Letting Go: Conceptualizing intervention de-implementation in public health and social service settings

The discontinuation of interventions that should be stopped, or de-implementation, has emerged as a novel line of inquiry within dissemination and implementation science. As this area grows in human services research, like public health and social work, theory is needed to help guide scientific endeavors. Given the infancy of de-implementation, this conceptual narrative provides a definition and criteria for determining if an intervention should be de-implemented. We identify three criteria for identifying interventions appropriate for de-implementation: (a) interventions that are not effective or harmful, (b) interventions that are not the most effective or efficient to provide, and (c) interventions that are no longer necessary. Detailed, well-documented examples illustrate each of the criteria. We describe de-implementation frameworks, but also demonstrate how other existing implementation frameworks might be applied to de-implementation research as a supplement. Finally, we conclude with a discussion of de-implementation in the context of other stages of implementation, like sustainability and adoption; next steps for de-implementation research, especially identifying interventions appropriate for de-implementation in a systematic manner; and highlight special ethical considerations to advance the field of de-implementation research

Planning for Flight System Availability Under Uncertainty

The prime problem of planning for aircraft availability is to economically evaluate and determine if system availabilities are continuously being achieved, as well as to identify availability problems and pinpoint where they exist. The risk to human life and property is far too great to warrant the use of structural components which may cause vital equipment to fail when most needed

Increasing prevalence of asthma diagnosis and symptoms in children is confined to mild symptoms

BACKGROUND: The prevalence of childhood asthma is increasing but few studies have investigated trends in asthma severity. We investigated trends in asthma diagnosis and symptom morbidity between an eight year time period in a paired prevalence study. METHODS: All children in one single school year aged 8-9 years in the city of Sheffield were given a parent respondent questionnaire in 1991 and 1999 based on questions from the International Survey of Asthma and Allergy in Children (ISAAC). Data were obtained regarding the prevalence of asthma and wheeze and current (12 month) prevalences of wheeze attacks, speech limiting wheeze, nocturnal cough and wheeze, and exertional symptoms. RESULTS: The response rates in 1991 and 1999 were 4580/5321 (85.3%) and 5011/6021 (83.2%), respectively. There were significant increases between the two surveys in the prevalence of asthma ever (19.9% v 29.7%, mean difference 11.9%, 95% confidence interval (CI) 10.16 to 13.57, p<0.001), current asthma (10.3% v 13.0%, mean difference 2.7%, 95% CI 1.44 to 4.03, p<0.001), wheeze ever (30.3% v 35.8%, mean difference 5.7%, 95% CI 3.76 to 7.56, p<0.001), wheeze in the previous 12 months (17.0% v 19.4%, mean difference 2.5, 95% CI 0.95 to 4.07, p<0.01), and reporting of medication use (16.9% v 20%, mean difference 3.0%, 95% CI 1.46 to 4.62, p<0.001). There were also significant increases in reported hayfever and eczema diagnoses. CONCLUSIONS: Diagnostic labelling of asthma and lifetime prevalence of wheeze has increased. The current 12 month point prevalence of wheeze has increased but this is confined to occasional symptoms. The increased medication rate may be responsible for the static prevalence of severe asthma symptoms. The significant proportion of children receiving medication but reporting no asthma symptoms identified from our 1999 survey suggests that some children are being inappropriately treated or overtreated

A qualitative view of cryogenic fluid injection into high speed flows

The injection of supercritical pressure, subcritical temperature fluids, into a 2-D, ambient, static temperature and static pressure supersonic tunnel and free jet supersonic nitrogen flow field was observed. Observed patterns with fluid air were the same as those observed for fluid nitrogen injected into the tunnel at 90 deg to the supersonic flow. The nominal injection pressure was of 6.9 MPa and tunnel Mach number was 2.7. When injected directly into and opposing the tunnel exhaust flow, the observed patterns with fluid air were similar to those observed for fluid nitrogen but appeared more diffusive. Cryogenic injection creates a high density region within the bow shock wake but the standoff distance remains unchanged from the gaseous value. However, as the temperature reaches a critical value, the shock faded and advanced into the supersonic stream. For both fluids, nitrogen and air, the phenomena was completely reversible

Quaternary Geology and Seismic Hazard of the Sierra Madre and Associated Faults, Western San Gabriel Mountains

This detailed study of a 40-km-long section of the Sierra Madre and associated fault zones in the central transverse Ranges, along the south side of the San Gabriel Mountains, is aimed at providing information for evaluating the seismic hazard that these faults pose to the heavily populated area immediately to the south. Evidence on the location of fault strands and the style and timing of fault movements during the Quaternary was obtained from detailed geologic mapping, aerial-photograph interpretation, alluvial stratigraphy, structural and stratigraphic relations in some 33 trench excavations at critical localities, and subsurface data. We present a time-stratigraphic classification for the Quaternary deposits in the study area, based on soil development, geomorphology, and contact relations among the alluvial units. We distinguish four units, with approximate ages, as follows: unit 4, about 200,000 yr to middle Quaternary; unit 3: about 11,000 to 200,000 yr; unit 2; about 1,000 to 11,000 yr; and unit 1; younger than about 1,000 yr. We use this classification to evaluate on a semi-quantitative basis the evidence for fault activity in the study area and to infer the relative seismicity of different segments of the Sierra Madre fault zone during the Quaternary. Alluvial-fan development (particularly fanhead incision and the ages of alluvial-fan deposits) also gives clues as to relative seismicity. The most active segment of the Sierra Madre fault zone within the study area is the westernmost section, adjacent to the faults that broke during the 1971 San Fernando, Calif., earthquake. The age of activity, as indicated by the occurrence of Holocene faulting, decreases toward the east. Along the Sierra Madre fault, through La Canada, Altadena, Sierra Madre, and Duarte, is abundant evidence of late Pleistocene faulting. Total vertical displacement is more than 600 m, but there is no evidence for Holocene fault movement. These observations suggest that the presently applicable recurrence interval between major earthquakes in the central and eastern sections of the Sierra Madre fault zone is longer than about 5,000 yr. The local magnitude (M_L) of the largest credible earthquake that could occur on the Sierra Madre fault zone in the study area is estimated at 7, on the grounds that the fault zone is probably limited mechanically by subdivision into separate arcuate segments about 15 km long. The Raymond fault, which branches southwestward from the Sierra Madre fault in the eastern part of the study area, shows well-defined evidence of a late Quaternary history of repeated fault movements. Displacements of alluvial strata observed in trench excavations across the fault give evidence of five major seismic events, whose times of occurrence can be estimated from radiometric dating at approximately 36,000, 25,000, 10,000-2,200 (two events), and 2,200-1,500 yr B.P. Further evidence suggests at least three more faulting events in the past 29,000 yr, for which specific dates cannot be determined. Because some additional events probably remain undetected, we infer that an average recurrence interval of about 3,000 yr, with an average vertical displacement of 0.4 m per event, is applicable to the Raymond fault in its present state, as indicated by its history of movement over the past 36,000 yr. This level of activity is distinctly higher than that found for the Sierra Madre fault zone in the central and eastern parts of the study area. If the entire 15-km length of the Raymond fault would rupture in a single event, as seems likely, a maximum credible earthquake of M_L 6 3/4 can reasonably be assumed

Sediment Denitrification In The Gulf Of Mexico Zone Of Hypoxia

The largest zone of anthropogenic bottom water hypoxia in the Western Hemisphere occurs seasonally in the northern Gulf of Mexico between the Mississippi River delta and the coast of eastern Texas. This zone of hypoxia reaches its greatest extent in the summer months and is a consequence of seasonal stratification of the water column combined with the decomposition of organic matter derived from accelerated rates of primary production. This enhanced productivity is driven primarily by the input of inorganic nitrogen from the Mississippi River. There are 3 likely sinks for fixed nitrogen within this zone of hypoxia: sequestration in the sediment, dispersion and dilution into the Gulf of Mexico, and denitrification. We assessed potential denitrification rates at 7 stations in the zone of hypoxia during the summer of 1999. Those data are compared with bottom water nitrate, ammonium and dissolved oxygen (DO) concentrations. No denitrification was observed in the water column. Denitrification potential rates in the surface sediments were unexpectedly low and ranged between 39.8 and 108.1 mumol m(-1) h(-1). The highest rates were observed at stations with bottom water DO concentrations between 1 and 3 mg l(-1). Denitrification activity was significantly lower at stations where DO was lower than 1 mg l(-1) or higher than 3 mg l(-1). Nutrient data for these stations demonstrate that as anoxia is approached, the dominant species of nitrogen shifts from nitrate to ammonium. The shift in nitrogen species suggests competition between microbial populations in the sediment community. The lower denitrification rates at stations with bottom water DO l(-1) may be due to nitrate limitation or an increase in the competitive advantage of microorganisms capable of dissimilatory nitrate reduction to ammonium (DNRA). Suppression of denitrification at low DO by any mechanism will increase the residence time of bioavailable nitrogen. This trend could act as a positive feedback mechanism in the formation of hypoxic bottom waters

Analysis of the shearing instability in nonlinear convection and magnetoconvection

Numerical experiments on two-dimensional convection with or without a vertical magnetic field reveal a bewildering variety of periodic and aperiodic oscillations. Steady rolls can develop a shearing instability, in which rolls turning over in one direction grow at the expense of rolls turning over in the other, resulting in a net shear across the layer. As the temperature difference across the fluid is increased, two-dimensional pulsating waves occur, in which the direction of shear alternates. We analyse the nonlinear dynamics of this behaviour by first constructing appropriate low-order sets of ordinary differential equations, which show the same behaviour, and then analysing the global bifurcations that lead to these oscillations by constructing one-dimensional return maps. We compare the behaviour of the partial differential equations, the models and the maps in systematic two-parameter studies of both the magnetic and the non-magnetic cases, emphasising how the symmetries of periodic solutions change as a result of global bifurcations. Much of the interesting behaviour is associated with a discontinuous change in the leading direction of a fixed point at a global bifurcation; this change occurs when the magnetic field is introduced