A multilevel neo-institutional analysis of infection prevention and control in English hospitals: coerced safety culture change?

Despite committed policy, regulative and professional efforts on healthcare safety, little is known about how such macro-interventions permeate organisations and shape culture over time. Informed by neo-institutional theory, we examined how inter-organisational influences shaped safety practices and inter-subjective meanings following efforts for coerced culture change. We traced macro-influences from 2000 to 2015 in infection prevention and control (IPC). Safety perceptions and meanings were inductively analysed from 130 in-depth qualitative interviews with senior- and middle-level managers from 30 English hospitals. A total of 869 institutional interventions were identified; 69% had a regulative component. In this context of forced implementation of safety practices, staff experienced inherent tensions concerning the scope of safety, their ability to be open and prioritisation of external mandates over local need. These tensions stemmed from conflicts among three co-existing institutional logics prevalent in the NHS. In response to requests for change, staff flexibly drew from a repertoire of cognitive, material and symbolic resources within and outside their organisations. They crafted 'strategies of action', guided by a situated assessment of first-hand practice experiences complementing collective evaluations of interventions such as 'pragmatic', 'sensible' and also 'legitimate'. Macro-institutional forces exerted influence either directly on individuals or indirectly by enriching the organisational cultural repertoire

Mobile technology use by people experiencing multiple sclerosis fatigue: a survey

BACKGROUND:Fatigue is one of the most commonly reported symptoms of multiple sclerosis (MS). It has a profound impact on all spheres of life, for people with MS and their relatives. It is one of the key precipitants of early retirement. Individual, group, and Internet cognitive behavioral therapy-based approaches to supporting people with MS to manage their fatigue have been shown to be effective. OBJECTIVE:The aim of this project was to (1) survey the types of mobile devices and level of Internet access people with MS use or would consider using for a health intervention and (2) characterize the levels of fatigue severity and their impact experienced by the people in our sample to provide an estimate of fatigue severity of people with MS in New Zealand. The ultimate goal of this work was to support the future development of a mobile intervention for the management of fatigue for people with MS. METHODS:Survey methodology using an online questionnaire was used to assess people with MS. A total of 51 people with MS participated. The average age was 48.5 years, and the large majority of the sample (77%) was female. RESULTS:Participants reported significant levels of fatigue as measured with the summary score of the Neurological Fatigue Index (mean 31.4 [SD 5.3]). Most (84%) respondents scored on average more than 3 on the fatigue severity questions, reflecting significant fatigue. Mobile phone usage was high with 86% of respondents reporting having a mobile phone; apps were used by 75% of respondents. Most participants (92%) accessed the Internet from home. CONCLUSIONS:New Zealand respondents with MS experienced high levels of both fatigue severity and fatigue impact. The majority of participants have a mobile device and access to the Internet. These findings, along with limited access to face-to-face cognitive behavioral therapy-based interventions, create an opportunity to develop a mobile technology platform for delivering a cognitive behavioral therapy-based intervention to decrease the severity and impact of fatigue in people with MS

Biotic and stable-isotope characterization of the Toarcian Ocean Anoxic Event through a carbonate–clastic sequence from Somerset, UK

This study focuses on a condensed sequence of alternating carbonate–clastic sediments of the Barrington Member, Beacon Limestone Formation (latest Pliensbachian to early Toarcian) from Somerset (SW England). Abundant ammonites confirm (apart from the absence of the Clevelandicum and Tenuicostatum ammonite subchronozones) the presence of Hawskerense Subchronozone to Fallaciosum–Bingmanni subchronozones. Well-preserved, sometimes diverse assemblages of ostracods, foraminifera, nannofossils and lowdiversity dinoflagellate assemblages support the chronostratigraphic framework. Stable-isotope analyses demonstrate the presence of a carbon isotope excursion, relating to the Toarcian Oceanic Anoxic Event, within the early Toarcian. Faunal, geochemical and sedimentological evidence suggest that deposition largely took place in a relatively deep-water (subwave base), mid-outer shelf environment under a well-mixed water column. However, reduced benthic diversity, the presence of weakly laminated sediments and changes in microplankton assemblage composition within the Toarcian Oceanic Anoxic Event indicates dysoxic, but probably never anoxic, bottom-water conditions during this event. The onset of the carbon isotope excursion coincides with extinction in the nannofossils and benthos, including the disappearance of the ostracod suborder Metacopina. Faunal evidence indicates connectivity with the Mediterranean region, not previously recorded for the UK during the early Toarcian

The physical parameters, excitation and chemistry of the rim, jets and knots of the planetary nebula NGC 7009

We present long-slit optical spectra along the major axis of the planetary nebula NGC 7009. These data allow us to discuss the physical, excitation and chemical properties of all the morphological components of the nebula, including its remarkable systems of knots and jets. The main results of this analysis are the following: i) the electron temperature throughout the nebula is remarkably constant, T_e[OIII] = 10200K; ii) the bright inner rim and inner pair of knots have similar densities of N_e = 6000cm^{-3}, whereas a much lower density of N_e = 1500cm^{-3} is derived for the outer knots as well as for the jets; iii) all the regions (rim, inner knots, jets and outer knots) are mainly radiatively excited; and iv) there are no clear abundance changes across the nebula for He, O, Ne, or S. There is a marginal evidence for an overabundance of nitrogen in the outer knots (ansae), but the inner ones (caps) and the rim have similar N/H values that are at variance with previous results. Our data are compared to the predictions of theoretical models, from which we conclude that the knots at the head of the jets are not matter accumulated during the jet expansion through the circumstellar medium, neither can their origin be explained by the proposed HD or MHD interacting-wind models for the formation of jets/ansae, since the densities as well as the main excitation mechanisms of the knots, disagree with model predictions.Comment: Figure 1 was changed because features were misidentified in the previous version. 17 pages including 5 figures and 3 tables. ApJ in press. Also available at http://www.iac.es/galeria/denise

Identity and belonging in social learning groups : the importance of distinguishing social, operational and knowledge-related identity congruence

Collaborative learning has much to offer but not all learners participate fully and peer groups can be exclusive. The paper examines how belonging or 'congruence' in learning groups is related to identities of gender, age, ethnicity and socio-economic status. A study of student experiences of collaborative learning on three different blended learning courses illustrated how learners negotiate identity congruence with peer groups to belong and engage. An analytical framework that distinguishes social, operational and knowledge-related identity congruence has emerged. Contrary to received wisdom, the social aspect appears least important for learner engagement while knowledge-related identity congruence is fundamental. Some of the consequences of identity incongruence, particularly concerning gender and maturity, are discussed and the paper points towards the pedagogies which might enable identities of group members to shift so that collaborative learning can flourish

A New Upper Limit for the Tau-Neutrino Magnetic Moment

Using a prompt neutrino beam in which a nu_tau component was identified for the first time, the nu_tau magnetic moment was measured based on a search for an anomalous increase in the number of neutrino-electron interactions. One such event was observed when 2.3 were expected from background processes, giving an upper 90% confidence limit of 3.9x10^-7 Bohr magnetons.Comment: 9 pages; 1 figur

Fermilab E791

Fermilab E791, a very high statistics charm particle experiment, recently completed its data taking at Fermilab's Tagged Photon Laboratory. Over 20 billion events were recorded through a loose transverse energy trigger and written to 8mm tape in the the 1991-92 fixed target run at Fermilab. This unprecedented data sample containing charm is being analysed on many-thousand MIP RISC computing farms set up at sites in the collaboration. A glimpse of the data taking and analysis effort is presented. We also show some preliminary results for common charm decay modes. Our present analysis indicates a very rich yield of over 200K reconstructed charm decays.Comment: 4 pages, 1 figure, LaTe

Search for the Flavor-Changing Neutral-Current Decays D+→π+μ+μ−D^+\to \pi^+ \mu^+ \mu^- and D+→π+e+e−D^+\to \pi^+ e^+ e^-

We report the results of a search for the flavor-changing neutral-current decays $D^+\rightarrow \pi^+ \mu^+ \mu^-$ and $D^+\rightarrow \pi^+ e^+ e^-$ in data from Fermilab charm hadroproduction experiment E791. No signal above background is found, and we obtain upper limits on branching fractions, $B(D^+\rightarrow \pi^+ \mu^+ \mu^-) < 1.8 \times 10^{-5}$ and $B(D^+\rightarrow \pi^+ e^+ e^-) < 6.6 \times 10^{-5}$, at the 90\% confidence level.Comment: nine pages with figures; compressed, uuencoded postscrip

Experimental evidence for a light and broad scalar resonance in D+→π−π+π+D^+\to \pi^-\pi^+\pi^+ decay

From a sample of $1172 \pm 61$ $D^+ \to \pi^- \pi^+ \pi^+$ decay, we find $\Gamma (D^+ \to \pi^- \pi^+ \pi^+) / \Gamma (D^+ \to K^- \pi^+ \pi^+) = 0.0311 \pm 0.0018 ^{+0.0016}_{-0.0026}$. Using a coherent amplitude analysis to fit the Dalitz plot of this decays, we find strong evidence that a scalar resonance of mass $478^{+24}_{-23} \pm 17$ MeV/$c^2$ and width $324^{+42}_{-40} \pm 21$ MeV/$c^2$ accounts for approximately half of all decays.Comment: 10 pages, 3 eps figure