The barriers to and enablers of providing reasonably adjusted health services to people with intellectual disabilities in acute hospitals: evidence from a mixed-methods study.

OBJECTIVE: To identify the factors that promote and compromise the implementation of reasonably adjusted healthcare services for patients with intellectual disabilities in acute National Health Service (NHS) hospitals. DESIGN: A mixed-methods study involving interviews, questionnaires and participant observation (July 2011-March 2013). SETTING: Six acute NHS hospital trusts in England. METHODS: Reasonable adjustments for people with intellectual disabilities were identified through the literature. Data were collected on implementation and staff understanding of these adjustments. RESULTS: Data collected included staff questionnaires (n=990), staff interviews (n=68), interviews with adults with intellectual disabilities (n=33), questionnaires (n=88) and interviews (n=37) with carers of patients with intellectual disabilities, and expert panel discussions (n=42). Hospital strategies that supported implementation of reasonable adjustments did not reliably translate into consistent provision of such adjustments. Good practice often depended on the knowledge, understanding and flexibility of individual staff and teams, leading to the delivery of reasonable adjustments being haphazard throughout the organisation. Major barriers included: lack of effective systems for identifying and flagging patients with intellectual disabilities, lack of staff understanding of the reasonable adjustments that may be needed, lack of clear lines of responsibility and accountability for implementing reasonable adjustments, and lack of allocation of additional funding and resources. Key enablers were the Intellectual Disability Liaison Nurse and the ward manager. CONCLUSIONS: The evidence suggests that ward culture, staff attitudes and staff knowledge are crucial in ensuring that hospital services are accessible to vulnerable patients. The authors suggest that flagging the need for specific reasonable adjustments, rather than the vulnerable condition itself, may address some of the barriers. Further research is recommended that describes and quantifies the most frequently needed reasonable adjustments within the hospital pathways of vulnerable patient groups, and the most effective organisational infrastructure required to guarantee their use, together with resource implications

Concentration of atomic hydrogen diffused into silicon in the temperature range 900–1300 °C

Boron-doped Czochralski silicon samples with [B]~1017 cm−3 have been heated at various temperatures in the range 800–1300 °C in an atmosphere of hydrogen and then quenched. The concentration of [H-B] pairs was measured by infrared localized vibrational mode spectroscopy. It was concluded that the solubility of atomic hydrogen is greater than [Hs] = 5.6 × 1018 exp( − 0.95 eV/kT)cm−3 at the temperatures investigated

Nitrous oxide emission from a range of land uses across Europe

International audienceThe results of a literature study examining quantitative estimates of N2O emission rates are presented for a range of land-uses across Europe. The analysis shows that the highest N2O emission rates are for agricultural lands compared to forests and grasslands. The main factors regulating these rates are available mineral nitrogen, soil temperature, soil water content and the available labile organic compounds. These controls operate across different time-scales, all must exceed a certain threshold for N2O emission to occur. The results support the need for an emission factor function of land-use and climate within models describing nitrogen dynamics in catchments. This would allow the assessment of the net N2O emission within catchments in terms of current levels and potential changes associated with climate variability, climate change and land use change. Keywords: nitrous oxide, soil water content, inorganic N, soil temperature, ecosystems, land-use management, soil typ

Surface-charge-induced freezing of colloidal suspensions

Using grand-canonical Monte Carlo simulations we investigate the impact of charged walls on the crystallization properties of charged colloidal suspensions confined between these walls. The investigations are based on an effective model focussing on the colloids alone. Our results demonstrate that the fluid-wall interaction stemming from charged walls has a crucial impact on the fluid's high-density behavior as compared to the case of uncharged walls. In particular, based on an analysis of in-plane bond order parameters we find surface-charge-induced freezing and melting transitions

X-Ray Detected Active Galactic Nuclei in Dwarf Galaxies At 0 \u3c Z \u3c 1

We present a sample of accreting supermassive black holes (SMBHs) in dwarf galaxies at z\lt 1. We identify dwarf galaxies in the NEWFIRM Medium Band Survey with stellar masses of {M}\star \lt 3× {10}9 {M}⊙ that have spectroscopic redshifts from the DEEP2 survey and lie within the region covered by deep (flux limit of ˜ 5× {10}-17{--}6× {10}-16 {erg} {{cm}}-2 {{{s}}}-1) archival Chandra X-ray data. From our sample of 605 dwarf galaxies, 10 exhibit X-ray emission consistent with that arising from active galactic nucleus (AGN) activity. If black-hole mass scales roughly with stellar mass, then we expect that these AGNs are powered by SMBHs with masses of ˜ {10}5{--}{10}6 {M}⊙ and typical Eddington ratios of ˜ 5 % . Furthermore, we find an AGN fraction consistent with extrapolations of other searches of ˜ 0.6 % {--}3 % for {10}9 {M}⊙ ≤slant {M}\star ≤slant 3× {10}9 {M}⊙ and 0.1\lt z\lt 0.6. Our AGN fraction is in good agreement with a semi-analytic model, suggesting that, as we search larger volumes, we may use comparisons between observed AGN fractions and models to understand seeding mechanisms in the early universe

J-band variability of M dwarfs in the WFCAM Transit Survey

We present an analysis of the photometric variability of M dwarfs in the Wide Field Camera (WFCAM) Transit Survey. Although periodic light-curve variability in low mass stars is generally dominated by photospheric star spot activity, M dwarf variability in the J band has not been as thoroughly investigated as at visible wavelengths. Spectral type estimates for a sample of over 200 000 objects are made using spectral type-colour relations, and over 9600 dwarfs (J 0.2 mag flaring event from an M4V star in our sample.Peer reviewe

Effect of many-body interactions on the solid-liquid phase-behavior of charge-stabilized colloidal suspensions

The solid-liquid phase-diagram of charge-stabilized colloidal suspensions is calculated using a technique that combines a continuous Poisson-Boltzmann description for the microscopic electrolyte ions with a molecular-dynamics simulation for the macroionic colloidal spheres. While correlations between the microions are neglected in this approach, many-body interactions between the colloids are fully included. The solid-liquid transition is determined at a high colloid volume fraction where many-body interactions are expected to be strong. With a view to the Derjaguin-Landau-Verwey-Overbeek theory predicting that colloids interact via Yukawa pair-potentials, we compare our results with the phase diagram of a simple Yukawa liquid. Good agreement is found at high salt conditions, while at low ionic strength considerable deviations are observed. By calculating effective colloid-colloid pair-interactions it is demonstrated that these differences are due to many-body interactions. We suggest a density-dependent pair-potential in the form of a truncated Yukawa potential, and show that it offers a considerably improved description of the solid-liquid phase-behavior of concentrated colloidal suspensions

Frontier fields clusters: deep Chandra observations of the complex merger MACS~J1149.6+2223

The Hubble Space Telescope Frontier Fields cluster MACS J1149.6+2223 is one of the most complex merging clusters, believed to consist of four dark matter halos. We present results from deep (365 ks) Chandra observations of the cluster, which reveal the most distant cold front (z = 0.544) discovered to date. In the cluster outskirts, we also detect hints of a surface brightness edge that could be the bow shock preceding the cold front. The substructure analysis of the cluster identified several components with large relative radial velocities, thus indicating that at least some collisions occur almost along the line of sight. The inclination of the mergers with respect to the plane of the sky poses significant observational challenges at X-ray wavelengths. MACS J1149.6+2223 possibly hosts a steep-spectrum radio halo. If the steepness of the radio halo is confirmed, then the radio spectrum, combined with the relatively regular ICM morphology, could indicate that MACS J1149.6+2223 is an old merging cluster

Latent Factor Modeling of Four Schizotypy Dimensions with Theory of Mind and Empathy

Preliminary evidence suggests that theory of mind and empathy relate differentially to factors of schizotypy. The current study assessed 686 undergraduate students and used structural equation modeling to examine links between a four-factor model of schizotypy with performance on measures of theory of mind (Reading the Mind in the Eyes Test [MIE]) and empathy (Interpersonal Reactivity Index [IRI]). Schizotypy was assessed using three self-report measures which were simultaneously entered into the model. Results revealed that the Negative factor of schizotypy showed a negative relationship with the Empathy factor, which was primarily driven by the Empathic Concern subscale of the IRI and the No Close Friends and Constricted Affect subscales of the Schizotypal Personality Questionnaire. These findings are consistent with a growing body of literature suggesting a relatively specific relationship between negative schizotypy and empathy, and are consistent with several previous studies that found no relationship between MIE performance and schizotypy