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

A search for X-ray emission from rich clusters, extended halos around clusters, and superclusters

The all-sky data base acquired with the HEAO A-2 experiment was searched for X-ray emission on a variety of metagalactic size scales which were either predicted or previously detected. Results in the 0.2-60 keV energy range are presented. The optically richest clusters, including those from which a microwave decrement were observed, appear to be relatively underluminous in X-rays. Observations of Abell 576 show its luminosity to be less than earlier estimates, and moreover less than the luminosity predicted from its microwave decrement, unless the intracluster gas is a factor of approximately 10 hotter than in typical clusters. Near SC0627 there are two X-ray sources, and the identification of the dominant source with SCO627 is probably incorrect. New spectral observations of Abell 401 and 2147, possible superclusters, reveal that they have typical cluster spectra with iron line emission

Reconstructing Deconstruction: High-Velocity Cloud Distance Through Disruption Morphology

We present Arecibo L-band Feed Array 21-cm observations of a sub-complex of HVCs at the tip of the Anti-Center Complex. These observations show morphological details that point to interaction with the ambient halo medium and differential drag within the cloud sub-complex. We develop a new technique for measuring cloud distances, which relies upon these observed morphological and kinematic characteristics, and show that it is consistent with H-alpha distances. These results are consistent with distances to HVCs and halo densities derived from models in which HVCs are formed from cooling halo gas.Comment: 8 pages, 2 figures, 1 tabe, Accepted to Ap

The evolution of mass loaded supernova remnants: II. Temperature dependent mass injection rates

We investigate the evolution of spherically symmetric supernova remnants in which mass loading takes place due to conductively driven evaporation of embedded clouds. Numerical simulations reveal significant differences between the evolution of conductively mass loaded and the ablatively mass loaded remnants studied in Paper I. A main difference is the way in which conductive mass loading is extinguished at fairly early times, once the interior temperature of the remnant falls below ~ 107 K. Thus, at late times remnants that ablatively mass load are dominated by loaded mass and thermal energy, while those that conductively mass load are dominated by swept-up mass and kinetic energy. Simple approximations to the remnant evolution, complementary to those in Paper I, are given

A Search for Small-Scale Clumpiness in Dense Cores of Molecular Clouds

We have analyzed HCN(1-0) and CS(2-1) line profiles obtained with high signal-to-noise ratios toward distinct positions in three selected objects in order to search for small-scale structure in molecular cloud cores associated with regions of high-mass star formation. In some cases, ripples were detected in the line profiles, which could be due to the presence of a large number of unresolved small clumps in the telescope beam. The number of clumps for regions with linear scales of ~0.2-0.5 pc is determined using an analytical model and detailed calculations for a clumpy cloud model; this number varies in the range: ~2 10^4-3 10^5, depending on the source. The clump densities range from ~3 10^5-10^6 cm^{-3}, and the sizes and volume filling factors of the clumps are ~(1-3) 10^{-3} pc and ~0.03-0.12. The clumps are surrounded by inter-clump gas with densities not lower than ~(2-7) 10^4 cm^{-3}. The internal thermal energy of the gas in the model clumps is much higher than their gravitational energy. Their mean lifetimes can depend on the inter-clump collisional rates, and vary in the range ~10^4-10^5 yr. These structures are probably connected with density fluctuations due to turbulence in high-mass star-forming regions.Comment: 23 pages including 4 figures and 4 table

The Energy Spectra and Relative Abundances of Electrons and Positrons in the Galactic Cosmic Radiation

Observations of cosmic-ray electrons and positrons have been made with a new balloon-borne detector, HEAT (the "High-Energy Antimatter Telescope"), first flown in 1994 May from Fort Sumner, NM. We describe the instrumental approach and the data analysis procedures, and we present results from this flight. The measurement has provided a new determination of the individual energy spectra of electrons and positrons from 5 GeV to about 50 GeV, and of the combined "all-electron" intensity (e+ + e-) up to about 100 GeV. The single power-law spectral indices for electrons and positrons are alpha = 3.09 +/- 0.08 and 3.3 +/- 0.2, respectively. We find that a contribution from primary sources to the positron intensity in this energy region, if it exists, must be quite small.Comment: latex2e file, 30 pages, 15 figures, aas2pp4.sty and epsf.tex needed. To appear in May 10, 1998 issue of Ap.

On the Hydrodynamic Interaction of Shock Waves with Interstellar Clouds. II. The Effect of Smooth Cloud Boundaries on Cloud Destruction and Cloud Turbulence

The effect of smooth cloud boundaries on the interaction of steady planar shock waves with interstellar clouds is studied using a high-resolution local AMR technique with a second-order accurate axisymmetric Godunov hydrodynamic scheme. A 3D calculation is also done to confirm the results of the 2D ones. We consider an initially spherical cloud whose density distribution is flat near the cloud center and has a power-law profile in the cloud envelope. When an incident shock is transmitted into a smooth cloud, velocity gradients in the cloud envelope steepen the smooth density profile at the upstream side, resulting in a sharp density jump having an arc-like shape. Such a ``slip surface'' forms immediately when a shock strikes a cloud with a sharp boundary. For smoother boundaries, the formation of slip surface and therefore the onset of hydrodynamic instabilities are delayed. Since the slip surface is subject to the Kelvin-Helmholtz and Rayleigh-Taylor instabilities, the shocked cloud is eventually destroyed in $\sim 3-10$ cloud crushing times. After complete cloud destruction, small blobs formed by fragmentation due to hydrodynamic instabilities have significant velocity dispersions of the order of 0.1 $v_b$, where $v_b$ is the shock velocity in the ambient medium. This suggests that turbulent motions generated by shock-cloud interaction are directly associated with cloud destruction. The interaction of a shock with a cold HI cloud should lead to the production of a spray of small HI shreds, which could be related to the small cold clouds recently observed by Stanimirovic & Heiles (2005). The linewidth-size relation obtained from our 3D simulation is found to be time-dependent. A possibility for gravitational instability triggered by shock compression is also discussed.Comment: 62 pages, 16 figures, submitted to Ap

Wave modelling - the state of the art

This paper is the product of the wave modelling community and it tries to make a picture of the present situation in this branch of science, exploring the previous and the most recent results and looking ahead towards the solution of the problems we presently face. Both theory and applications are considered. The many faces of the subject imply separate discussions. This is reflected into the single sections, seven of them, each dealing with a specific topic, the whole providing a broad and solid overview of the present state of the art. After an introduction framing the problem and the approach we followed, we deal in sequence with the following subjects: (Section) 2, generation by wind; 3, nonlinear interactions in deep water; 4, white-capping dissipation; 5, nonlinear interactions in shallow water; 6, dissipation at the sea bottom; 7, wave propagation; 8, numerics. The two final sections, 9 and 10, summarize the present situation from a general point of view and try to look at the future developments