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Street triage practitioners, consisting of mental health social workers and nurses, act as a conduit between service users and emergency services, and have a significant amount of discretion in determining the care and treatment pathways for individuals experiencing mental health crises. However, this is set against a backdrop of neoliberal reforms that have resulted in an increased focus on risk management, accountability, responsibilisation and managing scarce resources. Based on ethnographic research undertaken in a street triage setting in the UK, this article examines the role of street triage practitioners as ‘street-level bureaucrats’ and explores the impact of neoliberal mental health reforms on street-level practice and how these shape and constrain the use of discretion in a street triage context. Revisiting the relevance of Lipsky through a neoliberal lens, the article identifies how street triage practitioners use their discretion to navigate practice dilemmas in a contemporary mental health landscape.

This paper develops the theoretical position proposed by Zygmunt Bauman that one of the greatest contemporary ‘social evils' or injustices we face in society, is the total marketisation and individ...

This conceptual article aims to introduce and explore the practice of social streetwork. Streetwork is located as a historical professional discourse that has contemporary relevance for a rapidly changing and globalised world. As a practice discourse, streetwork occurs across a range of community-based helping professions, including social work, youth work and community work. The social work profession is increasingly becoming clinical and situated within statutory organisations, placing a greater emphasis on outcome-based targets, rather than building relationships. As a result of austerity, traditional youth workers are becoming invisible, often moving into statutory education settings and complex needs welfare agencies. This article will argue that for the broad helping professions to remain relevant, we must engage with vulnerable and complex populations where we find them – at the street level – promoting a direct practice of social justice at a micro-level. Within this discussion, we will define and explore a streetwork approach by examining the methodologies and objectives of streetwork practice. We will argue that by keeping to its origins of using informal and non-formal education as its primary tools, streetwork as an intervention works to combat poverty, social exclusion and discrimination. The article articulates a foundation for practice based on the promotion of low-threshold interventions with complex and hard-to-reach social populations. One of the key themes we will explore is how to locate streetwork practice as a form of social support, accompaniment and tool for promoting social inclusion and social democracy.

With the recognition of demographic change and impacts on the workforce, there is an increased focus on competency management within the pipeline industry. The Canadian Energy Pipeline Association (CEPA) is a voluntary, non-profit industry association representing major Canadian transmission pipeline companies that has been particularly active in this area. With recent publication of CEPA’s guidance document on competency management, CEPA member companies identified a need for a companion set of competency standards for technical staff. As such, the Pipeline Integrity Community of Practice (CoP) within CEPA formed a task group to identify and better understand potential solutions to address this need. The challenge in maturing competency management within the Canadian pipeline industry, as identified by the task group, is two fold: 1. First, the competency system needs to be flexible to address a broad range of topics, operation types as well as a progression of proficiencies (e.g., engineers in training through to senior level subject matter experts). 2. Second, there is a need for a system that is practical and can be developed / adopted in a relatively short time frame. In undertaking an assessment of the options available in industry, the adoption of the system that has been developed by the Australian Pipeline and Gas Association (APGA) was selected as the optimal path forward. The APGA Pipeline Engineer Competency System (APGA PECS) provides a mechanism for understanding competency as well as a means of assessing and documenting competency for pipeline engineers. Specifically, industry expert panels were used to develop the competency standards which were then published for broad consultation prior to finalizing. Within Australia, the system is now the responsibility of the APGA’s Pipeline Engineering Competency System (PECS) Committee for ongoing development, review and maintenance to ensure the system remains current and fit for purpose. One of the key characteristics of the APGA competency standards is the consistency of elements and a standard format for requirements in every stream of pipeline engineering. Further, the APGA System has been demonstrated to be practical and sustainable through use within Australia. The APGA System is now being customized for use in the Canadian Pipeline industry under an agreement announced in October 2019. This paper will provide insights into key aspects of competency system, the approach taken to assess viable options as well as the experience of customizing the APGA system for Canadian use. The system is anticipated to be available for Canadian companies in 2020 and provides a pathway to meeting the two main challenges identified for managing competency in the Canadian industry.

To compare the accuracy of intraoperative wavefront aberrometry (ORA) and the Hill-radial basis function (RBF) formula with other formulas based on preoperative biometry in predicting residual refractive error after cataract surgery in eyes with axial myopia.Private practice, Harrisburg, Pennsylvania, USA.Retrospective consecutive case series.Eyes with an axial length (AL) greater than 25.0 mm had cataract extraction with intraocular lens implantation. For each eye, the 1-center Wang-Koch AL-optimized Holladay 1 formula was used to select an IOL targeting emmetropia. Residual refractive error was predicted preoperatively using the SRK/T, Holladay 1 and 2, Barrett Universal II, and Hill-RBF formulas and intraoperatively using wavefront aberrometry. The postoperative refraction was compared with the preoperative and intraoperative predictions.The study comprised 37 patients (51 eyes). The mean numerical errors ± standard error associated with using the SRK/T, Holladay 1, AL-optimized Holladay 1, Holladay 2, Barrett Universal II, and Hill-RBF formulas and intraoperative wavefront aberrometry were 0.20 ± 0.06 diopters (D), 0.33 ± 0.06 D, -0.02 ± 0.06 D, 0.24 ± 0.06 D, 0.19 ± 0.06 D, 0.22 ± 0.06 D, and 0.056 ± 0.06 D, respectively (P .001). The proportion of patients within ±0.5 D of the predicted error was 74.5%, 62.8%, 82.4%, 79.1%, 73.9%, 76.7%, and 80.4%, respectively (P = .090). Hyperopic outcomes occurred in 70.6%, 76.5%, 49.0%, 74.4%, 76.1%, 74.4%, and 45.1% of the eyes, respectively (P = .007).Intraoperative wavefront aberrometry was better than all formulas based on preoperative biometry and as effective as the AL-optimized Holladay 1 formula in predicting residual refractive error and reducing hyperopic outcomes. The Hill-RBF formula's performance was similar to that of the fourth-generation formulas.

Background Carotid endarterectomy (CEA) has been performed since the 1950s and remains one of the most common surgical procedures in the United States. The procedure is performed by cardiothoracic, general, neurologic, and vascular surgeons. This study uses data from the National Surgical Quality Improvement Program (NSQIP) to examine the outcomes after CEA when performed by general or vascular surgeons. Materials and methods Data included 34,493 CEAs from years 2005 to 2010 recorded in the NSQIP database. Primary outcomes measured were length of stay, 30-d mortality, surgical site infection, cerebrovascular accident, myocardial infarction, and blood transfusion requirement. Secondary outcomes measured were the remaining intraoperative outcomes from the NSQIP database. Results After controlling for patient and surgical characteristics, patients treated by general surgeons did not have a significantly different LOS or 30-d mortality than those treated by vascular surgeons. Patients of general surgeons had nearly twice the risk of acquiring a surgical site infection (odds ratio [OR] = 1.94; P = 0.012), >1.5 times the risk of cerebrovascular accident (OR = 1.56; P = 0.008), and >1.8 times the risk of blood transfusion (OR = 1.85; P = 0.017) than those of vascular surgeons. Patients of general surgeons had less than half the risk of having a myocardial infarction (OR = 0.34; P = 0.031) than those of vascular surgeons. Conclusions Surgical specialty is associated with a wide range of postoperative outcomes after CEA. Additional research is needed to explore practice and cultural differences across surgical specialty that may lead to outcome differences.

Describes the evolution of industrial control systems from PLC to PC based systems including the use of the DeviceNet fieldbus standard. Also includes a case study of automotive gearbox assembly.

[1] In situ surface pressures measured at 2 s intervals during the 150 sol Phoenix mission are presented and seasonal variations discussed. The lightweight Barocap®/Thermocap® pressure sensor system performed moderately well. However, the original data processing routine had problems because the thermal environment of the sensor was subject to more rapid variations than had been expected. Hence, the data processing routine was updated after Phoenix landed. Further evaluation and the development of a correction are needed since the temperature dependences of the Barocap sensor heads have drifted after the calibration of the sensor. The inaccuracy caused by this appears when the temperature of the unit rises above 0°C. This frequently affects data in the afternoons and precludes a full study of diurnal pressure variations at this time. Short-term fluctuations, on time scales of order 20 s are unaffected and are reported in a separate paper in this issue. Seasonal variations are not significantly affected by this problem and show general agreement with previous measurements from Mars. During the 151 sol mission the surface pressure dropped from around 860 Pa to a minimum (daily average) of 724 Pa on sol 140 (Ls 143). This local minimum occurred several sols earlier than expected based on GCM studies and Viking data. Since battery power was lost on sol 151 we are not sure if the timing of the minimum that we saw could have been advanced by a low-pressure meteorological event. On sol 95 (Ls 122), we also saw a relatively low-pressure feature. This was accompanied by a large number of vertical vortex events, characterized by short, localized (in time), low-pressure perturbations.