Nurses' views of using computerized decision support software in NHS Direct

Background. Nurses working in NHS Direct, the 24-hour telephone advice line in England, use computerized decision support software to recommend to callers the most appropriate service to contact, or to advise on self-care. Aims. To explore nurses' views of their roles and the computerized decision support software in NHS Direct. Methods. Qualitative analysis of semi-structured interviews with 24 NHS Direct nurses in 12 sites. Findings. Nurses described both the software and themselves as essential to the clinical decision-making process. The software acted as safety net, provider of consistency, and provider of script, and was relied upon more when nurses did not have clinical knowledge relevant to the call. The nurse handled problems not covered by the software, probed patients for the appropriate information to enter into the software, and interpreted software recommendations in the light of contextual information which the software was unable to use. Nurses described a dual process of decision-making, with the nurse as active decision maker looking for consensus with the software recommendation and ready to override recommendations made by the software if necessary. However, nurses' accounts of the software as a guide, prompt or support did not fully acknowledge the power of the software, which they are required to use, and the recommendation of which they are required to follow under some management policies. Over time, the influence of nurse and software merges as nurses internalize the software script as their own knowledge, and navigate the software to produce recommendations that they feel are most appropriate. Conclusions. The nurse and the software have distinct roles in NHS Direct, although the effect of each on the clinical decision-making process may be difficult to determine in practice

Surface flashover of oil-immersed dielectric materials in uniform and non-uniform fields

The applied electrical fields required to initiate surface flashover of different types of dielectric material immersed in insulating oil have been investigated, by applying impulses of increasing peak voltage until surface flashover occurred. The behavior of the materials in repeatedly over-volted gaps was also analyzed in terms of breakdown mode (some bulk sample breakdown behaviour was witnessed in this regime), time to breakdown, and breakdown voltage. Cylindrical samples of polypropylene, low-density polyethylene, ultra-high molecular weight polyethylene, and Rexolite, were held between two electrodes immersed in insulating oil, and subjected to average applied electrical fields up to 870 kV/cm. Tests were performed in both uniform- and non-uniform-fields, and with different sample topologies. In applied field measurements, polypropylene required the highest levels of average applied field to initiate flashover in all electrode configurations tested, settling at similar to 600 kV/cm in uniform fields, and similar to 325 kV/cm in non-uniform fields. In over-volted point-plane gaps, ultra-high molecular weight polyethylene exhibited the longest pre-breakdown delay times. The results will provide comparative data for system designers for the appropriate choice of dielectric materials to act as insulators for high-voltage, pulsed-power machines

The suitability of N2 to replace SF6 in a triggered spark-gap switch for pulsed power applications

The high dielectric strength of sulphur hexafluoride (SF6) when compared with other gases, coupled with safety benefits such as non-flammability and non-toxicity, has seen the widespread use of SF6 for the insulation of switching components. However, SF6 is now widely recognised as a highly damaging greenhouse gas, and investigations of the switching properties of alternative gases to replace SF6 within the bounds of existing system topologies are required. In the present paper, a comparative study has been carried out on a triggered spark-gap of type presently deployed in industrial pulsed-power machines, to determine the suitability of nitrogen (N2) to replace SF6 as the switching medium, without compromising on functionality. Experiments were performed with fast-rising trigger pulses to minimise the delay time to breakdown and jitter, and three distinct operational regimes have been identified for both gases as the pressure inside the switch is increased. The static breakdown characteristics and upper pressure boundaries of operation have been determined for both gases at a range of dc charging voltages. Measurements of the time to breakdown have shown jitters as low as 1.3 ns when operating in N2, highlighting the potential of N2 to replace SF6 without the need for re-design or replacement of the presently used switch

Impulse-driven surface breakdown data : a Weibull statistical analysis

Surface breakdown of oil-immersed solids chosen to insulate high-voltage, pulsed-power systems is a problem that can lead to catastrophic failure. Statistical analysis of the breakdown voltages, or times, associated with such liquid-solid interfaces can reveal useful information to aid system designers in the selection of solid materials. Described in this paper are the results of a Weibull statistical analysis, applied to both breakdown-voltage data and time-to-breakdown data generated in gaps consisting of five different solid polymers immersed in mineral oil. Values of the location parameter γ provide an estimate of the applied voltage below which breakdown will not occur, and under uniform-field conditions, γ varied from 192 kV (480 kV/cm) for polypropylene to zero for ultra-high molecular weight polyethylene. Longer times to breakdown were measured for UHMWPE when compared with the other materials. However, high values of the shape parameter β reported in the present paper suggest greater sensitivity to an increase in applied voltage – that is, the probability of breakdown increases more sharply with increasing applied voltage for UHMWPE compared to the other materials. Analysing peak-applied-voltage data, only PP consistently reflected a low value of β across the different sets of test conditions. In general, longer mean times to breakdown were found for solid materials of εr more closely matched to that of the surrounding mineral oi

Disasters and Development: Natural Disasters, Credit Constraints and Economic Growth. ESRI WP411. October 2011

We demonstrate, using a simple two‐period equilibrium model of the economy, the potential effects of extreme event occurrences - such as natural or humanitarian disasters - on economic growth over the medium- to long-term. In particular, we focus on the effect of such shocks on investment. We examine two polar cases; an economy in which agents have unconstrained access to capital markets, versus a credit-constrained version, where the economy is assumed to operate in financial autarky. Considering these extreme cases allows us to highlight the interaction of disasters and economic underdevelopment, manifested through poorly developed financial markets. The theoretical analysis shows that the shock of a disaster occurrence could have lasting effects on economic growth only if agents face borrowing constraints. The predictions of our theoretical model are then tested using a panel of data on natural disaster events at the country-year level, covering the period 1979-2007. We find that for countries with low levels of financial sector development, natural disaster events exert a significant negative impact on economic growth. In particular, where access to credit is problematic, the negative effects of disasters on growth are persistent over the medium-term. These results are robust to various checks. Our findings suggest that natural disasters do represent significant threats to economic development in poor countries

Spin-dependent thermoelectric transport coefficients in near-perfect quantum wires

Thermoelectric transport coefficients are determined for semiconductor quantum wires with weak thickness fluctuations. Such systems exhibit anomalies in conductance near 1/4 and 3/4 of 2e^2/h on the rising edge to the first conductance plateau, explained by singlet and triplet resonances of conducting electrons with a single weakly bound electron in the wire [T. Rejec, A. Ramsak, and J.H. Jefferson, Phys. Rev. B 62, 12985 (2000)]. We extend this work to study the Seebeck thermopower coefficient and linear thermal conductance within the framework of the Landauer-Buettiker formalism, which also exhibit anomalous structures. These features are generic and robust, surviving to temperatures of a few degrees. It is shown quantitatively how at elevated temperatures thermal conductance progressively deviates from the Wiedemann-Franz law.Comment: To appear in Phys. Rev. B 2002; 3 figure

Bias and temperature dependence of the 0.7 conductance anomaly in Quantum Point Contacts

The 0.7 (2e^2/h) conductance anomaly is studied in strongly confined, etched GaAs/GaAlAs quantum point contacts, by measuring the differential conductance as a function of source-drain and gate bias as well as a function of temperature. We investigate in detail how, for a given gate voltage, the differential conductance depends on the finite bias voltage and find a so-called self-gating effect, which we correct for. The 0.7 anomaly at zero bias is found to evolve smoothly into a conductance plateau at 0.85 (2e^2/h) at finite bias. Varying the gate voltage the transition between the 1.0 and the 0.85 (2e^2/h) plateaus occurs for definite bias voltages, which defines a gate voltage dependent energy difference $\Delta$. This energy difference is compared with the activation temperature T_a extracted from the experimentally observed activated behavior of the 0.7 anomaly at low bias. We find \Delta = k_B T_a which lends support to the idea that the conductance anomaly is due to transmission through two conduction channels, of which the one with its subband edge \Delta below the chemical potential becomes thermally depopulated as the temperature is increased.Comment: 9 pages (RevTex) with 9 figures (some in low resolution

The NF-κB subunit c-Rel regulates Bach2 tumour suppressor expression in B-cell lymphoma

The REL gene, encoding the NF-κB subunit c-Rel, is frequently amplified in B-cell lymphoma and functions as a tumour-promoting transcription factor. Here we report the surprising result that c-rel–/– mice display significantly earlier lymphomagenesis in the c-Myc driven, Eμ-Myc model of B-cell lymphoma. c-Rel loss also led to earlier onset of disease in a separate TCL1-Tg-driven lymphoma model. Tumour reimplantation experiments indicated that this is an effect intrinsic to the Eμ-Myc lymphoma cells but, counterintuitively, c-rel–/– Eμ-Myc lymphoma cells were more sensitive to apoptotic stimuli. To learn more about why loss of c-Rel led to earlier onset of disease, microarray gene expression analysis was performed on B cells from 4-week-old, wild-type and c-rel–/– Eμ-Myc mice. Extensive changes in gene expression were not seen at this age, but among those transcripts significantly downregulated by the loss of c-Rel was the B-cell tumour suppressor BTB and CNC homology 2 (Bach2). Quantitative PCR and western blot analysis confirmed loss of Bach2 in c-Rel mutant Eμ-Myc tumours at both 4 weeks and the terminal stages of disease. Moreover, Bach2 expression was also downregulated in c-rel–/– TCL1-Tg mice and RelA Thr505Ala mutant Eμ-Myc mice. Analysis of wild-type Eμ-Myc mice demonstrated that the population expressing low levels of Bach2 exhibited the earlier onset of lymphoma seen in c-rel–/– mice. Confirming the relevance of these findings to human disease, analysis of chromatin immunoprecipitation sequencing data revealed that Bach2 is a c-Rel and NF-κB target gene in transformed human B cells, whereas treatment of Burkitt's lymphoma cells with inhibitors of the NF-κB/IκB kinase pathway or deletion of c-Rel or RelA resulted in loss of Bach2 expression. These data reveal a surprising tumour suppressor role for c-Rel in lymphoma development explained by regulation of Bach2 expression, underlining the context-dependent complexity of NF-κB signalling in cancer

Conductance anomalies and the extended Anderson model for nearly perfect quantum wires

Anomalies near the conductance threshold of nearly perfect semiconductor quantum wires are explained in terms of singlet and triplet resonances of conduction electrons with a single weakly-bound electron in the wire. This is shown to be a universal effect for a wide range of situations in which the effective single-electron confinement is weak. The robustness of this generic behavior is investigated numerically for a wide range of shapes and sizes of cylindrical wires with a bulge. The dependence on gate voltage, source-drain voltage and magnetic field is discussed within the framework of an extended Hubbard model. This model is mapped onto an extended Anderson model, which in the limit of low temperatures is expected to lead to Kondo resonance physics and pronounced many-body effects

Flooded cities

Does economic activity relocate away from areas that are at high risk of recurring shocks? We examine this question in the context of floods, which are among the costliest and most common natural disasters. Over the past thirty years, floods worldwide killed more than 500,000 people and displaced over 650,000,000 people. This paper analyzes the effect of large scale floods, which displaced at least 100,000 people each, in over 1,800 cities in 40 countries, from 2003-2008. We conduct our analysis using spatially detailed inundation maps and night lights data spanning the globe's urban areas. We find that low elevation areas are about 3-4 times more likely to be hit by large floods than other areas, and yet they concentrate more economic activity per square kilometre. When cities are hit by large floods, the low elevation areas also sustain more damage, but like the rest of the flooded cities they recover rapidly, and economic activity does not move to safer areas. Only in more recently populated urban areas, flooded areas show a larger and more persistent decline in economic activity. Our findings have important policy implications for aid, development and urban planning in a world with rising urbanization and sea levels