Different views : including others in participatory health service innovation

We describe our experiences employing experience-based design (EBD) to improve an outpatients health service in the UK and discuss the impacts of incorporating the voices of those not directly using or working within the service. We suggest that such new perspectives, experiences and expertise may enable the development of service innovations outside patients’ and staffs’ conceptual space of problems/solutions, but can affect the ownership and agency within the change project. To conclude, we propose a balance between accomplishing change and creating the self-belief to achieve it

Participatory healthcare service design and innovation

This paper describes the use of Experience Based Design (EBD), a participatory methodology for healthcare service design, to improve the outpatient service for older people at Sheffield Teaching Hospitals. The challenges in moving from stories to designing improvements, co-designing for wicked problems, and the effects of participants' limited scopes of action are discussed. It concludes by proposing that such problems are common to participatory service design in large institutions and recommends that future versions of EBD incorporate more tools to promote divergent thinking

Habitat Selection and Movement of a Stream-Resident Salmonid in a Regulated River and Tests of Four Bioenergetic Optimization Models

A bioenergetics model was constructed for stream-resident drift-feeding salmonids. Model predictions of surplus power (energy available per unit time for lll growth and reproduction) were not statistically distinguishable from observations of surplus power in three laboratory studies. Of 40 experimental trials in these three studies, the model correctly predicted surplus power in 39 cases (p \u3c 0.05). I collected observations of rainbow trout (Oncorhynchus mykiss) focal velocity and physical habitat availability in the Green River of northeastern Utah, USA (1988-1990). In the winter of 1988, Flaming Gorge Dam generated hydropower and delivered an lJDStable discharge regime with a higher mean discharge to the Green River. During 1989 and 1990, Flaming Gorge Dam\u27s operation was curtailed by drought. Therefore, the Green River exhibited a more stable discharge regime with lower mean daily discharge. During winters exhibiting the stable discharge regime, all size classes of rainbow trout selected slower focal velocities than under an unstable winter discharge regime. Season had less influence on microhabitat selection of large fish than smaller individuals. Rainbow trout larger than 33 cm (total length) find and use positions with low focal velocities and high velocity shear regardless of season. In contrast, during the summer, fish less than 33 cm TL find and use positions with much higher focal velocities and greater velocity shear compared to the winter. Four bioenergetic models were tested with the focal velocity use data. Two optimal goal models produced excellent fits (r2 = 0.91 and 0.93) to observed focal velocity use of rainbow trout larger than 33 cm TL. These results were consistent with the hypothesis that large rainbow trout were finding optimal focal velocity positions in stable discharge summers and under both discharge regimes in winter. Rainbow trout movement was quantified along two scales with radio-telemetered fish: 1) weekly observations generated estimates of distances moved at intervals greater than one day and 2) multiple observations of a fish in one day produced estimates of distances moved over hours. I found an unstable discharge regime significantly reduces movement measured weekly (F = 11.10, P = 0.0019); hourly movement rates (m/h) were also reduced (F = 5.90, P = 0.0273)

SPATIAL DISTRIBUTION AND GEOMORPHIC EVOLUTION OF PLAYA-LUNETTE SYSTEMS ON THE CENTRAL HIGH PLAINS OF KANSAS

Geographically and hydrologically isolated, ephemeral playa wetlands are ubiquitous features of the High Plains. Lunettes are dune-like features that form downwind of some larger playas. Although playas are important landscape elements, few systematic inventories have been conducted, and little is known about their evolutionary history. A comprehensive Geographic Information Systems database was created for Kansas utilizing several geospatial data sources, including aerial imagery, digital raster graphics, and SSURGO soils data. In addition, stratigraphic data collected from two representative playa-lunette systems (PLSs) were used to reconstruct paleoenvironment and geomorphic processes occurring within these systems throughout their formation and evolution. Mapping results indicate there are more than 22,000 playas in Kansas, ranging in size from 0.03 ha to 188 ha, with a mean area of 1.65 ha. More than 80% of all playas are smaller than 2 ha and only about 400 are larger than 10 ha. Results indicate that previous High Plains playa inventories failed to identify most playas smaller than 2 ha because data sources were not of sufficient resolution. Additionally, playa identification criteria have not been consistent for all inventories, making it difficult to compare results and establish trends for various playa attributes across the entire High Plains. Stratigraphic investigations of the two PLSs indicate they are composed of sediment spanning more than 40 kyrs, which began accumulating during at least Marine Isotope Stage (MIS) 3. Climate during MIS 3 was similar to modern: warm temperatures, low effective moisture, and playa floors exposed long enough to allow pedogenesis. During MIS 2, climate was relatively cool with higher effective moisture, and playas were inundated for longer periods. During the Pleistocene-Holocene transition, climate warmed, yet moisture availability remained relatively high. Several distinct shifts in δ13C identify rapid climate changes associated with the Bølling-Allerød/Younger Dryas climate sequence. Warming continued into the Holocene, though moisture availability was highly variable; Holocene soils are common. Thus, PLSs represents a continuum of the uplands High Plains loess sequence, though deposits are altered by playa hydrology. Geomorphic processes alternated between fluvial- and eolian-driven as climate changed, and detailed records of environmental change throughout their evolution are preserved

Consequences of Reservoir Drainage on Downstream Water Chemistry, Suspended Sediment, and Nutrients, Southwest Missouri

Construction and subsequent draining of reservoirs can have dramatic affects on the release of nutrients and sediments to waterways. This study describes how the temporary draining of a small reservoir for dam repair influences downstream water quality. The Valley Mill Reservoir has a surface area of 6.1 hectares and volume of 150,000 m3 when filled. Water chemistry monitoring and water sampling were performed at six sites during baseflow and ten sites during runoff events for one year. Water samples were analyzed for total nitrogen (TN), total phosphorous (TP), and total suspended sediment (TSS) concentrations. Results indicate that draining of Valley Mill Reservoir caused only minor changes in water chemistry. However, reservoir drainage caused significant erosion of the exposed lake bed as well as the stream channel upstream of the reservoir. Increases in TSS lagged behind drainage but increased dramatically once drainage was complete. Mean TSS increased from 7.5 mg/L upstream of the reservoir to 20.7 mg/L in reservoir outflow during baseflow. During storm events, TSS increased over 100 percent to nearly 100 mg/L in the drained reservoir outflow, with a maximum concentration of 525 mg/L. The increase in TSS resulted in TP increases during baseflow and storm events, since TP is known to attach to sediment. Mean outflowing TP increased by 10 percent to 43 ug/L during baseflow and by 20 percent to 207 ug/L following storm events. Total nitrogen remained below 5 mg/L at all monitoring sites and decreased by 5 to 15 percent after flowing over the exposed lakebed. Therefore, draining of Valley Mill Reservoir may have caused degradation of water quality downstream of reservoir outflow due to large amounts of sediment and phosphorus being released from the drained reservoir

Massive neutral gauge boson production as a probe of nuclear modifications of parton distributions at the LHC

We analyze the role of nuclear modifications of parton distributions, notably, the nuclear shadowing and antishadowing corrections, in production of lepton pairs from decays of neutral electroweak gauge bosons in proton-lead and lead-collisions at the LHC. Using the Collins-Soper-Sterman resummation formalism that we extended to the case of nuclear parton distributions, we observed a direct correlation between the predicted behavior of the transverse momentum and rapidity distributions of the produced vector bosons and the pattern of quark and gluon nuclear modifications. This makes Drell-Yan pair production in $pA$ and $AA$ collisions at the LHC a useful tool for constraining nuclear PDFs in the small-$x$ shadowing and moderate-$x$ antishadowing regions.Comment: 33 pages, 17 figure

Using popular culture to enable health service co-design with young people

This paper reports on participatory service design with young people with type 1 diabetes – a long-term condition that can impact their emotional wellbeing and where poor self-care often leads to negative health consequences. The paper describes a project working with young people with type 1 diabetes to design innovative health services. The project consisted of eight creative workshops, in which we used popular cultural references as a means to create enjoyable activities and encourage the young people to engage with design. These cultural references can be understood as creating design language games that allowed the young people to understand and participate in the activities required at each stage of the design process. However, not all popular culture references worked equally well and this paper explores the reasons for this

Reliability and identification of aortic valve prolapse in the horse

Background The objectives were to determine and assess the reliability of criteria for identification of aortic valve prolapse (AVP) using echocardiography in the horse. Results Opinion of equine cardiologists indicated that a long-axis view of the aortic valve (AoV) was most commonly used for identification of AVP (46%; n=13). There was consensus that AVP could be mimicked by ultrasound probe malignment. This was confirmed in 7 healthy horses, where the appearance of AVP could be induced by malalignment. In a study of a further 8 healthy horses (5 with AVP) examined daily for 5 days, by two echocardiographers standardized imaging guidelines gave good to excellent agreement for the assessment of AVP (kappa>0.80) and good agreement between days and observers (kappa >0.6). The technique allowed for assessment of the degree of prolapse and measurement of the prolapse distance that provided excellent agreement between echocardiographers, days and observers (kappa/ICC>0.8). Assessments made using real-time zoomed images provided similar measurements to the standard views (ICC=0.9), with agreement for the identification of AVP (kappa>0.8). Short axis views of the AoV were used for identification of AVP by fewer respondents (23%), however provided less agreement for the identification of AVP (kappa>0.6) and only adequate agreement with observations made in long axis (kappa>0.5), with AVP being identified more often in short axis (92%) compared to long axis (76%). Orthogonal views were used by 31% of respondents to identify the presence of AVP, and 85% to identify cusp. Its identification on both views on 4 days was used to categorise horses as having AVP, providing a positive predictive value of 79% and negative predictive value of 18%. Only the non-coronary cusp (NCC) of the AoV was observed to prolapse in these studies. Prolapse of the NCC was confirmed during the optimisation study using four-dimensional echocardiography, which concurred with the findings of two-dimensional echocardiography. Conclusions This study has demonstrated reliable diagnostic criteria for the identification and assessment of AVP that can be used for longitudinal research studies to better define the prevalence and natural history of this condition