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

The eta-prime propagator in quenched QCD

The calculation of the eta-prime hairpin diagram is carried out in the modified quenched approximation (MQA) in which the lattice artifact which causes exceptional configurations is removed by shifting observed poles at kappa<kappa_c in the quark propagators to the critical value of hop ping parameter. By this method, the eta-prime propagator can be accurately calculated even for very light quark mass. A determination of the topological susceptibility for quenched QCD is also obtained, using the fermionic method of Smit and Vink to calculate winding numbers.Comment: 3 pages, 3 postscript figure

Unquenched QCD with Light Quarks

We present recent results in unquenched lattice QCD with two degenerate light sea quarks using the truncated determinant approximation (TDA). In the TDA the infrared modes contributing to the quark determinant are computed exactly up to some cutoff in quark off-shellness (typically 2$\Lambda_{QCD}$). This approach allows simulations to be performed at much lighter quark masses than possible with conventional hybrid MonteCarlo techniques. Results for the static energy and topological charge distributions are presented using a large ensemble generated on very coarse (6$^4$) but physically large lattices. Preliminary results are also reported for the static energy and meson spectrum on 10$^3$x20 lattices (lattice scale $a^{-1}$=1.15 GeV) at quark masses corresponding to pions of mass $\leq$ 200 MeV. Using multiboson simulation to compute the ultraviolet part of the quark determinant the TDA approach becomes an exact with essentially no increase in computational effort. Some preliminary results using this fully unquenched algorithm are presented.Comment: LateX, 39 pages, 16 eps figures, 1 ps figur

Anomalous Chiral Behavior in Quenched Lattice QCD

A study of the chiral behavior of pseudoscalar masses and decay constants is carried out in quenched lattice QCD with Wilson fermions. Using the modified quenched approximation (MQA) to cure the exceptional configuration problem, accurate results are obtained for pion masses as low as $\approx$ 200 MeV. The anomalous chiral log effect associated with quenched $\eta'$ loops is studied in both the relation between $m_{\pi}^2$ vs. $m_q$ and in the light-mass behavior of the pseudoscalar and axial vector matrix elements. The size of these effects agrees quantitatively with a direct measurement of the $\eta'$ hairpin graph, as well as with a measurement of the topological susceptibility, thus providing several independent and quantitatively consistent determinations of the quenched chiral log parameter $\delta$. For $\beta=5.7$ with clover-improved fermions $(C_{sw} =1.57)$ all results are consistent with $\delta=0.065\pm 0.013$ .Comment: 51 pages, 20 figures, Late

Quenched Approximation Artifacts: A study in 2-dimensional QED

The spectral properties of the Wilson-Dirac operator in 2-dimensional QED responsible for the appearance of exceptional configurations in quenched simulations are studied in detail. The mass singularity structure of the quenched functional integral is shown to be extremely compicated, with multiple branch points and cuts. The connection of lattice topological charge and exactly real eigenmodes is explored using cooling techniques. The lattice volume and spacing dependence of these modes is studied, as is the effect of clover improvement of the action. A recently proposed modified quenched approximation is applied to the study of meson correlators, and the results compared with both naive quenched and full dynamical calculations of the same quantity.Comment: 34 pages (Latex) plus 9 embedded figures; title change

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

Model for self-tuning the cosmological constant

The vanishing cosmological constant in the four dimensional space-time is obtained in a 5D Randall-Sundrum model with a brane (B1) located at $y=0$. The matter fields can be located at the brane. For settling any vacuum energy generated at the brane to zero, we need a three index antisymmetric tensor field $A_{MNP}$ with a specific form for the Lagrangian. For the self-tuning mechanism, the bulk cosmological constant should be negative.Comment: LaTeX file of 4 pages, to appear in Phys. Rev. Let

Network robustness and fragility: Percolation on random graphs

Recent work on the internet, social networks, and the power grid has addressed the resilience of these networks to either random or targeted deletion of network nodes. Such deletions include, for example, the failure of internet routers or power transmission lines. Percolation models on random graphs provide a simple representation of this process, but have typically been limited to graphs with Poisson degree distribution at their vertices. Such graphs are quite unlike real world networks, which often possess power-law or other highly skewed degree distributions. In this paper we study percolation on graphs with completely general degree distribution, giving exact solutions for a variety of cases, including site percolation, bond percolation, and models in which occupation probabilities depend on vertex degree. We discuss the application of our theory to the understanding of network resilience.Comment: 4 pages, 2 figure