879 research outputs found
A feasibility study of signed consent for the collection of patient identifiable information for a national paediatric clinical audit database
Objectives: To investigate the feasibility of obtaining signed consent
for submission of patient identifiable data to a national clinical
audit database and to identify factors influencing the consent process
and its success.
Design: Feasibility study.
Setting: Seven paediatric intensive care units in England.
Participants: Parents/guardians of patients, or patients aged 12-16
years old, approached consecutively over three months for signed
consent for submission of patient identifiable data to the national
clinical audit database the Paediatric Intensive Care Audit Network
(PICANet).
Main outcome measures: The numbers and proportions of admissions for
which signed consent was given, refused, or not obtained (form not
returned or form partially completed but not signed), by age, sex,
level of deprivation, ethnicity (South Asian or not), paediatric index
of mortality score, length of hospital stay (days in paediatric
intensive care).
Results: One unit did not start and one did not fully implement the
protocol, so analysis excluded these two units. Consent was obtained
for 182 of 422 admissions (43%) (range by unit 9% to 84%). Most
(101/182; 55%) consents were taken by staff nurses. One refusal (0.2%)
was received. Consent rates were significantly better for children who
were more severely ill on admission and for hospital stays of six days
or more, and significantly poorer for children aged 10-14 years. Long
hospital stays and children aged 10-14 years remained significant in a
stepwise regression model of the factors that were significant in the
univariate model.
Conclusion: Systematically obtaining individual signed consent for
sharing patient identifiable information with an externally located
clinical audit database is difficult. Obtaining such consent is
unlikely to be successful unless additional resources are specifically
allocated to training, staff time, and administrative support
Global strategic partnerships to share international and local expertise between private sector and NGOs
The term ‘partnership’ can cover a wide range of relationships between different types of organisations.
However, genuine partnerships between the private and NGO sectors are still relatively uncommon. The
global consultancy firm Arup has developed a number of partnerships with NGOs in the water sector to bring
international expertise to help solve local problems. This paper briefly reviews the partnership context and
describes two water projects – one in Bangladesh and one in Ghana - where Arup staff have worked with
local NGOs to develop locally appropriate solutions to technical problems. The paper explores the mutual
benefits that both organisations can enjoy from this type of partnership
Prevention of venous thromboembolism in acute spontaneous intracerebral haemorrhage: A survey of opinion
INTRODUCTION: People immobilized following acute spontaneous intracerebral haemorrhage (ICH) are at risk of venous thromboembolism (VTE) but the role of short-term prophylactic anticoagulation remains uncertain. We surveyed UK clinical practice and opinion regarding preventing VTE after ICH. PATIENTS AND METHODS: An online survey was sent to stroke healthcare professionals within the United Kingdom and Ireland via a professional society (British and Irish Association of Stroke Physicians (BIASP)). RESULTS: One hundred and twenty-three staff members responded to the survey, of whom 80% were consultant stroke physicians. All responders except one considered the issue to be important or extremely important, but only 5 (4%) were “extremely certain” and 51 (41%) “fairly certain” regarding the optimal treatment approach. Intermittent pneumatic compression (IPC) devices alone were the most used method (in 60%) followed by IPC devices and switching to low molecular weight heparin (LMWH) (in 30%). We identified high levels of uncertainty regarding the role of anticoagulation, and its optimal timing; uncertainty was greater in lobar compared to deep ICH. Most respondents (93%) consider a randomised controlled trial investigating the role of pharmacological VTE prophylaxis after acute ICH as important and would consider participation. DISCUSSION AND CONCLUSION: The optimal method for the prevention of VTE in non-traumatic ICH patients remains an area of clinical uncertainty. Clinical trials assessing short-term anticoagulation in patients after acute ICH would be beneficial in providing evidence to resolve this clinical dilemma
The difference that tenure makes
This paper argues that housing tenures cannot be reduced to either production relations or consumption relations. Instead, they need to be understood as modes of housing distribution, and as having complex and dynamic relations with social classes. Building on a critique of both the productionist and the consumptionist literature, as well as of formalist accounts of the relations between tenure and class, the paper attempts to lay the foundations for a new theory of housing tenure. In order to do this, a new theory of class is articulated, which is then used to throw new light on the nature of class-tenure relations
Adaptive Evolution of the Myo6 Gene in Old World Fruit Bats (Family: Pteropodidae)
PMCID: PMC3631194This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Systematically reviewing and synthesizing evidence from conversation analytic and related discursive research to inform healthcare communication practice and policy: an illustrated guide
Background
Healthcare delivery is largely accomplished in and through conversations between people, and healthcare quality and effectiveness depend enormously upon the communication practices employed within these conversations. An important body of evidence about these practices has been generated by conversation analysis and related discourse analytic approaches, but there has been very little systematic reviewing of this evidence.
Methods
We developed an approach to reviewing evidence from conversation analytic and related discursive research through the following procedures:
• reviewing existing systematic review methods and our own prior experience of applying these
• clarifying distinctive features of conversation analytic and related discursive work which must be taken into account when reviewing
• holding discussions within a review advisory team that included members with expertise in healthcare research, conversation analytic research, and systematic reviewing
• attempting and then refining procedures through conducting an actual review which examined evidence about how people talk about difficult future issues including illness progression and dying
Results
We produced a step-by-step guide which we describe here in terms of eight stages, and which we illustrate from our ‘Review of Future Talk’. The guide incorporates both established procedures for systematic reviewing, and new techniques designed for working with conversation analytic evidence.
Conclusions
The guide is designed to inform systematic reviews of conversation analytic and related discursive evidence on specific domains and topics. Whilst we designed it for reviews that aim at informing healthcare practice and policy, it is flexible and could be used for reviews with other aims, for instance those aiming to underpin research programmes and projects. We advocate systematically reviewing conversation analytic and related discursive findings using this approach in order to translate them into a form that is credible and useful to healthcare practitioners, educators and policy-makers
Graphite and Hexagonal Boron-Nitride Possess the Same Interlayer Distance. Why?
Graphite and hexagonal boron nitride (h-BN) are two prominent members of the
family of layered materials possessing a hexagonal lattice. While graphite has
non-polar homo-nuclear C-C intra-layer bonds, h-BN presents highly polar B-N
bonds resulting in different optimal stacking modes of the two materials in
bulk form. Furthermore, the static polarizabilities of the constituent atoms
considerably differ from each other suggesting large differences in the
dispersive component of the interlayer bonding. Despite these major differences
both materials present practically identical interlayer distances. To
understand this finding, a comparative study of the nature of the interlayer
bonding in both materials is presented. A full lattice sum of the interactions
between the partially charged atomic centers in h-BN results in vanishingly
small monopolar electrostatic contributions to the interlayer binding energy.
Higher order electrostatic multipoles, exchange, and short-range correlation
contributions are found to be very similar in both materials and to almost
completely cancel out by the Pauli repulsions at physically relevant interlayer
distances resulting in a marginal effective contribution to the interlayer
binding. Further analysis of the dispersive energy term reveals that despite
the large differences in the individual atomic polarizabilities the
hetero-atomic B-N C6 coefficient is very similar to the homo-atomic C-C
coefficient in the hexagonal bulk form resulting in very similar dispersive
contribution to the interlayer binding. The overall binding energy curves of
both materials are thus very similar predicting practically the same interlayer
distance and very similar binding energies.Comment: 18 pages, 5 figures, 2 table
Squeezing a drop of nematic liquid crystal with strong elasticity effects
The One Drop Filling (ODF) method is widely used for the industrial manufacture of liquid crystal devices. Motivated by the need for a better fundamental understanding of the reorientation of the molecules due to the flow of the liquid crystal during this manufacturing method, we formulate and analyze a squeeze-film model for the ODF method. Specifically, we consider a nematic squeeze film in the asymptotic regime in which the drop is thin, inertial effects are weak, and elasticity effects are strong for four specific anchoring cases at the top plate and the substrate (namely, planar, homeotropic, hybrid aligned nematic, and π-cell infinite anchoring conditions) and for two different scenarios for the motion of the top plate (namely, prescribed speed and prescribed force). Analytical expressions for the leading- and first-order director angles, radial velocity, vertical velocity, and pressure are obtained. Shear and couple stresses at the top plate and the substrate are calculated and are interpreted in terms of the effect that flow may have on the alignment of the molecules at the plates, potentially leading to the formation of spurious optical defects (“mura”)
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