Studying clinical reasoning, part 2: Applying social judgement theory

Part 1 of this paper (Harries and Harries 2001) examined the reasoning studies of the 1980s and 1990s and critiqued the ethnographic and informationprocessing approaches, based on stated information use. The need for an approach that acknowledged the intuitive nature of experienced thinkers’ reasoning was identified. Part 2 describes such an approach ± social judgement theory ± and presents a pilot application in occupational therapy research. The method used is judgement analysis. The issue under study is that of prioritisation policies in community mental health work. The results present the prioritisation policies of four occupational therapists in relation to managing community mental health referrals

Theoretical studies of solar-pumped lasers

The investigation of stimulated emission causing transitions from the B(1) pi sub u state of sodium to the overlapping 2(1) sigma(+) sub g electronic state has been continued. A new method of estimating the Franck-Condon factors has been developed which instead of fitting the molecular potential curves with Morse functions, estimates the V(r) dependence by interpolation from given potential curves. The results for the sum of the rates from one vibrational level in the upper state to all the levels in the lower state show good agreement with the previous method, implying that curve crossing by stimulated emission due to photons from the oven is an important mechanism in sodium

Indirect Detection of Forming Protoplanets via Chemical Asymmetries in Disks

We examine changes in the molecular abundances resulting from increased heating due to a self-luminous planetary companion embedded within a narrow circumstellar disk gap. Using 3D models that include stellar and planetary irradiation, we find that luminous young planets locally heat up the parent circumstellar disk by many tens of Kelvin, resulting in efficient thermal desorption of molecular species that are otherwise locally frozen out. Furthermore, the heating is deposited over large regions of the disk, $\pm5$ AU radially and spanning $\lesssim60^\circ$ azimuthally. From the 3D chemical models, we compute rotational line emission models and full ALMA simulations, and find that the chemical signatures of the young planet are detectable as chemical asymmetries in $\sim10h$ observations. HCN and its isotopologues are particularly clear tracers of planetary heating for the models considered here, and emission from multiple transitions of the same species is detectable, which encodes temperature information in addition to possible velocity information from the spectra itself. We find submillimeter molecular emission will be a useful tool to study gas giant planet formation in situ, especially beyond $R\gtrsim10$ AU.Comment: 14 pages, 14 figures, accepted for publication in Ap

Line and continuum radiative transfer modelling of AA Tau

We present photometric and spectroscopic models of the Classical T Tauri star AA Tau. Photometric and spectroscopic variability present in observations of AA Tau is attributed to a magnetically induced warp in the accretion disc, periodically occulting the photosphere on an 8.2--day timescale. Emission line profiles show signatures of both infall, attributed to magnetospherically accreting material, and outflow. Using the radiative transfer code TORUS, we have investigated the geometry and kinematics of AA Tau's circumstellar disc and outflow, which is modelled here as a disc wind. Photometric models have been used to constrain the aspect ratio of the disc, the offset angle of the magnetosphere dipole with respect to the stellar rotation axis, and the inner radius of the circumstellar disc. Spectroscopic models have been used to constrain the wind and magnetosphere temperatures, wind acceleration parameter, and mass loss rate. We find observations are best fitted by models with a mass accretion rate of $5\times10^{-9}$ M$_\odot$ yr$^{-1}$, a dipole offset of between $10^\circ$ and $20^\circ$, a magnetosphere that truncates the disc from 5.2 to 8.8 R$_\star$, a mass-loss-rate to accretion-rate ratio of ~ 0.1, a magnetosphere temperature of 8500 -- 9000 K, and a disc wind temperature of 8000 K.Comment: 22 pages, 32 figures, 4 tables. Accepted by MNRAS. V3: Corrected typ

Operational research in Malawi: making a difference with cotrimoxazole preventive therapy in patients with tuberculosis and HIV.

BACKGROUND: In Malawi, high case fatality rates in patients with tuberculosis, who were also co-infected with HIV, and high early death rates in people living with HIV during the initiation of antiretroviral treatment (ART) adversely impacted on treatment outcomes for the national tuberculosis and ART programmes respectively. This article i) discusses the operational research that was conducted in the country on cotrimoxazole preventive therapy, ii) outlines the steps that were taken to translate these findings into national policy and practice, iii) shows how the implementation of cotrimoxazole preventive therapy for both TB patients and HIV-infected patients starting ART was associated with reduced death rates, and iv) highlights lessons that can be learnt for other settings and interventions. DISCUSSION: District and facility-based operational research was undertaken between 1999 and 2005 to assess the effectiveness of cotrimoxazole preventive therapy in reducing death rates in TB patients and subsequently in patients starting ART under routine programme conditions. Studies demonstrated significant reductions in case fatality in HIV-infected TB patients receiving cotrimoxazole and in HIV-infected patients about to start ART. Following the completion of research, the findings were rapidly disseminated nationally at stakeholder meetings convened by the Ministry of Health and internationally through conferences and peer-reviewed scientific publications. The Ministry of Health made policy changes based on the available evidence, following which there was countrywide distribution of the updated policy and guidelines. Policy was rapidly moved to practice with the development of monitoring tools, drug procurement and training packages. National programme performance improved which showed a significant decrease in case fatality rates in TB patients as well as a reduction in early death in people with HIV starting ART. SUMMARY: Key lessons for moving this research endeavour through to policy and practice were the importance of placing operational research within the programme, defining relevant questions, obtaining "buy-in" from national programme staff at the beginning of projects and having key actors or "policy entrepreneurs" to push forward the policy-making process. Ultimately, any change in policy and practice has to benefit patients, and the ultimate judge of success is whether treatment outcomes improve or not

Engaging with clinicians to implement and evaluate the ICF in neurorehabilitation practice

INTRODUCTION: Although deemed a globally accepted framework, there remains scare evidence on the process and outcome of implementing the International Classification of Functioning, Disability and Health (ICF) within neurorehabilitation. OBJECTIVES: This review briefly explores the existing, broader literature and then reports on two action research projects, undertaken in England, specifically within stroke and neurorehabilitation. Working with participants, including clinicians from in-patient and community settings, there are now 35 different ways identified for the use of the ICF. CONCLUSION: The outcome of the first project highlights that using the ICF enhances communication within and beyond the acute stroke service, fosters holistic thinking and clarifies team roles. To adopt it into clinical practice, the ICF must be adapted to meet local service needs. The use of action research has facilitated the knowledge translation process which has enabled the ICF to become a clinical reality in neurorehabilitation, with clinicians identifying a range of potential uses