A realistic evaluation of Early Warning Systems and acute care training in Northern Ireland: findings and recommendations

Statement of purpose The purpose of this concurrent session is to present the main findings and recommendations from a five year study evaluating the implementation of Early Warning Systems (EWS) and the Acute Life-threatening Events: Recognition and Treatment (ALERT) course in Northern Ireland. The presentation will provide delegates with an understanding of those factors that enable and constrain successful implementation of EWS and ALERT in practice in order to provide an impetus for change. Methods The research design was a multiple case study approach of four wards in two hospitals in Northern Ireland. It followed the principles of realist evaluation research which allowed empirical data to be gathered to test and refine RRS programme theory [1]. The stages included identifying the programme theories underpinning EWS and ALERT, generating hypotheses, gathering empirical evidence and refining the programme theories. This approach used a variety of mixed methods including individual and focus group interviews, observation and documentary analysis of EWS compliance data and ALERT training records. A within and across case comparison facilitated the development of mid-range theories from the research evidence. Results The official RRS theories developed from the realist synthesis were critically evaluated and compared with the study findings to develop a mid-range theory to explain what works, for whom in what circumstances. The findings of what works suggests that clinical experience, established working relationships, flexible implementation of protocols, ongoing experiential learning, empowerment and pre-emptive management are key to the success of EWS and ALERT implementation. Each concept is presented as ‘context, mechanism and outcome configurations’ to provide an understanding of how the context impacts on individual reasoning or behaviour to produce certain outcomes. Conclusion These findings highlight the combination of factors that can improve the implementation and sustainability of EWS and ALERT and in light of this evidence several recommendations are made to provide policymakers with guidance and direction for future policy development. References: 1. Pawson R and Tilley N. (1997) Realistic Evaluation. Sage Publications; London Type of submission: Concurrent session Source of funding: Sandra Ryan Fellowship funded by the School of Nursing & Midwifery, Queen’s University of Belfast

“They should stay at their desk until the work’s done”: a qualitative study examining perceptions of sedentary behaviour in a desk-based occupational setting

Background: Workplace sedentary behaviour is a priority target for health promotion. However, little is known about how to effect change. We aimed to explore desk-based office workers’ perceptions of factors that influenced sedentary behaviour at work and to explore the feasibility of using a novel mobile phone application to track their behaviours.

Methods: We invited office employees (n = 12) and managers (n = 2) in a software engineering company to participate in semi-structured interviews to explore perceived barriers and facilitators affecting workplace sedentary behaviour. We assessed participants’ sedentary behaviours using an accelerometer before and after they used a mobile phone application to record their activities at self-selected time intervals daily for 2 weeks. Interviews were analysed using a thematic framework.

Results: Software engineers (5 employees; 2 managers) were interviewed; 13 tested the mobile phone application; 8 returned feedback. Major barriers to reducing workplace sedentary behaviour included the pressure of ‘getting the job done’, the nature of their work requiring sitting at a computer, personal preferences for the use of time at and after work, and a lack of facilities, such as a canteen, to encourage moving from their desks. Facilitators for reduced sedentariness included having a definite reason to leave their desks, social interaction and relief of physical and mental symptoms of prolonged sitting. The findings were similar for participants with different levels of overall physical activity. Valid accelerometer data were tracked for four participants: all reduced their sedentary behaviour. Participants stated that recording data using the phone application added to their day’s work but the extent to which individuals perceived this as a burden varied and was counter-balanced by its perceived value in increasing awareness of sedentary behaviour. Individuals expressed a wish for flexibility in its configuration.

Conclusions: These findings indicate that employers’ and employees’ perceptions of the cultural context and physical environment of their work, as well as personal factors, must be considered in attempting to effect changes that reduce workplace sedentary behaviour. Further research should investigate appropriate individually tailored approaches to this challenge, using a framework of behaviour change theory which takes account of specific work practices, preferences and settings.

Pre-Processing Power Traces with a Phase-Sensitive Detector

As cryptographic implementations are increasingly subsumed as functional blocks within larger systems on chip, it becomes more difficult to identify the power consumption signatures of cryptographic operations amongst other unrelated processing activities. In addition, at higher clock frequencies, the current decay between successive processing rounds is only partial, making it more difficult to apply existing pattern matching techniques in side-channel analysis. We show however, through the use of a phase-sensitive detector, that power traces can be pre-processed to generate a filtered output which exhibits an enhanced round pattern, enabling the identification of locations on a device where encryption operations are occurring and also assisting with the re-alignment of power traces for side-channel attacks.

High Performance Real-time Pre-Processing for Fixed-Complexity Sphere Decoder

Pre-processing (PP) of received symbol vector and channel matrices is an essential pre-requisite operation for Sphere Decoder (SD)-based detection of Multiple-Input Multiple-Output (MIMO) wireless systems. PP is a highly complex operation, but relative to the total SD workload it represents a relatively small fraction of the overall computational cost of detecting an OFDM MIMO frame in standards such as 802.11n. Despite this, real-time PP architectures are highly inefficient, dominating the resource cost of real-time SD architectures. This paper resolves this issue. By reorganising the ordering and QR decomposition sub operations of PP, we describe a Field Programmable Gate Array (FPGA)-based PP architecture for the Fixed Complexity Sphere Decoder (FSD) applied to 4 × 4 802.11n MIMO which reduces resource cost by 50% as compared to state-of-the-art solutions whilst maintaining real-time performance.

A population-based study of visual impairment among pre-school children in Beijing: the Beijing study of visual impairment in children.

PURPOSE: To evaluate the prevalence and causes of visual impairment among Chinese children aged 3 to 6 years in Beijing. DESIGN: Population-based prevalence survey. METHODS: Presenting and pinhole visual acuity were tested using picture optotypes or, in children with pinhole vision < 6/18, a Snellen tumbling E chart. Comprehensive eye examinations and cycloplegic refraction were carried out for children with pinhole vision < 6/18 in the better-seeing eye. RESULTS: All examinations were completed on 17,699 children aged 3 to 6 years (95.3% of sample). Subjects with bilateral correctable low vision (presenting vision < 6/18 correctable to >or= 6/18) numbered 57 (0.322%; 95% confidence interval [CI], 0.237% to 0.403%), while 14 (0.079%; 95% CI, 0.038% to 0.120%) had bilateral uncorrectable low vision (best-corrected vision of < 6/18 and >or= 3/60), and 5 subjects (0.028%; 95% CI, 0.004% to 0.054%) were bilaterally blind (best-corrected acuity < 3/60). The etiology of 76 cases of visual impairment included: refractive error in 57 children (75%), hereditary factors (microphthalmos, congenital cataract, congenital motor nystagmus, albinism, and optic nerve disease) in 13 children (17.1 %), amblyopia in 3 children (3.95%), and cortical blindness in 1 child (1.3%). The cause of visual impairment could not be established in 2 (2.63%) children. The prevalence of visual impairment did not differ by gender, but correctable low vision was significantly (P < .0001) more common among urban as compared with rural children. CONCLUSION: The leading causes of visual impairment among Chinese preschool-aged children are refractive error and hereditary eye diseases. A higher prevalence of refractive error is already present among urban as compared with rural children in this preschool population.

Distant activity of 67P/Churyumov-Gerasimenko in 2014: Ground-based results during the Rosetta pre-landing phase

As the ESA Rosetta mission approached, orbited, and sent a lander to comet 67P/Churyumov-Gerasimenko in 2014, a large campaign of ground-based observations also followed the comet. We constrain the total activity level of the comet by photometry and spectroscopy to place Rosetta results in context and to understand the large-scale structure of the comet's coma pre-perihelion. We performed observations using a number of telescopes, but concentrate on results from the 8m VLT and Gemini South telescopes in Chile. We use R-band imaging to measure the dust coma contribution to the comet's brightness and UV-visible spectroscopy to search for gas emissions, primarily using VLT/FORS. In addition we imaged the comet in near-infrared wavelengths (JHK) in late 2014 with Gemini-S/Flamingos 2. We find that the comet was already active in early 2014 at heliocentric distances beyond 4 au. The evolution of the total activity (measured by dust) followed previous predictions. No gas emissions were detected despite sensitive searches. The comet maintains a similar level of activity from orbit to orbit, and is in that sense predictable, meaning that Rosetta results correspond to typical behaviour for this comet. The gas production (for CN at least) is highly asymmetric with respect to perihelion, as our upper limits are below the measured production rates for similar distances post-perihelion in previous orbits.

Evaluation of biomarkers for the prediction of pre-eclampsia in women with type 1 diabetes mellitus: A systematic review.

BACKGROUND: Pre-eclampsia is a leading cause of maternal and perinatal morbidity and mortality. Women with type 1 diabetes are considered a high-risk group for developing pre-eclampsia. Much research has focused on biomarkers as a means of screening for pre-eclampsia in the general maternal population; however, there is a lack of evidence for women with type 1 diabetes.
OBJECTIVES: To undertake a systematic review to identify potential biomarkers for the prediction of pre-eclampsia in women with type 1 diabetes.
SEARCH STRATEGY: We searched Medline, EMBASE, Maternity and Infant Care, Scopus, Web of Science and CINAHL SELECTION CRITERIA: Studies were included if they measured biomarkers in blood or urine of women who developed pre-eclampsia and had pre-gestational type 1 diabetes mellitus Data collection and analysis A narrative synthesis was adopted as a meta-analysis could not be performed, due to high study heterogeneity.
MAIN RESULTS: A total of 72 records were screened, with 21 eligible studies being included in the review. A wide range of biomarkers was investigated and study size varied from 34 to 1258 participants. No single biomarker appeared to be effective in predicting pre-eclampsia; however, glycaemic control was associated with an increased risk while a combination of angiogenic and anti-angiogenic factors seemed to be potentially useful.
CONCLUSIONS: Limited evidence suggests that combinations of biomarkers may be more effective in predicting pre-eclampsia than single biomarkers. Further research is needed to verify the predictive potential of biomarkers that have been measured in the general maternal population, as many studies exclude women with diabetes preceding pregnancy.

Pre- and post-settlement processes regulating recruitment of the shore crab Carcinus maenas

O sucesso do recrutamento em espécies com ciclos de vida complexos, i.e. com duas ou mais fases de desenvolvimento, depende do fornecimento de larvas aos locais apropriados do assentamento (mecanismos de pré-assentamento) e na consequente sobrevivência destas larvas até aos estágios bentónicos iniciais (mecanismos de pós-assentamento). O estudo dos principais processos físicos que controlam a variabilidade intra-anual do recrutamento do caranguejo Carcinus maenas foi possível com à obtenção em séries diárias da abundância de megalopas no plâncton e do seu assentamento em substratos artificiais de assentamento, e de parâmetros físicos relacionados com a amplitude de maré e o upwelling, durante os meses da época reprodutiva deste caranguejo. Os nossos resultados demonstraram um padrão cíclico de fornecimento de megalopas de C. maenas aos estuários na costa ocidental de Portugal, relacionado com a amplitude de maré e favorecido pelos ventos de sul. O assentamento de megalopas nos substratos artificiais de assentamento mostrou-se desacoplado do fornecimento nos dois estuários. Os dados obtidos sugerem que as megalopas são transportadas para a costa após a acção de ventos de downwelling, e o fornecimento para os estuários ocorre por transporte selectivo por corrente de maré. A utilização de substratos artificiais para medir densidades de juvenis de Carcinus maenas deve ser ponderada, uma vez que se verificou que em habitats estruturalmente menos complexos os juvenis utilizam os colectores como refúgio; em habitats mais complexos, os juvenis preferiram refugiar-se nas ervas marinhas existentes. No entanto, a estimativa de abundâncias diárias medidas nos colectores permitiu a descrição das abundâncias dos vários estádios de desenvolvimento juvenis, bem como as respectivas taxas de crescimento. As capacidades locomotoras de diferentes classes de tamanho de juvenis de C. maenas foram estimadas mediante o cálculo de um índice de locomoção. Os nossos resultados sugerem que os juvenis mais pequenos estão relativamente protegidos em habitats com vegetação densa, provavelmente porque este tipo de habitats inibe os movimentos dos juvenis de maiores dimensões. Foram também encontradas evidências da existência de segregação temporal na actividade locomotora das diferentes classes de juvenis, que funcionará como um mecanismo que permite reduzir o canibalismo e, consequentemente, aumentar a capacidade de suporte dos habitats juvenis. Foi realizado um estudo sobre o canibalismo nos juvenis de C. maenas na Ria de Aveiro, in situ e utilizando densidades reais. Verificou-se que as presas mais pequenas eram as mais vulneráveis, sendo os juvenis de maiores dimensões os predadores mais eficazes. Por outro lado, as taxas de canibalismo foram menores em habitats com elevadas densidades de refúgio (Zostera noltii). A estimativa das taxas diárias de mortalidade devidas ao canibalismo são aproximadamente metade das taxas diárias de mortalidade devidas aos processos de pré-assentamento, indicando que esta população de C. maenas será regulada pelo fornecimento larvar, i.e., será uma população regulada essencialmente por mecanismos préassentamento.