Using shared goal setting to improve access and equity: a mixed methods study of the Good Goals intervention

Background: Access and equity in children’s therapy services may be improved by directing clinicians’ use of resources toward specific goals that are important to patients. A practice-change intervention (titled ‘Good Goals’) was designed to achieve this. This study investigated uptake, adoption, and possible effects of that intervention in children’s occupational therapy services. Methods: Mixed methods case studies (n = 3 services, including 46 therapists and 558 children) were conducted. The intervention was delivered over 25 weeks through face-to-face training, team workbooks, and ‘tools for change’. Data were collected before, during, and after the intervention on a range of factors using interviews, a focus group, case note analysis, routine data, document analysis, and researchers’ observations. Results: Factors related to uptake and adoptions were: mode of intervention delivery, competing demands on therapists’ time, and leadership by service manager. Service managers and therapists reported that the intervention: helped therapists establish a shared rationale for clinical decisions; increased clarity in service provision; and improved interactions with families and schools. During the study period, therapists’ behaviours changed: identifying goals, odds ratio 2.4 (95% CI 1.5 to 3.8); agreeing goals, 3.5 (2.4 to 5.1); evaluating progress, 2.0 (1.1 to 3.5). Children’s LoT decreased by two months [95% CI −8 to +4 months] across the services. Cost per therapist trained ranged from £1,003 to £1,277, depending upon service size and therapists’ salary bands. Conclusions: Good Goals is a promising quality improvement intervention that can be delivered and adopted in practice and may have benefits. Further research is required to evaluate its: (i) impact on patient outcomes, effectiveness, cost-effectiveness, and (ii) transferability to other clinical contexts

The Elliptical Galaxy formerly known as the Local Group: Merging the Globular Cluster Systems

Prompted by a new catalogue of M31 globular clusters, we have collected together individual metallicity values for globular clusters in the Local Group. Although we briefly describe the globular cluster systems of the individual Local Group galaxies, the main thrust of our paper is to examine the collective properties. In this way we are simulating the dissipationless merger of the Local Group, into presumably an elliptical galaxy. Such a merger is dominated by the Milky Way and M31, which appear to be fairly typical examples of globular cluster systems of spiral galaxies. The Local Group `Elliptical' has about 700 +/- 125 globular clusters, with a luminosity function resembling the `universal' one. The metallicity distribution has peaks at [Fe/H] ~ -1.55 and -0.64 with a metal-poor to metal-rich ratio of 2.5:1. The specific frequency of the Local Group Elliptical is initially about 1 but rises to about 3, when the young stellar populations fade and the galaxy resembles an old elliptical. The metallicity distribution and stellar population corrected specific frequency are similar to that of some known early type galaxies. Based on our results, we briefly speculate on the origin of globular cluster systems in galaxies.Comment: 22 pages, Latex, 4 figures, 5 tables, submitted to A &

A study of resistojet systems directed to the space station/base Final report

Biowaste resistojet subsystem for integrated environmental control and life support of space statio

An airborne remote sensing system for urban air quality

Several NASA sponsored remote sensors and possible airborne platforms were evaluated. Outputs of dispersion models for SO2 and CO pollution in the Washington, D.C. area were used with ground station data to establish the expected performance and limitations of the remote sensors. Aircraft/sensor support requirements are discussed. A method of optimum flight plan determination was made. Cost trade offs were performed. Conclusions about the implementation of various instrument packages as parts of a comprehensive air quality monitoring system in Washington are presented

Risk factors for failure of outpatient parenteral antibiotic therapy (OPAT) in infective endocarditis

Objectives: To identify risk factors for failure of outpatient antibiotic therapy (OPAT) in infective endocarditis (IE). Patients and methods: We identified IE cases managed at a single centre over 12 years from a prospectively maintained database. ‘OPAT failure’ was defined as unplanned readmission or antibiotic switch due to adverse drug reaction or antibiotic resistance. We analysed patient and disease-related risk factors for OPAT failure by univariate and multivariate logistic regression. We also retrospectively collected follow-up data on adverse disease outcome (defined as IE-related death or relapse) and performed Kaplan–Meier survival analysis up to 36 months following OPAT. Results: We identified 80 episodes of OPAT in IE. Failure occurred in 25/80 episodes (31.3%). On multivariate analysis, cardiac or renal failure [pooled OR 7.39 (95% CI 1.84–29.66), P = 0.005] and teicoplanin therapy [OR 8.69 (95% CI 2.01–37.47), P = 0.004] were independently associated with increased OPAT failure. OPAT failure with teicoplanin occurred despite therapeutic plasma levels. OPAT failure predicted adverse disease outcome up to 36 months (P = 0.016 log-rank test). Conclusions: These data caution against selecting patients with endocarditis for OPAT in the presence of cardiac or renal failure and suggest teicoplanin therapy may be associated with suboptimal OPAT outcomes. Alternative regimens to teicoplanin in the OPAT setting should be further investigated

Extending the Globular Cluster System-Halo Mass Relation to the Lowest Galaxy Masses

High mass galaxies, with halo masses $M_{200} \ge 10^{10} M_{\odot}$, reveal a remarkable near-linear relation between their globular cluster (GC) system mass and their host galaxy halo mass. Extending this relation to the mass range of dwarf galaxies has been problematic due to the difficulty in measuring independent halo masses. Here we derive new halo masses based on stellar and HI gas kinematics for a sample of nearby dwarf galaxies with GC systems. We find that the GC system mass--halo mass relation for galaxies populated by GCs holds from halo masses of $M_{200} \sim 10^{14} M_{\odot}$ down to below $M_{200}$ $\sim 10^9 M_{\odot}$, although there is a substantial increase in scatter towards low masses. In particular, three well-studied ultra diffuse galaxies, with dwarf-like stellar masses, reveal a wide range in their GC-to-halo mass ratios. We compare our GC system--halo mass relation to the recent model of El Badry et al., finding that their fiducial model does not reproduce our data in the low mass regime. This may suggest that GC formation needs to be more efficient than assumed in their model, or it may be due to the onset of stochastic GC occupation in low mass halos. Finally, we briefly discuss the stellar mass-halo mass relation for our low mass galaxies with GCs, and we suggest some nearby dwarf galaxies for which searches for GCs may be fruitful.Comment: 16 pages, 5 figures, accepted for publication in MNRA

A Damping of the de Haas-van Alphen Oscillations in the superconducting state

Deploying a recently developed semiclassical theory of quasiparticles in the superconducting state we study the de Haas-van Alphen effect. We find that the oscillations have the same frequency as in the normal state but their amplitude is reduced. We find an analytic formulae for this damping which is due to tunnelling between semiclassical quasiparticle orbits comprising both particle-like and hole-like segments. The quantitative predictions of the theory are consistent with the available data.Comment: 7 pages, 5 figure