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Aims: Social prescribing continues to grow and change across healthcare services in Wales; however, research of the day-to-day performance of social prescribers is limited. This study aimed to explore which roles are perceived to be the most important and frequently used by social prescribers in Wales and compare these results to reports in studies of services in other countries in order to support future role development and potential standardisation. Methods: This study used the Group Concept Mapping via the Concept Systems Global Max™ software to collect and analyse all data from both participants and literature. Results: There was a total of 101 statements generated (119 participants, 84 literature) ranging from generic interpersonal skills to specialised training (cognitive behavioural therapy). These statements were then sorted by conceptual similarity into seven clusters (Providing a Specialist Service, Working in a person-centred way, Skills, Connecting Clients with Community, Collaborative Working, Evaluating and postprogramme duties, and Networking/Community). Statements were rated based on their perceived importance and frequency, with the 'Skills' cluster having the highest overall average and 'Providing a Specialist Service' having the lowest. Conclusions: Reports indicate that in general there is variation in the roles performed by individual participants in Wales; however, greater variation was observed between participants and literature suggesting geographical divergence in practice. In the top 12 highest rated statements for both frequency and importance, individualistic traits such as empathy and 'being a listener' are favoured over specialised methods such as cognitive behavioural therapy and behaviour change taxonomy. Results suggest that local need plays a part in the choices and performance of social prescribers and as such should be considered in future standardisation. [ABSTRACT FROM AUTHOR]

We study the relaxation of a topologically nontrivial vortex braid with zero net helicity in a barotropic fluid. The aim is to investigate the extent to which the topology of the vorticity field—characterized by braided vorticity field lines—determines the dynamics, particularly the asymptotic behavior under vortex reconnection in evolution at high Reynolds numbers (25 000). Analogous to the evolution of braided magnetic fields in plasma, we find that the relaxation of our vortex braid leads to a simplification of the topology into large-scale regions of opposite swirl, consistent with an inverse cascade of the helicity. The change of topology is facilitated by a cascade of vortex reconnection events. During this process, the existence of regions of positive and negative kinetic helicities imposes a lower bound for the kinetic energy. For the enstrophy, we derive analytically a lower bound given by the presence of unsigned kinetic helicity, which we confirm in our numerical experiments. [ABSTRACT FROM AUTHOR]

Aims: Social prescribing is being widely implemented in Wales, but there is no consensus on the necessary learning, training and education needs for people delivering social prescribing. The purpose of the study was to develop an education and training needs conceptual framework for social prescribers in Wales, which could be used by commissioners and providers for the development of social prescribing curricula.Methods: This study used two consensus methods. First, Group Concept Mapping using Concept Systems Global MaxTM software which identified the important and available learning needs of 18 (n = 18) geographically spread social prescribing practitioners. Second, a world café style workshop asked 85 (n = 85) social prescribers to identify when training and support would be most appropriate and valuable in developing their role and skills.Results: A Social Prescribing Learning Needs Framework was developed identifying important learning needs and their availability across a timeline from induction onwards. This was conceptualised from a group concept mapping cluster map and go-zone report. The map comprises five clusters of statements (compassion, interpersonal relationships, socioeconomic disadvantage, networking and monitoring data) from the original 120 statements of learning needs identified by participants. The Go-Zone report displayed how each learning need was rated by participants on scales of importance and availability. A large number of training needs (45%) that were identified as important, are not currently available to social prescribers. All training needs were placed within the first year of the social prescriber working timeline, with 39% placed in an induction period.Conclusion: The use of two different consensus methods enabled social prescribers geographically spread across Wales to engage with the study. The Social Prescribing Learning Needs Framework will be used to inform the commissioning and decommissioning of training for people delivering social prescribing in Wales. [ABSTRACT FROM AUTHOR]

Interchange reconnection has been proposed as a mechanism for the generation of the slow solar wind, and a key contributor to determining its characteristic qualities. In this paper we study the implications of interchange reconnection for the structure of the plasma and field in the heliosphere. We use the Adaptively Refined Magnetohydrodynamic Solver to simulate the coronal magnetic evolution in a coronal topology containing both a pseudostreamer and helmet streamer. We begin with a geometry containing a low-latitude coronal hole that is separated from the main polar coronal hole by a pseudostreamer. We drive the system by imposing rotating flows at the solar surface within and around the low-latitude coronal hole, which leads to a corrugation (at low altitudes) of the separatrix surfaces that separate open from closed magnetic flux. Interchange reconnection is induced both at the null points and separators of the pseudostreamer, and at the global helmet streamer. We demonstrate that a preferential occurrence of interchange reconnection in the "lanes" between our driving cells leads to a filamentary pattern of newly opened flux in the heliosphere. These flux bundles connect to but extend far from the separatrix-web (S-Web) arcs at the source surface. We propose that the pattern of granular and supergranular flows on the photosphere should leave an observable imprint in the heliosphere. [ABSTRACT FROM AUTHOR]

Context. An injection of energy towards a magnetic null point can drive reversals of current-sheet polarity leading to time-dependent, oscillatory reconnection (OR), which may explain periodic phenomena generated when reconnection occurs in the solar atmosphere. However, the details of what controls the period of these current-sheet oscillations in realistic systems is poorly understood, despite being of crucial importance in assessing whether a specific model of OR can account for observed periodic behaviour. Aims. This paper aims to highlight that different types of reconnection reversal are supported about null points, and that these can be distinct from the oscillation in the closed-boundary, linear systems considered by a number of authors in the 1990s. In particular, we explore the features of a nonlinear oscillation local to the null point, and examine the effect of resistivity and perturbation energy on the period, contrasting it to the linear, closed-boundary case. Methods. Numerical simulations of the single-fluid, resistive MHD equations are used to investigate the effects of plasma resistivity and perturbation energy upon the resulting OR. Results. It is found that for small perturbations that behave linearly, the inverse Lundquist number dictates the period, provided the perturbation energy (i.e. the free energy) is small relative to the inverse Lundquist number defined on the boundary, regardless of the broadband structure of the initial perturbation. However, when the perturbation energy exceeds the threshold required for "nonlinear" null collapse to occur, a complex oscillation of the magnetic field is produced which is, at most, only weakly-dependent on the resistivity. The resultant periodicity is instead strongly influenced by the amount of free energy, with more energetic perturbations producing higher-frequency oscillations. Conclusions. Crucially, with regards to typical solar-based and astrophysical-based input energies, we demonstrate that the majority far exceed the threshold for nonlinearity to develop. This substantially alters the properties and periodicity of both null collapse and subsequent OR. Therefore, nonlinear regimes of OR should be considered in solar and astrophysical contexts. [ABSTRACT FROM AUTHOR]

We present a simple method to efficiently compute a lower limit of the topological entropy and its spatial distribution for two-dimensional mappings. These mappings could represent either two-dimensional time-periodic fluid flows or three-dimensional magnetic fields, which are periodic in one direction. This method is based on measuring the length of a material line in the flow. Depending on the nature of the flow, the fluid can be mixed very efficiently which causes the line to stretch. Here, we study a method that adaptively increases the resolution at locations along the line where folds lead to a high curvature. This reduces the computational cost greatly which allows us to study unprecedented parameter regimes. We demonstrate how this efficient implementation allows the computation of the variation of the finite-time topological entropy in the mapping. This measure quantifies spatial variations of the braiding efficiency, important in many practical applications. [ABSTRACT FROM AUTHOR]

Using a magnetic carpet as model for the near surface solar magnetic field we study its effects on the propagation of energy injectected by photospheric footpoint motions. Such a magnetic carpet structure is topologically highly non-trivial and with its magnetic nulls exhibits qualitatively different behavior than simpler magnetic fields. We show that the presence of magnetic fields connecting back to the photosphere inhibits the propagation of energy into higher layers of the solar atmosphere, like the solar corona. By applying certain types of footpoint motions the magnetic field topology is is greatly reduced through magnetic field reconnection which facilitates the propagation of energy and disturbances from the photosphere. [ABSTRACT FROM AUTHOR]

We present a new code that performs a relaxation of a magnetic field toward a force-free state (Beltrami field) using a Lagrangian numerical scheme. Beltrami fields are of interest for the dynamics of many technical and astrophysical plasmas as they are the lowest energy states that the magnetic field can reach. The numerical method strictly preserves the magnetic flux and the topology of magnetic field lines. In contrast to other implementations we use mimetic operators for the spatial derivatives in order to improve accuracy for high distortions of the grid. Compared with schemes using direct derivatives we find that the final state of the simulation approximates a force-free state with a significantly higher accuracy. We implement the scheme in a code which runs on graphical processing units, which leads to an enhanced computing speed compared to previous relaxation codes. [ABSTRACT FROM AUTHOR]

In this work, the dynamic magnetic field within a tearing-unstable three-dimensional current sheet about a magnetic null point is described in detail. We focus on the evolution of the magnetic null points and flux ropes that are formed during the tearing process. Generally, we find that both magnetic structures are created prolifically within the layer and are non-trivially related. We examine how nulls are created and annihilated during bifurcation processes, and describe how they evolve within the current layer. The type of null bifurcation first observed is associated with the formation of pairs of flux ropes within the current layer. We also find that new nulls form within these flux ropes, both following internal reconnection and as adjacent flux ropes interact. The flux ropes exhibit a complex evolution, driven by a combination of ideal kinking and their interaction with the outflow jets from the main layer. The finite size of the unstable layer also allows us to consider the wider effects of flux rope generation. We find that the unstable current layer acts as a source of torsional magnetohydrodynamic waves and dynamic braiding of magnetic fields. The implications of these results to several areas of heliophysics are discussed. [ABSTRACT FROM AUTHOR]

The manner in which the rate of magnetic reconnection scales with the Lundquist number in realistic three-dimensional (3D) geometries is still an unsolved problem. It has been demonstrated that in 2D rapid non-linear tearing allows the reconnection rate to become almost independent of the Lundquist number (the "plasmoid instability"). Here, we present the first study of an analogous instability in a fully 3D geometry, defined by a magnetic null point. The 3D null current layer is found to be susceptible to an analogous instability but is marginally more stable than an equivalent 2D Sweet-Parker-like layer. Tearing of the sheet creates a thin boundary layer around the separatrix surface, contained within a flux envelope with a hyperbolic structure that mimics a spine-fan topology. Efficient mixing of flux between the two topological domains occurs as the flux rope structures created during the tearing process evolve within this envelope. This leads to a substantial increase in the rate of reconnection between the two domains. [ABSTRACT FROM AUTHOR]

Three-dimensional magnetic null points are ubiquitous in the solar corona and in any generic mixed-polarity magnetic field. We consider magnetic reconnection at an isolated coronal null point whose fan field lines form a dome structure. Using analytical and computational models, we demonstrate several features of spine-fan reconnection at such a null, including the fact that substantial magnetic flux transfer from one region of field line connectivity to another can occur. The flux transfer occurs across the current sheet that forms around the null point during spine-fan reconnection, and there is no separator present. Also, flipping of magnetic field lines takes place in a manner similar to that observed in the quasi-separatrix layer or slip-running reconnection. [ABSTRACT FROM AUTHOR]

Recent advances in theory and computational experiments have shown the need to refine the previous categorization of magnetic reconnection at three-dimensional null points—points at which the magnetic field vanishes. We propose here a division into three different types, depending on the nature of the flow near the spine and fan of the null. The spine is an isolated field line which approaches the null (or recedes from it), while the fan is a surface of field lines which recede from it (or approach it). So-called torsional spine reconnection occurs when field lines in the vicinity of the fan rotate, with current becoming concentrated along the spine so that nearby field lines undergo rotational slippage. In torsional fan reconnection field lines near the spine rotate and create a current that is concentrated in the fan with a rotational flux mismatch and rotational slippage. In both of these regimes, the spine and fan are perpendicular and there is no flux transfer across spine or fan. The third regime, called spine-fan reconnection, is the most common in practice and combines elements of the previous spine and fan models. In this case, in response to a generic shearing motion, the null point collapses to form a current sheet that is focused at the null itself, in a sheet that locally spans both the spine and fan. In this regime the spine and fan are no longer perpendicular and there is flux transfer across both of them. [ABSTRACT FROM AUTHOR]

Aims and objectives. To explore the factors that influence community children's nurses' (CCNs') perceptions of their workload. To identify ways that CCNs develop and maintain continuity of care and carer. Background. The notion of continuity of care/carer has been central to nursing development for the last 30 years. In the literature, community nursing is used to illustrate the concepts of responsibility relationships and continuity of care/carer. However, an assumption is made that the case allocation method is assumed to be the norm in community nursing. The recent UK literature indicates that the case allocation method is not necessarily working in community nursing. It suggests that there may be continuity of care via teams of community nurses and health care assistants, but not necessarily continuity of carer. This seems to reinforce the notion that ideas about the nature of nursing work, the relationship between nurse and client and the mode of care are constructed, contextual and not self-evident. Little has been written about this regarding CCN work. Design. Collaborative action research design using qualitative methods. Methods. In depth interviews with six CCNs drawn from a NHS funded, PCT hosted CCN service in the West of England; documentary analysis of caseload data; thematic analysis of analytical memos and field-notes. Results. The analysis of the CCNs' interviews identified the mechanisms and strategies they used for managing their work, meeting clients' needs while ensuring that continuity of care and carer was maintained. From their responses to questions, the responsibility relationship and autonomy characteristics of their role were perceived to be a good thing. However, they acknowledged that working in such a way is stressful and provided examples from their everyday working lives. They emphasised the role of support from colleagues as an important way of maintaining and sustaining the responsibility relationships inherent in their work pattern. Conclusions. The findings from this study seem to support the notions prevalent in the literature that ideas about the nature of nursing work, the relationship between nurse and client and the mode of care are socially constructed and automatically given. The group of CCNs in this project actively manage their caseloads to maintain the continuity of care and carer in a particular model of service delivery. Relevance to clinical practice. This project provides some illustrations of the way continuity of care may be achieved at the informational, management and relational levels of practice. The typology of continuity of care allows the discrete areas of CCN work to be highlighted and explored, providing insights on an area of practice that is under-reported. The study provides a basis for future research to examine the different configurations ofCCNservices for the same client group or services for different clients, e.g. diabetes care, so that service providers may configure provision to meet children's and their family's needs. [ABSTRACT FROM AUTHOR]

AIM: Little is known about the working practices of community children's nurses and how they manage the complexities of working with children and young people with life-limiting, life-threatening and chronic ill-health conditions and their families. This action research project aimed to find ways of managing community children's nursing caseloads that would improve the efficiency, effectiveness and equity of services and inform negotiations with service commissioners. METHODS: A data collection template comprising six input categories was adapted from the Cornwall Community Trust's health visitor weighting framework to reflect the complexity of need and the family focus of the service provided. Data were collected for one year by nurses in one integrated community children's nursing and clinical psychology service in the Southwest of England. Qualitative interviews were held with the nurses to further explore patterns identified in the input data. RESULTS: From the documentary analysis and the interviews it was possible to identify a typical ratio of client numbers in each category which allowed the nurses to be proactive in meeting children's and families' assessed needs. The numbers of clients on caseloads fluctuated over time and varied between geographical caseload areas. The type of work carried out by individual nurses varied depending on the type of contract for their locale. However, by weighting the clients in each category it was possible to arrive at a means of meaningful comparison in terms of family centred nursing. CONCLUSION: The nursing input framework supports monthly caseload monitoring by community children's nurses and informs reports to the service commissioners as part of activity monitoring data. The mechanism will be tested in comparable services in the UK to gauge its transferability. [ABSTRACT FROM AUTHOR]

PURPOSE. The number of children living with life-limiting, life-threatening, and chronic conditions nursed at home/in the community is increasing. There is limited literature on how community children's nurses (CCNs) manage their caseloads. DESIGN AND METHODS. A qualitative-action research study used in-depth interviews. RESULTS. The study generated a number of insights about the sorts of phenomena that contribute to CCNs' perceptions of workload. Themes included strategy, being proactive, purposeful visit, and knowing families. PRACTICE IMPLICATIONS. Using a workload tool may help CCNs manage caseloads. Further work in other areas is required to identify issues of cultural specificity. [ABSTRACT FROM AUTHOR]

The nature of the evolution of the magnetic field, and of current sheet formation, at three-dimensional (3D) magnetic null points is investigated. A kinematic example is presented that demonstrates that for certain evolutions of a 3D null (specifically those for which the ratios of the null point eigenvalues are time-dependent), there is no possible choice of boundary conditions that renders the evolution of the field at the null ideal. Resistive magnetohydrodynamics simulations are described that demonstrate that such evolutions are generic. A 3D null is subjected to boundary driving by shearing motions, and it is shown that a current sheet localized at the null is formed. The qualitative and quantitative properties of the current sheet are discussed. Accompanying the sheet development is the growth of a localized parallel electric field, one of the signatures of magnetic reconnection. Finally, the relevance of the results to a recent theory of turbulent reconnection is discussed. [ABSTRACT FROM AUTHOR]

The nature of current sheet formation in the vicinity of three-dimensional (3D) magnetic null points is investigated. The particular focus is upon the effect of the compressibility of the plasma on the qualitative and quantitative properties of the current sheet. An initially potential 3D null is subjected to shearing perturbations, as in a previous paper [Pontin et al., Phys. Plasmas 14, 052106 (2007)]. It is found that as the incompressible limit is approached, the collapse of the null point is suppressed and an approximately planar current sheet aligned to the fan plane is present instead. This is the case regardless of whether the spine or fan of the null is sheared. Both the peak current and peak reconnection rate are reduced. The results have a bearing on previous analytical solutions for steady-state reconnection in incompressible plasmas, implying that fan current sheet solutions are dynamically accessible, while spine current sheet solutions are not. [ABSTRACT FROM AUTHOR]

Aims and objectives. (1) To develop an insight into the opportunities and barriers to nurse prescribing for a case study of children's nurses. (2) To consider the implications of independent nurse prescribing for children's nurses and the potential for nurse prescribing to be developed in acute children's care settings. (3) To use research data to develop a training strategy. Background. Nurse prescribing in the UK is evolving and current initiatives aim to extend the range and scope of prescribing. Children's nursing presents interesting challenges because of off-license drugs. Successful nurse prescribing lies in practice area preparation, local policy and practice development and identifying precourse training needs. Design. Case study. Research questions. (1) What opportunities do children's nurses identify as being appropriate for nurse prescribing? (2) Can children's nurses identify the benefits of patient group directives and the different levels of nurse prescribing? (3) What preparation do children's nurses need for nurse prescribing? Methods. Focus group of health visitors/district nurses to inform a survey of 500 nurses working in acute and specialist care settings in a large Children's Hospital. Results. Focus group main themes - training, supervision and the development of confidence, record keeping, benefits of nurse prescribing, autonomous practice, the formulary and its use in practice. Response rate was 27%. Senior nurses and specialists identified potential benefits for their practice. Course content needed to focus on children, i.e. children's physiology and pharmokinetics. Children's nurses frequently advise junior medical colleagues on prescribing issues. Patient group directives are a useful alternative to prescribing. Conclusions. The results provide an insight into the training needs of children's nurses and specialist nurses which may be used to develop nurse prescribing training and practice. Training may need to be targeted at senior nurses/specialist nurses initially to develop a critical mass to change organizational culture. Relevance to clinical practice. Pertinent for senior nurses responsible for developing children's nursing practice and services for children in acute settings. [ABSTRACT FROM AUTHOR]

The provision of floral resources for the enhancement of beneficial insect populations has shown promise as a strategy to enhance biological control and pollination in agroecosystems. One approach involves the provision of a single flower species while a second involves the multiple flower species, but the two have never been compared experimentally. Here we examine the influence of single and multiple species flower treatments on the abundance and foraging behaviour of key beneficial insects in two agricultural agroecosystems (broccoli and lucerne crops). The five flower treatments comprised buckwheat only, phacelia only, a simple mixture of buckwheat and phacelia, a complex mixture of buckwheat, phacelia and a commercial seed blend or the existing crop as a control. The abundance of bumble-bees ( Bombus hortorum) and honey bees ( Apis mellifera) was highest in the three treatments that contained phacelia, while hoverfly ( Melanostoma fasciatum) numbers were high in all four flower treatments. Bumble-bees and honey bees probed almost exclusively phacelia flowers, even when provided with a choice of other flower species in the simple and complex mixture treatments. In contrast, hoverflies probed the flowers of all plant species in single and multiple species treatments, with no apparent difference in acceptance. However, in mixture treatments, the majority of individual bumble-bees, honey bees and hoverflies probed the flowers from only one species, despite the presence of alternative flower species. Our results illustrate how an appreciation of insect floral attractiveness can be used to customise the species composition of floral patches to potentially maximise biological control and pollination in targeted agroecosystems. [ABSTRACT FROM AUTHOR]

The formation of current singularities at line-tied two- and three-dimensional (2D and 3D, respectively) magnetic null points in a nonresistive magnetohydrodynamic environment is explored. It is shown that, despite the different separatrix structures of 2D and 3D null points, current singularities may be initiated in a formally equivalent manner. This is true no matter whether the collapse is triggered by flux imbalance within closed, line-tied null points or driven by externally imposed velocity fields in open, incompressible geometries. A Lagrangian numerical code is used to investigate the finite amplitude perturbations that lead to singular current sheets in collapsing 2D and 3D null points. The form of the singular current distribution is analyzed as a function of the spatial anisotropy of the null point, and the effects of finite gas pressure are quantified. It is pointed out that the pressure force, while never stopping the formation of the singularity, significantly alters the morphology of the current distribution as well as dramatically weakening its strength. The impact of these findings on 2D and 3D magnetic reconnection models is discussed. [ABSTRACT FROM AUTHOR]

A knowledge of the nature of fully three-dimensional magnetic reconnection is crucial in understanding a great many processes in plasmas. It has been previously shown that in the kinematic regime the evolution of magnetic flux in three-dimensional reconnection is very different from two dimensions. In this paper a numerical fully magnetohydrodynamic simulation is described, in which this evolution is investigated. The reconnection takes place in the absence of a magnetic null point, and the nonideal region is localized in the center of the domain. The effect of differently prescribed resistivities is considered. The magnetic field is stressed by shear boundary motions, and a current concentration grows within the volume. A stagnation-point flow develops, with strong outflow jets emanating from the reconnection region. The behavior of the magnetic flux matches closely that discovered in the kinematic regime. In particular, it is found that no unique field line velocity exists, and that as a result field lines change their connections continually and continuously throughout the nonideal region. In order to describe the motion of magnetic flux within the domain, it is therefore necessary to use two different field line velocities. The importance of a component of the electric field parallel to the magnetic field is also demonstrated. [ABSTRACT FROM AUTHOR]

Magnetic reconnection at a three-dimensional null point is a natural extension of the familiar two-dimensional X-point reconnection. A model is set up here for reconnection at a null point with current directed parallel to the fan plane, by solving the kinematic, steady, resistive magnetohydrodynamic equations in its vicinity. The magnetic field is assumed to be steady, and a localised diffusion region surrounding the null point is also assumed, outside which the plasma is ideal. Particular attention is focussed on the way that the magnetic flux changes its connections as a result of the reconnection. The resultant plasma flow is found to cross the spine and fan of the null, and thus transfer magnetic flux between topologically distinct regions. Solutions are also found in which the flow crosses either the spine or fan only. [ABSTRACT FROM AUTHOR]

1. The aim of this project was to identify and explore the issues facing men who live with erectile dysfunction (ED), in particular men's' relationships with women partners and men's interactions with the wider world. 2. In order to gain an understanding of their everyday lives, a qualitative research design was used. This is an account of the interpretation and analysis of nine interviews with men living with ED that were carried out during the autumn of 1997. 3. The analysis identified two main themes, 'loss' and 'being alone with it'; with meta-categories 'making sense of it' and 'telling other people', and 'place of sex'. The latter acts as a bridge between the two themes. 4. The implications for nursing practice are considered and recommendations are made for practice, education and research. [ABSTRACT FROM AUTHOR]

An examination of the literature surrounding primary nursing has shown that the term 'primary nursing' is used to mean different things by different authors. This results in a confusing situation where 'primary nursing' is considered by some to mean both a mode of organizing care delivery and a philosophy of nursing. In this paper I argue for a clear separation between the terms which refer to the set of ideas underpinning nursing and descriptions of modes of care. A case is made for using the term 'human centred nursing' to refer to nursing beliefs and 'primary nursing' to refer to the mode of nursing care delivery. [ABSTRACT FROM AUTHOR]

A care plan audit was carried out as part of an action research project involving the introduction of primary nursing. The audit tool was based on the Roper, Logan and Tierney Activities of Living model and the nursing process. The audit showed that few changes in documentation had taken place as a result of the introduction of primary nursing. The volume of communications had increased but much of this was not documented on care plans. Other positive changes as a result of introducing primary nursing were found, and both patients and nurses were aware of these. [ABSTRACT FROM AUTHOR]

This article reports on one aspect of a research project carried out to monitor and evaluate the introduction of primary nursing on four demonstration wards in one health authority. Nursing staff working on the wards were interviewed to identify how the changes were affecting them and their work. Stress questionnaires were also completed by a sample of nurses on the wards. Responsibility and communication -- key concepts emerging from the data -- are discussed and related to the literature on primary nursing. [ABSTRACT FROM AUTHOR]

This paper considers the current distributions that derive from finite amplitude perturbations of line-tied magnetic fields comprising hyperbolic field structures. The initial equilibrium on which we principally focus is a planar magnetic X-point threaded by a uniform axial field. This field is line-tied on all surfaces but subject to three-dimensional (3D) disturbances that alter the initial topology. Results of ideal relaxation simulations are presented which illustrate how intense current structures form that can be related, through the influence of line-tying, to the quasi-separatrix layers (QSLs) of the initial configuration. It is demonstrated that the location within the QSL that attracts the current, and its scaling properties, are strongly dependent on the relative dimensions of the QSL with respect to the line-tied boundaries. These results are contrasted with the behavior of a line-tied 3D field containing an isolated null point. In this case, it is found that the dominant current always forms at the null, but that the collapse is inhibited when the null is closer to a line-tied boundary. [ABSTRACT FROM AUTHOR]

We report here, for the first time, an observed instability of a Kelvin-Helmholtz nature occurring in a fully three-dimensional (3D) current-vortex sheet at the fan plane of a 3D magnetic null point. The current-vortex layer forms self-consistently in response to foot point driving around the spine lines of the null. The layer first becomes unstable at an intermediate distance from the null point, with the instability being characterized by a rippling of the fan surface and a filamentation of the current density and vorticity in the shear layer. Owing to the 3D geometry of the shear layer, a branching of the current filaments and vortices is observed. The instability results in a mixing of plasma between the two topologically distinct regions of magnetic flux on either side of the fan separatrix surface, as flux is reconnected across this surface. We make a preliminary investigation of the scaling of the system with the dissipation parameters. Our results indicate that the fan plane separatrix surface is an ideal candidate for the formation of current-vortex sheets in complex magnetic fields and, therefore, the enhanced heating and connectivity change associated with the instabilities of such layers. [ABSTRACT FROM AUTHOR]

The compression or expansion of a magnetic field that is initially potential is considered. It was recently suggested by Janse & Low that, following the volumetric deformation, the relevant lowest energy state for the magnetic field is another potential magnetic field that in general contains tangential discontinuities (current sheets). Here, we examine this scenario directly using a numerical relaxation method that exactly preserves the topology of the magnetic field. It is found that, of the magnetic fields discussed by Janse & Low, only those containing magnetic null points develop current singularities during an ideal relaxation, while the magnetic fields without null points relax toward smooth force-free equilibria with finite nonzero current. [ABSTRACT FROM AUTHOR]

Does a school based educational programme aimed at reducing consumption of carbonated drinks prevent excessive weight gain in children?METHODSDesign: cluster randomised controlled trial. Allocation: unclear allocation concealment. Blinding: unblinded.Follow up period: 1 year.Setting: 6 junior schools in the UK.Participants: 644 children 7-11 years of age (mean age 9 y, 50% boys) in 29 classes. Each class formed a cluster.Intervention: school based educational programme (intervention) (15 clusters, n = 325) or no intervention (14 clusters, n = 319). The intervention comprised four 1 hour sessions (1 each term) that focused on discouraging consumption of carbonated drinks. Teachers assisted in sessions and reinforced the message during lessons. The first session focused on the balance of good health, promotion of drinking water, sweetness of natural products including fruit, and effects of sweetened carbonated drinks on dentition. The second and third sessions involved a music competition, with the classes composing a song with a healthy message, and the fourth session involved art presentations and a classroom quiz based on a game show.Outcomes: change in body mass index (BMI), proportion of overweight and obese children (mean percentage >91st percentile for BMI), and consumption of carbonated drinks (self report in drink diaries).Patient follow up: 89%MAIN RESULTSGroups did not differ for mean change in BMI (table). The proportion of overweight or obese children decreased in the intervention clusters and increased in the control clusters (table). Data on carbonated drink consumption were available for <80% of students.CONCLUSIONA school based educational programme aimed at reducing consumption of carbonated drinks had a modest effect on prevention of obesity. [ABSTRACT FROM AUTHOR]

QUESTION: Do readmissions and length of care differ for hospital at home (HAH) and traditional hospital care (HC) for moderately ill children with breathing difficulties, diarrhoea with or without vomiting, or a feverish illness?DesignRandomised (allocation concealed)*, unblinded, controlled trial with follow up to 90 days.SettingA large district general hospital in northwest England.Patients399 moderately ill children (mean age 25.7 mo, 60% boys) who had breathing difficulties (n=202); diarrhoea with or without vomiting (n=125); or a feverish illness (n=72); and were likely to require >/= 24 hours of nursing observation. Exclusion criteria were child unsuitability as judged by the general practitioner (GP), assessing physician, or nurse; child unwillingness or inability to participate; no telephone access; or registration with a GP outside the health authority. 389 children (97%) completed the trial.Intervention210 children were allocated to HAH, a nursing scheme that operated 24 hours/day, 7 days/week, and provided planned visits until 2300 hours (1-4 visits/d) and nightly on call service. Before leaving the hospital, nurses and parents planned the child's treatment and care. Nurses supported and cared for children and their families, and also educated parents to care for their children. The nurse determined discharge from HAH using predetermined criteria. Families had direct access to a HAH nurse within 48 hours of discharge if the symptoms recurred. 189 children were allocated to traditional inpatient HC.Main outcome measuresMain outcome was readmission within 90 days. Secondary outcomes were accident and emergency department attendances and length of stay/care.Main resultsAnalysis was by intention to treat. The HAH and HC groups did not differ for readmissions (table) or attendances at the accident and emergency department (no data available). Children in the HAH group received an extra day of care compared with those in the HC group (mean bed/care d 2.37 v 1.37, p < 0.00l).ConclusionNumber of readmissions did not differ for hospital at home and traditional hospital care for moderately ill children with breathing difficulties, diarrhoea with or without vomiting, or a feverish illness.*Information provided by author. [ABSTRACT FROM AUTHOR]

QUESTION: Does an interactive, home based device that monitors asthma symptoms, aspects of quality of life, and self care (Health Buddy) reduce asthma symptoms and increase self care behaviours in inner city children with persistent asthma?DesignRandomised {allocation concealed}*, controlled trial with follow up at 6 and 12 weeks.SettingAn inner city primary care clinic in Oakland, California, USA.Patients134 children who were 8-16 years of age (mean age 12y, 57% boys, 76% African-American), had a diagnosis of persistent asthma, had an English speaking caregiver, and had a telephone at home. Exclusion criteria were involvement. in other asthma or drug efficacy studies or behaviour modification research, mental or physical challenges that made it difficult to use the Health Buddy, or comorbid conditions affecting quality of life. Follow up was 96% at 6 weeks and 91% at 12 weeks.Intervention66 children were allocated to the Health Buddy (Health Hero Network, Mountain View, California), an interactive device connected to a home telephone. Each day, nurse coordinator sent a set of queries (dialogues) using a standard internet browser. Children answered the queries by pressing 1 of 4 buttons. The dialogues were aimed at a third grade reading level and consisted of 10 questions about asthma symptoms, peak flow readings, use of medication and health services, and functional status. Each answer by the child received immediate feedback from the device fie, praise for a correct answer or encouragement to try again). Children were to access the device on their own at a regular time once each day. 68 children were allocated to the control group and used a standard asthma diary to log their symptoms. peak flow, medication use, and restricted activity.Main outcome measuresMain outcome was limitation in activity because of asthma Secondary outcomes included peak flow readings in the red zone (< 50% of personal best, signalling severe asthma exacerbation) or yellow zone (50% to 80% of personal best, signalling asthma that is not sufficiently controlled and requires additional medication), and perceived asthma symptoms in the previous 14 days; missed school days and use of health services because of astlma in the previous 6 weeks; and self care behaviours.Main resultsAnalyses adjusted for different visits, asthma severity, and baseline symptoms showed that children allocated to the Health Buddy were less likely than children allocated to the asthma diary to report limitations in activities (odds ratio [OR] 0.52, 95% CI 0.29 to 0.94), made fewer urgent calls to health services (OR 0.43, CI 0.18 to 0.99), and were more likely to take their asthma medication without additional reminders (p=0.04). They were also less likely to have peak flow readings in the yellow or red zones (OR 0.43, C1 0.23 to 0.82). The groups did not differ for coughing or wheezing (p=0.23), trouble sleeping (p=0.83), emergency department visits (p=0.21), or hospital admissions (p=0.96).ConclusionIn inner city children with asthma, an interactive communication device for monitoring asthma symptoms and functional status reduced limitations in activity and urgent calls to health services when compared with a standard asthma diary.* Information provided by author. [ABSTRACT FROM AUTHOR]