Caring for continence in stroke care settings: a qualitative study of patients’ and staff perspectives on the implementation of a new continence care intervention

Objectives: Investigate the perspectives of patients and nursing staff on the implementation of an augmented continence care intervention after stroke. Design: Qualitative data were elicited during semi-structured interviews with patients (n = 15) and staff (14 nurses; nine nursing assistants) and analysed using thematic analysis. Setting: Mixed acute and rehabilitation stroke ward. Participants: Stroke patients and nursing staff that experienced an enhanced continence care intervention. Results: Four themes emerged from patients’ interviews describing: (a) challenges communicating about continence (initiating conversations and information exchange); (b) mixed perceptions of continence care; (c) ambiguity of focus between mobility and continence issues; and (d) inconsistent involvement in continence care decision making. Patients’ perceptions reflected the severity of their urinary incontinence. Staff described changes in: (i) knowledge as a consequence of specialist training; (ii) continence interventions (including the development of nurse-led initiatives to reduce the incidence of unnecessary catheterisation among patients admitted to their ward); (iii) changes in attitude towards continence from containment approaches to continence rehabilitation; and (iv) the challenges of providing continence care within a stroke care context including limitations in access to continence care equipment or products, and institutional attitudes towards continence. Conclusion: Patients (particularly those with severe urinary incontinence) described challenges communicating about and involvement in continence care decisions. In contrast, nurses described improved continence knowledge, attitudes and confidence alongside a shift from containment to rehabilitative approaches. Contextual components including care from point of hospital admission, equipment accessibility and interdisciplinary approaches were perceived as important factors to enhancing continence care

Morphology, sedimentary infill and depositional environments of the Early Quaternary North Sea Basin (56°-62°N)

The North Sea Basin has been subsiding during the Quaternary and contains hundreds of metres of fill. Seismic surveys (170 000 km2) provide new evidence on Early Quaternary sedimentation, from about 2.75 Ma to around the Brunhes-Matuyama boundary (0.78 Ma). We present an informal seismic stratigraphy for the Early Quaternary of the North Sea, and calculate sediment volumes for major units. Early Quaternary sediment thickness is > 1000 m in the northern basin and >700 m in the central basin (total about 40 000 km3). Northern North Sea basin-fill comprises several clinoform units, prograding westward over 60 000 km2. Architecture of the central basin also comprises clinoforms, building from the southeast. To the west, an acoustically layered and mounded unit (Unit Z) was deposited. Remaining accommodation space was filled with fine-grained sediments of two Central Basin units. Above these units, an Upper Regional Unconformity-equivalent (URU) records a conformable surface with flat-lying units that indicate stronger direct glacial influence than on the sediments below. On the North Sea Plateau north of 59°N, the Upper Regional Unconformity (URU) is defined by a shift from westward to eastward dipping seismic reflectors, recording a major change in sedimentation, with the Shetland Platform becoming a significant source. A model of Early Quaternary sediment delivery to the North Sea shows sources from the Scandinavian ice sheet and major European rivers. Clinoforms prograding west in the northern North Sea Basin, representing glacigenic debris flows, indicate an ice sheet on the western Scandinavian margin. In the central basin, sediments are generally fine-grained, suggesting a distal fluvial or glacifluvial origin from European rivers. Ploughmarks also demonstrate that icebergs, derived from an ice sheet to the north, drifted into the central North Sea Basin. By contrast, sediments and glacial landforms above the URU provide evidence for the later presence of a grounded ice sheet.We thank Det norske oljeselskap for financial support and permission to publish this work. We also thank Petroleum Geoservices and TGS for permission to publish seismic lines and seismic amplitude maps and Exploro AS for their support of the project.This is the final published version. It first appeared at http://www.sciencedirect.com/science/article/pii/S0264817214001342

Measurement of stopping beam distributions in the PIBETA detector

Precise calculation of the geometrical acceptance of a large solid angle detector with an integrated stopping target relies on precise knowledge of the beam geometry. We describe four alternative methods that we used to measure the beam stopping distributions in the PIBETA detector active target: (i) light response of segmented target elements to incident beam particles, (ii) back-tracking of charged particles from pi+ and mu+ decays using multi-wire proportional chambers, (iii) volume distribution of the Dalitz decay (pi0->gamma e+e-) event vertices, and (iv) the opening angle distribution of two pi0 photons originating from the beta decay of pi+ at rest. We demonstrate consistent results obtained by these four independent approaches and show how particular beam stopping distributions affect the detector's geometrical acceptance.Comment: 38 pages, 16 postscript figures, 2 tables, LaTeX, submitted to Nucl. Instrum. Meth.

Assessing Economic Benefits of Good Ecological Status in Lakes under the EU Water Framework Directive. Case study report. Norway

An internet survey was conducted on 1113 households in Østfold County and southern muni­cipalities of Akershus County in the summer of 2008. The survey focused on households’ recreational use of water bodies and their willingness to pay for improvements in lake ecological status. The main objective of the study was to evaluate at what distance from improved lakes, households willingness to pay falls to zero. This is key to correctly determining how large a population has benefits from measures under the Water Framework Directive, and making correct estimates of total benefits of a programme of measures. Valuation methods aimed at capturing recreational use values and also non-use values. The largest lakes in Østfold in three different catchments (Morsa, Glomma and Halden) were considered, Alternative valuation methods are compared for two lakes in particular in this report (Vestre Vansjø and Storefjorden). The study was the Norwegian case study for the EUFP6 AQUAMONEY research project.European Commissio

Factors affecting continuation of clean intermittent catheterisation in people with multiple sclerosis: results of the COSMOS mixed-methods study

Background:  Clean intermittent catheterisation (CIC) is often recommended for people with multiple sclerosis (MS).  Objective:  To determine the variables that affect continuation or discontinuation of the use of CIC.  Methods:  A three-part mixed-method study (prospective longitudinal cohort (n = 56), longitudinal qualitative interviews (n = 20) and retrospective survey (n = 456)) was undertaken, which identified the variables that influenced CIC continuation/discontinuation. The potential explanatory variables investigated in each study were the individual’s age, gender, social circumstances, number of urinary tract infections, bladder symptoms, presence of co-morbidity, stage of multiple sclerosis and years since diagnosis, as well as CIC teaching method and intensity.  Results:  For some people with MS the prospect of undertaking CIC is difficult and may take a period of time to accept before beginning the process of using CIC. Ongoing support from clinicians, support at home and a perceived improvement in symptoms such as nocturia were positive predictors of continuation. In many cases, the development of a urinary tract infection during the early stages of CIC use had a significant detrimental impact on continuation.  Conclusion:  Procedures for reducing the incidence of urinary tract infection during the learning period (i.e. when being taught and becoming competent) should be considered, as well as the development of a tool to aid identification of a person’s readiness to try CIC

Treatment of energy loss and multiple scattering in the context of track parameter and covariance matrix propagation in continuous material in the ATLAS experiment

In this paper we study the energy loss, its fluctuations, and the multiple scattering of particles passing through matter, with an emphasis on muons. In addition to the well-known Bethe-Bloch and Bethe-Heitler equations describing the mean energy loss from ionization and bremsstrahlung respectively, new parameterizations of the mean energy loss of muons from the direct e+e- pair production and photonuclear interactions are presented along with new estimates of the most probable energy loss and its fluctuations in the ATLAS calorimeters. Moreover, a new adaptive Highland/Moliere approach to finding the multiple scattering angle is taken to accomodate a wide range of scatterer thicknesses. Furthermore, tests of the muon energy loss, its fluctuations, and multiple scattering are done in the ATLAS calorimeters. The material effects described in this paper are all part of the simultaneous track and error propagation (STEP) algorithm of the common ATLAS tracking software

Passenger mutations and aberrant gene expression in congenic tissue plasminogen activator‐deficient mouse strains

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134273/1/jth13338_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134273/2/jth13338.pd

Deeply buried glacigenic debris-flows imaged in 3D seismic data from early Quaternary sediments of the northern North Sea

Debris flows composed of diamictic glacial sediment are found on the continental slope offshore of many former ice streams in the Arctic and Antarctic (Vorren et al. 1998). The debris flows are often stacked, making up important building-blocks of the major trough-mouth fans that form huge depocentres on high-latitude margins (e.g. Laberg & Vorren 1995; King et al. 1996; Taylor et al. 2002). Such debris flows have been investigated previously using 2D-seismic methods and have also been mapped in plan using side-scan sonar and multibeam systems (Vogt et al. 1993; Dowdeswell et al. 1996; Nygård et al. 2002 ; Pedrosa et al. 2011). 3D-seismic data can be used to image and map these and other glacigenic landforms buried within Quaternary sediments (e.g. Dowdeswell & Ottesen 2013 ).This is the author accepted manuscript. The final version is available from[the Geological Society of London. via https://doi.org/10.1144/M46.13