Utility of US Norms for the Bayley Scales of Infant Development (III) in UK and Irish Children

The aim of this paper is to explore the utility of the United States norms for United Kingdom and Republic of Ireland populations. The Bayley Scales of Infant Development (BSID III) is a globally used developmental assessment for typically developing and clinical samples of children aged 1 to 42 months. A UK norming exercise (REF) confirmed the suitability of US norms for UK based research and practice. However, debate has continued concerning the utility of the US norms in other countries. This paper further explores the utility of the US norms for the UK and ROI populations using BSID III developmental outcome data from two samples of over one thousand typically developing children.

Automated retinal image quality assessment on the UK Biobank dataset for epidemiological studies

Morphological changes in the retinal vascular network are associated with future risk of many systemic and vascular diseases. However, uncertainty over the presence and nature of some of these associations exists. Analysis of data from large population based studies will help to resolve these uncertainties. The QUARTZ (QUantitative Analysis of Retinal vessel Topology and siZe) retinal image analysis system allows automated processing of large numbers of retinal images. However, an image quality assessment module is needed to achieve full automation. In this paper, we propose such an algorithm, which uses the segmented vessel map to determine the suitability of retinal images for use in the creation of vessel morphometric data suitable for epidemiological studies. This includes an effective 3-dimensional feature set and support vector machine classification. A random subset of 800 retinal images from UK Biobank (a large prospective study of 500,000 middle aged adults; where 68,151 underwent retinal imaging) was used to examine the performance of the image quality algorithm. The algorithm achieved a sensitivity of 95.33% and a specificity of 91.13% for the detection of inadequate images. The strong performance of this image quality algorithm will make rapid automated analysis of vascular morphometry feasible on the entire UK Biobank dataset (and other large retinal datasets), with minimal operator involvement, and at low cost.

Initiating advance care planning on end-of-life issues in dementia: Ambiguity among UK and Dutch physicians

Background
In dementia, advance care planning (ACP) of end-of-life issues may start as early as possible in view of the patient’s decreasing ability to participate in decision making. We aimed to assess whether practicing physicians in the Netherlands and the United Kingdom who provide most of the end-of-life care, differ in finding that ACP in dementia should start at diagnosis.

Methods
In a cross-sectional study, we surveyed 188 Dutch elderly care physicians who are on the staff of nursing homes and 133 general practitioners from Northern Ireland. We compared difference by country in the outcome (perception of ACP timing), rated on a 1–5 agreement scale. Regression analyses examined whether a country difference can be explained by contrasts in demographics, presence, exposure and role perceptions.

Results
There was wide variability in agreement with the initiation of ACP at dementia diagnosis, in particular in the UK but also in the Netherlands (60.8% agreed, 25.3% disagreed and 14.0% neither agreed, nor disagreed). Large differences in physician characteristics (Dutch physicians being more present, exposed and adopting a stronger role perception) hardly explained the modest country difference. The perception that the physician should take the initiative was independently associated with agreeing with ACP at diagnosis.

Conclusions
There is considerable ambiguity about initiating ACP in dementia at diagnosis among physicians practicing in two different European health care systems and caring for different patient populations. ACP strategies should accommodate not only variations in readiness to engage in ACP early among patient and families, but also among physicians.

Governance structures and performance management systems in universities: a comparative study between the UK and Portugal

À semelhança do que aconteceu em muitas instituições públicas, as universidades têm enfrentado pressões crescentes para mudar, tendo de repensar as suas formas de governança e de gestão, dando mais ênfase à implementação de sistemas de gestão do desempenho (SGD). Apesar de existirem vários estudos sobre o desempenho, estes têm ignorado o uso dado à informação recolhida. Além disso, e apesar de terem ocorrido várias reformas na governança destas instituições, existem ainda poucos estudos que relacionam a governança e o desempenho. Assim, esta pesquisa visa explorar a forma como as universidades medem, reportam e gerem o desempenho e como as estruturas de governança se relacionam com estas práticas. Para alcançar o objetivo proposto, um estudo comparativo entre universidades britânicas e portuguesas foi realizado. Os dados foram recolhidos através da utilização de uma metodologia qualitativa, sendo os métodos utilizados a análise documental e entrevistas semi-estruturadas a membros dos órgãos de governo e gestão de cada instituição. A análise dos dados mostrou a inexistência de um sistema completamente integrado de gestão de desempenho (SGD) em ambas as instituições, essencialmente devido à falta de práticas de gestão de desempenho. De facto, apesar de alguns dos entrevistados terem reportado o "uso positivo" de dados sobre o desempenho, alguns relataram o "não uso" desses dados, principalmente em relação ao desempenho individual, e outros o "mau uso" dessa informação, tendo sido reportadas práticas de gaming e deturpação dos resultados. Como forma de ultrapassar alguns destes problemas, verificou-se a co-existência de duas estruturas de governança: uma 'formal', da qual fazem parte todos os órgão de governo, com um valor mais 'simbólico'; e uma estrutura 'paralela', constituída por órgãos mais ágeis, que gerem a universidade no dia a dia. Verificou-se terem sido vários os fatores a afetarem, negativa e positivamente, os SGD em ambas as instituições, tendo sido rotulados de "inibidores" e "determinantes", respetivamente. A pesquisa mostrou que, apesar de as estruturas de governança serem importantes para a implementação e funcionamento de um SGD, há outros fatores que precisam de ser levados em consideração, nomeadamente, o nível de comunicação e o nível de envolvimento dos atores no processo. Estes dois fatores são considerados relevantes para a integração bem sucedida de práticas de medição, reporte e gestão de desempenho. Esta integração, juntamente com outras mudanças que ocorreram em termos de governança, contribuirá certamente para que se passe de um sistema em que se governa o desempenho para um sistema em que se governa para o desempenho.

Stresses reported by UK trainee counselling psychologists

This study examined stressors and psychological distress in 109 UK counselling psychology trainees. The research focus was two-fold. What is the profile of stressors that counselling psychology trainees report about the components of training? What relationship is there between this profile, and other characteristics of trainees, including their level of current psychological distress? Data from a stress survey and from the General Health Questionnaire were examined. High stress scores were found on three aspects of the stress survey ('academic', 'placements', 'personal and professional development'), but not-surprisingly-on the aspect, 'lack of support systems'. Significant stress differences were reported for gender and age of participants, and highly significant positive relationships were found between General Health Questionnaire and stress scores. Overall, the results suggest actions to be taken. Further research is needed to clarify unavoidable and avoidable stressors in training, and the reduction of trainees' experience of training stress to the necessary minimum needs to be adopted as an active target by programmes.

The strange death of UK civil defence education in the 1980s

In the cold war, the United Kingdom government devised a number of public education campaigns to inform citizens about the precautions that they should undertake in the event of a nuclear attack. One such campaign, Protect and Survive, was released to the general public and media in May 1980. The negative publicity this publication received is considered to be a reason why a successor publication was never released despite the increased risk of nuclear attack. Using recently released records from the UK National Archives the paper considers that, aside from this explanation, interlocking institutional objectives, rather than simply inertia, provides an explanation for this hiatus.

Intimate Ecologies: An exploration of the languages of contemporary exhibitions and making in museums and related cultural spaces in the UK

Intimate Ecologies considers the practice of exhibition-making over the past decade in formal museum and gallery spaces and its relationship to creating a concept of craft in contemporary Britain. Different forms of expression found in traditions of still life painting, film and moving image, poetic text and performance are examined to highlight the complex layers of language at play in exhibitions and within a concept of craft. The thesis presents arguments for understanding the value of embodied material knowledge to aesthetic experience in exhibitions, across a spectrum of human expression. These are supported by reference to exhibition case studies, critical and theoretical works from fields including social anthropology, architecture, art and design history and literary criticism and a range of individual, original works of art. Intimate Ecologies concludes that the museum exhibition, as a creative medium for understanding objects, becomes enriched by close study of material practice, and embodied knowledge that draws on a concept of craft. In turn a concept of craft is refreshed by the makers’ participation in shifting patterns of exhibition-making in cultural spaces that allow the layers of language embedded in complex objects to be experienced from different perspectives. Both art-making and the experience of objects are intimate, and infinitely varied: a vibrant ecology of exhibition-making gives space to this diversity.

Public-private partnerships and efficiency in public procurement of primary healthcare infrastructure: a qualitative research in the NHS UK

Aim There is growing interest in the contribution of public-private partnerships (PPPs) bridging the shortage of financial resources and management expertise in developing public healthcare infrastructure. However, few studies have evidenced PPPs’ ability in increasing efficiency in public procurement of primary healthcare infrastructure. The aim of this study was to assess to what extent PPPs would increase efficiency in public procurement of primary healthcare facilities. Subject and Methods A qualitative analysis, adopting a realistic research evaluation method, used data collected from a purposive sample of public (n=23) and private sector staff (n=2) directly involved in the UK National Health Service Local Improvement Finance Trust (LIFT). Results We find a positive association of LIFT helping to bridge public sector capital shortages for developing primary care surgeries. LIFT is negatively associated with inefficient procurement because it borrows finance from private banks, leaving public agencies paying high interest rates. The study shows that some contextual factors and mechanisms in LIFT play a major part in obstructing public staff from increasing procurement efficiency. Conclusion PPP’s ability to increase efficiency may be determined by contextual factors and mechanisms that restrict discretion over critical decisions by frontline public sector staff. Developing their capacity in monitoring PPP activities may make partnerships more efficient.

Regional Importance of Alnus Pollen as an Aeroallergen: A Comparative Study of Alnus Pollen Counts from Worcester (UK) and Poznań (Poland)

Daily average Alnus pollen counts (1996-2005) from Worcester (UK) and Poznań (Poland) were examined with the aim of assessing the regional importance of Alnus pollen as an aeroallergen. The average number of Alnus pollen grains recorded annually at Poznań was more than 2.5 times that of Worcester. Furthermore, daily average Alnus pollen counts exceeded the thresholds of 100, 500 and 1,000 grains/m3 more times at Poznań than Worcester. Skin prick test results (1996-2005) and allergen-specific IgE(asIgE) measurements using the CAP (Pharmacia) system (2002-2005), were supplied by the Allergic Diseases Diagnostic Centre in Poznań. The annual number of positive skin prick tests to Alnus pollen allergens was significantly related (p<0.05) to seasonal variations in the magnitude of the Alnus pollen catch recorded at Poznań (r=0.70). The symptoms of patients with positive skin prick tests to Alnus pollen allergens were: 51% pollinosis, 43% atopic dermatitis, 4% asthma, 1% chronic urticaria and 1% eczema. On a scale of 0-6, 20.5% of patients examined for serum asIgE in relation to Alnus pollen allergens had asIgE measurements in classes 5 and 6. Alnus pollen is generally considered to be mildly allergenic. However, the amount of Alnus pollen released into the atmosphere in places such as Poznań may increase its impact on the population and make it one of the more important aeroallergens present.

Detecting Submerged Macrophytes in a UK Chalk Stream Using Field Spectroscopy

Various studies using optical remote sensing in the marine environment have shown the possibilities of spectral discrimination of benthic macro and micro-algae. For in-land water bodies only very recently studies of have explored similar use of optical remote sensing to identify the taxonomic composition of algae and rooted plant communities. The importance of these communities for the functioning of river ecosystems warrants further research. In the study presented here, field spectroscopy is used to assess the possibilities of optically detecting macrophytes in a UK chalk streams. Spectral signatures of four common macrophytes were measured using a hand-held GER1500 spectroradiometer. Despite the strong absorption of near infrared in water, the results show that information on NIR can clearly contribute to the detection of submerged vegetation in shallow UK chalk stream environments. Observed spectra compare well with simulated submerged vegetation spectra, based on water absorption coefficients only. The field investigations, which were performed in the river Wylye, also indicate the confounding effects of specular reflection from riparian vegetation. The results of this study can inform remote sensing studies of the riverine environment using multi-spectral/low altitude sensors. Such larger scale studies will be highly beneficial for monitoring variation in chalk stream bioindicators, such as ranunculus.

Development of a Parent Version of the Manchester-Minneapolis Quality of Life Survey for use by Parents and Crers of UK Children: MMQL-UK (PF).

Background Although it is now widely endorsed that children should as far as possible rate their own health related quality of life (HRQL), there are situations where proxy information on child HRQL may be useful, especially where a child is too ill or young to provide their own HRQL assessment. There is limited availability of generic HRQL scales that have a parallel child and parent version and that are reliable, valid, brief, comprehensible and suitable for use in UK populations. The aims of this study were therefore to develop and validate a parent version of the anglicised Manchester-Minneapolis Quality of Life child form (MMQL-UK (CF)) and to determine the level of association between the child and parent versions of this form. Methods This study was undertaken concurrently with the anglicisation and validation of the MMQL, a measure of HRQL developed for use with children in North America. At that time, no parent version existed, so the MMQL form for children (MMQL-UK (CF)) was used as the basis for the development of the MMQL-UK parent form (PF). The sample included a control group of healthy children and their parents and five exemplar groups; children diagnosed with asthma, diabetes or inflammatory bowel disease and their parents, children in remission from cancer and their parents and children in public care and their carers. Consistency of the MMQL-UK (PF) components were assessed by calculating Cronbach's alpha. Validation of the parent questionnaire was undertaken by comparing MMQL-UK (PF) component scores with comparable components on the proxy PedsQL™ quality of life scales, comparing MMQL-UK (PF) component scores between parents of healthy and chronic disease children and by comparison of component scores from children and their parents or carers. Reproducibility and responsiveness were assessed by retesting parents by follow-up questionnaires. Results A total of 874 children (completing MMQL-UK (CF)) and 572 parents or carers (completing MMQL-UK (PF)) took part in the study. The internal consistency of all the MMQL-UK (PF) components exceeding the accepted criterion of 0.70 and the construct validity was good with moderate correlations being evident between comparable components of the MMQL-UK (PF) and the proxy PedsQL™. Discriminant validity was demonstrated with significant differences being identified between parents of healthy children and those with chronic conditions. Intra-class correlations exceeded 0.65 for all MMQL-UK (PF) components demonstrating good reproducibility. Weak to moderate levels of responsiveness were demonstrated for all but social functioning. The MMQL-UK (PF) showed moderate parent-child correlation with the MMQL-UK (CF) for all components. The best correlations were seen for those components measuring the same construct (Pearson's r ranged from 0.31 to 0.61, p < 0.01 for equivalent components). Conclusion The MMQL-UK (PF) showed moderate to good correlations with the MMQL-UK (CF) component scores. The MMQL-UK (PF) will be of use when comparing child and parent/carer perception of the impact of a child's condition on their HRQL or where the child is too ill or young to provide their own report.

Pollen Season and Climate: Is the Timing of Birch Pollen Release in the UK Approaching its Limit?

In light of heightened interest in the response of pollen phenology to temperature, we investigated recent changes to the onset of Betula (birch) pollen seasons in central and southern England, including a test of predicted advancement of the Betula pollen season for London. We calculated onset of birch pollen seasons using daily airborne pollen data obtained at London, Plymouth and Worcester, determined trends in the start of the pollen season and compared timing of the birch pollen season with observed temperature patterns for the period 1995–2010. We found no overall change in the onset of birch pollen in the study period although there was evidence that the response to temperature was nonlinear and that a lower asymptotic start of the pollen season may exist. The start of the birch pollen season was strongly correlated with March mean temperature. These results reinforce previous findings showing that the timing of the birch pollen season in the UK is particularly sensitive to spring temperatures. The climate relationship shown here persists over both longer decadal-scale trends and shorter, seasonal trends as well as during periods of ‘sign-switching’ when cooler spring temperatures result in later start dates. These attributes, combined with the wide geographical coverage of airborne pollen monitoring sites, some with records extending back several decades, provide a powerful tool for the detection of climate change impacts, although local site factors and the requirement for winter chilling may be confounding factors.