Putting policy initiatives into practice:adopting an “honest broker” approach to adapting small businesses against flooding

Purpose: Amidst the current economic climate, which places many constraints on expensive flood defence schemes, the policy makers tend to favour schemes that are sympathetic to the needs of small and medium-sized enterprises (SMEs) and which promote empowering local communities based on their individual local contexts. Research has shown that although several initiatives are in place to create behavioural change among SMEs in undertaking adaptation approaches against flooding, they often tend to delay their responses by means of a "wait and see" attitude. The paper aims to discuss these issues. Design/methodology/approach: This paper argues that unless there are conscious efforts in the policy-making community to undertake explicit measures to engage with SMEs in a collaborative way, the uptake of adaptation measures will not be achieved as intended. With the use of the "honest broker" approach the paper provides a conceptual way forward of how a sense of collaboration can be instigated in an engagement process between the policy makers and SMEs, so that the scientific knowledge is translated in an appropriately rational way, which best meets the expectations of the SMEs. Findings: The paper proposes a conceptual model for engaging SMEs that will potentially increase the uptake of flood adaptation measures by SMEs. This could be a useful model with which to kick start a collaborative engagement process that could escalate to wider participation in other areas to improve impact of policy initiatives. Originality/value: The paper lays the conceptual foundation for a new theoretical base in the area, which will encourage more empirical investigations that will potentially enhance the practicality of some of the existing policies. © Emerald Group Publishing Limited.

Aspects of 350 ºC (500 ºF) embrittlement in a CrMoV steel

A study has been made of the fracture modes associated with toughness minima, observed in notched impact tests at 173K, for a weldable CrMoV steel, quenched from different austenitising temperatures, and tempered in the range 300-900K. The fracture mode at 623K varied from 100% transgranular cleavage for an austenitising temperature of 1523K. The results are discussed in terms of mechanisms for 350 ºC embrittlement, such mechanisms require modification to allow for the difficulty of dissolving alloy carbides at low austenitising temperatures.

Pathway to clozapine use:a comparison between a patient cohort from New Zealand and a cohort from the United Kingdom

Background and Objective: Clozapine has been available since the early 1990s. Studies continue to demonstrate its superior efficacy in treatment-resistant schizophrenia. Despite this, numerous studies show under-utilisation, delayed access and reluctance by psychiatrists to prescribe clozapine. This retrospective cross-sectional study compared the prescribing of clozapine in two adult cohorts under the care of large public mental health services in Auckland (New Zealand) and Birmingham (United Kingdom) on 31 March 2007. Method: Time from first presentation to clozapine initiation, prior antipsychotics trialled and antipsychotic co-prescribing were compared. Data included demographics, psychiatric diagnosis, co-morbid conditions, year of first presentation, admissions and pharmacological treatment (clozapine dose, start date, prior antipsychotics, co-prescribed antipsychotic). Results: Overall, 664 people were prescribed clozapine (402 Auckland; 262 Birmingham); mean daily dose of 384 mg (Auckland) and 429 mg (Birmingham). 53 % presented after 1990 and the average duration of time before starting clozapine was significantly longer in the Birmingham cohort (6.5 vs. 5.3 years) but this reduced in both cohorts to a 1-year mean in those presenting within the last 3 years. The average number of antipsychotics trialled pre-clozapine for those presenting since 1990 was significantly higher in the Birmingham cohort (4.3 vs. 3.1) but in both cohorts this similarly reduced in those presenting within the last 3 years. Antipsychotic co-prescribing was significantly higher in the Birmingham cohort (22.9 vs. 10.7 %). Conclusions: There is evidence that access to clozapine has improved over time in both cohorts, with a reduction in the duration between presentation and initiation of clozapine and number of different antipsychotics trialled pre-clozapine. These are very positive findings in terms of optimising outcomes with clozapine and are possibly due to the impact of guideline recommendations, increasing clinician, consumer and carer knowledge, and experience with clozapine and funding changes. © 2014 Springer International Publishing.

An exploration of pharmacy-specific reasons for non-adherence to prescribed medicines in a socioeconomically deprived, ethnically diverse UK cohort

Methods - Ethical approval for the study was granted by both the local National Health Service (NHS) Research Ethics Committee (REC) and Aston University’s REC. Seven focus groups were conducted between October and December 2011 in medical or community settings within inner-city Birmingham (UK). Discussions were guided by a theme plan which was developed from key themes identified by a literature review and piloted via a Patient Consultation Group. Each focus group had between 3 and 7 participants. The groups were digitally recorded and subsequently transcribed verbatim. The transcriptions were then subjected to thematic analysis via constant comparison in order to identify emerging themes. Results - Participants recognised the pharmacist as an expert source of advice about prescribed medicines, a source they frequently felt a need to consult as a result of the inadequate supply of medicines information from the prescriber. However, an emerging theme was a perception that pharmacists had an oblique profit motive relating to the supply of generic medicines with frequent changes to the ‘brand’ of generic supplied being attributed to profit-seeking by pharmacists. Such changes had a negative impact on the patient’s perceived efficacy of the therapy which may make non-adherence more likely. Conclusions - Whilst pharmacists were recognised as medicines experts, trust in the pharmacist was undermined by frequent changes to generic medicines. Such changes have the potential to adversely impact adherence levels. Further, quantitative research is recommended to examine if such views are generalisable to the wider population of Birmingham and to establish if such views impact on adherence levels.

A conceptual framework for understanding resilience of construction SMEs to extreme weather events

Purpose Small and Medium-sized Enterprises (SMEs), which form a significant portion in many economies, are some of the most vulnerable to the impact of Extreme Weather Events (EWEs). This is of particular importance to the construction industry, as an overarching majority of construction companies are SMEs who account for the majority of employment and income generation within the industry. In the UK, previous research has identified construction SMEs as some of the worst affected by EWEs. Design/methodology/approach Given the recent occurrences of EWEs and predictions suggesting increases in both the intensity and frequency of EWEs in the future, improving the resilience of construction SMEs is vital for achieving a resilient construction industry. A conceptual framework is first developed which is then populated and expanded based on empirical evidence. Positioned within a pragmatic research philosophy, case study research strategy was adopted as the overall research strategy in undertaking this investigation. Findings Based on the findings of two in-depth case studies of construction SMEs, a framework was developed to represent EWE resilience of construction SMEs, where resilience was seen as a collective effect of vulnerability, coping strategies and coping capacities of SMEs, characteristics of the EWE and the wider economic climate. Originality/value The paper provides an original contribution towards the overarching agenda of the resilience of SMEs, and policy making in the area of EWE risk management by presenting a novel conceptual framework depicting the resilience of medium-sized construction companies.