Social workers in community care practice: Ideologies and interactions with older people

This article is available open access through the publisher’s website through the link below. Copyright @ 2008 The Authors.Since the inception of the NHS and Community Care in 1990, there has been a proliferation of studies examining its implementation at the front line. Considerable attention has been aimed at understanding how it is that social work practitioners, charged with the responsibility to implement community care recommendations for older people, are doing so in a challenging care environment. How a practitioner's ideological frame of reference may impact on his/her practice interactions remains relatively unanswered. However, the course by which professional ideology matures and then directs practice would appear to both complex and multifaceted. The outcome is one that may render the professional both powerful and political, and one that may leave the older care recipient both vulnerable and stigmatized. This paper explores community care practice with older people, emphasizing the ideological underpinnings in practice and their influence on practice interactions. Social work practitioners working on older people's teams in two contrasting communities in England were interviewed to discuss their assessment and care management interactions with older people. Using grounded theory and Goffman's theoretical constructs within frame analysis, a conceptual model for practice emerged, reinforcing that practitioners' understandings of social events, anchored in government and professional discourse and individual perceptions about older people, enabled them to organize and influence the interaction to lead to a professionally determined outcome. The routine work of assessment and care management became very powerful in absence of strategic intention by the practitioner. A move to more strategic behaviour occurred when practice dilemmas required practitioners to intervene, informed by their professionally based values juxtaposed against those supported within official discourse. The findings provide an insight into how social work practitioners manage to deliver community care in a complex environment. The outcomes also reinforce the need for practitioners to develop an understanding of how they construct their social realities, as this may impact on the experience of community care for older people

The Rules of Human T Cell Fate in vivo.

The processes governing lymphocyte fate (division, differentiation, and death), are typically assumed to be independent of cell age. This assumption has been challenged by a series of elegant studies which clearly show that, for murine cells in vitro, lymphocyte fate is age-dependent and that younger cells (i.e., cells which have recently divided) are less likely to divide or die. Here we investigate whether the same rules determine human T cell fate in vivo. We combined data from in vivo stable isotope labeling in healthy humans with stochastic, agent-based mathematical modeling. We show firstly that the choice of model paradigm has a large impact on parameter estimates obtained using stable isotope labeling i.e., different models fitted to the same data can yield very different estimates of T cell lifespan. Secondly, we found no evidence in humans in vivo to support the model in which younger T cells are less likely to divide or die. This age-dependent model never provided the best description of isotope labeling; this was true for naïve and memory, CD4+ and CD8+ T cells. Furthermore, this age-dependent model also failed to predict an independent data set in which the link between division and death was explored using Annexin V and deuterated glucose. In contrast, the age-independent model provided the best description of both naïve and memory T cell dynamics and was also able to predict the independent dataset

Contemporary medical television and crisis in the NHS

This article maps the terrain of contemporary UK medical television, paying particular attention to Call the Midwife as its centrepiece, and situating it in contextual relation to the current crisis in the NHS. It provides a historical overview of UK and US medical television, illustrating how medical television today has been shaped by noteworthy antecedents. It argues that crisis rhetoric surrounding healthcare leading up to the passing of the Health and Social Care Act 2012 has been accompanied by a renaissance in medical television. And that issues, strands and clusters have emerged in forms, registers and modes with noticeable regularity, especially around the value of affective labour, the cultural politics of nostalgia and the neoliberalisation of healthcare

Characterization and Evaluation of Methane Oxidation Catalysts for Dual-Fuel Diesel and Natural Gas Engines

The UK has incentivized the use of natural gas in heavy goods vehicles (HGVs) by converting to dual-fuel (DF) diesel-natural gas systems to reduce noxious and greenhouse gas emissions. Laboratory and on-road measurements of DF vehicles have demonstrated a decrease in CO$_2$ emissions relative to diesel, but there is an increase in greenhouse gas (CO$_2$e) emissions because of unburned methane. Decreasing tailpipe emissions of methane via after-treatment devices in lean-burn compression ignition engines is a challenge because of low exhaust temperatures (~400 °C) and the presence of water vapor. In this study, six commercially available methane oxidation catalysts (MOCs) were tested for their application in DF HGV vehicles. Each MOC was characterized in terms of the catalyst platinum group metal (PGM) loading (both Pd and Pt), particle size, catalytic surface area, and Pd:Pt ratio. In addition, the washcoat surface area, pore volume, and pore size were evaluated. The MOC conversion efficiency was evaluated in controlled methane-oxidation experiments with varying temperatures, flow rates, and gas compositions. Characteristic-conversion efficiency correlations demonstrate that the influential MOC characteristics were PGM loading (both Pd and Pt), Pd:Pt ratio, washcoat surface area, and washcoat pore volume. With 90 % methane oxidation at less than 400 °C in DF HGV exhaust conditions, sample 1 had the highest conversion efficiency because of a high PGM loading (330 g/ft$^3$, 12,000 g/m$^3$), a 5.9 Pd:Pt ratio, a high alumina washcoat surface area of 20 m$^2$/cm$^3$, and 74-mm$^3$/cm$^3$ pore volume. Additional studies showed increased MOC conversion efficiency with decreasing gas hourly space velocities (GHSVs) and increasing methane concentrations.We acknowledge support from the UK Engineering and Physical Sciences Research Council (EP/K00915X/1), the UK Department for Transport, the Office for Low Emission Vehicles and Innovate UK (project reference 400266), and the industrial partners of the Centre for Sustainable Road Freight. GreenUrban Technologies Ltd. (3) and Prins Autogas UK Ltd. (1) provided the samples for testing in this study

Systematic review and network meta-analysis on the efficacy of evolocumab and other therapies for the management of lipid levels in hyperlipidemia

Background: The proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors evolocumab and alirocumab substantially reduce low‐density lipoprotein cholesterol (LDL‐C) when added to statin therapy in patients who need additional LDL‐C reduction. Methods and Results: We conducted a systematic review and network meta‐analysis of randomized trials of lipid‐lowering therapies from database inception through August 2016 (45 058 records retrieved). We found 69 trials of lipid‐lowering therapies that enrolled patients requiring further LDL‐C reduction while on maximally tolerated medium‐ or high‐intensity statin, of which 15 could be relevant for inclusion in LDL‐C reduction networks with evolocumab, alirocumab, ezetimibe, and placebo as treatment arms. PCSK9 inhibitors significantly reduced LDL‐C by 54% to 74% versus placebo and 26% to 46% versus ezetimibe. There were significant treatment differences for evolocumab 140 mg every 2 weeks at the mean of weeks 10 and 12 versus placebo (−74.1%; 95% credible interval −79.81% to −68.58%), alirocumab 75 mg (−20.03%; 95% credible interval −27.32% to −12.96%), and alirocumab 150 mg (−13.63%; 95% credible interval −22.43% to −5.33%) at ≥12 weeks. Treatment differences were similar in direction and magnitude for PCSK9 inhibitor monthly dosing. Adverse events were similar between PCSK9 inhibitors and control. Rates of adverse events were similar between PCSK9 inhibitors versus placebo or ezetimibe. Conclusions: PCSK9 inhibitors added to medium‐ to high‐intensity statin therapy significantly reduce LDL‐C in patients requiring further LDL‐C reduction. The network meta‐analysis showed a significant treatment difference in LDL‐C reduction for evolocumab versus alirocumab

Multi-electron giant dipole resonances of atoms in crossed electric and magnetic fields

Multi-electron giant dipole resonances of atoms in crossed electric and magnetic fields are investigated. Stationary configurations corresponding to a highly symmetric arrangement of the electrons on a decentered circle are derived, and a normal-mode stability analysis is performed. A classification of the various modes, which are dominated either by the magnetic or Coulomb interactions, is provided. A six-dimensional wave-packet dynamical study, based on the MCTDH approach, is accomplished for the two-electron resonances, yielding in particular lifetimes of more than 0.1 $\mu$s for strong electric fields.Comment: 7 pages, 3 figure

Effect of stem cell source on long-term chimerism and event-free survival in children with primary immunodeficiency disorders after fludarabine and melphalan conditioning regimen

BACKGROUND: Reduced-intensity conditioning (RIC) regimens are increasingly being used in the transplantation of patients with primary immunodeficiency disorders (PIDs), but there are no large studies looking at long-term lineage-specific chimerism. OBJECTIVES: We sought to analyze long-term chimerism and event-free survival in children undergoing transplantation for PIDs using RIC with fludarabine and melphalan (Flu/Melph) and to study the effect of donor type and stem cell source. METHODS: One hundred forty-two children underwent transplantation with RIC by using Flu/Melph and for PIDs by using bone marrow (n = 93) or peripheral blood stem cells (PBSCs; n = 49). Donors were matched unrelated donors (n = 72), mismatched unrelated donors (n = 37), matched sibling donors (n = 14), matched family donors (n = 12), and mismatched family donors (n = 7). RESULTS: Overall survival at a median follow-up of 7.5 years was 78%, irrespective of stem cell source or donor type. When bone marrow was used as the stem cell source, 26% of patients ended up with very low levels of donor chimerism (50% donor chimerism) in all lineages. CONCLUSIONS: On the basis of our experience, we would suggest that PBSCs should be the stem cell source of choice in children with PIDs undergoing transplantation with Flu/Melph RIC from a matched donor source. This is most likely to ensure sustained high-level donor chimerism

Methods for reliability and uncertainty assessment and for applicability evaluations of classification- and regression-based QSARs

This article provides an overview of methods for reliability assessment of quantitative structure–activity relationship (QSAR) models in the context of regulatory acceptance of human health and environmental QSARs. Useful diagnostic tools and data analytical approaches are highlighted and exemplified. Particular emphasis is given to the question of how to define the applicability borders of a QSAR and how to estimate parameter and prediction uncertainty. The article ends with a discussion regarding QSAR acceptability criteria. This discussion contains a list of recommended acceptability criteria, and we give reference values for important QSAR performance statistics. Finally, we emphasize that rigorous and independent validation of QSARs is an essential step toward their regulatory acceptance and implementation. Key words: QSAR acceptability criteria, QSAR applicability domain, QSAR reliability, QSAR uncertainty estimation, QSAR validation