Improving continence services for older people from the service-providers' perspective: a qualitative interview study

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.Objective To examine in depth the views and experiences of continence service leads in England on key service and continence management characteristics in order to identify and to improve our understanding of barriers to a good-quality service and potential facilitators to develop and to improve services for older people with urinary incontinence (UI). Design Qualitative semistructured interviews using a purposive sample recruited across 16 continence services. Setting 3 acute and 13 primary care National Health Service Trusts in England. Participants 16 continence service leads in England actively treating and managing older people with UI. Results In terms of barriers to a good-quality service, participants highlighted a failure on the part of commissioners, managers and other health professionals in recognising the problem of UI and in acknowledging the importance of continence for older people and prevalent negative attitudes towards continence and older people. Patient assessment and continence promotion regardless of age, rather than pad provision, were identified as important steps for a good-quality service for older people with UI. More rapid and appropriate patient referral pathways, investment in service capacity, for example, more trained staff and strengthened interservice collaborations and a higher profile within medical and nurse training were specified as being important facilitators for delivering an equitable and high-quality continence service. There is a need, however, to consider the accounts given by our participants as perhaps serving the interests of their professional group within the context of interprofessional work. Conclusions Our data point to important barriers and facilitators of a good-quality service for older people with UI, from the perspective of continence service leads. Further research should address the views of other stakeholders, and explore options for the empirical evaluation of the effectiveness of identified service facilitators.Funding was received from the New Dynamics of Ageing Programme, led by the Economic & Social Research Council, UK (grantnumber RES-353-25-0010)

Using shared goal setting to improve access and equity: a mixed methods study of the Good Goals intervention

Background: Access and equity in children’s therapy services may be improved by directing clinicians’ use of resources toward specific goals that are important to patients. A practice-change intervention (titled ‘Good Goals’) was designed to achieve this. This study investigated uptake, adoption, and possible effects of that intervention in children’s occupational therapy services. Methods: Mixed methods case studies (n = 3 services, including 46 therapists and 558 children) were conducted. The intervention was delivered over 25 weeks through face-to-face training, team workbooks, and ‘tools for change’. Data were collected before, during, and after the intervention on a range of factors using interviews, a focus group, case note analysis, routine data, document analysis, and researchers’ observations. Results: Factors related to uptake and adoptions were: mode of intervention delivery, competing demands on therapists’ time, and leadership by service manager. Service managers and therapists reported that the intervention: helped therapists establish a shared rationale for clinical decisions; increased clarity in service provision; and improved interactions with families and schools. During the study period, therapists’ behaviours changed: identifying goals, odds ratio 2.4 (95% CI 1.5 to 3.8); agreeing goals, 3.5 (2.4 to 5.1); evaluating progress, 2.0 (1.1 to 3.5). Children’s LoT decreased by two months [95% CI −8 to +4 months] across the services. Cost per therapist trained ranged from £1,003 to £1,277, depending upon service size and therapists’ salary bands. Conclusions: Good Goals is a promising quality improvement intervention that can be delivered and adopted in practice and may have benefits. Further research is required to evaluate its: (i) impact on patient outcomes, effectiveness, cost-effectiveness, and (ii) transferability to other clinical contexts

Parameter dependent convergence bounds and complexity measure for a class of conceptual hydrological models

We provide analytical bounds on convergence rates for a class of hydrologic models and consequently derive a complexity measure based on the Vapnik–Chervonenkis (VC) generalization theory. The class of hydrologic models is a spatially explicit interconnected set of linear reservoirs with the aim of representing globally nonlinear hydrologic behavior by locally linear models. Here, by convergence rate, we mean convergence of the empirical risk to the expected risk. The derived measure of complexity measures a model’s propensity to overfit data. We explore how data finiteness can affect model selection for this class of hydrologic model and provide theoretical results on how model performance on a finite sample converges to its expected performance as data size approaches infinity. These bounds can then be used for model selection, as the bounds provide a tradeoff between model complexity and model performance on finite data. The convergence bounds for the considered hydrologic models depend on the magnitude of their parameters, which are the recession parameters of constituting linear reservoirs. Further, the complexity of hydrologic models not only varies with the magnitude of their parameters but also depends on the network structure of the models (in terms of the spatial heterogeneity of parameters and the nature of hydrologic connectivity)

ECLSS advanced automation preliminary requirements

A description of the total Environmental Control and Life Support System (ECLSS) is presented. The description of the hardware is given in a top down format, the lowest level of which is a functional description of each candidate implementation. For each candidate implementation, both its advantages and disadvantages are presented. From this knowledge, it was suggested where expert systems could be used in the diagnosis and control of specific portions of the ECLSS. A process to determine if expert systems are applicable and how to select the expert system is also presented. The consideration of possible problems or inconsistencies in the knowledge or workings in the subsystems is described

A diagnostic prototype of the potable water subsystem of the Space Station Freedom ECLSS

In analyzing the baseline Environmental Control and Life Support System (ECLSS) command and control architecture, various processes are found which would be enhanced by the use of knowledge based system methods of implementation. The most suitable process for prototyping using rule based methods are documented, while domain knowledge resources and other practical considerations are examined. Requirements for a prototype rule based software system are documented. These requirements reflect Space Station Freedom ECLSS software and hardware development efforts, and knowledge based system requirements. A quick prototype knowledge based system environment is researched and developed

The Dimension Six Triple Gluon Operator in Higgs+Jet Observables

Recently a lot of progress has been made towards a full classification of new physics effects in Higgs observables by means of effective dimension six operators. Specifically, Higgs production in association with a high transverse momentum jet has been suggested as a way to discriminate between operators that modify the Higgs-top coupling and operators that induce an effective Higgs-gluon coupling---a distinction that is hard to achieve with signal strength measurements alone. With this article we would like to draw attention to another source of new physics in Higgs+jet observables: the triple gluon operator $O_{3g}$ (consisting of three factors of the gluon field strength tensor). We compute the distortions of kinematic distributions in Higgs+jet production at a 14 TeV LHC due to $O_{3g}$ and compare them with the distortions due to dimension six operators involving the Higgs doublet. We find that the transverse momentum, the jet rapidity and the difference between the Higgs and jet rapidity are well suited to distinguish between the contributions from $O_{3g}$ and those from other operators, and that the size of the distortions are similar if the Wilson coefficients are of the same order as the expected bounds from other observables. We conclude that a full analysis of new physics in Higgs+jet observables must take the contributions from $O_{3g}$ into account.Comment: To appear as a Rapid Communication in Physical Review

Measurement of electron screening in muonic lead

Energies of the transitions between high-lying (n≥6) states of muonic lead were accurately determined. The results are interpreted as a ∼2% test of the electron screening. The agreement between experiment and theory is good if it is assumed that the refilling of the electron K shell is fast. The present results furthermore severely restrict possible ionization of the electron L shell

Turbulence Measurements in Shear Flow Liquid Systems

The paper is a composite of a number of years of work on turbulence measurements in a variety of liquid flow systems. The trials and tribulations of such measurements are emphasized. Pipe flow Is considered in some detail, and the consistency between results of various investigators is analyzed. Other systems discussed are a stirred tank unit and a multi-jet reactor configuration. Statistical turbulence measurements such as autocorrelation, spectrum, probability density, flatness factor, and skewness factor are considered in terms of obtaining these from digital signals obtained by conversion of the normal analog signals. Descriptive parameters of statistical turbulence, such as microscale, macroscale, and kinetic energy dissipation, are discussed, as well as various attempts at the estimation of these without using statistical turbulence measurements

Jeans analysis of self-gravitating systems in f(R)-gravity

Dynamics and collapse of collisionless self-gravitating systems is described by the coupled collisionless Boltzmann and Poisson equations derived from $f(R)$-gravity in the weak field approximation. Specifically, we describe a system at equilibrium by a time-independent distribution function $f_0(x,v)$ and two potentials $\Phi_0(x)$ and $\Psi_0(x)$ solutions of the modified Poisson and collisionless Boltzmann equations. Considering a small perturbation from the equilibrium and linearizing the field equations, it can be obtained a dispersion relation. A dispersion equation is achieved for neutral dust-particle systems where a generalized Jeans wave-number is obtained. This analysis gives rise to unstable modes not present in the standard Jeans analysis (derived assuming Newtonian gravity as weak filed limit of $f(R)=R$). In this perspective, we discuss several self-gravitating astrophysical systems whose dynamics could be fully addressed in the framework of $f(R)$-gravity.Comment: 8 pages, 2 figures, Accepted for publication in PR

Sub-Alfvenic Non-Ideal MHD Turbulence Simulations with Ambipolar Diffusion: I. Turbulence Statistics

Most numerical investigations on the role of magnetic fields in turbulent molecular clouds (MCs) are based on ideal magneto-hydrodynamics (MHD). However, MCs are weakly ionized, so that the time scale required for the magnetic field to diffuse through the neutral component of the plasma by ambipolar diffusion (AD) can be comparable to the dynamical time scale. We have performed a series of 256^3 and 512^3 simulations on supersonic but sub-Alfvenic turbulent systems with AD using the Heavy-Ion Approximation developed in Li, McKee, & Klein (2006). Our calculations are based on the assumption that the number of ions is conserved, but we show that these results approximately apply to the case of time-dependent ionization in molecular clouds as well. Convergence studies allow us to determine the optimal value of the ionization mass fraction when using the heavy-ion approximation for low Mach number, sub-Alfvenic turbulent systems. We find that ambipolar diffusion steepens the velocity and magnetic power spectra compared to the ideal MHD case. Changes in the density PDF, total magnetic energy, and ionization fraction are determined as a function of the AD Reynolds number. The power spectra for the neutral gas properties of a strongly magnetized medium with a low AD Reynolds number are similar to those for a weakly magnetized medium; in particular, the power spectrum of the neutral velocity is close to that for Burgers turbulence.Comment: 37 pages, 11 figures, 4 table