A national survey of the mangement of delirium in UK intensive care units

Background: Delirium is an acute organ dysfunction common amongst patients treated in intensive care units. The associated morbidity and mortality are known to be substantial. Previous surveys have described which screening tools are used to diagnose delirium and which medications are used to treat delirium, but these data are not available for the United Kingdom. Aim: This survey aimed to describe the UK management of delirium by consultant intensivists. Additionally, knowledge and attitudes towards management of delirium were sought. The results will inform future research in this area. Methods: A national postal survey of members of the UK Intensive Care Society was performed. A concise two page questionnaire survey was sent, with a second round of surveys sent to non-respondents after 6 weeks. The questionnaire was in tick-box format. Results: Six hundred and eighty-one replies were received from 1308 questionnaires sent, giving a response rate of 52%. Twenty-five percent of respondents routinely screen for delirium, but of these only 55% use a screening tool validated for use in intensive care. The majority (80%) of those using a validated instrument used the Confusion Assessment Method for the Intensive Care Unit. Hyperactive delirium is treated pharmacologically by 95%; hypoactive delirium is treated pharmacologically by 25%, with haloperidol the most common agent used in both. Over 80% of respondents agreed that delirium prolongs mechanical ventilation and hospital stay and requires active treatment. Conclusions: This UK survey demonstrates screening for delirium is sporadic. Pharmacological treatment is usually with haloperidol in spite of the limited evidence to support this practice. Hypoactive delirium is infrequently treated pharmacologically.

The VLT-FLAMES survey of massive stars: observations centered on the Magellanic Cloud clusters NGC 330, NGC 346, NGC 2004, and the N11 region

We present new observations of 470 stars using the Fibre Large Array Multi-Element Spectrograph ( FLAMES) instrument in fields centered on the clusters NGC330 and NGC346 in the Small Magellanic Cloud (SMC), and NGC2004 and the N11 region in the Large Magellanic Cloud (LMC). A further 14 stars were observed in the N11 and NGC330 fields using the Ultraviolet and Visual Echelle Spectrograph (UVES) for a separate programme. Spectral classifications and stellar radial velocities are given for each target, with careful attention to checks for binarity. In particular, we have investigated previously unexplored regions around the central LH9/LH10 complex of N11, finding similar to 25 new O-type stars from our spectroscopy. We have observed a relatively large number of Be-type stars that display permitted Fe II emission lines. These are primarily not in the cluster cores and appear to be associated with classical Be-type stars, rather than pre main-sequence objects. The presence of the Fe II emission, as compared to the equivalent width of Ha, is not obviously dependent on metallicity. We have also explored the relative fraction of Be- to normal B-type stars in the field-regions near to NGC330 and NGC2004, finding no strong evidence of a trend with metallicity when compared to Galactic results. A consequence of service observations is that we have reasonable time-sampling in three of our FLAMES fields. We find lower limits to the binary fraction of O- and early B-type stars of 23 to 36%. One of our targets (NGC346-013) is especially interesting with a massive, apparently hotter, less luminous secondary component.

Measuring material deprivation with EU-SILC: Lessons from the Irish survey

In this paper we consider the consequences for measurement of material deprivation, consistent poverty and economic vulnerability of the shift from the ECHP data set to the EU-SILC instrument. Despite the restricted number of deprivation items available in EU-SILC, we show that there is a substantial overlap between such measures when they are estimated using EU-wide and a set of Irish specific indicators. By placing the EU-wide measures in the context of the full range of Irish indicators, we demonstrate that they allow us to identify clusters of individuals sharply differentiated in terms of their multidimensional deprivation profiles. They also provide an understanding of the socio-economic factors associated with such differentiation that departs in only modest respects from that derived from the more comprehensive set of Irish specific indicators.

Choosing appropriate patient-reported outcomes instrument for glaucoma research: a systematic review of vision instruments

PURPOSE: To identify vision Patient-Reported Outcomes instruments relevant to glaucoma and assess their content validity.

METHODS: MEDLINE, MEDLINE in Process, EMBASE and SCOPUS (to January 2009) were systematically searched. Observational studies or randomised controlled trials, published in English, reporting use of vision instruments in glaucoma studies involving adults were included. In addition, reference lists were scanned to identify additional studies describing development and/or validation to ascertain the final version of the instruments. Instruments' content was then mapped onto a theoretical framework, the World Health Organization International Classification of Functioning, Disability and Health. Two reviewers independently evaluated studies for inclusion and quality assessed instrument content.

RESULTS: Thirty-three instruments were identified. Instruments were categorised into thirteen vision status, two vision disability, one vision satisfaction, five glaucoma status, one glaucoma medication related to health status, five glaucoma medication side effects and six glaucoma medication satisfaction measures according to each instruments' content. The National Eye Institute Visual Function Questionnaire-25, Impact of Vision Impairment and Treatment Satisfaction Survey-Intraocular Pressure had the highest number of positive ratings in the content validity assessment.

CONCLUSION: This study provides a descriptive catalogue of vision-specific PRO instruments, to inform the choice of an appropriate measure of patient-reported outcomes in a glaucoma context.

The Next Generation Transit Survey (NGTS)

The Next Generation Transit Survey (NGTS) is a new ground-based sky survey designed to find transiting Neptunes and super-Earths. By covering at least sixteen times the sky area of Kepler we will find small planets around stars that are sufficiently bright for radial velocity confirmation, mass determination and atmospheric characterisation. The NGTS instrument will consist of an array of twelve independently pointed 20cm telescopes fitted with red-sensitive CCD cameras. It will be constructed at the ESO Paranal Observatory, thereby benefiting from the very best photometric conditions as well as follow up synergy with the VLT and E-ELT. Our design has been verified through the operation of two prototype instruments, demonstrating white noise characteristics to sub-mmag photometric precision. Detailed simulations show that about thirty bright super-Earths and up to two hundred Neptunes could be discovered. Our science operations are due to begin in 2014.

Cosmological Constraints from Measurements of Type Ia Supernovae Discovered During the First 1.5 Yr of the Pan-STARRS1 Survey

We present griz_P1 light curves of 146 spectroscopically confirmed Type Ia supernovae (SNe Ia; 0.03 < z < 0.65) discovered during the first 1.5 yr of the Pan-STARRS1 Medium Deep Survey. The Pan-STARRS1 natural photometric system is determined by a combination of on-site measurements of the instrument response function and observations of spectrophotometric standard stars. We find that the systematic uncertainties in the photometric system are currently 1.2% without accounting for the uncertainty in the Hubble Space Telescope Calspec definition of the AB system. A Hubble diagram is constructed with a subset of 113 out of 146 SNe Ia that pass our light curve quality cuts. The cosmological fit to 310 SNe Ia (113 PS1 SNe Ia + 222 light curves from 197 low-z SNe Ia), using only supernovae (SNe) and assuming a constant dark energy equation of state and flatness, yields w = -1.120^+0.360_-0.206(Stat)^+0.269_0.291(Sys). When combined with BAO+CMB(Planck)+H₀, the analysis yields Ω_M = 0.280^+0.013_0.012 and w = -1.166^+0.072_-0.069 including all identified systematics. The value of w is inconsistent with the cosmological constant value of -1 at the 2.3σ level. Tension endures after removing either the baryon acoustic oscillation (BAO) or the H₀ constraint, though it is strongest when including the H₀ constraint. If we include WMAP9 cosmic microwave background (CMB) constraints instead of those from Planck, we find w = -1.124^+0.083_-0.065, which diminishes the discord to <2σ. We cannot conclude whether the tension with flat ΛCDM is a feature of dark energy, new physics, or a combination of chance and systematic errors. The full Pan-STARRS1 SN sample with ∼three times as many SNe should provide more conclusive results.

Measuring curriculum integration in the junior grades: the design of an instrument

This study \Alas initiated in response to the Junior Division Review (1985) publ ished by the Ministry of Education for the Province of Ontario. Curriculum integration is an element used within the educational paradigm designed by the Ontario Ministry of Education. It is a term frequent1y verbal ized b>' educators in this province, but because of 1 imi ted resource support regarding this methodology, it was open to broad interpretation resulting in an extreme v ar i at i on i nit simp 1 eme n tat i on • I n de ed, the Min i s try intimated that it was not occurring to any significant degree across the province. The objective of this thes is was· to define integration in the junior classroom and de-:.ign a meas.ur·ement in-:.tr-ument which would in turn high 1 i gh t indicators of curriculum integration. The :.tudy made a prel iminary, field-based survey of educa tiona 1 professionals in order to generate a relevant description of integrated curr-iculum programm i ng as def i ned in the j un i or classroom. The description was a compilation of views expressed by a random selection of teachers, consultants, supervisory officers and principals. The survey revea 1 ed a much more comprehens i ve vi et·<,l of the attributes of integrated programming than tradition would dictate and resulted in a functional definition tha t was broader than past prac t ices. Based on the information generated by this survey, an instrument ou t 1 in i ng program cr iter i a of was devised. an integrated junior cla~·sroom Th i s measuremen t i nstrumen t , designed for all levels of educators, was named uThe Han~.son I nstrumen t for the Measuremen t of Program Integrat ion in the Jun i or Cl assroom". It refl ected five categories intrinsic to the me thodol ogy of integration: Teacher Behaviour, Student Behaviour, Classroom Layout, Cl as~·r oom Environment and Progr amm i ng. Each category and the items therein were successfully tested in val idi ty and rel iabi 1 i ty checKs. Interestingly, the individual class was found to be the major variable programming in in the measuremen t the j un i or d i vis i on • of The integrated instrument demonstrated potential not onl)' a~· an initial measure of the degree of integrated curriculum, but as a guide to strategies to implement such a methodology.

Attitudes stigmatisantes envers les personnes vivant avec le VIH : développement et validation d’un instrument de mesure intégrant un dispositif participatif

Contexte : De manière générale, on considère que le processus de validation d’un instrument de mesure porte sur la validité et la fiabilité. Or, la nature dynamique et évolutive de certaines problématiques, comme la stigmatisation des personnes vivant avec le VIH (PVVIH), laisse croire qu’il est particulièrement important de réinvestir rapidement dans la pratique, les résultats produits par les mesures ainsi validées. Objectifs : La présente thèse vise à développer et valider une échelle de mesure des attitudes stigmatisantes envers les PVVIH en intégrant un dispositif participatif. La thèse utilise en partie les données d’une enquête de surveillance des attitudes envers les PVVIH au Québec, elle comporte trois études qui répondent aux trois objectifs spécifiques suivants : (1) valider la version révisée d’un instrument de mesure des attitudes favorables à la stigmatisation dans la population générale du Québec envers les PVVIH; (2) analyser la relation entre la mesure des attitudes favorables à la stigmatisation et le recours au dépistage du VIH dans la population générale du Québec; (3) décrire et analyser les processus de circulation et d’utilisation des connaissances produites par l’instrument de mesure dans les réseaux professionnels des membres d’un comité consultatif. Méthodes : Un comité consultatif réunissant plusieurs partenaires issus de différents milieux a été constitué dès l’obtention de la subvention. Il a été consulté et informé avant, pendant et après l’enquête téléphonique populationnelle (n=1500) ayant permis de colliger les données. L’Échelle des Attitudes Stigmatisantes envers les Personnes Vivant avec le VIH (EASE-PVVIH) a été validée au moyen de plusieurs analyses psychométriques : analyses factorielles exploratoires et confirmatives, corrélations, régression linéaire multiple, test-t, tests d’hypothèses d’invariance de la structure factorielle et alphas de Cronbach (objectif 1). L’association entre les attitudes favorables à la stigmatisation et le recours au dépistage du VIH a été testée à l’aide de régressions logistiques hiérarchiques (objectif 2). Quant aux processus de circulation et d’utilisation des connaissances dans les réseaux professionnels, ils ont été analysés au moyen d’une étude de cas rétrospective (objectif 3). Résultats : Les analyses ont révélé trois résultats importants. Premièrement, d’un point de vue psychométrique, l’EASE-PVVIH est un outil fiable et valide pour mesurer les attitudes stigmatisantes envers les personnes vivant avec le VIH. Deuxièmement, sous une certaine forme caractérisée par l’inquiétude éprouvée lors de rencontres occasionnelles, les attitudes stigmatisantes par rapport aux personnes vivant avec le VIH semblent nuire au recours au test de dépistage dans la population générale au Québec. Troisièmement, un dispositif participatif en particulier, soit un comité consultatif, semble être un moyen pour favoriser le réinvestissement rapide et étendre la portée des résultats produits par la recherche dans des actions concrètes de santé publique. Conclusion : Ces résultats mettent en lumière la portée d’un dispositif participatif pour la validation d’instrument de mesure. L’arrimage entre les préoccupations scientifiques et pratiques apparaît être une avenue prometteuse pour améliorer la qualité et la pertinence sociale des données produites par les mesures.

Ressources résidentielles pour adultes avec un trouble mental : développement d'un modèle et d'un instrument de mesure

Ce projet de recherche revisite la conceptualisation du logement et des ressources résidentielles pour les adultes avec un trouble mental. Les objectifs visent : (1) à identifier les attributs, dimensions et domaines ; (2) à développer un nouveau modèle ; (3) à concevoir un instrument de mesure pour décrire l’éventail des ressources résidentielles en santé mentale. Méthodologie : Phase 1: Le devis de recherche s’articule autour de la cartographie de concepts, caractérisée par une méthodologie mixte. L’échantillonnage, par choix raisonné, a permis de recueillir une pluralité de perceptions et d’expériences (p.ex. personnes utilisatrices de services, proches, responsables de ressources résidentielles, gestionnaires). Les participants proviennent de cinq régions du Québec (nombre total de participations = 722). Au cours des six étapes de la cartographie de concepts, les participants ont généré des attributs décrivant le logement (n = 221), leur ont accordé une cote numérique (n = 416) et les ont regroupés en catégories (n = 73). Douze participants ont interprété des cartes conceptuelles produites par des analyses multivariées, soit l’échelonnage multidimensionnel (MDS) et la typologie hiérarchique. Des analyses par composantes principales (PCAs) ont été utilisées pour raffiner la conceptualisation (n = 228). Phase II: L’instrument a été développé, utilisé et ajusté à la suite de deux groupes de discussions (n = 23) et d’une étude transversale auprès de ressources résidentielles (n = 258). La passation se fait via une entrevue téléphonique semi-structurée enregistrée, d’une durée moyenne de 130 minutes. Résultats : Les participants ont généré 1382 idées (99.5% de saturation). Les cartes conceptuelles issues de la cartographie de concepts comprennent 140 idées (attributs du logement), 12 dimensions et cinq domaines (indice de stress MDS = 0.2302, 10 itérations). Les analyses PCAs ont permis de retenir quatre domaines, 11 composantes (α = 0.600 à 0.933) et 81 attributs. Les domaines sont : (1) environnement géophysique; (2) atmosphère et fonctionnement du milieu; (3) soutien et interventions offerts; (4) pratiques organisationnelles et managériales. L’instrument développé comprend quatre domaines, 10 dimensions et 83 attributs. À cela s’ajoutent des variables descriptives. L’instrument résulte des Phases I et II de ce projet. Conclusion : L’instrument a été développé en collaboration avec diverses parties prenantes, à partir de considérations ontologiques, réalistes, causales et statistiques. Il dresse le profil détaillé d’une ressource résidentielle sous ses différentes facettes et s’appuie sur la prémisse qu’il n’existe pas de milieu résidentiel idéal pour tous.

Development of an instrument to assess Human Resource Quality (HRQ) and measuring the impact of TQM efforts on HRQ using the instrument

This research is aimed at developing an instrument for measuring human resource quality in organizations. The researcher has developed the instrument for measuring HRQ based on extensive literature survey and expert opinion. Statistical validity of the Instrument has also been established. This instrument was used to measure the changes in Human Resource Quality in selected organizations wherein quality management practices are being implemented. Data collected was analyzed and presented in this thesis. It has been found that there are significant changes in all the indicators of Human Resource Quality. There is improvement in Cultural Change Index(CCI), Quality of Work Life Index(QWLI) and Employee Satisfaction Index(ESI). The Human Resource Quality index has also increased significantly in all the organizations. It has been observed from the study that implementation of TQM leads to significant changes in Human Resource Quality. This instrument is capable of measuring minor variations in each indicator of HRQ and can be used to identify areas of weakness and strength in the case of Human Resource Quality. The instrument can further be modified by future research. This research work provided excellent opportunities for the researcher for self-development and has made him confident to undertake such activities for the benefit of the learning community.

Characterization of human and instrument related measurement errors

Measurement is the act or the result of a quantitative comparison between a given quantity and a quantity of the same kind chosen as a unit. It is generally agreed that all measurements contain errors. In a measuring system where both a measuring instrument and a human being taking the measurement using a preset process, the measurement error could be due to the instrument, the process or the human being involved. The first part of the study is devoted to understanding the human errors in measurement. For that, selected person related and selected work related factors that could affect measurement errors have been identified. Though these are well known, the exact extent of the error and the extent of effect of different factors on human errors in measurement are less reported. Characterization of human errors in measurement is done by conducting an experimental study using different subjects, where the factors were changed one at a time and the measurements made by them recorded. From the pre‐experiment survey research studies, it is observed that the respondents could not give the correct answers to questions related to the correct values [extent] of human related measurement errors. This confirmed the fears expressed regarding lack of knowledge about the extent of human related measurement errors among professionals associated with quality. But in postexperiment phase of survey study, it is observed that the answers regarding the extent of human related measurement errors has improved significantly since the answer choices were provided based on the experimental study. It is hoped that this work will help users of measurement in practice to better understand and manage the phenomena of human related errors in measurement.

What is the new medicines use review ‘patient survey’ attempting to capture in the context of existing patient satisfaction with pharmacy questionnaires and a new conceptual framework?

The community pharmacy service medicines use review (MUR) was introduced in 2005 ‘to improve patient knowledge, concordance and use of medicines’ through a private patient–pharmacist consultation. The MUR presents a fundamental change in community pharmacy service provision. While traditionally pharmacists are dispensers of medicines and providers of medicines advice, and patients as recipients, the MUR considers pharmacists providing consultation-type activities and patients as active participants. The MUR facilitates a two-way discussion about medicines use. Traditional patient–pharmacist behaviours transform into a new set of behaviours involving the booking of appointments, consultation processes and form completion, and the physical environment of the patient–pharmacist interaction moves from the traditional setting of the dispensary and medicines counter to a private consultation room. Thus, the new service challenges traditional identities and behaviours of the patient and the pharmacist as well as the environment in which the interaction takes place. In 2008, the UK government concluded there is at present too much emphasis on the quantity of MURs rather than on their quality.[1] A number of plans to remedy the perceived imbalance included a suggestion to reward ‘health outcomes’ achieved, with calls for a more focussed and scientific approach to the evaluation of pharmacy services using outcomes research. Specifically, the UK government set out the main principal research areas for the evaluation of pharmacy services to include ‘patient and public perceptions and satisfaction’as well as ‘impact on care and outcomes’. A limited number of ‘patient satisfaction with pharmacy services’ type questionnaires are available, of varying quality, measuring dimensions relating to pharmacists’ technical competence, behavioural impressions and general satisfaction. For example, an often cited paper by Larson[2] uses two factors to measure satisfaction, namely ‘friendly explanation’ and ‘managing therapy’; the factors are highly interrelated and the questions somewhat awkwardly phrased, but more importantly, we believe the questionnaire excludes some specific domains unique to the MUR. By conducting patient interviews with recent MUR recipients, we have been working to identify relevant concepts and develop a conceptual framework to inform item development for a Patient Reported Outcome Measure questionnaire bespoke to the MUR. We note with interest the recent launch of a multidisciplinary audit template by the Royal Pharmaceutical Society of Great Britain (RPSGB) in an attempt to review the effectiveness of MURs and improve their quality.[3] This template includes an MUR ‘patient survey’. We will discuss this ‘patient survey’ in light of our work and existing patient satisfaction with pharmacy questionnaires, outlining a new conceptual framework as a basis for measuring patient satisfaction with the MUR. Ethical approval for the study was obtained from the NHS Surrey Research Ethics Committee on 2 June 2008. References 1. Department of Health (2008). Pharmacy in England: Building on Strengths – Delivering the Future. London: HMSO. www. official-documents.gov.uk/document/cm73/7341/7341.pdf (accessed 29 September 2009). 2. Larson LN et al. Patient satisfaction with pharmaceutical care: update of a validated instrument. JAmPharmAssoc 2002; 42: 44–50. 3. Royal Pharmaceutical Society of Great Britain (2009). Pharmacy Medicines Use Review – Patient Audit. London: RPSGB. http:// qi4pd.org.uk/index.php/Medicines-Use-Review-Patient-Audit. html (accessed 29 September 2009).

A multi-instrument comparison of integrated water vapour measurements at a high latitude site

We compare measurements of integrated water vapour (IWV) over a subarctic site (Kiruna, Northern Sweden) from five different sensors and retrieval methods: Radiosondes, Global Positioning System (GPS), ground-based Fourier-transform infrared (FTIR) spectrometer, ground-based microwave radiometer, and satellite-based microwave radiometer (AMSU-B). Additionally, we compare also to ERA-Interim model reanalysis data. GPS-based IWV data have the highest temporal coverage and resolution and are chosen as reference data set. All datasets agree reasonably well, but the ground-based microwave instrument only if the data are cloud-filtered. We also address two issues that are general for such intercomparison studies, the impact of different lower altitude limits for the IWV integration, and the impact of representativeness error. We develop methods for correcting for the former, and estimating the random error contribution of the latter. A literature survey reveals that reported systematic differences between different techniques are study-dependent and show no overall consistent pattern. Further improving the absolute accuracy of IWV measurements and providing climate-quality time series therefore remain challenging problems.

Alcohol screening instruments in elderly male: a population-based survey in metropolitan São Paulo, Brazil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Promoting corporate social responsibility in small and medium enterprises in the Caribbean: survey results

Includes bibliography