial and how the methodologies have influenced their policy and structure. I will discuss how the implications of these decisions have been governed from the use of both quantitative and qualitative methods of data gathering and how the language has been used to develop the marketing to describe their cultural output and impacts. The research begins with investigating the cultural valuation techniques that have been applied to the Liverpool Biennial Festival’s research, and impact reports. This research investigates the methodologies applied to evaluate the cultural value of the Biennial’s programme of cultural activity to determine the efficiency and validity of the Festival’s cultural impact studies. I will show how the Biennial’s extensive demographic research has been used to enable them to develop from a niche trade Festival. Furthermore, I will illustrate how each successive Festival (1999 – 2012) has developed, its increasing economic impact to the city, as well as increasing its popularity to a more inclusive audience under the tutelage of Lewis Biggs, Paul Domela and Paul Smith. Through in-depth analysis of their approach to evaluation, the thesis also reveals how the language of their marketing and visitor profile information has enhanced the intrinsic impact, cultural experience, or customer satisfaction of the service provided within the Festival. The research shows how the finding from the evaluation and impact research has been implemented into the decision-making, planning and curation of the Liverpool Biennial organisation so that they produce significant cultural impact

Beyond “planning”: A meta-analysis of implementation intentions to support smoking cessation

Objective: Implementation intentions support behavior change by encouraging people to link critical situations with appropriate responses. Overall effectiveness for smoking cessation is unknown. This systematic review and meta-analysis aimed to evaluate the effectiveness of implementation intentions for smoking cessation. Method: Using PRISMA guidelines, 6 electronic databases were searched (updated February 2018) using key terms. Data were pooled for smoking cessation (categorical variable; yes/no) and entered into random effects models. Analyses assessed: (a) effectiveness as a single intervention, and (b) effectiveness when included as one of multiple intervention components. Results: Twelve studies were identified. Implementation intentions were effective for smoking cessation at follow up, OR = 1.70, CI [1.32, 2.20], p < .001, average 10.7% quit rate for intervention participants (4.9% in controls). Implementation intentions as a single intervention were effective for smoking cessation, OR = 5.69, 95% CI [1.39, 23.25], p = .02 (average quit rate 14.3% in intervention participants vs. 3.6% in controls) and as part of multicomponent interventions, OR = 1.67, 95% CI [1.29, 1.66], p < .001 (average quit rate 8.2% in intervention participants vs. 5.8% in controls). Conclusions: Implementation intentions are effective at helping smokers quit although the review reported substantial heterogeneity across the limited number of included studies. The present review sets the agenda for future research in this area including longer term objectively verified abstinence and identification of potential moderators of effectiveness including population characteristics