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The aim of this project is to improve the training experience of Psychiatry trainees across CNWL. In QI terms, we want to achieve a satisfaction rating of above 7/10 for all themes identified by August 2021.
Collected baseline data on satisfaction and priority ratings on 7 training themes Held discussion groups with trainees for specific themes to generate issues and solutions Developed and provided Quality Improvement training for trainees and trainers, 1:1 support and QI clinics – empowering trainees to develop their own local project and to make changes to issues on the ground Enacted central changes in communication, responsiveness, recognising success.
Reassessed and fedback to the trainees throughout.
Our baseline satisfaction survey was completed in June 2020. Trainees their satisfaction for each theme out of 10 and to rank their priorities for change. Results showed satisfaction was lowest in morale and in safety and highest in education and supervision. Their highest priorities for change were safety, then morale, with induction as the lowest priority.
We repeated the survey in October 2020. This showed improvements in most themes (apart from induction, perhaps due to induction having to be delivered virtually). Satisfaction in key priority areas of morale and safety increased from 4.53 to 6.37, and 5.12 to 6.70 respectively. We also asked what ‘one thing’ would they improve about their training. Key phrases included teaching, on-call, communication and induction.
From this data, and softer feedback from trainees, it is encouraging that we are moving in a positive direction, but we are continuing to make changes.
• Trainees must be central to the work in improving their training
• Using QI methodology helps – developing a structure and breaking down a bigger task helps make a plan
• Feedback is key – but people are busy and receive a lot of emails and requests to fill surveys – catching people ‘in person’ (virtually) was the best way to ensure a lot of responses
• Trainees have loads of great ideas, but they need support, time and resources to be able to develop their projects and changes
• Flexibility is crucial: some topics work better locally, driven by trainees and some require a more coordinated, central role
We hope that developing a structured approach to a large task like improving training will help make changes sustainable, and enables us to share our learning with others.
Public-Private Innovation Partnerships (PPIPs) are increasingly used as a tool for addressing ‘wicked’ public sector challenges. ‘Innovation’ is, however, frequently treated as a ‘magic’ concept: used unreflexively, taken to be axiomatically ‘good’, and left undefined within policy programmes. Using McConnell’s framework of policy success and failure and a case study of a multi-level PPIP in the English health service (NHS Test Beds), this paper critically explores the implications of the mobilisation of innovation in PPIP policy and practice. We highlight how the interplay between levels (macro/micro and policy maker/recipient) can shape both emerging policies and their prospects for success or failure. The paper contributes to an understanding of PPIP success and failure by extending McConnell’s framework to explore inter-level effects between policy and innovation project, and demonstrating how the success of PPIP policy cannot be understood without recognising the particular political effects of ‘innovation’ on formulation and implementation.
Given that smoking results in poor physical and mental health, reducing tobacco harm is of high importance. Recommendations published by the National Institute for Health and Care Excellence to reduce smoking harms included provision of support, use of nicotine containing products and commissioning of smoking cessation services.
This report explores the difficulties in obtaining such support, as observed in a recently conducted randomised controlled trial in patients with severe mental ill health, and outlines suggestions to improve facilitation of provision.
Data collected during the Smoking Cessation Intervention for Severe Mental Ill Health Trial (SCIMITAR+) (trial Registration ISRCTN72955454), was reviewed to identify the difficulties experienced, across the trial, with regards to access and provision of nicotine replacements therapy (NRT). Actions taken to facilitate access and provision of NRT were collated to outline how provision could be better facilitated.
Access to NRT varied across study settings and in some instances proved impossible for patients to access. Difficulty in access was irrespective of a diagnosis of severe mental ill health. Where NRT was provided, this was not always provided in accordance with NICE guidelines.
Availability of smoking cessation support, and NRT provision would benefit from being made clearer, simpler and more easily accessible so as to enhance smoking cessation rates.
Smoking contributes to health inequalities for people with severe mental illness (SMI). Although smoking cessation interventions are effective in the short term, there are few long-term trial-based estimates of abstinence. The SCIMITAR trials programme includes the largest trial to date of a smoking cessation intervention for people with SMI, but this was underpowered to detect anticipated long-term quit rates. By pooling pilot and full-trial data we found that quit rates were maintained at 12 months (OR = 1.67, 95% CI 1.02–2.73, P = 0.04). Policymakers can now be confident that bespoke smoking cessation interventions produce successful short- and long-term quitting.
The SCIMITAR+ trial was commissioned to evaluate the effectiveness of a bespoke smoking cessation intervention for people with severe mental ill health compared with usual services. It is difficult to define what constitutes usual care in smoking cessation services. We aimed to define what this was during the trial. Twenty-two National Health Service healthcare providers participated in a bespoke survey asking about usual care in their area.
All sites offered smoking cessation support; however, service provider and service type varied substantially. In some cases services were not streamlined, meaning that people received smoking cessation counselling from one organisation and smoking cessation medication from another.
To better implement the National Institute for Health and Care Excellence guideline PH48, clearer referral pathways need to be implemented and communicated to patients, staff and carers. People with severe mental ill health need to be able to access services that combine nicotine replacement therapy and behavioural support in a streamlined manner.
When focused ultrasound waves of moderate intensity in liquid encounter an air interface, a chain of drops emerges from the liquid surface to form what is known as a drop-chain fountain. Atomization, or the emission of micro-droplets, occurs when the acoustic intensity exceeds a liquid-dependent threshold. While the cavitation-wave hypothesis, which states that atomization arises from a combination of capillary-wave instabilities and cavitation bubble oscillations, is currently the most accepted theory of atomization, more data on the roles of cavitation, capillary waves, and even heat deposition or boiling would be valuable. In this paper, we experimentally test whether bubbles are a significant mechanism of atomization in drop-chain fountains. High-speed photography was used to observe the formation and atomization of drop-chain fountains composed of water and other liquids. For a range of ultrasonic frequencies and liquid sound speeds, it was found that the drop diameters approximately equalled the ultrasonic wavelengths. When water was exchanged for other liquids, it was observed that the atomization threshold increased with shear viscosity. Upon heating water, it was found that the time to commence atomization decreased with increasing temperature. Finally, water was atomized in an overpressure chamber where it was found that atomization was significantly diminished when the static pressure was increased. These results indicate that bubbles, generated by either acoustic cavitation or boiling, contribute significantly to atomization in the drop-chain fountain.
There is growing evidence that Behavioural Activation is an effective treatment for older adults with depression. However, there is a lack of detail given in studies about any adaptations made to interventions or efforts made to remove treatment barriers. Factors such as co-morbid physical health problems, cognitive impairment and problems with social support suggest there may be specific treatment considerations when developing interventions for this group. This article aims to describe adaptations made to a general adult Behavioural Activation manual using literature on treatment factors for older adults as an organizational framework. This information may be of use to mental health workers delivering behavioural interventions to older adults with depression and documents the initial phase of developing a complex intervention.
Although there is much written on the emotional labour of nursing, there is little research grounded in the experience of so-called ‘unqualified’ care assistants. This paper is drawn from an ethnographic study conducted with care assistants on three dementia care wards in one mental health trust within the United Kingdom National Health Service (NHS). We describe the emotional labour carried out by care assistants in their attempts to provide personalised care for people whose cognitive degeneration renders conventional relationship-building very difficult, produces unpredictable ‘challenging behaviour’ and calls into question the notion of ‘feeling rules’. This context requires the ability to strike a balance between emotional engagement and detachment, and it is the complexities of this relationship that are the focus of this paper, arguing that a degree of detachment is a prerequisite to engagement in this context. In conclusion, we argue that the contribution of care assistants in this context needs to be better acknowledged, supported and remunerated.
In February 2013, the LEECH (LBTI Exozodi Exoplanet Common Hunt) survey began its 100-night campaign from the Large Binocular Telescope atop Mount Graham in Arizona. LEECH neatly complements other high-contrast planet imaging efforts by observing stars in L' band (3.8 microns) as opposed to the shorter wavelength near-infrared bands (1–2.3 microns). This part of the spectrum offers deeper mass sensitivity for intermediate age (several hundred Myr-old) systems, since their Jovian-mass planets radiate predominantly in the mid-infrared. In this proceedings, we present the science goals for LEECH and a preliminary contrast curve from some early data.
Increasing spatial resolution and contrast capabilities will make possible new direct detections of exoplanets, exozodis, and circumstellar disks. The Large Binocular Telescope Interferometer (LBTI) has been engineered to sit at the combined focus of the Large Binocular Telescope's two 8.4m apertures. Both apertures are equipped with 672-actuator deformable secondary mirrors, the first of the next generation of “extreme” adaptive optics (AO) systems. We present an overview of the LBTI AO instrument suite and detail current on-sky performance.
The Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA) is an established outcome measure for child and adolescent mental health. Little is known of adolescent views on outcome.
To develop and test the properties of an adolescent, self-rated version of the scale (HoNOSCA–SR) against the established clinician-rated version.
A comparison was made of 6-weekly clinician-rated and self-rated assessments of adolescents attending two services, using HoNOSCA and other mental health measures.
Adolescents found HoNOSCA–SR acceptable and easy to rate. They rated fewer difficulties than the clinicians and these difficulties were felt to improve less during treatment, although this varied with diagnosis and length of treatment. Although HoNOSCA–SR showed satisfactory reliability and validity, agreement between clinicians and users in individual cases was poor.
Routine outcome measurement can include adolescent self-rating with modest additional resources. The discrepancy between staff and adolescent views requires further evaluation.
Post-Golgi sorting of different classes of newly synthesized proteins and lipids is central to the generation and maintenance of cellular polarity. to directly visualize the dynamics and location of apical/basolateral sorting and trafficking we used fast time-lapse multicolor video microscopy in living cells. Specifically, green fluorescent protein color variants (cyan, CFP; yellow, YFP) of apical cargo (GPI-anchored) and basolateral cargo (vesicular stomatitis virus glycoprotein, VSVG) were generated; see FIG 1. Fast dual color fluorescence video microscopy allowed visualization with high temporal and spatial resolution. Our studies revealed that apical and basolateral cargo progressively segregated into large domains in Golgi/TGN structures, excluded resident proteins, and exited in separate transport containers. These carries remained distinct and did not merge with endocytic structures en route to the plasma membrane. Interestingly, our data suggest that the primary sorting occurs by lateral segregation in the Golgi, prior to budding (FIG 2). Further characterization of morphological differences of apical versus basolateral transport carriers was achieved using a specialized microscopy technique called total internal reflection (TIR) microscopy. with this approach only the bottom of the cell (<100 nm) was illuminated by an exponentially decaying evanescent “wave” of light. A series of images, taken at ∼1 second intervals, shows a bright “flash” of fluorescence when the vesicle fuse with the plasma membrane and the fluorophore diffuses into the plasma membrane (FIG 3).
The Scanning Transmission Electron Microscope (STEM) facility at BNL is an NIH Biotechnology Research Resource and as such is available to users with suitable projects, free of charge. Currently, many of our users' projects involve studying the structures of a variety of filaments. Most of these are of biological origin, although a couple involve conducting polymers. The STEM has a long history of being used to study different types of filaments and resolving controversies about their structure.
The mainstay of the STEM is mass analysis on unstained, isolated, freeze-dried samples. On these, the STEM can collect in-focus digital data directly. In a scan (8 sec. in real time) of a sample, at each of 512x512 picture elements (pixels), the number of electrons scattered into two annular detectors is recorded. For each pixel, the number of scattered electrons is directly proportional to the mass thickness in that pixel.
The child and adolescent version of the Health of the Nation Outcome
Scales (HoNOSCA) represents the first attempt at a routine outcome
measure for Child and Adolescent Mental Health Services in the U.K.
Extensive field trials suggested that the scales were both acceptable to
clinicians from the various disciplines working in this area and also valid
and reliable. A growing number of services are now using the scales in
audit and research, supported by the national HoNOSCA base that
provides training and co-ordinates further developments.
Radiation curing of polymers, by UV light or E-beam, is of growing interest in the state-of-the-art industry. Radiation curing is solvent free and leads to important energy and money savings. Improved materials characteristics, better control of doses and more accurate application allow radiation curing to take a big part of the surface coating industry and, for the last ten years, the polymeric and microelectronics (lithography) industry. But behaviors of polymers under radiant source is often empirically characterized. In this abstract, it is proposed a way to obtain accurate energy distribution from Monte Carlo simulations. For bulk or thin polymeric films, it is therefore essential to simulate energy distribution, in order to foresee what happens in the sample.
CASINO is a single scattering Monte Carlo Simulation of electroN trajectory in sO lid -particularly designed for low energy beam interaction in a bulk and thin foil.
The AFM (atomic force microscopy) requires a stable and flat substrate on which a biological sample is readily immobilized. For instance, membrane protein 2D crystals in lipid bilayers have been adsorbed to silanized glass with covalently attachment using a photocrosslinker or to mica by physisorption under appropriate ionic conditions. For the immobilization of 2D crystals of water soluble proteins formed on lipid monolayers, a different approach is required to attach the highly hydrophobic tails of the lipid molecules. To find a suitably hydrophobic substrate, the hydrophobicity of different materials was determined by the sitting drop method. Briefly, a 10 μ1 droplet of deionized and filtered water was deposited on the substrate surface and the diameter measured. Table 1 shows a decrease in droplet diameter with increasing hydrophobicity, indicating that substrates such as silanized glass and HOPG (highly ordered pyrolytic graphite) may be suitable for adsorbing lipid monolayers.
The STEM facility at Brookhaven National Laboratory has been in operation since Oct. ‘77, using a custom-built instrument (STEM1) with cold field emission source, 2.5Å probe, -150°C cold stage, efficient dark field detectors and computer control & data acquisition system. A specimen changing air lock and several portable vacuum chambers permit vacuum transfer of specimens from a separate vacuum system where they were freeze dried overnight.
The large angle dark-field signal produced by the STEM is directly proportional to the total mass within the probed area. STEM mass mapping is based on this linear relationship and the fact that only specimen-specific atoms remain on the substrate after washing with volatile buffer and freeze drying. All images are digital and available via Internet. PC software can be provided for analysis.
STEM mass accuracy ranges from a fraction of a percent on well-defined individual particles such as viruses in the 50 MDa to 10 GDa range, to ∼1% around 1 MDa and ∼10% in the 50 kDa range.