A study of outcomes measures in forensic mental health

Outcomes measures, which is the measurement of effectiveness of interventions and services has been propelled onto the health service agenda since the introduction of the internal market in the 1990s. It arose as a result of the escalating cost of inpatient care, the need to identify what interventions work and in what situations, and the desire for effective information by service users enabled by the consumerist agenda introduced by Working for Patients white paper. The research reported in this thesis is an assessment of the readiness of the forensic mental health service to measure outcomes of interventions. The research examines the type, prevalence and scope of use of outcomes measures, and further seeks a consensus of views of key stakeholders on the priority areas for future development. It discusses the theoretical basis for defining health and advocates the argument that the present focus on measuring effectiveness of care is misdirected without the input of users, particularly patients in their care, drawing together the views of the many stakeholders who have an interest in the provision of care in the service. The research further draws on the theory of structuration to demonstrate the degree to which a duality of action, which is necessary for the development, and use of outcomes measures is in place within the service. Consequently, it highlights some of the hurdles that need to be surmounted before effective measurement of health gain can be developed in the field of study. It concludes by advancing the view that outcomes research can enable practitioners to better understand the relationship between the illness of the patient and the efficacy of treatment. This understanding it is argued would contribute to improving dialogue between the health care practitioner and the patient, and further providing the information necessary for moving away from untested assumptions, which are numerous in the field about the superiority of one treatment approach over another.

External audit in the National Health Service in England and Wales:a study of an oversight body's control of auditor remuneration

In the National Health Service (NHS) in England and Wales an oversight body, the Audit Commission (AC), defines the scope of the external auditors’ work, appoints the auditors and has oversight of their fees and audit quality. This heavily regulated audit regime mitigates some of the deficiencies observed in high profile corporate failures. Independence, it has been argued, is influenced by the total auditor remuneration paid by the client. In this study we examine total auditor remuneration in a regulated market which seeks to ensure audit independence and audit quality. In particular we undertake rigorous analysis of auditor remuneration by the type of auditor: We place emphasis on the differentiation between private sector firms and the AC’s in-house auditors (District Audit). Individual private audit firms charge premiums (up to 16%) for particular audit work in identified locations, but no premiums were found when we examined total auditor remuneration. The regime appears to permit efficient operation of the audit market while safeguarding both audit independence and standards.

The strategic role of investment banks in the retailer internationalisation process: is this venture marketing?

In recent years the scale and scope of retailer internationalisation activity has grown markedly, mainly through increasing levels of cross-border merger and acquisition activity. This has been particularly prevalent among companies operating in the food retail sector. During this time, and within the context of increased merger and acquisition activity in international markets, the financial institutions have taken an increasingly prominent role in the retail internationalisation process. Explores the nature of the financial institutions’ role in the retailer internationalisation process and, specifically, the extent to which the financial institutions actually inhibit and/or promote retail international activity. A key purpose of this study is to examine some of the drivers and inhibitors of the retailer internationalisation process. Reports the findings from 30 in-depth interviews with food retail analysts of the leading investment banks in the City of London. The findings from this study should help to provide further insights into the nature of the retailer internationalisation process.

Institutional shifts in inter-municipal service delivery:an analysis of developments in eight Western European countries

Comparative research on inter-municipal cooperation in eight European countries shows that there is a great variety of institutional arrangements for cooperation across the different countries. Also, these arrangements tend to change over time in terms of the scope of cooperation among partners, their composition and the degree of organizational integration. This article describes and analyzes the variety of and shifts in institutional arrangements for a specific class of inter-municipal cooperation arrangements: those that are set up to provide for the joint delivery of public services. It is argued that specific arrangements are typically the outcomes of interaction between national institutional contexts,?environmental factors and local preferences.

Computer control of machines utilising independent drive mechanisms

The thesis describes an investigation into methods for the specification, design and implementation of computer control systems for flexible manufacturing machines comprising multiple, independent, electromechanically-driven mechanisms. An analysis is made of the elements of conventional mechanically-coupled machines in order that the operational functions of these elements may be identified. This analysis is used to define the scope of requirements necessary to specify the format, function and operation of a flexible, independently driven mechanism machine. A discussion of how this type of machine can accommodate modern manufacturing needs of high-speed and flexibility is presented. A sequential method of capturing requirements for such machines is detailed based on a hierarchical partitioning of machine requirements from product to independent drive mechanism. A classification of mechanisms using notations, including Data flow diagrams and Petri-nets, is described which supports capture and allows validation of requirements. A generic design for a modular, IDM machine controller is derived based upon hierarchy of control identified in these machines. A two mechanism experimental machine is detailed which is used to demonstrate the application of the specification, design and implementation techniques. A computer controller prototype and a fully flexible implementation for the IDM machine, based on Petri-net models described using the concurrent programming language Occam, is detailed. The ability of this modular computer controller to support flexible, safe and fault-tolerant operation of the two intermittent motion, discrete-synchronisation independent drive mechanisms is presented. The application of the machine development methodology to industrial projects is established.

An applied linguistic analysis of the simplification of narrative texts

Simplification of texts has traditionally been carried out by replacing words and structures with appropriate semantic equivalents in the learner's interlanguage, omitting whichever items prove intractable, and thereby bringing the language of the original within the scope of the learner's transitional linguistic competence. This kind of simplification focuses mainly on the formal features of language. The simplifier can, on the other hand, concentrate on making explicit the propositional content and its presentation in the original in order to bring what is communicated in the original within the scope of the learner's transitional communicative competence. In this case, simplification focuses on the communicative function of the language. Up to now, however, approaches to the problem of simplification have been mainly concerned with the first kind, using the simplifier’s intuition as to what constitutes difficulty for the learner. There appear to be few objective principles underlying this process. The main aim of this study is to investigate the effect of simplification on the communicative aspects of narrative texts, which includes the manner in which narrative units at higher levels of organisation are structured and presented and also the temporal and logical relationships between lower level structures such as sentences/clauses, with the intention of establishing an objective approach to the problem of simplification based on a set of principled procedures which could be used as a guideline in the simplification of material for foreign students at an advanced level.

A survey of some small firms in the rural areas of England: their structure and functions, with special reference to factors that affect their development

This study was concerned with the structure, functions and development, especially the performance, of some rural small firms associated with the Council for Small Industries in Rural Areas (C?SIRA) of England. Forty firms were used as the main basis of analysis. For some aspects of the investigation, however, data from another 54 firms, obtained indirectly through nine CoSIRA Organisers, were also used. For performance-analysis, the 40 firms were firstly ranked according to their growth and profitability rates which were calculated from their financial data. Then each of the variables hypothesised to be related to performance was tested to ascertain its relationship with performance, using the Spearman's Rank Correlation technique. The analysis indicated that each of the four factors .. the principal, the firm itself, its management, and the environment - had a bearing upon the performance of the firm. Within the first factor, the owner-manager's background and attitudes were found to be most important; in the second, the firm's size, age and scope of activities were also found to be correlated with performance; with respect to the third, it was revealed that firms which practised some forms of systems in planning, control and costing performed better than those which did not and, finally with respect to the fourth factor, it was found that some of the services provided by CoSIRA, especially credit finance, were facilitative to the firm's performance. Another significant facet of the firms highlighted by the study was their multifarious roles. These, meeting economic, psychological, sociological and political needs, were considered to be most useful to man and his society. Finally, the study has added light to the structural characteristics of the sampled firms, including various aspects of their development, orientation and organisation, as well as their various structural strengths and weakness. ' .

Investigation of two-wave mixing in arbitrary oriented sillenite crystals

A generalized systematic description of the Two-Wave Mixing (TWM) process in sillenite crystals allowing for arbitrary orientation of the grating vector is presented. An analytical expression for the TWM gain is obtained for the special case of plane waves in a thin crystal (|g|d«1) with large optical activity (|g|/?«1, g is the coupling constant, ? the rotatory power, d the crystal thickness). Using a two-dimensional formulation the scope of the nonlinear equations describing TWM can be extended to finite beams in arbitrary geometries and to any crystal parameters. Two promising applications of this formulation are proposed. The polarization dependence of the TWM gain is used for the flattening of Gaussian beam profiles without expanding them. The dependence of the TWM gain on the interaction length is used for the determination of the crystal orientation. Experiments carried out on Bi12GeO20 crystals of a non-standard cut are in good agreement with the results of modelling.

The Kinematics of interference mechanisms in certain machining operations

The mechanism of "Helical Interference" in milled slots is examined and a coherent theory for the geometry of such surfaces is presented. An examination of the relevant literature shows a fragmented approach to the problem owing to its normally destructive nature, so a complete analysis is developed for slots of constant lead, thus giving a united and exact theory for many different setting parameters and a range of cutter shapes. For the first time, a theory is developed to explain the "Interference Surface" generated in variable lead slots for cylindrical work and attention is drawn to other practical surfaces, such as cones, where variable leads are encountered. Although generally outside the scope of this work, an introductory analysis of these cases is considered in order to develop the cylindrical theory. Special emphasis is laid upon practical areas where the interference mechanism can be used constructively and its application as the rake face of a cutting tool is discussed. A theory of rake angle for such cutting tools is given for commonly used planes, and relative variations in calculated rake angle between planes is examined. Practical tests are conducted to validate both constant lead and variable lead theories and some design improvements to the conventional dividing head are suggested in order to manufacture variable lead workpieces, by use of a "superposed" rotation. A prototype machine is manufactured and its kinematic principle given for both linear and non-linearly varying superposed rotations. Practical workpieces of the former type are manufactured and compared with analytical predictions,while theoretical curves are generated for non-linear workpieces and then compared with those of linear geometry. Finally suggestions are made for the application of these principles to the manufacture of spiral bevel gears, using the "Interference Surface" along a cone as the tooth form.

The derivation and application of risk tolerability criteria

This research involves a study of the questions, "what is considered safe", how are safety levels defined or decided, and according to whom. Tolerable or acceptable risk questions raise various issues: about values and assumptions inherent in such levels; about decision-making frameworks at the highest level of policy making as well as on the individual level; and about the suitability and competency of decision-makers to decide and to communicate their decisions. The wide-ranging topics covering philosophical and practical concerns examined in the literature review reveal the multi-disciplined scope of this research. To support this theoretical study empirical research was undertaken at the European Space Research and Technology Centre (ESTEC) of the European Space Agency (ESA). ESTEC is a large, multi-nationality, high technology organisation which presented an ideal case study for exploring how decisions are made with respect to safety from a personal as well as organisational aspect. A qualitative methodology was employed to gather, analyse and report the findings of this research. Significant findings reveal how experts perceive risks and the prevalence of informal decision-making processes partly due to the inadequacy of formal methods for deciding risk tolerability. In the field of occupational health and safety, this research has highlighted the importance and need for criteria to decide whether a risk is great enough to warrant attention in setting standards and priorities for risk control and resources. From a wider perspective and with the recognition that risk is an inherent part of life, the establishment of tolerability risk levels can be viewed as cornerstones indicating our progress, expectations and values, of life and work, in an increasingly litigious, knowledgeable and global society.

An evaluation of certain aspects of an occupational health service

This thesis has been concerned with obtaining evidence to explore the proposition that the provision of occupational health services as arranged at the present time represents a misallocation of resources. The research has been undertaken within the occupational health service of a large Midlands food factory. As the research progressed it became evident that questions were being raised about the nature and scope of occupational health as well as the contribution, in combating danger at work, that occupational health services can make to the health and safety team. These questions have been scrutinized in depth, as they are clearly important, and a resolution of the problem of the definition of occupational health has been proposed. I have taken the approach of attempting to identify specific objectives or benefits of occupational health activities so that it is possible to assess how far these objectives are being achieved. I have looked at three aspects of occupational health; audiometry, physiotherapy and pre-employment medical examinations as these activities embody crucial concepts which are common to all activities in an occupational health programme. A three category classification of occupational health activities is proposed such that the three activities provide examples within each category. These are called personnel therapy, personnel input screening and personnel throughput screening. I conclude that I have not shown audiometry to be cost-effective. My observations of the physiotherapy service lead me to support the suggestion that there is a decline in sickness absence rates due to physiotherapy in industry. With pre-employment medical examinations I have shown that the service is product safety oriented and that benefits are extremely difficult to identify. In regard to the three services studied, in the one factory investigated, and because of the immeasurability of certain activities, I find support for the proposition that the mix of occupational health services as provided at the present time represents a misallocation of resources.

The effects of the changing energy situation on demand for industrial heat exchangers

The Project arose during a period in which the World was still coming to terms with the effects and implications of the so called 'energy crisis' of 1973/74. Serck Heat Transfer is a manufacturer of heat exchangers which transfer heat between fluids of various sorts. As such the company felt that past and possible future changes in the energy situation could have an impact upon the demand for its products. The thesis represents the first attempt to examine the impact of changes in the energy situation (a major economic variable) on the long term demand for heat exchangers. The scope of the work was limited to the United Kingdom, this being the largest single market for Serek's products. The thesis analyses industrial heat exchanger markets and identifies those trends which are related to both the changing energy situation and the usage of heat exchangers. These trends have been interpreted In terms of projected values of heat exchanger demand. The projections cover the period 197S to the year 2000. Also examined in the thesis is the future energy situation both internationally and nationally and it is found that in the long term there will be increasing pressure on consumers to conserve energy through rising real prices. The possibility of a connection between energy consumption and heat exchanger demand is investigated and no significant correlation found. This appears to be because there are a number of determinants of demand besides energy related factors and also there is a wide diversity of individual markets for heat exchangers. Conclusions are that in all markets, bar one, the changing energy situation should lead to a higher level of heat exchanger demand than would otherwise be the case had the energy situation not changed. It is also pointed out that it is misleading to look at changes in one influence on the demand for a product and ignore others.

Design of an expandable manufacturing simulator through the application of object-oriented principles

In analysing manufacturing systems, for either design or operational reasons, failure to account for the potentially significant dynamics could produce invalid results. There are many analysis techniques that can be used, however, simulation is unique in its ability to assess detailed, dynamic behaviour. The use of simulation to analyse manufacturing systems would therefore seem appropriate if not essential. Many simulation software products are available but their ease of use and scope of application vary greatly. This is illustrated at one extreme by simulators which offer rapid but limited application whilst at the other simulation languages which are extremely flexible but tedious to code. Given that a typical manufacturing engineer does not posses in depth programming and simulation skills then the use of simulators over simulation languages would seem a more appropriate choice. Whilst simulators offer ease of use their limited functionality may preclude their use in many applications. The construction of current simulators makes it difficult to amend or extend the functionality of the system to meet new challenges. Some simulators could even become obsolete as users, demand modelling functionality that reflects the latest manufacturing system design and operation concepts. This thesis examines the deficiencies in current simulation tools and considers whether they can be overcome by the application of object-oriented principles. Object-oriented techniques have gained in popularity in recent years and are seen as having the potential to overcome any of the problems traditionally associated with software construction. There are a number of key concepts that are exploited in the work described in this thesis: the use of object-oriented techniques to act as a framework for abstracting engineering concepts into a simulation tool and the ability to reuse and extend object-oriented software. It is argued that current object-oriented simulation tools are deficient and that in designing such tools, object -oriented techniques should be used not just for the creation of individual simulation objects but for the creation of the complete software. This results in the ability to construct an easy to use simulator that is not limited by its initial functionality. The thesis presents the design of an object-oriented data driven simulator which can be freely extended. Discussion and work is focused on discrete parts manufacture. The system developed retains the ease of use typical of data driven simulators. Whilst removing any limitation on its potential range of applications. Reference is given to additions made to the simulator by other developers not involved in the original software development. Particular emphasis is put on the requirements of the manufacturing engineer and the need for Ihe engineer to carrv out dynamic evaluations.

A smart sensing platform for the classification of ambulatory patterns

This paper describes an innovative sensing approach allowing capture, discrimination, and classification of transients automatically in gait. A walking platform is described, which offers an alternative design to that of standard force plates with advantages that include mechanical simplicity and less restriction on dimensions. The scope of the work is to investigate as an experiment the sensitivity of the distributive tactile sensing method with the potential to address flexibility on gait assessment, including patient targeting and the extension to a variety of ambulatory applications. Using infrared sensors to measure plate deflection, gait patterns are compared with stored templates using a pattern recognition algorithm. This information is input into a neural network to classify normal and affected walking events, with a classification accuracy of just under 90 per cent achieved. The system developed has potential applications in gait analysis and rehabilitation, whereby it can be used as a tool for early diagnosis of walking disorders or to determine changes between pre- and post-operative gait.

Dimensions of perception and recognition of danger

Despite abundant literature on human behaviour in the face of danger, much remains to be discovered. Some descriptive models of behaviour in the face of danger are reviewed in order to identify areas where documentation is lacking. It is argued that little is known about recognition and assessment of danger and yet, these are important aspects of cognitive processes. Speculative arguments about hazard assessment are reviewed and tested against the results of previous studies. Once hypotheses are formulated, the reason for retaining the reportory grid as the main research instrument are outlined, and the choice of data analysis techniques is described. Whilst all samples used repertory grids, the rating scales were different between samples; therefore, an analysis is performed of the way in which rating scales were used in the various samples and of some reasons why the scales were used differently. Then, individual grids are looked into and compared between respondents within each sample; consensus grids are also discussed. the major results from all samples are then contrasted and compared. It was hypothesized that hazard assessment would encompass three main dimensions, i.e. 'controllability', 'severity of consequences' and 'likelihood of occurrence', which would emerge in that order. the results suggest that these dimensions are but facets of two broader dimensions labelled 'scope of human intervention' and 'dangerousness'. It seems that these two dimensions encompass a number of more specific dimensions some of which can be further fragmented. Thus, hazard assessment appears to be a more complex process about which much remains to be discovered. Some of the ways in which further discovery might proceed are discussed.