147 research outputs found
Wavenumber Sampling Issues in 2.5D Frequency Domain Seismic Modelling
There are several important wavenumber sampling issues associated with 2.5D seismic modelling in the frequency domain, which need careful attention if accurate results are to be obtained. At certain critical wavenumbers there exist rapid disruptions in the mainly smooth oscillatory spectra. The amplitudes of these disruptions can be very large, and this affects the accuracy of the inverse Fourier transformed frequency-space domain solution. In anisotropic elastic media there are critical wavenumbers associated with each wave mode—the quasi-P (qP) wave, and the two quasi-shear (qS1 and qS2) waves. A small wavenumber sampling interval is desirable in order to capture the highly oscillatory nature of the wavenumber spectrum, especially at increasing distance from the source. Obviously a small wavenumber sampling interval adds greatly to the computational effort because a 2D problem must be solved for every wavenumber and every frequency. The discretisation should be carried out up to some maximum wavenumber, beyond which the field becomes evanescent (exponentially decaying or diffusive). For receivers close to the source, activity persists beyond the critical wavenumber associated with the minimum shear wave velocity in the model. Fortunately, for receivers well removed from the source, the contribution from the evanescent energy is negligible and so there is no need to sample beyond this critical wavenumber. Sampling at Gauss-Legendre spacings is a satisfactory approach for acoustic media, but it is not practical in elastic media due to the difficulty of partitioning the integration around the different critical wavenumbers. We found to our surprise that in transversely isotropic media, the critical wavenumbers are independent of wave direction, but always occur at those wavenumbers corresponding to the maximum phase velocities of the three wave modes (qP, qS1 and qS2), which depend only on the elastic constants and the density. Additionally, we have observed that intermediate layers between source and receiver can filter out to a large degree, the sharp irregularities around the critical wavenumbers in the ω-k y spectra. We have found that, using the spectral element method, the singularities (poles) at the critical wavenumbers which exist with analytic solutions, do not arise. However, the troublesome spike-like behaviour still occurs and can be damped out without distorting the spectrum elsewhere, through the introduction of slight attenuatio
Use of geospatial data, analysis and tools in regional and local government: A scoping project by Northumbria University
The objectives of the research project were to:1) Work with Local Government, Local Enterprise Partnerships and other public sector stakeholders to identify spatial data availability and needs at local, city and sub-regional scales2) Identify accuracy, interoperability and coverage issues to inform formatting, filtering and validation of datasets to be represented spatially3) Develop process/protocol for creating a common GIS platform on which to share identified spatial datasets4) Create Geographic Information Systems platform using ESRI ArcGIS to portray spatial data and test efficacy with stakeholders to refine and improve as fit purpose as a data sharing and querying platfor
The Birchwood Junk Food Cafe, Skelmersdale
The University of Manchester conducted an evaluation of the Birchwood Junk Food Cafe, Skelmersdale, to assess the additional benefits of their adapted approach. A mixed methods evaluation was conducted, including interviews and questionnaires with both customers and those running the cafe. This highlighted benefits of the cafe and the impact of the cafe on its volunteers and customers. Key messages: Junk Food Cafes have the potential to have a positive impact on public health. Junk Food Cafes have the potential to help combat food poverty and social isolation in deprived communities
Financial incentives for large-scale wetland restoration: beyond markets to common asset trusts
Wetlands provide $47.4 trillion/year worth of ecosystem services globally and support immense biodiversity, yet face widespread drainage and pollution, and large-scale wetlands restoration is urgently needed. Payment for ecosystem service (PES) schemes provide a viable avenue for funding large-scale wetland restoration. However, schemes around the globe differ substantially in their goals, structure, challenges, and effectiveness in supporting large-scale wetland restoration. Here, we suggest wetland-based PES schemes use common asset trusts (CATs) to build investment portfolios of wetlands across landscapes that sustain and enhance overall provision of multiple ecosystem services. CATs can meet the needs of multiple investors, permit bundled payments, and provide flexibility to invest in the restoration of numerous services/values, all using a coordinated, highly collaborative, prioritized, and transparent process. CATs would support financial viability, facilitate efficiency to reduce administrative burdens, and enable credibility and social licence building to restore wetland values and services globally
Standards for heart valve surgery in a ‘heart valve centre of excellence’
Surgical centres of excellence should include multidisciplinary teams with specialist expertise in imaging, clinical assessment and surgery for patients with heart valve disease. There should be structured training programmes for the staff involved in the periprocedural care of the patient and these should be overseen by national or international professional societies. Good results are usually associated with high individual and centre volumes, but this relationship is complex. Results of surgery should be published by centre and should include rates of residual regurgitation for mitral repairs and reoperation rates matched to the preoperative pathology and risk
"They think we're OK and we know we're not". A qualitative study of asylum seekers' access, knowledge and views to health care in the UK
<i>Background</i>:
The provision of healthcare for asylum seekers is a global issue. Providing appropriate and culturally sensitive services requires us to understand the barriers facing asylum seekers and the facilitators that help them access health care. Here, we report on two linked studies exploring these issues, along with the health care needs and beliefs of asylum seekers living in the UK.
<i>Methods</i>:
Two qualitative methods were employed: focus groups facilitated by members of the asylum seeking community and interviews, either one-to-one or in a group, conducted through an interpreter. Analysis was facilitated using the Framework method.
<i>Results</i>:
Most asylum seekers were registered with a GP, facilitated for some by an Asylum Support nurse. Many experienced difficulty getting timely appointments with their doctor, especially for self-limiting symptoms that they felt could become more serious, especially in children. Most were positive about the health care they received, although some commented on the lack of continuity. However, there was surprise and disappointment at the length of waiting times both for hospital appointments and when attending accident and emergency departments. Most had attended a dentist, but usually only when there was a clinical need. The provision of interpreters in primary care was generally good, although there was a tension between interpreters translating verbatim and acting as patient advocates. Access to interpreters in other settings, e.g. in-patient hospital stays, was problematic. Barriers included the cost of over-the-counter medication, e.g. children's paracetamol; knowledge of out-of-hours medical care; and access to specialists in secondary care. Most respondents came from countries with no system of primary medical care, which impacted on their expectations of the UK system.
<i>Conclusion</i>:
Most asylum seekers were positive about their experiences of health care. However, we have identified issues regarding their understanding of how the UK system works, in particular the role of general practitioners and referral to hospital specialists. The provision of an Asylum Support nurse was clearly a facilitator to accessing primary medical care. Initiatives to increase their awareness and understanding of the UK system would be beneficial. Interpreting services also need to be developed, in particular their role in secondary care and the development of the role of interpreter as patient advocate
Understanding how front-line staff use patient experience data for service improvement: an exploratory case study evaluation
Background and aim: The NHS collects a large number of data on patient experience, but there are
concerns that it does not use this information to improve care. This study explored whether or not and
how front-line staff use patient experience data for service improvement.
Methods: Phase 1 – secondary analysis of existing national survey data, and a new survey of NHS trust patient
experience leads. Phase 2 – case studies in six medical wards using ethnographic observations and interviews.
A baseline and a follow-up patient experience survey were conducted on each ward, supplemented by
in-depth interviews. Following an initial learning community to discuss approaches to learning from and
improving patient experience, teams developed and implemented their own interventions. Emerging findings
from the ethnographic research were shared formatively. Phase 3 – dissemination, including an online guide
for NHS staff.
Key findings: Phase 1 – an analysis of staff and inpatient survey results for all 153 acute trusts in England
was undertaken, and 57 completed surveys were obtained from patient experience leads. The most
commonly cited barrier to using patient experience data was a lack of staff time to examine the data
(75%), followed by cost (35%), lack of staff interest/support (21%) and too many data (21%). Trusts were
grouped in a matrix of high, medium and low performance across several indices to inform case study
selection. Phase 2 – in every site, staff undertook quality improvement projects using a range of data
sources. The number and scale of these varied, as did the extent to which they drew directly on patient
experience data, and the extent of involvement of patients. Before-and-after surveys of patient experience
showed little statistically significant change. Making sense of patient experience ‘data’ Staff were engaged
in a process of sense-making from a range of formal and informal sources of intelligence. Survey data
remain the most commonly recognised and used form of data. ‘Soft’ intelligence, such as patient stories,
informal comments and daily ward experiences of staff, patients and family, also fed into staff’s improvement plans, but they and the wider organisation may not recognise these as ‘data’. Staff may lack confidence in
using them for improvement. Staff could not always point to a specific source of patient experience ‘data’
that led to a particular project, and sometimes reported acting on what they felt they already knew needed
changing. Staff experience as a route to improving patient experience Some sites focused on staff motivation
and experience on the assumption that this would improve patient experience through indirect cultural and
attitudinal change, and by making staff feel empowered and supported. Staff participants identified several
potential interlinked mechanisms: (1) motivated staff provide better care, (2) staff who feel taken seriously
are more likely to be motivated, (3) involvement in quality improvement is itself motivating and (4) improving
patient experience can directly improve staff experience. ‘Team-based capital’ in NHS settings We propose
‘team-based capital’ in NHS settings as a key mechanism between the contexts in our case studies and observed
outcomes. ‘Capital’ is the extent to which staff command varied practical, organisational and social resources
that enable them to set agendas, drive process and implement change. These include not just material or
economic resources, but also status, time, space, relational networks and influence. Teams involving a range of
clinical and non-clinical staff from multiple disciplines and levels of seniority could assemble a greater range of
capital; progress was generally greater when the team included individuals from the patient experience office.
Phase 3 – an online guide for NHS staff was produced in collaboration with The Point of Care Foundation.
Limitations: This was an ethnographic study of how and why NHS front-line staff do or do not use
patient experience data for quality improvement. It was not designed to demonstrate whether particular
types of patient experience data or quality improvement approaches are more effective than others.
Future research: Developing and testing interventions focused specifically on staff but with patient
experience as the outcome, with a health economics component. Studies focusing on the effect of team
composition and diversity on the impact and scope of patient-centred quality improvement. Research into
using unstructured feedback and soft intelligence
From theory to 'measurement' in complex interventions: methodological lessons from the development of an e-health normalisation instrument
<b>Background</b> Although empirical and theoretical understanding of processes of implementation in health care is advancing, translation of theory into structured measures that capture the complex interplay between interventions, individuals and context remain limited. This paper aimed to (1) describe the process and outcome of a project to develop a theory-based instrument for measuring implementation processes relating to e-health interventions; and (2) identify key issues and methodological challenges for advancing work in this field.<p></p>
<b>Methods</b> A 30-item instrument (Technology Adoption Readiness Scale (TARS)) for measuring normalisation processes in the context of e-health service interventions was developed on the basis on Normalization Process Theory (NPT). NPT focuses on how new practices become routinely embedded within social contexts. The instrument was pre-tested in two health care settings in which e-health (electronic facilitation of healthcare decision-making and practice) was used by health care professionals.<p></p>
<b>Results</b> The developed instrument was pre-tested in two professional samples (N = 46; N = 231). Ratings of items representing normalisation 'processes' were significantly related to staff members' perceptions of whether or not e-health had become 'routine'. Key methodological challenges are discussed in relation to: translating multi-component theoretical constructs into simple questions; developing and choosing appropriate outcome measures; conducting multiple-stakeholder assessments; instrument and question framing; and more general issues for instrument development in practice contexts.<p></p>
<b>Conclusions</b> To develop theory-derived measures of implementation process for progressing research in this field, four key recommendations are made relating to (1) greater attention to underlying theoretical assumptions and extent of translation work required; (2) the need for appropriate but flexible approaches to outcomes measurement; (3) representation of multiple perspectives and collaborative nature of work; and (4) emphasis on generic measurement approaches that can be flexibly tailored to particular contexts of study
Why is it difficult to implement e-health initiatives? A qualitative study
<b>Background</b> The use of information and communication technologies in healthcare is seen as essential for high quality and cost-effective healthcare. However, implementation of e-health initiatives has often been problematic, with many failing to demonstrate predicted benefits. This study aimed to explore and understand the experiences of implementers - the senior managers and other staff charged with implementing e-health initiatives and their assessment of factors which promote or inhibit the successful implementation, embedding, and integration of e-health initiatives.<p></p>
<b>Methods</b> We used a case study methodology, using semi-structured interviews with implementers for data collection. Case studies were selected to provide a range of healthcare contexts (primary, secondary, community care), e-health initiatives, and degrees of normalization. The initiatives studied were Picture Archiving and Communication System (PACS) in secondary care, a Community Nurse Information System (CNIS) in community care, and Choose and Book (C&B) across the primary-secondary care interface. Implementers were selected to provide a range of seniority, including chief executive officers, middle managers, and staff with 'on the ground' experience. Interview data were analyzed using a framework derived from Normalization Process Theory (NPT).<p></p>
<b>Results</b> Twenty-three interviews were completed across the three case studies. There were wide differences in experiences of implementation and embedding across these case studies; these differences were well explained by collective action components of NPT. New technology was most likely to 'normalize' where implementers perceived that it had a positive impact on interactions between professionals and patients and between different professional groups, and fit well with the organisational goals and skill sets of existing staff. However, where implementers perceived problems in one or more of these areas, they also perceived a lower level of normalization.<p></p>
<b>Conclusions</b> Implementers had rich understandings of barriers and facilitators to successful implementation of e-health initiatives, and their views should continue to be sought in future research. NPT can be used to explain observed variations in implementation processes, and may be useful in drawing planners' attention to potential problems with a view to addressing them during implementation planning
Validation of the disease burden morbidity assessment by self-report in a French-speaking population
<p>Abstract</p> <p>Background</p> <p>The Disease Burden Morbidity Assessment (DBMA) is a self-report questionnaire used to estimate the disease burden experienced by patients. The aim of this study was to test and to measure the properties of the French translation of the DBMA (DBMA-Fv).</p> <p>Methods</p> <p>The original version of the DBMA was translated into French (Canadian) and first assessed during cognitive interviews. In the validation study, patients recruited during consecutive consultation periods completed the DBMA-Fv questionnaire while they were in the waiting room of a primary care setting (T1). Participants completed the same questionnaire mailed to their home two weeks later (T2). Concomitant validity of the DBMA-Fv was assessed using the Cumulative Illness Rating Scale (CIRS). Patient medical records were reviewed to verify chronic diseases and past medical history.</p> <p>Results</p> <p>Ninety-seven patients were recruited and 85 (88%) returned the mailed questionnaires; 5 (5.9%) were incomplete. DBMA-Fv scores of the 80 participants with a complete questionnaire at T2 ranged from 0 to 30 (median 5.5, mean 7.7, SD = 7.0). Test-retest reliability of the DBMA-Fv was high (ICC: 0.86, 95% CI: 0.79-0.92). The DBMA-Fv and the CIRS correlated moderately at T1 (r = 0.46, 95% CI: 0.26 - 0.62, <it>p </it>< 0.01) and T2 (r = 0.56, 95% CI: 0.38 - 0.70, <it>p </it>< 0.01). The mean (SD) sensitivity of patient reports of a condition in relation to chart review at T2 was 73.9 (8.4) (range 62.5% to 90%). The overall mean (SD) specificity was 92.2 (6.7) (range 77.6% to 98.6%).</p> <p>Conclusions</p> <p>The DBMA-Fv's properties are similar to its English counterpart as to its median sensitivity and specificity compared to chart reviews. It correlated moderately with an established index of multimorbidity. A high percentage of patients were able to complete the test correctly as a mail questionnaire and it showed high test-retest reliability.</p
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