Optical Properties of the Kara Sea

This study was motivated by the need to understand dispersion processes which affect the redistribution of nuclear wastes in the Arctic from dump sites in the Kara Sea and in the rivers which flow into the Kara Sea. We focus on vertical profiles of light beam transmission and fluorometry made over the delta region fronting the Ob and Yenisey Rivers and over the East Novaya Zemlya Trough (ENZT). The delta region fronting the Ob River Estuary contains a large repository of particles in a dense bottom nepheloid layer with a maximum centered similar to 100 km in front of the estuary entrance and covering an area of roughly 200 km diameter. This suspended particle mass repository appears to contain both sediments and detritus and lends credence to the Lisitsyn [1995] concept of the marginal filter zone. In the deep water of the ENZT we found a strong increase of beam attenuation with depth, indicating a relatively large increase of particle mass concentration from similar to 50 m to the bottom (depths in excess of 300 m). The strongest concentration was adjacent to the southeast coast of Novaya Zemlya. We suggest that a type of hyperpycnical flow occurs from accumulation of sediments in the bottom waters of Novaya Zemlya fjords which then cascades down the steep slopes adjacent to the island, producing the particle mass distribution as observed by the transmissometer. The accumulation of these repositories of high particle mass concentrations in suspension would suggest that the residence time is high but that storm-driven events could act to disperse the material

Response shift in patient-reported outcomes:definition, theory, and a revised model

International audiencePurpose The extant response shift definitions and theoretical response shift models, while helpful, also introduce predicaments and theoretical debates continue. To address these predicaments and stimulate empirical research, we propose a more specific formal definition of response shift and a revised theoretical model. Methods This work is an international collaborative effort and involved a critical assessment of the literature. Results Three main predicaments were identified. First, the formal definitions of response shift need further specification and clarification. Second, previous models were focused on explaining change in the construct intended to be measured rather than explaining the construct at multiple time points and neglected the importance of using at least two time points to investigate response shift. Third, extant models do not explicitly distinguish the measure from the construct. Here we define response shift as an effect occurring whenever observed change (e.g., change in patient-reported outcome measures (PROM) scores) is not fully explained by target change (i.e., change in the construct intended to be measured). The revised model distinguishes the measure (e.g., PROM) from the underlying target construct (e.g., quality of life) at two time points. The major plausible paths are delineated, and the underlying assumptions of this model are explicated. Conclusion It is our hope that this refined definition and model are useful in the further development of response shift theory. The model with its explicit list of assumptions and hypothesized relationships lends itself for critical, empirical examination. Future studies are needed to empirically test the assumptions and hypothesized relationships

How do patient reported outcome measures (PROMs) support clinician-patient communication and patient care? A realist synthesis

Background: In this paper, we report the findings of a realist synthesis that aimed to understand how and in what circumstances patient reported outcome measures (PROMs) support patient-clinician communication and subsequent care processes and outcomes in clinical care. We tested two overarching programme theories: (1) PROMs completion prompts a process of self-reflection and supports patients to raise issues with clinicians and (2) PROMs scores raise clinicians’ awareness of patients’ problems and prompts discussion and action. We examined how the structure of the PROM and care context shaped the ways in which PROMs support clinician-patient communication and subsequent care processes. Results: PROMs completion prompts patients to reflect on their health and gives them permission to raise issues with clinicians. However, clinicians found standardised PROMs completion during patient assessments sometimes constrained rather than supported communication. In response, clinicians adapted their use of PROMs to render them compatible with the ongoing management of patient relationships. Individualised PROMs supported dialogue by enabling the patient to tell their story. In oncology, PROMs completion outside of the consultation enabled clinicians to identify problematic symptoms when the PROM acted as a substitute rather than addition to the clinical encounter and when the PROM focused on symptoms and side effects, rather than health related quality of life (HRQoL). Patients did not always feel it was appropriate to discuss emotional, functional or HRQoL issues with doctors and doctors did not perceive this was within their remit. Conclusions: This paper makes two important contributions to the literature. First, our findings show that PROMs completion is not a neutral act of information retrieval but can change how patients think about their condition. Second, our findings reveal that the ways in which clinicians use PROMs is shaped by their relationships with patients and professional roles and boundaries. Future research should examine how PROMs completion and feedback shapes and is influenced by the process of building relationships with patients, rather than just their impact on information exchange and decision making

Development of clinical ethics services in the UK : a national survey

Background: In 2001 a report on the provision of clinical ethics support in UK healthcare institutions identified 20 clinical ethics committees. Since then there has been no systematic evaluation or documentation of their work at a national level. Recent national surveys of clinical ethics services in other countries have identified wide variation in practice and scope of activities. Objective: To describe the current provision of ethics support in the UK and its development since 2001. Method: A postal/electronic questionnaire survey administered to the chairs of all 82 clinical ethics services registered with the UK Clinical Ethics Network in July 2010. Results: Response rate was 62% with the majority of responding services situated in acute trusts. All services included a clinical ethics committee with one service also having a clinical ethicist. Lay members were present in 72% of responding committees. Individual case consultation has increased since 2001 with 29% of chairs spending more than 50% of their time on this. Access to and involvement in the process of case consultation is less for patients and families than for clinical staff. There is wide variation in committee processes and levels of institutional support. Over half of the responding committees undertook some form of evaluation. Conclusion: Clinical ethics services in the UK are increasing as is their involvement in case consultation. However, the significant variation in committee processes suggests that further qualitative research is needed to understand how these committees function and the role they play in their institution

Efectos orográficos sobre la circulación en la capa superficial del oceáno en el Noroeste de África

Este trabajo presenta el análisis de los efectos de las irregularidades de la línea de costa y la batimetría de la platafoffi1a costera africana, así como la presencia de las Islas Canarias, sobre la denominada Corriente de Canarias, en la región comprendida entre 24° N y 30° N de latitud y 12° O y 19° O de longitud. Haciendo uso de los resultados de un modelo físico a escala y de secuencias de imágenes de temperatura superficial del mar y de concentración de pigmentos clorofílicos, se examinan los efectos orográficos citados sobre la generación de remolinos y filamentos en la zona de transición costera del Noroeste de Africa, así como las estructuras mesoescalares generadas detrás de las islas y la posible interacción de las mismas con las generadas en la zona de transición. En general, los resultados del modelo muestran un excelente nivel de concordancia con los obtenidos a través de imágenes de satélite. Estos resultados revelan que la ... (A