Intensive case management for severe psychotic illness: is there a general benefit for patients with complex needs? A secondary analysis of the UK700 trial data

The UK700 trial failed to demonstrate an overall benefit of intensive case management (ICM) in patients with severe psychotic illness. This does not discount a benefit for particular subgroups, and evidence of a benefit of ICM for patients of borderline intelligence has been presented. The aim of this study is to investigate whether this effect is part of a general benefit for patients with severe psychosis complicated by additional needs. In the UK700 trial patients with severe psychosis were randomly allocated to ICM or standard case management. For each patient group with complex needs the effect of ICM is compared with that in the rest of the study cohort. Outcome measures are days spent in psychiatric hospital and the admission and discharge rates. ICM may be of benefit to patients with severe psychosis complicated by borderline intelligence or depression, but may cause patients using illicit drugs to spend more time in hospital. There was no convincing evidence of an effect of ICM in a further seven patient groups. ICM is not of general benefit to patients with severe psychosis complicated by additional needs. The benefit of ICM for patients with borderline intelligence is an isolated effect which should be interpreted cautiously until further data are available.

The effect of intensive case management on the relatives of patients with severe mental illness

Objective: Relatives play a vital role in caring for patients with severe mental illness but receive inadequate support from psychiatric services. Evidence suggests that although intensive case management is directed primarily at patients, relatives may benefit a's well. This study examined whether relatives of patients who were receiving intensive case management had more contact with mental health professionals than relatives of patients who were receiving standard case management. It also examined whether relatives of patients receiving intensive case management appraised caregiving less negatively and experienced less psychological distress than relatives of patients receiving standard case management. Methods: The sample was drawn from the pool of patients participating in the UK700 randomized controlled trial of intensive case management. Prospective data on contact between case managers and the relatives of 146 patients were collected over a two-year period. At a two-year follow-up assessment, relatives of 116 patients were. interviewed with the Experience of Caregiving Inventory and the 12-item General Health Questionnaire. Results: Considerably more relatives of patients receiving intensive case management had contact with a case manager during the study period than relatives of patients receiving standard case management (70 percent compared with 45 percent). However, relatives of patients receiving intensive case management did not-appraise caregiving less negatively or experience less psychological distress than relatives of patients who were receiving. standard case management. Conclusions: Reducing case managers' caseloads alone. will not guarantee adequate support for relatives.. Instead, providing more support will need to be an explicit aim, and staff will require specific additional training to achieve it.

Contemporary social variations in household water use, management strategies and awareness under conditions of 'water stress': the case of Greater Amman Jordan

One of the distinctive characteristics of the water supply system of Greater Amman, the capital of Jordan, is that it has been based on a regime of rationing since 1987, with households receiving water once a week for various durations. This reflects the fact that while Amman's recent growth has been phenomenal, Jordan is one of the ten most water-scarce nations on earth. Amman is highly polarised socio-economically, and by means of household surveys conducted in both high- and low-income divisions of the city, the aim has been to provide detailed empirical evidence concerning the storage and use if water, the strategies used by households to manage water and overall satisfactions with water supply issues, looking specifically at issues of social equity. The analysis demonstrates the social costs of water rationing and consequent household management to be high, as well as emphasising that issues of water quality are of central importance to all consumers.

Private industrial project management: a systems-based case study

The technique of linear responsibility analysis is used for a retrospective case study of a private industrial development consisting of an extension to existing buildings to provide a warehouse, services block and packing line. The organizational structure adopted on the project is analysed using concepts from systems theory which are included in Walker's theoretical model of the structure of building project organizations (Walker, 1981). This model proposes that the process of building provision can be viewed as systems and subsystems which are differentiated from each other at decision points. Further to this, the subsystems can be viewed as the interaction of managing system and operating system. Using Walker's model, a systematic analysis of the relationships between the contributors gives a quantitative assessment of the efficacy of the organizational structure used. The causes of the client's dissatisfaction with the outcome of the project were lack of integration and complexity of the managing system. However, there was a high level of satisfaction with the completed project and this is reflected by the way in which the organization structure corresponded to the model's propositions.

An analysis of the management of a public sector project: a systems-based case study

The management of a public sector project is analysed using a model developed from systems theory. Linear responsibility analysis is used to identify the primary and key decision structure of the project and to generate quantitative data regarding differentiation and integration of the operating system, the managing system and the client/project team. The environmental context of the project is identified. Conclusions are drawn regarding the project organization structure's ability to cope with the prevailing environmental conditions. It is found that the complexity of the managing system imposed on the project was unable to achieve this and created serious deficiencies in the outcome of the project.

A data collection case study supporting requirements oriented prediction and management in software developments

Consider the statement "this project should cost X and has risk of Y". Such statements are used daily in industry as the basis for making decisions. The work reported here is part of a study aimed at providing a rational and pragmatic basis for such statements. Of particular interest are predictions made in the requirements and early phases of projects. A preliminary model has been constructed using Bayesian Belief Networks and in support of this, a programme to collect and study data during the execution of various software development projects commenced in May 2002. The data collection programme is undertaken under the constraints of a commercial industrial regime of multiple concurrent small to medium scale software development projects. Guided by pragmatism, the work is predicated on the use of data that can be collected readily by project managers; including expert judgements, effort, elapsed times and metrics collected within each project.

Participatory Farm Management methods for assessing the suitability of potential innovations. A case study on green manuring options for tomato producers in Ghana

This paper examines the potential of using Participatory Farm Management methods to examine the suitability of a technology with farmers prior to on-farm trials. A study examining the suitability of green manuring as a technology for use with wet season tomato producers in Ghana is described. Findings from this case-study demonstrate that Participatory Budgeting can be used by farmers and researchers to analyse current cultivation practices, identify the options for including green manures into the system and explore the direct and wider resource implications of the technology. Scored-Causal Diagrams can be used to identify farmers' perceptions of the relative importance of the problem that the technology seeks to address. The use of the methods in this examine evaluation process appears to have the potential to improve the effectiveness and efficiency of the adaptive research process. This ensures that technologies subsequently examined in trials ate relevant to farmers' interests, existing systems and resources, thereby increasing the chances of farmer adoption. It is concluded that this process has potential for use-with other technologies and in other farming systems. (C) 2002 Elsevier Science Ltd. All rights reserved.

The economic dimensions of integrating flood management and agri-environment through washland creation: a case from Somerset, England

In many river floodplains in the UK, there has been a long history of flood defence, land reclamation and water regime management for farming. In recent years, however, changing European and national policies with respect to farming, environment and flood management are encouraging a re-appraisal of land use in rural areas. In particular, there is scope to develop, through the use of appropriate promotional mechanisms, washland areas, which will simultaneously accommodate winter inundation, support extensive farming methods, deliver environmental benefits, and do this in a way which can underpin the rural economy. This paper explores the likely economic impacts of the development of flood storage and washland creation. In doing so, consideration is given to feasibility of this type of development, the environmental implications for a variety of habitats and species, and the financial and institutional mechanisms required to achieve implementation. (C) 2007 Elsevier Ltd. All rights reserved.

Investigating the effects of predator removal and habitat management on nest success and breeding population size of a farmland passerine: a case study

Passerines are especially vulnerable to predation at the pre-independence stage. Although the role of nest success in British farmland passerine declines is contentious, improvement in nest success through sympathetic management could play a role in their reversal. Because habitat is known to interact with predation, management options for mitigation will need to consider effects of nest predation. We present results from an observational study of a population of Common Blackbird Turdus merula on a farm which has experienced a range of agri-environment and game-management options, including a period with nest predator control, as a case study to address some of these issues. We used an information theoretic model comparison procedure to look for evidence of interactions between habitat and nest predation, and then asked whether habitat management and nest predator abundances could explain population trends at the site through their effects on nest success. Interactions were detected between measures of predator abundance and habitat variables, and these varied with nest stage - habitat within the vicinity of the nest appeared to be important at the egg stage, and nest-placement characteristics were important at the nestling stage. Although predator control appeared to have a positive influence on Blackbird breeding population size, the non-experimental set-up meant we could not eliminate other potential explanations. Variation in breeding population size did not appear to be influenced by variation in nest success alone. Our study demonstrates that observational data can only go so far in detection of such effects, and we discuss how it might be taken further. Agri-environment and game-management techniques are likely to influence nest predation pressure on farmland passerines, but the patterns, mechanisms and importance to population processes remain not wholly understood.

Investigating the effects of predator removal and habitat management on nest success and breeding population size of a farmland passerine: a case study

Passerines are especially vulnerable to predation at the pre-independence stage. Although the role of nest success in British farmland passerine declines is contentious, improvement in nest success through sympathetic management could play a role in their reversal. Because habitat is known to interact with predation, management options for mitigation will need to consider effects of nest predation. We present results from an observational study of a population of Common Blackbird Turdus merula on a farm which has experienced a range of agri-environment and game-management options, including a period with nest predator control, as a case study to address some of these issues. We used an information theoretic model comparison procedure to look for evidence of interactions between habitat and nest predation, and then asked whether habitat management and nest predator abundances could explain population trends at the site through their effects on nest success. Interactions were detected between measures of predator abundance and habitat variables, and these varied with nest stage - habitat within the vicinity of the nest appeared to be important at the egg stage, and nest-placement characteristics were important at the nestling stage. Although predator control appeared to have a positive influence on Blackbird breeding population size, the non-experimental set-up meant we could not eliminate other potential explanations. Variation in breeding population size did not appear to be influenced by variation in nest success alone. Our study demonstrates that observational data can only go so far in detection of such effects, and we discuss how it might be taken further. Agri-environment and game-management techniques are likely to influence nest predation pressure on farmland passerines, but the patterns, mechanisms and importance to population processes remain not wholly understood.

Challenges of linking scientific knowledge to river basin management policy: AquaTerra as a case study

The EU Project AquaTerra generates knowledge about the river-soil-sediment-groundwater system and delivers scientific information of value for river basin management. In this article, the use and ignorance of scientific knowledge in decision making is explored by a theoretical review. We elaborate on the 'two-communities theory', which explains the problems of the policy-science interface by relating and comparing the different cultures, contexts, and languages of researchers and policy makers. Within AquaTerra, the EUPOL subproject examines the policy-science interface with the aim of achieving a good connection between the scientific output of the project and EU policies. We have found two major barriers, namely language and resources, as well as two types of relevant relationships: those between different research communities and those between researchers and policy makers. (c) 2007 Elsevier Ltd. All rights reserved.