Economic Ideas and the Political Construction of the Financial Crash of 2008

This article is a short introduction to a special section on economic ideas and the political construction of the financial crash. It begins by explaining why economic ideas and the politics of appeals to certain ideas are so integral to the historical significance of the crash of 2008 and the question of whether it can be considered a crash at all. The first section covers the literature on ideas and economic crisis. The second section highlights that the contribution of the special section is to engage in a stock taking exercise of the empirical and conceptual patterns concerning the politics of ideational change underway in the areas of: comparative fiscal policy; monetary policy and Euro zone debt management; capital controls; and financial and securities market regulation and standard setting. The final section outlines the structure of this special section and content of the individual articles.

Factors that impact on the use of mechanical ventilation weaning protocols in critically ill adults and children: a qualitative-evidence synthesis

Background:
Prolonged mechanical ventilation is associated with a longer intensive care unit (ICU) length of stay and higher mortality. Consequently, methods to improve ventilator weaning processes have been sought. Two recent Cochrane systematic reviews in ICU adult and paediatric populations concluded that protocols can be effective in reducing the duration of mechanical ventilation, but there was significant heterogeneity in study findings. Growing awareness of the benefits of understanding the contextual factors impacting on effectiveness has encouraged the integration of qualitative evidence syntheses with effectiveness reviews, which has delivered important insights into the reasons underpinning (differential) effectiveness of healthcare interventions.

Objectives:
1. To locate, appraise and synthesize qualitative evidence concerning the barriers and facilitators of the use of protocols for weaning critically-ill adults and children from mechanical ventilation;

2. To integrate this synthesis with two Cochrane effectiveness reviews of protocolized weaning to help explain observed heterogeneity by identifying contextual factors that impact on the use of protocols for weaning critically-ill adults and children from mechanical ventilation;

3. To use the integrated body of evidence to suggest the circumstances in which weaning protocols are most likely to be used.

Search methods:
We used a range of search terms identified with the help of the SPICE (Setting, Perspective, Intervention, Comparison, Evaluation) mnemonic. Where available, we used appropriate methodological filters for specific databases. We searched the following databases: Ovid MEDLINE, Embase, OVID, PsycINFO, CINAHL Plus, EBSCOHost, Web of Science Core Collection, ASSIA, IBSS, Sociological Abstracts, ProQuest and LILACS on the 26th February 2015. In addition, we searched: the grey literature; the websites of professional associations for relevant publications; and the reference lists of all publications reviewed. We also contacted authors of the trials included in the effectiveness reviews as well as of studies (potentially) included in the qualitative synthesis, conducted citation searches of the publications reporting these studies, and contacted content experts.

We reran the search on 3rd July 2016 and found three studies, which are awaiting classification.

Selection criteria:
We included qualitative studies that described: the circumstances in which protocols are designed, implemented or used, or both, and the views and experiences of healthcare professionals either involved in the design, implementation or use of weaning protocols or involved in the weaning of critically-ill adults and children from mechanical ventilation not using protocols. We included studies that: reflected on any aspect of the use of protocols, explored contextual factors relevant to the development, implementation or use of weaning protocols, and reported contextual phenomena and outcomes identified as relevant to the effectiveness of protocolized weaning from mechanical ventilation.

Data collection and analysis:
At each stage, two review authors undertook designated tasks, with the results shared amongst the wider team for discussion and final development. We independently reviewed all retrieved titles, abstracts and full papers for inclusion, and independently extracted selected data from included studies. We used the findings of the included studies to develop a new set of analytic themes focused on the barriers and facilitators to the use of protocols, and further refined them to produce a set of summary statements. We used the Confidence in the Evidence from Reviews of Qualitative Research (CERQual) framework to arrive at a final assessment of the overall confidence of the evidence used in the synthesis. We included all studies but undertook two sensitivity analyses to determine how the removal of certain bodies of evidence impacted on the content and confidence of the synthesis. We deployed a logic model to integrate the findings of the qualitative evidence synthesis with those of the Cochrane effectiveness reviews.

Main results:
We included 11 studies in our synthesis, involving 267 participants (one study did not report the number of participants). Five more studies are awaiting classification and will be dealt with when we update the review.

The quality of the evidence was mixed; of the 35 summary statements, we assessed 17 as ‘low’, 13 as ‘moderate’ and five as ‘high’ confidence. Our synthesis produced nine analytical themes, which report potential barriers and facilitators to the use of protocols. The themes are: the need for continual staff training and development; clinical experience as this promotes felt and perceived competence and confidence to wean; the vulnerability of weaning to disparate interprofessional working; an understanding of protocols as militating against a necessary proactivity in clinical practice; perceived nursing scope of practice and professional risk; ICU structure and processes of care; the ability of protocols to act as a prompt for shared care and consistency in weaning practice; maximizing the use of protocols through visibility and ease of implementation; and the ability of protocols to act as a framework for communication with parents.

Authors' conclusions:
There is a clear need for weaning protocols to take account of the social and cultural environment in which they are to be implemented. Irrespective of its inherent strengths, a protocol will not be used if it does not accommodate these complexities. In terms of protocol development, comprehensive interprofessional input will help to ensure broad-based understanding and a sense of ‘ownership’. In terms of implementation, all relevant ICU staff will benefit from general weaning as well as protocol-specific training; not only will this help secure a relevant clinical knowledge base and operational understanding, but will also demonstrate to others that this knowledge and understanding is in place. In order to maximize relevance and acceptability, protocols should be designed with the patient profile and requirements of the target ICU in mind. Predictably, an under-resourced ICU will impact adversely on protocol implementation, as staff will prioritize management of acutely deteriorating and critically-ill patients.

The geoarchaeology of Paleolithic rivers of southwest Britain

In Britain, the majority of Lower and Middle Paleolithic archaeological finds come from river terrace deposits. The impressive “staircase” terrace sequences of southeast England, and research facilitated by aggregate extraction have provided a considerable body of knowledge about the terrace chronology and associated archaeology in that area. Such research has been essential in considering rates of uplift, climatic cycles, archaeological chronologies, and the landscapes in which hominins lived. It has also promoted the view that southeast England was a major hominin route into Britain. By contrast, the terrace deposits of the southwest have been little studied. The Palaeolithic Rivers of South West Britain (PRoSWEB) project employed a range of geoarchaeological methodologies to address similar questions at different scales, focusing on the rivers Exe, Axe, Otter, and the paleo-Doniford, all of which were located south of the maximum Pleistocene glacial limit (marine oxygen isotope stage [MIS] 4–2). Preliminary analysis of the fieldwork results suggests that although the evolution of these catchments is complex, most conform to a standard staircase-type model, with the exception of the Axe, and, to a lesser extent, the paleo-Doniford, which are anomalous. Although the terrace deposits are less extensive than in southeast Britain, differentiation between terraces does exist, and new dates show that some of these terraces are of great antiquity (MIS 10+). The project also reexamined the distribution of artifacts in the region and confirms the distributional bias to the river valleys, and particularly the rivers draining southward to the paleo–Channel River system. This distribution is consistent with a model of periodic occupation of the British peninsula along and up the major river valleys from the paleo–Channel River corridor. These data have a direct impact on our understanding of the paleolandscapes of the southwest region, and therefore our interpretations of the Paleolithic occupation of the edge of the continental landmass.

Second-Order Statistics of κ−µ Shadowed Fading Channels

In this paper, novel closed-form expressions for the level crossing rate and average fade duration of κ − μ shadowed fading channels are derived. The new equations provide the capability of modeling the correlation between the time derivative of the shadowed dominant and multipath components of the κ − μ shadowed fading envelope. Verification of the new equations is performed by reduction to a number of known special cases. It is shown that as the shadowing of the resultant dominant component decreases, the signal crosses lower threshold levels at a reduced rate. Furthermore, the impact of increasing correlation between the slope of the shadowed dominant and multipath components similarly acts to reduce crossings at lower signal levels. The new expressions for the second-order statistics are also compared with field measurements obtained for cellular device-to-device and body-centric communication channels, which are known to be susceptible to shadowed fading.