The National Institute for Health Research Service Delivery and Organisation Network: a descriptive narrative of the network

BACKGROUND: Governments from the 1990s have demonstrated a concern with bridging the gaps between biomedical, clinical and health services research (HSR), in particular with bringing the benefits of that research into practice. To address this concern, the National Coordinating Centre for NHS Service Delivery and Organisation Research and Development commissioned a network in 2007 for a period of 5 years to support NHS managers in accessing and engaging with HSR generally and specifically with their research portfolio. OBJECTIVES: The Service Delivery and Organisation (SDO) Network, hosted by the NHS Confederation, aimed to enable managers to improve and develop services by facilitating their access to the latest HSR. Through a combination of push, pull, and linkage and exchange strategies, the network proactively targeted interventions at senior, middle and new managers. METHODS: This report presents a descriptive narrative of the SDO Network building in the political and organisational contexts. Information contained in this report was obtained from informal discussions with the network team, document review, analysis of web content and a review of relevant academic and grey literature. Discussions with former and current SDO Network members of staff helped to capture perceptions of influence and working practices, and suggest significant/high-impact interventions. RESULTS: The evolution of the SDO Network is captured in four distinct phases of development: initiation of the SDO Network project and its place within a new NHS research and development infrastructure; a period of knowledge transfer and exchange to encourage interactions across interest groups and collaboration with other networks; then a period of increasing complexity and consolidation from research translation to capacity building; and finally the end of project and the new innovation landscape phase. CONCLUSION: Lessons for similar initiatives aimed at knowledge mobilisation in the health sector include ensuring an adequate evaluation framework is in place from initiation, to capture impact and inform strategy, and developing a range of collaborative relationships to expand the scope and reach of activities. Future work could compare or contrast the experience of the SDO Network with studies of other networks in health (nationally or internationally) to address its contribution within the wider research literature in this field. FUNDING: The Health Services and Delivery Research programme

DEARNE (Reino Unido) (Inglaterra) (Canal). Canales marítimos (1793?). 1:32200

Escala gráfica de 15 millas [= 25 cm]. Orientado con lis en cuadranteFigura una leyenda explicativa de las características del canal, así como una tabla con datos sobre los distintos niveles del mismoLa obra proyectada aparece resaltada en color rojoRepresentación esquemática de la vegetaciónForma parte de la Colección Mendoz

Convolutional neural networks applied to high-frequency market microstructure forecasting

Highly sophisticated artificial neural networks have achieved unprecedented performance across a variety of complex real-world problems over the past years, driven by the ability to detect significant patterns autonomously. Modern electronic stock markets produce large volumes of data, which are very suitable for use with these algorithms. This research explores new scientific ground by designing and evaluating a convolutional neural network in predicting future financial outcomes. A visually inspired transformation process translates high-frequency market microstructure data from the London Stock Exchange into four market-event based input channels, which are used to train six deep networks. Primary results indicate that con-volutional networks behave reasonably well on this task and extract interesting microstructure patterns, which are in line with previous theoretical findings. Furthermore, it demonstrates a new approach using modern deep-learning techniques for exploiting and analysing market microstructure behaviour

Measurement of the hyperfine structure of the 4d2D 3/2,5/2 levels and isotope shifts of the 4p2p 3/2 ? 4d2D3/2 and 4p2p 3/2 ? 4d2D5/2 transitions in gallium 69 and 71

The hyperfine structure of the 4d2D3/2,5/2 levels of 69,71Ga is determined. The 4p2P3/2 ? 4d2D3/2 (294.50-nm) and 4p2P3/2 ? 4d2D5/2 (294.45-nm) transitions are studied by laser-induced fluorescence in an atomic Ga beam. The hyperfine A constant measured for the 4d2D5/2 level is 77.3 ± 0.9 MHz for 69Ga and 97.9 ± 0.7 MHz for 71Ga (3s errors). The A constant measured for the 4d2D3/2 level is -36.3 ± 2.2 MHz for 69Ga and -46.2 ± 3.8 MHz for 71Ga. These measurements correct sign errors in the previous determination of these constants. For 69Ga the hyperfine B constants measured for the 4d2D5/2 and the 4d2D 3/2 levels are 5.3 ± 4.1 MHz and 4.6 ± 4.2 MHz, respectively. The isotope shift is determined to be 114 ± 8 MHz for the 4p2P3/2 ? 4d2D3/2 transition and 115 ± 7 MHz for the 4p2P3/2 ± 4d 2D5/2 transition. The lines of 71Ga are shifted to the blue. This is in agreement with previous measurement

Development of a German version of the Oswestry Disability Index. Part 1: cross-cultural adaptation, reliability, and validity

Patient-orientated assessment methods are of paramount importance in the evaluation of treatment outcome. The Oswestry Disability Index (ODI) is one of the condition-specific questionnaires recommended for use with back pain patients. To date, no German version has been published in the peer-reviewed literature. A cross-cultural adaptation of the ODI for the German language was carried out, according to established guidelines. One hundred patients with chronic low-back pain (35 conservative, 65 surgical) completed a questionnaire booklet containing the newly translated ODI, along with a 0-10 pain visual analogue scale (VAS), the Roland Morris Disability Questionnaire, and Likert scales for disability, medication intake and pain frequency [to assess ODI's construct (convergent) validity]. Thirty-nine of these patients completed a second questionnaire within 2weeks (to assess test-retest reliability). The intraclass correlation coefficient for the test-retest reliability of the questionnaire was 0.96. In test-retest, 74% of the individual questions were answered identically, and 21% just one grade higher or lower. The standard error of measurement (SEM) was 3.4, giving a "minimum detectable change” (MDC95%) for the ODI of approximately 9 points, i.e. the minimum change in an individual's score required to be considered "real change” (with 95% confidence) over and above measurement error. The ODI scores correlated with VAS pain intensity (r=0.78, P<0.001) and Roland Morris scores (r=0.80, P<0.001). The mean baseline ODI scores differed significantly between the surgical and conservative patients (P<0.001), and between the different categories of the Likert scales for disability, medication use and pain frequency (in each case P<0.001). Our German version of the Oswestry questionnaire is reliable and valid, and shows psychometric characteristics as good as, if not better than, the original English version. It should represent a valuable tool for use in future patient-orientated outcome studies in German-speaking land

Development of a German version of the Oswestry Disability Index. Part 2: sensitivity to change after spinal surgery

When functional scales are to be used as treatment outcome measures, it is essential to know how responsive they are to clinical change. This information is essential not only for clinical decision-making, but also for the determination of sample size in clinical trials. The present study examined the responsiveness of a German version of the Oswestry Disability Index version 2.1 (ODI) after surgical treatment for low back pain. Before spine surgery 63 patients completed a questionnaire booklet containing the ODI, along with a 0-10 pain visual analogue scale (VAS), the Roland Morris disability questionnaire, and Likert scales for disability, medication intake and pain frequency. Six months after surgery, 57 (90%) patients completed the same questionnaire booklet and also answered Likert-scale questions on the global result of surgery, and on improvements in pain and disability. Both the effect size for the ODI change score 6months after surgery (0.87) and the area under the receiver operating characteristics (ROC) curve for the relative improvement in ODI score in relation to global outcome 6months after surgery (0.90) indicated that the ODI showed good responsiveness. The ROC method revealed that a minimum reduction of the baseline (pre-surgery) ODI score by 18% (equal to a mean 8-point reduction in this patient group) represented the cut-off for indicating a "good” individual outcome 6months after surgery (sensitivity 91.4% and specificity 82.4%). The German version of the ODI is a sensitive instrument for detecting clinical change after spinal surgery. Individual improvements after surgery of at least an 18% reduction on baseline values are associated with a good outcome. This figure can be used as a reliable guide for the determination of sample size in future clinical trials of spinal surger

Rehabilitation following surgery for lumbar spinal stenosis: a Cochrane review

Study Design A systematic review of randomised controlled trials (RCTs) Objective To determine the effects of active rehabilitation on functional outcome following lumbar spinal stenosis surgery when compared with 'usual postoperative care'. Summary of background data Surgery rates for lumbar spinal stenosis have risen, yet outcomes remain suboptimal. Post-operative rehabilitation has been suggested as a tool to improve post-operative function but, to date, there is limited evidence to support its use. Methods CENTRAL (The Cochrane Library), the Cochrane Back Review Group Trials Register, MEDLINE, EMBASE, CINAHL and PEDro electronic databases were searched. Randomised controlled trials (RCTs) comparing the effectiveness of active rehabilitation with usual care in adults with lumbar spinal stenosis who had undergone primary spinal decompression surgery were included. Two authors independently selected studies, assessed the risk of bias, and extracted the data in line with the recommendations of the Cochrane Back Review Group. Study results were pooled in a meta-analysis when appropriate using functional status as the primary outcome, with secondary outcomes including measures of leg pain, low back pain, and global improvement/general health. The GRADE approach was used to assess the quality of the evidence. Results Our searches yielded 1,726 articles, of which three studies (N = 373 participants) were suitable for inclusion in meta-analysis. All included studies were deemed to have low risk of bias; no study had unacceptably high dropout rates. There was moderate evidence suggesting that active rehabilitation was more effective than usual care in improving both short- and long-term functional status following surgery. Similar findings were noted for secondary outcomes, including short-term improvement in low back pain and long-term improvement in both low back pain and leg pain. Conclusions We obtained moderate-quality evidence indicating that postoperative active rehabilitation after decompression surgery for lumbar spinal stenosis is more effective than usual care. Further work is required particularly with respect to the cost effectiveness of such interventions

Perform a gyro test of general relativity in a satellite and develop associated control technology

The progress accomplished in the Stanford Gyro Relativity program during the period November 1974 to October 1975 was described. Gyro developments were continued in the main laboratory dewar, concentrating on the operation of a three axis gyro readout and on improvements to the methods of canceling trapped fields in the rotor; these efforts culminated in the first successful observation of the London moment in the spinning gyro rotor in March 1975. Following a review meeting at that time, a new goal was formulated for the next 12 to 18 months, namely to operate a gyroscope in the new ultra-low field facility with readout resolution approaching 1 arc-second. The following other tasks were also completed: (1) sputtering work, (2) magnetometry, (3) construction and installation of the North Star simulator, (4) analysis of torques on the gyro, especially in inclined orbits, (5) equivalence principle accelerometer, and (6) analysis of a twin-satellite test of relativity