Patients' perceptions and experiences of transitions in diabetes care: a longitudinal qualitative study

Objective To examine patients' perceptions and experiences over time of the devolvement of diabetes care/reviews from secondary to primary health-care settings. Design Repeat in-depth interviews with 20 patients over 4 years. Participants and setting Twenty type 2 diabetes patients recruited from primary- and secondary-care settings across Lothian, Scotland. Results Patients' views about their current diabetes care were informed by their previous service contact. The devolvement of diabetes care/reviews to general practice was presented as a 'mixed blessing'. Patients gained reassurance from their perception that receiving practice-based care/reviews signified that their diabetes was well-controlled. However, they also expressed resentment that, by achieving good control, they received what they saw as inferior care and/or less-frequent reviews to others with poorer control. While patients tended to regard GPs as having adequate expertise to conduct their practice-based reviews, they were more ambivalent about nurses taking on this role. Opportunities to receive holistic care in general practice were not always realized due to patients seeing health-care professionals for diabetes management to whom they would not normally present for other health issues. Conclusions It is important to educate patients about their care pathways, and to reassure them that frequency of reviews depends more on clinical need than location of care and that similar care guidelines are followed in hospital clinics and general practice. A patients' history of service contact may need to be taken into account in future studies of service satisfaction.

Institutional work at field-configuring events:shaping industry change within sustainable transitions

Adopting an institutional approach from organization studies, this paper explores the role of key actors on “purposeful governance for sustainability” (Smith, Voss et al. 2010: 444) through the case of smart metering in the UK. Institutions are enduring patterns in social life, reflected in identities, routines, rules, shared meanings and social relations, which enable, and constrain, the beliefs and behaviours of individual and collective actors within a field (Thornton and Ocasio 2008). Large-scale external initiatives designed to drive regime-level change prompt ‘institutional entrepreneurs’ to perform ‘institutional work’ – “purposive action aimed at creating, maintaining and disrupting institutions” (Lawrence and Suddaby, 2006). Organization scholars are giving increasing attention to ‘field-configuring events’ (FCEs) which provide social spaces for diverse organizational actors to come together to collectively shape socio-technical pathways (Lampel and Meyer 2008). Our starting point for this exploratory study is that FCEs can offer important insights to the dynamics, politics and governance of sustainability transitions. Methodologically, FCEs allow us to observe and “link field evolution at the macro-level with individual action at the micro-level” (Lampel and Meyer, 2008: 1025). We examine the work of actors during a series of smart metering industry forums over a three-year period (industry presentations [n= 77] and panel discussions [n= 16]). The findings reveal new insights about how institutional change unfolds, alongside technological transitions, in ways that are partial and aligned with the interests of powerful incumbents whose voices are frequently heard at FCEs. The paper offers three contributions. First, the study responds to calls for more research examining FCEs and the role they play in transforming institutional fields. Second, the emergent findings extend research on institutional work by advancing our understanding of a specific site of institutional work, namely a face-to-face inter-organizational arena. Finally, in line with the research agenda for innovation studies and sustainability transitions elaborated by Smith et al (2010), the paper illustrates how actors in a social system respond to, translate, and enact interventions designed to promote industrial transformation, ultimately shaping the sustainability transition pathway.

Water-peptide dynamics during conformational transitions

Transitions between metastable conformations of a dipeptide are investigated using classical molecular dynamics simulation with explicit water molecules. The distribution of the surrounding water at different moments before the transitions and the dynamical correlations of water with the peptide's configurational motions indicate that the water molecules represent an integral part of the molecular system during the conformational changes, in contrast to the metastable periods when water and peptide dynamics are essentially decoupled.

Postcolonial transitions in Africa:Decolonization in West Africa and present day South Africa

Black Economic Empowerment is a highly debated issue in contemporary South Africa. Yet few South Africans realize that they are following a postcolonial trajectory already experienced by other countries. This paper presents a case study of British firms during decolonization in Ghana and Nigeria in the 1950s and 1960s, which saw a parallel development in business and society to that which occurred in South Africa in the 1990s and 2000s. Despite fundamental differences between these states, all have had to empower a majority of black citizens who had previously suffered discrimination on the basis of race. The paper employs concepts from social capital theory to show that the process of postcolonial transition in African economies has been more politically and socially disruptive than empowerment in Western countries. Historical research contributes to our understanding of the nature of institutional shocks in emerging economies.

Language independent on-off voice over IP source model with lognormal transitions

The recent explosive growth of voice over IP (VoIP) solutions calls for accurate modelling of VoIP traffic. This study presents measurements of ON and OFF periods of VoIP activity from a significantly large database of VoIP call recordings consisting of native speakers speaking in some of the world's most widely spoken languages. The impact of the languages and the varying dynamics of caller interaction on the ON and OFF period statistics are assessed. It is observed that speaker interactions dominate over language dependence which makes monologue-based data unreliable for traffic modelling. The authors derive a semi-Markov model which accurately reproduces the statistics of composite dialogue measurements. © The Institution of Engineering and Technology 2013.

Autonomous volume transitions of a polybase triblock copolymer gel in a chemically driven pH-oscillator

A pH-responsive ABA triblock copolymer, comprising poly(methyl methacrylate)-b/ock-poly(2-(diethylamino)ethyl methacrylate)-block-poly(methyl methacrylate) [PMMA-b-PDEA-b-PMMA], has been cast Into thin films with a well-defined microstructure. Small Angle X-ray Scattering (SAXS) and Atomic Force Microscopy (AFM) studies confirm that this copolymer forms a hydrogel consisting of PMMA spheres embedded within a polybase PDEA matrix, with the PMMA domains acting as physical cross-links. The hydrogel has a pH-reversible coil-globule transition at around pH 4.5. This responsive physical property was exploited by immersing a sample of copolymer hydrogel in an aqueous solution containing a cyclic pH-oscillating reaction, whereby the pH was continuously oscillated above and below the transition pH so as to induce autonomous volume transitions. The changes in microscopic and macroscopic length scales correlate closely during (de)swelling cycles, with affine behaviour occurring over five orders of magnitude. Copyright © 2007 WILEY-VCH Verlag GmbH & Co. KGaA,.

Dynamic complexity of chaotic transitions in high-dimensional classical dynamics:Leu-Enkephalin folding

Leu-Enkephalin in explicit water is simulated using classical molecular dynamics. A ß-turn transition is investigated by calculating the topological complexity (in the "computational mechanics" framework [J. P. Crutchfield and K. Young, Phys. Rev. Lett., 63, 105 (1989)]) of the dynamics of both the peptide and the neighbouring water molecules. The complexity of the atomic trajectories of the (relatively short) simulations used in this study reflect the degree of phase space mixing in the system. It is demonstrated that the dynamic complexity of the hydrogen atoms of the peptide and almost all of the hydrogens of the neighbouring waters exhibit a minimum precisely at the moment of the ß-turn transition. This indicates the appearance of simplified periodic patterns in the atomic motion, which could correspond to high-dimensional tori in the phase space. It is hypothesized that this behaviour is the manifestation of the effect described in the approach to molecular transitions by Komatsuzaki and Berry [T. Komatsuzaki and R.S. Berry, Adv. Chem. Phys., 123, 79 (2002)], where a "quasi-regular" dynamics at the transition is suggested. Therefore, for the first time, the less chaotic character of the folding transition in a realistic molecular system is demonstrated. © Springer-Verlag Berlin Heidelberg 2006.

A hierarchy of phase transitions in optimal neuronal coding:from binary to M-ary discrete optimal codes

We have investigated how optimal coding for neural systems changes with the time available for decoding. Optimization was in terms of maximizing information transmission. We have estimated the parameters for Poisson neurons that optimize Shannon transinformation with the assumption of rate coding. We observed a hierarchy of phase transitions from binary coding, for small decoding times, toward discrete (M-ary) coding with two, three and more quantization levels for larger decoding times. We postulate that the presence of subpopulations with specific neural characteristics could be a signiture of an optimal population coding scheme and we use the mammalian auditory system as an example.

Fiber-type transitions and satellite cell activation in low-frequency-stimulated muscles of young and aging rats

We examined satellite cell content and the activity of satellite cell progeny in tibialis anterior muscles of young (15 weeks) and aging (101 weeks) Brown Norway (BN) rats, after they were exposed for 50 days to a standardized and highly reproducible regime of chronic low-frequency electrical stimulation. Chronic low-frequency electrical stimulation was successful in inducing fast-to-slow fiber-type transformation, characterized by a 2.3-fold increase in the proportion of IIA fibers and fourfold and sevenfold decreases in the proportion of IID/X and IIB fibers in both young and aging BN rats. These changes were accompanied by a twofold increase in the satellite cell content in both the young and aging groups; satellite cell content reached a level that was significantly higher in the young group (p < .04). The total muscle precursor cell content (i.e., satellite cells plus progeny), however, did not differ between groups, because there was a greater number of satellite cell progeny passing through the proliferative and differentiative compartments of the aging group. The resulting 1.5-fold increase in myonuclear content was similar in the young and aging groups. We conclude that satellite cells and satellite cell progeny of aging BN rats possess an unaltered capacity to contribute to the adaptive response.

The verbal transformation effect and the perceptual organization of speech:influence of formant transitions and F0-contour continuity

This study explored the role of formant transitions and F0-contour continuity in binding together speech sounds into a coherent stream. Listening to a repeating recorded word produces verbal transformations to different forms; stream segregation contributes to this effect and so it can be used to measure changes in perceptual coherence. In experiment 1, monosyllables with strong formant transitions between the initial consonant and following vowel were monotonized; each monosyllable was paired with a weak-transitions counterpart. Further stimuli were derived by replacing the consonant-vowel transitions with samples from adjacent steady portions. Each stimulus was concatenated into a 3-min-long sequence. Listeners only reported more forms in the transitions-removed condition for strong-transitions words, for which formant-frequency discontinuities were substantial. In experiment 2, the F0 contour of all-voiced monosyllables was shaped to follow a rising or falling pattern, spanning one octave. Consecutive tokens either had the same contour, giving an abrupt F0 change between each token, or alternated, giving a continuous contour. Discontinuous sequences caused more transformations and forms, and shorter times to the first transformation. Overall, these findings support the notion that continuity cues provided by formant transitions and the F0 contour play an important role in maintaining the perceptual coherence of speech.

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.

Supply market uncertainty:exploring consequences and responses within sustainability transitions

Often it is commercial, not technological, factors which hinder the adoption of potentially valuable innovations. In energy policy, much attention is given to analysing and incentivising consumer demand for renewable energy, but new technologies may also need new supply markets, to provide products and services to build, operate and maintain the innovative technology. This paper addresses the impact of supply constraints on the long-term viability of sustainability related innovations, using the case of bioenergy from organic waste. Uncertainties in the pricing and availability of feedstock (i.e. waste) may generate market deadlock and deter potential investors. We draw on prior research to conceptualise the problem, and identify what steps might be taken to address it. We propose a research agenda aimed at purchasing and supply scholars and centred on the need to understand better the interplay between market evolution and supply uncertainty and 'market shaping' - how stakeholders can legitimately influence supply market evolution - to support the adoption of sustainability related innovation.

Medication discrepancies at transitions in pediatrics:a review of the literature

Medication reconciliation is an important process in reducing medication errors in many countries. Canada, the USA, and UK have incorporated medication reconciliation as a priority area for national patient safety initiatives and goals. The UK national guidance excludes the pediatric population. The aim of this review was to explore the occurrence of medication discrepancies in the pediatric population. The primary objective was to identify studies reporting the rate and clinical significance of the discrepancies and the secondary objective was to ascertain whether any specific interventions have been used for medication reconciliation in pediatric settings. The following electronic bibliographic databases were used to identify studies: PubMed, OVID EMBASE (1980 to 2012 week 1), ISI Web of Science, ISI Biosis, Cumulative Index to Nursing and Allied Health Literature, and OVID International Pharmaceutical Abstracts (1970 to January 2012). Primary studies were identified that observed medication discrepancies in children under 18 years of age upon hospital admission, transfer and discharge, or had reported medication reconciliation interventions. Two independent reviewers screened titles and abstracts for relevant articles and extracted data using pre-defined data fields, including risk of bias assessment. Ten studies were identified with variances in reportage of stage and rate of discrepancies. Studies were heterogeneous in definitions, methods, and patient populations. Most studies related to admissions and reported consistently high rates of discrepancies ranging from 22 to 72.3 % of patients (sample size ranging from 23 to 272). Seven of the studies were low-quality observational studies and three studies were 'grey literature' non-peer reviewed conference abstracts. Studies involving small numbers of patients have shown that medication discrepancies occur at all transitions of care in children. Further research is required to investigate and demonstrate how implementing medication reconciliation can reduce discrepancies and potential patient harm. © 2013 Springer International Publishing Switzerland.

Gain dependent pulse regimes transitions in a dissipative dispersion-managed fibre laser

For the first time, we demonstrate the possibility to switch between three distinct pulse regimes in a dissipative dispersion-managed (DM) fibre laser by solely controlling the gain saturation energy. Nonlinear Schrödinger equation based simulations show the transitions between hyper-Gaussian similaritons, parabolic similaritons, and dissipative solitons in the same laser cavity. It is also shown that such transitions exist in a wide dispersion range from all-normal to slightly net-normal dispersion. This work demonstrates that besides dispersion and filter managements gain saturation energy can be a new degree of freedom to manage pulse regimes in DM fibre lasers, which offers flexibility in designing ultrafast fibre lasers. Also, the result indicates that in contrast to conservative soliton lasers whose intensity profiles are unique, dissipative DM lasers show diversity in pulse shapes. The findings not only give a better understanding of pulse shaping mechanisms in mode-locked lasers, but also provide insight into dissipative systems.

Computation of rare transitions in the barotropic quasi-geostrophic equations

We investigate the theoretical and numerical computation of rare transitions in simple geophysical turbulent models. We consider the barotropic quasi-geostrophic and two-dimensional Navier–Stokes equations in regimes where bistability between two coexisting large-scale attractors exist. By means of large deviations and instanton theory with the use of an Onsager–Machlup path integral formalism for the transition probability, we show how one can directly compute the most probable transition path between two coexisting attractors analytically in an equilibrium (Langevin) framework and numerically otherWe adapt a class of numerical optimization algorithms known as minimum action methods to simple geophysical turbulent models. We show that by numerically minimizing an appropriate action functional in a large deviation limit, one can predict the most likely transition path for a rare transition between two states. By considering examples where theoretical predictions can be made, we show that the minimum action method successfully predicts the most likely transition path. Finally, we discuss the application and extension of such numerical optimization schemes to the computation of rare transitions observed in direct numerical simulations and experiments and to other, more complex, turbulent systems.