Genetic characterization of clinical isolates of Clostridium difficile using an optimized RAPD protocol and PCR ribotyping reveals strain diversity between two tertiary referral Trusts in the West Midlands, UK

Epidemiological investigations of Clostridium difficile often focus on differences between separate geographical areas. In this investigation, two populations of C. difficile recovered from separate tertiary referral Trusts within the West Midlands, UK, were characterized using both PCR ribotyping and an optimized RAPD (random amplification of polymorphic DNA) protocol. The PCR ribotyping and RAPD methodologies identified differences between the two C. difficile populations, in both the prevalence and the diversity of types identified. The use of PCR ribotyping in conjunction with RAPD further categorized different types within defined PCR ribotypes, identifying different types within the same PCR ribotype and therefore providing a greater discriminatory power than either of the methods when used alone. The differences observed in this study between the two Trusts in the distribution of both RAPD 'type' and PCR ribotype demonstrate the diversity that is present amongst isolates of C. difficile within a relatively small geographical area and warrants a need for further investigation into the local epidemiology of C. difficile.

Selectivity and timing performance of UK investment trusts

This study examines the selectivity and timing performance of 218 UK investment trusts over the period July 1981 to June 2009. We estimate the Treynor and Mazuy (1966) and Henriksson and Merton (1981) models augmented with the size, value, and momentum factors, either under the OLS method adjusted with the Newey-West procedure or under the GARCH(1,1)-in-mean method following the specification of Glosten et al. (1993; hereafter GJR-GARCH-M). We find that the OLS method provides little evidence in favour of the selectivity and timing ability, consistent with previous studies. Interestingly, the GJR-GARCH-M method reverses this result, showing some relatively strong evidence on favourable selectivity ability, particularly for international funds, as well as favourable timing ability, particularly for domestic funds. We conclude that the GJR-GARCH-M method performs better in evaluating fund performance compared with the OLS method and the non-parametric approach, as it essentially accounts for the time-varying characteristics of factor loadings and hence obtains more reliable results, in particular, when the high frequency data, such as the daily returns, are used in the analysis. Our results are robust to various in-sample and out-of-sample tests and have valuable implications for practitioners in making their asset allocation decisions across different fund styles. © 2012 Elsevier B.V.

Testamentary trusts and the rule against capricious purposes:an underlying rationale?

This paper examines the rule against capricious purpose trusts and examines its application in English law but more particularly drawing upon the experiences of other common law jurisdictions and seeks to create a rationale for the operation o the doctrine in the common law world.

Introduction to the Law of Trusts by Simon Gardner

Book review of Prof Gardiner's work on Trusts, thrid edition.

Interpreting "D.I.Y." documents:severance, release, trusts, certainty, vesting and undue influence

Comments on the Chancery Division decision in Wallbank v Price on whether a home-made ("DIY") document signed by a wife and purporting to revoke her rights as a beneficial joint tenant in the matrimonial home, which was acquired under the right-to-buy scheme, should be set aside for duress or undue influence. Details the court's analysis of the principles supporting a successful claim of undue influence, the nature of the DIY document, its meaning and its effect. Considers possible reasons for the parties' use of the document. Cases Wallbank v Price (2007) EWHC 3001 (Ch); (2008) 2 FLR 501 (Ch D (Birmingham)) : Royal Bank of Scotland Plc v Etridge (No.2) (2001) UKHL 44; (2002) 2 AC 773 (HL) : Paul v Constance (1977) 1 WLR 527 (CA (Civ Div)) Statutes Housing Act 1985

Overlapping of legal concepts:classifying the law of trusts

The purpose of this piece is to explain how the trust concept fits the overlapping analysis, presenting an example of why discrete categorisation is often unhelpful in understanding the operation of legal concepts.

Certainty of subject matter in the law of trusts

This piece argued that the accepted orthodoxy concerning the requirement that each individual piece of property is individually segregated for a valid trust to exist is unsupported by the case law, and that there is nothing wrong in principle or theory with a trust that exists for unsegregated property.

To err is human to forgive divine: spotlight on complaints in the NHS, the crusade for perceived justice

The Healthcare Commission’s recently published report ‘Spotlight on Complaints’ highlights a general state of malaise with the NHS’ approach to complaint management. The conclusion of this the second report by the Commission is clear, NHS Trusts still have much to do to improve the principle antecedents, which collectively construct complainants’ attainment of perceived justice.

Training and development needs of PCT strategic level pharmacists

Poster session - The aim of the study was to produce an analysis of the perceived training and professional development needs of strategic level pharmacists in primary care trusts - A survey was carried out in five areas in England of the training needs of PCT strategic level pharmacists on behalf of a West Midlands Workforce Confederation - The results show an increasing recognition by PCT pharmacists of the importance of business and management training - Several key topics of direct relevance to current heath policy were not highly rated by respondents - This study identified gaps in current training provision

Hard to swallow

The Dept of Health has invited applications from primary care trusts wishing to become pathfinder sites for repeat dispensing schemes. The NHS plan anticipated that a national scheme would be in operation by 2004. Research suggests repeat dispensing is welcomed by patients but does not save large amounts of money. Joint training for all those involved in a scheme is a key issue.

The impact of leadership and quality climate on hospital performance

Objective. To explore the relationship between leadership effectiveness and health-care trust performance, taking into account external quality measures and the number of patient complaints; also, to examine the role of care quality climate as a mediator. Design. We developed scales for rating leadership effectiveness and care quality climate. We then drew upon UK national indices of health-care trust performance—Commission for Health Improvement star ratings, Clinical Governance Review ratings and the number of patient complaints per thousand. We conducted statistical analysis to examine any significant relationships between predictor and outcome variables. Setting. The study is based on 86 hospital trusts run by the National Health Service (NHS) in the UK. The data collection is part of an annual staff survey commissioned by the NHS to explore the quality of working life. Participants. A total of 17 949 employees were randomly surveyed (41% of the total sample). Results. Leadership effectiveness is associated with higher Clinical Governance Review ratings and Commission for Health Improvement star ratings for our sample (ß = 0.42, P < 0.05; ß = 0.37, P < 0.05, respectively), and lower patient complaints (ß = –0.57, P < 0.05). In addition, 98% of the relationship between leadership and patient complaints is explained by care quality climate. Conclusions. Results offer insight into how non-clinical leadership may foster performance outcomes for health-care organizations. A frequently neglected area—patient complaints—may be a valid measure to consider when assessing leadership and quality in a health-care context.

The link between the management of employees and patient mortality in acute hospitals

The relationship between human resource management practices and organizational performance (including quality of care in health-care organizations) is an important topic in the organizational sciences but little research has been conducted examining this relationship in hospital settings. Human resource (HR) directors from sixty-one acute hospitals in England (Hospital Trusts) completed questionnaires or interviews exploring HR practices and procedures. The interviews probed for information about the extensiveness and sophistication of appraisal for employees, the extent and sophistication of training for employees and the percentage of staff working in teams. Data on patient mortality were also gathered. The findings revealed strong associations between HR practices and patient mortality generally. The extent and sophistication of appraisal in the hospitals was particularly strongly related, but there were links too with the sophistication of training for staff, and also with the percentages of staff working in teams.