A mixed method study into obstetric sonographer-led-discharge and other forms of sonographer role extension

INTRODUCTION: Sonographer-led-discharge was proposed in a maternity unit to provide a holistic service, cut waiting times, ease staffing pressures and increase job satisfaction. This study explored sonographers’ experiences and perspectives of this new extended role and other areas of non-obstetric role extension. Understanding these will inform future practice and the success of the proposed obstetric sonographer-led-discharge and career structure. METHODS: A mixed methodology, cross-sectional study was performed, with a purposive, non-probability sample using an online data collection tool. The data were analysed using descriptive statistics and thematic analysis. RESULTS: In total, 93 sonographers participated in the study. Of these, 25% of sonographers currently practising obstetric ultrasound said they would not undertake the proposed obstetric sonographer-led-discharge role extension although 90% of the participants said role extension provides job satisfaction. Several themes emerged from the data, including job satisfaction, benefits to the hospital, improved patient pathway, time, personal factors, litigation and intra- and interprofessional resistance. A total of 54% of staff currently performing a role extension have experienced either inter- or intraprofessional conflict and only 48.5% said their workload was manageable. CONCLUSIONS: The data collected suggested that, with training and support, the proposed obstetric sonographer-led-discharge role is an appropriate role extension for sonographers. These findings support the premise of the proposed sonographic career structure, although the inter- and intraprofessional resistance identified in the study could form a significant barrier if it is not appropriately considered and managed

Completeness of case ascertainment and survival time error in English cancer registries: impact on 1-year survival estimates.

BACKGROUND: It has been suggested that cancer registries in England are too dependent on processing of information from death certificates, and consequently that cancer survival statistics reported for England are systematically biased and too low. METHODS: We have linked routine cancer registration records for colorectal, lung, and breast cancer patients with information from the Hospital Episode Statistics (HES) database for the period 2001-2007. Based on record linkage with the HES database, records missing in the cancer register were identified, and dates of diagnosis were revised. The effects of those revisions on the estimated survival time and proportion of patients surviving for 1 year or more were studied. Cases that were absent in the cancer register and present in the HES data with a relevant diagnosis code and a relevant surgery code were used to estimate (a) the completeness of the cancer register. Differences in survival times calculated from the two data sources were used to estimate (b) the possible extent of error in the recorded survival time in the cancer register. Finally, we combined (a) and (b) to estimate (c) the resulting differences in 1-year cumulative survival estimates. RESULTS: Completeness of case ascertainment in English cancer registries is high, around 98-99%. Using HES data added 1.9%, 0.4% and 2.0% to the number of colorectal, lung, and breast cancer registrations, respectively. Around 5-6% of rapidly fatal cancer registrations had survival time extended by more than a month, and almost 3% of rapidly fatal breast cancer records were extended by more than a year. The resulting impact on estimates of 1-year survival was small, amounting to 1.0, 0.8, and 0.4 percentage points for colorectal, lung, and breast cancer, respectively. INTERPRETATION: English cancer registration data cannot be dismissed as unfit for the purpose of cancer survival analysis. However, investigators should retain a critical attitude to data quality and sources of error in international cancer survival studies

ALMA data suggest the presence of a spiral structure in the inner wind of CW Leo

(abbreviated) We aim to study the inner wind of the well-known AGB star CW Leo. Different diagnostics probing different geometrical scales have pointed toward a non-homogeneous mass-loss process: dust clumps are observed at milli-arcsec scale, a bipolar structure is seen at arcsecond-scale and multi-concentric shells are detected beyond 1". We present the first ALMA Cycle 0 band 9 data around 650 GHz. The full-resolution data have a spatial resolution of 0".42x0".24, allowing us to study the morpho-kinematical structure within ~6". Results: We have detected 25 molecular lines. The emission of all but one line is spatially resolved. The dust and molecular lines are centered around the continuum peak position. The dust emission has an asymmetric distribution with a central peak flux density of ~2 Jy. The molecular emission lines trace different regions in the wind acceleration region and suggest that the wind velocity increases rapidly from about 5 R* almost reaching the terminal velocity at ~11 R*. The channel maps for the brighter lines show a complex structure; specifically for the 13CO J=6-5 line different arcs are detected within the first few arcseconds. The curved structure present in the PV map of the 13CO J=6-5 line can be explained by a spiral structure in the inner wind, probably induced by a binary companion. From modeling the ALMA data, we deduce that the potential orbital axis for the binary system lies at a position angle of ~10-20 deg to the North-East and that the spiral structure is seen almost edge-on. We infer an orbital period of 55 yr and a binary separation of 25 au (or ~8.2 R*). We tentatively estimate that the companion is an unevolved low-mass main-sequence star. The ALMA data hence provide us for the first time with the crucial kinematical link between the dust clumps seen at milli-arcsecond scale and the almost concentric arcs seen at arcsecond scale.Comment: 22 pages, 18 Figures, Astronomy & Astrophysic

On the edge of a new frontier: Is gerontological social work in the UK ready to meet twenty-first-century challenges?

This article is available open access through the publisher’s website. Copyright @ 2013 The Authors.This article explores the readiness of gerontological social work in the UK for meeting the challenges of an ageing society by investigating the focus on work with older people in social work education and the scope of gerontological social work research. The discussion draws on findings from two exploratory studies: a survey of qualifying master's programmes in England and a survey of the content relating to older people over a six-year period in four leading UK social work journals. The evidence from master's programmes suggests widespread neglect of ageing in teaching content and practice learning. Social work journals present a more nuanced picture. Older people emerge within coverage of generic policy issues for adults, such as personalisation and safeguarding, and there is good evidence of the complexity of need in late life. However, there is little attention to effective social work interventions, with an increasingly diverse older population, or to the quality of gerontological social work education. The case is made for infusing content on older people throughout the social work curriculum, for extending practice learning opportunities in social work with older people and for increasing the volume and reporting of gerontological social work research.Brunel Institute for Ageing Studie

A projection method for statics and dynamics of lattice spin systems

A method based on Monte Carlo sampling of the probability flows projected onto the subspace of one or more slow variables is proposed for investigation of dynamic and static properties of lattice spin systems. We illustrate the method by applying it, with projection onto the order-parameter subspace, to the three-dimensional 3-state Potts model in equilibrium and to metastable decay in a three-dimensional 3-state kinetic Potts model.Comment: 4 pages, 3 figures, RevTex, final version to appear in Phys. Rev. Let

Orbital and stochastic far-UV variability in the nova-like system V3885 Sgr

Highly time-resolved time-tagged FUSE satellite spectroscopic data are analysed to establish the far-ultraviolet (FUV) absorption line characteristics of the nova-like cataclysmic variable binary, V3885 Sgr. We determine the temporal behaviour of low (Ly_beta, CIII, NIII) and high (SIV, PV, OVI) ion species, and highlight corresponding orbital phase modulated changes in these lines. On average the absorption troughs are blueshifted due to a low velocity disc wind outflow. Very rapid (~ 5 min) fluctuations in the absorption lines are isolated, which are indicative of stochastic density changes. Doppler tomograms of the FUV lines are calculated which provide evidence for structures where a gas stream interacts with the accretion disc. We conclude that the line depth and velocity changes as a function of orbital phase are consistent with an asymmetry that has its origin in a line-emitting, localised disc-stream interaction region.Comment: Accepted for publication in MNRA

Structure and stereochemistry of the base excision repair glycosylase MutY reveal a mechanism similar to retaining glycosidases.

MutY adenine glycosylases prevent DNA mutations by excising adenine from promutagenic 8-oxo-7,8-dihydroguanine (OG):A mismatches. Here, we describe structural features of the MutY active site bound to an azaribose transition state analog which indicate a catalytic role for Tyr126 and approach of the water nucleophile on the same side as the departing adenine base. The idea that Tyr126 participates in catalysis, recently predicted by modeling calculations, is strongly supported by mutagenesis and by seeing close contact between the hydroxyl group of this residue and the azaribose moiety of the transition state analog. NMR analysis of MutY methanolysis products corroborates a mechanism for adenine removal with retention of stereochemistry. Based on these results, we propose a revised mechanism for MutY that involves two nucleophilic displacement steps akin to the mechanisms accepted for 'retaining' O-glycosidases. This new-for-MutY yet familiar mechanism may also be operative in related base excision repair glycosylases and provides a critical framework for analysis of human MutY (MUTYH) variants associated with inherited colorectal cancer

Radiative Transitions in Charmonium from Lattice QCD

Radiative transitions between charmonium states offer an insight into the internal structure of heavy-quark bound states within QCD. We compute, for the first time within lattice QCD, the transition form-factors of various multipolarities between the lightest few charmonium states. In addition, we compute the experimentally unobservable, but physically interesting vector form-factors of the $\eta_c, J/\psi$ and $\chi_{c0}$. To this end we apply an ambitious combination of lattice techniques, computing three-point functions with heavy domain wall fermions on an anisotropic lattice within the quenched approximation. With an anisotropy $\xi=3$ at $a_s \sim 0.1 \mathrm{fm}$ we find a reasonable gross spectrum and a hyperfine splitting $\sim 90 \mathrm{MeV}$, which compares favourably with other improved actions. In general, after extrapolation of lattice data at non-zero $Q^2$ to the photopoint, our results agree within errors with all well measured experimental values. Furthermore, results are compared with the expectations of simple quark models where we find that many features are in agreement; beyond this we propose the possibility of constraining such models using our extracted values of physically unobservable quantities such as the $J/\psi$ quadrupole moment. We conclude that our methods are successful and propose to apply them to the problem of radiative transitions involving hybrid mesons, with the eventual goal of predicting hybrid meson photoproduction rates at the GlueX experiment.Comment: modified version as publishe