A realistic evaluation of track and trigger systems and acute care training for early recognition and treatment of deteriorating ward-based patients: research protocol.

Aim The aim of the study is to evaluate factors that enable or constrain the implementation and service delivery of early warnings systems or acute care training in practice. Background To date there is limited evidence to support the effectiveness of acute care initiatives (early warning systems, acute care training, outreach) in reducing the number of adverse events (cardiac arrest, death, unanticipated Intensive Care admission) through increased recognition and management of deteriorating ward based patients in hospital [1-3]. The reasons posited are that previous research primarily focused on measuring patient outcomes following the implementation of an intervention or programme without considering the social factors (the organisation, the people, external influences) which may have affected the process of implementation and hence measured end-points. Further research which considers the social processes is required in order to understand why a programme works, or does not work, in particular circumstances [4]. Method The design is a multiple case study approach of four general wards in two acute hospitals where Early Warning Systems (EWS) and Acute Life-threatening Events Recognition and Treatment (ALERT) course have been implemented. Various methods are being used to collect data about individual capacities, interpersonal relationships and institutional balance and infrastructures in order to understand the intended and unintended process outcomes of implementing EWS and ALERT in practice. This information will be gathered from individual and focus group interviews with key participants (ALERT facilitators, nursing and medical ALERT instructors, ward managers, doctors, ward nurses and health care assistants from each hospital); non-participant observation of ward organisation and structure; audit of patients' EWS charts and audit of the medical notes of patients who deteriorated during the study period to ascertain whether ALERT principles were followed. Discussion & progress to date This study commenced in January 2007. Ethical approval has been granted and data collection is ongoing with interviews being conducted with key stakeholders. The findings from this study will provide evidence for policy-makers to make informed decisions regarding the direction for strategic and service planning of acute care services to improve the level of care provided to acutely ill patients in hospital. References 1. Esmonde L, McDonnell A, Ball C, Waskett C, Morgan R, Rashidain A et al. Investigating the effectiveness of Critical Care Outreach Services: A systematic review. Intensive Care Medicine 2006; 32: 1713-1721 2. McGaughey J, Alderdice F, Fowler R, Kapila A, Mayhew A, Moutray M. Outreach and Early Warning Systems for the prevention of Intensive Care admission and death of critically ill patients on general hospital wards. Cochrane Database of Systematic Reviews 2007, Issue 3. www.thecochranelibrary.com 3. Winters BD, Pham JC, Hunt EA, Guallar E, Berenholtz S, Pronovost PJ (2007) Rapid Response Systems: A systematic review. Critical Care Medicine 2007; 35 (5): 1238-43 4. Pawson R and Tilley N. Realistic Evaluation. London; Sage: 1997

People and places: Understanding geographical accuracy in administrative data from the census and healthcare systems

Administrative systems such as health care registration are of increasing importance in providing information for statistical, research, and policy purposes. There is thus a pressing need to understand better the detailed relationship between population characteristics as recorded in such systems and conventional censuses. This paper explores these issues using the unique Northern Ireland Longitudinal Study (NILS). It takes the 2001 Census enumeration as a benchmark and analyses the social, demographic and spatial patterns of mismatch with the health register at individual level. Descriptive comparison is followed by multivariate and multilevel analyses which show that approximately 25% of individuals are reported to be in different addresses and that age, rurality, education, and housing type are all important factors. This level of mismatch appears to be maintained over time, as earlier migrants who update their address details are replaced by others who have not yet done so. In some cases, apparent mismatches seem likely to reflect complex multi-address living arrangements rather than data error.

Competitive adsorption of reactive dyes from solution: equilibrium isotherm studies in single and multisolute systems

Experimental data of the adsorption of reactive dyestuffs onto Filtrasorb 400 activated carbon (FS400) were determined in an equilibrium isotherm study. As most industrial wastewater contains more than one pollutant, an investigation into the effect of multisolute systems (using the unhydrolysed form of the reactive dyes) on the adsorption capacity was undertaken. Equilibrium isotherm models were employed to describe the adsorption capacities of single, binary and ternary dye solutions. The results of these analyses showed that adsorption of reactive dyes from single and multisolute systems can be successfully described by Langmuir, and Redlich–Peterson equilibrium isotherm models. Experimental data indicated that competitive adsorption for active sites on the carbon surface results in a reduction in the overall uptake capacity of the reactive dyes investigated.

Human information retrieval

Information retrieval in the age of Internet search engines has become part of ordinary discourse and everyday practice: "Google" is a verb in common usage. Thus far, more attention has been given to practical understanding of information retrieval than to a full theoretical account. In Human Information Retrieval, Julian Warner offers a comprehensive overview of information retrieval, synthesizing theories from different disciplines (information and computer science, librarianship and indexing, and information society discourse) and incorporating such disparate systems as WorldCat and Google into a single, robust theoretical framework. There is a need for such a theoretical treatment, he argues, one that reveals the structure and underlying patterns of this complex field while remaining congruent with everyday practice. Warner presents a labor theoretic approach to information retrieval, building on his previously formulated distinction between semantic and syntactic mental labor, arguing that the description and search labor of information retrieval can be understood as both semantic and syntactic in character. Warner's information science approach is rooted in the humanities and the social sciences but informed by an understanding of information technology and information theory. The chapters offer a progressive exposition of the topic, with illustrative examples to explain the concepts presented. Neither narrowly practical nor largely speculative, Human Information Retrieval meets the contemporary need for a broader treatment of information and information systems.

Male mating behaviour and mating systems of bees: an overview

Considerable interspecific diversity exists among bees in the rendezvous sites where males search for females and in the behaviours employed by males in their efforts to secure matings. I present an evolutionary framework in which to interpret this variation, and highlight the importance for the framework of (i) the distribution of receptive ( typically immediate post-emergence) females, which ordinarily translates into the distribution of nests, and (ii) the density of competing males. Other than the highly polyandrous honey bees ( Apis), most female bees are thought to be monandrous, though genetic data with which to support this view are generally lacking. Given the opportunity, male bees are typically polygamous. I highlight intraspecific diversity in rendezvous site, male behaviour and mating system, which is in part predicted from the conceptual framework. Finally, I suggest that inbreeding may be far more widespread among bees than has hitherto been considered the case.