Assessing the effectiveness of robot facilitated neurorehabilitation for relearning motor skills following a stroke

A growing awareness of the potential for machine-mediated neurorehabilitation has led to several novel concepts for delivering these therapies. To get from laboratory demonstrators and prototypes to the point where the concepts can be used by clinicians in practice still requires significant additional effort, not least in the requirement to assess and measure the impact of any proposed solution. To be widely accepted a study is required to use validated clinical measures but these tend to be subjective, costly to administer and may be insensitive to the effect of the treatment. Although this situation will not change, there is good reason to consider both clinical and mechanical assessments of recovery. This article outlines the problems in measuring the impact of an intervention and explores the concept of providing more mechanical assessment techniques and ultimately the possibility of combining the assessment process with aspects of the intervention.

PINCER trial: a cluster randomised trial comparing the effectiveness and cost-effectiveness of a pharmacist-led IT-based intervention with simple feedback in reducing rates of clinically important errors in medicines management in general practices

Background: Medication errors in general practice are an important source of potentially preventable morbidity and mortality. Building on previous descriptive, qualitative and pilot work, we sought to investigate the effectiveness, cost-effectiveness and likely generalisability of a complex pharm acist-led IT-based intervention aiming to improve prescribing safety in general practice. Objectives: We sought to: • Test the hypothesis that a pharmacist-led IT-based complex intervention using educational outreach and practical support is more effective than simple feedback in reducing the proportion of patients at risk from errors in prescribing and medicines management in general practice. • Conduct an economic evaluation of the cost per error avoided, from the perspective of the National Health Service (NHS). • Analyse data recorded by pharmacists, summarising the proportions of patients judged to be at clinical risk, the actions recommended by pharmacists, and actions completed in the practices. • Explore the views and experiences of healthcare professionals and NHS managers concerning the intervention; investigate potential explanations for the observed effects, and inform decisions on the future roll-out of the pharmacist-led intervention • Examine secular trends in the outcome measures of interest allowing for informal comparison between trial practices and practices that did not participate in the trial contributing to the QRESEARCH database. Methods Two-arm cluster randomised controlled trial of 72 English general practices with embedded economic analysis and longitudinal descriptive and qualitative analysis. Informal comparison of the trial findings with a national descriptive study investigating secular trends undertaken using data from practices contributing to the QRESEARCH database. The main outcomes of interest were prescribing errors and medication monitoring errors at six- and 12-months following the intervention. Results: Participants in the pharmacist intervention arm practices were significantly less likely to have been prescribed a non-selective NSAID without a proton pump inhibitor (PPI) if they had a history of peptic ulcer (OR 0.58, 95%CI 0.38, 0.89), to have been prescribed a beta-blocker if they had asthma (OR 0.73, 95% CI 0.58, 0.91) or (in those aged 75 years and older) to have been prescribed an ACE inhibitor or diuretic without a measurement of urea and electrolytes in the last 15 months (OR 0.51, 95% CI 0.34, 0.78). The economic analysis suggests that the PINCER pharmacist intervention has 95% probability of being cost effective if the decision-maker’s ceiling willingness to pay reaches £75 (6 months) or £85 (12 months) per error avoided. The intervention addressed an issue that was important to professionals and their teams and was delivered in a way that was acceptable to practices with minimum disruption of normal work processes. Comparison of the trial findings with changes seen in QRESEARCH practices indicated that any reductions achieved in the simple feedback arm were likely, in the main, to have been related to secular trends rather than the intervention. Conclusions Compared with simple feedback, the pharmacist-led intervention resulted in reductions in proportions of patients at risk of prescribing and monitoring errors for the primary outcome measures and the composite secondary outcome measures at six-months and (with the exception of the NSAID/peptic ulcer outcome measure) 12-months post-intervention. The intervention is acceptable to pharmacists and practices, and is likely to be seen as costeffective by decision makers.

Energy at work: a measurement validation and linkage to unit effectiveness

We introduce the notion that the energy of individuals can manifest as a higher-level, collective construct. To this end, we conducted four independent studies to investigate the viability and importance of the collective energy construct as assessed by a new survey instrument—the productive energy measure (PEM). Study 1 (n = 2208) included exploratory and confirmatory factor analyses to explore the underlying factor structure of PEM. Study 2 (n = 660) cross-validated the same factor structure in an independent sample. In study 3, we administered the PEM to more than 5000 employees from 145 departments located in five countries. Results from measurement invariance, statistical aggregation, convergent, and discriminant-validity assessments offered additional support for the construct validity of PEM. In terms of predictive and incremental validity, the PEM was positively associated with three collective attitudes—units' commitment to goals, the organization, and overall satisfaction. In study 4, we explored the relationship between the productive energy of firms and their overall performance. Using data from 92 firms (n = 5939employees), we found a positive relationship between the PEM (aggregated to the firm level) and the performance of those firms. Copyright © 2011 John Wiley & Sons, Ltd.

Policies to promote healthy eating in Europe: a structured review of policies and their effectiveness

This review provides a classification of public policies to promote healthier eating as well as a structured mapping of existing measures in Europe. Complete coverage of alternative policy types was ensured by complementing the review with a selection of major interventions from outside Europe. Under the auspices of the Seventh Framework Programme's Eatwell Project, funded by the European Commission, researchers from five countries reviewed a representative selection of policy actions based on scientific papers, policy documents, grey literature, government websites, other policy reviews, and interviews with policy-makers. This work resulted in a list of 129 policy interventions, 121 of which were in Europe. For each type of policy, a critical review of its effectiveness was conducted, based on the evidence currently available. The results of this review indicate a need exists for a more systematic and accurate evaluation of government-level interventions as well as for a stronger focus on actual behavioral change rather than changes in attitude or intentions alone. The currently available evidence is very heterogeneous across policy types and is often incomplete.

Mediterranean agriculture under climate change: adaptive capacity, adaptation, and ethics

In the coming decades, the Mediterranean region is expected to experience various climate impacts with negative consequences on agricultural systems and which will cause uneven reductions in agricultural production. By and large, the impacts of climate change on Mediterranean agriculture will be heavier for southern areas of the region. This unbalanced distribution of negative impacts underscores the significance and role of ethics in such a context of analysis. Consequently, the aim of this article is to justify and develop an ethical approach to agricultural adaptation in the Mediterranean and to derive the consequent implications for adaptation policy in the region. In particular, we define an index of adaptive capacity for the agricultural systems of the Mediterranean region on whose basis it is possible to group its different sub-regions, and we provide an overview of the suitable adaptation actions and policies for the sub-regions identified. We then vindicate and put forward an ethical approach to agricultural adaptation, highlighting the implications for the Mediterranean region and the limitations of such an ethical framework. Finally, we emphasize the broader potential of ethics for agricultural adaptation policy.

A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis

Background: Medication errors are common in primary care and are associated with considerable risk of patient harm. We tested whether a pharmacist-led, information technology-based intervention was more effective than simple feedback in reducing the number of patients at risk of measures related to hazardous prescribing and inadequate blood-test monitoring of medicines 6 months after the intervention. Methods: In this pragmatic, cluster randomised trial general practices in the UK were stratified by research site and list size, and randomly assigned by a web-based randomisation service in block sizes of two or four to one of two groups. The practices were allocated to either computer-generated simple feedback for at-risk patients (control) or a pharmacist-led information technology intervention (PINCER), composed of feedback, educational outreach, and dedicated support. The allocation was masked to general practices, patients, pharmacists, researchers, and statisticians. Primary outcomes were the proportions of patients at 6 months after the intervention who had had any of three clinically important errors: non-selective non-steroidal anti-inflammatory drugs (NSAIDs) prescribed to those with a history of peptic ulcer without co-prescription of a proton-pump inhibitor; β blockers prescribed to those with a history of asthma; long-term prescription of angiotensin converting enzyme (ACE) inhibitor or loop diuretics to those 75 years or older without assessment of urea and electrolytes in the preceding 15 months. The cost per error avoided was estimated by incremental cost-eff ectiveness analysis. This study is registered with Controlled-Trials.com, number ISRCTN21785299. Findings: 72 general practices with a combined list size of 480 942 patients were randomised. At 6 months’ follow-up, patients in the PINCER group were significantly less likely to have been prescribed a non-selective NSAID if they had a history of peptic ulcer without gastroprotection (OR 0∙58, 95% CI 0∙38–0∙89); a β blocker if they had asthma (0∙73, 0∙58–0∙91); or an ACE inhibitor or loop diuretic without appropriate monitoring (0∙51, 0∙34–0∙78). PINCER has a 95% probability of being cost eff ective if the decision-maker’s ceiling willingness to pay reaches £75 per error avoided at 6 months. Interpretation: The PINCER intervention is an effective method for reducing a range of medication errors in general practices with computerised clinical records. Funding: Patient Safety Research Portfolio, Department of Health, England.

School effectiveness and the displacement of equity discourses in education

An essential aspect of school effectiveness theory is the shift from the social to the organisational context, from the macro- to the micro-culture. The school is represented largely as a bounded institution, set apart, but also in a precarious relationship with the broader social context. It is ironic that at a time when social disadvantage appears to be increasing in Britain and elsewhere, school effectiveness theory places less emphasis on poverty, deprivation and social exclusion. Instead, it places more emphasis on organisational factors such as professional leadership, home/school partnerships, the monitoring of academic progress, shared vision and goals. In this article, the authors evaluate the extent to which notions of effectiveness have displaced concerns about equity in theories of educational change. They explore the extent to which the social structures of gender, ethnicity, sexualities, special needs, social class, poverty and other historical forms of inequality have been incorporated into or distorted and excluded from effectiveness thinking.

School effectiveness: new managerialism, quality and the Japanisation of education

School effectiveness is a microtechnology of change. It is a relay device, which transfers macro policy into everyday processes and priorities in schools. It is part of the growing apparatus of performance evaluation. Change is brought about by a focus on the school as a site-based system to be managed. There has been corporate restructuring in response to the changing political economy of education. There are now new work regimes and radical changes in organizational cultures. Education, like other public services, is now characterized by a range of structural realignments, new relationships between purchasers and providers and new coalitions between management and politics. In this article, we will argue that the school effectiveness movement is an example of new managerialism in education. It is part of an ideological and technological process to industrialize educational productivity. That is to say, the emphasis on standards and standardization is evocative of production regimes drawn from industry. There is a belief that education, like other public services can be managed to ensure optimal outputs and zero defects in the educational product.

A method to weight three categories of adaptive thermal comfort

The adaptive thermal comfort theory considers people as active rather than passive recipients in response to ambient physical thermal stimuli, in contrast with conventional, heat-balance-based, thermal comfort theory. Occupants actively interact with the environments they occupy by means of utilizing adaptations in terms of physiological, behavioural and psychological dimensions to achieve ‘real world’ thermal comfort. This paper introduces a method of quantifying the physiological, behavioural and psychological portions of the adaptation process by using the analytic hierarchy process (AHP) based on the case studies conducted in the UK and China. Apart from three categories of adaptations which are viewed as criteria, six possible alternatives are considered: physiological indices/health status, the indoor environment, the outdoor environment, personal physical factors, environmental control and thermal expectation. With the AHP technique, all the above-mentioned criteria, factors and corresponding elements are arranged in a hierarchy tree and quantified by using a series of pair-wise judgements. A sensitivity analysis is carried out to improve the quality of these results. The proposed quantitative weighting method provides researchers with opportunities to better understand the adaptive mechanisms and reveal the significance of each category for the achievement of adaptive thermal comfort.

Field study on thermal comfort and adaptive strategies in residential buildings in China

This paper fully describes a nation-wide field study on building thermal environment and thermal comfort of occupant, which was carried out in summer 2005 and in winter 2006 respectively in China, illustrating the adaptive strategies adopted by occupants in domestic buildings in China. According to the climate division in China, the buildings in Beijing (BJ), Shanghai (SH), Wuhan (WH) and Chongqing (CQ), Guangzhou (GZ), Kunming (KM), were selected as targets which are corresponding to cold zone, hot summer and cold winter zone (SWC-SH, WH, CQ), hot summer and warm winter zone and temperate zone, respectively. The methodology used in the field study is the combination of subjective questionnaire regarding thermal sensation and adaptive approaches and physical environmental monitoring including indoor air temperature and relative humidity. A total of 1671 subjects participate in this investigation with more than 80% response rate in all surveyed cities. Both physiological and non-physiological factors (behavioural and psychological adaptations) have been analysed.

Results of a DSP based adaptive cancellation filter system for the chirp, pulsar and localiser sirens

Sirens’ used by police, fire and paramedic vehicles generate noise that propagates inside the vehicle cab that subsequently corrupts intelligibility of voice communications from the emergency vehicle to the control room. It is even common for the siren to be turned off to enable the control room to hear what is being said. Both fixed filter and adaptive filter systems have previously been developed to help cancel the transmission of the siren noise over the radio. Previous cancellation systems have only concentrated on the traditional 2-tone, wail and yelp sirens. This paper discusses an improvement to a previous adaptive filter system and presents the cancellation results to three new types of sirens; being chirp pulsar and localiser. A siren noise filter system has the capability to improve the response time for an emergency vehicle and thus help save lives. To date, this system has been tested using live recordings taken from a nonemergency situation with good results.