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

Global Projections of Household Numbers Using Age Determined Ratios

A new method based upon age determined population ratios is described and used to estimate household population intensities (households per person). Using an additive and a bounded model household projections are given to 2050 for the world and to 2030 for seven fertility transition subgroups (cohorts) of the countries of the world. Based upon United Nations 2002 Revision data, from an estimated 1.56 billion households at 2000, household growth to 2030 is projected to be an additional 1.1 billion households, whether population increase is 1.3 billion persons under the United Nations low fertility variant or 2.7 billion persons under the high fertility variant. At that date over one third of all households are projected to be Chinese or Indian. By 2050 it is projected that there will be 3.3 billion households with a 95 per cent confidence interval on modelling error only of ± 0.5 billion. This compares with 3.2 billion in the Habitat: Global Report on Human Settlements 1996. The apparent similarity of total household growth under various scenarios conceals a wide range in the growth of household intensities across fertility transition cohorts. It is suggested that models, projections and error be reviewed biennially and that household and population projections be produced jointly.Household projections, world, age ratios, fertility

Can fundamental movement skill mastery be increased via a six week physical activity intervention to have positive effects on physical activity and physical self-perception?

Previous research has suggested a positive relationship between fundamental movement skills (FMS) mastery and physical activity (PA) level. Research conducted on interventions to improve FMS mastery is equivocal and further research is needed.An intervention group of 82 children (35 boys and 47 girls) and a control group of 83 children (42 boys and 41 girls) were recruited from Years 4 and 5 (mean age ± SD = 8.3 ± 0.4 years) of two schools in Central England. The intervention included a combination of circuits and dancing to music. Pre and post intervention tests were conducted. Tests included: subjective assessment of eight FMS; objective measurement of two FMS; four day pedometer step count recording; height and mass for Body Mass Index (BMI); and the completion of Harter et al.'s (1982) self-perception questionnaire.Following a two (pre to post) by two (intervention and control group) mixed-model ANOVA it was highlighted that the intervention group improved mastery in all eight FMS, and increased both daily steps and physical self-perception.It can be concluded that focussing one Physical Education (PE) lesson per week on the development of FMS has had a positive benefit on FMS, PA level and physical self-perception for the children in this study

Getting the best outcomes from epilepsy surgery.

Neurosurgery is an underutilized treatment that can potentially cure drug-refractory epilepsy. Careful, multidisciplinary presurgical evaluation is vital for selecting patients and to ensure optimal outcomes. Advances in neuroimaging have improved diagnosis and guided surgical intervention. Invasive electroencephalography allows the evaluation of complex patients who would otherwise not be candidates for neurosurgery. We review the current state of the assessment and selection of patients and consider established and novel surgical procedures and associated outcome data. We aim to dispel myths that may inhibit physicians from referring and patients from considering neurosurgical intervention for drug-refractory focal epilepsies. Ann Neurol 2018;83:676-690

The determination of the electrical resistance of the human body under conditions to be met within underground mining

The use of electric wires in mines for power purposes is dangerous to human life. Deaths occur every year from electric shocks, and in most cases these accidents could have been prevented if some precaution had been taken by the victims, or if some care had been taken to protect them from coming in contact with live wires. Most workingmen accustomed to working around electric wires become careless and a lack of knowledge of the danger involved gives rise to the many accidents that occur each year...The object of this investigation is to determine just what resistance the human body would offer to an electric current under all the conditions met with in mines --page 1 -2

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

Heat transport in Bi_{2+x}Sr_{2-x}CuO_{6+\delta}: departure from the Wiedemann-Franz law in the vicinity of the metal-insulator transition

We present a study of heat transport in the cuprate superconductor Bi_{2+x}Sr_{2-x}CuO_{6+\delta} at subkelvin temperatures and in magnetic fields as high as 25T. In several samples with different doping levels close to optimal, the linear-temperature term of thermal conductivity was measured both at zero-field and in presence of a magnetic field strong enough to quench superconductivity. The zero-field data yields a superconducting gap of reasonable magnitude displaying a doping dependence similar to the one reported in other families of cuprate. The normal-state data together with the results of the resistivity measurements allows us to test the Wiedemann-Franz(WF) law, the validity of which was confirmed in an overdoped sample in agreement with previous studies. In contrast, a systematic deviation from the WF law was resolved for samples displaying either a lower doping content or a higher disorder. Thus, in the vicinity of the metal-insulator cross-over, heat conduction in the zero-temperature limit appears to become significantly larger than predicted by the WF law. Possible origins of this observation are discussed.Comment: 9 pages including 7 figures, submitted to Phys. Rev.

Where is SGR1806-20?

We apply a statistical method to derive very precise locations for soft gamma repeaters using data from the interplanetary network. We demonstrate the validity of the method by deriving a 600 arcsec^2 error ellipse for SGR1900+14 whose center agrees well with the VLA source position. We then apply it to SGR1806-20, for which we obtain a 230 arcsec^2 error ellipse, the smallest burst error box to date. We find that the most likely position of the source has a small but significant displacement from that of the non-thermal core of the radio supernova remnant G10.0-0.3, which was previously thought to be the position of the repeater. We propose a different model to explain the changing supernova remnant morphology and the positions of the luminous blue variable and the bursting source.Comment: 12 pages and 2 color figures, accepted for publication in Astrophysical Journal Letter

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