Effect of sedimentary heterogeneities in the sealing formation on predictive analysis of geological CO₂ storage

Numerical models of geologic carbon sequestration (GCS) in saline aquifers use multiphase fluid flow-characteristic curves (relative permeability and capillary pressure) to represent the interactions of the non-wetting CO2 and the wetting brine. Relative permeability data for many sedimentary formations is very scarce, resulting in the utilisation of mathematical correlations to generate the fluid flow characteristics in these formations. The flow models are essential for the prediction of CO2 storage capacity and trapping mechanisms in the geological media. The observation of pressure dissipation across the storage and sealing formations is relevant for storage capacity and geomechanical analysis during CO2 injection. This paper evaluates the relevance of representing relative permeability variations in the sealing formation when modelling geological CO2 sequestration processes. Here we concentrate on gradational changes in the lower part of the caprock, particularly how they affect pressure evolution within the entire sealing formation when duly represented by relative permeability functions. The results demonstrate the importance of accounting for pore size variations in the mathematical model adopted to generate the characteristic curves for GCS analysis. Gradational changes at the base of the caprock influence the magnitude of pressure that propagates vertically into the caprock from the aquifer, especially at the critical zone (i.e. the region overlying the CO2 plume accumulating at the reservoir-seal interface). A higher degree of overpressure and CO2 storage capacity was observed at the base of caprocks that showed gradation. These results illustrate the need to obtain reliable relative permeability functions for GCS, beyond just permeability and porosity data. The study provides a formative principle for geomechanical simulations that study the possibility of pressure-induced caprock failure during CO2 sequestration

Task shifting in maternal and newborn care: a non-inferiority study examining delegation of antenatal counseling to lay nurse aides supported by job aids in Benin

<p>Abstract</p> <p>Background</p> <p>Shifting the role of counseling to less skilled workers may improve efficiency and coverage of health services, but evidence is needed on the impact of substitution on quality of care. This research explored the influence of delegating maternal and newborn counseling responsibilities to clinic-based lay nurse aides on the quality of counseling provided as part of a task shifting initiative to expand their role.</p> <p>Methods</p> <p>Nurse-midwives and lay nurse aides in seven public maternities were trained to use job aids to improve counseling in maternal and newborn care. Quality of counseling and maternal knowledge were assessed using direct observation of antenatal consultations and patient exit interviews. Both provider types were interviewed to examine perceptions regarding the task shift. To compare provider performance levels, non-inferiority analyses were conducted where non-inferiority was demonstrated if the lower confidence limit of the performance difference did not exceed a margin of 10 percentage points.</p> <p>Results</p> <p>Mean percent of recommended messages provided by lay nurse aides was non-inferior to counseling by nurse-midwives in adjusted analyses for birth preparedness (β = -0.0, 95% CI: -9.0, 9.1), danger sign recognition (β = 4.7, 95% CI: -5.1, 14.6), and clean delivery (β = 1.4, 95% CI: -9.4, 12.3). Lay nurse aides demonstrated superior performance for communication on general prenatal care (β = 15.7, 95% CI: 7.0, 24.4), although non-inferiority was not achieved for newborn care counseling (β = -7.3, 95% CI: -23.1, 8.4). The proportion of women with correct knowledge was significantly higher among those counseled by lay nurse aides as compared to nurse-midwives in general prenatal care (β = 23.8, 95% CI: 15.7, 32.0), birth preparedness (β = 12.7, 95% CI: 5.2, 20.1), and danger sign recognition (β = 8.6, 95% CI: 3.3, 13.9). Both cadres had positive opinions regarding task shifting, although several preferred 'task sharing' over full delegation.</p> <p>Conclusions</p> <p>Lay nurse aides can provide effective antenatal counseling in maternal and newborn care in facility-based settings, provided they receive adequate training and support. Efforts are needed to improve management of human resources to ensure that effective mechanisms for regulating and financing task shifting are sustained.</p

Does accreditation stimulate change? A study of the impact of the accreditation process on Canadian healthcare organizations

<p>Abstract</p> <p>Background</p> <p>One way to improve quality and safety in healthcare organizations (HCOs) is through accreditation. Accreditation is a rigorous external evaluation process that comprises self-assessment against a given set of standards, an on-site survey followed by a report with or without recommendations, and the award or refusal of accreditation status. This study evaluates how the accreditation process helps introduce organizational changes that enhance the quality and safety of care.</p> <p>Methods</p> <p>We used an embedded multiple case study design to explore organizational characteristics and identify changes linked to the accreditation process. We employed a theoretical framework to analyze various elements and for each case, we interviewed top managers, conducted focus groups with staff directly involved in the accreditation process, and analyzed self-assessment reports, accreditation reports and other case-related documents.</p> <p>Results</p> <p>The context in which accreditation took place, including the organizational context, influenced the type of change dynamics that occurred in HCOs. Furthermore, while accreditation itself was not necessarily the element that initiated change, the accreditation process was a highly effective tool for (i) accelerating integration and stimulating a spirit of cooperation in newly merged HCOs; (ii) helping to introduce continuous quality improvement programs to newly accredited or not-yet-accredited organizations; (iii) creating new leadership for quality improvement initiatives; (iv) increasing social capital by giving staff the opportunity to develop relationships; and (v) fostering links between HCOs and other stakeholders. The study also found that HCOs' motivation to introduce accreditation-related changes dwindled over time.</p> <p>Conclusions</p> <p>We conclude that the accreditation process is an effective leitmotiv for the introduction of change but is nonetheless subject to a learning cycle and a learning curve. Institutions invest greatly to conform to the first accreditation visit and reap the greatest benefits in the next three accreditation cycles (3 to 10 years after initial accreditation). After 10 years, however, institutions begin to find accreditation less challenging. To maximize the benefits of the accreditation process, HCOs and accrediting bodies must seek ways to take full advantage of each stage of the accreditation process over time.</p

How doctors generate diagnostic hypotheses: a study of radiological diagnosis with functional magnetic resonance imaging.

In medical practice, diagnostic hypotheses are often made by physicians in the first moments of contact with patients; sometimes even before they report their symptoms. We propose that generation of diagnostic hypotheses in this context is the result of cognitive processes subserved by brain mechanisms that are similar to those involved in naming objects or concepts in everyday life

Freedom at, through and from work: Rethinking labour rights

To what extent do labour rights promote freedom in relation to work? Methodologically, the article defines three freedoms: ‘freedom at work’, ‘freedom through work’, and ‘freedom from work’. It shows that fundamental labour rights have traditionally aimed at protecting workers in the labour market, not at expanding freedoms and in particular freedom ‘from’ work. In this respect, it outlines some limits of current proposals relying on productivity and redistribution, such as the basic income, to liberate from work. Beyond these proposals, the article develops new rights in the human economy framework. The article concludes that, in order to expand freedoms in relation to work, not fewer but more fundamental labour rights will be required

Mean level of subsidies received by host countries over the period of their respective agreements, as well as mean fee paid by the industry per tonne of tuna over the 2008–2012 period.

a<p>Liners usually pay lower fees than purse-seiners. Although purse-seiners catches are higher than that of liners, both gear types were given the same weight here.</p

Baseline data and estimate of the ‘total fee/gross revenue’ ratio for the mixed agreement with Mauritania over the 2008–2010 period (details are shown in the appended Dataset S1; ‘Calculations Mauritania’ spreadsheet).

a<p>‘Total fee’ was calculated by multiplying the fee per unit of fishing capacity (in 2012 EUR/GT) by the amount of capacity (GT) reported to have been used in each fishing category <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0079899#pone.0079899-Anon1" target="_blank">[61]</a>.</p

Extent of publicly funded EU fishing agreements with developing countries.

<p>Distribution of the twenty public agreements that the EU has signed with developing countries throughout Africa and Oceania in the 1980s (red), 1990s (yellow) and 2000s (green). EU vessels also have the possibility to freely fish in EU waters (represented by grey areas, including overseas territories with the exception of the Chagos Archipelago, in cross-hatch, which is now fully protected). Some of these agreements have been cancelled (Angola, Equatorial Guinea, Gabon, Gambia, Guinea-Bissau, Guinea, Senegal; highlighted with black crosses) or are currently being renegotiated (Mauritania, Mauritius, Micronesia, Morocco, Solomon Islands; highlighted with black squares). Situation as of December 2012.</p

Number of agreements and authorized capacity.

<p>Trends of A) the number of EU public fishing agreements signed with developing countries in Africa and Oceania, and B) authorized capacity of the tuna fleet (dark grey) and other fleets (light grey; mostly demersal fishing, but also includes some non-tuna pelagic fishing with various types of lines and nets), from 1980 to 2012, by month. The implementation of the Common Fisheries Policy (CFP) and its three reforms (the third one being ongoing) are indicated by black arrows.</p

Cost of tuna agreements for the industry.

<p>Ratio of fees paid by the industry relative to landed value for the tuna component of all agreements. This figure only includes agreements for which there were tuna quotas. The solid line represents the median, while the grey area represents the limit beyond which a point is considered to be an outlier [data points below quartile₁−1.5*(quartile₃–quartile₂), or above quartile₃+1.5*(quartile₃–quartile₂). The ‘smooth.spline’ function in R was used <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0079899#pone.0079899-Ripley1" target="_blank">[82]</a>, with a smoothing window ‘spar’ set to 0.5]. Note that for 2012, we considered the ex-vessel price of tuna to be 2,000 EUR/t, based on historical trends and various sources of information. This graph is based on 218 ‘country/year’ datapoints. Note that liners usually pay lower fees and also have lower catches than purse-seiners; however, both gear types were given the same weight here (the difference between weighted and non-weighted results was minimal). The implementation of the Common Fisheries Policy (CFP) and its three reforms (the third one being ongoing) are indicated by black arrows.</p