62 resultados para Transition to adult services
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A key obstacle to the wide-scale development of renewable energy is that public acceptability of wind energy cannot be taken for granted when wind energy moves from abstract support to local implementation. Drawing on a case study of opposition to the siting of a proposed off-shore wind farm in Northern Ireland, we offer a rhetorical analysis of a series of representative documents drawn from government, media, pro- and anti-wind energy sources, which identifies and interprets a number of discourses of objection and support. The analysis indicates that the key issue in terms of the transition to a renewable energy economy has little to do with the technology itself. Understanding the different nuances of pro- and anti-wind energy discourses highlights the importance of thinking about new ways of looking at these conflicts. These include adopting a “conflict resolution” approach and “upstreaming” public involvement in the decision-making process and also the counter-productive strategy of assuming that objection is based on ignorance (which can be solved by information) or NIMBY thinking (which can be solved by moral arguments about overcoming “free riders”).
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Institutional and individual accountability is an important feature of societies in transition from conflict or authoritarian rule. The imperative of accountability has both normative and transformational underpinnings in the context of restoration of the rule of law and democracy. This article argues a case for extending the purview of truth-telling processes to the judiciary in postauthoritarian contexts. The driving force behind the inquiry is the proposition that the judiciary as the third arm of government at all times participates in governance. To contextualize the argument, I focus on judicial governance and accountability within the paradigm of Nigeria’s transition to democracy after decades of authoritarian military rule.
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Over twenty years ago ‘Our Common Future’ presented a conceptualization and explanation of the concept of sustainable development. Since then numerous alternative definitions of the concept have been offered, of which at least some are exclusive to each other. At the same time, the role of business in the transition to sustainable development has increasingly received attention. Bringing these two trends in sustainable development together, this paper returns to the Brundtland version of the concept to examine to what extent the original principles of sustainable development are still embedded within key business guidelines, namely the UN Global Compact, the OECD Guidelines for Multinational Enterprises, the ICC Business Charter for Sustainable Development, the CAUX Principles, the Global Sullivan Principles and the CERES Principles. The findings suggest that these business guidelines tend to emphasize environmental rather than social aspects of sustainable development, in particular to the detriment of the original Brundtland prioritization of the needs of the poorest. Furthermore, the attention to environmental aspects stresses win-win situations and has a clear managerialist focus; whereas more conceptual environmental issues concerning systems interdependencies, critical thresholds or systemic limits to growth find little attention. The normative codes and principles targeted at the private sector thus not only add another voice to the multiple discourses on sustainable development but also contribute to a reinterpretation of the original agenda set by Brundtland towards conceptualizations of sustainable development around the needs of industrialised rather than developing countries. Copyright © 2011 John Wiley & Sons, Ltd and ERP Environment
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Introduction: Optimal management of mechanical ventilation and weaning requires dynamic and collaborative decision making to minimize complications and avoid delays in the transition to extubation. In the absence of collaboration, ventilation decision making may be fragmented, inconsistent, and delayed. Our objective was to describe the professional group with responsibility for key ventilation and weaning decisions and to examine organizational characteristics associated with nurse involvement.
Methods: A multi-center, cross-sectional, self-administered survey was sent to nurse managers of adult intensive care units (ICUs) in Denmark, Germany, Greece, Italy, Norway, Switzerland, Netherlands and United Kingdom (UK). We summarized data as proportions (95% confidence intervals (CIs)) and calculated odds ratios (OR) to examine ICU organizational variables associated with collaborative decision making.
Results: Response rates ranged from 39% (UK) to 92% (Switzerland), providing surveys from 586 ICUs. Interprofessional collaboration (nurses and physicians) was the most common approach to initial selection of ventilator settings (63% (95% CI 59 to 66)), determination of extubation readiness (71% (67 to 75)), weaning method (73% (69 to 76)), recognition of weaning failure (84% (81 to 87)) and weaning readiness (85% (82 to 87)), and titration of ventilator settings (88% (86 to 91)). A nurse-to-patient ratio other than 1:1 was associated with decreased interprofessional collaboration during titration of ventilator settings (OR 0.2, 95% CI 0.1 to 0.6), weaning method (0.4 (0.2 to 0.9)), determination of extubation readiness (0.5 (0.2 to 0.9)) and weaning failure (0.4 (0.1 to 1.0)). Use of a weaning protocol was associated with increased collaborative decision making for determining weaning (1.8 (1.0 to 3.3)) and extubation readiness (1.9 (1.2 to 3.0)), and weaning method (1.8 (1.1 to 3.0)). Country of ICU location influenced the profile of responsibility for all decisions. Automated weaning modes were used in 55% of ICUs.
Conclusions: Collaborative decision making for ventilation and weaning was employed in most ICUs in all countries although this was influenced by nurse-to-patient ratio, presence of a protocol, and varied across countries. Potential clinical implications of a lack of collaboration include delayed adaptation of ventilation to changing physiological parameters, and delayed recognition of weaning and extubation readiness resulting in unnecessary prolongation of ventilation.
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This study evaluates the implementation of Menter's gamma-Re-theta Transition Model within the CFX12 solver for turbulent transition prediction on a natural laminar flow nacelle. Some challenges associated with this type of modeling have been identified. The computational fluid dynamics transitional flow simulation results are presented for a series of cruise cases with freestream Mach numbers ranging from 0.8 to 0.88, angles of attack from 2 to 0 degrees, and mass flow ratios from 0.60 to 0.75. These were validated with a series of wind-tunnel tests on the nacelle by comparing the predicted and experimental surface pressure distributions and transition locations. A selection of the validation cases are presented in this paper. In all cases, computational fluid dynamics simulations agreed reasonably well with the experiments. The results indicate that Menter's gamma-Re-theta Transition Model is capable of predicting laminar boundary-layer transition to turbulence on a nacelle. Nonetheless, some limitations exist in both the Menter's gamma-Re-theta Transition Model and in the implementation of the computational fluid dynamics model. The implementation of a more comprehensive experimental correlation in Menter's gamma-Re-theta Transition Model, preferably the ones from nacelle experiments, including the effects of compressibility and streamline curvature, is necessary for an accurate transitional flow simulation on a nacelle. In addition, improvements to the computational fluid dynamics model are also suggested, including the consideration of varying distributed surface roughness and an appropriate empirical correction derived from nacelle experimental transition location data.
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Left ventricular pressure overload in response to aortic banding is an invaluable model for studying progression of cardiac hypertrophy and transition to heart failure. Traditional aortic banding has recently been superceded by minimally invasive transverse aortic banding (MTAB) which does not require ventilation so is less technically challenging. Although the MTAB procedure is superior, few laboratories have documented success and minimal information on the model is available. The aim of this study was to optimise conditions for MTAB and to characterise the development and progression of cardiac hypertrophy. Isofluorane proved the most suitable anaesthetic for MTAB surgery in mice and one week after surgery MTAB animals showed significant increases in systolic blood pressure (110±6 v's 78±3(mmHg), MTAB v's sham, n=7,p
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The late-glacial vegetation development in northern Norway in response to climate changes during the Allerod, Younger Dryas (YD), and the transition to the Holocene is poorly known. Here we present a high-resolution record of floral and vegetation changes at lake Lusvatnet, south-west Andoya, between 13500 and 8000 cal b.p. Plant macrofossil and pollen analyses were done on the same sediment core and the proxy records follow each other very closely. The core has also been analyzed using an ITRAX XRF scanner in order to check the sediment sequence for disturbances or hiatuses. The core has a good radiocarbon-based chronology. The Saksunarvatn tephra fits very well chronostratigraphically. During both the Allerod and the Younger Dryas time-periods arctic vegetation prevailed, dominated by Salix polaris associated with many typically arctic herbs such as Saxifraga cespitosa, Saxifraga rivularis and Oxyria digyna. Both periods were cold and dry. Between 12450 and 12250 cal b.p. during the Younger Dryas chronozone, the assemblage changed, particularly in the increased abundance of Papaver sect. Scapiflora and other high-Arctic herbs, suggesting the development of polar desert vegetation mainly as a response to increased aridity. After 11520 cal b.p. a gradually warmer and more oceanic climate initiated a succession to dwarf-shrub vegetation and the establishment of Betula woodland after 1,000 years at c. 10520 cal b.p. The overall late-glacial aridity contrasts with oceanic conditions in southern Norway and is probably related to sea-ice extent.
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Lead is a highly toxic metal known to be an important cause of morbidity and mortality in waterbirds and terrestrial birds worldwide. The risk to birds of poisoning from lead has resulted in the introduction of legislation in many countries, such as UK restrictions on the use of lead in angling weights and lead gunshot. In this study, we examined data on current and historical trends in lead poisoning in British waterbirds and related these to the introduction of legislation restricting the use of lead. Our results indicate that lead poisoning has continued to affect a wide range of British waterbirds long after legal restrictions were introduced. Elevated levels of lead (i.e. > 20.0 mu g/dL) were found in the blood of 34 % (n = 285) of waterbirds tested at four sites in Britain during the 2010/2011 winter and accounted for the deaths of at least 10.6 % (n = 2,365) of waterbirds recovered across Britain between 1971 and 2010 and 8.1 % (n = 1,051) between 2000 and 2010, with lead gunshot being the most likely source of poisoning. The proportion of birds dying from lead poisoning in England did not vary significantly after the introduction of legislation, accounting for 13.7 % of non-infectious causes of death between 1971 and 1987 (n = 204), 20.8 % (n = 360) between 1988 and 1999 and 11.8 % (n = 423) between 2000 and 2010, despite a significant change in lead-related mortality in mute swans found during the same time period, 25 % (n = 12) between 1971 and 1987, 4.6 % (n = 65) between 1988 and 1999 and 2 % (n = 100) between 2000 and 2010. Existing legislation needs review and extension to ensure the delivery of international commitments and a broad-scale transition to the use of non-toxic shot and angling materials in all environments.
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A repressor of the transition to flowering in Arabidopsis is the MADS box protein FLOWERING LOCUS C (FLC). FCA, an RNA-binding protein, and FY, a homolog of the yeast RNA 3' processing factor Pfs2p, downregulate FLC expression and therefore promote flowering. FCA/FY physically interact and alter polyadenylation/3' processing to negatively autoregulate FCA. Here, we show that FCA requires FLOWERING LOCUS D (FLD), a homolog of the human lysine-specific demethylase 1 (LSD1) for FLC downregulation. FCA also partially depends on DICER-LIKE 3, involved in chromatin silencing. fca mutations increased levels of unspliced sense FLC transcript, altered processing of antisense FLC transcripts, and increased H3K4 dimethylation in the central region of FLC. These data support a close association of FCA and FLD in mediating H3K4 demethylation and thus transcriptional silencing of FLC and reveal roles for antisense RNA processing and DCL3 function in this regulation.
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Prediction of biotic responses to future climate change in tropical Africa tends to be based on two modelling approaches: bioclimatic species envelope models and dynamic vegetation models. Another complementary but underused approach is to examine biotic responses to similar climatic changes in the past as evidenced in fossil and historical records. This paper reviews these records and highlights the information that they provide in terms of understanding the local- and regional-scale responses of African vegetation to future climate change. A key point that emerges is that a move to warmer and wetter conditions in the past resulted in a large increase in biomass and a range distribution of woody plants up to 400–500 km north of its present location, the so-called greening of the Sahara. By contrast, a transition to warmer and drier conditions resulted in a reduction in woody vegetation in many regions and an increase in grass/savanna-dominated landscapes. The rapid rate of climate warming coming into the current interglacial resulted in a dramatic increase in community turnover, but there is little evidence for widespread extinctions. However, huge variation in biotic response in both space and time is apparent with, in some cases, totally different responses to the same climatic driver. This highlights the importance of local features such as soils, topography and also internal biotic factors in determining responses and resilience of the African biota to climate change, information that is difficult to obtain from modelling but is abundant in palaeoecological records.
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A string of repulsively interacting particles exhibits a phase transition to a zigzag structure, by reducing the transverse trap potential or the interparticle distance. Based on the emergent symmetry Z2 it has been argued that this instability is a quantum phase transition, which can be mapped to an Ising model in transverse field. An extensive Density Matrix Renormalization Group analysis is performed, resulting in an high-precision evaluation of the critical exponents and of the central charge of the system, confirming that the quantum linear-zigzag transition belongs to the critical Ising model universality class. Quantum corrections to the classical phase diagram are computed, and the range of experimental parameters where quantum effects play a role is provided. These results show that structural instabilities of one-dimensional interacting atomic arrays can simulate quantum critical phenomena typical of ferromagnetic systems.
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Background: Women and their babies are entitled to equal access to high quality maternity care. However, when women fit into two or more categories of vulnerability they can face multiple, compound barriers to accessing and utilising services. Disabled women are up to three times more likely to experience domestic abuse than non-disabled women. Domestic abuse may compromise health service access and utilisation and disabled people in general have suboptimal access to healthcare services. Despite this, little is known about the compounding effects of disability and domestic abuse on women’s access to maternity care.
Methods: The aim of the study was to identify how women approach maternity care services, their expectations of services and whether they are able to get the type of care that they need and want. We conducted a qualitative, Critical Incident Technique study in Scotland. Theoretically we drew on Andersen’s model of healthcare use. The model was congruent with our interest in women’s intended/actual use of maternity services and the facilitators and barriers
impacting their access to care. Data were generated during 2013 using one-to-one interviews.
Results: Five women took part and collectively reported 45 critical incidents relating to accessing and utilising maternity services. Mapped to the underpinning theoretical framework, our findings show how the four domains of attitudes; knowledge; social norms; and perceived control are important factors shaping maternity care experiences.
Conclusions: Positive staff attitude and empowering women to have control over their own care is crucial in influencing women’s access to and utilisation of maternity healthcare services. Moreover these are cyclical, with the consequences and outcomes of healthcare use becoming part of the enabling or disabling factors affecting future healthcare decisions.Further consideration needs to be given to the development of strategies to access and recruit women in these circumstances. This will provide an opportunity for under-represented and silenced voices to be heard.
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Background English National Quality Requirements mandate out-of-hours primary care services to routinely audit patient experience, but do not state how it should be done.
Objectives We explored how providers collect patient feedback data and use it to inform service provision. We also explored staff views on the utility of out-of-hours questions from the English General Practice Patient Survey (GPPS).
Methods A qualitative study was conducted with 31 staff (comprising service managers, general practitioners and administrators) from 11 out-of-hours primary care providers in England, UK. Staff responsible for patient experience audits within their service were sampled and data collected via face-to-face semistructured interviews.
Results Although most providers regularly audited their patients’ experiences by using patient surveys, many participants expressed a strong preference for additional qualitative feedback. Staff provided examples of small changes to service delivery resulting from patient feedback, but service-wide changes were not instigated. Perceptions that patients lacked sufficient understanding of the urgent care system in which out-of-hours primary care services operate were common and a barrier to using feedback to enable change. Participants recognised the value of using patient experience feedback to benchmark services, but perceived weaknesses in the out-of-hours items from the GPPS led them to question the validity of using these data for benchmarking in its current form.
Conclusions The lack of clarity around how out-of-hours providers should audit patient experience hinders the utility of the National Quality Requirements. Although surveys were common, patient feedback data had only a limited role in service change. Data derived from the GPPS may be used to benchmark service providers, but refinement of the out-of-hours items is needed.