The myth of patient centrality

Purpose: The purpose of this paper is to critically examine the extent of patient centrality within integrated chronic back pain management services and compare policy rhetoric with practice reality. Context: Integrated chronic back pain management services. Data sources: We have drawn on theories of integration and context specific journals related to integration and pain management between 1966 and 2006 to identify evidence of patient centrality within integrated chronic pain management services. Discussions: Despite policy rhetoric and guidelines which promote patient centrality within multidisciplinary services, we argue that evaluations of these services are scant. Many papers have focused on the assessment of pain in multidisciplinary services as opposed to the patient’s experience of these services. Conclusions: A latent measure of the reality of its magnitude needs to be captured through analysis of the patient perspectives. Capturing patient’s thoughts about integrated services will promote patient centrality and support the reality rather than endorse the rhetoric

Characteristics and classification of A-type supergiants in the Small Magellanic Cloud

We address the relationship between spectral type and physical properties for A-type supergiants in the SMC. We first construct a self-consistent classification scheme for A supergiants, employing the calcium K to H epsilon line ratio as a temperature-sequence discriminant. Following the precepts of the `MK process', the same morphological criteria are applied to Galactic and SMC spectra with the understanding there may not be a correspondence in physical properties between spectral counterparts in different environments. We then discuss the temperature scale, concluding that A supergiants in the SMC are systematically cooler than their Galactic counterparts at the same spectral type, by up to ~10%. Considering the relative line strengths of H gamma and the CH G-band we extend our study to F and early G-type supergiants, for which similar effects are found. We note the implications for analyses of extragalactic luminous supergiants, for the flux-weighted gravity-luminosity relationship and for population synthesis studies in unresolved stellar systems.Comment: 14 pages, 14 figures, accepted by MNRAS; minor section removed prior to final publicatio

Discovery of a strong magnetic field on the O star HD 191612: new clues to the future of theta1 Orionis C?

From observations made with the ESPaDOnS spectropolarimeter, recently installed on the 3.6-m Canada--France--Hawaii Telescope, we report the discovery of a strong magnetic field in the Of?p spectrum variable HD 191612 -- only the second known magnetic O star (following theta1 Ori C). The stability of the observed Zeeman signature over four nights of observation, together with the non-rotational shape of line profiles, argue that the rotation period of HD 191612 is significantly longer than the 9-d value previously proposed. We suggest that the recently identified 538-d spectral-variability period is the rotation period, in which case the observed line-of-sight magnetic field of -220+-38 G implies a large-scale field (assumed dipolar) with a polar strength of about -1.5 kG. If confirmed, this scenario suggests that HD 191612 is, essentially, an evolved version of the near-ZAMS magnetic O star theta1 Ori C, but with an even stronger field (about 15 kG at an age similar to that of theta1Ori C). We suggest that the rotation rate of HD 191612, which is exceptionally slow by accepted O-star standards, could be due to angular-momentum dissipation through a magnetically confined wind.Comment: Accepted by MNRAS Letters, 5 pages, 2 figures, 2 table

Development of an Integrated Governance Strategy for the Voluntary and Community Sector

This report on governance provides a framework for thinking about how policy makers, funders,regulators and advisers can all work with Board members and staff to enhance the effectiveness of nonprofit organisations. It was commissioned by the Active Community Unit (ACU) of the Home Office, in parallel with other reviews designed to improve the capacity of the voluntary and community sector, at a time when the sector plays an increasingly important role in the delivery of services using public funds. That role has recently been investigated in two Government reports, the Cross Cutting Review carried out by the Treasury, and the Strategy Unit review of charities and nonprofits. Our report proposes actions of three types: some that can be taken immediately, some that require further discussion with key interests, and some integration with the other ACU reviews. Taken together they provide the starting point for an evolving strategy to improve governance across the sector. We recommend ACU chairs a group charged with the responsibility for planning and implementing this. Our focus is on governance as 'the systems and processes concerned with ensuring the overall direction, supervision and accountability of an organisation'. This is often taken to mean the way that a Board, management committee or other governing body steers the overall development of an organisation, where day-to-day management is in the hands of staff or volunteers. Sometimes, of course, the committee and volunteers are the same. They – like all governing bodies – have to balance the interests of the organisation and those they are trying to serve, while being conscious of financial and legal responsibilities, and the requirements of funders and other supporters

Implementation of an interior point source in the ultra weak variational formulation through source extraction

The Ultra Weak Variational Formulation (UWVF) is a powerful numerical method for the approximation of acoustic, elastic and electromagnetic waves in the time-harmonic regime. The use of Trefftz-type basis functions incorporates the known wave-like behaviour of the solution in the discrete space, allowing large reductions in the required number of degrees of freedom for a given accuracy, when compared to standard finite element methods. However, the UWVF is not well disposed to the accurate approximation of singular sources in the interior of the computational domain. We propose an adjustment to the UWVF for seismic imaging applications, which we call the Source Extraction UWVF. Differing fields are solved for in subdomains around the source, and matched on the inter-domain boundaries. Numerical results are presented for a domain of constant wavenumber and for a domain of varying sound speed in a model used for seismic imaging

Growing spaces : an evaluation of the mental health recovery programme using mixed methods

Background: Therapeutic horticulture is a nature-based method which includes a range of green activities such as gardening to promote wellbeing. It is believed that therapeutic horticulture provides a person-centred approach that can reduce social isolation for people with mental health problems. Aims: The aim of the project was to evaluate the impact of a mental health recovery programme that used therapeutic horticulture as an intervention to reduce social inclusion and improve engagement for people with mental health problems. Methods: A mixed-methods approach was used and data from four semi-structured focus group interviews, 11 exit interviews and 20 recovery star datasets were collected from September 2015 to October 2017. Qualitative data from the interviews were thematically analysed and quantitative data based on a recovery star outcomes tool were analysed using descriptive statistics to demonstrate trends and progression. The findings were then triangulated to provide a rich picture of the impact of the mental health recovery programme. Results: The recovery star data indicated that participants were working towards self-reliance. Qualitative data from the exit interview and semi-structured focus groups found similar results. The triangulated findings highlight that the mental health recovery programme enabled participant integration into the community through providing a space to grow and build self-confidence while re-engaging with society. The results suggest that using therapeutic horticulture as an intervention within the mental health recovery programme can support people with mental health problems to re-engage socially. Nature-based activities could be used within the ‘social prescribing’ movement to encourage partnership working between the NHS and voluntary sector organisations which can complement existing mental health services

FUSE Observations of a Full Orbit of Hercules X-1: Signatures of Disk, Star, and Wind

We observed an entire 1.7 day orbit of the X-ray binary Hercules X-1 with the Far Ultraviolet Spectroscopic Explorer (FUSE). Changes in the O VI 1032,1037 line profiles through eclipse ingress and egress indicate a Keplerian accretion disk spinning prograde with the orbit. These observations may show the first double-peaked accretion disk line profile to be seen in the Hercules X-1 system. Doppler tomograms of the emission lines show a bright spot offset from the Roche lobe of the companion star HZ Her, but no obvious signs of the accretion disk. Simulations show that the bright spot is too far offset from the Roche lobe to result from uneven X-ray heating of its surface. The absence of disk signatures in the tomogram can be reproduced in simulations which include absorption from a stellar wind. We attempt to diagnose the state of the emitting gas from the C III 977, C III 1175, and N III 991 emission lines. The latter may be enhanced through Bowen fluorescence.Comment: Accepted for publication in The Astrophysical Journa