Rehabilitation workers’ perspectives of orientation and mobility training with older visually impaired people

Three sequential studies investigate the professional practice of the rehabilitation worker in delivering Orientation and Mobility (O&M) training to older visually impaired people. The first study explored through in-depth, face-to-face interviews (n=17) professionals’ views of the relevance of O&M training to visually impaired people. Analysis of the findings suggested that the prevocational training of the rehabilitation worker equipped them with techniques that in the majority of cases required substantial adaptation to meet the needs of their predominant client group (older people). Emerging evidence of a gap between rehabilitation worker training and their practice prompted a second study to establish expert views of what constituted good practice in O&M with older people. Utilising a Delphi method, an expert panel (n=5) produced detailed descriptions of the elements of good practice (family; mobility aids; public transport; assessment; orientation; sighted guide; the individual; road crossing; the public; the senses) that they considered to be essential for effective O&M intervention with older people. This framework provided the structure for the third study which explored – through telephone interviews (n=29) with practising rehabilitation workers – how their experience of practice aligns with the expert view of ‘good practice’. A grounded analysis of the data uncovered how the rehabilitation worker adopts a common sense, pragmatic approach to the application of their practice. Whilst this enables them to draw directly from the expertise of their client, there is a lack of the underpinning knowledge they require to be confident that this practice is effective. Appreciating that the practising rehabilitation worker develops skills and abilities in order to deliver O&M that meets the needs of older visually impaired people, recommendations are made for the development of their pre- and post-vocational training

Five rules for managing large, complex projects

Large-scale, long-term projects are notoriously difficult to manage. But recent research on megaprojects — defined as projects costing more than $1 billion — reveals five lessons that can help executives manage any big, complex project more effectively

Dynamic capabilities in complex projects: the case of London Heathrow terminal 5

Whereas existing approaches and empirical studies of dynamic capabilities focus on the strategic innovation activities of firms (i.e., permanent organizations executing multiple projects and programs), this article identifies how certain types of dynamic capabilities are required to deliver large, complex, and risky projects involving multiple parties. Our longitudinal study of the design and construction of Heathrow Airport Terminal 5 by the British Airports Authority (BAA) makes three main contributions to the literature: (1) It contributes to the project management literature by identifying how specific dynamic capabilities (BAA's "T5 Agreement," strategic behaviors, and collaborative processes) are developed through a three-phase process (learning, codifying, and mobilizing) to support the strategic management of complex projects. (2) While emphasizing their importance for the successful management of complex projects, our findings also underline the continuing fragility of dynamic capabilities. (3) The case study reveals their fluidity and balancing role with respect to demands for stability and change in complex, uncertain, and volatile project environments

Molecular epidemiology of uropathogenic Escherichia coli in North West England and characterisation of the ST131 clone in the region

Multilocus Sequence-Typing (MLST) is a phylogenetic technique based on the detection of differences in multiple conserved housekeeping genes. Together with powerful evaluation software, MLST provides an extensive classification scheme for highly diverse species. However, despite the increasing use of MLST as a trusted epidemiological tool, the population structure of UPEC has been poorly studied using this technique, as most of the previous studies conducted have been limited either by bias towards certain characteristics, such as antimicrobial resistance and serogroup, or included a limited number of strains. Such studies can give a false impression of the population structure due to overrepresentation of certain Sequence types (STs).In this thesis, MLST was applied to 300 E. coli isolates collected from in the North West of England between June 2007 and June 2009. Firstly, the prevalence, diversity, epidemiological relationships and phylogenetic origins of the identified STs were determined. Secondly, possible associations of key UPEC STs with other genotypic and phenotypic profiles were assessed. Thirdly, as ST131 was recently reported as one of the most successful UPEC clones, an extensive examination of isolates of this clone was carried out involving identification of multiple drug resistant subclones and attempts were made to recognise putative predictor markers for identification of the ST131 clone.MLST analysis of the studied population revealed a consistent profile of STs that occurred repeatedly in the collection. It consisted primarily of ST73 (16%) followed by ST131 (13.3%), ST69 (9%), ST95 (6.3%), ST10 (4.3%), ST127 (3.6%), ST14 (2.6%) and ST405 (1.6%) some of the STs (ST127 and ST80) in the panel have never been reported as remarkable uropathogens.The broad range of virulence factor (VF) genes screened here allowed the recognition of VF patterns significantly associated with different STs. Most notably, ST127, which, based on phylogenetic analysis, appears to be a newly evolved clone, gave the highest virulence score. This virulent genotype may permit survival of ST127 isolates in the population long enough for them to gain antibiotic resistance. In contrast, multidrug resistant isolates of the ST131 clone were defined by a low virulence score and distinctive VF profiles.Metabolic reactions have been conventionally used for the classification of bacteria into families and species. Interestingly, in the assessment of the metabolic activity of different STs, members of the ST131 clone showed a high metabolic capacity compared to those of other STs, which may compensate for the low virulence capacity and explain the virulence reported for members of this ST. In contrast, ST127 showed the lowest metabolic capacity, even though it held the highest VF-score among the commonly detected STs. Multivariate logistic regression analysis demonstrated that ST131 is best described by its fluoroquinolone resistance and possession of PAI, the ibeA gene and expression of DR antigen-specific adhesins, whereas the O25b-CTX-M-15 ST131 sub-clone was only differentiated from the rest of the ST131 clone members by the production of Extended spectrum Beta-lactamase (ESBL) enzymes.EThOS - Electronic Theses Online ServiceLibyan governmentGBUnited Kingdo

Cosmic cookery : making a stereoscopic 3D animated movie.

This paper describes our experience making a short stereoscopic movie visualizing the development of structure in the universe during the 13.7 billion years from the Big Bang to the present day. Aimed at a general audience for the Royal Society's 2005 Summer Science Exhibition, the movie illustrates how the latest cosmological theories based on dark matter and dark energy are capable of producing structures as complex as spiral galaxies and allows the viewer to directly compare observations from the real universe with theoretical results. 3D is an inherent feature of the cosmology data sets and stereoscopic visualization provides a natural way to present the images to the viewer, in addition to allowing researchers to visualize these vast, complex data sets. The presentation of the movie used passive, linearly polarized projection onto a 2m wide screen but it was also required to playback on a Sharp RD3D display and in anaglyph projection at venues without dedicated stereoscopic display equipment. Additionally lenticular prints were made from key images in the movie. We discuss the following technical challenges during the stereoscopic production process; 1) Controlling the depth presentation, 2) Editing the stereoscopic sequences, 3) Generating compressed movies in display speci¯c formats. We conclude that the generation of high quality stereoscopic movie content using desktop tools and equipment is feasible. This does require careful quality control and manual intervention but we believe these overheads are worthwhile when presenting inherently 3D data as the result is signi¯cantly increased impact and better understanding of complex 3D scenes

Impact of recurrent Clostridium difficile infection: hospitalization and patient quality of life

Objectives: Data quantifying outcomes of recurrent Clostridium difficile infection (rCDI) are lacking. We sought to determine the UK hospital resource use and health-related quality of life (HrQoL) associated with rCDI hospitalisations. Patients and methods: A non-interventional study in 6 UK acute hospitals collected retrospective clinical and resource use data from medical records of 64 adults hospitalised for rCDI and 64 matched inpatient controls with a first episode only (f)CDI. Patients were observed from the index event (date rCDI/fCDI confirmed) for 28-days (or death, if sooner); UK-specific reference costs were applied. HrQoL was assessed prospectively in a separate cohort of 30 patients hospitalised with CDI, who completed the EQ-5D-3L questionnaire during their illness. Results: The median total management cost (post-index) was £7,539 and £6,294 for rCDI and fCDI, respectively (cost difference, p=0.075); median length of stay (LOS) was 21 days and 15.5 days, respectively (p=0.269). The median cost difference between matched rCDI and fCDI cases was £689 (IQR=£-1,873-£3,954). Subgroup analysis demonstrated the highest median costs (£8,542/patient) in severe rCDI cases. CDI management costs were driven primarily by hospital LOS, which accounted for >85% of costs in both groups. Mean EQ-5D index values were 46% lower in CDI patients compared with UK population values (0.42 and 0.78, respectively); EQ-VAS scores were 38% lower (47.82 and 77.3, respectively). Conclusions: CDI has considerable impact on patients and healthcare resources. This multicentre study provides a contemporaneous estimate of the real-world UK costs associated with rCDI management, which are substantial and comparable to fCDI costs

Use of multicriteria decision analysis for assessing the benefit and risk of over-the-counter analgesics

Objectives To test the ability of a multicriteria decision analysis (MCDA) model to incorporate disparate data sources of varying quality along with clinical judgement in a benefit–risk assessment of six well-known pain-relief drugs. Methods Six over-the-counter (OTC) analgesics were evaluated against three favourable effects and eight unfavourable effects by seven experts who specialise in the relief of pain, two in a 2-day facilitated workshop whose input data and judgements were later peer-reviewed by five additional experts. Key findings Ibuprofen salts and solubilised emerged with the best benefit–risk profile, followed by naproxen, ibuprofen acid, diclofenac, paracetamol and aspirin. Conclusions Multicriteria decision analysis enabled participants to evaluate the OTC analgesics against a range of favourable and unfavourable effects in a group setting that enabled all issues to be openly aired and debated. The model was easily communicated and understood by the peer reviewers, so the model should be comprehensible to physicians, pharmacists and other health professionals

Model-based evaluation of admission screening strategies for the detection and control of carbapenemase-producing Enterobacterales in the English hospital setting

BackgroundGlobally, detections of carbapenemase-producing Enterobacterales (CPE) colonisations and infections are increasing. The spread of these highly resistant bacteria poses a serious threat to public health. However, understanding of CPE transmission and evidence on effectiveness of control measures is severely lacking. This paper provides evidence to inform effective admission screening protocols, which could be important in controlling nosocomial CPE transmission.MethodsCPE transmission within an English hospital setting was simulated with a data-driven individual-based mathematical model. This model was used to evaluate the ability of the 2016 England CPE screening recommendations, and of potential alternative protocols, to identify patients with CPE-colonisation on admission (including those colonised during previous stays or from elsewhere). The model included nosocomial transmission from colonised and infected patients, as well as environmental contamination. Model parameters were estimated using primary data where possible, including estimation of transmission using detailed epidemiological data within a Bayesian framework. Separate models were parameterised to represent hospitals in English areas with low and high CPE risk (based on prevalence).ResultsThe proportion of truly colonised admissions which met the 2016 screening criteria was 43% in low-prevalence and 54% in high-prevalence areas respectively. Selection of CPE carriers for screening was improved in low-prevalence areas by adding readmission as a screening criterion, which doubled how many colonised admissions were selected. A minority of CPE carriers were confirmed as CPE positive during their hospital stay (10 and 14% in low- and high-prevalence areas); switching to a faster screening test pathway with a single-swab test (rather than three swab regimen) increased the overall positive predictive value with negligible reduction in negative predictive value.ConclusionsUsing a novel within-hospital CPE transmission model, this study assesses CPE admission screening protocols, across the range of CPE prevalence observed in England. It identifies protocol changes—adding readmissions to screening criteria and a single-swab test pathway—which could detect similar numbers of CPE carriers (or twice as many in low CPE prevalence areas), but faster, and hence with lower demand on pre-emptive infection-control resources. Study findings can inform interventions to control this emerging threat, although further work is required to understand within-hospital transmission sources

Genomic Epidemiology of Complex, Multispecies, Plasmid-Borne bla KPC Carbapenemase in Enterobacterales in the United Kingdom from 2009 to 2014.

Carbapenem resistance in Enterobacterales is a public health threat. Klebsiella pneumoniae carbapenemase (encoded by alleles of the bla KPC family) is one of the most common transmissible carbapenem resistance mechanisms worldwide. The dissemination of bla KPC historically has been associated with distinct K. pneumoniae lineages (clonal group 258 [CG258]), a particular plasmid family (pKpQIL), and a composite transposon (Tn4401). In the United Kingdom, bla KPC has represented a large-scale, persistent management challenge for some hospitals, particularly in North West England. The dissemination of bla KPC has evolved to be polyclonal and polyspecies, but the genetic mechanisms underpinning this evolution have not been elucidated in detail; this study used short-read whole-genome sequencing of 604 bla KPC-positive isolates (Illumina) and long-read assembly (PacBio)/polishing (Illumina) of 21 isolates for characterization. We observed the dissemination of bla KPC (predominantly bla KPC-2; 573/604 [95%] isolates) across eight species and more than 100 known sequence types. Although there was some variation at the transposon level (mostly Tn4401a, 584/604 [97%] isolates; predominantly with ATTGA-ATTGA target site duplications, 465/604 [77%] isolates), bla KPC spread appears to have been supported by highly fluid, modular exchange of larger genetic segments among plasmid populations dominated by IncFIB (580/604 isolates), IncFII (545/604 isolates), and IncR (252/604 isolates) replicons. The subset of reconstructed plasmid sequences (21 isolates, 77 plasmids) also highlighted modular exchange among non-bla KPC and bla KPC plasmids and the common presence of multiple replicons within bla KPC plasmid structures (>60%). The substantial genomic plasticity observed has important implications for our understanding of the epidemiology of transmissible carbapenem resistance in Enterobacterales for the implementation of adequate surveillance approaches and for control

A New Chicken Genome Assembly Provides Insight into Avian Genome Structure

The importance of the Gallus gallus (chicken) as a model organism and agricultural animal merits a continuation of sequence assembly improvement efforts. We present a new version of the chicken genome assembly (Gallus_gallus-5.0; GCA_000002315.3), built from combined long single molecule sequencing technology, finished BACs, and improved physical maps. In overall assembled bases, we see a gain of 183 Mb, including 16.4 Mb in placed chromosomes with a corresponding gain in the percentage of intact repeat elements characterized. Of the 1.21 Gb genome, we include three previously missing autosomes, GGA30, 31, and 33, and improve sequence contig length 10-fold over the previous Gallus_gallus-4.0. Despite the significant base representation improvements made, 138 Mb of sequence is not yet located to chromosomes. When annotated for gene content, Gallus_gallus-5.0 shows an increase of 4679 annotated genes (2768 noncoding and 1911 protein-coding) over those in Gallus_gallus-4.0. We also revisited the question of what genes are missing in the avian lineage, as assessed by the highest quality avian genome assembly to date, and found that a large fraction of the original set of missing genes are still absent in sequenced bird species. Finally, our new data support a detailed map of MHC-B, encompassing two segments: one with a highly stable gene copy number and another in which the gene copy number is highly variable. The chicken model has been a critical resource for many other fields of study, and this new reference assembly will substantially further these efforts