Developing patient-centred care: an ethnographic study of patient perceptions and influence on quality improvement.

BACKGROUND: Understanding quality improvement from a patient perspective is important for delivering patient-centred care. Yet the ways patients define quality improvement remains unexplored with patients often excluded from improvement work. We examine how patients construct ideas of 'quality improvement' when collaborating with healthcare professionals in improvement work, and how they use these understandings when attempting to improve the quality of their local services. METHODS: We used in-depth interviews with 23 'patient participants' (patients involved in quality improvement work) and observations in several sites in London as part of a four-year ethnographic study of patient and public involvement (PPI) activities run by Collaborations for Leadership in Applied Health Research and Care for Northwest London. We took an iterative, thematic and discursive analytical approach. RESULTS: When patient participants tried to influence quality improvement or discussed different dimensions of quality improvement their accounts and actions frequently started with talk about improvement as dependent on collective action (e.g. multidisciplinary healthcare professionals and the public), but usually quickly shifted away from that towards a neoliberal discourse emphasising the role of individual patients. Neoliberal ideals about individual responsibility were taken up in their accounts moving them away from the idea of state and healthcare providers being held accountable for upholding patients' rights to quality care, and towards the idea of citizens needing to work on self-improvement. Participants portrayed themselves as governed by self-discipline and personal effort in their PPI work, and in doing so provided examples of how neoliberal appeals for self-regulation and self-determination also permeated their own identity positions. CONCLUSIONS: When including patient voices in measuring and defining 'quality', governments and public health practitioners should be aware of how neoliberal rationalities at the heart of policy and services may discourage consumers from claiming rights to quality care by contributing to public unwillingness to challenge the status quo in service provision. If the democratic potential of patient and public involvement initiatives is to be realised, it will be crucial to help citizens to engage critically with how neoliberal rationalities can undermine their abilities to demand quality care

Clustering of exchange rates and their dynamics under different dependence measures

This paper proposes an improvement to the method for clustering exchange rates given by D. J. Fenn et al, in Quantitative Finance, 12 (10) 2012, pp.1493-1520. To deal with the potentially non linear nature of currency time series dependence, we propose two alternative similarity metrics to use instead of the one used in the aforementioned paper based on Pearson correlation. Our proposed similarity metrics are based upon Kendall and distance correlations. We observe how each of the newly adapted clustering methods respond over several years of currency exchange data and find significant differences in the resulting clusters.Peer ReviewedPostprint (published version

On methods to assess the significance of community structure in networks of financial time series

We consider the problem of determining whether the community structure found by a clustering algorithm applied to nancial time series is statistically signi cant, or is due to pure chance, when no other information than the observed values and a similarity measure among time series are available. As a subsidiary problem we also analyse the in uence of the choice of similarity measure in the accuracy of the clustering method. We propose two raw-data based methods for assessing robustness of clustering algorithms on time-dependent data linked by a relation of similarity: One based on community scoring functions that quantify some topological property that characterises ground-truth communities, and another based on random perturbations and quanti cation of the variation in the community structure. These methodologies are well-established in the realm of unweighted networks; our contribution are versions of these methodologies properly adapted to complete weighted networks.Peer ReviewedPostprint (published version

Nucleosynthesis during the Merger of White Dwarfs and the Origin of R Coronae Borealis Stars

Many hydrogen deficient stars are characterised by surface abundance patterns that are hard to reconcile with conventional stellar evolution. Instead, it has been suggested that they may represent the result of a merger episode between a helium and a carbon-oxygen white dwarf. In this Letter, we present a nucleosynthesis study of the merger of a 0.4 M_sol helium white dwarf with a 0.8 M_sol carbon-oxygen white dwarf, by coupling the thermodynamic history of Smoothed Particle Hydrodynamics particles with a post-processing code. The resulting chemical abundance pattern, particularly for oxygen and fluorine, is in qualitative agreement with the observed abundances in R Coronae Borealis stars.Comment: 5 Pages, 2 figures. Accepted to Astrophysical Journal Letters; http://stacks.iop.org/2041-8205/737/L3

Detecting clusters and their dynamics in the Forex Market

This project studies and implements the clustering methods introduced by Fenn et al. to detect correlations in the foreign exchange market. To deal with the potentially non linear nature of currency time series dependance, we propose two alternative similarity metrics to use instead of the Pearson linear correlation. We observe how each of them responds over several years of currency exchange data and find significant differences in the resulting clusters

Tratamiento de heridas por asta de toro con miel

Las cornadas suponen, en determinadas zonas de España, un importante problema de salud que no siempre se trata de forma correcta o estandarizada. Las terapias convencionales son, en muchas ocasiones, ineficaces. El tratamiento con miel de este tipo de heridas tiene como objetivo mejorar la calidad del lecho de la herida eliminando o previniendo su infección. Objetivos: Determinar si el uso de la miel es más eficaz que los tratamientos convencionales en heridas por asta de toro según las recomendaciones basadas en la evidencia para este tipo de heridas y establecer una guía práctica de intervención.Grado en Enfermerí