Evaluating case studies of community-oriented integrated care.

This paper summarises a ten-year conversation within London Journal of Primary Care about the nature of community-oriented integrated care (COIC) and how to develop and evaluate it. COIC means integration of efforts for combined disease-treatment and health-enhancement at local, community level. COIC is similar to the World Health Organisation concept of a Community-Based Coordinating Hub - both require a local geographic area where different organisations align their activities for whole system integration and develop local communities for health. COIC is a necessary part of an integrated system for health and care because it enables multiple insights into 'wicked problems', and multiple services to integrate their activities for people with complex conditions, at the same time helping everyone to collaborate for the health of the local population. The conversation concludes seven aspects of COIC that warrant further attention

Finding the niche: A review of market assessment methodologies for rural electrification with small scale wind power

The mass roll out of solar PV across the Global South has enabled electricity access for millions of people. In the right context, Small Wind Turbines (SWTs) can be complementary, offering the potential to generate at times of low solar resource (night, monsoon season, winter, etc.) and increasing the proportion of the total energy system that can be manufactured locally. However, many contextual factors critically affect the viability of the technology, such as the extreme variability in the wind resource itself and the local availability of technical support. Therefore, performing a detailed market analysis in each new context is much more important. The Wind Empowerment Market Assessment Methodology (WEMAM) is a multi-scalar, transdisciplinary methodology for identifying the niche contexts where small wind can make a valuable contribution to rural electrification. This paper aims to inform the development of WEMAM with a critical review of existing market assessment methodologies. By breaking down WEMAM into its component parts, reflecting upon its practical applications to date and drawing upon insights from the literature, opportunities where it could continue to evolve are highlighted. Key opportunities include shifting the focus towards development outcomes; creating community archetypes; localised studies in high potential regions; scenario modelling and MCDA ranking of proposed interventions; participatory market mapping; and applying socio-technical transitions theory to understand how the small wind niche can break through into the mainstream

State enrolment and energy-carbon transitions: syndromic experimentation and atomisation in England

This article analyses how national governments seek to enrol different subjects and objects in energy-carbon restructuring. It takes analysis beyond consideration of particular subjectivities and governmentalities to consider an expanded range of objects and subjects of governing at a distance. Developing an analytical model of ‘modes of enrolment’ focusing on power modalities, forms of policy integration and policy targets, the article explores five broad modes of enrolment employed in England. The article shows how policy across all modes of enrolment in England has increasingly tended towards disordered, syndromic experimentation and government by-project rather than any systematic programme of government

Identification of Radiopure Titanium for the LZ Dark Matter Experiment and Future Rare Event Searches

The LUX-ZEPLIN (LZ) experiment will search for dark matter particle interactions with a detector containing a total of 10 tonnes of liquid xenon within a double-vessel cryostat. The large mass and proximity of the cryostat to the active detector volume demand the use of material with extremely low intrinsic radioactivity. We report on the radioassay campaign conducted to identify suitable metals, the determination of factors limiting radiopure production, and the selection of titanium for construction of the LZ cryostat and other detector components. This titanium has been measured with activities of $^{238}$U$_{e}$~$<$1.6~mBq/kg, $^{238}$U$_{l}$~$<$0.09~mBq/kg, $^{232}$Th$_{e}$~$=0.28\pm 0.03$~mBq/kg, $^{232}$Th$_{l}$~$=0.25\pm 0.02$~mBq/kg, $^{40}$K~$<$0.54~mBq/kg, and $^{60}$Co~$<$0.02~mBq/kg (68\% CL). Such low intrinsic activities, which are some of the lowest ever reported for titanium, enable its use for future dark matter and other rare event searches. Monte Carlo simulations have been performed to assess the expected background contribution from the LZ cryostat with this radioactivity. In 1,000 days of WIMP search exposure of a 5.6-tonne fiducial mass, the cryostat will contribute only a mean background of $0.160\pm0.001$(stat)$\pm0.030$(sys) counts.Comment: 13 pages, 3 figures, accepted for publication in Astroparticle Physic

Pain assessment for people with dementia: a systematic review of systematic reviews of pain assessment tools.

BACKGROUND: There is evidence of under-detection and poor management of pain in patients with dementia, in both long-term and acute care. Accurate assessment of pain in people with dementia is challenging and pain assessment tools have received considerable attention over the years, with an increasing number of tools made available. Systematic reviews on the evidence of their validity and utility mostly compare different sets of tools. This review of systematic reviews analyses and summarises evidence concerning the psychometric properties and clinical utility of pain assessment tools in adults with dementia or cognitive impairment. METHODS: We searched for systematic reviews of pain assessment tools providing evidence of reliability, validity and clinical utility. Two reviewers independently assessed each review and extracted data from them, with a third reviewer mediating when consensus was not reached. Analysis of the data was carried out collaboratively. The reviews were synthesised using a narrative synthesis approach. RESULTS: We retrieved 441 potentially eligible reviews, 23 met the criteria for inclusion and 8 provided data for extraction. Each review evaluated between 8 and 13 tools, in aggregate providing evidence on a total of 28 tools. The quality of the reviews varied and the reporting often lacked sufficient methodological detail for quality assessment. The 28 tools appear to have been studied in a variety of settings and with varied types of patients. The reviews identified several methodological limitations across the original studies. The lack of a 'gold standard' significantly hinders the evaluation of tools' validity. Most importantly, the samples were small providing limited evidence for use of any of the tools across settings or populations. CONCLUSIONS: There are a considerable number of pain assessment tools available for use with the elderly cognitive impaired population. However there is limited evidence about their reliability, validity and clinical utility. On the basis of this review no one tool can be recommended given the existing evidence

Towards a multi-platform assimilative system for North Sea biogeochemistry

Oceanography has entered an era of new observing platforms, such as biogeochemical-Argo floats and gliders, some of which will provide three-dimensional maps of essential ecosystem variables on the North-West European (NWE) Shelf. In a foreseeable future operational centers will use multi-platform assimilation to integrate those valuable data into ecosystem reanalysis and forecast systems. Here we address some important questions related to glider biogeochemical data assimilation (DA) and introduce multi-platform DA in a preoperational model of the NWE Shelf sea ecosystem. We test the impact of the different multi-platform system components (glider vs. satellite, physical vs. biogeochemical) on the simulated biogeochemical variables. To characterize the model performance, we focus on the period around the phytoplankton spring bloom, since the bloom is a major ecosystem driver on the NWE Shelf. We found that the timing and magnitude of the phytoplankton bloom is insensitive to the physical DA, which is explained in the study. To correct the simulated phytoplankton bloom one needs to assimilate chlorophyll observations from glider or satellite Ocean Color (OC) into the model. Although outperformed by the glider chlorophyll assimilation, we show that OC assimilation has mostly desirable impact on the sub-surface chlorophyll. Since the OC assimilation updates chlorophyll only in the mixed layer, the impact on the sub-surface chlorophyll is the result of the model dynamical response to the assimilation. We demonstrate that the multi-platform assimilation combines the advantages of its components and always performs comparably to its best performing component

The Longitudinal Relationship Between Satisfaction with Transitional Care and Social and Emotional Quality of Life Among Chronically Ill Adolescents

This study aimed to identify the relationship between satisfaction with transitional care and quality of life of chronically ill adolescents over time. This longitudinal study included adolescents with type I diabetes, juvenile idiopathic arthritis (JIA), and neuromuscular disorders (NMD). At baseline 138 respondents (response rate 31 %) filled in a questionnaire and 188 about 1 year later (response rate 43 %). Analysis of variance showed that adolescents with diabetes reported the highest physical quality of life, followed in order by those with NMD and JIA (p ≤ 0.01). Adolescents with diabetes reported the highest social quality of life, followed in order by those with JIA and NMD (both at p ≤ 0.001). Univariate analyses showed that satisfaction with transitional care at T0 was significantly related to emotional and physical quality of life at T1 (both at p ≤ 0.05). At T1, satisfaction with transitional care was significantly related to the emotional, physical, and social domains of quality of life (all at p ≤ 0.001). Multiple regression analyses revealed that satisfaction with transitional care at T1 was related to emotional (β -0.20; p ≤ 0.05) and social (β -0.35; p ≤ 0.01) quality of life domains over time. This indicates that lower gap scores, which measured differences between 'best care' and 'current care,' are associated with better social and emotional quality of life in this sample of adolescents. Satisfaction with transitional care and social and emotional quality of life are related over time