Using shared goal setting to improve access and equity: a mixed methods study of the Good Goals intervention

Background: Access and equity in children’s therapy services may be improved by directing clinicians’ use of resources toward specific goals that are important to patients. A practice-change intervention (titled ‘Good Goals’) was designed to achieve this. This study investigated uptake, adoption, and possible effects of that intervention in children’s occupational therapy services. Methods: Mixed methods case studies (n = 3 services, including 46 therapists and 558 children) were conducted. The intervention was delivered over 25 weeks through face-to-face training, team workbooks, and ‘tools for change’. Data were collected before, during, and after the intervention on a range of factors using interviews, a focus group, case note analysis, routine data, document analysis, and researchers’ observations. Results: Factors related to uptake and adoptions were: mode of intervention delivery, competing demands on therapists’ time, and leadership by service manager. Service managers and therapists reported that the intervention: helped therapists establish a shared rationale for clinical decisions; increased clarity in service provision; and improved interactions with families and schools. During the study period, therapists’ behaviours changed: identifying goals, odds ratio 2.4 (95% CI 1.5 to 3.8); agreeing goals, 3.5 (2.4 to 5.1); evaluating progress, 2.0 (1.1 to 3.5). Children’s LoT decreased by two months [95% CI −8 to +4 months] across the services. Cost per therapist trained ranged from £1,003 to £1,277, depending upon service size and therapists’ salary bands. Conclusions: Good Goals is a promising quality improvement intervention that can be delivered and adopted in practice and may have benefits. Further research is required to evaluate its: (i) impact on patient outcomes, effectiveness, cost-effectiveness, and (ii) transferability to other clinical contexts

Model analysis of the factors regulating the trends and variability of carbon monoxide between 1988 and 1997

International audienceWe used a 3-D model of chemistry and transport to investigate trends and variability in tropospheric carbon monoxide (CO) for 1988?1997 caused by changes in the overhead ozone column, fossil fuel emissions, biomass burning emissions, methane, and transport. We found that the decreasing CO burden in the northern extra-tropics (?0.85%/y) was more heavily influenced by the decrease in European emissions during our study period than by the similar increase in Asian emissions, as transport pathways from Europe favored accumulation at higher latitudes in winter and spring. However, the opposite trends in the CO burdens from these two source regions counterbalanced at lower latitudes. Elsewhere, the factors influencing CO often compete, diminishing their cumulative impact, and trends in model CO were small or insignificant for our study period, except in the tropics in boreal fall (1.1%/y), a result of emissions from major fires in Indonesia late in 1997. There was a decrease in the ozone column during the study period as a result of the phase of the solar cycle and the eruption of Pinatubo in 1991. This decrease contributed negatively to the trend in model CO by increasing the hydroxyl radical (OH). The impact of this negative contribution was diminished by a positive contribution of similar magnitude from increasing methane. However, the trends in these two factors did not cancel for tropospheric OH, which responded primarily to changes in the ozone column

A Highly Ordered Faraday-Rotation Structure in the Interstellar Medium

We describe a Faraday-rotation structure in the Interstellar Medium detected through polarimetric imaging at 1420 MHz from the Canadian Galactic Plane Survey (CGPS). The structure, at l=91.8, b=-2.5, has an extent of ~2 degree, within which polarization angle varies smoothly over a range of ~100 degree. Polarized intensity also varies smoothly, showing a central peak within an outer shell. This region is in sharp contrast to its surroundings, where low-level chaotic polarization structure occurs on arcminute scales. The Faraday-rotation structure has no counterpart in radio total intensity, and is unrelated to known objects along the line of sight, which include a Lynds Bright Nebula, LBN 416, and the star cluster M39 (NGC7092). It is interpreted as a smooth enhancement of electron density. The absence of a counterpart, either in optical emission or in total intensity, establishes a lower limit to its distance. An upper limit is determined by the strong beam depolarization in this direction. At a probable distance of 350 +/- 50 pc, the size of the object is 10 pc, the enhancement of electron density is 1.7 cm-3, and the mass of ionized gas is 23 M_sun. It has a very smooth internal magnetic field of strength 3 microG, slightly enhanced above the ambient field. G91.8-2.5 is the second such object to be discovered in the CGPS, and it seems likely that such structures are common in the Magneto-Ionic Medium.Comment: 16 pages, 5 figures, ApJ accepte

A Damping of the de Haas-van Alphen Oscillations in the superconducting state

Deploying a recently developed semiclassical theory of quasiparticles in the superconducting state we study the de Haas-van Alphen effect. We find that the oscillations have the same frequency as in the normal state but their amplitude is reduced. We find an analytic formulae for this damping which is due to tunnelling between semiclassical quasiparticle orbits comprising both particle-like and hole-like segments. The quantitative predictions of the theory are consistent with the available data.Comment: 7 pages, 5 figure

Activities of \gamma-ray emitting isotopes in rainwater from Greater Sudbury, Canada following the Fukushima incident

We report the activity measured in rainwater samples collected in the Greater Sudbury area of eastern Canada on 3, 16, 20, and 26 April 2011. The samples were gamma-ray counted in a germanium detector and the isotopes 131I and 137Cs, produced by the fission of 235U, and 134Cs, produced by neutron capture on 133Cs, were observed at elevated levels compared to a reference sample of ice-water. These elevated activities are ascribed to the accident at the Fukushima Dai-ichi nuclear reactor complex in Japan that followed the 11 March earthquake and tsunami. The activity levels observed at no time presented health concerns.Comment: 4 pages, 8 figure

Observationally derived transport diagnostics for the lowermost stratosphere and their application to the GMI chemistry and transport model

International audienceTransport from the surface to the lowermost stratosphere (LMS) can occur on timescales of a few months or less, making it possible for short-lived tropospheric pollutants to influence stratospheric composition and chemistry. Models used to study this influence must demonstrate the credibility of their chemistry and transport in the upper troposphere and lower stratosphere (UT/LS). Data sets from satellite and aircraft instruments measuring CO, O3, N2O, and CO2 in the UT/LS are used to create a suite of diagnostics for the seasonally-varying transport into and within the lowermost stratosphere, and of the coupling between the troposphere and stratosphere in the extratropics. The diagnostics are used to evaluate a version of the Global Modeling Initiative (GMI) Chemistry and Transport Model (CTM) that uses a combined tropospheric and stratospheric chemical mechanism and meteorological fields from the GEOS-4 general circulation model. The diagnostics derived from N2O and O3 show that the model lowermost stratosphere has realistic input from the overlying high latitude stratosphere in all seasons. Diagnostics for the LMS show two distinct layers. The upper layer begins ~30 K potential temperature above the tropopause and has a strong annual cycle in its composition. The lower layer is a mixed region ~30 K thick near the tropopause that shows no clear seasonal variation in the degree of tropospheric coupling. Diagnostics applied to the GMI CTM show credible seasonally-varying transport in the LMS and a tropopause layer that is realistically coupled to the UT in all seasons. The vertical resolution of the GMI CTM in the UT/LS, ~1 km, is sufficient to realistically represent the extratropical tropopause layer. This study demonstrates that the GMI CTM has the transport credibility required to study the impact of tropospheric emissions on the stratosphere

Neck atonia with a focal stimulation-induced seizure arising from the SMA: pathophysiological considerations.

A 28-year-old patient with pharmacoresistant non-lesional right frontal epilepsy underwent extra-operative intracranial EEG recordings and electrical cortical stimulation (ECS) to map eloquent cortex. Right supplementary motor area (SMA) ECS induced a brief seizure with habitual symptoms involving neck tingling followed by asymmetric tonic posturing. An additional feature was neck atonia. During atonia and sensory aura, discharges were seen in the mesial frontal electrodes and precentral gyrus. Besides motor signs, atonia, although rare and not described in the neck muscles, and sensations have been reported with SMA stimulation. The mechanisms underlying neck atonia in seizures arising from the SMA can be explained by supplementary negative motor area (SNMA) - though this was not mapped in electrodes overlying the ictal onset zone in our patient - or primary sensorimotor cortex activation through rapid propagation. Given the broad spectrum of signs elicited by SMA stimulation and rapid spread of seizures arising from the SMA, caution should be taken to not diagnose these as non-epileptic, as had previously occurred in this patient

Limits on the Boron Isotopic Ratio in HD 76932

Data in the 2090 A B region of HD 76932 have been obtained at high S/N using the HST GHRS echelle at a resolution of 90,000. This wavelength region has been previously identified as a likely candidate for observing the B11/B10 isotopic splitting. The observations do not match a calculated line profile extremely well at any abundance for any isotopic ratio. If the B abundance previously determined from observations at 2500 A is assumed, the calculated line profile is too weak, indicating a possible blending line. Assuming that the absorption at 2090 A is entirely due to boron, the best-fit total B abundance is higher than but consistent with that obtained at 2500 A, and the best-fit isotopic ratio (B11/B10) is in the range ~10:1 to ~4:1. If the absorption is not entirely due to B and there is an unknown blend, the best-fit isotopic ratio may be closer to 1:1. Future observations of a similar metal-poor star known to have unusually low B should allow us to distinguish between these two possibilities. The constraints that can be placed on the isotopic ratio based on comparisons with similar observations of HD 102870 and HD 61421 (Procyon) are also discussed.Comment: Accepted for Nov 1998 Ap