What is the contribution of physician associates in hospital care in England? A mixed methods, multiple case study.

OBJECTIVES: To investigate the deployment of physician associates (PAs); the factors supporting and inhibiting their employment and their contribution and impact on patients' experience and outcomes and the organisation of services. DESIGN: Mixed methods within a case study design, using interviews, observations, work diaries and documentary analysis. SETTING: Six acute care hospitals in three regions of England in 2016-2017. PARTICIPANTS: 43 PAs, 77 other health professionals, 28 managers, 28 patients and relatives. RESULTS: A key influencing factor supporting the employment of PAs in all settings was a shortage of doctors. PAs were found to be acceptable, appropriate and safe members of the medical/surgical teams by the majority of doctors, managers and nurses. They were mainly deployed to undertake inpatient ward work in the medical/surgical team during core weekday hours. They were reported to positively contribute to: continuity within their medical/surgical team, patient experience and flow, inducting new junior doctors, supporting the medical/surgical teams' workload, which released doctors for more complex patients and their training. The lack of regulation and attendant lack of authority to prescribe was seen as a problem in many but not all specialties. The contribution of PAs to productivity and patient outcomes was not quantifiable separately from other members of the team and wider service organisation. Patients and relatives described PAs positively but most did not understand who and what a PA was, often mistaking them for doctors. CONCLUSIONS: This study offers new insights concerning the deployment and contribution of PAs in medical and surgical specialties in English hospitals. PAs provided a flexible addition to the secondary care workforce without drawing from existing professions. Their utility in the hospital setting is unlikely to be completely realised without the appropriate level of regulation and authority to prescribe medicines and order ionising radiation within their scope of practice

Biomechanics for inclusive urban design : effects of tactile paving on older adults’ gait when crossing the street

In light of our ageing population it is important that the urban environment is easily accessible and hence supports older adults’ independence. Tactile ‘blister’ paving was originally designed to provide guidance for visually impaired people at pedestrian crossings. However, as research links irregular surfaces to falls in older adults, such paving may have an adverse effect on older people. We investigated the effects of tactile paving on older adults’ gait in a scenario closely resembling “crossing the street”. Gait analysis of 32 healthy older adults showed that tactile, as compared to smooth, paving increases the variability in timing of foot placement by 20%, thereby indicating a disturbance of the rhythmic gait pattern. Moreover, toe-clearance during the swing phase increased by 7% on tactile paving, and the ability to stop upon cue from the traffic light was compromised. These results need to be viewed under consideration of the limitations associated with laboratory studies and real world analysis is needed to fully understand their implications for urban design

Linking Physical Education With Community Sport and Recreation: A Program for Adolescent Girls

The engagement of adolescent girls in physical activity (PA) is a persistent challenge. School-based PA programs have often met with little success because of the lack of linkages between school and community PA settings. The Triple G program aimed to improve PA levels of secondary school girls (12-15 years) in regional Victoria, Australia. The program included a school-based physical education (PE) component that uniquely incorporated student-centered teaching and behavioral skill development. The school component was conceptually and practically linked to a community component that emphasized appropriate structures for participation. The program was informed by ethnographic fieldwork to understand the contextual factors that affect girls’ participation in PA. A collaborative intervention design was undertaken to align with PE curriculum and coaching and instructional approaches in community PA settings. The theoretical framework for the intervention was the socioecological model that was underpinned by both individual-level (social cognitive theory) and organizational-level (building organizational/community capacity) strategies. The program model provides an innovative conceptual framework for linking school PE with community sport and recreation and may benefit other PA programs seeking to engage adolescent girls. The objective of this article is to describe program development and the unique theoretical framework and curriculum approaches

Plutonium stabilization in zircon: Effects of self-radiation

Zircon (ZrSiO4)(ZrSiO4) is the most thoroughly studied of all candidate ceramic phases for the stabilization of plutonium. Self-radiation damage from α-decay of the 239Pu,239Pu, which releases a 5.16 MeV α-particle and a 0.086 MeV 235U235U recoil nucleus, can significantly affect the structure and properties of zircon. Recent computer simulations using energy minimization techniques indicate that the lowest energy configuration occurs for a defect cluster composed of two near-neighbor Pu3+Pu3+ substitutions on Zr4+Zr4+ sites and a neighboring charge-compensating oxygen vacancy. © 2000 American Institute of Physics.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/87571/2/18_1.pd

Synthesis and characterisation of Ca1-xCexZrTi2-2xCr2xO7: Analogue zirconolite wasteform for the immobilisation of stockpiled UK plutonium

A series of Ca1-xCexZrTi2-2xCr2xO7 zirconolite ceramics (0 ≤ x ≤ 0.35) were reactively sintered in air at 1350 °C for 20 h. Single phase zirconolite-2M was formed for x ≤ 0.15, with Cr2O3 and an undesirable Ce-bearing perovskite phase present above x = 0.20. Electron diffraction analysis confirmed that the zirconolite-2M polytype was maintained over the solid solution. X-ray absorption near edge structure (XANES) data determined that between 10–20% Ce was speciated as Ce3+, and Cr was present uniformly as Cr3+ with near edge features consistent with occupation of octahedral sites within the zirconolite-2M structure. A sample corresponding to x = 0.20 was processed by reactive spark plasma sintering (RSPS), with a rapid processing time of less than 1 h. XANES data confirmed complete reduction to Ce3+ during RSPS, promoting the formation of a Ce-bearing perovskite, comprising 19.3 ± 0.4 wt. % of the phase assemblage