Quality matters: re-formatting the boundaries of care in Czech social care policy

This thesis deals with knowledge about the mechanics and effects of quality reforms in public service as advanced by critical policy studies. Critical policy studies have identified managerialism and marketization of public services as key conditions in introducing quality reforms. The argument has been built in opposition to proponents of quality who argue that marketization, when introduced to services, enhances their quality. In contrast, critical studies have shown that quality reforms have restructured organizational contexts of public services where quality acted mainly as a rhetorical figure, and where improvements remain dubious. The real effects of quality reforms, they argue, are increased control over practitioners’ labour process and de-professionalization. This thesis is a case study of a recent Czech social care reform. The Czech case is a case of a quality reform without marketization and managerialism, yet with a similar outcome in the form of managerialised care. As such, the Czech case offers an opportunity to further our knowledge about the mechanics of quality reforms provided we make a methodological step outside the analytics of managerialism. The thesis undertakes this methodological shift by drawing on Actor Network Theory. The question this thesis asks is how could managerialised care be achieved without either marketization or managerialism? Methodologically, the thesis argues that mapping social alliances among policy actors is necessary but in itself not sufficient to explain the outcome. The thesis traces the Czech quality reform from its inception as a policy project at the Ministry of Labour and Social Affairs to its circulation in social care sector. The Czech case shows how articulating quality service in quality standards re-organised care by extending (both conceptually and practically) its boundaries. Care traditionally understood as interactional bodywork was extended horizontally to include practices and forms outside the practitioner-client interaction (such as support planning), and it was extended vertically shifting the agency in care from an equipped practitioner to an equipped service. The contribution of the thesis is twofold. It shows that quality has gained a life in its own outside the managerialist causation model and may not necessarily follow in the footsteps of marketization and managerialism. Mainly, the thesis shows that quality is a complex shibboleth able to re-format the content of practitioner work rather than merely re-structure organizational contexts of public service provision

Can Comprehensive Geriatric Assessment be delivered without the need for geriatricians? A formative evaluation in two perioperative surgical settings

Introduction The aim of this study was to design an approach to improving care for frail older patients in hospital services where Comprehensive Geriatric Assessment (CGA) was not part of the clinical tradition. Methods The intervention was based on the principles of CGA, using quality improvement methodology to embed care processes. Qualitative methods and coproduction were used to inform development of the intervention, which was directed towards the health care professionals involved in peri-operative/surgical cancer care pathways in two large UK teaching hospitals. A formative, qualitative evaluation was undertaken; data collection and analysis were guided by Normalisation Process Theory. Results The clinicians involved agreed to use the toolkit, identifying potential benefits including improved surgical decision making and delivery of interventions pre-operatively. However, sites concluded that pre-operative assessment was not the best place for CGA, and at the end of the 12-month trial, implementation was still nascent. Efforts competed against the dominance of national time-limited targets, and concerns relating to patients’ immediate treatment and recovery. Some participants involved in the peri-operative pathway felt that CGA required ongoing specialist input from geriatricians, but it was not clear that this was sustainable. Conclusions Clinical toolkits designed to empower non-geriatric teams to deliver CGA were received with initial enthusiasm, but did not fully achieve their stated aims due to the need for an extended period of service development with geriatrician support, competing priorities, and divergent views about appropriate professional domains.NIH

Mercury emission and dispersion models from soils contaminated by cinnabar mining and metallurgy.

The laboratory flux measurement system (LFMS) and dispersion models were used to investigate the kinetics of mercury emission flux (MEF) from contaminated soils. Representative soil samples with respect to total Hg concentration (26?9770 mg g 1) surrounding a decommissioned mercury-mining area (Las Cuevas Mine), and a former mercury smelter (Cerco Metal urgico de Almadenejos), in the Almad en mercury mining district (South Central Spain), were collected. Altogether, 14 samples were analyzed to determine the variation in mercury emission flux (MEF) versus distance from the sources, regulating two major environmental parameters comprising soil temperature and solar radiation. In addition, the fraction of the water-soluble mercury in these samples was determined in order to assess how MEF from soil is related to the mercury in the aqueous soil phase. Measured MEFs ranged from less than 140 to over 10 000 ng m 2 h 1, with the highest emissions from contaminated soils adjacent to point sources. A significant decrease of MEF was then observed with increasing distance from these sites. Strong positive effects of both temperature and solar radiation on MEF was observed. Moreover, MEF was found to occur more easily in soils with higher proportions of soluble mercury compared to soils where cinnabar prevails. Based on the calculated Hg emission rates and with the support of geographical information system (GIS) tools and ISC AERMOD software, dispersion models for atmospheric mercury were implemented. In this way, the gaseous mercury plume generated by the soil originated emissions at different seasons was modeled. Modeling efforts revealed that much higher emissions and larger mercury plumes are generated in dry and warm periods (summer), while the plume is smaller and associated with lower concentrations of atmospheric mercury during colder periods with higher wind activity (fall). Based on the calculated emissions and the model implementation, yearly emissions from the ??Cerco Metal urgico de Almadenejos?? decommissioned metallurgical precinct were estimated at 16.4 kg Hg y 1, with significant differences between seasons

Mercury emissions in equilibrium: a novel approach for the quantification of mercury emissions from contaminated soils.

Mercury emissions from soil samples with different mercury contents have been estimated using a closed circuit array. The samples were collected from the Almaden mercury mining district. The emissions confirmed that temperature and light radiation favour mercury desorption due to the increase in the mercury vapour pressure. An additional positive factor could be the photocatalytic reduction of soluble Hg2+ to volatile Hg0 at the soil surface. A physicochemical model based on mass transfer and equilibrium was developed and was used to reproduce the mercury emissions at the laboratory scale. The use of this model allowed us to obtain the unknown mass transfer coeficient (KL) and adsorption parameters required to quantify the possible gaseous mercury fluxes from these contaminated soils. Experimental results indicate that an equilibrium between the solid and gas phases was established. The proposed kinetic model reproduced perfectly the experimental data, with KL found to be proportional to the inverse of temperature and independent of the radiation. The concentration of mercury in the gas phase was mainly dependent on the soluble mercury content (HgS). Equilibrium data were #64257;tted by Langmuir and Freundlich models and the best fit was obtained using the multi-layer model attending to the convex shape of the curves, which is characteristic of non-porous or possibly macroporous materials having a low adsorption energy. The Freundlich constant (KF) was also fitted as a polynomial function with temperature and this gave a straight line for the light radiation and a second grade equation for dark conditions. Once the parameters had been obtained, the Hg emission fluxes from contaminated soils were estimated and the values were between two and three orders of magnitude higher than those published in the literature for non-contaminated soils

Effect of beta low irradiation doses on the micromechanical properties of surface layer of LDPE

The experimental study deals with the effect of modification of the surface layer by irradiation cross-linking on the micromechanical properties of the low-density polyethylene (LDPE) tested using the instrumented nanohardness test. The surface layer of LDPE specimen made by injection technology was modified by irradiation cross-linking using beta irradiation, which significantly influences micromechanical properties of the surface layer. Compared to the heat and chemical-heat treatment of metal materials (e.g. hardening, nitridation, case hardening), cross-linking in polymers affects the surfaces in micro layers. These micromechanical changes of the surface layer are observed in the instrumented microhardness test. Our research confirms the comparable properties of surface layer of irradiated LDPE with highly efficient polymers. The subject of this research is the influence of irradiation dosage on the changes of micromechanical properties of surface layer of LDPE

Toward an assessment of the global inventory of present-day mercury releases to freshwater environments

Aquatic ecosystems are an essential component of the biogeochemical cycle of mercury (Hg), as inorganic Hg can be converted to toxic methylmercury (MeHg) in these environments and reemissions of elemental Hg rival anthropogenic Hg releases on a global scale. Quantification of effluent Hg releases to aquatic systems globally has focused on discharges to the global oceans, rather than contributions to freshwater systems that affect local exposures and risks associated with MeHg. Here we produce a first-estimate of sector-specific, spatially resolved global aquatic Hg discharges to freshwater systems. We compare our release estimates to atmospheric sources that have been quantified elsewhere. By analyzing available quantitative and qualitative information, we estimate that present-day global Hg releases to freshwater environments (rivers and lakes) associated with anthropogenic activities have a lower bound of ~1000 Mg· a−1. Artisanal and small-scale gold mining (ASGM) represents the single largest source, followed by disposal of mercury-containing products and domestic waste water, metal production, and releases from industrial installations such as chlor-alkali plants and oil refineries. In addition to these direct anthropogenic inputs, diffuse inputs from land management activities and remobilization of Hg previously accumulated in terrestrial ecosystems are likely comparable in magnitude. Aquatic discharges of Hg are greatly understudied and further constraining associated data gaps is crucial for reducing the uncertainties in the global biogeochemical Hg budget

Nanohardness of electron beam irradiated HDPE

Micromechanical changes in the surface layer of High-density polyethylene HDPE modified by beta radiation were measured by instrumented test of nanohardness. The specimens were prepared by injection technology and subjected to radiation doses of 0, 132, 165, 198 kGy. Measurements of nanohardness showed considerable changes of behavior of surface layer in middle as well as high radiation doses with higher values of indentation hardness and stiffness

Pathways to professionalism? Quality improvement, care pathways, and the interplay of standardisation and clinical autonomy.

Care pathways are a prominent feature of efforts to improve healthcare quality, outcomes and accountability, but sociological studies of pathways often find professional resistance to standardisation. This qualitative study examined the adoption and adaptation of a novel pathway as part of a randomised controlled trial in an unusually complex, non-linear field - emergency general surgery - by teams of surgeons and physicians in six theoretically sampled sites in the UK. We find near-universal receptivity to the concept of a pathway as a means of improving peri-operative processes and outcomes, but concern about the impact on appropriate professional judgement. However, this concern translated not into resistance and implementation failure, but into a nuancing of the pathways-as-realised in each site, and their use as a means of enhancing professional decision-making and inter-professional collaboration. We discuss our findings in the context of recent literature on the interplay between managerialism and professionalism in healthcare, and highlight practical and theoretical implications

Earth observation : An integral part of a smart and sustainable city

Over the course of the 21st century, a century in which the urbanization process of the previous one is ever on the rise, the novel smart city concept has rapidly evolved and now encompasses the broader aspect of sustainability. Concurrently, there has been a sea change in the domain of Earth observation (EO) where scientific and technological breakthroughs are accompanied by a paradigm shift in the provision of open and free data. While the urban and EO communities share the end goal of achieving sustainability, cities still lack an understanding of the value EO can bring in this direction, an next a consolidated framework for tapping the full potential of EO and integrating it in their operational modus operandi. The “SMart URBan Solutions for air quality, disasters and city growth” H2020 project (SMURBS/ERA-PLANET) sits at this scientific and policy crossroad, and, by creating bottom-up EO-driven solutions against an array of environmental urban pressures, and by expanding the network of engaged and exemplary smart cities that push the state-of-the-art in EO uptake, brings the international ongoing discussion of EO for sustainable cities closer to home and contributes in this discussion. This paper advocates for EO as an integral part of a smart and sustainable city and aspires to lead by example. To this end, it documents the project's impacts, ranging from the grander policy fields to an evolving portfolio of smart urban solutions and everyday city operations, as well as the cornerstones for successful EO integration. Drawing a parallel with the utilization of EO in supporting several aspects of the 2030 Agenda for Sustainable Development, it aspires to be a point of reference for upcoming endeavors of city stakeholders and the EO community alike, to tread together, beyond traditional monitoring or urban planning, and to lay the foundations for urban sustainability.Peer reviewe