Commissioning Care Act Advocacy

Local Authorities in England are required under the Care Act 2014 to make independent advocacy available to eligible service users and carers. In October 2014, the Social Care Institute for Excellence (SCIE) launched guidance to support good practice in commissioning independent advocacy. Early studies examining implementation of the Act highlighted lower than expected referrals for independent advocacy support and that many of those potentially eligible for advocacy under the Care Act might not be receiving it. In 2016, the Universities of Birmingham and Central Lancashire were commissioned by SCIE to undertake a rapid appraisal of how advocacy is being commissioned under the Care Act, and to identify the features of promising practice. This involved surveys of and interviews with commissioners and providers; documentary analysis; and a roundtable discussion involving people with experience of using social care services and other stakeholders to identify improvements in the commissioning process

The Role of Community Centre-based Arts, Leisure and Social Activities in Promoting Adult Well-being and Healthy Lifestyles

Developed countries are experiencing high levels of mental and physical illness associated with long term health conditions, unhealthy lifestyles and an ageing population. Given the limited capacity of the formal health care sector to address these public health issues, attention is turning to the role of agencies active in civil society. This paper sought to evaluate the associations between participation in community centre activities, the psycho-social wellbeing and health related behaviours. This was based on an evaluation of the South West Well-being programme involving ten organisations delivering leisure, exercise, cooking, befriending, arts and crafts activities. The evaluation consisted of a before-and-after study with 687 adults. The results showed positive changes in self-reported general health, mental health, personal and social well-being. Positive changes were associated with diet and physical activity. Some activities were different in their outcomes—especially in cases where group activities were combined with one-to-one support. The results suggest that community centre activities of this nature offer benefits that are generically supportive of health behaviour changes. Such initiatives can perform an important role in supporting the health improvement objectives of formal health care services. For commissioners and partner agencies, accessibility and participation are attractive features that are particularly pertinent to the current public health context

CO2 reduction through low cost electrification of the diesel powertrain at 48V

In order to achieve fleet average CO2 targets, mass market adoption of low CO2 technologies is required. Application of low cost technologies across a large number of vehicles is more cost-effective in reducing fleet CO2 than deploying high-impact, costly technology to a few. Therefore, to meet the CO2 reduction challenge, commercially viable, low cost technologies are of significant interest. This paper presents results from the ‘ADEPT’ collaborative research program which focuses on CO2 reduction through the application of intelligent 48V electrification to diesel engines for passenger car applications. Results were demonstrated on a C-segment vehicle with a class-leading 4-cylinder 1.5 litre Euro 6 diesel engine. Electrification was applied through a high power, high efficiency, switched reluctance belt integrated starter generator (B-ISG) capable of both generation and motoring, and an Advanced Lead Carbon Battery for energy storage. The conventional alternator was replaced with a highly efficient DC-DC converter to supply energy to the 12V system. These technologies enabled powertrain efficiency improvement through the recovery of kinetic energy with regenerative braking and reapplication of the recovered energy through motoring to offset fuel usage. Efficiency was further optimised through application of engine downspeeding and advanced auto-stop strategies to extended engine-off time. Additional electrification was investigated through 48V ancillaries, including water-pump and air-conditioning compressor, and a turbo-compound generator for waste heat recovery from exhaust gas. These technologies have demonstrated a combined CO2 reduction of 10–11% against the conventional vehicle baseline. Additional studies of advanced thermal systems for improved warm-up, and lubrication control for FMEP reduction have also been conducted on this program. These indicate that by applying intelligent electrification to ancillaries a further 3–4% reduction in CO2 is achievable. Overall, this program shows that 48V technologies can achieve CO2 savings with a lower cost per gram CO2 than full hybrid solutions

Genome-wide screening of mouse knockouts reveals novel genes required for normal integumentary and oculocutaneous structure and function.

Oculocutaneous syndromes are often due to mutations in single genes. In some cases, mouse models for these diseases exist in spontaneously occurring mutations, or in mice resulting from forward mutatagenesis screens. Here we present novel genes that may be causative for oculocutaneous disease in humans, discovered as part of a genome-wide screen of knockout-mice in a targeted single-gene deletion project. The International Mouse Phenotyping Consortium (IMPC) database (data release 10.0) was interrogated for all mouse strains with integument abnormalities, which were then cross-referenced individually to identify knockouts with concomitant ocular abnormalities attributed to the same targeted gene deletion. The search yielded 307 knockout strains from unique genes with integument abnormalities, 226 of which have not been previously associated with oculocutaneous conditions. Of the 307 knockout strains with integument abnormalities, 52 were determined to have ocular changes attributed to the targeted deletion, 35 of which represent novel oculocutaneous genes. Some examples of various integument abnormalities are shown, as well as two examples of knockout strains with oculocutaneous phenotypes. Each of the novel genes provided here are potentially relevant to the pathophysiology of human integumentary, or oculocutaneous conditions, such as albinism, phakomatoses, or other multi-system syndromes. The novel genes reported here may implicate molecular pathways relevant to these human diseases and may contribute to the discovery of novel therapeutic targets

Subjective experiences of compulsory treatment from a qualitative study of early implementation of the Mental Health (Care and Treatment)(Scotland) Act 2003

Compulsory psychiatric treatment is highly contested, and little research has focused specifically on direct experiences. The Mental Health (Care & Treatment) (Scotland) Act, 2003 introduced new roles and provisions including community treatment orders, and was designed to increase participation, ensure treatment was beneficial and was the ‘least restrictive’ alternative. This article draws on findings from semistructured interviews with 49 individuals who had experienced compulsion under this new legislation during 2007-08, that were part of a broader cohort study. Interviews with service users were conducted at two stages with 80% agreeing to be interviewed twice. The sample included people on a variety of compulsory orders from four Health Board areas, some of whom had been detained for the first time, while others reported ‘revolving door’ experiences. Peer researchers who were mental health service users carried out the interviews with professional researchers. The findings suggest that legislation had a limited impact on participation in the process of compulsion. Consensus was that although service users felt there was increased opportunity for their voices to be heard, this was not matched by having increased influence over professional decision-making, especially in relation to drug treatments. According to people's direct experiences, the passing of the legislation in itself had done little to change the dominant psychiatric paradigm. While providing a foundation for improving the process of compulsion, the findings suggest that as well as legislative reform, fundamental shifts in practice are needed both in terms of the nature of therapeutic relationships, and in embracing more holistic and recovery perspectives

The particularity of autonomy

1. The nature and scope of this thesis is the meaning and possibility of personal autonomy for the contemporary self embedded in a complex of changing organizations. 2. Its contribution is in relating philosophy to the study of complex organizations. 3. The research is based upon the relevant literature and empirical studies informed by the writer's organizational experience. 4. The thesis is structured in two parts with the following arguments. Part I (The Situated Self of Sensible Reasoning) sets out a checklist for personal autonomy as positive freedom and rejects a universalist concept of autonomy as moral autonomy for its neglect of the self s particularity - its situation, sentiments and contingency. A midway position combines the principle of detachment with an evaluatory understanding of the nested self of cognitive sensibility. The self's coherence and its perspective are embodied in a unique narrative which governs the portfolio of the individual as agent in its relations, roles and aims. The sells portfolio constitutes the choices of its nestedness and its autonomy: it's not here, not there but where I choose to locate it. Part II (Managing Contingency)explores different types of organizations and their members' behaviour to identify those which enable the individual to confront contingency in its own terms. The final chapter examines how the current organizationa disembedding process forces the individual to confront its autonomy in a contemporary world of change. 5. The main conclusions of the thesis are: (i) There is a workable concept of personal autonomy, understood sul generis, ie in terms of its own particularity ; (ii) Those organizations enabling the individual to confront contingency in its own terms offer the best hope of autonomy ; (iii) The architect and the entrepreneur are key in illustrating the role of autonomy in a creative relating of order and contingency; (iv) The demise of the metanarrative of permanent and full employment are Inter alla forcing upon the individual the choices of heteronomy (captured in another's metanarrative as consumer and viewer), anomie (whim or chance) or personal autonomy