A study of personalisation and the factors affecting the uptake of personal budgets by mental health service users in the UK - A research study commissioned by MIND

This project was commissioned by Mind to add to its knowledge base and existing work on Personalisation so as to support individuals to have greater choice and control over their care and support needs. The project was funded by the Department of Health as part of its Strategic Development fund „Personalisation and Choice of Care and Support (IESD1) 2011‟. This report provides an overview of the main findings of this qualitative study, exploring the concept of personalisation, the factors affecting its operationalisation by voluntary and statutory sector organisations, and service users‟ experiences of its implementation, particularly in relation to what affects their uptake and experience of Personal Budgets. In the course of our investigation into current practice and experience, we have identified a number of barriers and enablers. Our view is that the impact of effective action to tackle the barriers will result in an improved experience of the Personal Budget process and its outcomes for carers and front line staff as well as service users. Recommendations are made for future work in this area

Hiding in the Shadows II: Collisional Dust as Exoplanet Markers

Observations of the youngest planets ($\sim$1-10 Myr for a transitional disk) will increase the accuracy of our planet formation models. Unfortunately, observations of such planets are challenging and time-consuming to undertake even in ideal circumstances. Therefore, we propose the determination of a set of markers that can pre-select promising exoplanet-hosting candidate disks. To this end, N-body simulations were conducted to investigate the effect of an embedded Jupiter mass planet on the dynamics of the surrounding planetesimal disk and the resulting creation of second generation collisional dust. We use a new collision model that allows fragmentation and erosion of planetesimals, and dust-sized fragments are simulated in a post process step including non-gravitational forces due to stellar radiation and a gaseous protoplanetary disk. Synthetic images from our numerical simulations show a bright double ring at 850 $\mu$m for a low eccentricity planet, whereas a high eccentricity planet would produce a characteristic inner ring with asymmetries in the disk. In the presence of first generation primordial dust these markers would be difficult to detect far from the orbit of the embedded planet, but would be detectable inside a gap of planetary origin in a transitional disk.Comment: Accepted for publication in Ap

“I always feel like I have to rush…”: pet owner and small animal veterinary surgeons’ reflections on time during preventative healthcare consultations in the United Kingdom

Canine and feline preventative healthcare consultations can be more complex than other consultation types, but they are typically not allocated additional time in the United Kingdom (UK). Impacts of the perceived length of UK preventative healthcare consultations have not previously been described. The aim of this novel study was to provide the first qualitative description of owner and veterinary surgeon reflections on time during preventative healthcare consultations. Semi-structured telephone interviews were conducted with 14 veterinary surgeons and 15 owners about all aspects of canine and feline preventative healthcare consultations. These qualitative data were thematically analysed, and four key themes identified. This paper describes the theme relating to time and consultation length. Patient, owner, veterinary surgeon and practice variables were recalled to impact the actual, versus allocated, length of a preventative healthcare consultation. Preventative healthcare consultations involving young, old and multi-morbid animals and new veterinary surgeon-owner partnerships appear particularly susceptible to time pressures. Owners and veterinary surgeons recalled rushing and minimizing discussions to keep consultations within their allocated time. The impact of the pace, content and duration of a preventative healthcare consultation may be influential factors in consultation satisfaction. These interviews provide an important insight into the complex nature of preventative healthcare consultations and the behaviour of participants under different perceived time pressures. These data may be of interest and relevance to all stakeholders in dog and cat preventative healthcare

Commissioning care for people with dementia at the end of life: a mixed methods study.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ The version of record, Zoe M Gotts, Nicole Baur, Emma McLellan, Claire Goodman, Louise Robinson and Richard P Lee, ‘Commissioning care for people with dementia at the end of life: a mixed methods study’, BMJ Open, 2016,; 6: e013554, is available online at doi: 10.1136/ bmjopen-2016-013554Objectives To understand how end of life care for people with dementia is currently commissioned (.e contracted)and organised, with a view to informing the development of commissioning guidance for good quality community-based end of life care in dementia. Design Mixed-methods study; narrative review and qualitative interviews. Setting 8 NHS clinical commissioning groups and 5 Adult Services across England. Methods Narrative review of evidence; 20 semi structured interviews (telephone and face-to-face) with professionals involved in commissioning end of life care for people with dementia. Main outcome measures Summary of the existing evidence base for commissioning, commissioners’ approaches to the commissioning process for end of life care for people with dementia in England. Results In the context of commissioning end of life care for people with dementia, the literature review generated three key themes; (1) importance of joint commissioning; (2) lack of clarity for the process; and (3) factors influencing commissioning. In exploring health professionals’ perceptions of the commissioning process, ‘uncertainty’ was elicited as an overarching theme across the CCGs interviewed. Organisation of the process, lack of expertise, issues surrounding integration and the art of specification were considered important factors that contribute to the uncertainty surrounding the commissioning process. Conclusions The current evidence base for commissioning end of life care is limited with considerable uncertainty as how clinical commissioners in England undertake the process to ensure future services are evidence-based. Strengths and limitations of this study • The use of a multimethod approach (narrative review, qualitative interviews) allowed for triangulation of our findings. • The evidence indentified in the review may be limited given that ‘commissioning’ is a relatively new term in England. • The review presented is a narrative review; the manuscripts were not subject to a quality assessment process. • Generalisability of findings might be affected by the small number of published studies, their heterogeneity in methodologies, and small sample sizes. • The study highlights that information on commissioning specifically for health and social care in England is limited; this is mirrored in commissioners’ accounts.Peer reviewe

Depigmented-polymerised allergoids favour regulatory over effector T cells: enhancement by 1α, 25-dihydroxyvitamin D3

Background: Allergen immunotherapy (SIT) is the only treatment for allergic disease capable of modifying disease long term. To reduce the risk of anaphylaxis from SIT, allergen-extracts have been modified by polymerisation with glutaraldehyde to reduce IgE binding. It is suggested that these allergoid extracts also have reduced T cell activity, which could compromise clinical efficacy. Effective SIT is thought to act through regulatory T cells (Tregs) rather than activation of effector T cells. There is no published data on the activity of modified extracts on Tregs.Results: We compared the capacity of modified (depigmented-polymerised) versus unmodified (native) allergen extracts of grass pollen and house dust mite to stimulate proliferation/cytokine production and to modulate Treg/effector T cell frequency in cultures of peripheral blood mononuclear cells (PBMC), from volunteers sensitised to both allergens in vitro. Depigmented-polymerised allergen extracts stimulated less proliferation of PBMC, and reduced effector cell numbers after 7 days in culture than did native extracts. However, the frequency of Foxp3+ Tregs in cultures were similar to those seen with native extract so that ratios of regulatory to effector T cells were significantly increased in cultures stimulated with depigmented-polymerised extracts. Addition of 1 alpha, 25-dihydroxyvitamin D3 further favoured Treg, and reduced effector cytokine production, but not interleukin-10.Conclusions: Depigmented-polymerised allergen extracts appear to favour Treg expansion over activation of effector T cells and this may relate to their demonstrated efficacy and safety in SIT. 1 alpha, 25-dihydroxyvitamin D3 further reduces effector T cell activation by allergen extracts and may be a useful adjuvant for SIT.</p

The feasibility and challenges of energy self-sufficient wastewater treatment plants

Energy efficiency optimization is crucial for wastewater treatment plants (WWTPs) because of increasing energy costs and concerns about global climate change. Energy efficiency optimization can be achieved through a combination of energy recovery from the wastewater treatment process and energy saving-related technologies. Through these two approaches energy self-sufficiency of WWTPs is achievable, and research is underway to reduce operation costs and energy consumption and to achieve carbon neutrality. In this paper, we analyze energy consumption and recovery in WWTPs and characterize the factors that influence energy use in WWTPs, including treatment techniques, treatment capacities, and regional differences. Recent advances in the optimization of energy recovery technologies and theoretical analysis models for the analysis of different technological solutions are presented. Despite some challenges in implementation, such as technological barriers and high investment costs, particularly in developing countries, this paper highlights the potential for more energy self-sufficient WWTPs to be established in the future

Mapping Alternative Impact: Alternative approaches to impact from co-produced research

No abstract available