An Examination of the Use of Coercion by Assertive Outreach and Community Mental Health Teams in Northern Ireland.

In mental health services over recent decades, the positive move away from hospital-based care to community-based services has entailed that people with higher levels of need are being supported by community mental health services. This paper begins by reviewing the literature on coercion in the field of community-based mental health care and treatment. It is argued that the lack of a critical understanding of the concept and how it is used by practitioners and agencies can have serious repercussions for the rights of service users. Using a quasi-experimental, longitudinal design, the authors then seek to test some of the ideas about coercion by comparing the activities of assertive outreach and community mental health teams in Northern Ireland, particularly the key ideas of perceived coercion, workers’ strategies and engagement with services. Key findings were that assertive outreach appeared to be more successful at reducing perceived coercion, minimizing the need for coercive strategies, engaging high-risk clients and reducing inpatient bed use. These findings are compared with other studies in this area. The authors also argue that there is a need for greater transparency in the way that practitioners use coercive measures and more explicit guidance is required in this crucial area of mental health practice.

Outreach and Early Warning Systems (EWS) for the prevention of intensive care admission and death of critically ill adult patients on general hospital wards

BACKGROUND: Despite the fact that outreach and early warning systems (EWS) are an integral part of a hospital wide systems approach to improve the early identification and management of deteriorating patients on general hospital wards, the widespread implementation of these interventions in practice is not based on robust research evidence. OBJECTIVES: The primary objective was to determine the impact of critical care outreach services on hospital mortality rates. Secondary objectives included determining the effect of outreach services on intensive care unit (ICU) admission patterns, length of hospital stay and adverse events. SEARCH STRATEGY: The review authors searched the following electronic databases: EPOC Specialised Register, The Cochrane Central Register of Controlled Trials (CENTRAL) and other Cochrane databases (all on The Cochrane Library 2006, Issue 3), MEDLINE (1996-June week 3 2006), EMBASE (1974-week 26 2006), CINAHL (1982-July week 5 2006), First Search (1992-2005) and CAB Health (1990-July 2006); also reference lists of relevant articles, conference abstracts, and made contact with experts and critical care organisations for further information. SELECTION CRITERIA: Randomised controlled trials (RCTs), controlled clinical trials (CCTs), controlled before and after studies (CBAs) and interrupted time series designs (ITS) which measured hospital mortality, unanticipated ICU admissions, ICU readmissions, length of hospital stay and adverse events following implementation of outreach and EWS in a general hospital ward to identify deteriorating adult patients versus general hospital ward setting without outreach and EWS were included in the review. DATA COLLECTION AND ANALYSIS: Three review authors independently extracted data and two review authors assessed the methodological quality of the included studies. Meta-analysis was not possible due to heterogeneity. Summary statistics and descriptive summaries of primary and secondary outcomes are presented for each study. MAIN RESULTS: Two cluster-randomised control trials were included: one randomised at hospital level (23 hospitals in Australia) and one at ward level (16 wards in the UK). The primary outcome in the Australian trial (a composite score comprising incidence of unexpected cardiac arrests, unexpected deaths and unplanned ICU admissions) showed no statistical significant difference between control and medical emergency team (MET) hospitals (adjusted P value 0.640; adjusted odds ratio (OR) 0.98; 95% confidence interval (CI) 0.83 to 1.16). The UK-based trial found that outreach reduced in-hospital mortality (adjusted OR 0.52; 95% CI 0.32 to 0.85) compared with the control group. AUTHORS' CONCLUSIONS: The evidence from this review highlights the diversity and poor methodological quality of most studies investigating outreach. The results of the two included studies showed either no evidence of the effectiveness of outreach or a reduction in overall mortality in patients receiving outreach. The lack of evidence on outreach requires further multi-site RCT's to determine potential effectiveness.

Relaunching Titanic: Memory and Marketing in the New Belfast

Relaunching Titanic critically considers the invocation of Titanic heritage in Belfast in contributing to a new ‘post-conflict’ understanding of the city. The authors address how the memory of Titanic is being and should be represented in the place of its origin, from where it was launched into the collective consciousness and unconscious of western civilization.

Relaunching Titanic examines the issues in the context of international debates on the tension between place marketing of cities and other alternative portrayals of memory and meaning in places. Key questions include the extent to which the goals of economic development are congruous with the ‘contemplative city’ and especially the need for mature and creative reflection in the ‘post-conflict’ city, whether development interests have taken precedence over the need for a deeper appreciation of a more nuanced Titanic legacy in the city of Belfast, and what Belfast shares with other places in considering the sacred and profane in memory construction.

While Relaunching Titanic focuses on the conflicted history of Belfast and the Titanic, it will have lessons for planners and scholars of city branding, tourism, and urban re-imaging.

NAA and STS effects on bract survival time, carbohydrate content, respiration rate and carbohydrate balance of potted Bougainvillea spectabilis Willd

The aims of this work were to deepen the knowledge on the physiology of bract abscission in Bougainvillea spectabilis ‘Killie Campbell’ plants, in what relates to respiration and carbon balance. Using the effects induced by Silver Thiosulphate (STS) and/or Naphtalene Acetic Acid (NAA, at high concentration: 500 mg.l-1) on bract abscission under interior conditions, the relationship between bract survival time (longevity) and, respiration rate or carbohydrate levels, was investigated. Treatments that included NAA were the ones that reduced significantly bract abscission. Unexpectedly, the higher the levels of bract soluble and total carbohydrates, measured at day 10 postproduction (PP), the higher the abscission of bracts. These results show, for the first time, that abscission can positively correlate with non structural carbohydrates levels in the organ that abscise. Bract respiration rate was significantly affected by treatment and postproduction day (PP). Treatments that had higher bract respiration rates (WATER and STS) also had higher levels of non structural carbohydrates in the bracts. Bract respiration rate decreased from day 10 to day 17 PP by approximately 50% (on average of all treatments) and was negatively correlated with bract survival time. In the carbon balance per gram of bract dry weight, the treatments WATER and STS, showed the largest decrease in the content of total carbohydrates and had the highest consumption of carbohydrates through respiration. So, these were the bracts that needed to import a higher amount of carbohydrates per gram of bract dry weight. In the carbon balance for the whole mass of bracts and adjacent stems in an average plant, the treatments WATER and STS continued to allow for the largest decreases in total carbohydrate during postproduction. However, and contradicting the results per gram of bract dry weight, the highest total consumption of carbohydrates by respiration was obtained for the NAA and STS+NAA treatments. It makes sense that bracts that last longer have lower individual carbon consumption while, at the plant level, the increased number of remaining bracts causes a higher overall expenditure. Respiration rate has been used as an indicator of flower longevity, this correlation is here extended for the flower+bract system. Plants that had higher bract respiration rates, most probably, had a higher flow of carbohydrates through the bracts (and flowers), which, in the end, was sensed as a higher carbohydrate level.

User Profiling and Knowledge Extraction For Tourism

O sector do turismo é uma área francamente em crescimento em Portugal e que tem desenvolvido a sua divulgação e estratégia de marketing. Contudo, apenas se prende com indicadores de desempenho e de oferta instalada (número de quartos, hotéis, voos, estadias), deixando os indicadores estatísticos em segundo plano. De acordo com o “ Travel & tourism Competitiveness Report 2013”, do World Economic Forum, classifica Portugal em 72º lugar no que respeita à qualidade e cobertura da informação estatística, disponível para o sector do Turismo. Refira-se que Espanha ocupa o 3º lugar. Uma estratégia de mercado, sem base analítica, que sustente um quadro de orientações específico e objetivo, com relevante conhecimento dos mercados alvo, dificilmente é compreensível ou até mesmo materializável. A implementação de uma estrutura de Business Intelligence que permita a realização de um levantamento e tratamento de dados que possibilite relacionar e sustentar os resultados obtidos no sector do turismo revela-se fundamental e crucial, para que sejam criadas estratégias de mercado. Essas estratégias são realizadas a partir da informação dos turistas que nos visitam, e dos potenciais turistas, para que possam ser cativados no futuro. A análise das características e dos padrões comportamentais dos turistas permite definir perfis distintos e assim detetar as tendências de mercado, de forma a promover a oferta dos produtos e serviços mais adequados. O conhecimento obtido permite, por um lado criar e disponibilizar os produtos mais atrativos para oferecer aos turistas e por outro informá-los, de uma forma direcionada, da existência desses produtos. Assim, a associação de uma recomendação personalizada que, com base no conhecimento de perfis do turista proceda ao aconselhamento dos melhores produtos, revela-se como uma ferramenta essencial na captação e expansão de mercado.

Economics consulting project for the Iberian Marketing Oil department of Galp Energia: Strategy and Marketing guidelines for Galp Energia’sconvenience business in the Iberian market

Field lab: Consulting lab