A postal survey to identify and describe nurse led clinics in genitourinary medicine services across England

Background: Nurses in genitourinary medicine (GUM) services are progressively extending their roles to conduct "comprehensive care" nurse led clinics. In such roles the nurse coordinates the first line, comprehensive care of patients presenting with sexual health conditions and issues. Objectives: To identify and describe comprehensive care nurse led clinics in GUM services across England. Methods: A postal questionnaire consisting of 17 closed response questions was sent to 209 GUM services across England. A second questionnaire was sent to non-responders to increase the response rate. Data were single entered and analysed using SPSS. Results: Of the 190 GUM clinic respondents (91% response rate), 44 (23%) reported providing some form of comprehensive care nurse led clinic, 90% of which were initiated since 1995. Key results show staff development featured as the main reason for initiating such services and there was general consistency in the aspects of care undertaken by these nurses. There was evidence of guideline development specific to nurse led care and some patient group direction use for supplying medication. The level of support from medical staff while nurse led clinics were being conducted varied between services. Few services have conducted any audit or research to monitor/evaluate nurse led care. There was little consistency in the clinical experience and educational prerequisites to undertake comprehensive care nurse led clinics. Continuing professional development opportunities also varied between services. Conclusions: The steady growth of comprehensive care nurse led clinics indicates that the skills of GUM nurses are being recognised. Nurses working in advanced practice roles now require courses and study days reflecting these changes in practice. Locally agreed practice guidelines can define nursing practice boundaries and ensure accountability, as will the development of patient group directions to supply medication. Monitoring and evaluation of nurse led clinics also require attention

How typical is the Coma cluster?

Coma is frequently used as the archetype z~0 galaxy cluster to compare higher redshift work against. It is not clear, however, how representative the Coma cluster is for galaxy clusters of its mass or X-ray luminosity, and significantly: recent works have suggested that the galaxy population of Coma may be in some ways anomolous. In this work, we present a comparison of Coma to an X-ray selected control sample of clusters. We show that although Coma is typical against the control sample in terms of its internal kinematics (substructure and velocity dispersion profile), it has a significantly high (~3sigma) X-ray temperature set against clusters of comparable mass. By de-redshifting our control sample cluster galaxies star-formation rates using a fit to the galaxy main sequence evolution at z < 0.1, we determine that the typical star-formation rate of Coma galaxies as a function of mass is higher than for galaxies in our control sample at a confidence level of > 99 per cent. One way to alleviate this discrepency and bring Coma in-line with the control sample would be to have the distance to Coma to be slightly lower, perhaps through a non-negligible peculiar velocity with respect to the Hubble expansion, but we do not regard this as likely given precision measurements using a variety of approaches. Therefore in summary, we urge caution in using Coma as a z~0 baseline cluster in galaxy evolution studies.Comment: accepted for publication in MNRA

Impact of World War II on cost accounting at the Sperry Corporation

The impact of World War II on cost accountancy in the U.S. may be viewed as a double-edged sword. Its most positive effect was engendering greater cost awareness, particularly among companies that served as military contractors and, thus, had to make full representation to contracting agencies for reimbursement. On the negative side, the dislocations of war, especially shortages in the factors of production and capacity constraints, meant that such scientific management techniques as existed (standard costing, time-study, specific detailing of task routines) fell by the wayside. This paper utilizes the archive of the Sperry Corporation, a leading governmental contractor, to chart the firm\u27s accounting during World War II. It is concluded that any techniques that had developed from Taylorite principles were suspended, while methods similar to contemporary performance management, such as subcontracting, emphasis on the design phase of products, and substantial expenditure on research and deve­opment, flourished

Municipal accounting reform c. 1900: Ohio\u27s progressive accountants

Despite the fact that municipal accounting was a significant and permanent reform of the Progressive era, historians have failed to accord accountants proper credit for their leadership roles. Ohio was an important Progressive state and is particularly suited to an investigation of the contribution made by accountants. Ohio was the first state to require uniform municipal accounting and one of the first to inaugurate budgeting. Municipal research bureaus in major Ohio cities were among the most dynamic in the nation, inspiring important steps forward in cost accounting, budgeting, and the installation of accounting systems. Progressive municipal administrations came to depend increasingly on expert accountants to devise new systems and to audit the results

Government/business synergy: Early American innovations in budgeting and cost accounting

This paper examines certain interactions between American government and business which resulted in important innovations in the areas of budgeting and cost accounting early in the twentieth century. The evidence suggests that budgeting methods were initially developed by municipal reformers of the Progressive era and were subsequently adapted by business for planning and control purposes. In like fashion, standard costing and variance analysis were significant cost accounting techniques born to an industrial environment which came to contribute markedly to a continuing improvement of governmental budgeting procedures

Comparing families of dynamic causal models

Mathematical models of scientific data can be formally compared using Bayesian model evidence. Previous applications in the biological sciences have mainly focussed on model selection in which one first selects the model with the highest evidence and then makes inferences based on the parameters of that model. This “best model” approach is very useful but can become brittle if there are a large number of models to compare, and if different subjects use different models. To overcome this shortcoming we propose the combination of two further approaches: (i) family level inference and (ii) Bayesian model averaging within families. Family level inference removes uncertainty about aspects of model structure other than the characteristic of interest. For example: What are the inputs to the system? Is processing serial or parallel? Is it linear or nonlinear? Is it mediated by a single, crucial connection? We apply Bayesian model averaging within families to provide inferences about parameters that are independent of further assumptions about model structure. We illustrate the methods using Dynamic Causal Models of brain imaging data

Residential self-selection bias in the estimation of built environment effects on physical activity between adolescence and young adulthood

Abstract Background Built environment research is dominated by cross-sectional designs, which are particularly vulnerable to residential self-selection bias resulting from health-related attitudes, neighborhood preferences, or other unmeasured characteristics related to both neighborhood choice and health-related outcomes. Methods We used cohort data from the National Longitudinal Study of Adolescent Health (United States; Wave I, 1994-95; Wave III, 2001-02; n = 12,701) and a time-varying geographic information system. Longitudinal relationships between moderate to vigorous physical activity (MVPA) bouts and built and socioeconomic environment measures (landcover diversity, pay and public physical activity facilities per 10,000 population, street connectivity, median household income, and crime rate) from adolescence to young adulthood were estimated using random effects models (biased by unmeasured confounders) and fixed effects models (within-person estimator, which adjusts for unmeasured confounders that are stable over time). Results Random effects models yielded null associations except for negative crime-MVPA associations [coefficient (95% CI): -0.056 (-0.083, -0.029) in males, -0.061 (-0.090, -0.033) in females]. After controlling for measured and time invariant unmeasured characteristics using within-person estimators, MVPA was higher with greater physical activity pay facilities in males [coefficient (95% CI): 0.024 (0.006, 0.042)], and lower with higher crime rates in males [coefficient (95% CI): -0.107 (-0.140, -0.075)] and females [coefficient (95% CI): -0.046 (-0.083, -0.009)]. Other associations were null or in the counter-intuitive direction. Conclusions Comparison of within-person estimates to estimates unadjusted for unmeasured characteristics suggest that residential self-selection can bias associations toward the null, as opposed to its typical characterization as a positive confounder. Differential environment-MVPA associations by residential relocation suggest that studies examining changes following residential relocation may be vulnerable to selection bias. The authors discuss complexities of adjusting for residential self-selection and residential relocation, particularly during the adolescent to young adult transition

Dynamical Masses for the Large Magellanic Cloud Massive Binary System [L72] LH 54-425

We present results from an optical spectroscopic investigation of the massive binary system [L72] LH~54-425 in the LH 54 OB association in the Large Magellanic Cloud. We revise the ephemeris of [L72] LH 54-425 and find an orbital period of 2.247409 +/- 0.000010 days. We find spectral types of O3 V for the primary and O5 V for the secondary. We made a combined solution of the radial velocities and previously published V-band photometry to determine the inclination for two system configurations, i = 52 degrees for the configuration of the secondary star being more tidally distorted and i = 55 degrees for the primary as the more tidally distorted star. We argue that the latter case is more probable, and this solution yields masses and radii of M_1 = 47 +/- 2 M_Sun and R_1 = 11.4 +/- 0.1 R_Sun for the primary, and M_2 = 28 +/- 1 M_Sun and R_2 = 8.1 +/- 0.1 R_Sun for the secondary. Our analysis places LH 54-425 amongst the most massive stars known. Based on the position of the two stars plotted on a theoretical HR diagram, we find the age of the system to be about 1.5 Myr.Comment: 21 pages, 6 figures. Accepted in ApJ. To appear vol. 683, Aug. 10t