3,212 research outputs found

    Evaluating the articulation of programme theory in practice as observed in Quality Improvement initiatives

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    Background: The Action-Effect Method(AEM) was co-developed by NIHR CLAHRC Northwest London (CLAHRC NWL) researchers and QI practitioners, building on Driver Diagrams(DD). This study aimed to determine AEM effectiveness in terms of technical aspects (how diagrams produced in practice compared with theoretical ideals) and social aspects (how engagement with the method related to social benefits). Methods Diagrams were scored on criteria developed on theoretical ideals of programme theory. 65 programme theory diagrams were reviewed (21 published Driver Diagrams (External DDs), 22 CLAHRC NWL Driver Diagrams (Internal DDs), and 21 CLAHRC NWL Action-Effect Diagrams(AEDs)). Social functions were studied through ethnographic observation of frontline QI teams in AEM sessions facilitated by QI experts. Qualitative analysis used inductive and deductive coding. Results ANOVA indicated the AEM significantly improved the quality of programme theory diagrams over Internal and External DDs on an average of 5 criteria from an 8-point assessment. Articulated aims were more likely to be patient-focused and high-level in AEDs than DDs. The cause/effect relationships from intervention to overall aim also tended to be clearer and were more likely than DDs to contain appropriate measure concepts. Using the AEM also served several social functions such as facilitating dialogue among multidisciplinary teams, and encouraging teams to act scientifically and pragmatically about planning and measuring QI interventions. Implications: The Action-Effect Method developed by CLAHRC NWL resulted in improvements over Driver Diagrams in articulating programme theory, which has wide-ranging benefits to quality improvement, including encouraging broad multi-disciplinary buy-in to clear aims and pre-planning a rigorous evaluation strategy

    Pest-predator spatial relationships in winter rape: implications for integrated crop management

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    Douglas Warner, Les J Allen-Williams, Andrew W Ferguson, and Ingrid H Williams, 'Pest–predator spatial relationships in winter rape: implications for integrated crop management', Pest Management Science, Vol. 56 (11): 977-982, November 2000, doi: 10.1002/1526-4998(200011)56:113.0.CO;2-U. Copyright © 2000 Society of Chemical IndustryThe brassica pod midge (Dasineura brassicae) is an important and widespread pest of winter and spring oilseed rape throughout Europe. Pods infested by D brassicae larvae split prematurely, releasing seeds, and the larvae drop to the soil into which they burrow to pupate. At this stage in its lifecycle D brassicae is potentially vulnerable to predation by carabid beetles foraging on the soil surface. This is the first study in the UK to focus on carabid beetles as predators of D brassicae in the oilseed rape crop. The spatio-temporal distributions of larvae of D brassicae dropping to the soil from the crop canopy and of adult carabid beetles active on the soil surface were analysed in two consecutive years. Insect samples were collected from spatially referenced sampling points across each crop. Counts of insects were mapped and analysed, and the degree of spatial association between predator and prey determined using Spatial Analysis by Distance Indices (SADIE). Carabid species abundant and active during peak drop of first generation D brassicae larvae included Agonum dorsale, Amara similata, Harpalus rufipes and Nebria brevicollis. The larvae of D brassicae had a marked edge distribution within the crop. SADIE analysis revealed significant spatial association between larvae of D brassicae and adult H rufipes (P <0.05) in 1998, but not with adults of A dorsale, A similata or N brevicollis. In 1999, there was strong spatial association only between larvae of D brassicae and adult A dorsale (P <0.01). Aggregation of N brevicollis adults occurred in some areas of greatest D brassicae larval counts in 1999, but overall spatial association was not signi®cant. The distributions are discussed in terms of their relevance to integrated crop management (ICM) strategies and spatial targeting of insecticides.Peer reviewe

    Criteria for evaluating programme theory diagrams in quality improvement initiatives: a structured method for appraisal

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    Background: Despite criticisms that many Quality Improvement (QI) initiatives fail due to incomplete programme theory, there is no defined way to evaluate how programme theory has been articulated. The objective of this research was to develop, and assess the usability and reliability of, scoring criteria to evaluate programme theory diagrams. Methods: Criteria development was informed by published literature and QI experts. Inter-rater reliability was tested between two evaluators. 63 programme theory diagrams (42 driver diagrams and 21 action effect diagrams) were reviewed to establish whether the criteria could support comparative analysis of different approaches to constructing diagrams. Results: Components of the scoring criteria include: assessment of overall aim, logical overview, clarity of components, cause/effect relationships, evidence, and measurement. Independent reviewers had 78% inter-rater reliability. Scoring enabled direct comparison of different approaches to developing programme theory; Action-Effect diagrams were found to have had a statistically significant but moderate improvement in programme theory quality over Driver Diagrams; no significant differences were observed based on the setting in which Driver Diagrams were developed. Conclusions: The scoring criteria summarise the necessary components of programme theory that are thought to contribute to successful QI projects. The viability of the scoring criteria for practical application was demonstrated. Future uses include assessment of individual programme theory diagrams, and comparison of different approaches (e.g. methodological, teaching or other QI support) to produce programme theory. The criteria can be used as a tool to guide the production of better programme theory diagrams, and also highlights where additional support for QI teams could be needed

    Nucleus-associated intermediate filaments from chicken erythrocytes.

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    Equilibrium Simulation of the Slip Coefficient in Nanoscale Pores

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    Accurate prediction of interfacial slip in nanoscale channels is required by many microfluidic applications. Existing hydrodynamic solutions based on Maxwellian boundary conditions include an empirical parameter that depends on material properties and pore dimensions. This paper presents a derivation of a new expression for the slip coefficient that is not based on the assumptions concerning the details of solid-fluid collisions and whose parameters are obtainable from \textit{equilibrium} simulation. The results for the slip coefficient and flow rates are in good agreement with non-equilibrium molecular dynamics simulation.Comment: 11 pages, 4 figures, submitted to Phys Rev Let

    Amiodarone for Atrial Fibrillation Following Cardiac Surgery: Development of Clinical Practice Guidelines at a University Hospital

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    Atrial fibrillation (AF) usually develops within the first 72 h following cardiac surgery, and is often self-limiting. Within 48 h of acute onset of symptoms, approximately 50% of patients spontaneously convert to normal sinus rhythm. Thus, the relative risks and benefits of therapy must be carefully considered. The etiology of AF following cardiac surgery is similar to that in non-surgical patients except that pericardial inflammation and increased adrenergic tone play an increasingly important role. Further, AF after surgery may be associated with transient risk factors that resolve as the patient moves out from surgery, and the condition is less likely to recur compared to AF arising in other circumstances. Immediate heart rate control is important in preventing ischemia, tachycardia-induced cardiomyopathy, and left ventricular dilatation. At our institution, amiodarone is frequently used as a first-line drug for treating AF after cardiac surgery. Inconsistent prescribing practices, variable dosage regimens, and a lack of consensus regarding the appropriate use of amiodarone prompted the need for developing practice guidelines. Multidisciplinary collaboration between the departments of cardiac surgery, pharmacy, and anesthesiology led to the development of a protocol for postoperative AF. We review the clinical evidence from published trials and discuss our guidelines, defining amiodarone use for AF in the cardiac surgery setting. Copyright © 2007 Wiley Periodicals, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/57910/1/20040_ftp.pd

    Entropic Origin of the Growth of Relaxation Times in Simple Glassy Liquids

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    Transitions between ``glassy'' local minima of a model free-energy functional for a dense hard-sphere system are studied numerically using a ``microcanonical'' Monte Carlo method that enables us to obtain the transition probability as a function of the free energy and the Monte Carlo ``time''. The growth of the height of the effective free energy barrier with density is found to be consistent with a Vogel-Fulcher law. The dependence of the transition probability on time indicates that this growth is primarily due to entropic effects arising from the difficulty of finding low-free-energy saddle points connecting glassy minima.Comment: Four pages, plus three postscript figure

    Systems Science for Caribbean Health: the development and piloting of a model for guiding policy on diabetes in the Caribbean.

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    BACKGROUND: Diabetes is highly prevalent in the Caribbean, associated with a high morbidity and mortality and is a recognised threat to economic and social development. Heads of Government in the Caribbean Community came together in 2007 and declared their commitment to reducing the burden of non-communicable diseases (NCDs), including diabetes, by calling for a multi-sectoral, systemic response. To facilitate the development of effective policies, policymakers are being engaged in the development and use of a system dynamics (SD) model of diabetes for Caribbean countries. METHODS: Previous work on a diabetes SD model from the United States of America (USA) is being adapted to a local context for three countries in the region using input from stakeholders, a review of existing qualitative and quantitative data, and collection of new qualitative data. Three country models will be developed using one-on-one stakeholder engagement and iterative revision. An inter-country model will also be developed following a model-building workshop. Models will be compared to each other and to the USA model. The inter-country model will be used to simulate policies identified as priorities by stakeholders and to develop targets for prevention and control. The model and model-building process will be evaluated by stakeholders and a manual developed for use in other high-burden developing regions. DISCUSSION: SD has been applied with success for health policy development in high-income country settings. The utility of SD in developing countries as an aid to policy decision-making related to NCDs has not been tested. This study represents the first of its kind.The project is funded by a health initiatives development grant sponsored by the DFID/MRC/Wellcome Trust/ESRC. Reference: MR/N005384/1

    Time Scales for transitions between free energy minima of a hard sphere system

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    Time scales associated with activated transitions between glassy metastable states of a free energy functional appropriate for a dense hard sphere system are calculated by using a new Monte Carlo method for the local density variables. We calculate the time the system,initially placed in a shallow glassy minimum of the free energy, spends in the neighborhood of this minimum before making a transition to the basin of attarction of another free energy minimum. This time scale is found to increase with the average density. We find a crossover density near which this time scale increases very sharply and becomes longer than the longest times accessible in our simulation. This scale shows no evidence of dependence on sample size.Comment: 25 pages, Revtex, 6 postscript figures. Will appear in Phys Rev E, March 1996 or s
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