Components of complex interventions for healthcare: A narrative synthesis of qualitative studies

Objective:Qualitative research on therapeutic components is necessary to evaluate the efficacy of complex interventions in healthcare.As few qualitative syntheses have been conducted,this study aimed to derive a new conceptual framework for understanding the components of complex interventions and provide evidence for the implementation and evaluation of complex healthcare interventions.Methods:A systematic search of seven databases was conducted to identify qualitative studies that explored components of complex healthcare interventions.Meta-ethnography was used to analyze the data and thematic analysis was used to build the conceptual framework.Results:Of the 35 included studies,most complex interventions were non-pharmacological,with cancer accounting for 22%,mental health for 14%,and stroke for 8%.Half of the studies were conducted in the United Kingdom.Three main categories emerged:what should healthcare workers do?what qualifications should they have?and what should patients do?Five main themes were identified:psychological,biological,cognitive and behavioral,environmental,and social support.Conclusion:This analysis provides a reference for designing components of complex interventions in further studies.

Moving Away from Coercion: Social Justice and Behavior Change in Disability Services

The use of coercion to alter behavior in persons with intellectual and other developmental disabilities has a long history. Despite the work of leaders in the development of Positive Behaviour Support (PBS), the use of chemical, mechanical, physical or personal, and environmental restraints continues, resulting in traumatization, physical and emotional harm, and in some instances, death. When coercion is used, the trust between people breaks down, and the lack of trust is reinforced by the power differentials present when coercion occurs. Social justice provides an avenue for rebalancing power and regaining trust, but people affected by disabilities have historically been excluded from theories of social justice and, in some cases, do not fall within the definition of what it means to be a person in the paradigms put forth by a number of different authors. The term non-coercive has been used in an attempt to reframe behavior change theories and practices, but this term describes the absence of negative circumstances and interventions, rather than the presence of positive and affirming interactions which improve the quality of life of all stakeholders.

Effects of elastic support on the dynamic behaviors of the wind turbine drive train

The reliability and service life of wind turbines are influenced by the complex loading applied on the hub, especially amidst a poor external wind environment. A three-point elastic support, which includes the main bearing and two torque arms, was considered in this study. Based on the flexibilities of the planet carrier and the housing, a coupled dynamic model was developed for a wind turbine drive train. Then, the dynamic behaviors of the drive train for different elastic support parameters were computed and analyzed. Frequency response functions were used to examine how different elastic support parameters influence the dynamic behaviors of the drive train. Results showed that the elastic support parameters considerably influenced the dynamic behaviors of the wind turbine drive train. A large support stiffness of the torque arms decreased the dynamic response of the planet carrier and the main bearing, whereas a large support stiffness of the main bearing decreased the dynamic response of planet carrier while increasing that of the main bearing. The findings of this study provide the foundation for optimizing the elastic support stiffness of the wind turbine drive train.