Group treatments for sensitive health care problems : a randomised controlled trial of group versus individual physiotherapy sessions for female urinary incontinence

Background: The aim was to compare effectiveness of group versus individual sessions of physiotherapy in terms of symptoms, quality of life, and costs, and to investigate the effect of patient preference on uptake and outcome of treatment. Methods: A pragmatic, multi-centre randomised controlled trial in five British National Health Service physiotherapy departments. 174 women with stress and/or urge incontinence were randomised to receive treatment from a physiotherapist delivered in a group or individual setting over three weekly sessions. Outcome were measured as Symptom Severity Index; Incontinence-related Quality of Life questionnaire; National Health Service costs, and out of pocket expenses. Results: The majority of women expressed no preference (55%) or preference for individual treatment (36%). Treatment attendance was good, with similar attendance with both service delivery models. Overall, there were no statistically significant differences in symptom severity or quality of life outcomes between the models. Over 85% of women reported a subjective benefit of treatment, with a slightly higher rating in the individual compared with the group setting. When all health care costs were considered, average cost per patient was lower for group sessions (Mean cost difference £52.91 95%, confidence interval (£25.82 - £80.00)). Conclusion: Indications are that whilst some women may have an initial preference for individual treatment, there are no substantial differences in the symptom, quality of life outcomes or non-attendance. Because of the significant difference in mean cost, group treatment is recommended

Client self-assessment in community aged care: A comparative study involving older Australians and their case managers

Self-assessment of support needs is a relatively new and under-researched phenomenon in domiciliary aged care. This article outlines the results of a comparative study focusing on whether a self-assessment approach assists clients to identify support needs and the degree to which self-assessed needs differ from an assessment conducted by community care professionals. A total of 48 older people and their case managers completed a needs assessment tool. Twenty-two semi-structured interviews were used to ascertain older people’s views and preferences regarding the self-assessment process. The study suggests that while a co-assessment approach as outlined in this article has the potential to assist older people to gain a better understanding of their care needs as well as the assessment process and its ramifications, client self-assessment should be seen as part of a co-assessment process involving care professionals. Such a co-assessment process allows older people to gain a better understanding of their support needs and the wider community aged care context. The article suggests that a co-assessment process involving both clients and care professionals contains features that have the capacity to enhance domiciliary aged care

Gulf Province: text summaries, maps, code lists and village identification

The major purpose of the Papua New Guinea Agricultural Systems Project is to produce information on small holder (subsistence) agriculture at provincial and national levels (Allen et al 1995). Information was collected by field observation, interviews with villagers and reference to published and unpublished documents. Methods are described by Bourke et al. (1993). This Working Paper contains a written summary of the information on the Agricultural Systems in this Province, maps of the location of agriculture systems, a complete listing of all information in the database in coded form, and lists of villages with National Population Census codes, indexed by agricultural systems. This information is available as a map-linked database (GIS) suitable for use on a personal computer in ESRI and MapInfo formats. An Agricultural System is identified when a set of similar agricultural crops and practices occur within a defined area. Six criteria are used to distinguish one system from another: 1. Fallow type (the vegetation which is cleared from a garden site before cultivation). 2. Fallow period (the length of time a garden site is left unused between cultivations). 3. Cultivation intensity (the number of consecutive crops planted before fallow). 4. The staple, or most important, crops. 5. Garden and crop segregation (the extent to which crops are planted in separate gardens; in separate areas within a garden; or are planted sequentially). 6. Soil fertility maintenance techniques (other than natural regrowth fallows). Where one or more of these factors differs significantly and the differences can be mapped, then a separate system is distinguished. Where variation occurs, but is not able to be mapped at 1:500 000 scale because the areas in which the variation occurs are too small or are widely dispersed within the larger system, a subsystem is identified. Subsystems within an Agricultural System are allocated a separate record in the database, identified by the Agricultural System number and a subsystem number. Sago is a widespread staple food in lowland Papua New Guinea. Sago is produced from palms which are not grown in gardens. Most of the criteria above cannot be applied. In this case, systems are differentiated on the basis of the staple crops only. The Papua New Guinea Resource Information System (PNGRIS) is a GIS which contains information on the natural resources of PNG (Bellamy 1986). PNGRIS contains no information on agricultural practices, other than an assessment of land use intensity based on air photograph interpretation by Saunders (1993. The Agricultural Systems Project is designed to provide detailed information on agricultural practices and cropping patterns as part of an upgraded PNGRIS geographical information system. For this reason the Agricultural Systems database contains almost no information on the environmental settings of the systems, except for altitude and slope. The layout of the text descriptions, the database code files and the village lists are similar to PNGRIS formats (Cuddy 1987). The mapping of Agricultural Systems has been carried out on the same map base and scale as PNGRIS (Tactical Pilotage Charts, 1:500 000). Agricultural Systems were mapped within the areas of agricultural land use established by Saunders (1993) from aerial photography. Except where specifically noted, Agricultural Systems boundaries have been mapped without reference to PNGRIS Resource Mapping Unit (RMU) boundaries. Agricultural Systems are defined at the level of the Province (following PNGRIS) but their wider distribution is recognised in the database by cross-referencing systems which cross provincial borders. A preliminary view of the relationships between PNGRIS RMUs and the Agricultural Systems in this Province can be obtained from the listing of villages by Agricultural System, where RMU numbers are appended. Allen, B. J., R. M. Bourke and R. L. Hide 1995. The sustainability of Papua New Guinea agricultural systems: the conceptual background. Global Environmental Change 5(4): 297-312. Bourke, R. M., R. L. Hide, B. J. Allen, R. Grau, G. S. Humphreys and H. C. Brookfield 1993. Mapping agricultural systems in Papua New Guinea. Population Family Health and Development. T. Taufa and C. Bass. University of Papua New Guinea Press, Port Moresby: 205-224. Bellamy, J. A. and J. R. McAlpine 1995. Papua New Guinea Inventory of Natural Resources, Population Distribution and Land Use Handbook. Commonwealth Scientific and Industrial Research Organisation for the Australian Agency for International Development. PNGRIS Publication No. 6, Canberra. Cuddy, S. M. 1987. Papua New Guinea Inventory of Natural Resources, Population Distribution and Land Use: Code Files Part 1 Natural Resources. Division of Water and Land Resources, Commonwealth Scientific and Industrial Research Organisation and Land Utilization Section, Department of Primary Industry, Papua New Guinea, Canberra

Prelude: the future of structural bamboo

Prelude demonstrates the possibilities for engineered bamboo in structural applications. Our pavilion is composed of a spiral pathway that cantilevers from the base and embodies the function of the Muziekgebouw through a lightweight design that mirrors a musical prelude in structure, concept and form. Inspired by Guastavino´s masonry vaults, the structure evokes the image of a spiral staircase originally constructed from thin tiles, transformed in a novel material with properties distinct from structural masonry. With a growing need for the development of sustainable materials, engineered bamboo combines the benefits of a natural fibre composite with the advantages of a laminated material. Highly renewable, large diameter bamboo used for structural applications is harvested every 4-5 years. Once harvested, the raw material can be processed into strips, which are then laminated into a board product. The processing reduces inherent geometric and mechanical variability of the natural material that currently limit the application of bamboo products. Currently promoted as a decorative material, Prelude is an example of the potential use of engineered bamboo beyond surface applications in architecture

Scalar Decay in Chaotic Mixing

I review the local theory of mixing, which focuses on infinitesimal blobs of scalar being advected and stretched by a random velocity field. An advantage of this theory is that it provides elegant analytical results. A disadvantage is that it is highly idealised. Nevertheless, it provides insight into the mechanism of chaotic mixing and the effect of random fluctuations on the rate of decay of the concentration field of a passive scalar.Comment: 35 pages, 15 figures. Springer-Verlag conference style svmult.cls (included). Published in "Transport in Geophysical Flows: Ten Years After," Proceedings of the Grand Combin Summer School, 14-24 June 2004, Valle d'Aosta, Italy. Fixed some typo

How was it for you? Experiences of participatory design in the UK health service

Improving co-design methods implies that we need to understand those methods, paying attention to not only the effect of method choices on design outcomes, but also how methods affect the people involved in co-design. In this article, we explore participants' experiences from a year-long participatory health service design project to develop ‘Better Outpatient Services for Older People’. The project followed a defined method called experience-based design (EBD), which represented the state of the art in participatory service design within the UK National Health Service. A sample of participants in the project took part in semi-structured interviews reflecting on their involvement in and their feelings about the project. Our findings suggest that the EBD method that we employed was successful in establishing positive working relationships among the different groups of stakeholders (staff, patients, carers, advocates and design researchers), although conflicts remained throughout the project. Participants' experiences highlighted issues of wider relevance in such participatory design: cost versus benefit, sense of project momentum, locus of control, and assumptions about how change takes place in a complex environment. We propose tactics for dealing with these issues that inform the future development of techniques in user-centred healthcare design

Integration of professional judgement and decision-making in high-level adventure sports coaching practice

This study examined the integration of professional judgement and decision-making processes in adventure sports coaching. The study utilised a thematic analysis approach to investigate the decision-making practices of a sample of high-level adventure sports coaches over a series of sessions. Results revealed that, in order to make judgements and decisions in practice, expert coaches employ a range of practical and pedagogic management strategies to create and opportunistically use time for decision-making. These approaches include span of control and time management strategies to facilitate the decision-making process regarding risk management, venue selection, aims, objectives, session content, and differentiation of the coaching process. The implication for coaches, coach education, and accreditation is the recognition and training of the approaches that“create time” for the judgements in practice, namely“creating space to think”. The paper concludes by offering a template for a more expertise-focused progression in adventure sports coachin

The role of temperature in the variability and extremes of electricity and gas demand in Great Britain

The daily relationship of electricity and gas demand with temperature in Great Britain is analysed from 1975 to 2013 and 1996 to 2013 respectively. The annual mean and annual cycle amplitude of electricity demand exhibit low frequency variability. This low frequency variability is thought to be predominantly driven by socio-economic changes rather than temperature variation. Once this variability is removed, both daily electricity and gas demand have a strong anti-correlation with temperature (r elec = −0.90 , r gas = −0.94). However these correlations are inflated by the changing demand–temperature relationship during spring and autumn. Once the annual cycles of temperature and demand are removed, the correlations are ${r}_{{\rm{elec}}}=-0.60$ and ${r}_{{\rm{gas}}}=-0.83$. Winter then has the strongest demand–temperature relationship, during which a 1 °C reduction in daily temperature typically gives a ~1% increase in daily electricity demand and a 3%–4% increase in gas demand. Extreme demand periods are assessed using detrended daily temperature observations from 1772. The 1 in 20 year peak day electricity and gas demand estimates are, respectively, 15% (range 14%–16%) and 46% (range 44%–49%) above their average winter day demand during the last decade. The risk of demand exceeding recent extreme events, such as during the winter of 2009/2010, is also quantified

Multi-model assessment of the impact of soil moisture initialization on mid-latitude summer predictability

Land surface initial conditions have been recognized as a potential source of predictability in sub-seasonal to seasonal forecast systems, at least for near-surface air temperature prediction over the mid-latitude continents. Yet, few studies have systematically explored such an influence over a sufficient hindcast period and in a multi-model framework to produce a robust quantitative assessment. Here, a dedicated set of twin experiments has been carried out with boreal summer retrospective forecasts over the 1992–2010 period performed by five different global coupled ocean–atmosphere models. The impact of a realistic versus climatological soil moisture initialization is assessed in two regions with high potential previously identified as hotspots of land–atmosphere coupling, namely the North American Great Plains and South-Eastern Europe. Over the latter region, temperature predictions show a significant improvement, especially over the Balkans. Forecast systems better simulate the warmest summers if they follow pronounced dry initial anomalies. It is hypothesized that models manage to capture a positive feedback between high temperature and low soil moisture content prone to dominate over other processes during the warmest summers in this region. Over the Great Plains, however, improving the soil moisture initialization does not lead to any robust gain of forecast quality for near-surface temperature. It is suggested that models biases prevent the forecast systems from making the most of the improved initial conditions.The authors thank Jeff Knight (Met Office Hadley Centre) for his constructive comments on earlier versions of this manuscript. The research leading to these results received funding from the European Union Seventh Framework Programme (FP7/2007–2013) SPECS project (Grant Agreement Number 308378) and H2020 Framework Programme IMPREX project (Grant Agreement Number 641811). Constantin Ardilouze was also supported by the BSC Centro de Excelencia Severo Ochoa Programme.Peer ReviewedPostprint (author's final draft