Factors that Influence the Way Communities Respond to Proposals for Major Changes to Local Emergency Services: A Qualitative Study

According to policy commentators, decisions about how best to organise care involve trade-offs between factors relating to care quality, workforce, cost, and patient access. In England, proposed changes such as Emergency Department closures often face public opposition. This study examined the way communities respond to plans aimed at reorganising emergency services, including the trade-offs inherent in such decisions

Retinoblastoma: Identifying the Diagnostic Signs for Early Treatment

Retinoblastoma is a rare but significant cause of childhood eye cancer world-wide. The prognosis depends upon early diagnosis and treatment but also upon accurate classification of the tumours. Unilateral incidence is normally non-hereditary compared with bilateral incidence where secondary tumours are more common. Survivorship is much better for unilateral compared with bilateral and trilateral retinoblastoma. Early signs are important to detect and photography can assist in identifying no return of “red-eye” during flash photography and yellow appearance of the tumour. Treatment options are discussed together with new psycho-oncology approaches that address potential trauma in the survivor as well as in the family of the survivor

Rare quantum metastable states in the strongly dispersive Jaynes-Cummings oscillator

We present evidence of metastable rare quantum-fluctuation switching for the driven dissipative Jaynes-Cummings oscillator coupled to a zero-temperature bath in the strongly dispersive regime. We show that single-atom complex amplitude bistability is accompanied by the appearance of a low-amplitude long-lived transient state, hereinafter called `dark state', having a distribution with quasi-Poissonian statistics both for the coupled qubit and cavity mode. We find that the dark state is linked to a spontaneous flipping of the qubit state, detuning the cavity to a low-photon response. The appearance of the dark state is correlated with the participation of the two metastable states in the dispersive bistability, as evidenced by the solution of the Master Equation and single quantum trajectories.Comment: Extensively revised text, 18 revised figures (16 in main and 2 in appendix), 38(+1) references, appendi

Resistivity network and structural model of the oxide cathode for CRT application

In this paper, the electrical properties of oxide cathode and oxide cathode plus, supplied by LG Philips Displays, have been investigated in relation to different cathode activation regimes and methods. Oxide cathode activation treatment for different durations has been investigated. The formations of the compounds associated to the diffusion of reducing elements (Mg, Al, and W) to the Ni cap surface of oxide cathode were studied by a new suggestion method. Scanning electron microscopy (SEM) coupled with energy dispersive X-ray spectroscopy (EDX) was used as analytical techniques. Al, W, and Mg doping elements take place during heating to 1080 K (Ni-Brightness) under a rich controlled Ba–SrO atmosphere through an acceleration life test. The chemical transport of these elements was occurred mainly by the Ni cap grain boundary mechanism with significant pile-up of Mg compounds. Al and W show a superficial concentrations and distribution. A new structural and resistivity network model of oxide cathode plus are suggested. The new structural model shows a number of metallic and metallic oxide pathways are exist at the interface or extended through the oxide coating. The effective values of the resistances and the type of the equivalent circuit in the resistivity network model are temperature and activation time dependent.</p

Making a difference: Findings from Better Beginnings a family literacy intervention programme

Since 2005, Better Beginnings, an early intervention, statewide family literacy programme developed by The State Library of Western Australia, has provided thousands of families with strategies and resources to promote and support book-sharing from birth. This paper reports on the key findings of an independent longitudinal evaluation of the programme\u27s impact on parents / carers approximately one year after they were introduced to the Better Beginnings programme. Parents/carers were asked about their book sharing practices, beliefs about the importance of sharing books, and library membership and participation in related library activities. Responses from the participants strongly indicated that the programme was well received and had a significantly positive impact on the child, other family members and the participants. The evaluation also raised a number of issues, which have implications for further development of the programme

Vertebroplasty : letter to the editor

In separate letters the authors debate whether the promotion of vertebroplasty in routine care is both premature and potentially dangerous as there are no completed RCTs. <br /

Factors that influence career progression among postdoctoral clinical academics: a scoping review of the literature

Background: The future of academic medicine is uncertain. Concerns regarding the future availability of qualified and willing trainee clinical academics have been raised worldwide. Of significant concern is our failure to retain postdoctoral trainee clinical academics, who are likely to be our next generation of leaders in scientific discovery. / Objectives: To review the literature about factors that may influence postdoctoral career progression in early career clinical academics. / Design: This study employed a scoping review method. Three reviewers separately assessed whether the articles found fit the inclusion criteria. / Data sources: PubMed, Scopus, Web of Science and Google Scholar (1991–2015). / Article selection: The review encompassed a broad search of English language studies published anytime up to November 2015. All articles were eligible for inclusion, including research papers employing either quantitative or qualitative methods, as well as editorials and other summary articles. / Data extraction: Data extracted from included publications were charted according to author(s), sample population, study design, key findings, country of origin and year of publication. / Results: Our review identified 6 key influences: intrinsic motivation, work–life balance, inclusiveness, work environment, mentorship and availability of funding. It also detected significant gaps within the literature about these influences. / Conclusions: Three key steps are proposed to help support postdoctoral trainee clinical academics. These focus on ensuring that researchers feel encouraged in their workplace, involved in collaborative dialogue with key stakeholders and able to access reliable information regarding their chosen career pathway. Finally, we highlight recommendations for future research

The impact of Clinical Nurse Specialists on the decision making process in cancer multidisciplinary team meetings: A qualitative study

PURPOSE: There are well-documented barriers to nurse participation in cancer multidisciplinary team (MDT) meetings. This paper aims to identify the approaches used by Clinical Nurse Specialists (CNSs) in this setting to contribute during discussion, and to consider the impact of these approaches on the decision making process. In doing so it aims to highlight ways that CNSs can increase their influence, and enhance multidisciplinary engagement. METHODS: This study is based on analysis of observation data from 122 MDT meetings in gynaecology, haematology and skin cancer MDTs. Field notes were reviewed, identifying 58 cases where CNSs contributed to MDT discussion. Audio recordings of the relevant sections were then transcribed and analysed thematically. RESULTS: Five approaches were used by CNSs to contribute in MDT meetings: sharing information, asking questions, providing practical suggestions, framing and using humour. These approaches influenced three key intermediary processes identified during the analysis ('successful contributions'): prompting discussion, influencing a treatment plan and facilitating teamwork. CNSs contributed successfully in cases where medical factors (such as relapsed disease or complex comorbidities) or non-medical factors (such as strong patient preference), had the potential to impact on the ability of teams to deliver treatment. CONCLUSIONS: CNSs have an important role in cancer MDT meetings. By focusing on a subset of cases where CNSs contributed during MDT discussion, this study has provided an insight into approaches that can be adopted by CNSs to increase their influence on the decision making process, enabling teams to capitalise on their knowledge and expertise in MDT meetings

Rayleigh-B\'{e}nard convection in a homeotropically aligned nematic liquid crystal

We report experimental results for convection near onset in a thin layer of a homeotropically aligned nematic liquid crystal heated from below as a function of the temperature difference $\Delta T$ and the applied vertical magnetic field $H$ and compare them with theoretical calculations. The experiments cover the field range 8 \alt h \equiv H/ H_{F} \alt 80 ($H_F =$ is the Fr\'eedericksz field). For $h$ less than a codimension-two field $h_{ct} \simeq 46$ the bifurcation is subcritical and oscillatory, with travelling- and standing-wave transients. Beyond $h_{ct}$ the bifurcation is stationary and subcritical until a tricritical field $h_t= 57.2$ is reached, beyond which it is supercritical. The bifurcation sequence as a function of $h$ found in the experiment confirms the qualitative aspects of the theoretical predictions. However, the value of $h_{ct}$ is about 10% higher than the predicted value and the results for $k_c$ are systematically below the theory by about 2% at small $h$ and by as much as 7% near $h_{ct}$. At $h_{ct}$, $k_c$ is continuous within the experimental resolution whereas the theory indicates a 7% discontinuity. The theoretical tricritical field $h_t^{th} = 51$ is somewhat below the experimental one. The fully developed flow above $R_c$ for $h < h_{ct}$ is chaotic. For $h_{ct} < h < h_t$ the subcritical stationary bifurcation also leads to a chaotic state. The chaotic states persist upon reducing the Rayleigh number below $R_c$, i.e. the bifurcation is hysteretic. Above the tricritical field $h_t$, we find a bifurcation to a time independent pattern which within our resolution is non-hysteretic.Comment: 15 pages incl. 23 eps figure

Homozygous in-frame deletion in CATSPERE in a man producing spermatozoa with loss of CatSper function and compromised fertilizing capacity

STUDY QUESTIONDoes a man (patient 1) with a previously described deficiency in principle cation channel of sperm (CatSper) function have a mutation in the CatSper-epsilon (CATSPERE) and/or CatSper-zeta (CATSPERZ) gene?SUMMARY ANSWERPatient 1 has a homozygous in-frame 6-bp deletion in exon 18 (c.2393_2398delCTATGG, rs761237686) of CATSPERE.WHAT IS KNOWN ALREADYCatSper is the principal calcium channel of mammalian spermatozoa. Spermatozoa from patient 1 had a specific loss of CatSper function and were unable to fertilize at IVF. Loss of CatSper function could not be attributed to genetic abnormalities in coding regions of seven CatSper subunits. Two additional subunits (CatSper-epsilon (CATPSERE) and CatSper-zeta (CATSPERZ)) were recently identified, and are now proposed to contribute to the formation of the mature channel complex.STUDY DESIGN, SIZE, DURATIONThis was a basic medical research study analysing genomic data from a single patient (patient 1) for defects in CATSPERE and CATSPERZ.PARTICIPANTS/MATERIALS, SETTING, METHODSThe original exome sequencing data for patient 1 were analysed for mutations in CATSPERE and CATSPERZ. Sanger sequencing was conducted to confirm the presence of a rare variant.MAIN RESULTS AND THE ROLE OF CHANCEPatient 1 is homozygous for an in-frame 6-bp deletion in exon 18 (c.2393_2398delCTATGG, rs761237686) of CATSPERE that is predicted to be highly deleterious.LIMITATIONS, REASONS FOR CAUTIONThe nature of the molecular deficit caused by the rs761237686 variant and whether it is exclusively responsible for the loss of CatSper function remain to be elucidated.WIDER IMPLICATIONS OF THE FINDINGSPopulation genetics are available for a significant number of predicted deleterious variants of CatSper subunits. The consequence of homozygous and compound heterozygous forms on sperm fertilization potential could be significant. Selective targeting of CatSper subunit expression maybe a feasible strategy for the development of novel contraceptives.STUDY FUNDING/COMPETING INTEREST(S)This study was funded by project grants from the MRC (MR/K013343/1 and MR/012492/1), Chief Scientist Office/NHS research Scotland. This work was also supported by NIH R01GM111802, Pew Biomedical Scholars Award 00028642 and Packer Wentz Endowment Will to P.V.L. C.L.R.B is the editor-in-chief of Molecular Human Reproduction, has received lecturing fees from Merck and Ferring, and is on the Scientific Advisory Panel for Ohana BioSciences. C.L.R.B was chair of the World Health Organization Expert Synthesis Group on Diagnosis of Male infertility (2012–2016)