Materialities of clinical handover in intensive care: challenges of enactment and education

Abstract The research is situated in a busy intensive care unit in a tertiary referral centre university hospital in Scotland. To date no research appears to have been done with a focus on handover in intensive care, across the professions involved, examining how handover is enacted. This study makes an original contribution to the practical and pedagogical aspects of handover in intensive care both in terms of the methodology used and also in terms of its findings. In order to study handover a mixed methods approach has been adopted and fieldwork has been done in the ethnographic mode. Data has been audio recorded and transcribed and analysed to explore the clinical handovers of patients by doctors and nurses in this intensive care unit. Texts of both handover, and the artefacts involved, are reviewed. Material from journals, books, lectures and websites, including those for health care professionals, patients and relatives, and those in industry are explicated. This study explores the role of material artefacts and texts, such as the intensive care-based electronic patient record, the whiteboards in the doctors’ office, and in the ward, in the enactment of handover. Through analysis of the data I explore some of the entanglements and ontologies of handover and the multiple things of healthcare: patients, information, equipment, activities, texts, ideas, diseases, staff, diagnoses, illnesses, floating texts, responsibility, a plan, a family. The doing of handover is framed theoretically through the empirical philosophy of Mol’s identification of multiple ontologies in clinical practice (Mol, 2002). Each chapter is prefaced by a poem, each of which has relevant socio-material elements embedded in it. The significance of the findings of the research for both patient care and clinical education and learning is surfaced

24 NO 1 FEBRUARY

Patient simulation lends itself very well to training and education for acute clinical situations. It is an excellent learning environment to explore interactions and behaviours such as team working, decision making, handover and other elements of communication which are so important in the acute clinical setting. This review provides some practical and educational 'directions' to help you get involved in this kind of teaching

Vertical migration maintains phytoplankton position in a tidal channel with residual flow

A tidal channel can retain phytoplankton, despite a residual flow, if the phytoplankton migrate vertically with a daily rhythm. Tidal currents are slowed down by bed friction and so plankton experience faster flow when higher in the water column. The lateral movement of the plankton depends on the nature of the vertical migration, particularly the time spent near the surface and the phase of the tide. A model of this process accorded with observations of chlorophyll derived from in situ fluorescence at a mooring in a tidal channel. Peaks in chlorophyll at the end of the flood tide indicated the presence of a phytoplankton bloom downstream of the mooring. Peaks in chlorophyll at the ends of the morning flood tides were 3 to 4 times larger than at the ends of the evening floods, over several days. In contrast, well-mixed particulates were removed from the channel by the residual flow in just 2 d. Both the day-night asymmetry and the sustained presence of chlorophyll were explained by allowing for vertical migration of the phytoplankton and constraining the period during which they were near the surface. Tidal channels retaining phytoplankton that migrate vertically can be ecologically more diverse and yield higher commercial output of farmed bivalves. The natural timings of some phytoplankton blooms in tidal channels are controlled by the nature of the migration. Although a by-product of vertical migration, longer residence in the tidal channel affords the phytoplankton more nutrients than phytoplankton that advect offshore

The effect of a pedometer-based community walking intervention "Walking for Wellbeing in the West" on physical activity levels and health outcomes: a 12-week randomized controlled trial

Background Recent systematic reviews have suggested that pedometers may be effective motivational tools to promote walking. However, studies tend to be of a relatively short duration, with small clinical based samples. Further research is required to demonstrate their effectiveness in adequately powered, community based studies. Objective Using a randomized controlled trial design, this study assessed the impact of a 12-week graduated pedometer-based walking intervention on daily step-counts, self-reported physical activity and health outcomes in a Scottish community sample not meeting current physical activity recommendations. Method Sixty-three women and 16 men (49.2 years ± 8.8) were randomly assigned to either an intervention (physical activity consultation and 12-week pedometer-based walking program) or control (no action) group. Measures for step-counts, 7-day physical activity recall, affect, quality of life (n = 79), body mass, BMI, % body fat, waist and hip circumference (n = 76), systolic/diastolic blood pressure, total cholesterol and HDL cholesterol (n = 66) were taken at baseline and week 12. Analyses were performed on an intention to treat basis using 2-way mixed factorial analyses of variance for parametric data and Mann Whitney and Wilcoxon tests for non-parametric data. Results Significant increases were found in the intervention group for step-counts (p < .001), time spent in leisure walking (p = .02) and positive affect (p = .027). Significant decreases were found in this group for time spent in weekday (p = .003), weekend (p = .001) and total sitting (p = .001) with no corresponding changes in the control group. No significant changes in any other health outcomes were found in either group. In comparison with the control group at week 12, the intervention group reported a significantly greater number of minutes spent in leisure time (p = .008), occupational (p = .045) and total walking (p = .03), and significantly fewer minutes in time spent in weekend (p = .003) and total sitting (p = .022). Conclusion A pedometer-based walking program, incorporating a physical activity consultation, is effective in promoting walking and improving positive affect over 12 weeks in community based individuals. The discussion examines possible explanations for the lack of significant changes in health outcomes. Continued follow-up of this study will examine adherence to the intervention and possible resulting effects on health outcomes

The effect of a pedometer-based community walking intervention "Walking for Wellbeing in the West" on physical activity levels and health outcomes: a 12-week randomized controlled trial

Since publication of our article[1] we have found some imputation errors in the main text and Table Four (Table 1) and Table Five (Table 2) corresponding to the 12-week results

Does physical activity counselling enhance the effects of a pedometer-based intervention over the long-term : 12-month findings from the Walking for Wellbeing in the West study

Peer reviewedPublisher PD

Genome-wide association study implicates immune activation of multiple integrin genes in inflammatory bowel disease

Genetic association studies have identified 215 risk loci for inflammatory bowel disease, thereby uncovering fundamental aspects of its molecular biology. We performed a genome-wide association study of 25,305 individuals and conducted a meta-analysis with published summary statistics, yielding a total sample size of 59,957 subjects. We identified 25 new susceptibility loci, 3 of which contain integrin genes that encode proteins in pathways that have been identified as important therapeutic targets in inflammatory bowel disease. The associated variants are correlated with expression changes in response to immune stimulus at two of these genes ($\textit{ITGA4 }$ and $\textit{ITGB8}$) and at previously implicated loci ($\textit{ITGAL }$and $\textit{ICAM1}$). In all four cases, the expression-increasing allele also increases disease risk. We also identified likely causal missense variants in a gene implicated in primary immune deficiency, $\textit{PLCG2}$, and a negative regulator of inflammation, $\textit{SLAMF8}$. Our results demonstrate that new associations at common variants continue to identify genes relevant to therapeutic target identification and prioritization.This work was co-funded by the Wellcome Trust [098051] and the Medical Research Council, UK [MR/J00314X/1]. Case collections were supported by Crohn’s and Colitis UK. KMdL, LM, CAL, YL, DR, JG-A, NJP, CAA and JCB are supported by the Wellcome Trust [098051; 093885/Z/10/Z; 094491/Z/10/Z]. KMdL is supported by a Woolf Fisher Trust scholarship. CAL is a clinical lecturer funded by the NIHR. We thank Anna Stanton for co-ordinating the Guy’s and St Thomas’ patient recruitment. We acknowledge support from the Department of Health via the NIHR comprehensive Biomedical Research Centre awards to Guy’s and St Thomas’ NHS Foundation Trust in partnership with King’s College London and to Addenbrooke’s Hospital, Cambridge in partnership with the University of Cambridge. This research was also supported by the NIHR Newcastle Biomedical Research Centre. The UK Household Longitudinal Study is led by the Institute for Social and Economic Research at the University of Essex and funded by the Economic and Social Research Council

Advancing multi-vehicle deployments in oceanographic field experiments

Our research concerns the coordination and control of robotic vehicles for upper water-column oceanographic observations. In such an environment, operating multiple vehicles to observe dynamic oceanographic phenomena, such as ocean processes and marine life, from fronts to cetaceans, has required that we design, implement and operate software, methods and processes which can support opportunistic needs in real-world settings with substantial constraints. In this work, an approach for coordinated measurements using such platforms, which relate directly to task outcomes, is presented. We show the use and operational value of a new Artificial Intelligence based mixed-initiative system for handling multiple platforms along with the networked infrastructure support needed to conduct such operations in the open sea. We articulate the need and use of a range of middleware architectures, critical for such deployments and ground this in the context of a field experiment in open waters of the mid-Atlantic in the summer of 2015.Advancing multi-vehicle deployments in oceanographic field experimentsacceptedVersio

Localization of type 1 diabetes susceptibility to the MHC class I genes HLA-B and HLA-A

The major histocompatibility complex (MHC) on chromosome 6 is associated with susceptibility to more common diseases than any other region of the human genome, including almost all disorders classified as autoimmune. In type 1 diabetes the major genetic susceptibility determinants have been mapped to the MHC class II genes HLA-DQB1 and HLA-DRB1 (refs 1-3), but these genes cannot completely explain the association between type 1 diabetes and the MHC region. Owing to the region's extreme gene density, the multiplicity of disease-associated alleles, strong associations between alleles, limited genotyping capability, and inadequate statistical approaches and sample sizes, which, and how many, loci within the MHC determine susceptibility remains unclear. Here, in several large type 1 diabetes data sets, we analyse a combined total of 1,729 polymorphisms, and apply statistical methods - recursive partitioning and regression - to pinpoint disease susceptibility to the MHC class I genes HLA-B and HLA-A (risk ratios >1.5; Pcombined = 2.01 × 10-19 and 2.35 × 10-13, respectively) in addition to the established associations of the MHC class II genes. Other loci with smaller and/or rarer effects might also be involved, but to find these, future searches must take into account both the HLA class II and class I genes and use even larger samples. Taken together with previous studies, we conclude that MHC-class-I-mediated events, principally involving HLA-B*39, contribute to the aetiology of type 1 diabetes. ©2007 Nature Publishing Group