The Management of Long-Term Sickness Absence in Large Public Sector Healthcare Organisations: A Realist Evaluation Using Mixed Methods

Purpose The success of measures to reduce long-term sickness absence (LTSA) in public sector organisations is contingent on organisational context. This realist evaluation investigates how interventions interact with context to influence successful management of LTSA. Methods Multi-method case study in three Health and Social Care Trusts in Northern Ireland comprising realist literature review, semi-structured interviews (61 participants), Process-Mapping and feedback meetings (59 participants), observation of training, analysis of documents. Results Important activities included early intervention; workplace-based occupational rehabilitation; robust sickness absence policies with clear trigger points for action. Used appropriately, in a context of good interpersonal and interdepartmental communication and shared goals, these are able to increase the motivation of staff to return to work. Line managers are encouraged to take a proactive approach when senior managers provide support and accountability. Hindering factors: delayed intervention; inconsistent implementation of policy and procedure; lack of resources; organisational complexity; stakeholders misunderstanding each other’s goals and motives. Conclusions Different mechanisms have the potential to encourage common motivations for earlier return from LTSA, such as employees feeling that they have the support of their line manager to return to work and having the confidence to do so. Line managers’ proactively engage when they have confidence in the support of seniors and in their own ability to address LTSA. Fostering these motivations calls for a thoughtful, diagnostic process, taking into account the contextual factors (and whether they can be modified) and considering how a given intervention can be used to trigger the appropriate mechanisms.

Low cycle fatigue properties of CLAM steel at 823 K

China Low Activation Martensitic (CLAM) steel is considered to be the main candidate material for the first wall components of future fusion reactors in China. In this paper, the low cycle fatigue (LCF) behavior of CLAM steel is studied under fully reversed tension–compression loading at 823 K in air. Total strain amplitude was controlled from 0.14% to 1.8% with a constant strain rate of 2.4×10−3 s−1. The corresponding plastic strain amplitude ranged from 0.023% to 1.613%. The CLAM steel displayed continuous softening to failure at 823 K. The relationship between strain, stress and fatigue life was obtained using the parameters obtained from fatigue tests. The LCF properties of CLAM steel at 823 K followed Coffin–Manson relationship. Furthermore, irregular serration was observed on the stress–strain hysteresis loops of CLAM steel tested with the total strain amplitude of 0.45–1.8%, which was attributed to the dynamic strain aging (DSA) effect. During continuous cyclic deformation, the microstructure and precipitate distribution of CLAM steel changed gradually. Many tempered martensitic laths were decomposed into subgrains, and the size and number of M23C6 carbide and MX carbonitride precipitates decreased with the increase of total strain amplitude. The response cyclic stress promoted the recovery of martensitic lath, while the thermal activation mainly played an important role on the growth of precipitates in CLAM steel at 823 K. In order to have a better understanding of high-temperature LCF behavior, the potential mechanisms controlling stress–strain response, DSA phenomenon and microstructure changes have also been evaluated.

Ethanol-induced water stress and fungal growth

Fungal growth inhibition by ethanol was compared with that caused by five other agents of water stress (at 25, 40 and 42.5°C), using Aspergillus oryzae. Ethanol, KCl, glycerol, glucose, sorbitol, and polyethylene glycol 400 were incorporated into media at concentrations corresponding to water activity (a(w)) values in the range 1 to 0.75. Generally, as temperature increased there was a decrease in the a(w) value at which optimum growth occurred. The a(w) limit for growth on KCl, glycerol, glucose, sorbitol, or polyethylene glycol 400 media was about 0.85, regardless of temperature. However, the a(w) limit for growth on ethanol media varied between 0.97 and 0.99 a(w) and was temperature-dependent. Water stress accounted for up to 31, 18 and 6% of growth inhibition by ethanol at 25, 40, and 42.5°C, respectively. For media containing ethanol, the decrease in growth rate per unit of a(w) reduction was greater as temperature increased. However, ethanol-induced water stress remained constant regardless of temperature, suggesting that other inhibitory effects of ethanol are closely temperature- dependent. Water stress may account for considerably more than 30% of growth inhibition by ethanol in cells that remain metabolically active at higher ethanol concentrations.

The extended phenotype of Scots pine Pinus sylvestris structures the understorey assemblage

Heritable variation in plant secondary compounds in dominant species has been hypothesised to effect ecosystem function and the structure of associated assemblages of plants, microbes and animals. The functioning of this extended phenotype in relation to the understorey vegetation composition was tested within a boreal forest system dominated by Pinus sylvestris which contains a range of monoterpenes, the composition of which is largely under genetic control. A variance partitioning approach was adopted to identify the relative importance of tree chemistry, environment, spatial location and tree architecture in controlling the distribution of species in the ground flora under individual trees. The monoterpene composition of the pine needles appeared to contribute significantly to controlling understorey vegetation composition, but was less important than environmental factors, though similar to spatial factors. Thus there appears to be a link between variation in the chemical composition of the single, dominant tree species within this system and the pattern of occurrence and abundance in other species at the same trophic level.

Proportioning variability in the dispensation of hand-mixed dental cements

Objectives: The purpose of this investigation was to determine for dispensed multiples (1 through 4) of powder (P) and liquid (L) in hand-mixed dental cement whether: (1) the mean (P/L) ratio (m/m) and (2) the maximum difference in (P/L) ratio is dependent on the number of multiples dispensed. The Null hypotheses were: (a) mean (P/L) ratio is independent of the number of multiples dispensed and (b) maximum difference in (P/L) ratio is independent of the number of multiples dispensed.
Methods: The materials investigated are listed in the Table. The masses of dispensed aliquots of powder and liquid were measured by a single operator (n=10, for multiples 1 through 4) on a 4-place analytical balance. All measurements were made independently and all possible (P/L) ratios calculated for each sample. The effect of multiple dispensations on (P/L) ratios and maximum (P/L) differences was by one-way ANOVA and linear regression, respectively, with the Tukey post-hoc correction for multiple comparisons.MULTIPLE DISPENSEDDISPENSED MU(x1)(x2)(x3)(x4)Zinc phosphateHeraeus12.271(0.691)a13.051(1.269)b13.215(0.824)b13.118(1.149)bFuji IXGC4.209(0.373)a4.085(0.275)b4.095(0.226)b4.095(0.217)bIRMDentsply7.933(0.767)a7.430(0.451)b7.977(0.729)a8.186(0.929)aKetac-Cem3M Espe9.6206(0.613)a9.714(0.523)a9.298(0.314)b9.321(0.292)bMean (SD) powder/liquid ratio (m/m). Superscript letters represent significances (α = 0.05) within each material
Results: Mean (SD) (P/L) ratios are presented in the Table. Null hypothesis (a) is rejected: either (x1) or (x2) dispensation yields a different (P/L) ratio to (x3) or (x4) (p < 0.05). Null hypothesis (b) is rejected: a negative correlation is observed in max (P/L) ratio difference with dispensed multiple for Ketac Cem (p = 0.029).
Conclusion: For hand-mixed dental cements: (1) more consistent (P/L) ratios may be observed with multiple dispensations of powder & liquid; (2) maximum differences in (P/L) ratio may be negatively correlated with dispensation multiple in some materials.

Machine learning for transient discovery in Pan-STARRS1 difference imaging

Efficient identification and follow-up of astronomical transients is hindered by the need for humans to manually select promising candidates from data streams that contain many false positives. These artefacts arise in the difference images that are produced by most major ground-based time-domain surveys with large format CCD cameras. This dependence on humans to reject bogus detections is unsustainable for next generation all-sky surveys and significant effort is now being invested to solve the problem computationally. In this paper, we explore a simple machine learning approach to real-bogus classification by constructing a training set from the image data of similar to 32 000 real astrophysical transients and bogus detections from the Pan-STARRS1 Medium Deep Survey. We derive our feature representation from the pixel intensity values of a 20 x 20 pixel stamp around the centre of the candidates. This differs from previous work in that it works directly on the pixels rather than catalogued domain knowledge for feature design or selection. Three machine learning algorithms are trained (artificial neural networks, support vector machines and random forests) and their performances are tested on a held-out subset of 25 per cent of the training data. We find the best results from the random forest classifier and demonstrate that by accepting a false positive rate of 1 per cent, the classifier initially suggests a missed detection rate of around 10 per cent. However, we also find that a combination of bright star variability, nuclear transients and uncertainty in human labelling means that our best estimate of the missed detection rate is approximately 6 per cent.

Early-type stars observed in the ESO UVES Paranal Observatory Project - V. Time-variable interstellar absorption

The structure and properties of the diffuse interstellar medium (ISM) on small scales, sub-au to 1 pc, are poorly understood. We compare interstellar absorption-lines, observed towards a selection of O- and B-type stars at two or more epochs, to search for variations over time caused by the transverse motion of each star combined with changes in the structure in the foreground ISM. Two sets of data were used: 83 VLT- UVES spectra with approximately 6 yr between epochs and 21 McDonald observatory 2.7m telescope echelle spectra with 6 - 20 yr between epochs, over a range of scales from 0 - 360 au. The interstellar absorption-lines observed at the two epochs were subtracted and searched for any residuals due to changes in the foreground ISM. Of the 104 sightlines investigated with typically five or more components in Na I D, possible temporal variation was identified in five UVES spectra (six components), in Ca II, Ca I and/or Na I absorption-lines. The variations detected range from 7\% to a factor of 3.6 in column density. No variation was found in any other interstellar species. Most sightlines show no variation, with 3{\sigma} upper limits to changes of the order 0.1 - 0.3 dex in Ca II and Na I. These variations observed imply that fine-scale structure is present in the ISM, but at the resolution available in this study, is not very common at visible wavelengths. A determination of the electron densities and lower limits to the total number density of a sample of the sightlines implies that there is no striking difference between these parameters in sightlines with, and sightlines without, varying components.

Large- and small-scale structure of the intermediate- and high-velocity clouds towards the LMC and SMC.

We employ Ca II K and Na I D interstellar absorption-line spectroscopy of early-type stars in the Large and Small Magellanic Clouds (LMC, SMC) to investigate the large- and small-scale structure in foreground intermediate- and high-velocity clouds (I/HVCs). Data include FLAMES-GIRAFFE Ca II K observations of 403 stars in four open clusters, plus FEROS or UVES spectra of 156 stars in the LMC and SMC. The FLAMES observations are amongst the most extensive probes to date of Ca II structures on ∼20 arcsec scales in Magellanic I/HVCs. From the FLAMES data within a 0 ∘.∘.∘.5 field of view, the Ca II K equivalent width in the I/HVC components towards three clusters varies by factors of ≥10. There are no detections of molecular gas in absorption at intermediate or high velocities, although molecular absorption is present at LMC and Galactic velocities towards some sightlines. The FEROS/UVES data show Ca II K I/HVC absorption in ∼60 per cent of sightlines. The range in the Ca II/Na I ratio in I/HVCs is from –0.45 to +1.5 dex, similar to previous measurements for I/HVCs. In 10 sightlines we find Ca II/O I ratios in I/HVC gas ranging from 0.2 to 1.5 dex below the solar value, indicating either dust or ionization effects. In nine sightlines I/HVC gas is detected in both H I and Ca II at similar velocities, implying that the two elements form part of the same structure.

Religious Geopolitics of Palestinian Christianity: Palestinian Christian Zionists, Palestinian Liberation Theologists, and American Missions to Palestine

The introduction of Protestantism into the Middle East by American missionaries in the nineteenth century met with limited success while the responses and internalizations of local converts proved incredibly diverse. The two resultant theological descendants are Palestinian Christian Zionists and Palestinian Liberation Theologists. The article provides a short history of these two movements and highlights influential voices through interviews and media analysis. This article argues that hybrid religious identifications with nation and place has transcended, in some cases, political struggle for territory.

Spitzer infrared spectrograph point source classification in the Small Magellanic Cloud

The Magellanic Clouds are uniquely placed to study the stellar contribution to dust emission. Individual stars can be resolved in these systems even in the mid-infrared, and they are close enough to allow detection of infrared excess caused by dust. We have searched the Spitzer Space Telescope data archive for all Infrared Spectrograph (IRS) staring-mode observations of the Small Magellanic Cloud (SMC) and found that 209 Infrared Array Camera (IRAC) point sources within the footprint of the Surveying the Agents of Galaxy Evolution in the Small Magellanic Cloud (SAGE-SMC) Spitzer Legacy programme were targeted, within a total of 311 staring-mode observations. We classify these point sources using a decision tree method of object classification, based on infrared spectral features, continuum and spectral energy distribution shape, bolometric luminosity, cluster membership and variability information. We find 58 asymptotic giant branch (AGB) stars, 51 young stellar objects, 4 post-AGB objects, 22 red supergiants, 27 stars (of which 23 are dusty OB stars), 24 planetary nebulae (PNe), 10 Wolf-Rayet stars, 3 H II regions, 3 R Coronae Borealis stars, 1 Blue Supergiant and 6 other objects, including 2 foreground AGB stars. We use these classifications to evaluate the success of photometric classification methods reported in the literature.

Selective Hydrogenation of Halogenated Arenes using porous Manganese Oxide (OMS-2) and Platinum supported OMS-2 Catalysts

Porous manganese oxide (OMS-2) and platinum supported on OMS-2 catalysts have been shown to facilitate the hydrogenation of the nitro group on chloronitrobenzene to give chloroaniline with no dehalogenation. Complete conversion was obtained within 2 h at 25 [degree]C and, although the rate of reaction increased with increasing temperature up to 100 [degree]C, the selectivity to chloroaniline remained at 99.0%. Use of Pd/OMS-2 or Pt/Al2O3 resulted in significant dechlorination even at 25 [degree]C and 2 bar hydrogen pressure giving selectivity to chloroaniline of 34.5% and 77.8%, respectively, at complete conversion. This demonstrates the potential of using platinum group metal free catalysts for the selective hydrogenation of halogenated aromatics. Two pathways were observed for the analogous nitrobenzene hydrogenation depending on the catalyst used. The hydrogenation of nitrobenzene was found to follow a direct pathway to aniline and nitrosobenzene over Pd/OMS-2 in contrast to the OMS and Pt/OMS-2 catalysts which resulted in formation of nitrosobenzene, azoxybenzene and azobenzene/hydrazobenzene intermediates before complete conversion to aniline. These results indicate that for the Pt/OMS-2 the hydrogenation proceeds predominantly over the support with the metal acting to dissociate the hydrogen. In the case of the Pd/OMS-2 both the hydrogenation and the hydrogen adsorption occur on the metal sites.