Referral patterns in a global store-and-forward telemedicine system

We examined the nature of the referral patterns in the email telemedicine network operated by the Swinfen Charitable Trust with a view to informing long-term resource planning. Over the first six years of operation, 62 hospitals from 19 countries registered with the Trust in order to be able to refer cases for specialist advice; 55 of these hospitals (89%) actually referred cases during this period. During the first six years of operation, nearly 1000 referrals were submitted and answered, from a wide range of specialty areas. Between July 2002 and March 2005 the referral rate rose from 127 to 318 cases per year. The median length of time required to provide a specialist's response was 2.3 days during the first 12 months and 1.8 days during the last 12 months. Five hospitals submitted cases for more than four years (together sending a total of 493 cases). Their activity data showed a trend to declining referral rates over the four-year period, which may represent successful knowledge transfer. There is some evidence that over the last three years the growth in demand has been exponential, while the growth in resources available (i.e. specialists) has been linear, a situation which cannot continue for very long before demand outstrips supply.

The use of expert manpower in health and safety in France

The thesis examines the system of occupational health and safety in France. It analyses the use of expert manpower in the field with a view to establishing the possibility of a profession in health and safety. An input-output model is developed to bring together the necessary elements of prevention of accidents and occupational diseases. The role of institutions concerned with health and safety is analysed with reference to this model. The research establishes the need for a health and safety specialist role. The recognition and status of this role are found to be subject to other criteria including the acceptance by institutions of such a specialist role. The model is also used to define the role of this specialist as expected by the various institutions intervening in the field.

Self-regulation of health and safety in a Local Authority with particular reference to safety representatives, supervisors and safety committees

The Report of the Robens Committee (1972), the Health and Safety at Work Act (1974) and the Safety Representatives and Safety Committees Regulations (1977) provide the framework within which this study of certain aspects of health and safety is carried out. The philosophy of self-regulation is considered and its development is set within an historical and an industrial relations perspective. The research uses a case study approach to examine the effectiveness of self-regulation in health and safety in a public sector organisation. Within this approach, methodological triangulation employs the techniques of interviews, questionnaires, observation and documentary analysis. The work is based in four departments of a Scottish Local Authority and particular attention is given to three of the main 'agents' of self-regulation - safety representatives, supervisors and safety committees and their interactions, strategies and effectiveness. A behavioural approach is taken in considering the attitudes, values, motives and interactions of safety representatives and management. Major internal and external factors, which interact and which influence the effectiveness of joint self-regulation of health and safety, are identified. It is emphasised that an organisation cannot be studied without consideration of the context within which it operates both locally and in the wider environment. One of these factors, organisational structure, is described as bureaucratic and the model of a Representative Bureaucracy described by Gouldner (1954) is compared with findings from the present study. An attempt is made to ascertain how closely the Local Authority fits Gouldner's model. This research contributes both to knowledge and to theory in the subject area by providing an in-depth study of self-regulation in a public sector organisation, which when compared with such studies as those of Beaumont (1980, 1981, 1982) highlights some of the differences between the public and private sectors. Both empirical data and hypothetical models are used to provide description and explanation of the operation of the health and safety system in the Local Authority. As data were collected during a dynamic period in economic, political and social terms, the research discusses some of the effects of the current economic recession upon safety organisation.

Retinal and systemic vascular function in health and disease: the effect of smoking and coronary artery disease

The purpose of the following studies was to explore the effect of systemic vascular and endothelial dysfunction upon the ocular circulation and functionality of the retina. There are 6 principal sections to the present work. Retinal vessel activity in smokers and non-smokers: the principal findings of this work were: chronic smoking affects retinal vessel motion at baseline and during stimulation with flickering light; chronic smoking leads to a vaso-constrictory shift in retinal arteriolar reactivity to flicker; retinal arteriolar elasticity is decreased in chronic smokers. The effect of acute smoking on retinal vessel dynamics in smokers and non-smokers: the principal finding of this work was that retinal reactivity in chronic smokers is blunted when exposed to clicker light provocation immediately after smoking one cigarette. Ocular blood flow in coronary artery disease: The principal findings of this work were: retrobulbar and retinal blood flow is preserved in CAD patients, despite a change pulse wave transmission; arterial retinal response to flickering light provocation is significantly delayed in CAD patients; retinal venular diameters are significantly dilated in CAD patients. Autonomic nervous system function and peripheral circulation in CAD: The principal findings in this work were: CAD patients demonstrate a sympathetic overdrive during a 24 period; a delay in peripheral vascular reactivity (nail-fold capillaries) as observed in patients suffering from CAD could be caused by either arteriosclerotic changes of the vascular walls or due to systemic haemodynamic changes. Visual function in CAD: The principal findings in this work were: overall visual function in CAD patients is preserved, despite a decrease in contrast sensitivity; applying a filtering technique selecting those with greater coefficient of variance which in turn represents a decrease in reliability, some patients appear to have an impaired visual function as assessed using FDT visual field evaluation. Multiple functional, structural and biochemical vascular endothelial dysfunctions in patients suffering from CAD: relationships and possible implications: The principal findings of this work were: BMI significantly correlated with vWF (a marker of endothelial function) in CAD patients. Retinal vascular reactivity showed a significant correlation with peripheral reactivity parameters in controls which lacked in the CAD group and could reflect a loss in vascular endothelial integrity; visual field parameters as assessed by frequency doubling technology were strongly related with systemic vascular elasticity (ambulatory arterial stiffness index) in controls but not CAD patients.

Real options and demographic decisions:empirical evidence from East and West Germany

Iyer and Velu (2006) have convincingly argued that contemporary analyses of fertility behaviour fail to explain why a woman (or a couple) will choose to postpone childbirth, and in particular to consider the role of uncertainty in this regard. They have addressed this lacuna in the literature by using a real options approach to model fertility decisions by relating uncertainty experienced by individuals to the likelihood of childbirth. However, they did not present empirical evidence. Since the theory implies the existence of two offsetting effects of uncertainty on fertility decisions, a positive insurance effect and a negative option value effect, it is not easy to reject the theory on the basis of empirical analysis, when one of these effects offsets the other. We construct such a test for East (and also West) Germany during that country's reunification, which takes advantage of the fact that because of the country's strong welfare system, the insurance effect should be dominated by the option value effect, thereby suggesting that the net relationship should be negative. The results provide rather strong support for the real options link, especially for Eastern Germany.

Undermining patient and public engagement and limiting its impact:the consequences of the Health and Social Care Act 2012 on collective patient and public involvement

Patient and public involvement has been at the heart of UK health policy for more than two decades. This commitment to putting patients at the heart of the British National Health Service (NHS) has become a central principle helping to ensure equity, patient safety and effectiveness in the health system. The recent Health and Social Care Act 2012 is the most significant reform of the NHS since its foundation in 1948. More radically, this legislation undermines the principle of patient and public involvement, public accountability and returns the power for prioritisation of health services to an unaccountable medical elite. This legislation marks a sea-change in the approach to patient and public involvement in the UK and signals a shift in the commitment of the UK government to patient-centred care. © 2013 John Wiley & Sons Ltd.

We know what you want to buy:a demographic-based system for product recommendation on microblogs

Product recommender systems are often deployed by e-commerce websites to improve user experience and increase sales. However, recommendation is limited by the product information hosted in those e-commerce sites and is only triggered when users are performing e-commerce activities. In this paper, we develop a novel product recommender system called METIS, a MErchanT Intelligence recommender System, which detects users' purchase intents from their microblogs in near real-time and makes product recommendation based on matching the users' demographic information extracted from their public profiles with product demographics learned from microblogs and online reviews. METIS distinguishes itself from traditional product recommender systems in the following aspects: 1) METIS was developed based on a microblogging service platform. As such, it is not limited by the information available in any specific e-commerce website. In addition, METIS is able to track users' purchase intents in near real-time and make recommendations accordingly. 2) In METIS, product recommendation is framed as a learning to rank problem. Users' characteristics extracted from their public profiles in microblogs and products' demographics learned from both online product reviews and microblogs are fed into learning to rank algorithms for product recommendation. We have evaluated our system in a large dataset crawled from Sina Weibo. The experimental results have verified the feasibility and effectiveness of our system. We have also made a demo version of our system publicly available and have implemented a live system which allows registered users to receive recommendations in real time. © 2014 ACM.

Selected psychosocial and demographic factors affecting levels of pre-retirement planning

In September 2002, the State of Florida implemented a new retirement structure for those employed in the Florida Public School System. Teachers were given the option to maintain their existing defined benefit plan or choose the newly offered defined contribution plan. The variables that affect planning for retirement are innumerable. Identifying the most significant variables is essential to understanding how one plans for retirement. ^ This study examined the relationship between hypothesized psychosocial and demographic factors and an individual's level of pre-retirement planning. The criterion variable, the level of pre-retirement planning, comprised two concepts. First, the time spent thinking about retirement was determined by the score an individual received on a pre-retirement planning scale. This scale included the concepts of information gathering, goals, anticipated resources, and long-range planning. Second, implementation of retirement plan procedures was determined by the percentage an individual annually deferred to retirement. ^ The survey used for data collection contained 50 close-ended items. It was distributed to all full-time teachers in nine randomly selected elementary, middle, and senior high schools throughout Miami-Dade County Public Schools. Multiple regression and crosstabulation indicated that math anxiety, general risk, years of service, and total family income were significant predictors of the level of pre-retirement planning, as measured by the pre-retirement planning scale. In addition, the statistical analysis indicated that math anxiety, internal locus of control, years of service, and total family income were significant predictors of the level pre-retirement planning, as measured by the amount deferred to retirement. An individual's level of math anxiety and family income were the two factors that were the most significant predictors for both concepts on the level of pre-retirement planning. ^ Based on the findings of the study, recommendations focused on assessing an individual's level of math anxiety and educating teachers, particularly pre-service candidates, about the factors that affect pre-retirement planning. Further research should investigate the benefit of such educational programs. ^

Placental contribution to the origins of sexual dimorphism in health and diseases: sex chromosomes and epigenetics

Sex differences occur in most non-communicable diseases, including metabolic diseases, hypertension, cardiovascular disease, psychiatric and neurological disorders and cancer. In many cases, the susceptibility to these diseases begins early in development. The observed differences between the sexes may result from genetic and hormonal differences and from differences in responses to and interactions with environmental factors, including infection, diet, drugs and stress. The placenta plays a key role in fetal growth and development and, as such, affects the fetal programming underlying subsequent adult health and accounts, in part for the developmental origin of health and disease (DOHaD). There is accumulating evidence to demonstrate the sex-specific relationships between diverse environmental influences on placental functions and the risk of disease later in life. As one of the few tissues easily collectable in humans, this organ may therefore be seen as an ideal system for studying how male and female placenta sense nutritional and other stresses, such as endocrine disruptors. Sex-specific regulatory pathways controlling sexually dimorphic characteristics in the various organs and the consequences of lifelong differences in sex hormone expression largely account for such responses. However, sex-specific changes in epigenetic marks are generated early after fertilization, thus before adrenal and gonad differentiation in the absence of sex hormones and in response to environmental conditions. Given the abundance of X-linked genes involved in placentogenesis, and the early unequal gene expression by the sex chromosomes between males and females, the role of X- and Y-chromosome-linked genes, and especially those involved in the peculiar placenta-specific epigenetics processes, giving rise to the unusual placenta epigenetic landscapes deserve particular attention. However, even with recent developments in this field, we still know little about the mechanisms underlying the early sex-specific epigenetic marks resulting in sex-biased gene expression of pathways and networks. As a critical messenger between the maternal environment and the fetus, the placenta may play a key role not only in buffering environmental effects transmitted by the mother but also in expressing and modulating effects due to preconceptional exposure of both the mother and the father to stressful conditions.

Pig producer perspectives on the use of meat inspection as an animal health and welfare diagnostic tool in the Republic of Ireland and Northern Ireland

Background
Currently, there is growing interest in developing ante and post mortem meat inspection (MI) to incorporate measures of pig health and welfare for use as a diagnostic tool on pig farms. However, the success of the development of the MI process requires stakeholder engagement with the process. Knowledge gaps and issues of trust can undermine the effective exchange and utilisation of information across the supply chain. A social science research methodology was employed to establish stakeholder perspectives towards the development of MI to include measures of pig health and welfare. In this paper the findings of semi-structured telephone interviews with 18 pig producers from the Republic of Ireland and Northern Ireland are presented.

Results
Producers recognised the benefit of the utilisation of MI data as a health and welfare diagnostic tool. This acknowledgment, however, was undermined for some by dissatisfaction with the current system of MI information feedback, by trust and fairness concerns, and by concerns regarding the extent to which data would be used in the producers’ interests. Tolerance of certain animal welfare issues may also have a negative impact on how producers viewed the potential of MI data. The private veterinary practitioner was viewed as playing a vital role in assisting them with the interpretation of MI data for herd health planning.

Conclusions
The development of positive relationships based on trust, commitment and satisfaction across the supply chain may help build a positive environment for the effective utilisation of MI data in improving pig health and welfare. The utilisation of MI as a diagnostic tool would benefit from the development of a communication strategy aimed at building positive relationships between stakeholders in the pig industry.

The Perceived Benefits of an Arts Project for Health and Wellbeing of Older Offenders

Background: The increasing ageing prison population is becoming a pressing issue throughout the criminal justice system. Alongside the rising population, are a host of health and wellbeing issues that contribute to older offenders needs whilst in prison. It has been recommended that meaningful activities can have positive effects on this population and therefore this paper uniquely reviews older offenders accounts of taking part in an arts based project, Good Vibrations, whilst imprisoned. Objective and design: The Good Vibrations project engages individuals in Gamelan music making with an end of project performance. This study used independent in-depth interviews to capture the voices of older offenders who took part in an art based prison project. Analysis and Results: The interview data was analysed using thematic analysis, which highlighted themes that were consistent with other populations who have taken part in a Good Vibrations project, along with specific age relating issues of mobility, motivation, identity and wellbeing.

Effect of ambient levels of ozone on photosynthetic components and radical scavenging system in leaves of African cowpea varieties

Tropospheric ozone (O3), a main component of photochemical oxidants, adversely affects not only human health but also vegetation. To clarify the long-term effects of ambient levels of tropospheric ozone (O3) on photosynthetic components and radical scavenging system in the leaves of cowpea ( Vigna unguiculata L.), two African varieties, Blackeye and Asontem, were grown in open-top chambers and exposed to filtered air (FA), non-filtered air (NF) or non-filtered air with additional O3 of approximately 50 nl l-1. Ambient levels of O3 significantly reduced chlorophyll concentration, quantum yield and activity of ribulose 1,5-bisphosphate carboxylase/oxygenase (Rubisco), thus contributing to the reduction in net photosynthetic rate at the reproductive growth stage of both varieties; with no significant variety difference in the sensitivity to O3. The O3-induced significant reduction in catalase activity was observed in Blackeye at vegetative and reproductive growth stages; and in Asontem at reproductive growth stage. On the other hand, exposure to O3 significantly increased ascorbate peroxidase activity in Blackeye at reproductive stage and did not significantly affect that in Blackeye at vegetative growth stage and that in Asontem at both growth stages. At reproductive growth stage, activities of monodehydroascorbate reductase and glutathione reductase were significantly increased by the exposure to O3 in both varieties. The results obtained in this study suggest that, although ascorbate peroxidase, monodehydroascorbate reductase and glutathione reductase played important roles in scavenging O3-induced reactive oxygen species in the leaves, radical scavenging ability of these enzymes is not sufficient to avoid detrimental effects of ambient levels of O3 on photosynthesis in both African cowpea varieties.

Radiation health and safety : issues of congressional interest /

Bibliography: p. 17-19.

French good practice guidelines for medical and occupational surveillance of the low back pain risk among workers exposed to manual handling of loads

International audience