Improving clinical leadership and management in the NHS

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Nicol ED

2012-08-01

Full Text Available Edward D Nicol1,21Department of Cardiology, Royal Brompton Hospital and Harefield NHS Trust, London, United Kingdom; 2Clinical Leadership Academy, School of Medicine, Keele University, Staffordshire, United KingdomAbstract: The National Health Service (NHS is one of the UKs most cherished but political public institutions, providing healthcare, free at the point of delivery. The English NHS must make £20bn efficiency savings in the next 3 years whilst in the midst of fundamental structural change outlined in the government's Health and Social Care Bill. This paper will explore the history of leadership and management in the NHS; the evolution of clinical leadership; national strategies to improve NHS clinical and managerial leadership and Lord Darzi's pivotal NHS review. It defines the kind of leadership and management required for today's NHS, looking to overcome some of the main challenges such as improving healthcare quality whilst making efficiency savings and engaging grass roots workers to deliver sustainable, long term improvements. Finally this manuscript makes suggestions as to where future investment is required to improve clinical leadership and management in the NHS.Keywords: clinical leadership, healthcare management, national health service

Overseeing oversight: governance of quality and safety by hospital boards in the English NHS.

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Mannion, Russell; Davies, Huw; Freeman, Tim; Millar, Ross; Jacobs, Rowena; Kasteridis, Panos

2015-01-01

To contribute towards an understanding of hospital board composition and to explore board oversight of patient safety and health care quality in the English NHS. We reviewed the theory related to hospital board governance and undertook two national surveys about board management in NHS acute and specialist hospital trusts in England. The first survey was issued to 150 trusts in 2011/2012 and was completed online via a dedicated web tool. A total 145 replies were received (97% response rate). The second online survey was undertaken in 2012/2013 and targeted individual board members, using a previously validated standard instrument on board members' attitudes and competencies (the Board Self-Assessment Questionnaire). A total of 334 responses were received from 165 executive and 169 non-executive board members, providing at least one response from 95 of the 144 NHS trusts then in existence (66% response rate). Over 90% of the English NHS trust boards had 10-15 members. We found no significant difference in board size between trusts of different types (e.g. Foundation Trusts versus non-Foundation Trusts and Teaching Hospital Trusts versus non-Teaching Hospital Trusts). Clinical representation on boards was limited: around 62% had three or fewer members with clinical backgrounds. For about two-thirds of the trusts (63%), board members with a clinical background comprised less than 30% of the members. Boards were using a wide range and mix of quantitative performance metrics and soft intelligence (e.g. walk-arounds, patient stories) to monitor their organisations with regard to patient safety. The Board Self-Assessment Questionnaire data showed generally high or very high levels of agreement with desirable statements of practice in each of its six dimensions. Aggregate levels of agreement within each dimension ranged from 73% (for the dimension addressing interpersonal issues) to 85% (on the political). English NHS boards largely hold a wide range of attitudes and

NHS market liberalisation and the TTIP agreement.

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Regan, Paul; Ball, Elaine

2016-07-01

Governments over the past three decades have undermined the founding principles of the NHS through reforms and market liberalisation. With greater involvement of commercial interests in health care, the NHS will become less democratic and transparent. Recent reforms, which were intended to improve productivity, quality and cost efficiency, have left the NHS exposed to the unwieldy model of market liberalisation and the attrition of public health care. The role of community nurses has been particularly destabilised by commissioning, as their work is difficult to measure. The advent of the Transatlantic Trade and Investment Partnership could further undermine the NHS to the benefit of international commercial interests.

Employee engagement within the NHS: a cross-sectional study.

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Jeve, Yadava Bapurao; Oppenheimer, Christina; Konje, Justin

2015-02-01

Employee engagement is the emotional commitment of the employee towards the organisation. We aimed to analyse baseline work engagement using Utrecht Work Engagement Scale (UWES) at a teaching hospital. We have conducted a cross-sectional study within the National Health Service (NHS) Teaching Hospital in the UK. All participants were working age population from both genders directly employed by the hospital. UWES has three constituting dimensions of work engagement as vigor, dedication, and absorption. We conducted the study using UWES-9 tool. Outcome measures were mean score for each dimension of work engagement (vigor, dedication, absorption) and total score compared with control score from test manual. We found that the score for vigor and dedication is significantly lower than comparison group (Pengagement level is below average within the NHS employees. Vigor and dedication are significantly lower, these are characterised by energy, mental resilience, the willingness to invest one's effort, and persistence as well as a sense of significance, enthusiasm, inspiration, pride, and challenge. The NHS employees are immersed in work. Urgent need to explore strategies to improve work engagement as it is vital for improving productivity, safety and patient experience.

Team performance in the Italian NHS: the role of reflexivity.

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Urbini, Flavio; Callea, Antonino; Chirumbolo, Antonio; Talamo, Alessandra; Ingusci, Emanuela; Ciavolino, Enrico

2018-04-09

Purpose The purpose of this paper is twofold: first, to investigate the goodness of the input-process-output (IPO) model in order to evaluate work team performance within the Italian National Health Care System (NHS); and second, to test the mediating role of reflexivity as an overarching process factor between input and output. Design/methodology/approach The Italian version of the Aston Team Performance Inventory was administered to 351 employees working in teams in the Italian NHS. Mediation analyses with latent variables were performed via structural equation modeling (SEM); the significance of total, direct, and indirect effect was tested via bootstrapping. Findings Underpinned by the IPO framework, the results of SEM supported mediational hypotheses. First, the application of the IPO model in the Italian NHS showed adequate fit indices, showing that the process mediates the relationship between input and output factors. Second, reflexivity mediated the relationship between input and output, influencing some aspects of team performance. Practical implications The results provide useful information for HRM policies improving process dimensions of the IPO model via the mediating role of reflexivity as a key role in team performance. Originality/value This study is one of a limited number of studies that applied the IPO model in the Italian NHS. Moreover, no study has yet examined the role of reflexivity as a mediator between input and output factors in the IPO model.

Paternity leave experiences of NHS doctors.

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Gordon, Hannah; Szram, Joanna

2013-10-01

This study assesses NHS doctors' experiences of paternity leave and evaluates whether practices have changed since the introduction of additional paternity leave (APL) in April 2011. An anonymised online survey designed to discover experiences and uptake of APL and ordinary paternity leave (OPL) was distributed to all members of the London Deanery Synapse® network. In total, 364 fathers responded. Their seniority ranged from foundation trainees to consultants. Following the formal introduction of OPL in 2003, the number of fathers taking any paternity leave increased (from 50% to 95.6%). The majority of respondents (76.7%) felt well supported by their employer. Since the introduction of APL, 3% of respondents took additional leave. Reasons for the low uptake of APL included the impracticalities of the law, poor awareness and perceived attitudes and implications for training. Problems with OPL included the inadequate provision of cover and difficulties in timing the leave appropriately.

Nance-Horan syndrome protein, NHS, associates with epithelial cell junctions.

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Sharma, Shiwani; Ang, Sharyn L; Shaw, Marie; Mackey, David A; Gécz, Jozef; McAvoy, John W; Craig, Jamie E

2006-06-15

Nance-Horan syndrome, characterized by congenital cataracts, craniofacial, dental abnormalities and mental disturbances, is an X-linked disorder with significant phenotypic heterogeneity. Affected individuals have mutations in the NHS (Nance-Horan syndrome) gene typically resulting in premature truncation of the protein. This report underlines the complexity of the regulation of the NHS gene that transcribes several isoforms. We demonstrate the differential expression of the two NHS isoforms, NHS-A and NHS-1A, and differences in the subcellular localization of the proteins encoded by these isoforms. This may in part explain the pleiotropic features of the syndrome. We show that the endogenous and exogenous NHS-A isoform localizes to the cell membrane of mammalian cells in a cell-type-dependent manner and that it co-localizes with the tight junction (TJ) protein ZO-1 in the apical aspect of cell membrane in epithelial cells. We also show that the NHS-1A isoform is a cytoplasmic protein. In the developing mammalian lens, we found continuous expression of NHS that became restricted to the lens epithelium in pre- and postnatal lens. Consistent with the in vitro findings, the NHS-A isoform associates with the apical cell membrane in the lens epithelium. This study suggests that disturbances in intercellular contacts underlie cataractogenesis in the Nance-Horan syndrome. NHS is the first gene localized at TJs that has been implicated in congenital cataracts.

The impact of NHS based primary care complementary therapy services on health outcomes and NHS costs: a review of service audits and evaluations

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Wye Lesley

2009-03-01

Full Text Available Abstract Background The aim of this study was to review evaluations and audits of primary care complementary therapy services to determine the impact of these services on improving health outcomes and reducing NHS costs. Our intention is to help service users, service providers, clinicians and NHS commissioners make informed decisions about the potential of NHS based complementary therapy services. Methods We searched for published and unpublished studies of NHS based primary care complementary therapy services located in England and Wales from November 2003 to April 2008. We identified the type of information included in each document and extracted comparable data on health outcomes and NHS costs (e.g. prescriptions and GP consultations. Results Twenty-one documents for 14 services met our inclusion criteria. Overall, the quality of the studies was poor, so few conclusions can be made. One controlled and eleven uncontrolled studies using SF36 or MYMOP indicated that primary care complementary therapy services had moderate to strong impact on health status scores. Data on the impact of primary care complementary therapy services on NHS costs were scarcer and inconclusive. One controlled study of a medical osteopathy service found that service users did not decrease their use of NHS resources. Conclusion To improve the quality of evaluations, we urge those evaluating complementary therapy services to use standardised health outcome tools, calculate confidence intervals and collect NHS cost data from GP medical records. Further discussion is needed on ways to standardise the collection and reporting of NHS cost data in primary care complementary therapy services evaluations.

Next Generation Hemostatic Materials Based on NHS-Ester Functionalized Poly(2-oxazoline)s.

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Boerman, Marcel A; Roozen, Edwin; Sánchez-Fernández, María José; Keereweer, Abraham R; Félix Lanao, Rosa P; Bender, Johan C M E; Hoogenboom, Richard; Leeuwenburgh, Sander C; Jansen, John A; Van Goor, Harry; Van Hest, Jan C M

2017-08-14

In order to prevent hemorrhage during surgical procedures, a wide range of hemostatic agents have been developed. However, their efficacy is variable; hemostatic devices that use bioactive components to accelerate coagulation are dependent on natural sources, which limits reproducibility. Hybrid devices in which chain-end reactive poly(ethylene glycol) is employed as active component sometimes suffer from irregular cross-linking and dissolution of the polar PEG when blood flow is substantial. Herein, we describe a synthetic, nonbioactive hemostatic product by coating N-hydroxysuccinimide ester (NHS)-functional poly(2-oxazoline)s (POx-NHS) onto gelatin patches, which acts by formation of covalent cross-links between polymer, host blood proteins, gelatin and tissue to seal the wound site and prevent hemorrhage during surgery. We studied different process parameters (including polymer, carrier, and coating technique) in direct comparison with clinical products (Hemopatch and Tachosil) to obtain deeper understanding of this class of hemostatic products. In this work, we successfully prove the hemostatic efficacy of POx-NHS as polymer powders and coated patches both in vitro and in vivo against Hemopatch and Tachosil, demonstrating that POx-NHS are excellent candidate polymers for the development of next generation hemostatic patches.

Online directed journaling in dental hygiene clinical education.

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Gwozdek, Anne E; Klausner, Christine P; Kerschbaum, Wendy E

2009-01-01

Reflecting upon and sharing of clinical experiences in dental hygiene education is a strategy used to support the application of didactic material to patient care. The promotion of interactive, clinically focused discussions creates opportunities for students to foster critical thinking and socialization skills in dental hygiene practice. Twenty-eight dental hygiene students in their first semester of patient care utilized online directed journaling via blogging software, as a reflection and sharing strategy. Journal entries found critical thinking and socialization themes including connection of didactic material to clinical experience, student-patient interaction, student-student collaboration, and a vision of the professional role of the dental hygienist. A 7 item evaluation instrument provided data that the online journaling strategy was perceived as effective and valuable by the students. Online directed journaling is a strategy that has the potential to enhance critical thinking and socialization skills in dental hygiene clinical education.

Morality and Markets in the NHS

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Barnabas J Gilbert

2014-12-01

Full Text Available Since its establishment in 1948, the history of the National Health Service (NHS has been characterized by organisational turbulence and system reform. At the same time, progress in science, medicine and technology throughout the western world have revolutionized the delivery of healthcare. The NHS has become a much loved, if much critiqued, national treasure. It is against this backdrop that the role of this state-funded health service has been brought into moral question. Certainly, the challenges facing healthcare policy-makers are numerous and complex, but in the wake of the Health and Social Care Act (2012, no issue is more divisive than that of market-based reform. Here we explore the turbulent history of the NHS, from its foundation to the birth of the healthcare marketplace. We explore arguments for and against the healthcare market and resolve that, amid an evolving economic and moral framework, the NHS must ensure that its original tenets of equity and autonomy remain at its core. We propose a values-explicit, systems-based approach to renew focus on both the processes and the outcomes of care.

Use staff wisely to save NHS money.

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Moore, Alison

2015-12-09

The NHS could save up to £ 2 billion a year by improving workflow and containing workforce costs, according to Labour peer Lord Carter's review of NHS efficiency. Changes in areas such as rostering and management of annual leave must avoid increasing the pressure on staff.

'Searching for the people in charge': appraising the 1983 Griffiths NHS management inquiry.

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Gorsky, Martin

2013-01-01

This is the first of two related articles in the present volume which examine the recent history of health services management using the case of the British National Health Service (NHS). In the historiography of the NHS the 1980s is widely seen as a watershed, when public policy first sought to introduce market disciplines into its operation. Administrative and managerial reforms were central to this process, and their origins and impact have been the subject of continuing debate. This article examines and evaluates one of the key events in this history, the Griffiths NHS Inquiry of 1983, which put in place the principles of 'general management' in the NHS. Drawing on both documentary records and oral evidence it offers fresh perspectives on the reasons why the Conservative government embarked on this reform, on the workings of the inquiry team under the leadership of the businessman Roy Griffiths, and on the uneven course of the implementation of his recommendations. While its initial impact arguably did not meet the expectations of its supporters, it is suggested that several of Griffiths' key concerns have grown, not diminished, in importance as aspects of subsequent health politics. These include: the need for clinician involvement in NHS management and financing; the conundrum of how to depoliticise the central direction of the service while retaining political accountability; the desirability of measuring and improving performance; and the question of how best to incorporate the wishes of patients and public in the decision-making arena.

A cross-sectional study of all clinicians' conflict of interest disclosures to NHS hospital employers in England 2015-2016.

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Feldman, Harriet Ruth; DeVito, Nicholas J; Mendel, Jonathan; Carroll, David E; Goldacre, Ben

2018-03-05

We set out to document how NHS trusts in the UK record and share disclosures of conflict of interest by their employees. Cross-sectional study of responses to a Freedom of Information Act request for Gifts and Hospitality Registers. NHS Trusts (secondary/tertiary care organisations) in England. 236 Trusts were contacted, of which 217 responded. We assessed all disclosures for completeness and openness, scoring them for achieving each of five measures of transparency. 185 Trusts (78%) provided a register. 71 Trusts did not respond within the 28 day time limit required by the FoIA. Most COI registers were incomplete by design, and did not contain the information necessary to assess conflicts of interest. 126/185 (68%) did not record the names of recipients. 47/185 (25%) did not record the cash value of the gift or hospitality. Only 31/185 registers (16%) contained the names of recipients, the names of donors, and the cash amounts received. 18/185 (10%) contained none of: recipient name, donor name, and cash amount. Only 15 Trusts had their disclosure register publicly available online (6%). We generated a transparency index assessing whether each Trust met the following criteria: responded on time; provided a register; had a register with fields identifying donor, recipient, and cash amount; provided a register in a format that allowed further analysis; and had their register publicly available online. Mean attainment was 1.9/5; no NHS trust met all five criteria. Overall, recording of employees' conflicts of interest by NHS trusts is poor. None of the NHS Trusts in England met all transparency criteria. 19 did not respond to our FoIA requests, 51 did not provide a Gifts and Hospitality Register and only 31 of the registers provided contained enough information to assess employees' conflicts of interest. Despite obligations on healthcare professionals to disclose conflicts of interest, and on organisations to record these, the current system for logging and

Employee Engagement within the NHS: A Cross-Sectional Study

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Yadava Bapurao Jeve

2015-02-01

Full Text Available Background Employee engagement is the emotional commitment of the employee towards the organisation. We aimed to analyse baseline work engagement using Utrecht Work Engagement Scale (UWES at a teaching hospital. Methods We have conducted a cross-sectional study within the National Health Service (NHS Teaching Hospital in the UK. All participants were working age population from both genders directly employed by the hospital. UWES has three constituting dimensions of work engagement as vigor, dedication, and absorption. We conducted the study using UWES-9 tool. Outcome measures were mean score for each dimension of work engagement (vigor, dedication, absorption and total score compared with control score from test manual. Results We found that the score for vigor and dedication is significantly lower than comparison group (P< 0.0001 for both. The score for absorption was significantly higher than comparison group (P< 0.0001. However, total score is not significantly different. Conclusion The study shows that work engagement level is below average within the NHS employees. Vigor and dedication are significantly lower, these are characterised by energy, mental resilience, the willingness to invest one’s effort, and persistence as well as a sense of significance, enthusiasm, inspiration, pride, and challenge. The NHS employees are immersed in work. Urgent need to explore strategies to improve work engagement as it is vital for improving productivity, safety and patient experience.

Refinement of the NHS locus on chromosome Xp22.13 and analysis of five candidate genes.

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Toutain, Annick; Dessay, Benoît; Ronce, Nathalie; Ferrante, Maria-Immacolata; Tranchemontagne, Julie; Newbury-Ecob, Ruth; Wallgren-Pettersson, Carina; Burn, John; Kaplan, Josseline; Rossi, Annick; Russo, Silvia; Walpole, Ian; Hartsfield, James K; Oyen, Nina; Nemeth, Andrea; Bitoun, Pierre; Trump, Dorothy; Moraine, Claude; Franco, Brunella

2002-09-01

Nance-Horan syndrome (NHS) is an X-linked condition characterised by congenital cataracts, dental abnormalities, dysmorphic features, and mental retardation in some cases. Previous studies have mapped the disease gene to a 2 cM interval on Xp22.2 between DXS43 and DXS999. We report additional linkage data resulting from the analysis of eleven independent NHS families. A maximum lod score of 9.94 (theta=0.00) was obtained at the RS1 locus and a recombination with locus DXS1195 on the telomeric side was observed in two families, thus refining the location of the gene to an interval of around 1 Mb on Xp22.13. Direct sequencing or SSCP analysis of the coding exons of five genes (SCML1, SCML2, STK9, RS1 and PPEF1), considered as candidate genes on the basis of their location in the critical interval, failed to detect any mutation in 12 unrelated NHS patients, thus making it highly unlikely that these genes are implicated in NHS.

Benchmarking clinical photography services in the NHS.

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Arbon, Giles

2015-01-01

Benchmarking is used in services across the National Health Service (NHS) using various benchmarking programs. Clinical photography services do not have a program in place and services have to rely on ad hoc surveys of other services. A trial benchmarking exercise was undertaken with 13 services in NHS Trusts. This highlights valuable data and comparisons that can be used to benchmark and improve services throughout the profession.

Non-price competition in NHS secondary care contracting: empirical results.

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Gray, Keith; Bailey, Mark F

2008-01-01

The purpose of this paper is, for English acute NHS hospitals, to investigate how they operate their governance systems in the area of secondary care contracting and identify the key determinants of relationship building within the contacting/commissioning of secondary care focusing upon non-price competitive behaviour. A survey instrument was designed and mailed to a sample of all acute NHS hospitals in England of whom 35 per cent responded. This survey was then analysed using logit techniques. The analysis suggests that: those NHS Trusts offering volume discounts, non-price competitive incentives or having a strong belief in performance being by "payment by results" criteria are significantly more likely to offer augmented services to secondary care purchasers over and above contractual minima; those NHS Trusts strongly believing in the importance of non-price factors (such as contract augmentation or quality) in the contracting process are more likely to offer customisation of generic services; and those NHS Trusts using cost-sharing agreements to realign contracts when negotiating contracts or who strongly believe in the importance of service augmentation in strengthening relationships, or that increased hospital efficiency is the most important aspect of recent NHS reform are more likely to utilise default measures to help realign contracts. This paper fills a gap in the area of non-price competition in English NHS acute secondary care contracting.

From Hippocrates to Commodities: three models of NHS governance: NHS governance, regulation, Mid Staffordshire inquiry, health care as a commodity.

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Newdick, Christopher

2014-01-01

A series of inquiries and reports suggest considerable failings in the care provided to some patients in the NHS. Although the Bristol Inquiry report of 2001 led to the creation of many new regulatory bodies to supervise the NHS, they have never enjoyed consistent support from government and the Mid Staffordshire Inquiry in 2013 suggests they made little difference. Why do some parts of the NHS disregard patients' interests and how we should we respond to the challenge? The following discusses the evolution of approaches to NHS governance through the Hippocratic, Managerial and Commercial models, and assesses their risks and benefits. Apart from the ethical imperative, the need for effective governance is driven both by the growth in information available to the public and the resources wasted by ineffective systems of care. Appropriate solutions depend on an understanding of the perverse incentives inherent in each model and the need for greater sensitivity to the voices of patients and the public. © The Author 2014. Published by Oxford University Press; all rights reserved. For Permissions, please email: journals. permissions@oup.com.

Applying Case-Based Method in Designing Self-Directed Online Instruction: A Formative Research Study

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Luo, Heng; Koszalka, Tiffany A.; Arnone, Marilyn P.; Choi, Ikseon

2018-01-01

This study investigated the case-based method (CBM) instructional-design theory and its application in designing self-directed online instruction. The purpose of this study was to validate and refine the theory for a self-directed online instruction context. Guided by formative research methodology, this study first developed an online tutorial…

IMatter: validation of the NHS Scotland Employee Engagement Index.

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Snowden, Austyn; MacArthur, Ewan

2014-11-08

Employee engagement is a fundamental component of quality healthcare. In order to provide empirical data of engagement in NHS Scotland an Employee Engagement Index was co-constructed with staff. 'iMatter' consists of 25 Likert questions developed iteratively from the literature and a series of validation events with NHS Scotland staff. The aim of this study was to test the face, content and construct validity of iMatter. Cross sectional survey of NHS Scotland staff. In January 2013 iMatter was sent to 2300 staff across all disciplines in NHS Scotland. 1280 staff completed it. Demographic data were collected. Internal consistency of the scale was calculated. Construct validity consisted of concurrent application of factor analysis and Rasch analysis. Face and content validity were checked using 3 focus groups. The sample was representative of the NHSScotland population. iMatter showed very strong reliability (α = 0.958). Factor analysis revealed a four-factor structure consistent with the following interpretation: iMatter showed evidence of high reliability and validity. It is a popular measure of staff engagement in NHS Scotland. Implications for practice focus on the importance of coproduction in psychometric development.

NHS Gene Mutations in Ashkenazi Jewish Families with Nance-Horan Syndrome.

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Shoshany, Nadav; Avni, Isaac; Morad, Yair; Weiner, Chen; Einan-Lifshitz, Adi; Pras, Eran

2017-09-01

To describe ocular and extraocular abnormalities in two Ashkenazi Jewish families with infantile cataract and X-linked inheritance, and to identify their underlying mutations. Seven affected members were recruited. Medical history, clinical findings, and biometric measurements were recorded. Mutation analysis of the Nance-Horan syndrome (NHS) gene was performed by direct sequencing of polymerase chain reaction-amplified exons. An unusual anterior Y-sutural cataract was documented in the affected male proband. Other clinical features among examined patients included microcorneas, long and narrow faces, and current or previous dental anomalies. A nonsense mutation was identified in each family, including a previously described 742 C>T, p.(Arg248*) mutation in Family A, and a novel mutation 2915 C>A, p.(Ser972*) in Family B. Our study expands the repertoire of NHS mutations and the related phenotype, including newly described anterior Y-sutural cataract and dental findings.

An evaluation of mindfulness-based childbirth and parenting courses for pregnant women and prospective fathers/partners within the UK NHS (MBCP-4-NHS).

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Warriner, Sian; Crane, Catherine; Dymond, Maret; Krusche, Adele

2018-05-26

An evaluation of mindfulness-based childbirth and parenting courses for pregnant women and prospective fathers/partners within the UK NHS (MBCP-4-NHS). To explore the usefulness within the National Health Service (NHS) of a brief (four week, ten hour) course based upon the Mindfulness Based Childbirth and Parenting (MBCP) programme (Duncan and Bardacke, 2010) described here as MBCP-4-NHS. The National Maternity Review (2016) and report of The Independent Mental Health Taskforce to the NHS (2016a, 2016b) in England highlight the need for significant investment into perinatal mental health services, with the Government pledging funding to improve such services through a range of measures. Whilst the field of mindfulness during the perinatal period is in need of well controlled trials and studies exploring the mechanisms of action (Hall et al., 2016) the limited research to date supports the potential for mindfulness based interventions in pregnancy and the need for further scientific study in this area (Dhillon et al., 2017; Shi and Macbeth, 2017). Particularly because it may broaden women's repertoire of coping strategies with the potential to improve the developmental trajectory of both parents and infants (Dunn et al., 2012; Duncan and Bardacke, 2010; Vieten and Astin, 2008). However, most of the studies to date have involved lengthy courses of around 8-9 weeks (24 h) duration, which may not be feasible or economical within a UK NHS setting and therefore, would be unlikely to be adopted as routine practice. An initial pilot study to discover if MBCP-4-NHS is acceptable and feasible within NHS maternity services, comparing maternal and paternal pre and post intervention self-report measures of mental health to begin to explore the effectiveness of this intervention. NHS antenatal education classes held in children's centres for expectant parents across Oxfordshire. All expectant parents receiving Oxfordshire maternity services between October 2014 and January 2015

Identification of three novel NHS mutations in families with Nance-Horan syndrome

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Huang, Kristen M.; Wu, Junhua; Brooks, Simon P.; Hardcastle, Alison J.; Lewis, Richard Alan; Stambolian, Dwight

2007-01-01

Purpose Nance-Horan Syndrome (NHS) is an infrequent and often overlooked X-linked disorder characterized by dense congenital cataracts, microphthalmia, and dental abnormalities. The syndrome is caused by mutations in the NHS gene, whose function is not known. The purpose of this study was to identify the frequency and distribution of NHS gene mutations and compare genotype with Nance-Horan phenotype in five North American NHS families. Methods Genomic DNA was isolated from white blood cells f...

The NHS: the story so far (1948-2010).

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Shapiro, Jonathan

2010-08-01

The NHS has long held a paradoxical position in the national psyche: a constant, reassuring presence that seems to be in a state of continual flux. This is partly because while the service is based in the public sector (with its reputation for risk aversion and change at a glacial pace), it is also exposed to the ever present currents of political pressure. Equally important is the changing nature of both medical technology and public expectation, each of which exert constant and inexorable pressures on the service. This article will briefly describe the story of the NHS from its inception in 1948 to the present day, with an emphasis on developments over the last 20 years. During this time the notion of organising healthcare has developed and formed the focus of much of the change in systems across the developed world. The narrative will highlight some of the major challenges that the NHS will face over the next few years, and introduce the series about the future of the NHS that will appear in this journal signposting some of the topics that will be followed up in these articles.

Measuring progress towards a primary care-led NHS.

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Miller, P; Craig, N; Scott, A; Walker, A; Hanlon, P

1999-07-01

The push towards a 'primary care-led' National Health Service (NHS) has far-reaching implications for the future structure of the NHS. The policy involves both a growing emphasis on the role of primary care practitioners in the commissioning of health services, and a change from hospital to primary and community settings for a range of services and procedures. Although the terminology has changed, this emphasis remains in the recent Scottish Health Service White Paper and its English counterpart. To consider three questions in relation to this policy goal. First, does the evidence base support the changes? Secondly, what is the scale of the changes that have occurred? Thirdly, what are the barriers to the development of a primary care-led NHS? Programme budgets were compiled to assess changes over time in the balance of NHS resource allocation with respect to primary and secondary care. Total NHS revenue expenditure for the 15 Scottish health boards was grouped into four blocks or 'programmes': primary care, secondary care, community services, and a residual. The study period was 1991/2 to 1995/6. Expenditure data were supplied by the Scottish Office. Ambiguity of definitions and the absence of good data cause methodological difficulties in evaluating the scale and the appropriateness of the shift. The data that are available suggest that, at the aggregate level, there have been changes over time in the balance of resource allocation between care settings: relative investment into primary care has increased. It would appear that this investment is relatively small and from growth money rather than a 'shift' from secondary care. In addition, the impact of GP-led commissioning is variable but limited. General practitioners' (GPs') attitudes to the policy suggest that progress towards a primary care-led NHS will continue to be patchy. The limited shift to date, alongside evidence of ambivalent attitudes to the shift on the part of GPs, suggest that this is a policy

New mutations in the NHS gene in Nance-Horan Syndrome families from the Netherlands

NARCIS (Netherlands)

Florijn, Ralph J.; Loves, Willem; Maillette de Buy Wenniger-Prick, Liesbeth J. J. M.; Mannens, Marcel M. A. M.; Tijmes, Nel; Brooks, Simon P.; Hardcastle, Alison J.; Bergen, Arthur A. B.

2006-01-01

Mutations in the NHS gene cause Nance-Horan Syndrome (NHS), a rare X-chromosomal recessive disorder with variable features, including congenital cataract, microphthalmia, a peculiar form of the ear and dental anomalies. We investigated the NHS gene in four additional families with NHS from the

Employee engagement within the NHS: a cross-sectional study

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Jeve, Yadava Bapurao; Oppenheimer, Christina; Konje, Justin

2015-01-01

Background: Employee engagement is the emotional commitment of the employee towards the organisation. We aimed to analyse baseline work engagement using Utrecht Work Engagement Scale (UWES) at a teaching hospital. Methods: We have conducted a cross-sectional study within the National Health Service (NHS) Teaching Hospital in the UK. All participants were working age population from both genders directly employed by the hospital. UWES has three constituting dimensions of work engagement as vigor, dedication, and absorption. We conducted the study using UWES-9 tool. Outcome measures were mean score for each dimension of work engagement (vigor, dedication, absorption) and total score compared with control score from test manual. Results: We found that the score for vigor and dedication is significantly lower than comparison group (Pemployees. Vigor and dedication are significantly lower, these are characterised by energy, mental resilience, the willingness to invest one’s effort, and persistence as well as a sense of significance, enthusiasm, inspiration, pride, and challenge. The NHS employees are immersed in work. Urgent need to explore strategies to improve work engagement as it is vital for improving productivity, safety and patient experience PMID:25674571

Understanding the roles of NHS trust board members.

Science.gov (United States)

Deffenbaugh, J

1996-01-01

The establishment of NHS trust boards on a business format was a recent innovation resulting from the NHS reforms. In order to realize benefits for patients, it is essential that boards operate effectively. Explores within the framework of corporate governance, the practical implications of board member roles. Drawing on experience of strategy formulation at board level, analyses and clarifies the roles, and presents recommendations to increase board effectiveness.

Lessons from 2012: What the NHS Can Learn from Britain's Olympic Success.

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Maile, Edward J; Blake, Alastair M

2013-01-01

The 2012 London Olympic and Paralympic Games were widely regarded as an organisational and sporting success for the United Kingdom. Therefore, it is prudent to consider what other large, public endeavours might learn from the Games' success. Team GB worked to develop a positive team culture based around shared values. This is something the National Health Service (NHS) could learn from, as an organisation which can appear to lack this culture. The NHS should also work harder to adopt evidence-based practices, and to adopt them quickly, as is often the case in sport. Sport is the ultimate example of transparent results reporting, and the NHS ought to consider systematic reporting of risk-adjusted performance data, which may drive improved performance. The NHS should pay attention to the experiences of successful Olympic sports with centralised centres of excellence, and to medical data which suggests that better outcomes result from centres of excellence. The NHS and wider government should look to Olympic athletes and place more emphasis on prevention of disease by encouraging positive lifestyle choices. Finally, the NHS should develop private sector partnerships carefully. We must look to gather knowledge and ideas from every area of life in pursuit of excellence in the NHS. Experience of the Olympics offers a number of instructive lessons.

A model of organisational dysfunction in the NHS.

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Pope, Rachael

2013-01-01

This paper explores the reasons for the sometimes seemingly irrational and dysfunctional organisational behaviour within the NHS. It seeks to provide possible answers to the persistent historical problem of intimidating and negative behaviour between staff, and the sometimes inadequate organisational responses. The aim is to develop a model to explain and increase understanding of such behaviour in the NHS. This paper is conceptual in nature based upon a systematic literature review. The concepts of organisational silence, normalised organisational corruption, and protection of image, provide some possible answers for these dysfunctional responses, as does the theory of selective moral disengagement. The NHS exhibits too high a level of collective ego defences and protection of its image and self-esteem, which distorts its ability to address problems and to learn. Organisations and the individuals within them can hide and retreat from reality and exhibit denial; there is a resistance to voice and to "knowing". The persistence and tolerance of negative behaviour is a corruption and is not healthy or desirable. Organisations need to embrace the identity of a listening and learning organisation; a "wise" organisation. The "Elephant in the room" of persistent negative behaviour has to be acknowledged; the silence must be broken. There is a need for cultures of "respect", exhibiting "intelligent kindness". A model has been developed to increase understanding of dysfunctional organisational behaviour in the NHS primarily for leaders/managers of health services, health service regulators and health researchers/academics. Research, with ethical approval, is currently being undertaken to test and develop the conceptual model to further reflect the complexities of the NHS culture.

Medical Tourism: A Cost or Benefit to the NHS?

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Hanefeld, Johanna; Horsfall, Daniel; Lunt, Neil; Smith, Richard

2013-01-01

‘Medical Tourism’ – the phenomenon of people travelling abroad to access medical treatment - has received increasing attention in academic and popular media. This paper reports findings from a study examining effect of inbound and outbound medical tourism on the UK NHS, by estimating volume of medical tourism and associated costs and benefits. A mixed methods study it includes analysis of the UK International Passenger Survey (IPS); interviews with 77 returning UK medical tourists, 63 policymakers, NHS managers and medical tourism industry actors policymakers, and a review of published literature. These informed costing of three types of treatments for which patients commonly travel abroad: fertility treatment, cosmetic and bariatric surgery. Costing of inbound tourism relied on data obtained through 28 Freedom-of-Information requests to NHS Foundation Trusts. Findings demonstrate that contrary to some popular media reports, far from being a net importer of patients, the UK is now a clear net exporter of medical travellers. In 2010, an estimated 63,000 UK residents travelled for treatment, while around 52,000 patients sought treatment in the UK. Inbound medical tourists treated as private patients within NHS facilities may be especially profitable when compared to UK private patients, yielding close to a quarter of revenue from only 7% of volume in the data examined. Costs arise where patients travel abroad and return with complications. Analysis also indicates possible savings especially in future health care and social costs averted. These are likely to be specific to procedures and conditions treated. UK medical tourism is a growing phenomenon that presents risks and opportunities to the NHS. To fully understand its implications and guide policy on issues such as NHS global activities and patient safety will require investment in further research and monitoring. Results point to likely impact of medical tourism in other universal public health systems

Medical tourism: a cost or benefit to the NHS?

Directory of Open Access Journals (Sweden)

Johanna Hanefeld

Full Text Available 'Medical Tourism' - the phenomenon of people travelling abroad to access medical treatment - has received increasing attention in academic and popular media. This paper reports findings from a study examining effect of inbound and outbound medical tourism on the UK NHS, by estimating volume of medical tourism and associated costs and benefits. A mixed methods study it includes analysis of the UK International Passenger Survey (IPS; interviews with 77 returning UK medical tourists, 63 policymakers, NHS managers and medical tourism industry actors policymakers, and a review of published literature. These informed costing of three types of treatments for which patients commonly travel abroad: fertility treatment, cosmetic and bariatric surgery. Costing of inbound tourism relied on data obtained through 28 Freedom-of-Information requests to NHS Foundation Trusts. Findings demonstrate that contrary to some popular media reports, far from being a net importer of patients, the UK is now a clear net exporter of medical travellers. In 2010, an estimated 63,000 UK residents travelled for treatment, while around 52,000 patients sought treatment in the UK. Inbound medical tourists treated as private patients within NHS facilities may be especially profitable when compared to UK private patients, yielding close to a quarter of revenue from only 7% of volume in the data examined. Costs arise where patients travel abroad and return with complications. Analysis also indicates possible savings especially in future health care and social costs averted. These are likely to be specific to procedures and conditions treated. UK medical tourism is a growing phenomenon that presents risks and opportunities to the NHS. To fully understand its implications and guide policy on issues such as NHS global activities and patient safety will require investment in further research and monitoring. Results point to likely impact of medical tourism in other universal public health

Medical tourism: a cost or benefit to the NHS?

Science.gov (United States)

Hanefeld, Johanna; Horsfall, Daniel; Lunt, Neil; Smith, Richard

2013-01-01

'Medical Tourism' - the phenomenon of people travelling abroad to access medical treatment - has received increasing attention in academic and popular media. This paper reports findings from a study examining effect of inbound and outbound medical tourism on the UK NHS, by estimating volume of medical tourism and associated costs and benefits. A mixed methods study it includes analysis of the UK International Passenger Survey (IPS); interviews with 77 returning UK medical tourists, 63 policymakers, NHS managers and medical tourism industry actors policymakers, and a review of published literature. These informed costing of three types of treatments for which patients commonly travel abroad: fertility treatment, cosmetic and bariatric surgery. Costing of inbound tourism relied on data obtained through 28 Freedom-of-Information requests to NHS Foundation Trusts. Findings demonstrate that contrary to some popular media reports, far from being a net importer of patients, the UK is now a clear net exporter of medical travellers. In 2010, an estimated 63,000 UK residents travelled for treatment, while around 52,000 patients sought treatment in the UK. Inbound medical tourists treated as private patients within NHS facilities may be especially profitable when compared to UK private patients, yielding close to a quarter of revenue from only 7% of volume in the data examined. Costs arise where patients travel abroad and return with complications. Analysis also indicates possible savings especially in future health care and social costs averted. These are likely to be specific to procedures and conditions treated. UK medical tourism is a growing phenomenon that presents risks and opportunities to the NHS. To fully understand its implications and guide policy on issues such as NHS global activities and patient safety will require investment in further research and monitoring. Results point to likely impact of medical tourism in other universal public health systems.

Customer care in the NHS.

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Ruddick, Fred

2015-01-20

Viewing individuals in need of NHS care as customers has the potential to refocus the way their care is delivered. This article highlights some of the benefits of reframing the nurse-patient relationship in terms of customer care, and draws parallels between good customer care and the provision of high quality patient care in the NHS. It explores lessons to be learned from those who have studied the customer experience, which can be adapted to enhance the customer care experience within the health service. Developing professional expertise in the knowledge and skills that underpin good-quality interpersonal encounters is essential to improve the customer experience in health care and should be prioritised alongside the development of more technical skills. Creating a culture where emotional intelligence, caring and compassion are essential requirements for all nursing staff will improve patient satisfaction.

A novel NHS mutation causes Nance-Horan Syndrome in a Chinese family.

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Tian, Qi; Li, Yunping; Kousar, Rizwana; Guo, Hui; Peng, Fenglan; Zheng, Yu; Yang, Xiaohua; Long, Zhigao; Tian, Runyi; Xia, Kun; Lin, Haiying; Pan, Qian

2017-01-07

Nance-Horan Syndrome (NHS) (OMIM: 302350) is a rare X-linked developmental disorder characterized by bilateral congenital cataracts, with occasional dental anomalies, characteristic dysmorphic features, brachymetacarpia and mental retardation. Carrier females exhibit similar manifestations that are less severe than in affected males. Here, we report a four-generation Chinese family with multiple affected individuals presenting Nance-Horan Syndrome. Whole-exome sequencing combined with RT-PCR and Sanger sequencing was used to search for a genetic cause underlying the disease phenotype. Whole-exome sequencing identified in all affected individuals of the family a novel donor splicing site mutation (NM_198270: c.1045 + 2T > A) in intron 4 of the gene NHS, which maps to chromosome Xp22.13. The identified mutation results in an RNA processing defect causing a 416-nucleotide addition to exon 4 of the mRNA transcript, likely producing a truncated NHS protein. The donor splicing site mutation NM_198270: c.1045 + 2T > A of the NHS gene is the causative mutation in this Nance-Horan Syndrome family. This research broadens the spectrum of NHS gene mutations, contributing to our understanding of the molecular genetics of NHS.

Five-year workplace wellness intervention in the NHS

OpenAIRE

Blake, Holly; Zhou, Dingyuan; Batt, Mark E.

2013-01-01

aims:\\ud Poor health and well-being has been observed among NHS staff and has become a key focus in current public health policy. The objective of this study was to deliver and evaluate a five-year employee wellness programme aimed at improving the health and well-being of employees in a large NHS workplace.\\ud method:\\ud A theory-driven multi-level ecological workplace wellness intervention was delivered including health campaigns, provision of facilities and health-promotion activities to e...

Private patients in NHS hospitals: comparison of two sources of information.

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Williams, B T; Pearson, J

1999-03-01

The use of National Health Service (NHS) hospitals to treat private patients is debatable on the grounds of equity of access. Hospital Episodes Statistics (HES) annual reports are the only routine source of information on the scale of this activity. The accuracy of the information is doubted. This enquiry tested the completeness of HES data against information obtained directly from private patient unit managers. Managers of the 71 pay bed units in NHS hospitals in England were asked to supply from local registers and accounts the numbers of in-patients and day cases admitted in 1995-1996. Their reports were matched with the numbers of first consultant episodes for private in-patients and day cases shown for those hospitals in the HES data file for that year. Of the 71 units 62 responded; 53 of these gave usable data. The 53 included, and 18 excluded from the comparison, matched on median and range of bed numbers. Managers identified 16 per cent more total admissions than did HES, 62,572 against 54,131; 13 per cent more in-patient admissions, 39,776 against 35,319; and 21 per cent more day cases, 22,796 against 18,812. More total admissions were reported by managers of 38 pay bed units than were recorded in HES, fewer by 12, and equal numbers by three. Similar sized discrepancies were noted for in-patient admissions and day cases. Reasons for the under-reporting of private patients in HES included the use of separate patient administration systems for private patients with a failure to feed data to HES, and the omission of some provider units altogether by a minority of trusts from the returns made to the Department of Health. Overall, HES underestimates the amount of private patient activity reported directly by NHS hospitals. No method of validating private patient data is currently available. An amendment to an existing statistical return would provide a check on numbers. Central guidance on the inclusion of private patient activity in data transmitted by

Tackling racism in the NHS.

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Dean, Erin

2016-11-30

Essential facts Trade union Unite has developed a policy briefing on a new toolkit to combat racism in the NHS. It can help nurses and other staff tackle racial discrimination in health, with black and minority ethnic (BME) nurses often treated unequally compared with their white colleagues.

Hopewell Furnace NHS : alternative transportation study

Science.gov (United States)

2009-12-31

This study assesses the potential for an alternative transportation system (ATS) at Hopewell Furnace National Historic Site (NHS). The Volpe Center investigated internal circulation and potential partnerships with local historic, cultural, and recrea...

Modeling the impact of normative beliefs in the context of online buying: Direct and moderating effects

OpenAIRE

Iconaru Claudia

2012-01-01

Normative beliefs tend to play a significant role in the context of online buying, having both direct and moderating effects. The results of the structural equation modeling indicate a direct effect of normative beliefs on the intention to buy online. Also, the magnitude of the relationship between online trust and perceived risk depends on the level of normative beliefs, showing that the effect of online trust on perceived risk varies as a function of the level of the moderator variable. Thi...

Policy and organizational implications of gender imbalance in the NHS.

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Miller, Karen

2007-01-01

The purpose of the paper is to examine the policy and organizational implications of gender imbalance in management, which research suggests exists in the NHS. The research in this paper involved a qualitative approach with an analysis of elite interviews conducted with a non-random sample of officials involved in health policy and interviews with a random sample of senior managers in NHS Scotland. The research formed part of a larger study, which explored the enablers and inhibitors to female career progression in various Scottish sectors. The paper finds that gender imbalance in management exists in the NHS. This is manifested in a masculine organizational context, leadership and policy decision-making process, which have implications for female career advancement opportunities and subsequently access to macro policy decisions. The paper involved a sample (30 percent) of senior managers and examined policy processes in NHS Scotland. To improve the external validity of the findings further research should be conducted in NHS organizations in England and Wales. The findings in the paper suggest that gender imbalance in management and a masculine organizational context and leadership style within the NHS create a less than conducive environment for female employees. This has practical implications in terms of levels of part-time employment, career progression and attrition rates. The paper adds to the debate of gender and organizational studies by examining the health sector, which has high levels of female employment but low levels of female representation at senior management levels. The paper therefore adds to an often-neglected area of study, women in leadership and senior managerial positions. The paper is original in its approach by examining the micro and meso organizational dimensions which impact on women's ability to influence macro health policy.

Who uses NHS health checks? Investigating the impact of ethnicity and gender and method of invitation on uptake of NHS health checks.

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Cook, Erica J; Sharp, Chloe; Randhawa, Gurch; Guppy, Andy; Gangotra, Raj; Cox, Jonathon

2016-01-20

NHS Health Checks is a national risk assessment prevention programme for all individuals aged 40-74 that reside in England. Through the systematic assessment of an individual's ten year disease risk, this programme aims to provide early identification and subsequent management of this risk. However, there is limited evidence on how socio-demographic factors impact on uptake and what influence the invitation method has on uptake to this programme. NHS Health Check data from April 2013 to March 2014 was analysed (N = 50,485) for all 30 GP Practices in Luton, a culturally diverse town in England, UK. Data was collected for age, ethnicity, uptake (attendance and non attendance) and invitation method (letter written, verbal face-to-face, telephone). Actual usage of NHS Health Checks was determined for each ethnic group of the population and compared using Chi-square analysis. The overall uptake rate for Luton was 44 %, markedly lower that the set target of 50-75 %. The findings revealed a variation of uptake in relation to age, gender, level of deprivation. Ethnicity and gender variations were also found, with 'White British' 'Black Caribbean' and 'Indian' patients most likely to take up a NHS Health Check. However, patients from 'Any Other White Background' and 'Black African' were significantly less likely to uptake an NHS Health Check compared to all other ethnic groups. Ethnicity and gender differences were also noted in relation to invitation method. The findings revealed that different invitation methods were effective for different ethnic and gender groups. Therefore, it is suggested that established protocols of invitation are specifically designed for maximizing the response rate for each population group. Future research should now focus on uncovering the barriers to uptake in particular culturally diverse population groups to determine how public health teams can better engage with these communities.

Motivational Factors in Self-Directed Informal Learning from Online Learning Resources

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Song, Donggil; Bonk, Curtis J.

2016-01-01

Learning is becoming more self-directed and informal with the support of emerging technologies. A variety of online resources have promoted informal learning by allowing people to learn on demand and just when needed. It is significant to understand self-directed informal learners' motivational aspects, their learning goals, obstacles, and…

Complementary therapy use by patients and parents of children with asthma and the implications for NHS care: a qualitative study

Directory of Open Access Journals (Sweden)

Sharp Debbie

2006-06-01

Full Text Available Abstract Background Patients are increasingly using complementary therapies, often for chronic conditions. Asthma is the most common chronic condition in the UK. Previous research indicates that some asthma patients experience gaps in their NHS care. However, little attention has been given to how and why patients and parents of children with asthma use complementary therapies and the implications for NHS care. Methods Qualitative study, comprising 50 semi-structured interviews with a purposeful sample of 22 adults and 28 children with asthma (plus a parent, recruited from a range of NHS and non-NHS settings in Bristol, England. Data analysis was thematic, drawing on the principles of constant comparison. Results A range of complementary therapies were being used for asthma, most commonly Buteyko breathing and homeopathy. Most use took place outside of the NHS, comprising either self-treatment or consultation with private complementary therapists. Complementary therapies were usually used alongside not instead of conventional asthma treatment. A spectrum of complementary therapy users emerged, including "committed", "pragmatic" and "last resort" users. Motivating factors for complementary therapy use included concerns about conventional NHS care ("push factors" and attractive aspects of complementary therapies ("pull factors". While participants were often uncertain whether therapies had directly helped their asthma, breathing techniques such as the Buteyko Method were most notably reported to enhance symptom control and enable reduction in medication. Across the range of therapies, the process of seeking and using complementary therapies seemed to help patients in two broad ways: it empowered them to take greater personal control over their condition rather than feel dependant on medication, and enabled exploration of a broader range of possible causes of their asthma than commonly discussed within NHS settings. Conclusion Complementary therapy

Impact of case-mix on comparisons of patient-reported experience in NHS acute hospital trusts in England.

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Raleigh, Veena; Sizmur, Steve; Tian, Yang; Thompson, James

2015-04-01

To examine the impact of patient-mix on National Health Service (NHS) acute hospital trust scores in two national NHS patient surveys. Secondary analysis of 2012 patient survey data for 57,915 adult inpatients at 142 NHS acute hospital trusts and 45,263 adult emergency department attendees at 146 NHS acute hospital trusts in England. Changes in trust scores for selected questions, ranks, inter-trust variance and score-based performance bands were examined using three methods: no adjustment for case-mix; the current standardization method with weighting for age, sex and, for inpatients only, admission method; and a regression model adjusting in addition for ethnicity, presence of a long-term condition, proxy response (inpatients only) and previous emergency attendances (emergency department survey only). For both surveys, all the variables examined were associated with patients' responses and affected inter-trust variance in scores, although the direction and strength of impact differed between variables. Inter-trust variance was generally greatest for the unadjusted scores and lowest for scores derived from the full regression model. Although trust scores derived from the three methods were highly correlated (Kendall's tau coefficients 0.70-0.94), up to 14% of trusts had discordant ranks of when the standardization and regression methods were compared. Depending on the survey and question, up to 14 trusts changed performance bands when the regression model with its fuller case-mix adjustment was used rather than the current standardization method. More comprehensive case-mix adjustment of patient survey data than the current limited adjustment reduces performance variation between NHS acute hospital trusts and alters the comparative performance bands of some trusts. Given the use of these data for high-impact purposes such as performance assessment, regulation, commissioning, quality improvement and patient choice, a review of the long-standing method for analysing

Protein quantitation using Ru-NHS ester tagging and isotope dilution high-pressure liquid chromatography-inductively coupled plasma mass spectrometry determination.

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Liu, Rui; Lv, Yi; Hou, Xiandeng; Yang, Lu; Mester, Zoltan

2012-03-20

An accurate, simple, and sensitive method for the direct determination of proteins by nonspecies specific isotope dilution and external calibration high-performance liquid chromatography-inductively coupled plasma mass spectrometry (HPLC-ICPMS) is described. The labeling of myoglobin (17 kDa), transferrin (77 kDa), and thyroglobulin (670 kDa) proteins was accomplished in a single-step reaction with a commercially available bis(2,2'-bipyridine)-4'-methyl-4-carboxybipyridine-ruthenium N-succinimidyl ester-bis(hexafluorophosphate) (Ru-NHS ester). Using excess amounts of Ru-NHS ester compared to the protein concentration at optimized labeling conditions, constant ratios for Ru to proteins were obtained. Bioconjugate solutions containing both labeled and unlabeled proteins as well as excess Ru-NHS ester reagent were injected onto a size exclusion HPLC column for separation and ICPMS detection without any further treatment. A (99)Ru enriched spike was used for nonspecies specific ID calibration. The accuracy of the method was confirmed at various concentration levels. An average recovery of 100% ± 3% (1 standard deviation (SD), n = 9) was obtained with a typical precision of better than 5% RSD at 100 μg mL(-1) for nonspecies specific ID. Detection limits (3SD) of 1.6, 3.2, and 7.0 fmol estimated from three procedure blanks were obtained for myoglobin, transferrin, and thyroglobulin, respectively. These detection limits are suitable for the direct determination of intact proteins at trace levels. For simplicity, external calibration was also tested. Good linear correlation coefficients, 0.9901, 0.9921, and 0.9980 for myoglobin, transferrin, and thyroglobulin, respectively, were obtained. The measured concentrations of proteins in a solution were in good agreement with their volumetrically prepared values. To the best of our knowledge, this is the first application of nonspecies specific ID for the accurate and direct determination of proteins using a Ru-NHS ester

Five-year workplace wellness intervention in the NHS.

Science.gov (United States)

Blake, Holly; Zhou, Dingyuan; Batt, Mark E

2013-09-01

Poor health and well-being has been observed among NHS staff and has become a key focus in current public health policy. The objective of this study was to deliver and evaluate a five-year employee wellness programme aimed at improving the health and well-being of employees in a large NHS workplace. A theory-driven multi-level ecological workplace wellness intervention was delivered including health campaigns, provision of facilities and health-promotion activities to encourage employees to make healthy lifestyle choices and sustained behaviour changes. An employee questionnaire survey was distributed at baseline (n = 1,452) and at five years (n = 1,134), including measures of physical activity, BMI, diet, self-efficacy, social support, perceived general health and mood, smoking behaviours, self-reported sickness absence, perceived work performance and job satisfaction. Samples were comparable at baseline and follow-up. At five years, significantly more respondents actively travelled (by walking or cycling both to work and for non-work trips) and more were active while at work. Significantly more respondents met current recommendations for physical activity at five years than at baseline. Fewer employers reported 'lack of time' as a barrier to being physically active following the intervention. Significantly lower sickness absence, greater job satisfaction and greater organisational commitment was reported at five years than at baseline. Improvements in health behaviours, reductions in sickness absence and improvements in job satisfaction and organisational commitment were observed following five years of a workplace wellness intervention for NHS employees. These findings suggest that health-promoting programmes should be embedded within NHS infrastructure.

Efficiency in pathology laboratories: a survey of operations management in NHS bacteriology.

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Szczepura, A K

1991-01-01

In recent years pathology laboratory services in the U.K. have experienced large increases in demand. But the extent to which U.K. laboratories have introduced controls to limit unnecessary procedures within the laboratory was previously unclear. This paper presents the results of a survey of all 343 NHS bacteriology laboratories which records the extent to which such operations management controls are now in place. The survey shows large differences between laboratories. Quality controls over inputs, the use of screening tests as a culture substitute, the use of direct susceptibility testing, controls over routine antibiotic susceptibility testing, and controls over reporting of results all vary widely. The survey also records the prevalence of hospital antibiotic policies, the extent to which laboratories produce antibiograms for user clinicians, the degree of computerisation in data handling, and the degree of automation in processing specimens. Finally, the survey uncovers a large variation between NHS labs in the percentage of bacteriology samples which prove positive and lead to antibiotic susceptibility tests being carried out.

How does the outcome of research training fellowships funded via the NHS compare with that from competitively funded fellowships from the MRC and other charities: a cross-sectional retrospective survey of trainees undertaking research training in the West Midlands.

Science.gov (United States)

Maybury, Charlotte; Morgan, Matthew David; Smith, Russell; Harper, Lorraine

2018-01-23

This study aimed to investigate the impact of research training funded via the National Health Service (NHS) on medical trainees compared with traditional clinical research training fellowships (CRTFs). Online survey of 221 clinical trainees who had completed a period of research during their clinical training between 2009 and 2015 in the West Midlands. Research outcomes. Overall response rate was 59%, of whom 72 participants were funded by CRTFs and 51 funded by the NHS. Although participants with CRTFs were more likely to be awarded a higher degree compared with those on NHS-administered funding (66/72 CRTFs and 37/51 NHS, P=0.005), similar proportions of NHS-funded and CRTF-funded participants entered clinical lecturer posts on completing initial research training (8/51 NHS and 16/72 CRTF, P=0.37). 77% of participants had three or more publications (CRTF 57 and NHS 39, P=0.72). 57 participants had completed clinical training; similar proportions of CRTF-funded and NHS-funded trainees had research included in their consultant contract (12/22 NHS and 14/26 CRTF, P=0.96) or were appointed to academic posts (3 of 25 NHS funded and 6 of 32 CRTF, P>0.05). 95% of participants would recommend to colleagues and 82% of participants felt the research experience improved their provision of clinical care with no difference between CRTF-funded and NHS-funded participants (P=0.49). Continuing to participate in clinical work during the research reduced reports of trainee difficulty on returning to clinical work (23/108 continued clinical work vs 12/22 no clinical work, P=0.001). Research training funded by the NHS provides a quality experience and contributes to the clinical academic capacity within the UK. More needs to be done to support NHS participants to successfully achieve a higher degree. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly

Approaches to leadership and managing change in the NHS.

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Lumbers, Melanie

2018-05-24

The NHS is continually changing as research evidence leads to new practices and technology transforms the workplace. Resistance to some changes may occur because of staff fears about adapting to and coping with new methods. This is where change models and leadership are important. This article discusses changes taking place in the NHS, and some theoretical models of change. Leadership styles are also discussed, including those most useful for the nurse to use when leading a team and implementing change.

Disconfirming User Expectations of the Online Service Experience: Inferred versus Direct Disconfirmation Modeling.

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O'Neill, Martin; Palmer, Adrian; Wright, Christine

2003-01-01

Disconfirmation models of online service measurement seek to define service quality as the difference between user expectations of the service to be received and perceptions of the service actually received. Two such models-inferred and direct disconfirmation-for measuring quality of the online experience are compared (WebQUAL, SERVQUAL). Findings…

Job evaluation for clinical nursing jobs by implementing the NHS JE system.

Science.gov (United States)

Kahya, Emin; Oral, Nurten

2007-10-01

The purpose of this paper was to evaluate locally all the clinical nursing jobs implementing the NHS JE system in four hospitals. The NHS JE was developed by the Department of Health in the UK in 2003-2004. A job analysis questionnaire was designed to gather current job descriptions. It was distributed to each of 158 clinical nurses and supervisor nurses in 31 variety clinics at four hospitals in one city. The questionnaires were analysed to evaluate locally all the identified 94 nursing jobs. Fourteen of 19 nursing jobs in the medical and surgical clinics can be matched to the nurse national job in the NHS JE system. The results indicated that two new nursing jobs titled nurse B and nurse advanced B should be added to the list of national nursing jobs in the NHS JE system.

Refinement of the X-linked cataract locus (CXN) and gene analysis for CXN and Nance-Horan syndrome (NHS).

Science.gov (United States)

Brooks, Simon; Ebenezer, Neil; Poopalasundaram, Subathra; Maher, Eamonn; Francis, Peter; Moore, Anthony; Hardcastle, Alison

2004-06-01

The X-linked congenital cataract (CXN) locus has been mapped to a 3-cM (approximately 3.5 Mb) interval on chromosome Xp22.13, which is syntenic to the mouse cataract disease locus Xcat and encompasses the recently refined Nance-Horan syndrome (NHS) locus. A positional cloning strategy has been adopted to identify the causative gene. In an attempt to refine the CXN locus, seven microsatellites were analysed within 21 individuals of a CXN family. Haplotypes were reconstructed confirming disease segregation with markers on Xp22.13. In addition, a proximal cross-over was observed between markers S3 and S4, thereby refining the CXN disease interval by approximately 400 Kb to 3.2 Mb, flanked by markers DXS9902 and S4. Two known genes (RAI2 and RBBP7) and a novel gene (TL1) were screened for mutations within an affected male from the CXN family and an NHS family by direct sequencing of coding exons and intron- exon splice sites. No mutations or polymorphisms were identified, therefore excluding them as disease-causative in CXN and NHS. In conclusion, the CXN locus has been successfully refined and excludes PPEF1 as a candidate gene. A further three candidates were excluded based on sequence analysis. Future positional cloning efforts will focus on the region of overlap between CXN, Xcat, and NHS.

International patients within the NHS: a case of public sector entrepreneurialism.

Science.gov (United States)

Lunt, Neil; Exworthy, Mark; Hanefeld, Johanna; Smith, Richard D

2015-01-01

Many public health systems in high- and middle-income countries are under increasing financial pressures as a result of ageing populations, a rise in chronic and non-communicable diseases and shrinking public resources. At the same time the rise in patient mobility and concomitant market in medical tourism provides opportunities for additional income. This is especially the case where public sector hospitals have a reputation as global centres of excellence. Yet, this requires public sector entrepreneurship which, given the unique features of the public sector, means a change to professional culture. This paper examines how and under what conditions public sector entrepreneurship develops, drawing on the example of international patients in the UK NHS. It reports on a subset of data from a wider study of UK medical tourism, and explores inward flows and NHS responses through the lens of public entrepreneurship. Interviews in the English NHS were conducted with managers of Foundation Trusts with interest in international patient work. Data is from seven Foundation Trusts, based on indepth, semi-structured interviews with a range of NHS managers, and three other key stakeholders (n = 16). Interviews were analysed using a framework on entrepreneurship developed from academic literature. Empirical findings showed that Trust managers were actively pursuing a strategy of expanding international patient activity. Respondents emphasised that this was in the context of the current financial climate for the NHS. International patients were seen as a possible route to ameliorating pressure on stretched NHS resources. The analysis of interviews revealed that public entrepreneurial behaviour requires an organisational managerial or political context in order to develop, such as currently in the UK. Public sector workers engaged in this process develop entrepreneurship - melding political, commercial and stakeholder insights - as a coping mechanism to health system constraints

Xcat, a novel mouse model for Nance-Horan syndrome inhibits expression of the cytoplasmic-targeted Nhs1 isoform.

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Huang, Kristen M; Wu, Junhua; Duncan, Melinda K; Moy, Chris; Dutra, Amalia; Favor, Jack; Da, Tong; Stambolian, Dwight

2006-01-15

Nance-Horan syndrome (NHS) is an X-linked disorder characterized by congenital cataracts, dental anomalies, dysmorphic features and mental retardation. A recent report suggests that the novel gene NHS1 is involved in this disorder due to the presence of point mutations in NHS patients. A possible mouse model for NHS, Xcat, was mapped to a 2.11 Mb interval on the X-chromosome. Sequence and FISH analysis of the X-chromosome region containing the Xcat mutation reveal a large insertion between exons 1 and 2 of the mouse Nhs1 gene. The insertion inhibits the expression of the Nhs1 isoform containing exon 1 and results in exclusive expression of the alternative isoform containing exon 1A. Quantitative RT-PCR of Xcat cDNA shows reduced levels of Nhs1 transcripts. The Nhs1 protein is strongly expressed within the cytoplasm of elongating lens fiber cells from wild-type neonate lens, but is significantly reduced within the Xcat lens. Transient transfection studies of CHO cells with Nhs1-GFP fusion proteins were done to determine whether the amino acids encoded by exon 1 were critical for protein localization. We found the presence of Nhs1 exon 1 critical for localization of the fusion protein to the cytoplasm, whereas fusion proteins lacking Nhs1 exon 1 are predominantly nuclear. These results indicate that the first exon of Nhs1 contains crucial information required for the proper expression and localization of Nhs1 protein. Inhibition of expression of the exon 1 containing isoform results in the abnormal phenotype of Xcat.

The fallacy of choice in the common law and NHS policy.

Science.gov (United States)

Whiteman, Ingrid

2013-06-01

Neither the English courts nor the National Health Service (NHS) have been immune to the modern mantra of patient choice. This article examines whether beneath the rhetoric any form of real choice is endorsed either in law or in NHS policy. I explore the case law on 'consent', look at choice within the NHS and highlight the dilemmas that a mismatch of language and practice poses for clinicians. Given the variance in interpretation and lack of consistency for the individual patient I argue for a semantic change that obviates the use of 'choice', focussing instead on the options for treatment that are available and accessible, with due acknowledgement of individual patient preferences, without raising unfettered and false expectations.

Self-rostering can improve work-life balance and staff retention in the NHS.

Science.gov (United States)

Barrett, Renee; Holme, Annie

2018-03-08

Renee Barrett, Staff Nurse, ITU, Great Ormond Street Hospital NHS Trust, renee.barrett@gosh.nhs.uk , and Annie Holme, Lecturer, King's College London, look at how e-rostering can benefit health organisations and staff.

Comparing Person-Centered Communication Education in Long-Term Care Using Onsite and Online Formats.

Science.gov (United States)

Coleman, Carissa K; Fanning, Kim; Williams, Kristine N

2015-11-01

Educating nursing home (NH) staff to provide person-centered care is complicated by scheduling, costs, and other feasibility issues. The current study compared outcomes for an in-service program focused on person-centered communication provided in onsite and online formats. The Changing Talk program was provided onsite in seven NHs (n = 327 staff). The online program included eight NHs (n = 211 staff). Analysis of variance revealed an interaction between format type and pre-/post-test scores with improved recognition of person-centered communication in the onsite group only. Group program evaluations based on the modified Diffusion of Innovation in Long-Term Care Battery indicated no significant differences between training formats. Staff perception of the program was similar. Although statistically significant gains were noted in posttest scores indicating awareness of person-centered communication for the onsite group, gains were of limited clinical significance. Feasibility and effectiveness are important considerations for in-service education supporting NH culture change. Copyright 2015, SLACK Incorporated.

Clinical psychologists' experiences of NHS organisational change

OpenAIRE

Colley, Rich; Eccles, Fiona; Hutton, Cheryl

2015-01-01

Organisational-change experiences of eight clinical psychologists working in the NHS were captured. Three themes revealed the challenges they experienced and how their knowledge and skills have helped them understand, cope with, and respond to change.

Novel causative mutations in patients with Nance-Horan syndrome and altered localization of the mutant NHS-A protein isoform

OpenAIRE

Sharma, Shiwani; Burdon, Kathryn P.; Dave, Alpana; Jamieson, Robyn V.; Yaron, Yuval; Billson, Frank; Van Maldergem, Lionel; Lorenz, Birgit; Gécz, Jozef; Craig, Jamie E.

2008-01-01

Purpose Nance-Horan syndrome is typically characterized by severe bilateral congenital cataracts and dental abnormalities. Truncating mutations in the Nance-Horan syndrome (NHS) gene cause this X-linked genetic disorder. NHS encodes two isoforms, NHS-A and NHS-1A. The ocular lens expresses NHS-A, the epithelial and neuronal cell specific isoform. The NHS-A protein localizes in the lens epithelium at the cellular periphery. The data to date suggest a role for this isoform at cell-cell junction...

The NHS and market forces in healthcare: the need for organisational ethics.

Science.gov (United States)

Frith, Lucy

2013-01-01

The NHS in England is an organisation undergoing substantial change. The passage of the Health and Social Care Act 2012, consolidates and builds on previous health policies and introduces further 'market-style' reforms of the NHS. One of the main aspects of these reforms is to encourage private and third sector providers to deliver NHS services. The rationale for this is to foster a more competitive market in healthcare to encourage greater efficiency and innovation. This changing healthcare environment in the English NHS sharpens the need for attention to be paid to the ethical operation of healthcare organisations. All healthcare organisations need to consider the ethical aspects of their operation, whether state or privately run. However, the changes in the type of organisations used to provide healthcare (such as commercial companies) can create new relationships and ethical tensions. This paper will chart the development of organisational ethics as a concern in applied ethics and how it arose in the USA largely owing to changes in the organisation of healthcare financing and provision. It will be argued that an analogous transition is happening in the NHS in England. The paper will conclude with suggestions for the development of organisational ethics programmes to address some of the possible ethical issues raised by this new healthcare environment that incorporates both private and public sector providers.

Online learning in dentistry: an overview of the future direction for dental education.

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Schönwetter, D J; Reynolds, P A; Eaton, K A; De Vries, J

2010-12-01

This paper provides an overview of the diversity of tools available for online learning and identifies the drivers of online learning and directives for future research relating to online learning in dentistry. After an introduction and definitions of online learning, this paper considers the democracy of knowledge and tools and systems that have democratized knowledge. It identifies assessment systems and the challenges of online learning. This paper also identifies the drivers for online learning, including those for instructors, administrators and leaders, technology innovators, information and communications technology personnel, global dental associations and government. A consideration of the attitudes of the stakeholders and how they might work together follows, using the example of the unique achievement of the successful collaboration between the Universities of Adelaide, Australia and Sharjah, United Arab Emirates. The importance of the interaction of educational principles and research on online learning is discussed. The paper ends with final reflections and conclusions, advocating readers to move forward in adopting online learning as a solution to the increasing worldwide shortage of clinical academics to teach dental clinicians of the future. © 2010 Blackwell Publishing Ltd.

Directing the public to evidence-based online content.

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Cooper, Crystale Purvis; Gelb, Cynthia A; Vaughn, Alexandra N; Smuland, Jenny; Hughes, Alexandra G; Hawkins, Nikki A

2015-04-01

To direct online users searching for gynecologic cancer information to accurate content, the Centers for Disease Control and Prevention's (CDC) 'Inside Knowledge: Get the Facts About Gynecologic Cancer' campaign sponsored search engine advertisements in English and Spanish. From June 2012 to August 2013, advertisements appeared when US Google users entered search terms related to gynecologic cancer. Users who clicked on the advertisements were directed to relevant content on the CDC website. Compared with the 3 months before the initiative (March-May 2012), visits to the CDC web pages linked to the advertisements were 26 times higher after the initiative began (June-August 2012) (padvertisements were supplemented with promotion on television and additional websites (September 2012-August 2013) (padvertisements can direct users to evidence-based content at a highly teachable moment--when they are seeking relevant information. © The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Do expanded seven-day NHS services improve clinical outcomes? Analysis of comparative institutional performance from the ?NHS Services, Seven Days a Week? project 2013?2016

OpenAIRE

Gan, Hoong-Wei; Wong, Danny Jon Nian; Dean, Benjamin John Floyd; Hall, Alistair Scott

2017-01-01

Background The cause of adverse weekend clinical outcomes remains unknown. In 2013, the ?NHS Services, Seven Days a Week? project was initiated to improve access to services across the seven-day week. Three years on, we sought to analyse the impact of such changes across the English NHS. Methods Aggregated trust-level data on crude mortality rates, Summary Hospital-Level Mortality Indicator (SHMI), mean length of stay (LOS), A&E admission and four-hour breach rates were obtained from national...

Do expanded seven-day NHS services improve clinical outcomes? Analysis of comparative institutional performance from the "NHS Services, Seven Days a Week" project 2013-2016

OpenAIRE

Gan, H-W; Wong, D. J. N.; Dean, B. J. F.; Hall, A. S.

2017-01-01

Background: The cause of adverse weekend clinical outcomes remains unknown. In 2013, the “NHS Services, Seven Days a Week” project was initiated to improve access to services across the seven-day week. Three years on, we sought to analyse the impact of such changes across the English NHS. Methods: Aggregated trust-level data on crude mortality rates, Summary Hospital-Level Mortality Indicator (SHMI), mean length of stay (LOS), A&E admission and four-hour breach rates were obtained f...

Provider diversity in the English NHS: a study of recent developments in four local health economies.

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Allen, Pauline; Turner, Simon; Bartlett, Will; Perotin, Virginie; Matchaya, Greenwell; Zamora, Bernarda

2012-01-01

To assess the impact of provider diversity on quality and innovation in the English NHS by mapping the extent of diverse provider activity and identifying the differences in performance between Third Sector Organisations (TSOs), for-profit private enterprises, and incumbent organizations within the NHS, and the factors that affect the entry and growth of new providers. Case studies of four local health economies. Data included: semi-structured interviews with 48 managerial and clinical staff from NHS organizations and providers from the private and third sector; some documentary evidence; a focus group with service users; and routine data from the Care Quality Commission and Companies House. Data collection was mainly between November 2008 and November 2009. Involvement of diverse providers in the NHS is limited. Commissioners' local strategies influence degrees of diversity. Barriers to entry for TSOs include lack of economies of scale in the bidding process. Private providers have greater concern to improve patient pathways and patient experience, whereas TSOs deliver quality improvements by using a more holistic approach and a greater degree of community involvement. Entry of new providers drives NHS trusts to respond by making improvements. Information sharing diminishes as competition intensifies. There is scope to increase the participation of diverse providers in the NHS but care must be taken not to damage public accountability, overall productivity, equity and NHS providers (especially acute hospitals, which are likely to remain in the NHS) in the process.

Online, directed journaling in community health advanced practice nursing clinical education.

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Daroszewski, Ellen Beth; Kinser, Anita G; Lloyd, Susan L

2004-04-01

The sharing of experiences in advanced practice nursing clinical courses allows for application of core principals to different facets of practice, with the potential to promote discussions beyond the course objectives, create opportunities for mentoring, foster critical thinking, and facilitate change and socialization into advanced practice. A pilot test of online, directed journaling, an innovative sharing and reflection strategy, was incorporated in a two-quarter community health advanced practice nursing clinical course in an attempt to enhance clinical learning. Six female graduate nursing students completed the journaling. A 10-item evaluation measure demonstrated that the online journaling strategy was highly effective and valuable for the students. An assessment of the journaling entries found multiple examples of discussion, mentoring, critical thinking, and socialization. Innovative online strategies should become the standard for sharing in advanced practice nursing education.

Differential biotin labelling of the cell envelope proteins in lipopolysaccharidic diderm bacteria: Exploring the proteosurfaceome of Escherichia coli using sulfo-NHS-SS-biotin and sulfo-NHS-PEG4-bismannose-SS-biotin.

Science.gov (United States)

Monteiro, Ricardo; Chafsey, Ingrid; Leroy, Sabine; Chambon, Christophe; Hébraud, Michel; Livrelli, Valérie; Pizza, Mariagrazia; Pezzicoli, Alfredo; Desvaux, Mickaël

2018-06-15

Surface proteins are the major factor for the interaction between bacteria and its environment, playing an important role in infection, colonisation, virulence and adaptation. However, the study of surface proteins has proven difficult mainly due to their hydrophobicity and/or relatively low abundance compared with cytoplasmic proteins. To overcome these issues new proteomic strategies have been developed, such as cell-surface protein labelling using biotinylation reagents. Sulfo-NHS-SS-biotin is the most commonly used reagent to investigate the proteins expressed at the cell surface of various organisms but its use in lipopolysaccharidic diderm bacteria (archetypical Gram-negative bacteria) remains limited to a handful of species. While generally pass over in silence, some periplasmic proteins, but also some inner membrane lipoproteins, integral membrane proteins and cytoplasmic proteins (cytoproteins) are systematically identified following this approach. To limit cell lysis and diffusion of the sulfo-NHS-SS-biotin through the outer membrane, biotin labelling was tested over short incubation times and proved to be as efficient for 1 min at room temperature. To further limit labelling of protein located below the outer membrane, the use of high-molecular weight sulfo-NHS-PEG4-bismannose-SS-biotin appeared to recover differentially cell-envelope proteins compared to low-molecular weight sulfo-NHS-SS-biotin. Actually, the sulfo-NHS-SS-biotin recovers at a higher extent the proteins completely or partly exposed in the periplasm than sulfo-NHS-PEG4-bismannose-SS-biotin, namely periplasmic and integral membrane proteins as well as inner membrane and outer membrane lipoproteins. These results highlight that protein labelling using biotinylation reagents of different sizes provides a sophisticated and accurate way to differentially explore the cell envelope proteome of lipopolysaccharidic diderm bacteria. While generally pass over in silence, some periplasmic proteins

Market--what market? A review of Health Authority purchasing in the NHS internal market.

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West, P A

1998-05-01

This paper argues that the British NHS Reforms (the 'Reforms') set out in Working for Patients [1] largely failed to create a market, to achieve the changes that market forces might have been expected to achieve or to meet the objectives set for the NHS in Working for Patients. It draws on the available literature and the author's experience of work with the NHS during the 6 years after Working for Patients. It is hampered, as are all such reviews of the UK Reforms, by the lack of a detailed and systematic research appraisal of the internal market. Many small changes, resulting from market mechanisms, may have occurred throughout the NHS without being publicized or well documented. But overall, there is little convincing evidence that the Reforms have achieved their goals or met the objectives of the politicians who initiated them. The argument here is necessarily limited by the space available (but see [2] for a detailed analysis of the NHS Reforms). The initial sections of the paper examine the characteristics of markets and market power and the extent to which the NHS Reforms created a market, with health authorities and fund-holders as its buyers. The paper concentrates in particular on health authorities. Later sections then examine the extent to which the Reforms met the objectives set out in Working for Patients.

Do NHS walk-in centres in England provide a model of integrated care?

Directory of Open Access Journals (Sweden)

C. Salisbury

2003-08-01

Full Text Available Purpose: To undertake a comprehensive evaluation of NHS walk-in centres against criteria of improved access, quality, user satisfaction and efficiency. Context: Forty NHS walk-in centres have been opened in England, as part of the UK governments agenda to modernise the NHS. They are intended to improve access to primary care, provide high quality treatment at convenient times, and reduce inappropriate demand on other NHS providers. Care is provided by nurses rather than doctors, using computerised algorithms, and nurses use protocols to supply treatments previously only available from doctors. Data sources: Several linked studies were conducted using different sources of data and methodologies. These included routinely collected data, site visits, patient interviews, a survey of users of walk-in centres, a study using simulated patients to assess quality of care, analysis of consultation rates in NHS services near to walk-in centres, and audit of compliance with protocols. Conclusion & discussion: The findings illustrate many of the issues described in a recent WHO reflective paper on Integrated Care, including tensions between professional judgement and use of protocols, problems with incompatible IT systems, balancing users' demands and needs, the importance of understanding health professionals' roles and issues of technical versus allocative efficiency.

NHS constitution values for values-based recruitment: a virtue ethics perspective.

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Groothuizen, Johanna Elise; Callwood, Alison; Gallagher, Ann

2018-05-17

Values-based recruitment is used in England to select healthcare staff, trainees and students on the basis that their values align with those stated in the Constitution of the UK National Health Service (NHS). However, it is unclear whether the extensive body of existing literature within the field of moral philosophy was taken into account when developing these values. Although most values have a long historical tradition, a tendency to assume that they have just been invented, and to approach them uncritically, exists within the healthcare sector. Reflection is necessary. We are of the opinion that selected virtue ethics writings, which are underpinned by historical literature as well as practical analysis of the healthcare professions, provide a helpful framework for evaluation of the NHS Constitution values, to determine whether gaps exist and improvements can be made. Based on this evaluation, we argue that the definitions of certain NHS Constitution values are ambiguous. In addition to this, we argue that 'integrity' and 'practical wisdom', two important concepts in the virtue ethics literature, are not sufficiently represented within the NHS Constitution values. We believe that the NHS Constitution values could be strengthened by providing clearer definitions, and by integrating 'integrity' and 'practical wisdom'. This will benefit values-based recruitment strategies. Should healthcare policy-makers in other countries wish to develop a similar values-based recruitment framework, we advise that they proceed reflectively, and take previously published virtue ethics literature into consideration. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The early NHS and the crisis of public health nursing.

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Webster, C

2000-01-01

Establishment of the NHS in 1948 is rightly seen as a major turning point in health care in the United Kingdom. Notwithstanding conditions of severe austerity, the NHS succeeded remarkably well in its basic remit to make all essential medical care available to the entire population, free at point of delivery. The benefits of the new system extended across the entire front of its services. However, it is important to recognise that the reforms of 1948 were uniformly advantageous. It has for instance long been recognised that the NHS failed to bring about the expected transformation in standards of general medical practice. In this short paper the author argues that public health represented a further major sphere of underdevelopment. The fact that, with minor exceptions, public health is the least studied aspect of the early NHS is itself suggestive of its status as the Cinderella of the modern health services. The author also underlines the adverse implications of this inferior position for domiciliary midwifery, district nursing and health visiting. These constituted small but strategically important sectors of nursing, all of which fell under public health administration in the new health service. The author concentrates on the first phase of the NHS, the period between 1948 and 1974, now often regarded as its golden age. For the purposes of this discussion, most of the evidence relates to the formative phase of the new service, when many major policy questions relating to public health were first confronted. It is suggested that the early neglect of public health and its constituent nursing functions has left a legacy of problems that have still not entirely been resolved. For the purposes of this paper the term will be used to embrace the totality of health functions administered by departments of local government in the period from 1948 to 1974. Most of these services fell within the public health departments of local government, headed by the Medical Office

Fluorescence studies on the aggregation behaviors of collagen modified with NHS-activated poly(γ-glutamic acid).

Science.gov (United States)

Zhang, Min; Yang, Junhui; Yang, Qili; Huang, Liulian; Wu, Hui; Chen, Lihui; Ding, Cuicui

2018-06-01

The poly(γ-glutamic acid)-NHS (γ-PGA-NHS) esters were used to endow collagen with both of excellent water-solubility and thermal stability via cross-linking reaction between γ-PGA-NHS and collagen. In the present work, the effect of γ-PGA-NHS on the aggregation of collagen molecules was studied by fluorescence techniques. The fluorescence emission spectra of pyrene in collagen solutions and the intrinsic fluorescence emission spectra of collagen suggested different effects of γ-PGA-NHS on collagen molecules: inhibiting aggregation below critical aggregation concentration (CAC) and promoting aggregation above CAC. The two-dimensional (2D) fluorescence correlation spectra indicated that the intermolecular hydrogen bonding and cross-linking between γ-PGA-NHS and collagen would influence the aggregation of collagen molecules. By the ultra-sensitive differential scanning calorimeter (VP-DSC), it was found that the main denaturational transition temperature (T m2 ) of modified collagen increased, while its calorimetric enthalpy changes (ΔH 2 ) decreased compared to those of native collagen, further indicating that the modification of γ-PGA-NHS influenced the aggregation of collagen molecules. The study provide useful information for the utilizing and or the processing of water-soluble collagen in aqueous solution in the fields such as cosmetics, health care products, tissue engineering and biomedical materials, etc. Copyright © 2018 Elsevier B.V. All rights reserved.

The NHS: assessing new technologies, NICE and value for money.

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Stevens, A; Chalkidou, K; Littlejohns, P

2011-06-01

The healthcare system in the UK, essentially the NHS, is an open economic system subject to the same pressures as any other economic system. The pressures concern limited resources coupled with powerful drivers for increasing spending: invention, demography and inflation. There have only ever been three types of economic system: steady state (everything, as in a feudal system, stays as it was the year before), market capitalism (supply and demand are allowed to find their own equilibrium) and some version of central planning. In healthcare, most advanced countries favour the last of the three. This is for three reasons: distribution (not only are the poor less able to pay for sickness, but sickness exacerbates poverty), information (markets operate poorly when providers can easily outsmart customers) and externalities (it is in the interest of everyone that infectious diseases and the other knock-on consequences of ill health are ameliorated). So in the UK, the state, with a good deal of cross-party consensus, directs most of health service supply. This system has become more complex over the decades since the formation of the NHS in 1948. A notable element of the complexity is the regulation of the introduction of new technologies. A key element of the regulatory system has been the National Institute for Health and Clinical Excellence (NICE), and a key aspect of NICE's decisions has been not just value, but also value for money. This has not been without controversy.

Can Six Sigma be the "cure" for our "ailing" NHS?

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Antony, Jiju; Downey-Ennis, Kay; Antony, Frenie; Seow, Chris

2007-01-01

The purpose of this research is to analyse whether Six Sigma business strategy can be used to improve the financial and operational performance of the NHS. The paper will also look at some of the major challenges and barriers in the implementation of this powerful process improvement strategy within the healthcare sector. This paper discusses whether Six Sigma DMAIC methodology can be a useful and disciplined approach to tackle process- and quality-related problems in the NHS. The paper presents some key findings from other researchers in the field, followed by some comments on whether Six Sigma is a useful approach to be considered by the NHS for cost reduction and defect reduction strategies. The paper illustrates the point that Six Sigma is not confined just to manufacturing industry, rather it is equally applicable to service industry, especially the healthcare and financial sectors. The application of Six Sigma in the UK health sector is relatively new and the purpose of the paper is to increase the awareness of this powerful business strategy in healthcare discipline.

Novel causative mutations in patients with Nance-Horan syndrome and altered localization of the mutant NHS-A protein isoform.

Science.gov (United States)

Sharma, Shiwani; Burdon, Kathryn P; Dave, Alpana; Jamieson, Robyn V; Yaron, Yuval; Billson, Frank; Van Maldergem, Lionel; Lorenz, Birgit; Gécz, Jozef; Craig, Jamie E

2008-01-01

Nance-Horan syndrome is typically characterized by severe bilateral congenital cataracts and dental abnormalities. Truncating mutations in the Nance-Horan syndrome (NHS) gene cause this X-linked genetic disorder. NHS encodes two isoforms, NHS-A and NHS-1A. The ocular lens expresses NHS-A, the epithelial and neuronal cell specific isoform. The NHS-A protein localizes in the lens epithelium at the cellular periphery. The data to date suggest a role for this isoform at cell-cell junctions in epithelial cells. This study aimed to identify the causative mutations in new patients diagnosed with Nance-Horan syndrome and to investigate the effect of mutations on subcellular localization of the NHS-A protein. All coding exons of NHS were screened for mutations by polymerase chain reaction (PCR) and sequencing. PCR-based mutagenesis was performed to introduce three independent mutations in the NHS-A cDNA. Expression and localization of the mutant proteins was determined in mammalian epithelial cells. Truncating mutations were found in 6 out of 10 unrelated patients from four countries. Each of four patients carried a novel mutation (R248X, P264fs, K1198fs, and I1302fs), and each of the two other patients carried two previously reported mutations (R373X and R879X). No mutation was found in the gene in four patients. Two disease-causing mutations (R134fs and R901X) and an artificial mutation (T1357fs) resulted in premature truncation of the NHS-A protein. All three mutant proteins failed to localize to the cellular periphery in epithelial cells and instead were found in the cytoplasm. This study brings the total number of mutations identified in NHS to 18. The mislocalization of the mutant NHS-A protein, revealed by mutation analysis, is expected to adversely affect cell-cell junctions in epithelial cells such as the lens epithelium, which may explain cataractogenesis in Nance-Horan syndrome patients. Mutation analysis also shed light on the significance of NHS-A regions for

Barking, Havering and Redbridge University Hospitals NHS Trust Fellowships in Clinical Leadership Programme

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Miani, Celine; Marjanovic, Sonja; Jones, Molly Morgan; Marshall, Martin; Meikle, Samantha; Nolte, Ellen

2013-01-01

Abstract Leadership is seen to be central to improving the quality of healthcare and existing research suggests that absence of leadership is related to poor quality and safety performance. Leadership training might therefore provide an important means through which to promote quality improvement and, more widely, performance within the healthcare environment. This article presents an evaluation of the Fellowships in Clinical Leadership Programme, which combines leadership training and quality improvement initiatives with the placement of temporary external clinical champions in Barking, Havering and Redbridge University Hospitals NHS Trust. We assessed impacts of the Programme on individual and organisational change, alongside core enablers and barriers for Programme success. Analyses drew on the principles of a theory-of-change-led realist evaluation, using logic modelling to specify the underlying causal mechanisms of the Programme. Data collection involved a stakeholder workshop, online questionnaires of programme participants, senior managers and support staff (n=114), and follow-up in-depth semi-structured interviews with a subsample of survey participants (n=15). We observed that the Programme had notable impacts at individual and organisational levels. Examples of individual impact included enhanced communication and negotiation skills or increased confidence as a result of multi-modal leadership training. At the organisational level, participants reported indications of behaviour change among staff, with evidence of spill-over effects to non-participants towards a greater focus on patient-centred care. Our findings suggest that there is potential for combined leadership training and quality improvement programmes to contribute to strengthening a culture of care quality in healthcare organisations. Our study provides useful insights into strategies seeking to achieve sustainable improvement in NHS organisations. PMID:28083304

Provision of NHS generalist and specialist services to care homes in England: review of surveys.

Science.gov (United States)

Iliffe, Steve; Davies, Susan L; Gordon, Adam L; Schneider, Justine; Dening, Tom; Bowman, Clive; Gage, Heather; Martin, Finbarr C; Gladman, John R F; Victor, Christina; Meyer, Julienne; Goodman, Claire

2016-03-01

The number of beds in care homes (with and without nurses) in the United Kingdom is three times greater than the number of beds in National Health Service (NHS) hospitals. Care homes are predominantly owned by a range of commercial, not-for-profit or charitable providers and their residents have high levels of disability, frailty and co-morbidity. NHS support for care home residents is very variable, and it is unclear what models of clinical support work and are cost-effective. To critically evaluate how the NHS works with care homes. A review of surveys of NHS services provided to care homes that had been completed since 2008. It included published national surveys, local surveys commissioned by Primary Care organisations, studies from charities and academic centres, grey literature identified across the nine government regions, and information from care home, primary care and other research networks. Data extraction captured forms of NHS service provision for care homes in England in terms of frequency, location, focus and purpose. Five surveys focused primarily on general practitioner services, and 10 on specialist services to care home. Working relationships between the NHS and care homes lack structure and purpose and have generally evolved locally. There are wide variations in provision of both generalist and specialist healthcare services to care homes. Larger care home chains may take a systematic approach to both organising access to NHS generalist and specialist services, and to supplementing gaps with in-house provision. Access to dental care for care home residents appears to be particularly deficient. Historical differences in innovation and provision of NHS services, the complexities of collaborating across different sectors (private and public, health and social care, general and mental health), and variable levels of organisation of care homes, all lead to persistent and embedded inequity in the distribution of NHS resources to this population

Volunteering and overseas placements in the NHS: a survey of current activity.

Science.gov (United States)

Chatwin, John; Ackers, Louise

2016-10-19

The study aimed to establish current levels of overseas volunteering and placement activity across all staff grades within the National Health Service (NHS) in the North West of England. Cross-sectional survey. Descriptive statistics. 4 main regional hospitals in the North West of England, and additional NHS staff training events. Convenience sample of NHS staff (n=911). 911 NHS staff took part in the survey. The medical and dental staff group returned the highest number of responses (32.1%). 42% of staff reported some form of overseas volunteering or placement experience. Most staff took an international placement as students (33.6% men; 40.6% women). Medium-term placements were undertaken by 46.7% of men, and 52.5% of women. Settlement stays (ie, over 1 year) were reported by 7.6% men, and 8.3% women). The majority of respondents engaged in international placement were from the age groups incorporating 'below 25' to '41-50' (74%). Multiple placement experiences were uncommon: 2.5% of respondents reported three periods of overseas activity, and 1.5% reported four. All those with multiple placement experience came from the staff groups incorporating midwife/nurse/health visitor, and medical and dental. This survey captured a snapshot of current levels of volunteering and overseas placement activity across NHS staff grades in the North West. Owing to relatively homogenous organisational structures, findings are likely to broadly represent the position across the organisation as a whole. Although some degree of overseas placement activity is undertaken by a relatively high proportion of NHS staff, such activity is currently heavily skewed towards higher clinical staff grades. Significant numbers of allied health professionals and equivalent non-clinical cadres also report overseas experience, and we anticipate that the numbers will continue to rise if current policy initiatives gain momentum. Published by the BMJ Publishing Group Limited. For permission to use

What Consumers Say About Nursing Homes in Online Reviews.

Science.gov (United States)

Kellogg, Caitlyn; Zhu, Yujun; Cardenas, Valeria; Vazquez, Katalina; Johari, Kayla; Rahman, Anna; Enguidanos, Susan

2018-04-20

Although patient-centered care is an expressed value of our healthcare system, no studies have examined what consumers say in online reviews about nursing homes (NHs). Insight into themes addressed in these reviews could inform improvement efforts that promote patient-centered NH care. We analyzed nursing home (NH) Yelp reviews. From a list of all NHs in California, we drew a purposeful sample of 51 NHs, selecting facilities representing a range of geographical areas and occupancy rates. Two research teams analyzed the reviews using grounded theory to identify codes and tracked how frequently each code was mentioned. We evaluated 264 reviews, identifying 24 codes, grouped under five categories: quality of staff care and staffing; physical facility and setting; resident safety and security; clinical care quality; and financial issues. More than half (53.41%) of Yelp reviewers posted comments related to staff attitude and caring and nearly a third (29.2%) posted comments related to staff responsiveness. Yelp reviewers also often posted about NHs' physical environment. Infrequently mentioned were the quality of health care provided and concerns about resident safety and security. Our results are consistent with those from related studies. Yelp reviewers focus on NH aspects that are not evaluated in most other NH rating systems. The federal Nursing Home Compare website, for instance, does not report measures of staff attitudes or the NH's physical setting. Rather, it reports measures of staffing levels and clinical processes and outcomes. We recommend that NH consumers consult both types of rating systems because they provide complementary information.

The National Health Service (NHS) at 70: some comparative reflections.

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Tuohy, Carolyn H

2018-03-16

As the National Health Service (NHS) turns 70, it bears comparison with another universal system celebrating an anniversary this year: Canada's 50-year-old medicare model. Each system is iconically popular, and each revolves around a profession-state accommodation. Both the popularity and the central axis of each system have been tested by external shocks in the form of periodic fiscal cycles of investment and austerity, and internal stresses generating organizational cycles of centralization and decentralization. In addition, the English NHS has undergone periodic bursts of major policy change, which have arguably moved the system closer to the Canadian single-payer model.

Student Directed Learning: An Online Exhibition for a Historic Costume Collection

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Saiki, Diana; Nam, Jinhee; Beck, Jessica

2012-01-01

This article highlights the structure, procedures, and outcomes of a course organized using a student-directed learning approach to develop an online exhibition website as an outcome for a client. The teaching strategy required students to work in teams and carefully plan assignments to build on the development of the exhibition. Students said…

Managing clinical negligence litigation and costs in the NHS.

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Tingle, John

2016-11-24

John Tingle, Reader in Health Law, Nottingham Trent University, discusses recent Government proposals to improve NHS maternity services and make changes to litigation and patient safety investigation procedures.

Setting standards and monitoring quality in the NHS 1999-2013: a classic case of goal conflict.

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Littlejohns, Peter; Knight, Alec; Littlejohns, Anna; Poole, Tara-Lynn; Kieslich, Katharina

2017-04-01

2013 saw the National Health Service (NHS) in England severely criticized for providing poor quality despite successive governments in the previous 15 years, establishing a range of new institutions to improve NHS quality. This study seeks to understand the contributions of political and organizational influences in enabling the NHS to deliver high-quality care through exploring the experiences of two of the major new organizations established to set standards and monitor NHS quality. We used a mixed method approach: first a cross-sectional, in-depth qualitative interview study and then the application of principal agent modeling (Waterman and Meier broader framework). Ten themes were identified as influencing the functioning of the NHS regulatory institutions: socio-political environment; governance and accountability; external relationships; clarity of purpose; organizational reputation; leadership and management; organizational stability; resources; organizational methods; and organizational performance. The organizations could be easily mapped onto the framework, and their transience between the different states could be monitored. We concluded that differing policy objectives for NHS quality monitoring resulted in central involvement and organizational change. This had a disruptive effect on the ability of the NHS to monitor quality. Constant professional leadership, both clinical and managerial, and basing decisions on best evidence, both technical and organizational, helped one institution to deliver on its remit, even within a changing political/policy environment. Application of the Waterman-Meier framework enabled an understanding and description of the dynamic relationship between central government and organizations in the NHS and may predict when tensions will arise in the future. © 2016 The Authors. The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd. © 2016 The Authors. The International Journal of Health

Consensus methodology to determine minor ailments appropriate to be directed for management within community pharmacy.

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Nazar, Hamde; Nazar, Zachariah; Yeung, Andre; Maguire, Mike; Connelly, Alex; Slight, Sarah P

2018-01-04

National Health Service (NHS) 111, a medical helpline for urgent care used within the England and Scotland, receives significant numbers of patient calls yearly for a range of clinical conditions. Some are considered high acuity and mainly directed to urgent and emergency care. Low acuity conditions are also directed to these costly, overburdened services. Community pharmacy is a recognised setting for effective low acuity condition management and could offer an alternative. To design and evaluate a new NHS111 pathway re-directing patients with low acuity conditions to community pharmacy. Two consensus development stakeholder workshops were undertaken. A "low acuity" condition was defined as one that can be clinically assessed by a community pharmacist and requires a treatment and/or advice available within a community pharmacy. Retrospective NHS111 patient data (February-August 2016) from the North East of England and access to the NHS Pathways clinical decision support software were available to stakeholders. The NHS111 data demonstrated the volume of patient calls for these conditions that could have been redirected to community pharmacy. Stakeholders reached consensus that 64 low acuity conditions could be safely redirected to community pharmacy via NHS111. This represented approximately 35,000 patients (11.5% of total) being shifted away from the higher cost settings in the North East region alone during February-August 2016. The stakeholder group discussions provided rationale behind their classifications of conditions to ensure patient safety, the care experience and added value. The resulting definitive list of low acuity conditions that could be directed to community pharmacy via NHS111 could result in a shift of workload from urgent and emergency care settings. Future work needs to evaluate the cost, clinical outcomes, patient satisfaction of a community pharmacy referral service that has the potential to improve integration of community pharmacy in the

The economic burden of ill health due to diet, physical inactivity, smoking, alcohol and obesity in the UK: an update to 2006-07 NHS costs.

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Scarborough, Peter; Bhatnagar, Prachi; Wickramasinghe, Kremlin K; Allender, Steve; Foster, Charlie; Rayner, Mike

2011-12-01

Estimates of the economic cost of risk factors for chronic disease to the NHS provide evidence for prioritization of resources for prevention and public health. Previous comparable estimates of the economic costs of poor diet, physical inactivity, smoking, alcohol and overweight/obesity were based on economic data from 1992-93. Diseases associated with poor diet, physical inactivity, smoking, alcohol and overweight/obesity were identified. Risk factor-specific population attributable fractions for these diseases were applied to disease-specific estimates of the economic cost to the NHS in the UK in 2006-07. In 2006-07, poor diet-related ill health cost the NHS in the UK £5.8 billion. The cost of physical inactivity was £0.9 billion. Smoking cost was £3.3 billion, alcohol cost £3.3 billion, overweight and obesity cost £5.1 billion. The estimates of the economic cost of risk factors for chronic disease presented here are based on recent financial data and are directly comparable. They suggest that poor diet is a behavioural risk factor that has the highest impact on the budget of the NHS, followed by alcohol consumption, smoking and physical inactivity.

Plus ça change, plus c'est la même chose: senior NHS managers' narratives of restructuring.

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Macfarlane, Fraser; Exworthy, Mark; Wilmott, Micky; Greenhalgh, Trish

2011-09-01

The UK National Health Service (NHS) is regularly restructured. Its smooth operation and organisational memory depends on the insights and capability of managers, especially those with experience of previous transitions. Narrative methods can illuminate complex change from the perspective of key actors. We used an adaptation of Wengraf's biographical narrative life interview method to explore how 20 senior NHS managers (chief executives, directors and assistant directors) had perceived and responded to major transitions since 1974. Data were analysed thematically using insights from phenomenology, neo-institutional theory and critical management studies. Findings were contextualised within a literature review of NHS policy and management 1974-2009. Managers described how experience in different NHS organisations helped build resilience and tacit knowledge, and how a strong commitment to the 'NHS brand' allowed them to weather a succession of policy changes and implement and embed such changes locally. By synthesising these personal and situated micro-narratives, we built a wider picture of macro-level institutional change in the NHS, in which the various visible restructurings in recent years appear to have masked a deeper continuity in terms of enduring values, norms and ways of working. We consider the implications of these findings for the future NHS. © 2011 The Authors. Sociology of Health & Illness © 2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.

Effectiveness of an online knowledge training and assessment program for stop smoking practitioners.

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Brose, Leonie S; West, Robert; Michie, Susan; Kenyon, Jennifer A M; McEwen, Andy

2012-07-01

In English National Health Service (NHS) stop smoking services, stop smoking practitioners (SSPs) provide behavioral support and medication to support smokers wanting to quit. This study aimed to evaluate an evidence-based national online knowledge training program for SSPs developed by the NHS Centre for Smoking Cessation and Training (NCSCT). Knowledge required to deliver effective stop smoking interventions was assessed using 25 multiple-choice questions drawn randomly from a common larger pool at baseline and after use of the training program in 778 consecutive users. Change in knowledge and association of this change with time spent on the training were assessed. Baseline and change in knowledge of SSPs with different amounts of experience, prior training, and time dedicated to smoking cessation were compared. Knowledge improved from 64.4% correct to 77.7% (p < .001). Time spent on the training predicted improvement. Pretraining knowledge scores differed with experience, prior training, and time practicing. Training improved even the highest performing SSPs and minimized differences between groups. Knowledge required to deliver effective stop smoking intervention is improved efficiently by using the NCSCT online training program for English smoking cessation practitioners. SSPs with all levels of prior knowledge benefit.

Setting standards and monitoring quality in the NHS 1999–2013: a classic case of goal conflict

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Knight, Alec; Littlejohns, Anna; Poole, Tara‐Lynn; Kieslich, Katharina

2016-01-01

Abstract 2013 saw the National Health Service (NHS) in England severely criticized for providing poor quality despite successive governments in the previous 15 years, establishing a range of new institutions to improve NHS quality. This study seeks to understand the contributions of political and organizational influences in enabling the NHS to deliver high‐quality care through exploring the experiences of two of the major new organizations established to set standards and monitor NHS quality. We used a mixed method approach: first a cross‐sectional, in‐depth qualitative interview study and then the application of principal agent modeling (Waterman and Meier broader framework). Ten themes were identified as influencing the functioning of the NHS regulatory institutions: socio‐political environment; governance and accountability; external relationships; clarity of purpose; organizational reputation; leadership and management; organizational stability; resources; organizational methods; and organizational performance. The organizations could be easily mapped onto the framework, and their transience between the different states could be monitored. We concluded that differing policy objectives for NHS quality monitoring resulted in central involvement and organizational change. This had a disruptive effect on the ability of the NHS to monitor quality. Constant professional leadership, both clinical and managerial, and basing decisions on best evidence, both technical and organizational, helped one institution to deliver on its remit, even within a changing political/policy environment. Application of the Waterman–Meier framework enabled an understanding and description of the dynamic relationship between central government and organizations in the NHS and may predict when tensions will arise in the future. © 2016 The Authors. The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd. PMID:27435020

Mass casualty incidents: are NHS staff prepared? An audit of one NHS foundation trust.

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Milkhu, C S; Howell, D C J; Glynne, P A; Raptis, D; Booth, H L; Langmead, L; Datta, V K

2008-09-01

Lack of knowledge of an NHS trust's major incident policies by clinical staff may result in poorly coordinated responses during a mass casualty incident (MCI). To audit knowledge of the major incident policy by clinical staff working in a central London major acute NHS trust designated to receive casualties on a 24-h basis during a MCI. A 12-question proforma was distributed to 307 nursing and medical staff in the hospital, designed to assess their knowledge of the major incident policy. Completed proformas were collected over a 2-month period between December 2006 and February 2007. A reply rate of 34% was obtained, with a reasonable representation from all disciplines ranging from nurses to consultants. Despite only 41% having read the policy in full, 70% knew the correct immediate action to take if informed of major incident activation. 76% knew the correct stand-down procedure. 56% knew the correct reporting point but less than 25% knew that an action card system was utilised. Nurses had significantly (p<0.01) more awareness of the policy than doctors. In view of the heightened terrorist threat in London, knowledge of major incident policy is essential. The high percentage of positive responses relating to immediate and stand-down actions reflects the rolling trust-wide MCI education programme and the organisational memory of the trust following several previous MCI in the capital. There is still scope for an improvement in awareness, however, particularly concerning knowledge of action cards, which are now displayed routinely throughout clinical areas and will be incorporated into induction packs.

NHS should provide nurses with decent catering facilities.

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Whelan, Adrian

2016-11-16

How about the NHS gives us access to decent catering facilities or even tables and chairs that aren't a 10 to 15-minute walk away from the ward or unit - which must be taken out of the already paltry half-hour meal break?

Measuring and modelling occupancy time in NHS continuing healthcare

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Millard Peter H

2011-06-01

Full Text Available Abstract Background Due to increasing demand and financial constraints, NHS continuing healthcare systems seek to find better ways of forecasting demand and budgeting for care. This paper investigates two areas of concern, namely, how long existing patients stay in service and the number of patients that are likely to be still in care after a period of time. Methods An anonymised dataset containing information for all funded admissions to placement and home care in the NHS continuing healthcare system was provided by 26 (out of 31 London primary care trusts. The data related to 11289 patients staying in placement and home care between 1 April 2005 and 31 May 2008 were first analysed. Using a methodology based on length of stay (LoS modelling, we captured the distribution of LoS of patients to estimate the probability of a patient staying in care over a period of time. Using the estimated probabilities we forecasted the number of patients that are likely to be still in care after a period of time (e.g. monthly. Results We noticed that within the NHS continuing healthcare system there are three main categories of patients. Some patients are discharged after a short stay (few days, some others staying for few months and the third category of patients staying for a long period of time (years. Some variations in proportions of discharge and transition between types of care as well as between care groups (e.g. palliative, functional mental health were observed. A close agreement of the observed and the expected numbers of patients suggests a good prediction model. Conclusions The model was tested for care groups within the NHS continuing healthcare system in London to support Primary Care Trusts in budget planning and improve their responsiveness to meet the increasing demand under limited availability of resources. Its applicability can be extended to other types of care, such as hospital care and re-ablement. Further work will be geared towards

Peer Communication in Online Mental Health Forums for Young People: Directional and Nondirectional Support

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Hanley, Terry; Ujhelyi, Katalin

2017-01-01

Background The Internet has the potential to help young people by reducing the stigma associated with mental health and enabling young people to access services and professionals which they may not otherwise access. Online support can empower young people, help them develop new online friendships, share personal experiences, communicate with others who understand, provide information and emotional support, and most importantly help them feel less alone and normalize their experiences in the world. Objective The aim of the research was to gain an understanding of how young people use an online forum for emotional and mental health issues. Specifically, the project examined what young people discuss and how they seek support on the forum (objective 1). Furthermore, it looked at how the young service users responded to posts to gain an understanding of how young people provided each other with peer-to-peer support (objective 2). Methods Kooth is an online counseling service for young people aged 11-25 years and experiencing emotional and mental health problems. It is based in the United Kingdom and provides support that is anonymous, confidential, and free at the point of delivery. Kooth provided the researchers with all the online forum posts between a 2-year period, which resulted in a dataset of 622 initial posts and 3657 initial posts with responses. Thematic analysis was employed to elicit key themes from the dataset. Results The findings support the literature that online forums provide young people with both informational and emotional support around a wide array of topics. The findings from this large dataset also reveal that this informational or emotional support can be viewed as directive or nondirective. The nondirective approach refers to when young people provide others with support by sharing their own experiences. These posts do not include explicit advice to act in a particular way, but the sharing process is hoped to be of use to the poster. The

Peer Communication in Online Mental Health Forums for Young People: Directional and Nondirectional Support.

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Prescott, Julie; Hanley, Terry; Ujhelyi, Katalin

2017-08-02

The Internet has the potential to help young people by reducing the stigma associated with mental health and enabling young people to access services and professionals which they may not otherwise access. Online support can empower young people, help them develop new online friendships, share personal experiences, communicate with others who understand, provide information and emotional support, and most importantly help them feel less alone and normalize their experiences in the world. The aim of the research was to gain an understanding of how young people use an online forum for emotional and mental health issues. Specifically, the project examined what young people discuss and how they seek support on the forum (objective 1). Furthermore, it looked at how the young service users responded to posts to gain an understanding of how young people provided each other with peer-to-peer support (objective 2). Kooth is an online counseling service for young people aged 11-25 years and experiencing emotional and mental health problems. It is based in the United Kingdom and provides support that is anonymous, confidential, and free at the point of delivery. Kooth provided the researchers with all the online forum posts between a 2-year period, which resulted in a dataset of 622 initial posts and 3657 initial posts with responses. Thematic analysis was employed to elicit key themes from the dataset. The findings support the literature that online forums provide young people with both informational and emotional support around a wide array of topics. The findings from this large dataset also reveal that this informational or emotional support can be viewed as directive or nondirective. The nondirective approach refers to when young people provide others with support by sharing their own experiences. These posts do not include explicit advice to act in a particular way, but the sharing process is hoped to be of use to the poster. The directive approach, in contrast, involves

Leadership in the NHS: does the Emperor have any clothes?

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Checkland, Kath

2014-10-01

In this essay, I explore the rise of the concept of 'leadership' in the English NHS, highlighting the similarity with a previous shift from (bad, old) 'administration' to (good, new) 'management'. I take a critical look at this discursive shift and highlight some of the overblown claims made for the value of 'clinical leadership'. I argue that, rather than turning all NHS staff into leaders, we should perhaps tone down the level of our rhetoric and instead emphasize the need for a service full of good followers who will maintain a relentless focus on care, quality and efficiency. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

A clean bill of health? The efficacy of an NHS commissioned outsourced police custody healthcare service.

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de Viggiani, Nick

2013-08-01

Police custody healthcare services for detainees in the UK are most commonly outsourced to independent healthcare providers who employ custody nurses and forensic physicians to deliver forensic healthcare services. A pilot was introduced in 2008 by the Department of Health to explore the efficacy of commissioning custody healthcare via the NHS, in the wake of the 2005-2006 shift of prison healthcare to the NHS. The objective was to improve quality and accountability through NHS commissioning and the introduction of NHS governance to the management and delivery of custody healthcare. This article discusses key themes that arose from the project evaluation, which focused on the commissioning relationship between the police, the NHS commissioner and the private healthcare provider. The evaluation observed an evolving relationship between the police, the local NHS and the front-line nurses, which was complicated by the quite distinctive professional values and ideologies operating, with their contrasting organisational imperatives and discordant values and principles. A key challenge for commissioners is to develop synergy between operational and strategically located stakeholders so that they can work effectively towards common goals. Government policy appears to remain focused on creating safe, supportive and humane custody environments that balance criminal justice and health imperatives and support the rights and needs of detainees, victims, professionals and the public. This remains an ambitious agenda and presents a major challenge for new criminal justice health partnerships. Copyright © 2013 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Trouble Spots in Online Direct-to-Consumer Prescription Drug Promotion: Teaching Drug Marketers How to Inform Better or Spin Better? Comment on "Trouble Spots in Online Direct-to-Consumer Prescription Drug Promotion: A Content Analysis of FDA Warning Letters".

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Doran, Evan

2016-02-21

Hyosun Kim's report "Trouble Spots in Online Direct to Consumer Prescription Drug Promotion: A content Analysis of FDA Warning Letters" aims to teach marketers how to avoid breaching current Food and Drug Administration (FDA) guidelines in their online drug promotion. While Kim hopes to minimise the potential for online promotion to misinform consumers and the study is carefully conducted, teaching drug marketers how to avoid the common mistakes in online drug promotion is more likely to make marketers more adept at spinning information than appropriately balancing it. © 2016 by Kerman University of Medical Sciences.

Market-driven production of biospecimens and the role of NHS hospital-led biobanks.

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Timmons, Stephen; Vezyridis, Paraskevas

2017-09-01

Biobanks are vital for biospecimen production in research, despite the regulatory, recruitment and commercial difficulties they face. We conducted interviews with clinicians, researchers, volunteers who recruit biobank participants, regulators and NHS managers about the integration of a biobank into an NHS hospital. We show that medical waste collected for biomedical research acquires its socio-ethical and economic value from the level of integration (both technologically and organisationally) of the biobank into the NHS hospital. There is extensive investment in a range of intellectual and commercial relationships and labour among stakeholders involved in the production of biospecimens. It is not only the boundaries of research, clinical care and commercialisation of biospecimens that blur but also those of volunteerism and citizenship. Hospital-led biobanks provide an opportunity to study the intertwining of biomedical innovation and healthcare. © 2017 Foundation for the Sociology of Health & Illness.

Mixed messages: An evaluation of NHS Trust Social Media policies in the North West of England.

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Scragg, B; Shaikh, S; Robinson, L; Mercer, C

2017-08-01

Despite National Health Service (NHS) information strategy promoting the use of Social Media (SoMe) to encourage greater engagement between service users and providers, a team investigating online SoMe interaction between breast screening practitioners and clients found that practitioners alleged discouragement from employers' policies. This study aimed to investigate whether this barrier was genuine, and illuminate whether local policy differed from national strategy. The study used a qualitative grounded theory approach to generate a theory. Nine policies from the North West of England were analysed. A framework was derived from the data, and an analysis of policy tone followed by a detailed coding of policy content was undertaken. Comparative analysis continued by reviewing the literature, and a condensed framework revealed five broad categories that policies addressed. The analysis revealed the policies varied in content, but not in tone, which was mostly discouraging. Coding the content revealed that the most frequently addressed point was that of protecting the employers' reputation, and after further analysis, the resultant condensed framework showed that policies were imbalanced and heavily skewed towards Security, Conduct & Behaviour and Reputation. Practitioners within breast screening services are discouraged by overly prohibitive and prescriptive SoMe policies; with these varying tremendously in comprehensiveness, but with a narrow focus on security and employers reputation; in contrast with national strategy. Recommendations are that policy revision is undertaken with consultation by more than one stakeholder, and SoMe training is offered for all members of NHS staff. Copyright © 2017 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

Mutations in a novel gene, NHS, cause the pleiotropic effects of Nance-Horan syndrome, including severe congenital cataract, dental anomalies, and mental retardation.

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Burdon, Kathryn P; McKay, James D; Sale, Michèle M; Russell-Eggitt, Isabelle M; Mackey, David A; Wirth, M Gabriela; Elder, James E; Nicoll, Alan; Clarke, Michael P; FitzGerald, Liesel M; Stankovich, James M; Shaw, Marie A; Sharma, Shiwani; Gajovic, Srecko; Gruss, Peter; Ross, Shelley; Thomas, Paul; Voss, Anne K; Thomas, Tim; Gécz, Jozef; Craig, Jamie E

2003-11-01

Nance-Horan syndrome (NHS) is an X-linked disorder characterized by congenital cataracts, dental anomalies, dysmorphic features, and, in some cases, mental retardation. NHS has been mapped to a 1.3-Mb interval on Xp22.13. We have confirmed the same localization in the original, extended Australian family with NHS and have identified protein-truncating mutations in a novel gene, which we have called "NHS," in five families. The NHS gene encompasses approximately 650 kb of genomic DNA, coding for a 1,630-amino acid putative nuclear protein. NHS orthologs were found in other vertebrates, but no sequence similarity to known genes was identified. The murine developmental expression profile of the NHS gene was studied using in situ hybridization and a mouse line containing a lacZ reporter-gene insertion in the Nhs locus. We found a complex pattern of temporally and spatially regulated expression, which, together with the pleiotropic features of NHS, suggests that this gene has key functions in the regulation of eye, tooth, brain, and craniofacial development.

Barking, Havering and Redbridge University Hospitals NHS Trust Fellowships in Clinical Leadership Programme: An Evaluation.

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Miani, Celine; Marjanovic, Sonja; Jones, Molly Morgan; Marshall, Martin; Meikle, Samantha; Nolte, Ellen

2013-01-01

Leadership is seen to be central to improving the quality of healthcare and existing research suggests that absence of leadership is related to poor quality and safety performance. Leadership training might therefore provide an important means through which to promote quality improvement and, more widely, performance within the healthcare environment. This article presents an evaluation of the Fellowships in Clinical Leadership Programme, which combines leadership training and quality improvement initiatives with the placement of temporary external clinical champions in Barking, Havering and Redbridge University Hospitals NHS Trust. We assessed impacts of the Programme on individual and organisational change, alongside core enablers and barriers for Programme success. Analyses drew on the principles of a theory-of-change-led realist evaluation, using logic modelling to specify the underlying causal mechanisms of the Programme. Data collection involved a stakeholder workshop, online questionnaires of programme participants, senior managers and support staff (n=114), and follow-up in-depth semi-structured interviews with a subsample of survey participants (n=15). We observed that the Programme had notable impacts at individual and organisational levels. Examples of individual impact included enhanced communication and negotiation skills or increased confidence as a result of multi-modal leadership training. At the organisational level, participants reported indications of behaviour change among staff, with evidence of spill-over effects to non-participants towards a greater focus on patient-centred care. Our findings suggest that there is potential for combined leadership training and quality improvement programmes to contribute to strengthening a culture of care quality in healthcare organisations. Our study provides useful insights into strategies seeking to achieve sustainable improvement in NHS organisations.

The National Health Service (NHS) at 70: Bevan's double-edged legacy.

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Klein, Rudolf

2018-01-08

The paper analyses the achievements and problems stemming from Nye Bevan's model of a tax funded national health care system, on the assumption that only so could equity be achieved. The evidence shows that indeed the National Health Service (NHS) scores highly on equity, so vindicating Bevan's vision. The price paid is that fiscal crises are the norm for the NHS, with ever more centralisation, intensive regulation and performance management. Successive reorganisations represent attempts to square the circle - to combine the strengths of Bevan's model and those of a less hierarchic system - but have so far failed to deliver and can be expected to continue.

Complexity in the new NHS: longitudinal case studies of CCGs in England.

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Checkland, Katherine; McDermott, Imelda; Coleman, Anna; Perkins, Neil

2016-01-07

The reform in the English National Health Services (NHS) under the Health and Social Care Act 2012 is unlike previous NHS reorganisations. The establishment of clinical commissioning groups (CCGs) was intended to be 'bottom up' with no central blueprint. This paper sets out to offer evidence about how this process has played out in practice and examines the implications of the complexity and variation which emerged. Detailed case studies in CCGs across England, using interviews, observation and documentary analysis. Using realist framework, we unpacked the complexity of CCG structures. In phase 1 of the study (January 2011 to September 2012), we conducted 96 interviews, 439 h of observation in a wide variety of meetings, 2 online surveys and 38 follow-up telephone interviews. In phase 2 (April 2013 to March 2015), we conducted 42 interviews with general practitioners (GPs) and managers and observation of 48 different types of meetings. Our study has highlighted the complexity inherent in CCGs, arising out of the relatively permissive environment in which they developed. Not only are they very different from one another in size, but also in structure, functions between different bodies and the roles played by GPs. The complexity and lack of uniformity of CCGs is important as it makes it difficult for those who must engage with CCGs to know who to approach at what level. This is of increasing importance as CCGs are moving towards greater integration across health and social care. Our study also suggests that there is little consensus as to what being a 'membership' organisation means and how it should operate. The lack of uniformity in CCG structure and lack of clarity over the meaning of 'membership' raises questions over accountability, which becomes of greater importance as CCG is taking over responsibility for primary care co-commissioning. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go

Trouble Spots in Online Direct-to-Consumer Prescription Drug Promotion: Teaching Drug Marketers How to Inform Better or Spin Better?; Comment on “Trouble Spots in Online Direct-to-Consumer Prescription Drug Promotion: A Content Analysis of FDA Warning Letters”

Directory of Open Access Journals (Sweden)

Evan Doran

2016-05-01

Full Text Available Hyosun Kim’s report “Trouble Spots in Online Direct to Consumer Prescription Drug Promotion: A content Analysis of FDA Warning Letters”aims to teach marketers how to avoid breaching current Food and Drug Administration (FDA guidelines in their online drug promotion. While Kim hopes to minimise the potential for online promotion to misinform consumers and the study is carefully conducted, teaching drug marketers how to avoid the common mistakes in online drug promotion is more likely to make marketers more adept at spinning information than appropriately balancing it.

Variation in Direct Access to Tests to Investigate Cancer: A Survey of English General Practitioners.

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Brian D Nicholson

Full Text Available The 2015 NICE guidelines for suspected cancer recommend that English General Practitioners have direct access to diagnostic tests to investigate symptoms of cancer that do not meet the criteria for urgent referral. We aimed to identify the proportion of GPs in England with direct access to these tests.We recruited 533 English GPs through a national clinical research network to complete an online survey about direct access to laboratory, radiology, and endoscopy tests in the three months leading up to the release of the 2015 NICE guidance. If they had direct access to a diagnostic test, GPs were asked about the time necessary to arrange a test and receive a report. Results are reported by NHS sub-region and, adjusting for sampling, for England as a whole.Almost all GPs reported direct access to x-ray and laboratory investigations except faecal occult blood testing (54%, 95% CI 49-59% and urine protein electrophoresis (89%, 95% CI 84-92%. Fewer GPs had direct access to CT scans (54%, 95% CI 49-59% or endoscopy (colonoscopy 32%, 95% CI 28-37%; gastroscopy 72%, 95% CI 67-77%. There was significant variation in direct access between NHS regions for the majority of imaging tests-for example, from 20 to 85% to MRI. Apart from x-ray, very few GPs (1-22% could access radiology and endoscopy within the timescales recommended by NICE. The modal request to test time was 2-4 weeks for routine radiology and 4-6 weeks for routine endoscopy with results taking another 1-2 weeks.At the time that the 2015 NICE guideline was released, local investment was required to not only provide direct access but also reduce the interval between request and test and speed up reporting. Further research using our data as a benchmark is now required to identify whether local improvements in direct access have been achieved in response to the NICE targets. If alternative approaches to test access are to be proposed they must be piloted comprehensively and underpinned by robust

Caseload of NHS plastic surgeons in Scotland, 2005-2006: analysis of Scottish hospital activity data.

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Brewster, Colin T; Shoaib, Taimur

2009-04-01

To assess the contemporary caseload of NHS plastic surgeons. Descriptive study. Scotland. Analysis of routinely collected NHS hospital activity data relating to the financial year 2005-2006. Number of inpatient/day-case episodes and bed-days by principal diagnosis and main operative procedure. During the study period, 12,844 inpatient and 9439 day-case episodes were recorded in 19,166 patients, accounting for 36,300 bed-days. There were more female patients, especially among middle-age groups. Socioeconomic deprivation was more common than expected (P accounted for a higher proportion of bed-days (37.3%) than neoplasms (23.8%). Only approximately half of all surgical procedures were assigned to the skin chapter of the OPCS-4 classification. Despite some limitations, this study provides an insight into the current caseload of NHS plastic surgeons working in Scotland. The data suggest that cosmetic surgery for purely aesthetic reasons represents a relatively small part of NHS plastic surgery activity in Scotland, and that the majority of caseload is in reconstructive plastic surgery.

Centralised 3D printing in the NHS: a radiological review.

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Eley, K A

2017-04-01

In recent years, three-dimensional (3D) printing has seen an explosion of interest fuelled by improvements in technology and associated reduction in costs. The literature is replete with novel medical applications of custom anatomical models, prostheses, and surgical guides. Although the fundamental core of 3D printing lies in image manipulation, the driving force in many National Health Service (NHS) trusts has come from individual surgical specialties with 3D printers independently run and confined to respective departments. In this review of 3D printing, experience of establishing a new centralised 3D-printing service within an NHS hospital trust is reported, focusing on the requirements and challenges of such an endeavour. Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Radical 10-point plan to refocus NHS estate.

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Ellis, Conor; Baldwin, Ed; Dick, Rachel

2010-11-01

Conor Ellis, head of health, Ed Baldwin, partner, and Rachel Dick, consultant, at international built asset consultancy EC Harris, present a "10-step guide" to help the NHS achieve radical efficiency savings, optimise the use of its estate, maximise the value of under-utilised land, buildings, and other assets, and harness better value from its existing FM operations.

Lack of language skills and knowledge of local culture in international medical graduates: Implications for the NHS.

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Hamarneh, Ashraf

2015-01-01

International Medical Graduates (IMGs) form a coherent part of the National Health Service (NHS). Nearly 25% of the doctors working in the NHS are IMGs who obtained their primary medical degree from outside the EU. Moving to a different country that holds a different set of values and belief systems can be very challenging for IMGs, which in turn could have a significant effect on the service provided to NHS patients. This article will address the issue of effective communication skills within the IMG population and will explore the underlying issues behind this problem.

Doing transformational change in the English NHS in the context of "big bang" redisorganisation.

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Hunter, David J; Erskine, Jonathan; Small, Adrian; McGovern, Tom; Hicks, Chris; Whitty, Paula; Lugsden, Edward

2015-01-01

The purpose of this paper is to examine a bold and ambitious scheme known as the North East transformation system (NETS). The principal aim of the NETS is the achievement of a step-change in the quality of health services delivered to people living in the North East region of England. The paper charts the origins of the NETS and its early journey before describing what happened to it when the UK coalition government published its proposals for unexpected major structural change in the NHS. This had a profound impact on the leadership and direction of the NETS and resulted in it taking a different direction from that intended. The research design took the form of a mixed methods, longitudinal 3.5-year study aimed at exploring transformational change in terms of content, context, process and outcomes. The sample of study sites comprised 14 NHS trusts in the North East region chosen to provide geographical coverage of the area and to reflect the scale, scope and variety of the bodies that formed part of the NETS programme. The qualitative component of the research, which the paper draws upon, included 68 semi-structured interviews, observational studies and focus groups. Data analysis made use of both deductive and inductive frameworks. The deductive framework adopted was Pettigrew et al.'s "receptive contexts for change" and four of the eight factors stood out as especially important and form the basis of the paper. The fate of the NETS was shaped and influenced by the eight factors comprising the Pettigrew et al. receptive contexts for change framework but four factors in particular stood out as being especially significant: environmental pressure, quality and coherence of policy, key people leading change, supportive organisational culture. Perhaps the most significant lesson from the NETS is that achieving whole systems change is particularly vulnerable to the vicissitudes of politics especially where that system, like the UK NHS, is itself subject to those very

Moral Legitimacy: The Struggle Of Homeopathy in the NHS.

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Crawford, Louise

2016-02-01

This article deploys a well-established theoretical model from the accountability literature to the domain of bioethics. Specifically, homeopathy is identified as a controversial industry and the strategic action of advocates to secure moral legitimacy and attract public funding is explored. The Glasgow Homeopathic Hospital (GHH) is used as the location to examine legitimizing strategies, from gaining legitimacy as a National Health Service (NHS) hospital in 1948, followed by maintaining and repairing legitimacy in response to government enquires in 2000 and 2010. An analysis of legitimizing strategies leads to the conclusion that advocates have been unsuccessful in maintaining and repairing moral legitimacy for homeopathy, thus threatening continued public funding for this unscientific medical modality. This is an encouraging development towards open and transparent NHS accountability for targeting limited public resources in pursuit of maximizing society's health and well-being. Policy implications and areas for future research are suggested. © 2016 John Wiley & Sons Ltd.

Part-time work and job sharing in health care: is the NHS a family-friendly employer?

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Branine, Mohamed

2003-01-01

This paper examines the nature and level of flexible employment in the National Health Service (NHS) by investigating the extent to which part-time work and job sharing arrangements are used in the provision and delivery of health care. It attempts to analyse the reasons for an increasing number of part-timers and a very limited number of job sharers in the NHS and to explain the advantages and disadvantages of each pattern of employment. Data collected through the use of questionnaires and interviews from 55 NHS trusts reveal that the use of part-time work is a tradition that seems to fit well with the cost-saving measures imposed on the management of the service but at the same time it has led to increasing employee dissatisfaction, and that job sharing arrangements are suitable for many NHS employees since the majority of them are women with a desire to combine family commitments with career prospects but a very limited number of employees have had the opportunity to job share. Therefore it is concluded that to attract and retain the quality of staff needed to ensure high performance standards in the provision and delivery of health care the NHS should accept the diversity that exists within its workforce and take a more proactive approach to promoting a variety of flexible working practices and family-friendly policies.

Can conditional health policies be justified? A policy analysis of the new NHS dental contract reforms.

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Laverty, Louise; Harris, Rebecca

2018-06-01

Conditional policies, which emphasise personal responsibility, are becoming increasingly common in healthcare. Although used widely internationally, they are relatively new within the UK health system where there have been concerns about whether they can be justified. New NHS dental contracts include the introduction of a conditional component that restricts certain patients from accessing a full range of treatment until they have complied with preventative action. A policy analysis of published documents on the NHS dental contract reforms from 2009 to 2016 was conducted to consider how conditionality is justified and whether its execution is likely to cause distributional effects. Contractualist, paternalistic and mutualist arguments that reflect notions of responsibility and obligation are used as justification within policy. Underlying these arguments is an emphasis on preserving the finite resources of a strained NHS. We argue that the proposed conditional component may differentially affect disadvantaged patients, who do not necessarily have access to the resources needed to meet the behavioural requirements. As such, the conditional component of the NHS dental contract reform has the potential to exacerbate oral health inequalities. Conditional health policies may challenge core NHS principles and, as is the case with any conditional policy, should be carefully considered to ensure they do not exacerbate health inequities. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Effect of Some Synthetic Parameters on Size and Polydispersity Index of Gelatin Nanoparticles Cross-Linked by CDI/NHS System

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S. Zinatloo-Ajabshir

2015-04-01

Full Text Available In our previous work, the effect of use of a water soluble CDI/NHS system as nontoxic cross-linking agent on fabrication of gelatin nanoparticles was investigated. In this research, the effect of variation in some synthetic parameters of gelatin nanoparticles cross-linked by CDI/NHS system such as type of gelatin and formulation of cross- linking agent on their size and distribution was examined. The conventional two step desolvation method was used for preparation of gelatin nanoparticles. The morphology, mean size and size distribution of the formed nanoparticles were evaluated and compared with each other. In addition, intrinsic viscosities of all the nanoparticles were measured and compared under different conditions. The results showed that the presence of more NHS and absence of NHS catalyst in CDI/NHS system lead to the large particle size and broad size distribution of nanoparticles that were attributed to the fast and slow cross-linking rate, respectively.

NHS Trusts' clinical research activity and overall CQC performance - Is there a correlation?

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Jonker, L; Fisher, S J

2015-11-01

Since the late 2000's, the creation of the National Institute for Health Research (NIHR) has transformed clinical research activity in the United Kingdom. This study sought to establish if there is a link between clinical research activity and overall NHS Trust performance. Retrospective cohort study. Data for NHS Trust performance were obtained from public databases, namely the Care Quality Commission (CQC) 2013 risk rating for overall performance, and 2012-13 NIHR records for clinical research activity. Applying Spearman's rank analysis, none of the Trust categories showed a correlation with CQC risk rating: small hospitals, r = -0.062 (P = 0.76; n = 27); medium, r = -0.224 (P = 0.13; n = 47); large, r = -0.008 (P = 0.96; n = 57); academic, r = -0.18 (P = 0.41; n = 24). Similar results were observed when CQC risk rating was compared with the number of different clinical research studies conducted per Trust. The degree of NIHR National Portfolio clinical research activity is not significantly related to CQC risk rating, used as an indicator of overall NHS Trust performance. Other studies have previously shown that increased research activity correlates with improved mortality rates, one component of CQC risk rating scores. Alternative tools may have to be explored to evaluate the impact of clinical research on NHS Trusts and its patients. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

An investigation into dental digital radiography in dental practices in West Kent following the introduction of the 2006 NHS General Dental Services contract.

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Mauthe, Peter W; Eaton, Kenneth A

2011-04-01

The primary aims of the study were to investigate the use of digital radiography within primary dental care practices in the West Kent Primary Care Trust (PCT) area and general dental practitioners' (GDPs) self-reported change in radiographic prescribing patterns following the introduction of the nGDS contract in 2006. Data were gathered via a piloted, self-completed questionnaire, and circulated to all GDPs listed on the National Health Service (NHS) Choices website as practising in the West Kent PCT area. There were three mailings and follow-up telephone calls. The resulting data were entered into a statistical software database and, where relevant, statistically tested, using the chi-square test and Pearson correlation coefficient. Of 223 GDPs, 168 (75%) responded. There were 163 usable questionnaires. The respondents represented 85% of the general dental practices in West Kent. Eighty (49%) respondents were using digital intra-oral radiography. Of those who used digital radiography, 44 (55%) reported that they used phosphor plate systems and 36 (45%) that they used direct digital sensors. Eighty-three (51%) had a panoramic machine in their practice, 46 of whom (55%) were using digital systems; of these, 32 (67%) were using a direct digital system. Seventy-one GDPs reported that they worked exclusively or mainly in private practice. Forty (56%) of these 'mainly private' GDPs reported that they used digital radiographic systems, whereas only 40 (44%) of the 89 'mainly NHS' GDPs reported using digital radio-graphic systems. On average, mainly private GDPs made the transition to a digital radiographic system six months before mainly NHS GDPs. Of those who provided NHS dentistry before and after April 2006, only 18 (14%) reported taking fewer radiographs and seven (6%) taking more. In February 2010, of the West Kent GDPs who responded to the questionnaire, just under 50% used digital radio graphy. Mainly private GDPs were more likely to use digital radiography than

Capitalising on leadership fellowships for clinicians in the NHS.

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Nicol, Edward D

2011-04-01

Clinical leadership has become a primary focus of the NHS with many leadership programmes, particularly those aimed at junior clinicians, being developed. This article illustrates the potential of these programmes but also urges caution when assessing the success of these schemes both from an individual and organisational perspective.

Addressing current and future challenges for the NHS: the role of good leadership.

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Elton, Lotte

2016-10-03

Purpose This paper aims to describe and analyse some of the ways in which good leadership can enable those working within the National Health Service (NHS) to weather the changes and difficulties likely to arise in the coming years, and takes the format of an essay written by the prize-winner of the Faculty of Medical Leadership and Management's Student Prize. The Faculty of Medical Leadership and Management ran its inaugural Student Prize in 2015-2016, which aimed at medical students with an interest in medical leadership. In running the Prize, the Faculty hoped to foster an enthusiasm for and understanding of the importance of leadership in medicine. Design/methodology/approach The Faculty asked entrants to discuss the role of good leadership in addressing the current and future challenges faced by the NHS, making reference to the Leadership and Management Standards for Medical Professionals published by the Faculty in 2015. These standards were intended to help guide current and future leaders and were grouped into three categories, namely, self, team and corporate responsibility. Findings This paper highlights the political nature of health care in the UK and the increasing impetus on medical professionals to navigate debates on austerity measures and health-care costs, particularly given the projected deficit in NHS funding. It stresses the importance of building organisational cultures prizing transparency to prevent future breaches in standards of care and the value of patient-centred approaches in improving satisfaction for both patients and staff. Identification of opportunities for collaboration and partnership is emphasised as crucial to assuage the burden that lack of appropriate social care places on clinical services. Originality/value This paper offers a novel perspective - that of a medical student - on the complex issues faced by the NHS over the coming years and utilises a well-regarded set of standards in conceptualising the role that health

Alzheimer's Caregiver Support Online: lessons learned, initial findings and future directions.

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Glueckauf, Robert L; Loomis, Jeffrey S

2003-01-01

Family caregivers of older adults with progressive dementia (e.g., Alzheimer's disease) are faced with a variety of emotional and behavioral difficulties, such as dealing with persistent, repetitive questions, managing agitation and depression, and monitoring hygiene and self-care activities. Although professional and governmental organizations have called for the creation of community-based education and support programs, most dementia caregivers continue to receive little or no formal instruction in responding effectively to these challenges. The current paper describes the development and implementation of Alzheimer's Caregiver Support Online, a Web- and telephone-based education and support network for caregivers of individuals with progressive dementia. Lessons learned from the first two years of this state-supported initiative are discussed, followed by the findings of a Robert Wood Johnson Foundation-funded strategic marketing initiative and an initial program evaluation of AlzOnline's Positive Caregiving classes. Finally, clinical implications and future directions for program development and evaluation research are proposed.

The clinician impact and financial cost to the NHS of litigation over pregabalin: a cohort study in English primary care.

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Croker, Richard; Smyth, Darren; Walker, Alex J; Goldacre, Ben

2018-06-07

Following litigation over pregabalin's second-use medical patent for neuropathic pain, National Health Service (NHS) England was required by the court to instruct general practitioners (GPs) to prescribe the branded form (Lyrica) for pain. Pfizer's patent was found invalid in 2015, a ruling subject to ongoing appeals. If the Supreme Court appeal in February 2018, whose judgement is awaited, is unsuccessful, the NHS can seek to reclaim excess prescribing costs. We set out to describe the variation in prescribing of pregabalin as branded Lyrica, geographically and over time; to determine how clinicians responded to the NHS England instruction to GPs; and to model excess costs to the NHS attributable to the legal judgements. English primary care. English general practices. Variation in prescribing of branded Lyrica across the country before and after the NHS England instruction, by practice and by Clinical Commissioning Group; excess prescribing costs. The proportion of pregabalin prescribed as Lyrica increased from 0.3% over 6 months before the NHS England instruction (September 2014 to February 2015) to 25.7% afterwards (April to September 2015). Although 70% of pregabalin is estimated to be for pain, including neuropathic pain, only 11.6% of practices prescribed Lyrica at this level; the median proportion prescribed as Lyrica was 8.8% (IQR 1.1%-41.9%). If pregabalin had come entirely off patent in September 2015, and Pfizer had not appealed, we estimate the NHS would have spent £502 million less on pregabalin to July 2017. NHS England instructions to GPs regarding branded prescription of pregabalin were widely ignored and have created much debate around clinical independence in prescribing. Protecting revenue from 'skinny labels' will pose a challenge. If Pfizer's final appeal on the patent is unsuccessful, the NHS can seek reimbursement of excess pregabalin prescribing costs, potentially £502 million. © Article author(s) (or their employer(s) unless

NHS-Esters As Versatile Reactivity-Based Probes for Mapping Proteome-Wide Ligandable Hotspots.

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Ward, Carl C; Kleinman, Jordan I; Nomura, Daniel K

2017-06-16

Most of the proteome is considered undruggable, oftentimes hindering translational efforts for drug discovery. Identifying previously unknown druggable hotspots in proteins would enable strategies for pharmacologically interrogating these sites with small molecules. Activity-based protein profiling (ABPP) has arisen as a powerful chemoproteomic strategy that uses reactivity-based chemical probes to map reactive, functional, and ligandable hotspots in complex proteomes, which has enabled inhibitor discovery against various therapeutic protein targets. Here, we report an alkyne-functionalized N-hydroxysuccinimide-ester (NHS-ester) as a versatile reactivity-based probe for mapping the reactivity of a wide range of nucleophilic ligandable hotspots, including lysines, serines, threonines, and tyrosines, encompassing active sites, allosteric sites, post-translational modification sites, protein interaction sites, and previously uncharacterized potential binding sites. Surprisingly, we also show that fragment-based NHS-ester ligands can be made to confer selectivity for specific lysine hotspots on specific targets including Dpyd, Aldh2, and Gstt1. We thus put forth NHS-esters as promising reactivity-based probes and chemical scaffolds for covalent ligand discovery.

Evidence-based policy-making in the NHS: exploring the interface between research and the commissioning process.

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Harries, U; Elliott, H; Higgins, A

1999-03-01

The UK National Health Service (NHS) R&D strategy acknowledges the importance of developing an NHS where practice and policy is more evidence-based. This paper is based on a qualitative study which aimed to identify factors which facilitate or impede evidence-based policy-making at a local level in the NHS. The study involved a literature review and case studies of social research projects which were initiated by NHS health authority managers or general practitioner (GP) fundholders in one region of the NHS. Data were collected through in-depth interviews with lead policy-makers, GPs and researchers working on each of the case studies and analysis of project documentation. An over-arching theme from the analysis was that of the complexity of R&D in purchasing. The two worlds of research and health services management often sit uncomfortably together. For this reason it was not possible to describe a 'blueprint' for successful R&D, although several important issues emerged. These include sharing an appropriate model for research utilization, the importance of relationships in shaping R&D, the importance of influence and commitment in facilitating evidence-based change, and the resourcing of R&D in purchasing. These issues have important implications for the strategic development of R&D as well as for individual project application. Moving beyond the rhetoric of evidence-based policy-making is more likely if both policy-makers and researchers openly acknowledge this complexity and give due concern to the issues outlined.

Trouble Spots in Online Direct-to-Consumer Prescription Drug Promotion: A Content Analysis of FDA Warning Letters

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Hyosun Kim

2015-12-01

Full Text Available Background For the purpose of understanding the Food and Drug Administration’s (FDA’s concerns regarding online promotion of prescription drugs advertised directly to consumers, this study examines notices of violations (NOVs and warning letters issued by the FDA to pharmaceutical manufacturers. Methods The FDA’s warning letters and NOVs, which were issued to pharmaceutical companies over a 10-year period (2005 to 2014 regarding online promotional activities, were content-analyzed. Results Six violation categories were identified: risk information, efficacy information, indication information, product labeling, material information issues, and approval issues. The results reveal that approximately 95% of the alleged violations were found on branded drug websites, in online paid advertisements, and in online videos. Of the total 179 violations, the majority of the alleged violations were concerned with the lack of risk information and/or misrepresentation of efficacy information, suggesting that achieving a fair balance of benefit versus risk information is a major problem with regard to the direct-to-consumer advertising (DTCA of prescription drugs. In addition, the character space limitations of online platforms, eg, sponsored links on search engines, pose challenges for pharmaceutical marketers with regard to adequately communicating important drug information, such as indication information, risk information, and product labeling. Conclusion Presenting drug information in a fair and balanced manner remains a major problem. Industry guidance should consider addressing visibility and accessibility of information in the web environment to help pharmaceutical marketers meet the requirements for direct-to-consumer promotion and to protect consumers from misleading drug information. Promotion via social media warrants further attention, as pharmaceutical manufacturers have already begun actively establishing a social media presence, and the

Trouble Spots in Online Direct-to-Consumer Prescription Drug Promotion: A Content Analysis of FDA Warning Letters.

Science.gov (United States)

Kim, Hyosun

2015-08-25

For the purpose of understanding the Food and Drug Administration's (FDA's) concerns regarding online promotion of prescription drugs advertised directly to consumers, this study examines notices of violations (NOVs) and warning letters issued by the FDA to pharmaceutical manufacturers. The FDA's warning letters and NOVs, which were issued to pharmaceutical companies over a 10-year period (2005 to 2014) regarding online promotional activities, were content-analyzed. Six violation categories were identified: risk information, efficacy information, indication information, product labeling, material information issues, and approval issues. The results reveal that approximately 95% of the alleged violations were found on branded drug websites, in online paid advertisements, and in online videos. Of the total 179 violations, the majority of the alleged violations were concerned with the lack of risk information and/or misrepresentation of efficacy information, suggesting that achieving a fair balance of benefit versus risk information is a major problem with regard to the direct-to-consumer advertising (DTCA) of prescription drugs. In addition, the character space limitations of online platforms, eg, sponsored links on search engines, pose challenges for pharmaceutical marketers with regard to adequately communicating important drug information, such as indication information, risk information, and product labeling. Presenting drug information in a fair and balanced manner remains a major problem. Industry guidance should consider addressing visibility and accessibility of information in the web environment to help pharmaceutical marketers meet the requirements for direct-to-consumer promotion and to protect consumers from misleading drug information. Promotion via social media warrants further attention, as pharmaceutical manufacturers have already begun actively establishing a social media presence, and the FDA has thus begun to keep tabs on social media promotions of

UK doctors and equal opportunities in the NHS: national questionnaire surveys of views on gender, ethnicity and disability.

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Lambert, Trevor; Surman, Geraldine; Goldacre, Michael

2014-10-01

To seek doctors' views about the NHS as an employer, our surveys about doctors' career intentions and progression, undertaken between 1999 and 2013, also asked whether the NHS was, in their view, a good 'equal opportunities' employer for women doctors, doctors from ethnic minority groups and doctors with disabilities. Surveys undertaken in the UK by mail and Internet. UK medical graduates in selected graduation years between 1993 and 2012. Respondents were asked to rate their level of agreement with three statements starting 'The NHS is a good equal opportunities employer for…' and ending 'women doctors', 'doctors from ethnic minorities' and 'doctors with disabilities'. Of first-year doctors surveyed in 2013, 3.6% (78/2158) disagreed that the NHS is a good equal opportunities employer for women doctors (1.7% of the men and 4.7% of the women); 2.2% (44/1968) disagreed for doctors from ethnic minorities (0.9% of white doctors and 5.8% of non-white doctors) and 12.6% (175/1387) disagreed for doctors with disabilities. Favourable perceptions of the NHS in these respects improved substantially between 1999 and 2013; among first-year doctors of 2000-2003, combined, the corresponding percentages of disagreement were 23.5% for women doctors, 23.1% for doctors from ethnic minorities and 50.6% for doctors with disabilities. Positive views about the NHS as an equal opportunities employer have increased in recent years, but the remaining gap in perception of this between women and men, and between ethnic minority and white doctors, is a concern. © The Royal Society of Medicine.

External and internal factors influencing self-directed online learning of physiotherapy undergraduate students in Sweden: a qualitative study.

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Hammarlund, Catharina Sjödahl; Nilsson, Maria H; Gummesson, Christina

2015-01-01

Online courses have become common in health sciences education. This learning environment can be designed using different approaches to support student learning. To further develop online environment, it is important to understand how students perceive working and learning online. The aim of this study is to identify aspects influencing students' learning processes and their adaptation to self-directed learning online. Thirty-four physiotherapy students with a mean age of 25 years (range, 21 to 34 years) participated. Qualitative content analysis and triangulation was used when investigating the students' self-reflections, written during a five week self-directed, problem-oriented online course. Two categories emerged: 'the influence of the structured framework' and 'communication and interaction with teachers and peers.' The learning processes were influenced by external factors, e.g., a clear structure including a transparent alignment of assignments and assessment. Important challenges to over-come were primarily internal factors, e.g., low self-efficacy, difficulties to plan the work effectively and adapting to a new environment. The analyses reflected important perspectives targeting areas which enable further course development. The influences of external and internal factors on learning strategies and self-efficacy are important aspects to consider when designing online courses. Factors such as pedagogical design, clarity of purpose, goals, and guidelines were important as well as continuous opportunities for communication and collaboration. Further studies are needed to understand and scaffold the motivational factors among students with low self-efficacy.

Considerations, clues and challenges: Gaining Ethical and Trust research approval when using the NHS as a research setting

International Nuclear Information System (INIS)

Jonker, Leon; Cox, Diane; Marshall, Gill

2011-01-01

Substantial changes have been made in recent years to the process of obtaining ethical and research governance approval for research projects in the NHS. The advent of the Integrated Research Application System (IRAS) has streamlined the process, providing a single point of entry. Ethical approval gained in one part of the country is now valid throughout the UK. The previous process of gaining research governance approval in NHS Trusts was maligned and it has been overhauled with the introduction of the National Institute of Health Research (NIHR) Coordinated System for gaining NHS Permission. In addition to updating the reader about the new processes around gaining ethical and Trust approval for research within an NHS setting, essential research project documentation needed for submission are discussed. The aspects of a proposal that Ethics Committees and Trust R and D Departments consider when reviewing applications are highlighted. The implemented changes to the research approval processes will mostly benefit large multi-centre studies; small scale unfunded studies and student projects are potentially at risk of being marginalised in the quest for a streamlined ethics and NHS Trust research governance approval process. However, researchers' familiarity with the approval system should minimise rejection rates and delays.

Considerations, clues and challenges: Gaining Ethical and Trust research approval when using the NHS as a research setting

Energy Technology Data Exchange (ETDEWEB)

Jonker, Leon, E-mail: leon.jonker@cumbria.ac.uk [Faculty of Health and Wellbeing, University of Cumbria, Lancaster LA1 3JD (United Kingdom); Research and Development Department, North Cumbria University Hospitals NHS Trust, Carlisle CA2 7HY (United Kingdom); Cox, Diane; Marshall, Gill [Faculty of Health and Wellbeing, University of Cumbria, Lancaster LA1 3JD (United Kingdom)

2011-08-15

Substantial changes have been made in recent years to the process of obtaining ethical and research governance approval for research projects in the NHS. The advent of the Integrated Research Application System (IRAS) has streamlined the process, providing a single point of entry. Ethical approval gained in one part of the country is now valid throughout the UK. The previous process of gaining research governance approval in NHS Trusts was maligned and it has been overhauled with the introduction of the National Institute of Health Research (NIHR) Coordinated System for gaining NHS Permission. In addition to updating the reader about the new processes around gaining ethical and Trust approval for research within an NHS setting, essential research project documentation needed for submission are discussed. The aspects of a proposal that Ethics Committees and Trust R and D Departments consider when reviewing applications are highlighted. The implemented changes to the research approval processes will mostly benefit large multi-centre studies; small scale unfunded studies and student projects are potentially at risk of being marginalised in the quest for a streamlined ethics and NHS Trust research governance approval process. However, researchers' familiarity with the approval system should minimise rejection rates and delays.

Do clinicians receive adequate training to identify trafficked persons? A scoping review of NHS Foundation Trusts.

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Thompson, Charles Dr; Mahay, Arun; Stuckler, David; Steele, Sarah

2017-09-01

We investigate whether physicians in secondary care in the English NHS receive adequate training to recognise and appropriately refer for services those persons suspected to be victims of human trafficking. Freedom of Information requests were sent to the 105 England's NHS Trusts delivering acute care in England. NHS Trusts providing secondary care in England. English NHS Trusts. We requested data about the training provided on human trafficking to clinicians, including the nature, delivery, and format of any education, and any planned training. A total of 89.5% of the 105 Trusts responded. Of these Trusts, 69% provide education to physicians on human trafficking, and a further 6% provide training but did not specify who received it. The majority of Trusts providing training did so within wider safeguarding provision (91%). Only one trust reported that it provides stand-alone training on trafficking to all its staff, including physicians. Within training offered by Trusts, 54% observed best practice providing training on the clinical indicators of trafficking, while 16% referenced the National Referral Mechanism. Amongst those not providing training, 39% of Trusts report provision is in development. Our results find that 25% of NHS Foundation Trusts appear to lack training for physicians around human trafficking. It is also of concern that of the Trusts who currently do not provide training, only 39% are developing training or planning to do so. There is an urgent need to review and update the scope of available training and bring it into alignment with current legislation.

Do clinicians receive adequate training to identify trafficked persons? A scoping review of NHS Foundation Trusts

Science.gov (United States)

Mahay, Arun; Stuckler, David; Steele, Sarah

2017-01-01

Objective We investigate whether physicians in secondary care in the English NHS receive adequate training to recognise and appropriately refer for services those persons suspected to be victims of human trafficking. Design Freedom of Information requests were sent to the 105 England’s NHS Trusts delivering acute care in England. Setting NHS Trusts providing secondary care in England. Participants English NHS Trusts. Main outcome measures We requested data about the training provided on human trafficking to clinicians, including the nature, delivery, and format of any education, and any planned training. Results A total of 89.5% of the 105 Trusts responded. Of these Trusts, 69% provide education to physicians on human trafficking, and a further 6% provide training but did not specify who received it. The majority of Trusts providing training did so within wider safeguarding provision (91%). Only one trust reported that it provides stand-alone training on trafficking to all its staff, including physicians. Within training offered by Trusts, 54% observed best practice providing training on the clinical indicators of trafficking, while 16% referenced the National Referral Mechanism. Amongst those not providing training, 39% of Trusts report provision is in development. Conclusions Our results find that 25% of NHS Foundation Trusts appear to lack training for physicians around human trafficking. It is also of concern that of the Trusts who currently do not provide training, only 39% are developing training or planning to do so. There is an urgent need to review and update the scope of available training and bring it into alignment with current legislation. PMID:28904806

Mixed messages: An evaluation of NHS Trust Social Media policies in the North West of England

International Nuclear Information System (INIS)

Scragg, B.; Shaikh, S.; Robinson, L.; Mercer, C.

2017-01-01

Introduction: Despite National Health Service (NHS) information strategy promoting the use of Social Media (SoMe) to encourage greater engagement between service users and providers, a team investigating online SoMe interaction between breast screening practitioners and clients found that practitioners alleged discouragement from employers' policies. This study aimed to investigate whether this barrier was genuine, and illuminate whether local policy differed from national strategy. Method: The study used a qualitative grounded theory approach to generate a theory. Nine policies from the North West of England were analysed. A framework was derived from the data, and an analysis of policy tone followed by a detailed coding of policy content was undertaken. Comparative analysis continued by reviewing the literature, and a condensed framework revealed five broad categories that policies addressed. Results: The analysis revealed the policies varied in content, but not in tone, which was mostly discouraging. Coding the content revealed that the most frequently addressed point was that of protecting the employers' reputation, and after further analysis, the resultant condensed framework showed that policies were imbalanced and heavily skewed towards Security, Conduct & Behaviour and Reputation. Conclusion: Practitioners within breast screening services are discouraged by overly prohibitive and prescriptive SoMe policies; with these varying tremendously in comprehensiveness, but with a narrow focus on security and employers reputation; in contrast with national strategy. Recommendations are that policy revision is undertaken with consultation by more than one stakeholder, and SoMe training is offered for all members of NHS staff. - Highlights: • Practitioners are discouraged from using SoMe by employers' policies. • This is at odds with national strategy of engagement with all stakeholders. • Policies are skewed towards protecting reputation and

Open courses: one view of the future of online education.

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Alemi, Farrokh; Maddox, P J

2008-01-01

Open courses provide the entire course (lectures, assignments, syllabus, student's discussions, and student's projects) online without revealing student's personal information. We report on our experience in managing 8 open online courses at http://nhs.georgetown.edu/open. Open courses have several advantages over password protected courses: (1) they are available through search engines and thus reduce the program's marketing cost, (2) continuous feedback from the web enables rapid improvements to the course, (3) customer relationship tools, tied to open courses, radically reduce faculty time spent on one-on-one emails while increasing student/faculty interaction. We provide details of one course. In 15 weeks, 803 emails were received by and 1181 sent by the faculty (all within 6% of a working week and 82% savings of faculty time). We show how open courses can be accessed through search engines, how students questions are answered on the web and how student projects, in popular sites such as You Tube and Face Book, improve course marketing. The paper reports that student satisfaction with three open online courses delivered overall several semesters was high.

Exploring HRD in two Welsh NHS Trusts: analysing the discursive resources used by senior managers.

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Sambrook, Sally

2007-01-01

The purpose of this paper is to examine human resource development (HRD) in the UK National Health Service (NHS), and particularly in two Welsh NHS Trusts, to help illuminate the various ways in which learning, training and development are talked about. The NHS is a complex organisation, not least with its recent devolution and separation into the four distinct countries of the UK. Within this, there are multiple and often conflicting approaches to human resource development associated with the various forms of employee, professional (nursing, medical etc.), managerial and organisational development. How people are developed is crucial to developing a modern health service, and yet, with the diverse range of health workers, HRD is a complex process, and one which receives little attention. Managers have a key role and their perceptions of HRD can be analysed through the discursive resources they employ. From an interpretivist stance, the paper employs semi-structured interviews with seven Directorate-General Managers, and adopts discourse analysis to explore how HRD is talked about in two Welsh NHS Trusts. The paper finds some of the different discourses used by different managers, including those with a nursing background and those without. It examines how they talk about HRD, and also explores their own (management) development and the impact this has had on their sense of identity. The paper highlights some of the tensions associated with HRD in the NHS, including ambiguities between professional and managerial development, the functional and physical fragmentation of HRD, conflict between a focus on performance/service delivery and the need to learn, discursive dissonance between the use of the terms training and learning, a delicate balance between "going on courses" and informal, work-related learning, inequities regarding "protected time" and discourses shifting between competition and cooperation. These tensions are exposed to help develop a shared

Weight Watchers on prescription: An observational study of weight change among adults referred to Weight Watchers by the NHS

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Aston Louise M

2011-06-01

Full Text Available Abstract Background The scale of overweight and obesity in the UK places a considerable burden on the NHS. In some areas the NHS has formed partnerships with commercial companies to offer weight management services, but there has been little evaluation of these schemes. This study is an independent audit of the Weight Watchers NHS Referral scheme and evaluates the weight change of obese and overweight adults referred to Weight Watchers (WW by the NHS. Method Data was obtained from the WW NHS Referral Scheme database for 29,326 referral courses started after 2nd April 2007 and ending before 6th October 2009 [90% female; median age 49 years (IQR 38 - 61 years; median BMI 35.1 kg/m2 (IQR 31.8 - 39.5 kg/m2. Participants received vouchers (funded by the PCT following referral by a healthcare professional to attend 12 WW meetings. Body weight was measured at WW meetings and relayed to the central database. Results Median weight change for all referrals was -2.8 kg [IQR -5.9 - -0.7 kg] representing -3.1% initial weight. 33% of all courses resulted in loss of ≥5% initial weight. 54% of courses were completed. Median weight change for those completing a first course was -5.4 kg [IQR -7.8 - -3.1 kg] or -5.6% of initial weight. 57% lost ≥5% initial weight. Conclusions A third of all patients who were referred to WW through the WW NHS Referral Scheme and started a 12 session course achieved ≥5% weight loss, which is usually associated with clinical benefits. This is the largest audit of NHS referral to a commercial weight loss programme in the UK and results are comparable with other options for weight loss available through primary care.

Assessment approaches in massive open online courses: Possibilities, challenges and future directions

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Xiong, Yao; Suen, Hoi K.

2018-03-01

The development of massive open online courses (MOOCs) has launched an era of large-scale interactive participation in education. While massive open enrolment and the advances of learning technology are creating exciting potentials for lifelong learning in formal and informal ways, the implementation of efficient and effective assessment is still problematic. To ensure that genuine learning occurs, both assessments for learning (formative assessments), which evaluate students' current progress, and assessments of learning (summative assessments), which record students' cumulative progress, are needed. Providers' more recent shift towards the granting of certificates and digital badges for course accomplishments also indicates the need for proper, secure and accurate assessment results to ensure accountability. This article examines possible assessment approaches that fit open online education from formative and summative assessment perspectives. The authors discuss the importance of, and challenges to, implementing assessments of MOOC learners' progress for both purposes. Various formative and summative assessment approaches are then identified. The authors examine and analyse their respective advantages and disadvantages. They conclude that peer assessment is quite possibly the only universally applicable approach in massive open online education. They discuss the promises, practical and technical challenges, current developments in and recommendations for implementing peer assessment. They also suggest some possible future research directions.

Advance care planning in 21st century Australia: a systematic review and appraisal of online advance care directive templates against national framework criteria.

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Luckett, Tim; Bhattarai, Priyanka; Phillips, Jane; Agar, Meera; Currow, David; Krastev, Yordanka; Davidson, Patricia M

2015-11-01

A drive to promote advance care planning at a population level has led to a proliferation of online advance care directive (ACD) templates but little information to guide consumer choice. The current study aimed to appraise the quality of online ACD templates promoted for use in Australia. A systematic review of online Australian ACD templates was conducted in February 2014. ACD templates were identified via Google searches, and quality was independently appraised by two reviewers against criteria from the 2011 report A National Frameworkfor Advance Care Directives. Bias either towards or against future medical treatment was assessed using criteria designed to limit subjectivity. Fourteen online ACD templates were included, all of which were available only in English. Templates developed by Southern Cross University best met the framework criteria. One ACD template was found to be biased against medical treatment--the Dying with Dignity Victoria Advance Healthcare Directive. More research is needed to understand how online resources can optimally elicit and record consumers' individual preferences for future care. Future iterations of the framework should address online availability and provide a simple rating system to inform choice and drive quality improvement.

NHS health checks through general practice: randomised trial of population cardiovascular risk reduction

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Cochrane Thomas

2012-11-01

Full Text Available Abstract Background The global burden of the major vascular diseases is projected to rise and to remain the dominant non-communicable disease cluster well into the twenty first century. The Department of Health in England has developed the NHS Health Check service as a policy initiative to reduce population vascular disease risk. The aims of this study were to monitor population changes in cardiovascular disease (CVD risk factors over the first year of the new service and to assess the value of tailored lifestyle support, including motivational interview with ongoing support and referral to other services. Methods Randomised trial comparing NHS Health Check service only with NHS Health Check service plus additional lifestyle support in Stoke on Trent, England. Thirty eight general practices and 601 (365 usual care, 236 additional lifestyle support patients were recruited and randomised independently between September 2009 and February 2010. Changes in population CVD risk between baseline and one year follow-up were compared, using intention-to-treat analysis. The primary outcome was the Framingham 10 year CVD risk score. Secondary outcomes included individual modifiable risk measures and prevalence of individual risk categories. Additional lifestyle support included referral to a lifestyle coach and free sessions as needed for: weight management, physical activity, cook and eat and positive thinking. Results Average population CVD risk decreased from 32.9% to 29.4% (p Conclusions The NHS Health Check service in Stoke on Trent resulted in significant reduction in estimated population CVD risk. There was no evidence of further benefit of the additional lifestyle support services in terms of absolute CVD risk reduction.

Trouble Spots in Online Direct-to-Consumer Prescription Drug Promotion: Teaching Drug Marketers How to Inform Better or Spin Better?

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Doran, Evan

2016-01-01

Hyosun Kim’s report "Trouble Spots in Online Direct to Consumer Prescription Drug Promotion: A content Analysis of FDA Warning Letters" aims to teach marketers how to avoid breaching current Food and Drug Administration (FDA) guidelines in their online drug promotion. While Kim hopes to minimise the potential for online promotion to misinform consumers and the study is carefully conducted, teaching drug marketers how to avoid the common mistakes in online drug promotion is more likely to make marketers more adept at spinning information than appropriately balancing it PMID:27239884

Variation in Direct Access to Tests to Investigate Cancer: A Survey of English General Practitioners

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Nicholson, Brian D.; Oke, Jason L.; Rose, Peter W.; Mant, David

2016-01-01

Background The 2015 NICE guidelines for suspected cancer recommend that English General Practitioners have direct access to diagnostic tests to investigate symptoms of cancer that do not meet the criteria for urgent referral. We aimed to identify the proportion of GPs in England with direct access to these tests. Methods We recruited 533 English GPs through a national clinical research network to complete an online survey about direct access to laboratory, radiology, and endoscopy tests in the three months leading up to the release of the 2015 NICE guidance. If they had direct access to a diagnostic test, GPs were asked about the time necessary to arrange a test and receive a report. Results are reported by NHS sub-region and, adjusting for sampling, for England as a whole. Results Almost all GPs reported direct access to x-ray and laboratory investigations except faecal occult blood testing (54%, 95% CI 49–59%) and urine protein electrophoresis (89%, 95% CI 84–92%). Fewer GPs had direct access to CT scans (54%, 95% CI 49–59%) or endoscopy (colonoscopy 32%, 95% CI 28–37%; gastroscopy 72%, 95% CI 67–77%). There was significant variation in direct access between NHS regions for the majority of imaging tests—for example, from 20 to 85% to MRI. Apart from x-ray, very few GPs (1–22%) could access radiology and endoscopy within the timescales recommended by NICE. The modal request to test time was 2–4 weeks for routine radiology and 4–6 weeks for routine endoscopy with results taking another 1–2 weeks. Conclusion At the time that the 2015 NICE guideline was released, local investment was required to not only provide direct access but also reduce the interval between request and test and speed up reporting. Further research using our data as a benchmark is now required to identify whether local improvements in direct access have been achieved in response to the NICE targets. If alternative approaches to test access are to be proposed they must be

Fostering postgraduate student engagement: online resources supporting self-directed learning in a diverse cohort

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Luciane V. Mello

2016-03-01

Full Text Available The research question for this study was: ‘Can the provision of online resources help to engage and motivate students to become self-directed learners?’ This study presents the results of an action research project to answer this question for a postgraduate module at a research-intensive university in the United Kingdom. The analysis of results from the study was conducted dividing the students according to their programme degree – Masters or PhD – and according to their language skills. The study indicated that the online resources embedded in the module were consistently used, and that the measures put in place to support self-directed learning (SDL were both perceived and valued by the students, irrespective of their programme or native language. Nevertheless, a difference was observed in how students viewed SDL: doctoral students seemed to prefer the approach and were more receptive to it than students pursuing their Masters degree. Some students reported that the SDL activity helped them to achieve more independence than did traditional approaches to teaching. Students who engaged with the online resources were rewarded with higher marks and claimed that they were all the more motivated within the module. Despite the different learning experiences of the diverse cohort, the study found that the blended nature of the course and its resources in support of SDL created a learning environment which positively affected student learning.

Future Directions for Research on Online Technical Education

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Horvitz, Brian S.

2017-01-01

Most research on online learning in higher education has been focused on general education at four-year institutions. There is a need for more research that focuses on online and hybrid education at community colleges in technical education fields. This issue includes articles from eight National Science Foundation funded projects doing innovative…

Online consumer contracts

NARCIS (Netherlands)

Luzak, J.

2014-01-01

The new Consumer Rights Directive introduced some changes to the level of consumers’ protection online. However, just like with its predecessor, the Distance Selling Directive, the main focus of the protection that consumers have been granted online is to provide them with transparent and salient

External and internal factors influencing self-directed online learning of physiotherapy undergraduate students in Sweden: a qualitative study

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Catharina Sjödahl Hammarlund

2015-06-01

Full Text Available Purpose: Online courses have become common in health sciences education. This learning environment can be designed using different approaches to support student learning. To further develop online environment, it is important to understand how students perceive working and learning online. The aim of this study is to identify aspects influencing students’ learning processes and their adaptation to self-directed learning online. Methods: Thirty-four physiotherapy students with a mean age of 25 years (range, 21 to 34 years participated. Qualitative content analysis and triangulation was used when investigating the students’ self-reflections, written during a five week self-directed, problem-oriented online course. Results: Two categories emerged: ‘the influence of the structured framework’ and ‘communication and interaction with teachers and peers.’ The learning processes were influenced by external factors, e.g., a clear structure including a transparent alignment of assignments and assessment. Important challenges to over-come were primarily internal factors, e.g., low self-efficacy, difficulties to plan the work effectively and adapting to a new environment. Conclusion: The analyses reflected important perspectives targeting areas which enable further course development. The influences of external and internal factors on learning strategies and self-efficacy are important aspects to consider when designing online courses. Factors such as pedagogical design, clarity of purpose, goals, and guidelines were important as well as continuous opportunities for communication and collaboration. Further studies are needed to understand and scaffold the motivational factors among students with low self-efficacy.

Direct and Indirect Effects of Perceived Risk and Website Reputation on Purchase Intention: The Mediating Role of Online Trust

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Chatpong Tangmanee

2016-10-01

Full Text Available Success in electronic commerce relies greatly on customer trust. While other studies have examined various factors affecting online customer trust, few have investigated the joint effects of perceived risk and website reputation on purchase intention using online trust as a mediator. The current study attempts to fill this gap. 300 online shoppers participated via web-based questionnaires using a quota sampling technique. Based on confirmatory factor analysis (CFA, our measurements were found to be valid and reliable. Using structural equation modeling (SEM, we confirmed significant direct effects of perceived risk and website reputation on customer purchase intentions. Furthermore, both factors had significant indirect effects on purchase intention through online trust. In addition to extending theoretical insight into online trust as a mediator for the effects of perceived risk and website reputation on purchase intention, web-based vendors may adopt the findings to adjust their online stores to raise customer trust and ultimately increase the possibility of online purchases.

Corneal Stromal Cell Growth on Gelatin/Chondroitin Sulfate Scaffolds Modified at Different NHS/EDC Molar Ratios

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Jui-Yang Lai

2013-01-01

Full Text Available A nanoscale modification strategy that can incorporate chondroitin sulfate (CS into the cross-linked porous gelatin materials has previously been proposed to give superior performance for designed corneal keratocyte scaffolds. The purpose of this work was to further investigate the influence of carbodiimide chemistry on the characteristics and biofunctionalities of gelatin/CS scaffolds treated with varying N-hydroxysuccinimide (NHS/1-ethyl-3-(3-dimethyl aminopropyl carbodiimide hydrochloride (EDC molar ratios (0-1 at a constant EDC concentration of 10 mM. Results of Fourier transform infrared spectroscopy and dimethylmethylene blue assays consistently indicated that when the NHS to EDC molar ratio exceeds a critical level (i.e., 0.5, the efficiency of carbodiimide-mediated biomaterial modification is significantly reduced. With the optimum NHS/EDC molar ratio of 0.5, chemical treatment could achieve relatively high CS content in the gelatin scaffolds, thereby enhancing the water content, glucose permeation, and fibronectin adsorption. Live/Dead assays and interleukin-6 mRNA expression analyses demonstrated that all the test samples have good cytocompatibility without causing toxicity and inflammation. In the molar ratio range of NHS to EDC from 0 to 0.5, the cell adhesion ratio and proliferation activity on the chemically modified samples significantly increased, which is attributed to the increasing CS content. Additionally, the materials with highest CS content (0.143 ± 0.007 nmol/10 mg scaffold showed the greatest stimulatory effect on the biosynthetic activity of cultivated keratocytes. These findings suggest that a positive correlation is noticed between the NHS to EDC molar ratio and the CS content in the biopolymer matrices, thereby greatly affecting the corneal stromal cell growth.

The NHS could learn from inspiring leaders like Barack Obama.

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Coghill, Yvonne

2017-02-01

I remember November 2008 like it was yesterday. I was the lead for the NHS Leadership Academy's national Breaking Through programme for black and minority ethnic staff, and recall being at our annual conference bursting with pride at the news that Barack Obama had been elected president of the United States.

The disposal of redundant teletherapy units from NHS hospitals

International Nuclear Information System (INIS)

Gaffka, A.P.; Ord, M.A.

1994-01-01

The removal/disposal of redundant teletherapy units from NHS hospitals is described, detailing the operational procedures and the transport package background. The Harwell section of the Transport Technology Department has been carrying out these operations since 1991, where initially the service was just offered to the NHS; however, today their specialist transport service has significantly widened and is now offered to other business sectors. Due to the level of radioactivity found in each teletherapy unit, it was necessary to design a special transport packaging to meet the requirements for shipment of these units. Approval was sought from the Department of Transport to adapt a standard Type B package as no other packaging could be found to comply with the necessary requirements. All work undertaken on the removal and disposal of these units complied with an approved scheme of work and was carried out in accordance with a Quality Assurance workplan. However, to keep abreast of modern standards in a manner which is cost effective to customers and acceptable to the general public, the full development of a new Type B packaging is taking place, which is specifically designed to undertake these removal/disposal duties. (author)

The Effects of Immigration on NHS Waiting Times

OpenAIRE

Giuntella, Osea; Nicodemo, Catia; Vargas-Silva, Carlos

2015-01-01

This paper analyses the effects of immigration on waiting times in the National Health Service (NHS) in England. Linking administrative records from the Hospital Episode Statistics (2003-2012) with immigration data drawn from the UK Labour Force Survey, we find that immigration reduced waiting times for outpatient referrals and did not have significant effects on waiting times in Accident and Emergency (A&E) and elective care. These results are explained by the fact that immigration increases...

Tracing experiences of NHS change in England: a process philosophy perspective.

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McMurray, Robert

2010-01-01

For over three decades public services have been the subject of unprecedented change. Nowhere has this been more evident than in the English National Health Service (NHS) where despite the effort expended on change there is growing evidence that such restructuring is largely ineffective. Drawing on a study of culture modification in the English NHS, this paper utilizes Chia's (1999) account of the metaphysics of processual change to consider why attempts to restructure public services are not always successful. The paper contributes to our understanding of public management reform by considering how an ontology of becoming, and a loosening of control, might alter how we approach reforming. Further, the paper offers a theoretical justification for the use of standard research methods for novel processual ends. The paper concludes with a reflection on the implications of a processual perspective for the future management, organization and study of change in public administration.

Direct access: how is it working?

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Turner, S; Ross, M

2017-02-10

Aim The aim of this study was to identify and survey dental hygienists and therapists working in direct access practices in the UK, obtain their views on its benefits and disadvantages, establish which treatments they provided, and what barriers they had encountered.Method The study used a purposive sample of GDC-registered hygienists and therapists working in practices offering direct access, identified through a 'Google' search. An online survey was set up through the University of Edinburgh, and non-responses followed up by post.Results The initial search identified 243 individuals working in direct access practices. Where a practice listed more than one hygienist/therapist, one was randomly selected. This gave a total of 179 potential respondents. Eighty-six responses were received, representing a response rate of 48%. A large majority of respondents (58, 73%) were favourable in their view of the GDC decision to allow direct access, and most thought advantages outnumbered disadvantages for patients, hygienists, therapists and dentists. There were no statistically significant differences in views between hygienists and therapists. Although direct access patients formed a small minority of their caseload for most respondents, it is estimated that on average respondents saw approximately 13 per month. Treatment was mainly restricted to periodontal work, irrespective of whether the respondent was singly or dually qualified. One third of respondents reported encountering barriers to successful practice, including issues relating to teamwork and dentists' unfavourable attitudes. However, almost two thirds (64%) felt that direct access had enhanced their job satisfaction, and 45% felt their clinical skills had increased.Discussion Comments were mainly positive, but sometimes raised worrying issues, for example in respect to training, lack of dental nurse support and the limited availability of periodontal treatment under NHS regulations.

From NHS Choices to the integrated customer service platform.

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Gann, Bob; Grant, Maria J

2013-03-01

In 2013 the NHS Commissioning Board launches its new integrated customer service platform. The new service utilises the full range of channels (web, telephone, apps etc) to provide access to information to support transparency, participation and transactions. Digital health services have proven benefits in informed choice, shared decision making and patient participation. © 2013 The authors. Health Information and Libraries Journal © 2013 Health Libraries Group.

The NHS as a learning organization: aspirations beyond the rainbow?

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Timpson, J

1998-09-01

It is the intention of this paper to review the issues and challenges organizations face when aspiring to embrace and enact the tenets of a learning organization; and in particular the perceived impact on management strategy, structure and leadership styles. The paper is predicated on the premise that learning and knowledge act as vital strategic resources, crucial not only to organizations in terms of competitive advantage but to ethical enterprise per se. Modern life is characterized by change, against the backdrop of this continual turmoil, organizational learning has emerged as a dominant theme within contemporary management theory, with many commentators increasingly locating the capacity of an aspiring organization to accommodate the ethos of organizational learning, as the vital component in ensuring enduring efficiency, innovation and competitiveness. However, the utility of such learning needs to be scrutinized and evaluated in terms of service need and expectation. The paper will expand upon wider theoretical debates extant within the literature, by considering the concept and utility of the learning organization with specific reference to management reform extant within the British National Health Service (NHS). During the course of the review the various the theoretical positions contributing to the notion of the learning organization will be analysed, the practical ramifications of which will be examined in the context of reflective practice, clinical supervision and the wider cultural background of nursing and the NHS. The paper concludes that the NHS needs to reorientate management perspectives to focus attention more acutely on systems which are deliberately designed to facilitate shared learning, to unravel the ambiguities of organizational life, to affirm management belief in the nursing contribution and to achieve an as yet unrealized potential in terms of patient care and advanced nursing practice.

Duncan Tanner Essay Prize Winner 2014. Against the 'Sacred Cow': NHS Opposition and the Fellowship for Freedom in Medicine, 1948-72.

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Seaton, Andrew

2015-01-01

This essay recovers organized opposition to the National Health Service (NHS) by considering the Fellowship for Freedom in Medicine (FFM), a conservative organization of doctors who challenged the 'Sacred Cow' of nationalized healthcare in the 1950s and 1960s. While there has been little interest in anti-NHS politics because of shortcomings in the institution's historiography, this study suggests ways a new history of the service can be written. Central to that project is taking the broader ideological and emotive quality of the NHS seriously, and appreciating the way, for all sides of the political spectrum, as well as the general public, the service has always been a contested symbol of post-war British identity. This essay argues that two NHS 'crises'--panics over costs, and disillusionment within general practice--were not merely disagreements over budgets and pay-packets but politically charged moments infused with conservative anxieties over Britain's post-war trajectory. The FFM imagined the NHS as an economically dangerous bureaucratic machine that crushed medical independence and risked pushing the country towards dictatorship. Allies within the Conservative Party, private health insurance industry, and free-market 'think-tanks' worked with the FFM to challenge defences of both the service's operation and meaning. To appreciate why the NHS remains 'the closest thing the English have to a religion', one must consider the apostates as well as the faithful.

Assessing the impact of a new health sector pay system upon NHS staff in England

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Buchan James

2008-06-01

Full Text Available Abstract Background Pay and pay systems are a critical element in any health sector human resource strategy. Changing a pay system can be one strategy to achieve or sustain organizational change. This paper reports on the design and implementation of a completely new pay system in the National Health Service (NHS in England. 'Agenda for Change' constituted the largest-ever attempt to introduce a new pay system in the UK public services, covering more than one million staff. Its objectives were to improve the delivery of patient care as well as enhance staff recruitment, retention and motivation, and to facilitate new ways of working. Methods This study was the first independent assessment of the impact of Agenda for Change at a local and national level. The methods used in the research were a literature review; review of 'grey' unpublished documentation provided by key stakeholders in the process; analysis of available data; interviews with key national informants (representing government, employers and trade unions, and case studies conducted with senior human resource managers in ten NHS hospitals in England Results Most of the NHS trust managers interviewed were in favour of Agenda for Change, believing it would assist in delivering improvements in patient care and staff experience. The main benefits highlighted were: 'fairness', moving different staff groups on to harmonized conditions; equal pay claim 'protection'; and scope to introduce new roles and working practices. Conclusion Agenda for Change took several years to design, and has only recently been implemented. Its very scale and central importance to NHS costs and delivery of care argues for a full assessment at an early stage so that lessons can be learned and any necessary changes made. This paper highlights weaknesses in evaluation and limitations in progress. The absence of systematically derived and applied impact indicators makes it difficult to assess impact and impact

Use of programme budgeting and marginal analysis to set priorities for local NHS dental services: learning from the north east of England.

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Holmes, R D; Steele, J G; Exley, C; Vernazza, C R; Donaldson, C

2018-05-03

Priority setting is necessary where competing demands exceed the finite resources available. The aim of the study was to develop and test a prioritization framework based upon programme budgeting and marginal analysis (PBMA) as a tool to assist National Health Service (NHS) commissioners in their management of resources for local NHS dental services. Twenty-seven stakeholders (5 dentists, 8 commissioners and 14 patients) participated in a case-study based in a former NHS commissioning organization in the north of England. Stakeholders modified local decision-making criteria and applied them to a number of different scenarios. The majority of financial resources for NHS dental services in the commissioning organization studied were allocated to primary care dental practitioners' contracts in perpetuity, potentially constraining commissioners' abilities to shift resources. Compiling the programme budget was successful, but organizational flux and difficulties engaging local NHS commissioners significantly impacted upon the marginal analysis phase. NHS dental practitioners' contracts resemble budget-silos which do not facilitate local resource reallocation. 'Context-specific' factors significantly challenged the successful implementation and impact of PBMA. A local PBMA champion embedded within commissioning organizations should be considered. Participants found visual depiction of the cost-value ratio helpful during their initial priority setting deliberations.

Pedagogical directions to design and support collaborative knowledge building on-line tasks

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Ingrid Noguera Fructuoso

2013-02-01

Full Text Available 0 0 1 187 1034 USAL 8 2 1219 14.0 Normal 0 21 false false false ES JA X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Tabla normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:Calibri; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-ansi-language:ES; mso-fareast-language:EN-US;} Research on Computer-Supported Collaborative Learning (CSCL demonstrates that proposing that students work in groups does not improve their learning or increase their motivation. It is essential to design appropriate learning tasks and suitable pedagogical and technological support. The aim of this research is to identify pedagogical directions to design and support collaborative knowledge building tasks in on-line education. We conducted a case study at the Open University of Catalonia where we carried out two experiments: the first focusing on how teachers design and support collaborative on-line learning tasks and, the second, based on the control exerted over the tasks. As a result of the investigation we characterize the type of tasks that promote collaborative knowledge building, the teachers’ role and functions supporting these types of tasks, and we identify different stages in task regulation. Based on these results, we propose pedagogical directions to design and support collaborative on-line tasks divided into 4 stages: 1 Task design and individual preparation, 2 Task organization and group negotiation, 3 Task performance and collaborative knowledge building, and 4 Critical evaluation.

Supplying commercial biomedical companies from a human tissue bank in an NHS hospital--a view from personal experience.

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Gray, N; Womack, C; Jack, S J

1999-04-01

NHS histopathology laboratories are well placed to develop banks of surgically removed surplus human tissues to meet the increasing demands of commercial biomedical companies. The ultimate aim could be national network of non-profit making NHS tissue banks conforming to national minimum ethical, legal, and quality standards which could be monitored by local research ethics committees. The Nuffield report on bioethics provides ethical and legal guidance but we believe that the patient should be fully informed and the consent given explicit. Setting up a tissue bank requires enthusiasm, hard work, and determination as well as coordination between professionals in the NHS trust and in the commercial sector. The rewards are exiting new collaborations with commercial biomedical companies which could help secure our future.

Online Piracy

OpenAIRE

Daniel A. Howard

2017-01-01

Piracy, whether made online or in any other way is an illegal act, which should be avoided and stopped. In this era of rapid globalization and booming technology, online piracy can be seen in many forms. However, the main area of concern are the consequences that the online piracy has for the many people who are directly or indirectly involved in it. These consequences provide implications for ethical considerations. In my opinion, online piracy is an unethical act and should be avoided, howe...

Can NHS politics, power and conflict ever be a good thing for nurses?

Science.gov (United States)

Lees, Carolyn

2016-07-14

This article explores how organisational politics, power and conflict have a positive role to play for nurses in NHS organisational change and improvement, rather than always leading to disagreement and dispute.

A digital intervention to increase motivation and access to NHS Stop Smoking Services: Applying the Behaviour Change Wheel to develop the ‘Stop-app’.

Directory of Open Access Journals (Sweden)

Emily Fulton

2015-10-01

Full Text Available Background: Smokers are four times more likely to stop smoking with the help of an NHS Stop Smoking Service (SSS. However attendance is in decline, possibly due to the increase in popularity of e-cigarettes. SSS’s will support smokers who choose to use e-cigarettes as part of a quit attempt, therefore interventions are needed to encourage continued access and uptake of SSS. Aim: To design an evidence based intervention (Stop-app to increase referrals, 4 week quit rates and reduce ‘did not attend’ (DNA rates within SSS. Methods/Results: In Phase 1 we collected data to explore the barriers and facilitators to people using SSS. Smokers and ex-smokers identified a number of barriers, including a lack of knowledge about what happens at the service; the belief that there would be ’scare tactics’, ‘nagging’, that the service would be unfriendly and clinical; and a lack of perceived efficacy of the service. In Phase 2, data from extant literature and phase 1 were subject to behavioural analysis as outlined by the Behaviour Change Wheel framework. A range of factors were identified as needing to change. These aligned with capability (e.g. a lack of knowledge about the benefits of SSS, opportunity (e.g. beliefs that SSS are not easy to access and to motivation to act (e.g. beliefs that they did not need and would not benefit from SSS. We describe the content development process, illustrating the choice of 19 ‘Behaviour Change Techniques’ included in our digital intervention. In Phase 3 we assessed the acceptability of the proposed intervention by interviewing stop smoking service advisors and non-NHS provider sites (e.g. library services and children’s centres. Findings from interviews are presented and have been used to consider the best path for implementation of the web-app within service provision. Conclusion: The ‘Stop –app’ is in development and will be accessible online, linking with the SSS booking system used by Public

Global reach of direct-to-consumer advertising using social media for illicit online drug sales.

Science.gov (United States)

Mackey, Tim Ken; Liang, Bryan A

2013-05-29

Illicit or rogue Internet pharmacies are a recognized global public health threat that have been identified as utilizing various forms of online marketing and promotion, including social media. To assess the accessibility of creating illicit no prescription direct-to-consumer advertising (DTCA) online pharmacy social media marketing (eDTCA2.0) and evaluate its potential global reach. We identified the top 4 social media platforms allowing eDTCA2.0. After determining applicable platforms (ie, Facebook, Twitter, Google+, and MySpace), we created a fictitious advertisement advertising no prescription drugs online and posted it to the identified social media platforms. Each advertisement linked to a unique website URL that consisted of a site error page. Employing Web search analytics, we tracked the number of users visiting these sites and their location. We used commercially available Internet tools and services, including website hosting, domain registration, and website analytic services. Illicit online pharmacy social media content for Facebook, Twitter, and MySpace remained accessible despite highly questionable and potentially illegal content. Fictitious advertisements promoting illicit sale of drugs generated aggregate unique user traffic of 2795 visits over a 10-month period. Further, traffic to our websites originated from a number of countries, including high-income and middle-income countries, and emerging markets. Our results indicate there are few barriers to entry for social media-based illicit online drug marketing. Further, illicit eDTCA2.0 has globalized outside US borders to other countries through unregulated Internet marketing.

Transcranial direct current stimulation versus user training on improving online myoelectric control for amputees

Science.gov (United States)

Pan, Lizhi; Zhang, Dingguo; Jiang, Ning; Sheng, Xinjun; Zhu, Xiangyang

2017-08-01

Objective. Transcranial direct current stimulation (tDCS) and user training (UT) are two types of methods to improve myoelectric control performance for amputees. In this study, we compared the independent effect between tDCS and UT, and investigated the combined effect of tDCS and UT. Approach. An online paradigm of simultaneous and proportional control (SPC) based on electromyography (EMG) was adopted. The proposed experiments were conducted on six naïve unilateral trans-radial amputees. The subjects each received three types of 20 min interventions: active tDCS with motor training (tDCS  +  UT), active tDCS with quiet sitting (tDCS), and sham tDCS with motor training (UT). The interventions were applied at one week intervals in a randomized order. The subjects performed online control of a feedback arrow with two degrees of freedom (DoFs) to accomplish target reaching motor tasks in pre-sessions and post-sessions. We compared the performance, measured by completion rate, completion time, and efficiency coefficient, between pre-sessions and post-sessions. Main results. The results showed that the intervention tDCS  +  UT and tDCS significantly improved the online SPC performance (i.e. improved the completion rate; reduced the completion time; and improved the efficiency coefficient), while intervention UT did not significantly change the performance. The results also showed that the online SPC performance after intervention tDCS  +  UT and tDCS was not significantly different, but both were significantly better than that after intervention UT. Significance. tDCS could be an effective intervention to improve the online SPC performance in a short time.

An investigation into the move towards electronic journals: a case study of NHS libraries in Kent, Surrey and Sussex.

Science.gov (United States)

England, Rebecca

2013-09-01

Electronic journals are so embedded into practice in academic libraries that it is easy to forget that this is not the case everywhere. In NHS libraries, for example, the staff face a particular set of issues. This article is based on Rebecca England's dissertation on this topic, completed as part of the MSc Econ course in Information and Library studies at Aberystwyth University. Rebecca is E-resources Librarian at the Maidstone and Tunbridge Wells NHS Trust. She investigated the momentum towards electronic journals in NHS libraries in the Kent, Surrey and Sussex region and the potential for a regional purchasing consortium. © 2013 The author. Health Information and Libraries Journal © 2013 Health Libraries Group.

Enacting localist health policy in the English NHS: the 'governing assemblage' of Clinical Commissioning Groups.

Science.gov (United States)

Hammond, Jonathan; Coleman, Anna; Checkland, Kath

2018-01-01

Objectives The Health and Social Care Act 2012 introduced Clinical Commissioning Groups to take responsibility for commissioning (i.e. planning and purchasing) the majority of services for local populations in the English NHS. Constituted as 'membership organizations', with membership compulsory for all GP practices, Clinical Commissioning Groups are overseen by, and are accountable to, a new arm's-length body, NHS England. This paper critically engages with the content and policy narrative of the 2012 Act and explores this in relation to the reality of local policy enactment. Methods Set against a careful review of the 2012 Act, a case study of a nascent Clinical Commissioning Groups was conducted. The research included observations of Clinical Commissioning Group meetings and events (87 h), and in-depth interviews (16) with clinical commissioners, GPs, and managers. Results The 2012 Act was presented as part of a broader government agenda of decentralization and localism. Clinical Commissioning Group membership organizations were framed as a means of better meeting the needs and preferences of local patients and realizing a desirable increase in localism. The policy delineated the 'governing body' and 'the membership', with the former elected from/by the latter to oversee the organization. 'The membership' was duty bound to be 'good', engaged members and to represent their patients' interests. Fieldwork with Notchcroft Clinical Commissioning Group revealed that Clinical Commissioning Groups' statutory duty to NHS England to 'ensure the continuous improvement' of GP practice members involved performance scrutiny of GP practices. These governance processes were carried out by a varied cast of individuals, many of whom did not fit into the binary categorization of membership and governing body constructed in the policy. A concept, the governing assemblage, was developed to describe the dynamic cast of people involved in shaping the work and direction of the Clinical

Case-mix & patients' reports of outcome in Independent Sector Treatment Centres: Comparison with NHS providers.

Science.gov (United States)

Browne, John; Jamieson, Liz; Lewsey, Jim; van der Meulen, Jan; Copley, Lynn; Black, Nick

2008-04-09

There has been considerable concern expressed about the outcomes achieved in Independent Sector Treatment Centres (ISTCs) introduced in England since 2003. Our aim was to compare the case-mix and patients' reported outcomes of surgery in ISTCs and in NHS providers. Prospective cohort study of 769 patients treated in six ISTCs and 1895 treated in 20 NHS providers (acute hospitals and treatment centres) in England during 2006-07. Participants underwent one of three day surgery procedures (inguinal hernia repair, varicose vein surgery, cataract extraction) or hip or knee replacement. Change in patient-reported health status and health related quality of life (measured using a disease-specific and a generic (EQ-5D) instrument) was assessed either 3-months (day surgery) or 6-months (hip/knee) after surgery. In addition patient-reported post-operative complications and an overall assessment of success of surgery were collected. Outcome measures were adjusted (using multivariable regression) for patient characteristics (disease severity, duration of symptoms, age, sex, socioeconomic status, general health, previous similar surgery, comorbidity). Post-operative response rates varied by procedure (73%-88%) and were similar for those treated in ISTCs and NHS facilities. Patients treated in ISTCs were healthier, were less likely to have any comorbidity and, for those undergoing cataract surgery or joint replacement, their primary condition was less severe. Those undergoing hernia repair or joint replacement were less likely to have had similar surgery before. When adjustment was made for pre-operative characteristics, patients undergoing cataract surgery or hip replacement in ISTCs achieved a slightly greater improvement in functional status and quality of life than those treated in NHS facilities, while the opposite was true of patients undergoing hernia repair. No significant differences were found for the two other procedures. Patients treated in ISTCs were less likely to

Medical Tourism: A Cost or Benefit to the NHS?

OpenAIRE

Hanefeld, Johanna; Horsfall, Daniel; Lunt, Neil; Smith, Richard

2013-01-01

'Medical Tourism' - the phenomenon of people travelling abroad to access medical treatment - has received increasing attention in academic and popular media. This paper reports findings from a study examining effect of inbound and outbound medical tourism on the UK NHS, by estimating volume of medical tourism and associated costs and benefits. A mixed methods study it includes analysis of the UK International Passenger Survey (IPS); interviews with 77 returning UK medical tourists, 63 policym...

Challenges of commissioning and contracting for integrated care in the National Health Service (NHS) in England.

Science.gov (United States)

Addicott, Rachael

2016-01-01

For many years there has been a separation between purchasing and provision of services in the English National Health Service (NHS). Many studies report that this commissioning function has been weak: purchasers have had little impact or power in negotiations with large acute providers, and have had limited strategic control over the delivery of care. Nevertheless, commissioning has become increasingly embedded in the NHS structure since the arrival of Clinical Commissioning Groups (CCGs) in 2012. Recently, some of these CCGs have focused on how they can contract and commission in different ways to stimulate greater collaboration across providers. This paper examines experiences of commissioning and contracting for integrated care in the English NHS, based on a series of national-level interviews and case studies of five health economies that are implementing novel contracting models. The cases illustrated here demonstrate early experiments to drive innovation through contracting in the NHS that have largely relied on the vision of individual teams or leaders, in combination with external legal, procurement and actuarial support. It is unlikely that this approach will be sustainable or replicable across the country or internationally, despite the best intentions of commissioners. Designing and operating novel contractual approaches will require considerable determination, alongside advanced skills in procurement, contract management and commissioning. The cost of developing new contractual approaches is high, and as the process is difficult and resource-intensive, it is likely that dedicated teams or programs will be required to drive significant improvement.

Direct aperture optimization for online adaptive radiation therapy

International Nuclear Information System (INIS)

Mestrovic, Ante; Milette, Marie-Pierre; Nichol, Alan; Clark, Brenda G.; Otto, Karl

2007-01-01

This paper is the first investigation of using direct aperture optimization (DAO) for online adaptive radiation therapy (ART). A geometrical model representing the anatomy of a typical prostate case was created. To simulate interfractional deformations, four different anatomical deformations were created by systematically deforming the original anatomy by various amounts (0.25, 0.50, 0.75, and 1.00 cm). We describe a series of techniques where the original treatment plan was adapted in order to correct for the deterioration of dose distribution quality caused by the anatomical deformations. We found that the average time needed to adapt the original plan to arrive at a clinically acceptable plan is roughly half of the time needed for a complete plan regeneration, for all four anatomical deformations. Furthermore, through modification of the DAO algorithm the optimization search space was reduced and the plan adaptation was significantly accelerated. For the first anatomical deformation (0.25 cm), the plan adaptation was six times more efficient than the complete plan regeneration. For the 0.50 and 0.75 cm deformations, the optimization efficiency was increased by a factor of roughly 3 compared to the complete plan regeneration. However, for the anatomical deformation of 1.00 cm, the reduction of the optimization search space during plan adaptation did not result in any efficiency improvement over the original (nonmodified) plan adaptation. The anatomical deformation of 1.00 cm demonstrates the limit of this approach. We propose an innovative approach to online ART in which the plan adaptation and radiation delivery are merged together and performed concurrently--adaptive radiation delivery (ARD). A fundamental advantage of ARD is the fact that radiation delivery can start almost immediately after image acquisition and evaluation. Most of the original plan adaptation is done during the radiation delivery, so the time spent adapting the original plan does not

Inferring tie strength from online directed behavior.

Directory of Open Access Journals (Sweden)

Jason J Jones

Full Text Available Some social connections are stronger than others. People have not only friends, but also best friends. Social scientists have long recognized this characteristic of social connections and researchers frequently use the term tie strength to refer to this concept. We used online interaction data (specifically, Facebook interactions to successfully identify real-world strong ties. Ground truth was established by asking users themselves to name their closest friends in real life. We found the frequency of online interaction was diagnostic of strong ties, and interaction frequency was much more useful diagnostically than were attributes of the user or the user's friends. More private communications (messages were not necessarily more informative than public communications (comments, wall posts, and other interactions.

An online clinical governance learning package for student radiographers

International Nuclear Information System (INIS)

Messer, Simon; Griffiths, Marc

2007-01-01

Purpose: Clinical governance is a key element of the Government's plan for reform in the National Health Service. As such, it is an essential element for final year undergraduate radiography studies. With Ciris becoming a standard web-based solution for clinical governance within the NHS, a need has been identified for it to be introduced at university to undergraduate radiographers. Methods: A distance learning package for Ciris has therefore been developed that was trialed by third year radiography students whilst on their final clinical placement. The package includes a specifically designed online virtual hospital which the students engaged with interactively using a workbook. The students undertook detailed individual and group exercises aimed at delivering practical experience of the Ciris program and its role in clinical governance. Results: The package was evaluated by the students in terms of their experiential learning and their perceived learning needs for clinical governance. Technical and support issues associated with the delivery of this package online were identified. Conclusion: The combination of a distance online learning environment, supported by a workbook, is an effective method of engaging students and is beneficial in terms of helping achieve learning outcomes in clinical governance for final year radiography studies

Carbon reduction in the NHS : a role for finance

OpenAIRE

Brown, Steve

2009-01-01

HFMA briefing sponsored by ACCA NHS bodies’ performance on carbon reduction is increasingly having an impact on annual audit assessments, and a new energy efficiency scheme, involving the purchase and trading of carbon emissions allowances, will provide real financial consequences for under or over consumption of carbon. But perhaps the biggest driver for the finance community is the fact that carbon reduction should in fact help them meet their key challenge – the need for efficienc...

Global Reach of Direct-to-Consumer Advertising Using Social Media for Illicit Online Drug Sales

Science.gov (United States)

Liang, Bryan A

2013-01-01

Background Illicit or rogue Internet pharmacies are a recognized global public health threat that have been identified as utilizing various forms of online marketing and promotion, including social media. Objective To assess the accessibility of creating illicit no prescription direct-to-consumer advertising (DTCA) online pharmacy social media marketing (eDTCA2.0) and evaluate its potential global reach. Methods We identified the top 4 social media platforms allowing eDTCA2.0. After determining applicable platforms (ie, Facebook, Twitter, Google+, and MySpace), we created a fictitious advertisement advertising no prescription drugs online and posted it to the identified social media platforms. Each advertisement linked to a unique website URL that consisted of a site error page. Employing Web search analytics, we tracked the number of users visiting these sites and their location. We used commercially available Internet tools and services, including website hosting, domain registration, and website analytic services. Results Illicit online pharmacy social media content for Facebook, Twitter, and MySpace remained accessible despite highly questionable and potentially illegal content. Fictitious advertisements promoting illicit sale of drugs generated aggregate unique user traffic of 2795 visits over a 10-month period. Further, traffic to our websites originated from a number of countries, including high-income and middle-income countries, and emerging markets. Conclusions Our results indicate there are few barriers to entry for social media–based illicit online drug marketing. Further, illicit eDTCA2.0 has globalized outside US borders to other countries through unregulated Internet marketing. PMID:23718965

The role of private non-profit healthcare organizations in NHS systems: Implications for the Portuguese hospital devolution program.

Science.gov (United States)

Almeida, Álvaro S

2017-06-01

The national health services (NHS) of England, Portugal, Finland and other single-payer universalist systems financed by general taxation, are based on the theoretical principle of an integrated public sector payer-provider. However, in practice one can find different forms of participation of non-public healthcare providers in those NHS, including private for profit providers, but also third sector non-profit organizations (NPO). This paper reviews the role of non-public non-profit healthcare organizations in NHS systems. By crossing a literature review on privatization of national health services with a literature review on the comparative performance of non-profit and for-profit healthcare organizations, this paper assesses the impact of contracting private non-profit healthcare organizations on the efficiency, quality and responsiveness of services, in public universal health care systems. The results of the review were then compared to the existing evidence on the Portuguese hospital devolution to NPO program. The evidence in this paper suggests that NHS health system reforms that transfer some public-sector hospitals to NPO should deliver improvements to the health system with minimal downside risks. The very limited existing evidence on the Portuguese hospital devolution program suggests it improved efficiency and access, without sacrificing quality. Copyright © 2017 Elsevier B.V. All rights reserved.

Combination Therapy with NHS-muIL12 and Avelumab (anti-PD-L1) Enhances Antitumor Efficacy in Preclinical Cancer Models.

Science.gov (United States)

Xu, Chunxiao; Zhang, Yanping; Rolfe, P Alexander; Hernández, Vivian M; Guzman, Wilson; Kradjian, Giorgio; Marelli, Bo; Qin, Guozhong; Qi, Jin; Wang, Hong; Yu, Huakui; Tighe, Robert; Lo, Kin-Ming; English, Jessie M; Radvanyi, Laszlo; Lan, Yan

2017-10-01

Purpose: To determine whether combination therapy with NHS-muIL12 and the anti-programmed death ligand 1 (PD-L1) antibody avelumab can enhance antitumor efficacy in preclinical models relative to monotherapies. Experimental Design: BALB/c mice bearing orthotopic EMT-6 mammary tumors and μMt - mice bearing subcutaneous MC38 tumors were treated with NHS-muIL12, avelumab, or combination therapy; tumor growth and survival were assessed. Tumor recurrence following remission and rechallenge was evaluated in EMT-6 tumor-bearing mice. Immune cell populations within spleen and tumors were evaluated by FACS and IHC. Immune gene expression in tumor tissue was profiled by NanoString® assay and plasma cytokine levels were determined by multiplex cytokine assay. The frequency of tumor antigen-reactive IFNγ-producing CD8 + T cells was evaluated by ELISpot assay. Results: NHS-muIL12 and avelumab combination therapy enhanced antitumor efficacy relative to either monotherapy in both tumor models. Most EMT-6 tumor-bearing mice treated with combination therapy had complete tumor regression. Combination therapy also induced the generation of tumor-specific immune memory, as demonstrated by protection against tumor rechallenge and induction of effector and memory T cells. Combination therapy enhanced cytotoxic NK and CD8 + T-cell proliferation and T-bet expression, whereas NHS-muIL12 monotherapy induced CD8 + T-cell infiltration into the tumor. Combination therapy also enhanced plasma cytokine levels and stimulated expression of a greater number of innate and adaptive immune genes compared with either monotherapy. Conclusions: These data indicate that combination therapy with NHS-muIL12 and avelumab increased antitumor efficacy in preclinical models, and suggest that combining NHS-IL12 and avelumab may be a promising approach to treating patients with solid tumors. Clin Cancer Res; 23(19); 5869-80. ©2017 AACR . ©2017 American Association for Cancer Research.

NHS trust chief executives as heroes?

Science.gov (United States)

Learmonth, M

2001-01-01

This paper presents a reading of the transcripts of interviews with NHS Trust Chief Executives. Using a poststructuralist understanding of the interviews, it privileges a reading that (ironically) represents these Chief Executives as heroes. Following the classic hero story line, they leave the civilized order of home and journey into a threatening wilderness where they encounter dangerous and magical things but overcome them all because of their masculine characteristics such as rationality, strength and resourcefulness. One way in which these stories can be understood to have significance is that they (misleadingly but powerfully) portray management as obvious and necessary by evocatively drawing on a myth of ancient origin. The piece concludes with some reflections on the ontological implications of the analysis and reflexive comments on the production of truth as a problem.

NIRS-EEG joint imaging during transcranial direct current stimulation: Online parameter estimation with an autoregressive model.

Science.gov (United States)

Sood, Mehak; Besson, Pierre; Muthalib, Makii; Jindal, Utkarsh; Perrey, Stephane; Dutta, Anirban; Hayashibe, Mitsuhiro

2016-12-01

Transcranial direct current stimulation (tDCS) has been shown to perturb both cortical neural activity and hemodynamics during (online) and after the stimulation, however mechanisms of these tDCS-induced online and after-effects are not known. Here, online resting-state spontaneous brain activation may be relevant to monitor tDCS neuromodulatory effects that can be measured using electroencephalography (EEG) in conjunction with near-infrared spectroscopy (NIRS). We present a Kalman Filter based online parameter estimation of an autoregressive (ARX) model to track the transient coupling relation between the changes in EEG power spectrum and NIRS signals during anodal tDCS (2mA, 10min) using a 4×1 ring high-definition montage. Our online ARX parameter estimation technique using the cross-correlation between log (base-10) transformed EEG band-power (0.5-11.25Hz) and NIRS oxy-hemoglobin signal in the low frequency (≤0.1Hz) range was shown in 5 healthy subjects to be sensitive to detect transient EEG-NIRS coupling changes in resting-state spontaneous brain activation during anodal tDCS. Conventional sliding window cross-correlation calculations suffer a fundamental problem in computing the phase relationship as the signal in the window is considered time-invariant and the choice of the window length and step size are subjective. Here, Kalman Filter based method allowed online ARX parameter estimation using time-varying signals that could capture transients in the coupling relationship between EEG and NIRS signals. Our new online ARX model based tracking method allows continuous assessment of the transient coupling between the electrophysiological (EEG) and the hemodynamic (NIRS) signals representing resting-state spontaneous brain activation during anodal tDCS. Published by Elsevier B.V.

Determination of risk identification process employed by NHS for a PFI hospital project in the UK

Directory of Open Access Journals (Sweden)

F. E. Mohamed Ghazali

2009-12-01

Full Text Available Long-term concession contracts associated with Private Finance Initiative (PFI projects, such as National Health Service (NHS hospitals, are subject to substantial risks, which may not only emerge from project activities such as design and construction, but also from global issues beyond the control of project parties, such as commercial, legal and political risks. Therefore, the principal parties involved must manage risks effectively and efficiently, as early as the project initiation stage, in order to ensure a successful delivery. The aim of this paper is to examine the risk identification process of the NHS PFI hospital in the UK, as a case study, in order to determine the techniques used in risk identification, and their significance, based on estimated probabilities of occurrence. These objectives were achieved through interviews with key personnel within the NHS Trust involved. Results found the sole technique used in risk identification to be brainstorming, through which more than thirty risks were identified and classified under six risk categories: planning, pre-commissioning, design, land purchasing, construction and operation. Thirteen risks were identified as significant based on their estimated probability of occurrence had the project been developed via public procurement. The results of this research will enable public sector clients like the NHS Trust to not only identify the significant risks, which will allow them to focus more attention on developing appropriate mitigation strategies and contingency plans, but also to improve its risk identification process through the use of other techniques in order to support findings from the brainstorming process.

Healthcare reform. Is the NHS ready for US business guru's strategy?

Science.gov (United States)

Cavendish, Will; Edwards, Nigel; Swindells, Matthew; Henke, Nicolaus; Robinson, Edna; Smith, Richard

2006-12-07

The central argument of the new book by renowned US academics Michael Porter and Elizabeth Olmsted Teisberg is that the US health system is broken because rather than improving quality and efficiency, it focuses on budgetary battles. HSJ gathered together six leading healthcare insiders to discuss whether his diagnosis is applicable to the NHS. Nick Edwards was there.

Organisational innovation in health services: lessons from the NHS treatment centres

National Research Council Canada - National Science Library

Gabbay, J

2011-01-01

... design and methods References Index 103 133 147 149 155 165 v List of abbreviationsOrganisational innovation in health services List of abbreviations A&E ACAD DH DTC GP G-Supp NHS NIHR PCT PFI SDO SHA TC accident and emergency (department) Ambulatory Care and Diagnostic Centre Department of Health ('the Department') diagnosis and treatment centr...

Case-mix & patients' reports of outcome in Independent Sector Treatment Centres: Comparison with NHS providers

Directory of Open Access Journals (Sweden)

van der Meulen Jan

2008-04-01

Full Text Available Abstract Background There has been considerable concern expressed about the outcomes achieved in Independent Sector Treatment Centres (ISTCs introduced in England since 2003. Our aim was to compare the case-mix and patients' reported outcomes of surgery in ISTCs and in NHS providers. Methods Prospective cohort study of 769 patients treated in six ISTCs and 1895 treated in 20 NHS providers (acute hospitals and treatment centres in England during 2006–07. Participants underwent one of three day surgery procedures (inguinal hernia repair, varicose vein surgery, cataract extraction or hip or knee replacement. Change in patient-reported health status and health related quality of life (measured using a disease-specific and a generic (EQ-5D instrument was assessed either 3-months (day surgery or 6-months (hip/knee after surgery. In addition patient-reported post-operative complications and an overall assessment of success of surgery were collected. Outcome measures were adjusted (using multivariable regression for patient characteristics (disease severity, duration of symptoms, age, sex, socioeconomic status, general health, previous similar surgery, comorbidity. Results Post-operative response rates varied by procedure (73%–88% and were similar for those treated in ISTCs and NHS facilities. Patients treated in ISTCs were healthier, were less likely to have any comorbidity and, for those undergoing cataract surgery or joint replacement, their primary condition was less severe. Those undergoing hernia repair or joint replacement were less likely to have had similar surgery before. When adjustment was made for pre-operative characteristics, patients undergoing cataract surgery or hip replacement in ISTCs achieved a slightly greater improvement in functional status and quality of life than those treated in NHS facilities, while the opposite was true of patients undergoing hernia repair. No significant differences were found for the two other

A novel small deletion in the NHS gene associated with Nance-Horan syndrome.

Science.gov (United States)

Li, Huajin; Yang, Lizhu; Sun, Zixi; Yuan, Zhisheng; Wu, Shijing; Sui, Ruifang

2018-02-05

Nance-Horan syndrome is a rare X-linked recessive inherited disease with clinical features including severe bilateral congenital cataracts, characteristic facial and dental abnormalities. Data from Chinese Nance-Horan syndrome patients are limited. We assessed the clinical manifestations of a Chinese Nance-Horan syndrome pedigree and identified the genetic defect. Genetic analysis showed that 3 affected males carried a novel small deletion in NHS gene, c.263_266delCGTC (p.Ala89TrpfsTer106), and 2 female carriers were heterozygous for the same variant. All 3 affected males presented with typical Nance-Horan syndrome features. One female carrier displayed lens opacities centered on the posterior Y-suture in both eyes, as well as mild dental abnormalities. We recorded the clinical features of a Chinese Nance-Horan syndrome family and broadened the spectrum of mutations in the NHS gene.

Comparing the similarity of responses received from studies in Amazon's Mechanical Turk to studies conducted online and with direct recruitment.

Science.gov (United States)

Bartneck, Christoph; Duenser, Andreas; Moltchanova, Elena; Zawieska, Karolina

2015-01-01

Computer and internet based questionnaires have become a standard tool in Human-Computer Interaction research and other related fields, such as psychology and sociology. Amazon's Mechanical Turk (AMT) service is a new method of recruiting participants and conducting certain types of experiments. This study compares whether participants recruited through AMT give different responses than participants recruited through an online forum or recruited directly on a university campus. Moreover, we compare whether a study conducted within AMT results in different responses compared to a study for which participants are recruited through AMT but which is conducted using an external online questionnaire service. The results of this study show that there is a statistical difference between results obtained from participants recruited through AMT compared to the results from the participant recruited on campus or through online forums. We do, however, argue that this difference is so small that it has no practical consequence. There was no significant difference between running the study within AMT compared to running it with an online questionnaire service. There was no significant difference between results obtained directly from within AMT compared to results obtained in the campus and online forum condition. This may suggest that AMT is a viable and economical option for recruiting participants and for conducting studies as setting up and running a study with AMT generally requires less effort and time compared to other frequently used methods. We discuss our findings as well as limitations of using AMT for empirical studies.

Interventions for information systems introduction in the NHS.

Science.gov (United States)

Maguire, Stuart; Ojiako, Udechukwu

2007-12-01

This article provides a historical review of five long-term interventions which were undertaken within the NHS. The objective of the exercise was to examine how information systems (IS) were introduced into operational environments. The length of the interventions ranged from 9 months to almost 3 years. The five sites were all at different stages of system development and the research was carried out using a combination of participant observation and action research. The research question asks, 'How can organizations think about and hence go about their information provision in such a way that successful IS are introduced?'

Immobilization of heparin to EDC/NHS-crosslinked collagen. Characterization and in vitro evaluation

NARCIS (Netherlands)

Wissink, M.J.B.; Beernink, R.; Pieper, J.S.; Poot, Andreas A.; Engbers, G.H.M.; Beugeling, T.; Beugeling, T.; van Aken, W.G.; Feijen, Jan

2001-01-01

In the present study, heparin immobilization to a non-cytotoxic crosslinked collagen substrate for endothelial cell seeding was investigated. Crosslinking of collagen using N-(3-dimethylaminopropyl)-N′-ethylcarbodiimide (EDC) and N-hydroxysuccinimide (NHS) resulted in a material containing 14 free

Enhancing Learners' Self-Directed Use of Technology for Language Learning: The Effectiveness of an Online Training Platform

Science.gov (United States)

Lai, Chun; Shum, Mark; Tian, Yan

2016-01-01

Enhancing self-directed use of technology for language learning is essential for maximizing the potential of technology for language learning. Understanding how to construct learner training to promote this critical competency is of great significance. This study examined the effectiveness of an online training platform aimed at enhancing the…

Exploring dispositional tendencies to seek online information about direct-to-consumer genetic testing.

Science.gov (United States)

Paquin, Ryan S; Richards, Adam S; Koehly, Laura M; McBride, Colleen M

2012-12-01

Varying perspectives exist regarding the implications of genetic susceptibility testing for common disease, with some anticipating adverse effects and others expecting positive outcomes; however, little is known about the characteristics of people who are most likely to be interested in direct-to-consumer genetic testing. To that end, this study examines the association of individual dispositional differences with health risk perceptions and online information seeking related to a free genetic susceptibility test. Healthy adults enrolled in a large health maintenance organization were surveyed by telephone. Eligible participants (N = 1,959) were given access to a secure website that provided risk and benefit information about a genetic susceptibility test and given the option to be tested. Neuroticism was associated with increased perceptions of disease risk but not with logging on. Those scoring high in conscientiousness were more likely to log on. We found no evidence that neuroticism, a dispositional characteristic commonly linked to adverse emotional response, was predictive of online genetic information seeking in this sample of healthy adults.

Advancing non-directive pregnancy options counseling skills: A pilot Study on the use of blended learning with an online module and simulation.

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Lupi, Carla; Ward-Peterson, Melissa; Chang, Winnie

2016-10-01

Limitations on didactic time pose barriers to teaching non-directive pregnancy options counseling. This study set out to explore the use of an online module to support trainee performance in a pregnancy options counseling standardized-patient exercise implemented among third-year medical students, and to examine the effect of clinical experience on student performance. An online module was developed. A convenience sample of forty-six student performances in a family medicine clerkship participated in a standardized patient exercise. Trained faculty rated performances. Students completed a self-assessment and provided feedback on the online module. Chi-square and Mann-Whitney-U tests were used to analyze data. Three coders qualitatively examined narrative student comments. Thirty-four students passed, 11 achieved a minimal pass, and one failed. The mean global rating from faculty was 2.8 (pass). Students with prior clinical experience significantly outperformed those without on the global rating scale with mean scores of 3.1 compared to 2.7, respectively (p=.044). All students agreed that the online module helped prepare them for the exercise. Qualitative analysis of students' feedback on the module revealed strengths in content and pedagogy. In their self-assessments, all but two students referred to content explicitly conveyed in the module. All students agreed that an online module supported their performance of non-directive pregnancy options counseling skills. Prior clinical experience was associated with improved performance. This module, along with the simulated exercise, can be implemented as a blended learning exercise without additional faculty teaching effort in standardized patient resource centers. Students agreed that an online module facilitates simulated performance of non-directive pregnancy options counseling skills. Future work should compare the impact of this approach to others, and explore the additional training needed to maintain and build on

Medical leadership arrangements in English healthcare organisations: findings from a national survey and case studies of NHS trusts.

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Dickinson, Helen; Ham, Chris; Snelling, Iain; Spurgeon, Peter

2013-11-01

This project sought to describe the involvement of doctors in leadership roles in the NHS and the organisational structures and management processes in use in NHS trusts. A mixed methods approach was adopted combining a questionnaire survey of English NHS trusts and in-depth case studies of nine organisations who responded to the survey. Respondents identified a number of challenges in the development of medical leadership, and there was often perceived to be an engagement gap between medical leaders and doctors in clinical roles. While some progress has been made in the development of medical leadership in the NHS in England, much remains to be done to complete the journey that started with the Griffiths Report in 1983. We conclude that a greater degree of professionalism needs to be brought to bear in the development of medical leadership. This includes developing career structures to make it easier for doctors to take on leadership roles; providing training, development and support in management and leadership at different stages of doctors' careers; and ensuring that pay and other rewards are commensurate with the responsibilities of medical leaders. The time commitment of medical leaders and the proportion of doctors in leadership roles both need to increase. The paper concludes considering the implications of these findings for other health systems. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

An estimated carbon footprint of NHS primary dental care within England. How can dentistry be more environmentally sustainable?

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Duane, B; Lee, M Berners; White, S; Stancliffe, R; Steinbach, I

2017-10-27

Introduction National Health Service (NHS) England dental teams need to consider from a professional perspective how they can, along with their NHS colleagues, play their part in reducing their carbon emissions and improve the sustainability of the care they deliver. In order to help understand carbon emissions from dental services, Public Health England (PHE) commissioned a calculation and analysis of the carbon footprint of key dental procedures.Methods Secondary data analysis from Business Services Authority (BSA), Health and Social Care Information Centre (HSCIC) (now called NHS Digital, Information Services Division [ISD]), National Association of Specialist Dental Accountants (NASDA) and recent Scottish papers was undertaken using a process-based and environmental input-output analysis using industry established conversion factors.Results The carbon footprint of the NHS dental service is 675 kilotonnes carbon dioxide equivalents (CO2e). Examinations contributed the highest proportion to this footprint (27.1%) followed by scale and polish (13.4%) and amalgam/composite restorations (19.3%). From an emissions perspective, nearly 2/3 (64.5%) of emissions related to travel (staff and patient travel), 19% procurement (the products and services dental clinics buy) and 15.3% related to energy use.Discussion The results are estimates of carbon emissions based on a number of broad assumptions. More research, education and awareness is needed to help dentistry develop low carbon patient pathways.

Success factors for implementation of the balanced scorecard in a NHS multi-agency setting.

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Radnor, Zoe; Lovell, Bill

2003-01-01

Even though the balanced scorecard (BSC) has become a highly popular performance management tool, usage in local public sector National Health Service (NHS) organisations is still rare. This paper conditionally outlines some grounds in supporting such usage. In particular underlying conceptual concerns with the BSC system and its implementation pitfalls require full consideration. This paper then outlines some factors to be taken into account for "successful" BSC implementation in a NHS multi-agency setting. These findings emerged from a series of focus groups that took place with contributors drawn from all the key organisations within the Bradford Health Action Zone. Finally, this paper argues that if key criteria are met, successful implementation of the BSC may then proceed. However, "blind" BSC implementation without consideration of these factors may result in potential "failure".

PBL online

DEFF Research Database (Denmark)

Kolbæk, Ditte; Nortvig, Anne-Mette

2017-01-01

Problem- and Project-Based Learning (PBL) is a widely used pedagogical method in higher education. Although PBL encourages self-directed learning and works with the students’ own projects and problems, it also includes teacher presentations, discussions and group reflections, both on......-campus and online. Therefore, the teacher’s plans might be relevant to the students’ projects, but that is not always the case. This study investigates how master’s students interact with an online Problem-Based Learning design and examines how technology influences these interactions. The empirical data stem from...... lessons at an online master’s course, and they were collected and analyzed using a netnographic approach. The study finds that concepts like self-directed learning and active involvement of everyone can have very different meanings from the teachers’ and the students’ points of view. If the students do...

Students’ online purchasing behavior in Malaysia: Understanding online shopping attitude

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Marzieh Zendehdel

2015-12-01

Full Text Available Studies examining the factors that affect the online purchasing behavior of consumers are rare, despite the prospective advance of e-commerce in Malaysia. The present study examines particular factors that influence the attitude of potential consumers to purchase online by using the attributes from the diffusion of innovations theory of Rogers, the attribute of perception of risk, and the subjective norms toward online purchasing. Consumers’ perceived risks of online shopping have become a vital subject in research because they directly influence users’ attitude toward online purchasing. The structural equation modeling method was used to analyze the data gathered on students using e-commerce, and, thus, to validate the model. According to the results, consumers’ attitude toward online purchasing affects the intention toward online purchasing. The other influential factors are compatibility, relative advantage, and subjective norm.

GPs' views of health policy changes: a qualitative 'netnography' study of UK general practice online magazine commentary.

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Elvey, Rebecca; Voorhees, Jennifer; Bailey, Simon; Burns, Taylor; Hodgson, Damian

2018-06-01

Shifts in health policy since 2010 have brought major structural changes to the English NHS, with government stating intentions to increase GPs' autonomy and improve access to care. Meanwhile, GPs' levels of job satisfaction are low, while stress levels are high. PulseToday is a popular UK general practice online magazine that provides a key discussion forum on news relevant to general practice. To analyse readers' reactions to news stories about health policy changes published in an online general practice magazine. A qualitative 'netnography' was undertaken of readers' comments to PulseToday. METHOD: A sample of readers' comments on articles published in PulseToday was collated and subjected to thematic analysis. Around 300 comments on articles published between January 2012 and March 2016 were included in the analysis, using 'access to care' as a tracer theme. Concern about the demand and strain on general practice was perhaps to be expected. However, analysis revealed various dimensions to this concern: GPs' underlying feelings about their work and place in the NHS; constraints to GPs' control of their own working practices; a perceived loss of respect for the role of GP; and disappointment with representative bodies and GP leadership. This study shows a complex mix of resistance and resignation in general practice about the changing character of GPs' roles. This ambivalence deserves further attention because it could potentially shape responses to further change in primary care in ways that are as yet unknown. © British Journal of General Practice 2018.

Understanding the Self-Directed Online Learning Preferences, Goals, Achievements, and Challenges of MIT OpenCourseWare Subscribers

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Bonk, Curtis J.; Lee, Mimi Miyoung; Kou, Xiaojing; Xu, Shuya; Sheu, Feng-Ru

2015-01-01

This research targeted the learning preferences, goals and motivations, achievements, challenges, and possibilities for life change of self-directed online learners who subscribed to the monthly OpenCourseWare (OCW) e-newsletter from MIT. Data collection included a 25-item survey of 1,429 newsletter subscribers; 613 of whom also completed an…

Investigating the governance of autonomous public hospitals in England: multi-site case study of NHS foundation trusts.

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Allen, Pauline; Keen, Justin; Wright, John; Dempster, Paul; Townsend, Jean; Hutchings, Andrew; Street, Andrew; Verzulli, Rossella

2012-04-01

To investigate the external and internal governance of NHS foundation trusts (FTs), which have increased autonomy, and local members and governors unlike other NHS trusts. In depth, three-year case studies of four FTs; and analysis of national quantitative data on all FT hospitals and NHS Trust hospitals to give national context. Data included 111 interviews with managers, clinicians, governors and members, and local purchasers; observation of meetings; and analysis of FTs' documents. The four case study FTs were similar to other FTs. They had used their increased autonomy to develop more business-like practices. The FT regulator, Monitor, intervened only when there were reported problems in FT performance. National targets applying to the NHS also had a large effect on FT behaviour. FTs saw themselves as part of the local health economy and tried to maintain good relationships with local organisations. Relationships between governors and the FTs' executives were still developing, and not all governors felt able to hold their FT to account. The skills and experience of staff members and governors were under-used in the new governance structures. It is easier to increase autonomy for public hospitals than to increase local accountability. Hospital managers are likely to be interested in making decisions with less central government control, whilst mechanisms for local accountability are notoriously difficult to design and operate. Further consideration of internal governance of FTs is needed. In a deteriorating financial climate, FTs should be better placed to make savings, due to their more business-like practices.

Comparing the similarity of responses received from studies in Amazon's Mechanical Turk to studies conducted online and with direct recruitment.

Directory of Open Access Journals (Sweden)

Christoph Bartneck

Full Text Available Computer and internet based questionnaires have become a standard tool in Human-Computer Interaction research and other related fields, such as psychology and sociology. Amazon's Mechanical Turk (AMT service is a new method of recruiting participants and conducting certain types of experiments. This study compares whether participants recruited through AMT give different responses than participants recruited through an online forum or recruited directly on a university campus. Moreover, we compare whether a study conducted within AMT results in different responses compared to a study for which participants are recruited through AMT but which is conducted using an external online questionnaire service. The results of this study show that there is a statistical difference between results obtained from participants recruited through AMT compared to the results from the participant recruited on campus or through online forums. We do, however, argue that this difference is so small that it has no practical consequence. There was no significant difference between running the study within AMT compared to running it with an online questionnaire service. There was no significant difference between results obtained directly from within AMT compared to results obtained in the campus and online forum condition. This may suggest that AMT is a viable and economical option for recruiting participants and for conducting studies as setting up and running a study with AMT generally requires less effort and time compared to other frequently used methods. We discuss our findings as well as limitations of using AMT for empirical studies.

An online brain-machine interface using decoding of movement direction from the human electrocorticogram

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Milekovic, Tomislav; Fischer, Jörg; Pistohl, Tobias; Ruescher, Johanna; Schulze-Bonhage, Andreas; Aertsen, Ad; Rickert, Jörn; Ball, Tonio; Mehring, Carsten

2012-08-01

A brain-machine interface (BMI) can be used to control movements of an artificial effector, e.g. movements of an arm prosthesis, by motor cortical signals that control the equivalent movements of the corresponding body part, e.g. arm movements. This approach has been successfully applied in monkeys and humans by accurately extracting parameters of movements from the spiking activity of multiple single neurons. We show that the same approach can be realized using brain activity measured directly from the surface of the human cortex using electrocorticography (ECoG). Five subjects, implanted with ECoG implants for the purpose of epilepsy assessment, took part in our study. Subjects used directionally dependent ECoG signals, recorded during active movements of a single arm, to control a computer cursor in one out of two directions. Significant BMI control was achieved in four out of five subjects with correct directional decoding in 69%-86% of the trials (75% on average). Our results demonstrate the feasibility of an online BMI using decoding of movement direction from human ECoG signals. Thus, to achieve such BMIs, ECoG signals might be used in conjunction with or as an alternative to intracortical neural signals.

Evaluating the evidence: direct-to-consumer screening tests advertised online.

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Lovett, Kimberly M; Mackey, Timothy K; Liang, Bryan A

2012-09-01

Unsupervised online direct-to-consumer (DTC) access to medical services has rapidly expanded to medical screening tests, which have not been critically evaluated for their evidence basis. The objective of this study is to identify the scope of online-advertised DTC screening tests, outline the evidence for use of available DTC testing and suggest regulatory reform to address the relevant issues. An observational study of website advertisements, testing services and counselling/follow-up services for DTC testing was conducted. Data were collected from websites between 4 April and 1 June 2011. Each website was assessed for tests offered, advertised indications and availability of counselling/follow-up services. Advertised testing indications were compared with US Preventive Services Task Force recommendations and/or specialty guidelines and categorized as Supported, Against, Insufficient Evidence or No Guidance. Of 20 companies identified as offering DTC screening tests, 95% (19/20) do not clearly offer pretest counselling, post-test counselling and/or test follow-up. One hundred and twenty-seven different tests were identified. Only 19/127 (15%) could be Supported for screening in a target group selected for testing; 38/127 (30%) were given recommendations to avoid use in specific target group(s) selected for testing ('Against recommendations'); 29/127 (23%) had Insufficient Evidence of value, and for 64/127 (50%) No Guidance could be given. Only 4/127 (3%) tests were Supported for general screening use. Virtually all identified medical tests advertised and offered DTC are not recommended for use in screening by evidence-based guidelines. Limited oversight may lead to inaccurate self-diagnosis, treatment and wasted health resources.

Developing leadership interventions for black and minority ethnic staff: A case study of the National Health Service (NHS) in the U.K.

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Kalra, V S; Abel, P; Esmail, A

2009-01-01

The National Health Service (NHS) is the largest employer in the U.K. but, despite decades of equal opportunities legislation, its senior management workforce does not reflect the diversity of either the wider NHS workforce or the U.K. population. The aim of the paper is to consider the range of management interventions available to organisations like the NHS to deliver change in the area of promotion of Black and minority ethnic staff. Intervention programmes in a range of public and private organisations are reviewed and the nature of barriers to promotion and the range of interventions to overcome these are explored. The paper uses the paradigm of institutional racism to examine the ways in which the NHS discriminates against certain sections of its workforce. The methods used include a literature review combined with key stakeholder interviews. A comparative dimension which involved a review of research on leadership initiatives in the U.S.A. was also undertaken. The literature review found that there were a range of initiatives which could be implemented by public organisations such as the NHS to increase the presence of Black and Minority Ethnic (BME) staff in senior management positions. Most of these interventions were largely focused on the individual. Much more progress on institutional or organisational change needed to be made before the NHS could be perceived as a model employer in this area. The literature review also indicated that there is little published research on such initiatives within other European Union countries. The paper is targeted at both policy makers and human resource officers responsible for equality and diversity issues within large organisations, who have a remit to improve the career pathways of staff. The analysis provided offers a set of critical tools and interventions that have not hitherto been well examined in the U.K. context.

The Tip of the Iceberg of Misleading Online Advertising Comment on "Trouble Spots in Online Direct-to-Consumer Prescription Drug Promotion: A Content Analysis of FDA Warning Letters".

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Mintzes, Barbara

2016-02-18

Kim's overview of Food and Drug Administration (FDA) regulatory actions from 2005 to 2014 is a comprehensive analysis of the US regulatory experience with online direct-to-consumer advertising (DTCA) of prescription medicines. This experience is of relevance internationally as online DTCA reaches the English-speaking public globally, despite the illegality of DTCA in most countries. The most common violations were omissions or minimizations of risk information, overstatements of efficacy, unsubstantiated claims, and promotion of unapproved ("off-label") use. Nearly one fourth of violations involved cancer drugs, raising additional concerns about patient vulnerability, limited treatment advance, and high costs. Based on content analyses of online DTCA, these cases likely reflect a small proportion of unbalanced and misleading promotional information available on the web. The FDA is only able to review a small proportion of promotional materials submitted to them, due to limited staffing, and the delay between first posting and regulatory action means that many people may be exposed to messages that are found to be inaccurate and misleading. The sheer volume of online DTCA, combined with the ability for content to shift continually, poses unique regulatory challenges. © 2016 by Kerman University of Medical Sciences.

Mortality in NHS Greater Glasgow and Clyde employees: 2007-2009.

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Freer, K; Waclawski, E

2013-09-01

Just over a fifth of all deaths in Scotland occur in those under the age of 65. This study examined deaths in service in employees of the National Health Service Greater Glasgow and Clyde (NHS GG&C) Health Board over a 3-year period. To assess crude death rates by occupational group, the main causes of death and evidence of causes that could have been prevented or modified by lifestyle changes. Demographic details, occupational grouping and death certificate data were obtained for all NHS GG&C employees who died in service between 2007 and 2009. A total of 138 employees died in this period. The occupational groups in which most deaths occurred were support services (porters, domestic and catering staff; 35%) and nurses (34%). The commonest causes of death were lung cancer (15%), ischaemic heart disease (9%) and suicide (9%). The overall crude death rate was 1.2/1000 persons/year (females 1.0 and males 1.7) and was highest among support services employees (2.4) and lowest among medical staff (0.5). The relative risk of death in support services was significantly greater than the majority of occupational groups. These findings suggest health inequality within this workforce. The main causes of death identified in the support services group could potentially be modified through workplace risk factor screening and health promotion.

Collaborative learning about e-health for mental health professionals and service users in a structured anonymous online short course: pilot study

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Ashurst Emily J

2012-05-01

Full Text Available Abstract Background Professionals are interested in using e-health but implementation of new methods is slow. Barriers to implementation include the need for training and limited awareness or experience. Research may not always convince mental health professionals (MHPs. Adding the 'voice' of mental health service users (MHSUs in collaborative learning may help. Involving MHSUs in face-face education can be difficult. We had previously been unable to engage MHPs in online discussion with MHSUs. Here we assessed the feasibility of short online courses involving MHSUs and MHPs. Methods We ran three e-health courses, comprising live interactive webcast, week’s access to a discussion forum, and final live interactive webcast. We recruited MHPs via posters, newsletters, and telephone from a local NHS trust, and online via mailing lists and personal contacts from NHS trusts and higher education. We recruited MHSUs via a previous project and an independent user involvement service. Participants were presented with research evidence about e-health and asked to discuss topics using professional and lived experience. Feasibility was assessed through recruitment and attrition, participation, and researcher workloads. Outcomes of self-esteem and general self-efficacy (MHSUs, and Internet self-efficacy and confidence (MHPs were piloted. Results Online recruiting was effective. We lost 15/41 from registration to follow-up but only 5/31 that participated in the course failed to complete follow-up. Nineteen MHPs and 12 MHSUs took part and engaged with each other in online discussion. Feedback was positive; three-quarters of MHPs indicated future plans to use the Internet for practice, and 80% of MHSUs felt the course should be continued. Running three courses for 31 participants took between 200 to 250 hours. Before and after outcome measures were completed by 26/31 that participated. MHP Internet self-efficacy and general Internet confidence, MHSU self

Collaborative learning about e-health for mental health professionals and service users in a structured anonymous online short course: pilot study.

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Ashurst, Emily J; Jones, Ray B; Williamson, Graham R; Emmens, Tobit; Perry, Jon

2012-05-31

Professionals are interested in using e-health but implementation of new methods is slow. Barriers to implementation include the need for training and limited awareness or experience. Research may not always convince mental health professionals (MHPs). Adding the 'voice' of mental health service users (MHSUs) in collaborative learning may help. Involving MHSUs in face-face education can be difficult. We had previously been unable to engage MHPs in online discussion with MHSUs. Here we assessed the feasibility of short online courses involving MHSUs and MHPs. We ran three e-health courses, comprising live interactive webcast, week's access to a discussion forum, and final live interactive webcast. We recruited MHPs via posters, newsletters, and telephone from a local NHS trust, and online via mailing lists and personal contacts from NHS trusts and higher education. We recruited MHSUs via a previous project and an independent user involvement service. Participants were presented with research evidence about e-health and asked to discuss topics using professional and lived experience. Feasibility was assessed through recruitment and attrition, participation, and researcher workloads. Outcomes of self-esteem and general self-efficacy (MHSUs), and Internet self-efficacy and confidence (MHPs) were piloted. Online recruiting was effective. We lost 15/41 from registration to follow-up but only 5/31 that participated in the course failed to complete follow-up. Nineteen MHPs and 12 MHSUs took part and engaged with each other in online discussion. Feedback was positive; three-quarters of MHPs indicated future plans to use the Internet for practice, and 80% of MHSUs felt the course should be continued. Running three courses for 31 participants took between 200 to 250 hours. Before and after outcome measures were completed by 26/31 that participated. MHP Internet self-efficacy and general Internet confidence, MHSU self-esteem and general self-efficacy, all seemed reliable and

Provision of relapse prevention interventions in UK NHS Stop Smoking Services: a survey

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McEwen Andy

2010-07-01

Full Text Available Abstract Background UK NHS Stop Smoking Services provide cost effective smoking cessation interventions but, as yet, there has been no assessment of their provision of relapse prevention interventions. Methods Electronic questionnaire survey of 185 UK Stop Smoking Services Managers. Results Ninety six Stop Smoking Service managers returned completed questionnaires (52% response rate. Of these, 58.3% (n = 56 ran NHS Stop Smoking Services which provided relapse prevention interventions for clients with the most commonly provided interventions being behavioural support: telephone (77%, group (73%, and individual (54%. Just under half (48%, n = 27 offered nicotine replacement therapy (NRT, 21.4% (n = 12 bupropion; 19.6% (n = 11 varenicline. Over 80% of those providing relapse prevention interventions do so for over six months. Nearly two thirds of all respondents thought it was likely that they would either continue to provide or commence provision of relapse prevention interventions in their services. Of the remaining respondents, 66.7% (n = 22 believed that the government focus on four-week quit rates, and 42.9% (14 services believed that inadequate funding for provision of relapse prevention interventions, were major barriers to introducing these interventions into routine care. Conclusions Just over half of UK managers of NHS Stop Smoking Services who responded to the questionnaire reported that, in their services, relapse prevention interventions were currently provided for clients, despite, at that time, there being a weak evidence base for their effectiveness. The most commonly provided relapse prevention interventions were those for which there was least evidence. If these interventions are found to be effective, barriers would need to be removed before they would become part of routine care.

Facing the future: the effects of the impending financial drought on NHS finances and how UK radiology services can contribute to expected efficiency savings

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Grant, L; Appleby, J; Griffin, N; Adam, A; Gishen, P

2012-01-01

The recent turmoil within the banking sector has led to the development of the most significant recession since the “great depression” of the 1930s. Although the coalition government has promised to “guarantee that health spending increases in real terms in each year of Parliament”, this may still not be enough to meet future needs over the coming years due to increasing demand and cost pressures. The expected mismatch between actual National Health Service (NHS) funding post-2011 and that required to satisfy increasing demand has been estimated by the Department of Health to require efficiency savings representing up to one-fifth of the overall NHS budget. This paper explains the reasons behind the anticipated slowdown in the growth of real NHS funding, and how, as a discipline, radiology can increase the efficiency of the services it provides in anticipation of future financial austerity within the NHS. PMID:22167516

Enhanced invitation methods to increase uptake of NHS health checks: study protocol for a randomized controlled trial.

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Forster, Alice S; Burgess, Caroline; McDermott, Lisa; Wright, Alison J; Dodhia, Hiten; Conner, Mark; Miller, Jane; Rudisill, Caroline; Cornelius, Victoria; Gulliford, Martin C

2014-08-30

NHS Health Checks is a new program for primary prevention of heart disease, stroke, diabetes, chronic kidney disease, and vascular dementia in adults aged 40 to 74 years in England. Individuals without existing cardiovascular disease or diabetes are invited for a Health Check every 5 years. Uptake among those invited is lower than anticipated. The project is a three-arm randomized controlled trial to test the hypothesis that enhanced invitation methods, using the Question-Behaviour Effect (QBE), will increase uptake of NHS Health Checks compared with a standard invitation. Participants comprise individuals eligible for an NHS Health Check registered in two London boroughs. Participants are randomized into one of three arms. Group A receives the standard NHS Health Check invitation letter, information sheet, and reminder letter at 12 weeks for nonattenders. Group B receives a QBE questionnaire 1 week before receiving the standard invitation, information sheet, and reminder letter where appropriate. Group C is the same as Group B, but participants are offered a £5 retail voucher if they return the questionnaire. Participants are randomized in equal proportions, stratified by general practice. The primary outcome is uptake of NHS Health Checks 6 months after invitation from electronic health records. We will estimate the incremental health service cost per additional completed Health Check for trial groups B and C versus trial arm A, as well as evaluating the impact of the QBE questionnaire, and questionnaire plus voucher, on the socioeconomic inequality in uptake of Health Checks.The trial includes a nested comparison of two methods for implementing allocation, one implemented manually at general practices and the other implemented automatically through the information systems used to generate invitations for the Health Check. The research will provide evidence on whether asking individuals to complete a preliminary questionnaire, by using the QBE, is effective

Liberating the NHS; commissioning, outsourcing and a new politics debate.

Science.gov (United States)

Regan, Paul; Ball, Elaine

2010-10-01

In the short months following the result of the UK 2010 General election, a new Government White Paper has been released entitled: Equity and Excellence: Liberating the NHS (Department of Health (DH), 2010a). It strives to distance itself from previous health-care proposals (DH, 2009), yet if the initiatives of this latest paper are combined against previous initiatives, also using high impact declarative terms, such as competition and choice, it is clear that little has changed and more important principles than saving money are at risk.

The Tip of the Iceberg of Misleading Online Advertising; Comment on “Trouble Spots in Online Direct-to-Consumer Prescription Drug Promotion: A Content Analysis of FDA Warning Letters”

Directory of Open Access Journals (Sweden)

Barbara Mintzes

2016-05-01

Full Text Available Kim’s overview of Food and Drug Administration (FDA regulatory actions from 2005 to 2014 is a comprehensive analysis of the US regulatory experience with online direct-to-consumer advertising (DTCA of prescription medicines. This experience is of relevance internationally as online DTCA reaches the English-speaking public globally, despite the illegality of DTCA in most countries. The most common violations were omissions or minimizations of risk information, overstatements of efficacy, unsubstantiated claims, and promotion of unapproved (“off-label” use. Nearly one fourth of violations involved cancer drugs, raising additional concerns about patient vulnerability, limited treatment advance, and high costs. Based on content analyses of online DTCA, these cases likely reflect a small proportion of unbalanced and misleading promotional information available on the web. The FDA is only able to review a small proportion of promotional materials submitted to them, due to limited staffing, and the delay between first posting and regulatory action means that many people may be exposed to messages that are found to be inaccurate and misleading. The sheer volume of online DTCA, combined with the ability for content to shift continually, poses unique regulatory challenges.

Truncating mutation in the NHS gene: phenotypic heterogeneity of Nance-Horan syndrome in an asian Indian family.

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Ramprasad, Vedam Lakshmi; Thool, Alka; Murugan, Sakthivel; Nancarrow, Derek; Vyas, Prateep; Rao, Srinivas Kamalakar; Vidhya, Authiappan; Ravishankar, Krishnamoorthy; Kumaramanickavel, Govindasamy

2005-01-01

A four-generation family containing eight affected males who inherited X-linked developmental lens opacity and microcornea was studied. Some members in the family had mild to moderate nonocular clinical features suggestive of Nance-Horan syndrome. The purpose of the study was to map genetically the gene in the large 57-live-member Asian-Indian pedigree. PCR-based genotyping was performed on the X-chromosome, by using fluorescent microsatellite markers (10-cM intervals). Parametric linkage analysis was performed by using two disease models, assuming either recessive or dominant X-linked transmission by the MLINK/ILINK and FASTLINK (version 4.1P) programs (http:www.hgmp.mrc.ac.uk/; provided in the public domain by the Human Genome Mapping Project Resources Centre, Cambridge, UK). The NHS gene at the linked region was screened for mutation. By fine mapping, the disease gene was localized to Xp22.13. Multipoint analysis placed the peak LOD of 4.46 at DSX987. The NHS gene mapped to this region. Mutational screening in all the affected males and carrier females (heterozygous form) revealed a truncating mutation 115C-->T in exon 1, resulting in conversion of glutamine to stop codon (Q39X), but was not observed in unaffected individuals and control subjects. conclusions. A family with X-linked Nance-Horan syndrome had severe ocular, but mild to moderate nonocular, features. The clinical phenotype of the truncating mutation (Q39X) in the NHS gene suggests allelic heterogeneity at the NHS locus or the presence of modifier genes. X-linked families with cataract should be carefully examined for both ocular and nonocular features, to exclude Nance-Horan syndrome. RT-PCR analysis did not suggest nonsense-mediated mRNA decay as the possible mechanism for clinical heterogeneity.

Transforming dementia care in an NHS trust.

Science.gov (United States)

Robinson, Jennifer; Longden, Jane; Murphy, Jayne

2015-02-01

Walsall Healthcare NHS Trust was one of nine trusts selected to take part in the RCN development programme transforming dementia care in hospitals during 2013. The programme aimed to improve the experience of care for people with dementia and their carers in hospital. This article outlines a two-day training programme delivered to staff on two pilot wards with a larger cohort of adults with dementia than other wards in Manor Hospital. A range of staff were trained including nurses, clinical support workers and allied health professionals and also, in a bespoke format, housekeepers, porters and security staff. The programme has led to a noticeable cultural change and significantly improved care and management of patients with cognitive impairment and/or dementia on the two pilot wards. As a result, the training programme has been implemented more widely across the hospital.

Challenges of a negative work load and implications on morale, productivity and quality of service delivered in NHS laboratories in England

OpenAIRE

Osaro, Erhabor; Chima, Njemanze

2014-01-01

The National Health Service (NHS) is a term used to describe the publicly funded healthcare delivery system providing quality healthcare services in the United Kingdom. There are several challenges militating against the effective laboratory service delivery in the NHS in England. Biomedical scientists work in healthcare to diagnose disease and evaluate the effectiveness of treatment through the analysis of body fluids and tissue samples from patients. They provide the “engine room” of modern...

Identification of a novel NHS mutation in a Chinese family with Nance-Horan syndrome.

Science.gov (United States)

Li, Aijun; Li, Bingzhen; Wu, Lemeng; Yang, Liping; Chen, Ningning; Ma, Zhizhong

2015-04-01

To identiy the disease causing mutation in a Chinese family presenting with early-onset cataract and dental anomalies. A specific Hereditary Eye Disease Enrichment Panel (HEDEP) (personalized customization by MyGenostics, Baltimore, MD) based on targeted exome capture technology was used to collect the protein coding regions of 30 early-onset cataract associated genes, and high throughput sequencing was done with Illumina HiSeq 2000 platform. The identified variant was confirmed with Sanger sequencing. A novel deletion in exon 4 (c.852delG) of NHS gene was identified; the identified 1 bp deletion altered the reading frame and was predicted to result in a premature stop codon after the addition of twelve novel amino acid (p.S285PfsX13). This mutation co-segregated in affected males and obligate female carriers, but was absent in 100 matched controls. Our findings broaden the spectrum of NHS mutations causing Nance-Horan syndrome and phenotypic spectrum of the disease in Chinese patients.

Evaluation of an online peer fundus photograph matching program in teaching direct ophthalmoscopy to medical students.

Science.gov (United States)

Kwok, Jason; Liao, Walter; Baxter, Stephanie

2017-10-01

Direct ophthalmoscopy is an important clinical skill that is often poorly performed by medical professionals and students. This is attributable to a declining emphasis on ophthalmology in medical school. We present and evaluate a self-directed approach of teaching ophthalmoscopy to medical students that is suitable for the current medical curriculum. Prospective medical education trial. Ninety-five second-year medical students at Queen's University: 32 in the experimental group and 63 in the control group. The experimental group consisted of medical students who practised ophthalmoscopy with one another using an online peer fundus photograph matching exercise created by the Department of Ophthalmology at Queen's University. To use the program, students first examined a peer with an ophthalmoscope and then selected an online photograph of a fundus corresponding to that of the examinee. The program notifies students if a correct selection is made. To encourage use of the program, students participated in a 2-week ophthalmoscopy competition during their ophthalmology rotation. The control group consisted of students who did not participate in the learning exercise. On assessment at the end of the ophthalmology rotation, the experimental group (n = 32) was more accurate in matching fundus photographs compared with the control group (n = 63) (p = 0.02). Participants were faster at performing ophthalmoscopy at the end of the learning exercise (p peer fundus photographs in a self-directed manner appeared to increase the skill and confidence of medical students in ophthalmoscopy. Copyright © 2017 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

The mutuality metaphor: understanding healthcare provision in NHS Scotland.

Science.gov (United States)

Howieson, Brian

2016-06-20

Purpose - Better Health, Better Care Action Plan (Scottish Government, 2007) sets out how the Scottish Government intends to strengthen public ownership of the National Health Service in Scotland. The purpose of this paper is to advance extant knowledge by understanding how a state-led mutual health policy may be interpreted, and importantly, communicated. Design/methodology/approach - The definitional problem of mutuality will be discussed and analysed in terms of how it is (or perhaps should be) communicated? will be offered. Findings - It actually may be more instructive to think of, and communicate, mutuality as a metaphor to aid understanding of the openness and fluidity found in NHS Scotland. Research limitations/implications - The existence of paradox and ambiguity does not, however, negate the usefulness of the term "mutuality". Quite the opposite in fact: it is precisely by examining healthcare and its delivery through the lens of mutuality (rather than rejecting its complexity as a failure) that this amorphousness can be better appreciated. Practical implications - There is a need for more public, professional, and academic debate to explore and clarify its implementation, and how it is to be led. This must be provided whilst recognising the daily imperatives that NHS leaders must face. This would suggest, therefore, that a dual development path may help. Originality/value - Although Better Health, Better Care Action Plan was published in 2007, some eight years on there is still confusion and misunderstanding as to what mutuality in healthcare is, not only in policy and theory, but also in practice. It is hoped that this analysis will help address, in part, some of this confusion and misunderstanding.

Views of commissioners, managers and healthcare professionals on the NHS Health Check programme: a systematic review.

Science.gov (United States)

Mills, Katie; Harte, Emma; Martin, Adam; MacLure, Calum; Griffin, Simon J; Mant, Jonathan; Meads, Catherine; Saunders, Catherine L; Walter, Fiona M; Usher-Smith, Juliet A

2017-11-15

To synthesise data concerning the views of commissioners, managers and healthcare professionals towards the National Health Service (NHS) Health Check programme in general and the challenges faced when implementing it in practice. A systematic review of surveys and interview studies with a descriptive analysis of quantitative data and thematic synthesis of qualitative data. An electronic literature search of MEDLINE, Embase, Health Management Information Consortium, Cumulative Index of Nursing and Allied Health Literature, Global Health, PsycInfo, Web of Science, OpenGrey, the Cochrane Library, NHS Evidence, Google Scholar, Google, ClinicalTrials.gov and the International Standard Randomised Controlled Trial Number registry from 1 January 1996 to 9 November 2016 with no language restriction and manual screening of reference lists of all included papers. Primary research reporting views of commissioners, managers or healthcare professionals on the NHS Health Check programme and its implementation in practice. Of 18 524 citations, 15 articles met the inclusion criteria. There was evidence from both quantitative and qualitative studies that some commissioners and general practice (GP) healthcare professionals were enthusiastic about the programme, whereas others raised concerns around inequality of uptake, the evidence base and cost-effectiveness. In contrast, those working in pharmacies were all positive about programme benefits, citing opportunities for their business and staff. The main challenges to implementation were: difficulties with information technology and computer software, resistance to the programme from some GPs, the impact on workload and staffing, funding and training needs. Inadequate privacy was also a challenge in pharmacy and community settings, along with difficulty recruiting people eligible for Health Checks and poor public access to some venues. The success of the NHS Health Check Programme relies on engagement by those responsible for its

Developing Mobile Clinical Decision Support for Nursing Home Staff Assessment of Urinary Tract Infection using Goal-Directed Design.

Science.gov (United States)

Jones, Wallace; Drake, Cynthia; Mack, David; Reeder, Blaine; Trautner, Barbara; Wald, Heidi

2017-06-20

Unique characteristics of nursing homes (NHs) contribute to high rates of inappropriate antibiotic use for asymptomatic bacteriuria (ASB), a benign condition. A mobile clinical decision support system (CDSS) may support NH staff in differentiating urinary tract infections (UTI) from ASB and reducing antibiotic days. We used Goal-Directed Design to: 1) Characterize information needs for UTI identification and management in NHs; 2) Develop UTI Decide, a mobile CDSS prototype informed by personas and scenarios of use constructed from Aim 1 findings; 3) Evaluate the UTI Decide prototype with NH staff. Focus groups were conducted with providers and nurses in NHs in Denver, Colorado (n= 24). Qualitative descriptive analysis was applied to focus group transcripts to identify information needs and themes related to mobile clinical decision support for UTI identification and management. Personas representing typical end users were developed; typical clinical context scenarios were constructed using information needs as goals. Usability testing was performed using cognitive walk-throughs and a think-aloud protocol. Four information needs were identified including guidance regarding resident assessment; communication with providers; care planning; and urine culture interpretation. Design of a web-based application incorporating a published decision support algorithm for evidence-based UTI diagnoses proceeded with a focus on nursing information needs during resident assessment and communication with providers. Certified nursing assistant (CNA) and registered nurse (RN) personas were constructed in 4 context scenarios with associated key path scenarios. After field testing, a high fidelity prototype of UTI Decide was completed and evaluated by potential end users. Design recommendations and content recommendations were elicited. Goal-Directed Design informed the development of a mobile CDSS supporting participant-identified information needs for UTI assessment and communication

Creating an impersonal NHS? Personalization, choice and the erosion of intimacy.

Science.gov (United States)

Owens, John

2015-02-01

Personalization - most often understood in terms of granting patients greater opportunity to participate in, and make choices about, the services they receive - has become a key principle guiding reform of the English NHS. This study sets out to explore the relationship between two senses of the term 'personal' within the context of personalization. Firstly, much of the policy literature equates a 'personal' service with one that is responsive to the choices of individual patients. Secondly, the term 'personal' can be thought to refer to the intimate relationships between patients and medical professionals that have typified traditional models of good practice. I combine a review of the relevant academic and policy literature on personalization with a process of conceptual analysis to uncover three arguments, which suggest that personalization based on choice may adversely affect standards of care by eroding the qualities of intimacy at the heart of the care process. Thus, an unintended consequence of the drive for personalization may be the creation of an NHS that is, in an important sense, less personal than it once was. Whilst personalization may deliver many potential benefits, the tension between promoting patient choice and retaining intimate professional-patient relationships ought to be taken seriously. Thus, the task of promoting choice whilst retaining intimacy represents a key policy challenge for advocates of personalization. © 2012 John Wiley & Sons Ltd.

Psychoanalysis and analytic psychotherapy in the NHS--a problem for medical ethics.

Science.gov (United States)

Wilkinson, G

1986-01-01

I question the place of psychoanalysis and psychoanalytically oriented psychotherapy in the National Health Service (NHS), with reference to published material; and, particularly, in relation to primary care, health economics and medical ethics. I argue that there are pressing clinical, research, economic, and ethical reasons in support of the contention that an urgent review of the extent and impact of psychoanalytic practices in the health service is called for. PMID:3735363

Problem Based Learning Online

DEFF Research Database (Denmark)

Kolbæk, Ditte

2018-01-01

“How do two online learning designs affect student engagement in the PBL online modules?” The empirical data were collected and analyzed using a netnographic approach. The study finds that concepts such as self-directed learning and active involvement may be perceived very differently from the students...

Persuasion strategies and sexual solicitations and interactions in online sexual grooming of adolescents: Modeling direct and indirect pathways.

Science.gov (United States)

Gámez-Guadix, Manuel; Almendros, Carmen; Calvete, Esther; De Santisteban, Patricia

2018-02-01

Online sexual grooming and exploitation of adolescents is receiving increasing social attention. Drawing on a social influence framework, the aim of this study was to test a model of the direct and mediated relationships between an adult's use of persuasion strategies and online sexual grooming of early adolescents. The initial sample of the study consisted of 2731 early Spanish adolescents between 12 and 15 years old (50.6% female). Of these, 196 adolescents (7.17% of the total; 53% girls) were involved in online grooming (mean age = 14.93, SD = 0.90). Persuasion strategies by the adult through internet increased the probability of using deceit, bribery, and the minor's nonsexual involvement. In addition, deceit and bribery were associated with higher rates of sexual solicitation, which in turn increased abusive sexual interactions. Understanding strategies used by adults to groom minors contributes to the prevention of and intervention in this crucial societal problem. Copyright © 2017 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

Attendance at NHS mandatory training sessions.

Science.gov (United States)

Brand, Darren

2015-02-17

To identify factors that affect NHS healthcare professionals' attendance at mandatory training sessions. A quantitative approach was used, with a questionnaire sent to 400 randomly selected participants. A total of 122 responses were received, providing a mix of qualitative and quantitative data. Quantitative data were analysed using statistical methods. Open-ended responses were reviewed using thematic analysis. Clinical staff value mandatory training sessions highly. They are aware of the requirement to keep practice up-to-date and ensure patient safety remains a priority. However, changes to the delivery format of mandatory training sessions are required to enable staff to participate more easily, as staff are often unable to attend. The delivery of mandatory training should move from classroom-based sessions into the clinical area to maximise participation. Delivery should be assisted by local 'experts' who are able to customise course content to meet local requirements and the requirements of different staff groups. Improved arrangements to provide staff cover, for those attending training, would enable more staff to attend training sessions.

Effects of Motivation, Academic Stress and Age in Predicting Self-Directed Learning Readiness (SDLR): Focused on Online College Students

Science.gov (United States)

Heo, JeongChul; Han, Sumi

2018-01-01

The purpose of this study is to determine whether the self-directed learning readiness (SDLR) among online students might be significantly predicted by motivation, academic stress, and age. To complete the purpose of this study, the Pearson correlation and multiple-regression are analyzed. The participants for this study are college students who…

A case study into labour turnover within an NHS Trust.

Science.gov (United States)

Bamford, David; Hall, Catherine

2007-02-01

This paper investigates turnover in a British NHS Trust, to find out why staff left and whether factors identified in the literature with regards to improving turnover were pertinent to the organization. The research also investigated staff groups with high turnover--staff with less than 12 months service, and the unqualified nursing staff group--to ascertain whether there were any reasons for leaving or areas of dissatisfaction particular to these groups. The outcomes of the research complied with much of the published research with some interesting differences. The main reasons for leaving were identified as moving house, promotion or career development and taking up education and training opportunities elsewhere. There was no evidence of 'level of pay', commonly given as a significant influence behind turnover, as a reason for leaving. It was also found that the retention strategies identified in the published research were mainly applicable to the research, with evidence to support the improvement of line management skills, training and development, career development, appraisal, communications and induction in order to reduce turnover. There was less evidence for introducing work-life balance policies, improving communications, pay and working relationships as retention strategies. Recommendations for future management of labour turnover within the NHS Trust and elsewhere are made, with observations about the validity of some existing models. The core contribution of this research is in adding to the body of knowledge about labour turnover issues. This is of value to those working in the UK health-care and wider public sector. Specific recommendations for future research are made.

Staff perceptions of quality of care: an observational study of the NHS Staff Survey in hospitals in England.

Science.gov (United States)

Pinder, Richard J; Greaves, Felix E; Aylin, Paul P; Jarman, Brian; Bottle, Alex

2013-07-01

There is some evidence to suggest that higher job satisfaction among healthcare staff in specific settings may be linked to improved patient outcomes. This study aimed to assess the potential of staff satisfaction to be used as an indicator of institutional performance across all acute National Health Service (NHS) hospitals in England. Using staff responses from the NHS Staff Survey 2009, and correlating these with hospital standardised mortality ratios (HSMR), correlation analyses were conducted at institutional level with further analyses of staff subgroups. Over 60 000 respondents from 147 NHS trusts were included in the analysis. There was a weak negative correlation with HSMR where staff agreed that patient care was their trust's top priority (Kendall τ = -0.22, psatisfaction with the quality of care delivered by oneself and institutional HSMR. In the context of the continued debate about the relationship of HSMR to hospital performance, these findings of a weak correlation between staff satisfaction and HSMR are intriguing and warrant further investigation. Such measures in the future have the advantage of being intuitive for lay and specialist audiences alike, and may be useful in facilitating patient choice. Whether higher staff satisfaction drives quality or merely reflects it remains unclear.

Human trafficking and health: a cross-sectional survey of NHS professionals’ contact with victims of human trafficking

Science.gov (United States)

Ross, Claire; Dimitrova, Stoyanka; Howard, Louise M; Dewey, Michael; Zimmerman, Cathy; Oram, Siân

2015-01-01

Objectives (1) To estimate the proportion of National Health Service (NHS) professionals who have come into contact with trafficked people and (2) to measure NHS professionals’ knowledge and confidence to respond to human trafficking. Design A cross-sectional survey. Setting Face-to-face mandatory child protection and/or vulnerable adults training sessions at 10 secondary healthcare provider organisations in England, and meetings of the UK College of Emergency Medicine. Participants 782/892 (84.4%) NHS professionals participated, including from emergency medicine, maternity, mental health, paediatrics and other clinical disciplines. Measures Self-completed questionnaire developed by an expert panel. Questionnaire asks about prior training and contact with potential victims of trafficking, perceived and actual human trafficking knowledge, confidence in responding to human trafficking, and interest in future human trafficking training. Results 13% participants reported previous contact with a patient they knew or suspected of having been trafficked; among maternity services professionals this was 20.4%. However, 86.8% (n=679) reported lacking knowledge of what questions to ask to identify potential victims and 78.3% (n=613) reported that they had insufficient training to assist trafficked people. 71% (n=556), 67.5% (n=528) and 53.4% (n=418) lacked confidence in making appropriate referrals for men, women and children, respectively, who had been trafficked. 95.3% (n=746) of respondents were unaware of the scale of human trafficking in the UK, and 76.5% (n=598) were unaware that calling the police could put patients in more danger. Psychometric analysis showed that subscales measuring perceived knowledge, actual knowledge and confidence to respond to human trafficking demonstrated good internal consistency (Cronbach's αs 0.93, 0.63 and 0.64, respectively) and internal correlations. Conclusions NHS professionals working in secondary care are in contact with potential

Master of science in medical leadership and management and its role in the current NHS.

Science.gov (United States)

Barratt, Shaney; Bateman, Kathryn; Harvey, John

2010-10-01

Traditionally there has been little formal leadership and management education in the core medical curriculum. The Department of Health has recently emphasised the development of clinical leadership within the NHS. In this article, trainees share their experience of the Master of Science in medical leadership and management postgraduate qualification.

Introduction into the NHS of magnetic sphincter augmentation: an innovative surgical therapy for reflux - results and challenges.

Science.gov (United States)

Prakash, D; Campbell, B; Wajed, S

2018-04-01

Introduction Gastro-oesophageal reflux disease (GORD) is a common, chronic debilitating condition. Surgical management traditionally involves fundoplication. Magnetic sphincter augmentation (MSA) is a new definitive treatment. We describe our experience of introducing this innovative therapy into NHS practice and report the early clinical outcomes. Methods MSA was introduced into NHS practice following successful acceptance of a cost-effective business plan and close observation of National Institute for Health and Care Excellence (NICE) recommendations for new procedures, including a carefully planned prospective data collection over a two-year follow-up period. Results Forty-seven patients underwent MSA over the 40-month period. Reflux health-related quality of life (GERD-HRQL) was significantly improved after the procedure and maintained at one- and two-year (P business plan and compliance with NICE recommendations.

Evaluating PLATO: postgraduate teaching and learning online.

Science.gov (United States)

Brown, Menna; Bullock, Alison

2014-02-01

  The use of the Internet as a teaching medium has increased rapidly over the last decade. PLATO (postgraduate learning and teaching online) was launched in 2008 by the e-learning unit (ELU) of Wales Deanery. Located within Learning@NHSWales, a Moodle virtual learning environment (VLE), it hosts a wide range of freely available courses and resources tailored to support the education, training and continuing professional development (CPD) needs of health care professionals working across the National Health Service (NHS) Wales. The evaluation aimed to identify the costs and benefits of PLATO, report its value as attributed by users, identify potential cost savings and make recommendations.   Five courses (case studies) were selected, representing the range of available e-learning resources: e-induction; fetal heart monitoring; cervical screening; GP prospective trainers; and tools for trainers. Mixed methods were used: one-to-one qualitative interviews, focus group discussions and surveys explored user views, and identified individual and organisational value.   Qualitative findings identified six key areas of value for users: ELU support and guidance; avoidance of duplication and standardisation; central reference; local control; flexibility for learners; and specific features. Survey results (n=72) indicated 72 per cent of consultants reported that PLATO was easy to access and user friendly. E-learning was rated as 'very/important' for CPD by 79 per cent of respondents. Key challenges were: access, navigation, user concerns, awareness and support.   PLATO supports education and helps deliver UK General Medical Council standards. Future plans should address the suggested recommendations to realise cost savings for NHS Wales and the Wales Deanery. The findings have wider applicability to others developing or using VLEs. © 2014 John Wiley & Sons Ltd.

Healthcare scandals in the NHS: crime and punishment.

Science.gov (United States)

Alghrani, Amel; Brazier, Margaret; Farrell, Anne-Maree; Griffiths, Danielle; Allen, Neil

2011-04-01

The Francis Report into failures of care at Mid Staffordshire NHS Foundation Trust Hospital documented a series of 'shocking' systematic failings in healthcare that left patients routinely neglected, humiliated and in pain as the Trust focused on cutting costs and hitting government targets. At present, the criminal law in England plays a limited role in calling healthcare professionals to account for failures in care. Normally, only if a gross error leads to death will a doctor or nurse face the prospect of prosecution. Doctors and nurses caring for patients under the Mental Health Act 1983 and the Mental Capacity Act 2005 may however be prosecuted for wilful neglect of a patient. In the light of the Francis Report, this article considers whether the criminal offence of wilful neglect should be extended to a broader healthcare setting and not confined to mental healthcare.

Leadership Online: Expanding the Horizon

Science.gov (United States)

Phelps, Kirstin

2012-01-01

With an increase of online teaching, social media, and use of classroom technology by both location-bound and distance students, how do educators teach and learn leadership through online tools? The International Leadership Association (ILA, 2009) guidelines, specifically the overarching questions for teaching and learning, provide direction in…

Artificial Intelligence Techniques to Optimize the EDC/NHS-Mediated Immobilization of Cellulase on Eudragit L-100

Directory of Open Access Journals (Sweden)

Min-Chao He

2012-06-01

Full Text Available Two artificial intelligence techniques, namely artificial neural network (ANN and genetic algorithm (GA were combined to be used as a tool for optimizing the covalent immobilization of cellulase on a smart polymer, Eudragit L-100. 1-Ethyl-3-(3-dimethyllaminopropyl carbodiimide (EDC concentration, N-hydroxysuccinimide (NHS concentration and coupling time were taken as independent variables, and immobilization efficiency was taken as the response. The data of the central composite design were used to train ANN by back-propagation algorithm, and the result showed that the trained ANN fitted the data accurately (correlation coefficient R² = 0.99. Then a maximum immobilization efficiency of 88.76% was searched by genetic algorithm at a EDC concentration of 0.44%, NHS concentration of 0.37% and a coupling time of 2.22 h, where the experimental value was 87.97 ± 6.45%. The application of ANN based optimization by GA is quite successful.

One stop or full stop? The continuing challenges for researchers despite the new streamlined NHS research governance process.

Science.gov (United States)

Thompson, Andrew G H; France, Emma F

2010-05-13

Obtaining the necessary approvals and permission for clinical research requires successful negotiation of the ethical and R&D layers of the NHS. Differences in structure and governance frameworks feature between the constituent nations of the UK (England, Scotland, Wales and Northern Ireland), which adds complexity to cross-national studies. Difficulties in carrying out research in the NHS in the UK due to bureaucratic and time-consuming governance processes have led to the development of a new system of application and co-ordination from 2009. This paper illustrates how this new system fails to be consistent and streamlined and is unlikely to become so unless changes are made to the implementation and management of the governance processes. We present a case study of the research governance process at the survey stage of an investigation into the use, preferences and need for information by people making choices or decisions about health care. The method involved home-based, face-to-face interviewing in a questionnaire survey in relation to decisions about lymphoma treatment, Down's syndrome screening in pregnancy, and caring for people with dementia. Our experience of the ethics stage was very positive, noting an efficient process of application and a speedy decision, both in relation to the initial application and to subsequent substantial amendments. By contrast, the R&D stages were very slow, most with unexplained delays, but some offering contradictory advice and exhibiting a lack of clear guidance and training for NHS staff. The R&D arrangements in Scotland were far quicker and more likely to be successful than in England. Overall, the delays were so severe that substantial parts of the research could not be delivered as planned within the funding timescale. If high-quality research in the NHS, particularly in England, is to be delivered in a timely and cost-effective way, R&D processes for gaining research governance approval need improvement. Attention is

Medication incidents reported to an online incident reporting system.

LENUS (Irish Health Repository)

Alrwisan, Adel

2011-01-15

AIMS: Approximately 20% of deaths from adverse events are related to medication incidents, costing the NHS an additional £500 million annually. Less than 5% of adverse events are reported. This study aims to assess the reporting rate of medication incidents in NHS facilities in the north east of Scotland, and to describe the types and outcomes of reported incidents among different services. Furthermore, we wished to quantify the proportion of reported incidents according to the reporters\\' profession. METHODS: A retrospective description was made of medication incidents reported to an online reporting system (DATIX) over a 46-month-period (July 2005 to April 2009). Reports originated from acute and community hospitals, mental health, and primary care facilities. RESULTS: Over the study period there were 2,666 incidents reported with a mean monthly reporting rate of 78.2\\/month (SD±16.9). 6.1% of all incidents resulted in harm, with insulin being the most commonly implicated medication. Nearly three-quarters (74.2%, n=1,978) of total incidents originated from acute hospitals. Administration incidents were implicated in the majority of the reported medication incidents (59%), followed by prescribing (10.8%) and dispensing (9.9%), while the nondescript "other medication incidents" accounted for 20.3% of total incidents. The majority of reports were made by nursing and midwifery staff (80%), with medical and dental professionals reporting the lowest number of incidents (n=56, 2%). CONCLUSIONS: The majority of medication incidents in this study were reported by nursing and midwifery staff, and were due to administration incidents. There is a clear need to elucidate the reasons for the limited contribution of the medical and dental professionals to reporting medication incidents.

Towards Religious/Spiritual Competence for Applied Psychologists in NHS Settings in the UK

OpenAIRE

Koce, Precious

2013-01-01

The profession of psychology in the UK is gradually showing signs of renewed interest in the area of religion/spirituality (e.g., Collicut, 2011). The present study aimed to (i) explore applied psychologists‟ accounts of their practice in the NHS, UK, with clients with religious/spiritual issues; and (ii) from these accounts identify participants‟ indications of religious/spiritual competencies. Thematic analysis as outlined by Braun and Clarke (2006) was employed and subscribed to a critical...

An algorithm for online optimization of accelerators

Energy Technology Data Exchange (ETDEWEB)

Huang, Xiaobiao [SLAC National Accelerator Lab., Menlo Park, CA (United States); Corbett, Jeff [SLAC National Accelerator Lab., Menlo Park, CA (United States); Safranek, James [SLAC National Accelerator Lab., Menlo Park, CA (United States); Wu, Juhao [SLAC National Accelerator Lab., Menlo Park, CA (United States)

2013-10-01

We developed a general algorithm for online optimization of accelerator performance, i.e., online tuning, using the performance measure as the objective function. This method, named robust conjugate direction search (RCDS), combines the conjugate direction set approach of Powell's method with a robust line optimizer which considers the random noise in bracketing the minimum and uses parabolic fit of data points that uniformly sample the bracketed zone. Moreover, it is much more robust against noise than traditional algorithms and is therefore suitable for online application. Simulation and experimental studies have been carried out to demonstrate the strength of the new algorithm.

Online Platform Support for Sustained, Collaborative and Self-directed Engagement of Teachers in a Blended Professional Development Program

Science.gov (United States)

Osburg, Thomas; Todorova, Albena

Professional development of teachers plays a significant role for the success of educational reforms and for student achievement. Programs for developing teachers’ skills to integrate digital media in the classroom have received increased attention, due to the role of technology in today’s world. Recent research and field experiences have identified elements which contribute to the effectiveness of such programs, among them opportunities for sustained, collaborative and self-directed learning. This paper explores how an online platform of a large scale blended program for professional development, Intel® Teach - Advanced Online, supports the implementation of such opportunities in practice and incorporates them in the structure of the program. The positive outcomes from the program as evidenced by its evaluation indicate that professional development based on the design principles identified as effective by recent research is a viable solution for addressing the limitations of traditional teacher training for technology integration.

Human trafficking and health: a cross-sectional survey of NHS professionals' contact with victims of human trafficking.

Science.gov (United States)

Ross, Claire; Dimitrova, Stoyanka; Howard, Louise M; Dewey, Michael; Zimmerman, Cathy; Oram, Siân

2015-08-20

(1) To estimate the proportion of National Health Service (NHS) professionals who have come into contact with trafficked people and (2) to measure NHS professionals' knowledge and confidence to respond to human trafficking. A cross-sectional survey. Face-to-face mandatory child protection and/or vulnerable adults training sessions at 10 secondary healthcare provider organisations in England, and meetings of the UK College of Emergency Medicine. 782/892 (84.4%) NHS professionals participated, including from emergency medicine, maternity, mental health, paediatrics and other clinical disciplines. Self-completed questionnaire developed by an expert panel. Questionnaire asks about prior training and contact with potential victims of trafficking, perceived and actual human trafficking knowledge, confidence in responding to human trafficking, and interest in future human trafficking training. 13% participants reported previous contact with a patient they knew or suspected of having been trafficked; among maternity services professionals this was 20.4%. However, 86.8% (n=679) reported lacking knowledge of what questions to ask to identify potential victims and 78.3% (n=613) reported that they had insufficient training to assist trafficked people. 71% (n=556), 67.5% (n=528) and 53.4% (n=418) lacked confidence in making appropriate referrals for men, women and children, respectively, who had been trafficked. 95.3% (n=746) of respondents were unaware of the scale of human trafficking in the UK, and 76.5% (n=598) were unaware that calling the police could put patients in more danger. Psychometric analysis showed that subscales measuring perceived knowledge, actual knowledge and confidence to respond to human trafficking demonstrated good internal consistency (Cronbach's αs 0.93, 0.63 and 0.64, respectively) and internal correlations. NHS professionals working in secondary care are in contact with potential victims of human trafficking, but lack knowledge and confidence in

Clinical audit of core podiatry treatment in the NHS.

Science.gov (United States)

Farndon, Lisa; Barnes, Andrew; Littlewood, Keith; Harle, Justine; Beecroft, Craig; Burnside, Jaclyn; Wheeler, Tracey; Morris, Selwyn; Walters, Stephen J

2009-03-13

Core podiatry involves treatment of the nails, corns and callus and also giving footwear and foot health advice. Though it is an integral part of current podiatric practice little evidence is available to support its efficacy in terms of research and audit data. This information is important in order to support the current NHS commissioning process where services are expected to provide data on standards including outcomes. This study aimed to increase the evidence base for this area of practice by conducting a multi-centre audit in 8 NHS podiatry departments over a 1-year period. The outcome measure used in this audit was the Podiatry Health Questionnaire which is a self completed short measure of foot health including a pain visual analogue scale and a section for the podiatrist to rate an individual's foot health based on their podiatric problems. The patient questionnaire was completed by individuals prior to receiving podiatry care and then 2 weeks after treatment to assess the effect of core podiatry in terms of pain and foot health. 1047 patients completed both questionnaires, with an age range from 26-95 years and a mean age of 72.9 years. The podiatrists clinical rating at baseline showed 75% of patients had either slight or moderate podiatric problems. The differences in questionnaire and visual analogue scores before and after treatment were determined according to three categories - better, same, worse and 75% of patients' scores either remained the same or improved after core podiatry treatment. A student t-test showed a statistical significant difference in pre and post treatment scores where P podiatry has been shown to sustain or improve foot health and pain in 75% of the patients taking part in the audit. Simple outcome measures including pain scales should be used routinely in podiatric practice to assess the affect of different aspects of treatments and improve the evidence base for podiatry.

Clinical audit of core podiatry treatment in the NHS

Directory of Open Access Journals (Sweden)

Burnside Jaclyn

2009-03-01

Full Text Available Abstract Background Core podiatry involves treatment of the nails, corns and callus and also giving footwear and foot health advice. Though it is an integral part of current podiatric practice little evidence is available to support its efficacy in terms of research and audit data. This information is important in order to support the current NHS commissioning process where services are expected to provide data on standards including outcomes. This study aimed to increase the evidence base for this area of practice by conducting a multi-centre audit in 8 NHS podiatry departments over a 1-year period. Methods The outcome measure used in this audit was the Podiatry Health Questionnaire which is a self completed short measure of foot health including a pain visual analogue scale and a section for the podiatrist to rate an individual's foot health based on their podiatric problems. The patient questionnaire was completed by individuals prior to receiving podiatry care and then 2 weeks after treatment to assess the effect of core podiatry in terms of pain and foot health. Results 1047 patients completed both questionnaires, with an age range from 26–95 years and a mean age of 72.9 years. The podiatrists clinical rating at baseline showed 75% of patients had either slight or moderate podiatric problems. The differences in questionnaire and visual analogue scores before and after treatment were determined according to three categories – better, same, worse and 75% of patients' scores either remained the same or improved after core podiatry treatment. A student t-test showed a statistical significant difference in pre and post treatment scores where P Conclusion Core podiatry has been shown to sustain or improve foot health and pain in 75% of the patients taking part in the audit. Simple outcome measures including pain scales should be used routinely in podiatric practice to assess the affect of different aspects of treatments and improve the

Investigating the use of CD-Rom CBT for bulimia nervosa and binge eating disorder in an NHS adult outpatient eating disorders service.

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Graham, Lisa; Walton, Mark

2011-07-01

Many patients who experience bulimia nervosa (BN) and binge eating disorder (BED) find it hard to access evidence-based treatments. Rates of failure to enter outpatient services following initial assessment are high, as are dropout rates from specialist outpatient eating disorders services. To offer CD-Rom CBT, a cognitive-behavioural multi-media supported self-help treatment, in a locality-based outpatient NHS Eating Disorders Service to patients who have binge eating disorder and bulimia nervosa. Patients referred to a catchment-based NHS outpatient eating disorders service who were assessed and had an eating disorder with a binge-eating component were offered CD-Rom based CBT (Overcoming Bulimia) whilst on the waiting list for individual CBT. Forty patients completed the 8 sessions and attended the evaluation appointment (13 had BN, 27 had BED). For both groups, there were significant improvements in well-being and functioning, as well as significant reductions in problems and risk. There was also a significant reduction on the "Bulimic Subscale" of the EDI. These results were comparable with the original study findings (Schmidt, Treasure and Williams, 2001). Dropouts from the CD-Rom reflected rates common to other EDS treatments suggesting that CD-Rom did not directly impact upon service dropout rates. Computer assisted CBT for Eating Disorders offers a promising, feasible and acceptable first step for patients who have bulimia nervosa or binge eating disorder and access treatment from specialist eating disorders services.

Suspect online sellers and contraceptive access.

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Liang, Bryan A; Mackey, Tim K; Lovett, Kimberly M

2012-11-01

Issues surrounding contraception access have been a national focus. During this debate, adolescent and adult women may seek these products online. Due to safety concerns, including potential counterfeit forms, we wished to assess whether online "no prescription" contraceptives were available. We assessed online availability of reversible, prescription contraceptive methods resulting in online pharmacy marketing is shifting from direct search engine access to social media (Facebook, Twitter, Slidehare, flickr). Online contraceptive sales represent patient safety risks and a parallel system of high-risk product access absent professional guidance. Providers should educate patients, while policy makers employ legal strategies to address these systemic risks. Copyright © 2012 Elsevier Inc. All rights reserved.

A novel small deletion in the NHS gene associated with Nance-Horan syndrome

OpenAIRE

Li, Huajin; Yang, Lizhu; Sun, Zixi; Yuan, Zhisheng; Wu, Shijing; Sui, Ruifang

2018-01-01

Nance-Horan syndrome is a rare X-linked recessive inherited disease with clinical features including severe bilateral congenital cataracts, characteristic facial and dental abnormalities. Data from Chinese Nance-Horan syndrome patients are limited. We assessed the clinical manifestations of a Chinese Nance-Horan syndrome pedigree and identified the genetic defect. Genetic analysis showed that 3 affected males carried a novel small deletion in NHS gene, c.263_266delCGTC (p.Ala89TrpfsTer106), a...

Illicit online marketing of lorcaserin before DEA scheduling.

Science.gov (United States)

Liang, Bryan A; Mackey, Tim K; Archer-Hayes, Ashley N; Shinn, Linda M

2013-05-01

Antiobesity drugs have been marketed illicitly by "no prescription" online pharmacies after approval and scheduling by the drug enforcement agency. We assess whether antiobesity drug Belviq® (lorcaserin HCl) was available from illicit online vendors before DEA-scheduling when sales are unauthorized. Online searches of "buy Belviq no prescription" examining first five result pages marketing the drug. Searches were performed from 11/5/2012-12/8/2012, prior to DEA scheduing. Belviq® is actively marketed by "no prescription" online vendors despite official unavailability and prescription requirements. Approaches included direct-to-consumer advertising using descriptive website URLs; linking to illicit marketers; and directing customers to other weight-loss websites for additional marketing. Finally, large quantities were marketed by business-to-business vendors. Illicit online "no prescription" pharmacies are marketing unauthorized, suspect antiobesity drugs before DEA scheduling and permitted marketing. Regulators must legally intercede to ensure patient safety, and providers must educate patients about online-sourcing risks. Copyright © 2013 The Obesity Society.

Challenges of a negative work load and implications on morale, productivity and quality of service delivered in NHS laboratories in England.

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Osaro, Erhabor; Chima, Njemanze

2014-06-01

The National Health Service (NHS) is a term used to describe the publicly funded healthcare delivery system providing quality healthcare services in the United Kingdom. There are several challenges militating against the effective laboratory service delivery in the NHS in England. Biomedical scientists work in healthcare to diagnose disease and evaluate the effectiveness of treatment through the analysis of body fluids and tissue samples from patients. They provide the "engine room" of modern medicine with 70% of diagnosis based on the laboratory results generated by them. This review involved the search of literature for information on working condition of biomedical scientist in the NHS in England. Laboratory service delivery in the NHS in England faces numerous daunting challenges; staffing levels in the last few years have become dangerously low, less remunerated, relatively less experienced and predominantly band 5's, multidisciplinary rather than specialty based, associated with working more unsocial hours without adequate recovery time, de-banding of staff, high staff turnaround, profit and cost driven rather than quality. These factors has resulted in burn out, low morale, high sickness absences, increased error rate, poor team spirit, diminished productivity and suboptimal laboratory service delivery. There is the urgent need to retract our steps on unpopular policies to ensure that patient care is not compromised by ensuring adequate staffing level and mix, ensuring adequate remuneration of laboratory staff, implementing evidenced-based specialty oriented service, determining the root cause/s for the high staff turnover and implementing corrective action, identifying other potential sources of waste in the system rather than pruning the already dangerously low staffing levels and promoting a quality delivery side by side cost effectiveness.

Which online format is most effective for assisting Baby Boomers to complete advance directives? A randomised controlled trial of email prompting versus online education module.

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Bradley, Sandra L; Tieman, Jennifer J; Woodman, Richard J; Phillips, Paddy A

2017-08-29

Completion of Advance Directives (ADs), being financial and healthcare proxy or instructional documents, is relatively uncommon in Australia. Efforts to increase completion rates include online education and prompting which past literature suggests may be effective. The aim of this randomized controlled trial was to assess computer-based online AD information and email prompting for facilitating completion of ADs by Australian Baby Boomers (b.1946-1965) as well as factors which may impede or assist completion of these documents by this generation when using the online environment. Two hundred eighty-two men and women aged 49-68 years at the time of the trial were randomly assigned to one of 3 intervention groups: education module only; email prompt only; email prompt and education module; and a control group with no education module and no email prompt. The randomized controlled trial was undertaken in participants' location of choice. Randomization and allocation to trial group were carried out by a central computer system. The primary analysis was based on a final total of 189 participants who completed the trial (n = 52 education module only; n = 44 email prompt only; n = 46 email prompt and education module; and n = 47 control). The primary outcome was the number of individuals in any group completing any of the 4 legal ADs in South Australia within 12 months or less from entry into the trial. Frequency analysis was conducted on secondary outcomes such as reasons for non-completion. Mean follow-up post-intervention at 12 months showed that 7% of overall participants completed one or more of the 4 legal ADs but without significant difference between groups (delta = 1%, p = .48 Prompt/Non-Prompt groups, delta = 5%, p = .44 education/non-education groups). Reasons offered for non-completion were too busy (26%) and/or it wasn't the right time (21%). Our results suggest that neither email prompting nor provision of additional educational material

Cyber security issues in online games

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Zhao, Chen

2018-04-01

With the rapid development of the Internet, online gaming has become a way of entertainment for many young people in the modern era. However, in recent years, cyber security issues in online games have emerged in an endless stream, which have also caused great attention of many game operators. Common cyber security problems in the game include information disclosure and cyber-attacks. These problems will directly or indirectly cause economic losses to gamers. Many gaming companies are enhancing the stability and security of their network or gaming systems in order to enhance the gaming user experience. This article has carried out the research of the cyber security issues in online games by introducing the background and some common cyber security threats, and by proposing the latent solution. Finally, it speculates the future research direction of the cyber security issues of online games in the hope of providing feasible solution and useful information for game operators.

Options for change in the NHS consultant contract.

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Clarke, R W; Gray, C

The lead negotiators for the management and consultant sides in an NHS trust in northern England responded to debate in their trust about consultant contracts by offering to research the attitudes of their peers towards a variety of contract options. The options tested included the current contract; models already examined in the trust and elsewhere, such as time sensitive and mild performance related contracts; and some more radical and speculative possibilities, including consultants franchising their services to the trust. Beyond the predictable conclusion that consultants would prefer no change while managers desired it, a time sensitive contract emerged as having potential for successful negotiation. On the other hand, neither consultants nor managers favoured a strict performance related contract or a fee for service contract. There was a strong similarity of opinion between the two groups on the relative salary values of the options, though the consultants consistently priced these higher than the managers.

The effects of immigration on NHS waiting times.

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Giuntella, Osea; Nicodemo, Catia; Vargas-Silva, Carlos

2018-03-01

This paper analyzes the effects of immigration on waiting times for the National Health Service (NHS) in England. Linking administrative records from Hospital Episode Statistics (2003-2012) with immigration data drawn from the UK Labour Force Survey, we find that immigration reduced waiting times for outpatient referrals and did not have significant effects on waiting times in accident and emergency departments (A&E) and elective care. The reduction in outpatient waiting times can be explained by the fact that immigration increases natives' internal mobility and that immigrants tend to be healthier than natives who move to different areas. Finally, we find evidence that immigration increased waiting times for outpatient referrals in more deprived areas outside of London. The increase in average waiting times in more deprived areas is concentrated in the years immediately following the 2004 EU enlargement and disappears in the medium term (e.g., 3-4 years). Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.

Engaging dental professionals in NHS leadership - the challenges, the opportunities and the risks.

Science.gov (United States)

Ford, J

2014-09-01

Leadership training in dentistry and the wider NHS is often overlooked or seen as an unnecessary distraction from front line duties. Dentists themselves are often reluctant to adopt formal leadership learning due to the way work is structured and rewarded. So, what is it like for a dentist to undertake leadership training and how can the gap be bridged between the need for highly trained leaders in dentistry and the reticence of front line professionals to take time away from practice?

What motivates doctors to leave the UK NHS for a "life in the sun" in New Zealand; and, once there, why don't they stay?

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Gauld, Robin; Horsburgh, Simon

2015-09-08

At 44%, New Zealand has the highest proportion of international medical graduates (IMGs) in its workforce amongst OECD member countries. Around half of New Zealand's IMGs come from the UK NHS, yet only around 50% stay longer than 1 year post-registration with significant costs to the New Zealand health care system. Why these doctors go to New Zealand and do not stay for long is an important question. UK-trained doctors who had gained registration with the Medical Council of New Zealand and currently practising in New Zealand were surveyed (n = 1357) on the motivation for their move to New Zealand, experiences once there and what was prompting any intentions to move away from New Zealand. Multivariate proportional odds models (POM) were used to quantify various associations. The survey had a 47% response (n = 632). Quality of life considerations motivated 96% of respondents to move to New Zealand, although 65% indicated they were pushed by a desire to leave the NHS. POM analyses revealed older respondents were significantly less likely than younger respondents to be motivated by quality of life considerations. Younger doctors were significantly more likely to be seeking to leave the NHS. Seventy-six per cent of respondents signalling an intention to leave New Zealand indicated that the desire to return to the UK was the primary reason for this. There is a long history of medical migration from the UK to New Zealand. However, the 65% of respondents in this study seeking to leave the NHS was much higher than found elsewhere, perhaps reflecting increasing workplace and funding pressures in recent years. Of concern to policy makers were the higher odds of seeking to leave the NHS motivating younger doctors. Various changes "down under", in New Zealand as well as Australia, mean their IMG markets may well be tightening up.

One stop or full stop? The continuing challenges for researchers despite the new streamlined NHS research governance process

Directory of Open Access Journals (Sweden)

France Emma F

2010-05-01

Full Text Available Abstract Background Obtaining the necessary approvals and permission for clinical research requires successful negotiation of the ethical and R&D layers of the NHS. Differences in structure and governance frameworks feature between the constituent nations of the UK (England, Scotland, Wales and Northern Ireland, which adds complexity to cross-national studies. Difficulties in carrying out research in the NHS in the UK due to bureaucratic and time-consuming governance processes have led to the development of a new system of application and co-ordination from 2009. This paper illustrates how this new system fails to be consistent and streamlined and is unlikely to become so unless changes are made to the implementation and management of the governance processes. Methods We present a case study of the research governance process at the survey stage of an investigation into the use, preferences and need for information by people making choices or decisions about health care. The method involved home-based, face-to-face interviewing in a questionnaire survey in relation to decisions about lymphoma treatment, Down's syndrome screening in pregnancy, and caring for people with dementia. Results Our experience of the ethics stage was very positive, noting an efficient process of application and a speedy decision, both in relation to the initial application and to subsequent substantial amendments. By contrast, the R&D stages were very slow, most with unexplained delays, but some offering contradictory advice and exhibiting a lack of clear guidance and training for NHS staff. The R&D arrangements in Scotland were far quicker and more likely to be successful than in England. Overall, the delays were so severe that substantial parts of the research could not be delivered as planned within the funding timescale. Conclusions If high-quality research in the NHS, particularly in England, is to be delivered in a timely and cost-effective way, R&D processes for

Laid bare: religious intolerance within online commentary about 'bare below the elbows' guidance in professional journals.

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Jones, June; Shanks, Andrew

2013-09-01

The decision by the Department of Health to introduce amendments to the uniform and workwear policy for the NHS in response to increasing problems with infection control seemed uncontroversial. There was, however, some difficulty with implementing the policy, which arose largely because of the conflict this caused for staff who wished to keep their arms covered for reasons which stemmed from religious beliefs. This paper uses textual analysis to examine how those reasons and challenges were discussed in online commentary within a medical and nursing journal. The papers shows that there was a marked difference in how the two groups of professionals responded to the changes to workwear, and exposes a worrying degree of religious intolerance expressed by contributors to the nursing journal.

Does competition between hospitals improve clinical quality?: a review of evidence from two eras of competition in the English NHS

OpenAIRE

Gwyn Bevan; Matthew Skellern

2011-01-01

Gwyn Bevan and Matthew Skellern review evidence on the effects of hospital competition on quality of care within the English NHS and question whether they support government proposals to extend competition.

Marketing Online Services: Product, Market and Strategy.

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Trudell, Libby

1991-01-01

Describes characteristics of the online marketplace. Topics discussed include technology barriers; data ownership; markets for online services, including libraries and end users; marketing and promotion tactics, including exhibits and conferences, advertising, direct mail, and user groups; international marketing and service; strategic marketing…

Evidence-based commissioning in the English NHS: who uses which sources of evidence? A survey 2010/2011.

Science.gov (United States)

Clarke, Aileen; Taylor-Phillips, Sian; Swan, Jacky; Gkeredakis, Emmanouil; Mills, Penny; Powell, John; Nicolini, Davide; Roginski, Claudia; Scarbrough, Harry; Grove, Amy

2013-05-28

To investigate types of evidence used by healthcare commissioners when making decisions and whether decisions were influenced by commissioners' experience, personal characteristics or role at work. Cross-sectional survey of 345 National Health Service (NHS) staff members. The study was conducted across 11 English Primary Care Trusts between 2010 and 2011. A total of 440 staff involved in commissioning decisions and employed at NHS band 7 or above were invited to participate in the study. Of those, 345 (78%) completed all or a part of the survey. Participants were asked to rate how important different sources of evidence (empirical or practical) were in a recent decision that had been made. Backwards stepwise logistic regression analyses were undertaken to assess the contributions of age, gender and professional background, as well as the years of experience in NHS commissioning, pay grade and work role. The extent to which empirical evidence was used for commissioning decisions in the NHS varied according to the professional background. Only 50% of respondents stated that clinical guidelines and cost-effectiveness evidence were important for healthcare decisions. Respondents were more likely to report use of empirical evidence if they worked in Public Health in comparison to other departments (pfinance OR  0.19, 95%CI 0.05 to 0.78, other departments OR 0.35, 95%CI 0.17 to 0.71) or if they were female (OR 1.8 95% CI 1.01 to 3.1) rather than male. Respondents were more likely to report use of practical evidence if they were more senior within the organisation (pay grade 8b or higher OR 2.7, 95%CI 1.4 to 5.3, p=0.004 in comparison to lower pay grades). Those trained in Public Health appeared more likely to use external empirical evidence while those at higher pay scales were more likely to use practical evidence when making commissioning decisions. Clearly, National Institute for Clinical Excellence (NICE) guidance and government publications (eg, National Service

Evidence-based commissioning in the English NHS: who uses which sources of evidence? A survey 2010/2011

Science.gov (United States)

Clarke, Aileen; Taylor-Phillips, Sian; Swan, Jacky; Gkeredakis, Emmanouil; Mills, Penny; Powell, John; Nicolini, Davide; Roginski, Claudia; Scarbrough, Harry; Grove, Amy

2013-01-01

Objectives To investigate types of evidence used by healthcare commissioners when making decisions and whether decisions were influenced by commissioners’ experience, personal characteristics or role at work. Design Cross-sectional survey of 345 National Health Service (NHS) staff members. Setting The study was conducted across 11 English Primary Care Trusts between 2010 and 2011. Participants A total of 440 staff involved in commissioning decisions and employed at NHS band 7 or above were invited to participate in the study. Of those, 345 (78%) completed all or a part of the survey. Main outcome measures Participants were asked to rate how important different sources of evidence (empirical or practical) were in a recent decision that had been made. Backwards stepwise logistic regression analyses were undertaken to assess the contributions of age, gender and professional background, as well as the years of experience in NHS commissioning, pay grade and work role. Results The extent to which empirical evidence was used for commissioning decisions in the NHS varied according to the professional background. Only 50% of respondents stated that clinical guidelines and cost-effectiveness evidence were important for healthcare decisions. Respondents were more likely to report use of empirical evidence if they worked in Public Health in comparison to other departments (pfinance OR  0.19, 95%CI 0.05 to 0.78, other departments OR 0.35, 95%CI 0.17 to 0.71) or if they were female (OR 1.8 95% CI 1.01 to 3.1) rather than male. Respondents were more likely to report use of practical evidence if they were more senior within the organisation (pay grade 8b or higher OR 2.7, 95%CI 1.4 to 5.3, p=0.004 in comparison to lower pay grades). Conclusions Those trained in Public Health appeared more likely to use external empirical evidence while those at higher pay scales were more likely to use practical evidence when making commissioning decisions. Clearly, National Institute for

Adult patients' experiences of NHS specialist services for chronic fatigue syndrome (CFS/ME): a qualitative study in England.

Science.gov (United States)

Broughton, Jessica; Harris, Sarah; Beasant, Lucy; Crawley, Esther; Collin, Simon M

2017-06-02

Few studies have explored patients' experiences of treatment for CFS/ME. This study aims to fill this gap by capturing the perspective of patients who have been treated by NHS specialist CFS/ME services in England. Semi-structured interviews were conducted during the period June-September 2014 with 16 adults who were completing treatment at one of three outpatient NHS specialist CFS/ME services. Interviews were analysed thematically using constant comparison techniques, with particular attention paid to contrasting views. Three themes were identified: 'Journey to specialist services'; 'Things that help or hinder treatment'; and 'Support systems'. Within these themes nine sub-themes were identified. A wide range of factors was evident in forming participants' experiences, including personal characteristics such as perseverance and optimism, and service factors such as flexibility and positive, supportive relationships with clinicians. Participants described how specialist services played a unique role, which was related to the contested nature of the condition. Many participants had experienced a lack of validation and medical and social support before attending a specialist service. Patients' experiences of life before referral, and the concerns that they expressed about being discharged, highlighted the hardship and obstacles which people living with CFS/ME continue to experience in our society. The experiences of CFS/ME patients in our study showed that NHS specialist CFS/ME services played a vital role in patients' journeys towards an improved quality of life. This improvement came about through a process which included validation of patients' experiences, acceptance of change, practical advice and support, and therapeutic outcomes.

Barriers to healthy eating by National Health Service (NHS hospital doctors in the hospital setting: results of a cross-sectional survey

Directory of Open Access Journals (Sweden)

Wilson Sue

2008-08-01

Full Text Available Abstract Background With high levels of obesity and related illness, improving the health of the nation is a major public health concern. This study aimed to identify factors that prevent healthy eating among doctors, and that are associated with satisfaction with catering services. Findings Methods: Cross-sectional survey of 328 NHS doctors working in two NHS Trusts with on-site hospital canteen. Questionnaire to establish perceived barriers to healthy eating, weekly use and satisfaction with the hospital canteen, lifestyle and dietary habits, gender, age, height, weight, job details, and affect. Results: 70% of doctors reported using their hospital canteen each week, with 2 visits per week on average. Canteen opening times, lack of selection and lack of breaks were the most commonly perceived barriers to healthy eating. Availability of healthy options caused the most dissatisfaction. Only 12% felt the NHS was supportive of healthy eating. 74% did not feel their canteen advocated healthy eating. Canteen use is associated with younger age (r = -0.254, p Conclusion Interventions to encourage regular meal breaks, eating breakfast and drinking more water each day need developing. Improved canteen accessibility and availability of healthy options at evenings and weekends may be beneficial.

Cerebellar direct current stimulation enhances on-line motor skill acquisition through an effect on accuracy.

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Cantarero, Gabriela; Spampinato, Danny; Reis, Janine; Ajagbe, Loni; Thompson, Tziporah; Kulkarni, Kopal; Celnik, Pablo

2015-02-18

The cerebellum is involved in the update of motor commands during error-dependent learning. Transcranial direct current stimulation (tDCS), a form of noninvasive brain stimulation, has been shown to increase cerebellar excitability and improve learning in motor adaptation tasks. Although cerebellar involvement has been clearly demonstrated in adaptation paradigms, a type of task that heavily relies on error-dependent motor learning mechanisms, its role during motor skill learning, a behavior that likely involves error-dependent as well as reinforcement and strategic mechanisms, is not completely understood. Here, in humans, we delivered cerebellar tDCS to modulate its activity during novel motor skill training over the course of 3 d and assessed gains during training (on-line effects), between days (off-line effects), and overall improvement. We found that excitatory anodal tDCS applied over the cerebellum increased skill learning relative to sham and cathodal tDCS specifically by increasing on-line rather than off-line learning. Moreover, the larger skill improvement in the anodal group was predominantly mediated by reductions in error rate rather than changes in movement time. These results have important implications for using cerebellar tDCS as an intervention to speed up motor skill acquisition and to improve motor skill accuracy, as well as to further our understanding of cerebellar function. Copyright © 2015 the authors 0270-6474/15/353285-06$15.00/0.

Nance-Horan syndrome in females due to a balanced X;1 translocation that disrupts the NHS gene: Familial case report and review of the literature.

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Gómez-Laguna, Laura; Martínez-Herrera, Alejandro; Reyes-de la Rosa, Alejandra Del Pilar; García-Delgado, Constanza; Nieto-Martínez, Karem; Fernández-Ramírez, Fernando; Valderrama-Atayupanqui, Tania Yanet; Morales-Jiménez, Ariadna Berenice; Villa-Morales, Judith; Kofman, Susana; Cervantes, Alicia; Morán-Barroso, Verónica Fabiola

2018-01-01

The Nance-Horan syndrome is an X-linked disorder characterized by congenital cataract, facial features, microcornea, microphthalmia, and dental anomalies; most of the cases are due to NHS gene mutations on Xp22.13. Heterozygous carrier females generally present less severe features, and up to 30% of the affected males have intellectual disability. We describe two patients, mother and daughter, manifesting Nance-Horan syndrome. The cytogenetic and molecular analyses demonstrated a 46,X,t(X;1)(p22.13;q22) karyotype in each of them. No copy-number genomic imbalances were detected by high-density microarray analysis. The mother had a preferential inactivation of the normal X chromosome; expression analysis did not detect any mRNA isoform of NHS. This is the first report of Nance-Horan syndrome due to a skewed X chromosome inactivation resulting from a balanced translocation t(X;1) that disrupts the NHS gene expression, with important implications for clinical presentation and genetic counseling.

Invisible Motivation of Online Adult Learners During Contract Learning

Directory of Open Access Journals (Sweden)

Seung Youn (Yonnie Chyung, Ed.D.

2007-07-01

Full Text Available In a face-to-face classroom, the instructor can easily diagnose students’ motivational status by observing their facial expressions and postures, but such cues are absent in an online classroom. Therefore, online instructors often estimate students’ motivational level based on their online behavior such as the number of messages they post, and look for effective strategies to help them actively participate in online dialogues. One such strategy is contract learning which facilitates self-directed behaviors through structuring an agreed learning process. This study reports a contract learning strategy in a graduate-level online class, examining whether a sample of 28 students’ motivation could indeed be predicted by their online behavior. Results from the study found that the students’ online behavior was not a predictor for their motivational status, though there were age and gender differences in their online behavior. The students felt more self-directed and motivated during contract learning, but what they really liked was being able to select assignments that were relevant to their interests and needs. This paper concludes by discussing practical implications of the findings at the end.

MODELLING THE INFLUENCE OF ONLINE MARKETING COMMUNICATION ON BEHAVIOURAL INTENTIONS

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Alexandra PERJU-MITRAN

2014-12-01

Full Text Available The present study addresses the manners in which potential consumers react to and examine online marketing communication efforts, and how their perceptions influence various decisions. By drawing from theories of consumer behaviour, several variables are taken into consideration, a model designed to integrate existing theories and a three-way study of online user behaviour in response to online marketing messages is defined and tested. The results of the study demonstrate that there are direct and positive links between the manner in which users perceive online marketing communication efforts, and direct and positive links between users’ attitudes towards online communication and their intention to either further inform themselves, forward the information obtained, or even become loyal to the company.

Online Consumer Trust: Trends in Research

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Antonina Bauman

2017-07-01

Full Text Available This paper presents the literature review of studies published in 2004-2014 (Web 2.0 period in the area of consumer online trust. Based on the content analysis of 138 papers, this study highlights three major research themes: (1 trust models, (2 technological, and (3 social factors impacting online trust. It also explores topics in each major theme found in direct studies of online consumer trust. Since this literature review uses the concept-centric approach, it points out not only the major trends in research but also three understudied areas: (1 green trust, (2 trust recovery, and (3 the role of ethics in developing online trust.

Can UK NHS research ethics committees effectively monitor publication and outcome reporting bias?

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Begum, Rasheda; Kolstoe, Simon

2015-07-25

Publication and outcome reporting bias is often caused by researchers selectively choosing which scientific results and outcomes to publish. This behaviour is ethically significant as it distorts the literature used for future scientific or clinical decision-making. This study investigates the practicalities of using ethics applications submitted to a UK National Health Service (NHS) research ethics committee to monitor both types of reporting bias. As part of an internal audit we accessed research ethics database records for studies submitting an end of study declaration to the Hampshire A research ethics committee (formerly Southampton A) between 1st January 2010 and 31st December 2011. A literature search was used to establish the publication status of studies. Primary and secondary outcomes stated in application forms were compared with outcomes reported in publications. Out of 116 studies the literature search identified 57 publications for 37 studies giving a publication rate of 32%. Original Research Ethics Committee (REC) applications could be obtained for 28 of the published studies. Outcome inconsistencies were found in 16 (57%) of the published studies. This study showed that the problem of publication and outcome reporting bias is still significant in the UK. The method described here demonstrates that UK NHS research ethics committees are in a good position to detect such bias due to their unique access to original research protocols. Data gathered in this way could be used by the Health Research Authority to encourage higher levels of transparency in UK research.

Direct coupling of polymer-based microchip electrophoresis to online MALDI-MS using a rotating ball inlet.

Science.gov (United States)

Musyimi, Harrison K; Guy, Jason; Narcisse, Damien A; Soper, Steven A; Murray, Kermit K

2005-12-01

We report on the coupling of a polymer-based microfluidic chip to a MALDI-TOF MS using a rotating ball interface. The microfluidic chips were fabricated by micromilling a mold insert into a brass plate, which was then used for replicating polymer microparts via hot embossing. Assembly of the chip was accomplished by thermally annealing a cover slip to the embossed substrate to enclose the channels. The linear separation channel was 50 microm wide, 100 microm deep, and possessed an 8 cm effective length separation channel with a double-T injector (V(inj) = 10 nL). The exit of the separation channel was machined to allow direct contact deposition of effluent onto a specially constructed rotating ball inlet to the mass spectrometer. Matrix addition was accomplished in-line on the surface of the ball. The coupling utilized the ball as the cathode transfer electrode to transport sample into the vacuum for desorption with a 355 nm Nd:YAG laser and analyzed on a TOF mass spectrometer. The ball was cleaned online after every rotation. The ability to couple poly(methylmethacrylate) microchip electrophoresis devices for the separation of peptides and peptide fragments produced from a protein digest with subsequent online MALDI MS detection was demonstrated.

Mapping student online actions

DEFF Research Database (Denmark)

Bruun, Jesper; Jensen, Pia; Udby, Linda

The Virtual Neutrons for Teaching project (vnt.nmi3.org) has converted traditional text book material into a wiki-style online text book that contains the same text and equations as the traditionally styled text book but has added features due to the online nature. Two of these features...... their problem solving strategy. In this study, we use web analytics software to track student online behavior by recording what particular objects on particular web-pages students click on and when each click occurs. For each recorded session, we create networks based on student clicks: A directed link between...... two nodes, 1 and 2, is drawn, if the object represented by node 2 is clicked right af the object represented by node 1. Preliminary analysis of these networks show two general types of behavior: In one type, there is little interaction with the online contents. The student navigates to the page...

Lerot: An Online Learning to Rank Framework

NARCIS (Netherlands)

Schuth, A.; Hofmann, K.; Whiteson, S.; de Rijke, M.

2013-01-01

Online learning to rank methods for IR allow retrieval systems to optimize their own performance directly from interactions with users via click feedback. In the software package Lerot, presented in this paper, we have bundled all ingredients needed for experimenting with online learning to rank for

Does a modified mindfulness-based cognitive therapy (MBCT) course have the potential to reduce stress and burnout in NHS GPs? Feasibility study.

Science.gov (United States)

Hamilton-West, Kate; Pellatt-Higgins, Tracy; Pillai, Neil

2018-04-19

AimTo explore, for the first time, whether a modified mindfulness-based cognitive therapy (MBCT) course has the potential to reduce stress and burnout among National Health Service (NHS) General Practitioners. There is a crisis of low morale among NHS GPs, with most describing their workload as 'unmanageable'. MBCT has been demonstrated to improve stress and burnout in other populations, but has not yet been evaluated in a cohort of NHS GPs. NHS GPs in South East England (n=22) attended a modified version of the MBCT course approved by National Institute for Health and Care Excellence for prevention of depressive relapse. This comprised eight weekly 2-h sessions with homework (mindfulness practice) between sessions. Participants completed the Maslach Burnout Inventory (MBI) and Perceived Stress Scale (PSS) before (baseline) and then again one month (T2) and three months (T3) after attending the course. We also obtained qualitative data on participants' experiences of the course.FindingsCompliance with the intervention was very high. All GPs attended at least six sessions and all completed baseline questionnaires. At T2, data were obtained from 21 participants (95%); PSS scores were significantly lower than at baseline (P<0.001), as were MBI emotional exhaustion (P<0.001) and depersonalization scores (P=0.0421). At T3 we obtained data for 13 participants (59%); PSS scores and MBI emotional exhaustion scores were significantly lower (P<0.001; P=0.0024, respectively) and personal accomplishment scores were significantly higher (P<0.001) than at baseline. Participants reported that the course helped them to manage work pressures, feel more relaxed, enjoy their work and experience greater empathy and compassion (for self, colleagues and patients). Findings of this preliminary evaluation are promising. Further research is needed to evaluate this approach within a larger randomized-controlled trial.

Exploring a shared leadership perspective for NHS doctors.

Science.gov (United States)

Willcocks, Stephen George; Wibberley, Gemma

2015-01-01

The purpose of this paper is to explore involving doctors in shared leadership. It examines the policies that have led to the focus on shared leadership and the implications for practice. This is a conceptual paper, examining policy developments and key literature to understand the move towards shared leadership. It focuses on UK NHS, and in particular doctors, although the concepts will be relevant to other disciplines in healthcare, and healthcare systems in other countries. This paper suggests that the shared-leadership approach for doctors has potential given the nature of clinical practice, the inherently collaborative nature of healthcare and the demands of new healthcare organisations. Health policy reform, generally, will mean that all doctors need to be engaged with leadership, albeit, perhaps, at different levels, and with different degrees of formality. Leadership will remain an important precondition for the success of the reforms. This is likely to be the case for other countries involved in healthcare reform. To highlight the benefits and barriers to shared leadership for doctors. Offers an alternative to traditional approaches to leadership.

The Romanian Consumer And Online Marketing – An Exploratory Research Approach

Directory of Open Access Journals (Sweden)

Pantea Carmen

2008-04-01

Full Text Available In recent decades, online marketing has been quickly overtaking the traditional means of marketing due to several reasons, such as: low costs, the growing number of internet users and the long lasting relationship developed with them, the effortless usage of the web and of the online marketing tools. Online marketing is done by those individuals or organizations which exchange ideas and offers by using computers, online networks and interactive media, in order to reach their marketing objectives. The results of an exploratory research in terms of the consumers’ exposure, their behavior in relationship with the specific campaigns oriented toward them and the future of the online and offline direct communication at the level of the pre-defined target segments are presented in a comparative manner: online versus offline direct communication tools.

Electrochemical impedance and spectroscopy study of the EDC/NHS activation of the carboxyl groups on poly(ε-caprolactone/poly(m-anthranilic acid nanofibers

Directory of Open Access Journals (Sweden)

Z. Guler

2016-02-01

Full Text Available Electrochemical impedance spectroscopy (EIS and spectroscopy was applied to investigate the surface activation of carboxyl group (–COOH containing nanofibers by the reaction of 1-ethyl-3-(dimethyl-aminopropyl carbodiimide hydrochloride (EDC/N-hydroxyl succinimide (NHS in different concentrations. Poly(!-caprolactone/poly(m-anthranilic acid (PCL/P3ANA nanofibers were fabricated by electrospinning and were activated with 5/0.5, 0.5/5, 5/5 and 50/50 mM of EDC/NHS. The surface activation was investigated by Attenuated Total Reflectance Fourier transform infrared spectroscopy (FTIR-ATR and activation yield was estimated. Albumin was immobilized after surface activation and the amount of covalently immobilized protein was determined by bicinchoninic acid (BCA assay. Morphology and composition of albumin immobilized nanofibers were characterized by Scanning Electron Microscopy/Energy-Dispersive X-ray Spectroscopy (SEM/EDX and Atomic force microscope (AFM. EIS measurements indicated that nanofibers become resistant after albumin immobilization. The obtained data revealed that the highest amount of albumin bound to nanofibers activated with 50/50 mM of EDC/NHS which was found to be the optimum concentration for the activation of PCL/P3ANA nanofibers.

Nurses are human beings too.

Science.gov (United States)

Neeson, Jimmy

2017-03-15

Your story 'Thousands of nurses leave NHS posts to maintain work-life balance' (online news, 3 March) made me think. Maybe it would be better if employers didn't break the Working Time Directive, making us swap from a 12-hour night shift to a 14-hour day with no day off in-between, or two long days in a row with not enough time to go home, shower, sleep and get ready for work between them.

Measuring change in health care equity using small-area administrative data - evidence from the English NHS 2001-2008.

Science.gov (United States)

Cookson, Richard; Laudicella, Mauro; Donni, Paolo Li

2012-10-01

This study developed a method for measuring change in socio-economic equity in health care utilisation using small-area level administrative data. Our method provides more detailed information on utilisation than survey data but only examines socio-economic differences between neighbourhoods rather than individuals. The context was the English NHS from 2001 to 2008, a period of accelerated expenditure growth and pro-competition reform. Hospital records for all adults receiving non-emergency hospital care in the English NHS from 2001 to 2008 were aggregated to 32,482 English small areas with mean population about 1500 and combined with other small-area administrative data. Regression models of utilisation were used to examine year-on-year change in the small-area association between deprivation and utilisation, allowing for population size, age-sex composition and disease prevalence including (from 2003 to 2008) cancer, chronic kidney disease, coronary heart disease, diabetes, epilepsy, hypertension, hypothyroidism, stroke, transient ischaemic attack and (from 2006 to 2008) atrial fibrillation, chronic obstructive pulmonary disease, obesity and heart failure. There was no substantial change in small-area associations between deprivation and utilisation for outpatient visits, hip replacement, senile cataract, gastroscopy or coronary revascularisation, though overall non-emergency inpatient admissions rose slightly faster in more deprived areas than elsewhere. Associations between deprivation and disease prevalence changed little during the period, indicating that observed need did not grow faster in more deprived areas than elsewhere. We conclude that there was no substantial deterioration in socio-economic equity in health care utilisation in the English NHS from 2001 to 2008, and if anything, there may have been a slight improvement. Copyright © 2012 Elsevier Ltd. All rights reserved.

Online Customization of Retailers’ Activities

Directory of Open Access Journals (Sweden)

Natorina Alona O.

2017-03-01

Full Text Available The aim of the article is to develop recommendations on correct online customization of retailers’ activities in the online space based on results of studying and analyzing trends in digital activity of consumers under real time conditions and taking into account the factors directly influencing buyers’ purchasing from corresponding online retailers. The trends of changes in digital forms of contacting consumers in different countries and regions of the world are studied, and their access to the digital content with details of gadget types and devices is analyzed. The level of digital activity of consumers in the online space is diagnosed in accordance with the consumer inclusion index using the GfK methodology. It is grounded that retailers are advisable to look for new tools of online customization with mandatory consideration of consumer preferences, which depend on the influence of various factors on their behavior. It is found out that a high level of online confidence in a retailer acts as a catalyst for purchasing on the Internet, and factors influencing it are identified. The prerequisites for successful online customization of retailers’ activities are considered, and categories of behavioral patterns of potential buyers to achieve the most effective digital promotion of retailers in the online space are proposed. The aspects of online customization that guarantee the necessary level of competitiveness of retailers for effective functioning in the online space are justified.

Direct observation of children's preferences and activity levels during interactive and online electronic games.

Science.gov (United States)

Sit, Cindy H P; Lam, Jessica W K; McKenzie, Thomas L

2010-07-01

Interactive electronic games have recently been popularized and are believed to help promote children's physical activity (PA). The purpose of the study was to examine preferences and PA levels during interactive and online electronic games among overweight and nonoverweight boys and girls. Using a modification of the SOFIT, we systematically observed 70 Hong Kong Chinese children (35 boys, 35 girls; 50 nonoverweight, 20 overweight), age 9 to 12 years, during 2 60-minute recreation sessions and recorded their game mode choices and PA levels. During Session One children could play either an interactive or an online electronic bowling game and during Session Two they could play an interactive or an online electronic running game. Children chose to play the games during 94% of session time and split this time between interactive (52%) and online (48%) versions. They engaged in significantly more moderate-to-vigorous physical activity (MVPA) during interactive games than their online electronic versions (70% vs. 2% of game time). Boys and nonoverweight children expended relatively more energy during the interactive games than girls and overweight children, respectively. New-generation interactive games can facilitate physical activity in children, and given the opportunity children may select them over sedentary versions.

Linking NHS data for pediatric pharmacovigilance: Results of a Delphi survey.

Science.gov (United States)

Hopf, Y M; Francis, J; Helms, P J; Haughney, J; Bond, C

2016-01-01

Adverse drug events are a major cause of patient safety incidents. Current systems of pharmacovigilance under-report adverse drug reactions (ADRs), especially in children, leading to delays in their identification. This is of particular concern, as children especially have an increased vulnerability to ADRs. The objective was to seek consensus among healthcare professionals (HCPs) about barriers and facilitators to the linkage of routinely collected health data for pediatric pharmacovigilance in Scotland. A Delphi survey was conducted with a random sample of HCPs including nurses, pharmacists and doctors, working in primary or secondary care, in Scotland. Participants were identified from sampling frames of the target professionals such as an NHS workforce list for general practitioners and recruited by postal invitation. A total of 819 HCPs were invited to take part. Those agreeing to participate were given the option of completing the questionnaires online or as hard copy. Reminders were sent twice at a fortnightly interval. Questions content included description of professional role as well as testing for the willingness to support the proposed project and was informed by the Theoretical Domains Framework of Behavior Change (TDF) and earlier qualitative work. Three Delphi rounds were administered, including a first round for item generation. 121 of those invited agreed to take part (15%). The first round of the Delphi study included 21 open questions and generated over a 1000 individual statements from 61 participants that returned the questionnaires (50.4%). These were rationalized to 149 items for the second round in which participants rated their views on the importance (or not) of each item on a 9-point Likert scale (strongly disagree - strongly agree). After the third round, there was consensus on items that focused on professional standards, and practical requirements, overall there was support for data linkage and a multi-professional approach. It would

Online Databases for Health Professionals

OpenAIRE

Marshall, Joanne Gard

1987-01-01

Recent trends in the marketing of electronic information technology have increased interest among health professionals in obtaining direct access to online biomedical databases such as Medline. During 1985, the Canadian Medical Association (CMA) and Telecom Canada conducted an eight-month trial of the use made of online information retrieval systems by 23 practising physicians and one pharmacist. The results of this project demonstrated both the value and the limitations of these systems in p...

HTP-OligoDesigner: An Online Primer Design Tool for High-Throughput Gene Cloning and Site-Directed Mutagenesis.

Science.gov (United States)

Camilo, Cesar M; Lima, Gustavo M A; Maluf, Fernando V; Guido, Rafael V C; Polikarpov, Igor

2016-01-01

Following burgeoning genomic and transcriptomic sequencing data, biochemical and molecular biology groups worldwide are implementing high-throughput cloning and mutagenesis facilities in order to obtain a large number of soluble proteins for structural and functional characterization. Since manual primer design can be a time-consuming and error-generating step, particularly when working with hundreds of targets, the automation of primer design process becomes highly desirable. HTP-OligoDesigner was created to provide the scientific community with a simple and intuitive online primer design tool for both laboratory-scale and high-throughput projects of sequence-independent gene cloning and site-directed mutagenesis and a Tm calculator for quick queries.

Reengineering NHS Hospitals in Greece: Redistribution Leads to Rational Mergers.

Science.gov (United States)

Nikolentzos, Athanasios; Kontodimopoulos, Nick; Polyzos, Nikolaos; Thireos, Eleftherios; Tountas, Yannis

2015-03-18

The purpose of this study was to record and evaluate existing public hospital infrastructure of the National Health System (NHS), in terms of clinics and laboratories, as well as the healthcare workforce in each of these units and in every health region in Greece, in an attempt to optimize the allocation of these resources. An extensive analysis of raw data according to supply and performance indicators was performed to serve as a solid and objective scientific baseline for the proposed reengineering of the Greek public hospitals. Suggestions for "reshuffling" clinics and diagnostic laboratories, and their personnel, were made by using a best versus worst outcome indicator approach at a regional and national level. This study is expected to contribute to the academic debate about the gap between theory and evidence based decision-making in health policy.

Short message service (SMS) texting as a method of communication during on call: prevalence and experience of medical staff in a large acute NHS Trust in the UK.

Science.gov (United States)

Matharu, J; Hale, B; Ammar, M; Brennan, P A

2016-10-01

With the widespread use of smartphones, text messaging has become an accepted form of communication for both social and professional use in medicine. To our knowledge no published studies have assessed the prevalence and use of short message service (SMS) texting by doctors on call. We have used an online questionnaire to seek information from doctors in a large NHS Trust in the UK about their use of texting while on call, what they use it for, and whether they send images relevant to patients' care. We received 302 responses (43% response rate), of whom 166 (55%) used SMS while on call. There was a significant association between SMS and age group (p=0.005), with the 20-30-year-old group using it much more than the other age groups. Doctors in the surgical specialties used it significantly less than those in other speciality groups (pcall was deemed to be safe and reliable (pcommunication to use when on call. Copyright © 2016 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Direct to Public Peer Support and e-Therapy Program Versus Information to Aid Self-Management of Depression and Anxiety: Protocol for a Randomized Controlled Trial.

Science.gov (United States)

Kaylor-Hughes, Catherine J; Rawsthorne, Mat; Coulson, Neil S; Simpson, Sandra; Simons, Lucy; Guo, Boliang; James, Marilyn; Moran, Paul; Simpson, Jayne; Hollis, Chris; Avery, Anthony J; Tata, Laila J; Williams, Laura; Morriss, Richard K

2017-12-18

Regardless of geography or income, effective help for depression and anxiety only reaches a small proportion of those who might benefit from it. The scale of the problem suggests a role for effective, safe, anonymized public health-driven Web-based services such as Big White Wall (BWW), which offer immediate peer support at low cost. Using Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) methodology, the aim of this study was to determine the population reach, effectiveness, cost-effectiveness, and barriers and drivers to implementation of BWW compared with Web-based information compiled by UK's National Health Service (NHS, NHS Choices Moodzone) in people with probable mild to moderate depression and anxiety disorder. A pragmatic, parallel-group, single-blind randomized controlled trial (RCT) is being conducted using a fully automated trial website in which eligible participants are randomized to receive either 6 months access to BWW or signposted to the NHS Moodzone site. The recruitment of 2200 people to the study will be facilitated by a public health engagement campaign involving general marketing and social media, primary care clinical champions, health care staff, large employers, and third sector groups. People will refer themselves to the study and will be eligible if they are older than 16 years, have probable mild to moderate depression or anxiety disorders, and have access to the Internet. The primary outcome will be the Warwick-Edinburgh Mental Well-Being Scale at 6 weeks. We will also explore the reach, maintenance, cost-effectiveness, and barriers and drivers to implementation and possible mechanisms of actions using a range of qualitative and quantitative methods. This will be the first fully digital trial of a direct to public online peer support program for common mental disorders. The potential advantages of adding this to current NHS mental health services and the challenges of designing a public health campaign and RCT of

Online professionalism: A synthetic review.

Science.gov (United States)

Chretien, Katherine C; Tuck, Matthew G

2015-04-01

The rise of social media has increased connectivity and blurred personal and professional boundaries, bringing new challenges for medical professionalism. Whether traditional professionalism principles apply to the online social media space remains unknown. The purpose of this synthetic literature review was to characterize the original peer-reviewed research studies published between 1 January 2000-1 November 2014 on online professionalism, to assess methodologies and approaches used, and to provide insights to guide future studies in this area. The investigators searched three databases and performed manual searches of bibliographies to identify the 32 studies included. Most studies originated in the USA. Cross-sectional surveys and analyses of publicly available online content were the most common methodologies employed. Studies covered the general areas of use and privacy, assessment of unprofessional online behaviours, consensus-gathering of what constitutes unprofessional or inappropriate online behaviours, and education and policies. Studies were of variable quality; only around half of survey studies had response rates of 50% or greater. Medical trainees were the most common population studied. Future directions for research include public perspectives of online professionalism, impact on patient trust, and how to use social media productively as medical professionals.

Supporting staff in employment: the emotional wellbeing of staff in an NHS psychiatric hospital.

Science.gov (United States)

Patterson, I D; Bell, J S

2000-09-01

The objective of this study was to assess the emotional wellbeing of a broad sample of NHS employees in a psychiatric setting; to seek their views on sources of distress; and to identify preferred ways of dealing with it. A cross-sectional postal survey, employing two questionnaires: GHQ-28, and a semi-structured questionnaire. These were sent to a nominal 50% sample (n = 599). The population was the staff of a large Scottish psychiatric service. A 47.9% response rate was achieved; 32.9% of respondents exceeded a cut-off score of four on the GHQ-28. Neither occupational, group nor gender effects were significant on this measure. The reporting of emotionally-distressing problems affecting their performance was found to be more common amongst doctors; males, overall, showed a non-significant trend towards having been affected more than females by such problems; and older staff (above 45) were affected significantly more often than younger staff. Almost a third of staff were unaware of the availability of an internal organisational resource (the Occupational Health service). NHS Trusts should ensure the culture at work is appropriate from a preventative point of view and be aware that factors outwith the workplace can affect employees emotional wellbeing and performance. Preventative and supportive measures to minimise psychological distress in the workforce should be considered; the Scottish Needs Assessment Programme: Mental Health in the Workplace offers useful guidance.

Unmeasured improvement work: the lack of routinely collected, service-related data in NHS endoscopy units in England involved in "modernisation"

Directory of Open Access Journals (Sweden)

Hutchings Hayley A

2008-01-01

Full Text Available Abstract Background The availability of routinely collected service-related endoscopy data from NHS endoscopy units has never been quantified. Methods This retrospective observational study asked 19 endoscopy units to submit copies of all in-house, service-related endoscopy data that had been routinely collected by the unit – Referral numbers, Activity, Number of patients waiting and Number of lost slots. Nine of the endoscopy units had previously participated in the Modernising Endoscopy Services (MES project during 2003 to redesign their endoscopy services. These MES sites had access to additional funding and data collection software. The other ten (Control sites had modernised independently. All data was requested in two phases and corresponded to eight specific time points between January 2003 and April 2006. Results Only eight of 19 endoscopy units submitted routinely collected, service-related data. Another site's data was collected specifically for the study. A further two units claimed to routinely collect service-related data but did not submit any to the study. The remaining eight did not collect any service-related endoscopy data routinely and liaised with their Trust for data. Of the eight sites submitting service-related data, only three were MES project sites. Of these three, the data variables collected were limited and none collected the complete set of endoscopy data variables requested. Of the other five sites, two collected all four endoscopy data types. Data for the three MES project sites went back as far as January 2003, whilst the five Control sites were only able to submit data from December 2003 onwards. Conclusion There was a lack of service-related endoscopy data routinely collected by the study sites, especially those who had participated in the MES project. Without this data, NHS endoscopy services cannot have a true understanding of their services, cannot identify problems and cannot measure the impact of any

Online discussions mirroring family life during pregnancy

Directory of Open Access Journals (Sweden)

Pirkko Kouri

2006-03-01

Conclusions Today, the relationship between clients and professionals is inevitably changing. More online services and advocacy are needed if families are to have access to online health services. The role of professionals is diversifying from being authorities to supporting and facilitating clients' individual self-care. Based on direct client feedback, the quality of maternity care can be improved.

Type-Directed Partial Evaluation

DEFF Research Database (Denmark)

Danvy, Olivier

1998-01-01

Type-directed partial evaluation uses a normalization function to achieve partial evaluation. These lecture notes review its background, foundations, practice, and applications. Of specific interest is the modular technique of offline and online type-directed partial evaluation in Standard ML...

Type-Directed Partial Evaluation

DEFF Research Database (Denmark)

Danvy, Olivier

1998-01-01

Type-directed partial evaluation uses a normalization function to achieve partial evaluation. These lecture notes review its background, foundations, practice, and applications. Of specific interest is the modular technique of offline and online type-directed partial evaluation in Standard ML of ...

Are NHS foundation trusts able and willing to exercise autonomy? 'You can take a horse to water...'.

Science.gov (United States)

Exworthy, Mark; Frosini, Francesca; Jones, Lorelei

2011-10-01

Foundation trusts (FTs) have been a central part of the government's National Health Service (NHS) reforms in England since 2004. They illustrate the government's claim to decentralization, by granting greater autonomy to high performing organizations. The number of FTs has grown steadily, reaching 131 in September 2010, over 50% of eligible trusts. Despite this growth, and notwithstanding the fact that organizations which initially became FTs were previously high performing, doubts remain about the implementation of the FT policy. This article examines the implementation of FTs in the NHS and focuses on the nature and exercise of autonomy by FTs. It argues that the ability of FTs to exercise autonomy is in place, but the (relatively limited) extent of implementation may be explained by trusts' lack of willingness to exercise such autonomy. Such unwillingness may be because of continued centralization, unclear policy and financial regimes, fear of negative impacts on relations with other local organizations, and awareness of greater risk to the FT, among others. Addressing the tension between FTs' ability and willingness to exercise autonomy will largely explain the extent to which the government's provider side reforms will be implemented.

Improving service quality in NHS Trust hospitals: lessons from the hotel sector.

Science.gov (United States)

Desombre, T; Eccles, G

1998-01-01

This article looks to review recent practice undertaken within the UK hotel sector to improve customer service, and suggests ideals that could be implemented within National Health (NHS) Trust hospitals. At a time of increasing competition, hotel firms are using service enhancement as a means to gain competitive advantage, and therefore developing a range of techniques to measure levels of service quality improvement. With continued change in the health service, where greater focus now lies with patient satisfaction, so there is a requirement for managers to adapt techniques presently being offered in other service industries to improve levels of customer service and ensure patients are targeted to define their levels of satisfaction.

The association of diagnosis in the private or NHS sector on prostate cancer stage and treatment.

Science.gov (United States)

Barbiere, J M; Greenberg, D C; Wright, K A; Brown, C H; Palmer, C; Neal, D E; Lyratzopoulos, G

2012-03-01

To examine associations of private healthcare with stage and management of prostate cancer. Regional population-based cancer registry information on 15 916 prostate cancer patients. Compared with patients diagnosed in the National Health Service (NHS) (94%), those diagnosed in private hospitals (5%) were significantly more affluent (69 versus 52% in deprivation quintiles 1-2), younger (mean 69 versus 73 years) and diagnosed at earlier stage (72 versus 79% in Stages Private hospital of diagnosis was independently associated with lower probability of advanced disease stage [odds ratio (OR) 0.75, P = 0.002], higher probability of surgery use (OR 1.28, P = 0.037) and lower probability of radiotherapy use (OR 0.75, P = 0.001). Private hospital of diagnosis independently predicted higher surgery and lower radiotherapy use, particularly in more deprived patients aged ≤ 70. In prostate cancer patients, private hospital diagnosis predicts earlier disease stage, higher use of surgery and lower use of radiotherapy, independently of case-mix differences between the two sectors. Substantial socioeconomic differences in stage and treatment patterns remain across centres in the NHS, even after adjusting for private sector diagnosis. Cancer registration data could be used to identify private care use on a population basis and the potential associated treatment disparities.

The impact of integrated team care taught using a live NHS contract on the educational experience of final year dental students.

Science.gov (United States)

Radford, D R; Holmes, S; Woolford, M J; Dunne, S M

2014-11-01

To investigate the responses of the dental student body in the first three years of outreach education (2010-13) at the University of Portsmouth Dental Academy in the areas of integrated team work and use of a current NHS contact. Use of a questionnaire to allow both quantitative and qualitative data to be obtained, administered to the three cohorts of students at the end of their longitudinal attendance at the Academy in their final year of education at King's College London Dental Institute. Data were obtained from 227 students which represented a 95% return rate. Sixty-four percent of students strongly agreed with both statements: 'I am confident with working with a dental nurse' and 'I now understand properly the scope of practice of dental hygiene-therapists'. Sixty-seven percent strongly agreed with the statement 'I have had useful experience of working in NHS primary care during the final year'. Eighty percent either strongly agreed or agreed with the statement 'My experience of real Units of Dental Activity and Key Performance Indicators has encouraged me to positively consider NHS high street dentistry as a career option'. Within the limitations of this study the dental students reported having gained useful experience of working in integrated team care dentistry. They expressed strong support for the education that is being delivered in an outreach environment and, most importantly, the student body was looking forward to entering general dental practice in the UK.

Use of online recruitment strategies in a randomized trial of cancer survivors.

Science.gov (United States)

Juraschek, Stephen P; Plante, Timothy B; Charleston, Jeanne; Miller, Edgar R; Yeh, Hsin-Chieh; Appel, Lawrence J; Jerome, Gerald J; Gayles, Debra; Durkin, Nowella; White, Karen; Dalcin, Arlene; Hermosilla, Manuel

2018-04-01

Despite widespread Internet adoption, online advertising remains an underutilized tool to recruit participants into clinical trials. Whether online advertising is a cost-effective method to enroll participants compared to other traditional forms of recruitment is not known. Recruitment for the Survivorship Promotion In Reducing IGF-1 Trial, a community-based study of cancer survivors, was conducted from June 2015 through December 2016 via in-person community fairs, advertisements in periodicals, and direct postal mailings. In addition, "Right Column" banner ads were purchased from Facebook to direct participants to the Survivorship Promotion In Reducing IGF-1 Trial website. Response rates, costs of traditional and online advertisements, and demographic data were determined and compared across different online and traditional recruitment strategies. Micro-trials optimizing features of online advertisements were also explored. Of the 406 respondents to our overall outreach efforts, 6% (24 of 406) were referred from online advertising. Facebook advertisements were shown over 3 million times (impressions) to 124,476 people, which resulted in 4401 clicks on our advertisement. Of these, 24 people ultimately contacted study staff, 6 underwent prescreening, and 4 enrolled in the study. The cost of online advertising per enrollee was $794 when targeting a general population versus $1426 when accounting for strategies that specifically targeted African Americans or men. By contrast, community fairs, direct mail, or periodicals cost $917, $799, or $436 per enrollee, respectively. Utilization of micro-trials to assess online ads identified subtleties (e.g. use of an advertisement title) that substantially impacted viewer interest in our trial. Online advertisements effectively directed a relevant population to our website, which resulted in new enrollees in the Survivorship Promotion In Reducing IGF-1 Trial at a cost comparable to traditional methods. Costs were

Direction of glucose fermentation towards hydrogen or ethanol production through on-line pH control

Energy Technology Data Exchange (ETDEWEB)

Karadag, Dogan; Puhakka, Jaakko A. [Department of Chemistry and Bioengineering, Tampere University of Technology, Tampere (Finland)

2010-10-15

The present study investigated the production of hydrogen (H{sub 2}) and ethanol from glucose in an Anaerobic Continuous Stirred Tank Reactor (ACSTR). Effects of hydraulic retention time (HRT) and pH on the preference of producing H{sub 2} and/or ethanol and other soluble metabolic products in an open anaerobic enriched culture were studied. Production rates of H{sub 2} and ethanol increased with the increase of biomass concentration. Open anaerobic fermentation was directed and managed through on-line pH control for the production of H{sub 2} or ethanol. Hydrogen was produced by ethanol and acetate-butyrate type fermentations. pH has strong effect on the H{sub 2} or ethanol production by changing fermentation pathways. ACSTR produced mainly ethanol at over pH 5.5 whereas highest H{sub 2} production was obtained at pH 5.0. pH 4.9 favored the lactate production and accumulation of lactate inhibited the biomass concentration in the reactor and the production of H{sub 2} and ethanol. The microbial community structure quickly responded to pH changes and the Clostridia dominated in ACSTR during the study. H{sub 2} production was maintained mainly by Clostridium butyricum whereas in the presence of Bacillus coagulans glucose oxidation was directed to lactate production. (author)

Digital health promotion in sexual health clinics: results of a feasibility trial of the Men’s Safer Sex website

Directory of Open Access Journals (Sweden)

Julia V Bailey

2015-10-01

The best way to assess the impact of the MenSS website was by recording STI diagnoses from clinical records. Response rates for the online questionnaire were poor despite offers of incentives. There were many challenges to conducting an online trial of a sexual health website including ethical committee concerns about email content, poor reliability of trial-related software, balancing data protection and security protocols against ease of access for participants, barriers to patient access to IT in NHS clinics, and trying to ensure that participants engage with a digital intervention for long enough. Whilst digital interventions have great potential for health promotion, we encountered significant obstacles to online research, and to implementation of an IDI in an NHS clinical setting.

Comparing Online Algorithms for Bin Packing Problems

DEFF Research Database (Denmark)

Epstein, Leah; Favrholdt, Lene Monrad; Kohrt, Jens Svalgaard

2012-01-01

The relative worst-order ratio is a measure of the quality of online algorithms. In contrast to the competitive ratio, this measure compares two online algorithms directly instead of using an intermediate comparison with an optimal offline algorithm. In this paper, we apply the relative worst-ord......-order ratio to online algorithms for several common variants of the bin packing problem. We mainly consider pairs of algorithms that are not distinguished by the competitive ratio and show that the relative worst-order ratio prefers the intuitively better algorithm of each pair....

A comparative study of mid-life, women nurses working in the NHS and UK care homes.

OpenAIRE

Durant, Lesley.

2010-01-01

This thesis examines the working lives of mid-life (aged 40-55) women who are currently working as nurses. The research focuses on why these mid-life nurses demonstrate occupational and organisational commitment, and compares the NHS and care home sectors. The research explores how the differences in organisational structure, culture and context of these two sectors influence nurses' work orientation, job satisfaction and their motivation to continue nursing, incorporating sociological perspe...

Influence of EDC/NHS coupling chemistry on stability and cytotoxicity of ZnO nanoparticles modified with proteins

Science.gov (United States)

Keleştemur, Seda; Altunbek, Mine; Culha, Mustafa

2017-05-01

The toxicity of ZnO nanoparticles (NPs) is a growing concern due to its increasing use in several products including sunscreens, paints, pigments and ceramics for its antibacterial, antifungal, anti-corrosive and UV filtering properties. The toxicity of ZnO NPs is mostly attributed to the Zn2+ release causing an increase in the intracellular reactive oxygen species (ROS) level. The surface modification with a biocompatible ligand or a polymer can be a good strategy to reduce dissolution based toxicity. In two previous studies, the conflicting results with EDC/NHS coupling chemistry for ZnO NPs were reported. In this study, the same surface modification strategy with an emphasis on the stability of ZnO NPs is clarified. First, the density of -OH groups on the ZnO NPs is increased with hydrogen peroxide (H2O2) treatment, and then a silica coating on the ZnO NPs (Si-ZnO) surface is performed. Finally, a covalent attachment of bovine serum albumin (BSA) on three different concentrations of ZnO-Si is carried out by EDC/NHS coupling chemistry. ZnO NPs have a very high dissolution rate under acidic conditions of EDC/NHS coupling chemistry as determined from the ICP-MS analysis. In addition, the amount of ZnO NPs in coupling reaction has an important effect on the dissolution rate of Zn2+ and dependently BSA attached on the ZnO NP surfaces. Finally, the cytotoxicity of the BSA modified Si-ZnO NPs on human lung cancer (A549) and human skin fibroblast (HSF) is evaluated. Although an increased association of BSA modified ZnO NPs with cells was observed, the modification significantly decreased their cytotoxicity. This can be explained with the decreased active surface area of ZnO NPs with the surface modification. However, an increase in the mitochondrial depolarization and ROS production was observed depending on the amount of BSA coverage.

Balancing exploration and exploitation in learning to rank online

NARCIS (Netherlands)

Hofmann, K.; Whiteson, S.; de Rijke, M.

2011-01-01

As retrieval systems become more complex, learning to rank approaches are being developed to automatically tune their parameters. Using online learning to rank approaches, retrieval systems can learn directly from implicit feedback, while they are running. In such an online setting, algorithms need

Social value of online information in the hotel industry

Directory of Open Access Journals (Sweden)

Moraru Remus Christian

2017-07-01

Full Text Available Studies show that public information can create social value, which reflects on the purpose of this paper in identifying information on the online environment of the hotel industry which can directly or indirectly create social value and ultimately a competitive edge. Privately owned, small and mid-sized hotels in Romania find themselves in competitive online environment and, as such, many of them cannot compete or don’t possess the know-how to compete within the online environment. With identifying the information shared on the hotels online environment and the capability of the information in creating social value, hotels can reevaluate their online strategies. The immediate objective of this paper is to analyze the websites of a sample of 99 small and mid-sized hotels in Romania and to identify critical information that can directly or indirectly create social value. Part of the objective is to draw a conclusion of the main differences on the information shared on the hotels website, which in terms will show where small and mid-sized hotels can improve their online content strategy with socially valuable information. Key findings reflect that Romanian hotels have a clear pattern across the country when it come to their online environment. However, there are serious deficiencies that can influence both economical results and the possibility of creating socially valuable information online. This work increases our understanding of the information shared on the hotels websites in Romania and comes with suggestions that hoteliers can apply in the future to increase the competitiveness and the social value of their online environment.

Improving distress in dialysis (iDiD): a feasibility two-arm parallel randomised controlled trial of an online cognitive behavioural therapy intervention with and without therapist-led telephone support for psychological distress in patients undergoing haemodialysis.

Science.gov (United States)

Hudson, Joanna L; Moss-Morris, Rona; Game, David; Carroll, Amy; McCrone, Paul; Hotopf, Matthew; Yardley, Lucy; Chilcot, Joseph

2016-04-12

Psychological distress is common in end-stage kidney disease (ESKD) and is associated with poorer health outcomes. Cognitive behavioural therapy (CBT) is recommended in UK clinical guidelines for the management of depression in people with long-term conditions. Access to skilled therapists competent in managing the competing mental and physical health demands of ESKD is limited. Online CBT treatments tailored to the needs of the ESKD population offers a pragmatic solution for under-resourced services. This study examines the feasibility and acceptability of implementing a two-arm parallel randomised controlled trial of online CBT with (intervention arm) and without (control arm) therapist support to improve psychological distress in patients undergoing haemodialysis. Patients will be screened for depression and anxiety while attending for their haemodialysis treatments. We aim to recruit 60 adult patients undergoing haemodialysis who meet criteria for mild to moderately severe symptoms of depression and/or anxiety. Patients will be randomised individually (using a 1:1 computerised sequence ratio) to either online CBT with therapist telephone support (intervention arm), or online CBT with no therapist (control arm). Outcomes include feasibility and acceptability descriptive data on rates of recruitment, randomisation, retention and treatment adherence. Self-report outcomes include measures of depression (Patient Health Questionnaire-9), anxiety (Generalised Anxiety Disorder-7), quality of life (Euro-QoL), service use (client service receipt inventory) and illness cognitions (brief illness perception questionnaire). A qualitative process evaluation will also be conducted. The statistician will be blinded to treatment allocation. A National Health Service (NHS) research ethics committee approved the study. Data from this study will provide essential information for the design and testing of further interventions to ameliorate distress in patients undergoing dialysis

Report on accreditation learning sets in the West Midlands region of the NHS.

Science.gov (United States)

Giles, G

2000-12-01

This article reports on the evaluation of the first year of a project, which utilized learning sets to support librarians undergoing the accreditation process, in the health libraries in the West Midlands region of the NHS. The West Midlands Health region is divided up into education consortia patches. Each group of patch librarians was allocated a local accreditation facilitator. The groups met regularly to discuss problems and progress relating to their library's accreditation. The results of the evaluation suggest that this is a valuable approach to use. The recommendations state that regular, frequent meetings are needed. Extra training and guidance would help the facilitators to be more effective in their role.

Detection of illicit online sales of fentanyls via Twitter.

Science.gov (United States)

Mackey, Tim K; Kalyanam, Janani

2017-01-01

A counterfeit fentanyl crisis is currently underway in the United States.  Counterfeit versions of commonly abused prescription drugs laced with fentanyl are being manufactured, distributed, and sold globally, leading to an increase in overdose and death in countries like the United States and Canada.  Despite concerns from the U.S. Drug Enforcement Agency regarding covert and overt sale of fentanyls online, no study has examined the role of the Internet and social media on fentanyl illegal marketing and direct-to-consumer access.  In response, this study collected and analyzed five months of Twitter data (from June-November 2015) filtered for the keyword "fentanyl" using Amazon Web Services.  We then analyzed 28,711 fentanyl-related tweets using text filtering and a machine learning approach called a Biterm Topic Model (BTM) to detect underlying latent patterns or "topics" present in the corpus of tweets.  Using this approach we detected a subset of 771 tweets marketing the sale of fentanyls online and then filtered this down to nine unique tweets containing hyperlinks to external websites.  Six hyperlinks were associated with online fentanyl classified ads, 2 with illicit online pharmacies, and 1 could not be classified due to traffic redirection.  Importantly, the one illicit online pharmacy detected was still accessible and offered the sale of fentanyls and other controlled substances direct-to-consumers with no prescription required at the time of publication of this study.   Overall, we detected a relatively small sample of Tweets promoting illegal online sale of fentanyls.  However, the detection of even a few online sellers represents a public health danger and a direct violation of law that demands further study.

Exploring the role of communications in quality improvement: A case study of the 1000 Lives Campaign in NHS Wales.

Science.gov (United States)

Cooper, Andrew; Gray, Jonathon; Willson, Alan; Lines, Chris; McCannon, Joe; McHardy, Karina

2015-03-01

Effective communication is critical to successful large-scale change. Yet, in our experience, communications strategies are not formally incorporated into quality improvement (QI) frameworks. The 1000 Lives Campaign ('Campaign') was a large-scale national QI collaborative that aimed to save an additional 1000 lives and prevent 50 000 episodes of harm in Welsh health care over a 2-year period. We use the Campaign as a case study to describe the development, application, and impact of a communications strategy embedded in a large-scale QI initiative. A comprehensive communications strategy guided communications work during the Campaign. The main aims of the communications strategy were to engage the hearts and minds of frontline National Health Service (NHS) staff in the Campaign and promote their awareness and understanding of specific QI interventions and the wider patient safety agenda. We used qualitative and quantitative measures to monitor communications outputs and assess how the communications strategy influenced awareness and knowledge of frontline NHS staff. The communications strategy facilitated clear and consistent framing of Campaign messages and allowed dissemination of information related to the range of QI interventions. It reaffirmed the aim and value of the Campaign to frontline staff, thereby promoting sustained engagement with Campaign activities. The communications strategy also built the profile of the Campaign both internally with NHS organizations across Wales and externally with the media, and played a pivotal role in improving awareness and understanding of the patient safety agenda. Ultimately, outcomes from the communications strategy could not be separated from overall Campaign outcomes. Systematic and structured communications can support and enhance QI initiatives. From our experience, we developed a 'communications bundle' consisting of six core components. We recommend that communications bundles be incorporated into existing QI

Assessing psychological well-being: a holistic investigation of NHS employees.

Science.gov (United States)

Loretto, W; Popham, F; Platt, S; Pavis, S; Hardy, G; MacLeod, L; Gibbs, J

2005-10-01

A substantial body of research has investigated the effects of work on the psychological well-being of employees. However, there has been little assessment of the ways in which workplace factors (such as job demands, working conditions, inter-personal relations and workplace change) interact with personal factors (such as work-life balance, family circumstances, key personality traits or demographic characteristics) to affect psychological health. This article reports findings from a study which aimed to construct and test a comprehensive model of the influences on employee well-being within the UK National Health Service (NHS). The results show that psychological well-being is influenced by a complex array of personal, environmental and work factors. A key finding is that there are clear associations between workplace change and well-being and between work-life (im)balance and well-being. These effects appear to be independent of one another and therefore require separate attention from managers and employers.

Preparation and properties of EDC/NHS mediated crosslinking poly (gamma-glutamic acid)/epsilon-polylysine hydrogels

Energy Technology Data Exchange (ETDEWEB)

Hua, Jiachuan [Key Laboratory of Advanced Textile Composites, Tianjin Polytechnic University, Ministry of Education, Tianjin 300387 (China); School of Textiles, Tianjin Polytechnic University, Tianjin 300387 (China); Li, Zheng, E-mail: lizheng_nx@163.com [Key Laboratory of Advanced Textile Composites, Tianjin Polytechnic University, Ministry of Education, Tianjin 300387 (China); School of Textiles, Tianjin Polytechnic University, Tianjin 300387 (China); Xia, Wen; Yang, Ning; Gong, Jixian [Key Laboratory of Advanced Textile Composites, Tianjin Polytechnic University, Ministry of Education, Tianjin 300387 (China); School of Textiles, Tianjin Polytechnic University, Tianjin 300387 (China); Zhang, Jianfei, E-mail: zhangjianfei1960@126.com [Key Laboratory of Advanced Textile Composites, Tianjin Polytechnic University, Ministry of Education, Tianjin 300387 (China); School of Textiles, Tianjin Polytechnic University, Tianjin 300387 (China); Qiao, Changsheng [Key Laboratory of Industrial Microbiology, Tianjin University of Science and Technology, Ministry of Education, Tianjin 300457 (China)

2016-04-01

In this paper, a novel pH-sensitive poly (amino acid) hydrogel based on poly γ-glutamic acid (γ-PGA) and ε-polylysine (ε-PL) was prepared by carbodiimide (EDC) and N-hydroxysuccinimide (NHS) mediated polymerization. The influence of PGA/PL molar ratio and EDC/NHS concentration on the structure and properties was studied. Fourier transform infrared spectroscopy (FT-IR) and X-ray photoelectron spectroscopy (XPS) proved that hydrogels were crosslinked through amide bond linkage, and the conversion rate of a carboxyl group could reach 96%. Scanning electron microscopy (SEM) results showed a regularly porous structure with 20 μm pore size in average. The gelation time in the crosslink process of PGA/PL hydrogels was within less than 5 min. PGA/PL hydrogels had excellent optical performance that was evaluated by a novel optotype method. Furthermore, PGA/PL hydrogels were found to be pH-sensitive, which could be adjusted to the pH of swelling media intelligently. The terminal pH of swelling medium could be controlled at 5 ± 1 after equilibrium when the initial pH was within 3–11. The swelling kinetics was found to follow a Voigt model in deionized water but a pseudo-second-order model in normal saline and phosphate buffer solution, respectively. The differential swelling degrees were attributed to the swelling theory based on the different ratio of –COOH/–NH{sub 2} and pore size in hydrogels. The results of mechanical property indicated that PGA/PL hydrogels were soft and elastic. Moreover, PGA/PL hydrogels exhibited excellent biocompatibility by cell proliferation experiment. PGA/PL hydrogels could be degraded in PBS solution and the degradation rate was decreased with the increase of the molar ratio of PL. Considering the simple preparation process and pH-sensitive property, these PGA/PL hydrogels might have high potential for use in medical and clinical fields. - Highlights: • We prepared a biocompatible and degradable poly amino acids hydrogel via EDC/NHS

The impact of the European Working Time Directive 10 years on: views of the UK medical graduates of 2002 surveyed in 2013-2014.

Science.gov (United States)

Lambert, Trevor W; Smith, Fay; Goldacre, Michael J

2016-03-01

To report doctors' views about the European Working Time Directive ('the Directive'). Survey of the medical graduates of 2002 (surveyed in 2013-2014). Medical graduates. UK. Questions on views about the Directive. The response rate was 64% (2056/3196). Twelve per cent of respondents agreed that the Directive had benefited senior doctors, 39% that it benefited junior doctors, and 17% that it had benefited the NHS. More women (41%) than men (35%) agreed that the Directive had benefited junior doctors. Surgeons (6%) and adult medical specialists (8%) were least likely to agree that the Directive had benefited senior doctors. Surgeons (20%) were less likely than others to agree that the Directive had benefited junior doctors, whilst specialists in emergency medicine (57%) and psychiatry (52%) were more likely to agree. Surgeons (7%) were least likely to agree that the Directive had benefited the NHS. Most respondents (62%) reported a positive effect upon work-life balance. With regard to quality of patient care, 45% reported a neutral effect, 40% reported a negative effect, and 15% a positive effect. Most respondents (71%) reported a negative effect of the Directive on continuity of patient care, and 71% felt that the Directive had a negative effect upon junior doctors' training opportunities. Fifty-two per cent reported a negative effect on efficiency in managing patient care. Senior doctors agreed that the Directive benefited doctors' work-life balance. In other respects, they were more negative about it. Surgeons were the least positive about aspects of the Directive.

Online marketingová strategie Grandhotelu Pupp

OpenAIRE

Fuxová, Zuzana

2014-01-01

The thesis analyses and evaluates a marketing strategy of the Grandhotel Pupp in comparison with its direct competitor, the Ambassador Grandhotel Narodni dum. The thesis focuses mainly on evaluating the online atributes of the marketing strategy including the online presentation of the hotel on all distribution channels the hotel uses. The main emphasis is put on current trends, because in marketing, these play the crucial role. First part of the thesis defines accommodation services, hospita...

Enhancing nurse satisfaction: an exploration of specialty nurse shortage in a region of NHS England.

Science.gov (United States)

Gray, Keith; Wilde, Rebecca; Shutes, Karl

2018-03-22

This article offers nurse managers guidance on analysing, managing and addressing a potentially dissatisfied nursing workforce, focusing on three priority shortage specialties: emergency care, paediatrics and cardiology. The aim of the study was to explore to what extent registered nurses and healthcare assistants, referred to collectively here as 'nursing staff', are satisfied with teamworking opportunities, continuing professional development (CPD) opportunities and workplace autonomy. A survey questionnaire was developed to evaluate three derived determinants of nurse satisfaction: team working, CPD and autonomy. The NHS West Midlands region was the focus given that it is among the poorest performing regions outside London in filling nursing posts. Overall, nursing staff respondents were satisfied with teamworking, CPD and autonomy, which challenges the perception that nurses in NHS England are dissatisfied with these satisfaction determinants. The findings give a complex picture of nurse satisfaction; for example a large minority of respondents were dissatisfied with their ability to carry out duties as they see fit. When developing management systems to investigate, manage and enhance nurse satisfaction, nurse managers must recognise the complexity and subtleties of determining factors. This will increase as nursing becomes more specialised. Subsequently, nurse managers need to work closely with staff at higher education institutions and other professional agencies to commission appropriate professional development. ©2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

Exploring emergency department 4-hour target performance and cancelled elective operations: a regression analysis of routinely collected and openly reported NHS trust data.

Science.gov (United States)

Keogh, Brad; Culliford, David; Guerrero-Ludueña, Richard; Monks, Thomas

2018-05-24

To quantify the effect of intrahospital patient flow on emergency department (ED) performance targets and indicate if the expectations set by the National Health Service (NHS) England 5-year forward review are realistic in returning emergency services to previous performance levels. Linear regression analysis of routinely reported trust activity and performance data using a series of cross-sectional studies. NHS trusts in England submitting routine nationally reported measures to NHS England. 142 acute non-specialist trusts operating in England between 2012 and 2016. The primary outcome measures were proportion of 4-hour waiting time breaches and cancelled elective operations. Univariate and multivariate linear regression models were used to show relationships between the outcome measures and various measures of trust activity including empty day beds, empty night beds, day bed to night bed ratio, ED conversion ratio and delayed transfers of care. Univariate regression results using the outcome of 4-hour breaches showed clear relationships with empty night beds and ED conversion ratio between 2012 and 2016. The day bed to night bed ratio showed an increasing ability to explain variation in performance between 2015 and 2016. Delayed transfers of care showed little evidence of an association. Multivariate model results indicated that the ability of patient flow variables to explain 4-hour target performance had reduced between 2012 and 2016 (19% to 12%), and had increased in explaining cancelled elective operations (7% to 17%). The flow of patients through trusts is shown to influence ED performance; however, performance has become less explainable by intratrust patient flow between 2012 and 2016. Some commonly stated explanatory factors such as delayed transfers of care showed limited evidence of being related. The results indicate some of the measures proposed by NHS England to reduce pressure on EDs may not have the desired impact on returning services to previous

Exhaust gas aftertreatment with online burner; Abgasnachbehandlung mit Online-Brenner

Energy Technology Data Exchange (ETDEWEB)

Rembor, Hans-Joerg; Bischler, Thomas [Huss Technologies GmbH, Nuernberg (Germany)

2010-09-15

In order to fulfil continuously tightened emission standards, modern Diesel engines for on and off road have to meet demands of catalytic exhaust gas aftertreatment with their thermomanagement. With an online burner from Huss Technologies, even with low load duty cycles, catalytic exhaust gas aftertreatment is possible. Diesel engine development can therefore be redirected again more on efficiency enhancement and other direct customer demands. (orig.)

A Safe Place to Stay Sharp: Action Learning Meets Cooperative Inquiry in the Service of NHS OD Capacity Building

Science.gov (United States)

Traeger, James; Norgate, Carolyn

2015-01-01

This is an account of practice. It explores the meeting point between action learning and action research, as a way of doing capacity building in organisational development (OD) in the NHS in the UK. The authors were part of a short cooperative inquiry (Heron, J. 1996. "Co-operative Inquiry: Research into the Human Condition." London:…

Effectiveness of a national cardiovascular disease risk assessment program (NHS Health Check): results after one year.

Science.gov (United States)

Artac, Macide; Dalton, Andrew R H; Majeed, Azeem; Car, Josip; Millett, Christopher

2013-08-01

We aimed to assess whether the National Health Service (NHS) Health Check, a systematic cardiovascular disease (CVD) risk assessment and management program, was associated with reduction in CVD risk in attendees after one year. We extracted data from patients aged 40-74 years, with high estimated CVD risk, who were registered with general practices in a deprived, culturally diverse setting in England. We included 4748 patients at baseline (July 2008-November 2009), with 3712 at follow-up (December 2009-March 2011). We used a pre-post study design to assess changes in global CVD risk, individual CVD risk factors and statin prescription in patients with a complete and partial Health Check. There were significant reductions in mean CVD risk score (28.2%; 95% confidence interval (CI)=27.3-29.1 to 26.2%; 95% CI, 25.4-27.1), diastolic blood pressure, total cholesterol levels and lipid ratios after one year in patients with a complete Health Check. Statin prescription increased from 14.0% (95% CI=11.9-16.0) to 60.6% (95% CI=57.7-63.5). The introduction of NHS Health Check was associated with significant but modest reductions in CVD risk among screened high-risk individuals. Further cost-effectiveness analysis and work accounting for uptake is required to assess whether the program can make significant changes to population health. Copyright © 2013 Elsevier Inc. All rights reserved.

How do NHS general hospitals in England deal with patients with alcohol-related problems? A questionnaire survey.

Science.gov (United States)

Owens, Lynn; Gilmore, Ian T; Pirmohamed, Munir

2005-01-01

Alcohol-related disease represents a major burden on hospitals. However, it is unclear whether hospitals have developed the necessary expertise and guidelines to deal with this burden. The aim of this survey was to determine what measures general hospital NHS Trusts in England had in place to deal with alcohol-related problems, including the employment of dedicated alcohol specialist nurses. Two postal surveys of all NHS general hospital Trusts in England, the first in 2000 (n = 138; 54% response rate) and the second in 2003 after the publication of the Royal College of Physicians (RCP) report on alcohol in secondary care (n = 164; 75% response rate). Between the two surveys, there was a significant increase (P = 0.005) in the number of dedicated alcohol nurses employed by general hospital trusts; however, the numbers remain low (n = 21). Additionally, the availability of prescribing guidelines for the management of alcohol withdrawal increased significantly (P = 0.0001). The survey indicates that most general hospitals do not have appropriate services in place to deal with such patients. Although there is a need and willingness to develop alcohol services in general hospitals, which is one of the key recommendations of the RCP report, the lack of funding is going to act as a major barrier.

Learning to Facilitate (Online) Meetings

DEFF Research Database (Denmark)

Reimann, Peter; Bull, Susan; Vatrapu, Ravi

2013-01-01

We describe an approach to teaching collaboration skills directly by building on competences for meeting facilitation. (Online) meetings provide a rich arena to practice collaboration since they can serve multiple purposes: learning, problem solving, decision making, idea generation and advancement...

UK doctors' views on the implementation of the European Working Time Directive as applied to medical practice: a quantitative analysis.

Science.gov (United States)

Maisonneuve, Jenny J; Lambert, Trevor W; Goldacre, Michael J

2014-02-06

To report on doctors' views, from all specialty backgrounds, about the European Working Time Directive (EWTD) and its impact on the National Health Service (NHS), senior doctors and junior doctors. All medical school graduates from 1999 to 2000 were surveyed by post and email in 2012. The UK. Among other questions, in a multipurpose survey on medical careers and career intentions, doctors were asked to respond to three statements about the EWTD on a five-point scale (from strongly agree to strongly disagree): 'The implementation of the EWTD has benefited the NHS', 'The implementation of the EWTD has benefited senior doctors' and 'The implementation of the EWTD has benefited junior doctors'. The response rate was 54.4% overall (4486/8252), 55.8% (2256/4042) of the 1999 cohort and 53% (2230/4210) of the 2000 cohort. 54.1% (2427) of all respondents were women. Only 12% (498/4136 doctors) agreed that the EWTD has benefited the NHS, 9% (377) that it has benefited senior doctors and 31% (1289) that it has benefited junior doctors. Doctors' views on EWTD differed significantly by specialty groups: 'craft' specialties such as surgery, requiring extensive experience in performing operations, were particularly critical. These cohorts have experience of working in the NHS before and after the implementation of EWTD. Their lack of support for the EWTD 4 years after its implementation should be a concern. However, it is unclear whether problems rest with the current ceiling on hours worked or with the ways in which EWTD has been implemented.

A NOVELTY MODEL OF ONLINE ACCOMMODATION PRESENTATION AND DISCOVERY

OpenAIRE

Sjekavica, Tomo; Žitnik, Marjan; Miličević, Mario

2017-01-01

Extreme expansion of digital technologies and social networks in recent years has had a huge impact on the travel market and online tourism. Along with the digitalization of tourism and travel business, every day more and more accommodation bookings take place online. Most popular online travel web sites are commonly charging provision for the accommodation booking and don't allow direct contact with the accommodation owners. Today tourists demand more for their money, so they are more likely...

A discussion: the future role of homeopathy in the National Health Service (NHS).

Science.gov (United States)

Ng, Daniel Yu-Hin

2011-07-01

Homeopathy has been provided by the National Health Service in the UK for over 60 years, funded largely by taxpayer's money. However, in recent years, its provision has come under much criticism questioning its true value. Taking a neutral stance, arguments both for and against the provision of homeopathy on the NHS is presented. It includes issues such as the evidence and safety profile of homeopathy, but also takes into account costs and benefits of homeopathy in a wider perspective. Overall, the provision of homeopathy is justified as long as there is a need within the population, occupying a complementary role alongside conventional medicine. Copyright © 2011 Elsevier Ltd. All rights reserved.

Mining Trust Relationships from Online Social Networks

Institute of Scientific and Technical Information of China (English)

Yu Zhang; Tong Yu

2012-01-01

With the growing popularity of online social network,trust plays a more and more important role in connecting people to each other.We rely on our personal trust to accept recommendations,to make purchase decisions and to select transaction partners in the online community.Therefore,how to obtain trust relationships through mining online social networks becomes an important research topic.There are several shortcomings of existing trust mining methods.First,trust is category-dependent.However,most of the methods overlook the category attribute of trust relationships,which leads to low accuracy in trust calculation.Second,since the data in online social networks cannot be understood and processed by machines directly,traditional mining methods require much human effort and are not easily applied to other applications.To solve the above problems,we propose a semantic-based trust reasoning mechanism to mine trust relationships from online social networks automatically.We emphasize the category attribute of pairwise relationships and utilize Semantic Web technologies to build a domain ontology for data communication and knowledge sharing.We exploit role-based and behavior-based reasoning functions to infer implicit trust relationships and category-specific trust relationships.We make use of path expressions to extend reasoning rules so that the mining process can be done directly without much human effort.We perform experiments on real-life data extracted from Epinions.The experimental results verify the effectiveness and wide application use of our proposed method.

Tackling online inequality: Making digital platforms work for inclusive ...

International Development Research Centre (IDRC) Digital Library (Canada)

Tackling online inequality: Making digital platforms work for inclusive development. As they become an essential part of the digital experience, online platforms such as Facebook, Amazon, Uber, AirBnB, and Twitter are having a direct bearing on social inclusion and opportunity in many spheres of life for people around the ...

Public Health England's Migrant Health Guide: an online resource for primary care practitioners.

Science.gov (United States)

Crawshaw, A F; Kirkbride, H

2018-05-01

Approximately 13% of the UK population in 2015 was born overseas. Most migrants have come to the UK to work or study although there has been a small increase in the number of asylum applications in the UK in recent years, reflective of the ongoing humanitarian situation across Europe. Migrants in the UK tend to be young and healthy, but some may face unique health needs as a result of their experiences before, during and after migration. For these needs to be appropriately recognised and addressed, evidence-based advice is needed for UK professionals. The Migrant Health Guide is a free online tool for healthcare professionals. It was launched in 2011 and is widely used in the UK and internationally. It has four sections: 1) Migrants and the NHS-information on access and entitlements to the National Health Service (NHS); 2) Assessing patients-includes a checklist for initial healthcare assessments and advice for patients travelling abroad to visit friends and relatives; 3) Countries-country-specific advice on infectious diseases, women's health and nutritional and metabolic concerns; and 4) Health topics-information about communicable and non-communicable diseases and other health issues. The guide has undergone an extensive update in 2017. In particular, the pages on mental health and human trafficking have been expanded. A formal evaluation will obtain feedback on the guide and measure changes in awareness, knowledge, opinions, attitudes and behaviour of end users. Findings will inform future revisions and updates to the guide. Public Health England's Migrant Health Guide is a valuable resource for healthcare professionals. The relaunched guide builds on the previous version in raising awareness of key issues and providing evidence-based advice to improve the health of migrants and refugees internationally and in the UK. Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.

On-line spectroscopy with thermal atomic beams

International Nuclear Information System (INIS)

Thibault, C.; Guimbal, P.; Klapisch, R.; Saint Simon, M. de; Serre, J.M.; Touchard, F.; Duong, H.T.; Jacquinot, P.; Juncar, P.

1981-01-01

On-line high resolution laser spectroscopy experiments have been performed in which the light from a cw tunable dye laser interacts at right angles with a thermal atomic beam. sup(76-98)Rb, sup(118-145)Cs and sup(208-213)Fr have been studied using the ionic beam delivered by the ISOLDE on-line mass separator at CERN while sup(20-31)Na and sup(38-47)K have been studied by setting the apparaturs directly on-line with the PS 20 GeV proton beam. The principle of the method is briefly explained and some results concerning nuclear structure are given. (orig.)

Running an NHS community homeopathy clinic - 10-year anniversary 2001-2011.

Science.gov (United States)

Bawden, Stella

2012-01-01

An outcome series was conducted over a five-year period of patients attending a community NHS homeopathy clinic in Dorchester, Dorset. 273 new patients were seen. 183 (67%) questionnaires were completed at six months after initial consultation. 44% of patients had been unwell for more than five years; 19% of all patients for more than 15 years. A wide variety of conditions were seen, the largest group with depression, anxiety or grief. For follow-up patients 75-81% indicated an improvement in their symptoms and activity while 58% recorded an improvement in their overall wellbeing. Six months after the initiation of treatment 155 (84.7%) felt an improvement in their condition with 148 (81%) attributing this to homeopathy. Nobody reported deterioration due to homeopathic treatment; conventional drug use was reduced in 46 patients (25%). Copyright © 2011 The Faculty of Homeopathy. Published by Elsevier Ltd. All rights reserved.

Online labs and the MARVEL experience

Directory of Open Access Journals (Sweden)

Dieter Mueller

2005-06-01

Full Text Available MARVEL is a Leonardo da Vinci project that provides a framework to analyse the pedagogic effectiveness of online labs in various heterogeneous areas that include solar energy, robotics, electronics and electro-pneumatics. It is also used as a test bench to compare the implementation of purely remote labs, where all devices are real, versus mixed-reality environments, where real devices work together with simulation models. This paper describes the basic concepts underlying the implementation of such online labs and presents two case studies (which are openly available to the public. A final section discusses the main pedagogical implications of online labs and presents the research directions that are being considered as a follow-up from this project.

African Journals Online: Libya

African Journals Online (AJOL)

Libyan Journal of Medicine. The aim of the journal is to publish high quality medical data in the different discipline of medicine. It also aims at rapid publication via the advanced online publication. The journal is directed to clinicians and researcher around the globe. The scope of the journal covers all medical research and ...

Enhanced invitation methods to increase uptake of NHS health checks: study protocol for a randomized controlled trial

OpenAIRE

Forster, Alice S; Burgess, Caroline; McDermott, Lisa; Wright, Alison J; Dodhia, Hiten; Conner, Mark; Miller, Jane; Rudisill, Caroline; Cornelius, Victoria; Gulliford, Martin C

2014-01-01

Background NHS Health Checks is a new program for primary prevention of heart disease, stroke, diabetes, chronic kidney disease, and vascular dementia in adults aged 40 to 74 years in England. Individuals without existing cardiovascular disease or diabetes are invited for a Health Check every 5 years. Uptake among those invited is lower than anticipated. Method The project is a three-arm randomized controlled trial to test the hypothesis that enhanced invitation methods, using the Question-Be...

Critical Care nurses' understanding of the NHS knowledge and skills framework. An interpretative phenomenological analysis.

Science.gov (United States)

Stewart, Laura F M; Rae, Agnes M

2013-01-01

This small-scale research study aimed to explore Critical Care nurses' understanding of the National Health Service (NHS) Knowledge and Skills Framework (KSF) in relationship to its challenges and their nursing role. The NHS KSF is central to the professional development of nurses in Critical Care and supports the effective delivery of health care in the UK. KSF was implemented in 2004 yet engagement seems lacking with challenges often identified. This qualitative study adopted an Interpretative Phenomenological Analysis framework. Data were collected from five Critical Care nurses using semi-structured interviews that were transcribed for analysis. Two super-ordinate themes of 'engagement' and 'theory-practice gap' were identified. Six subthemes of 'fluency', 'transparency', 'self-assessment', 'achieving for whom', 'reflection' and 'the nursing role' further explained the super-ordinate themes. Critical Care nurses demonstrated layers of understanding about KSF. Challenges identified were primarily concerned with complex language, an unclear process and the use of reflective and self-assessment skills. Two theory-practice gaps were found. Critical Care nurses understood the principles of KSF but they either did not apply or did not realize they applied these principles. They struggled to relate KSF to Critical Care practice and felt it did not capture the 'essence' of their nursing role in Critical Care. Recommendations were made for embedding KSF into Critical Care practice, using education and taking a flexible approach to KSF to support the development and care delivery of Critical Care nurses. © 2012 The Authors. Nursing in Critical Care © 2012 British Association of Critical Care Nurses.

Online Resources

Indian Academy of Sciences (India)

Home; Journals; Journal of Genetics; Online Resources. Journal of Genetics. Online Resources. Volume 97. 2018 | Online resources. Volume 96. 2017 | Online resources. Volume 95. 2016 | Online resources. Volume 94. 2015 | Online resources. Volume 93. 2014 | Online resources. Volume 92. 2013 | Online resources ...

Clinical negligence in foot and ankle surgery: A 17-year review of claims to the NHS Litigation Authority.

Science.gov (United States)

Ring, J; Talbot, C L; Clough, T M

2014-11-01

We present a review of litigation claims relating to foot and ankle surgery in the NHS in England during the 17-year period between 1995 and 2012. A freedom of information request was made to obtain data from the NHS litigation authority (NHSLA) relating to orthopaedic claims, and the foot and ankle claims were reviewed. During this period of time, a total of 10 273 orthopaedic claims were made, of which 1294 (12.6%) were related to the foot and ankle. 1036 were closed, which comprised of 1104 specific complaints. Analysis was performed using the complaints as the denominator. The cost of settling these claims was more than £36 million. There were 372 complaints (33.7%) involving the ankle, of which 273 (73.4%) were related to trauma. Conditions affecting the first ray accounted for 236 (21.4%), of which 232 (98.3%) concerned elective practice. Overall, claims due to diagnostic errors accounted for 210 (19.0%) complaints, 208 (18.8%) from alleged incompetent surgery and 149 (13.5%) from alleged mismanagement. Our findings show that the incorrect, delayed or missed diagnosis of conditions affecting the foot and ankle is a key area for improvement, especially in trauma practice. ©2014 The British Editorial Society of Bone & Joint Surgery.

The Daresbury On-Line Isotope Separator (DOLIS)

International Nuclear Information System (INIS)

Grant, I.S.; Eastham, D.A.; Groves, J.; Tolfree, D.W.L.; Walker, P.M.; Green, V.R.; Rikovska, J.; Stone, N.J.; Hamilton, W.D.

1987-01-01

The isotope separator DOLIS, which is on-line to the Daresbury Laboratory's 20-MV tandem accelerator, is used to measure nuclear moments and decay schemes. Separated beams may be collected on a tape and transported to a counting station, implanted directly into a host lattice at on-line temperatures down to less than 10 mK, or allowed to interact with a collinear laser beam. The present status of DOLIS and its ancillary equipment is described

The Daresbury on-line isotope separator (DOLIS)

International Nuclear Information System (INIS)

Grant, I.S.; Eastham, D.A.; Groves, J.; Tolfree, D.W.L.; Walker, P.M.; Green, V.R.; Rikovska, J.; Stone, N.J.; Hamilton, W.D.

1987-01-01

The isotope separator DOLIS, which is on-line to the Daresbury Laboratory's 20-MV tandem accelerator, is used to measure nuclear moments and decay schemes. Separated beams may be collected on a tape and transported to a counting station, implanted directly into a host lattice at on-line temperatures down to less than 10 mK, or allowed to interact with a collinear laser beam. The present status of DOLIS and its ancillary equipment is described. (orig.)

Follow The Money: Piracy and Online Advertising

OpenAIRE

Batikas, Michail; Claussen, Jörg; Peukert, Christian

2017-01-01

Online copyright enforcement, in the form of either direct action against the supply- side (via website shutdowns) or the demand-side (via individual lawsuits against users), has not been very effective in reducing piracy. Regulators have therefore put forward the so called “follow the money" approach. Because the main source of revenue for infringing websites often comes from online advertising, the idea is that cutting access to advertisers could lower the financial incentives for website o...

Self- directed learning barriers in a virtual environment: a qualitative study

Directory of Open Access Journals (Sweden)

NOUSHIN KOHAN

2017-07-01

Full Text Available Introduction: There is a growing trend in online education courses in higher education institutes. Previous studies have shown that high levels of self-direction are essential for successful online learning. The present study aims to investigate challenges of and barriers to self-directed virtual-learning among postgraduate students of medical sciences. Methods: 23 postgraduate virtual students of medical sciences in Iran, collected through maximum variation purposive sampling and semi-structured interviews, served as the sample of this study. The collected data were analyzed using the inductive content analysis method. Results: Three themes and six sub-themes were identified as barriers to self-directed learning in virtual education, including cognitive barriers (information overload and lack of focus on learning or mind wondering, communication barriers (inadequate coping skills and inadequate writing skills and educational environment barriers (heavy workload and role ambiguity. Conclusion: By the importance of self-direction in online education, the present study results can be used by virtual education planners in the review and design of courses, so as to adequately equip students, obviate barriers to self-directed virtual education, and ultimately train highly self-directed learners in online medical education.

Self- directed learning barriers in a virtual environment: a qualitative study.

Science.gov (United States)

Kohan, Noushin; Soltani Arabshahi, Kamran; Mojtahedzadeh, Rita; Abbaszadeh, Abbas; Rakhshani, Tayebeh; Emami, Amirhousein

2017-07-01

There is a growing trend in online education courses in higher education institutes. Previous studies have shown that high levels of self-direction are essential for successful online learning. The present study aims to investigate challenges of and barriers to self-directed virtual-learning among postgraduate students of medical sciences. 23 postgraduate virtual students of medical sciences in Iran, collected through maximum variation purposive sampling and semi-structured interviews, served as the sample of this study. The collected data were analyzed using the inductive content analysis method. Three themes and six sub-themes were identified as barriers to self-directed learning in virtual education, including cognitive barriers (information overload and lack of focus on learning or mind wondering), communication barriers (inadequate coping skills and inadequate writing skills) and educational environment barriers (heavy workload and role ambiguity). By the importance of self-direction in online education, the present study results can be used by virtual education planners in the review and design of courses, so as to adequately equip students, obviate barriers to self-directed virtual education, and ultimately train highly self-directed learners in online medical education.

Self- directed learning barriers in a virtual environment: a qualitative study

Science.gov (United States)

KOHAN, NOUSHIN; SOLTANI ARABSHAHI, KAMRAN; MOJTAHEDZADEH, RITA; ABBASZADEH, ABBAS; RAKHSHANI, TAYEBEH; EMAMI, AMIRHOUSEIN

2017-01-01

Introduction: There is a growing trend in online education courses in higher education institutes. Previous studies have shown that high levels of self-direction are essential for successful online learning. The present study aims to investigate challenges of and barriers to self-directed virtual-learning among postgraduate students of medical sciences. Method: 23 postgraduate virtual students of medical sciences in Iran, collected through maximum variation purposive sampling and semi-structured interviews, served as the sample of this study. The collected data were analyzed using the inductive content analysis method. Results: Three themes and six sub-themes were identified as barriers to self-directed learning in virtual education, including cognitive barriers (information overload and lack of focus on learning or mind wondering), communication barriers (inadequate coping skills and inadequate writing skills) and educational environment barriers (heavy workload and role ambiguity). Conclusion: By the importance of self-direction in online education, the present study results can be used by virtual education planners in the review and design of courses, so as to adequately equip students, obviate barriers to self-directed virtual education, and ultimately train highly self-directed learners in online medical education. PMID:28761885

A Fresh look at Online Lexicography

DEFF Research Database (Denmark)

Nielsen, Sandro

2011-01-01

that lexicographers should distinguish between the database and the dictionary: The database is not a dictionary, but a repository of structured data. Furthermore, modern online dictionaries do not contain data, but are search engines that search for structured data in databases, retrieve the relevant data...... online dictionaries that allow them to make structured searches relating directly to the problems they need to solve. The search engines have been designed according to lexicographical functions, i.e. the type of help dictionaries can provide in certain types of situation. All dictionaries have both...

Autonomy and performance in the public sector: the experience of English NHS hospitals.

Science.gov (United States)

Verzulli, Rossella; Jacobs, Rowena; Goddard, Maria

2018-05-01

Since 2004, English NHS hospitals have been given the opportunity to acquire a more autonomous status known as a Foundation Trust (FT), whereby regulations and restrictions over financial, management, and organizational matters were reduced in order to create incentives to deliver higher-quality services in the most efficient way. Using difference-in-difference models, we test whether achieving greater autonomy (FT status) improved hospital performance, as proxied by measures of financial management, quality of care, and staff satisfaction. Results provide little evidence that the FT policy per se has made any difference to the performance of hospitals in most of these domains. Our findings have implications for health policy and inform the trend towards granting greater autonomy to public-sector organizations.

Cost Issues in Online Learning: Using "Co-opetition" to Advantage.

Science.gov (United States)

Sjogren, Jane; Fay, James

2002-01-01

Suggests strategies for campuses to use in building partnerships with online education providers that are complementary rather than competitive. Suggests that institutions begin by being clear about which model they are adopting for their online ventures. Discusses the direct and indirect costs of e-learning, and identifies "co-opetitional"…

Jesuit Colleges Try To Bring Their Values to Online Education.

Science.gov (United States)

McMurtrie, Beth

2000-01-01

Reports on development of a consortium, Jesuit Distance Education Network, of 24 Jesuit colleges and universities that will offer online courses. Rather than offer degrees directly, the network will act as a Web portal for participating colleges to market their online programs. Courses will emphasis Jesuit values and the teacher-student…

The current approach to human error and blame in the NHS.

Science.gov (United States)

Ottewill, Melanie

There is a large body of research to suggest that serious errors are widespread throughout medicine. The traditional response to these adverse events has been to adopt a 'person approach' - blaming the individual seen as 'responsible'. The culture of medicine is highly complicit in this response. Such an approach results in enormous personal costs to the individuals concerned and does little to address the root causes of errors and thus prevent their recurrence. Other industries, such as aviation, where safety is a paramount concern and which have similar structures to the medical profession, have, over the past decade or so, adopted a 'systems' approach to error, recognizing that human error is ubiquitous and inevitable and that systems need to be developed with this in mind. This approach has been highly successful, but has necessitated, first and foremost, a cultural shift. It is in the best interests of patients, and medical professionals alike, that such a shift is embraced in the NHS.

CRITICAL COMPONENTS OF ONLINE LEARNING READINESS AND THEIR RELATIONSHIPS WITH LEARNER ACHIEVEMENT

Directory of Open Access Journals (Sweden)

Harun CIGDEM

2016-04-01

Full Text Available This study aimed to examine the relationship between certain factors of online learning readiness and learners’ end-of-course achievements. The study was conducted at a two-year post-secondary Turkish military school within the scope of the course titled Computer Literacy, which was designed and implemented in a blended way. The data were collected from 155 post-secondary military students through an online questionnaire. Three sub-scales of Hung et al.’s Online Learning Readiness Scale were used to collect the data during the first two weeks of the course. Descriptive and inferential statistics, such as Pearson correlation coefficients and linear regression analyses were performed to analyze the data. The descriptive results of the study indicated that students’ motivation for online learning was higher than both their computer/Internet self-efficacy and their orientations to self-directed learning. The inferential results revealed that the students’ end-of-course grades had significantly positive relationships with their computer/Internet self-efficacy and self-directed learning orientations. Finally, the students’ self-direction towards online learning appeared to be the strongest predictor of their achievements within the course; whereas computer/Internet self-efficacy and motivation for learning did not predict the learner achievement significantly.

UNISOR on-line nuclear orientation facility (UNISOR/NOF)

International Nuclear Information System (INIS)

Girit, I.C.; Alton, G.D.; Bingham, C.R.; Carter, H.K.; Simpson, M.L.; Cole, J.D.; Croft, W.L.; Hamilton, J.H.; Jones, E.F.; Gore, P.M.; Kormicki, J.; Xie, H.; Kern, B.D.; Krane, K.S.; Xu, Y.S.; Mantica, P.F. Jr.; Zimmermann, B.E.; Nettles, W.G.; Zganjar, E.F.; Kortelahti, M.O.; Newbolt, W.B.

1988-01-01

The UNISOR on-line nuclear orientation facility (UNISOR/NOF) consists of a 3 He- 4 He dilution refrigerator on line to the isotope separator. Nuclei are implanted directly into a target foil which is soldered to the bottom accessed cold finger of the refrigerator. A 1.5 T superconducting magnet polarizes the ferromagnetic target foils and determines the axis of symmetry. Up to eight gamma detectors can be positioned around the refrigerator, each 9 cm from the target. A unique feature of this system is that the k=4 term in the directional distribution function can be directly and unambigously deduced so that a single solution for the mixing ratio can be found. The first on-line experiment at this facility reported here was a study of the decay of the 191 Hg and 193 Hg isotopes. (orig.)

Information diffusion in structured online social networks

Science.gov (United States)

Li, Pei; Zhang, Yini; Qiao, Fengcai; Wang, Hui

2015-05-01

Nowadays, due to the word-of-mouth effect, online social networks have been considered to be efficient approaches to conduct viral marketing, which makes it of great importance to understand the diffusion dynamics in online social networks. However, most research on diffusion dynamics in epidemiology and existing social networks cannot be applied directly to characterize online social networks. In this paper, we propose models to characterize the information diffusion in structured online social networks with push-based forwarding mechanism. We introduce the term user influence to characterize the average number of times that messages are browsed which is incurred by a given type user generating a message, and study the diffusion threshold, above which the user influence of generating a message will approach infinity. We conduct simulations and provide the simulation results, which are consistent with the theoretical analysis results perfectly. These results are of use in understanding the diffusion dynamics in online social networks and also critical for advertisers in viral marketing who want to estimate the user influence before posting an advertisement.

Motivation of Online Buyer Behavior

Directory of Open Access Journals (Sweden)

Svatošová Veronika

2013-09-01

Full Text Available Buyer behavior of consumers plays one of the key roles in fulfillment of the main goals of a company. It is influenced by many external and internal factors but the company can also influence the final process of buyer decision-making process significantly by its activities. The subject matter of this article is an analysis of the features of online buyer behavior compared to the general regularities of buyer behavior, definition of the main motives of online shopping, and description of the current trends. The article uses the basic terminology of this subject and current bibliography as well as other resources. Theoretical knowledge is based on historic directions of Maslow’s theory of motivation where it is possible to find the basis for a buyer behavior analysis. The article is also based on the formerly carried out questionnaire survey which examines the motives and experience of the respondents with online shopping. By means of the independence test it is verified whether there is a relation between the age of respondents and motivation for online shopping. Subsequently, the survey carried out in person is compared with other relevant research solutions.

The mediating effect of gaming motivation between psychiatric symptoms and problematic online gaming: an online survey.

Science.gov (United States)

Király, Orsolya; Urbán, Róbert; Griffiths, Mark D; Ágoston, Csilla; Nagygyörgy, Katalin; Kökönyei, Gyöngyi; Demetrovics, Zsolt

2015-04-07

The rapid expansion of online video gaming as a leisure time activity has led to the appearance of problematic online gaming (POG). According to the literature, POG is associated with different psychiatric symptoms (eg, depression, anxiety) and with specific gaming motives (ie, escape, achievement). Based on studies of alcohol use that suggest a mediator role of drinking motives between distal influences (eg, trauma symptoms) and drinking problems, this study examined the assumption that there is an indirect link between psychiatric distress and POG via the mediation of gaming motives. Furthermore, it was also assumed that there was a moderator effect of gender and game type preference based on the important role gender plays in POG and the structural differences between different game types. This study had two aims. The first aim was to test the mediating role of online gaming motives between psychiatric symptoms and problematic use of online games. The second aim was to test the moderator effect of gender and game type preference in this mediation model. An online survey was conducted on a sample of online gamers (N=3186; age: mean 21.1, SD 5.9 years; male: 2859/3186, 89.74%). The Brief Symptom Inventory (BSI), the Motives for Online Gaming Questionnaire (MOGQ), and the Problematic Online Gaming Questionnaire (POGQ) were administered to assess general psychiatric distress, online gaming motives, and problematic online game use, respectively. Structural regression analyses within structural equation modeling were used to test the proposed mediation models and multigroup analyses were used to test gender and game type differences to determine possible moderating effects. The mediation models fitted the data adequately. The Global Severity Index (GSI) of the BSI indicated that the level of psychiatric distress had a significant positive direct effect (standardized effect=.35, Pgaming motives: escape (standardized effect=.139, Pgaming (standardized effect size=.64

Future Challenges and Opportunities in Online Prescription Drug Promotion Research Comment on "Trouble Spots in Online Direct-to-Consumer Prescription Drug Promotion: A Content Analysis of FDA Warning Letters".

Science.gov (United States)

Southwell, Brian G; Rupert, Douglas J

2016-01-16

Despite increased availability of online promotional tools for prescription drug marketers, evidence on online prescription drug promotion is far from settled or conclusive. We highlight ways in which online prescription drug promotion is similar to conventional broadcast and print advertising and ways in which it differs. We also highlight five key areas for future research: branded drug website influence on consumer knowledge and behavior, interactive features on branded drug websites, mobile viewing of branded websites and mobile advertisements, online promotion and non-US audiences, and social media and medication decisions. © 2016 by Kerman University of Medical Sciences.

Continuous Improvement Implementation in the Nottingham University Hospitals NHS Trust: A Case Study of a Continuous Improvement Programme & Project

OpenAIRE

Velzen, Jeena

2012-01-01

This paper aims at identifying the extent to which the Nottingham University Hospitals NHS Trust has fulfilled literature requirements for successful continuous improvement as exemplified by its Better for You programme and chemotherapy service improvement project. Both the theory and ideals of the continuous improvement programme, along with the actualization of these philosophies and methodologies in the context of the particular project,were compared against a framework for the enabling...

Online Sellers’ Website Quality Influencing Online Buyers’ Purchase Intention

Science.gov (United States)

Shea Lee, Tan; Ariff, Mohd Shoki Md; Zakuan, Norhayati; Sulaiman, Zuraidah; Zameri Mat Saman, Muhamad

2016-05-01

The increase adoption of Internet among young users in Malaysia provides high prospect for online seller. Young users aged between 18 and 25 years old are important to online sellers because they are actively involved in online purchasing and this group of online buyers is expected to dominate future online market. Therefore, examining online sellers’ website quality and online buyers’ purchase intention is crucial. Based on the Theory of planned behavior (TPB), a conceptual model of online sellers’ website quality and purchase intention of online buyers was developed. E-tailQ instrument was adapted in this study which composed of website design, reliability/fulfillment, security, privacy & trust, and customer service. Using online questionnaire and convenience sampling procedure, primary data were obtained from 240 online buyers aged between 18 to 25 years old. It was discovered that website design, website reliability/fulfillment, website security, privacy & trust, and website customer service positively and significantly influence intention of online buyers to continuously purchase via online channels. This study concludes that online sellers’ website quality is important in predicting online buyers’ purchase intention. Recommendation and implication of this study were discussed focusing on how online sellers should improve their website quality to stay competitive in online business.

Capacity of English NHS hospitals to monitor quality in infection prevention and control using a new European framework: a multilevel qualitative analysis

Science.gov (United States)

Iwami, Michiyo; Ahmad, Raheelah; Castro-Sánchez, Enrique; Birgand, Gabriel; Johnson, Alan P; Holmes, Alison

2017-01-01

Objective (1) To assess the extent to which current English national regulations/policies/guidelines and local hospital practices align with indicators suggested by a European review of effective strategies for infection prevention and control (IPC); (2) to examine the capacity of local hospitals to report on the indicators and current use of data to inform IPC management and practice. Design A national and local-level analysis of the 27 indicators was conducted. At the national level, documentary review of regulations/policies/guidelines was conducted. At the local level data collection comprised: (a) review of documentary sources from 14 hospitals, to determine the capacity to report performance against these indicators; (b) qualitative interviews with 3 senior managers from 5 hospitals and direct observation of hospital wards to find out if these indicators are used to improve IPC management and practice. Setting 2 acute English National Health Service (NHS) trusts and 1 NHS foundation trust (14 hospitals). Participants 3 senior managers from 5 hospitals for qualitative interviews. Primary and secondary outcome measures As primary outcome measures, a ‘Red-Amber-Green’ (RAG) rating was developed reflecting how well the indicators were included in national documents or their availability at the local organisational level. The current use of the indicators to inform IPC management and practice was also assessed. The main secondary outcome measure is any inconsistency between national and local RAG rating results. Results National regulations/policies/guidelines largely cover the suggested European indicators. The ability of individual hospitals to report some of the indicators at ward level varies across staff groups, which may mask required improvements. A reactive use of staffing-related indicators was observed rather than the suggested prospective strategic approach for IPC management. Conclusions For effective patient safety and infection prevention in

Capacity of English NHS hospitals to monitor quality in infection prevention and control using a new European framework: a multilevel qualitative analysis.

Science.gov (United States)

Iwami, Michiyo; Ahmad, Raheelah; Castro-Sánchez, Enrique; Birgand, Gabriel; Johnson, Alan P; Holmes, Alison

2017-01-23

(1) To assess the extent to which current English national regulations/policies/guidelines and local hospital practices align with indicators suggested by a European review of effective strategies for infection prevention and control (IPC); (2) to examine the capacity of local hospitals to report on the indicators and current use of data to inform IPC management and practice. A national and local-level analysis of the 27 indicators was conducted. At the national level, documentary review of regulations/policies/guidelines was conducted. At the local level data collection comprised: (a) review of documentary sources from 14 hospitals, to determine the capacity to report performance against these indicators; (b) qualitative interviews with 3 senior managers from 5 hospitals and direct observation of hospital wards to find out if these indicators are used to improve IPC management and practice. 2 acute English National Health Service (NHS) trusts and 1 NHS foundation trust (14 hospitals). 3 senior managers from 5 hospitals for qualitative interviews. As primary outcome measures, a 'Red-Amber-Green' (RAG) rating was developed reflecting how well the indicators were included in national documents or their availability at the local organisational level. The current use of the indicators to inform IPC management and practice was also assessed. The main secondary outcome measure is any inconsistency between national and local RAG rating results. National regulations/policies/guidelines largely cover the suggested European indicators. The ability of individual hospitals to report some of the indicators at ward level varies across staff groups, which may mask required improvements. A reactive use of staffing-related indicators was observed rather than the suggested prospective strategic approach for IPC management. For effective patient safety and infection prevention in English hospitals, routine and proactive approaches need to be developed. Our approach to evaluation can

Cryptanalysis and improvement of a quantum communication-based online shopping mechanism

Science.gov (United States)

Huang, Wei; Yang, Ying-Hui; Jia, Heng-Yue

2015-06-01

Recently, Chou et al. (Electron Commer Res 14:349-367, 2014) presented a novel controlled quantum secure direct communication protocol which can be used for online shopping. The authors claimed that their protocol was immune to the attacks from both external eavesdropper and internal betrayer. However, we find that this protocol is vulnerable to the attack from internal betrayer. In this paper, we analyze the security of this protocol to show that the controller in this protocol is able to eavesdrop the secret information of the sender (i.e., the customer's shopping information), which indicates that it cannot be used for secure online shopping as the authors expected. Accordingly, an improvement of this protocol, which could resist the controller's attack, is proposed. In addition, we present another protocol which is more appropriate for online shopping. Finally, a discussion about the difference in detail of the quantum secure direct communication process between regular quantum communications and online shopping is given.

Perbedaan Postpurchase Dissonance Pada Pembelian Online dan Offline

OpenAIRE

Tarigan, Elka Putri Desi Amanda

2015-01-01

The development of dynamic lifestyle on the consumer, the using of marketing strategy has also increasingly become diversed. One of them is online purchasing. However, online purchasing have some weakness associated to security and direct contact with the products. Some risk make individuals tend to choose offline purchasing. When individuals find the negative factor out of their alternatives of choices, it will cause doubt after purchasing the product. It is known as postpurchase dissonance....

An Information System to Access Status Information of the LHCb Online

International Nuclear Information System (INIS)

Frank, M; Gaspar, C

2012-01-01

The LHCb collaboration consists of roughly 700 physicists from 52 institutes and universities. Most of the collaborating physicists - including subdetector experts - are not permanently based at CERN. This paper describes the architecture used to publish data internal to the LHCb experiment control- and data acquisition system to the World Wide Web. Collaborators can access the online (sub-) system status and the system performance directly from the institute abroad, from home or from a smart phone without the need of direct access to the online computing infrastructure.

Health information technology and sociotechnical systems: a progress report on recent developments within the UK National Health Service (NHS).

Science.gov (United States)

Waterson, Patrick

2014-03-01

This paper summarises some of the research that Ken Eason and colleagues at Loughborough University have carried out in the last few years on the introduction of Health Information Technologies (HIT) within the UK National Health Service (NHS). In particular, the paper focuses on three examples which illustrate aspects of the introduction of HIT within the NHS and the role played by the UK National Programme for Information Technology (NPfIT). The studies focus on stages of planning and preparation, implementation and use, adaptation and evolution of HIT (e.g., electronic patient records, virtual wards) within primary, secondary and community care settings. Our findings point to a number of common themes which characterise the use of these systems. These include tensions between national and local strategies for implementing HIT and poor fit between healthcare work systems and the design of HIT. The findings are discussed in the light of other large-scale, national attempts to introduce similar technologies, as well as drawing out a set of wider lessons learnt from the NPfIT programme based on Ken Eason's earlier work and other research on the implementation of large-scale HIT. Copyright © 2013 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Online Training of Teachers Using OER: Promises and Potential Strategies

Science.gov (United States)

Misra, Pradeep Kumar

2014-01-01

Teacher education nowadays needs a change in vision and action to cater to the demands of changing societies. Reforms, improvements, and new approaches in teacher education are an immediate need. Online training of teachers using OER has emerged as a new approach in this direction. This approach is based on the assumption that online training will…

A Pharmacy Preregistration Course Using Online Teaching and Learning Methods

Science.gov (United States)

McDowell, Jenny; Marriott, Jennifer L.; Calandra, Angela; Duncan, Gregory

2009-01-01

Objective To design and evaluate a preregistration course utilizing asynchronous online learning as the primary distance education delivery method. Design Online course components including tutorials, quizzes, and moderated small-group asynchronous case-based discussions were implemented. Online delivery was supplemented with self-directed and face-to-face learning. Assessment Pharmacy graduates who had completed the course in 2004 and 2005 were surveyed. The majority felt they had benefited from all components of the course, and that online delivery provided benefits including increased peer support, shared learning, and immediate feedback on performance. A majority of the first cohort reported that the workload associated with asynchronous online discussions was too great. The course was altered in 2005 to reduce the online component. Participant satisfaction improved, and most felt that the balance of online to face-to-face delivery was appropriate. Conclusion A new pharmacy preregistration course was successfully implemented. Online teaching and learning was well accepted and appeared to deliver benefits over traditional distance education methods once workload issues were addressed. PMID:19777092

Assessing Online Discussions: A Holistic Approach

Science.gov (United States)

Wang, Yu-mei; Chen, Der-Thanq

2017-01-01

This article reports a holistic approach to assessing online discussions. This holistic approach integrates three assessment methods: assessment of learning, assessment for learning, and assessment as learning. Assessment of learning directly examines students' learning products to decide whether they have achieved the expected learning through…

The Mediating Effect of Gaming Motivation Between Psychiatric Symptoms and Problematic Online Gaming: An Online Survey

Science.gov (United States)

Király, Orsolya; Urbán, Róbert; Griffiths, Mark D; Ágoston, Csilla; Nagygyörgy, Katalin; Kökönyei, Gyöngyi

2015-01-01

Background The rapid expansion of online video gaming as a leisure time activity has led to the appearance of problematic online gaming (POG). According to the literature, POG is associated with different psychiatric symptoms (eg, depression, anxiety) and with specific gaming motives (ie, escape, achievement). Based on studies of alcohol use that suggest a mediator role of drinking motives between distal influences (eg, trauma symptoms) and drinking problems, this study examined the assumption that there is an indirect link between psychiatric distress and POG via the mediation of gaming motives. Furthermore, it was also assumed that there was a moderator effect of gender and game type preference based on the important role gender plays in POG and the structural differences between different game types. Objective This study had two aims. The first aim was to test the mediating role of online gaming motives between psychiatric symptoms and problematic use of online games. The second aim was to test the moderator effect of gender and game type preference in this mediation model. Methods An online survey was conducted on a sample of online gamers (N=3186; age: mean 21.1, SD 5.9 years; male: 2859/3186, 89.74%). The Brief Symptom Inventory (BSI), the Motives for Online Gaming Questionnaire (MOGQ), and the Problematic Online Gaming Questionnaire (POGQ) were administered to assess general psychiatric distress, online gaming motives, and problematic online game use, respectively. Structural regression analyses within structural equation modeling were used to test the proposed mediation models and multigroup analyses were used to test gender and game type differences to determine possible moderating effects. Results The mediation models fitted the data adequately. The Global Severity Index (GSI) of the BSI indicated that the level of psychiatric distress had a significant positive direct effect (standardized effect=.35, Pgaming motives: escape (standardized effect=.139

Future Challenges and Opportunities in Online Prescription Drug Promotion Research; Comment on “Trouble Spots in Online Direct-to-Consumer Prescription Drug Promotion: A Content Analysis of FDA Warning Letters”

Directory of Open Access Journals (Sweden)

Brian G. Southwell

2016-03-01

Full Text Available Despite increased availability of online promotional tools for prescription drug marketers, evidence on online prescription drug promotion is far from settled or conclusive. We highlight ways in which online prescription drug promotion is similar to conventional broadcast and print advertising and ways in which it differs. We also highlight five key areas for future research: branded drug website influence on consumer knowledge and behavior, interactive features on branded drug websites, mobile viewing of branded websites and mobile advertisements, online promotion and non-US audiences, and social media and medication decisions.

Digital marketing strategies, online reviews and hotel performance

OpenAIRE

Pelsmacker, De, Patrick; Tilburgh, van, Sophie; Holthof, Christian

2018-01-01

Abstract: We investigate to what extent digital marketing strategies (such as having a digital marketing plan, responsiveness to guest reviews, and monitoring and tracking online review information) influence hotel room occupancy and RevPar directly, and indirectly through the mediating effect of the volume and valence of online reviews they lead to, and to what extent this mechanism is different for different types of hotels in terms of star rating and independent versus chain hotels. The re...

Facilitating Sustainable Waste Management Behaviors Within the Health Sector: A Case Study of the National Health Service (NHS in Southwest England, UK

Directory of Open Access Journals (Sweden)

Janet Richardson

2012-04-01

Full Text Available Waste costs the National Health Service (NHS £71.2 million in 2007/2008; recycling all papers, newspapers and cardboard produced by the NHS in England and Wales could save up to 42,000 tonnes of CO2. As the largest employer in the UK, the NHS is in a prime position to both lead the way towards a sustainable future, but also act as a test bed for organizational change and provide evidence of what works at an individual level to change attitudes and behavior. However these require changes in mindset, including values, attitudes, norms and behaviors which are required along with clear definitions of the problems faced in terms of economics, society and culture. Initial investigations of the literature indicate that behavior change theory may provide a feasible means of achieving constructive changes in clinical waste management; such approaches require further investigation. This paper describes a feasibility study designed to examine issues that might affect the introduction of a behavior change strategy and improve waste management in a healthcare setting. Guided by the evidence gained from our systematic review, 20 interviews were carried out with senior managers, clinicians and support staff involved in the management of healthcare waste from a broad range of agencies in South West England. Interviews were audio-recorded and transcribed for analysis. Thematic content analysis was conducted in order to identify key issues and actions. Data extraction, coding and analysis were cross checked independently by the four members of the research team. Initial findings suggest tensions, between Government and local policies, between packaging and storage space at ward level and, and between the operational requirements of infection control and maintaining appropriate and ethical patient care. These tensions increase pressures on staff already trying to maintain high quality care in a resource restricted and changing environment.

Interview with Joe Freidhoff: A Bird's-Eye View of K-12 Online Learning

Science.gov (United States)

Pourreau, Leslie

2015-01-01

The intent of this article is to introduce long-time "Online Learning" readership to the field of K-12 online learning while also providing direction for the K-12 online learning scholars about where the field is going or should be going in terms of meeting the needs of K-12 stakeholders. Recently an interview was conducted with Dr. Joe…

Neutron activation as an online procedure in cement plants; Neutronenaktivierung als Online-Verfahren in Zementwerken

Energy Technology Data Exchange (ETDEWEB)

Anon.

2012-07-01

The use of PGNAA (Prompt Gamma Neutron Activation Analysis) makes it possible to determine the content of the components in bulk flows in cement plants directly online on the conveyor belt. The nature of the excitation and radiation means that the material can be penetrated even with large layer thicknesses on the belt. (orig.)

The Business Information Services: Old-Line Online Moves to the Web.

Science.gov (United States)

O'Leary, Mick

1997-01-01

Although the availability of free information on the World Wide Web has placed traditional, fee-based proprietary online services on the defensive, most major online business services are now on the Web. Highlights several business information providers: Profound, NewsNet and ProQuest Direct, Dow Jones and Wall Street Journal Interactive Edition,…

Connecting Scientific Articles with Research Data: New Directions in Online Scholarly Publishing

Directory of Open Access Journals (Sweden)

IJsbrand Jan Aalbersberg

2013-05-01

Full Text Available Researchers across disciplines are increasingly utilizing electronic tools to collect, analyze, and organize data. However, when it comes to publishing their work, there are no common, well-established standards on how to make that data available to other researchers. Consequently, data are often not stored in a consistent manner, making it hard or impossible to find data sets associated with an article - even though such data might be essential to reproduce results or to perform further analysis. Data repositories can play an important role in improving this situation, offering increased visibility, domain-specific coordination, and expert knowledge on data management. As a leading STM publisher, Elsevier is actively pursuing opportunities to establish links between the online scholarly article and data repositories. This helps to increase usage and visibility for both articles and data sets and also adds valuable context to the data. These data-linking efforts tie in with other initiatives at Elsevier to enhance the online article in order to connect with current researchers’ workflows and to provide an optimal platform for the communication of science in the digital era.

Thermographic Sensing For On-Line Industrial Control

Science.gov (United States)

Holmsten, Dag

1986-10-01

It is today's emergence of thermoelectrically cooled, highly accurate infrared linescanners and imaging systems that has definitely made on-line Infraread Thermography (IRT) possible. Specifically designed for continuous use, these scanners are equipped with dedicated software capable of monitoring and controlling highly complex thermodynamic situations. This paper will outline some possible implications of using IRT on-line by describing some uses of this technology in the steel-making (hot rolling) and automotive industries (machine-vision). A warning is also expressed that IRT technology not originally designed for automated applications e.g. high resolution, imaging systems, should not be directly applied to an on-line measurement situation without having its measurement resolution, accuracy and especially its repeatability, reliably proven. Some suitable testing procedures are briefly outlined at the end of the paper.

How is success achieved by individuals innovating for patient safety and quality in the NHS?

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Sheard, Laura; Jackson, Cath; Lawton, Rebecca

2017-09-11

Innovation in healthcare is said to be notoriously difficult to achieve and sustain yet simultaneously the health service is under intense pressure to innovate given the ever increasing demands placed upon it. Whilst many studies have looked at diffusion of innovation from an organisational perspective, few have sought to understand how individuals working in healthcare innovate successfully. We took a positive deviance approach to understand how innovations are achieved by individuals working in the NHS. We conducted in depth interviews in 2015 with 15 individuals who had received a national award for being a successful UK innovator in healthcare. We invited only those people who were currently (or had recently) worked in the NHS and whose innovation focused on improving patient safety or quality. Thematic analysis was used. Four themes emerged from the data: personal determination, the ability to broker relationships and make connections, the ways in which innovators were able to navigate organisational culture to their advantage and their ability to use evidence to influence others. Determination, focus and persistence were important personal characteristics of innovators as were skills in being able to challenge the status quo. Innovators were able to connect sometimes disparate teams and people, being the broker between them in negotiating collaborative working. The culture of the organisation these participants resided in was important with some being able to use this (and the current patient safety agenda) to their advantage. Gathering robust data to demonstrate their innovation had a positive impact and was seen as essential to its progression. This paper reveals a number of factors which are important to the success of innovators in healthcare. We have uncovered that innovators have particular personal traits which encourage a propensity towards change and action. Yet, for fruitful innovation to take place, it is important for relational networks and

Pengaruh Online Reviews Terhadap Online Hotel Booking Intentions Pada Online Travel Agent Lokal

OpenAIRE

Widya Putra, Surya Aditya; Riorini, Sri Vandayuli

2016-01-01

Perkembangan penggunaan internet yang pesat saat ini, menunjukkan adanya pergesaran teknologi yang semakin maju mengarah ke media berbasis online. Konsumen cenderung untuk menelusuri (surfing) kelengkapan informasi produk dan jasa melalui internet dan melakukan pembelian secara online dikarenakan keterbatasan waktu serta kemudahan yang dirasakan. Penelitian yang dilakukan bertujuan untuk menganalisis pengaruh online reviews beserta dimensi-nya, yaitu: usefullness of online review, reviewer ex...

The Dynamics of Online Purchase Visits: Inertia or Switching?

Institute of Scientific and Technical Information of China (English)

Zelin Zhang; Xia Wang; Peter T.L.Popkowski Leszczyc; Xiao Zuo

2016-01-01

This paper studies the dynamics of online purchase patterns,focusing on the impact of the channel used on conversion probability,as well as the transition of channel use over time.A novel data set from a major Chinese online travel agency is used for analysis,consisting of four months of data with 24,337 store visits through three types of channels:direct visit,search advertising and referral.Results of a Bayesian multinomial logit model show that the search channel significantly affects consumers' conversion probability,and show a high degree of inertia in channel use.This finding contrasts sharply with suggestions of previous research that most future purchases will converge to the direct-visit channel.

The effect of changing from one to two views at incident (subsequent) screens in the NHS breast screening programme in England: impact on cancer detection and recall rates

International Nuclear Information System (INIS)

Blanks, R.G.; Bennett, R.L.; Patnick, J.; Cush, S.; Davison, C.; Moss, S.M.

2005-01-01

AIM: To assess the effect on cancer detection and recall rates of changing from one to two views for incident (subsequent) screens. METHODS: Controlled, comparative, observational study of programmes in NHS breast screening programme in England. Subjects: women aged 50-64 years were screened by the NHSBSP between 1 April 2001 and 31 March 2003. RESULTS: The effect of changing to two-view mammography was a 20% increase in overall incident screen cancer detection rate, with the biggest effect seen for small (<15 mm) invasive cancers. This increased detection rate was achieved with an 11% drop-in recall rate. CONCLUSION: The introduction of two-view mammography for incident screens has resulted in considerable improvements in overall NHS breast screening performance

Direct online extraction and determination by supercritical fluid extraction with chromatography and mass spectrometry of targeted carotenoids from red Habanero peppers (Capsicum chinense Jacq.).

Science.gov (United States)

Zoccali, Mariosimone; Giuffrida, Daniele; Dugo, Paola; Mondello, Luigi

2017-10-01

Recently, supercritical fluid chromatography coupled to mass spectrometry has gained attention as a fast and useful technology applied to the carotenoids analysis. However, no reports are available in the literature on the direct online extraction and determination by supercritical fluid extraction with chromatography and mass spectrometry. The aim of this research was the development of an online method coupling supercritical fluid extraction and supercritical fluid chromatography for a detailed targeted native carotenoids characterization in red habanero peppers. The online nature of the system, compared to offline approaches, improves run-to-run precision, enables the setting of batch-type applications, and reduces the risks of sample contamination. The extraction has been optimized using different temperatures, starting from 40°C up to 80°C. Multiple extractions, until depletion, were performed on the same sample to evaluate the extraction yield. The range of the first extraction yield, carried out at 80°C, which was the best extraction temperature, was 37.4-65.4%, with a %CV range of 2-12. Twenty-one targeted analytes were extracted and identified by the developed methodology in less than 17 min, including free, monoesters, and diesters carotenoids, in a very fast and efficient way. Quantification of the β-carotene was carried out by using the optimized conditions. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Suicidality, psychopathology, and the internet: Online time vs. online behaviors.

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Harris, Keith M; Starcevic, Vladan; Ma, Jing; Zhang, Wei; Aboujaoude, Elias

2017-09-01

This study investigated whether several psychopathology variables, including suicidality, could predict the time people spend using the internet (hours online). Next, we examined a specific at-risk population (suicidal individuals) by their online behaviors, comparing suicidal individuals who went online for suicide-related purposes with suicidal individuals who did not go online for suicide-related purposes. An anonymous online sample of 713 (aged 18-71) reported hours online, psychiatric histories, and completed several standardized scales. After accounting for age and education, hierarchical regression modeling showed that the assessed psychopathology variables, including suicidality, did not explain significant variance in hours online. Hours online were better predicted by younger age, greater willingness to develop online relationships, higher perceived social support, higher curiosity, and lower extraversion. Suicidal participants, who did or did not go online for suicide-related purposes, did not differ on hours online. Multiple regression modeling showed that those who went online for suicide-related purposes were likely to be younger, more suicidal, and more willing to seek help from online mental health professionals. These findings revealed that hours online are not a valid indicator of psychopathology. However, studying online behaviors of specific at-risk groups could be informative and useful, including for suicide prevention efforts. Copyright © 2017. Published by Elsevier B.V.

The Conundrum of Online Prescription Drug Promotion Comment on "Trouble Spots in Online Direct-to-Consumer Prescription Drug Promotion: A Content Analysis of FDA Warning Letters".

Science.gov (United States)

Wanasika, Isaac

2016-03-26

This commentary discusses pertinent issues from Hyosun Kim's paper on online prescription drug promotion. The study is well-designed and the findings highlight some of the consequences of the Food and Drug Administration's (FDA's) decision to deregulate online advertising of prescription drugs. While Kim's findings confirm some of the early concerns, they also provide a perspective of implementation challenges in the ever-changing technological environment. © 2016 by Kerman University of Medical Sciences.

Catalog Use Studies--Since the Introduction of Online Interactive Catalogs: Impact on Design for Subject Access.

Science.gov (United States)

Cochrane, Pauline A.; Markey, Karen

1983-01-01

This review of the transition from library card catalogs to online public access catalogs (OPAC) (1981-1982) discusses methods employed by online catalog use studies (self-administered questionnaires, OPAC transaction logs, focused-group interviews, feature analysis, online search and retrieval experiments) and new directions for OPAC research…

Grimstone v Epsom and St Helier University Hospitals NHS Trust: (It's Not) Hip To Be Square.

Science.gov (United States)

Austin, Louise V

2017-11-24

In Montgomery v Lanarkshire Health Board [2015] UKSC 11 the Supreme Court redefined the standard of disclosure in informed consent to medical treatment, rejecting the application of the doctor-focused Bolam standard in favour of one focused on what was significant to patients. In Grimstone v Epsom and St Helier University Hospitals NHS Trust [2015] EWHC 3756 (QB), despite acknowledging a new standard now applied, McGowan J nevertheless used the Bolam test to determine liability for non-disclosure. This illustrates ongoing judicial deference to the medical profession and this case commentary explores that decision and its implications. © The Author 2017. Published by Oxford University Press.

Experiences as an embedded librarian in online courses.

Science.gov (United States)

Konieczny, Alison

2010-01-01

Embedded librarianship gives librarians a prime opportunity to have a direct, positive impact in a clinical setting, classroom setting, or within a working group by providing integrated services that cater to the group's needs. Extending embedded librarian services beyond the various physical settings and into online classrooms is an exceptional way for librarians to engage online learners. This group of students is growing rapidly in numbers and could benefit greatly from having library services and resources incorporated into their classes. The author's services as an embedded librarian in fully online courses at a medium-sized university will be discussed, as will strategies, lessons learned, and opportunities for engaging in this realm. To develop a foundation of knowledge on embedded librarianship, an overview of this topic is provided.

Ｗeb-based Archiving of Parallel and Comparable Documents for Online Translators

OpenAIRE

Kageura, Kyo; Murayama, Ryo

2013-01-01

This paper introduces a Web-based system that archives parallel and comparable online documents. The system, QRpac, is specifically designed to meet the requirements of online volunteer translators who need to refer to relevant translation document pairs as well as comparable document sets. While many systems have been proposed so far to construct parallel and/or comparable corpora from the web, there have been none that directly respond to online translators'needs. The system is currently fu...

Online and offline effects of cerebellar transcranial direct current stimulation on motor learning in healthy older adults: a randomized double-blind sham-controlled study.

Science.gov (United States)

Samaei, Afshin; Ehsani, Fatemeh; Zoghi, Maryam; Hafez Yosephi, Mohaddese; Jaberzadeh, Shapour

2017-05-01

The aim of this randomized double blinded sham-controlled study was to determine the effect of cerebellar anodal transcranial direct current stimulation (a-tDCS) on online and offline motor learning in healthy older individuals. Thirty participants were randomly assigned in experimental (n = 15) or sham tDCS (n = 15) groups. Participants in experimental group received 2 mA cerebellar a-tDCS for 20 min. However, the tDCS was turned off after 30 seconds in sham group. Response time (RT) and error rate (ER) in serial RT test were assessed before, during 35 minutes and 48 h after the intervention. Reduction of RT and ER following the intervention session was considered as short-term (35 min post intervention) and long-term offline learning (48 h post intervention), respectively. Online RT and ER reduction were similar in both groups (P > 0.05). RT was significantly reduced 48 hours post intervention in cerebellar a-tDCS group (P = 0.03). Moreover, RT was significantly increased after 35 minutes and 48 hours in sham tDCS group (P = 0.03, P = 0.007), which indicates a lack of short-term and long-term offline learning in older adults. A-tDCS on cerebellar region produced more short-term and long-term offline improvement in RT (P = 0.014, P = 0.01) compared to sham tDCS. In addition, online, short-term and long-term (48 h) offline error reduced in cerebellar a-tDCS as compared to sham-control group, although this reduction was not significant (P > 0.05). A deficit suggests that a direct comparison to a younger group was made. The findings suggested that cerebellar a-tDCS might be useful for improvement of offline motor learning in older individuals. © 2017 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.

The utility of an online diagnostic decision support system (Isabel) in general practice: a process evaluation.

Science.gov (United States)

Henderson, Emily J; Rubin, Greg P

2013-05-01

To evaluate the utility of Isabel, an online diagnostic decision support system developed by Isabel Healthcare primarily for secondary medical care, in the general practice setting. Focus groups were conducted with clinicians to understand why and how they used the system. A modified online post-use survey asked practitioners about its impact on their decision-making. Normalization process theory (NPT) was used as a theoretical framework to determine whether the system could be incorporated into routine clinical practice. The system was introduced by NHS County Durham and Darlington in the UK in selected general practices as a three-month pilot. General practitioners and nurse practitioners who had access to Isabel as part of the Primary Care Trust's pilot. General practitioners' views, experiences and usage of the system. Seven general practices agreed to pilot Isabel. Two practices did not subsequently use it. The remaining five practices conducted searches on 16 patients. Post-use surveys (n = 10) indicated that Isabel had little impact on diagnostic decision-making. Focus group participants stated that, although the diagnoses produced by Isabel in general did not have an impact on their decision-making, they would find the tool useful if it were better tailored to the primary care setting. Our analysis concluded that normalization was not likely to occur in its current form. Isabel was of limited utility in this short pilot study and may need further modification for use in general practice.

Development of an online preparation system for multitracer solutions

Energy Technology Data Exchange (ETDEWEB)

Kasamatsu, Yoshitaka [Graduate School of Science, Osaka University, Toyonaka, Osaka 560-0043 (Japan); Advanced Science Research Center, Japan Atomic Energy Agency, Tokai, Ibaraki 319-1195 (Japan)], E-mail: kasamatsu.yoshitaka@jaea.go.jp; Yatsukawa, Makoto; Sato, Wataru; Ninomiya, Kazuhiko; Ohki, Toshihiro; Takahashi, Naruto [Graduate School of Science, Osaka University, Toyonaka, Osaka 560-0043 (Japan); Yokoyama, Akihiko [Graduate School of Natural Science and Technology, Kanazawa University, Kanazawa, Ishikawa 920-1192 (Japan); Kikunaga, Hidetoshi [Graduate School of Natural Science and Technology, Kanazawa University, Kanazawa, Ishikawa 920-1192 (Japan); RIKEN, Wako, Saitama 351-0198 (Japan); Kinoshita, Norikazu [Graduate School of Natural Science and Technology, Kanazawa University, Kanazawa, Ishikawa 920-1192 (Japan); Shibata, Sadao [Nuclear Safety Technology Center, Rokkasho, Aomori 039-3212 (Japan); Shinohara, Atsushi [Graduate School of Science, Osaka University, Toyonaka, Osaka 560-0043 (Japan)

2008-03-15

We have developed a new target-irradiation system for the online preparation of multitracer solutions, where the nuclear-reaction products recoiling out of the target are directly implanted in a solvent as a liquid catcher. A rapid online transportation of the solution has enabled highly efficient recovery of the multitracer solutions having even short-lived radioactive isotopes without any chemical treatments. It has been suggested that the collection efficiency depends on the chemical properties of the recoil elements.

Development of an online preparation system for multitracer solutions

International Nuclear Information System (INIS)

Kasamatsu, Yoshitaka; Yatsukawa, Makoto; Sato, Wataru; Ninomiya, Kazuhiko; Ohki, Toshihiro; Takahashi, Naruto; Yokoyama, Akihiko; Kikunaga, Hidetoshi; Kinoshita, Norikazu; Shibata, Sadao; Shinohara, Atsushi

2008-01-01

We have developed a new target-irradiation system for the online preparation of multitracer solutions, where the nuclear-reaction products recoiling out of the target are directly implanted in a solvent as a liquid catcher. A rapid online transportation of the solution has enabled highly efficient recovery of the multitracer solutions having even short-lived radioactive isotopes without any chemical treatments. It has been suggested that the collection efficiency depends on the chemical properties of the recoil elements

Exploration of Online Culture Through Network Analysis of Wikipedia.

Science.gov (United States)

Park, Sung Joo; Kim, Jong Woo; Lee, Hong Joo; Park, Hyunjung; Han, Deugcheon; Gloor, Peter

2015-11-01

Understanding online culture is becoming crucial in the global and connected world. Contrary to conventional attitudinal surveys used in cultural research, this study uses the approach of directly observing culture-specific behavior that emerges from online collaboration on the Internet. The editing data of Wikipedia were analyzed in 12 languages. Distinctive cultural dimensions were identified, including collectivism, extraversion, boldness, and egalitarianism. Using network analysis, the language-framed cultural factors were extracted as an emergent phenomenon in the virtual world.

Evaluation of an online interactive Diabetes Needs Assessment Tool (DNAT versus online self-directed learning: a randomised controlled trial

Directory of Open Access Journals (Sweden)

Kellner Thomas

2011-06-01

Full Text Available Abstract Background Methods for the dissemination, understanding and implementation of clinical guidelines need to be examined for their effectiveness to help doctors integrate guidelines into practice. The objective of this randomised controlled trial was to evaluate the effectiveness of an interactive online Diabetes Needs Assessment Tool (DNAT (which constructs an e-learning curriculum based on individually identified knowledge gaps, compared with self-directed e-learning of diabetes guidelines. Methods Health professionals were randomised to a 4-month learning period and either given access to diabetes learning modules alone (control group or DNAT plus learning modules (intervention group. Participants completed knowledge tests before and after learning (primary outcome, and surveys to assess the acceptability of the learning and changes to clinical practice (secondary outcomes. Results Sixty four percent (677/1054 of participants completed both knowledge tests. The proportion of nurses (5.4% was too small for meaningful analysis so they were excluded. For the 650 doctors completing both tests, mean (SD knowledge scores increased from 47.4% (12.6 to 66.8% (11.5 [intervention group (n = 321, 64%] and 47.3% (12.9 to 67.8% (10.8 [control group (n = 329, 66%], (ANCOVA p = 0.186. Both groups were satisfied with the usability and usefulness of the learning materials. Seventy seven percent (218/284 of the intervention group reported combining the DNAT with the recommended reading materials was "very useful"/"useful". The majority in both groups (184/287, 64.1% intervention group and 206/299, 68.9% control group [95% CI for the difference (-2.8 to 12.4] reported integrating the learning into their clinical practice. Conclusions Both groups experienced a similar and significant improvement in knowledge. The learning materials were acceptable and participants incorporated the acquired knowledge into practice. Trial registration ISRCTN: ISRCTN67215088

A tewlve detector coincidence spectrometer for on-line and off-line measurements of nuclear g-factors

International Nuclear Information System (INIS)

Alfter, I.; Bodenstedt, E.; Hamer, B.; Hoff, J. van den; Knichel, W.; Muenning, H.; Piel, S.; Schueth, J.; Sajok, R.

1992-01-01

A twelve detector γ-γ directional correlation setup is described which has been designed and constructed for high precision on-line and off-line IPAC measurements. A ring of twelve BaF 2 detectors which may be replaced by Ge detectors is arranged around a superconducting magnet providing a maximum magnetic field of 4.5 T. In on-line experiments the magnetic field has the direction of the beam which passes through a central bore of the magnet. The data acquisition system stores directly the Esub(γ 1 )-Esub(γ 2 ) coincidence matrices for all 66 two-detector combinations in two 8 Mbyte RAMs, one for each of the two field directions. This allows a very fast data evaluation with a small on-line computer. The apparatus got into operation one-and-a-halve years ago and revealed excellent properties. (orig.)

Embedding online patient record access in UK primary care: a survey of stakeholder experiences.

Science.gov (United States)

Pagliari, Claudia; Shand, Tim; Fisher, Brian

2012-05-01

To explore the integration of online patient Record Access within UK Primary Care, its perceived impacts on workload and service quality, and barriers to implementation. Mixed format survey of clinicians, administrators and patients. Telephone interviews with non-users. Primary care centres within NHS England that had offered online record access for the preceding year. Of the 57 practices initially agreeing to pilot the system, 32 had adopted it and 16 of these returned questionnaires. The 42 individual respondents included 14 practice managers, 15 clinicians and 13 patients. Follow-up interviews were conducted with one participant from 15 of the 25 non-adopter practices. Most professionals believed that the system is easy to integrate within primary care; while most patients found it easy to integrate within their daily lives. Professionals perceived no increase in the volume of patient queries or clinical consultations as a result of Record Access; indeed some believed that these had decreased. Most clinicians and patients believed that the service had improved mutual trust, communication, patients' health knowledge and health behaviour. Inhibiting factors included concerns about security, liability and resource requirements. Non-adoption was most frequently attributed to competing priorities, rather than negative beliefs about the service. Record access has an important role to play in supporting patient-focused healthcare policies in the UK and may be easily accommodated within existing services. Additional materials to facilitate patient recruitment, inform system set-up processes, and assure clinicians of their legal position are likely to encourage more widespread adoption.

Change management of mergers: the impact on NHS staff and their psychological contracts.

Science.gov (United States)

Cortvriend, Penny

2004-08-01

The NHS has experienced a significant amount of organisational change and restructuring, which has included numerous mergers and de-mergers, since the Labour party came to power in the UK in 1997. However, to date there has been little in the way of evaluation of such changes, particularly the impact of organisational restructuring on the staff involved. This paper examines the human aspect of a merger, and subsequent de-merger, within a primary care trust (PCT) in the North of England, using a focus group methodology. The findings demonstrate that leadership and management styles have a significant impact on staff experiencing such changes. In addition, the psychological contract can be damaged due to the impact of several factors, inducing exit or intention to leave. Employees experienced a constant cycle of change with little time for stabilisation or adjustment, leading to negativity and lowered motivation at times.

Racial Exclusion in the Online World

Directory of Open Access Journals (Sweden)

Bhoomi K. Thakore

2013-05-01

Full Text Available As the internet has become an integral part of everyday life, it is understood that patterns of racial stereotyping and discrimination found in the offline world are often reproduced online. In our paper, we examine two exclusionary practices in an online environment for adult toy collectors: First, the exclusion of non-white individuals who are expected to form immediate friendships with other non-white members; and second, the essentializing of racial issues when concerns over the lack of racial diversity in the toys are discussed. This dismissal is often directly connected to non-white members’ decisions to no longer participate, resulting in a new form of segregation within virtual space.

CUSTOMER PERCEPTION ON ONLINE PURCHASE INTENTION: THE IMPACT OF ONLINE SHOPPING ORIENTATIONS ON ONLINE BUYING INTENTION

OpenAIRE

Ghouri, Arsalan Mujahid; Ul Haq, Mirza Amin; Khan, Naveed R

2017-01-01

This paper endeavorsto recognize the customer perception on online purchase intention among theyouth of Pakistan. Customer perception on online purchase intention, thus ourresearch variables are impulse purchase orientation, brand orientation,and quality orientation were considered along with online trust andprior online purchase experience. The results are focused 292 responses gotfrom the online study. The exploration made that impulse purchase orientation;prior o...

Unwanted online sexual solicitation and online sexual risk behavior

NARCIS (Netherlands)

Baumgartner, S.E.; Valkenburg, P.M.; Peter, J.; Yan, Z.

2012-01-01

In recent years, there have been growing concerns about online sexual solicitations and online sexual risk behaviors. Recent studies suggest that only a minority of adolescents is confronted with online sexual solicitations or engages in online sexual risk behavior. Whereas more girls encounter

Strategies for active learning in online continuing education.

Science.gov (United States)

Phillips, Janet M

2005-01-01

Online continuing education and staff development is on the rise as the benefits of access, convenience, and quality learning are continuing to take shape. Strategies to enhance learning call for learner participation that is self-directed and independent, thus changing the educator's role from expert to coach and facilitator. Good planning of active learning strategies promotes optimal learning whether the learning content is presented in a course or a just-in-time short module. Active learning strategies can be used to enhance online learning during all phases of the teaching-learning process and can accommodate a variety of learning styles. Feedback from peers, educators, and technology greatly influences learner satisfaction and must be harnessed to provide effective learning experiences. Outcomes of active learning can be assessed online and implemented conveniently and successfully from the initiation of the course or module planning to the end of the evaluation process. Online learning has become accessible and convenient and allows the educator to track learner participation. The future of online education will continue to grow, and using active learning strategies will ensure that quality learning will occur, appealing to a wide variety of learning needs.

Does online harassment constitute bullying? An exploration of online harassment by known peers and online-only contacts.

Science.gov (United States)

Wolak, Janis; Mitchell, Kimberly J; Finkelhor, David

2007-12-01

To shed light on the nature of online harassment and the extent to which it may be bullying by examining differences in the characteristics of harassed youth, online harassment incidents, and distressing online harassment based on the identity of online harassers (known peer vs. online-only contact). A telephone survey of a nationally representative sample of 1500 youth Internet users, ages 10 to 17, conducted between March and June 2005. Nine percent (n = 129) of youth were harassed online in the past year, 43% (n = 56) by known peers and 57% (n = 73) by people they met online and did not know in person (online-only contacts). Most online harassment incidents did not appear to meet the standard definition of bullying used in school-based research and requiring aggression, repetition, and power imbalance. Only 25% of incidents by known peers and 21% by online-only contacts involved both repeated incidents and either distress to targets or adult intervention. In many cases, the concept of "bullying" or "cyber-bullying" may be inappropriate for online interpersonal offenses. We suggest using "online harassment," with disclaimers that it does not constitute bullying unless it is part of or related to offline bullying. This would include incidents perpetrated by peers that occur entirely online, but arise from school-related events or relationships and have school-related consequences for targets. The Internet provides opportunities for the extension of conventional school bullying to new venues. Those who study conventional school bullying should include online forms of the behavior in research, prevention, and intervention paradigms.

Tailoring of feedback in online assessment: Lessons learnt

NARCIS (Netherlands)

Vasilyeva, E.; De Bra, P.M.E.; Pechenizkiy, M.; Bonk, C.J.; et al., xx

2008-01-01

Feedback plays an important role in the learning process. Particularly, the functions of the elaborated feedback (EF) in online assessment may include assisting students in understanding their mistakes and misconceptions, motivating the student for further learning, suggesting directions for

Driving online shopping: Spending and behavioral differences among women in Saudi Arabia

Directory of Open Access Journals (Sweden)

Al-maghrabi, T.

2010-01-01

Full Text Available This study proposes a revised technology acceptance model that integrates expectation confirmation theory to measure gender differences with regard to continuance online shopping intentions in Saudi Arabia. The sample consists of 650 female respondents. A structural equation model confirms model fit. Perceived enjoyment, usefulness, and subjective norms are determinants of online shopping continuance in Saudi Arabia. High and low online spenders among women in Saudi Arabia are equivalent. The structural weights are also largely equivalent, but the regression paths from perceived site quality to perceived usefulness is not invariant between high and low e-shoppers in Saudi Arabia. This research moves beyond online shopping intentions and includes factors affecting online shopping continuance. The research model explains 60% of the female respondents’ intention to continue shopping online. Online strategies cannot ignore either the direct and indirect spending differences on continuance intentions, and the model can be generalized across Saudi Arabia.

31 CFR 360.3 - Converting definitive savings bonds to book-entry bonds in New Treasury Direct.

Science.gov (United States)

2010-07-01

... Treasury Direct, an online system for holding Treasury securities. The Web address for New Treasury Direct... follow online instructions for conversion. Regulations governing converted bonds are found at 31 CFR part 363. [70 FR 14942, Mar. 23, 2005] ...

Self-Injury, Help-Seeking, and the Internet: Informing Online Service Provision for Young People.

Science.gov (United States)

Frost, Mareka; Casey, Leanne; Rando, Natalie

2016-01-01

Although increasing numbers of young people are seeking help online for self-injury, relatively little is known about their online help-seeking preferences. To investigate the perspectives of young people who self-injure regarding online services, with the aim of informing online service delivery. A mixed-methods exploratory analysis regarding the perspectives of a subsample of young people who reported a history of self-injury and responded to questions regarding preferences for future online help-seeking (N = 457). The sample was identified as part of a larger study (N = 1,463) exploring self-injury and help-seeking. Seven themes emerged in relation to preferences for future online help-seeking: information, guidance, reduced isolation, online culture, facilitation of help-seeking, access, and privacy. Direct contact with a professional via instant messaging was the most highly endorsed form of online support. Young people expressed clear preferences regarding online services for self-injury, supporting the importance of consumer consultation in development of online services.

ENHANCING ENGLISH LANGUAGE LEARNERS’ MOTIVATION THROUGH ONLINE GAMES

Directory of Open Access Journals (Sweden)

Nataliia V. Iaremenko

2017-06-01

Full Text Available In this article, we examine the potentials of online games which teachers can employ in order to motivate their students and summarize the positive effects of playing learning games. The study addresses the question of how gamified learning is applicable to learning English as a second language. The other research questions refer to the reasons that make language learners want to play a learning game and the influence of particular game elements onto players. All of these questions are investigated on the example of Kahoot web resource. The study suggests that online learning games can foster intrinsic motivation and help engage students in learning activities. The use of online games in English as a second language learning shows the direct relationship between a high energy level of fun competition and increased motivation.

Understanding the online channel extension of traditional retailers: Online-offline and online-prototypical congruence

OpenAIRE

Wu Jinfeng; Li Yilong

2016-01-01

Many Chinese traditional retailers have turned to the multichannel forms by establishing their own online stores. When doing so, retail managers face a difficult choice between two online marketing orientations: “pursuit of ideal” (i.e. online-prototypical congruence orientation) and “retention of tradition” (i.e. online-offline congruence orientation). To help managers make this choice, this study proposes a conceptual framework to illustrate how these two orientations affect retail store at...

Cyberdrugs: a cross-sectional study of online pharmacies characteristics

OpenAIRE

Orizio, Grazia; Schulz, Peter; Domenighini, Serena; Caimi, Luigi; Rosati, Cristina; Rubinelli, Sara; Gelatti, Umberto

2017-01-01

As e-commerce and online pharmacies (OPs) arose, the potential impact of the Internet on the world of health shifted from merely the spread of information to a real opportunity to acquire health services directly. Aim of the study was to investigate the offer of prescription drugs in OPs, analysing their characteristics, using the content analysis method. The research performed using the Google search engine led to an analysis of 118 online pharmacies. Only 51 (43.2%) of them stated their pre...

Barter Online Network

Directory of Open Access Journals (Sweden)

Van Ngoc Tran

2015-12-01

Full Text Available Barter is the direct exchange of goods or services without using a medium of exchange, such as money. Barter faced a number of limitations, and according to Smith (1776, these limitations led to the emergence of money. However, trading with money also exposes traders to the problems of monetary economy such as inflation, deflation, currency de-valuation, and currency exchange fluctuation. According to Statista.com (2015, in 2016, global Business to Customer (B2C e-commerce sales will reach 1.92 trillion US dollars. On the other hand, online barter solutions are rare on the market. The only attempts to tackle online barter are mobile applications, carried out by small businesses. The market gap is caused by the unsolved inefficiencies of barter. The aim of this thesis is to identify the problems of barter, propose an IT solution for the problems of barter, and finally, produce an artefact, which is the realisation of the proposed IT solution by utilising computer systems and computer algorithms.

COULD BE ONLINE GROCERIES AN ALTERNATIVE FOR ROMANIAN FOOD RETAIL?

Directory of Open Access Journals (Sweden)

Silvius T. STANCIU

2014-11-01

Full Text Available The new technologies, competition, consumer convenience and the lack of time for shopping are some factors that have encouraged the Romanian online retail food market. On the food market identifying the viable direction of development and business continuity represents a major concern for economic operators. For a new business online commerce is the most affordable and the fastest way to enter the market. The domestic online retail food market is estimated to reach 6 million euros in 2014. Studies carried out by specialized companies have identified the Romanian consumers' appetite for food shopping on the Internet. Although Romania is only at the beginning in online food market as compared to its European neighbours, experiments in other domestic sectors demonstrate the possibility of surprises in this domain. The article proposes a short analysis of the Romanian online food retail market, tendencies and opportunities in this new domain for local commerce.

An online learning course in Ergonomics.

Science.gov (United States)

Weiss, Patrice L Tamar; Schreuer, Naomi; Jermias-Cohen, Tali; Josman, Naomi

2004-01-01

For the past two years, the Department of Occupational Therapy at the University of Haifa has offered an online course to third year occupational therapists on the topic of Ergonomics for Health Care Professionals. The development and implementation of this course was funded by the Israeli Ministry of Education. Unique teaching materials, developed and uploaded to the University's server via "High Learn", included interactive and self-directed documents containing graphics, animations, and video clips. Extensive use was made of the discussion forum and survey tools, and students submitted all assignments online. For the final topic, an expert in ergonomics from Boston University delivered a lecture via two-way videoconferencing. The course site included comprehensive library listings in which all bibliographic materials were made available online. Students accessed course materials at the University in a computer classroom and at home via modem. In an accompanying research study, the frequency of student usage of the various online tools was tracked and extensive data were collected via questionnaires documenting students' demographic background, preferred learning style, prior usage of technology, satisfaction with the course and academic achievement. This paper focuses on the results of the research study that examined how the students responded to and coped with teaching material presented and accessed in this format.

Implications of the UK NHS consent policy for nuclear medicine practice.

Science.gov (United States)

Greaves, Claire D; Tindale, Wendy B

2005-02-01

To comply with government policy on consent, the Sheffield Teaching Hospitals (STH) National Health Service (NHS) Trust introduced a new consent policy in February 2002. Verbal or written consent (depending on the level of risk) must be obtained prior to each study. The patient must be fully informed and given time to reach a decision. Consideration needs to be given to the following: to whom, when and how to provide such information and obtain consent. Each study type and patient circumstance needs to be classified according to risk. Consideration of the risks resulted in a local policy in which written consent is required for the following: therapeutic procedures, studies on pregnant women, studies in which pregnancy needs to be avoided, research procedures, cardiac stress for myocardial perfusion scintigraphy and intrathecal administration. Patient information leaflets have been updated with new information about the study and any risks. Information is now available for both patients and hospital staff. Compliance with the consent policy in a service department provides logistic challenges, but it is possible to fully inform patients in advance about their treatment, allowing them to give informed consent.

Evidence-based health care: development and audit of a clinical standard for research and its impact on an NHS trust.

Science.gov (United States)

Parkin, Claire; Bullock, Ian

2005-04-01

Working within a modern National Health Service in the United Kingdom, the place for research and its dissemination is increasingly important. The organization of this within each National Health Service (NHS) Trust is challenging but nevertheless essential. If health care professionals are to be empowered to adopt an evidence-based approach in both the planning and delivery of care, research aware employees are crucial. This paper highlights the importance of NHS hospital trusts implementing initiatives that will facilitate this process. One such initiative has been the development and survey of a clinical standard for research. The primary development aim was to provide a benchmark standard for all nursing research. The standard was developed to fit within the current dynamic quality improvement (DQI) programme and has directly contributed to an evolving culture of research by shaping nurses' awareness, and offering a support and consultancy network within the Trust. The standard is one aspect of a research awareness programme, with the primary objective of providing guidance and education whilst developing nurses throughout the research process. The planned strategic outcome is to see a positive outcome on the quality of research in the Trust. A baseline survey was conducted to provide a definitive snap shot of research understanding and practice within the Trust following the introduction of the research standard. The standard was developed by a team of clinicians led by a member of the quality team, to ensure that it fitted the DQI structure, and a member of the Nursing Research Unit (NRU). The standard was distributed to every clinical area and 192 nurses were surveyed to evaluate its impact on their awareness of educational opportunities, their use of the consultancy and support service, their use of other support services, their research utilization and research quality. The survey demonstrated that the implementation of the standard had increased awareness

eBook management in NHS libraries in the North of England: perceptions and practice.

Science.gov (United States)

Nicholas, Katie

2018-03-01

In this article, Katie Nicholas presents the findings of a very topical piece of research into the use of eBooks in health libraries, which she completed for a Masters dissertation. Katie graduated with an MA in Library and Information Management (Distinction) from Manchester Metropolitan University in July 2017. She would like to acknowledge the support of her supervisor, Rachel Delbridge, in helping her to gain a Distinction in her dissertation. In the article, she points out that the use of eBooks in the NHS is low compared to other sectors and she presents the findings from her research, which help to explain this. She outlines the development of an electronic tool to help library and information staff make sense of the complexity around eBooks and makes further very practical recommendations for practitioners. A. M. © 2018 Health Libraries Group.

Effects of Online Reciprocal Teaching on Reading Strategies, Comprehension, Self-Efficacy, and Motivation

Science.gov (United States)

Huang, Ching-Ting; Yang, Shu Ching

2015-01-01

This study examines the effects of two types of online remedial reading interventions on the reading strategy and comprehension, motivational beliefs, and self-efficacy of 36 low-achieving students (explicit teaching before reciprocal teaching [ET-RT] vs. direct instruction [DI]). We designed a 10-unit online remedial English reading program based…

Global Online Entrepreneurship and the Impact of Innovation on Brands

Directory of Open Access Journals (Sweden)

Ipek Krom

2015-11-01

Full Text Available AbstractThe purpose of this paper is to evaluate the significance of innovation driven online entrepreneurship as well as the impact of innovation on brand trust, customer satisfaction and brand loyalty in the extent of service innovations.Global online entrepreneurship was explored on a theoretical basis and correlation and regression analyses were used in order to evaluate the impact of the innovations of Google on brand trust, customer satisfaction and brand loyalty. Furthermore correlation and regression analyses were used in order to find out the relationship between brand loyalty and brand trust and the relationship between brand loyalty and customer relationship in the extent of service industry. The results show a direct and positive relationship between innovation and brand loyalty, a direct and positive relationship between innovation and brand trust and a direct and positive relationship between innovation and customer satisfaction. Furthermore, according to the research findings brand trust and customer satisfaction have a direct and positive relationship with brand loyalty. This research is limited to Google users since it is the most popular search engine worldwide. In this article the impact of innovation on brand trust, customer satisfaction and brand loyalty was evaluated. For future research the impact of innovation on other variables of brand loyalty can be studied.The findings of this study inform the readers about the impact of brand trust, customer satisfaction and brand loyalty on innovation in the extent of service innovations driven by global online entrepreneurship. 

Online intimacy and well-being in the digital age

Directory of Open Access Journals (Sweden)

Anna M. Lomanowska

2016-05-01

Full Text Available Engagement in intimate social interactions and relationships has an important influence on well-being. However, recent advances in Internet and mobile communication technologies have lead to a major shift in the mode of human social interactions, raising the question of how these technologies are impacting the experience of interpersonal intimacy and its relationship with well-being. Although the study of intimacy in online social interactions is still in its early stages, there is general agreement that a form of online intimacy can be experienced in this context. However, research into the relationship between online intimacy and well-being is critically limited. Our aim is to begin to address this research void by providing an operative perspective on this emerging field. After considering the characteristics of online intimacy, its multimodal components and its caveats, we present an analysis of existing evidence for the potential impact of online intimacy on well-being. We suggest that studies thus far have focused on online social interactions in a general sense, shedding little light on how the level of intimacy in these interactions may affect well-being outcomes. We then consider findings from studies of different components of intimacy in online social interactions, specifically self-disclosure and social support, to indirectly explore the potential contribution of online intimacy to health and well-being. Based on this analysis, we propose future directions for fundamental and practical research in this important new area of investigation.

The UK Human Genome Mapping Project online computing service.

Science.gov (United States)

Rysavy, F R; Bishop, M J; Gibbs, G P; Williams, G W

1992-04-01

This paper presents an overview of computing and networking facilities developed by the Medical Research Council to provide online computing support to the Human Genome Mapping Project (HGMP) in the UK. The facility is connected to a number of other computing facilities in various centres of genetics and molecular biology research excellence, either directly via high-speed links or through national and international wide-area networks. The paper describes the design and implementation of the current system, a 'client/server' network of Sun, IBM, DEC and Apple servers, gateways and workstations. A short outline of online computing services currently delivered by this system to the UK human genetics research community is also provided. More information about the services and their availability could be obtained by a direct approach to the UK HGMP-RC.

Accountable to whom, for what? An exploration of the early development of Clinical Commissioning Groups in the English NHS.

Science.gov (United States)

Checkland, Kath; Allen, Pauline; Coleman, Anna; Segar, Julia; McDermott, Imelda; Harrison, Stephen; Petsoulas, Christina; Peckham, Stephen

2013-12-10

One of the key goals of the current reforms in the English National Health Service (NHS) under the Health and Social Care Act, 2012, is to increase the accountability of those responsible for commissioning care for patients (clinical commissioning groups (CCGs)), while at the same time allowing them a greater autonomy. This study was set out to explore CCG's developing accountability relationships. We carried out detailed case studies in eight CCGs, using interviews, observation and documentary analysis to explore their multiple accountabilities. We interviewed 91 people, including general practitioners, managers and governing body members in developing CCGs, and undertook 439 h of observation in a wide variety of meetings. CCGs are subject to a managerial, sanction-backed accountability to NHS England (the highest tier in the new organisational hierarchy), alongside a number of other external accountabilities to the public and to some of the other new organisations created by the reforms. In addition, unlike their predecessor commissioning organisations, they are subject to complex internal accountabilities to their members. The accountability regime to which CCGs are subject to is considerably more complex than that which applied their predecessor organisations. It remains to be seen whether the twin aspirations of increased autonomy and increased accountability can be realised in practice. However, this early study raises some important issues and concerns, including the risk that the different bodies to whom CCGs are accountable will have differing (or conflicting) agendas, and the lack of clarity over the operation of sanction regimes.

An educational experience with online teaching – not a best practice

DEFF Research Database (Denmark)

Kolbæk, Ditte; Nortvig, Anne-Mette

2017-01-01

Problem- and Project-Based Learning (PBL) is a widely used pedagogical method in higher education. Although PBL encourages self-directed learning and works with the students’ own projects and problems, it also includes teacher presentations, discussions and group reflections, both on-campus and o......Problem- and Project-Based Learning (PBL) is a widely used pedagogical method in higher education. Although PBL encourages self-directed learning and works with the students’ own projects and problems, it also includes teacher presentations, discussions and group reflections, both on......-campus and online. Therefore, the teacher’s plans might be relevant to the students’ projects, but that is not always the case. This study investigates how master’s students interact with an online Problem-Based Learning design and examines how technology influences these interactions. This study describes...... an experience and provides a point of departure for further discussion, but it is not an example of best practices for online PBL....

Online Cancer Information Seeking: Applying and Extending the Comprehensive Model of Information Seeking.

Science.gov (United States)

Van Stee, Stephanie K; Yang, Qinghua

2017-10-30

This study applied the comprehensive model of information seeking (CMIS) to online cancer information and extended the model by incorporating an exogenous variable: interest in online health information exchange with health providers. A nationally representative sample from the Health Information National Trends Survey 4 Cycle 4 was analyzed to examine the extended CMIS in predicting online cancer information seeking. Findings from a structural equation model supported most of the hypotheses derived from the CMIS, as well as the extension of the model related to interest in online health information exchange. In particular, socioeconomic status, beliefs, and interest in online health information exchange predicted utility. Utility, in turn, predicted online cancer information seeking, as did information-carrier characteristics. An unexpected but important finding from the study was the significant, direct relationship between cancer worry and online cancer information seeking. Theoretical and practical implications are discussed.

Detection of illicit online sales of fentanyls via Twitter [version 1; referees: 2 approved

Directory of Open Access Journals (Sweden)

Tim K. Mackey

2017-11-01

Full Text Available A counterfeit fentanyl crisis is currently underway in the United States.  Counterfeit versions of commonly abused prescription drugs laced with fentanyl are being manufactured, distributed, and sold globally, leading to an increase in overdose and death in countries like the United States and Canada.  Despite concerns from the U.S. Drug Enforcement Agency regarding covert and overt sale of fentanyls online, no study has examined the role of the Internet and social media on fentanyl illegal marketing and direct-to-consumer access.  In response, this study collected and analyzed five months of Twitter data (from June-November 2015 filtered for the keyword “fentanyl” using Amazon Web Services.  We then analyzed 28,711 fentanyl-related tweets using text filtering and a machine learning approach called a Biterm Topic Model (BTM to detect underlying latent patterns or “topics” present in the corpus of tweets.  Using this approach we detected a subset of 771 tweets marketing the sale of fentanyls online and then filtered this down to nine unique tweets containing hyperlinks to external websites.  Six hyperlinks were associated with online fentanyl classified ads, 2 with illicit online pharmacies, and 1 could not be classified due to traffic redirection.  Importantly, the one illicit online pharmacy detected was still accessible and offered the sale of fentanyls and other controlled substances direct-to-consumers with no prescription required at the time of publication of this study.   Overall, we detected a relatively small sample of Tweets promoting illegal online sale of fentanyls.  However, the detection of even a few online sellers represents a public health danger and a direct violation of law that demands further study.

Pengaruh Sistem Pembayaran Listrik Online (Payment Point Online Bank Terhadap Pengendalian Internal Kas Pada PT. PLN (Persero DJBB

Directory of Open Access Journals (Sweden)

Maulana Yusup

2012-04-01

Full Text Available The company has its own way in the benefit and boost profits from year to year. Gains usually obtained sourced from a network perusahaan.System activities related procedures in a comprehensive series to carry out an enterprise activity. Therefore, the service strategy very big influence on the activities of the company. With the waiters are good, it is expected there will be no diversion of the company The research objective was to determine the effect of electricity online payment system (payment points online bank to internal control of cash at PT.PLN (Persero Distribution West Java and Banten Distribution Office. Conventional payment systems that rely on physical cash as a payment instrument has been shifted due to advances in technology can replace conventional ways of containing the risk of endangering safety. Based on research data on the PT. PLN (Persero Distribution West Java and Banten and discussion based on the theory, it can be concluded that the system of online payment of electricity was instrumental in supporting the effectiveness of internal control of cash, it can be seen from (1 The presence of general controls and application controls are adequate. Customers make payment through bank online payment points, (2 Reconciliation of receipt of funds receipt and bookkeeping is done regularly and directed accordingly (2 Process Online Payment System Electrical PPOB (Payment Point Online Bank is an electricity bill payment service and other bills online real -Time. For it can be suggested that understanding is not uniform (the existence of different viewpoints of employees with regard to the value and effect of the application of the company's progress PPOB can be removed and can eliminate the old paradigm of doing business processes PLN and increased knowledge of the mechanism of action of the system so as to improve performance and ultimately increase customer satisfaction and loyalty.

On-line, proximate analysis of ground beef directly at a meat grinder outlet.

Science.gov (United States)

Isaksson, T; Nilsen, B N; Tøgersen, G; Hammond, R P; Hildrum, K I

1996-07-01

The fat, moisture and protein contents of ground beef were determined on-line by a diffuse reflectance near infrared (NIR) spectroscopy instrument at the outlet of a meat grinder. Beef samples in the range of 6.2-21.7% fat, 59.6-72.9% moisture and 18.1-20.7% protein were studied. Calibrations from samples ground with hole diameters of 4, 8, 13 or 19 mm in the grinder plate were validated. In addition, calibrations of combinations of these samples from the different hole diameters were validated. Prediction errors, expressed as root mean square error of cross validation of the beef samples, were 0.73-1.50% for fat, 0.75-1.33% for moisture and 0.23-0.32% for protein, depending on the hole diameter of the grinder plate. Calibrations from samples ground with the smallest hole diameters gave lowest prediction errors. The present prediction error results are only slightly higher compared to reported prediction error results using conventional at- and off-line NIR instruments. It is concluded that the on-line NIR prediction results were acceptable for samples ground with grinder plates of 4, 8 or 13 mm hole diameter.

Online counseling: An exploratory survey of Italian psychologists' attitudes towards new ways of interaction.

Science.gov (United States)

Cipolletta, Sabrina; Mocellin, Damiano

2017-01-09

Online counseling may be defined as an interaction between users and mental health professionals that takes place through computer mediated communication technology. This study aimed to investigate the attitudes of Italian psychologists towards different aspects of online counseling provided via email, chat, forums, and videoconference. An online questionnaire was administered to a sample of 289 licensed psychologists in the Veneto Region (Italy) in order to collect opinions, preferences, and intentions to use online modalities, along with prior knowledge and practice experiences. Only 18.3% of the respondents had previous experience with online counseling. Overall, the majority of psychologists (62.6%) were favorable towards online counseling, but they also had several reservations about the provision of online diagnosis and therapeutic interventions. Results showed a consistent lack of clarity regarding ethical and penal issues concerning online modalities. More efforts must be directed to deepening the application of new technologies in the field of psychology in order to enable an ethical and professional practice of online counseling in Italy.

Social Media Use and Online Political Participation Among College Students During the US Election 2012

Directory of Open Access Journals (Sweden)

Hongwei “Chris” Yang

2016-01-01

Full Text Available A total of 4,556 US college students were surveyed immediately after Election 2012 to investigate what social media–related psychological and behavioral factors predicted their online political participation. Structural equation modeling and hierarchical multiple regression results showed that online social capital, political self-efficacy, and Facebook group participation were positive predictors of online political participation, while social trust did not directly influence online political participation. General political use of Facebook and Twitter was a positive predictor of online political participation; however, extensive Facebook and Twitter use was a negative predictor. Implications for research and political practice are discussed.

Development and application of online Stelmor Controlled Cooling System

International Nuclear Information System (INIS)

Yu Wanhua; Chen Shaohui; Kuang Yonghai; Cao Kaichao

2009-01-01

An online Stelmor Controlled Cooling System (SCCS) has been developed successfully for the Stelmor production line, which can communicate with the material flow management system and Program Logic Control System (PLCs) automatically through local network. This online model adopts Implicit Finite Difference Time Domain (FDTD) method to calculate temperature evolution and phase transformation during the production process and predicts final properties. As Continuous Cooling Temperature (CCT) curves of various steels can be coupled in the model, it can predict the latent heat rise and range of phase transformation for various steels, which can provide direct guidance for new steel development and optimization of present Stelmor cooling process. This unique online system has been installed in three Stelmor production lines at present with good results.

Kajian Pembelajaran Online Berbasis Wiki Di Lingkup Perguruan Tinggi

Directory of Open Access Journals (Sweden)

Soetam Rizky Wicaksono

2012-01-01

Full Text Available Scope of online learning in higher education now more widely assumed to be a repository of teaching materials for both teachers and students. Nevertheless there are still many things that can still be developed and studied with an experimental model for online learning can be more participatory in the learning context given that the scope of the college is more directed to andragogik. One innovation that leads to this is to make the application of model-based learning wiki adopting crowdsourcing. This paper explores theoretical study attempted as a first step in the research development of wiki-based online learning model. The results of this study should be the basis for experiments to be conducted in order to adapt contextually in real state.

Employing post-DEA cross-evaluation and cluster analysis in a sample of Greek NHS hospitals.

Science.gov (United States)

Flokou, Angeliki; Kontodimopoulos, Nick; Niakas, Dimitris

2011-10-01

To increase Data Envelopment Analysis (DEA) discrimination of efficient Decision Making Units (DMUs), by complementing "self-evaluated" efficiencies with "peer-evaluated" cross-efficiencies and, based on these results, to classify the DMUs using cluster analysis. Healthcare, which is deprived of such studies, was chosen as the study area. The sample consisted of 27 small- to medium-sized (70-500 beds) NHS general hospitals distributed throughout Greece, in areas where they are the sole NHS representatives. DEA was performed on 2005 data collected from the Ministry of Health and the General Secretariat of the National Statistical Service. Three inputs -hospital beds, physicians and other health professionals- and three outputs -case-mix adjusted hospitalized cases, surgeries and outpatient visits- were included in input-oriented, constant-returns-to-scale (CRS) and variable-returns-to-scale (VRS) models. In a second stage (post-DEA), aggressive and benevolent cross-efficiency formulations and clustering were employed, to validate (or not) the initial DEA scores. The "maverick index" was used to sort the peer-appraised hospitals. All analyses were performed using custom-made software. Ten benchmark hospitals were identified by DEA, but using the aggressive and benevolent formulations showed that two and four of them respectively were at the lower end of the maverick index list. On the other hand, only one 100% efficient (self-appraised) hospital was at the higher end of the list, using either formulation. Cluster analysis produced a hierarchical "tree" structure which dichotomized the hospitals in accordance to the cross-evaluation results, and provided insight on the two-dimensional path to improving efficiency. This is, to our awareness, the first study in the healthcare domain to employ both of these post-DEA techniques (cross efficiency and clustering) at the hospital (i.e. micro) level. The potential benefit for decision-makers is the capability to examine high

Direct Detection of Biotinylated Proteins by Mass Spectrometry

Science.gov (United States)

2015-01-01

Mass spectrometric strategies to identify protein subpopulations involved in specific biological functions rely on covalently tagging biotin to proteins using various chemical modification methods. The biotin tag is primarily used for enrichment of the targeted subpopulation for subsequent mass spectrometry (MS) analysis. A limitation of these strategies is that MS analysis does not easily discriminate unlabeled contaminants from the labeled protein subpopulation under study. To solve this problem, we developed a flexible method that only relies on direct MS detection of biotin-tagged proteins called “Direct Detection of Biotin-containing Tags” (DiDBiT). Compared with conventional targeted proteomic strategies, DiDBiT improves direct detection of biotinylated proteins ∼200 fold. We show that DiDBiT is applicable to several protein labeling protocols in cell culture and in vivo using cell permeable NHS-biotin and incorporation of the noncanonical amino acid, azidohomoalanine (AHA), into newly synthesized proteins, followed by click chemistry tagging with biotin. We demonstrate that DiDBiT improves the direct detection of biotin-tagged newly synthesized peptides more than 20-fold compared to conventional methods. With the increased sensitivity afforded by DiDBiT, we demonstrate the MS detection of newly synthesized proteins labeled in vivo in the rodent nervous system with unprecedented temporal resolution as short as 3 h. PMID:25117199

The Little Engine That Could – How to Start the Motor? Motivating the Online Student

Directory of Open Access Journals (Sweden)

Michael Eskey

2007-01-01

Full Text Available Motivation is a function of initiating and sustaining goal-directed action. In addition to individual variables, student motivation is influenced by situational variables that include course design, instructional approach, and to a great extent, faculty behavior. This article presents classic literature on motivation and offers a grounded set of instructional methods and strategies with which faculty can spark and sustain motivation that leads to deep rather than superficial learning in the online learner. These classic motivational techniques have a direct relationship with today's online learner. The authors highlight the significance of external influences and describe some of the many opportunities available to faculty to enhance the motivation of online students to learn.

論線上目錄之主題檢索 Subject Access in Online Catalog

Directory of Open Access Journals (Sweden)

Ming-Yueh Tsay

1995-09-01

Full Text Available 無This paper first (describes the current clevelopments of online catalog subject access. In particular, it emphasizes the application of DDC, LCC and LCSH for retrieving subject information through online catalogs. Subsequently, studies in the literature on enhancements to the above subject searching as well as keywords or phrases extracted from the bibliographic record are discussed. Finally, an overall pictures of online catalog which is under the Internet environment and some directions in which the future online catalog should evolve are provided.

Fair Balance and Adequate Provision in Direct-to-Consumer Prescription Drug Online Banner Advertisements: A Content Analysis

Science.gov (United States)

2016-01-01

Background The current direct-to-consumer advertising (DTCA) guidelines were developed with print, television, and radio media in mind, and there are no specific guidelines for online banner advertisements. Objective This study evaluates how well Internet banner ads comply with existing Food and Drug Administration (FDA) guidelines for DTCA in other media. Methods A content analysis was performed of 68 banner advertisements. A coding sheet was developed based on (1) FDA guidance documents for consumer-directed prescription drug advertisements and (2) previous DTCA content analyses. Specifically, the presence of a brief summary detailing the drug’s risks and side effects or of a “major statement” identifying the drug’s major risks, and the number and type of provisions made available to consumers for comprehensive information about the drug were coded. In addition, the criterion of “fair balance,” the FDA’s requirement that prescription drug ads balance information relating to the drug’s risks with information relating to its benefits, was measured by numbering the benefit and risk facts identified in the ads and by examining the presentation of risk and benefit information. Results Every ad in the sample included a brief summary of risk information and at least one form of adequate provision as required by the FDA for broadcast ads that do not give audiences a brief summary of a drug’s risks. No ads included a major statement. There were approximately 7.18 risk facts for every benefit fact. Most of the risks (98.85%, 1292/1307) were presented in the scroll portion of the ad, whereas most of the benefits (66.5%, 121/182) were presented in the main part of the ad. Out of 1307 risk facts, 1292 were qualitative and 15 were quantitative. Out of 182 benefit facts, 181 were qualitative and 1 was quantitative. The majority of ads showed neutral images during the disclosure of benefit and risk facts. Only 9% (6/68) of the ads displayed positive images and

Fair Balance and Adequate Provision in Direct-to-Consumer Prescription Drug Online Banner Advertisements: A Content Analysis.

Science.gov (United States)

Adams, Crystal

2016-02-18

The current direct-to-consumer advertising (DTCA) guidelines were developed with print, television, and radio media in mind, and there are no specific guidelines for online banner advertisements. This study evaluates how well Internet banner ads comply with existing Food and Drug Administration (FDA) guidelines for DTCA in other media. A content analysis was performed of 68 banner advertisements. A coding sheet was developed based on (1) FDA guidance documents for consumer-directed prescription drug advertisements and (2) previous DTCA content analyses. Specifically, the presence of a brief summary detailing the drug's risks and side effects or of a "major statement" identifying the drug's major risks, and the number and type of provisions made available to consumers for comprehensive information about the drug were coded. In addition, the criterion of "fair balance," the FDA's requirement that prescription drug ads balance information relating to the drug's risks with information relating to its benefits, was measured by numbering the benefit and risk facts identified in the ads and by examining the presentation of risk and benefit information. Every ad in the sample included a brief summary of risk information and at least one form of adequate provision as required by the FDA for broadcast ads that do not give audiences a brief summary of a drug's risks. No ads included a major statement. There were approximately 7.18 risk facts for every benefit fact. Most of the risks (98.85%, 1292/1307) were presented in the scroll portion of the ad, whereas most of the benefits (66.5%, 121/182) were presented in the main part of the ad. Out of 1307 risk facts, 1292 were qualitative and 15 were quantitative. Out of 182 benefit facts, 181 were qualitative and 1 was quantitative. The majority of ads showed neutral images during the disclosure of benefit and risk facts. Only 9% (6/68) of the ads displayed positive images and none displayed negative images when presenting risks

A proposed instrument for the assessment of job satisfaction in Greek mental NHS hospitals.

Science.gov (United States)

Labiris, Georgios; Gitona, Kleoniki; Drosou, Vasiliki; Niakas, Dimitrios

2008-08-01

Since its introduction in 1983, the Greek NHS is under an almost constant reform, aiming improvement on the efficiency and the quality of provided services. The national program of psychiatric reform "Psychargos" introduced new models of therapeutic approach to the care of the mentally ill, that required expansion of the existing roles and development of new roles of the healthcare staff. Consequently, the efficient management of the healthcare workforce in Greek mental facilities was identified as a primary determinant of the successful implementation of the program. Primary objective of this study was the development of a research framework for the assessment of job satisfaction in Greek Mental Health Hospitals. Among the objectives was the evaluation of the capacity of the underlying motivators and hygiene factors and the identification of potential correlations of the global job satisfaction and the motivation and retention factors with the demographic, social and occupational characteristics of the employees. A custom questionnaire was developed, based on Herzberg two-factor theory, after a systematic review of the relevant literature. The instrument was constructed by two parts and 37 items. Ten items addressed the sociodemographic characteristics of the subjects, while the remaining 27 items were distributed in 11 subscales which addressed the global satisfaction index and the "retention" and the "motivation" variables. The instrument was validated by means of the Cronbach alpha for each subscale and by confirmatory factor analysis. The study was conducted at the Public Mental Hospital of Chania (PMHC). From the 300 employees of the PMHC, 133 subjects successfully responded to the questionnaire (response rate, 44.3%). In accordance to former surveys, subjects presented average scores in the global satisfaction index (GSI). The professional category of the employee was identified as the primary determinant of the GSI. Nurses presented statistically

Consumer Perceived Risk, Attitude and Online Shopping Behaviour; Empirical Evidence from Malaysia

Science.gov (United States)

Ariff, Mohd Shoki Md; Sylvester, Michele; Zakuan, Norhayati; Ismail, Khalid; Mat Ali, Kamarudin

2014-06-01

The development of e-commerce has increased the popularity of online shopping worldwide. In Malaysia, it was reported that online shopping market size was RM1.8 billion in 2013 and it is estimated to reach RM5 billion by 2015. However, online shopping was rated 11th out of 15 purposes of using internet in 2012. Consumers' perceived risks of online shopping becomes a hot topic to research as it will directly influence users' attitude towards online purchasing, and their attitude will have significant impact to the online purchasing behaviour. The conceptualization of consumers' perceived risk, attitude and online shopping behaviour of this study provides empirical evidence in the study of consumer online behaviour. Four types of risks - product risk, financial, convenience and non-delivery risks - were examined in term of their effect on consumers' online attitude. A web-based survey was employed, and a total of 300 online shoppers of a Malaysia largest online marketplace participated in this study. The findings indicated that product risk, financial and non-delivery risks are hazardous and negatively affect the attitude of online shoppers. Convenience risk was found to have positive effect on consumers' attitude, denoting that online buyers of this site trusted the online seller and they encountered less troublesome with the site. It also implies that consumers did not really concern on non-convenience aspect of online shopping, such as handling of returned products and examine the quality of products featured in the online seller website. The online buyers' attitude was significantly and positively affects their online purchasing behaviour. The findings provide useful model for measuring and managing consumers' perceived risk in internet-based transaction to increase their involvement in online shopping and to reduce their cognitive dissonance in the e-commerce setting.

Instructional strategies for online introductory college physics based on learning styles

Science.gov (United States)

Ekwue, Eleazer U.

The practical nature of physics and its reliance on mathematical presentations and problem solving pose a challenge toward presentation of the course in an online environment for effective learning experience. Most first-time introductory college physics students fail to grasp the basic concepts of the course and the problem solving skills if the instructional strategy used to deliver the course is not compatible with the learners' preferred learning styles. This study investigates the effect of four instructional strategies based on four learning styles (listening, reading, iconic, and direct-experience) to improve learning for introductory college physics in an online environment. Learning styles of 146 participants were determined with Canfield Learning Style inventory. Of the 85 learners who completed the study, research results showed a statistically significant increase in learning performance following the online instruction in all four learning style groups. No statistically significant differences in learning were found among the four groups. However, greater significant academic improvement was found among learners with iconic and direct-experience modes of learning. Learners in all four groups expressed that the design of the unit presentation to match their individual learning styles contributed most to their learning experience. They were satisfied with learning a new physics concept online that, in their opinion, is either comparable or better than an instructor-led classroom experience. Findings from this study suggest that learners' performance and satisfaction in an online introductory physics course could be improved by using instructional designs that are tailored to learners' preferred ways of learning. It could contribute toward the challenge of providing viable online physics instruction in colleges and universities.

Determinants of online trust and their impact on online purchase intention

OpenAIRE

Kooli, Kaouther; Ben Mansour, K.; Rizky , Utama

2014-01-01

Abundant literature has examined online trust. However the different approaches were scarcely integrated to address the determinants of online trust and their impacts on online purchase intention. An integrative approach to online trust is adopted in this paper. A survey is carried out on a sample of 401 online consumers in Indonesia. The findings show that purchase intention is significantly influenced by online trust. Besides, there is significant impact of personality based trust (benevole...

Our Anonymous Online Research Participants Are Not Always Anonymous: Is This a Problem?

Science.gov (United States)

Dawson, Phillip

2014-01-01

When educational research is conducted online, we sometimes promise our participants that they will be anonymous--but do we deliver on this promise? We have been warned since 1996 to be careful when using direct quotes in Internet research, as full-text web search engines make it easy to find chunks of text online. This paper details an empirical…

The Mapping of On-Line Learning to Flipped Classroom: Small Private Online Course

Directory of Open Access Journals (Sweden)

Muqiang Zheng

2018-03-01

Full Text Available This study uses an integrated pedagogical tool for knowledge learning as an on-line tool for flipped classroom activities and as an off-line capability training tool. Theoretically, the Experiential Learning Cycle (ELC plays a critical role in promoting students learning effectiveness and performance. However, a dearth of research has applied M-learning and flipped classroom in combination with the ELC stages such as concrete experience, reflective observation, abstract conceptualization, and active experimentation to examine the knowledge and ability learning outcomes for students. This study integrates the On line to Off line (O2O classroom development and usage derived from the four stages of ELC based on on-line knowledge learning and off-line ability training in Microeconomics courses. The results revealed significant improvements in students learning outcomes after O2O mode was implemented. In comparison with traditional teaching methods, not only does O2O teaching significantly improve the students’ learning result of professional knowledge, but O2O teaching also significantly enhanced the capabilities of the students. Furthermore, this study reports the findings from major activities of each ELC stage in O2O classroom practice along with the mapping of on-line learning and off-line training included in the aforementioned stages. Finally, the study provides pedagogical implications and future research directions.

Moms and Media: Exploring the Effects of Online Communication on Infant Feeding Practices.

Science.gov (United States)

McKeever, Robert; McKeever, Brooke W

2017-09-01

Using a survey of mothers with young children (N = 455), this study applies Fishbein and Ajzen's reasoned action approach (RAA) to examine the relationship between online communication and infant feeding practices. Contrary to expectations, attitudes, perceived normative pressure, and perceived behavioral control (PBC) did not fully mediate the relationship between time spent online and behavioral intentions. Our findings indicate a significant, direct, negative association between time spent online and breastfeeding intentions In this article, theoretical and practical implications for health communication are discussed.

Direct access to INIS

International Nuclear Information System (INIS)

Zheludev, I.S.; Romanenko, A.G.

1981-01-01

Librarians, researchers, and information specialists throughout the world now have the opportunity for direct access to coverage of almost 95% of the world's literature dealing with the peaceful uses of atomic energy and nuclear science. This opportunity has been provided by the International Nuclear Information System (INIS) of the IAEA. INIS, with the voluntary collaboration of more than 60 of the Agency's Member States, maintains a comprehensive, computer-resident data-base, containing the bibliographic details plus informative abstracts of the bulk of the world's literature on nuclear science and technology. Since this data-base is growing at a rate of 75,000 items per year, and already contains more than 500,000 items, it is obviously important to be able to search this collection conveniently and efficiently. The usefulness of this ability is enhanced when other data-bases on related subjects are made available on an information network. During the early 1970s, on-line interrogation of large bibliographic data-bases became the accepted method for searching this type of information resource. Direct interaction between the searcher and the data-base provides quick feed-back resulting in improved literature listings for launching research and development projects. On-line access enables organizations which cannot store a large data-base on their own computer to expand the information resources at their command. Because of these advantages, INIS undertook to extend to interested Member States on-line access to its data-base in Vienna

Online grocery retailing: What do consumers think?

DEFF Research Database (Denmark)

Ramus, Kim Bjarne; Nielsen, Niels Asger

2005-01-01

beliefs in predicting internet shopping behavior. Practical implications: The findings could be used to direct attention to consumer beliefs about internet grocery shopping which have the potential of acting as barriers to this line of e-commerce. Originality/value: To shed some light on the role...... Kingdom and three in Denmark, were conducted among consumers with different degrees of experience with internet grocery shopping. This diversification of respondents was chosen to capture a broad range of the consumer beliefs that predict intentions to buy groceries online or not. The TPB framework...... of consumers in an underperforming and understudied branch of internet retailing. Barriers in the consumers' minds to shop for groceries online are identified using an established theoretical framework....

PENYELIDIKAN NIAT PERILAKU PELAJAR SEKOLAH MENENGAH PERTAMA BERKAITAN DENGAN BELANJA ONLINE

Directory of Open Access Journals (Sweden)

Erriska Rahma Putri

2017-10-01

Full Text Available This study is to understand the effect of perceived characteristics, personal innovativeness, and self-efficacy on the intention online shopping. In contrast to previous studies on online shopping, this study refers to the Technology Acceptance Theory that is integrated with the Innovation Diffusion Theory. Respondents of this study are junior high school students in Jakarta. By using the quantitative research methods and convenience methods to collect data, so the respondents as many as 356 students of junior high school have been taken. The data collected were then analyzed by using Structural Equation Modeling by confirmatory factor analyses. Four of the five hypotheses were accepted. This study carried out findings that the TAM can be integrated with the IDT to predict the intentions of online shopping, so the businessman of online shopping can know the direct or indirect effect from the perceived characteristics, self-efficacy, and personal innovativeness to the intention online shopping.

Antecedents to Intention to Engage in the Online Negative Word-of-Mouth Communication

Directory of Open Access Journals (Sweden)

Dien Mardhiyah

2013-06-01

Full Text Available Complaints delivered directly to a firm will not be a problem if they can be handled properly, while the ones that are not disclosed directly to the firm but to a third party or even warnings to others not to use particular products or services, will be negative word-of-mouth communication. It can damage the image of the firm and be very detrimental. The purpose of this study was to analyze the antecedents of intention to engage in negative online word-of-mouth communication that includes dissatisfaction, service importance, success of complaint, complaint benefit, self confidence, altruism, retaliatory intention, and complaint cost. Medical services were selected considering the impact caused by the negligence of the service provider possibly giving rise to negative word-of-mouth communication. The online environment has been considered because of the developments in technology which provide opportunities for consumers to communicate with ach other. In addition, the dissemination of information through online media can spread incredibly widely and rapidly. The samples in this study comprised consumers of medical services who had disappointing experiences in using those services either directly or indirectly. A total of 123 questionnaires were analyzed with multiple regression analysis to test the research hypothesis. The results showed that the factors influencing the intentions behind negative online word-of-mouth communication were success of complaint, altruism, retaliatory intention, and complaint cost.

Online tracking: questioning the power of informed consent

NARCIS (Netherlands)

van Eijk, N.; Helberger, N.; Kool, L.; van der Plas, A.; van der Sloot, B.

2011-01-01

Online tracking technologies have raised considerable concerns regarding privacy and the protection of personal data of users. In order to help users to regain control over their personal data, Europe has amended its ePrivacy directive towards an opt-in regime. There are however many open questions

The limits of market-based reforms in the NHS: the case of alternative providers in primary care.

Science.gov (United States)

Coleman, Anna; Checkland, Kath; McDermott, Imelda; Harrison, Stephen

2013-01-01

Historically, primary medical care in the UK has been delivered by general practitioners who are independent contractors, operating under a contract, which until 2004 was subject to little performance management. In keeping with the wider political impetus to introduce markets and competition into the NHS, reforms were introduced to allow new providers to bid for contracts to provide primary care services in England. These contracts known as 'Alternative Provider Medical Services', were encouraged by two centrally-driven rounds of procurement (2007/8 and 2008/9). This research investigated the commissioning and operation of such Alternative Providers of Primary Care (APPCs). Two qualitative case studies were undertaken in purposively sampled English Primary Care Trusts (PCTs) and their associated APPCs over 14 months (2009-10). We observed 65 hours of meetings, conducted 23 interviews with PCT and practice staff, and gathered relevant associated documentation. We found that the procurement and contracting process was costly and time-consuming. Extensive local consultation was undertaken, and there was considerable opposition in some areas. Many APPCs struggled to build up their patient list sizes, whilst over-performing on walk-in contracts. Contracting for APPCs was 'transactional', in marked contrast to the 'relational' contracting usually found in the NHS, with APPCs subject to tight performance management. These complicated and costly processes contrast to those experienced by traditionally owned GP partnerships. However, managers reported that the perception of competition had led existing practices to improve their services. The Coalition Government elected in 2010 is committed to 'Any Qualified Provider' of secondary care, and some commentators argue that this should also be applied to primary care. Our research suggests that, if this is to happen, a debate is needed about the operation of a market in primary care provision, including the trade-offs between

Expanding Learning Presence to Account for the Direction of Regulative Intent: Self-, Co- and Shared Regulation in Online Learning

Science.gov (United States)

Hayes, Suzanne; Smith, Sedef Uzuner; Shea, Peter

2015-01-01

As the pivotal role of self-regulation has been widely accepted in online learning literature, much interest is focused on identifying pedagogical strategies to help foster regulatory behaviors in online learners. The authors of this article argue that the learning presence (LP) construct, a recently proposed addition to the Community of Inquiry…

NHS-based Tandem Mass Tagging of Proteins at the Level of Whole Cells: A Critical Evaluation in Comparison to Conventional TMT-Labeling Approaches for Quantitative Proteome Analysis.

Science.gov (United States)

Megger, Dominik A; Pott, Leona L; Rosowski, Kristin; Zülch, Birgit; Tautges, Stephanie; Bracht, Thilo; Sitek, Barbara

2017-01-01

Tandem mass tags (TMT) are usually introduced at the levels of isolated proteins or peptides. Here, for the first time, we report the labeling of whole cells and a critical evaluation of its performance in comparison to conventional labeling approaches. The obtained results indicated that TMT protein labeling using intact cells is generally possible, if it is coupled to a subsequent enrichment using anti-TMT antibody. The quantitative results were similar to those obtained after labeling of isolated proteins and both were found to be slightly complementary to peptide labeling. Furthermore, when using NHS-based TMT, no specificity towards cell surface proteins was observed in the case of cell labeling. In summary, the conducted study revealed first evidence for the general possibility of TMT cell labeling and highlighted limitations of NHS-based labeling reagents. Future studies should therefore focus on the synthesis and investigation of membrane impermeable TMTs to increase specificity towards cell surface proteins.

Using alternative or direct anthropometric measurements to assess risk for malnutrition in nursing homes.

Science.gov (United States)

Lorini, Chiara; Collini, Francesca; Castagnoli, Mariangela; Di Bari, Mauro; Cavallini, Maria Chiara; Zaffarana, Nicoletta; Pepe, Pasquale; Lucenteforte, Ersilia; Vannacci, Alfredo; Bonaccorsi, Guglielmo

2014-10-01

The aim of this study was to use the Malnutrition Universal Screening Tool (MUST) to assess the applicability of alternative versus direct anthropometric measurements for evaluating the risk for malnutrition in older individuals living in nursing homes (NHs). We conducted a cross-sectional survey in 67 NHs in Tuscany, Italy. We measured the weight, standing height (SH), knee height (KH), ulna length (UL), and middle-upper-arm circumference of 641 NH residents. Correlations between the different methods for calculating body mass index (BMI; using direct or alternative measurements) were evaluated by the intraclass correlation coefficient and the Bland-Altman method; agreement in the allocation of participants to the same risk category was assessed by squared weighted kappa statistic and indicators of internal relative validity. The intraclass correlation coefficient for BMI calculated using KH was 0.839 (0.815-0.861), whereas those calculated by UL were 0.890 (0.872-0.905). The limits of agreement were ±6.13 kg/m(2) using KH and ±4.66 kg/m(2) using UL. For BMI calculated using SH, 79.9% of the patients were at low risk, 8.1% at medium risk, and 12.2% at high risk for malnutrition. The agreement between this classification and that obtained using BMI calculated by alternative measurements was "fair-good." When it is not possible to determine risk category by using SH, we suggest using the alternative measurements (primarily UL, due to its highest sensitivity) to predict the height and to compare these evaluations with those obtained by using middle-upper-arm-circumference to predict the BMI. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

Online variational Bayesian filtering-based mobile target tracking in wireless sensor networks.

Science.gov (United States)

Zhou, Bingpeng; Chen, Qingchun; Li, Tiffany Jing; Xiao, Pei

2014-11-11

The received signal strength (RSS)-based online tracking for a mobile node in wireless sensor networks (WSNs) is investigated in this paper. Firstly, a multi-layer dynamic Bayesian network (MDBN) is introduced to characterize the target mobility with either directional or undirected movement. In particular, it is proposed to employ the Wishart distribution to approximate the time-varying RSS measurement precision's randomness due to the target movement. It is shown that the proposed MDBN offers a more general analysis model via incorporating the underlying statistical information of both the target movement and observations, which can be utilized to improve the online tracking capability by exploiting the Bayesian statistics. Secondly, based on the MDBN model, a mean-field variational Bayesian filtering (VBF) algorithm is developed to realize the online tracking of a mobile target in the presence of nonlinear observations and time-varying RSS precision, wherein the traditional Bayesian filtering scheme cannot be directly employed. Thirdly, a joint optimization between the real-time velocity and its prior expectation is proposed to enable online velocity tracking in the proposed online tacking scheme. Finally, the associated Bayesian Cramer-Rao Lower Bound (BCRLB) analysis and numerical simulations are conducted. Our analysis unveils that, by exploiting the potential state information via the general MDBN model, the proposed VBF algorithm provides a promising solution to the online tracking of a mobile node in WSNs. In addition, it is shown that the final tracking accuracy linearly scales with its expectation when the RSS measurement precision is time-varying.

INTEGRATING VISUALIZATION AND MULTI-ATTRIBUTE UTILITY THEORY FOR ONLINE PRODUCT SELECTION

OpenAIRE

CHUREE THEETRANONT; PETER HADDAWY; DONYAPRUETH KRAIRIT

2007-01-01

Effectively selling products online is a challenging task. Today's product domains often contain a dizzying variety of brands and models with highly complex sets of characteristics. This paper addresses the problem of supporting product search and selection in domains containing large numbers of alternatives with complex sets of features. A number of online shopping websites provide product choice assistance by making direct use of Multi-Attribute Utility Theory (MAUT). While the MAUT approac...

Direct Marketing Communication at SEAL Communication Company

OpenAIRE

Wachtler, Kamilla Dóra

2010-01-01

The appearance of the Internet and new, rapidly changing emerging online technologies have led to some fundamental changes in marketing -- especially direct marketing. Besides the growing popularity of the Internet, the appearance of databases and one-to-one marketing are challenging traditional marketing methods. This thesis attempts to illustrate how direct marketing techniques can be implemented in an IT company. It starts with an overview of the concepts of direct marketing and its techni...

Pengaruh Shopping Orientation, Online Trust Dan Prior Online Purchase Experience Terhadap Online Purchase Intention (Studi Pada Online Shop Hijabi House)

OpenAIRE

Azifah, Nurul; Dewi, Citra Kusuma

2016-01-01

Salah satu fashion yang semakin berkembang di kalangan masyarakat Indonesia khususnya wanita muslimah adalah jilbab. Hijabi House merupakan salah satu online shop yang menawarkan jilbab hasil produksinya melalui media sosial Instagram. Hasil wawancara awal, Hijabi House dinilai baik namun masih ada keluhan dari para followers berkaitan shopping orientation, online trust, dan prior online purchase experience. Penelitian yang bertujuan untuk mengetahui pengaruh ketiga variabel tersebut terhadap...

Crowdsourced Curriculum Development for Online Medical Education.

Science.gov (United States)

Shappell, Eric; Chan, Teresa M; Thoma, Brent; Trueger, N Seth; Stuntz, Bob; Cooney, Robert; Ahn, James

2017-12-08

In recent years online educational content, efforts at quality appraisal, and integration of online material into institutional teaching initiatives have increased. However, medical education has yet to develop large-scale online learning centers. Crowd-sourced curriculum development may expedite the realization of this potential while providing opportunities for innovation and scholarship. This article describes the current landscape, best practices, and future directions for crowdsourced curriculum development using Kern's framework for curriculum development and the example topic of core content in emergency medicine. A scoping review of online educational content was performed by a panel of subject area experts for each step in Kern's framework. Best practices and recommendations for future development for each step were established by the same panel using a modified nominal group consensus process. The most prevalent curriculum design steps were (1) educational content and (2) needs assessments. Identified areas of potential innovation within these steps included targeting gaps in specific content areas and developing underrepresented instructional methods. Steps in curriculum development without significant representation included (1) articulation of goals and objectives and (2) tools for curricular evaluation. By leveraging the power of the community, crowd-sourced curriculum development offers a mechanism to diffuse the burden associated with creating comprehensive online learning centers. There is fertile ground for innovation and scholarship in each step along the continuum of curriculum development. Realization of this paradigm's full potential will require individual developers to strongly consider how their contributions will align with the work of others.

Determinants of Customer Continuance Intention of Online Shopping

Directory of Open Access Journals (Sweden)

Al-maghrabi, T.

2011-01-01

Full Text Available The purpose of this study is to clarify theory and identify factors that could explain the level of continuance intention of e-shopping. A revised technology acceptance model integrates expectation confirmation theory and investigates effects of age differences. An online survey of internet shoppers in Saudi Arabia. Structural equation modelling and invariance analysis confirm model fit. The findings confirm that perceived usefulness, enjoyment and social pressure are determinants of e-shopping continuance. The structural weights are mostly equivalent between young and old but the regression path from perceived usefulness to social pressure is stronger for younger respondents. This research moves beyond e-shopping intentions to factors affecting e-shopping continuance, explaining 55% of intention to continue shopping online. Online strategies cannot ignore direct and indirect effects on continuance intentions. The findings contribute to literature on internet shopping and continuance intentions in the context of Saudi Arabia.

An on-line monitoring system for navigation equipment

Science.gov (United States)

Wang, Bo; Yang, Ping; Liu, Jing; Yang, Zhengbo; Liang, Fei

2017-10-01

Civil air navigation equipment is the most important infrastructure of Civil Aviation, which is closely related to flight safety. In addition to regular flight inspection, navigation equipment's patrol measuring, maintenance measuring, running measuring under special weather conditions are the important means of ensuring aviation flight safety. According to the safety maintenance requirements of Civil Aviation Air Traffic Control navigation equipment, this paper developed one on-line monitoring system with independent intellectual property rights for navigation equipment, the system breakthroughs the key technologies of measuring navigation equipment on-line including Instrument Landing System (ILS) and VHF Omni-directional Range (VOR), which also meets the requirements of navigation equipment ground measurement set by the ICAO DOC 8071, it provides technical means of the ground on-line measurement for navigation equipment, improves the safety of navigation equipment operation, and reduces the impact of measuring navigation equipment on airport operation.

Online Educators' Recommendations for Teaching Online: Crowdsourcing in Action

Science.gov (United States)

Dunlap, Joanna C.; Lowenthal, Patrick R.

2018-01-01

Over the years, online educators have learned a great deal about what works and does not work when designing and facilitating online courses. During the past few years, we have used crowdsourcing to invite experienced online educators to share their recommendations for teaching online. In this article, we describe our use of crowdsourcing to…

BENEFITS AND DRAWBACKS OF ONLINE TRADING VERSUS TRADITIONAL TRADING. EDUCATIONAL FACTORS IN ONLINE TRADING

Directory of Open Access Journals (Sweden)

Petric (Iancu Ioana Ancuta

2015-07-01

Full Text Available In terms of marketing, online trading is a new distribution channel and trading platforms are products of Investment and Financial Services Companies. Internet shortens the connection between the investor and the products they wish to purchase (shares, futures, CFDs, government securities, bonds, etc., and in some cases it no longer needs a security broker. Increasing use of the Internet and increasing competitiveness between Investment and Financial Services Companies do the latter, to seek new distribution channels to specific products. The purpose of this paper is to examine to what extent the investor education level affects the decision to move from traditional trading to online trading and the benefits and disadvantages of these types of transactions. To whom should the Investment and Financial Services Companies guide their marketing campaign to attract more investors for online platforms? The work presented is part of a larger project that will be part of author thesis, studying other factors that influence the decision to move from traditional to online trading: cost factor, time factor, psychological and social attributes of investors, yield portfolios and technological capacities of Investment and Financial Services Companies. Starting from the idea that with the increase of experience in stock investments the investors will want to make their own decisions, Investment and Financial Services Companies should provide new products. Compared to competitors, an Investment and Financial Services Company must innovate, and information technology currently offers the tools for innovation facilities. At the same time, the existence and development of the Internet has made the transaction without assistance or with minimal human intervention possible (Voss, 2000. The difference is in the knowledge about stock market, the speed the transaction orders arrive in the stock market, direct access to multiple markets, transaction costs and the level

New composite materials prepared by calcium phosphate precipitation in chitosan/collagen/hyaluronic acid sponge cross-linked by EDC/NHS.

Science.gov (United States)

Kaczmarek, B; Sionkowska, A; Kozlowska, J; Osyczka, A M

2018-02-01

Nowadays, fabrication of composite materials based on biopolymers is a rising field due to potential for bone repair and tissue engineering application. Blending of different biopolymers and incorporation of inorganic particles in the blend can lead to new materials with improved physicochemical properties and biocompatibility. In this work 3D porous structures called scaffolds based on chitosan, collagen and hyaluronic acid were obtained through the lyophilization process. Scaffolds were cross-linked by EDC/NHS. Infrared spectra for the materials were made, the percentage of swelling, scaffolds porosity and density, mechanical parameters, thermal stability were studied. Moreover, the scaffolds were used as matrixes for the calcium phosphate in situ precipitation. SEM images were taken and EDX analysis was carried out for calcium and phosphorous content determination in the scaffold. In addition, the adhesion and proliferation of human osteosarcoma SaOS-2 cells was examined on obtained scaffolds. The results showed that the properties of 3D composites cross-linked by EDC/NHS were altered after the addition of 1, 2 and 5% hyaluronic acid. Mechanical parameters, thermal stability and porosity of scaffolds were improved. Moreover, calcium and phosphorous were found in each kind of scaffold. SEM images showed that the precipitation was homogeneously carried in the whole volume of samples. Attachment of SaOS-2 cells to all modified materials was better compared to unmodified control and proliferation of these cells was markedly increased on scaffolds with precipitated calcium phosphate. Obtained materials can provide the support useful in tissue engineering and regenerative medicine. Copyright © 2017 Elsevier B.V. All rights reserved.

Euroscepticism Online

DEFF Research Database (Denmark)

Dutceac Segesten, Anamaria; Bossetta, Michael

The 2014 elections for the European Parliament are likely to result in the highest number of MEPs representing right-wing parties across Europe. The prolonged eurocrisis and its direct, visible effects (e.g. unemployment and poverty) have already polarized the public opinion in many of EU:s membe...... and nationalism as the two poles on a continuum of attitudes coming out of the discourses. We discuss finally the consequences of the expected Swedish-Danish divergence of online debate content for the idea of a unified European public sphere.......The 2014 elections for the European Parliament are likely to result in the highest number of MEPs representing right-wing parties across Europe. The prolonged eurocrisis and its direct, visible effects (e.g. unemployment and poverty) have already polarized the public opinion in many of EU:s member......-criticism between Sweden and Denmark? Methodologically we combine quantitative and qualitative content analysis of the forum discussions pertaining to the EU critique taking place on the two platforms respectively. Our focus is thus not on the republished content originated in traditional media channels...

Private health care expenditure and quality in Beveridge systems: cross-regional differences in the Italian NHS.

Science.gov (United States)

Del Vecchio, Mario; Fenech, Lorenzo; Prenestini, Anna

2015-03-01

Private health care expenditure ranges from 15% to 30% of total healthcare spending in OECD countries. The literature suggests that there should be an inverse correlation between quality of public services and private expenditures. The main objective of this study is to explore the association between quality of public healthcare and private expenditures in the Italian Regional Healthcare Systems (RHSs). The institutional framework offered by the Italian NHS allows to investigate on the differences among the regions while controlling for institutional factors. The study uses micro-data from the ISTAT Household Consumption Survey (HCS) and a rich set of regional quality indicators. The results indicate that there is a positive and significant correlation between quality and private spending per capita across regions. The study also points out the strong association between the distribution of private consumption and income. In order to account for the influence of income, the study segmented data in three socio-economic classes and computed cross-regional correlations of RHSs quality and household healthcare expenditure per capita, within each class. No correlation was found between the two variables. These findings are quite surprising and call into question the theory that better quality of public services crowds out private spending, or, at the very least, it undermines the simplistic notions that higher levels of private spending are a direct consequence of poor quality in the public sector. This suggests that policies should avoid to simplistically link private spending with judgements or assessments about the functioning or efficacy of the public system and its organizations. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Adolescent Eating Disorder Risk and the Online World.

Science.gov (United States)

Saul, Jennifer S; Rodgers, Rachel F

2018-04-01

The proliferation of social media and rapid increase in the use of the Internet by adolescents generates new dynamics and new risks for the development and maintenance of eating disorders. Here, the authors review different types of online content and how they are relevant to eating disorders within different theoretic frameworks, before examining the empirical evidence for the risks posed by online content in the development and maintenance of eating disorders. They describe pro-eating disorder content specifically and examine the research related to it, before considering its implications, and considering directions for future research, and prevention and intervention strategies. Copyright © 2017 Elsevier Inc. All rights reserved.

Future directions and emerging techniques for ISOL systems

International Nuclear Information System (INIS)

Talbert, W.L. Jr.; Bunker, M.E.

1986-01-01

The current status and future promise of ISOL systems are discussed, with emphasis on newly conceived experimental capabilities and interests. In addition to studies of nuclear structure using traditional or new on-line approaches, such as on-line nuclear orientation, the possibilities for studies with accelerated radioactive beams that have direct application to basic problems in materials science and astrophysics as well as to nuclear theory are pointed out. 43 refs., 3 figs., 1 tab

An evaluation on the effectiveness of Web 2.0 Startpages (Netvibes & Pageflakes) within NHS libraries.

Science.gov (United States)

McCormick, Carol; Pickard, Alison Jane

2013-06-01

Carol McCormick was Learning Resources Advisor in the library at James Cook University Hospital, South Teesside when she completed her BSc (Hons) Librarianship (Work Based Learning) degree at Northumbria University. She gained a 1st Class Honours and is now Learning Resources Librarian. Carol's dissertation formed part of a wider action research project into the provision of current awareness services at James Cook University Hospital. This article reports on the evaluation which was conducted after a Web 2.0 Startpage, or portal, had been introduced to improve access to current awareness information for all staff within the Trust. It is the second article in the Dissertations into practice series to examine the use of web-based tools to improve access to information for NHS staff. AM. © 2013 The authors. Health Information and Libraries Journal © 2013 Health Libraries Group.

Impact of Online Shopping on the Purchase Behavior of Consumers in Chennai City

Directory of Open Access Journals (Sweden)

A.VARADARAJ

2016-12-01

Full Text Available Online shopping or e-shopping is a form of electronic commerce which allows consumers to directly buy goods or services from a seller over the Internet using a web browser. The proliferation of online group buying websites is changing marketing strategies and buyers' habits without doubt. The study focuses on the impact of online shopping on the purchase behaviour of consumers in Chennai city. Questionnaire was used to collect the primary data. The sample size of the study was 150 and the sample design adopted was convenience sampling. This paper tried to find out the impact of online market towards purchase behaviour of consumers and gives suggestions to improve the same.

Quality Assurance in Open, Distance and Online Education in ...

African Journals Online (AJOL)

admpather

The current vision and strategic direction of many organisations has raised the importance of ... Keywords: distance education, quality assurance, online learning ... Instead, teachers and students may communicate at times of their own ... initially posing no threat to established institutions, over time challenges conventional.

Understanding the online channel extension of traditional retailers: Online-offline and online-prototypical congruence

Directory of Open Access Journals (Sweden)

Wu Jinfeng

2016-01-01

Full Text Available Many Chinese traditional retailers have turned to the multichannel forms by establishing their own online stores. When doing so, retail managers face a difficult choice between two online marketing orientations: “pursuit of ideal” (i.e. online-prototypical congruence orientation and “retention of tradition” (i.e. online-offline congruence orientation. To help managers make this choice, this study proposes a conceptual framework to illustrate how these two orientations affect retail store attitude when retail brand familiarity differs. The results indicate that both orientations can improve consumers’ retail store attitudes. When retail brand familiarity is low, the online stores of traditional retailers should balance both orientations in product selections and adopt “pursuit of ideal” in prices. When retail brand familiarity is high, “retention of tradition” should be applied in product selections and both orientations should be integrated in prices for gaining more positive change in retail store attitude.

Online Shopping Behavior

OpenAIRE

Shahzad, Hashim

2015-01-01

Online shopping is a very much developed phenomena in Scandinavian countries. Different online factors impact online consumers’ behavior differently depending on the environment of different regions. Sweden is one of the developed and technologically advanced countries. To see the impact of different factors on consumers’ online shopping behavior, the purpose of this study is to analyse the factors that influence consumers’ online shopping behavior in Sweden’s context. One of the objectives o...

Share price trend based on analysis of investor’s online activity

Directory of Open Access Journals (Sweden)

Mihail Dumitru SACALĂ

2011-07-01

Full Text Available The desire of modeling the influence coming from behavioral economics, representing mostly qualitative variables, requires new approaches to quantify this influence. In this paper we present an analytical method for determining the direction of the share future return using an aggregate indicator calculated based exclusively on the trend of registered variables from investor’s online activity. This online activity refers to the number and content of messages posted by investors on shares analysis dedicated web blogs.