Evaluating the articulation of programme theory in practice as observed in Quality Improvement initiatives

Background: The Action-Effect Method(AEM) was co-developed by NIHR CLAHRC Northwest London (CLAHRC NWL) researchers and QI practitioners, building on Driver Diagrams(DD). This study aimed to determine AEM effectiveness in terms of technical aspects (how diagrams produced in practice compared with theoretical ideals) and social aspects (how engagement with the method related to social benefits). Methods Diagrams were scored on criteria developed on theoretical ideals of programme theory. 65 programme theory diagrams were reviewed (21 published Driver Diagrams (External DDs), 22 CLAHRC NWL Driver Diagrams (Internal DDs), and 21 CLAHRC NWL Action-Effect Diagrams(AEDs)). Social functions were studied through ethnographic observation of frontline QI teams in AEM sessions facilitated by QI experts. Qualitative analysis used inductive and deductive coding. Results ANOVA indicated the AEM significantly improved the quality of programme theory diagrams over Internal and External DDs on an average of 5 criteria from an 8-point assessment. Articulated aims were more likely to be patient-focused and high-level in AEDs than DDs. The cause/effect relationships from intervention to overall aim also tended to be clearer and were more likely than DDs to contain appropriate measure concepts. Using the AEM also served several social functions such as facilitating dialogue among multidisciplinary teams, and encouraging teams to act scientifically and pragmatically about planning and measuring QI interventions. Implications: The Action-Effect Method developed by CLAHRC NWL resulted in improvements over Driver Diagrams in articulating programme theory, which has wide-ranging benefits to quality improvement, including encouraging broad multi-disciplinary buy-in to clear aims and pre-planning a rigorous evaluation strategy

Survey of patient and public perceptions of electronic health records for healthcare, policy and research: Study protocol

BACKGROUND: Immediate access to patients’ complete health records via electronic databases could improve healthcare and facilitate health research. However, the possible benefits of a national electronic health records (EHR) system must be balanced against public concerns about data security and personal privacy. Successful development of EHR requires better understanding of the views of the public and those most affected by EHR: users of the National Health Service. This study aims to explore the correlation between personal healthcare experience (including number of healthcare contacts and number and type of longer term conditions) and views relating to development of EHR for healthcare, health services planning and policy and health research. METHODS/DESIGN: A multi-site cross-sectional self-complete questionnaire designed and piloted for use in waiting rooms was administered to patients from randomly selected outpatients’ clinics at a university teaching hospital (431 beds) and general practice surgeries from the four primary care trusts within the catchment area of the hospital. All patients entering the selected outpatients clinics and general practice surgeries were invited to take part in the survey during August-September 2011. Statistical analyses will be conducted using descriptive techniques to present respondents’ overall views about electronic health records and logistic regression to explore associations between these views and participants’ personal circumstances, experiences, sociodemographics and more specific views about electronic health records. DISCUSSION: The study design and implementation were successful, resulting in unusually high response rates and overall recruitment (85.5%, 5336 responses). Rates for face-to-face recruitment in previous work are variable, but typically lower (mean 76.7%, SD 20). We discuss details of how we collected the data to provide insight into how we obtained this unusually high response rate

The Lippmann–Schwinger Formula and One Dimensional Models with Dirac Delta Interactions

We show how a proper use of the Lippmann–Schwinger equation simplifies the calculations to obtain scattering states for one dimensional systems perturbed by N Dirac delta equations. Here, we consider two situations. In the former, attractive Dirac deltas perturbed the free one dimensional Schrödinger Hamiltonian. We obtain explicit expressions for scattering and Gamow states. For completeness, we show that the method to obtain bound states use comparable formulas, although not based on the Lippmann–Schwinger equation. Then, the attractive N deltas perturbed the one dimensional Salpeter equation. We also obtain explicit expressions for the scattering wave functions. Here, we need regularisation techniques that we implement via heat kernel regularisation

Knockout studies reveal an important role of <i>plasmodium</i> lipoic acid protein ligase a1 for asexual blood stage parasite survival

Lipoic acid (LA) is a dithiol-containing cofactor that is essential for the function of a-keto acid dehydrogenase complexes. LA acts as a reversible acyl group acceptor and 'swinging arm' during acyl-coenzyme A formation. The cofactor is post-translationally attached to the acyl-transferase subunits of the multienzyme complexes through the action of octanoyl (lipoyl): &lt;i&gt;N&lt;/i&gt;-octanoyl (lipoyl) transferase (LipB) or lipoic acid protein ligases (LplA). Remarkably, apicomplexan parasites possess LA biosynthesis as well as scavenging pathways and the two pathways are distributed between mitochondrion and a vestigial organelle, the apicoplast. The apicoplast-specific LipB is dispensable for parasite growth due to functional redundancy of the parasite's lipoic acid/octanoic acid ligases/transferases. In this study, we show that &lt;i&gt;LplA1&lt;/i&gt; plays a pivotal role during the development of the erythrocytic stages of the malaria parasite. Gene disruptions in the human malaria parasite &lt;i&gt;P.falciparum&lt;/i&gt; consistently were unsuccessful while in the rodent malaria model parasite &lt;i&gt;P. berghei&lt;/i&gt; the &lt;i&gt;LplA1&lt;/i&gt; gene locus was targeted by knock-in and knockout constructs. However, the &lt;i&gt;LplA1&lt;/i&gt; &lt;sup&gt;(-)&lt;/sup&gt; mutant could not be cloned suggesting a critical role of LplA1 for asexual parasite growth &lt;i&gt;in vitro&lt;/i&gt; and &lt;i&gt;in vivo&lt;/i&gt;. These experimental genetics data suggest that lipoylation during expansion in red blood cells largely occurs through salvage from the host erythrocytes and subsequent ligation of LA to the target proteins of the malaria parasite

Elevated CO₂ does not increase eucalypt forest productivity on a low-phosphorus soil

Rising atmospheric CO2 stimulates photosynthesis and productivity of forests, offsetting CO2 emissions. Elevated CO2 experiments in temperate planted forests yielded ~23% increases in productivity over the initial years. Whether similar CO2 stimulation occurs in mature evergreen broadleaved forests on low-phosphorus (P) soils is unknown, largely due to lack of experimental evidence. This knowledge gap creates major uncertainties in future climate projections as a large part of the tropics is P-limited. Here,we increased atmospheric CO2 concentration in a mature broadleaved evergreen eucalypt forest for three years, in the first large-scale experiment on a P-limited site. We show that tree growth and other aboveground productivity components did not significantly increase in response to elevated CO2 in three years, despite a sustained 19% increase in leaf photosynthesis. Moreover, tree growth in ambient CO2 was strongly P-limited and increased by ~35% with added phosphorus. The findings suggest that P availability may potentially constrain CO2-enhanced productivity in P-limited forests; hence, future atmospheric CO2 trajectories may be higher than predicted by some models. As a result, coupled climate-carbon models should incorporate both nitrogen and phosphorus limitations to vegetation productivity in estimating future carbon sinks

Cross-polarized photon-pair generation and bi-chromatically pumped optical parametric oscillation on a chip

Nonlinear optical processes are one of the most important tools in modern optics with a broad spectrum of applications in, for example, frequency conversion, spectroscopy, signal processing and quantum optics. For practical and ultimately widespread implementation, on-chip devices compatible with electronic integrated circuit technology offer great advantages in terms of low cost, small footprint, high performance and low energy consumption. While many on-chip key components have been realized, to date polarization has not been fully exploited as a degree of freedom for integrated nonlinear devices. In particular, frequency conversion based on orthogonally polarized beams has not yet been demonstrated on chip. Here we show frequency mixing between orthogonal polarization modes in a compact integrated microring resonator and demonstrate a bi-chromatically pumped optical parametric oscillator. Operating the device above and below threshold, we directly generate orthogonally polarized beams, as well as photon pairs, respectively, that can find applications, for example, in optical communication and quantum optics

Autonomous quantum machines and the finite sized Quasi-Ideal clock

Processes such as quantum computation, or the evolution of quantum cellular automata are typically described by a unitary operation implemented by an external observer. In particular, an interaction is generally turned on for a precise amount of time, using a classical clock. A fully quantum mechanical description of such a device would include a quantum description of the clock whose state is generally disturbed because of the back-reaction on it. Such a description is needed if we wish to consider finite sized autonomous quantum machines requiring no external control. The extent of the back-reaction has implications on how small the device can be, on the length of time the device can run, and is required if we want to understand what a fully quantum mechanical treatment of an observer would look like. Here, we consider the implementation of a unitary by a finite sized device which we call the "Quasi-Ideal clock", and show that the back-reaction on it can be made exponentially small in the device's dimension with only a linear increase in energy. As a result, an autonomous quantum machine need only be of modest size and or energy. We are also able to solve a long-standing open problem by using a finite sized quantum clock to approximate the continuous evolution of an Idealised clock. The result has implications on the equivalence of different paradigms of quantum thermodynamics, some which allow external control and some which only allow autonomous thermal machines.Comment: Main text: 9 + 53 pages. V4: Close to the published version, J. Annales Henri Poincar\'e (2018) [Communicated by David P\'erez-Garc\'ia

Postglacial expansion of the arctic keystone copepod calanus glacialis

Calanus glacialis, a major contributor to zooplankton biomass in the Arctic shelf seas, is a key link between primary production and higher trophic levels that may be sensitive to climate warming. The aim of this study was to explore genetic variation in contemporary populations of this species to infer possible changes during the Quaternary period, and to assess its population structure in both space and time. Calanus glacialis was sampled in the fjords of Spitsbergen (Hornsund and Kongsfjorden) in 2003, 2004, 2006, 2009 and 2012. The sequence of a mitochondrial marker, belonging to the ND5 gene, selected for the study was 1249 base pairs long and distinguished 75 unique haplotypes among 140 individuals that formed three main clades. There was no detectable pattern in the distribution of haplotypes by geographic distance or over time. Interestingly, a Bayesian skyline plot suggested that a 1000-fold increase in population size occurred approximately 10,000 years before present, suggesting a species expansion after the Last Glacial Maximum.GAME from the National Science Centre, the Polish Ministry of Science and Higher Education Iuventus Plus [IP2014 050573]; FCT-PT [CCMAR/Multi/04326/2013]; [2011/03/B/NZ8/02876