A Damascene Conversion:Additional Accommodation Church of St George and St Thomas

Additional Accommodation Church of St George and St Thomas - Critical Appraisal ‘A Damascene Conversion’ by Shane O’Toole in The Sunday Times December 2008.

The use of Ecological and Carbon Footprint Analysis in regional policy making: application and insights using the REAP model

This paper builds on and extends previous research to contribute to ongoing discussion on the use of resource and carbon accounting tools in regional policy making. The Northern Visions project has produced the first evidence-based footpath setting out the actions that need to be taken to achieve the step changes in the Ecological and Carbon Footprint of Northern Ireland. A range of policies and strategies were evaluated using the Resources and Energy Analysis Programme. The analysis provided the first regional evidence base that current sustainable development policy commitments would not lead to the necessary reductions in either the Ecological Footprint or carbon dioxide emissions. Building on previous applications of Ecological Footprint analysis in regional policy making, the research has demonstrated that there is a valuable role for Ecological and Carbon Footprint Analysis in policy appraisal. The use of Ecological and Carbon Footprint Analysis in regional policy making has been evaluated and recommendations made on ongoing methodological development. The authors hope that the research can provide insights for the ongoing use Ecological and Carbon Footprint Analysis in regional policy making and help set out the priorities for research to support this important policy area

The role of regret minimisation in lifestyle choices affecting the risk of coronary heart disease

This paper introduces the discrete choice model-paradigm of Random Regret Minimisation (RRM) to the field of health economics. The RRM is a regret-based model that explores a driver of choice different from the traditional utility-based Random Utility Maximisation (RUM). The RRM approach is based on the idea that, when choosing, individuals aim to minimise their regret–regret being defined as what one experiences when a non-chosen alternative in a choice set performs better than a chosen one in relation to one or more attributes. Analysing data from a discrete choice experiment on diet, physical activity and risk of a fatal heart attack in the next ten years administered to a sample of the Northern Ireland population, we find that the combined use of RUM and RRM models offer additional information, providing useful behavioural insights for better informed policy appraisal.

A controlled trial of early interventions to promote maternal adjustment and development in infants born with severe congenital heart disease

Background: Congenital heart disease can have a negative impact on both infant development and maternal adjustment. This study considered the impact of a new programme of early psychosocial interventions on such outcomes, following the birth of a child with severe congenital heart disease.
Methods: Seventy infants and their mothers were assigned to an intervention or control group based on order of presentation to the unit. Interventions aimed at bolstering mother–infant transactions, through psychoeducation, parent skills training and narrative therapy techniques were implemented.
Results: Clinically and statistically signi?cant gains were observed at 6-month follow-up on the mental (but not the psychomotor) scale of the Bayleys-II. Positive gains were also manifested on feeding practices, maternal anxiety, worry and appraisal of their situation.
Conclusions: A programme of generalizable psychosocial interventions is shown to have a positive impact on the infant with severe congenital heart disease and the mother.

How young people cope with chronic kidney disease:Literature review

Background: Chronic kidney disease (CKD) is a complex, long-term condition occurring in all age groups. It has been reported that the incidence of renal replacement therapy in young people is 7-8 per million population. Notwithstanding those individuals who may receive a donor kidney, many individuals may be disenfranchised by perceptions of helplessness and feelings of powerlessness against a backdrop of diminished health outlook, consequently impacting on capacity for effective coping. Aim: The aim of this review is to explore how young people cope with CKD. Methods: Three hundred and thirty-seven abstracts were identified. Sixty-three papers were cross-examined using a Critical Appraisal Skills Checklist Tool. Results: Young people face various demands; these may be episodic or ongoing, depending on health and circumstance. The themes this review uncovers are: 'Lack of a Coping Definition'; 'Coping Strategies in Young People'; and 'Barriers to the Understanding of Coping in Young People'. Conclusion: More qualitative research is vital to retrieve 'real-life' perceptions from young people coping with kidney disease to identify how care should be made more explicit for them. © 2012 European Dialysis and Transplant Nurses Association/European Renal Care Association.

An Investigation towards colossal success of Larsen and Toubro Limited: Human resource management perspective

Larsen and Toubro (L&T) Limited is India’s largest construction conglomerate. L&T’s expertise is harnessed to execute high value projects that demand adherence to stringent timelines in a scenario where disparate disciplines of engineering are required to be coordinated on a critical path. However, no company can acquire such a feat without systematic management of its human resource. An investigation on the human resource management practices in orienting L&T’s success can help to identify some of the ethical human resource practices, especially in the context of Indian market. Accordingly, a well-designed employee satisfaction survey was conducted for assessment of the HRM practices being followed in L&T. Unlike other companies, L&T aims to meet the long-term needs of its employees rather than short-term needs. There were however few areas of concerns, such as yearly appraisal system and equality to treat the employees. It is postulated that the inequality to treat the male and female employees is primarily a typical stereotype due to the fact that construction is conventionally believed to be a male dominant activity. A periodic survey intended to provide 360° feedback system can help to avoid such irregularities. This study is thus expected to provide healthy practices of HRM to nurture the young talents of India. This may help them to evaluate their decisions by analyzing the complex relationship between HRM practices and output of an organization.

A systematic review evaluating the impact of online or blended learning vs. face-to-face learning of clinical skills in undergraduate nurse education.

Aim: To determine whether the use of an online or blended learning paradigm has the potential to enhance the teaching of clinical skills in undergraduate nursing.

Background: The need to adequately support and develop students in clinical skills is now arguably more important than previously considered due to reductions in practice opportunities. Online and blended teaching methods are being developed to try and meet this requirement, but knowledge about their effectiveness in teaching clinical skills is limited.

Design: Mixed methods systematic review, which follows the Joanna Briggs Institute User guide version 5.

Data Sources: Computerized searches of five databases were undertaken for the period 1995-August 2013.

Review Methods: Critical appraisal and data extraction were undertaken using Joanna Briggs Institute tools for experimental/observational studies and interpretative and critical research. A narrative synthesis was used to report results.

Results: Nineteen published papers were identified. Seventeen papers reported on online approaches and only two papers reported on a blended approach. The synthesis of findings focused on the following four areas: performance/clinical skill, knowledge, self-efficacy/clinical confidence and user experience/satisfaction. The e-learning interventions used varied throughout all the studies.

Conclusion: The available evidence suggests that online learning for teaching clinical skills is no less effective than traditional means. Highlighted by this review is the lack of available evidence on the implementation of a blended learning approach to teaching clinical skills in undergraduate nurse education. Further research is required to assess the effectiveness of this teaching methodology.

Treatments for macular oedema following central retinal vein occlusion: systematic review

Objectives: To review systematically the randomised controlled trial (RCT) evidence for treatment of macular oedema due to central retinal vein occlusion (CRVO).

Data sources: MEDLINE, EMBASE, CDSR, DARE, HTA, NHSEED, CENTRAL and meeting abstracts (January 2005 to March 2013).

Study eligibility criteria, participants and interventions: RCTs with at least 12 months of follow-up assessing pharmacological treatments for CRVO were included with no language restrictions.

Study appraisal and synthesis methods: 2 authors screened titles and abstracts and conducted data extracted and Cochrane risk of bias assessment. Meta-analysis was not possible due to lack of comparable studies.

Results: 8 studies (35 articles, 1714 eyes) were included, assessing aflibercept (n=2), triamcinolone (n=2), bevacizumab (n=1), pegaptanib (n=1), dexamethasone (n=1) and ranibizumab (n=1). In general, bevacizumab, ranibizumab, aflibercept and triamcinolone resulted in clinically significant increases in the proportion of participants with an improvement in visual acuity of ≥15 letters, with 40–60% gaining ≥15 letters on active drugs, compared to 12–28% with sham. Results for pegaptanib and dexamethasone were mixed. Steroids were associated with cataract formation and increased intraocular pressure. No overall increase in adverse events was found with bevacizumab, ranibizumab, aflibercept or pegaptanib compared with control. Quality of life was poorly reported. All studies had a low or unclear risk of bias.

Limitations: All studies evaluated a relatively short primary follow-up (1 year or less). Most had an unmasked extension phase. There was no head-to-head evidence. The majority of participants included had non-ischaemic CRVO.

Conclusions and implications of key findings: Bevacizumab, ranibizumab, aflibercept and triamcinolone appear to be effective in treating macular oedema secondary to CRVO. Long-term data on effectiveness and safety are needed. Head-to-head trials and research to identify ‘responders’ is needed to help clinicians make the right choices for their patients. Research aimed to improve sight in people with ischaemic CRVO is required.

What Are the Effects of Teaching Evidence-Based Health Care (EBHC)? Overview of Systematic Reviews

Background

An evidence-based approach to health care is recognized internationally as a key competency for healthcare practitioners. This overview systematically evaluated and organized evidence from systematic reviews on teaching evidence-based health care (EBHC).

Methods/Findings

We searched for systematic reviews evaluating interventions for teaching EBHC to health professionals compared to no intervention or different strategies. Outcomes covered EBHC knowledge, skills, attitudes, practices and health outcomes. Comprehensive searches were conducted in April 2013. Two reviewers independently selected eligible reviews, extracted data and evaluated methodological quality. We included 16 systematic reviews, published between 1993 and 2013. There was considerable overlap across reviews. We found that 171 source studies included in the reviews related to 81 separate studies, of which 37 are in more than one review. Studies used various methodologies to evaluate educational interventions of varying content, format and duration in undergraduates, interns, residents and practicing health professionals. The evidence in the reviews showed that multifaceted, clinically integrated interventions, with assessment, led to improvements in knowledge, skills and attitudes. Interventions improved critical appraisal skills and integration of results into decisions, and improved knowledge, skills, attitudes and behaviour amongst practicing health professionals. Considering single interventions, EBHC knowledge and attitude were similar for lecture-based versus online teaching. Journal clubs appeared to increase clinical epidemiology and biostatistics knowledge and reading behavior, but not appraisal skills. EBHC courses improved appraisal skills and knowledge. Amongst practicing health professionals, interactive online courses with guided critical appraisal showed significant increase in knowledge and appraisal skills. A short workshop using problem-based approaches, compared to no intervention, increased knowledge but not appraisal skills.

Conclusions

EBHC teaching and learning strategies should focus on implementing multifaceted, clinically integrated approaches with assessment. Future rigorous research should evaluate minimum components for multifaceted interventions, assessment of medium to long-term outcomes, and implementation of these interventions.

Productive Synergies in the City

The chapter focuses on the development of sustainable growing infrastructure in the city at two scales. Firstly the development of a large-scale city wide fuel productive landscape through the development of algae arrays in Liverpool and their connection through urban agriculture systems to develop a closed-cycle food and energy system where waste is food and secondly a hyper-localised neighbourhood food production system in Salford UK that utilises a closed cycle aquaponic system to re-invigorate an urban food desert.

The author develops a three-part model for the implementation of urban agriculture based on hardware (the technological system), software (the biological components) and interface (the links to food and other social networks). The conclusion being that it is possible to develop urban agriculture in cities if their implementation is seen as a process, rather than a static design. Also that as the benefits of such systems are wider than purely the physical outputs of the system in terms of energy and food, and thus we should re-evaluate the purely economic model of appraisal to include these.

European Economic and Social Constitutionalism after the Treaty of Lisbon

European studies frequently regard the economic and social dimensions of EU integration as diametrically opposed, maintaining that this state of affairs is beyond change. This edited collection challenges this perceived wisdom, focusing on the post-Lisbon constitutional landscape. Taking the multi-layered polity that is Europe today as its central organising theme, it examines how the social and the economic might be reconciled under the Union's different forms of governance. The collection has a clear structure, opening with a theoretical appraisal of its theme, before considering three specific policy fields: migration policy and civic integration, company law and corporate social responsibility and the role of third sector providers in public healthcare. It concludes with three case studies in these fields, illustrating how the argument can be practically applied. Insightful and topical, with a unique interdisciplinary perspective, this is an important contribution to European Union law after the Lisbon Treaty

Prefab (and preserve): An investigation of retrofitting for Belfast's Victorian terraced social housing

This paper investigates the potential for the reuse of Belfast's existing Victorian terraced housing. The aim is to study methods behind retrofitting these unique pieces of architectural heritage, bringing them up to modern day standards with reduced energy costs and CO2 emissions in line with the Climate Change Act of 2008 (‘the Act’). It also highlights the characteristics of sustainable retrofitting examples and original prefabricated element, which enable the 19th-century properties to be re-adapted to suit modern day needs. The analysis builds on a report by Mark Hines Architects, in association with SAVE Britain's Heritage,1 in which the company explains the detrimental effect that the ‘Pathfinder’ scheme has had on English cities. Similarly, in Belfast, redevelopment schemes such as that in the ‘Village’ district have intended to replace undervalued terraced housing stock, and search for more sustainable options to retain these homes along with with the embodied energy and traditions attached to them.

Diagnosis and management of hyponatraemia: AGREEing the guidelines

Hyponatraemia is a common electrolyte disorder associated with significant complications and controversies regarding its optimal management. Clinical practice guidelines and consensus statements have attempted to provide clinicians with evidence-based diagnostic and treatment strategies for hyponatraemia. Recently published guidance documents differ in their methods employed to review the quality of available evidence. Nagler et al. used the Appraisal of Guideline for Research and Evaluation (AGREE II) instrument in a systematic review of guidelines and consensus statements for the diagnosis and management of hyponatraemia. Nagler and colleagues highlighted the variability in methodological rigour applied to guideline development and inconsistencies between publications in relation to management of hyponatraemia (including the recommended rate of correction of a low serum sodium concentration). These differences could cause confusion for practising physicians managing patients with hyponatraemia.

British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus

These guidelines provide a practical and evidence-based resource for the management of patients with Barrett's oesophagus and related early neoplasia. The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument was followed to provide a methodological strategy for the guideline development. A systematic review of the literature was performed for English language articles published up until December 2012 in order to address controversial issues in Barrett's oesophagus including definition, screening and diagnosis, surveillance, pathological grading for dysplasia, management of dysplasia, and early cancer including training requirements. The rigour and quality of the studies was evaluated using the SIGN checklist system. Recommendations on each topic were scored by each author using a five-tier system (A+, strong agreement, to D+, strongly disagree). Statements that failed to reach substantial agreement among authors, defined as >80% agreement (A or A+), were revisited and modified until substantial agreement (>80%) was reached. In formulating these guidelines, we took into consideration benefits and risks for the population and national health system, as well as patient perspectives. For the first time, we have suggested stratification of patients according to their estimated cancer risk based on clinical and histopathological criteria. In order to improve communication between clinicians, we recommend the use of minimum datasets for reporting endoscopic and pathological findings. We advocate endoscopic therapy for high-grade dysplasia and early cancer, which should be performed in high-volume centres. We hope that these guidelines will standardise and improve management for patients with Barrett's oesophagus and related neoplasia.

Investigation into the potential of using micro gas turbines in plug-in hybrid electric vehicles

The transport sector is considered to be one of the most dependent sectors on fossil fuels. Meeting ecological, social and economic demands throughout the sector has got increasingly important in recent times. A passenger vehicle with a more environmentally friendly propulsion system is the hybrid electric vehicle. Combining an internal combustion engine and an electric motor offers the potential to reduce carbon dioxide emissions. The overall objective of this research is to provide an appraisal of the use of a micro gas turbine as the range extender in a plug-in hybrid electric vehicle. In this application, the gas turbine can always operate at its most efficient operating point as its only requirement is to recharge the battery. For this reason, it is highly suitable for this purpose. Gas turbines offer many benefits over traditional internal combustion engines which are traditionally used in this application. They offer a high power-to-weight ratio, multi-fuel capability and relatively low emission levels due to continuous combustion.