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The prevalence of delaying psychiatric care until the patient has received ‘medical clearance’, and the definitions and understanding of ‘medical clearance’ terminology by relevant clinicians, are largely unknown. In a service evaluation of adult liaison psychiatry services across England, we explore the prevalence, definitions and understanding of ‘medical clearance’ terminology in three parallel studies: (a) an analysis of trust policies, (b) a survey of liaison psychiatry services and (c) a survey of referring junior doctors. Content and thematic analyses were performed.
Results
‘Medical clearance’ terminology was used in the majority of trust policies, reported as a referral criterion by many liaison psychiatry services and had been encountered by most referring doctors. ‘Medical clearance’ was identified as a common barrier to liaison psychiatry referral. Terms were inconsistently used and poorly defined.
Clinical implications
Many liaison psychiatry services seem not to comply with guidance promoting parallel assessment. This may affect parity of physical and mental healthcare provision.
Despite promising steps towards the elimination of hepatitis C virus (HCV) in the UK, several indicators provide a cause for concern for future disease burden. We aimed to improve understanding of geographical variation in HCV-related severe liver disease and historic risk factor prevalence among clinic attendees in England and Scotland. We used metadata from 3829 HCV-positive patients consecutively enrolled into HCV Research UK from 48 hospital centres in England and Scotland during 2012–2014. Employing mixed-effects statistical modelling, several independent risk factors were identified: age 46–59 y (ORadj 3.06) and ≥60 y (ORadj 5.64) relative to <46 y, male relative to female sex (ORadj 1.58), high BMI (ORadj 1.73) and obesity (ORadj 2.81) relative to normal BMI, diabetes relative to no diabetes (ORadj 2.75), infection with HCV genotype (GT)-3 relative to GT-1 (ORadj 1.75), route of infection through blood products relative to injecting drug use (ORadj 1.40), and lower odds were associated with black ethnicity (ORadj 0.31) relative to white ethnicity. A small proportion of unexplained variation was attributed to differences between hospital centres and local health authorities. Our study provides a baseline measure of historic risk factor prevalence and potential geographical variation in healthcare provision, to support ongoing monitoring of HCV-related disease burden and the design of risk prevention measures.
Master the art of vibration monitoring of induction motors with this unique guide to on-line condition assessment and fault diagnosis, building on the author's fifty years of investigative expertise.It includes:*Robust techniques for diagnosing of a wide range of common faults, including shaft misalignment and/or soft foot, rolling element bearing faults, sleeve bearing faults, magnetic and vibrational issues, resonance in vertical motor drives, and vibration and acoustic noise from inverters.*Detailed technical coverage of thirty real-world industrial case studies, from initial vibration spectrum analysis through to fault diagnosis and final strip-down. *An introduction to real-world vibration spectrum analysis for fault diagnosis, and practical guidelines to reduce bearing failure through effective grease management. This definitive book is essential reading for industrial end-users, engineers, and technicians working in motor design, manufacturing, and condition monitoring. It will also be of interest to researchers and graduate students working on condition monitoring.
In recent years, a variety of efforts have been made in political science to enable, encourage, or require scholars to be more open and explicit about the bases of their empirical claims and, in turn, make those claims more readily evaluable by others. While qualitative scholars have long taken an interest in making their research open, reflexive, and systematic, the recent push for overarching transparency norms and requirements has provoked serious concern within qualitative research communities and raised fundamental questions about the meaning, value, costs, and intellectual relevance of transparency for qualitative inquiry. In this Perspectives Reflection, we crystallize the central findings of a three-year deliberative process—the Qualitative Transparency Deliberations (QTD)—involving hundreds of political scientists in a broad discussion of these issues. Following an overview of the process and the key insights that emerged, we present summaries of the QTD Working Groups’ final reports. Drawing on a series of public, online conversations that unfolded at www.qualtd.net, the reports unpack transparency’s promise, practicalities, risks, and limitations in relation to different qualitative methodologies, forms of evidence, and research contexts. Taken as a whole, these reports—the full versions of which can be found in the Supplementary Materials—offer practical guidance to scholars designing and implementing qualitative research, and to editors, reviewers, and funders seeking to develop criteria of evaluation that are appropriate—as understood by relevant research communities—to the forms of inquiry being assessed. We dedicate this Reflection to the memory of our coauthor and QTD working group leader Kendra Koivu.1
Chapter 10 presents the fundamental causes of electromagnetic forces and consequential vibration in induction motors, including the twice supply frequency component and its harmonics, and the classical rotor slot passing frequency components.
Chapter 9 presents fundamental knowledge on the construction and operation of sleeve bearings.The practical measurement of shaft displacement is also described, to support the case histories in this chapter on vibration monitoring to diagnose problems in sleeve bearings.
Chapter 1 provides an overview of publications on sources of vibration in electrical machines.Problems in rolling element bearings account for the largest number of failures of induction motors, therefore a review is presented on the use of vibration measurements and spectrum analysis to diagnose faults in rolling element bearings.The practical difficulty of accessing the housings of rolling element bearings is strongly emphasised, because if bearing housings cannot be accessed then it is more difficult to diagnose bearing faults. A brief overview of shaft misalignment and soft foot in induction motor drives is included, and five industrial case histories are presented on vibration analysis to detect shaft misalignment and/or soft foot.
Chapter 2 is a preparatory chapter for Chapters 3 and 4 and presents the main types and basic features of rolling element bearings, which are used in induction motors.
Chapter 4 presents an introduction to vibration spectrum analysis to diagnose faults in rolling element bearings in induction motors.This chapter is a precursor to the presentation of industrial case histories in Chapters 5 to 8 using conventional vibration spectrum analysis (VSA) to diagnose the onset of faults in rolling element bearings before actual bearing failures occur. It is emphasised that previously published books and papers that cover the theory and application of vibration monitoring to diagnose faults in rolling element bearings assume that vibration transducers such as accelerometers can be always placed on the bearing housings.In many cases access to bearing housings is not practically possible on induction motors and this a key fact which is demonstrated in this book.