Rural water service provision by municipalities and CBOs: Performance milestones and KPIs

The advantages of using Community Based Organisations for the provision of water services in rural areas have been advocated for some time. These benefits have always been intuitively known, however there is little documentation assessing the real experiences of applying this model of service provision on a large scale within the South African context. This paper describes a process of identifying appropriate targets and monitoring standards that have been implemented in a number of areas in the Eastern Cape where a co-operative approach between Municipalities, CBOs and the private sector has been adopted. In the absence of readily available performance and costing benchmarks it has proved difficult to compare the tender proposals and indeed the delivery of services from all role-players. A series of cost estimating tools and responsibility milestones have been developed through an empirical process of critically analysing our experiences and developing an operational model from first principles. These milestones are defined in terms of developing the CBO to take on more and more responsibility, as far as is possible, while ensuring an appropriate and cost effective level of service. The paper will present a number of options that take into account the relative capacity of municipalities and any development process that they may be planning for their own organisation. Critical to the model is that effective delivery of service must be ensured from the start and that any transition as milestones are reached, should be as seamless as possible. Furthermore a series of operational performance indicators and benchmarks are proposed. Water SA Vol.30(5)Special 2004: 549-55

Preregistration house officers in general practice: review of evidence

OBJECTIVES: To examine the strengths and weaknesses of the national and local schemes for preregistration house officers to spend four months in general practice, to identify any added value from such placements, and to examine the impact on career choices. DESIGN: Review of all studies that reported on placements of preregistration house officers in general practice. SETTING: 19 accounts of preregistration house officers’ experience in general practice, ranging from single case reports to a national evaluation study, in a variety of locations in Scotland and England. PARTICIPANTS: Views of 180 preregistration house officers, 45 general practitioner trainers, and 105 consultant trainers. MAIN OUTCOME MEASURES: Main findings or themes weighted according to number of studies reporting them and weighted for sample size. RESULTS: The studies were unanimous about the educational benefits of the placements. The additional learning included communication skills, social and psychological factors in illness, patient centred consultations, broadening of knowledge base, and dealing with uncertainty about diagnosis and referral. CONCLUSIONS: Despite the reported benefits and recommendations of the scheme, it is not expanding. General practitioner trainers reported additional supervision that was unremunerated. The reforms of the senior house officer grade may resolve this problem by offering the placements to senior house officers, who require less supervision

All-Optical Switching with Transverse Optical Patterns

We demonstrate an all-optical switch that operates at ultra-low-light levels and exhibits several features necessary for use in optical switching networks. An input switching beam, wavelength $\lambda$, with an energy density of $10^{-2}$ photons per optical cross section [$\sigma=\lambda^2/(2\pi)$] changes the orientation of a two-spot pattern generated via parametric instability in warm rubidium vapor. The instability is induced with less than 1 mW of total pump power and generates several $\mu$Ws of output light. The switch is cascadable: the device output is capable of driving multiple inputs, and exhibits transistor-like signal-level restoration with both saturated and intermediate response regimes. Additionally, the system requires an input power proportional to the inverse of the response time, which suggests thermal dissipation does not necessarily limit the practicality of optical logic devices

User perceptions of multi-source feedback tools for junior doctors

Context:  The effectiveness of multi-source feedback (MSF) tools, which are increasingly important in medical careers, will be influenced by their users’ attitudes. This study compared perceptions of two tools for giving MSF to UK junior doctors, of which one provides mainly textual feedback and one provides mainly numerical feedback. We then compared the perceptions of three groups, including: trainees; raters giving feedback, and supervisors delivering feedback. Methods:  Postal questionnaires about the usability, usefulness and validity of a feedback system were distributed to trainees, raters and supervisors across the north of England. Results:  Questionnaire responses were analysed to compare opinions of the two tools and among the different user groups. Overall there were few differences. Attitudes towards MSF in principle were positive and the tools were felt to be usable, but there was little agreement that they could effectively identify doctors in difficulty or provide developmental feedback. The text-oriented tool was rated as more useful for giving feedback on communication and attitude, and as more useful for identifying a doctor in difficulty. Raters were more positive than other users about the usefulness of numerical feedback, but, overall, text was felt to be more useful. Some trainees expressed concern that feedback was based on insufficient knowledge of their work. This was not supported by raters’ responses, although many did use indirect information. Trainees selected raters mainly for the perceived value of their feedback, but also based on personal relationships and the simple pragmatics of getting a tool completed. Discussion:  Despite positive attitudes to MSF, the perceived effectiveness of the tools was low. There are small but significant preferences for textual feedback, although raters may prefer numerical scales. Concerns about validity imply that greater awareness of contextual and psychological influences on feedback generation is necessary to allow the formative benefits of MSF to be optimised and to negate the risk of misuse in high-stakes contexts

All-optical switching in rubidium vapor

We report on an all-optical switch that operates at low light levels. It consists of laser beams counterpropagating through a warm rubidium vapor that induce an off-axis optical pattern. A switching laser beam causes this pattern to rotate even when the power in the switching beam is much lower than the power in the pattern. The observed switching energy density is very low, suggesting that the switch might operate at the single-photon level with system optimization. This approach opens the possibility of realizing a single-photon switch for quantum information networks and for improving transparent optical telecommunication networks.Comment: 20 pages, 6 figures; published in Science; http://www.sciencemag.org/cgi/content/short/308/5722/67

Can Streamer Blobs prevent the Buildup of the Interplanetetary Magnetic Field?

Coronal Mass Ejections continuously drag closed magnetic field lines away from the Sun, adding new flux to the interplanetary magnetic field (IMF). We propose that the outward-moving blobs that have been observed in helmet streamers are evidence of ongoing, small-scale reconnection in streamer current sheets, which may play an important role in the prevention of an indefinite buildup of the IMF. Reconnection between two open field lines from both sides of a streamer current sheet creates a new closed field line, which becomes part of the helmet, and a disconnected field line, which moves outward. The blobs are formed by plasma from the streamer that is swept up in the trough of the outward moving field line. We show that this mechanism is supported by observations from SOHO/LASCO. Additionally, we propose a thorough statistical study to quantify the contribution of blob formation to the reduction of the IMF, and indicate how this mechanism may be verified by observations with SOHO/UVCS and the proposed NASA STEREO and ESA Polar Orbiter missions.Comment: 7 pages, 2 figures; accepted by The Astrophysical Journal Letters; uses AASTe

Photoluminescence and photoluminescence excitation studies of lateral size effects in Zn_{1-x}Mn_xSe/ZnSe quantum disc samples of different radii

Quantum disc structures (with diameters of 200 nm and 100 nm) were prepared from a Zn_{0.72}Mn_{0.28}Se/ZnSe single quantum well structure by electron beam lithography followed by an etching procedure which combined dry and wet etching techniques. The quantum disc structures and the parent structure were studied by photoluminescence and photoluminescence excitation spectroscopy. For the light-hole excitons in the quantum well region, shifts of the energy positions are observed following fabrication of the discs, confirming that strain relaxation occurs in the pillars. The light-hole exciton lines also sharpen following disc fabrication: this is due to an interplay between strain effects (related to dislocations) and the lateral size of the discs. A further consequence of the small lateral sizes of the discs is that the intensity of the donor-bound exciton emission from the disc is found to decrease with the disc radius. These size-related effects occur before the disc radius is reduced to dimensions necessary for lateral quantum confinement to occur but will remain important when the discs are made small enough to be considered as quantum dots.Comment: LaTeX2e, 13 pages, 6 figures (epsfig

Preparing medical students for clinical practice: easing the transition

The transition from medical student to junior doctor is a challenge; the UK General Medical Council has issued guidance emphasizing the importance of adequate preparation of medical students for clinical practice. This study aimed to determine whether a junior doctor-led simulation-based course is an effective way of preparing final year medical students for practice as a junior doctor. We piloted a new 'preparation for practice' course for final year medical students prior to beginning as Foundation Year 1 (first year of practice) doctors. The course ran over three days and consisted of four simulated stations: ward round, prescribing, handover, and lessons learnt. Quantitative and qualitative feedback was obtained .A total of 120 students attended (40 on each day) and feedback was collected from 95 of them. Using a scale of 1 (lowest) to 5 (highest), feedback was positive, with 99% and 96% rating 4 or 5 for the overall quality of the program and the relevance of the program content, respectively. A score of 5 was awarded by 67% of students for the ward round station; 58% for the handover station; 71% for the prescribing station, and 35% for the lessons learnt station. Following the prescribing station, students reported increased confidence in their prescribing. Preparation for practice courses and simulation are an effective and enjoyable way of easing the transition from medical student to junior doctor. Together with 'on-the-job' shadowing time, such programs can be used to improve students' confidence, competence, and ultimately patient safety and quality of care

Survey of endoscopic skull base surgery practice patterns among otolaryngologists

Background Endoscopic skull base surgery (ESBS) is a rapidly expanding field. Despite divergent reported preferences for reconstructive techniques and perioperative management, limited data exist regarding contemporary practice patterns among otolaryngologists performing ESBS. This study aims to elucidate current practice patterns, primarily the volumes of cases performed and secondarily a variety of other perioperative preferences. Methods An anonymous 32-item electronic survey examining perioperative ESBS preferences was distributed to the American Rhinologic Society membership. Statistical significance between variables was determined utilizing Student t, chi-square, and Fisher exact tests. Results Seventy otolaryngologists completed the survey. The effective response rate was approximately 22.5%. Sixty percent of respondents were in full-time academic practice and 70% had completed rhinology/skull base fellowships. Annually, 43.3 mean ESBS cases were performed (29.1 private practice vs. 52.9 academic practice, P = .009). Academic practice averaged 24.1 expanded cases versus only 11 in private practice (P = .01). Of respondents, 55.7% stood on the same side as the neurosurgeon and 72.9% remained present for the entire case. Current procedural terminology coding and antibiotic regimens were widely divergent; 31.4% never placed lumbar drains preoperatively, while 41.4% did so for anticipated high-flow cerebrospinal fluid leaks. While considerable variation in reconstructive techniques were noted, intradural defect repairs utilized vascularized flaps 86.3% of the time versus only 51.3% for extradural repairs (P < 0.001). Major complications were rare. Postoperative restrictions varied considerably, with most activity limitations between 2–8 weeks and positive airway pressure use for 2–6 weeks. Most respondents started saline irrigations 0–2 weeks postoperatively. Conclusions Based on responses from fellowship- and non-fellowship-trained otolaryngologists in various practice settings, there remains considerable variation in the perioperative management of patients undergoing ESBS. Level of Evidence