Child mortality and poverty in three world regions (the West, Asia and Sub-Saharan Africa) 1988-2010: Evidence of relative intra-regional neglect?

AIMS: Poverty kills children. This study assesses the relationship between poverty and child mortality rates (CMRs) in 71 societies from three world regions to determine whether some countries, relative to their region, neglect their children. METHODS: Spearman rank order correlations were calculated to determine any association between the CMR and poverty data, including income inequality and gross national income. A current CMR one standard deviation (SD) above or below the regional average and a percentage change between 1988 and 2010 were used as the measures to assess the progress of nations. RESULTS: There were positive significant correlations between higher CMRs and relative poverty measures in all three regions. In Western countries, the current CMRs in the USA, New Zealand and Canada were 1 SD below the Western mean. The narrowest income inequalities, apart from Japan, were seen in the Scandinavian nations alongside low CMRs. In Asia, the current CMRs in Pakistan, Myanmar and India were the highest in their region and were 1 SD below the regional mean. Alongside South Korea, these nations had the lowest percentage reductions in CMRs. In Sub-Saharan Africa, the current CMRs in Somalia, Burkina Faso, Sierra Leone, Chad, Democratic Republic of Congo and Angola were the highest in their region and were 1 SD below the regional mean. CONCLUSIONS: Those concerned with the pursuit of social justice need to alert their societies to the corrosive impact of poverty on child mortality. Progress in reducing CMRs provides an indication of how well nations are meeting the needs of their children. Further country-specific research is required to explain regional differences.

Bias-free identification of a linear model-predictive steering controller from measured driver steering behavior.

Recent developments in modeling driver steering control with preview are reviewed. While some validation with experimental data has been presented, the rigorous application of formal system identification methods has not yet been attempted. This paper describes a steering controller based on linear model-predictive control. An indirect identification method that minimizes steering angle prediction error is developed. Special attention is given to filtering the prediction error so as to avoid identification bias that arises from the closed-loop operation of the driver-vehicle system. The identification procedure is applied to data collected from 14 test drivers performing double lane change maneuvers in an instrumented vehicle. It is found that the identification procedure successfully finds parameter values for the model that give small prediction errors. The procedure is also able to distinguish between the different steering strategies adopted by the test drivers.

Broadband optical absorbance spectroscopy using a whispering gallery mode microsphere resonator.

We demonstrate the ability to excite and monitor many whispering gallery modes (WGMs) of a microsphere resonator simultaneously in order to make broadband optical absorbance measurements. The 340 microm diameter microsphere is placed in a microfluidic channel. A hemispherical prism is used for coupling the WGMs into and out of the microsphere. The flat surface of the prism seals the microfluidic channel. The slight nonsphericity in the microsphere results in coupling to precessed modes whose emission is spatially separated from the reflected excitation light. The evanescent fields of the light trapped in WGMs interact with the surrounding environment. The change in transmission observed in the precessed modes is used to determine the absorbance of the surrounding environment. In contrast to our broadband optical absorbance measurements, previous WGM sensors have used only a single narrow mode to measure properties such as refractive index. With the microfluidic cell, we have measured the absorbance of solutions of dyes (lissamine green B, sunset yellow, orange G, and methylene blue), aromatic molecules (benzylamine and benzoic acid), and biological molecules (tryptophan, phenylalanine, tyrosine, and o-phospho-L-tyrosine) at visible and ultraviolet wavelengths. The microsphere surface was reacted with organosilane molecules to attach octadecyl groups, amino groups, and fluorogroups to the surface. Both electrostatic and hydrophobic interactions were observed between the analytes and the microsphere surface, as indicated by changes in the measured effective pathlength with different organosilanes. For a given analyte and coated microsphere, the pathlength measurement was repeatable within a few percent. Methylene blue dye had a very strong interaction with the surface and pathlengths of several centimeters were measured. Choosing an appropriate surface coating to interact with a specific analyte should result in the highest sensitivity detection.

Reflections on a 'virtual' practice development unit: changing practice through identity development.

AIMS: This paper draws together the personal thoughts and critical reflections of key people involved in the establishment of a 'virtual' practice development unit of clinical nurse specialists in the south of England. BACKGROUND: This practice development unit is 'virtual' in that it is not constrained by physical or specialty boundaries. It became the first group of Trust-wide clinical nurse specialists to be accredited in the UK as a practice development unit in 2004. DESIGN AND METHODS: The local university was asked to facilitate the accreditation process via 11 two-hour audio-recorded learning sessions. Critical reflections from practice development unit members, leaders and university staff were written 12 months after successful accreditation, and the framework of their content analysed. FINDINGS AND DISCUSSION: Practice development was seen as a way for the clinical nurse specialists to realize their potential for improving patient care by transforming care practice in a collaborative, interprofessional and evolutionary manner. The practice development unit provided a means for these nurses to analyse their role and function within the Trust. Roberts' identity development model for nursing serves as a useful theoretical underpinning for the reflections contained in this paper. CONCLUSIONS: These narratives provide another example of nurses making the effort to shape and contribute to patient care through organizational redesign. This group of nurses began to realize that the structure of the practice development unit process provided them with the means to analyse their role and function within the organization and, as they reflected on this structure, their behaviour began to change. RELEVANCE TO CLINICAL PRACTICE: Evidence from these reflections supports the view that practice development unit participants have secured a positive and professional identity and are, therefore, better able to improve the patient experience.

Practice development 'without walls' and the quandary of corporate practice.

AIM: The context of this study is a group of clinical nurse specialists from across a Trust seeking accreditation as a practice development unit. The university was asked to facilitate the accreditation process via 11 2-hour learning sessions (including a one-hour focus group). During initial discussions between the university and practice development unit, the overarching research question for this study was set as: 'what are the main roles and responsibilities of clinical nurse specialists?' BACKGROUND: Although there is no known study of a practice development unit based beyond a ward or speciality, the central tenet of the practice development unit literature is that units must demonstrate their worth if they are to survive and harness senior management support in doing so. DESIGN AND METHODS: Data gleaned from the transcribed audio tape-recordings of the learning sessions were studied at least three times to ensure transcription accuracy and produce detailed charts. Ethical approval was granted by the appropriate Local Research Ethics Committee and written informed consent obtained from clinical nurse specialists. The study lasted 30 months and ended in October 2004. RESULTS: The four crucial statements that give meaning to specialist practice are: quality care giver; expert; information giver and initiator of change. Further analysis reveals the area of corporate and political practice as being missing from this and other lists of clinical nurse specialist attributes found in the literature. Clinical nurse specialists characterize their relationship with the Trust in terms of dichotomy--differing agendas and perceptions of value. CONCLUSIONS: The specialist role requires professional development in the areas of corporate and political acumen and professional business management. While the findings of this study relate to one Trust and a group of 16 clinical nurse specialists, with careful application they may be transferable to other settings and groups of senior nurses.

Public health practitioners in NHS hospital trusts: the impact of 'medical care epidemiologists'.

BACKGROUND: In the late 1990s, one NHS region created posts of 'medical care epidemiologists' (MCEs) to employ public health skills in NHS Trusts in pursuit of the 'evidence-based medicine' agenda. METHODS: A qualitative interview study and documentary analysis of MCEs' activities were carried out, followed by case studies of selected activities with plausibility of claims assessed by a 'counterfactual panel'. RESULTS: Most MCEs were centrally involved in the following: Trust committee structures related to clinical effectiveness; service review and evaluation; development of information systems or of access to existing systems to support clinical effectiveness; training in critical appraisal or similar skills; local development of clinical guidelines. A minority adopted narrower roles; only one had concentrated on identifying usable clinical outcome measures, an original objective of the MCE initiative. Case studies of selected activities showed the following: the government's clinical governance agenda created a receptive context in which Trusts connected their MCE's appointment with an external policy agenda; the activities undertaken were nevertheless chosen and shaped by the MCEs themselves, leading to a close fit between the activity and their individual skills and interests; the main impact of MCE activity resulted from deployment of these in ways that transmitted messages about changing organizational culture, rather than from the formal output of their activities. CONCLUSIONS: It is unrealistic to expect individuals to change the culture of whole organizations. In the right policy context, a real contribution can be made by individuals with appropriate skills and strong personal agendas consonant with, but not determined by organizational agendas.