Women’s experiences of receiving care for pelvic organ prolapse: a qualitative study

Background Pelvic organ prolapse is a common urogenital condition affecting 41–50% of women over the age of 40. To achieve early diagnosis and appropriate treatment, it is important that care is sensitive to and meets women’s needs, throughout their patient journey. This study explored women’s experiences of seeking diagnosis and treatment for prolapse and their needs and priorities for improving person-centred care. Methods Twenty-two women receiving prolapse care through urogynaecology services across three purposefully selected NHS UK sites took part in three focus groups and four telephone interviews. A topic guide facilitated discussions about women’s experiences of prolapse, diagnosis, treatment, follow-up, interactions with healthcare professionals, overall service delivery, and ideals for future services to meet their needs. Data were analysed thematically. Results Three themes emerged relating to women’s experiences of a) Evaluating what is normal b) Hobson’s choice of treatment decisions, and c) The trial and error of treatment and technique. Women often delayed seeking help for their symptoms due to lack of awareness, embarrassment and stigma. When presented to GPs, their symptoms were often dismissed and unaddressed until they became more severe. Women reported receiving little or no choice in treatment decisions. Choices were often influenced by health professionals’ preferences which were subtly reflected through the framing of the offer. Women’s embodied knowledge of their condition and treatment was largely unheeded, resulting in decisions that were inconsistent with women’s preferences and needs. Physiotherapy based interventions were reported as helping women regain control over their symptoms and life. A need for greater awareness of prolapse and physiotherapy interventions among women, GPs and consultants was identified alongside greater focus on prevention, early diagnosis and regular follow-up. Greater choice and involvement in treatment decision making was desired. Conclusions As prolapse treatment options expand to include more conservative choices, greater awareness and education is needed among women and professionals about these as a first line treatment and preventive measure, alongside a multi-professional team approach to treatment decision making. Women presenting with prolapse symptoms need to be listened to by the health care team, offered better information about treatment choices, and supported to make a decision that is right for them

What young people want from health-related online resources: a focus group study

The growth of the Internet as an information source about health, particularly amongst young people, is well established. The aim of this study was to explore young people's perceptions and experiences of engaging with health-related online content, particularly through social media websites. Between February and July 2011 nine focus groups were facilitated across Scotland with young people aged between 14 and 18 years. Health-related user-generated content seems to be appreciated by young people as a useful, if not always trustworthy, source of accounts of other people's experiences. The reliability and quality of both user-generated content and official factual content about health appear to be concerns for young people, and they employ specialised strategies for negotiating both areas of the online environment. Young people's engagement with health online is a dynamic area for research. Their perceptions and experiences of health-related content seem based on their wider familiarity with the online environment and, as the online environment develops, so too do young people's strategies and conventions for accessing it

Design of organic Rankine cycles using a non-conventional optimization approach

The organic Rankine cycle is a suitable technology for utilizing low grade heat for electricity production. Compared to the traditional steam Rankine cycle, the organic Rankine cycle is beneficial, since it enables the choice of a working fluid which performs better than steam at low heat input temperatures and at lowpower outputs. Selecting the process layout of the organic Rankine cycle and the working fluid are two key design decisions which are critical for the thermodynamic and economic performance of the cycle. The prevailing approach used in the design and optimization of organic Rankine cycles is to model the heatexchangers by assuming a fixed minimum temperature difference. The objective of this work is to assess the applicability of this conventional optimization approach and a non-conventional optimization approach. In thenon-conventional optimization approach a total UA-value (the product of the overall heat transfer coefficient and the heat transfer area) is assigned to the cycle, while the distribution of this total UA-value to each of the heat exchangers is optimized. Optimizations are carried out for three different marine engine waste heatsources at temperatures ranging from 90 °C to 285 °C. The results suggest that the conventional optimization approach is not suitable for estimating the performance potential when the temperature profiles in the heat exchangers are closely matched. This is exemplified for the fluid MDM where the temperature profile of preheating aligns with the heat source fluid and for the zeotropic mixture R32/R134a where the temperature profile of condensation aligns with the cooling water. Furthermore, the conventional optimization approach shows weaknesses in evaluating the feasibility of using a recuperator, when the expander outlet temperature is high. In these cases the non-conventional optimization approach is the more suited methodology for designing organic Rankine cycles

Assessing the Utility of Early Warning Systems for Detecting Failures in Major Wind Turbine Components

This paper provides enhancements to normal behaviour models for monitoring major wind turbine components and a methodology to assess the monitoring system reliability based on SCADA data and decision analysis. Typically, these monitoring systems are based on fully data-driven regression of damage sensitive-parameters. Firstly, the problem of selecting suitable inputs for building a temperature model of operating main bearings is addressed, based on a sensitivity study. This shows that the dimensionality of the dataset can be greatly reduced while reaching sufficient prediction accuracy. Subsequently, performance quantities are derived from a statistical description of the prediction error and used as input to a decision analysis. Two distinct intervention policies, replacement and repair, are compared in terms of expected utility. The aim of this study is to provide a method to quantify the benefit of implementing the online system from an economic risk perspective. Under the realistic hypotheses made, the numerical example shows for instance that replacement is not convenient compared to repair

University space planning and space-type profiles

Universities planning the provision of space for their teaching requirements need to do so in a fashion that reduces capital and maintenance costs whilst still providing a high-quality level of service. Space plans should aim to provide sufficient capacity without incurring excessive costs due to over-capacity. A simple measure used to estimate over-provision is utilisation. Essentially, the utilisation is the fraction of seats that are used in practice, or the ratio of demand to supply. However, studies usually find that utilisation is low, often only 20–40%, and this is suggestive of significant over-capacity. Our previous work has provided methods to improve such space planning. They identify a critical level of utilisation as the highest level that can be achieved whilst still reliably satisfying the demand for places to allocate teaching events. In this paper, we extend this body of work to incorporate the notions of event-types and space-types. Teaching events have multiple ‘event-types’, such as lecture, tutorial, workshop, etc., and there are generally corresponding space-types. Matching the type of an event to a room of a corresponding space-type is generally desirable. However, realistically, allocation happens in a mixed space-type environment where teaching events of a given type are allocated to rooms of another space-type; e.g., tutorials will borrow lecture theatres or workshop rooms. We propose a model and methodology to quantify the effects of space-type mixing and establish methods to search for better space-type profiles; where the term “space-type profile” refers to the relative numbers of each type of space. We give evidence that these methods have the potential to improve utilisation levels. Hence, the contribution of this paper is twofold. Firstly, we present informative studies of the effects of space-type mixing on utilisation, and critical utilisations. Secondly, we present straightforward though novel methods to determine better space-type profiles, and give an example in which the resulting profiles are indeed significantly improved. <br/

Ontology-driven monitoring of patient's vital signs enabling personalized medical detection and alert

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