Could in-home sensors surpass human observation of people with Parkinson’s at high risk of falling? An ethnographic study

Self-report underpins our understanding of falls among people with Parkinson’s (PwP) as they largely happen unwitnessed at home. In this qualitative study, we used an ethnographic approach to investigate which in-home sensors, in which locations, could gather useful data about fall risk. Over six weeks, we observed five independently mobile PwP at high risk of falling, at home. We made field notes about falls (prior events and concerns) and recorded movement with video, Kinect, and wearable sensors. The three women and two men (aged 71 to 79 years) having moderate or severe Parkinson’s were dependent on others and highly sedentary. We most commonly noted balance protection, loss, and restoration during chair transfers, walks across open spaces and through gaps, turns, steps up and down, and tasks in standing (all evident walking between chair and stairs, e.g.). Our unobtrusive sensors were acceptable to participants: they could detect instability during everyday activity at home and potentially guide intervention. Monitoring the route between chair and stairs is likely to give information without invading the privacy of people at high risk of falling, with very limited mobility, who spend most of the day in their sitting rooms.

Lesbian migrants in the gentrified valley: other 'geographies' of rural gentrification

This paper explores the migration and cultural consumption practices of lesbian households within processes of rural change. Taking forward Phillips' (2004. Progress in Human Geography 28, 5-30) discussion of neglected geographies of rural gentrification, and building upon Halfacree's (2001. International Journal of Population Geography 7, 395-411) critique of dominant conceptualisations of rural in-migrants, the paper presents empirical findings from a qualitative study of lesbian households in Hebden Bridge, West Yorkshire. This follows up an earlier study of rural gentrification (Smith and Phillips, 2001. Journal of Rural Studies 19, 457-469). Lesbian households are shown to be a significant group that socially and culturally (re)produce distinct constructions of rurality, and act as gentrifiers via their migration, residential, and consumption practices. Many parallels to the migration processes of non-lesbian gentrifiers in Hebden Bridge are revealed, with the alternative cultural structures of Hebden Bridge being a key factor. We therefore argue that lesbian households should not be 'othered' within discourses of rural gentrification. The discussion emphasises the value of focussing upon neglected socio-cultural groups in robust ways, in order to shed light on the wider lifestyles and experiences of diverse rural populations, and to deepen understandings of other geographies of rural gentrification. (c) 2005 Elsevier Ltd. All rights reserved.

International construction and Brazilian contractors’ operations

The international construction market is very complex, and requires strong structure and strategy for companies wanting to operate overseas. This article investigates characteristics of international construction. The international operation of Brazilian contractors is explored via results from a qualitative study which was carried out using case studies. The case studies comprised ten big Brazilian contractors, six of which operate abroad. The study identified the patterns of international operation, the competitive advantages of these contractors, as well as the difficulties faced by them in the international construction market. Four of the contractors studied operate only in the domestic market. The study of these cases revealed both obstacles and motivations for future international operations. The study revealed that despite the existing competitive advantages, Brazilian contractors' presence in the international market is limited. The main reason for that is probably their main competitive disadvantage: the lack of financial support from the government.

English-only language-in-education policy in multilingual classrooms in Ghana

This paper, based on the findings of a qualitative study, discusses the influence of Ghana's recently introduced English-only language-in-education policy on pupils' classroom communicative practices and learning generally. It highlights how the use of English- an unfamiliar language- creates anxiety among students and stalls effective classroom participation. The paper first considers the key issues that impinge on the literacy development in multilingual classrooms in postcolonial Africa including the uninformed attitudes towards mother tongue/bilingual education. It then draws on the empirical data from Africa and elsewhere to refute the negative perceptions about mother-tongue education, and examines the prospects for bilingual/mother-tongue education in multilingual classrooms in Ghana.

Protocol for the PINCER trial: a cluster randomised trial comparing the effectiveness of a pharmacist-led IT-based intervention with simple feedback in reducing rates of clinically important errors in medicines management in general practices

Background: Medication errors are an important cause of morbidity and mortality in primary care. The aims of this study are to determine the effectiveness, cost effectiveness and acceptability of a pharmacist-led information-technology-based complex intervention compared with simple feedback in reducing proportions of patients at risk from potentially hazardous prescribing and medicines management in general (family) practice. Methods: Research subject group: "At-risk" patients registered with computerised general practices in two geographical regions in England. Design: Parallel group pragmatic cluster randomised trial. Interventions: Practices will be randomised to either: (i) Computer-generated feedback; or (ii) Pharmacist-led intervention comprising of computer-generated feedback, educational outreach and dedicated support. Primary outcome measures: The proportion of patients in each practice at six and 12 months post intervention: - with a computer-recorded history of peptic ulcer being prescribed non-selective non-steroidal anti-inflammatory drugs - with a computer-recorded diagnosis of asthma being prescribed beta-blockers - aged 75 years and older receiving long-term prescriptions for angiotensin converting enzyme inhibitors or loop diuretics without a recorded assessment of renal function and electrolytes in the preceding 15 months. Secondary outcome measures; These relate to a number of other examples of potentially hazardous prescribing and medicines management. Economic analysis: An economic evaluation will be done of the cost per error avoided, from the perspective of the UK National Health Service (NHS), comparing the pharmacist-led intervention with simple feedback. Qualitative analysis: A qualitative study will be conducted to explore the views and experiences of health care professionals and NHS managers concerning the interventions, and investigate possible reasons why the interventions prove effective, or conversely prove ineffective. Sample size: 34 practices in each of the two treatment arms would provide at least 80% power (two-tailed alpha of 0.05) to demonstrate a 50% reduction in error rates for each of the three primary outcome measures in the pharmacist-led intervention arm compared with a 11% reduction in the simple feedback arm. Discussion: At the time of submission of this article, 72 general practices have been recruited (36 in each arm of the trial) and the interventions have been delivered. Analysis has not yet been undertaken.

Effect of patient age on management decisions in breast cancer: consensus from a national consultation

This qualitative study investigated the attitudes, perceptions, and practices of breast cancer specialists with reference to the effect of patient age on management decisions in breast cancer, and attempted to identify national consensus on this issue. One hundred thirty-three relevant specialists, including 75 surgeons and 43 oncologists, participated in a virtual consultation using e-mailed questionnaires and open-ended discussion documents, culminating in the development of proposed consensus statements sent to participants for validation. A strong consensus was seen in favor of incorporating minimum standards of diagnostic services, treatment, and care for older patients with breast cancer into relevant national guidance, endorsed by professional bodies. Similarly, an overwhelming majority of participants agreed that simple, evidence-based protocols or guidelines on standardizing assessment of biological and chronological age should be produced by the National Institute for Health and Clinical Excellence and the Scottish Medicines Consortium, developed in collaboration with specialist oncogeriatricians, and endorsed by professional bodies. A further recommendation that all breast cancer patient treatment and diagnostic procedures be undertaken in light of up-to-date, relevant scientific data met with majority support. This study was successful in gauging national specialist opinion regarding the effect of patient age on management decisions in breast cancer in the U.K.

Best practice in the training, appointment and remuneration of members of dispute boards for large infrastructure projects

This paper reports part of a qualitative study into evolving practice in the implementation of the Dispute Adjudication Board (DAB) construction dispute resolution technique, a variant of the Dispute Review Board (DRB) concept used in the US and Canada. Data was collected through a focus group interview of 20 highly experienced dispute resolution practitioners from engineering and the law. The group was assembled from members of FIDIC-NET with direct experience of project DABs. The part reported here concerns practice and procedure for establishing DABs. The main findings are that: constitution of the DABs is often delayed because of either project owners' ignorance of the DAB process or deterrence by the cost of the DABs; such owners also tend to insist on appointing DAB members from local engineers and lawyers without sufficient understanding of the DAB process; rates of remuneration of DAB members vary widely; the training provision for DAB membership and advocacy skills is inadequate; the process of selecting candidates for DAB membership and negotiating the tripartite agreement between each member and the contractual parties needs to be navigated with great care to avoid raising ethical problems. The research contribution is threefold. First, it highlights the importance of realistic fees for DAB members within a standard framework in achieving timely establishment of a board that works well as a team. Second, it illustrates the use of qualitative focus group interview to study the impact of new contract terms from multiple stakeholder perspectives. Finally, it identifies areas where further research is needed.

Ethics of care in supporting disabled forced migrants: interactions with professionals and ethical dilemmas in health and social care in the South-East of England

This article explores the interactions between disabled forced migrants with care needs and professionals and the restrictive legal, policy and practice context that health and social care professionals have to confront, based on the findings of a qualitative study with 45 participants in the South-East of England. In-depth interviews were conducted with 15 forced migrants who had diverse impairments and chronic illnesses (8 women and 7 men), 13 family caregivers and 17 support workers and strategic professionals working in social care and the third sector in Slough, Reading and London. The legal status of forced migrants significantly affects their entitlements to health and social care provision, resulting in prolonged periods of destitution for many families. National asylum support policies, difficult working relationships with UK Border Agency, higher eligibility thresholds and reduced social care budgets of local authorities were identified as significant barriers in responding to the support needs of disabled forced migrants and family caregivers. In this context, social workers experienced considerable ethical dilemmas. The research raises profound questions about the potential and limitations of health and social care policies, provision, and practice as means of protection and support in fulfilling the human rights of forced migrants with care needs.

'Mental mobility’ in the digital age: entrepreneurs and the online home-based business

Home-based online business ventures are an increasingly pervasive yet under-researched phenomenon. The experiences and mindset of entrepreneurs setting up and running such enterprises require better understanding. Using data from a qualitative study of 23 online home-based business entrepreneurs, we propose the augmented concept of ‘mental mobility’ to encapsulate how they approach their business activities. Drawing on Howard P. Becker's early theorising of mobility, together with Victor Turner's later notion of liminality, we conceptualise mental mobility as the process through which individuals navigate the liminal spaces between the physical and digital spheres of work and the overlapping home/workplace, enabling them to manipulate and partially reconcile the spatial, temporal and emotional tensions that are present in such work environments. Our research also holds important applications for alternative employment contexts and broader social orderings because of the increasingly pervasive and disruptive influence of technology on experiences of remunerated work.

Stakeholder interpretations of design: Semiotic insights into the briefing process

Briefing phase interactions between clients and designers are recognized as social engagements, characterized by communicative sign use, where conceptual ideas are gradually transformed into potential design solutions. A semiotic analysis of briefing communications between client stakeholders and designers provides evidence of the significance and importance of stakeholder interpretation and understanding of design, empirical data being drawn from a qualitative study of NHS hospital construction projects in the UK. It is contended that stakeholders engage with a project through communicative signs and artefacts of design, referencing personal cognitive knowledge in acts of interpretation that may be different from those of designers and externally appointed client advisers. Such interpretations occur in addition to NHS client and design team efforts to ‘engage’ with and ‘understand’ stakeholders using a variety of methods. Social semiotic theorizations indicate how narrative strategies motivate the formulation of signs and artefacts in briefing work, the role of sign authors and sign readers being elucidated as a result. Findings are contextualized against current understandings of briefing communications and stakeholder management practices, a more socially attuned understanding of briefing countering some of the process-led improvement models that have characterized much of the post-Egan report literature. A stakeholder interpretation model is presented as one potential method to safeguard against unforeseen interpretations occurring, the model aligning with the proposal for a more measured recognition of how designs can trigger interpretations among client stakeholders.

Experiential learning from entrepreneurial failure

This paper examines the phenomenon of 'entrepreneurial failure' from a UK regionally-based qualitative study, being that of explanations for failure provided by entrepreneurial CEOs. This paper contends that there are valuable lessons to be learned, from explanations provided of failure, that may reduce the very high recorded mortality rates of entrepreneurial businesses, in particular that of nascent entrepreneurs. Our intention is to make nascent entrepreneurs and their advisors more aware of the consequences of the likely personal risks they will be assuming, especially before they embark on their new business ventures. This paper focuses strongly on entrepreneurial 'personality characteristics' which can detrimentally influence the quality of decision-making. We provide data of some 'experiential learning from failure' from our case studies, that were compiled from interviews with the former directors, following their completion of the questionnaire survey. We describe 'failed entrepreneurs' who have successfully restarted their businesses as 'phoenix' entrepreneurs.

The use of ICT by adults with learning disabilities in day and residential services

The use of Information and Communication Technology (ICT) by adults with learning disabilities has been positively promoted over the past decade. More recently, policy statements and guidance from the UK government have underlined the importance of ICT for adults with learning disabilities specifically, as well as for the population in general, through the potential it offers for social inclusion. The aim of the present study was to provide a picture of how ICT is currently being used within one organisation providing specialist services for adults with learning disabilities and more specifically to provide a picture of its use in promoting community participation. Nine day and 14 residential services were visited as part of a qualitative study to answer three main questions: What kinds of computer programs are being used? What are they being used for? Does this differ between day and residential services? Computers and digital cameras were used for a wide range of activities and ‘mainstream’ programs were used more widely than those developed for specific user groups. In day services, ICT was often embedded in wider projects and activities, whilst use in houses was based around leisure interests. In both contexts, ICT was being used to facilitate communication, although this was more linked to within-service activities, rather than those external to service provision.

Gender diversity and board performance: women's experiences and perspectives

Despite considerable progress that organizations have made during the past 20 years to increase the representation of women at board level, they still hold few board seats. Drawing on a qualitative study involving 30 companies with women directors in the United Kingdom, the United States, and Ghana, we investigate how the relationship between gender in the boardroom and corporate governance operates. The fi ndings indicate that the presence of a minority of women on the board has an insignifi cant effect on board performance. Yet the chairperson’s role is vital in leading the change for recruiting and evaluating candidates and their commitment to the board with diversity and governance in mind. Our study also sheds light on the multifaceted reasons why women directors appear to be resisting the discourse of gender quotas.

Legal and regulatory barriers to effective public-private partnership governance in Kazakhstan

Purpose – The purpose of this paper is to provide a critical assessment of legal and regulatory impediments to effective governance of public-private partnerships (PPPs) in Kazakhstan. Design/methodology/approach – The qualitative study develops propositions from the PPP literature and then tests them against findings from in-depth interviews. Interviewees have been selected by a purposeful sampling from PPP projects in Kazakhstan as well as from national and regional PPP centres. Findings – The identified barriers to effective PPP management include irregularities in the PPP legal framework, such as lack of legal definition of a PPP and controversy with the government guarantee’s legal status for its long-term payments to partnerships; bureaucratic tariff setting for partnership services; non-existent opportunity for private asset ownership; and excessive government regulation of PPP workers’ wage rates. Practical implications – The partners’ opposing perspectives on a number of PPP issues show that management needs to identify and carefully reconcile stakeholder values in a partnership in order to achieve more effective PPP governance. Practitioners, particularly those in the public agencies, have to be concerned with ways to reduce the government overregulation of the private operators, which is likely to result in greater PPP flexibility in management and, ultimately, higher efficiency in delivering the public services. Originality/value – By elucidating multiple examples of overregulation and PPPs’ inefficiency, the paper demonstrates that the government dominance in PPP management is conceptually inappropriate. Instead, the government should adopt the concept of co-production and manage its relations with the private sector partner in a collaborative fashion.