Playing to win or trying your best: Media representations of national anxieties over the role of sport participation during the 2002 commonwealth games.

In the last few years, growing concern has emerged in New Zealand sport about the shift towards a more commercial or professionalised model of sport and away from a mass participation-based model. In the midst of a relatively intense period of debate and concern over this change in direction, the 2002 Commonwealth Games took place in Manchester, England. In this article, we analyse how media coverage of the Games articulated with the broader public debate over the direction of New Zealand sport. Grounded in the assumption that the media both reflects and impacts on public understandings of cultural issues, we believe this analysis of coverage of the Games reveals a profound ambivalence over a more profess ionalised model of sport and points to an unwillingness to give up traditional values of sports participation in order to win. We explore how this debate articulates with current tensions in the realm of Physical Education and suggest that health and physical educators have an important role to play in challenging current pressures towards a win-at-all-costs approach to sport

Novel inferences of ionisation & recombination for particle/power balance during detached discharges using deuterium Balmer line spectroscopy

The physics of divertor detachment is determined by divertor power, particle and momentum balance. This work provides a novel analysis technique of the Balmer line series to obtain a full particle/power balance measurement of the divertor. This supplies new information to understand what controls the divertor target ion flux during detachment. Atomic deuterium excitation emission is separated from recombination quantitatively using Balmer series line ratios. This enables analysing those two components individually, providing ionisation/recombination source/sinks and hydrogenic power loss measurements. Probabilistic Monte Carlo techniques were employed to obtain full error propagation - eventually resulting in probability density functions for each output variable. Both local and overall particle and power balance in the divertor are then obtained. These techniques and their assumptions have been verified by comparing the analysed synthetic diagnostic 'measurements' obtained from SOLPS simulation results for the same discharge. Power/particle balance measurements have been obtained during attached and detached conditions on the TCV tokamak.Comment: The analysis results of this paper were formerly in arXiv:1810.0496

Quantification of mixture composition, liquid-phase fraction and temperature in transcritical sprays

How do fuel and air mix, if a liquid fuel is injected into an environment featuring pressure and temperature that exceed the critical pressure and the critical temperature of the fuel? It is subject of current discussion on whether and if so when, the fuel/air-mixture becomes supercritical or not. We here report experimental data comprising three mixture properties that are relevant for the current debate, all spatially and temporally resolved throughout the spray and injection event: The overall composition of the fuel/air-mixture, the liquid fraction of the fuel/air-mixture, and the temperature of the liquid phase. To this end, we applied Raman spectroscopy and gave special attention to the signature of the Raman OH-band of ethanol, which we used as fuel. Its signature is connected to the development of a hydrogen bonded network between the ethanol molecules and thus extremely sensitive to thermodynamic state and temperature. Measurements were carried out in a high-pressure, high-temperature combustion vessel in a pressure range of 3−8 MPa and a temperature range of 573−923 K. For the highest set temperature we found ethanol in liquid-like mixtures that exceeded the mixture critical temperature. This is an indication of the existence of a single-phase mixing path

General practitioners' views and experiences in caring for patients after sepsis:a qualitative interview study

Contains fulltext : 232438.pdf (Publisher’s version ) (Open Access)BACKGROUND: Patients surviving critical illnesses, such as sepsis, often suffer from long-term complications. After discharge from hospital, most patients are treated in primary care. Little is known how general practitioners (GPs) perform critical illness aftercare and how it can be improved. Within a randomised controlled trial, an outreach training programme has been developed and applied. OBJECTIVES: The aim of this study is to describe GPs' views and experiences of caring for postsepsis patients and of participating a specific outreach training. DESIGN: Semistructured qualitative interviews. SETTING: 14 primary care practices in the metropolitan area of Berlin, Germany. PARTICIPANTS: 14 GPs who had participated in a structured sepsis aftercare programme in primary care. RESULTS: Themes identified in sepsis aftercare were: continuity of care and good relationship with patients, GP's experiences during their patient's critical illness and impact of persisting symptoms. An outreach education as part of the intervention was considered by the GPs to be acceptable, helpful to improve knowledge of the management of postintensive care complications and useful for sepsis aftercare in daily practice. CONCLUSIONS: GPs provide continuity of care to patients surviving sepsis. Better communication at the intensive care unit-GP interface and training in management of long-term complications of sepsis may be helpful to improve sepsis aftercare. TRIAL REGISTRATION NUMBER: ISRCTN61744782

Factors associated with the impact of quality improvement collaboratives in mental healthcare: An exploratory study

<p>Abstract</p> <p>Background</p> <p>Quality improvement collaboratives (QICs) bring together groups of healthcare professionals to work in a structured manner to improve the quality of healthcare delivery within particular domains. We explored which characteristics of the composition, participation, functioning, and organization of these collaboratives related to changes in the healthcare for patients with anxiety disorders, dual diagnosis, or schizophrenia.</p> <p>Methods</p> <p>We studied three QICs involving 29 quality improvement (QI) teams representing a number of mental healthcare organizations in the Netherlands. The aims of the three QICs were the implementation of multidisciplinary practice guidelines in the domains of anxiety disorders, dual diagnosis, and schizophrenia, respectively. We used eight performance indicators to assess the impact of the QI teams on self-reported patient outcomes and process of care outcomes for 1,346 patients. The QI team members completed a questionnaire on the characteristics of the composition, participation in a national program, functioning, and organizational context for their teams. It was expected that an association would be found between these team characteristics and the quality of care for patients with anxiety disorders, dual diagnosis, and schizophrenia.</p> <p>Results</p> <p>No consistent patterns of association emerged. Theory-based factors did not perform better than practice-based factors. However, QI teams that received support from their management and both active and inspirational team leadership showed better results. Rather surprisingly, a lower average level of education among the team members was associated with better results, although less consistently than the management and leadership characteristics. Team views with regard to the QI goals of the team and attitudes towards multidisciplinary practice guidelines did not correlate with team success.</p> <p>Conclusions</p> <p>No general conclusions about the impact of the characteristics of QI teams on the quality of healthcare can be drawn, but support of the management and active, inspirational team leadership appear to be important. Not only patient outcomes but also the performance indicators of monitoring and screening/assessment showed improvement in many but not all of the QI teams with such characteristics. More studies are needed to identify factors associated with the impact of multidisciplinary practice guidelines in mental healthcare.</p

Patient Care Teams in treatment of diabetes and chronic heart failure in primary care: an observational networks study

Contains fulltext : 97203.pdf (publisher's version ) (Open Access)ABSTRACT: BACKGROUND: Patient care teams have an important role in providing medical care to patients with chronic disease, but insight into how to improve their performance is limited. Two potentially relevant determinants are the presence of a central care provider with a coordinating role and an active role of the patient in the network of care providers. In this study, we aimed to develop and test measures of these factors related to the network of care providers of an individual patient. METHODS: We performed an observational study in patients with type 2 diabetes or chronic heart failure, who were recruited from three primary care practices in The Netherlands. The study focused on medical treatment, advice on physical activity, and disease monitoring. We used patient questionnaires and chart review to measure connections between the patient and care providers, and a written survey among care providers to measure their connections. Data on clinical performance were extracted from the medical records. We used network analysis to compute degree centrality coefficients for the patient and to identify the most central health professional in each network. A range of other network characteristics were computed including network centralization, density, size, diversity of disciplines, and overlap among activity-specific networks. Differences across the two chronic conditions and associations with disease monitoring were explored. RESULTS: Approximately 50% of the invited patients participated. Participation rates of health professionals were close to 100%. We identified 63 networks of 25 patients: 22 for medical treatment, 16 for physical exercise advice, and 25 for disease monitoring. General practitioners (GPs) were the most central care providers for the three clinical activities in both chronic conditions. The GP's degree centrality coefficient varied substantially, and higher scores seemed to be associated with receiving more comprehensive disease monitoring. The degree centrality coefficient of patients also varied substantially but did not seem to be associated with disease monitoring. CONCLUSIONS: Our method can be used to measure connections between care providers of an individual patient, and to examine the association between specific network parameters and healthcare received. Further research is needed to refine the measurement method and to test the association of specific network parameters with quality and outcomes of healthcare