Healthcare services managers: what information do they need and use?

Objectives: To gain insight into the information behaviour of healthcare services managers as they draw on information while engaged in decision making unrelated to individual patient care. Objectives – The purpose of this research project was to gain insight into the information behaviour of healthcare services managers as they use information while engaged in decision-making unrelated to individual patient care. Methods – This small-scale, exploratory, multiple case study used the critical incident technique in nineteen semi-structured interviews. Responses were analyzed using ‘Framework,’ a matrix-based content analysis system. Results – This paper presents findings related to the internal information that healthcare services managers need and use. Their decisions are influenced by a wide variety of factors. They must often make decisions without all of the information they would prefer to have. Internal information and practical experience set the context for new research-based information, so they are generally considered first. Conclusions – Healthcare services managers support decisions with both facts and value-based information. These results may inform both delivery of health library services delivery and strategic health information management planning. They may also support librarians who extend their skills beyond managing library collections and teaching published information retrieval skills, to managing internal and external information, teaching information literacy, and supporting information sharing

Reaching health service managers with research

Introduction. The aim of this paper is to identify and characterize the routes by which research may reach health service managers to influence their critical decisions. Method.This research used two series of qualitative interviews, documentary analysis (a calendar study) and a card-sorting exercise to explore the workplace information practices of thirty-six health service managers. Analysis. Both interview studies used the cross-case analysis. The second interview study also used within-case analysis in the form of information transaction mapping. Information transactions, calendar study and card-sorting exercise data were reported quantitatively. Results. This exploratory study found that these health service managers overcame short time lines, unclear processes and simultaneous conflicting priorities by bringing together groups accustomed to sharing information orally to inform their critical decisions. Each decision was informed by different categories and types of information. Group decisions allowed information from multiple sources, including research, to be integrated until there was just enough for a comfortable decision. Research reached these managers through one or more of at least eight different routes. Conclusions. Professional standards, conferences, structurally positioned gatekeepers (knowledgeable co-workers in positions related to the critical decision subject) and other information sources that appraise and filter research then blend it with local context are preferred over research papers that must be searched, read, appraised and then integrated with other information types. Eight routes by which research reaches health services managers are compared with seven elements in a research-to-policy conceptual framework

PADAMOT : project overview report

Background and relevance to radioactive waste management International consensus confirms that placing radioactive wastes and spent nuclear fuel deep underground in a geological repository is the generally preferred option for their long-term management and disposal. This strategy provides a number of advantages compared to leaving it on or near the Earth’s surface. These advantages come about because, for a well chosen site, the geosphere can provide: • a physical barrier that can negate or buffer against the effects of surface dominated natural disruptive processes such as deep weathering, glaciation, river and marine erosion or flooding, asteroid/comet impact and earthquake shaking etc. • long and slow groundwater return pathways from the facility to the biosphere along which retardation, dilution and dispersion processes may operate to reduce radionuclide concentration in the groundwater. • a stable, and benign geochemical environment to maximise the longevity of the engineered barriers such as the waste containers and backfill in the facility. • a natural radiation shield around the wastes. • a mechanically stable environment in which the facility can be constructed and will afterwards be protected. • an environment which reduces the likelihood of the repository being disturbed by inadvertent human intrusion such as land use changes, construction projects, drilling, quarrying and mining etc. • protection against the effects of deliberate human activities such as vandalism, terrorism and war etc. However, safety considerations for storing and disposing of long-lived radioactive wastes must take into account various scenarios that might affect the ability of the geosphere to provide the functionality listed above. Therefore, in order to provide confidence in the ability of a repository to perform within the deep geological setting at a particular site, a demonstration of geosphere “stability” needs to be made. Stability is defined here to be the capacity of a geological and hydrogeological system to minimise the impact of external influences on the repository environment, or at least to account for them in a manner that would allow their impacts to be evaluated and accounted for in any safety assessments. A repository should be sited where the deep geosphere is a stable host in which the engineered containment can continue to perform according to design and in which the surrounding hydrogeological, geomechanical and geochemical environment will continue to operate as a natural barrier to radionuclide movement towards the biosphere. However, over the long periods of time during which long-lived radioactive wastes will pose a hazard, environmental change at the surface has the potential to disrupt the stability of the geosphere and therefore the causes of environmental change and their potential consequences need to be evaluated. As noted above, environmental change can include processes such as deep weathering, glaciation, river and marine erosion. It can also lead to changes in groundwater boundary conditions through alternating recharge/discharge relationships. One of the key drivers for environmental change is climate variability. The question then arises, how can geosphere stability be assessed with respect to changes in climate? Key issues raised in connection with this are: • What evidence is there that 'going underground' eliminates the extreme conditions that storage on the surface would be subjected to in the long term? • How can the additional stability and safety of the deep geosphere be demonstrated with evidence from the natural system? As a corollary to this, the capacity of repository sites deep underground in stable rock masses to mitigate potential impacts of future climate change on groundwater conditions therefore needs to be tested and demonstrated. To date, generic scenarios for groundwater evolution relating to climate change are currently weakly constrained by data and process understanding. Hence, the possibility of site-specific changes of groundwater conditions in the future can only be assessed and demonstrated by studying groundwater evolution in the past. Stability of groundwater conditions in the past is an indication of future stability, though both the climatic and geological contexts must be taken into account in making such an assertion

Dipyridamole plus aspirin versus aspirin alone in the secondary prevention after TIA or stroke: a meta-analysis by risk

Objectives: Our aim was to study the effect of combination therapy with aspirin and dipyridamole (A+D) over aspirin alone (ASA) in secondary prevention after transient ischemic attack or minor stroke of presumed arterial origin and to perform subgroup analyses to identify patients that might benefit most from secondary prevention with A+D. Data sources: The previously published meta-analysis of individual patient data was updated with data from ESPRIT (N=2,739); trials without data on the comparison of A+D versus ASA were excluded. Review methods: A meta-analysis was performed using Cox regression, including several subgroup analyses and following baseline risk stratification. Results: A total of 7,612 patients (5 trials) were included in the analyses, 3,800 allocated to A+D and 3,812 to ASA alone. The trial-adjusted hazard ratio for the composite event of vascular death, non-fatal myocardial infarction and non-fatal stroke was 0.82 (95% confidence interval 0.72-0.92). Hazard ratios did not differ in subgroup analyses based on age, sex, qualifying event, hypertension, diabetes, previous stroke, ischemic heart disease, aspirin dose, type of vessel disease and dipyridamole formulation, nor across baseline risk strata as assessed with two different risk scores. A+D were also more effective than ASA alone in preventing recurrent stroke, HR 0.78 (95% CI 0.68 – 0.90). Conclusion: The combination of aspirin and dipyridamole is more effective than aspirin alone in patients with TIA or ischemic stroke of presumed arterial origin in the secondary prevention of stroke and other vascular events. This superiority was found in all subgroups and was independent of baseline risk. ---------------------------7dc3521430776 Content-Disposition: form-data; name="c14_creators_1_name_family" Halke

Individual patient data meta-analysis of randomized controlled trials of community occupational therapy for stroke patients

<p><b>Background and Purpose:</b> Trials of occupational therapy for stroke patients living in the community have varied in their findings. It is unclear why these discrepancies have occurred.</p> <p><b>Methods:</b> Trials were identified from searches of the Cochrane Library and other sources. The primary outcome measure was the Nottingham Extended Activities of Daily Living (NEADL) score at the end of intervention. Secondary outcome measures included the Barthel Index or the Rivermead ADL (Personal ADL), General Health Questionnaire (GHQ), Nottingham Leisure Questionnaire (NLQ), and death. Data were analyzed using linear or logistic regression with a random effect for trial and adjustment for age, gender, baseline dependency, and method of follow-up. Subgroup analyses compared any occupational therapy intervention with control.</p> <p><b>Results:</b> We included 8 single-blind randomized controlled trials incorporating 1143 patients. Occupational therapy was associated with higher NEADL scores at the end of intervention (weighted mean difference [WMD], 1.30 points, 95% confidence intervals [CI], 0.47 to 2.13) and higher leisure scores at the end of intervention (WMD, 1.51 points; 95% CI, 0.24 to 2.79). Occupational therapy emphasizing activities of daily living (ADL) was associated with improved end of intervention NEADL (WMD, 1.61 points; 95% CI, 0.72 to 2.49) and personal activities of daily living (odds ratio [OR], 0.65; 95% CI, 0.46 to 0.91), but not NLQ. Leisure-based occupational therapy improved end of intervention NLQ (WMD, 1.96 points; 95% CI, 0.27 to 3.66) but not NEADL or PADL.</p> <p><b>Conclusions:</b> Community occupational therapy significantly improved personal and extended activities of daily living and leisure activity in patients with stroke. Better outcomes were found with targeted interventions.</p&gt

The fluorine link between a supergiant ore deposit and a silicic large igneous province

Olympic Dam is a supergiant Fe oxide Cu-U-Au-Ag ore deposit (~9 × 109 t) that is also enriched in rare earth elements (REEs) and fluorine (F). The immediate host to the ore is hydrothermal breccia within granite and volcanic rocks of a Mesoproterozoic silicic large igneous province. Analyses of melt inclusions in quartz phenocrysts in rhyolite show that the silicic magmas of this province were unusually rich in F (up to 1.3 wt%). Fluorite and other F-rich minerals that crystallized from these magmas provided a gigantic reservoir of F. As a result, the Olympic Dam ore-forming fluid was F-rich and had exceptional capacity to transport diverse elements. Further, we infer that hydrofluoric acid, the most corrosive acid known, contributed to hydrothermal breccia formation by dissolution that in turn increased permeability and accelerated the rate of fluid-rock interaction. It is no accident that the world's largest hydrothermal ore deposit occurs in an F-rich silicic large igneous province

Design of hidden thermodynamic driving for non-equilibrium systems via mismatch elimination during DNA strand displacement

Recent years have seen great advances in the development of synthetic self-assembling molecular systems. Designing out-of-equilibrium architectures, however, requires a more subtle control over the thermodynamics and kinetics of reactions. We propose a mechanism for enhancing the thermodynamic drive of DNA strand-displacement reactions whilst barely perturbing forward reaction rates: the introduction of mismatches within the initial duplex. Through a combination of experiment and simulation, we demonstrate that displacement rates are strongly sensitive to mismatch location and can be tuned by rational design. By placing mismatches away from duplex ends, the thermodynamic drive for a strand-displacement reaction can be varied without significantly affecting the forward reaction rate. This hidden thermodynamic driving motif is ideal for the engineering of non-equilibrium systems that rely on catalytic control and must be robust to leak reactions

Relationships between Larval and Juvenile Abundance of Winter-Spawned Fishes in North Carolina, USA

We analyzed the relationships between the larval and juvenile abundances of selected estuarine-dependent fishes that spawn during the winter in continental shelf waters of the U.S. Atlantic coast. Six species were included in the analysis based on their ecological and economic importance and relative abundance in available surveys: spot Leiostomus xanthurus, pinfish Lagodon rhomboides, southern flounder Paralichthys lethostigma, summer flounder Paralichthys dentatus, Atlantic croaker Micropogonias undulatus, and Atlantic menhaden Brevoortia tyrannus. Cross-correlation analysis was used to examine the relationships between the larval and juvenile abundances within species. Tests of synchrony across species were used to find similarities in recruitment dynamics for species with similar winter shelf-spawning life-history strategies. Positive correlations were found between the larval and juvenile abundances for three of the six selected species (spot, pinfish, and southern flounder). These three species have similar geographic ranges that primarily lie south of Cape Hatteras. There were no significant correlations between the larval and juvenile abundances for the other three species (summer flounder, Atlantic croaker, and Atlantic menhaden); we suggest several factors that could account for the lack of a relationship. Synchrony was found among the three southern species within both the larval and juvenile abundance time series. These results provide support for using larval ingress measures as indices of abundance for these and other species with similar geographic ranges and winter shelf-spawning life-history strategies

Information overload and information poverty: challenges for healthcare services managers?

Purpose – The purpose of this paper is to gain insight into managers' decision-making practices when challenged by inappropriate information quality, and to test frameworks developed from research to see whether they apply to these managers. Design/methodology/approach – This exploratory, multiple case study used the critical incident technique in 19 semi-structured interviews. Responses were analyzed using framework analysis, a matrix-based content analysis technique, and then considered with respect to the research literature on information overload, information poverty and satisficing. Findings – The managers in this study tended to satisfice (terminate the search process and make a good enough decision, while recognizing that information gaps remain). Those challenged by too little information appear to fit descriptions of information poverty, while others described aspects of information overload. Research limitations/implications – A shortage of information behavior research on managers makes it difficult to conclude whether these results are typical of managers in general or of healthcare services managers specifically. Further research is needed to confirm initial findings and address questions suggested by this paper. Practical implications – This paper suggests that existing definitions for the concepts of information poverty and information overload can be used to describe managers' experiences. Originality/value – This paper contributes to what is known about information behavior in managers in general and healthcare services managers specifically. It may serve as an example of how to consider new research findings within existing frameworks