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"Green, J. S."
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The passing of Protestant England : secularisation and social change, c.1920-1960
\"In The Passing of Protestant England, S. J. D. Green offers an important new account of the causes, courses and consequences of the secularisation of English society. He argues that the critical cultural transformation of modern English society was forged in the agonised abandonment of a long-domesticated Protestant, Christian tradition between 1920 and 1960. Its effects were felt across the nation and amongst all classes. Yet their significance in the evolution of contemporary indigenous identities remains curiously neglected in most mainstream accounts of post-Victorian Britain. Dr Green traces the decline of English ecclesiastical institutions after 1918. He also investigates the eclipse of once-common moral sensibilities during the years up to 1945. Finally, he examines why subsequent efforts to reverse these trends so comprehensively failed. His work will be of enduring interest to modern historians, sociologists of religion, and all those concerned with the future of faith in Britain and beyond\"-- Provided by publisher.
Book
Near-100 MeV protons via a laser-driven transparency-enhanced hybrid acceleration scheme
The range of potential applications of compact laser-plasma ion sources motivates the development of new acceleration schemes to increase achievable ion energies and conversion efficiencies. Whilst the evolving nature of laser-plasma interactions can limit the effectiveness of individual acceleration mechanisms, it can also enable the development of hybrid schemes, allowing additional degrees of control on the properties of the resulting ion beam. Here we report on an experimental demonstration of efficient proton acceleration to energies exceeding 94 MeV via a hybrid scheme of radiation pressure-sheath acceleration in an ultrathin foil irradiated by a linearly polarised laser pulse. This occurs via a double-peaked electrostatic field structure, which, at an optimum foil thickness, is significantly enhanced by relativistic transparency and an associated jet of super-thermal electrons. The range of parameters over which this hybrid scenario occurs is discussed and implications for ion acceleration driven by next-generation, multi-petawatt laser facilities are explored.
It is a challenge to scale up laser-ion acceleration to higher ion energies. Here the authors demonstrate a hybrid acceleration scheme based on the relativistic induced transparency mechanism using linearly polarised laser interaction with foil targets and its future implication in using high power lasers.
Journal Article
Stable laser-acceleration of high-flux proton beams with plasma collimation
Laser-plasma acceleration of protons offers a compact, ultra-fast alternative to conventional acceleration techniques, and is being widely pursued for potential applications in medicine, industry and fundamental science. Creating a stable, collimated beam of protons at high repetition rates presents a key challenge. Here, we demonstrate the generation of multi-MeV proton beams from a fast-replenishing ambient-temperature liquid sheet. The beam has an unprecedentedly low divergence of 1° (≤20 mrad), resulting from magnetic self-guiding of the proton beam during propagation through a low density vapour. The proton beams, generated at a repetition rate of 5 Hz using only 190 mJ of laser energy, exhibit a hundred-fold increase in flux compared to beams from a solid target. Coupled with the high shot-to-shot stability of this source, this represents a crucial step towards applications.
Applications of laser-plasma accelerated protons in fundamental, applied and medical sciences crucially depend on the creation of stable collimated beams with high repetition rates. Here the authors demonstrate the generation of multi-MeV protons at 5 Hz, with low (degree-level) proton beam divergence from a laser pulse focused onto a water sheet target, potentially mitigating the need for beam capturing techniques.
Journal Article
Facilitators and Barriers to Teamworking and Patient Centeredness in Multidisciplinary Cancer Teams: Findings of a National Study
Background
Multidisciplinary teams (MDTs) are the standard means of making clinical decisions in surgical oncology. The aim of this study was to explore the views of MDT members regarding contribution to the MDT, representation of patients’ views, and dealing with disagreements in MDT meetings—issues that affect clinical decision making, but have not previously been addressed.
Methods
Responses to open questions from a 2009 national survey of MDT members about effective MDT working in the United Kingdom were analyzed for content. Emergent themes were identified and tabulated, and verbatim quotes were extracted to validate and illustrate themes.
Results
Free-text responses from 1,636 MDT members were analyzed. Key themes were: (1) the importance of nontechnical skills, organizational support, and good relationships between team members for effective teamworking; (2) recording of disagreements (potentially sharing them with patients) and the importance of patient-centered information in relation to team decision making; (3) the central role of clinical nurse specialists as the patient’s advocates, complementing the role of physicians in relation to patient centeredness.
Conclusions
Developing team members’ nontechnical skills and providing organizational support are necessary to help ensure that MDTs are delivering high-quality, patient-centered care. Recording dissent in decision making within the MDT is an important element, which should be defined further. The question of how best to represent the patient in MDT meetings also requires further exploration.
Journal Article
Dual stage approach to laser-driven helical coil proton acceleration
Helical coil accelerators are a recent development in laser-driven ion production, acting on the intrinsically wide divergence and broadband energy spectrum of laser-accelerated protons to deliver ultra-low divergence and quasi-monoenergetic beams. The modularity of helical coil accelerators also provides the attractive prospective of multi-staging. Here we show, on a proof-of-principle basis, a two-stage configuration which allows optical tuning of the energy of the selected proton beamlet. Experimental data, corroborated by particle tracing simulations, highlights the importance of controlling precisely the beam injection. Efficient post-acceleration of the protons with an energy gain up to ∼16 MeV (∼8 MeV per stage, at an average rate of ∼1 GeV m −1 ) was achieved at an optimal time delay, which allows synchronisation of the selected protons with the accelerating longitudinal electric fields to be maintained through both stages.
Journal Article
Quality Improvement in Multidisciplinary Cancer Teams: An Investigation of Teamwork and Clinical Decision-Making and Cross-Validation of Assessments
Purpose
Teamworking and clinical decision-making are important in multidisciplinary cancer teams (MDTs). Our objective is to assess the quality of information presentation and MDT members’ contribution to decision-making via expert observation and self-report, aiming to cross-validate the two methods and assess the insight of MDT members into their own team performance.
Materials and Methods
Behaviors were scored using (i) a validated observational tool employing Likert scales with objective anchors, and (ii) a 29-question online self-report tool. Data were collected from observation of 164 cases in five MDTs, and 47 surveys from MDT members (response rate 70%). Presentation of information (case history, radiological, pathological, comorbidities, psychosocial, and patients’ views) and quality of contribution to decision-making of MDT members (surgeons, oncologists, radiologists, pathologists, nurses, and MDT coordinators) were analyzed via descriptive statistics and the Jonckheere–Terpstra test. Correlation between observational and self-report assessments was assessed with Spearman’s correlations.
Results
Quality of information presentation:
Case histories and radiology information rated highest; patients’ views and comorbidities/psychosocial issues rated lowest (observed:
Z
= 14.80,
P
≤ 0.001; self-report:
Z
= 3.70,
P
< 0.001).
Contribution to decision-making
: Surgeons and oncologists rated highest, nurses and MDT coordinators rated lowest, and others in between (observed:
Z
= 20.00,
P
≤ 0.001; self-report:
Z
= 8.10,
P
< 0.001).
Correlations between observational and self-report assessments:
Median Spearman’s rho = 0.74 (range = 0.66–0.91;
P
< 0.05).
Conclusions
The quality of teamworking and clinical decision-making in MDTs can reliably be assessed using observational and self-report metrics. MDT members have good insight into their own team performance. Such robust assessment methods could provide the basis of a toolkit for MDT team evaluation and improvement.
Journal Article
Spaceflight alters host-gut microbiota interactions
The ISS rodent habitat has provided crucial insights into the impact of spaceflight on mammals, inducing symptoms characteristic of liver disease, insulin resistance, osteopenia, and myopathy. Although these physiological responses can involve the microbiome on Earth, host-microbiota interactions during spaceflight are still being elucidated. We explore murine gut microbiota and host gene expression in the colon and liver after 29 and 56 days of spaceflight using multiomics. Metagenomics revealed significant changes in 44 microbiome species, including relative reductions in bile acid and butyrate metabolising bacteria like Extibacter muris and Dysosmobacter welbionis. Functional prediction indicate over-representation of fatty acid and bile acid metabolism, extracellular matrix interactions, and antibiotic resistance genes. Host gene expression described corresponding changes to bile acid and energy metabolism, and immune suppression. These changes imply that interactions at the host-gut microbiome interface contribute to spaceflight pathology and that these interactions might critically influence human health and long-duration spaceflight feasibility.
Journal Article
Development and Validation of a Short Version of the Metric for the Observation of Decision-Making in Multidisciplinary Tumor Boards: MODe-Lite
BackgroundEvidence-based tools are necessary for scientifically improving the way MTBs work. Such tools are available but can be difficult to use. This study aimed to develop a robust observational assessment tool for use on cancer multidisciplinary tumor boards (MTBs) by health care professionals in everyday practice.MethodsA retrospective cross-sectional observational study was conducted in the United Kingdom from September 2015 to July 2016. Three tumor boards from three teaching hospitals were recruited, with 44 members overall. Six weekly meetings involving 146 consecutive cases were video-recorded and scored using the validated MODe tool. Data were subjected to reliability and validity analysis in the current study to develop a shorter version of the MODe.ResultsPhase 1, a reduction of the original items in the MODe, was achieved through two focus group meetings with expert assessors based on previous research. The 12 original items were reduced to 6 domains, receiving full agreement by the assessors. In phase 2, the six domains were subjected to item reliability, convergent validation, and internal consistency testing against the MODe-Lite global score, the MODe global score, and the items of the MODe. Significant positive correlations were evident across all domains (p < 0.01), indicating good reliability and validity. In phase 3, feasibility and high inter-assessor reliability were achieved by two clinical assessors. Six domains measuring clinical input, holistic input, clinical collaboration, pathology, radiology, and management plan were integrated into MODe-Lite.ConclusionsAs an evidence-based tool for health care professionals in everyday practice, MODe-Lite gives cancer MTBs insight into the way they work and facilitates improvements in practice.
Journal Article
Multidisciplinary Cancer Team Meeting Structure and Treatment Decisions: A Prospective Correlational Study
Background
Anecdotally, organizational factors appear to have an effect on the quality of decision-making in the multidisciplinary team (MDT) meeting. We assess the effect of the number of team-members present, number and order of cases, and the timing of meetings on the process of decision-making in MDT meetings.
Methods
Between December 2009 and January 2010, data were prospectively collected on treatment decisions, meeting characteristics, quality of information, and teamworking for all cases discussed at a London-based MDT meeting. Variables measured using a validated assessment tool (MDT MODe) and correlational analyses were performed.
Results
Treatment decisions were reached in 254 of 298 (85 %) cases. Cases toward the end of meetings were associated with lower rates of decision-making, information quality, and teamworking (
r
= −0.15 to −0.37). Increased number of cases per meeting and team members in attendance were associated with better information and teamworking (
r
= 0.29–0.43). More time per case was associated with improved teamworking (
r
= 0.16). A positive correlation was obtained between ability to reach decisions and improved information and teamworking (
r
= 0.36–0.54; all
P
≤ 0.001).
Conclusions
Organizational factors related to the structure of the MDT meeting are associated with variation in the likelihood of reaching a treatment decision. Further research is required to establish causation and to modify such factors in order to improve the quality of cancer care.
Journal Article