Evaluation of a pilot telemedicine network for accident and emergency work

A pilot accident and emergency. teleconsulting service was established in Scotland. It was based at the accident and emergency department of the main hospital in Aberdeen. There were three peripheral sites in rural Grampian (Peterhead, Turriff and Huntly) and one in the Shetland Isles. The videoconferencing equipment used was connected by ISDN at 384 kbit/s. During the 15 months of the study, 1998 videoconference calls were made, of which 402 (20%) calls were made to the accident and emergency department for clinical consultations. The majority of the clinical calls (95%) were made between 09:00 and 17:00, and more than 90% were completed within 20 min. During the majority of calls (87%) one or more X-ray images were transmitted. The majority of patients (89%) received treatment without transportation to the main centre in Aberdeen. The present study demonstrated that accident and emergency teleconsultations can be technically reliable, effective in reducing the number of patient transfers and acceptable to the referring clinicians. As a result, approximately pound1.5 million has been made available by the government to develop a national system for Scotland.

A critical evaluation of contrast susceptibility as a predictor of driving accident involvement

Contrast susceptibility is defined as the difference in visual acuity recorded for high and low contrast optotypes. Other researchers refer to this parameter as "normalised low contrast acuity". Pilot surveys have revealed that contrast susceptibility deficits are more strongly related to driving accident involvement than are deficits in high contrast visual acuity. It has been hypothesised that driving situation avoidance is purely based upon high contrast visual acuity. Hence, the relationship between high contrast visual acuity and accidents is masked by situation avoidance whilst drivers with contrast susceptibility deficits remain prone to accidents in poor visibility conditions. A national survey carried out to test this hypothesis provided no support for either the link between contrast susceptibility deficits and accidents involvement or the proposed hypothesis. Further, systematically worse contrast susceptibility scores emerged from vision screeners compared to wall mounted test charts. This discrepancy was not due to variations in test luminance or instrument myopia. Instead, optical imperfections inherent in vision screeners were considered to be responsible. Although contrast susceptibility is unlikely to provide a useful means of screening drivers' vision, previous research does provide support for its ability to detect visual deficits that may influence everyday tasks. In this respect, individual contrast susceptibility variations were found to reflect variations in the contrast sensitivity function - a parameter that provides a global estimate of human contrast sensitivity.

Culture and behaviour in the English National Health Service:overview of lessons from a large multimethod study

Background - Problems of quality and safety persist in health systems worldwide. We conducted a large research programme to examine culture and behaviour in the English National Health Service (NHS). Methods - Mixed-methods study involving collection and triangulation of data from multiple sources, including interviews, surveys, ethnographic case studies, board minutes and publicly available datasets. We narratively synthesised data across the studies to produce a holistic picture and in this paper present a highlevel summary. Results - We found an almost universal desire to provide the best quality of care. We identified many 'bright spots' of excellent caring and practice and high-quality innovation across the NHS, but also considerable inconsistency. Consistent achievement of high-quality care was challenged by unclear goals, overlapping priorities that distracted attention, and compliance-oriented bureaucratised management. The institutional and regulatory environment was populated by multiple external bodies serving different but overlapping functions. Some organisations found it difficult to obtain valid insights into the quality of the care they provided. Poor organisational and information systems sometimes left staff struggling to deliver care effectively and disempowered them from initiating improvement. Good staff support and management were also highly variable, though they were fundamental to culture and were directly related to patient experience, safety and quality of care. Conclusions - Our results highlight the importance of clear, challenging goals for high-quality care. Organisations need to put the patient at the centre of all they do, get smart intelligence, focus on improving organisational systems, and nurture caring cultures by ensuring that staff feel valued, respected, engaged and supported.

The use of treatment theories and procedures for postural control in adult with hemiplegia: A national survey

This study investigated the use of treatment theories and procedures for postural control training used by Occupational Therapists (OTs) when working with hemiplegic adults who have had cerebrovascular accident (CVA) or traumatic brain injury (TBI). The method of data collection was a national survey of 400 randomly selected physical disability OTs with 127 usable surveys returned. Results showed that the most common used treatment theory was neurodevelopmental treatment (NDT), followed by motor relearning program (MRP), proprioceptive neuromuscular facilitation (PNF), Brunnstrom's approach, and the approach of Rood. The most common treatment posture used was sitting, followed by standing, mat activity, equilibrium reaction training, and walking. The factors affecting the use of various treatment theories procedures were years certified, years of clinical experience, work situation and work status. Pearson correlation coefficient analyses found significant positive relationships between treatment theories and postures. There were significant high correlations between usage of all pairs of treatment procedures. ^

The Ghana National Service Scheme: Perceptions of former educational personnel, students and guardians

The purpose of this inquiry was to investigate the perceptions of former service personnel, students and their parents about the organizational effectiveness of the Ghana National Service Scheme (GNSS). The inquiry addressed the following questions: How do the participants perceive the effectiveness of the national service program on the Ghanaian society? What are the perceptions of school administrators who worked with service personnel, parents and students vis-à-vis the over all impact of the GNSS on the educational system? What are the perceptions of former service personnel, students and their parents in regard to the impact of the GNSS on them? ^ The GNSS is a part within the ministry of education, which is also part in the Ghanaian social structure. Hence, a systems theory approach which asks, “How and why a system as a whole functions as it does” (Patton, 1990), was utilized in the study. Methodologies included purposive sampling; interviews; participant observation, and follow-up interviews. The study was conducted over a six-moth period. ^ A cross-sectional survey design was used to generate data. The survey was followed up with an ethnographic study where in-depth, face-to-face interviews were conducted together with observations. The results were described and interpreted. ^ The summary of findings concludes that perceptional determinants of the effectiveness of the GNSS were biased by the age and zone of origin but not gender. This partially agrees with Marenin's (1990) except for gender. A significant difference was detected between the responses of those who were officials of the National service Secretariat and of former service personnel. The administrators defended the status quo and demonstrated their deeper knowledge about the scheme. The former personnel and parents freely criticized the program when necessary and did not seem to know much about the GNSS. Respondents mostly stressed the need for the secretariat to focus on the following areas: (1) involvement in the agricultural sector of the economy, (2) involvement in rural mass, civic and health education, (3) adequacy of remuneration and personnel welfare, and (4) ensuring posting of personnel to areas of their expertise. Recommendation for further research concluded the study. ^

The National Institute of Justice guide for eyewitness identification evidence: Can it improve juror decision-making?

Mistaken eyewitness identifications of innocent lead to more false convictions in the United States than any other cause. In response to concerns about the reliability of eyewitness evidence, the National Institute of Justice (NIJ) in 1999 published a Guide for the gathering and preservation of eyewitness evidence by law enforcement personnel. Previous research has shown that eyewitness identifications are more accurate when obtained using procedures recommended in the NIJ Guide. This experiment assessed whether informing jurors about the Guide can improve their ability to discriminate between eyewitness identifications likely to be accurate and those likely to be inaccurate and, if so, how to most effectively provide jurors with such information. ^ Seven hundred sixteen U.S. citizens who reported for criminal jury duty participated. Half of the participant jurors read a summary of an armed robbery trial in which the police followed the NIJ Guide when obtaining an eyewitness identification of the defendant. The other half read about an identical case in which the police did not follow the Guide. Jurors received information about the Guide from a court-appointed expert witness, one of the attorneys in the case, the trial judge, the judge in combination with one of the attorneys, or from no one (in the control groups). Jurors then rendered a verdict in the case and answered questions about the evidence in the case. ^ When an expert witness or the judge (either alone or in combination with one of the attorneys) informed jurors about the Guide, the jurors voted to convict defendants likely to be guilty and to acquit defendants likely to be innocent more often than did uninformed jurors assigned to a control group. These data suggest that informing jurors about the NIJ Guide using expert testimony or instructions from a judge will improve the quality and accuracy of jurors' verdict decisions in cases involving eyewitness identification evidence. However, more research is needed to determine whether the judge will remain an effective source of information about the Guide in a longer, more detailed trial scenario and to learn more about the underlying psychological processes governing the effects observed in this experiment. ^

Using soil profiles of seeds and molecular markers as proxies for sawgrass and wet prairie slough vegetation in Shark Slough, Everglades National Park

We measured the abundance of Cladium jamaicense (Crantz) seeds and three biomarkers in freshwater marsh soils in Shark River Slough (SRS), Everglades National Park (ENP) to determine the degree to which these paleoecological proxies reflect spatial and temporal variation in vegetation. We found that C. jamaicense seeds and the biomarkers Paq, total lignin phenols (TLP) and kaurenes analyzed from surface soils were all significantly correlated with extant aboveground C. jamaicense biomass quantified along a vegetation gradient from a C. jamaicense to a wet prairie/slough (WPS) community. Our results also suggest that these individual proxies may reflect vegetation over different spatial scales: Paq and kaurenes correlated most strongly (R 2 = 0.88 and 0.99, respectively) with vegetation within 1 m of a soil sample, while seeds and TLP reflected vegetation 0–20 m upstream of soil samples. These differences in the spatial scale depicted by the different proxies may be complementary in understanding aspects of historic landscape patterning. Soil profiles of short (25 cm) cores showed that downcore variation in C. jamaicense seeds was highly correlated with two of the three biomarkers (Paq, R 2 = 0.84, p<0.005; TLP, R 2 = 0.97, p<0.0001), and all four of the proxies indicated a recent increase in C. jamaicense biomass at the site. Using a preliminary depth-to-age relationship based on matching charcoal peaks with available ENP fire records (1980-present) specific to our coring site, we found that peak-depths in C. jamaicense seed concentration appeared to correspond to recent minimum water levels (e.g., 1989 and 2001), and low seed abundance corresponded to high water levels (e.g., 1995), consistent with the known autecology of C. jamaicense. In summary, the combination of C. jamaicense seeds and biomarkers may be useful for paleoecological reconstruction of vegetation change and ultimately in guaging the success of ongoing efforts to restore historic hydrologic conditions in the South Florida Everglades.

Market reforms and privatisation in the English National Health Service

The article examines developments in the marketisation and privatisation of the English National Health Service, primarily since 1997. It explores the use of competition and contracting out in ancillary services and the levering into public services of private finance for capital developments through the Private Finance Initiative. A substantial part of the article examines the repeated restructuring of the health service as a market in clinical services, initially as an internal market but subsequently as a market increasing opened up to private sector involvement. Some of the implications of market processes for NHS staff and for increased privatisation are discussed. The article examines one episode of popular resistance to these developments, namely the movement of opposition to the 2011 health and social care legislative proposals. The article concludes with a discussion of the implications of these system reforms for the founding principles of the NHS and the sustainability of the service.

Executive summary -- 2015 Corridor Management Plan - The Iowa Great River Road

The 2015 Corridor Management Plan for the Iowa Great River Road is modeled after similar plans for other National Scenic Byways: it is a dynamic, written document that describes the broad range of goals, objectives, policies, programs, projects and activities which can assist with protecting the intrinsic resources of a byway; interpreting the engaging stories of the byway; and promoting and presenting the byway with services and amenities to meet the needs and expectations of the traveling public.

Avian influenza in Australia: a summary of 5 years of wild bird surveillance

BackgroundAvian influenza viruses (AIVs) are found worldwide in numerous bird species, causing significant disease in gallinaceous poultry and occasionally other species. Surveillance of wild bird reservoirs provides an opportunity to add to the understanding of the epidemiology of AIVs. MethodsThis study examined key findings from the National Avian Influenza Wild Bird Surveillance Program over a 5-year period (July 2007-June 2012), the main source of information on AIVs circulating in Australia. ResultsThe overall proportion of birds that tested positive for influenza A via PCR was 1.90.1%, with evidence of widespread exposure of Australian wild birds to most low pathogenic avian influenza (LPAI) subtypes (H1-13, H16). LPAI H5 subtypes were found to be dominant and widespread during this 5-year period. ConclusionGiven Australia's isolation, both geographically and ecologically, it is important for Australia not to assume that the epidemiology of AIV from other geographic regions applies here. Despite all previous highly pathogenic avian influenza outbreaks in Australian poultry being attributed to H7 subtypes, widespread detection of H5 subtypes in wild birds may represent an ongoing risk to the Australian poultry industry.

The symbolic, socio-economic and exchange value of Imperial German and National Socialist medals and badges, 1701 to the present

This thesis examines the manufacture, use, exchange (including gift exchange), collecting and commodification of German medals and badges from the early 18th century until the present-day, with particular attention being given to the symbols that were deployed by the National Socialist German Workers’ Party (NSDAP) between 1919 and 1945. It does so by focusing in particular on the construction of value through insignia, and how such badges and their symbolic and monetary value changed over time. In order to achieve this, the thesis adopts a chronological structure, which encompasses the creation of Prussia in 1701, the Napoleonic wars and the increased democratisation of military awards such as the Iron Cross during the Great War. The collapse of the Kaiserreich in 1918 was the major factor that led to the creation of the NSDAP under the eventual strangle-hold of Hitler, a fundamentally racist and anti-Semitic movement that continued the German tradition of awarding and wearing badges. The traditional symbols of Imperial Germany, such as the eagle, were then infused with the swastika, an emblem that was meant to signify anti-Semitism, thus creating a hybrid identity. This combination was then replicated en-masse, and eventually eclipsed all the symbols that had possessed symbolic significance in Germany’s past. After Hitler was appointed Chancellor in 1933, millions of medals and badges were produced in an effort to create a racially based “People’s Community”, but the steel and iron that were required for munitions eventually led to substitute materials being utilised and developed in order to manufacture millions of politically oriented badges. The Second World War unleashed Nazi terror across Europe, and the conscripts and volunteers who took part in this fight for living-space were rewarded with medals that were modelled on those that had been instituted during Imperial times. The colonial conquest and occupation of the East by the Wehrmacht, the Order Police and the Waffen-SS surpassed the brutality of former wars that finally culminated in the Holocaust, and some of these horrific crimes and the perpetrators of them were perversely rewarded with medals and badges. Despite Nazism being thoroughly discredited, many of the Allied soldiers who occupied Germany took part in the age-old practice of obtaining trophies of war, which reconfigured the meaning of Nazi badges as souvenirs, and began the process of their increased commodification on an emerging secondary collectors’ market. In order to analyse the dynamics of this market, a “basket” of badges is examined that enables a discussion of the role that aesthetics, scarcity and authenticity have in determining the price of the artefacts. In summary, this thesis demonstrates how the symbolic, socio-economic and exchange value of German military and political medals and badges has changed substantially over time, provides a stimulus for scholars to conduct research in this under-developed area, and encourages collectors to investigate the artefacts that they collect in a more historically contextualised manner.

Using health-related quality of life instruments for children with long-term conditions : On the basis of a national quality registry system

Introduction: There has been a continuous development of new technologies in healthcare that are derived from national quality registries. However, this innovation needs to be translated into the workflow of healthcare delivery, to enable children with long-term conditions to get the best support possible to manage their health during everyday life. Since children living with long-term conditions experience different interference levels in their lives, healthcare professionals need to assess the impact of care on children’s day-to-day lives, as a complement to biomedical assessments. Aim: The overall aim of this thesis was to explore and describe the use of instruments about health-related quality of life (HRQOL) in outpatient care for children with long-term conditions on the basis of a national quality registry system. Methods: The research was conducted by using comparative, cross-sectional and explorative designs and data collection was performed by using different methods. The questionnaire DISABKIDS Chronic Generic Measure -37 was used as well as semi-structured interviews and video-recordings from consultations. Altogether, 156 children (8–18 years) and nine healthcare professionals participated in the studies. Children with Type 1 Diabetes (T1D) (n 131) answered the questionnaire DISABKIDS and children with rheumatic diseases, kidney diseases and T1D (n 25) were interviewed after their consultation at the outpatient clinic after the web-DISABKIDS had been used. In total, nine healthcare professionals used the HRQOL instrument as an assessment tool during the encounters which was video-recorded (n 21). Quantitative deductive content analysis was used to describe content in different HRQOL instruments. Statistical inference was used to analyse results from DISABKIDS and qualitative content analysis was used to analyse the interviews and video-recordings. Results: The findings showed that based on a biopsychosocial perspective, both generic and disease-specific instruments should be used to gain a comprehensive evaluation of the child’s HRQOL. The DISABKIDS instrument is applicable when describing different aspects of health concerning children with T1D. When DISABKIDS was used in the encounters, children expressed positive experiences about sharing their results with the healthcare professional. It was discovered that different approaches led to different outcomes for the child when the healthcare professionals were using DISABKIDS during the encounter. When an instructing approach is used, the child’s ability to learn more about their health and how to improve their health is limited. When an inviting or engaging approach is used by the professional, the child may become more involved during the conversations. Conclusions: It could be argued that instruments of HRQOL could be used as a complement to biomedical variables, to promote a biopsychosocial perspective on the child’s health. According to the children in this thesis, feedback on their results after answering to web-DISABKIDS is important, which implies that healthcare professionals need to prioritize time for discussions about results from HRQOL instruments in the encounters. If healthcare professionals involve the child in the discussion of the results of the HRQOL, misinterpreted answers could be corrected during the conversation. Concurrently, this claims that healthcare professionals invite and engage the child.

Summary and Conclusion

This monograph outlines the process and results of development of a common educational programme at masters level in health and social care management, which was supported by the Erasmus Life Long Education project CareMan (Cul- ture and Care Management). The CareMan project brought together university partners actively involved in educating social and health care professionals in leadership and management at master’s level in Europe. The five partners of the consortium were Lahti University of Applied Sciences – Lahti UAS (administra- tive and academic coordinator, Finland), Charles University – CU (the Czech Republic), Edinburgh Napier University – ENU (Scotland), Hammeline University of Applied Sciences – HAMK (Finland), and University of Évora – UoE (Portugal). The objectives of the project were to achieve lower -level educational goals that included the development through education cultural and value -driven leadership, quality of care and quality management to effectively manage an integrated health and social care service. Through mapping the situation in the field and comparing curricula of all participating universities the overall aim was to develop a joint masters programme in social and healthcare management. After the detailed understanding of national and institutional specifics of each of the individual academic entities it was recognised that, due to a number of regulation issues, the original aim was not achievable. Following subsequent analytical work, it was decided to develop a set of three master’s level modules. At the end of the project it was intended that all created modules would be available virtually to the participating programmes and would contribute some added value to existing curricula. In the future these ready -to -use modules are intended to be taught in cooperation with the participating universities or as a separate module in each university. The chosen theoretical framework of the project that underpinned the devel- opment, management and evaluation of the inter -cultural educational provision relied on the combination of two learning theories – ‘cooperative collaborative and social learning’ and ’transformational’ (Mezirow, 2009). This theoretical framework helped to align with European collaborative policy and its application on all levels of implementation of the project.