Paediatric 'care closer to home':stake-holder views and barriers to implementation

In this study we explore the views of NHS stakeholders on providing paediatric ‘care closer to home’ (CCTH), in community-based outpatient clinics delivered by consultants. Design: Semi-structured interviews and thematic framework analysis. Setting: UK specialist children's hospital and surrounding primary care trusts. Participants: 37 NHS stakeholders including healthcare professionals, managers, commissioners and executive team members. Results: Participants acknowledged that outreach clinics would involve a change in traditional ways of working and that the physical setting of the clinic would influence aspects of professional practice. Different models of CCTH were discussed, as were alternatives for improving access to specialist care. Participants supported CCTH as a good principle for paediatric outpatient services; however the challenges of setting up and maintaining community clinics meant they questioned how far it could be achieved in practice. Conclusions: The place of service delivery is both an issue of physical location and professional identity. Policy initiatives which ignore assumptions about place, power and identity are likely to meet with limited success.

Pulse oximetry as a screening test for congenital heart defects in newborn infants: a test accuracy study with evaluation of acceptability and cost-effectiveness

Background: Screening for congenital heart defects (CHDs) relies on antenatal ultrasound and postnatal clinical examination; however, life-threatening defects often go undetected. Objective: To determine the accuracy, acceptability and cost-effectiveness of pulse oximetry as a screening test for CHDs in newborn infants. Design: A test accuracy study determined the accuracy of pulse oximetry. Acceptability of testing to parents was evaluated through a questionnaire, and to staff through focus groups. A decision-analytic model was constructed to assess cost-effectiveness. Setting: Six UK maternity units. Participants: These were 20,055 asymptomatic newborns at = 35 weeks’ gestation, their mothers and health-care staff. Interventions: Pulse oximetry was performed prior to discharge from hospital and the results of this index test were compared with a composite reference standard (echocardiography, clinical follow-up and follow-up through interrogation of clinical databases). Main outcome measures: Detection of major CHDs – defined as causing death or requiring invasive intervention up to 12 months of age (subdivided into critical CHDs causing death or intervention before 28 days, and serious CHDs causing death or intervention between 1 and 12 months of age); acceptability of testing to parents and staff; and the cost-effectiveness in terms of cost per timely diagnosis. Results: Fifty-three of the 20,055 babies screened had a major CHD (24 critical and 29 serious), a prevalence of 2.6 per 1000 live births. Pulse oximetry had a sensitivity of 75.0% [95% confidence interval (CI) 53.3% to 90.2%] for critical cases and 49.1% (95% CI 35.1% to 63.2%) for all major CHDs. When 23 cases were excluded, in which a CHD was already suspected following antenatal ultrasound, pulse oximetry had a sensitivity of 58.3% (95% CI 27.7% to 84.8%) for critical cases (12 babies) and 28.6% (95% CI 14.6% to 46.3%) for all major CHDs (35 babies). False-positive (FP) results occurred in 1 in 119 babies (0.84%) without major CHDs (specificity 99.2%, 95% CI 99.0% to 99.3%). However, of the 169 FPs, there were six cases of significant but not major CHDs and 40 cases of respiratory or infective illness requiring medical intervention. The prevalence of major CHDs in babies with normal pulse oximetry was 1.4 (95% CI 0.9 to 2.0) per 1000 live births, as 27 babies with major CHDs (6 critical and 21 serious) were missed. Parent and staff participants were predominantly satisfied with screening, perceiving it as an important test to detect ill babies. There was no evidence that mothers given FP results were more anxious after participating than those given true-negative results, although they were less satisfied with the test. White British/Irish mothers were more likely to participate in the study, and were less anxious and more satisfied than those of other ethnicities. The incremental cost-effectiveness ratio of pulse oximetry plus clinical examination compared with examination alone is approximately £24,900 per timely diagnosis in a population in which antenatal screening for CHDs already exists. Conclusions: Pulse oximetry is a simple, safe, feasible test that is acceptable to parents and staff and adds value to existing screening. It is likely to identify cases of critical CHDs that would otherwise go undetected. It is also likely to be cost-effective given current acceptable thresholds. The detection of other pathologies, such as significant CHDs and respiratory and infective illnesses, is an additional advantage. Other pulse oximetry techniques, such as perfusion index, may enhance detection of aortic obstructive lesions.

Follow-ups and interpreter-mediated discourse

The edited volume documents the proceedings of the ESF workshop "Follow-ups across discourse domains: a cross-cultural exploration of their forms and functions". It examines the forms and functions of the dialogue act of a follow-up, viz. accepting or challenging a prior communicative act, in political discourse across spoken and written dialogic genres. Specifically, it considers (1) the discourse domains of political interviews, editorials, op-eds and discussion forums, (2) their sequential organization as regards the status of initial (or 1st order) follow-up, a follow-up of a prior follow-up (2nd order follow-up), or nth-order follow-up, and (3) their discursive realization as regards degrees of indirectness and responsiveness which are conceptualized as a continuum along the lines of degrees of explicitness and degrees of responsiveness. The chapters come from the fields of linguistics, discourse analysis, socio-pragmatics, communication, political science and psychology, examining the heterogeneous field of political discourse and its manifestation in diverse discourse genres with respect to evasiveness, indirectness and redundancy in mediated political discourse, professional discourse, discourse identity and doing politics, to name but the most prominent questions.

Hydrodynamics and mass transfer studies in a scheibel extractor

A 10 cm diameter four-stage Scheibel column with dispersed phase wetted packing sections has been constructed to study the hydrodynamics and mass transfer using the system toluene-acetone-water. The literature pertaining to the above extractor has been examined and the important phenomena such as droplet break-up and coalescence, mass transfer and backmixing have been reviewed. A critical analysis of the backmixing or axial mixing models and the corresponding techniques for parameter estimation was applied and an optimization technique based on Marquardt's algorithm was implemented. A single phase sampling technique was developed to estimate the acetone concentration profile in both phases along the column. Column flooding characteristics were investigated under various operating conditions and it was found that, when the impellers were located at about DI/5cm from the upper surface of the pads, the limiting flow rates increased with impeller speed. This unusual behaviour was explained in terms of the pumping effect created by the turbine impellers. Correlations were developed to predict Sauter mean drop diameters. A five-cell with backflow model was used to estimate the column performance (stage efficiency) and phases non-ideality (backflow parameters). Overall mass transfer coefficients were computed using the above model and compared with those calculated using the correlations based on single drop mechanism.

The Rover Task Force:a case study in proactive and reactive policy intervention?

The paper examines the policy responses in the UK West Midlands to the successive crises at the car maker MG-Rover. Whilst the firm’s eventual collapse in 2005 was a substantial shock to the West Midlands economy, the impact was much less than was anticipated when the firm was first threatened with closure in 2000 at the time of its break-up and sale by the German car firm BMW. Although the firm struggled as an independent producer, the five years of continued production until 2005 and the work of the initial Rover Task Force (RTF1), enabled many suppliers to adjust and diversify away from their hitherto dependence on MG-Rover resulting in as many as 10,000–12,000 jobs being ‘saved’. This first intervention was later followed by a programme to help ex-workers to find new jobs or re-train and assist supply firms to continue trading in the short term. Examination of the effectiveness of these emergency initiatives enables a wider discussion about the nature of industrial policy in the region and the work of the local regional development agency’s cluster-based approach to economic development and business support. Whilst the actions taken were successful in a number of aspects, there were a number of significant ‘failures’ at both national and local level. The MG-Rover case also illustrates a number of critical issues pertaining to regionally based cluster policies and the organization of cluster management groups where the ‘cluster’ in question not only crosses both administrative and ‘sector’ boundaries but is also subject to the imperatives of the global market car market.

From Spanish paintings to murder:topic transitions in casual conversations between native and non-native speakers of English

This article explores some of the strategies used by international students of English to manage topic shifts in casual conversations with English-speaking peers. It therefore covers aspects of discourse which have been comparatively under-researched, and where research has also tended to focus on the problems rather than the communicative achievements of non-native speakers. A detailed analysis of the conversations under discussion, which were recorded by the participants themselves, showed that they all flowed smoothly, and this was in large measure due to the ways in which topic shifts were managed. The paper will focus on a very distinct type of topic shift, namely that of topic transitions, which enable a smooth flow from one topic to another, but which do not explicitly signal that a shift is taking place. It will examine how the non-native speakers achieved coherence in the topic transitions which they initiated, which strategies or procedures they employed, and show how their initiations were effective in enabling the proposed topic to be understood, taken up and developed. It therefore adds to our understanding of the interactional achievements of international speakers in informal, social contexts. © 2013 Elsevier B.V.

Reproducible computing with Tzar and Docker

The potential for sharing environmental data and models is huge, but can be challenging for experts without specific programming expertise. We built an open-source, cross-platform framework (‘Tzar’) to run models across distributed machines. Tzar is simple to set up and use, allows dynamic parameter generation and enhances reproducibility by accessing versioned data and code. Combining Tzar with Docker helps us lower the entry barrier further by versioning and bundling all required modules and dependencies, together with the database needed to schedule work.

Indirect and direct controls of macroinvertebrates and small fish by abiotic factors and trophic interactions in the Florida Everglades

1. The roles of nutrients, disturbance and predation in regulating consumer densities have long been of interest, but their indirect effects have rarely been quantified in wetland ecosystems. The Florida Everglades contains gradients of hydrological disturbance (marsh drying) and nutrient enrichment (phosphorus), often correlated with densities of macroinvertebrate infauna (macroinvertebrates inhabiting periphyton), small fish and larger invertebrates, such as snails, grass shrimp, insects and crayfish. However, most causal relationships have yet to be quantified. 2.  We sampled periphyton (content and community structure) and consumer (small omnivores, carnivores and herbivores, and infaunal macroinvertebrates inhabiting periphyton) density at 28 sites spanning a range of hydrological and nutrient conditions and compared our data to seven a priori structural equation models. 3.  The best model included bottom-up and top-down effects among trophic groups and supported top-down control of infauna by omnivores and predators that cascaded to periphyton biomass. The next best model included bottom-up paths only and allowed direct effects of periphyton on omnivore density. Both models suggested a positive relationship between small herbivores and small omnivores, indicating that predation was unable to limit herbivore numbers. Total effects of time following flooding were negative for all three consumer groups even when both preferred models suggested positive direct effects for some groups. Total effects of nutrient levels (phosphorus) were positive for consumers and generally larger than those of hydrological disturbance and were mediated by changes in periphyton content. 4.  Our findings provide quantitative support for indirect effects of nutrient enrichment on consumers, and the importance of both algal community structure and periphyton biomass to Everglades food webs. Evidence for top-down control of infauna by omnivores was noted, though without substantially greater support than a competing bottom-up-only model.

The Mature Market: Underlying Dimensions and Group Differences of a Potential Market for the Hotel Industry

The mature market, defined as age 55 and up and consisting of approximately 64 million Americans, is expected to increase. Studies show that this group travels more frequently, travels greater distances, and stays longer. The authors seek to determine if underlying dimensions exist for the mature individual with regard to the selection criteria for lodging when traveling for pleasure, and to determine if differences exist between various demographic subsegments of this market with regard to these underlying dimensions.

Analysis of organomercurials in environmental and biological samples by capillary column gas chromatography with atomic fluorescence detection

The general method for determining organomercurials in environmental and biological samples is gas chromatography with electron capture detection (GC-ECD). However, tedious sample work up protocols and poor chromatographic response show the need for the development of new methods. Here, Atomic Fluorescence-based methods are described, free from these deficiencies. The organomercurials in soil, sediment and tissue samples are first released from the matrices with acidic KBr and cupric ions and extracted into dichloromethane. The initial extracts are subjected to thiosulfate clean up and the organomercury species are isolated as their chloride derivatives by cupric chloride and subsequent extraction into a small volume of dichloromethane. In water samples the organomercurials are pre-concentrated using a sulfhydryl cotton fiber adsorbent, followed by elution with acidic KBr and CuSO 4 and extraction into dichloromethane. Analysis of the organomercurials is accomplished by capillary column chromatography with atomic fluorescence detection.

The relationship between coping strategies and level of depression among spousal caregivers of elders with dementia

Caregivers are often under a great deal of stress while caring for their spouses with dementia. It is when the stress builds up and becomes overwhelming that the caregiver is at risk for developing depression. The primary objective of this study was to determine which cognitive and behavioral coping strategies are associated with lower levels of depression; once these strategies are identified, interventions can be established to educate these caregivers. Thirty-two spousal caregivers participated in this study. They each filled out a questionnaire, which contained three sections. The first section asked them for demographic information about themselves and their spouses; the second section consisted of a coping strategies scale; and, the third section contained a depression scale. Results of this study indicate that problem-focused coping strategies were associated with a lesser degree of depressive symptomatology, whereas most of the emotion-focused strategies were associated with a greater degree of depressive symptomatology among the present sample of spousal caregivers. In addition, no relationship was found between the length of time providing care to their spouses and their level of depression.

Data compilation on the biological response to ocean acidification: environmental and experimental context of data sets and related literature

The exponential growth of studies on the biological response to ocean acidification over the last few decades has generated a large amount of data. To facilitate data comparison, a data compilation hosted at the data publisher PANGAEA was initiated in 2008 and is updated on a regular basis (doi:10.1594/PANGAEA.149999). By January 2015, a total of 581 data sets (over 4 000 000 data points) from 539 papers had been archived. Here we present the developments of this data compilation five years since its first description by Nisumaa et al. (2010). Most of study sites from which data archived are still in the Northern Hemisphere and the number of archived data from studies from the Southern Hemisphere and polar oceans are still relatively low. Data from 60 studies that investigated the response of a mix of organisms or natural communities were all added after 2010, indicating a welcomed shift from the study of individual organisms to communities and ecosystems. The initial imbalance of considerably more data archived on calcification and primary production than on other processes has improved. There is also a clear tendency towards more data archived from multifactorial studies after 2010. For easier and more effective access to ocean acidification data, the ocean acidification community is strongly encouraged to contribute to the data archiving effort, and help develop standard vocabularies describing the variables and define best practices for archiving ocean acidification data.

A hora da alfabetização: atores, ideias e instituições na construção do PAIC-CE

The objective of this thesis is to understand how a certain social condition becomes relevant enough to be regarded as an issue worthy of government action and how certain proposed initiatives prevail while others are discarded. More specifically, the goal is to discuss public policy for education and check whether the analytical models employed are significant enough to explain how the literacy issue became part of the policy agenda of the government of the State of Ceará in Brazil, and how the Literacy Program at the Right Age (PAIC) developed over time. From the empirical perspective about public policy for education in Brazil, this is a relevant case when one takes into account that, historically, the literacy policies are focused on teenagers and adults, implying a lack of specific initiatives towards children at the proper age of learning to read and write. In order to understand what drove this issue to the top of the state government agenda, this thesis is primarily based on the literature about public policy analysis, with focus on the agenda setting process and development of proposals. A hybrid approach is used, combining analytical tools from Kingdon’s Multiple Streams Model (1995), the Advocacy Coalition Framework by Sabatier and Jenkins Smith (1993) and the historical new institutionalism lens. The research method is qualitative and based on the single case study method. The data set was assembled from institutional PAIC-related documents, tachygraphy notes from sessions at Ceará’s State House of Representatives, press clippings, academic studies and interviews with key participants from several organizations. The conclusion of this thesis is that, given the complexity of the case in point, the combination of the three analytical methods is adequate and necessary to understanding the multiple drivers for this issue to have entered Ceará’s state government agenda and the design of the PAIC itself. Particularly relevant are the ideas and the policy entrepreneurs, the processes of problem recognition for the composition of a wide coalition and for the specification of alternatives, and the path dependence of the education policy in Ceará. This study adds, as a result, to a better understanding of the stages that make up the agenda setting in public policy, in particular in the field of education.

A hora da alfabetização: atores, ideias e instituições na construção do PAIC-CE

The objective of this thesis is to understand how a certain social condition becomes relevant enough to be regarded as an issue worthy of government action and how certain proposed initiatives prevail while others are discarded. More specifically, the goal is to discuss public policy for education and check whether the analytical models employed are significant enough to explain how the literacy issue became part of the policy agenda of the government of the State of Ceará in Brazil, and how the Literacy Program at the Right Age (PAIC) developed over time. From the empirical perspective about public policy for education in Brazil, this is a relevant case when one takes into account that, historically, the literacy policies are focused on teenagers and adults, implying a lack of specific initiatives towards children at the proper age of learning to read and write. In order to understand what drove this issue to the top of the state government agenda, this thesis is primarily based on the literature about public policy analysis, with focus on the agenda setting process and development of proposals. A hybrid approach is used, combining analytical tools from Kingdon’s Multiple Streams Model (1995), the Advocacy Coalition Framework by Sabatier and Jenkins Smith (1993) and the historical new institutionalism lens. The research method is qualitative and based on the single case study method. The data set was assembled from institutional PAIC-related documents, tachygraphy notes from sessions at Ceará’s State House of Representatives, press clippings, academic studies and interviews with key participants from several organizations. The conclusion of this thesis is that, given the complexity of the case in point, the combination of the three analytical methods is adequate and necessary to understanding the multiple drivers for this issue to have entered Ceará’s state government agenda and the design of the PAIC itself. Particularly relevant are the ideas and the policy entrepreneurs, the processes of problem recognition for the composition of a wide coalition and for the specification of alternatives, and the path dependence of the education policy in Ceará. This study adds, as a result, to a better understanding of the stages that make up the agenda setting in public policy, in particular in the field of education.

Study of the calibration method of pressure-velocity probes and its application in a field of progressive plane waves

This dissertation presents a calibration procedure for a pressure velocity probe. The dissertation is divided into four main chapters. The first chapter is divided into six main sections. In the firsts two, the wave equation in fluids and the velocity of sound in gases are calculated, the third section contains a general solution of the wave equation in the case of plane acoustic waves. Section four and five report the definition of the acoustic impedance and admittance, and the practical units the sound level is measured with, i.e. the decibel scale. Finally, the last section of the chapter is about the theory linked to the frequency analysis of a sound wave and includes the analysis of sound in bands and the discrete Fourier analysis, with the definition of some important functions. The second chapter describes different reference field calibration procedures that are used to calibrate the P-V probes, between them the progressive plane wave method, which is that has been used in this work. Finally, the last section of the chapter contains a description of the working principles of the two transducers that have been used, with a focus on the velocity one. The third chapter of the dissertation is devoted to the explanation of the calibration set up and the instruments used for the data acquisition and analysis. Since software routines were extremely important, this chapter includes a dedicated section on them and the proprietary routines most used are thoroughly explained. Finally, there is the description of the work that has been done, which is identified with three different phases, where the data acquired and the results obtained are presented. All the graphs and data reported were obtained through the Matlab® routine. As for the last chapter, it briefly presents all the work that has been done as well as an excursus on a new probe and on the way the procedure implemented in this dissertation could be applied in the case of a general field.