The Acute Care Undergraduate TEaching (ACUTE) initiative: consensus development of core competencies in acute care for undergraduates in the United Kingdom

Background: The care of the acutely ill patient in hospital is often sub-optimal. Poor recognition of critical illness combined with a lack of knowledge, failure to appreciate the clinical urgency of a situation, a lack of supervision, failure to seek advice and poor communication have been identified as contributory factors. At present the training of medical students in these important skills is fragmented. The aim of this study was to use consensus techniques to identify the core competencies in the care of acutely ill or arrested adult patients that medical students should possess at the point of graduation. Design: Healthcare professionals were invited to contribute suggestions for competencies to a website as part of a modified Delphi survey. The competency proposals were grouped into themes and rated by a nominal group comprised of physicians, nurses and students from the UK. The nominal group rated the importance of each competency using a 5-point Likert scale. Results: A total of 359 healthcare professionals contributed 2,629 competency suggestions during the Delphi survey. These were reduced to 88 representative themes covering: airway and oxygenation; breathing and ventilation; circulation; confusion and coma; drugs, therapeutics and protocols; clinical examination; monitoring and investigations; team-working, organisation and communication; patient and societal needs; trauma; equipment; pre-hospital care; infection and inflammation. The nominal group identified 71 essential and 16 optional competencies which students should possess at the point of graduation. Conclusions: We propose these competencies form a core set for undergraduate training in resuscitation and acute care.

Developing children and young people’s participation in strategic processes: the experience of the Children’s Fund Initiative

The extent of children’s and young people’s participation activities has increased considerably among statutory, voluntary and community sector organisations across the UK in recent years. The Children’s Fund, a major government initiative launched in 2000, represents a systematic drive towards promoting children and young people’s participation in planning, implementing and evaluating preventative services within all 149 local authority areas in England. Based on research carried out by the National Evaluation of the Children’s Fund, this paper explores the experience of Children’s Fund partnerships of engaging children and young people in strategic processes.

Perspectives on community representation within the Extractive Industries Transparency Initiative: experiences from south-east Madagascar

This article critically examines the nature and quality of governance in community representation and civil society engagement in the context of trans-national large-scale mining, drawing on experiences in the Anosy Region of south-east Madagascar. An exploration of functional relationships between government, mining business and civil society stakeholders reveals an equivocal legitimacy of certain civil society representatives, created by state manipulation, which contributes to community disempowerment. The appointment of local government officials, rather than election, creates a hierarchy of upward dependencies and a culture where the majority of officials express similar views and political alliances. As a consequence, community resistance is suppressed. Voluntary mechanisms such as Corporate Social Responsibility (CSR) and the Extractive Industries Transparency Initiative (EITI) advocate community stakeholder engagement in decision making processes as a measure to achieve public accountability. In many developing countries, where there is a lack of transparency and high levels of corruption, the value of this engagement, however, is debatable. Findings from this study indicate that the power relationships which exist between stakeholders in the highly lucrative mining industry override efforts to achieve "good governance" through voluntary community engagement. The continuing challenge lies in identifying where the responsibility sits in order to address this power struggle to achieve fair representation.

An earth-system prediction initiative for the twenty-first century

The necessity and benefits for establishing the international Earth-system Prediction Initiative (EPI) are discussed by scientists associated with the World Meteorological Organization (WMO) World Weather Research Programme (WWRP), World Climate Research Programme (WCRP), International Geosphere–Biosphere Programme (IGBP), Global Climate Observing System (GCOS), and natural-hazards and socioeconomic communities. The proposed initiative will provide research and services to accelerate advances in weather, climate, and Earth system prediction and the use of this information by global societies. It will build upon the WMO, the Group on Earth Observations (GEO), the Global Earth Observation System of Systems (GEOSS) and the International Council for Science (ICSU) to coordinate the effort across the weather, climate, Earth system, natural-hazards, and socioeconomic disciplines. It will require (i) advanced high-performance computing facilities, supporting a worldwide network of research and operational modeling centers, and early warning systems; (ii) science, technology, and education projects to enhance knowledge, awareness, and utilization of weather, climate, environmental, and socioeconomic information; (iii) investments in maintaining existing and developing new observational capabilities; and (iv) infrastructure to transition achievements into operational products and services.

Lessons from the private finance initiative in the UK: benefits, problems and critical success factors

Purpose – This paper summarises the main research findings from a detailed, qualitative set of structured interviews and case studies of private finance initiative (PFI) schemes in the UK, which involve the construction of built facilities. The research, which was funded by the Foundation for the Built Environment, examines the emergence of PFI in the UK. Benefits and problems in the PFI process are investigated. Best practice, the key critical factors for success, and lessons for the future are also analysed. Design/methodology/approach – The research is based around 11 semi-structured interviews conducted with stakeholders in key PFI projects in the UK. Findings – The research demonstrates that value for money and risk transfer are key success criteria. High procurement and transaction costs are a feature of PFI projects, and the large-scale nature of PFI projects frequently acts as barrier to entry. Research limitations/implications – The research is based on a limited number of in-depth case study interviews. The paper also shows that further research is needed to find better ways to measure these concepts empirically. Practical implications – The paper is important in highlighting four main areas of practical improvement in the PFI process: value for money assessment; establishing end-user needs; developing competitive markets and developing appropriate skills in the public sector. Originality/value – The paper examines the drivers, barriers and critical success factors for PFI in the UK for the first time in detail and will be of value to property investors, financiers, and others involved in the PFI process.

The ESA climate change initiative: satellite data records for essential climate variables

Observations of Earth from space have been made for over 40 years and have contributed to advances in many aspects of climate science. However, attempts to exploit this wealth of data are often hampered by a lack of homogeneity and continuity and by insufficient understanding of the products and their uncertainties. There is, therefore, a need to reassess and reprocess satellite datasets to maximize their usefulness for climate science. The European Space Agency has responded to this need by establishing the Climate Change Initiative (CCI). The CCI will create new climate data records for (currently) 13 essential climate variables (ECVs) and make these open and easily accessible to all. Each ECV project works closely with users to produce time series from the available satellite observations relevant to users' needs. A climate modeling users' group provides a climate system perspective and a forum to bring the data and modeling communities together. This paper presents the CCI program. It outlines its benefit and presents approaches and challenges for each ECV project, covering clouds, aerosols, ozone, greenhouse gases, sea surface temperature, ocean color, sea level, sea ice, land cover, fire, glaciers, soil moisture, and ice sheets. It also discusses how the CCI approach may contribute to defining and shaping future developments in Earth observation for climate science.

Sea surface temperature climate change initiative: alternative image classification algorithms for sea-ice affected oceans

We present a Bayesian image classification scheme for discriminating cloud, clear and sea-ice observations at high latitudes to improve identification of areas of clear-sky over ice-free ocean for SST retrieval. We validate the image classification against a manually classified dataset using Advanced Along Track Scanning Radiometer (AATSR) data. A three way classification scheme using a near-infrared textural feature improves classifier accuracy by 9.9 % over the nadir only version of the cloud clearing used in the ATSR Reprocessing for Climate (ARC) project in high latitude regions. The three way classification gives similar numbers of cloud and ice scenes misclassified as clear but significantly more clear-sky cases are correctly identified (89.9 % compared with 65 % for ARC). We also demonstrate the poetential of a Bayesian image classifier including information from the 0.6 micron channel to be used in sea-ice extent and ice surface temperature retrieval with 77.7 % of ice scenes correctly identified and an overall classifier accuracy of 96 %.

SPARC Data Initiative: Comparison of water vapor climatologies from international satellite limb sounders

Within the SPARC Data Initiative, the first comprehensive assessment of the quality of 13 water vapor products from 11 limb-viewing satellite instruments (LIMS, SAGE II, UARS-MLS, HALOE, POAM III, SMR, SAGE III, MIPAS, SCIAMACHY, ACE-FTS, and Aura-MLS) obtained within the time period 1978-2010 has been performed. Each instrument's water vapor profile measurements were compiled into monthly zonal mean time series on a common latitude-pressure grid. These time series serve as basis for the "climatological" validation approach used within the project. The evaluations include comparisons of monthly or annual zonal mean cross sections and seasonal cycles in the tropical and extratropical upper troposphere and lower stratosphere averaged over one or more years, comparisons of interannual variability, and a study of the time evolution of physical features in water vapor such as the tropical tape recorder and polar vortex dehydration. Our knowledge of the atmospheric mean state in water vapor is best in the lower and middle stratosphere of the tropics and midlatitudes, with a relative uncertainty of. 2-6% (as quantified by the standard deviation of the instruments' multiannual means). The uncertainty increases toward the polar regions (+/- 10-15%), the mesosphere (+/- 15%), and the upper troposphere/lower stratosphere below 100 hPa (+/- 30-50%), where sampling issues add uncertainty due to large gradients and high natural variability in water vapor. The minimum found in multiannual (1998-2008) mean water vapor in the tropical lower stratosphere is 3.5 ppmv (+/- 14%), with slightly larger uncertainties for monthly mean values. The frequently used HALOE water vapor data set shows consistently lower values than most other data sets throughout the atmosphere, with increasing deviations from the multi-instrument mean below 100 hPa in both the tropics and extratropics. The knowledge gained from these comparisons and regarding the quality of the individual data sets in different regions of the atmosphere will help to improve model-measurement comparisons (e.g., for diagnostics such as the tropical tape recorder or seasonal cycles), data merging activities, and studies of climate variability.