The inter-relation between policy and practice for transitions from hospital to home: An ethnographic case study in England’s National Health Service

© 2014 Shaw et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.No abstract available (poster presentation)

Shot noise in carbon nanotube based Fabry-Perot interferometers

We report on shot noise measurements in carbon nanotube based Fabry-Perot electronic interferometers. As a consequence of quantum interferences, the noise power spectral density oscillates as a function of the voltage applied to the gate electrode. The quantum shot noise theory accounts for the data quantitatively. It allows to confirm the existence of two nearly degenerate orbitals. At resonance, the transmission of the nanotube approaches unity, and the nanotube becomes noiseless, as observed in quantum point contacts. In this weak backscattering regime, the dependence of the noise on the backscattering current is found weaker than expected, pointing either to electron-electron interactions or to weak decoherence

Congenital erythropoietic porphyria associated with myelodysplasia presenting in a 72-year-old man: report of a case and review of the literature

Congenital erythropoietic porphyria (CEP) is a rare autosomal recessive disease owing to the deficient activity of uroporphyrinogen III synthase, the fourth enzyme in the porphyrin–haem synthetic pathway. Of the porphyrias, it is the most mutilating type, usually presenting early in life. To date, 12 documented cases of adult onset CEP have been reported. We report the second oldest documented patient with late onset CEP with incidental findings of thrombocytopenia and myelodysplasia with bone-marrow sideroblasts. We further discuss several current and future treatment options for this therapeutically challenging disease.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73760/1/j.1365-2133.2003.05040.x.pd

Conserved spin and orbital phase along carbon nanotubes connected with multiple ferromagnetic contacts

We report on spin dependent transport measurements in carbon nanotubes based multi-terminal circuits. We observe a gate-controlled spin signal in non-local voltages and an anomalous conductance spin signal, which reveal that both the spin and the orbital phase can be conserved along carbon nanotubes with multiple ferromagnetic contacts. This paves the way for spintronics devices exploiting both these quantum mechanical degrees of freedom on the same footing.Comment: 8 pages - minor differences with published versio

Active Control of Fan Noise: Feasibility Study

An extension of a prior study has been completed to examine the potential reduction of aircraft flyover noise by the method of active noise control (ANC). It is assumed that the ANC system will be designed such that it cancels discrete tones radiating from the engine fan inlet or fan exhaust duct, at least to the extent that they no longer protrude above the surrounding broadband noise levels. Thus, without considering the engineering details of the ANC system design, tone levels am arbitrarily removed from the engine component noise spectrum and the flyover noise EPNL levels are compared with and without the presence of tones. The study was conducted for a range of engine cycles, corresponding to fan pressure ratios of 1.3, 1.45, 1.6, and 1.75. This report is an extension of an effort reported previously. The major conclusions drawn from the prior study, which was restricted to fan pressure ratios of 1.45 and 1.75, are that, for a fan pressure ratio of 1.75, ANC of tones gives about the same suppression as acoustic treatment without ANC. For a fan pressure ratio of 1.45, ANC appears to offer less effectiveness from passive treatment. In the present study, the other two fan pressure ratios are included in a more detailed examination of the benefits of the ANC suppression levels. The key results of this extended study are the following observations: (1) The maximum overall benefit obtained from suppression of BPF alone was 2.5 EPNdB at high fan speeds. The suppression benefit increases with increase in fan pressure ratio (FPR), (2) The maximum overall benefit obtained from suppression of the first three harmonics was 3 EPNdB at high speeds. Suppression benefit increases with increase in FPR, (3) At low FPR, only about 1.0 EPNdB maximum reduction was obtained. Suppression is primarily from reduction of BPF at high FPR values and from the combination of tones at low FPR, (4) The benefit from ANC is about the same as the benefit from passive treatment at fan pressure ratios of 1.75 and 1.60. At the two lower fan pressure ratios, the effectivness of treatment is much greater than that of ANC, and (5) No significant difference in ANC suppression behavior was found from the QCSEE engine database analysis compared to that of the E3 engine database, for the FPR = 1.3 engine cycle. The effects of ANC on EPNL noise reduction are difficult to generalize. It was found that the reduction obtained in any particular case depended upon the frequency of the tones and their shift with rpm, the amount of ANC suppression received by each tone (which depended on its protrusion from the background), and the NOY-value of the tone relative to the NOY-value of other tones and the peak broadband levels, because PNL is determined from the sum of the NOY-values

Active Control of Fan Noise-Feasibility Study

A study has been completed to examine the potential reduction of aircraft flyover noise by the method of active noise control (ANC). It is assumed that the ANC system will be designed such that it cancels discrete tones radiating from the engine fan inlet or fan exhaust duct. Thus, without considering the engineering details of the ANC system design, tone levels are arbitrarily removed from the engine component noise spectrum and the flyover noise EPNL levels are compared with and without the presence of tones. The study was conducted for a range of engine cycles, corresponding to fan pressure ratios from 1.3 to 1.75. The major conclusions that can be drawn are that, for a fan pressure ratio of 1.75, ANC of tones gives about the same suppression as acoustic treatment without ANC, and for a fan pressure ratio of 1.45, ANC appears to offer less effectiveness than passive treatment. Additionally, ANC appears to be more effective at sideline and cutback conditions than at approach. Overall EPNL suppressions due to tone removal range from about 1 to 3 dB at takeoff engine speeds and from 1 to 5 db at approach speeds. Studies of economic impact of the installation of an ANC system for the four engine cases indicate increases of DOC ranging from 1 to 2 percent, favoring the lower fan pressure ratio engines. Further study is needed to confirm the results by examining additional engine data, particularly at low fan pressure ratios, and studying the details of the current results to obtain a more complete understanding. Further studies should also include determining the effects of combining passive and active treatment

The Institutional Logic of Integrated Care: An Ethnography of Patient Transitions

© Shaw, Kontos, Martin and Victor. Purpose: To use theories of institutional logics and institutional entrepreneurship to examine how and why macro-, meso-, and micro-level influences inter-relate in the implementation of integrated transitional care out of hospital in the English National Health Service. Design/Methodology/Approach: We conducted an ethnographic case study of a hospital and surrounding services within a large urban centre in England. Specific methods included qualitative interviews with patients/caregivers, health/social care providers, and organizational leaders; observations of hospital transition planning meetings, community “hub” meetings, and other instances of transition planning; reviews of patient records; and analysis of key policy documents. Analysis was iterative and informed by theory on institutional logics and institutional entrepreneurship. Findings: Organizational leaders at the meso-level of health and social care promoted a partnership logic of integrated care in response to conflicting institutional ideas found within a key macro-level policy enacted in 2003 (The Community Care (Delayed Discharges) Act). Through institutional entrepreneurship at the micro-level, the partnership logic became manifest in the form of relationship work among health and social care providers; they sought to build strong interpersonal relationships to enact more integrated transitional care. Originality/Value: Our study has three key implications. First, efforts to promote integrated care should strategically include institutional entrepreneurs at the organizational and clinical levels. Second, integrated care initiatives should emphasize relationship-building among health and social care providers. Finally, theoretical development on institutional logics should further examine the role of interpersonal relationships in facilitating the “spread” of logics between macro-, meso-, and micro-level influences on inter-organizational change.Canadian Institutes of Health Research and Brunel University