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Recovery Colleges are opening internationally. The evaluation focus has been on outcomes for Recovery College students who use mental health services. However, benefits may also arise for: staff who attend or co-deliver courses; the mental health and social care service hosting the Recovery College; and wider society. A theory-based change model characterising how Recovery Colleges impact at these higher levels is needed for formal evaluation of their impact, and to inform future Recovery College development. The aim of this study was to develop a stratified theory identifying candidate mechanisms of action and outcomes (impact) for Recovery Colleges at staff, services and societal levels.
Inductive thematic analysis of 44 publications identified in a systematised review was supplemented by collaborative analysis involving a lived experience advisory panel to develop a preliminary theoretical framework. This was refined through semi-structured interviews with 33 Recovery College stakeholders (service user students, peer/non-peer trainers, managers, community partners, clinicians) in three sites in England.
Candidate mechanisms of action and outcomes were identified at staff, services and societal levels. At the staff level, experiencing new relationships may change attitudes and associated professional practice. Identified outcomes for staff included: experiencing and valuing co-production; changed perceptions of service users; and increased passion and job motivation. At the services level, Recovery Colleges often develop somewhat separately from their host system, reducing the reach of the college into the host organisation but allowing development of an alternative culture giving experiential learning opportunities to staff around co-production and the role of a peer workforce. At the societal level, partnering with community-based agencies gave other members of the public opportunities for learning alongside people with mental health problems and enabled community agencies to work with people they might not have otherwise. Recovery Colleges also gave opportunities to beneficially impact on community attitudes.
This study is the first to characterise the mechanisms of action and impact of Recovery Colleges on mental health staff, mental health and social care services, and wider society. The findings suggest that a certain distance is needed in the relationship between the Recovery College and its host organisation if a genuine cultural alternative is to be created. Different strategies are needed depending on what level of impact is intended, and this study can inform decision-making about mechanisms to prioritise. Future research into Recovery Colleges should include contextual evaluation of these higher level impacts, and investigate effectiveness and harms.
There is a known high prevalence of genetic and clinical syndrome diagnoses in the paediatric cardiac population. These disorders often have multisystem effects, which may have an important impact on neurodevelopmental outcomes. Taken together, these facts suggest that patients and families may benefit from consultation by genetic specialists in a cardiac neurodevelopmental clinic.
This study assessed the burden of genetic disorders and utility of genetics evaluation in a cardiac neurodevelopmental clinic.
A retrospective chart review was conducted of patients evaluated in a cardiac neurodevelopmental clinic from 6 December, 2011 to 16 April, 2013. All patients were seen by a cardiovascular geneticist with genetic counselling support.
A total of 214 patients were included in this study; 64 of these patients had a pre-existing genetic or syndromic diagnosis. Following genetics evaluation, an additional 19 were given a new clinical or laboratory-confirmed genetic diagnosis including environmental such as teratogenic exposures, malformation associations, chromosomal disorders, and single-gene disorders. Genetic testing was recommended for 112 patients; radiological imaging to screen for congenital anomalies for 17 patients; subspecialist medical referrals for 73 patients; and non-genetic clinical laboratory testing for 14 patients. Syndrome-specific guidelines were available and followed for 25 patients with known diagnosis. American Academy of Pediatrics Red Book asplenia guideline recommendations were given for five heterotaxy patients, and family-based cardiac screening was recommended for 23 families affected by left ventricular outflow tract obstruction.
Genetics involvement in a cardiac neurodevelopmental clinic is helpful in identifying new unifying diagnoses and providing syndrome-specific care, which may impact the patient’s overall health status and neurodevelopmental outcome.
To examine whether weight history and weight transitions over adult lifespan contribute to physical impairment among postmenopausal women.
BMI categories were calculated among postmenopausal women who reported their weight and height at age 18 years. Multiple-variable logistic regression was used to determine the association between BMI at age 18 years and BMI transitions over adulthood on severe physical impairment (SPI), defined as scoring <60 on the Physical Functioning subscale of the Rand thirty-six-item Short-Form Health Survey.
Participants were part of the Women’s Health Initiative Observational Study (WHI OS), where participants’ health was followed over time via questionnaires and clinical assessments.
Postmenopausal women (n 76 016; mean age 63·5 (sd 7·3) years).
Women with overweight (BMI=25·0–29·9 kg/m2) or obesity (BMI≥30·0 kg/m2) at 18 years had greater odds (OR (95 % CI)) of SPI (1·51 (1·35, 1·69) and 2·14 (1·72, 2·65), respectively) than normal-weight (BMI=18·5–24·9 kg/m2) counterparts. Transitions from normal weight to overweight/obese or to underweight (BMI<18·5 kg/m2) were associated with greater odds of SPI (1·97 (1·84, 2·11) and 1·35 (1·06, 1·71), respectively) compared with weight stability. Shifting from underweight to overweight/obese also had increased odds of SPI (1·52 (1·11, 2·09)). Overweight/obese to normal BMI transitions resulted in a reduced SPI odds (0·52 (0·39, 0·71)).
Higher weight history and transitions into higher weight classes were associated with higher likelihood of SPI, while transitioning into lower weight classes for those with overweight/obesity was protective among postmenopausal women.
We present the results of the search for candidate Planetary Nebulae interacting with the interstellar medium (PN–ISM) in the framework of the INT Photometric Hα Survey (IPHAS) and located in the right ascension range 18–20 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 PN–ISM 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.
This study explores stress relaxation of epitaxial SiGe layers grown on Si substrates with unique orientations. The crystallographic orientations of the Si substrates used were off-axis from the (001) plane towards the (111) plane by angles, θ = 0, 10, and 22 degrees. We have grown 100nm thick Si(1−x) Ge(x) epitaxial layers with x=0.3 on the Si substrates to examine the relaxation process. The as-deposited films are metastable to the formation of strain relaxing misfit dislocations, and thermal annealing is used to obtain highly relaxed films for comparison. Raman spectroscopy has been used to measure the strain relaxation, and atomic force microscopy has been used to explore the development of surface morphology. The Raman scattering indicated that the strain in the as-deposited films is dependent on the substrate orientation with strained layers grown on Si with 0 and 22 degree orientations while highly relaxed films were grown on the 10 degree substrate. The surface morphology also differed for the substrate orientations. The 10 degree surface is relatively smooth with hut shaped structures oriented at predicted angles relative to the step edges.
Capacity recovery after long term storage and loaded storage is a critical issue with the NiMH system since its inception. A measurable loss in capacity is observed when cells are stored for long periods of time or discharged deeply to zero volts. The different mechanisms that are known to cause self discharge and capacity loss after storage and loaded storage will be the focus of this paper. Capacity loss after long term storage involves two main events. One is self discharge which causes the open circuit voltage(OCV) of the cell to drop. Self discharge is caused by decomposition of NiOOH, migration of metal ions and possible degradation of separator. Self discharge can be prevented by using separators which are stable at high temperatures and pH and have good ion trapping capability. Various separator types and treatments can play an important role in inhibiting metal ions from migrating thus reducing self discharge. Self discharge during storage causes a severe suppression in the voltage of the foam positive electrode. This drop in voltage causes a breakdown of the cobalt conductive network in the nickel positive electrode. Reduction of high valence cobalt(III) which forms the electrode's conductive network takes place at these low voltages. A permanent breakdown in the conductive network results in low efficiency of the cell on consecutive charge and discharge cycles. In addition, the cobalt in its lower valence states can migrate away from the electrode into the separator causing shorts. These events effect the charge and discharge efficiency of these cells thereby resulting in capacity loss. Various mechanisms causing self discharge which affect capacity recovery after long term storage and loaded storage are discussed in this paper.
To assess the hearing changes associated with sacrificing an intact ossicular chain during cholesteatoma surgery.
We reviewed the operation notes of surgical procedures performed by the senior author between October 2000 and April 2006. Thirty-three cases were identified in which cholesteatoma surgery had been performed in the presence of a mobile, intact ossicular chain. One set of case notes was missing; therefore, 32 cases were included in the analysis. The ossicular chain was preserved in 17 cases (14 males and three females) and sacrificed in 15 (eight males and seven females).
At the first post-operative assessment, a median air–bone gap deterioration of 3.3 dB was seen in patients in whom the ossicular chain had been sacrificed, while a median air–bone gap improvement of 3.3 dB was seen in those in whom the chain had been preserved. However, multivariable logistic regression analysis suggested that this difference in hearing outcomes was due to pre-operative hearing status, and that preservation of the ossicular chain did not lead to a better outcome.
In cholesteatoma surgery, there is at most a marginal benefit in preserving the ossicular chain. In the current study, the better hearing outcomes associated with preservation of the ossicular chain were accounted for by patients' better pre-operative hearing status. This study did not demonstrate a difference in residual disease rate, but was underpowered to do so.
Campylobacter jejuni serogroup reference strains and collections of sporadic and outbreak- associated isolates were examined for restriction fragment length polymorphisms (RFLPs), using C. jejuni random chromosomal and 16S rRNA gene probes. A collection of 48 Penner (HS) and 14 Lior (HL) serogroup reference strains, plus 10 clinical isolates, generated 35 RFLP and 26 ribotype patterns. In combination the two loci generated 48 distinct genotypes. Both probes were able to differentiate between certain random isolates of the same HS/HL serogroups but greater discrimination was obtained with RFLP than with ribotyping. Genotyping distinguished accurately between related and unrelated strains when applied to several outbreaks. Genotypic analysis of C. jejuni by restriction fragment length polymorphisms is a valuable technique for epidemiological typing. Chromosomal variation detected by the two unlinked probe loci provides some information about the genetic relationship between isolates.
To present the first published case of a child with bilateral profound sudden sensorineural hearing loss found in association with sickle cell anaemia, and to demonstrate the importance of early recognition, investigation and empirical treatment of sudden sensorineural hearing loss.
Case report and review of world literature.
The authors present the case of a seven-year-old child with known sickle cell anaemia, who presented with bilateral profound sensorineural hearing loss developing over a period of five days. There was a history of ophthalmological disease in the preceding weeks, and inflammatory markers were raised. The differential diagnosis included a vaso-occlusive or inflammatory aetiology such as Cogan's syndrome, and treatment for both was instigated. Hearing thresholds did not recover, and the patient underwent cochlear implantation 12 weeks later.
Sudden sensorineural hearing loss has a variable aetiology and is rare in children. Immediate treatment for all possible aetiologies is essential, along with targeted investigations and early referral for cochlear implantation if no recovery is demonstrated.
Glomus tumours are the most common primary neoplasms of the middle ear, typically benign and slowly progressive. Pulsatile tinnitus and ipsilateral hearing loss are the most common symptoms at presentation by far; otalgia, aural fullness and otorrhoea being less frequent. A case of primary glomus tympanicum presenting with recurrent epistaxis, previously unreported in the literature, is described and associated imaging presented.
Intratympanic gentamicin is increasingly used in the treatment of Ménière’s disease. Many protocols have been published for its use, but there is little difference in outcome between them. The goal of the study was therefore to assess current UK practice in the use of intratympanic gentamicin.
A postal and e-mail survey of consultant ENT surgeons in the UK was conducted. Of 34 consultants who regularly used intratympanic gentamicin, 21 used a protocol based upon a single intratympanic dose of gentamicin via a needle through the tympanic membrane and repeated after at least a week. The remaining 13 used either a regime of more frequent administration or attempted a more complicated route of delivery in an effort to improve reliability and selectivity of action.
In the absence of evidence demonstrating benefit from regimens of increased complexity the majority of consultants are using the simplest possible protocol.
This study presents results of wavelength-dependent Raman scattering from amorphous silicon carbon (a-Si:C:H). The a-Si:C:H films were produced by radio-frequency plasma-enhanced chemical vapor deposition. Prior results with amorphous carbon indicate that laser excitation selectively probes clusters with differing sizes. Our measurements with a-Si:C:H indicate that when using red (632.8 nm), green (514.5 nm), and blue (488.0 nm) excitation, the Raman D and G peaks shift to higher wave numbers as the excitation energy increases. The higher frequency is associated with smaller clusters that are preferentially excited with higher photon energy. It appears that photoluminescence occurs due to radiative recombination from intracluster transitions in Si-alloyed sp2-bonded carbon clusters
A case is presented of an entirely intracanalicular meningioma in a 48-year-old woman that was excised via a conventional translabyrinthine approach to the internal auditory canal (IAC). Pre-operative magnetic resonance imaging (MRI) suggested that the tumour was a vestibular schwannoma (VS). Histological examination confirmed the intra-operative impression that the tumour was a meningioma. Although VS is by far the commonest intracanalicular tumour, the differential diagnosis includes meningioma. MRI is unable to distinguish between these two entities when the tumour is located entirely in the internal auditory canal.
Genomic profiles were obtained for 76 strains of Campylobacter
jejuni isolated from bacteraemic patients in England and Wales over
period 1981–94. Genotyping was
performed by restriction fragment length polymorphism (RFLP) analysis using
cloned DNA probe, and by ribotyping with a PCR-generated C. jejuni
probe. Phenotypic characterization was achieved by heat-stable (HS) and
serogrouping, and Preston phagetyping and biotyping. The blood isolates
heterogenous, with 24 RFLP/16S profiles occurring within the 76 strains.
Forty-four percent of
isolates belonged to one of three RFLP/16S genotypes, reflecting the
seen in faecal
isolates, except that genotypes usually associated with the HS 1 antigen
two most prevalent genotypes, characteristic of HS 2 and HS 4 strains,
cluster analysis. Further evidence was seen of associations between phenotypic
characters within some HS serogroups. Chromosomal profiling by RFLP analysis
not indicate that particular genotypes have a predisposition to invade
Giant cell reparative granuloma (GCRG) is an uncommon benign lesion which has been reported at several sites in the head and neck. We present a case of a GCRG of the cricoid cartilage not previously described in the literature. It must be differentiated from the brown tumour of hyperparathyroidism and true giant cell tumours of bone. These were excluded on clinical, biochemical, radiological and histological grounds. The lesion responded well to surgical debulking and curettage and the patient remained disease-free 15 months after treatment.
In a randomized 6-week trial comparing fluoxetine with placebo, the Medical Outcomes Study 36-Item Short-Form Health Status Survey (SF-36) scales were used to measure the effects of treatment on functional health and well-being among elderly (age ≥ 60 years) outpatients with major depression. In the fluoxetine and placebo groups, 261 and 271 patients, respectively, completed the SF-36 before treatment and at Weeks 3 and 6. Compared with national norms for individuals over age 60, study patients before treatment exhibited baseline decrements on the following SF-36 scales: mental health, role limitations due to emotional problems, social functioning, vitality, role limitations due to physical problems, and bodily pain. Analyses of SF-36 changed scores from baseline to Week 6 revealed that the fluoxetine group improved more than the placebo group across all scales. Differences in changes of scores between groups were significant (p < .05), favoring the fluoxetine group for the scales of mental health, role limitations due to emotional problems, physical functioning, and bodily pain. Improvements observed in the fluoxetine group were both clinically and socially significant.
The hypothermic, growth hormone and corticotrophin (ACTH) responses to the 5-HT1A receptor agonist buspirone (30 mg orally) were measured in 20 unmedicated patients with major depression and 20 healthy controls. Compared with the controls, the hypothermic responses of the depressed patients to buspirone were significantly attenuated, particularly in patients with melancholic depression. In contrast, the responses of growth hormone and ACTH to buspirone were unchanged. The data suggest that major depression may be associated with impaired sensitivity of 5-HT1A autoreceptors but that the function of the post-synaptic 5-HT1A receptors that mediate growth hormone and ACTH release is unaltered. Within the limitations that attend the use of buspirone as a 5-HT1A probe, our data suggest that the decrement in serotonin neurotransmission at post-synaptic 5-HT1A receptors in depression is due to decreased serotonin release rather than impaired responsivity of post-synaptic 5-HT1A receptors.