55 research outputs found

    Risk assessment and decision making about in-labour transfer from rural maternity care: a social judgment and signal detection analysis

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    Background: The importance of respecting women's wishes to give birth close to their local community is supported by policy in many developed countries. However, persistent concerns about the quality and safety of maternity care in rural communities have been expressed. Safe childbirth in rural communities depends on good risk assessment and decision making as to whether and when the transfer of a woman in labour to an obstetric led unit is required. This is a difficult decision. Wide variation in transfer rates between rural maternity units have been reported suggesting different decision making criteria may be involved; furthermore, rural midwives and family doctors report feeling isolated in making these decisions and that staff in urban centres do not understand the difficulties they face. In order to develop more evidence based decision making strategies greater understanding of the way in which maternity care providers currently make decisions is required. This study aimed to examine how midwives working in urban and rural settings and obstetricians make intrapartum transfer decisions, and describe sources of variation in decision making. Methods: The study was conducted in three stages. 1. 20 midwives and four obstetricians described factors influencing transfer decisions. 2. Vignettes depicting an intrapartum scenario were developed based on stage one data. 3. Vignettes were presented to 122 midwives and 12 obstetricians who were asked to assess the level of risk in each case and decide whether to transfer or not. Social judgment analysis was used to identify the factors and factor weights used in assessment. Signal detection analysis was used to identify participants' ability to distinguish high and low risk cases and personal decision thresholds. Results: When reviewing the same case information in vignettes midwives in different settings and obstetricians made very similar risk assessments. Despite this, a wide range of transfer decisions were still made, suggesting that the main source of variation in decision making and transfer rates is not in the assessment but the personal decision thresholds of clinicians. Conclusions: Currently health care practice focuses on supporting or improving decision making through skills training and clinical guidelines. However, these methods alone are unlikely to be effective in improving consistency of decision making

    Employment of ex-prisoners with mental health problems, a realistic evaluation protocol

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    Background Offenders with a mental illness are routinely excluded from vocational services due to their mental health. Employment has shown to be very important in improving mental health, reducing recidivism, and connecting people to society. This study examines the effectiveness of an established intervention which is relatively untested in this population, Individual Placement and Support (IPS), to help offenders with mental health problems into competitive employment. The overall research question is whether IPS is effective in gaining and sustaining competitive employment for offenders with a Severe Mental Illness (SMI). The context is an English criminal justice setting across different populations. The study will also measure non-vocational outcomes such as recidivism, mental health and social stability. Methods/Design A Realistic Evaluation (RE) design will address the questions “What works, for whom, and in what circumstances?” This study includes pre and post comparisons for a cohort of approximately 20 people taking part in IPS, and a similar number of controls, over a one year period. The RE also consists of interviews with practitioners and offenders in order to understand how IPS works and develops within the criminal justice system (CJS). By applying this framework the research can go from discovering whether IPS works, to how and why (or why not) IPS works. This is achieved by examining where the intervention is occurring (Context (C)), the mechanisms (M) that create particular behaviours, and how the outcomes (O) from the intervention all come together (CMOs). Employment outcomes will also be examined for all participants. Discussion By applying RE the research will permit inferences to be drawn about how and why (or why not) IPS works, by examining context, mechanisms and outcomes. IPS has never been implemented within the CJS in the United Kingdom. As a result, this evaluative research will not only provide a novel insight into the core research areas, but also how the intervention can be improved for others in the future

    The impact of oil prices on bioenergy, emissions and land use

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    We evaluate how alternative future oil prices will influence the penetration of biofuels, energy production, greenhouse gas (GHG) emissions, land use and other outcomes. Our analysis employs a global economy wide model and simulates alternative oil prices out to 2050 with and without a price on GHG emissions. In one case considered, based on estimates of available resources, technological progress and energy demand, the reference oil price rises to 124by2050.Othercasesseparatelyconsiderconstantreferenceoilpricesof124 by 2050. Other cases separately consider constant reference oil prices of 50, 75and75 and 100, which are targeted by adjusting the quantity of oil resources. In our simulations, higher oil prices lead to more biofuel production, more land being used for bioenergy crops, and fewer GHG emissions. Reducing oil resources to simulate higher oil prices has a strong income effect, so decreased food demand under higher oil prices results in an increase in land allocated to natural forests. We also find that introducing a carbon price reduces the differences in oil use and GHG emissions across oil price cases. Keyword: Biofuels; Deforestation; Greenhouse gas emissions; Climate polic

    New data for representing irrigated agriculture in economy-wide models

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    We develop a framework to represent the value of irrigated crop production and the expansion potential of irrigated land within economy-wide models, providing integrated assessment capabilities for energy, land, and water interactions. Specifically, we compute the value of production on irrigated and rainfed cropland at both a 5 arcminute by 5 arcminute level (about 10 square kilometers) and for the 140 regions and eight crop sectors in Version 9 of the Global Trade Analysis Project (GTAP) Data Base. For each crop category, we estimate the shares of production on irrigated and rainfed land using estimates of production quantities and prices, compared to approximations based on output volumes used in the GTAP-Water Data Base. We construct a global dataset of evaluation metrics to identify region-crop combinations where there are large differences in irrigated production value shares based on direct calculation and approximated by output volumes. The scope to expand the amount of irrigated land and the cost of doing so is quantified through irrigable land supply curves for 126 water regions globally, based on water availability and the costs of irrigation infrastructure. We also make available our adaptable work stream to calculate crop production values and to estimate irrigable land supply elasticities for use in economy-wide models. Altogether, this work can enhance integrated assessment and economy-wide modeling by more accurately capturing the value of crop production and facilitating the representation of endogenous investment in irrigation infrastructure in response to changing water availability. These data and modeling contributions allow for a more rigorous exploration of the regional and global impacts of water availability on land use, energy production, and economic activity.The authors acknowledge support for this work from U.S. Department of Energy, Office of Science (DE-FG02-94ER61937) and also acknowledge support for the basic development of the MIT Integrated Assessment Model (IGSM) from the Joint Program on the Science and Policy of Global Change, which is funded by a consortium of industrial sponsors and Federal grants. For a complete list of sponsors see http://globalchange.mit.edu/sponsors/current.htm

    Optimizing Prisms of All Shapes and Dimensions

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    Accumulation of Microplastic on Shorelines Woldwide: Sources and Sinks

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    Plastic debris 1900 fibers per wash. This suggests that a large proportion of microplastic fibers found in the marine environment may be derived from sewage as a consequence of washing of clothes. As the human population grows and people use more synthetic textiles, contamination of habitats and animals by microplastic is likely to increase

    Grade School Triangles

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