A rounded picture is what we need : rhetorical strategies, arguments, and the negotiation of change in a UK hospital trust

This article is concerned with the introduction of the agenda of New Public Management (NPM) within the board of a UK Hospital Trust: West London Hospital (WLH). We discuss the literature on New Public Management, including its limitations for analysing the organizational reality of implementing NPM. But we will also be drawing on discourse theory and the literature on rhetoric. The main argument in this article is that in order to understand the reality of the NPM paradigm, we need to study the rhetorical strategies of protagonists involved in the negotiation of the NPM agenda. Rhetorical strategies are means of making general viewpoints more convincing, for example, by comparing 'our' organization with similar organizations. Rhetorical strategies show patterns, which reappear in conversations and arguments made by protagonists. Specifically, we identified three rhetorical strategies justifying why and what kind of a more 'rounded picture' was required: widening the argument to include national productivity comparisons with other hospitals; widening the argument away from a narrow focus on finance toward a strategic and political perspective; and, lastly, widening the argument to look at innovation in the whole clinical process

Paperwork, compassion and temporal conflicts in British social work.

While previous literature has examined time discourses in social work and demonstrated that social work is predicated on linear understandings of time, one area that has received little theoretical and empirical attention in the literature on time and social work is what effects various social work temporalities exert on the lifeworld of social workers and how they shape their working days. This paper draws on semi-structured interviews with British social workers and employs an abductive approach to data analysis. By analysing the participants' experiences of time and work, the article identifies two temporalities that exist in social work practice, paperwork time and compassionate time. Paperwork time is linear, instantaneous and accelerated, requiring social workers to juggle multiple competing demands and needs. Compassionate time is more developmental and cyclical and requires slower engagement. The paper then discusses how social workers negotiated these contradictory temporalities and highlights the potentially negative effects of temporal conflicts on people's health, well-being and on social work practice at large

3+2 + X: what is the most useful depolarization input for retrieving microphysical properties of non-spherical particles from lidar measurements using the spheroid model of Dubovik et al. (2006)?

The typical multiwavelength aerosol lidar data set for inversion of optical to microphysical parameters is composed of three backscatter coefficients (β) at 355, 532, and 1064 nm and two extinction coefficients (α) at 355 and 532 nm. This data combination is referred to as a 3β+2α or 3+2 data set. This set of data is sufficient for retrieving some important microphysical particle parameters if the particles have spherical shape. Here, we investigate the effect of including the particle linear depolarization ratio (δ) as a third input parameter for the inversion of lidar data. The inversion algorithm is generally not used if measurements show values of δ that exceed 0.10 at 532 nm, i.e. in the presence of non-spherical particles such as desert dust, volcanic ash, and, under special circumstances, biomass-burning smoke. We use experimental data collected with instruments that are capable of measuring δ at all three lidar wavelengths with an inversion routine that applies the spheroidal light-scattering model of Dubovik et al. (2006) with a fixed axis-ratio distribution to replicate scattering properties of non-spherical particles. The inversion gives the fraction of spheroids required to replicate the optical data as an additional output parameter. This is the first systematic test of the effect of using all theoretically possible combinations of δ taken at 355, 532, and 1064 nm as input in the lidar data inversion. We find that depolarization information of at least one wavelength already provides useful information for the inversion of optical data that have been collected in the presence of non-spherical mineral dust particles. However, any choice of δλ will give lower values of the single-scattering albedo than the traditional 3+2 data set. We find that input data sets that include δ355 give a spheroid fraction that closely resembles the dust ratio we obtain from using β532 and δ532 in a methodology applied in aerosol-type separation. The use of δ355 in data sets of two or three δλ reduces the spheroid fraction that is retrieved when using δ532 and δ1064. Use of the latter two parameters without accounting for δ355 generally leads to high spheroid fractions that we consider not trustworthy. The use of three δλ instead of two δλ, including the constraint that one of these is measured at 355 nm does not provide any advantage over using 3+2+δ355 for the observations with varying contributions of mineral dust considered here. However, additional measurements at wavelengths different from 355 nm would be desirable for application to a wider range of aerosol scenarios that may include non-spherical smoke particles, which can have values of δ355 that are indistinguishable from those found for mineral dust. We therefore conclude that – depending on measurement capability – the future standard input for inversion of lidar data taken in the presence of mineral dust particles and using the spheroid model of Dubovik et al. (2006) might be 3+2+δ355 or 3+2+δ355+δ532.Peer reviewe

What It Means to Be Created in the Image of God

The purpose of this study is to understand what it means to be created in the image of God. In order to do this, both the form and function of the image of God in humankind are considered. Gen. 1 :26-27 is the primary text, but is always understood in the greater context of Gen. 1-3, as well as the references to image and likeness in 5:1-3 and 9:6. Atomizing the form of the image of God into a particular human characteristic or attribute is proven to be insufficient, while identifying the function of the image of God as human dominion is revealed to be an over simplification of the issues at large. Instead, the likeness of the image of God in adam is understood to be the holistic human being as displayed in relational fellowship with God, dominion over creation, and intimate union with each other as male and female. From understanding the image of God in the human being, we learn four things about God Himself: that He is seeking to have relationship with the human being, that He has a kingdom in which humankind is invited to live and work, that there is a unified plurality in the Godhead, and that He has an intimate love for humankind

In-situ characterization of the thermal state of resonant optical interferometers via tracking of their higher-order mode resonances

Thermal lensing in resonant optical interferometers such as those used for gravitational wave detection is a concern due to the negative impact on control signals and instrument sensitivity. In this paper we describe a method for monitoring the thermal state of such interferometers by probing the higher-order spatial mode resonances of the cavities within them. We demonstrate the use of this technique to measure changes in the Advanced LIGO input mode cleaner cavity geometry as a function of input power, and subsequently infer the optical absorption at the mirror surfaces at the level of 1 ppm per mirror. We also demonstrate the generation of a useful error signal for thermal state of the Advanced LIGO power recycling cavity by continuously tracking the first order spatial mode resonance frequency. Such an error signal could be used as an input to thermal compensation systems to maintain the interferometer cavity geometries in the presence of transients in circulating light power levels, thereby maintaining optimal sensitivity and maximizing the duty-cycle of the detectors

Bayesian hierarchical approaches for multiple outcomes in routinely collected healthcare data

Background: Routinely collected healthcare data provides a rich environment for the investigation of drug performance in the general population, while also offering the possibility of assessing rare outcomes. The statistical analysis of this data poses a number of challenges. The data may be biased and lack the structure and balance provided by the drugs’ clinical trials. Outcomes are often modelled individually with an associated lack of control for multiple comparisons, as well as a difficulty in assessing multiple risks. Methods: Bayesian models provide methods for analysing multiple clinical outcomes, using relationships between outcomes and handling the types of multiple comparison issues which may occur when using multiple single-variate approaches. Lack of balance within the data may be catered for by dividing the population into clusters with similar characteristics, allowing within cluster inferences to be made. A Bayesian hierarchical model for multiple outcomes is proposed and applied to data from a safety and effectiveness study of direct oral anticoagulants (DOACs) in Scotland 2009 – 2015. Results: The Bayesian modelling results were comparable to the results from the original safety and effectiveness study, with the additional benefit of balancing patient clusters and controlling for relationships in the data. Conclusion: Bayesian hierarchical models are a suitable approach for modelling routinely collected healthcare data. There is the possibility of moving to an integrated Bayesian approach, with the inclusion of treatment relationships; uncertainty regarding cluster membership; and treatment allocation in the model, eventually leading to more reliable treatment decisions

“But I’ve always lived here”: Evidence Informed Analysis on Aging in Place

Purpose: The purpose of this poster/presentation is to provide an exploration and analysis of aging in place. To ensure the success of the older adult to remain in their home it is essential to determine and meet the changing needs of the aging population in a way that preserves lifelong health and wellness. Description: The global trend of population aging is on the continual rise due to longer life expectancy and lower fertility rates.1 It is predicted that by the year 2036 one in every four individuals will be a senior citizen. In some areas, the availability of long-term care facilities is not sufficient to meet the needs of the population, resulting in seniors living in hospitals up to 6 months awaiting a room. This problem is expected to continue to grow.1 While age related declines compromise an individual’s ability to maintain their personal wellbeing and household, maintaining independence is essential in the perception of successful aging.2 Aging in place is the primary goal in the aging population; US housing data suggests that this is accomplished by 80% of older adults.2 In addition to benefiting the emotional needs of seniors, aging in place has significant financial benefits on both the individual and the community at large, however the demands of the environment and the abilities of the person must align or a mal-adaptive situation occurs.2 Methods: Search USA: 2010-2019; Ag(e)ing in place, Ag(e)ing in place AND Challenges, Ag(e)ing in place AND quality of life, Ag(e)ing in place AND modification(s), Review of 7 articles Conclusion: Recent evidence is suggesting that in the next 10 years, middle income seniors will no longer be able to afford assisted living facilities so the need for maximizing aging in place will significantly increase. Summary of Use: This poster/presentation provides a summary of the benefits to aging in place, modifications and maintenance requirements for success and analyzes the factors contributing to decision making to ensure successful aging in place. Clinical Relevance: Therapists working in the home health setting are often required to provide appropriate information when asked by their clients if they should or could safely remain in the home, aging in place. This poster/presentation provides therapists with an analysis of the benefits and challenges for individuals desiring to age in place and provides the therapist suitable topics to introduce to the conversation to ensure that an appropriate and evidence-informed decision is made by the client and their family

Comparative safety and effectiveness of direct oral anticoagulants in patients with atrial fibrillation in clinical practice in Scotland

To compare the clinical effectiveness and safety of direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF) in routine clinical practice. Retrospective cohort study using linked administrative data. The study population (n=14,577) included patients with a diagnosis of AF (confirmed in hospital) who initiated DOAC treatment in Scotland between August 2011 and December 2015. Multivariate Cox proportional hazard models were used to estimate hazard ratios of thromboembolic events, mortality, and bleeding events. No differences between the DOACs were observed in the risks of stroke, systemic embolism, or cardiovascular death. In contrast, the risk of myocardial infarction was higher among apixaban patients in comparison to rivaroxaban (1.67 [1.02 - 2.71]), and all-cause mortality was higher among rivaroxaban patients in contrast to both apixaban (1.22 [1.01 - 1.47]) and dabigatran (1.55 [1.16 - 2.05]); rivaroxaban patients also had a higher risk of pulmonary embolism than apixaban patients (5.27 [1.79 - 15.53]). The risk of other major bleeds was higher among rivaroxaban patients compared to apixaban (1.50 [1.10 - 2.03]) and dabigatran (1.58 [1.01 - 2.48]); the risks of gastro-intestinal bleeds and overall bleeding were higher among rivaroxaban patients than among apixaban patients (1.48 [1.01 - 2.16] and 1.52[1.21 - 1.92], respectively). All DOACs were similarly effective in preventing strokes and systemic embolisms, while patients being treated with rivaroxaban exhibited the highest bleeding risks. Observed differences in the risks of all-cause mortality, myocardial infarction, and pulmonary embolism warrant further research. [Abstract copyright: This article is protected by copyright. All rights reserved.