(Table 2) Radiocarbon contents of TOC and alkenone samples

Radiocarbon age relationships between co-occurring planktic foraminifera, alkenones, and total organic carbon in sediments from the continental margins of southern Chile, northwest Africa, and the South China Sea were compared with published results from the Namibian margin. Age relationships between the sediment components are site-specific and relatively constant over time. Similar to the Namibian slope, where alkenones have been reported to be 1000-4500 years older than co-occurring foraminifera, alkenones were significantly (~1000 years) older than co-occurring foraminifera in the Chilean margin sediments. In contrast, alkenones and foraminifera were of similar age (within 2 sigma error or better) in the NW African and South China Sea sediments. Total organic matter and alkenone ages were similar off Namibia (age difference TOC alkenones: 200-700 years), Chile (100-450 years), and NW Africa (360-770 years), suggesting minor contributions of preaged terrigenous material. In the South China Sea, total organic carbon is significantly (2000-3000 years) older owing to greater inputs of preaged terrigenous material. Age offsets between alkenones and planktic foraminifera are attributed to lateral advection of organic matter. Physical characteristics of the depositional setting, such as seafloor morphology, shelf width, and sediment composition, may control the age of co-occurring sediment components. In particular, offsets between alkenones and foraminifera appear to be greatest in deposition centers in morphologic depressions. Aging of organic matter is promoted by transport. Age offsets are correlated with organic richness, suggesting that formation of organic aggregates is a key process.

Space-Time Smoothing Models for Surveillance and Complex Survey Data

Thesis (Ph.D.)--University of Washington, 2016-06

Optimising care of acute coronary syndromes in three Australian hospitals

Objective. To improve quality of in-hospital care of patients with acute coronary syndromes using a multifaceted quality improvement program. Design. Prospective, before and after study of the effects of quality improvement interventions between October 2000 and August 2002. Quality of care of patients admitted between 1 October 2000 and 16 April 2001 (baseline) was compared with that of those admitted between 15 February 2002 and 31 August 2002 (post-intervention). Setting. Three teaching hospitals in Brisbane, Australia. Study participants. Consecutive patients (n = 1594) admitted to hospital with acute coronary syndrome [mean age 68 years (SD 14 years); 65% males]. Interventions. Clinical guidelines, reminder tools, and educational interventions; 6-monthly performance feedback; pharmacist-mediated patient education program; and facilitation of multidisciplinary review of work practices. Main outcome measures. Changes in key quality indicators relating to timing of electrocardiogram (ECG) and thrombolysis in emergency departments, serum lipid measurement, prescription of adjunctive drugs, and secondary prevention. Results. Comparing post-intervention with baseline patients, increases occurred in the proportions of eligible patients: (i) undergoing timely ECG (70% versus 61%; P = 0.04); (ii) prescribed angiotensin-converting enzyme inhibitors (70% versus 60%; P = 0.002) and lipid-lowering agents (77% versus 68%; P = 0.005); (iii) receiving cardiac counselling in hospital (57% versus 48%; P = 0.009); and (iv) referred to cardiac rehabilitation (17% versus 8%; P < 0.001). Conclusions. Multifaceted approaches can improve care processes for patients hospitalized with acute coronary syndromes. Care processes under direct clinician control changed more quickly than those reliant on complex system factors. Identifying and overcoming organizational impediments to quality improvement deserves greater attention.

Stock price distributions and news:evidence from index options

We estimate the shape of the distribution of stock prices using data from options on the underlying asset, and test whether this distribution is distorted in a systematic manner each time a particular news event occurs. In particular we look at the response of the FTSE100 index to market wide announcements of key macroeconomic indicators and policy variables. We show that the whole distribution of stock prices can be distorted on an event day. The shift in distributional shape happens whether the event is characterized as an announcement occurrence or as a measured surprise. We find that larger surprises have proportionately greater impact, and that higher moments are more sensitive to events however characterised.

An investigation of thin amorphous carbon-based sputtered coatings for MEMS and micro-engineering applications

The work presented in this thesis describes an investigation into the production and properties of thin amorphous C films, with and without Cr doping, as a low wear / friction coating applicable to MEMS and other micro- and nano-engineering applications. Firstly, an assessment was made of the available testing techniques. Secondly, the optimised test methods were applied to a series of sputtered films of thickness 10 - 2000 nm in order to: (i) investigate the effect of thickness on the properties of coatingslcoating process (ii) investigate fundamental tribology at the nano-scale and (iii) provide a starting point for nanotribological coating optimisation at ultra low thickness. The use of XPS was investigated for the determination of Sp3/Sp2 carbon bonding. Under C 1s peak analysis, significant errors were identified and this was attributed to the absence of sufficient instrument resolution to guide the component peak structure (even with a high resolution instrument). A simple peak width analysis and correlation work with C KLL D value confirmed the errors. The use of XPS for Sp3/Sp2 was therefore limited to initial tentative estimations. Nanoindentation was shown to provide consistent hardness and reduced modulus results with depth (to < 7nm) when replicate data was suitably statistically processed. No significant pile-up or cracking of the films was identified under nanoindentation. Nanowear experimentation by multiple nanoscratching provided some useful information, however the conditions of test were very different to those expect for MEMS and micro- / nano-engineering systems. A novel 'sample oscillated nanoindentation' system was developed for testing nanowear under more relevant conditions. The films were produced in an industrial production coating line. In order to maximise the available information and to take account of uncontrolled process variation a statistical design of experiment procedure was used to investigate the effect of four key process control parameters. Cr doping was the most significant control parameter at all thicknesses tested and produced a softening effect and thus increased nanowear. Substrate bias voltage was also a significant parameter and produced hardening and a wear reducing effect at all thicknesses tested. The use of a Cr adhesion layer produced beneficial results at 150 nm thickness, but was ineffective at 50 nm. Argon flow to the coating chamber produced a complex effect. All effects reduced significantly with reducing film thickness. Classic fretting wear was produced at low amplitude under nanowear testing. Reciprocating sliding was produced at higher amplitude which generated three body abrasive wear and this was generally consistent with the Archard model. Specific wear rates were very low (typically 10-16 - 10-18 m3N-1m-1). Wear rates reduced exponentially with reduced film thickness and below (approx.) 20 nm, thickness was identified as the most important control of wear.

Resonance studies of artificial earth satellites

Orbit determination from artificial satellite observations is a key process in obtaining information about the Earth and its environment. A study of the perturbations experienced by these satellites enables knowledge to be gained of the upper atmosphere, the gravity field, ocean tides, solid-Earth tides and solar radiation. The gravity field is expressed as a double infinite series of associated Legendre functions (tesseral harmonics). In contemporary global gravity field models the overall geoid is well determined. An independent check on these gravity field harmonics of a particular order may be made by analysis of satellites that pass through resonance of that order. For such satellites the perturbations of the orbital elements close to resonance are analysed to derive lumped harmonic coefficients. The orbital parameters of 1984-106A have been determined at 43 epochs, during which time the satellite was close to 14th order resonance. Analysis of the inclination and eccentricity yielded 6 lumped harmonic coefficients of order 14 whilst analysis of the mean motion yielded additional pairs of lumped harmonics of orders 14, 28 and 42, with the 14th order harmonics superseding those obtained from analysis of the inclination. This thesis concentrates in detail on the theoretical changes of a near-circular satellite orbit perturbed by the Earth's gravity field under the influence of minimal air-drag whilst in resonance with the Earth. The satellite 1984-106A experienced the interesting property of being temporarily trapped with respect to a secondary resonance parameter due to the low air-drag in 1987. This prompted the theoretical investigation of such a phenomenon. Expressions obtained for the resonance parameter led to the determination of 8 lumped harmonic coefficients, coincidental to those already obtained. All the derived lumped harmonic values arc used to test the accuracy of contemporary gravity field models and the underlying theory in this thesis.

Obstacles and solutions to maximising biodiversity in major urban development schemes

The current rate of global biodiversity loss led many governments to sign the international agreement ‘Halting Biodiversity Loss by 2010 and beyond’ in 2001. The UK government was one of these and has a number of methods to tackle this, such as: commissioning specific technical guidance and supporting the UK Biodiversity Acton Plan (BAP) targets. However, by far the most effective influence the government has upon current biodiversity levels is through the town planning system. This is due to the control it has over all phases of a new development scheme’s lifecycle.There is an increasing myriad of regulations, policies and legislation, which deal with biodiversity protection and enhancement across the hierarchical spectrum: from the global and European level, down to regional and local levels. With these drivers in place, coupled with the promotion of benefits and incentives, increasing biodiversity value ought to be an achievable goal on most, if not all development sites. However, in the professional world, this is not the case due to a number of obstructions. Many of these tend to be ‘process’ barriers, which are particularly prevalent with ‘urban’ and ‘major’ development schemes, and is where the focus of this research paper lies.The paper summarises and discusses the results of a questionnaire survey, regarding obstacles to maximising biodiversity enhancements on major urban development schemes. The questionnaire was completed by Local Government Ecologists in England. The paper additionally refers to insights from previous action research, specialist interviews, and case studies, to reveal the key process obstacles.Solutions to these obstacles are then alluded to and recommendations are made within the discussion.

The role of apoptotic cell clearance in a high-lipid environment:links to ageing

Individuals within the aged population show an increased susceptibility to infection, implying a decline in immune function, a phenomenon known as immunosenescence. Paradoxically, an increase in autoimmune disease, such as rheumatoid arthritis, is also associated with ageing, therefore some aspects of the immune system appear to be inappropriately active in the elderly. The above evidence suggests inappropriate control of the immune system as we age. Macrophages, and their precursors monocytes, play a key role in control of the immune system. They play an important role in host defence in the form of phagocytosis, and also link the innate and adaptive immune system via antigen presentation. Macrophages also have a reparative role, as professional phagocytes of dead and dying cells. Clearance of apoptotic cells by macrophages has also been shown to directly influence immune responses in an anti-inflammatory manner. Inappropriate control of macrophage function with regards to dead cell clearance may contribute to pathology as we age. The aims of this study were to assess the impact of lipid treatment, as a model of the aged environment, on the ability of macrophages to interact with, and respond to, apoptotic cells. Using a series of in vitro cell models, responses of macrophages (normal and lipid-loaded) to apoptotic macrophages (normal and lipid-loaded) were investigated. Monocyte recruitment to apoptotic cells, a key process in resolving inflammation, was assessed in addition to cytokine responses. Data here shows, for the first time, that apoptotic macrophages (normal and lipid-loaded) induce inflammation in human monocyte-derived macrophages, a response that could drive inflammation in age-associated pathology e.g. atherosclerosis. Monoclonal antibody inhibition studies suggest the classical chemokine CX3CL1 may be involved in monocyte recruitment to apoptotic macrophages, but not apoptotic foam cells, therefore differential clearance strategies may be employed following lipid-loading. CD14, an important apoptotic cell tethering receptor, was not found to have a prominent role in this process, whilst the role for ICAM-3 remains unclear. Additionally, a small pilot study using macrophages from young (<25) and mid-life (>40) donors was undertaken. Preliminary data was gathered to assess the ability of primary human monocyte-derived macrophages, from young and mid-life donors, to interact with, and respond to, apoptotic cells. MØ from mid-life individuals showed no significant differences in their ability to respond to immune modulation by apoptotic cells compared to MØ from young donors. Larger cohorts would be required to investigate whether immune modulation of MØ by apoptotic cells contribute to inflammatory pathology throughout ageing.

Network learning:Exploring learning by interorganizational networks

The importance of interorganizational networks in supporting or hindering the achievement of organizational objectives is now widely acknowledged. Network research is directed at understanding network processes and structures, and their impact upon performance. A key process is learning. The concepts of individual, group and organizational learning are long established. This article argues that learning might also usefully be regarded as occurring at a fourth system level, the interorganizational network. The concept of network learning - learning by a group of organizations as a group - is presented, and differentiated from other types of learning, notably interorganizational learning (learning in interorganizational contexts). Four cases of network learning are identified and analysed to provide insights into network learning processes and outcomes. It is proposed that 'network learning episode' offers a suitable unit of analysis for the empirical research needed to develop our understanding of this potentially important concept.

Comparison of the measurement performance of high precision multi-axis metal cutting machine tools

High precision manufacturers continuously seek out disruptive technologies to improve the quality, cost, and delivery of their products. With the advancement of machine tool and measurement technology many companies are ready to capitalise on the opportunity of on-machine measurement (OMM). Coupled with business case, manufacturing engineers are now questioning whether OMM can soon eliminate the need for post-process inspection systems. Metrologists will however argue that the machining environment is too hostile and that there are numerous process variables which need consideration before traceable measurement on-the-machine can be achieved. In this paper we test the measurement capability of five new multi-axis machine tools enabled as OMM systems via on-machine probing. All systems are tested under various operating conditions in order to better understand the effects of potentially significant variables. This investigation has found that key process variables such as machine tool warm-up and tool-change cycles can have an effect on machine tool measurement repeatability. New data presented here is important to many manufacturers whom are considering utilising their high precision multi-axis machine tools for both the creation and verification of their products.

Sharing of value in business relationships:a theoretical model

This paper explores the sharing of value in business transactions. Although there is an increased usage of the terminology of value in marketing (such concepts as value based selling and pricing), as well as in purchasing (value-based purchasing), the definition of the term is still vague. In order to better understand the definition of value, the author’s argue that it is important to understand the sharing of value, in general and the element of power for the sharing of value in particular. The aim of this paper is to add to this debate and this requires us to critique the current models. The key process that the analysis of power will help to explain is the division of the available revenue stream flowing up the chain from the buyer's customers. If the buyer and supplier do not cooperate, then power will be key in the sharing of that money flow. If buyers and suppliers fully cooperate, they may be able to reduce their costs and/or increase the quality of the sales offering the buyer makes to their customer.

Validação do instrumento dos indicadores observáveis da qualidade do cuidado em instituições de longa permanência para idosos

The Nursing Homes are an important alternative care in the world, but Brazil still has no valid instrument to monitor the quality these institutions. In the United States, the Observable Indicators of Nursing Home Care Quality Instrument (OIQ) is used to assess the quality of Nursing Home care using 30 indicators of structure (2 dimensions) and process (5 dimensions) related to quality person-centered care. The present study aimed at cross-culturally adapting the OIQ in order to evaluate the quality of Nursing Home care in Brazil. Conceptual and item equivalence were determined to assess the relevance and viability of OIQ in the Brazilian context, using the Content Validity Index (CVI) and a group of specialists composed of 10 participants directly involved in the object of study. Next, operational, idiomatic and semantic equivalence were carried out concurrently. This consisted of 5 phases: (1) two translations and (2) their respective back translations; (3) formal appraisal of referential and general meaning; (4) review by a second group of specialists; (5) application of the pretest at three Nursing Homes by different social entities: health professionals, sanitary surveillance regulators and potential consumers. Measurement equivalence was evaluated by the Cronbach’s alpha test to verify the internal consistency of the instrument. To measure inter-evaluator agreement, the General Agreement Index (ICG) and Kappa coefficient were used. Timely compliance and 95% Confidence Interval of indicators, dimensions and total construct were estimated. The CVI obtained high results for both relevance (95.3%) and viability (94.3%) in the Brazilian context. With respect to referential meaning, similarity was observed, ranging between 90-100% for the first back translation and 70-100% for the second. In relation to general meaning, version 1 was better, classified as “unchanged” in 80% of the items, whereas in version 2 it was only 47%. In the pretest, the OIQ was easy to understand and apply. The following outcomes were obtained: a high Cronbach’s alpha (0.93), satisfactory ICG (75%) and substantial agreement between the pairs of evaluators (health professionals, regulators from the Superintendency of Sanitary Surveillance –SUVISA-, and potential consumers), according to the Kappa coefficient (0.65). It´s possible take the operational equivalence held since it preserved the original layout in the Brazilian version from the maintenance in application mode, response options, number of items, statements and scores. The performance of nursing homes obtained approximate average scores of 87, a variation 55-111 considering a range from 30 to 150 points. The worst outcomes were related to process indicators with a mean of 2.8 per item, while structure was 3.75 on a scale of 1 to 5. The lowest score was obtained for the care dimension (mean 2). The OIQ version was deemed to be a valid and reliable instrument in the Brazilian context. It is recommended that health professionals, regulators and potential consumers adopt it to access and monitor the quality of Nursing Home care and demonstrating opportunities for improvement.

Compilation of organic carbon distribution and sedimentology in the surface sediments on the continental margin offshore southwestern Africa

In this study we demonstrate the relevance of lateral particle transport in nepheloid layers for organic carbon (OC) accumulation and burial across high-productive continental margins. We present geochemical data from surface sediments and suspended particles in the bottom nepheloid layer (BNL) from the most productive coastal upwelling area of the modern ocean, the Benguela upwelling system offshore southwest Africa. Interpretation of depositional patterns and comparison of downslope trends in OC content, organic matter composition, and 14C age between suspended particles and surface sediments indicate that lateral particle transport is the primary mechanism controlling supply and burial of OC. We propose that effective seaward particle transport primarily along the BNL is a key process that promotes and maintains local high sedimentation rates, ultimately causing high preservation of OC in a depocenter on the upper slope offshore Namibia. As lateral transport efficiently displaces areas of enhanced OC burial from maximum production at highly productive continental margins, vertical particle flux models do not sufficiently explain the relationship between primary production and shallow-marine OC burial. On geologic time scales, the widest distribution and strongest intensity of lateral particle transport is expected during periods of rapid sea-level change. At times in the geologic past, widespread downslope lateral transport of OC thus may have been a primary driver of enhanced OC burial at deeper continental slopes and abyssal basins.

Dissolution of a spatially variable DNAPL (dense non aqueous phase liquid) source

Dissolution of non-aqueous phase liquids (NAPLs) or gases into groundwater is a key process, both for contamination problems originating from organic liquid sources, and for dissolution trapping in geological storage of CO2. Dissolution in natural systems typically will involve both high and low NAPL saturations and a wide range of pore water flow velocities within the same source zone for dissolution to groundwater. To correctly predict dissolution in such complex systems and as the NAPL saturations change over time, models must be capable of predicting dissolution under a range of saturations and flow conditions. To provide data to test and validate such models, an experiment was conducted in a two-dimensional sand tank, where the dissolution of a spatially variable, 5x5 cm**2 DNAPL tetrachloroethene source was carefully measured using x-ray attenuation techniques at a resolution of 0.2x0.2 cm**2. By continuously measuring the NAPL saturations, the temporal evolution of DNAPL mass loss by dissolution to groundwater could be measured at each pixel. Next, a general dissolution and solute transport code was written and several published rate-limited (RL) dissolution models and a local equilibrium (LE) approach were tested against the experimental data. It was found that none of the models could adequately predict the observed dissolution pattern, particularly in the zones of higher NAPL saturation. Combining these models with a model for NAPL pool dissolution produced qualitatively better agreement with experimental data, but the total matching error was not significantly improved. A sensitivity study of commonly used fitting parameters further showed that several combinations of these parameters could produce equally good fits to the experimental observations. The results indicate that common empirical model formulations for RL dissolution may be inadequate in complex, variable saturation NAPL source zones, and that further model developments and testing is desirable.

Task sharing within a managed clinical network to improve child health in Malawi

BACKGROUND: Eighty per cent of Malawi's 8 million children live in rural areas, and there is an extensive tiered health system infrastructure from village health clinics to district hospitals which refers patients to one of the four central hospitals. The clinics and district hospitals are staffed by nurses, non-physician clinicians and recently qualified doctors. There are 16 paediatric specialists working in two of the four central hospitals which serve the urban population as well as accepting referrals from district hospitals. In order to provide expert paediatric care as close to home as possible, we describe our plan to task share within a managed clinical network and our hypothesis that this will improve paediatric care and child health.

PRESENTATION OF THE HYPOTHESIS: Managed clinical networks have been found to improve equity of care in rural districts and to ensure that the correct care is provided as close to home as possible. A network for paediatric care in Malawi with mentoring of non-physician clinicians based in a district hospital by paediatricians based at the central hospitals will establish and sustain clinical referral pathways in both directions. Ultimately, the plan envisages four managed paediatric clinical networks, each radiating from one of Malawi's four central hospitals and covering the entire country. This model of task sharing within four hub-and-spoke networks may facilitate wider dissemination of scarce expertise and improve child healthcare in Malawi close to the child's home.

TESTING THE HYPOTHESIS: Funding has been secured to train sufficient personnel to staff all central and district hospitals in Malawi with teams of paediatric specialists in the central hospitals and specialist non-physician clinicians in each government district hospital. The hypothesis will be tested using a natural experiment model. Data routinely collected by the Ministry of Health will be corroborated at the district. This will include case fatality rates for common childhood illness, perinatal mortality and process indicators. Data from different districts will be compared at baseline and annually until 2020 as the specialists of both cadres take up posts.

IMPLICATIONS OF THE HYPOTHESIS: If a managed clinical network improves child healthcare in Malawi, it may be a potential model for the other countries in sub-Saharan Africa with similar cadres in their healthcare system and face similar challenges in terms of scarcity of specialists.