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Sample records for acute nhs trust

  1. Developing a market orientation in the Health Service: a survey of acute NHS Trusts in Scotland.

    PubMed

    Laing, A W; Galbraith, A

    1996-01-01

    Argues that the introduction of the quasi market mechanism into the Health Service has required that managers within NHS trusts acquire new managerial skills relating to market operations and, more importantly, reorientate their organizations towards the marketplace. Examines the pattern of development which has occurred within acute trusts across Scotland in the past three years, and argues that managers in the majority of trusts have developed a remarkably robust and relevant conceptualization of the nature and application of marketing within the NHS, reflecting the difficulties managers have faced in selling the concept of marketing to a generally sceptical body of clinicians. Notes, in part owing to such professional scepticism, that the development of marketing as an implementable approach to operations has lagged significantly behind the managerial conceptualization, although this cannot be attributed solely to resistance from clinicians and other health care professionals. Rather, suggests that such limited progress in implementing a market orientation reflects a range of "structural" barriers, both within individual trusts and the specific market environment faced by trusts.

  2. Intranet technology in Scottish NHS Trusts.

    PubMed

    Wilson, S M; Jackson, K A

    1999-02-01

    Intranet technology has the potential to turn everything we've taken for granted in internal communication upside down. This paper looks at the uptake and use of Intranet technology in NHS Trusts in Scotland and discusses some of the uses of an Intranet system. PMID:10218226

  3. An analysis of catering options within NHS acute hospitals.

    PubMed

    Hwang, J L; Desombre, T; Eves, A; Kipps, M

    1999-01-01

    Reforms of the NHS's healthcare structure have placed additional pressure on all aspects of hospital management. Evaluation of the effects of these reforms is difficult without more information on current conditions. Hospital catering in acute care trusts has little contemporary background research available. With this in mind, a survey of all the acute care NHS trusts within the eight regions in England was undertaken to investigate the hospital meal service process. A mailed questionnaire asked for the meal production system, food service method and food delivery personnel used by each trust, and a copy of a weekly menu. Results, from an 80.7 per cent response rate, indicate that most trusts use batch cooking to prepare their meals, and plated meal service to deliver the food to the wards. Almost 75 per cent of the trusts use nurses, at least in part, to serve food. English foodstuffs dominate the menus. Most of the trusts have moved towards meeting the goals set by the Patients' Charter and other NHS recommendations. PMID:10724573

  4. An analysis of catering options within NHS acute hospitals.

    PubMed

    Hwang, J L; Desombre, T; Eves, A; Kipps, M

    1999-01-01

    Reforms of the NHS's healthcare structure have placed additional pressure on all aspects of hospital management. Evaluation of the effects of these reforms is difficult without more information on current conditions. Hospital catering in acute care trusts has little contemporary background research available. With this in mind, a survey of all the acute care NHS trusts within the eight regions in England was undertaken to investigate the hospital meal service process. A mailed questionnaire asked for the meal production system, food service method and food delivery personnel used by each trust, and a copy of a weekly menu. Results, from an 80.7 per cent response rate, indicate that most trusts use batch cooking to prepare their meals, and plated meal service to deliver the food to the wards. Almost 75 per cent of the trusts use nurses, at least in part, to serve food. English foodstuffs dominate the menus. Most of the trusts have moved towards meeting the goals set by the Patients' Charter and other NHS recommendations.

  5. Strategic marketing in the NHS: Kwik-health NHS Trust.

    PubMed

    Laing, A W; Galbraith, A

    1995-01-01

    Unlike managers in most service organizations, hospital managers do not have significant control over the shape or cost of the service product or the manner of its delivery. Hence, the crucial issue for hospital management to address is how to develop the marketing of a service the control of which is divorced from those with the strategic market perspective. While the internal management of hospital care in NHS is in its infancy, initial developments such as clinical directorates point the way forward in creating a market orientation within provider units. Ultimately, it must be considered what degree of influence over clinical decisions affecting hospital services is realistic, ethical and desirable for strategic marketing and business services. Arguably there is a case for the adoption of some middle ground, with both sides moving from their present positions but perhaps with the clinicians moving furthest.

  6. Understanding the roles of NHS trust board members.

    PubMed

    Deffenbaugh, J

    1996-01-01

    The establishment of NHS trust boards on a business format was a recent innovation resulting from the NHS reforms. In order to realize benefits for patients, it is essential that boards operate effectively. Explores within the framework of corporate governance, the practical implications of board member roles. Drawing on experience of strategy formulation at board level, analyses and clarifies the roles, and presents recommendations to increase board effectiveness. PMID:10162758

  7. Trusting in the New NHS: instrumental versus communicative action.

    PubMed

    Brown, Patrick R

    2008-04-01

    Recent reforms within the UK National Health Service, particularly the introduction of clinical governance, have been enacted with the apparent aim of rebuilding patient trust. This paper analyses the approach taken by policy makers, arguing that it is based very much on an instrumental conception of trust. The assumptions and limitations of this model are discussed and in so doing, a communicative understanding of trust is proposed as an alternative. It is argued that the instrumental rationality and institutional focus inherent to instrumental trust neglect the importance of the communication between patient and medical professional and its affective dimensions. Communicative trust goes beyond a mere cognitive appreciation of the system and rather is dependent on the qualitative interaction at the access point, where the patient comes to believe that the communicative rationality of their best interests is mirrored by the professional's instrumental rationality. Whilst recent challenges to the confidence of patients in professionals and medical knowledge make some approximation of an ideal speech situation more imperative than previously, the application of an instrumental concept of trust in the NHS makes such interactions less likely, as well as facilitating a divergence between instrumental and communicative rationality in healthcare provision.

  8. Best practice organizational effectiveness in NHS Trusts. Leeds Teaching Hospitals NHS Trust. Case study.

    PubMed

    Zairi, M; Cooke, M; Whymark, J

    1999-01-01

    Measuring organisational effectiveness in a health-care delivery context is quite a challenging task. Although there are numerous performance assessment models, audit tools and managerial diagnostic tools, they all, however, tend to fall short in their attempts to scrutinize how health-care organizations deploy their capabilities to deliver optimum quality in service provision and what performance levels they achieved as a result of their approach. The project reported here attempted to address these issues, reflecting the experience of Leeds Teaching Hospitals, one of a series of Trusts whose approach to organizational effectiveness was closely examined.

  9. Any qualified provider: a qualitative case study of one community NHS Trust's response

    PubMed Central

    Walumbe, Jackie; Swinglehurst, Deborah; Shaw, Sara

    2016-01-01

    Objective To examine how those managing and providing community-based musculoskeletal (MSK) services have experienced recent policy allowing patients to choose any provider that meets certain quality standards from the National Health Service (NHS), private or voluntary sector. Design Intrinsic case study combining qualitative analysis of interviews and field notes. Setting An NHS Community Trust (the main providers of community health services in the NHS) in England, 2013–2014. Participants NHS Community Trust employees involved in delivering MSK services, including clinical staff and managerial staff in senior and mid-range positions. Findings Managers (n=4) and clinicians (n=4) working within MSK services understood and experienced the Any Qualified Provider (AQP) policy as involving: (1) a perceived trade-off between quality and cost in its implementation; (2) deskilling of MSK clinicians and erosion of professional values; and (3) a shift away from interprofessional collaboration and dialogue. These ways of making sense of AQP policy were associated with dissatisfaction with market-based health reforms. Conclusions AQP policy is poorly understood. Clinicians and managers perceive AQP as synonymous with competition and privatisation. From the perspective of clinicians providing MSK services, AQP, and related health policy reforms, tend, paradoxically, to drive down quality standards, supporting reconfiguration of services in which the complex, holistic nature of specialised MSK care may become marginalised by policy concerns about efficiency and cost. Our analysis indicates that the potential of AQP policy to increase quality of care is, at best, equivocal, and that any consideration of how AQP impacts on practice can only be understood by reference to a wider range of health policy reforms. PMID:26908521

  10. The management of ultrasound equipment at Sheffield Teaching Hospitals NHS Foundation Trust.

    PubMed

    Verma, P K; Peacock, M

    2014-02-01

    Management of ultrasound equipment at Sheffield Teaching Hospitals NHS Foundation Trust is described. The organisation and input of various stakeholders and their involvement with ultrasound equipment management and scientific ultrasound is discussed. Two important stakeholders are the Medical Equipment Management Group and the Radiation Safety Steering Committee. The Medical Equipment Management Group has a specific sub-group, the Ultrasound sub-group, and its role is to coordinate the purchase, replacement and quality assurance of ultrasound equipment in the Trust. The Radiation Safety Steering Committee has a non-ionising radiation representative and the role of this committee is to provide corporate assurance that any health and safety issues arising from the use of radiation to either patients, members of the public or staff within the Trust are being effectively managed. The Ultrasound sub-group of the Medical Equipment Management Group has successfully brought together management of all ultrasound equipment within the Trust and is in the process of fulfilling the quality assurance and training milestones set out by the Medical Equipment Management Group. Advice from the Radiation Safety Steering Committee has helped to increase awareness of ultrasound safety and good scanning practice, especially in the case of neonatal ultrasound imaging, within the Trust. In addition, the RSSC has given advice on clinical pathways for patients undergoing ionising radiation imaging while being treated by extra-corporeal shockwave lithotripsy.

  11. The management of ultrasound equipment at Sheffield Teaching Hospitals NHS Foundation Trust

    PubMed Central

    Peacock, M

    2013-01-01

    Management of ultrasound equipment at Sheffield Teaching Hospitals NHS Foundation Trust is described. The organisation and input of various stakeholders and their involvement with ultrasound equipment management and scientific ultrasound is discussed. Two important stakeholders are the Medical Equipment Management Group and the Radiation Safety Steering Committee. The Medical Equipment Management Group has a specific sub-group, the Ultrasound sub-group, and its role is to coordinate the purchase, replacement and quality assurance of ultrasound equipment in the Trust. The Radiation Safety Steering Committee has a non-ionising radiation representative and the role of this committee is to provide corporate assurance that any health and safety issues arising from the use of radiation to either patients, members of the public or staff within the Trust are being effectively managed. The Ultrasound sub-group of the Medical Equipment Management Group has successfully brought together management of all ultrasound equipment within the Trust and is in the process of fulfilling the quality assurance and training milestones set out by the Medical Equipment Management Group. Advice from the Radiation Safety Steering Committee has helped to increase awareness of ultrasound safety and good scanning practice, especially in the case of neonatal ultrasound imaging, within the Trust. In addition, the RSSC has given advice on clinical pathways for patients undergoing ionising radiation imaging while being treated by extra-corporeal shockwave lithotripsy. PMID:27433195

  12. The challenge of effectively addressing tobacco control within a health promoting NHS Trust.

    PubMed

    Quinn, J; Sengupta, S; Cleary, H

    2001-12-15

    As part of its participation in the international network of health promoting hospitals (HPH), South Tyneside Health Care NHS Trust has initiated a series of sub-projects that are informed by the contemporary evidence-base and the principles of the HPH programme. This paper concerns the first of these sub-projects, whose aim is to establish an equitable and effective Trust-wide system to address smoking in South Tyneside. The ambition is to build a framework for, and foster a culture within which, individuals will be treated considerately, whilst managing "unhealthy" behaviour in such a way as to have a long-term positive impact within the organisation and the surrounding community. This paper will briefly outline the key activities underway, and the manner in which it is hoped this approach to undertaking a HPH sub-project will contribute to sustainable local health improvement, while also supporting the Trust's broader transformation into a truly health promoting organisation. PMID:11755769

  13. Service contribution and cost-effectiveness of specialist registrars in NHS trusts: a survey and costing analysis.

    PubMed

    Dafydd, Derfel Ap; Baskaradas, Aroon; Bobdiwala, Shabnam; Anwar, Muhammad Saleem; Abrahams, Rachel; Jeremy, Levy

    2016-06-01

    Since the introduction of the European Working Time Directive, specialist registrars arguably contribute less to clinical service. The purpose of this study was to broadly quantify the service contribution of specialist registrars across a range of specialties and their value to an NHS organisation. A questionnaire-based survey of the clinical activities of specialist registrars in a large NHS trust was undertaken. Simple costing analyses of this -clinical activity were performed. Responses from 66 specialist registrars in 24 specialties showed an average of 51% overall clinical autonomy. Trainees attended an average of 2.7 outpatient clinics per week and spent 3.5 sessions a week doing ward work. Medical trainees took more referrals and attended more clinics. An analysis of costings suggested that surgical trainees might have generated around £700,000 income per year for the trust. Overall, specialist registrars make a substantial contribution to NHS clinical service and are cost-effective.

  14. Service contribution and cost-effectiveness of specialist registrars in NHS trusts: a survey and costing analysis.

    PubMed

    Dafydd, Derfel Ap; Baskaradas, Aroon; Bobdiwala, Shabnam; Anwar, Muhammad Saleem; Abrahams, Rachel; Jeremy, Levy

    2016-06-01

    Since the introduction of the European Working Time Directive, specialist registrars arguably contribute less to clinical service. The purpose of this study was to broadly quantify the service contribution of specialist registrars across a range of specialties and their value to an NHS organisation. A questionnaire-based survey of the clinical activities of specialist registrars in a large NHS trust was undertaken. Simple costing analyses of this -clinical activity were performed. Responses from 66 specialist registrars in 24 specialties showed an average of 51% overall clinical autonomy. Trainees attended an average of 2.7 outpatient clinics per week and spent 3.5 sessions a week doing ward work. Medical trainees took more referrals and attended more clinics. An analysis of costings suggested that surgical trainees might have generated around £700,000 income per year for the trust. Overall, specialist registrars make a substantial contribution to NHS clinical service and are cost-effective. PMID:27251912

  15. Improving service quality in NHS Trust hospitals: lessons from the hotel sector.

    PubMed

    Desombre, T; Eccles, G

    1998-01-01

    This article looks to review recent practice undertaken within the UK hotel sector to improve customer service, and suggests ideals that could be implemented within National Health (NHS) Trust hospitals. At a time of increasing competition, hotel firms are using service enhancement as a means to gain competitive advantage, and therefore developing a range of techniques to measure levels of service quality improvement. With continued change in the health service, where greater focus now lies with patient satisfaction, so there is a requirement for managers to adapt techniques presently being offered in other service industries to improve levels of customer service and ensure patients are targeted to define their levels of satisfaction. PMID:10177367

  16. Medical leadership arrangements in English healthcare organisations: findings from a national survey and case studies of NHS trusts.

    PubMed

    Dickinson, Helen; Ham, Chris; Snelling, Iain; Spurgeon, Peter

    2013-11-01

    This project sought to describe the involvement of doctors in leadership roles in the NHS and the organisational structures and management processes in use in NHS trusts. A mixed methods approach was adopted combining a questionnaire survey of English NHS trusts and in-depth case studies of nine organisations who responded to the survey. Respondents identified a number of challenges in the development of medical leadership, and there was often perceived to be an engagement gap between medical leaders and doctors in clinical roles. While some progress has been made in the development of medical leadership in the NHS in England, much remains to be done to complete the journey that started with the Griffiths Report in 1983. We conclude that a greater degree of professionalism needs to be brought to bear in the development of medical leadership. This includes developing career structures to make it easier for doctors to take on leadership roles; providing training, development and support in management and leadership at different stages of doctors' careers; and ensuring that pay and other rewards are commensurate with the responsibilities of medical leaders. The time commitment of medical leaders and the proportion of doctors in leadership roles both need to increase. The paper concludes considering the implications of these findings for other health systems.

  17. Medical leadership arrangements in English healthcare organisations: findings from a national survey and case studies of NHS trusts.

    PubMed

    Dickinson, Helen; Ham, Chris; Snelling, Iain; Spurgeon, Peter

    2013-11-01

    This project sought to describe the involvement of doctors in leadership roles in the NHS and the organisational structures and management processes in use in NHS trusts. A mixed methods approach was adopted combining a questionnaire survey of English NHS trusts and in-depth case studies of nine organisations who responded to the survey. Respondents identified a number of challenges in the development of medical leadership, and there was often perceived to be an engagement gap between medical leaders and doctors in clinical roles. While some progress has been made in the development of medical leadership in the NHS in England, much remains to be done to complete the journey that started with the Griffiths Report in 1983. We conclude that a greater degree of professionalism needs to be brought to bear in the development of medical leadership. This includes developing career structures to make it easier for doctors to take on leadership roles; providing training, development and support in management and leadership at different stages of doctors' careers; and ensuring that pay and other rewards are commensurate with the responsibilities of medical leaders. The time commitment of medical leaders and the proportion of doctors in leadership roles both need to increase. The paper concludes considering the implications of these findings for other health systems. PMID:25595009

  18. Addressing Library Anxiety (LA) in student nurses: a study in an NHS Foundation Trust Hospital library and information service.

    PubMed

    Still, Madeleine

    2015-12-01

    Library anxiety is a concept which has been recognised in academic library circles since the early 1990s. It can result in students actively avoiding the library for the duration of their studies. Madeleine Still is Trust Librarian at North Tees & Hartlepool NHS Foundation Trust and while studying for an MSc, recognised that some student nurses were exhibiting signs of library anxiety. She decided to make it the focus of her MSc dissertation, and this article discusses her research project as well as highlighting the measures she has taken to address the issues she uncovered. Madeleine graduated in July 2013 with an MSc in Information & Library Studies from Robert Gordon University.

  19. Yearworth v. North Bristol NHS trust: a property case of uncertain significance?

    PubMed

    Harmon, Shawn H E

    2010-11-01

    It has long been the position in law that, subject to some minor but important exceptions, property cannot be held in the human body, whether living or dead. In the recent case of Yearworth and Others v North Bristol NHS Trust, however, the Court of Appeal for England and Wales revisited the property debate and threw into doubt a number of doctrines with respect to property and the body. This brief article analyses Yearworth, (1) reviewing the facts and the Court's decision with respect to the originators' proprietary and contractual interests in their body and bodily products, (2) considering the significance of relying on property and its use a legal metaphor, (3) questioning the scope of the property right created, and (4) querying whether an alternate conceptual approach to extending rights and a remedy was warranted. It concludes that, while Yearworth engages with, and impacts on, important theoretical and practical issues--from legal, healthcare and research perspectives--it does not offer a great deal of guidance and, for that reason, its precedential significance is in doubt. PMID:20596782

  20. Trust-level risk evaluation and risk control guidance in the NHS East of England.

    PubMed

    Card, Alan J; Ward, James R; Clarkson, P John

    2014-08-01

    In recent years, the healthcare sector has adopted the use of operational risk assessment tools to help understand the systems issues that lead to patient safety incidents. But although these problem-focused tools have improved the ability of healthcare organizations to identify hazards, they have not translated into measurable improvements in patient safety. One possible reason for this is a lack of support for the solution-focused process of risk control. This article describes a content analysis of the risk management strategies, policies, and procedures at all acute (i.e., hospital), mental health, and ambulance trusts (health service organizations) in the East of England area of the British National Health Service. The primary goal was to determine what organizational-level guidance exists to support risk control practice. A secondary goal was to examine the risk evaluation guidance provided by these trusts. With regard to risk control, we found an almost complete lack of useful guidance to promote good practice. With regard to risk evaluation, the trusts relied exclusively on risk matrices. A number of weaknesses were found in the use of this tool, especially related to the guidance for scoring an event's likelihood. We make a number of recommendations to address these concerns. The guidance assessed provides insufficient support for risk control and risk evaluation. This may present a significant barrier to the success of risk management approaches in improving patient safety.

  1. A Multi-Faceted Approach of One Teaching Hospital NHS Trust during the Clostridium difficile Epidemic-Antibiotic Management and Beyond.

    PubMed

    White, Helena; Wiselka, Martin; Bell, David

    2016-02-26

    The incidence of Clostridium difficile infection (CDI) in the UK rose dramatically during the early years of this century, in part associated with the emergence of the hyper-virulent ribotype 027 strain. The University Hospitals of Leicester (UHL), a 2000-bed acute UK NHS Trust, implemented a number of interventions, which led to an 80% reduction in new cases over a twelve month period. Changes were introduced as a result of collaboration between the Infection Prevention team, the departments of Microbiology and Infectious Diseases, and with the support of the Trust Executive. These strategies are described in detail and included; implementation of antimicrobial stewardship, specific hygiene and cleaning measures, the introduction of a care pathway form for all infected patients, the opening of an isolation ward for patients with CDI, strengthened organisation and clinical management, and rigorous attention to education within the Trust. The implementations described are of continued relevance in the face of new infection challenges, such as the increasing incidence of multi-drug resistant organisms.

  2. Action Learning: Developing Innovative Networks of Practice ... for Ideas Worth Sharing--Design Event Held at Mersey Care NHS Trust Liverpool on 6 November, 2008

    ERIC Educational Resources Information Center

    Harvey, Brendon

    2009-01-01

    In this article, the author talks about the highlights of the first design event of the "Northern Action Learning Network" held in Mersey Care NHS Trust Liverpool last November 6, 2008. The intent of the event was to tap into the diverse and flourishing action learning (AL) community by growing an innovative network of practitioners keen to create…

  3. Mind the gap: are NHS trusts falling short of recommended standards for consent to autopsy?

    PubMed

    Eka, Ime; Rowan, Camilla; Osborn, Michael

    2014-01-01

    The decline of the hospital autopsy is a well-known phenomenon that shows no sign of ending. Debate continues for the reasons behind this, but inadequate consent practices are thought to play a role. The furore resulting from organ retention scandals at Bristol Royal Infirmary and The Royal Liverpool Children's Hospital led to widespread soul searching in the medical profession, and a fundamental change in how we treat the dead body. In response, the 2004 Human Tissue Act was created, and consent is now centrally placed to permit all activities dealing with the cadaver, including autopsy. This article reflects on consent practices for hospital autopsy in England and Wales. Relevant policies from 26 National Health Service trusts were examined against the recommended standards set by the Human Tissue Authority. We found numerous failures of multiple trusts to follow these standards. Several trust policies failed to outline basic information to guide staff in conducting the consent process, such as the training requirements of the consent taker, and the desired approach to take consent. Many trusts failed to outline vital recommendations of the Human tissue Authority, such as the requirement of the consent taker to be experienced, trained in dealing with the bereaved and well informed on autopsy practice, as well as the requirement to have witnessed an autopsy. We recommend trusts reassess their practices in order meet the established standards with an emphasis on educating staff and developing a team-based approach to consent taking.

  4. Sample evaluation of caseload complexity in a community health-care NHS trust.

    PubMed

    McGarry, Anne

    2015-04-01

    People diagnosed with a multiple long-term conditions and those with profound and multiple learning disabilities are the most intensive users of health and social care. In addition, around 30% of patients with long-term physical conditions also have a mental health problem. The close relationship between mental and physical health is reflected in the high frequency with which illnesses of both kinds overlap in an age of multi-morbidity. This study demonstrates that those with comorbid mental health problems show poorer clinical outcomes, lower quality of life and reduced ability to manage physical symptoms effectively. This also affects their capacity to engage in treatment and make decisions, which affects not only their care and treatment but ultimately their quality of life. The NHS Call to Action demanded improvement in the service provided to support the needs of people with long-term conditions. The scale of the impact of comorbid mental health problems on costs and outcomes suggests that developing services that respond more effectively to these needs should be a priority. PMID:25839875

  5. Limits to employee empowerment in the UK NHS. Locality managers in a community health trust.

    PubMed

    Procter, S; Currie, G; Orme, H

    1999-01-01

    The concern of this paper lies with empowerment of middle managers in a community health trust. It considers the impact of traditional structures and cultures upon the level of decision which middle managers are empowered to make. The conclusion reached is one which suggests that the level of discretion available to middle managers was one of making task-oriented decisions rather than decisions about strategic change. However, even this was compromised by financial constraints and by "best practices" imposed by the personnel function.

  6. Improving efficiency in robotic theatres in the Royal Wolverhampton NHS Trust: a gynaecology theatres perspective.

    PubMed

    Harding, V; Williams, J

    2016-03-01

    Improving efficiency within the operating theatre is always a key concern when running a successful operating list. However, with robotic surgery, this can become paramount. Robotic procedures require a more technical set up, additional planning, and good solid communication within the multidisciplinary team. Efficiency needs to be at the forefront of everyone's mind. Forward planning requires knowledge of the procedures being carried out and adequate training with the robot. Trouble shooting will also improve efficiency in robotic surgery, as being able to expect the unexpected can be a major advantage. This article looks at the hurdles encountered by the theatre team at Royal Wolverhampton Trust at the implementation of the robotic programme, and how the theatre team made adjustments to working practice in order to minimise disruption and maximise efficiency. PMID:27149833

  7. Improving efficiency in robotic theatres in the Royal Wolverhampton NHS Trust: a gynaecology theatres perspective.

    PubMed

    Harding, V; Williams, J

    2016-03-01

    Improving efficiency within the operating theatre is always a key concern when running a successful operating list. However, with robotic surgery, this can become paramount. Robotic procedures require a more technical set up, additional planning, and good solid communication within the multidisciplinary team. Efficiency needs to be at the forefront of everyone's mind. Forward planning requires knowledge of the procedures being carried out and adequate training with the robot. Trouble shooting will also improve efficiency in robotic surgery, as being able to expect the unexpected can be a major advantage. This article looks at the hurdles encountered by the theatre team at Royal Wolverhampton Trust at the implementation of the robotic programme, and how the theatre team made adjustments to working practice in order to minimise disruption and maximise efficiency.

  8. An analysis of National Health Service Trust websites on the occupational backgrounds of ‘Non-Executive Directors’ on England’s Acute Trusts

    PubMed Central

    Harding, Andrew JE

    2014-01-01

    Summary Objectives To explore the occupational backgrounds of English Non-Executive Directors (NED) on Acute National Health Service (NHS) Trusts. Design Data extrapolated from Trust websites of NED’ occupational backgrounds by gender and occupations, and inter-rater reliability test undertaken. Setting Data were available on all but 24 of the 166 Acute Trusts’ from all regions. Participants Trust Chairs and NED were categorised by their dominant occupation. Main outcome measure Differentiating NED with and without health or social care leadership experience. Results The ratings of NED’ occupations positively correlated (p < 0.001). Occupational categories were Commerce and Finance from private and public sectors or with Medical or Community leadership experience. Only 4% of Chairs were Medical, 2% from Community – the majority (61%) from Commerce and Finance. Of the 1001 NED, 8% and 6% respectively had Medical or Community leadership experience; most (86%) were Commerce, Finance and non-clinical Managerial backgrounds. Females made up 27% of NED. Conclusions With a predominance of Chairs and NED without health or social care leadership experience, are current Boards equipped to avoid inadvertently ‘doing the system's business’ (Francis, 2013) rather than developing a more patient-centred, clinically led and integrated NHS? It is suggested that Boards need more NED with health and social care leadership experience and methods to identify the ‘patient’s agenda’ to create ‘a common culture’ that places ‘patients at the centre of everything we do’ (Hunt, 2012). A key context for Trust Boards operations is funding, which Francis’ terms of reference excluded, an issue that is briefly discussed. PMID:25057396

  9. Analysing the medicine-management interface in acute trusts.

    PubMed

    Ong, B N; Boaden, M; Cropper, S

    1997-01-01

    The impact of the NHS reforms, and the resulting purchaser-provider split, has refocused attention on the relationship between management and medicine in acute hospitals. It is timely to assess the explanatory power of various theoretical models regarding the management-medicine interface. Argues that this interface is currently rather fluid and that a dynamic and adaptive model is best suited to understanding the way in which doctors and managers develop their relationship within the changing policy context. Two examples illustrate these shifting boundaries.

  10. An investigation into the feasibility of designing a framework for the quantitative evaluation of the Clinical Librarian service at an NHS Trust in Brighton, UK.

    PubMed

    Deshmukh, Archana; Roper, Tom

    2014-12-01

    This feature presents research undertaken by Archana Deshmukh for her MA dissertation at the University of Brighton. She worked closely with Tom Roper, the Clinical Librarian at Brighton and Sussex University Hospitals NHS Trust, in a project to explore the feasibility of applying quantitative measures to evaluate the Clinical Librarian service. The investigation used an innovative participatory approach and the findings showed that although an exclusively quantitative approach to evaluation is not feasible, using a mixed methods approach is a way forward. Agreed outputs and outcomes could be embedded in a marketing plan, and the resulting framework could provide evidence to demonstrate overall impact. Archana graduated in July 2014, gaining a Distinction in the MA in Information Studies, and she is currently looking for work in the health information sector. PMID:25443028

  11. An investigation into the feasibility of designing a framework for the quantitative evaluation of the Clinical Librarian service at an NHS Trust in Brighton, UK.

    PubMed

    Deshmukh, Archana; Roper, Tom

    2014-12-01

    This feature presents research undertaken by Archana Deshmukh for her MA dissertation at the University of Brighton. She worked closely with Tom Roper, the Clinical Librarian at Brighton and Sussex University Hospitals NHS Trust, in a project to explore the feasibility of applying quantitative measures to evaluate the Clinical Librarian service. The investigation used an innovative participatory approach and the findings showed that although an exclusively quantitative approach to evaluation is not feasible, using a mixed methods approach is a way forward. Agreed outputs and outcomes could be embedded in a marketing plan, and the resulting framework could provide evidence to demonstrate overall impact. Archana graduated in July 2014, gaining a Distinction in the MA in Information Studies, and she is currently looking for work in the health information sector.

  12. To explore and understand the leadership experiences of modern matrons, within an acute NHS Trust.

    PubMed

    Lawrence, Nigel; Richardson, Janet

    2014-01-01

    Aim  The aim of this study was to explore and understand the leadership experiences of modern matrons. Background  Modern matrons were re-introduced to the National Health Service in 2002, and effective leadership has been identified as being essential for the role to be successful. However, there is minimal evidence of how modern matrons experience effective leadership. Methods  The study used a descriptive generic qualitative methodology; one-to-one semi-structured interviews were conducted with nine matrons. This was subjected to an inductive thematic analysis. Results  Three themes were found to influence modern matron's leadership experiences: leadership behaviours, negative influences and leadership investment. They did not follow one leadership style but adapted this to their situation. Various factors appeared to restrict their leadership effectiveness. Conclusions  The findings suggest that exposure to a range of leadership styles should be included in preparation and CPD for the modern matron role and a more consistent job description and job purpose should be developed. Implications for nursing management  Leadership styles such as transformational leadership alone do not meet the complex demands of nursing leaders, and therefore there is a requirement for greater flexibility in leadership development for all health care professionals. PMID:23410106

  13. Impact of the Department of Health initiative to equip and train acute trusts to manage chemically contaminated casualties

    PubMed Central

    Al-Damouk, M; Bleetman, A

    2005-01-01

    Background: Before 1999, there was no national model or standard doctrine for managing casualties from chemical incidents in the UK. A Department of Health (DoH) initiative to prepare the National Health Service (NHS) for chemical incidents was launched in the same year. This led to the distribution of an NHS standard chemical personal protective equipment suit (CPPE) together with a new single half day training package (Structured Approach to Chemical Casualties (SACC)) in 2001. Objectives: To assess the impact of the DoH initiative on acute hospital and ambulance trusts. To identify deficiencies in the design and operational deployment of the new CPPE, training initiative, and decontamination procedures at hospital level. Method: A survey to assess progress in specific areas of chemical incident preparedness and two simulated incidents with "live" chemically contaminated casualties conducted in two acute trusts. Umpires evaluated the operational performance against DoH SACC standards. Results: There has been marked improvement in many aspects of preparedness for chemical incidents since the original National Focus survey. Some deficiencies remain and this study identified areas for further work. In the live casualty exercises, hospital staff complied well with SACC protocols. Some practical difficulties were encountered with the deployment of the CPPE and in some aspects of the operational response, leading to some delays in the delivery of care to the casualties and to the integrity of the uncontaminated (clean) zones within the hospitals. Conclusion: Problems with the design and deployment of the CPPE, together with training difficulties have been fed back into the planning and development process. PMID:15843703

  14. Accountability in the NHS.

    PubMed

    Bassett, Sally

    2012-12-01

    In the first three articles in this series, we looked at the various components of good governance and how nurse leaders can create cultures and systems to promote and measure good governance. We used the quality governance framework of foundation trust regulator Monitor to explore how an NHS organisation's strategy, systems and process and the measurement of performance are designed to ensure delivery of high quality care.

  15. A Pilot Action Learning Set for NHS R&D Managers

    ERIC Educational Resources Information Center

    Boaden, Margaret

    2004-01-01

    A pilot action learning set was established in late September 2002, with the objective to develop a model of action learning appropriate for R&D managers. This initiative was one of a number of responses to a request for training and support by a small group of R&D managers who were based in non-teaching acute and primary care NHS trusts. The…

  16. Trust

    ERIC Educational Resources Information Center

    Harris, Paul L.

    2007-01-01

    Children rely extensively on others' testimony to learn about the world. However, they are not uniformly credulous toward other people. From an early age, children's reliance on testimony is tempered by selective trust in particular informants. Three- and 4-year-olds monitor the accuracy or knowledge of informants, including those that are…

  17. Benchmarking clinical photography services in the NHS.

    PubMed

    Arbon, Giles

    2015-01-01

    Benchmarking is used in services across the National Health Service (NHS) using various benchmarking programs. Clinical photography services do not have a program in place and services have to rely on ad hoc surveys of other services. A trial benchmarking exercise was undertaken with 13 services in NHS Trusts. This highlights valuable data and comparisons that can be used to benchmark and improve services throughout the profession. PMID:26828540

  18. Cohort profile of the South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLaM BRC) Case Register: current status and recent enhancement of an Electronic Mental Health Record-derived data resource

    PubMed Central

    Perera, Gayan; Broadbent, Matthew; Callard, Felicity; Chang, Chin-Kuo; Downs, Johnny; Dutta, Rina; Fernandes, Andrea; Hayes, Richard D; Henderson, Max; Jackson, Richard; Jewell, Amelia; Kadra, Giouliana; Little, Ryan; Pritchard, Megan; Shetty, Hitesh; Tulloch, Alex; Stewart, Robert

    2016-01-01

    Purpose The South London and Maudsley National Health Service (NHS) Foundation Trust Biomedical Research Centre (SLaM BRC) Case Register and its Clinical Record Interactive Search (CRIS) application were developed in 2008, generating a research repository of real-time, anonymised, structured and open-text data derived from the electronic health record system used by SLaM, a large mental healthcare provider in southeast London. In this paper, we update this register's descriptive data, and describe the substantial expansion and extension of the data resource since its original development. Participants Descriptive data were generated from the SLaM BRC Case Register on 31 December 2014. Currently, there are over 250 000 patient records accessed through CRIS. Findings to date Since 2008, the most significant developments in the SLaM BRC Case Register have been the introduction of natural language processing to extract structured data from open-text fields, linkages to external sources of data, and the addition of a parallel relational database (Structured Query Language) output. Natural language processing applications to date have brought in new and hitherto inaccessible data on cognitive function, education, social care receipt, smoking, diagnostic statements and pharmacotherapy. In addition, through external data linkages, large volumes of supplementary information have been accessed on mortality, hospital attendances and cancer registrations. Future plans Coupled with robust data security and governance structures, electronic health records provide potentially transformative information on mental disorders and outcomes in routine clinical care. The SLaM BRC Case Register continues to grow as a database, with approximately 20 000 new cases added each year, in addition to extension of follow-up for existing cases. Data linkages and natural language processing present important opportunities to enhance this type of research resource further, achieving both volume

  19. Effective management of trust volunteers.

    PubMed

    Rawlings, Carol

    2012-04-01

    A robust, well-managed volunteer programme can help NHS trusts have a better patient experience, engage with local communities, and improve and maintain their reputations. This article looks at the benefits of involving volunteers in trust activities and sets out the requirements to do this effectively, to enable them to achieve these aims.

  20. Funding the NHS. A little local difficulty?

    PubMed Central

    Dixon, J.; Harrison, A.

    1997-01-01

    The media have been full of reports of crisis in the NHS. Although national analyses suggest that the NHS should be able to cope within the increases in spending it has been given, local pressures can leave parts of the service struggling. Firstly, the change to allocation of funds on the basis of population needs has meant that some authorities and trusts have had effective cuts in their budgets, requiring them to trim services. Secondly, the government's insistence on an annual 3% increase in efficiency may have resulted in authorities taking short term measures that actually decrease efficiency in the long term. Thirdly, health authorities have had to bear the costs of national targets such as reducing waiting lists and junior doctors' hours as well as local problems such as higher numbers of mentally disordered offenders. However, all these factors can be controlled by national or local management and so their impact is not inevitable. PMID:9022445

  1. Opportunities and dangers for neurosurgery in the current NHS.

    PubMed

    Bell, B Anthony

    2015-01-01

    The NHS is entering a third decade of administrative turbulence and cost pressures and many view the new NHS structure and systems as complex and confusing. Health and social care budgets are being merged in some geographical areas and large efficiency savings are needed by 2020. There are risks that lie ahead for neurosurgery and our patients if the specialty becomes further fragmented and opportunities for positive change are missed. One of the new care models proposed in the NHS five year plan is specialist care provided across multiple hospital sites by a single overarching specialist trust, mirroring ophthalmology where the Moorfields trust provides specialist eye services in over 20 locations in London and the South East. This model lends itself to adoption by neurosurgery and has the potential to increase standards, efficiency, training and research. PMID:26488224

  2. Implementation of a Shoulder Soft Tissue Injury Triage Service in a UK NHS Teaching Hospital Improves Time to Surgery for Acute Rotator Cuff Tears.

    PubMed Central

    Bateman, Marcus; Davies-Jones, Gareth; Tambe, Amol; Clark, David I

    2016-01-01

    Shoulder problems account for 2.4% of GP consultations in the United Kingdom and of those 70% are related to the rotator cuff. Many rotator cuff tears are of a degenerate nature but they can occur as a result of trauma in 8% of cases. Evidence suggests that patients with traumatic rotator cuff tears gain a better outcome in terms of pain and function if the tear is repaired early after injury. A specialist shoulder soft tissue injury clinic was set up in a large UK NHS teaching hospital with the primary purpose in the first year to halve the length of time patients with traumatic rotator cuff tears had to wait to consult a specialist and double the number of patients undergoing surgical repair within three months. The secondary purpose was to ensure that the new clinic was utilised to capacity by the end of the first year. The clinic was later expanded to manage patients with acute glenohumeral joint (GHJ) or acromioclavicular joint (ACJ) dislocations and identify those patients requiring surgical stabilisation. The new service involved referral of all patients presenting to the Accident & Emergency department with recent shoulder trauma and either an inability to raise the arm over shoulder height with a normal set of radiographs, or a confirmed GHJ or ACJ dislocation; to a specialist clinic run by an experienced upper limb physiotherapist. Patients were reassessed and referred for further imaging if required. Those patients found to have traumatic rotator cuff tears or structural instability lesions were listed for expedited surgery. The clinic ran alongside a consultant-led fracture clinic giving fast access to surgical decision-making. The service was reviewed after 3, 6, and 12 months and findings compared to a sample of 30 consecutive patients having undergone rotator cuff repair surgery via the previous pathway. 144 patients were referred to the clinic in the first year: 62 with rotator cuff symptoms, 38 with GHJ instability, 13 with ACJ instability, and 33

  3. Trust and British Gas partner in EPC scheme.

    PubMed

    Bevan, Patrick

    2015-02-01

    In late August last year the St George's Healthcare NHS Trust in south-west London signed what the Trust's Estates and Facilities team described as 'a historic partnership' with British Gas for a £12 m Energy Performance Contract energy reduction scheme--via which the energy company has guaranteed to deliver £1.1 m in annual savings over the next 15 years. The agreement will see British Gas replace four 35-year-old gas-powered steam boilers and an ageing CHP plant in the boiler house at the Trust's main acute facility, the StGeorge's Hospital in Tooting, and upgrade some of the associated infrastructure. British Gas will also maintain the new plant to ensure that the projected savings are achieved while the Trust owns the new assets. The Trust should gain financially--via lower energy costs and carbon emissions, while estates personnel will be better able to complete the many other estate maintenance issues that would otherwise be contracted out at one of London's biggest acute hospitals. PMID:26268017

  4. Trust and British Gas partner in EPC scheme.

    PubMed

    Bevan, Patrick

    2015-02-01

    In late August last year the St George's Healthcare NHS Trust in south-west London signed what the Trust's Estates and Facilities team described as 'a historic partnership' with British Gas for a £12 m Energy Performance Contract energy reduction scheme--via which the energy company has guaranteed to deliver £1.1 m in annual savings over the next 15 years. The agreement will see British Gas replace four 35-year-old gas-powered steam boilers and an ageing CHP plant in the boiler house at the Trust's main acute facility, the StGeorge's Hospital in Tooting, and upgrade some of the associated infrastructure. British Gas will also maintain the new plant to ensure that the projected savings are achieved while the Trust owns the new assets. The Trust should gain financially--via lower energy costs and carbon emissions, while estates personnel will be better able to complete the many other estate maintenance issues that would otherwise be contracted out at one of London's biggest acute hospitals.

  5. Trust paid as overseas recruitment agent to help employers find staff.

    PubMed

    Osborne, Katie

    2014-09-23

    Two south east trusts are paying King's College Hospital NHS Foundation Trust to recruit hundreds of nurses from the Philippines for them in a bid to save tens of thousands of pounds on recruitment agency fees.

  6. Options for change in the NHS consultant contract.

    PubMed Central

    Clarke, R. W.; Gray, C.

    1994-01-01

    The lead negotiators for the management and consultant sides in an NHS trust in northern England responded to debate in their trust about consultant contracts by offering to research the attitudes of their peers towards a variety of contract options. The options tested included the current contract; models already examined in the trust and elsewhere, such as time sensitive and mild performance related contracts; and some more radical and speculative possibilities, including consultants franchising their services to the trust. Beyond the predictable conclusion that consultants would prefer no change while managers desired it, a time sensitive contract emerged as having potential for successful negotiation. On the other hand, neither consultants nor managers favoured a strict performance related contract or a fee for service contract. There was a strong similarity of opinion between the two groups on the relative salary values of the options, though the consultants consistently priced these higher than the managers. PMID:8086915

  7. Trust enhances IT service management.

    PubMed

    2007-08-01

    ITIL process adoption may be a prerequisite for the National Programme for IT (NPfIT), but implementation is far from straightforward. IT services company Plan-Net has been assisting Barts and The London NHS Trust with implementing its ambitious ITIL processes deployment. PMID:17847874

  8. Trust enhances IT service management.

    PubMed

    2007-08-01

    ITIL process adoption may be a prerequisite for the National Programme for IT (NPfIT), but implementation is far from straightforward. IT services company Plan-Net has been assisting Barts and The London NHS Trust with implementing its ambitious ITIL processes deployment.

  9. Unexpected consequences of midwifery in the NHS.

    PubMed

    Pollock, Jane

    2015-11-01

    This article presents information from the Caring for the carers conference held at George Eliot Hospital in July 2015. For many midwives, feelings of stress are an unexpected consequence of rising birth rates, low staffing levels and negative organisational cultures, so our aim was that delegates would take away skills for 'surviving' in maternity services. The conference was the catalyst to a project at George Eliot NHS Trust to improve the wellbeing of staff so that they can develop a positive outlook towards the care which they offer. As part of the project, a toolkit for survival was produced which helps to prompt maternity workers to remember their own wellbeing. This project is continuing to grow and the results will be available next year. PMID:26669051

  10. Unexpected consequences of midwifery in the NHS.

    PubMed

    Pollock, Jane

    2015-11-01

    This article presents information from the Caring for the carers conference held at George Eliot Hospital in July 2015. For many midwives, feelings of stress are an unexpected consequence of rising birth rates, low staffing levels and negative organisational cultures, so our aim was that delegates would take away skills for 'surviving' in maternity services. The conference was the catalyst to a project at George Eliot NHS Trust to improve the wellbeing of staff so that they can develop a positive outlook towards the care which they offer. As part of the project, a toolkit for survival was produced which helps to prompt maternity workers to remember their own wellbeing. This project is continuing to grow and the results will be available next year.

  11. Medical tourism: a cost or benefit to the NHS?

    PubMed

    Hanefeld, Johanna; Horsfall, Daniel; Lunt, Neil; Smith, Richard

    2013-01-01

    'Medical Tourism' - the phenomenon of people travelling abroad to access medical treatment - has received increasing attention in academic and popular media. This paper reports findings from a study examining effect of inbound and outbound medical tourism on the UK NHS, by estimating volume of medical tourism and associated costs and benefits. A mixed methods study it includes analysis of the UK International Passenger Survey (IPS); interviews with 77 returning UK medical tourists, 63 policymakers, NHS managers and medical tourism industry actors policymakers, and a review of published literature. These informed costing of three types of treatments for which patients commonly travel abroad: fertility treatment, cosmetic and bariatric surgery. Costing of inbound tourism relied on data obtained through 28 Freedom-of-Information requests to NHS Foundation Trusts. Findings demonstrate that contrary to some popular media reports, far from being a net importer of patients, the UK is now a clear net exporter of medical travellers. In 2010, an estimated 63,000 UK residents travelled for treatment, while around 52,000 patients sought treatment in the UK. Inbound medical tourists treated as private patients within NHS facilities may be especially profitable when compared to UK private patients, yielding close to a quarter of revenue from only 7% of volume in the data examined. Costs arise where patients travel abroad and return with complications. Analysis also indicates possible savings especially in future health care and social costs averted. These are likely to be specific to procedures and conditions treated. UK medical tourism is a growing phenomenon that presents risks and opportunities to the NHS. To fully understand its implications and guide policy on issues such as NHS global activities and patient safety will require investment in further research and monitoring. Results point to likely impact of medical tourism in other universal public health systems. PMID

  12. Medical Tourism: A Cost or Benefit to the NHS?

    PubMed Central

    Hanefeld, Johanna; Horsfall, Daniel; Lunt, Neil; Smith, Richard

    2013-01-01

    ‘Medical Tourism’ – the phenomenon of people travelling abroad to access medical treatment - has received increasing attention in academic and popular media. This paper reports findings from a study examining effect of inbound and outbound medical tourism on the UK NHS, by estimating volume of medical tourism and associated costs and benefits. A mixed methods study it includes analysis of the UK International Passenger Survey (IPS); interviews with 77 returning UK medical tourists, 63 policymakers, NHS managers and medical tourism industry actors policymakers, and a review of published literature. These informed costing of three types of treatments for which patients commonly travel abroad: fertility treatment, cosmetic and bariatric surgery. Costing of inbound tourism relied on data obtained through 28 Freedom-of-Information requests to NHS Foundation Trusts. Findings demonstrate that contrary to some popular media reports, far from being a net importer of patients, the UK is now a clear net exporter of medical travellers. In 2010, an estimated 63,000 UK residents travelled for treatment, while around 52,000 patients sought treatment in the UK. Inbound medical tourists treated as private patients within NHS facilities may be especially profitable when compared to UK private patients, yielding close to a quarter of revenue from only 7% of volume in the data examined. Costs arise where patients travel abroad and return with complications. Analysis also indicates possible savings especially in future health care and social costs averted. These are likely to be specific to procedures and conditions treated. UK medical tourism is a growing phenomenon that presents risks and opportunities to the NHS. To fully understand its implications and guide policy on issues such as NHS global activities and patient safety will require investment in further research and monitoring. Results point to likely impact of medical tourism in other universal public health systems

  13. The problem with rational approaches to reforming the NHS.

    PubMed

    Smith, Tom

    2002-12-01

    Several papers with a common theme published between May and August 2002 are drawn together to present a research-informed critique of economic logic present within recent NHS reform. They attempt to persuade the reader that excessive faith in predictive systems of thought that are underpinned by theories of rational behaviour is misplaced within the NHS. They suggest rational economic theory makes some problematic assumptions about human and individual behaviour. The problem is that there are many modes of thought at work within the NHS, and not all of these cogs are turned by economic rationality. Increasingly, over the last 10 years or so, economic concepts have become more and more prominent in the NHS. Their influence has gone beyond finance becoming a dominant issue. In addition to budgets, contracts and cost itemisation, theoretical relationships of supply and demand are now called upon to change professional behaviour. A new framework for the NHS has been built which is developing market forces. The papers provide some insight into whether the systems set in place to produce a patient-centred service do so in a meaningful way. The first paper examines an emerging primary care group (PCG). Now part of primary care trusts, PCGs were a lynchpin of new economic relationships in the new NHS. Community based, in theory PCGs take decisions made about healthcare resources closer to the patient for whom they are a proxy demander and shaper of services. To what extent do PCGs fulfil this role? The first paper is based on data collected during an in-depth 2 year observation study to test the applicability of health economics to healthcare organisations. It examines the early experience of commissioning services for coronary heart disease (CHD). PMID:12468703

  14. Medical tourism: a cost or benefit to the NHS?

    PubMed

    Hanefeld, Johanna; Horsfall, Daniel; Lunt, Neil; Smith, Richard

    2013-01-01

    'Medical Tourism' - the phenomenon of people travelling abroad to access medical treatment - has received increasing attention in academic and popular media. This paper reports findings from a study examining effect of inbound and outbound medical tourism on the UK NHS, by estimating volume of medical tourism and associated costs and benefits. A mixed methods study it includes analysis of the UK International Passenger Survey (IPS); interviews with 77 returning UK medical tourists, 63 policymakers, NHS managers and medical tourism industry actors policymakers, and a review of published literature. These informed costing of three types of treatments for which patients commonly travel abroad: fertility treatment, cosmetic and bariatric surgery. Costing of inbound tourism relied on data obtained through 28 Freedom-of-Information requests to NHS Foundation Trusts. Findings demonstrate that contrary to some popular media reports, far from being a net importer of patients, the UK is now a clear net exporter of medical travellers. In 2010, an estimated 63,000 UK residents travelled for treatment, while around 52,000 patients sought treatment in the UK. Inbound medical tourists treated as private patients within NHS facilities may be especially profitable when compared to UK private patients, yielding close to a quarter of revenue from only 7% of volume in the data examined. Costs arise where patients travel abroad and return with complications. Analysis also indicates possible savings especially in future health care and social costs averted. These are likely to be specific to procedures and conditions treated. UK medical tourism is a growing phenomenon that presents risks and opportunities to the NHS. To fully understand its implications and guide policy on issues such as NHS global activities and patient safety will require investment in further research and monitoring. Results point to likely impact of medical tourism in other universal public health systems.

  15. Planned implementations of ePrescribing systems in NHS hospitals in England: a questionnaire study

    PubMed Central

    Crowe, Sarah; Cresswell, Kathrin; Avery, Anthony J; Slee, Ann; Coleman, Jamie J; Sheikh, Aziz

    2010-01-01

    Objectives To describe the plans of English NHS hospitals to implement ePrescribing systems. Design and setting Questionnaire-based survey of attendees of the National ePrescribing Forum. Participants A piloted questionnaire was distributed to all NHS and non-NHS hospital-based attendees. The questionnaire enquired about any completed or planned implementation of ePrescribing systems, the specific systems of interest, and functionality they offered. Main outcome measures Estimate of the number of NHS Trusts planning to implement ePrescribing systems. Results Ninety-one of the 166 questionnaires distributed to NHS hospital-based staff were completed and returned. Of those, six were incomplete, resulting in a total usable response rate of 51% (n = 85). Eighty-two percent (n = 46) of the 56 Trusts represented at the Forum were either ‘thinking of implementing’ or ‘currently implementing’ an ePrescribing system, such as Ascribe (13%, n = 7) and JAC (20%, n = 11). Forty percent (n = 22) of respondents specified other systems, including those procured by NHS Connecting for Health e.g. RiO, Lorenzo and Cerner. Knowledge support, decision support and computerized links to other elements of patients’ individual care records were the functionalities of greatest interest. Conclusion There is considerable reported interest and activity in implementing ePrescribing systems in hospitals across England. Whether such developments have the desired impact on improving the safety of prescribing is however, yet to be determined. PMID:21103125

  16. Healthcare Assistants: distributional losses as a consequence of NHS modernisation?

    PubMed Central

    Clark, Ian; Thompson, Amanda

    2015-01-01

    This paper examines the labour process of Healthcare Assistants (HCAs) at a National Health Service (NHS) hospital trust (TUH) in the context of the NHS modernisation agenda. It determines whether application of the modernisation agenda is formalised at TUH and considers how HCAs are affected. The paper is based upon 60 interviews with HCAs, structured questionnaires completed by all interview respondents, observation of HCAs and interviews with non‐clinical managers. The findings show that elements of the modernisation agenda are informally implemented at TUH to the detriment of HCAs. HCAs experience distributional losses in the form of intensification as nurses deflect duties to HCAs and insulate themselves from adverse effects. HCAs resist, using selective absence when pressures mount. They ameliorate losses by re‐internalising their work as a job with caring elements not a genuine caring role. They rationalise their altered behaviour towards patients by blaming the regime's treatment of them as a subordinated group. PMID:27570359

  17. Is follow-up capacity the current NHS bottleneck?

    PubMed

    Allder, Steven; Walley, Paul; Silvester, Kate

    2011-02-01

    Capacity and demand theory suggests that the presence of a queue is not necessarily an indication of a shortage of capacity in a system. It is much more likely that either there is a demand and capacity variation that creates queues or there is a delay designed into the system. A shortage of capacity is only really indicated where a backlog is not stable and continues to grow. In this article, data are taken from one NHS trust that provides evidence for a continually growing backlog for follow-up outpatient services. It is believed that these data are representative of most locations within the NHS in England and therefore suggest an immediate shortage in effective follow-up capacity. To avoid compromise to patient care, the problem will have to be addressed before the situation becomes unmanageable. The paper highlights options to reduce or deflect demand or to increase effective capacity.

  18. Hypnobirth within the NHS: time to ditch the parent craft?

    PubMed

    Gavin-Jones, Teri

    2016-05-01

    Antenatal education within the National Health Service (NHS) is a service in decline within some hospital trusts. Classes on offer are being moved into online formats or discontinued completely. Whilst research into antenatal education remains limited, what is known is that good birth preparation is of value. "Participative preparation for childbirth can enhance women's overall satisfaction with the childbirth experience" (Schrader McMillan et al 2009: 49). There are pockets of excellent antenatal education within the NHS, but no system for regulating the quality and content. Traditional 'parent craft' classes can be oversubscribed, turning what should be a participative group into an audience. Offering good quality antenatal education has the potential to increase normality, improve the birth outcome and the experience of both woman and her birth partner. Is it time to ditch the parent craft and implement dynamic woman-focused education? PMID:27295754

  19. Planning for alternative futures in the NHS.

    PubMed

    Ferlie, E; McKee, L

    1988-03-01

    'The NHS needs the ability to move much more quickly' (The Griffiths Report, 1983, p13) This paper grew out of preliminary research undertaken for the research project on which we both work, entitled the Management of Change in the NHS. The project is based in the Centre for Corporate Strategy and Change at the University of Warwick, and is directed by Professor Andrew Pettigrew, who has previously undertaken a longitudinal study of strategic change in ICI (Pettigrew, 1985), and also a pilot study within the NHS which identified the implementation of strategic intent as the jugular problem confronting NHS managers. But a central research problem is why it is that some Health Districts manage to achieve a faster rate of change than others. Hence there was a need to trace the evolution of local systems through time, with the result that the historical analysis of changing is a key aspect of this research. The project is financed jointly by the NHSTA and a consortium of eight of the English Regions and ten case study districts are included. The research design focusses on strategic service changes in both the acute and priority group sectors and incorporates developments and contractions. The choice of strategic changes was informed by a detailed review of the most recent regional strategic plans and the review itself prompted this paper. It led us to a number of observations about the content of the change agenda. First, there is a high rate of change projected in the current strategic round and earlier studies of incrementalist approaches to change may have to be revised (Hunter, 1980; Ham, 1981). Secondly, these regional change agendas to a great extent reflect national/central policy and the pattern is one of uniformity. These standard agendas include RAWP; the construction of a DGH network; the run-down of long-stay mental illness/handicap hospitals; cost improvements and an increase in health promotion activity. Thirdly, alongside the top-down mechanisms to

  20. Cold comfort in NHS winter.

    PubMed

    1987-11-21

    No matter how smoothly Goverment may insist that all that can be I done is being done in funding I health care and supporting the NHS, no matter what percentages are circulated to prove that financial allocation and commitment is rising - services continue to be curtailed.

  1. An investigation into the move towards electronic journals: a case study of NHS libraries in Kent, Surrey and Sussex.

    PubMed

    England, Rebecca

    2013-09-01

    Electronic journals are so embedded into practice in academic libraries that it is easy to forget that this is not the case everywhere. In NHS libraries, for example, the staff face a particular set of issues. This article is based on Rebecca England's dissertation on this topic, completed as part of the MSc Econ course in Information and Library studies at Aberystwyth University. Rebecca is E-resources Librarian at the Maidstone and Tunbridge Wells NHS Trust. She investigated the momentum towards electronic journals in NHS libraries in the Kent, Surrey and Sussex region and the potential for a regional purchasing consortium.

  2. Complications of facial fillers: resource implications for NHS hospitals

    PubMed Central

    Hachach-Haram, Nadine; Gregori, Marco; Kirkpatrick, Niall; Young, Richard; Collier, Jonathan

    2013-01-01

    Facial rejuvenation seeks to reverse the negative sequelae of multiple factors but most importantly of genetic predisposition, sun damage and smoking. With the advent of the so-called ‘non-surgical’ techniques, and perhaps fuelled by these austere times, volumetric facial augmentation using dermal fillers has soared in popularity among both patients and practitioners. However, legislation has yet to keep pace with the change in clinical practices leaving patients poorly informed and with no protection against unscrupulous suppliers and unregulated practitioners. When things go wrong, patients often turn to the National Health Service (NHS) to rectify both the acute and chronic sequelae resulting in potentially difficult ethical and resource implications. Here, we report one of an increasing number of cases presenting to our NHS craniofacial service with acute filler-related complications. PMID:23362071

  3. Customer care in the NHS.

    PubMed

    Ruddick, Fred

    2015-01-20

    Viewing individuals in need of NHS care as customers has the potential to refocus the way their care is delivered. This article highlights some of the benefits of reframing the nurse-patient relationship in terms of customer care, and draws parallels between good customer care and the provision of high quality patient care in the NHS. It explores lessons to be learned from those who have studied the customer experience, which can be adapted to enhance the customer care experience within the health service. Developing professional expertise in the knowledge and skills that underpin good-quality interpersonal encounters is essential to improve the customer experience in health care and should be prioritised alongside the development of more technical skills. Creating a culture where emotional intelligence, caring and compassion are essential requirements for all nursing staff will improve patient satisfaction. PMID:25585766

  4. Customer care in the NHS.

    PubMed

    Ruddick, Fred

    2015-01-20

    Viewing individuals in need of NHS care as customers has the potential to refocus the way their care is delivered. This article highlights some of the benefits of reframing the nurse-patient relationship in terms of customer care, and draws parallels between good customer care and the provision of high quality patient care in the NHS. It explores lessons to be learned from those who have studied the customer experience, which can be adapted to enhance the customer care experience within the health service. Developing professional expertise in the knowledge and skills that underpin good-quality interpersonal encounters is essential to improve the customer experience in health care and should be prioritised alongside the development of more technical skills. Creating a culture where emotional intelligence, caring and compassion are essential requirements for all nursing staff will improve patient satisfaction.

  5. Professional Trust

    ERIC Educational Resources Information Center

    Frowe, Ian

    2005-01-01

    This paper examines the concept of professional trust and argues that trust is an essential component of what it means to be a professional. The first part of the paper discusses the nature of trust in general and attempts to establish two main points: that we are all involved in relationships of trust and that all trust involves risk. The second…

  6. International patients within the NHS: a case of public sector entrepreneurialism.

    PubMed

    Lunt, Neil; Exworthy, Mark; Hanefeld, Johanna; Smith, Richard D

    2015-01-01

    Many public health systems in high- and middle-income countries are under increasing financial pressures as a result of ageing populations, a rise in chronic and non-communicable diseases and shrinking public resources. At the same time the rise in patient mobility and concomitant market in medical tourism provides opportunities for additional income. This is especially the case where public sector hospitals have a reputation as global centres of excellence. Yet, this requires public sector entrepreneurship which, given the unique features of the public sector, means a change to professional culture. This paper examines how and under what conditions public sector entrepreneurship develops, drawing on the example of international patients in the UK NHS. It reports on a subset of data from a wider study of UK medical tourism, and explores inward flows and NHS responses through the lens of public entrepreneurship. Interviews in the English NHS were conducted with managers of Foundation Trusts with interest in international patient work. Data is from seven Foundation Trusts, based on indepth, semi-structured interviews with a range of NHS managers, and three other key stakeholders (n = 16). Interviews were analysed using a framework on entrepreneurship developed from academic literature. Empirical findings showed that Trust managers were actively pursuing a strategy of expanding international patient activity. Respondents emphasised that this was in the context of the current financial climate for the NHS. International patients were seen as a possible route to ameliorating pressure on stretched NHS resources. The analysis of interviews revealed that public entrepreneurial behaviour requires an organisational managerial or political context in order to develop, such as currently in the UK. Public sector workers engaged in this process develop entrepreneurship - melding political, commercial and stakeholder insights - as a coping mechanism to health system constraints

  7. International patients within the NHS: a case of public sector entrepreneurialism.

    PubMed

    Lunt, Neil; Exworthy, Mark; Hanefeld, Johanna; Smith, Richard D

    2015-01-01

    Many public health systems in high- and middle-income countries are under increasing financial pressures as a result of ageing populations, a rise in chronic and non-communicable diseases and shrinking public resources. At the same time the rise in patient mobility and concomitant market in medical tourism provides opportunities for additional income. This is especially the case where public sector hospitals have a reputation as global centres of excellence. Yet, this requires public sector entrepreneurship which, given the unique features of the public sector, means a change to professional culture. This paper examines how and under what conditions public sector entrepreneurship develops, drawing on the example of international patients in the UK NHS. It reports on a subset of data from a wider study of UK medical tourism, and explores inward flows and NHS responses through the lens of public entrepreneurship. Interviews in the English NHS were conducted with managers of Foundation Trusts with interest in international patient work. Data is from seven Foundation Trusts, based on indepth, semi-structured interviews with a range of NHS managers, and three other key stakeholders (n = 16). Interviews were analysed using a framework on entrepreneurship developed from academic literature. Empirical findings showed that Trust managers were actively pursuing a strategy of expanding international patient activity. Respondents emphasised that this was in the context of the current financial climate for the NHS. International patients were seen as a possible route to ameliorating pressure on stretched NHS resources. The analysis of interviews revealed that public entrepreneurial behaviour requires an organisational managerial or political context in order to develop, such as currently in the UK. Public sector workers engaged in this process develop entrepreneurship - melding political, commercial and stakeholder insights - as a coping mechanism to health system constraints.

  8. NHS market liberalisation and the TTIP agreement.

    PubMed

    Regan, Paul; Ball, Elaine

    2016-07-01

    Governments over the past three decades have undermined the founding principles of the NHS through reforms and market liberalisation. With greater involvement of commercial interests in health care, the NHS will become less democratic and transparent. Recent reforms, which were intended to improve productivity, quality and cost efficiency, have left the NHS exposed to the unwieldy model of market liberalisation and the attrition of public health care. The role of community nurses has been particularly destabilised by commissioning, as their work is difficult to measure. The advent of the Transatlantic Trade and Investment Partnership could further undermine the NHS to the benefit of international commercial interests.

  9. NHS market liberalisation and the TTIP agreement.

    PubMed

    Regan, Paul; Ball, Elaine

    2016-07-01

    Governments over the past three decades have undermined the founding principles of the NHS through reforms and market liberalisation. With greater involvement of commercial interests in health care, the NHS will become less democratic and transparent. Recent reforms, which were intended to improve productivity, quality and cost efficiency, have left the NHS exposed to the unwieldy model of market liberalisation and the attrition of public health care. The role of community nurses has been particularly destabilised by commissioning, as their work is difficult to measure. The advent of the Transatlantic Trade and Investment Partnership could further undermine the NHS to the benefit of international commercial interests. PMID:27401200

  10. The UK National Health Service's 'innovation agenda': lessons on commercialisation and trust.

    PubMed

    Sterckx, Sigrid; Cockbain, Julian

    2014-01-01

    The UK National Health Service (the 'NHS'), encouraged by the 2011 report Innovation Health and Wealth, Accelerating Adoption and Diffusion in the NHS, and empowered by the Health and Social Care Act 2012, is in the process of adopting a new agenda for stimulating innovation in healthcare. For this, the bodies, body materials, and confidential health information of NHS patients may be co-opted. We explain why this brings the NHS into a moral conflict with its basic goal of providing a universal healthcare service. Putting NHS databases at the disposal of industry, without addressing ethical concerns regarding the privacy, autonomy, and moral integrity of patients and without requiring a 'kick-back' to enhance the service that the NHS provides, is inappropriate. As this article shows, with reference to the commercial arena of direct-to-consumer genetic testing, it is crucial that patient and public trust in the NHS is not eroded.

  11. The future of ethnic minority nurses in the NHS.

    PubMed

    Cortis, J D; Rinomhota, A S

    1996-11-01

    The subject of discrimination especially with regard to the ethnic minority workforce in the NHS was the focus of a specially commissioned Task Force funded by the Department of Health and the King's Fund in 1991 followed by the PSI Report published last year to help health authorities to address racial discrimination. The first of these reports, for example, states quite clearly that 'racial inequalities between managers and staff in the service are glaring... black and ethnic minority staff will not join or remain in a service which they do not see to be providing good and fair employment prospects. This perhaps influenced the Secretary of State for Health, in 1993, to set up a programme of action which included a number of targets to be achieved. Goal seven, for example, specifically addresses nursing by stating that NHS authorities and trusts are to set local objectives to achieve representation of ethnic minority nurses at ward manager level within 5 years. This programme seems to focus on the issue of equal opportunities but although in does make reference to 'racial harassment' it does not include 'racism'. Hence the purpose of this paper is to address the issues of equal opportunities and anti-racism from a theoretical and practice base. It also intends to offer alternatives for the way forward by focusing on local initiatives.

  12. The procurement of NHS dental services--a guide.

    PubMed

    Jones, C L; Rooney, E

    2009-05-23

    This paper gives an overview of the strategic background for procurement of NHS primary care dental services and an outline of the processes involved in procurement. The main aim is to bring procurement to the attention of a wider audience of dental practitioners and provide advice for potential primary care dental service providers. The move towards local procurement of healthcare services, including primary care dental services, has been shaped by a number of strategic Government publications and is supported by law. In line with other public bodies, the NHS is subject to the European Union and international rules regarding procurement and awarding contracts. Primary Care Trust (PCT) Dental Service Commissioners have to ensure that their procurement strategy is transparent and non-discriminatory so that all providers have an equal opportunity to compete for contracts. In order to successfully tender for future service provision contracts, dental practitioners not only need to be aware of the process of procurement and its associated legal requirements. It is also important that they have a grasp of the expectations of PCTs. Commissioning services via procurement is set to become more commonplace and it is likely, in time, that competition for some contracts will increase in intensity. The importance of researching proposals thoroughly and adopting a professional, businesslike approach to tendering cannot be understated as this maximises chance of success in the new commissioning environment.

  13. Can the NHS cope in future?

    PubMed Central

    Harrison, A.; Dixon, J.; New, B.; Judge, K.

    1997-01-01

    Four potential pressures are likely to determine whether the NHS will be able to cope in future: the change in population structure, changes in level of morbidity, introduction of new technologies, and increasing expectations of patients and NHS providers. New technology and changes in expectations are likely to have the biggest effect and are also the most difficult to quantify. Nevertheless, these pressures are to some extent amenable to control. If the growth in funding continues as it has in the past there is no convincing evidence that the NHS will not continue to cope. PMID:9006479

  14. Early warning systems in the UK: variation in content and implementation strategy has implications for a NHS early warning system.

    PubMed

    Patterson, Caroline; Maclean, Fiona; Bell, Cameron; Mukherjee, Elora; Bryan, Leoni; Woodcock, Thomas; Bell, Derek

    2011-10-01

    The Royal College of Physicians report Acute medical care: the right person, in the right setting--first time advocates the introduction of a standardised NHS Early Warning Score (NEWS). Recommendations for the optimum scoring system have been released by NHS Quality Improvement Scotland (NHS QIS) and the National Institute for Health and Clinical Excellence (NICE). This study reviewed clinical practice in London and Scotland against national guidelines. All hospitals responsible for acute medical admissions completed a telephone survey (n = 25 London; n = 23 Scotland). All used an early warning system at point of entry to care. Eleven different systems were used in London and five in Scotland. Forty per cent of London hospitals and 70% of Scottish hospitals incorporated the minimum data set recommended by NICE. Overall, Scotland was closer to achieving standardisation. If NEWS is implemented, consideration of the NHS QIS approach may support a more consistent response.

  15. Conflict resolution training in the NHS.

    PubMed

    Molloy, Steve; Henderson, Iain

    2006-07-01

    The following article is based on a presentation at AfPP's Annual Congress in October 2005. It deals with the increasing level of violence and aggression directed towards NHS staff in the workplace and advises on conflict resolution.

  16. Getting the basics right: choosing paper hand towels for use in one trust.

    PubMed

    Raymond, Paul

    2004-07-01

    Hand towels that are effective and pleasant to use are an important element of a good infection control practice and are purchased in enormous quantities by NHS trusts. A balance between clinical and cost effectiveness was achieved at one trust following the audit and introduction of a new paper towel product. PMID:15317341

  17. Monitor to investigate trust for making patients wait too long.

    PubMed

    2014-10-01

    HEALTH REGULATOR Monitor has launched an investigation into Yorkshire Teaching Hospital NHS Foundation Trust after finding that some patients had been waiting too long to be assessed for emergency care. The regulator believes that repeated failures to ensure patients were seen soon enough may indicate wider problems at the trust, which has failed to meet the quarterly national emergency department waiting time target five times in nearly two years.

  18. Tackling Work Related Stress in a National Health Service Trust

    ERIC Educational Resources Information Center

    Vick, Donna; Whyatt, Hilary

    2004-01-01

    The challenge of tackling the problem of coping with work related stress in a National Health Service (NHS) Trust was undertaken. Ideas were developed within the context of two different action learning sets and led to actions resulting in a large therapy Taster Session event and the establishment of a centre offering alternative therapies and…

  19. Excellence in cost-effective inpatient specialist palliative care in the NHS - a new model.

    PubMed

    Grogan, Eleanor; Paes, Paul; Peel, Tim

    2016-02-01

    There is little in the literature describing hospital specialist palliative care units (PCUs) within the NHS. This paper describes how specialist PCUs can be set up within and be entirely funded by the NHS, and outlines some of the challenges and successes of the units. Having PCUs within hospitals has offered patients increased choice over their place of care and death; perhaps not surprisingly leading to a reduced death rate in the acute hospital. However, since the opening of the PCUs there has also been an increased home death rate. The PCUs are well received by patients, families and other staff within the hospital. We believe they offer a model for excellence in cost-effective inpatient specialist palliative care within the NHS.

  20. Empowerment: the right medicine for improving employee commitment and morale in the NHS?

    PubMed

    Cunningham, I; Hyman, J

    1996-01-01

    States that in recent years, empowerment of National Health Service (NHS) Trust employees has been given substantial political and managerial support. Examines the extent to which the commitment and morale of staff in two NHS Trust hospitals has altered following the introduction of a raft of techniques under the empowerment label. The researchers interviewed substantial numbers of staff with managerial responsibilities, personnel specialists and conducted written surveys seeking employee opinion. Reports the findings, which confirm that, under empowerment, the work of both managers and staff has become more intensive, but managers claim that their commitment has risen, while for non-managerial employees, severe problems of commitment to the Trust, declining morale and high stress were exposed. Identifies reasons for these difficulties which were: the salience of budgetary and operational priorities; lack of training; resistance to the implementation of empowerment; and recognition that little real authority was being devolved to employees. Concludes that the limited effects attributable to empowerment could be explained by its association with harder-edged manpower policies introduced to meet financial and competitive pressures. Under favourable contextual conditions, empowerment may exert more positive effects.

  1. The bed crisis of winter 1995-1996 in the British NHS: an illustration of accountability issues.

    PubMed

    Young, A P

    1999-07-01

    The aim of this article is to explore the practical complexity of accountability in health care by focusing on a particular crisis affecting one NHS trust in the UK, that of insufficient beds to meet demand. It is presented through the eyes of five middle managers with nursing backgrounds. Although the focus is on their words, their expressions of distress and their awareness of conflict, these lead to a commentary highlighting some of the relationships between theory and practice, policy making and implementation, and, in the final analysis, compulsion and choice. The managers seemed to work within four main patterns of provider accountability: public, professional, pecuniary and personal. These four Ps of accountability created incompatibilities in the accountability process, but the conclusion attempts to draw the threads together to suggest a possible way forward. In order to protect confidentiality, pseudonyms are used for the NHS trust and the interviewees, and some personal details have been disguised.

  2. Morality and markets in the NHS

    PubMed Central

    Gilbert, Barnabas J; Clarke, Emma; Leaver, Laurence

    2014-01-01

    Since its establishment in 1948, the history of the National Health Service (NHS) has been characterized by organisational turbulence and system reform. At the same time, progress in science, medicine and technology throughout the western world have revolutionized the delivery of healthcare. The NHS has become a much loved, if much critiqued, national treasure. It is against this backdrop that the role of this state-funded health service has been brought into moral question. Certainly, the challenges facing healthcare policy-makers are numerous and complex, but in the wake of the Health and Social Care Act (2012), no issue is more divisive than that of market-based reform. Here we explore the turbulent history of the NHS, from its foundation to the birth of the healthcare marketplace. We explore arguments for and against the healthcare market and resolve that, amid an evolving economic and moral framework, the NHS must ensure that its original tenets of equity and autonomy remain at its core. We propose a values-explicit, systems-based approach to renew focus on both the processes and the outcomes of care. PMID:25489594

  3. NHS failing its black and minority workforce.

    PubMed

    2016-06-01

    The findings are in and are far from surprising. The first report of the NHS Workforce Race Equality Standard (WRES) was published on June 2 and contains a highly predictable litany of woe: black and minority ethnic (BME) staff are more likely than white staff to be bullied or abused, wherever they work. PMID:27286582

  4. Morality and markets in the NHS.

    PubMed

    Gilbert, Barnabas J; Clarke, Emma; Leaver, Laurence

    2014-12-01

    Since its establishment in 1948, the history of the National Health Service (NHS) has been characterized by organisational turbulence and system reform. At the same time, progress in science, medicine and technology throughout the western world have revolutionized the delivery of healthcare. The NHS has become a much loved, if much critiqued, national treasure. It is against this backdrop that the role of this state-funded health service has been brought into moral question. Certainly, the challenges facing healthcare policy-makers are numerous and complex, but in the wake of the Health and Social Care Act (2012), no issue is more divisive than that of market-based reform. Here we explore the turbulent history of the NHS, from its foundation to the birth of the healthcare marketplace. We explore arguments for and against the healthcare market and resolve that, amid an evolving economic and moral framework, the NHS must ensure that its original tenets of equity and autonomy remain at its core. We propose a values-explicit, systems-based approach to renew focus on both the processes and the outcomes of care.

  5. Liberating the NHS: a brave new world, or litigation nightmare?

    PubMed

    McHale, Jean

    The coalition Government, in its White Paper Equity and Excellence: Liberating the NHS and in the subsequent paper Liberating the NHS: the new Legislative Framework has advanced its proposals for NHS restructuring. These proposals are intended to provide much enhanced roles for GPs in relation to the commissioning of NHS services in the future. This article explores these proposals and considers whether they can be seen as a return to the 1990s and the approach of the NHS Community Care Act 1990. It also explores the nature of these greater responsibilities and some of the problems that this may give rise to in the future.

  6. Who cares about equity in the NHS?

    PubMed

    Whitehead, M

    1994-05-14

    The concept of equity in relation to the National Health Service in Britain encompasses not one but at least eight distinct principles. Until the 1980s the NHS had a good record of incorporating these principles into practice. Throughout the 1980s, however, there has been a pronounced change, with the gradual introduction of business values into the service, culminating in the market based reforms of the 1990s. Several recent policies seem to be taking the NHS away from the goal of an equitable system--for example, the new arrangements for community care and the incentives within contracting to select patients on financial grounds. To restore equity as a value demands priority for ethical values, monitoring of policies for their effects on equity, some national planning, and a new debate about the entitlement to services such as continuing care.

  7. Wanless voices concern for NHS future.

    PubMed

    Sir Derek Wanless

    2007-10-01

    While the programme of building new hospitals seems to be on track, targets for existing estate replacement look unlikely to be reached, and backlog maintenance has increased. These are comments in Our Future Health Secured?--a comprehensive King's Fund report by Sir Derek Wanless on the unprecedented levels of funding invested by the Government in the NHS over the past five years. Health Estate Journal reports. PMID:18019471

  8. A model for change in the NHS.

    PubMed

    Keleher, R J; Cole, C

    1988-12-01

    Rowena Keleher and Carol Cole set the scene for change with a brief description of the current rapidly developing internal and external environment of the NHS. They then identify a range of "supports" used to facilitate such change, explore how they are selected and examine their apparent advantages and disadvantages. Common themes leading to effective change are drawn out. Finally, a four-factor model for effective change is presented; deficiencies in current change efforts identified and recommendations for improvements suggested. PMID:10291463

  9. Health care quality in NHS hospitals.

    PubMed

    Youssef, F N; Nel, D; Bovaird, T

    1996-01-01

    Hospitals provide the same type of service, but they do not all provide the same quality of service. No one knows this better than patients. Reports the results of a market research exercise initiated to ascertain the different factors which patients of health care identify as being necessary to provide error-free service quality in the NHS hospitals. To measure patients' satisfaction with NHS hospitals, the internationally-used market research technique called SERVQUAL was used in order to measure patients' expectations before admission, record their perceptions after discharge from the hospital, and then to close the gap between them. This technique compares expectations with perceptions of service received across five broad dimensions of service quality, namely: tangibility; reliability; responsiveness; assurance; and empathy. This analysis covered 174 patients who had completed the SERVQUAL questionnaire, including patients who had had treatment in surgical, orthopaedic, spinal injury, medicinal, dental and other specialties in the West Midlands region. Recorded the average weighted NHS service quality score overall for the five dimensions as significantly negative.

  10. Health care quality in NHS hospitals.

    PubMed

    Youssef, F N; Nel, D; Bovaird, T

    1996-01-01

    Hospitals provide the same type of service, but they do not all provide the same quality of service. No one knows this better than patients. Reports the results of a market research exercise initiated to ascertain the different factors which patients of health care identify as being necessary to provide error-free service quality in the NHS hospitals. To measure patients' satisfaction with NHS hospitals, the internationally-used market research technique called SERVQUAL was used in order to measure patients' expectations before admission, record their perceptions after discharge from the hospital, and then to close the gap between them. This technique compares expectations with perceptions of service received across five broad dimensions of service quality, namely: tangibility; reliability; responsiveness; assurance; and empathy. This analysis covered 174 patients who had completed the SERVQUAL questionnaire, including patients who had had treatment in surgical, orthopaedic, spinal injury, medicinal, dental and other specialties in the West Midlands region. Recorded the average weighted NHS service quality score overall for the five dimensions as significantly negative. PMID:10156537

  11. Challenges of commissioning and contracting for integrated care in the National Health Service (NHS) in England.

    PubMed

    Addicott, Rachael

    2016-01-01

    For many years there has been a separation between purchasing and provision of services in the English National Health Service (NHS). Many studies report that this commissioning function has been weak: purchasers have had little impact or power in negotiations with large acute providers, and have had limited strategic control over the delivery of care. Nevertheless, commissioning has become increasingly embedded in the NHS structure since the arrival of Clinical Commissioning Groups (CCGs) in 2012. Recently, some of these CCGs have focused on how they can contract and commission in different ways to stimulate greater collaboration across providers. This paper examines experiences of commissioning and contracting for integrated care in the English NHS, based on a series of national-level interviews and case studies of five health economies that are implementing novel contracting models. The cases illustrated here demonstrate early experiments to drive innovation through contracting in the NHS that have largely relied on the vision of individual teams or leaders, in combination with external legal, procurement and actuarial support. It is unlikely that this approach will be sustainable or replicable across the country or internationally, despite the best intentions of commissioners. Designing and operating novel contractual approaches will require considerable determination, alongside advanced skills in procurement, contract management and commissioning. The cost of developing new contractual approaches is high, and as the process is difficult and resource-intensive, it is likely that dedicated teams or programs will be required to drive significant improvement. PMID:26328512

  12. Challenges of commissioning and contracting for integrated care in the National Health Service (NHS) in England.

    PubMed

    Addicott, Rachael

    2016-01-01

    For many years there has been a separation between purchasing and provision of services in the English National Health Service (NHS). Many studies report that this commissioning function has been weak: purchasers have had little impact or power in negotiations with large acute providers, and have had limited strategic control over the delivery of care. Nevertheless, commissioning has become increasingly embedded in the NHS structure since the arrival of Clinical Commissioning Groups (CCGs) in 2012. Recently, some of these CCGs have focused on how they can contract and commission in different ways to stimulate greater collaboration across providers. This paper examines experiences of commissioning and contracting for integrated care in the English NHS, based on a series of national-level interviews and case studies of five health economies that are implementing novel contracting models. The cases illustrated here demonstrate early experiments to drive innovation through contracting in the NHS that have largely relied on the vision of individual teams or leaders, in combination with external legal, procurement and actuarial support. It is unlikely that this approach will be sustainable or replicable across the country or internationally, despite the best intentions of commissioners. Designing and operating novel contractual approaches will require considerable determination, alongside advanced skills in procurement, contract management and commissioning. The cost of developing new contractual approaches is high, and as the process is difficult and resource-intensive, it is likely that dedicated teams or programs will be required to drive significant improvement.

  13. Accountability and the accounting regime in the public sector. Some messages from the NHS.

    PubMed

    Mellett, H; Williams, J

    1997-01-01

    In the UK, the government is keen to introduce private sector procedures into the public sector. The latest stage of this process has been to suggest the adoption of accruals accounting by those parts of the public sector where it is not already operated. This approach to accounting was introduced into the NHS as part of the reforms which implemented a quasi-market to match the demands of purchasers of health care with its providers. Outlines the assumptions which underlie accruals accounting and considers whether the environment created for NHS Trusts is sufficiently like that of the private sector to justify its use. Shows that the initial ideas of the extent to which Trusts could mimic private sector organizations have not been fulfilled in practice, and concludes that it is not possible to justify the use of accruals accounting in the public sector simply on the grounds that as it is the technique used in the private sector it must be superior to the available alternatives.

  14. Open Dialogue and its Relevance to the NHS: Opinions of NHS Staff and Service Users.

    PubMed

    Razzaque, Russell; Wood, Lisa

    2015-11-01

    Open Dialogue is a model of mental health services that originated in Finland and has since, been taken up in trial teams worldwide. As this is a relatively unknown approach in the UK, it is important to tentatively explore perspectives of NHS staff and service-users. Sixty-one Open Dialogue conference attendees, both staff and service-users, were recruited for this study. A feedback questionnaire was administered to determine the extent to which they believed the key tenets of Open Dialogue were important to service user care, and the extent to which they existed within current NHS services. Analysis of data demonstrated a strong consensus on the importance of the key principles of Open Dialogue for mental health care and also moderate disagreement that these principles exist within current NHS service provision. The Open Dialogue principles may offer a useful framework in order to develop services in a clinically meaningful way.

  15. Justice and NHS dental treatment--is injustice rife in NHS dentistry?

    PubMed

    Holden, A C L

    2013-04-01

    In this article the issue of injustice in NHS dental care is examined using the philosophical principles of non-ideal theory. The causes for this injustice in this context are examined as well as how injustice may be perpetuated within the NHS dental system. The focus upon targets that the current system supports contributes in shifting the focus of healthcare provision from being patient-centred to that of financial gain. This leads to a drop in quality of care and to dissatisfaction within the dental workforce. This article aims to examine this perversity and how this further contributes to injustice.

  16. Reducing length of stay for acute diabetic foot episodes: employing an extended scope of practice podiatric high-risk foot coordinator in an acute foundation trust hospital

    PubMed Central

    2013-01-01

    Background To enhance the acute management of people with diabetic foot disease requiring admission, an extended scope of practice, podiatric high-risk foot coordinator position, was established at the Great Western Hospital, Swindon in 2010. The focus of this new role was to facilitate more efficient and timely management of people with complex diabetic foot disease. The aim of this project was to investigate the impact of the podiatric high-risk foot coordinator role on length of stay, rate of re-admission and bed cost. Method This study evaluated the difference in length of stay and rate of re-admission between an 11- month pre-pilot period (November 2008 to October 2009) and a 10-month pilot period (August 2010 to June 2011). The estimated difference in bed cost between the pre-pilot and pilot audits was also calculated. Inclusion criteria were restricted to inpatients admitted with a diabetic foot ulcer, gangrene, cellulitis or infection as the primary cause for admission. Eligible records were retrieved using ICD-10 (V9) coding via the hospital clinical audit department for the pre-pilot period and a unique database was used to source records for the pilot phase. Results Following the introduction of the podiatric high-risk foot coordinator, the average length of stay reduced from 33.7 days to 23.3 days (mean difference 10.4 days, 95% CI 0.0 to 20.8, p = 0.050). There was no statistically significant difference in re-admission rate between the two study periods, 17.2% (95% CI 12.2% to 23.9%) in the pre-pilot phase and 15.4% (95% CI 12.0% to 19.5%) in the pilot phase (p = 0.820). The extrapolated annual cost saving following the implementation of the new coordinator role was calculated to be £234,000 for the 2010/2011 year. Conclusions This audit found that the extended scope of practice coordinator role may have a positive impact on reducing length of stay for diabetic foot admissions. This paper advocates the role of a podiatric high-risk foot

  17. Patterning NHS-terminated SAMs on germanium.

    PubMed

    Morris, Carleen J; Shestopalov, Alexander A; Gold, Brian H; Clark, Robert L; Toone, Eric J

    2011-05-17

    Here we report a simple, robust approach to patterning functional SAMs on germanium. The protocol relies on catalytic soft-lithographic pattern transfer from an elastomeric stamp bearing pendant immobilized sulfonic acid moieties to an NHS-functionalized bilayer molecular system comprising a primary ordered alkyl monolayer and a reactive ester secondary overlayer. The catalytic polyurethane-acrylate stamp was used to form micrometer-scale features of chemically distinct SAMs on germanium. The methodology represents the first example of patterned SAMs on germanium, a semiconductor material.

  18. Trusted Objects

    SciTech Connect

    CAMPBELL,PHILIP L.; PIERSON,LYNDON G.; WITZKE,EDWARD L.

    1999-10-27

    In the world of computers a trusted object is a collection of possibly-sensitive data and programs that can be allowed to reside and execute on a computer, even on an adversary's machine. Beyond the scope of one computer we believe that network-based agents in high-consequence and highly reliable applications will depend on this approach, and that the basis for such objects is what we call ''faithful execution.''

  19. Improving acute medical management: Junior Doctor Emergency Prescription Cards

    PubMed Central

    Hutton, Joe; Gingell, Megan; Hutchinson, Lisa

    2016-01-01

    Doctors commencing Foundation Year (FY) training face many stresses and challenges. FY doctors are often the first point of contact for acutely unwell and deteriorating patients. Trust guidelines are used to aid acute medical management. Accessing guidelines is often fraught with barriers. Evidence suggests aide-memoire cards can provide easier access to guidelines and management pathways. We aimed to improve prescribing accuracy and efficiency of FY doctors for acute medical conditions within Gloucestershire trust by improving access to and usability of trust guidelines. Questionnaires were distributed to FY doctors to identify acute medical conditions to include on the emergency prescription cards (EPCs). Two small double-sided cards were created containing bullet pointed trust guidelines for: hyper/hypokalaemia, status epilepticus, diabetic emergencies, arrhythmias, myocardial infarction, acute asthma, pulmonary oedema, anaphylaxis and a ward-round checklist. Feedback was used to improve EPCs prior to distribution. Pre (N=53) and post-intervention (N=46) written questionnaires were completed by FY doctors. These assessed acute clinical management including use of guidance, confidence in management, speed of prescribing and EPC “usability”. To assess prescribing accuracy, prescriptions for acute medical conditions were reviewed pre (N=8) and post-intervention (N=12). The EPCs were well received (80% quite/very useful) and found “easy to use” (83%). The introduction of EPCs increased guidance use (pre-intervention 58.8%, post-intervention 71.7%), increased confidence (pre-intervention 79%, post-intervention 89%) and significantly improved prescribing speed (p=0.05). There was a significant correlation with confidence and prescribing speed (p = 0.023). The accuracy of prescribed doses improved (pre-intervention 62.5%, post-intervention 87.5% accurate) as did details regarding route / additional required information (pre-intervention 75%, post

  20. Improving acute medical management: Junior Doctor Emergency Prescription Cards.

    PubMed

    Hutton, Joe; Gingell, Megan; Hutchinson, Lisa

    2016-01-01

    Doctors commencing Foundation Year (FY) training face many stresses and challenges. FY doctors are often the first point of contact for acutely unwell and deteriorating patients. Trust guidelines are used to aid acute medical management. Accessing guidelines is often fraught with barriers. Evidence suggests aide-memoire cards can provide easier access to guidelines and management pathways. We aimed to improve prescribing accuracy and efficiency of FY doctors for acute medical conditions within Gloucestershire trust by improving access to and usability of trust guidelines. Questionnaires were distributed to FY doctors to identify acute medical conditions to include on the emergency prescription cards (EPCs). Two small double-sided cards were created containing bullet pointed trust guidelines for: hyper/hypokalaemia, status epilepticus, diabetic emergencies, arrhythmias, myocardial infarction, acute asthma, pulmonary oedema, anaphylaxis and a ward-round checklist. Feedback was used to improve EPCs prior to distribution. Pre (N=53) and post-intervention (N=46) written questionnaires were completed by FY doctors. These assessed acute clinical management including use of guidance, confidence in management, speed of prescribing and EPC "usability". To assess prescribing accuracy, prescriptions for acute medical conditions were reviewed pre (N=8) and post-intervention (N=12). The EPCs were well received (80% quite/very useful) and found "easy to use" (83%). The introduction of EPCs increased guidance use (pre-intervention 58.8%, post-intervention 71.7%), increased confidence (pre-intervention 79%, post-intervention 89%) and significantly improved prescribing speed (p=0.05). There was a significant correlation with confidence and prescribing speed (p = 0.023). The accuracy of prescribed doses improved (pre-intervention 62.5%, post-intervention 87.5% accurate) as did details regarding route / additional required information (pre-intervention 75%, post-intervention 97

  1. Step up in orthopaedic care for Stockport Trust.

    PubMed

    Baillie, Jonathan

    2009-04-01

    Specialist in the design and construction of modular healthcare buildings MTX Contracts has recently completed, on time and on budget, Stockport NHS Foundation Trust's impressive new four-storey orthopaedic and surgical facility at Stepping Hill Hospital. The company claims the new facility offers a quality of build and finish "as close to that of traditional build as is possible using modular construction techniques". Jonathan Baillie reports. PMID:19452799

  2. Effective medical leadership development for a complex NHS.

    PubMed

    Edmonstone, John; Malby, Rebecca

    2014-08-01

    The NHS Leadership Academy in England is investing £46 million in a standardized model of development, with academic qualifications becoming essential in future NHS leadership roles. This represents a cul-de-sac for medical leaders because it is based on a series of misplaced assumptions about health-care leadership and its development.

  3. Is NHS dentistry in crisis? 'Traffic light' maps of dentists distribution in England and Wales

    PubMed Central

    Boulos, Maged N Kamel; Phillipps, Guy Picton

    2004-01-01

    Background 'Traffic light' (red-yellow-green) maps are potentially powerful tools for 'at a glance' problem detection, for optimising resource allocation/reallocation, setting priorities, and targeting interventions to areas most in need. The maps can be also used for administrative area comparisons and performance monitoring over time. Interactive Web versions of the maps can be generated with many handy features to further empower organisations and decision makers. Methodological issues to consider when creating 'traffic light' maps include hue thresholding, data timeliness and stability of administrative boundaries. Results We used 'traffic light' maps to study the distribution of dentists per 1,000 population in all 304 English Primary Care Trusts (PCTs) and 22 Welsh Local Health Boards (LHBs) using datasets of dentist numbers per PCT (as at 31 December 2002) and LHB (as at 26 February 2004) from the Dental Practice Board, and 2001 Census population figures for PCTs and LHBs from the Office for National Statistics. The overall NHS dentists per 1,000 population figures for England (0.374) and Wales (0.359) are low compared to many other countries, with less than 0.3 dentist per 1,000 people available to 24.1% of the total population of England (81 PCTs or 26.6% of all PCTs) and 26.1% of the total population of Wales (6 LHBs or 27.3% of all LHBs). A general shortage of NHS dentists can be observed at a glance across England and Wales on all the 'traffic light' maps in our study, even on those using a more "tolerant" classification and an additional orange-yellow class. The distribution of NHS dentists in England and Wales was also found to be not uniform, with some PCTs/LHBs, especially those located in some of the deprived or less populated urban and rural communities, suffering significantly more shortage of dentists than others (see ). These results confirm recent media reports of a shortage of NHS dentists in various parts of England and Wales. Conclusion

  4. The relationship between organizational culture and performance in acute hospitals.

    PubMed

    Jacobs, Rowena; Mannion, Russell; Davies, Huw T O; Harrison, Stephen; Konteh, Fred; Walshe, Kieran

    2013-01-01

    This paper examines the relationship between senior management team culture and organizational performance in English acute hospitals (NHS Trusts) over three time periods between 2001/2002 and 2007/2008. We use a validated culture rating instrument, the Competing Values Framework, to measure senior management team culture. Organizational performance is assessed using a wide range of routinely collected indicators. We examine the associations between organizational culture and performance using ordered probit and multinomial logit models. We find that organizational culture varies across hospitals and over time, and this variation is at least in part associated in consistent and predictable ways with a variety of organizational characteristics and routine measures of performance. Moreover, hospitals are moving towards more competitive culture archetypes which mirror the current policy context, though with a stronger blend of cultures. The study provides evidence for a relationship between culture and performance in hospital settings.

  5. The relationship between organizational culture and performance in acute hospitals.

    PubMed

    Jacobs, Rowena; Mannion, Russell; Davies, Huw T O; Harrison, Stephen; Konteh, Fred; Walshe, Kieran

    2013-01-01

    This paper examines the relationship between senior management team culture and organizational performance in English acute hospitals (NHS Trusts) over three time periods between 2001/2002 and 2007/2008. We use a validated culture rating instrument, the Competing Values Framework, to measure senior management team culture. Organizational performance is assessed using a wide range of routinely collected indicators. We examine the associations between organizational culture and performance using ordered probit and multinomial logit models. We find that organizational culture varies across hospitals and over time, and this variation is at least in part associated in consistent and predictable ways with a variety of organizational characteristics and routine measures of performance. Moreover, hospitals are moving towards more competitive culture archetypes which mirror the current policy context, though with a stronger blend of cultures. The study provides evidence for a relationship between culture and performance in hospital settings. PMID:23159305

  6. Nursing leadership within the NHS: an evolutionary perspective.

    PubMed

    Sherring, Simon

    Effective leadership is crucial to the delivery of quality NHS care, particularly in the current economic climate. These are unprecedented times for the NHS; at no other time in its life has the need for leadership been greater. It is hard to define nursing leadership, with roles becoming increasingly complex. Although there has been much invested in leadership training, NHS guidance has suggested the service has only just begun to understand the importance of leadership. There is unparalleled change in the NHS; nurses are being asked to be innovators and entrepreneurs. In this article, the author considers what leadership is, and stresses the need for it to continue evolving to meet the changing demands of the NHS. PMID:22585078

  7. Nursing leadership within the NHS: an evolutionary perspective.

    PubMed

    Sherring, Simon

    Effective leadership is crucial to the delivery of quality NHS care, particularly in the current economic climate. These are unprecedented times for the NHS; at no other time in its life has the need for leadership been greater. It is hard to define nursing leadership, with roles becoming increasingly complex. Although there has been much invested in leadership training, NHS guidance has suggested the service has only just begun to understand the importance of leadership. There is unparalleled change in the NHS; nurses are being asked to be innovators and entrepreneurs. In this article, the author considers what leadership is, and stresses the need for it to continue evolving to meet the changing demands of the NHS.

  8. Who should lead in the NHS?

    PubMed

    Oni, O O

    1995-01-01

    Until recently, health care was regarded in the UK as something exception, and distinct from the world of business. In the last few years, the vocabulary of the health market has changed beyond recognition. Very rapid changes are taking place in the NHS and the service is being fragmented. New relationships are emerging and new roles are being created. Argues that it is becoming evident that the new reforms are not understood clearly by those who are charged with carrying them out, and that as a consequence of all these and other factors, the workforce is confused and demoralized. There is a need for leadership to help people cope. Concludes that the professionals, not managers, are best equipped to provide this leadership.

  9. Culture, compassion and clinical neglect: probity in the NHS after Mid Staffordshire.

    PubMed

    Newdick, Christopher; Danbury, Christopher

    2015-12-01

    Speaking of the public response to the deaths of children at the Bristol Royal Infirmary before 2001, the BMJ commented that the NHS would be 'all changed, changed utterly'. Today, two inquiries into the Mid Staffordshire Foundation Trust suggest nothing changed at all. Many patients died as a result of their care and the stories of indifference and neglect there are harrowing. Yet Bristol and Mid Staffordshire are not isolated reports. In 2011, the Health Services Ombudsman reported on the care of elderly and frail patients in the NHS and found a failure to recognise their humanity and individuality and to respond to them with sensitivity, compassion and professionalism. Likewise, the Care Quality Commission and Healthcare Commission received complaints from patients and relatives about the quality of nursing care. These included patients not being fed, patients left in soiled bedding, poor hygiene practices, and general disregard for privacy and dignity. Why is there such tolerance of poor clinical standards? We need a better understanding of the circumstances that can lead to these outcomes and how best to respond to them. We discuss the findings of these and other reports and consider whether attention should be devoted to managing individual behaviour, or focus on the systemic influences which predispose hospital staff to behave in this way. Lastly, we consider whether we should look further afield to cognitive psychology to better understand how clinicians and managers make decisions?

  10. Culture, compassion and clinical neglect: probity in the NHS after Mid Staffordshire.

    PubMed

    Newdick, Christopher; Danbury, Christopher

    2015-12-01

    Speaking of the public response to the deaths of children at the Bristol Royal Infirmary before 2001, the BMJ commented that the NHS would be 'all changed, changed utterly'. Today, two inquiries into the Mid Staffordshire Foundation Trust suggest nothing changed at all. Many patients died as a result of their care and the stories of indifference and neglect there are harrowing. Yet Bristol and Mid Staffordshire are not isolated reports. In 2011, the Health Services Ombudsman reported on the care of elderly and frail patients in the NHS and found a failure to recognise their humanity and individuality and to respond to them with sensitivity, compassion and professionalism. Likewise, the Care Quality Commission and Healthcare Commission received complaints from patients and relatives about the quality of nursing care. These included patients not being fed, patients left in soiled bedding, poor hygiene practices, and general disregard for privacy and dignity. Why is there such tolerance of poor clinical standards? We need a better understanding of the circumstances that can lead to these outcomes and how best to respond to them. We discuss the findings of these and other reports and consider whether attention should be devoted to managing individual behaviour, or focus on the systemic influences which predispose hospital staff to behave in this way. Lastly, we consider whether we should look further afield to cognitive psychology to better understand how clinicians and managers make decisions? PMID:23704781

  11. An evaluation on the effectiveness of Web 2.0 Startpages (Netvibes & Pageflakes) within NHS libraries.

    PubMed

    McCormick, Carol; Pickard, Alison Jane

    2013-06-01

    Carol McCormick was Learning Resources Advisor in the library at James Cook University Hospital, South Teesside when she completed her BSc (Hons) Librarianship (Work Based Learning) degree at Northumbria University. She gained a 1st Class Honours and is now Learning Resources Librarian. Carol's dissertation formed part of a wider action research project into the provision of current awareness services at James Cook University Hospital. This article reports on the evaluation which was conducted after a Web 2.0 Startpage, or portal, had been introduced to improve access to current awareness information for all staff within the Trust. It is the second article in the Dissertations into practice series to examine the use of web-based tools to improve access to information for NHS staff. AM.

  12. Change management of mergers: the impact on NHS staff and their psychological contracts.

    PubMed

    Cortvriend, Penny

    2004-08-01

    The NHS has experienced a significant amount of organisational change and restructuring, which has included numerous mergers and de-mergers, since the Labour party came to power in the UK in 1997. However, to date there has been little in the way of evaluation of such changes, particularly the impact of organisational restructuring on the staff involved. This paper examines the human aspect of a merger, and subsequent de-merger, within a primary care trust (PCT) in the North of England, using a focus group methodology. The findings demonstrate that leadership and management styles have a significant impact on staff experiencing such changes. In addition, the psychological contract can be damaged due to the impact of several factors, inducing exit or intention to leave. Employees experienced a constant cycle of change with little time for stabilisation or adjustment, leading to negativity and lowered motivation at times.

  13. The NHS Performance Assessment Framework: a "balanced scorecard" approach?

    PubMed

    Chang, Li-Cheng; Lin, Stephen W; Northcott, Deryl N

    2002-01-01

    The NHS in the UK has recently adopted a new Performance Assessment Framework (PAF), aiming to provide a broader view of performance within the NHS The PAF is not only a multi-stakeholder approach reflecting various stakeholders' interests across six dimensions, but is also used by the Government as a strategic management tool to ink national strategies with local operation activities. The Government claims that the PAF is a "balanced scorecard" approach This study discusses the concepts of the BSC underlying the NHS PAF. PMID:12463649

  14. Trust in scientific publishing.

    PubMed

    Hummels, H; Roosendaal, H E

    2001-11-01

    Trust is an important phenomenon to reduce organizational complexity and uncertainty. In the literature many types of trust are distinguished. An important framework to understand the variety and development of trust in organisations is provided by Zucker. She distinguishes three types of trust: process-based trust, institutional-based trust, characteristic-based trust. In this article we will add a fourth type: values-based trust. Similarly, it is customary in scientific communication to distinguish four main communication functions: registration, archiving, certification, awareness. These types of trust and communication functions offer somewhat similar classification schemes. In this paper we will elaborate on these classification schemes with the aim to analyse possible similarities or even mapping. Such similarities will allow drawing conclusions on the development of trust in a (virtual) organisation in general and the process of scientific communication as a special kind of a (virtual) organisation in particular.

  15. Safeguarding tissue viability services in today's NHS: JWC conference report.

    PubMed

    Cowan, T

    2008-05-01

    The increasing business orientation of the NHS poses a challenge to wound-care practitioners. At a recent JWC conference, speakers and delegates discussed how we can adapt to this new climate to protect and expand tissue viability services.

  16. Information governance--a view from the NHS.

    PubMed

    Donaldson, Alistair; Walker, Phil

    2004-03-31

    In this paper, a range of issues influencing and affecting NHS information governance policy and practice will be considered. The expansion of electronic information services within the NHS and with its other information partners has reinforced the need for effective security and confidentiality arrangements to apply at multiple levels and in a variety of different business contexts. Added to these, the need to consistently address issues of data protection, records management and data quality, has resulted in a NHS information governance initiative. This initiative is intended to provide approved tools, methods and guidance that may be applied consistently throughout the NHS and that will be underpinned through appropriate support and helpdesk services. This paper emphasises the need to consider a range of applicable topics when determining a responsible and extensible approach to the governance of information collected, used and shared by healthcare organisations.

  17. Looking at the extent of fraud within the NHS.

    PubMed

    Griffith, Richard; Tengnah, Cassam

    2011-10-01

    Fraud costs the NHS billions of pounds each year, and takes money away from frontline services. The Fraud Act 2006 has made the offence clearer and therefore easier to bring prosecutions. Offences can range from false representation about qualifications and experience to fraudulent consent forms, and through to bogus invoices and charging ghost patients. In this article, Richard Griffith and Cassam Tengnah outline what constitutes fraud and the measures taken by the NHS to counter fraudulent activity.

  18. The NHS Health Check programme: implementation in east London 2009–2011

    PubMed Central

    Robson, John; Dostal, Isabel; Madurasinghe, Vichithranie; Sheikh, Aziz; Hull, Sally; Boomla, Kambiz; Page, Helen; Griffiths, Chris; Eldridge, Sandra

    2015-01-01

    Objectives To describe implementation and results from the National Health Service (NHS) Health Check programme. Design Three-year observational open cohort study: 2009–2011. Participants People of age 40–74 years eligible for an NHS Health Check. Setting 139/143 general practices in three east London primary care trusts (PCTs) serving an ethnically diverse and socially disadvantaged population. Method Implementation was supported with education, IT support and performance reports. Tower Hamlets PCT additionally used managed practice networks and prior-stratification to call people at higher cardiovascular (CVD) risk first. Main outcomes measures Attendance, proportion of high-risk population on statins and comorbidities identified. Results Coverage 2009, 2010, 2011 was 33.9% (31 878/10 805), 60.6% (30 757/18 652) and 73.4% (21 194/28 890), respectively. Older people were more likely to attend than younger people. Attendance was similar across deprivation quintiles and was in accordance with population distributions of black African/Caribbean, South Asian and White ethnic groups. 1 in 10 attendees were at high-CVD risk (20% or more 10-year risk). In the two PCTs stratifying risk, 14.3% and 9.4% of attendees were at high-CVD risk compared to 8.6% in the PCT using an unselected invitation strategy. Statin prescription to people at high-CVD risk was higher in Tower Hamlets 48.9%, than in City and Hackney 23.1% or Newham 20.2%. In the 6 months following an NHS Health Check, 1349 new cases of hypertension, 638 new cases of diabetes and 89 new cases of chronic kidney disease (CKD) were diagnosed. This represents 1 new case of hypertension per 38 Checks, 1 new case of diabetes per 80 Checks and 1 new case of CKD per 568 Checks. Conclusions Implementation of the NHS Health Check programme in these localities demonstrates limited success. Coverage and treatment of those at high-CVD risk could be improved. Targeting invitations to people at high-CVD risk

  19. From Hippocrates to Commodities: three models of NHS governance: NHS governance, regulation, Mid Staffordshire inquiry, health care as a commodity.

    PubMed

    Newdick, Christopher

    2014-01-01

    A series of inquiries and reports suggest considerable failings in the care provided to some patients in the NHS. Although the Bristol Inquiry report of 2001 led to the creation of many new regulatory bodies to supervise the NHS, they have never enjoyed consistent support from government and the Mid Staffordshire Inquiry in 2013 suggests they made little difference. Why do some parts of the NHS disregard patients' interests and how we should we respond to the challenge? The following discusses the evolution of approaches to NHS governance through the Hippocratic, Managerial and Commercial models, and assesses their risks and benefits. Apart from the ethical imperative, the need for effective governance is driven both by the growth in information available to the public and the resources wasted by ineffective systems of care. Appropriate solutions depend on an understanding of the perverse incentives inherent in each model and the need for greater sensitivity to the voices of patients and the public. PMID:24841525

  20. British National Health Service trust chief executives on nurse education: corporate instrumentalism and doubts on quasi-market structure.

    PubMed

    Humphreys, J

    1996-01-01

    The funding of nurse education through Working Paper 10 arrangements is susceptible to analysis as a 'quasi-market' in which regional purchasers (in England) commission education and training services on behalf of National Health Service (NHS) trusts. In this context, some regions have developed ways of managing the demand side of the market in such a way as to enable NHS trust involvement in purchasing decisions, sometimes through consortium configurations. This paper reports the findings of an empirical study of the views of NHS trust chief executives on nurse education. The investigation was conducted to provide the information base for a consortium development reported earlier in the Journal of Advanced Nursing. The consensus views of chief executives revealed an ideological stance, referred to as corporate instrumentalism. This was shown to be derived from the position of trusts as newly corporate organizations undergoing considerable change in a volatile and competitive environment. Education was seen as potentially capable of contributing significantly to both health service quality and organizational change. Chief executives described an ideal of collaboration in which college providers are highly responsive to their needs, but doubted that the current quasi-market arrangements can in fact deliver this. A comparison of chief executive and senior executive nurse views revealed some significant differences of emphasis, and a mechanism is provisionally suggested by which educational innovation could be suppressed. Finally the education quasi-market was analysed in terms of both its implications for the professional status of nurses and its potential to facilitate NHS reform.

  1. Marginal-cost contracting in the NHS: results of a preliminary survey.

    PubMed

    Beddow, A J; Cohen, D R

    2001-05-01

    Market disciplines and incentives were expected to improve efficiency in the UK National Health Service following the introduction of an 'internal market' in 1991. An exploratory survey of all Health Authorities and Trusts in the UK was undertaken to investigate whether players in the NHS managed market are behaving as economic theory predicts they should. The focus was on how and to what extent marginal costing has been used in the contracting process and on whether in some instances an inappropriate use of marginal costing may be resulting in inappropriate investment decisions. Twenty of 29 responding Health Authorities (69%) and 16 of 39 Trusts (41%) stated that they had considered purchasing/providing services on a marginal-cost basis and all of these led to contracts. Marginal-cost contracting appears to be fairly commonplace and the process does not appear to be causing insurmountable conflicts between players. Most marginal-cost contracts were specifically to meet waiting-list initiative targets. Overall results suggest that economic principles are not being particularly adhered to, with expansion in output rarely being related to available capacity. As increased responsibility for commissioning passes to primary care teams and local health groups, there are lessons for those involved in this more disaggregated approach to service shaping and service delivery. PMID:11373994

  2. Pressure-ulcer management and prevention in acute and primary care.

    PubMed

    Newham, Roger; Hudgell, Lynne

    This article describes a study to ascertain what it is like to follow the processes in practice for prevention and management of pressure ulcers as one aspect of care among others. The participants in this study were bands 5 and 6 staff nurses and healthcare assistants (HCAs) (n=72) recruited from two acute and two primary NHS trusts. Data were gathered from open-ended questions via an online survey (n=61) and interviews (n=11). The interviews were transcribed and all the data were analysed by thematic analysis. The findings show that participants believe there has been a high-profile imposition of guidelines and policies by management during at least the past 18 months, resulting in perceived good outcomes in the form of fewer pressure ulcers generally and less fragmentation of care, particularly within primary care. However, a number of perceived obstacles to the implementation of recommended interventions remain, notably lack of time and lack of knowledge.

  3. Reliable Design Versus Trust

    NASA Technical Reports Server (NTRS)

    Berg, Melanie; LaBel, Kenneth A.

    2016-01-01

    This presentation focuses on reliability and trust for the users portion of the FPGA design flow. It is assumed that the manufacturer prior to hand-off to the user tests FPGA internal components. The objective is to present the challenges of creating reliable and trusted designs. The following will be addressed: What makes a design vulnerable to functional flaws (reliability) or attackers (trust)? What are the challenges for verifying a reliable design versus a trusted design?

  4. Assessing an adherent silicone foam dressing: a clinical evaluation across five NHS trusts.

    PubMed

    Stephen-Haynes, Jackie; Callaghan, Rosie; Bethell, Elaine; Linthwaite, Adele; Bullough, Lindsey; Armstrong, Jayne

    2015-12-01

    The wound contact layer of UrgoTul Absorb Border (Urgo Medical) foam dressing contains a Technology Lipido Colloid (TLC) Healing Matrix, which includes hydrocolloid and lipophilic substances designed to stimulate fibroblast proliferation and thus promote granulation tissue formation. A multicentre, noncomparative, clinical evaluation of UrgoTul Absorb Border investigated whether use of the dressing promoted granulation tissue formation and the management of wound exudate. Other parameters evaluated included: pain-free dressing changes, protection and improvement of surrounding tissue, ease of application, conformability, ability to remain in place, wear time, effect on peri-wound skin, durability, ease of removal, and patient comfort. There were 43 patients recruited into the evaluation. Results show that 8 wounds (19%) achieved full epithelialisation and 34 (81%) improved. All participating clinicians rated the dressing's overall performance, including its ability to manage exudate, as excellent, very good, or good. PMID:26639071

  5. Can learning organizations survive in the newer NHS?

    PubMed Central

    Sheaff, Rod; Pilgrim, David

    2006-01-01

    Background This paper outlines the principal characteristics of a learning organisation and the organisational features that define it. It then compares these features with the organisational conditions that currently obtain, or are being created, within the British NHS. The contradictory development of recent British health policy, resulting in the NHS becoming both more marketised and more bureaucratised has correspondingly ambiguous implications for attempts to implement a 'learning organisation' model. Methods Texts that define and debate the characteristics of a learning organisation were found by snowballing references from the founding learning organisation books and published papers, and then by searching a database specifically devised for a literature review on organisational structures and processes in health care. COPAC and ABI-Info databases for subsequent peer-reviewed publications that also appeared relevant to the present study were searched. Results The outcomes of the above search are summarised and mapped onto the current constituent organisations of the NHS to identify the extent to which they achieve or approximate to a learning organisation status. Conclusion Because of the complexity of the NHS and the contradictory processes of marketisation and bureaucratisation characterising it, it cannot, as a whole system, become a learning organisation. However, it is possible that its constituent organisations may achieve this status to varying degrees. Constraints upon NHS managers to speak their minds freely place an ultimate limit on learning organisation development. This limitation suggests that current British health service policy encourages organisational learning-but not too openly and not too much. PMID:17074083

  6. Can calls to NHS Direct be used for syndromic surveillance?

    PubMed

    Harcourt, S E; Smith, G E; Hollyoak, V; Joseph, C A; Chaloner, R; Rehman, Y; Warburton, F; Ejidokun, O O; Watson, J M; Griffiths, R K

    2001-09-01

    This study assessed whether NHS Direct could be a useful source of surveillance data for communicable diseases, using influenza as a pilot condition. Data on the weekly total number of calls and the number from people reporting influenza-like symptoms to three pilot NHS Direct sites were collected between November 1999 and March 2000. NHS Direct data were compared with routinely available influenza surveillance data. The NHS Direct call rate peaked at 331 per 100,000 population in week 52 of 1999. The percentage of calls for 'influenza-like illness' (one site) peaked at 15% during week 51. Information about weekly call numbers to NHS Direct could be produced in a timely way. It was not clear whether the observed peak in calls reflected a true increase in influenza or whether it was the result of an increase in calls over the Christmas/Millennium holiday period due to more difficulty in accessing other services. The ability to assess the proportion of calls made directly by, or on behalf of, each age group will be of vital importance in interpreting seasonal respiratory disease.

  7. Exploring patients' rights: what does the NHS Constitution tell us?

    PubMed

    McHale, Jean V

    On 8 March 2012, the NHS published the latest version of its Constitution. In this article, the author explores the background of the debate regarding patients' rights and entitlements in the NHS. The author also discusses the provisions of the NHS Constitution, noting that it is largely a statement of existing principles, rather than a bold statement of rights. The paper suggests that, in some instances, its discussion of rights may suggest that patients have broader rights than may in fact be the case. The Constitution is currently under review, and the author recommends that the way forward for a society where the provision of care is likely to be more complex would be the introduction of a Patients' Rights Act.

  8. Lifestyle treatments in cystic fibrosis: The NHS should pay.

    PubMed

    Ketchell, Robert Ian

    2016-08-01

    With the NHS under increasing financial pressure and healthcare costs soaring year on year, it is perhaps not surprising that assessment agencies focus on cost-effectiveness analysis when assessing new therapies. Such an approach does not however, always take sufficient account of treatment burden, lifestyle and patient choice and therefore new equally effective but perhaps "easier to take" formulations and faster delivery systems for current therapies do not always take precedence in current treatment guidelines. In arguing that the NHS should pay for so-called lifestyle treatments in cystic fibrosis the counterintuitive nature of some of the current decision making is discussed and a more holistic approach to improve NHS efficiency is presented.

  9. Lifestyle treatments in cystic fibrosis: The NHS should not pay.

    PubMed

    Hull, Jeremy

    2016-08-01

    Lifestyle treatments can be defined as those which may have in impact on quality of life but do not affect health outcomes. Particular treatment options may be preferred by patients because they are for example, easier to use, take up less time or taste better. The impact on adherence needs to be considered. Treatment options that promote greater adherence to therapy are likely to be more efficacious and so are not, by definition, lifestyle treatments. The NHS is facing unprecedented financial pressure and resources are limited. When lifestyle treatments are more expensive than standard therapy, they should not be funded by the NHS.

  10. Lifestyle treatments in cystic fibrosis: The NHS should not pay.

    PubMed

    Hull, Jeremy

    2016-08-01

    Lifestyle treatments can be defined as those which may have in impact on quality of life but do not affect health outcomes. Particular treatment options may be preferred by patients because they are for example, easier to use, take up less time or taste better. The impact on adherence needs to be considered. Treatment options that promote greater adherence to therapy are likely to be more efficacious and so are not, by definition, lifestyle treatments. The NHS is facing unprecedented financial pressure and resources are limited. When lifestyle treatments are more expensive than standard therapy, they should not be funded by the NHS. PMID:27349724

  11. All for one, one for all: collaboration between NHS and Higher Education in establishing provision of a multi-disciplinary, hospital-based library and information services.

    PubMed

    Black, Coral; Bury, Rachel

    2004-06-01

    Developing multi-disciplinary library and information services is high on the agenda for many NHS trusts and this brings with it a climate of change for both those who manage and work in services today. The development of such new services needs to be carefully managed and developed, and this presents a challenge for librarians and service managers. In the UK during 1999 and 2000, Aintree Hospital Trust, in conjunction with Edge Hill College of Higher Education, established a truly multi-disciplinary service based at its hospital site and managed by Edge Hill. This paper outlines the key stages in the development of the Library and Information Service with the focus on the management of change, collaboration and the development of a unique partnership between Higher Education and an NHS trust. The case study example will provide an outline of strategic and project planning, with insights into staff management and development, delivering user expectations and developing stakeholder relationships in the health library setting.

  12. Where should health services go: local authorities versus the NHS?

    PubMed Central

    Pollock, A. M.

    1995-01-01

    The Association of Metropolitan Authorities has recently proposed that responsibility for the NHS should pass from health authorities to local authorities. One of the fiercest debates at the outset of the NHS was whether the hospitals should be run by local authorities. In the end the minister for health, Aneurin Bevan, decided against local democracy and in favour of a national health service. His arguments included the fact that equality of treatment could not be guaranteed if facilities varied with local finances and that even the largest authorities were not big enough to pool risks and expertise. All these arguments still apply today, and the recent changes in community care provide an insight into how a market model of local authority control might work. The changes have been accompanied by a shift from public to private sector provision and the introduction of charges for services that the NHS once provided free. As important, the willingness and ability of local authorities to raise extra revenue from local taxes and charges affect the service they can provide, so leading to inequalities of provision. Local authorities have yet to make the case that they can preserve the fundamental principles and benefits of the NHS, including its reliance on central taxation and unified funding formulas. PMID:7787651

  13. From NHS Choices to the integrated customer service platform.

    PubMed

    Gann, Bob; Grant, Maria J

    2013-03-01

    In 2013 the NHS Commissioning Board launches its new integrated customer service platform. The new service utilises the full range of channels (web, telephone, apps etc) to provide access to information to support transparency, participation and transactions. Digital health services have proven benefits in informed choice, shared decision making and patient participation.

  14. What makes for successful TQM in the NHS?

    PubMed

    Joss, R

    1994-01-01

    A three-year evaluation of total quality management (TQM) at NHS demonstration sites shows there are clear factors which predict successful implementation of TQM. The intention is to raise awareness at both TQM and non-TQM sites of the need to have a structured, pre-planned approach to TQM, based on a thorough understanding of alternative approaches.

  15. The geography of trust.

    PubMed

    Joni, Saj-nicole A

    2004-03-01

    Leaders who rely forever on the same internal advisers, entrusting them with issues of ever greater sensitivity and consequence, run the risk of being sold short and possibly betrayed. Alternatively, lone-wolf leaders who trust no one may make enormous, yet preventable, mistakes when trying to sort through difficult decisions. A sophisticated understanding of trust can protect leaders from both fates. During the past decade, author and consultant Saj-nicole Joni studied leadership in more than 150 European and North American companies. Her research reveals three fundamental types of trustpersonal trust, expertise trust, and structural trust. Executives may persevere in relationships that are based on personal trust, no matter how exalted their leadership roles become. But such relationships are unlikely to remain static. They also probably won't provide the kinds of deep, often specialized knowledge leaders need. In circumstances where advisers' competence matters as much as their character, expertise trust--reliance on an adviser's ability in a specific subject--enters the picture. In organizations, leaders develop expertise trust by working closely with people who consistently demonstrate their mastery of particular subjects or processes. Structural trust refers to how roles and ambitions influence advisers' perspectives and candor. It shifts constantly as people rise through organizations. High-level structural trust can provide leaders with pure insight and information--but advisers in positions of the highest structural trust generally reside outside organizations. These advisers provide leaders with insights that their organizations cannot. High-performing leaders' most enduring--and most valuable--relationships are characterized by enormous levels of all three kinds of trust.

  16. With such an NHS staff shortfall, who will work on the 'mothballed' wards?

    PubMed

    Chilver, Karen

    2016-03-01

    I was interested to read your article about Lord Carter of Coles' report on saving the NHS £5 billion a year (analysis, February 17). However, the article and Lord Carter's report fail to mention the £4.5 billion wasted on the NHS internal market, which adds nothing to patient care according to independent and parliamentary reports into the NHS since 2010.

  17. Trust in interprofessional collaboration

    PubMed Central

    Gregory, Paul A. M.; Austin, Zubin

    2016-01-01

    Background: Trust is integral to effective interprofessional collaboration. There has been scant literature characterizing how trust between practitioners is formed, maintained or lost. The objective of this study was to characterize the cognitive model of trust that exists between pharmacists and family physicians working in collaborative primary care settings. Methods: Pharmacists and family physicians who work collaboratively in primary care were participants in this study. Family health teams were excluded from this study because of the distinct nature of these settings. Through a snowball convenience sampling method, a total of 11 pharmacists and 8 family physicians were recruited. A semistructured interview guide was used to guide discussion around trust, relationships and collaboration. Constant-comparative coding was used to identify themes emerging from these data. Results: Pharmacists and family physicians demonstrate different cognitive models of trust in primary care collaboration. For pharmacists, trust appears to be conferred on physicians based on title, degree, status and positional authority. For family physicians, trust appears to be earned based on competency and performance. These differences may lead to interprofessional tension when expectations of reciprocal trust are not met. Conclusions: Further work in characterizing how trust is developed in interprofessional relationships is needed to support effective team formation and functioning. PMID:27540406

  18. Innovation in tissue viability documentation for acute services.

    PubMed

    Parnham, A

    2011-09-01

    This paper discusses the developmental process, outcome and delivery of an innovative approach to standardising tissue viability documentation across two sites within Nottingham University Hospitals NHS Trust, following the results of benchmarking pressure ulcer preventive care strategies and recommendations from pressure ulcer root cause analysis. It reflects upon the process, highlighting the lessons learnt.

  19. National Education Trust Fund

    ERIC Educational Resources Information Center

    Shapp, Milton J.

    1975-01-01

    A proposal from the governor of Pennsylvania for financing all levels of education through a National Education Trust Fund (NETF) that would operate as the present Federal Highway Trust Fund does on a revolving, self-liquidating basis with the cost of an individual's education repaid through a progressive education tax on income. (JT)

  20. Trust versus Manipulation

    ERIC Educational Resources Information Center

    Lewis, Anne C.

    2005-01-01

    This article discusses the issue of trust in the education system. What is different about the issue of trust in the education system is the assault upon it, sometimes overt but most often subtle. There is a difference between strong criticism and willful manipulation. The nation's schools are responding to the former--perhaps too slowly for…

  1. The enemies of trust.

    PubMed

    Galford, Robert; Drapeau, Anne Seibold

    2003-02-01

    Researchers have established that trust is critical to organizational effectiveness. Being trustworthy yourself, however, does not guarantee that you are capable of building trust in an organization. That takes old-fashioned managerial virtues like consistency, clear communication, and a willingness to tackle awkward questions. It also requires a good defense: You must protect trust from its enemies. Any act of bad management erodes trust, so the list of potential enemies is endless. Among the most common enemies of trust, though, are inconsistent messages from top management, inconsistent standards, a willingness to tolerate incompetence or bad behavior, dishonest feedback, a failure to trust others to do good work, a tendency to ignore painful or politically charged situations, consistent corporate underperformance, and rumors. Fending off these enemies must be at the top of every chief executive's agenda. But even with constant vigilance, an organization and its leaders will sometimes lose people's trust. During a crisis, managers should enlist the help of an objective third party--chances are you won't be thinking clearly--and be available physically and emotionally. If you "go dark" in the face of a crisis, employees will worry about the company's survival, about their own capacity to cope, and about your abilities as a leader. And if trust has broken down so badly that your only choice is to start over, you can do so by figuring out exactly how the breach of trust happened, ascertaining the depth and breadth of the loss, owning up to the loss instead of downplaying it, and identifying as precisely as possible the specific changes you must make to rebuild trust.

  2. Nature of the N-H...S hydrogen bond.

    PubMed

    Biswal, Himansu S; Wategaonkar, Sanjay

    2009-11-19

    The N-H...S hydrogen-bonded complexes of the model compounds of tryptophan (indole and 3-methylindole) and methionine (dimethyl sulfide, Me(2)S) have been characterized by a combination of experimental techniques like resonant two-photon ionization (R2PI), resonant ion dip infrared spectroscopy (RIDIRS), and fluorescence dip infrared spectroscopy (FDIRS) and computational methods like ab initio electronic structure calculations, atoms-in-molecules (AIM), natural bond orbital (NBO), and energy decomposition analyses. The results are compared with the N-H...O (M.H(2)O; M = indole, 3-methyl indole) sigma-type and N-H...Phi (M.benzene) pi-type hydrogen-bonded complexes. It was shown that the S(1)-S(0) band origin red shifts in the N-H...S hydrogen-bonded complexes correlated well with the polarizability of the acceptor rather than their proton affinity, contrary to the trend observed in most X-H...Y (X, Y = O, N, halogens, etc.) hydrogen-bonded systems. The red shift in the N-H stretching frequency in the N-H...S HB clusters (Me(2)S as HB acceptor) was found to be 1.8 times greater than that for the N-H...O hydrogen-bonded complexes (H(2)O as HB acceptor), although the binding energies for the two complexes were comparable. The energy decomposition analyses for all of the N-H...S hydrogen-bonded complexes showed that the correlation (or dispersion) energy has significant contribution to the total binding energy. It is pointed out that the binding energy of the N-H...S complex was also comparable to that of the indole.benzene complex, which is completely dominated by the dispersion interaction. Atoms-in-molcules (AIM) and natural bond orbital (NBO) analyses indicated a nontrivial electrostatic component in the hydrogen-bonding interaction. Greater dispersion contribution to the stabilization energy as well as greater red shifts in the N-H stretch relative to those of N-H...O hydrogen-bonded complexes makes the indole.dimethylsulfide complex unique in regard to the

  3. Is compassion possible in a market-led NHS?

    PubMed

    Flynn, Maria; Mercer, Dave

    The principle of compassionate care is increasingly seen as the core element of good nursing practice. However, recent media reports have focused on the "compassion deficit". We carried out a review of national and international evidence on core professional values, which showed that caring and compassion are inherent nursing values. While the development of these values is influenced by training and role modelling, the main influence is the organisation and culture in which nurses work. This article discusses the findings of the review in relation to the national debate around compassionate care within an NHS that is being fundamentally changed. We suggest any failure in compassion is more likely to be due to government health policy and NHS organisational culture than to any shortcomings of nurses or nursing practice.

  4. Moral Legitimacy: The Struggle Of Homeopathy in the NHS.

    PubMed

    Crawford, Louise

    2016-02-01

    This article deploys a well-established theoretical model from the accountability literature to the domain of bioethics. Specifically, homeopathy is identified as a controversial industry and the strategic action of advocates to secure moral legitimacy and attract public funding is explored. The Glasgow Homeopathic Hospital (GHH) is used as the location to examine legitimizing strategies, from gaining legitimacy as a National Health Service (NHS) hospital in 1948, followed by maintaining and repairing legitimacy in response to government enquires in 2000 and 2010. An analysis of legitimizing strategies leads to the conclusion that advocates have been unsuccessful in maintaining and repairing moral legitimacy for homeopathy, thus threatening continued public funding for this unscientific medical modality. This is an encouraging development towards open and transparent NHS accountability for targeting limited public resources in pursuit of maximizing society's health and well-being. Policy implications and areas for future research are suggested.

  5. Coproduction in commissioning decisions: is there an association with decision satisfaction for commissioners working in the NHS? A cross-sectional survey 2010/2011

    PubMed Central

    Taylor-Phillips, Sian; Clarke, Aileen; Grove, Amy; Swan, Jacky; Parsons, Helen; Gkeredakis, Emmanouil; Mills, Penny; Powell, John; Nicolini, Davide; Roginski, Claudia; Scarbrough, Harry

    2014-01-01

    Objectives To undertake an assessment of the association between coproduction and satisfaction with decisions made for local healthcare communities. Design A coproduction scale was developed and tested to measure individual National Health Service (NHS) commissioners’ satisfaction with commissioning decisions. Setting 11 English Primary Care Trusts in 2010–2011. Participants Staff employed at NHS band 7 or above involved in commissioning decisions in the NHS. 345/440 (78%) of participants completed part of all of the survey. Main outcome measure Reliability and validity of a coproduction scale were assessed using a correlation-based principal component analysis model with direct oblimin rotation. Multilevel modelling was used to predict decision satisfaction. Results The analysis revealed that coproduction consisted of three principal components: productive discussion, information and dealing with uncertainty. Higher decision satisfaction was associated with smaller decisions, more productive discussion, decisions where information was readily available to use and those where decision-making tools were more often used. Conclusions The research indicated that coproduction may be an important factor for satisfaction with decision-making in the commissioning of healthcare services. PMID:24902728

  6. Employee engagement within the NHS: a cross-sectional study

    PubMed Central

    Jeve, Yadava Bapurao; Oppenheimer, Christina; Konje, Justin

    2015-01-01

    Background: Employee engagement is the emotional commitment of the employee towards the organisation. We aimed to analyse baseline work engagement using Utrecht Work Engagement Scale (UWES) at a teaching hospital. Methods: We have conducted a cross-sectional study within the National Health Service (NHS) Teaching Hospital in the UK. All participants were working age population from both genders directly employed by the hospital. UWES has three constituting dimensions of work engagement as vigor, dedication, and absorption. We conducted the study using UWES-9 tool. Outcome measures were mean score for each dimension of work engagement (vigor, dedication, absorption) and total score compared with control score from test manual. Results: We found that the score for vigor and dedication is significantly lower than comparison group (P< 0.0001 for both). The score for absorption was significantly higher than comparison group (P< 0.0001). However, total score is not significantly different. Conclusion: The study shows that work engagement level is below average within the NHS employees. Vigor and dedication are significantly lower, these are characterised by energy, mental resilience, the willingness to invest one’s effort, and persistence as well as a sense of significance, enthusiasm, inspiration, pride, and challenge. The NHS employees are immersed in work. Urgent need to explore strategies to improve work engagement as it is vital for improving productivity, safety and patient experience PMID:25674571

  7. Evidence-based commissioning in the English NHS: who uses which sources of evidence? A survey 2010/2011

    PubMed Central

    Clarke, Aileen; Taylor-Phillips, Sian; Swan, Jacky; Gkeredakis, Emmanouil; Mills, Penny; Powell, John; Nicolini, Davide; Roginski, Claudia; Scarbrough, Harry; Grove, Amy

    2013-01-01

    Objectives To investigate types of evidence used by healthcare commissioners when making decisions and whether decisions were influenced by commissioners’ experience, personal characteristics or role at work. Design Cross-sectional survey of 345 National Health Service (NHS) staff members. Setting The study was conducted across 11 English Primary Care Trusts between 2010 and 2011. Participants A total of 440 staff involved in commissioning decisions and employed at NHS band 7 or above were invited to participate in the study. Of those, 345 (78%) completed all or a part of the survey. Main outcome measures Participants were asked to rate how important different sources of evidence (empirical or practical) were in a recent decision that had been made. Backwards stepwise logistic regression analyses were undertaken to assess the contributions of age, gender and professional background, as well as the years of experience in NHS commissioning, pay grade and work role. Results The extent to which empirical evidence was used for commissioning decisions in the NHS varied according to the professional background. Only 50% of respondents stated that clinical guidelines and cost-effectiveness evidence were important for healthcare decisions. Respondents were more likely to report use of empirical evidence if they worked in Public Health in comparison to other departments (p<0.0005, commissioning and contracts OR   0.32, 95%CI   0.18 to 0.57, finance OR  0.19, 95%CI 0.05 to 0.78, other departments OR 0.35, 95%CI 0.17 to 0.71) or if they were female (OR 1.8 95% CI 1.01 to 3.1) rather than male. Respondents were more likely to report use of practical evidence if they were more senior within the organisation (pay grade 8b or higher OR 2.7, 95%CI 1.4 to 5.3, p=0.004 in comparison to lower pay grades). Conclusions Those trained in Public Health appeared more likely to use external empirical evidence while those at higher pay scales were more likely to use practical

  8. Chimpanzees Trust Their Friends.

    PubMed

    Engelmann, Jan M; Herrmann, Esther

    2016-01-25

    The identification and recruitment of trustworthy partners represents an important adaptive challenge for any species that relies heavily on cooperation [1, 2]. From an evolutionary perspective, trust is difficult to account for as it involves, by definition, a risk of non-reciprocation and defection by cheaters [3, 4]. One solution for this problem is to form close emotional bonds, i.e., friendships, which enable trust even in contexts where cheating would be profitable [5]. Little is known about the evolutionary origins of the human tendency to form close social bonds to overcome the trust problem. Studying chimpanzees (Pan troglodytes), one of our closest living relatives, is one way of identifying these origins. While a growing body of research indicates that at least some of the properties of close human relationships find parallels in the social bonds of chimpanzees [6-10] and that chimpanzees extend favors preferentially toward selected individuals [11-14], it is unclear whether such interactions are based on trust. To fill this gap in knowledge, we observed the social interactions of a group of chimpanzees and established dyadic friendship relations. We then presented chimpanzees with a modified, non-verbal version of the human trust game and found that chimpanzees trust their friends significantly more frequently than their non-friends. These results suggest that trust within closely bonded dyads is not unique to humans but rather has its evolutionary roots in the social relationships of our closest primate relatives. PMID:26776735

  9. [Fidelity to trust].

    PubMed

    Alvarez Avello, José Manuel

    2014-01-01

    Trust in the doctor, an essential condition of medical practice throughout its history, appears to be considered as an outdated value, destined to extinction. In his work, Pellegrino analyzes the epistemological, empirical and conceptual basis of trust in professional relationships, the reasons for its weakening in an ethics of distrust, and he presents his philosophical proposal, which recovers and reappraises the fidelity to trust placed in the doctor-patient relationship, as an essential virtue for an appropriate ethical behaviour in the practice of medicine as in a moral community.

  10. The impact of electronic prescribing systems on pharmacists’ time and workflow: protocol for a time-and-motion study in English NHS hospitals

    PubMed Central

    Schofield, Behnaz; Cresswel, Kathrin; Westbrook, Johanna; Slee, Ann; Girling, Alan; Shah, Sonal; Coleman, Jamie; Sheikh, Aziz

    2015-01-01

    Introduction Electronic prescribing (ePrescribing) systems are rapidly being introduced into National Health Systems (NHS) hospitals in England following their widespread earlier adoption into primary care settings. Such systems require substantial changes in the way pharmacists organise their work and perform their roles. There is however as yet limited evidence on the extent to which these changes may support or compromise efficient and safe working practices by pharmacists. Identifying and quantifying these changes, and their effects, is central to informing system and work practice design, as well as informing training and implementation processes. This protocol describes a study to measure the impact of ePrescribing systems on pharmacists’ time and workflow. Methods and analysis A direct observational controlled pre–post implementation time-and-motion study will be conducted in six wards at one NHS Trust over two observational periods. Pharmacists will be shadowed and details of all work tasks performed will be collected and time-stamped. Task distribution, frequency and duration will be measured and changes in these measures preimplementation and postimplementation, and between control and intervention wards will be measured. Interviews with pharmacists will investigate their perceptions of the impact of the ePrescribing systems on their work and will be conducted in both periods. The extent to which pharmacists’ expectations of the impact of the ePrescribing systems on their work with postimplementation reports will be qualitatively explored, as will any differences between perceptions and results from the time-and-motion analysis. Ethics and dissemination Institutional research ethics approval has been obtained from The University of Edinburgh. Local approval from the participating NHS Trust and informed consent from participating pharmacists have been obtained, while also complying with local governance requirements. The results of the study will be

  11. Some correlates of trust.

    PubMed

    Frost, T; Stimpson, D V; Maughan, M R

    1978-05-01

    Trust has been variously defined by behavioral scientists and not very thoroughly investigated. In this study trust was defined as an expectancy held by an individual that the behavior of another person or a group would be altruistic and personally beneficial. An attempt was made, using this conceptual definition, to identify some personality and behavioral correlates of trust. Seven interpersonal relations groups with approximately 10 male and female undergraduates per group were studied with use of the Janis and Field self-esteem inventory, Schutz's FIRO-B scale, and the Rotter internal-external scale. It was discovered that a trusted person is one who is highly influential, has an internal locus of control, a low need to control others, high self-esteem, and is open to being influenced by others.

  12. Trusting Crowdsourced Geospatial Semantics

    NASA Astrophysics Data System (ADS)

    Goodhue, P.; McNair, H.; Reitsma, F.

    2015-08-01

    The degree of trust one can place in information is one of the foremost limitations of crowdsourced geospatial information. As with the development of web technologies, the increased prevalence of semantics associated with geospatial information has increased accessibility and functionality. Semantics also provides an opportunity to extend indicators of trust for crowdsourced geospatial information that have largely focused on spatio-temporal and social aspects of that information. Comparing a feature's intrinsic and extrinsic properties to associated ontologies provides a means of semantically assessing the trustworthiness of crowdsourced geospatial information. The application of this approach to unconstrained semantic submissions then allows for a detailed assessment of the trust of these features whilst maintaining the descriptive thoroughness this mode of information submission affords. The resulting trust rating then becomes an attribute of the feature, providing not only an indication as to the trustworthiness of a specific feature but is able to be aggregated across multiple features to illustrate the overall trustworthiness of a dataset.

  13. TrustBuilder2

    2007-07-20

    TrustBuilder2 is a flexible framework for supporting research in the area trust negotiation protocols, designed to allow researchers to quickly prototype and experiment with various approaches to trust negotiation. In Trustbuilder2, the primary components of a trust negotiation system are represented using abstract interfaces. Any or all of these components can be implemented or extended by users of the TrustBuilder2 system, thereby making the system's functionality easily extensible. The TrustBuilder2 configuration files can be modifiedmore » to load these custom components in place of the default system components; this facilitates the use of new features without modifications to the underlying runtime system. In our implementation, we provide support for one negotiation strategy, a policy compliance checker based on Jess (the Java Expert System Shell), query interfaces enabling access to disk-based credential and policy repositories, a credential chain construction algorithm, two credential chain verification routines, and both graphical and text-based logging facilities. Trustbuilder2 also supports the interposition of user-defined plug-ins at communication points between system components to allow for easy monitoring of system activity or the modification of messages passed between components.« less

  14. Computationally modeling interpersonal trust

    PubMed Central

    Lee, Jin Joo; Knox, W. Bradley; Wormwood, Jolie B.; Breazeal, Cynthia; DeSteno, David

    2013-01-01

    We present a computational model capable of predicting—above human accuracy—the degree of trust a person has toward their novel partner by observing the trust-related nonverbal cues expressed in their social interaction. We summarize our prior work, in which we identify nonverbal cues that signal untrustworthy behavior and also demonstrate the human mind's readiness to interpret those cues to assess the trustworthiness of a social robot. We demonstrate that domain knowledge gained from our prior work using human-subjects experiments, when incorporated into the feature engineering process, permits a computational model to outperform both human predictions and a baseline model built in naiveté of this domain knowledge. We then present the construction of hidden Markov models to investigate temporal relationships among the trust-related nonverbal cues. By interpreting the resulting learned structure, we observe that models built to emulate different levels of trust exhibit different sequences of nonverbal cues. From this observation, we derived sequence-based temporal features that further improve the accuracy of our computational model. Our multi-step research process presented in this paper combines the strength of experimental manipulation and machine learning to not only design a computational trust model but also to further our understanding of the dynamics of interpersonal trust. PMID:24363649

  15. Trusted Computing Technologies, Intel Trusted Execution Technology.

    SciTech Connect

    Guise, Max Joseph; Wendt, Jeremy Daniel

    2011-01-01

    We describe the current state-of-the-art in Trusted Computing Technologies - focusing mainly on Intel's Trusted Execution Technology (TXT). This document is based on existing documentation and tests of two existing TXT-based systems: Intel's Trusted Boot and Invisible Things Lab's Qubes OS. We describe what features are lacking in current implementations, describe what a mature system could provide, and present a list of developments to watch. Critical systems perform operation-critical computations on high importance data. In such systems, the inputs, computation steps, and outputs may be highly sensitive. Sensitive components must be protected from both unauthorized release, and unauthorized alteration: Unauthorized users should not access the sensitive input and sensitive output data, nor be able to alter them; the computation contains intermediate data with the same requirements, and executes algorithms that the unauthorized should not be able to know or alter. Due to various system requirements, such critical systems are frequently built from commercial hardware, employ commercial software, and require network access. These hardware, software, and network system components increase the risk that sensitive input data, computation, and output data may be compromised.

  16. Impact of signals and experience on trust and trusting behavior.

    PubMed

    Chen, Ying-Hueih; Chien, Shu-Hua; Wu, Jyh-Jeng; Tsai, Pei-Yin

    2010-10-01

    Trust is an essential factor that drives virtual interaction and transactions on the Internet. Researchers have investigated the trust development process, and identified several important factors that form the basis for trust. This research combines the signal perspective and trust theory to examine the impact of market signals and past experience on trust formation and trusting behavior. Three market signals, including brand image, Web-site investment, and privacy policies, are identified and empirically tested to determine their impact on consumer trust. Based on 322 active Web users, the quantitative results suggest that brand image, Web-site investment, privacy policies, and past experience all positively impact trust formation. Furthermore, trust shows a positive effect on Web-site stickiness. Both theoretical and practical implications of the results are also offered.

  17. Trusting Beliefs: A Functional Measurement Study

    ERIC Educational Resources Information Center

    Vidotto, Giulio; Massidda, Davide; Noventa, Stefano; Vicentini, Marco

    2012-01-01

    Trust is a fundamental aspect of everyday life. Several authors define trust as the wish to depend on another entity and split the concept of trust into several interconnected components such as trusting beliefs (e.g., benevolence, competence, honesty, and predictability), trusting intentions, trusting behaviors, disposition to trust, and…

  18. Slow Poisoning? Interests, Emotions, and the Strength of the English NHS

    PubMed Central

    Greer, Scott L.

    2015-01-01

    Martin Powell makes the point that the death of the National Health Service (NHS) is constantly asserted without criteria. This article suggests that the NHS is many things, which makes criteria unstable. The alignment of interests in the structure of the NHS enables both overheated rhetoric and political strength, and that pluralization of provision might actually undermine that alignment over time10.15171/ijhpm.2015.72 PMID:26673183

  19. Wasting your assets--how to make better use of the NHS estate.

    PubMed

    Locke, J

    1994-05-01

    The impact of the health reforms together with other developments will mean that the 24 billion pounds NHS estate will undergo the most fundamental change since the days of Florence Nightingale. Against this background it is more important than ever that the utilisation of the estate is improved and that the NHS learns how to make the best use of private sector investment, says John Locke, Chief Executive of NHS Estates.

  20. Development of voice telecommunication services in the NHS.

    PubMed

    Cullingford, R G

    1998-10-01

    There is now an opportunity to accelerate the process of modernisation in the delivery of healthcare by the use of new technology. Advanced voice services such as the virtual private network, Centrex and mobile extension facilities are increasingly used in the NHS to the benefit of staff and patient. The provision of reliable and feature-rich integrated voice solutions across all groups in the healthcare arena is an essential factor in the development of new and better services to the public into the next millennium.

  1. Deconstructing the toolkit: creativity and risk in the NHS workforce.

    PubMed

    Allen, Von; Brodzinski, Emma

    2009-12-01

    Deconstructing the Toolkit explores the current desire for toolkits that promise failsafe structures to facilitate creative success. The paper examines this cultural phenomenon within the context of the risk-averse workplace-with particular focus on the NHS. The writers draw on Derrida and deconstructionism to reflect upon the principles of creativity and the possibilities for being creative within the workplace. Through reference to The Extra Mile project facilitated by Open Art, the paper examines the importance of engaging with an aesthetic of creativity and embracing a more holistic approach to the problems and potential of the creative process. PMID:19821031

  2. Illness prevention in the NHS five year forward view.

    PubMed

    Fuller, Sabrina

    2015-06-01

    Illness prevention is a priority for the NHS Mandate and the Five Year Forward View, and offers a means to maintain sustainable health and social care services in the context of an ageing population and the growth of behaviour-related illness. The National Institute for Health and Care Excellence guidance recommends a structured approach to embedding behaviour change interventions into clinical care, and effective implementation requires organisational support. This article describes how nurse leaders, managers and commissioners can ensure this implementation through setting objectives for staff, training and development, as well as supporting staff to adopt healthier lifestyles. PMID:26014792

  3. The rationing agenda in the NHS. Rationing Agenda Group.

    PubMed

    New, B

    1996-06-22

    The Rationing Agenda Group has been founded to deepen the British debate on rationing health care. It believes that rationing in health care is inevitable and that the public must be involved in the debate about issues relating to rationing. The group comprises people from all parts of health care, none of whom represent either their group or their institutions. RAG has begun by producing this document, which attempts to set an agenda of all the issues that need to be considered when debating the rationing of health care. We hope for responses to the document. The next stage will be to incorporate the responses into the agenda. Then RAG will divide the agenda into manageable chunks and commission expert, detailed commentaries. From this material a final paper will be published and used to prompt public debate. This stage should be reached early in 1997. While these papers are being prepared RAG is developing ways to involve the public in the debate and evaluate the whole process. We present as neutrally as possible all the issues related to rationing and priority setting in the NHS. We focus on the NHS for two reasons. Firstly, for those of us resident in the United Kingdom the NHS is the health care system with which we are most familiar and most concerned. Secondly, focusing on one system alone allows more coherent analysis than would be possible if issues in other systems were included as well. Our concern is with the delivery of health care, not its finance, though we discuss the possible effects of changing the financing system of the NHS. Finally, though our position is neutral, we hold two substantive views--namely, that rationing is unavoidable and that there should be more explicit debate about the principles and issues concerned. We consider the issues under four headings: preliminaries, ethics, democracy, and empirical questions. Preliminaries deal with the semantics of rationing, whether rationing is necessary, and with the range of services to which

  4. NHS internal market 1991-2: towards a balance sheet.

    PubMed Central

    Petchey, R

    1993-01-01

    The first year of the internal market in the NHS has been claimed to have resulted in increased efficiency. These claims, however, are hard to substantiate because the systems for operating the market are not fully in place. Examination of data on tax relief for private health insurance premiums for over 60s, general practice fundholding, and implementation and transaction costs suggest that much of the increased efficiency is not due to the reforms but to increased funding. Furthermore, some of the changes seem to be decreasing market forces and reducing efficiency. Images p700-a PMID:8471927

  5. The rationing agenda in the NHS. Rationing Agenda Group.

    PubMed

    New, B

    1996-06-22

    The Rationing Agenda Group has been founded to deepen the British debate on rationing health care. It believes that rationing in health care is inevitable and that the public must be involved in the debate about issues relating to rationing. The group comprises people from all parts of health care, none of whom represent either their group or their institutions. RAG has begun by producing this document, which attempts to set an agenda of all the issues that need to be considered when debating the rationing of health care. We hope for responses to the document. The next stage will be to incorporate the responses into the agenda. Then RAG will divide the agenda into manageable chunks and commission expert, detailed commentaries. From this material a final paper will be published and used to prompt public debate. This stage should be reached early in 1997. While these papers are being prepared RAG is developing ways to involve the public in the debate and evaluate the whole process. We present as neutrally as possible all the issues related to rationing and priority setting in the NHS. We focus on the NHS for two reasons. Firstly, for those of us resident in the United Kingdom the NHS is the health care system with which we are most familiar and most concerned. Secondly, focusing on one system alone allows more coherent analysis than would be possible if issues in other systems were included as well. Our concern is with the delivery of health care, not its finance, though we discuss the possible effects of changing the financing system of the NHS. Finally, though our position is neutral, we hold two substantive views--namely, that rationing is unavoidable and that there should be more explicit debate about the principles and issues concerned. We consider the issues under four headings: preliminaries, ethics, democracy, and empirical questions. Preliminaries deal with the semantics of rationing, whether rationing is necessary, and with the range of services to which

  6. Trust Transitivity in Social Networks

    PubMed Central

    Richters, Oliver; Peixoto, Tiago P.

    2011-01-01

    Non-centralized recommendation-based decision making is a central feature of several social and technological processes, such as market dynamics, peer-to-peer file-sharing and the web of trust of digital certification. We investigate the properties of trust propagation on networks, based on a simple metric of trust transitivity. We investigate analytically the percolation properties of trust transitivity in random networks with arbitrary in/out-degree distributions, and compare with numerical realizations. We find that the existence of a non-zero fraction of absolute trust (i.e. entirely confident trust) is a requirement for the viability of global trust propagation in large systems: The average pair-wise trust is marked by a discontinuous transition at a specific fraction of absolute trust, below which it vanishes. Furthermore, we perform an extensive analysis of the Pretty Good Privacy (PGP) web of trust, in view of the concepts introduced. We compare different scenarios of trust distribution: community- and authority-centered. We find that these scenarios lead to sharply different patterns of trust propagation, due to the segregation of authority hubs and densely-connected communities. While the authority-centered scenario is more efficient, and leads to higher average trust values, it favours weakly-connected “fringe” nodes, which are directly trusted by authorities. The community-centered scheme, on the other hand, favours nodes with intermediate in/out-degrees, in detriment of the authorities and its “fringe” peers. PMID:21483683

  7. Trust transitivity in social networks.

    PubMed

    Richters, Oliver; Peixoto, Tiago P

    2011-04-05

    Non-centralized recommendation-based decision making is a central feature of several social and technological processes, such as market dynamics, peer-to-peer file-sharing and the web of trust of digital certification. We investigate the properties of trust propagation on networks, based on a simple metric of trust transitivity. We investigate analytically the percolation properties of trust transitivity in random networks with arbitrary in/out-degree distributions, and compare with numerical realizations. We find that the existence of a non-zero fraction of absolute trust (i.e. entirely confident trust) is a requirement for the viability of global trust propagation in large systems: The average pair-wise trust is marked by a discontinuous transition at a specific fraction of absolute trust, below which it vanishes. Furthermore, we perform an extensive analysis of the Pretty Good Privacy (PGP) web of trust, in view of the concepts introduced. We compare different scenarios of trust distribution: community- and authority-centered. We find that these scenarios lead to sharply different patterns of trust propagation, due to the segregation of authority hubs and densely-connected communities. While the authority-centered scenario is more efficient, and leads to higher average trust values, it favours weakly-connected "fringe" nodes, which are directly trusted by authorities. The community-centered scheme, on the other hand, favours nodes with intermediate in/out-degrees, in detriment of the authorities and its "fringe" peers.

  8. Trusted Translation Services

    NASA Astrophysics Data System (ADS)

    Atif, Yacine; Serhani, Mohamed Adel; Campbell, Piers; Mathew, Sujith Samuel

    Administering multilingual Web sites and applications reliably, involves interconnected and multipart tasks, where trust in the involved parties and content translation sources is paramount. Published Web sites may reflect content from databases, content management systems and other repositories to manage related Web content. But a Web site mirrored wholly or selectively onto a target language version requires streamlined trusted processes. Traditionally, files are translated and transferred via FTP, e-mail, or other communication means. Similarly, translation instructions are communicated between involved parties through verbal instruction, e-mail, and instruction files lead to a variety of inconsistencies and lack of trust in the translation process. This paper proposes a Web service approach to streamline the translation processes and an integration of trust properties in the proposed translation Web services. Web Services have been instrumental in handling problems inherent to systems integration, allowing web-based systems to converse and communicate data automatically. The OASIS Translation Web Services Technical Committee has released a standard way for Web Services to serve the translation and localization business. This article proposes a framework to centralize translation services at a reputable source providing a workflow and a mechanism to quantify service trust. An implementation of the framework is also described in the context of a localization case study.

  9. Quantifying and Qualifying Trust: Spectral Decomposition of Trust Networks

    NASA Astrophysics Data System (ADS)

    Pavlovic, Dusko

    In a previous FAST paper, I presented a quantitative model of the process of trust building, and showed that trust is accumulated like wealth: the rich get richer. This explained the pervasive phenomenon of adverse selection of trust certificates, as well as the fragility of trust networks in general. But a simple explanation does not always suggest a simple solution. It turns out that it is impossible to alter the fragile distribution of trust without sacrificing some of its fundamental functions. A solution for the vulnerability of trust must thus be sought elsewhere, without tampering with its distribution. This observation was the starting point of the present paper. It explores different methods for securing trust: not by redistributing, but by qualifying it. The methods used to break privacy can be used to secure trust.

  10. Managing healthcare information: analyzing trust.

    PubMed

    Söderström, Eva; Eriksson, Nomie; Åhlfeldt, Rose-Mharie

    2016-08-01

    Purpose - The purpose of this paper is to analyze two case studies with a trust matrix tool, to identify trust issues related to electronic health records. Design/methodology/approach - A qualitative research approach is applied using two case studies. The data analysis of these studies generated a problem list, which was mapped to a trust matrix. Findings - Results demonstrate flaws in current practices and point to achieving balance between organizational, person and technology trust perspectives. The analysis revealed three challenge areas, to: achieve higher trust in patient-focussed healthcare; improve communication between patients and healthcare professionals; and establish clear terminology. By taking trust into account, a more holistic perspective on healthcare can be achieved, where trust can be obtained and optimized. Research limitations/implications - A trust matrix is tested and shown to identify trust problems on different levels and relating to trusting beliefs. Future research should elaborate and more fully address issues within three identified challenge areas. Practical implications - The trust matrix's usefulness as a tool for organizations to analyze trust problems and issues is demonstrated. Originality/value - Healthcare trust issues are captured to a greater extent and from previously unchartered perspectives. PMID:27477934

  11. Trust in Anonymity Networks

    NASA Astrophysics Data System (ADS)

    Sassone, Vladimiro; Hamadou, Sardaouna; Yang, Mu

    Anonymity is a security property of paramount importance, as we move steadily towards a wired, online community. Its import touches upon subjects as different as eGovernance, eBusiness and eLeisure, as well as personal freedom of speech in authoritarian societies. Trust metrics are used in anonymity networks to support and enhance reliability in the absence of verifiable identities, and a variety of security attacks currently focus on degrading a user's trustworthiness in the eyes of the other users. In this paper, we analyse the privacy guarantees of the Crowds anonymity protocol, with and without onion forwarding, for standard and adaptive attacks against the trust level of honest users.

  12. The limits of market-based reforms in the NHS: the case of alternative providers in primary care

    PubMed Central

    2013-01-01

    Background Historically, primary medical care in the UK has been delivered by general practitioners who are independent contractors, operating under a contract, which until 2004 was subject to little performance management. In keeping with the wider political impetus to introduce markets and competition into the NHS, reforms were introduced to allow new providers to bid for contracts to provide primary care services in England. These contracts known as ‘Alternative Provider Medical Services’, were encouraged by two centrally-driven rounds of procurement (2007/8 and 2008/9). This research investigated the commissioning and operation of such Alternative Providers of Primary Care (APPCs). Methods Two qualitative case studies were undertaken in purposively sampled English Primary Care Trusts (PCTs) and their associated APPCs over 14 months (2009-10). We observed 65 hours of meetings, conducted 23 interviews with PCT and practice staff, and gathered relevant associated documentation. Results and conclusions We found that the procurement and contracting process was costly and time-consuming. Extensive local consultation was undertaken, and there was considerable opposition in some areas. Many APPCs struggled to build up their patient list sizes, whilst over-performing on walk-in contracts. Contracting for APPCs was ‘transactional’, in marked contrast to the ‘relational’ contracting usually found in the NHS, with APPCs subject to tight performance management. These complicated and costly processes contrast to those experienced by traditionally owned GP partnerships. However, managers reported that the perception of competition had led existing practices to improve their services. The Coalition Government elected in 2010 is committed to ‘Any Qualified Provider’ of secondary care, and some commentators argue that this should also be applied to primary care. Our research suggests that, if this is to happen, a debate is needed about the operation of a market

  13. Investigating and Learning Lessons from Early Experiences of Implementing ePrescribing Systems into NHS Hospitals: A Questionnaire Study

    PubMed Central

    Cresswell, Kathrin; Coleman, Jamie; Slee, Ann; Williams, Robin; Sheikh, Aziz

    2013-01-01

    Background ePrescribing systems have significant potential to improve the safety and efficiency of healthcare, but they need to be carefully selected and implemented to maximise benefits. Implementations in English hospitals are in the early stages and there is a lack of standards guiding the procurement, functional specifications, and expected benefits. We sought to provide an updated overview of the current picture in relation to implementation of ePrescribing systems, explore existing strategies, and identify early lessons learned. Methods A descriptive questionnaire-based study, which included closed and free text questions and involved both quantitative and qualitative analysis of the data generated. Results We obtained responses from 85 of 108 NHS staff (78.7% response rate). At least 6% (n = 10) of the 168 English NHS Trusts have already implemented ePrescribing systems, 2% (n = 4) have no plans of implementing, and 34% (n = 55) are planning to implement with intended rapid implementation timelines driven by high expectations surrounding improved safety and efficiency of care. The majority are unclear as to which system to choose, but integration with existing systems and sophisticated decision support functionality are important decisive factors. Participants highlighted the need for increased guidance in relation to implementation strategy, system choice and standards, as well as the need for top-level management support to adequately resource the project. Although some early benefits were reported by hospitals that had already implemented, the hoped for benefits relating to improved efficiency and cost-savings remain elusive due to a lack of system maturity. Conclusions Whilst few have begun implementation, there is considerable interest in ePrescribing systems with ambitious timelines amongst those hospitals that are planning implementations. In order to ensure maximum chances of realising benefits, there is a need for increased guidance in

  14. The problem of obesity in the NHS all comes down to cost.

    PubMed

    Salter, Catherine

    2014-09-01

    Well done to NHS England chief executive Simon Stevens for speaking up about the sensitive issue of obese nurses and the need for NHS staff to be healthy advocates (Analysis August 13, Editorial and Letters August 20 and Wright Angle August 27).

  15. A service user-initiated project investigating the attitudes of mental health staff towards clients and services in an acute mental health unit.

    PubMed

    Tyson, P J

    2013-04-01

    Mental Health Service Users (MHSU) are becoming increasingly recognized as very valuable contributors to the research process. The current study originated from the idea of a group of MHSU within a service user and carer research group. They wanted to investigate the attitudes of mental health staff towards clients in an acute mental health setting, as well as their attitudes towards certain aspects of service. An amended version of the 'Attitudes Towards Acute Mental Health Scale' was sent to nursing and allied staff at an acute psychiatric unit within the Gloucestershire 2gether NHS Foundation Trust. Fifty-seven of the 200 anonymous questionnaires were returned. Generally positive opinions of MHSU were obtained, but there were divided opinions on questions regarding the aetiology of mental health problems (e.g. social vs. genetic determinants). Opinions on aspects of the admissions process, therapeutic aspects of care, the use of medication and the use of control and restraint techniques were also obtained. Demographic variables of staff age, status and years of experience in mental health were found to be associated with attitudes and opinions. This MHSU-initiated study has extended the literature on mental health staff attitudes towards clients and services in an acute mental health setting. This study is split into two parts, Part A is focused on the process of involving MHSU in this project, Part B is concerned with the empirical investigation.

  16. Making a success of providing NHS Health Checks in community pharmacies across the Tees Valley: a qualitative study

    PubMed Central

    2011-01-01

    Background In England and Wales, the Department of Health introduced a primary prevention programme, NHS Health Checks, to provide screening for cardiovascular risk amongst people aged 40-74. The aim of this programme is to offer treatment and advice to those identified with an increased risk of cardiovascular diseases (CVD). The North East of England has some of the highest rates of CVD in the UK and prevention is therefore a priority. NHS Tees funded this programme of work under the local branding of Healthy Heart Checks (HHC). These were initially implemented principally through GP practices from October 2008 but, in order to mitigate the possibility that some hard to reach communities would be reluctant to engage with some primary care settings, plans were also developed to deliver the programme through workplace settings and through community pharmacies. This paper reports specifically on the findings from the evaluation in respect of the setting up of HHCs in community pharmacies and aims to offer some lessons for other service settings where this option is seen as a way of providing low threshold services which will minimise inequalities in intervention uptake. Methods In assessing the community pharmacy component of HHCs, a selection of staff having direct involvement in the process was invited to take part in the evaluation. Interviews were carried out with representatives from community pharmacy, staff members from the commissioning Primary Care Trusts and with Local Pharmaceutical Committee members. Results Evaluation and analysis identified challenges which should be anticipated and addressed in initiating HHC in community pharmacies. These have been categorised into four main themes for discussion in this paper: (1) establishing and maintaining pharmacy Healthy Heart Checks, (2) overcoming IT barriers, (3) developing confident, competent staff and (4) ensuring volume and through flow in pharmacy. Conclusions Delivering NHS health checks through

  17. Development of clinical policies and guidelines in acute settings.

    PubMed

    Collins, Sean; Patel, Seraphim

    This article outlines a model for developing policies and discusses some of the issues involved in the process of writing, approving and disseminating clinical policies and guidelines. It does not seek to dwell on policy drafting per se because guidance is readily available that can help authors to write and implement policies using evidence-based practice, research, implementation and audit skills. Any individual policy, however, does not exist in a vacuum, but in a network of related policies. There is relatively little practical guidance, literature or debate about the methodology that can be applied to developing an organisational policy framework, or how an understanding of this context can help those planning to develop a policy for their organisation. The article draws on the authors' experiences of policy development from the perspective of an acute NHS trust and discusses the challenges of developing a proactive and co-ordinated approach to policy work. It concludes with a recognition of some useful internal and external checks that can help policy authors to identify the extent to which policy is translated into practice.

  18. Trust in the Contemporary Principalship

    ERIC Educational Resources Information Center

    Noonan, Brian; Walker, Keith; Kutsyuruba, Benjamin

    2008-01-01

    The social relevance of trust and the principals' obligation to foster trust in schools have been strongly advocated. This paper describes an in-depth, qualitative study that engaged a group of twenty-five Canadian school principals over a period of seven months, exploring the issues of trust as it affects principals' roles and responsibilities.…

  19. Why Teachers Trust School Leaders

    ERIC Educational Resources Information Center

    Handford, Victoria; Leithwood, Kenneth

    2013-01-01

    Purpose: Trust among teachers in schools is significantly related to student achievement and trust in school leaders is an important influence on such trust. The purpose of this study is to identify leadership practices which teachers interpret as signs of trustworthiness on the part of their principals. Design/methodology/approach: Evidence for…

  20. Trust Development in Outdoor Leadership

    ERIC Educational Resources Information Center

    Shooter, Wynn; Paisley, Karen; Sibthorp, Jim

    2010-01-01

    Establishing trusting relationships between leaders and participants is one way that outdoor leaders can create an emotionally safe and productive milieu that supports the attainment of desirable outcomes. Multidisciplinary literature offers considerable insight into leader trust development and the outcomes that are linked to trust in a leader.…

  1. Trust models in ubiquitous computing.

    PubMed

    Krukow, Karl; Nielsen, Mogens; Sassone, Vladimiro

    2008-10-28

    We recapture some of the arguments for trust-based technologies in ubiquitous computing, followed by a brief survey of some of the models of trust that have been introduced in this respect. Based on this, we argue for the need of more formal and foundational trust models.

  2. Trust It or Trash It?

    MedlinePlus

    Trust It or Trash It? About | Contact | Español Tab 1 Tab 2 What is Trust It or Trash It? This is a tool to help you think ... here for the developer version. Home Who Said It? Who wrote it? Think about TRUSTING IT if: ...

  3. Four Essential Practices for Building Trust

    ERIC Educational Resources Information Center

    Combs, Julie Peterson; Harris, Sandra; Edmonson, Stacey

    2015-01-01

    The presence of trust can enhance an organization's efforts to fulfill its mission, and the lack of trust can constrict those efforts. The authors offer four essential guidelines to help school leaders communicate in a way that builds trust. Build trust by understanding trust. Trusted leaders demonstrate care, character, and competence in their…

  4. Trust, Collegiality, and Community

    ERIC Educational Resources Information Center

    DeShaw, Michele

    2009-01-01

    The purpose of this study was to examine and describe the role of trust, a complex and understudied aspect of working relationships, among teachers in smaller learning communities (SLC). Based on a review of the literature, four kinds of interpersonal professional relationships were defined and described from individualism to community. An…

  5. Reclaiming the Public Trust.

    ERIC Educational Resources Information Center

    Bok, Derek

    1994-01-01

    The former president of Harvard University (Massachusetts) argues that college and university public relations specialists must attempt to understand what underlies the public's concerns about higher education, rather than simply to react to individual complaints. To reclaim public trust, higher education's leaders must consider carefully how they…

  6. A trust-wide strategy for the management of anaphylaxis.

    PubMed

    Moor, Jackie; Jennison, Neil

    Anaphylaxis is a life-threatening medical emergency. Although it is uncommon, when it does occur prompt recognition and appropriate treatment are essential. This article describes how a multidisciplinary working party review of practices concerning the management of anaphylaxis in an acute hospital trust led to the introduction of standardised anaphylaxis emergency boxes.

  7. Controlling healthcare-associated infections in the NHS.

    PubMed

    Duerden, Brian

    2008-04-01

    The prevention and control of healthcare-associated infection (HCAI) is a priority for the NHS. The delivery of national targets for reducing methicillin resistant Staphylococcus aureus bacteraemias and Clostridium difficile infection are supported by enhanced mandatory surveillance through the Health Protection Agency and a Department of Health improvement programme that promotes policies and protocols for enhancing clinical procedures and places infection prevention and control at the centre of clinical and corporate governance. The Health Act 2006 Code of Practice makes such policies and protocols a legal requirement and compliance will be assessed by the Healthcare Commission. Clinicians must recognise their responsibilities for patient safety and take a lead role in ensuring good practice to reduce HCAI. PMID:18478854

  8. Reengineering NHS Hospitals in Greece: Redistribution Leads to Rational Mergers

    PubMed Central

    Nikolentzos, Athanasios; Kontodimopoulos, Nick; Polyzos, Nikolaos; Thireos, Eleftherios; Tountas, Yannis

    2015-01-01

    The purpose of this study was to record and evaluate existing public hospital infrastructure of the National Health System (NHS), in terms of clinics and laboratories, as well as the healthcare workforce in each of these units and in every health region in Greece, in an attempt to optimize the allocation of these resources. An extensive analysis of raw data according to supply and performance indicators was performed to serve as a solid and objective scientific baseline for the proposed reengineering of the Greek public hospitals. Suggestions for “reshuffling” clinics and diagnostic laboratories, and their personnel, were made by using a best versus worst outcome indicator approach at a regional and national level. This study is expected to contribute to the academic debate about the gap between theory and evidence based decision-making in health policy. PMID:26156925

  9. Leadership in the UK NHS: where are we now?

    PubMed

    Goodwin, N

    1998-01-01

    The introduction of changes to the UK National Health Service from the 1980s onwards, coupled with recognition that successful improvement to health and health services places greater pressure on developing good inter-personal and inter-organisational relationships, underlines the need for greater leadership of health services in the future. Argues that insufficient attention has been paid to the development of external leadership, the growing importance of which is emphasised by the most recent proposals for change to health services from the 1997 Labour government. Comparisons of managerial life between the public and private sectors are made and surveys of NHS managerial work, carried out over a number of years, seem to have produced similar conclusions. Finally a paradigm shift is called for in the leadership of health services in the future if the impact of the external environment is to be managed more effectively and no longer to be seen as a constraint on public sector managerial activity. PMID:10185757

  10. Reengineering NHS Hospitals in Greece: Redistribution Leads to Rational Mergers.

    PubMed

    Nikolentzos, Athanasios; Kontodimopoulos, Nick; Polyzos, Nikolaos; Thireos, Eleftherios; Tountas, Yannis

    2015-03-18

    The purpose of this study was to record and evaluate existing public hospital infrastructure of the National Health System (NHS), in terms of clinics and laboratories, as well as the healthcare workforce in each of these units and in every health region in Greece, in an attempt to optimize the allocation of these resources. An extensive analysis of raw data according to supply and performance indicators was performed to serve as a solid and objective scientific baseline for the proposed reengineering of the Greek public hospitals. Suggestions for "reshuffling" clinics and diagnostic laboratories, and their personnel, were made by using a best versus worst outcome indicator approach at a regional and national level. This study is expected to contribute to the academic debate about the gap between theory and evidence based decision-making in health policy.

  11. Reengineering NHS Hospitals in Greece: Redistribution Leads to Rational Mergers.

    PubMed

    Nikolentzos, Athanasios; Kontodimopoulos, Nick; Polyzos, Nikolaos; Thireos, Eleftherios; Tountas, Yannis

    2015-01-01

    The purpose of this study was to record and evaluate existing public hospital infrastructure of the National Health System (NHS), in terms of clinics and laboratories, as well as the healthcare workforce in each of these units and in every health region in Greece, in an attempt to optimize the allocation of these resources. An extensive analysis of raw data according to supply and performance indicators was performed to serve as a solid and objective scientific baseline for the proposed reengineering of the Greek public hospitals. Suggestions for "reshuffling" clinics and diagnostic laboratories, and their personnel, were made by using a best versus worst outcome indicator approach at a regional and national level. This study is expected to contribute to the academic debate about the gap between theory and evidence based decision-making in health policy. PMID:26156925

  12. The mutuality metaphor: understanding healthcare provision in NHS Scotland.

    PubMed

    Howieson, Brian

    2016-06-20

    Purpose - Better Health, Better Care Action Plan (Scottish Government, 2007) sets out how the Scottish Government intends to strengthen public ownership of the National Health Service in Scotland. The purpose of this paper is to advance extant knowledge by understanding how a state-led mutual health policy may be interpreted, and importantly, communicated. Design/methodology/approach - The definitional problem of mutuality will be discussed and analysed in terms of how it is (or perhaps should be) communicated? will be offered. Findings - It actually may be more instructive to think of, and communicate, mutuality as a metaphor to aid understanding of the openness and fluidity found in NHS Scotland. Research limitations/implications - The existence of paradox and ambiguity does not, however, negate the usefulness of the term "mutuality". Quite the opposite in fact: it is precisely by examining healthcare and its delivery through the lens of mutuality (rather than rejecting its complexity as a failure) that this amorphousness can be better appreciated. Practical implications - There is a need for more public, professional, and academic debate to explore and clarify its implementation, and how it is to be led. This must be provided whilst recognising the daily imperatives that NHS leaders must face. This would suggest, therefore, that a dual development path may help. Originality/value - Although Better Health, Better Care Action Plan was published in 2007, some eight years on there is still confusion and misunderstanding as to what mutuality in healthcare is, not only in policy and theory, but also in practice. It is hoped that this analysis will help address, in part, some of this confusion and misunderstanding.

  13. The mutuality metaphor: understanding healthcare provision in NHS Scotland.

    PubMed

    Howieson, Brian

    2016-06-20

    Purpose - Better Health, Better Care Action Plan (Scottish Government, 2007) sets out how the Scottish Government intends to strengthen public ownership of the National Health Service in Scotland. The purpose of this paper is to advance extant knowledge by understanding how a state-led mutual health policy may be interpreted, and importantly, communicated. Design/methodology/approach - The definitional problem of mutuality will be discussed and analysed in terms of how it is (or perhaps should be) communicated? will be offered. Findings - It actually may be more instructive to think of, and communicate, mutuality as a metaphor to aid understanding of the openness and fluidity found in NHS Scotland. Research limitations/implications - The existence of paradox and ambiguity does not, however, negate the usefulness of the term "mutuality". Quite the opposite in fact: it is precisely by examining healthcare and its delivery through the lens of mutuality (rather than rejecting its complexity as a failure) that this amorphousness can be better appreciated. Practical implications - There is a need for more public, professional, and academic debate to explore and clarify its implementation, and how it is to be led. This must be provided whilst recognising the daily imperatives that NHS leaders must face. This would suggest, therefore, that a dual development path may help. Originality/value - Although Better Health, Better Care Action Plan was published in 2007, some eight years on there is still confusion and misunderstanding as to what mutuality in healthcare is, not only in policy and theory, but also in practice. It is hoped that this analysis will help address, in part, some of this confusion and misunderstanding. PMID:27296885

  14. 26 CFR 26.2654-1 - Certain trusts treated as separate trusts.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 26 Internal Revenue 14 2011-04-01 2010-04-01 true Certain trusts treated as separate trusts. 26... 1986 § 26.2654-1 Certain trusts treated as separate trusts. (a) Single trust treated as separate trusts... to each beneficiary (or group of beneficiaries) is treated as a separate trust for purposes...

  15. Slow Poisoning? Interests, Emotions, and the Strength of the English NHS: Comment on "Who Killed the English National Health Service?".

    PubMed

    Greer, Scott L

    2015-10-01

    Martin Powell makes the point that the death of the National Health Service (NHS) is constantly asserted without criteria. This article suggests that the NHS is many things, which makes criteria unstable. The alignment of interests in the structure of the NHS enables both overheated rhetoric and political strength, and that pluralization of provision might actually undermine that alignment over time.

  16. Social Trust of Virtual Identities

    NASA Astrophysics Data System (ADS)

    Seigneur, Jean-Marc

    Most other chapters of this book discuss computational models of trust in broader terms, giving definitions of trust, explaining how trust should evolve over time, surveying the different facets of trust .On the other hand, this chapter has a clear focus on the important element of identity in computational trust mechanisms. Trust and reputation are easier to form in face-to-face situations than in situations involving the use of computers and networks because the identity of the trustee is more difficult to verify. In this chapter, the different means to recognise virtual identities are surveyed. Next, their integration into computational trust engines is discussed, especially according to four main requirements: Adaptability, Security, Usability and Privacy (ASUP).

  17. A cost-minimisation study of 1,001 NHS Direct users

    PubMed Central

    2013-01-01

    Background To determine financial and quality of life impact of patients calling the ‘0845’ NHS Direct (NHS Direct) telephone helpline from the perspective of NHS service providers. Methods Cost-minimisation of repeated cohort measures from a National Survey of NHS Direct’s telephone service using telephone survey results. 1,001 people contacting NHS Direct’s 0845 telephone service in 2009 who agreed to a 4-6 week follow-up. A cost comparison between NHS Direct recommendation and patient-stated first alternative had NHS Direct not been available. Analysis also considers impact on quality of life of NHS Direct recommendations using the Visual Analogue Scale of the EQ-5D. Results Significant referral pattern differences were observed between NHS Direct recommendation and patient-stated first alternatives (p < 0.001). Per patient cost savings resulted from NHS Direct’s recommendation to attend A&E (£36.54); GP Practice (£19.41); Walk-In Centre (£49.85); Pharmacist (£25.80); Dentist (£2.35) and do nothing/treat at home (£19.77), while it was marginally more costly for 999 calls (£3.33). Overall an average per patient saving of £19.55 was found (a 36% saving compared with patient-stated first alternatives). For 5 million NHS Direct telephone calls per year, this represents an annual cost saving of £97,756,013. Significant quality of life differences were observed at baseline and follow-up between those who believed their problem was ‘urgent’ (p = 0.001) and those who said it was ‘non-urgent’ (p = 0.045). Whilst both groups improved, self-classified ‘urgent’ cases made greater health gains than those who said they were ‘non-urgent’ (urgent by 21.5 points; non-urgent by 16.1 points). Conclusions The ‘0845’ service of NHS Direct produced substantial cost savings in terms of referrals to the other parts of the NHS when compared with patients’ own stated first alternative. Health-related quality of life also improved for users of this

  18. Clinical audit of core podiatry treatment in the NHS

    PubMed Central

    Farndon, Lisa; Barnes, Andrew; Littlewood, Keith; Harle, Justine; Beecroft, Craig; Burnside, Jaclyn; Wheeler, Tracey; Morris, Selwyn; Walters, Stephen J

    2009-01-01

    Background Core podiatry involves treatment of the nails, corns and callus and also giving footwear and foot health advice. Though it is an integral part of current podiatric practice little evidence is available to support its efficacy in terms of research and audit data. This information is important in order to support the current NHS commissioning process where services are expected to provide data on standards including outcomes. This study aimed to increase the evidence base for this area of practice by conducting a multi-centre audit in 8 NHS podiatry departments over a 1-year period. Methods The outcome measure used in this audit was the Podiatry Health Questionnaire which is a self completed short measure of foot health including a pain visual analogue scale and a section for the podiatrist to rate an individual's foot health based on their podiatric problems. The patient questionnaire was completed by individuals prior to receiving podiatry care and then 2 weeks after treatment to assess the effect of core podiatry in terms of pain and foot health. Results 1047 patients completed both questionnaires, with an age range from 26–95 years and a mean age of 72.9 years. The podiatrists clinical rating at baseline showed 75% of patients had either slight or moderate podiatric problems. The differences in questionnaire and visual analogue scores before and after treatment were determined according to three categories – better, same, worse and 75% of patients' scores either remained the same or improved after core podiatry treatment. A student t-test showed a statistical significant difference in pre and post treatment scores where P < 0.001, though the confidence interval indicated that the improvement was relatively small. Conclusion Core podiatry has been shown to sustain or improve foot health and pain in 75% of the patients taking part in the audit. Simple outcome measures including pain scales should be used routinely in podiatric practice to assess the

  19. Comparison of an 'intuitive' NHS hearing aid prescription method with DSL 4.1 targets for amplification.

    PubMed

    Parsons, Jonathan O; Clark, Charles R

    2002-09-01

    This study aimed to evaluate current practice in a National Health Service Trust in setting hearing aid output to meet amplification targets prescribed by desired sensation level (DSL) using a range of NHS hearing aids. A consecutive sample of 33 patients was drawn from the hearing aid waiting list of the Royal Devon & Exeter Hospital (RD&E). The age range was 33-83 years. Patients not giving written consent and those with complex hearing losses were excluded. At review, pure-tone audiogram, uncomfortable loudness levels, real-ear coupler difference, user gain and maximum output were recorded. Data were entered into DSL 4.1 prescription software. Wilcoxon tests were used to compare the measured user gain and maximum output with DSL 4.1-generated targets. The results demonstrate significant differences (p<0.05) at 0.25, 0.5, 0.75, 1.5, 2, 3, 4 and 6 kHz between target and measured values for user gain. This study reveals that the routine intuitive method for prescribing hearing aids at the RD&E is not effective in meeting targets for amplified speech as prescribed by DSL.

  20. Towards a politics of trust.

    PubMed

    Gilbert, T

    1998-05-01

    This paper draws upon sociological theory to demonstrate that the manufacture and deployment of trust is an integral part of the function of complex systems such as health care. The discussion begins by identifying the error within the nursing literature which arises from a rather technical conceptualization of trust. This tends to limit the dimensions to trust which is established, and fails to recognize that trust may be subject to competition and conflict. The paper continues by drawing upon the work of two theorists, Niklas Luhmann and Susan P. Shapiro, to demonstrate how trust functions within systems such as health care and the mechanisms through which it is controlled. The title of this paper, 'Towards a politics of trust', identifies that this is merely the first stage in the analysis. Further stages are necessary which analyse the ways in which power is exercised in the conflict for control within discrete elements of the system.

  1. Optimal Distinctiveness Signals Membership Trust.

    PubMed

    Leonardelli, Geoffrey J; Loyd, Denise Lewin

    2016-07-01

    According to optimal distinctiveness theory, sufficiently small minority groups are associated with greater membership trust, even among members otherwise unknown, because the groups are seen as optimally distinctive. This article elaborates on the prediction's motivational and cognitive processes and tests whether sufficiently small minorities (defined by relative size; for example, 20%) are associated with greater membership trust relative to mere minorities (45%), and whether such trust is a function of optimal distinctiveness. Two experiments, examining observers' perceptions of minority and majority groups and using minimal groups and (in Experiment 2) a trust game, revealed greater membership trust in minorities than majorities. In Experiment 2, participants also preferred joining minorities over more powerful majorities. Both effects occurred only when minorities were 20% rather than 45%. In both studies, perceptions of optimal distinctiveness mediated effects. Discussion focuses on the value of relative size and optimal distinctiveness, and when membership trust manifests. PMID:27140657

  2. Trust-Effectiveness Patterns in Schools

    ERIC Educational Resources Information Center

    Forsyth, Patrick B.; Barnes, Laura L. B.; Adams, Curt M.

    2006-01-01

    Purpose: To investigate the consequences of relational trust, especially parent measured trust, for desirable school outcomes. Design/methodology/approach: Using a US Midwestern state sample of 79 schools, parent and teacher trust data are used to derive a trust-effectiveness typology. Trust was conceptualized as one party's willingness to be…

  3. The NHS Lanarkshire Intranet site (FirstPort) and its effectiveness as a knowledge management tool.

    PubMed

    Herbert, Paul

    2013-03-01

    The use of intranets as knowledge management tools in the NHS has been applied with varying success. This study set out to evaluate the effectiveness of the NHS Lanarkshire intranet site FirstPort as a knowledge management tool and to capture opinions on what would be required of a new FirstPort 2 site to be launched in the summer of 2012. The research was conducted in June 2011 by Paul Herbert as part of MSc in Health Informatics at the University of Sheffield, supervised by Nigel Ford. At the time of the study, Paul was working at NHS Lanarkshire and he was able to give his employers a useful set of recommendations. He moved to his present post with Healthcare Improvement Scotland in June 2012. This article is the first in the Dissertations into Practice series to investigate web-based tools for information and communication inside the NHS, but there are more in the pipeline. AM.

  4. The NHS Lanarkshire Intranet site (FirstPort) and its effectiveness as a knowledge management tool.

    PubMed

    Herbert, Paul

    2013-03-01

    The use of intranets as knowledge management tools in the NHS has been applied with varying success. This study set out to evaluate the effectiveness of the NHS Lanarkshire intranet site FirstPort as a knowledge management tool and to capture opinions on what would be required of a new FirstPort 2 site to be launched in the summer of 2012. The research was conducted in June 2011 by Paul Herbert as part of MSc in Health Informatics at the University of Sheffield, supervised by Nigel Ford. At the time of the study, Paul was working at NHS Lanarkshire and he was able to give his employers a useful set of recommendations. He moved to his present post with Healthcare Improvement Scotland in June 2012. This article is the first in the Dissertations into Practice series to investigate web-based tools for information and communication inside the NHS, but there are more in the pipeline. AM. PMID:23413795

  5. Opening the oyster: the 2010-11 NHS reforms in England.

    PubMed

    Reynolds, Lucy; McKee, Martin

    2012-04-01

    This opinion paper briefly considers the credibility of the announced rationale behind the current extensive reform of the NHS in light of recent research evidence about performance of the system. The paper outlines the authors' views of the history of the reform, which originates in a set of documents, produced in the late 1980s by the Centre for Policy Studies, which aimed to introduce private sector involvement throughout the NHS, and a brief report by a consultant for a health maintenance organisation in the USA. Tracking of the pro-private sector changes in the NHS demonstrates that the bill is a major step in the implementation of NHS privatisation and also delineates a roadmap for coming developments, which have been explained to corporate providers and investors seeking new profit opportunities but have not yet been debated openly with the electorate in the UK.

  6. Can NHS politics, power and conflict ever be a good thing for nurses?

    PubMed

    Lees, Carolyn

    2016-07-14

    This article explores how organisational politics, power and conflict have a positive role to play for nurses in NHS organisational change and improvement, rather than always leading to disagreement and dispute. PMID:27409782

  7. The Need to Trust and to Trust More Wisely in Academe

    ERIC Educational Resources Information Center

    Bowman, Richard F.

    2012-01-01

    Where trust is an issue, there is no trust. Trust in diverse organizations has never been lower. A shadow of doubt stalks one's every decision to trust collegially and institutionally. Still, colleagues sense intuitively that institutions cannot function optimally without a bedrock level of trust. In academic life, trust is a form of social…

  8. Generalized Trust and Trust in Institutions in Confucian Asia

    ERIC Educational Resources Information Center

    Tan, Soo Jiuan; Tambyah, Siok Kuan

    2011-01-01

    This study examines generalized trust and trust in institutions in Confucian Asia, covering six countries namely, China, Japan, Singapore, South Korea, Taiwan and Vietnam, and one dependent region, Hong Kong. Using data from the 2006 AsiaBarometer Survey, our study affirms the reliability and validity of using a two-item scale to measure…

  9. A clean bill of health? The efficacy of an NHS commissioned outsourced police custody healthcare service.

    PubMed

    de Viggiani, Nick

    2013-08-01

    Police custody healthcare services for detainees in the UK are most commonly outsourced to independent healthcare providers who employ custody nurses and forensic physicians to deliver forensic healthcare services. A pilot was introduced in 2008 by the Department of Health to explore the efficacy of commissioning custody healthcare via the NHS, in the wake of the 2005-2006 shift of prison healthcare to the NHS. The objective was to improve quality and accountability through NHS commissioning and the introduction of NHS governance to the management and delivery of custody healthcare. This article discusses key themes that arose from the project evaluation, which focused on the commissioning relationship between the police, the NHS commissioner and the private healthcare provider. The evaluation observed an evolving relationship between the police, the local NHS and the front-line nurses, which was complicated by the quite distinctive professional values and ideologies operating, with their contrasting organisational imperatives and discordant values and principles. A key challenge for commissioners is to develop synergy between operational and strategically located stakeholders so that they can work effectively towards common goals. Government policy appears to remain focused on creating safe, supportive and humane custody environments that balance criminal justice and health imperatives and support the rights and needs of detainees, victims, professionals and the public. This remains an ambitious agenda and presents a major challenge for new criminal justice health partnerships.

  10. A clean bill of health? The efficacy of an NHS commissioned outsourced police custody healthcare service.

    PubMed

    de Viggiani, Nick

    2013-08-01

    Police custody healthcare services for detainees in the UK are most commonly outsourced to independent healthcare providers who employ custody nurses and forensic physicians to deliver forensic healthcare services. A pilot was introduced in 2008 by the Department of Health to explore the efficacy of commissioning custody healthcare via the NHS, in the wake of the 2005-2006 shift of prison healthcare to the NHS. The objective was to improve quality and accountability through NHS commissioning and the introduction of NHS governance to the management and delivery of custody healthcare. This article discusses key themes that arose from the project evaluation, which focused on the commissioning relationship between the police, the NHS commissioner and the private healthcare provider. The evaluation observed an evolving relationship between the police, the local NHS and the front-line nurses, which was complicated by the quite distinctive professional values and ideologies operating, with their contrasting organisational imperatives and discordant values and principles. A key challenge for commissioners is to develop synergy between operational and strategically located stakeholders so that they can work effectively towards common goals. Government policy appears to remain focused on creating safe, supportive and humane custody environments that balance criminal justice and health imperatives and support the rights and needs of detainees, victims, professionals and the public. This remains an ambitious agenda and presents a major challenge for new criminal justice health partnerships. PMID:23910844

  11. The immunocytokine NHS-IL12 as a potential cancer therapeutic

    PubMed Central

    Kradjian, Giorgio; Guzman, Wilson; Bernhardt, Anna; Neuteboom, Berend; Lan, Yan; Sabzevari, Helen; Schlom, Jeffrey; Greiner, John W.

    2014-01-01

    Targeted delivery of IL-12 might turn this cytokine into a safer, more effective cancer therapeutic. Here we describe a novel immunocytokine, NHS-IL12, consisting of two molecules of IL-12 fused to a tumor necrosis-targeting human IgG1 (NHS76). The addition of the human IgG1 moiety resulted in a longer plasma half-life of NHS-IL12 than recombinant IL-12, and a selective targeting to murine tumors in vivo. Data from both in vitro assays using human PBMCs and in vivo primate studies showed that IFN-gamma production by immune cells is attenuated following treatment with the immunocytokine, suggesting an improved toxicity profile than seen with recombinant IL-12 alone. NHS-IL12 was superior to recombinant IL-12 when evaluated as an anti-tumor agent in three murine tumor models. Mechanistic studies utilizing immune cell subset-depleting antibodies, flow cytometric methods, and in vitro cytotoxicity and ELISA assays all indicated that the anti-tumor effects of NHS-IL12 were primarily CD8+ T cell-dependent and likely IL-12-mediated. Combining NHS-IL12 treatment with a cancer vaccine, radiation, or chemotherapy resulted in greater anti-tumor effects than each individual therapy alone. These preclinical findings provide a rationale for the clinical testing of this immunocytokine, both as a single agent and in combination with vaccines, radiation and chemotherapy. PMID:24681847

  12. Guidance for commissioning NHS England dental conscious sedation services: a framework tool.

    PubMed

    Howlett, Paul

    2014-01-01

    Conscious sedation is an integral part of modern day dental care and should be delivered through a high quality, effective and evidence-based approach. Commissioning of NHS dental services in England is currently under review by NHS England and the National Dental Commissioning Group. This group has identified the management of vulnerable people including anxious patients, as one of its priorities. The Society for the Advancement of Anaesthesia in Dentistry (SAAD) believes this provides an opportunity to influence the commissioning of NHS conscious sedation services. With this aim in mind,"Guidance for Commissioning NHS England Dental Conscious Sedation Services: A Framework Tool" was developed. This guidance proposes a common approach to the organisation of NHS dental conscious sedation services in England, advocating the provision of Tier 1 and Tier 2 services in all regions. Its ethos is a"hub and spoke" model of service delivery with patient assessment delivered by experienced and well trained dental sedationists at its core. In line with the recent Francis Report fundamental standards for all aspects of dental conscious sedation practice are outlined, supported by a robust and predictable quality assurance process. This work has been shared with key stakeholders in NHS England including the Chief Dental Officer and the Head of Primary Care Commissioning.

  13. Has NHS reorganisation saved lives? A CuSum study using 65 years of data

    PubMed Central

    Lale, Alice S

    2016-01-01

    Objectives To determine if NHS reforms affect population mortality. Design Retrospective study using routinely published data. Setting & participants Resident population of England and Wales 1948 to 2012 Main outcome measure All cause age sex directly standardised mortality England and Wales 1948 to 2012. Methods Using the CuSum technique and Change-Point Analysis to identify sustained changes in the improving age-standardised mortality rates for the period 1948-2012, and comparing the time of these changes with periods of NHS reform. Where observed changes did not fit with NHS reform, changes external to the NHS were sought as a possible explanation of changes observed. Results CuSum plotting and CPA showed no significant changes in female mortality trend between 1948 and 2012. However, this analysis identified a sustained improvement in the male mortality trend, occurring in the mid-1970s. A further change in the rate of male mortality decline was found around the Millennium. Conclusion The 1974 NHS reorganisation, changing service arrangements predominantly for women and children, is considered an unlikely explanation of the improved rate of male mortality decline. Thus, centrally led NHS reorganisation has never had any detectable effect on either male or female mortality and must be considered ineffective for this purpose. But some evidence supporting the view that increased funding improves outcomes is found. PMID:26432817

  14. Improving the acute care of COPD patients across Gloucestershire: a quality improvement project.

    PubMed

    Miller, Craig; Cushley, Claire; Redler, Kasey; Mitchell, Claire; Aynsley Day, Elizabeth; Mansfield, Helen; Nye, Abigail

    2015-01-01

    Admissions for exacerbations of chronic obstructive pulmonary disease (COPD) present a significant proportion of patients in the acute medical take. The British Thoracic Society (BTS) provides guidelines for time specific interventions, that should be delivered to those with an acute exacerbation of COPD through the admission care bundle. These include correct diagnosis, correct assessment of oxygenation, early administration of treatment, recognition of respiratory failure, and specialist review. Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT) chose improvement in acute COPD care to be a local Commissioning for Quality and Innovation (CQUIN) scheme, which enables commissioners to reward excellence by linking a proportion of English healthcare providers' income to the achievement of local quality improvement goals. The effects of initiatives put in place by senior clinicians had waned, and further improvements were required to meet the CQUIN target. The aim of the scheme was to improve compliance with the BTS guidelines and CQUIN scheme for patients admitted with an exacerbation of COPD. Specific bundle paperwork to be used for all patients admitted to the Trust with an exacerbation of COPD was introduced to the Trust in June 2014, with training and education of medical staff at that time. This had improved compliance rates from 10% to 63% by September 2014. Compliance with each intervention was audited through the examination of notes of patients admitted with an exacerbation of COPD. Compliance rates had plateaued over the last three months, and so a focus group involving junior medical staff met in September 2014 to try to increase awareness further, in order to drive greater improvements in care, and meet the CQUIN requirements. Their strategies were implemented, and then compliance with the CQUIN requirements was reaudited as described above. The December 2014 audit results showed a further improvement in overall COPD care, with 73% of patients

  15. Interpersonal Trust, Trustworthiness, and Gullibility.

    ERIC Educational Resources Information Center

    Rotter, Julian B.

    1980-01-01

    Reviews positive and potential negative consequences of being high or low in interpersonal trust in social life, particularly in interacting with ordinary people. Research suggests that people who trust are less likely to lie or to be unhappy and more likely to be sought out as a friend. (Author/JLF)

  16. epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England.

    PubMed

    Loveday, H P; Wilson, J A; Pratt, R J; Golsorkhi, M; Tingle, A; Bak, A; Browne, J; Prieto, J; Wilcox, M; UK Department of Health

    2014-01-01

    National evidence-based guidelines for preventing healthcare-associated infections (HCAI) in National Health Service (NHS) hospitals in England were originally commissioned by the Department of Health and developed during 1998-2000 by a nurse-led multi-professional team of researchers and specialist clinicians. Following extensive consultation, they were first published in January 2001(1) and updated in 2007.(2) A cardinal feature of evidence-based guidelines is that they are subject to timely review in order that new research evidence and technological advances can be identified, appraised and, if shown to be effective for the prevention of HCAI, incorporated into amended guidelines. Periodically updating the evidence base and guideline recommendations is essential in order to maintain their validity and authority. The Department of Health commissioned a review of new evidence and we have updated the evidence base for making infection prevention and control recommendations. A critical assessment of the updated evidence indicated that the epic2 guidelines published in 2007 remain robust, relevant and appropriate, but some guideline recommendations required adjustments to enhance clarity and a number of new recommendations were required. These have been clearly identified in the text. In addition, the synopses of evidence underpinning the guideline recommendations have been updated. These guidelines (epic3) provide comprehensive recommendations for preventing HCAI in hospital and other acute care settings based on the best currently available evidence. National evidence-based guidelines are broad principles of best practice that need to be integrated into local practice guidelines and audited to reduce variation in practice and maintain patient safety. Clinically effective infection prevention and control practice is an essential feature of patient protection. By incorporating these guidelines into routine daily clinical practice, patient safety can be enhanced and

  17. Trusted computing strengthens cloud authentication.

    PubMed

    Ghazizadeh, Eghbal; Zamani, Mazdak; Ab Manan, Jamalul-lail; Alizadeh, Mojtaba

    2014-01-01

    Cloud computing is a new generation of technology which is designed to provide the commercial necessities, solve the IT management issues, and run the appropriate applications. Another entry on the list of cloud functions which has been handled internally is Identity Access Management (IAM). Companies encounter IAM as security challenges while adopting more technologies became apparent. Trust Multi-tenancy and trusted computing based on a Trusted Platform Module (TPM) are great technologies for solving the trust and security concerns in the cloud identity environment. Single sign-on (SSO) and OpenID have been released to solve security and privacy problems for cloud identity. This paper proposes the use of trusted computing, Federated Identity Management, and OpenID Web SSO to solve identity theft in the cloud. Besides, this proposed model has been simulated in .Net environment. Security analyzing, simulation, and BLP confidential model are three ways to evaluate and analyze our proposed model. PMID:24701149

  18. Online bargaining and interpersonal trust.

    PubMed

    Naquin, Charles E; Paulson, Gaylen D

    2003-02-01

    The presented study explores the effect of interacting over the Internet on interpersonal trust when bargaining online. Relative to face-to-face negotiations, online negotiations were characterized by (a) lower levels of pre-negotiation trust and (b) lower levels of post-negotiation trust. The reduced levels of pre-negotiation trust in online negotiations (i.e., before any interaction took place) demonstrate that negotiators bring different expectations to the electronic bargaining table than to face-to-face negotiations. These negative perceptions of trust were found to mediate another aspect of the relationship, namely, desired future interaction. Those who negotiated online reported less desire for future interactions with the other party. Online negotiators also were less satisfied with their outcome and less confident in the quality of their performance, despite the absence of observable differences in economic outcome quality.

  19. Trusted Computing Strengthens Cloud Authentication

    PubMed Central

    2014-01-01

    Cloud computing is a new generation of technology which is designed to provide the commercial necessities, solve the IT management issues, and run the appropriate applications. Another entry on the list of cloud functions which has been handled internally is Identity Access Management (IAM). Companies encounter IAM as security challenges while adopting more technologies became apparent. Trust Multi-tenancy and trusted computing based on a Trusted Platform Module (TPM) are great technologies for solving the trust and security concerns in the cloud identity environment. Single sign-on (SSO) and OpenID have been released to solve security and privacy problems for cloud identity. This paper proposes the use of trusted computing, Federated Identity Management, and OpenID Web SSO to solve identity theft in the cloud. Besides, this proposed model has been simulated in .Net environment. Security analyzing, simulation, and BLP confidential model are three ways to evaluate and analyze our proposed model. PMID:24701149

  20. Trusted computing strengthens cloud authentication.

    PubMed

    Ghazizadeh, Eghbal; Zamani, Mazdak; Ab Manan, Jamalul-lail; Alizadeh, Mojtaba

    2014-01-01

    Cloud computing is a new generation of technology which is designed to provide the commercial necessities, solve the IT management issues, and run the appropriate applications. Another entry on the list of cloud functions which has been handled internally is Identity Access Management (IAM). Companies encounter IAM as security challenges while adopting more technologies became apparent. Trust Multi-tenancy and trusted computing based on a Trusted Platform Module (TPM) are great technologies for solving the trust and security concerns in the cloud identity environment. Single sign-on (SSO) and OpenID have been released to solve security and privacy problems for cloud identity. This paper proposes the use of trusted computing, Federated Identity Management, and OpenID Web SSO to solve identity theft in the cloud. Besides, this proposed model has been simulated in .Net environment. Security analyzing, simulation, and BLP confidential model are three ways to evaluate and analyze our proposed model.

  1. Examining the role of Scotland's telephone advice service (NHS 24) for managing health in the community: analysis of routinely collected NHS 24 data

    PubMed Central

    Elliott, Alison M; McAteer, Anne; Heaney, David; Ritchie, Lewis D; Hannaford, Philip C

    2015-01-01

    Objectives To examine the type, duration and outcome of the symptoms and health problems Scotland's nurse-led telephone advice service (NHS 24) is contacted about and explore whether these vary by time of contact and patient characteristics. Design Analysis of routinely collected NHS 24 data. Setting Scotland, UK. Participants Users of NHS 24 during 2011. Main outcome measures Proportion of the type, duration and outcome of the symptoms and health problems NHS 24 is contacted about. Results 82.6% of the calls were made out-of-hours and 17.4% in-hours. Abdominal problems accounted for the largest proportion of calls (12.2%) followed by dental (6.8%) and rash/skin problems (6.0%). There were differences in the type of problems presented in-hours and out-of-hours. Most problems (62.9%) had lasted <24 h before people contacted NHS 24. Out-of-hours calls tended to be for problems of shorter duration. Problems reported out-of-hours most commonly resulted in advice to visit an out-of-hours centre and in-hours advice to contact a general practitioner. Most of the service users were female and from more affluent areas. Use of the service declined with age in those over 35 years. The characteristics of users varied according to when NHS 24 was contacted. The number of calls made by an individual in the year ranged from 1 to 866, although most users (69.2%) made only one call. The type of problem presented varied by age and deprivation, but was broadly similar by gender, rural/urban status and geographic area. Call outcomes also varied by user characteristics. Conclusions This is the first study to examine how the public uses NHS 24. It has identified the patterns of problems which the service must be equipped to deal with. It has also provided important information about who uses the service and when. This information will help future planning and development of the service. PMID:26310396

  2. Clarifying the scope of Italian NHS coverage. Is it feasible? Is it desirable?

    PubMed

    Fattore, G

    1999-12-01

    The reduction in National Health Service (NHS) expenditure as a share of total health care expenditure, the fragmentation of the NHS into 21 regional systems and the implementation of a 'quasi-market' on the provider side of the system has pressed the government to define and specify, in detail, the set of services that are to be guaranteed by the public sector. To understand whether rationing can be more rational and explicit in the Italian NHS, the following are analysed: (i) the new positive list of drugs, as a major example of limiting and making more rational NHS pharmaceutical coverage; (ii) the Di Bella case, as an example of the difficulties of rational policy-making on sensitive issues; (iii) what Italian people think about health care rationing and priority setting (using the 1998 Eurobarometer Survey);( iv) the criteria defining the set of 'essential services' to be guaranteed to all Italian citizens, which are contained in the recently released National Health Plan. The 'revolution' that has taken place in the pharmaceutical sector shows it is feasible to limit, in an explicit and rational way, the extent of NHS coverage. However, the re-classification of the positive list should be regarded as an exceptional event in the history of Italian social policy. The 'Di Bella' case, on the contrary, shows that limiting NHS coverage can be very unpopular, and that the Italian cultural and social context can be unfavourable for the implementation of hard choices. Public attitude toward rationing seems to confirm that Italians are not familiar with rationing issues. Thus, it is very difficult to predict whether the national government will really go ahead with the implementation of a 'list of essential services' and whether this attempt will be successful. Rationing and priority setting should be discussed in the context of a general debate concerning the future of the Italian NHS.

  3. Commissioning healthcare for people with long term conditions: the persistence of relational contracting in England’s NHS quasi-market

    PubMed Central

    2013-01-01

    Background Since 1991, there has been a series of reforms of the English National Health Service (NHS) entailing an increasing separation between the commissioners of services and a widening range of public and independent sector providers able to compete for contracts to provide services to NHS patients. We examine the extent to which local commissioners had adopted a market-oriented (transactional) model of commissioning of care for people with long term conditions several years into the latest period of market-oriented reform. The paper also considers the factors that may have inhibited or supported market-oriented behaviour, including the presence of conditions conducive to a health care quasi-market. Methods We studied the commissioning of services for people with three long term conditions - diabetes, stroke and dementia - in three English primary care trust (PCT) areas over two years (2010-12). We took a broadly ethnographic approach to understanding the day-to-day practice of commissioning. Data were collected through interviews, observation of meetings and from documents. Results In contrast to a transactional, market-related approach organised around commissioner choice of provider and associated contracting, commissioning was largely relational, based on trust and collaboration with incumbent providers. There was limited sign of commissioners significantly challenging providers, changing providers, or decommissioning services. In none of the service areas were all the conditions for a well functioning quasi-market in health care in place. Choice of provider was generally absent or limited; information on demand and resource requirements was highly imperfect; motivations were complex; and transaction costs uncertain, but likely to be high. It was difficult to divide care into neat units for contracting purposes. As a result, it is scarcely surprising that commissioning practice in relation to all six commissioning developments was dominated by a

  4. Trust, Respect, and Reciprocity

    PubMed Central

    Phong, Tran Viet; Nhan, Le Nguyen Thanh; Dung, Nguyen Thanh; Ngan, Ta Thi Dieu; Kinh, Nguyen Van; Parker, Michael; Bull, Susan

    2015-01-01

    International science funders and publishers are driving a growing trend in data sharing. There is mounting pressure on researchers in low- and middle-income settings to conform to new sharing policies, despite minimal empirically grounded accounts of the ethical challenges of implementing the policies in these settings. This study used in-depth interviews and focus group discussions with 48 stakeholders in Vietnam to explore the experiences, attitudes, and expectations that inform ethical and effective approaches to sharing clinical research data. Distinct views on the role of trust, respect, and reciprocity were among those that emerged to inform culturally appropriate best practices. We conclude by discussing the challenges that authors of data-sharing policies should consider in this unique context. PMID:26297747

  5. The Business of Trust.

    PubMed

    Frisse, Mark E

    2016-04-01

    New mobile devices, social networks, analytics, and communications technologies are emerging at an unparalleled rate. As a result, academic health centers will face both new opportunities and formidable challenges. Unlike previous transitions from paper-based systems to networked computer systems, these new technologies are the product of new entrepreneurial and commercial interests driven by consumers. As these new commercial products and services are more widely adopted, the likelihood grows that data will be used in unanticipated ways inconsistent with societal norms. Academic health centers will have to understand the implications of these technologies and engage more actively in processes governing the collection, aggregation, and use of health data produced in a new era of consumer-driven health care technology. Maintaining public trust should be a paramount concern.

  6. Trusted Data Repositories

    NASA Astrophysics Data System (ADS)

    Giaretta, D.

    2008-08-01

    Data is valuable, expensive to create, and may be impossible to re-create, so who can be trusted to look after it in the long term? This is a question which applies to all the types of digital data on which most astronomical research, and much of the rest of civilisation, depends. This talk will outline the work which has been, and continues to be, carried out to provide an answer to the question of how to judge whether any given data repository is up to the task and deserves to be funded. The OAIS Reference Model (ISO 14721) forms the basis of most serious work on digital preservation and the aim of the work described here is to build on OAIS to create an international standard on which an accreditation and certification process can be based. The talk will touch on some of the fundamental ideas about preservation of digital objects and on ways to detect preservation snakeoil salesmen.

  7. Low yield of unselected testing in patients with acutely abnormal liver function tests

    PubMed Central

    Chadwick, Andrew

    2015-01-01

    Objectives To audit the diagnostic yield and cost implications of the use of a ‘liver screen’ for inpatients with abnormal liver function tests. Design We performed a retrospective audit of inpatients with abnormal liver function tests. We analysed all investigations ordered including biochemistry, immunology, virology and radiology. The final diagnosis was ascertained in each case, and the diagnostic yield and cost per positive diagnosis for each investigation were calculated. Setting St Thomas’ NHS Trust. Participants All inpatients investigated for abnormal liver function tests over a 12-month period. Main outcome measures We calculated the percentage of courses due to each diagnosis, the yield of each investigation and the cost per positive diagnosis for each investigation. Results A total of 308 patients were included, and a final diagnosis was made in 224 patients (73%) on the basis of both clinical data and investigations. There was considerable heterogeneity in the tests included in an acute liver screen. History and ultrasound yielded the most diagnoses (40% and 30%, respectively). The yield of autoimmune and metabolic screens was minimal. Conclusions Our results demonstrate the low yield of unselected testing in patients with abnormal liver function tests. A thorough history, ultrasound and testing for blood-borne viruses are the cornerstones of diagnosis. Specialist input should be sought before further testing. Prospective studies to evaluate the yield and cost-effectiveness of different testing strategies are needed. PMID:26770816

  8. 'Searching for the people in charge': appraising the 1983 Griffiths NHS management inquiry.

    PubMed

    Gorsky, Martin

    2013-01-01

    This is the first of two related articles in the present volume which examine the recent history of health services management using the case of the British National Health Service (NHS). In the historiography of the NHS the 1980s is widely seen as a watershed, when public policy first sought to introduce market disciplines into its operation. Administrative and managerial reforms were central to this process, and their origins and impact have been the subject of continuing debate. This article examines and evaluates one of the key events in this history, the Griffiths NHS Inquiry of 1983, which put in place the principles of 'general management' in the NHS. Drawing on both documentary records and oral evidence it offers fresh perspectives on the reasons why the Conservative government embarked on this reform, on the workings of the inquiry team under the leadership of the businessman Roy Griffiths, and on the uneven course of the implementation of his recommendations. While its initial impact arguably did not meet the expectations of its supporters, it is suggested that several of Griffiths' key concerns have grown, not diminished, in importance as aspects of subsequent health politics. These include: the need for clinician involvement in NHS management and financing; the conundrum of how to depoliticise the central direction of the service while retaining political accountability; the desirability of measuring and improving performance; and the question of how best to incorporate the wishes of patients and public in the decision-making arena. PMID:23393404

  9. The NHS and market forces in healthcare: the need for organisational ethics.

    PubMed

    Frith, Lucy

    2013-01-01

    The NHS in England is an organisation undergoing substantial change. The passage of the Health and Social Care Act 2012, consolidates and builds on previous health policies and introduces further 'market-style' reforms of the NHS. One of the main aspects of these reforms is to encourage private and third sector providers to deliver NHS services. The rationale for this is to foster a more competitive market in healthcare to encourage greater efficiency and innovation. This changing healthcare environment in the English NHS sharpens the need for attention to be paid to the ethical operation of healthcare organisations. All healthcare organisations need to consider the ethical aspects of their operation, whether state or privately run. However, the changes in the type of organisations used to provide healthcare (such as commercial companies) can create new relationships and ethical tensions. This paper will chart the development of organisational ethics as a concern in applied ethics and how it arose in the USA largely owing to changes in the organisation of healthcare financing and provision. It will be argued that an analogous transition is happening in the NHS in England. The paper will conclude with suggestions for the development of organisational ethics programmes to address some of the possible ethical issues raised by this new healthcare environment that incorporates both private and public sector providers.

  10. Solution Versus Gas-Phase Modification of Peptide Cations with NHS-Ester Reagents

    NASA Astrophysics Data System (ADS)

    Mentinova, Marija; Barefoot, Nathan Z.; McLuckey, Scott A.

    2012-02-01

    A comparison between solution and gas phase modification of primary amine sites in model peptide cations with N-hydroxysuccinimide (NHS) ester reagents is presented. In all peptides, the site of modification in solution was directed to the N-terminus by conducting reactions at pH = 5, whereas for the same peptides, a lysine residue was preferentially modified in the gas phase. The difference in pKa values of the N-terminus and ɛ-amino group of the lysine allows for a degree of control over sites of protonation of the peptides in aqueous solution. With removal of the dielectric and multiple charging of the peptide ions in the gas phase, the accommodation of excess charge can affect the preferred sites of reaction. Interaction of the lone pair of the primary nitrogen with a proton reduces its nucleophilicity and, as a result, its reactivity towards NHS-esters. While no evidence for reaction of the N-terminus with sulfo-NHS-acetate was noted in the model peptide cations, a charge inversion experiment using bis[sulfosuccinimidyl] suberate, a cross-linking reagent with two sulfo-NHS-ester functionalities, showed modification of the N-terminus. Hence, an unprotonated N-terminus can serve as a nucleophile to displace NHS, which suggests that its lack of reactivity with the peptide cations is likely due to the participation of the N-terminus in solvating excess charge.

  11. 'Searching for the people in charge': appraising the 1983 Griffiths NHS management inquiry.

    PubMed

    Gorsky, Martin

    2013-01-01

    This is the first of two related articles in the present volume which examine the recent history of health services management using the case of the British National Health Service (NHS). In the historiography of the NHS the 1980s is widely seen as a watershed, when public policy first sought to introduce market disciplines into its operation. Administrative and managerial reforms were central to this process, and their origins and impact have been the subject of continuing debate. This article examines and evaluates one of the key events in this history, the Griffiths NHS Inquiry of 1983, which put in place the principles of 'general management' in the NHS. Drawing on both documentary records and oral evidence it offers fresh perspectives on the reasons why the Conservative government embarked on this reform, on the workings of the inquiry team under the leadership of the businessman Roy Griffiths, and on the uneven course of the implementation of his recommendations. While its initial impact arguably did not meet the expectations of its supporters, it is suggested that several of Griffiths' key concerns have grown, not diminished, in importance as aspects of subsequent health politics. These include: the need for clinician involvement in NHS management and financing; the conundrum of how to depoliticise the central direction of the service while retaining political accountability; the desirability of measuring and improving performance; and the question of how best to incorporate the wishes of patients and public in the decision-making arena.

  12. 14 CFR 47.8 - Voting trusts.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Voting trusts. 47.8 Section 47.8... REGISTRATION General § 47.8 Voting trusts. (a) If a voting trust is used to qualify a domestic corporation as a... the fully executed voting trust agreement, which must identify each voting interest of the...

  13. 43 CFR 426.7 - Trusts.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Trusts. 426.7 Section 426.7 Public Lands... LIMITATION RULES AND REGULATIONS § 426.7 Trusts. (a) Definitions for purposes of this section: Grantor revocable trust means a trust that holds irrigable land or irrigation land that may be revoked at...

  14. TRUST: TDRSS Resource User Support Tool

    NASA Technical Reports Server (NTRS)

    Sparn, Thomas P.; Gablehouse, R. Daniel

    1991-01-01

    TRUST-TDRSS (Tracking Data and Relay Satellite System) Resource User Support Tool is presented in the form of the viewgraphs. The following subject areas are covered: TRUST development cycle; the TRUST system; scheduling window; ODM/GCMR window; TRUST architecture; surpass; and summary.

  15. Trust, Behavior, and High School Outcomes

    ERIC Educational Resources Information Center

    Romero, Lisa S.

    2015-01-01

    Purpose: The purpose of this paper is to contribute to the literature on student trust and to examine the relationship between student trust, behavior, and academic outcomes in high school. It asks, first, does trust have a positive effect on high school outcomes? Second, does trust influence student behavior, exerting an indirect effect on…

  16. Revealing Preconditions for Trustful Collaboration in CSCL

    ERIC Educational Resources Information Center

    Gerdes, Anne

    2010-01-01

    This paper analyses preconditions for trust in virtual learning environments. The concept of trust is discussed with reference to cases reporting trust in cyberspace and through a philosophical clarification holding that trust in the form of self-surrender is a common characteristic of all human co-existence. In virtual learning environments,…

  17. 26 CFR 26.2654-1 - Certain trusts treated as separate trusts.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ..., additions to, and distributions from, such trusts are allocated pro rata among the separate trusts, unless..., additions to, and distributions from, such trusts are allocated pro rata among the separate trusts, unless... Code. Also, additions to, and distributions from, such trusts are allocated pro rata among the...

  18. 26 CFR 26.2654-1 - Certain trusts treated as separate trusts.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ..., additions to, and distributions from, such trusts are allocated pro rata among the separate trusts, unless..., additions to, and distributions from, such trusts are allocated pro rata among the separate trusts, unless... Code. Also, additions to, and distributions from, such trusts are allocated pro rata among the...

  19. 26 CFR 26.2654-1 - Certain trusts treated as separate trusts.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ..., additions to, and distributions from, such trusts are allocated pro rata among the separate trusts, unless..., additions to, and distributions from, such trusts are allocated pro rata among the separate trusts, unless... Code. Also, additions to, and distributions from, such trusts are allocated pro rata among the...

  20. Annual appraisal and liege homage: why the British NHS is fundamentally a feudal organisation.

    PubMed

    Tyler, Len; Evans, Ann

    2003-01-01

    A study of the past can help us understand present-day management structures. Strong parallels can be seen between the present-day British National Health Service (NHS) and English feudal society in the early Middle Ages. Both systems are hierarchical, both show limited mobility between layers in the hierarchies and in both there is a strong element of central control coexisting with significant day-to-day delegation of responsibility. Ceremony plays a key role in relationships, such as through the swearing of liege homage in feudal society and through formal assessment and appraisal in the modern NHS. Although the NHS clearly does not show parallels for every element of feudal society, it is possible to draw practical lessons from the comparison, particularly relating to the ownership of problems, team-working and appraisal. PMID:12683435

  1. The direct cost of intravenous insulin infusions to the NHS in England and Wales.

    PubMed

    Rajendran, Rajesh; Scott, Anne; Rayman, Gerry

    2015-08-01

    The cost of intravenous insulin infusion to the NHS is unknown. The aim of this study was to estimate the direct cost of insulin infusions to the NHS in England and Wales in the first 24-hour period of infusion. Data from the National Inpatient Diabetes Audit 2013 in the UK were used to estimate the number of insulin infusions in use across England and Wales. Costs were calculated for six models for setting up and maintenance of insulin infusions, depending on the extent of involvement of different healthcare professionals in the UK. In this study, the direct costs of intravenous insulin infusions to the NHS in England and Wales have been estimated to vary from £6.4-8.5 million in the first 24-hour period on infusion. More appropriate use of these infusions could result in substantial cost savings.

  2. The fallacy of choice in the common law and NHS policy.

    PubMed

    Whiteman, Ingrid

    2013-06-01

    Neither the English courts nor the National Health Service (NHS) have been immune to the modern mantra of patient choice. This article examines whether beneath the rhetoric any form of real choice is endorsed either in law or in NHS policy. I explore the case law on 'consent', look at choice within the NHS and highlight the dilemmas that a mismatch of language and practice poses for clinicians. Given the variance in interpretation and lack of consistency for the individual patient I argue for a semantic change that obviates the use of 'choice', focussing instead on the options for treatment that are available and accessible, with due acknowledgement of individual patient preferences, without raising unfettered and false expectations.

  3. Trust and Privacy in Healthcare

    NASA Astrophysics Data System (ADS)

    Singleton, Peter; Kalra, Dipak

    This paper considers issues of trust and privacy in healthcare around increased data-sharing through Electronic Health Records (EHRs). It uses a model structured around different aspects of trust in the healthcare organisation’s reasons for greater data-sharing and their ability to execute EHR projects, particularly any associated confidentiality controls. It reflects the individual’s personal circumstances and attitude to use of health records.

  4. Trust and Online Reputation Systems

    NASA Astrophysics Data System (ADS)

    Kwan, Ming; Ramachandran, Deepak

    Web 2.0 technologies provide organizations with unprecedented opportunities to expand and solidify relationships with their customers, partners, and employees—while empowering firms to define entirely new business models focused on sharing information in online collaborative environments. Yet, in and of themselves, these technologies cannot ensure productive online interactions. Leading enterprises that are experimenting with social networks and online communities are already discovering this fact and along with it, the importance of establishing trust as the foundation for online collaboration and transactions. Just as today's consumers must feel secure to bank, exchange personal information and purchase products and services online; participants in Web 2.0 initiatives will only accept the higher levels of risk and exposure inherent in e-commerce and Web collaboration in an environment of trust. Indeed, only by attending to the need to cultivate online trust with customers, partners and employees will enterprises ever fully exploit the expanded business potential posed by Web 2.0. But developing online trust is no easy feat. While various preliminary attempts have occurred, no definitive model for establishing or measuring it has yet been established. To that end, nGenera has identified three, distinct dimensions of online trust: reputation (quantitative-based); relationship (qualitative-based) and process (system-based). When considered together, they form a valuable model for understanding online trust and a toolbox for cultivating it to support Web 2.0 initiatives.

  5. Reducing waste in the NHS: an overview of the literature and challenges for the nursing profession.

    PubMed

    Minogue, Virginia; Wells, Bill

    2016-07-01

    Waste in the NHS is estimated to account for 20% of health expenditure. This article examines the literature on reducing waste, analyses some approaches to waste reduction, and identifies the role that nurses and other health professionals can play in developing a sustainable NHS. For the purposes of the article, and to inform nursing practice, the definition of, and discussion about, waste is broader than that outlined by the Department for Environment, Food and Rural Affairs (Defra) controlled waste regulations, and the Royal College of Nursing classification. It includes clinical waste, waste arising out of clinical practice, service delivery and care, infrastructure, and carbon emissions. PMID:27369724

  6. Reducing waste in the NHS: an overview of the literature and challenges for the nursing profession.

    PubMed

    Minogue, Virginia; Wells, Bill

    2016-07-01

    Waste in the NHS is estimated to account for 20% of health expenditure. This article examines the literature on reducing waste, analyses some approaches to waste reduction, and identifies the role that nurses and other health professionals can play in developing a sustainable NHS. For the purposes of the article, and to inform nursing practice, the definition of, and discussion about, waste is broader than that outlined by the Department for Environment, Food and Rural Affairs (Defra) controlled waste regulations, and the Royal College of Nursing classification. It includes clinical waste, waste arising out of clinical practice, service delivery and care, infrastructure, and carbon emissions.

  7. Telemedicine and Older Neurology Outpatients: Use of NHS Direct and of the Internet in the UK.

    PubMed

    Larner, Aj

    2011-12-01

    Telemedicine is one potential approach to address the under-serviced health needs of older people. This article presents data from a project investigating neurology patients' awareness and use of the NHS Direct telephone helpline and the Internet over a 10-year period (2001-2010). Older people's awareness and use of the NHS Direct telephone helpline was low compared to other age groups and did not change with time. Although Internet access and use was also low compared to other age groups, access did increase over time. Hence, future generations of older people may be amenable to health contacts and inputs via cyberspace. PMID:23251322

  8. Why Do Speech and Language Therapists Stay in, Leave and (Sometimes) Return to the National Health Service (NHS)?

    ERIC Educational Resources Information Center

    Loan-Clarke, John; Arnold, John; Coombs, Crispin; Bosley, Sara; Martin, Caroline

    2009-01-01

    Background: Research into recruitment, retention and return of speech and language therapists in the National Health Service (NHS) is relatively limited, particularly in respect of understanding the factors that drive employment choice decisions. Aims: To identify what factors influence speech and language therapists working in the NHS to stay,…

  9. Wolves and Big Yellow Taxis: How Would Be Know If the NHS Is at Death’s Door?

    PubMed Central

    Greener, Ian

    2015-01-01

    Martin Powell suggests that the death of the English National Health Service (NHS) has been announced so many times we are at risk of not noticing should it actually happen. He is right. If we ‘cry wolf’ too many times, we risk losing sight of what is important about the NHS and why. PMID:26673181

  10. Elimination of Subjectivity from Trust Recommendation

    NASA Astrophysics Data System (ADS)

    Hasan, Omar; Brunie, Lionel; Pierson, Jean-Marc; Bertino, Elisa

    In many distributed applications, a party who wishes to make a transaction requires that it has a certain level of trust in the other party. It is frequently the case that the parties are unknown to each other and thus share no pre-existing trust. Trust-based systems enable users to establish trust in unknown users through trust recommendation from known users. For example, Bob may choose to trust an unknown user Carol when he receives a recommendation from his friend Alice that Carol’s trustworthiness is 0.8 on the interval [0,1].

  11. Experiences of patients and healthcare professionals of NHS cardiovascular health checks: a qualitative study

    PubMed Central

    Riley, R.; Coghill, N.; Montgomery, A.; Feder, G.; Horwood, J.

    2016-01-01

    Background NHS Health Checks are a national cardiovascular risk assessment and management programme in England and Wales. We examined the experiences of patients attending and healthcare professionals (HCPs) conducting NHS Health Checks. Methods Interviews were conducted with a purposive sample of 28 patients and 16 HCPs recruited from eight general practices across a range of socio-economic localities. Interviews were audio recorded, transcribed, anonymized and analysed thematically. Results Patients were motivated to attend an NHS Health Check because of health beliefs, the perceived value of the programme, a family history of cardiovascular and other diseases and expectations of receiving a general health assessment. Some patients reported benefits including reassurance and reinforcement of healthy lifestyles. Others experienced confusion and frustration about how results and advice were communicated, some having a poor understanding of the implications of their results. HCPs raised concerns about the skill set of some staff to competently communicate risk and lifestyle information. Conclusions To improve the satisfaction of patients attending and improve facilitation of lifestyle change, HCPs conducting the NHS Health Checks require sufficient training to equip them with appropriate skills and knowledge to deliver the service effectively. PMID:26408822

  12. Management Development in the NHS: Nurses and Managers, Discourses and Identities

    ERIC Educational Resources Information Center

    Sambrook, Sally

    2006-01-01

    Purpose: Aims to provide a brief discussion of discourses of HRD, then a brief review of HRD within the NHS, including stakeholders in HRD, and particularly management development. To explore some of the different discourses used by different managers, particularly those with a nursing background and those without, and the possible reasons for the…

  13. Fiscal decentralization in the Italian NHS: what happens to interregional redistribution?

    PubMed

    Ferrario, Caterina; Zanardi, Alberto

    2011-04-01

    This paper explores how pressures for an increased decentralization of taxing powers to sub-national governments may affect the degree of income redistribution across regional territories accomplished by the Italian NHS. In Italy, political responsibilities for health care are decentralized to regional governments, but the central government retains a critical role in ensuring all citizens uniform access to health services. To this end the central government runs an expenditure needs equalizing system to top up regional governments own resources. However, this system is currently put under question by strong political pressures calling for a weakening of central government involvement. Applying a well developed econometric approach we find that the NHS currently reduces interregional differences in per-capita income by about 7% of GDP. A reform of the NHS in terms of a reduction of expenditure standards produces a weakening of redistribution across jurisdictions, the size of which crucially depends on the financing arrangements of health care that will be actually adopted. We conclude that the decentralization of the NHS would give rise to relevant policy issues concerning in particular the different health care spending possibilities across regions and the impact on the interregional mobility of patients. PMID:20864204

  14. Giving night shift staff healthy food choices is a priority, says NHS chief.

    PubMed

    Kleebauer, Alistair

    2014-11-01

    Night shift staff will have access to healthy food options as part of a drive to improve the health of hospital staff in England, NHS chief executive Simon Stevens said as he announced his vision for the health service last week. PMID:25351052

  15. Partial progress: governing the pharmaceutical industry and the NHS, 1948-2008.

    PubMed

    Abraham, John

    2009-12-01

    Coinciding with sixty years of the U.K. National Health Service (NHS), this article reviews the neglected area of the governance of the pharmaceutical industry and the NHS. It traces the relationships between the pharmaceutical industry, the state, and the NHS from the creation of the health service to the present, as they have grappled with the overlapping challenges of pharmaceutical safety, efficacy, cost-effectiveness, pricing, promotion, and advertising. The article draws on the concepts of "corporate bias" and "regulatory capture" from political theory, and "counter-vailing powers" and "clinical autonomy" in medical sociology, while also introducing the new concepts of "assimilated allies" and "pharmaceuticalization" in order to synthesize a theoretical framework capable of longitudinal empirical analysis of pharmaceutical governance. The analysis identifies areas in which the governance of pharmaceuticals and the NHS has contributed to progress in health care since 1948. However, it is argued that that progress has been slow, restricted, and vulnerable to misdirection due to the enormous and unrivaled influence afforded to the pharmaceutical industry in policy developments. Countervailing influences against such corporate bias have often been limited and subject to destabilization by the industry's assimilated allies either within the state or in the embrace of pharmaceuticalization and consumerism. PMID:20018987

  16. Partial progress: governing the pharmaceutical industry and the NHS, 1948-2008.

    PubMed

    Abraham, John

    2009-12-01

    Coinciding with sixty years of the U.K. National Health Service (NHS), this article reviews the neglected area of the governance of the pharmaceutical industry and the NHS. It traces the relationships between the pharmaceutical industry, the state, and the NHS from the creation of the health service to the present, as they have grappled with the overlapping challenges of pharmaceutical safety, efficacy, cost-effectiveness, pricing, promotion, and advertising. The article draws on the concepts of "corporate bias" and "regulatory capture" from political theory, and "counter-vailing powers" and "clinical autonomy" in medical sociology, while also introducing the new concepts of "assimilated allies" and "pharmaceuticalization" in order to synthesize a theoretical framework capable of longitudinal empirical analysis of pharmaceutical governance. The analysis identifies areas in which the governance of pharmaceuticals and the NHS has contributed to progress in health care since 1948. However, it is argued that that progress has been slow, restricted, and vulnerable to misdirection due to the enormous and unrivaled influence afforded to the pharmaceutical industry in policy developments. Countervailing influences against such corporate bias have often been limited and subject to destabilization by the industry's assimilated allies either within the state or in the embrace of pharmaceuticalization and consumerism.

  17. 'Evidence for binge drinking pill does not justify cost to NHS'.

    PubMed

    2016-09-21

    There is 'no direct evidence' to support the effectiveness of nalmefene, the drug approved for use in the NHS in England by the National Institute for Health and Care Excellence (NICE) to curb excess drinking among those who are alcohol dependent. PMID:27654537

  18. A Survey of Food Projects in the English NHS Regions and Health Action Zones in 2001

    ERIC Educational Resources Information Center

    Caraher, Martin; Cowburn, Gill

    2004-01-01

    Background and Objective: This article sets out the findings from an analysis of food projects, with a particular emphasis on fruit and vegetables, from the 26 Health Action Zones (HAZs) in England and those taking place within the former NHS regional areas in 2001. The objective was to gather information on the existing practice to inform future…

  19. Online trust, trustworthiness, or assurance?

    PubMed

    Cheshire, Coye

    2011-01-01

    Every day, individuals around the world retrieve, share, and exchange information on the Internet. We interact online to share personal information, find answers to questions, make financial transactions, play social games, and maintain professional and personal relationships. Sometimes our online interactions take place between two or more humans. In other cases, we rely on computers to manage information on our behalf. In each scenario, risk and uncertainty are essential for determining possible actions and outcomes. This essay highlights common deficiencies in our understanding of key concepts such as trust, trustworthiness, cooperation, and assurance in online environments. Empirical evidence from experimental work in computer-mediated environments underscores the promises and perils of overreliance on security and assurance structures as replacements for interpersonal trust. These conceptual distinctions are critical because the future shape of the Internet will depend on whether we build assurance structures to limit and control ambiguity or allow trust to emerge in the presence of risk and uncertainty.

  20. Online trust, trustworthiness, or assurance?

    PubMed

    Cheshire, Coye

    2011-01-01

    Every day, individuals around the world retrieve, share, and exchange information on the Internet. We interact online to share personal information, find answers to questions, make financial transactions, play social games, and maintain professional and personal relationships. Sometimes our online interactions take place between two or more humans. In other cases, we rely on computers to manage information on our behalf. In each scenario, risk and uncertainty are essential for determining possible actions and outcomes. This essay highlights common deficiencies in our understanding of key concepts such as trust, trustworthiness, cooperation, and assurance in online environments. Empirical evidence from experimental work in computer-mediated environments underscores the promises and perils of overreliance on security and assurance structures as replacements for interpersonal trust. These conceptual distinctions are critical because the future shape of the Internet will depend on whether we build assurance structures to limit and control ambiguity or allow trust to emerge in the presence of risk and uncertainty. PMID:22167913

  1. A Trusted Portable Computing Device

    NASA Astrophysics Data System (ADS)

    Ming-wei, Fang; Jun-jun, Wu; Peng-fei, Yu; Xin-fang, Zhang

    A trusted portable computing device and its security mechanism were presented to solve the security issues, such as the attack of virus and Trojan horse, the lost and stolen of storage device, in mobile office. It used smart card to build a trusted portable security base, virtualization to create a secure virtual execution environment, two-factor authentication mechanism to identify legitimate users, and dynamic encryption to protect data privacy. The security environment described in this paper is characteristic of portability, security and reliability. It can meet the security requirement of mobile office.

  2. Salmonella Typhimurium and Salmonella Enteritidis in England: costs to patients, their families, and primary and community health services of the NHS.

    PubMed

    Santos, A C; Roberts, J A; Cook, A J C; Simons, R; Sheehan, R; Lane, C; Adak, G K; Clifton-Hadley, F A; Rodrigues, L C

    2011-05-01

    This is the first study comparing societal costs of acute illness with Salmonella Typhimurium (ST) and Salmonella Enteritidis (SE) in the UK. It included the cost and severity of the illness and explored the impact of each Salmonella serovar on the patients, their families, the NHS, and the wider economy. The study ascertained confirmed cases of ST and SE between July and November 2008. The mean costs per case were £1282 (ST) and £993 (SE). The indirect costs associated with the work-time lost by the case, parents, or carers were £409 (ST) and £228 (SE); this difference was statistically significant. The aggregate cost of ST and SE identified using laboratory test results for the UK as a whole was estimated as £6.5 million. Work-time lost and caring activities are cost categories that are not frequently investigated within the infectious intestinal disease literature, although they represent an important societal cost.

  3. Adequate trust avails, mistaken trust matters: on the moral responsibility of doctors as proxies for patients' trust in biobank research.

    PubMed

    Johnsson, Linus; Helgesson, Gert; Hansson, Mats G; Eriksson, Stefan

    2013-11-01

    In Sweden, most patients are recruited into biobank research by non-researcher doctors. Patients' trust in doctors may therefore be important to their willingness to participate. We suggest a model of trust that makes sense of such transitions of trust between domains and distinguishes adequate trust from mistaken trust. The unique position of doctors implies, we argue, a Kantian imperfect duty to compensate for patients' mistaken trust. There are at least three kinds of mistaken trust, each of which requires a different set of countermeasures. First, trust is mistaken when necessary competence is lacking; the competence must be developed or the illusion dispelled. Second, trust is irrational whenever the patient is mistaken about his actual reasons for trusting. Care must therefore be taken to support the patient's reasoning and moral agency. Third, some patients inappropriately trust doctors to recommend only research that will benefit them directly. Such trust should be counteracted by nurturing a culture where patients expect to be asked occasionally to contribute to the common good. PMID:22681564

  4. The effects of hospital executives' personality traits on their perceptions and trust.

    PubMed

    Saccardi, T A; Banai, M

    1996-01-01

    This field study examines the relationship between hospital executives' personality traits and both their perceptions of their subordinates' levels of skills and their level of trust in those subordinates. CEOs or senior executives of 37 acute care hospitals with at least 200 beds were surveyed. The high Nurturant manager did not perceive greater trust or skills than the low Nurturant manager. However, there was a significant and negative correlation between Person-Dominant managers and trust scores. Furthermore, the high Goal-Dominant managers varied significantly less than the low Goal-Dominant managers in their perceptions of their subordinates' skill. The study calls for a reexamination of the influence of personality traits on hospital executives' perceptions and trust. Power in the hands of certain managers may lead to the devaluation of the abilities and motivations of subordinates, and even the devaluation of their subordinates themselves.

  5. Trust or Consequences: The Relationship between Faculty Trust and Faculty Learning Communities in Higher Education

    ERIC Educational Resources Information Center

    Wilson, Gaye R.

    2011-01-01

    The purpose of this study was to investigate relationships between FLC membership and faculty trust in higher education colleagues and faculty trust in higher education administration in public and private universities in the United States. This quantitative study examines trust in colleagues and trust in administration in higher education, two…

  6. 26 CFR 26.2654-1 - Certain trusts treated as separate trusts.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... children and grandchildren. The trust provides that, when T's youngest child reaches age 21, the trust will... youngest child reaches age 21 will be recognized as of that date as separate trusts for purposes of Chapter... before the severance. Any allocation of GST tax exemption to the trust after T's youngest child...

  7. 77 FR 5065 - Preservation Trust Advisors, LLC and Northern Lights Fund Trust; Notice of Application

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-01

    ... From the Federal Register Online via the Government Publishing Office SECURITIES AND EXCHANGE COMMISSION Preservation Trust Advisors, LLC and Northern Lights Fund Trust; Notice of Application January 26...'') and Northern Lights Fund Trust (the ``Trust''). FILING DATES: The application was filed on...

  8. Plus ça change, plus c'est la même chose: senior NHS managers' narratives of restructuring.

    PubMed

    Macfarlane, Fraser; Exworthy, Mark; Wilmott, Micky; Greenhalgh, Trish

    2011-09-01

    The UK National Health Service (NHS) is regularly restructured. Its smooth operation and organisational memory depends on the insights and capability of managers, especially those with experience of previous transitions. Narrative methods can illuminate complex change from the perspective of key actors. We used an adaptation of Wengraf's biographical narrative life interview method to explore how 20 senior NHS managers (chief executives, directors and assistant directors) had perceived and responded to major transitions since 1974. Data were analysed thematically using insights from phenomenology, neo-institutional theory and critical management studies. Findings were contextualised within a literature review of NHS policy and management 1974-2009. Managers described how experience in different NHS organisations helped build resilience and tacit knowledge, and how a strong commitment to the 'NHS brand' allowed them to weather a succession of policy changes and implement and embed such changes locally. By synthesising these personal and situated micro-narratives, we built a wider picture of macro-level institutional change in the NHS, in which the various visible restructurings in recent years appear to have masked a deeper continuity in terms of enduring values, norms and ways of working. We consider the implications of these findings for the future NHS. PMID:21371053

  9. Plus ça change, plus c'est la même chose: senior NHS managers' narratives of restructuring.

    PubMed

    Macfarlane, Fraser; Exworthy, Mark; Wilmott, Micky; Greenhalgh, Trish

    2011-09-01

    The UK National Health Service (NHS) is regularly restructured. Its smooth operation and organisational memory depends on the insights and capability of managers, especially those with experience of previous transitions. Narrative methods can illuminate complex change from the perspective of key actors. We used an adaptation of Wengraf's biographical narrative life interview method to explore how 20 senior NHS managers (chief executives, directors and assistant directors) had perceived and responded to major transitions since 1974. Data were analysed thematically using insights from phenomenology, neo-institutional theory and critical management studies. Findings were contextualised within a literature review of NHS policy and management 1974-2009. Managers described how experience in different NHS organisations helped build resilience and tacit knowledge, and how a strong commitment to the 'NHS brand' allowed them to weather a succession of policy changes and implement and embed such changes locally. By synthesising these personal and situated micro-narratives, we built a wider picture of macro-level institutional change in the NHS, in which the various visible restructurings in recent years appear to have masked a deeper continuity in terms of enduring values, norms and ways of working. We consider the implications of these findings for the future NHS.

  10. Impact of the urgent care telephone service NHS 111 pilot sites: a controlled before and after study

    PubMed Central

    Turner, J; O'Cathain, A; Knowles, E; Nicholl, J

    2013-01-01

    Objectives To measure the impact of the urgent care telephone service NHS 111 on the emergency and urgent care system. Design Controlled before and after study using routine data. Setting Four pilot sites and three control sites covering a total population of 3.6 million in England, UK. Participants and data Routine data on 36 months of use of emergency ambulance service calls and incidents, emergency department attendances, urgent care contacts (general practice (GP) out of hours, walk in and urgent care centres) and calls to the telephone triage service NHS direct. Intervention NHS 111, a new 24 h 7 day a week telephone service for non-emergency health problems, operated by trained non-clinical call handlers with clinical support from nurse advisors, using NHS Pathways software to triage calls to different services and home care. Main outcomes Changes in use of emergency and urgent care services. Results NHS 111 triaged 277 163 calls in the first year of operation for a population of 1.8 million. There was no change overall in emergency ambulance calls, emergency department attendances or urgent care use. There was a 19.3% reduction in calls to NHS Direct (95% CI −24.6% to −14.0%) and a 2.9% increase in emergency ambulance incidents (95% CI 1.0% to 4.8%). There was an increase in activity overall in the emergency and urgent care system in each site ranging 4.7–12%/month and this remained when assuming that NHS 111 will eventually take all NHS Direct and GP out of hours calls. Conclusions In its first year of operation in four pilot sites NHS 111 did not deliver the expected system benefits of reducing calls to the 999 ambulance service or shifting patients to urgent rather than emergency care. There is potential that this type of service increases overall demand for urgent care. PMID:24231457

  11. 14 CFR 47.8 - Voting trusts.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 1 2014-01-01 2014-01-01 false Voting trusts. 47.8 Section 47.8 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRCRAFT REGISTRATION General § 47.8 Voting trusts. (a) If a voting trust is used to qualify a domestic corporation as...

  12. 14 CFR 47.8 - Voting trusts.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 1 2011-01-01 2011-01-01 false Voting trusts. 47.8 Section 47.8... REGISTRATION General § 47.8 Voting trusts. Link to an amendment published at 75 FR 41979, July 20, 2010. Link to an amendment published at 75 FR 41980, July 20, 2010. (a) If a voting trust is used to qualify...

  13. 12 CFR 7.2022 - Voting trusts.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 1 2011-01-01 2011-01-01 false Voting trusts. 7.2022 Section 7.2022 Banks and Banking COMPTROLLER OF THE CURRENCY, DEPARTMENT OF THE TREASURY BANK ACTIVITIES AND OPERATIONS Corporate Practices § 7.2022 Voting trusts. The shareholders of a national bank may establish a voting trust under...

  14. 12 CFR 7.2022 - Voting trusts.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 1 2010-01-01 2010-01-01 false Voting trusts. 7.2022 Section 7.2022 Banks and Banking COMPTROLLER OF THE CURRENCY, DEPARTMENT OF THE TREASURY BANK ACTIVITIES AND OPERATIONS Corporate Practices § 7.2022 Voting trusts. The shareholders of a national bank may establish a voting trust under...

  15. 40 CFR 280.102 - Trust fund.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 26 2010-07-01 2010-07-01 false Trust fund. 280.102 Section 280.102...) Financial Responsibility § 280.102 Trust fund. (a) An owner or operator may satisfy the requirements of § 280.93 by establishing a trust fund that conforms to the requirements of this section. The...

  16. Factors predicting trust between GPs and OPs

    PubMed Central

    Nauta, A.P.; von Grumbkow, J.

    2001-01-01

    Abstract Purpose To study possible differences in trust between general practitioners (GPs) and occupational physicians (OPs) and the explanatory factors for trust. Insight into the factors predicting trust can improve programmes for stimulating the co-operation of GPs and OPs. Theory On the basis of theories of trust and of social identity theory we expected, (1) in both professions a higher level of knowledge-based trust than of identification-based trust, (2) a relationship between higher levels of identification-based trust and higher frequency of contact, (3) OPs to have a higher level of identification-based trust than GPs. We hypothesised (4) that OPs perceiving an equal status have higher levels of trust and (5) GPs perceiving a higher status have lower levels of trust. Methods A mail survey sent to 2297 doctors (1728 GPs and 569 OPs) of which we used 547 questionnaires. Results Hypotheses 1 and 2 were supported. Hypothesis 3 was not supported. Hypotheses 4 and 5 were supported for knowledge-based trust. On the basis of these findings it is possible that co-operation between the two groups is still in its early stages. Conclusions Programmes to improve the co-operation of GPs and OPs should focus on equalising status and stimulating contacts to build (identification-based) trust. PMID:16896412

  17. 46 CFR 67.36 - Trust.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Citizenship Requirements for Vessel Documentation § 67.36 Trust. (a) For the purpose of obtaining a registry or recreational endorsement, a trust arrangement meets citizenship requirements if: (1) Each of its...) For the purpose of obtaining a fishery endorsement, a trust arrangement meets citizenship...

  18. 46 CFR 67.36 - Trust.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Citizenship Requirements for Vessel Documentation § 67.36 Trust. (a) For the purpose of obtaining a registry or recreational endorsement, a trust arrangement meets citizenship requirements if: (1) Each of its...) For the purpose of obtaining a fishery endorsement, a trust arrangement meets citizenship...

  19. 46 CFR 67.36 - Trust.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Citizenship Requirements for Vessel Documentation § 67.36 Trust. (a) For the purpose of obtaining a registry or recreational endorsement, a trust arrangement meets citizenship requirements if: (1) Each of its...) For the purpose of obtaining a fishery endorsement, a trust arrangement meets citizenship...

  20. 46 CFR 67.36 - Trust.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Citizenship Requirements for Vessel Documentation § 67.36 Trust. (a) For the purpose of obtaining a registry or recreational endorsement, a trust arrangement meets citizenship requirements if: (1) Each of its...) For the purpose of obtaining a fishery endorsement, a trust arrangement meets citizenship...

  1. 46 CFR 67.36 - Trust.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Citizenship Requirements for Vessel Documentation § 67.36 Trust. (a) For the purpose of obtaining a registry or recreational endorsement, a trust arrangement meets citizenship requirements if: (1) Each of its...) For the purpose of obtaining a fishery endorsement, a trust arrangement meets citizenship...

  2. Trust and Schooling in the United States

    ERIC Educational Resources Information Center

    Dincer, Oguzhan C.

    2011-01-01

    I investigate the effects of trust on human capital measured as average years of schooling in U.S. states using data from the 1980s and the 1990s. I find robust evidence that an increase in trust increases schooling across U.S. states. According the results of the seemingly unrelated regression estimation, a 25 percentage point increase in "Trust"…

  3. Sex Differences in Children's Trust in Peers.

    ERIC Educational Resources Information Center

    Rotenberg, Ken J.

    1984-01-01

    Children (in Grades K, 2, and 4) were required to judge how much they trusted each of their classmates. A same sex pattern of peer trust was found in fourth and second graders, but not in kindergarten children. Contrary to expectation, girls were not significantly more trusting in peers than were boys. (KH)

  4. Animal Behaviour: Friendship Enhances Trust in Chimpanzees.

    PubMed

    Silk, Joan

    2016-01-25

    Individuals that participate in exchanges with delayed rewards can be exploited if their partners don't reciprocate. In humans, friendships are built on trust, and trust enhances cooperation. New evidence suggests that close social bonds also enhance trust in chimpanzees.

  5. 17 CFR 300.104 - Trust accounts.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 17 Commodity and Securities Exchanges 3 2010-04-01 2010-04-01 false Trust accounts. 300.104... A to Part 285 RULES OF THE SECURITIES INVESTOR PROTECTION CORPORATION Accounts of âseparateâ Customers of Sipc Members § 300.104 Trust accounts. (a) A trust account held with a member shall be deemed...

  6. 17 CFR 300.104 - Trust accounts.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 17 Commodity and Securities Exchanges 3 2013-04-01 2013-04-01 false Trust accounts. 300.104... A to Part 285 RULES OF THE SECURITIES INVESTOR PROTECTION CORPORATION Accounts of âseparateâ Customers of Sipc Members § 300.104 Trust accounts. (a) A trust account held with a member shall be deemed...

  7. 17 CFR 300.104 - Trust accounts.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 17 Commodity and Securities Exchanges 3 2012-04-01 2012-04-01 false Trust accounts. 300.104... A to Part 285 RULES OF THE SECURITIES INVESTOR PROTECTION CORPORATION Accounts of âseparateâ Customers of Sipc Members § 300.104 Trust accounts. (a) A trust account held with a member shall be deemed...

  8. 17 CFR 300.104 - Trust accounts.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 17 Commodity and Securities Exchanges 4 2014-04-01 2014-04-01 false Trust accounts. 300.104... A to Part 285 RULES OF THE SECURITIES INVESTOR PROTECTION CORPORATION Accounts of âseparateâ Customers of Sipc Members § 300.104 Trust accounts. (a) A trust account held with a member shall be deemed...

  9. 17 CFR 300.104 - Trust accounts.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 17 Commodity and Securities Exchanges 3 2011-04-01 2011-04-01 false Trust accounts. 300.104... A to Part 285 RULES OF THE SECURITIES INVESTOR PROTECTION CORPORATION Accounts of âseparateâ Customers of Sipc Members § 300.104 Trust accounts. (a) A trust account held with a member shall be deemed...

  10. Trust and Relationship Building in Electronic Commerce.

    ERIC Educational Resources Information Center

    Papadopoulou, Panagiota; Andreou, Andreas; Kanellis, Panagiotis; Martakos, Drakoulis

    2001-01-01

    Discussion of the need for trust in electronic commerce to build customer relationships focuses on a model drawn from established theoretical work on trust and relationship marketing that highlights differences between traditional and electronic commerce. Considers how trust can be built into virtual environments. (Contains 50 references.)…

  11. Enhancing Trust in SOA Based Collaborative Environments

    NASA Astrophysics Data System (ADS)

    Boursas, Latifa; Bourimi, Mohamed; Hommel, Wolfgang; Kesdogan, Dogan

    Considering trust and privacy requirements for online and collaborative distance learning environments, this paper discusses potential extensions of SOA based applications to simultaneously support authentication and authorization services, and offering mutual trust to both learners and service providers. This study shows that the security mechanisms integrated in the SOA platform can be effectively extended and correlated with a trust model.

  12. 43 CFR 426.7 - Trusts.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... indirectly to a person(s) or entity(ies) other than the grantor(s). Otherwise revocable trust means a trust... entity(ies) other than the grantor(s). (b) Attribution of land held by a trust. The acreage...

  13. The Relationship between Collective Student Trust and Student Achievement

    ERIC Educational Resources Information Center

    Casper, David Carl

    2012-01-01

    The relationship between collective student trust and student achievement was tested in a sample of 1,748 5th grade students in 34 Title I elementary schools in an urban and urban fringe district. Trust was defined, the conditions of trust described, and the facets of trust discussed. Collective trust was distinguished from relational trust and…

  14. The Role of Trust in Information Science and Technology.

    ERIC Educational Resources Information Center

    Marsh, Stephen; Dibben, Mark R.

    2003-01-01

    Discusses the notion of trust as it relates to information science and technology, specifically user interfaces, autonomous agents, and information systems. Highlights include theoretical meaning of trust; trust and levels of analysis, including organizational trust; electronic commerce, user interfaces, and static trust; dynamic trust; and trust…

  15. Interregional Patient Mobility in the Italian NHS: A Case of Badly-Managed Decentralization Comment on "Regional Incentives and Patient Cross-Border Mobility: Evidence From the Italian Experience".

    PubMed

    Neri, Stefano

    2015-01-01

    The article by Brenna and Spandonaro on interregional mobility for acute hospital care in Italy raises important issues concerning social and territorial equity in a healthcare system. Based on Regions and private providers' strategic behavior, the hypothesis adopted to explain patient cross-border mobility (CBM), demonstrated by statistical analysis, may be further explored using qualitative methods. In order to reduce CBM, the central government needs to play a more active role in coordination, even in a highly decentralized National Health Service (NHS). PMID:26673474

  16. Views of NHS commissioners on commissioning support provision. Evidence from a qualitative study examining the early development of clinical commissioning groups in England

    PubMed Central

    Petsoulas, Christina; Allen, Pauline; Checkland, Kath; Coleman, Anna; Segar, Julia; Peckham, Stephen; Mcdermott, Imelda

    2014-01-01

    Objective The 2010 healthcare reform in England introduced primary care-led commissioning in the National Health Service (NHS) by establishing clinical commissioning groups (CCGs). A key factor for the success of the reform is the provision of excellent commissioning support services to CCGs. The Government's aim is to create a vibrant market of competing providers of such services (from both for-profit and not-for-profit sectors). Until this market develops, however, commissioning support units (CSUs) have been created from which CCGs are buying commissioning support functions. This study explored the attitudes of CCGs towards outsourcing commissioning support functions during the initial stage of the reform. Design The research took place between September 2011 and June 2012. We used a case study research design in eight CCGs, conducting in-depth interviews, observation of meetings and analysis of policy documents. Setting/participants We conducted 96 interviews and observed 146 meetings (a total of approximately 439 h). Results Many CCGs were reluctant to outsource core commissioning support functions (such as contracting) for fear of losing local knowledge and trusted relationships. Others were disappointed by the absence of choice and saw CSUs as monopolies and a recreation of the abolished PCTs. Many expressed doubts about the expectation that outsourcing of commissioning support functions will result in lower administrative costs. Conclusions Given the nature of healthcare commissioning, outsourcing vital commissioning support functions may not be the preferred option of CCGs. Considerations of high transaction costs, and the risk of fragmentation of services and loss of trusted relationships involved in short-term contracting, may lead most CCGs to decide to form long-term partnerships with commissioning support suppliers in the future. This option, however, limits competition by creating ‘network closure’ and calls into question the Government

  17. The Administrative Team, Trust & Gender.

    ERIC Educational Resources Information Center

    Garfinkel, Elliot Z.

    This paper describes the first phase of a research study that examined (1) how superintendents define and select their administrative teams; (2) how team values are conceptualized by superintendents; (3) how "trust" is defined and its value perceived by superintendents; and (4) whether or not gender influences the way superintendents define "team"…

  18. The Sutton Trust: Mobility Manifesto

    ERIC Educational Resources Information Center

    Sutton Trust, 2014

    2014-01-01

    Ahead of the party conference season, the Sutton Trust is urging fairer admissions to comprehensives, grammar schools and independent schools as part of a 10-point Mobility Manifesto setting out ten practical policy steps designed to put social mobility at the heart of the 2015 election campaign. The manifesto urges greater use of ballots (random…

  19. Taxability of Educational Benefits Trusts

    ERIC Educational Resources Information Center

    Temple Law Quarterly, 1976

    1976-01-01

    Corporations have found the promise of providing a college education to the children of employees--without the recognition of income to the parent-employee--to be a popular fringe benefit. The Internal Revenue Service has attacked educational benefit trusts in Revenue Ruling 75-448. Implications are discussed. (LBH)

  20. Trust as a Teaching Skill

    ERIC Educational Resources Information Center

    Leon-Weil, Anica; Hewitt, Carol

    2008-01-01

    Should I stop the conflict or narrate it? Do I redirect or reassure? Two infant/toddler teachers explain how they use trust as a teaching tool, "teaching" less and involving the toddlers in their classroom in the decisions that affect them. They took to heart the philosophy of Magda Gerber, who urged parents to "observe more, do less." The author…

  1. Lack of language skills and knowledge of local culture in international medical graduates: Implications for the NHS.

    PubMed

    Hamarneh, Ashraf

    2015-01-01

    International Medical Graduates (IMGs) form a coherent part of the National Health Service (NHS). Nearly 25% of the doctors working in the NHS are IMGs who obtained their primary medical degree from outside the EU. Moving to a different country that holds a different set of values and belief systems can be very challenging for IMGs, which in turn could have a significant effect on the service provided to NHS patients. This article will address the issue of effective communication skills within the IMG population and will explore the underlying issues behind this problem.

  2. The Slow, Lingering Death of the English NHS: Comment on "Who Killed the English National Health Service?".

    PubMed

    Hunter, David J

    2016-01-01

    The death of the English National Health Service (NHS) may be slow in coming but that does not mean that it is not the Conservative-led UK government's desired end state. The government is displaying tactical cunning in achieving its long-term purpose to remould the British state. Powell seeks greater clarity amidst the confusion but the lack of clarity is a principal weapon in the government's assault on the public realm, including the NHS. Moreover, there is ample supporting evidence to caution against Powell's tendency to complacency concerning the ultimate fate of the NHS.

  3. Using programme budgeting and marginal analysis (PBMA) to set priorities: reflections from a qualitative assessment in an English Primary Care Trust.

    PubMed

    Goodwin, Elizabeth; Frew, Emma J

    2013-12-01

    In England from 2002 to 2013, Primary Care Trusts (PCTs) were responsible for commissioning healthcare for their local populations. The NHS has recently undergone rapid organisational change whereby clinicians have assumed responsibility for local commissioning decisions. This change in commissioning arrangements alongside the current financial pressures facing the NHS provides an impetus for considering the use of technical prioritisation methods to enable the identification of savings without having a detrimental effect on the health of the population. This paper reports on the design and implementation of a technical prioritisation method termed PBMA applied within NHS Plymouth, an English PCT responsible for commissioning services for a population of approximately 270,000. We evaluated the effectiveness of the process, the extent to which it was appropriate for local healthcare commissioning and whether it identified budget savings. Using qualitative research methodology, we found the process produced clear strategic and operational priorities for 2010/11, providing staff with focus and structure, and delivered a substantial planned reduction in hospital activity levels. Participants expressed satisfaction with the process. NHS Plymouth adhered to the PBMA process, although concerns were raised about the evidence for some priorities, decibel rationing, and a lack of robust challenge at priority-setting meetings. Further work is required to enhance participants' understanding of marginal analysis. Participants highlighted several external benefits, particularly in terms of cultural change, and felt the process should encompass the whole local health and social care community. This evaluation indicates that the prioritisation method was effective in producing priorities for NHS Plymouth, and that PBMA provides an appropriate method for allocating resources at a local level. In order for PBMA to identify savings, cultural and structural barriers to disinvestment

  4. NHS values, compassion and quality indicators for relationship based person-centred healthcare. Comment on "Morality and markets in the NHS".

    PubMed

    Cox, John

    2015-06-01

    The paper by Gilbert et al. should be on the table of every politician and National Health Service (NHS) manager in the run up to the general election, when the NHS is at the hustings. They have raised profound moral dilemmas of the internal and external market in their present form, such as the practicalities of distributive justice and the enhancement of autonomy--to which are added the preservation of personhood, the values of listening, the maintenance of altruism and the origins of compassion. It is asserted that the quality of healthcare is dependent on the quality of the caring relationship between healthcare staff members, and between staff and patients. The nature of Compassionate Resilience is outlined with respect to Health Visitor training--and the contribution of faith communities to public health is also considered. The four Quality Indicators of an enabling environment first proposed by Cox and Gray are summarised, and the need for increased conceptual clarity of these key values recognised.

  5. Multidisciplinary team working, clinical networks, and chambers; opportunities to work differently in the NHS

    PubMed Central

    Carter, S; Garside, P; Black, A

    2003-01-01

    Recently in the United Kingdom some new organisational structures for clinicians have been discussed. So far little has changed, but the intensity of interest suggests this may be an opportunity to link change in working practices with improvements in quality. Multidisciplinary team working is developing within the National Health Service (NHS) and some groups are expanding their roles across traditional institutional boundaries to form complex clinical networks. It would require little to make these functional networks autonomous from current NHS structures. Other models of working without traditional institutional boundaries have been discussed, including the formation of "chambers" for doctors and other professionals. We describe the first tentative steps of one group as an example and suggest that further experimentation with evaluation is required. PMID:14645745

  6. Law, patient's rights and NHS resource allocation: is Eurostar the answer?

    PubMed

    McHale, Jean V

    2006-09-01

    Historically attempts to use the courts as a means of challenging decisions to refuse NHS resources have met with little success. However two recent developments, that of the Human Rights Act 1998 and the development of European Union law through the application of Article 49 of the EC Treaty have provided the prospect for a challenge to this position. This article examines the impact of a recent case that of Watts v Bedford PCT in which a woman sought to by-pass NHS waiting lists by seeking treatment in France and then claimed reimbursement of the cost of the operation and the possible impact of this case in the context of patients's rights and resource allocation.

  7. Success factors for implementation of the balanced scorecard in a NHS multi-agency setting.

    PubMed

    Radnor, Zoe; Lovell, Bill

    2003-01-01

    Even though the balanced scorecard (BSC) has become a highly popular performance management tool, usage in local public sector National Health Service (NHS) organisations is still rare. This paper conditionally outlines some grounds in supporting such usage. In particular underlying conceptual concerns with the BSC system and its implementation pitfalls require full consideration. This paper then outlines some factors to be taken into account for "successful" BSC implementation in a NHS multi-agency setting. These findings emerged from a series of focus groups that took place with contributors drawn from all the key organisations within the Bradford Health Action Zone. Finally, this paper argues that if key criteria are met, successful implementation of the BSC may then proceed. However, "blind" BSC implementation without consideration of these factors may result in potential "failure". PMID:12870249

  8. Tracing experiences of NHS change in England: a process philosophy perspective.

    PubMed

    McMurray, Robert

    2010-01-01

    For over three decades public services have been the subject of unprecedented change. Nowhere has this been more evident than in the English National Health Service (NHS) where despite the effort expended on change there is growing evidence that such restructuring is largely ineffective. Drawing on a study of culture modification in the English NHS, this paper utilizes Chia's (1999) account of the metaphysics of processual change to consider why attempts to restructure public services are not always successful. The paper contributes to our understanding of public management reform by considering how an ontology of becoming, and a loosening of control, might alter how we approach reforming. Further, the paper offers a theoretical justification for the use of standard research methods for novel processual ends. The paper concludes with a reflection on the implications of a processual perspective for the future management, organization and study of change in public administration.

  9. Using informed consent to save trust.

    PubMed

    Eyal, Nir

    2014-07-01

    Increasingly, bioethicists defend informed consent as a safeguard for trust in caretakers and medical institutions.This paper discusses an ‘ideal type’ of that move. What I call the trust-promotion argument for informed consent states:1. Social trust, especially trust in caretakers and medical institutions, is necessary so that, for example,people seek medical advice, comply with it, and participate in medical research.2. Therefore, it is usually wrong to jeopardise that trust.3. Coercion, deception, manipulation and other violations of standard informed consent requirements seriously jeopardise that trust.4. Thus, standard informed consent requirements are justified.This article describes the initial promise of this argument, then identifies challenges to it. As I show, the value of trust fails to account for some common sense intuitions about informed consent. We should revise the argument, common sense morality, or both.

  10. Questions about the NHS Supply Chain's generic specifications project arise at TVS 2016.

    PubMed

    Fronzo, C

    2016-05-01

    The last session at this year's Tissue Viability Society (TVS) conference was a debate surrounding the Government's proposed NHS Supply Chain generics programme. In one corner explaining the full proposal, how it will work and who will be involved was Mandie Sunderland, and in the other was Richard White, who had a number of questions to ask. Here Camila Fronzo, JWC Chief Sub Editor, summarises the main points of the debate and the questions still to be addressed. PMID:27169336

  11. Public knowledge and public trust.

    PubMed

    Cunningham-Burley, Sarah

    2006-01-01

    As health care applications derived from human genetics research are likely to move increasingly from 'clinic to community', there is growing interest not just in how patients understand and take up health-related genetic information but also in the views of the wider population, as well as a range of professional groups. In this paper, issues relating public knowledge and public trust are raised and discussed in an attempt to move forward debates about public involvement in genomic research and the role of sociologists within interdisciplinary teams. As the field of public understanding of science has developed, we have seen a shift from a focus on the lack of scientific literacy as problem to a recognition of the range of different knowledges that people have and use as they confront science and technology in their everyday lives. As a mood for dialogue pervades many institutions in their relations with 'publics', attention must now be paid to the way in which knowledge and expertise is expressed, heard and acted upon in dialogic encounters. There is increasing concern about public trust in science and calls to increase public confidence, particularly through more open engagement with a range of publics. However, lack of trust or loss of confidence may be constructed as problems rather than reflecting empirical reality, where more complex relationships and attitudes prevail. Lack of trust is often privatized, deeply rooted in lived experience and routinely managed. Trust relations are generally characterized by ambivalence, uncertainty and risk, and are always provisional. Drawing on selected literature and empirical research to review and illustrate this field, this paper argues that scepticism or ambivalence on the part of publics are not necessarily problems to be overcome in the interest of scientific progress, but rather should be mobilized to enhance open and public debates about the nature and direction of genomics research, medicine, and the related

  12. The changing National Health Service: market-based reform and morality: Comment on "Morality and Markets in the NHS".

    PubMed

    Frith, Lucy

    2015-04-01

    This commentary explores some of the issues raised by Gilbert et al. short communication, Morality and Markets in the NHS. The increasing role of market mechanisms and the changing types of healthcare providers together with the use of choice and competition to drive improvements in quality in the National Health Service (NHS), all have important ethical implications. In order for the NHS to continue providing the level of service quality that out performs many high-income countries, despite spending much less on healthcare, we need a re-think of creeping marketization and privatisation and a consolidation of the NHS as a publically owned resource run for the benefit of patients and the public, not commercial interests.

  13. The changing National Health Service: market-based reform and morality: Comment on "Morality and Markets in the NHS".

    PubMed

    Frith, Lucy

    2015-04-01

    This commentary explores some of the issues raised by Gilbert et al. short communication, Morality and Markets in the NHS. The increasing role of market mechanisms and the changing types of healthcare providers together with the use of choice and competition to drive improvements in quality in the National Health Service (NHS), all have important ethical implications. In order for the NHS to continue providing the level of service quality that out performs many high-income countries, despite spending much less on healthcare, we need a re-think of creeping marketization and privatisation and a consolidation of the NHS as a publically owned resource run for the benefit of patients and the public, not commercial interests. PMID:25844389

  14. Making health care more sustainable: the case of the English NHS.

    PubMed

    Pencheon, David

    2015-10-01

    The NHS is the most revered organisation in Britain: 'the proudest achievement of our modern society'. It is certainly the largest, although since its inception in 1948 it has operated in a government-funded environment of restricted resources. Nevertheless, it has also benefitted from a generally effective model of intervention centred on a hospital care system integrating specialist and emergency care and a primary care system which functions as both a source of treatment and a gatekeeper to specialist care. New circumstances, including environmentally-generated risk and a shifting disease reality, challenges the adequacy of this model. This paper argues that these new circumstances, some of which have seen a legislative response by government, mean that the NHS has to apply sustainable development thinking programmatically throughout its management and operations. It is also argued that the organisation needs to refocus towards prevention particularly in order to stem the rising tide of non-communicable disease. This paper sets out the thinking and actions of the Sustainable Development Unit, which has the task of developing and implanting sustainability concepts in the NHS. It is argued that the cause of sustainable development calls for a mix of cultural and technological shifts, new incentives and a rolling programme of innovative change. Some examples of success are presented. PMID:26410181

  15. Making health care more sustainable: the case of the English NHS.

    PubMed

    Pencheon, David

    2015-10-01

    The NHS is the most revered organisation in Britain: 'the proudest achievement of our modern society'. It is certainly the largest, although since its inception in 1948 it has operated in a government-funded environment of restricted resources. Nevertheless, it has also benefitted from a generally effective model of intervention centred on a hospital care system integrating specialist and emergency care and a primary care system which functions as both a source of treatment and a gatekeeper to specialist care. New circumstances, including environmentally-generated risk and a shifting disease reality, challenges the adequacy of this model. This paper argues that these new circumstances, some of which have seen a legislative response by government, mean that the NHS has to apply sustainable development thinking programmatically throughout its management and operations. It is also argued that the organisation needs to refocus towards prevention particularly in order to stem the rising tide of non-communicable disease. This paper sets out the thinking and actions of the Sustainable Development Unit, which has the task of developing and implanting sustainability concepts in the NHS. It is argued that the cause of sustainable development calls for a mix of cultural and technological shifts, new incentives and a rolling programme of innovative change. Some examples of success are presented.

  16. General practitioner-led commissioning in the NHS: progress, prospects and pitfalls.

    PubMed

    Mannion, Russell

    2011-01-01

    The latest NHS reforms in England will require all general practices to become members of general practitioner (GP) consortia. These organisations will have responsibility for commissioning the majority of health care for their local populations. This article reviews the history and evidence on impact of the previous models of GP commissioning that have been introduced in the NHS with the aim of distilling key lessons for the design, implementation and evaluation of the latest reforms. GP commissioning has the potential to generate a variety of benefits for the NHS and patients, including lowering elective and non-elective referrals, reducing waiting times, improved coordination of primary and community support services and better financial risk management. GP commissioning has also the potential to reduce patient satisfaction, increase inequalities between geographical areas and may generate substantial management and transaction costs. The GP community will need to display strong directive leadership as well as nurture a culture of collaboration and group camaraderie among practices if the GP consortia model of commissioning is to deliver the desired improvements in quality and performance. The implementation of the new GP consortia model of commissioning needs to be monitored and evaluated to ensure that the benefits are maximized and any unintended and dysfunctional effects mitigated.

  17. Carbodiimide/NHS derivatization of COOH-terminated SAMs: activation or byproduct formation?

    PubMed

    Palazon, Francisco; Benavides, Cindy Montenegro; Léonard, Didier; Souteyrand, Éliane; Chevolot, Yann; Cloarec, Jean-Pierre

    2014-04-29

    COOH-terminated self-assembled monolayers (SAMs) are widely used in biosensor technology to bind different amine-containing biomolecules. A covalent amide bond, however, can be achieved only if the carboxylic acids are activated. This activation process usually consists of forming an N-hydroxysuccinimidyl ester (NHS-ester) by consecutively reacting carboxylic acids with a carbodiimide and NHS. Though many papers report using this method,1-8 the experimental conditions vary greatly between them and chemical characterization at this stage is often omitted. Evidence of an efficient activation is therefore rarely shown. Furthermore, recent publications9-11 have highlighted the complexity of this process, with the possible formation of different byproducts. In this paper, we have conducted a study on NHS activation under different conditions with chemical characterization by polarization-modulation infrared reflection-absorption spectroscopy (PM-IRRAS) and time-of-flight secondary ion mass spectroscopy (ToF-SIMS). Our results indicate that the nature of the solvent and carbodiimide and the reactant concentrations play crucial roles in activation kinetics and efficiency.

  18. Estimating the financial cost of chronic kidney disease to the NHS in England

    PubMed Central

    Kerr, Marion; Bray, Benjamin; Medcalf, James; O'Donoghue, Donal J.; Matthews, Beverley

    2012-01-01

    Background Chronic kidney disease (CKD) is a major challenge for health care systems around the world, and the prevalence rates appear to be increasing. We estimate the costs of CKD in a universal health care system. Methods Economic modelling was used to estimate the annual cost of Stages 3–5 CKD to the National Health Service (NHS) in England, including CKD-related prescribing and care, renal replacement therapy (RRT), and excess strokes, myocardial infarctions (MIs) and Methicillin-Resistant Staphylococcus Aureus (MRSA) infections in people with CKD. Results The cost of CKD to the English NHS in 2009–10 is estimated at £1.44 to £1.45 billion, which is ∼1.3% of all NHS spending in that year. More than half this sum was spent on RRT, which was provided for 2% of the CKD population. The economic model estimates that ∼7000 excess strokes and 12 000 excess MIs occurred in the CKD population in 2009–10, relative to an age- and gender-matched population without CKD. The cost of excess strokes and MIs is estimated at £174–£178 million. Conclusions The financial impact of CKD is large, with particularly high costs relating to RRT and cardiovascular complications. It is hoped that these detailed cost estimates will be useful in analysing the cost-effectiveness of treatments for CKD. PMID:22815543

  19. Exploring equity in uptake of the NHS Health Check and a nested physical activity intervention trial

    PubMed Central

    Attwood, S.; Morton, K.; Sutton, S.

    2016-01-01

    Background Socio-demographic factors characterizing disadvantage may influence uptake of preventative health interventions such as the NHS Health Check and research trials informing their content. Methods A cross-sectional study examining socio-demographic characteristics of participants and non-participants to the NHS Health Check and a nested trial of very brief physical activity interventions within this context. Age, gender, Index of Multiple Deprivation (IMD) and ethnicity were extracted from patient records of four General Practices (GP) in England. Results In multivariate analyses controlling for GP surgery, the odds of participation in the Health Check were higher for older patients (OR 1.05, 95% CI 1.04–1.07) and lower from areas of greater deprivation (IMD Quintiles 4 versus 1, OR 0.37, 95% CI 0.18–0.76, 5 versus 1 OR 0.42, 95% CI 0.20–0.88). Older patients were more likely to participate in the physical activity trial (OR 1.04, 95% CI 1.02–1.06). Conclusions Younger patients and those living in areas of greater deprivation may be at risk of non-participation in the NHS Health Check, while younger age also predicted non-participation in a nested research trial. The role that GP-surgery-specific factors play in influencing participation across different socio-demographic groups requires further exploration. PMID:26036701

  20. Healthcare financing reform in Latvia: switching from social health insurance to NHS and back?

    PubMed

    Mitenbergs, Uldis; Brigis, Girts; Quentin, Wilm

    2014-11-01

    In the 1990s, Latvia aimed at introducing Social Health Insurance (SHI) but later changed to a National Health Service (NHS) type system. The NHS is financed from general taxation, provides coverage to the entire population, and pays for a basic service package purchased from independent public and private providers. In November 2013, the Cabinet of Ministers passed a draft Healthcare Financing Law, aiming at increasing public expenditures on health by introducing Compulsory Health Insurance (CHI) and linking entitlement to health services to the payment of income tax. Opponents of the reform argue that linking entitlement to health services to the payment of income tax does not have the potential to increase public expenditures on health but that it can contribute to compromising universal coverage and access to health services of certain population groups. In view of strong opposition, it is unlikely that the law will be adopted before parliamentary elections in October 2014. Nevertheless, the discussion around the law is interesting because of three main reasons: (1) it can illustrate why the concept of SHI remains attractive - not only for Latvia but also for other countries, (2) it shows that a change from NHS to SHI does not imply major institutional reforms, and (3) it demonstrates the potential problems of introducing SHI, i.e. of linking entitlement to health services to the payment of contributions. PMID:25445111

  1. New roles and responsibilities of NHS chief executives in relation to quality and clinical governance

    PubMed Central

    Sausman, C.

    2001-01-01

    The role of the chief executive in the NHS is to act as organisational head, with financial and managerial responsibility, and now responsibility has been extended to include clinical standards as part of the duty of quality and the introduction of clinical governance. These new responsibilities have implications for relations with staff inside the organisation and, in particular, with clinicians, as well as adding to the overall public accountability of chief executives. As well as increasing expectations of chief executives to meet performance objectives and other targets within the organisation, their role remains relatively new and sometimes contentious in the health service, forming part of the history of NHS management reform. The developing role of chief executives and the complex world in which they operate in the health service is discussed. It is suggested that support from colleagues at both the organisational and national levels is required to help them discharge their new responsibilities, together with a greater focus on the development of their role and skills. Key Words: NHS chief executives; management reform; clinical governance PMID:11700374

  2. Healthcare financing reform in Latvia: switching from social health insurance to NHS and back?

    PubMed

    Mitenbergs, Uldis; Brigis, Girts; Quentin, Wilm

    2014-11-01

    In the 1990s, Latvia aimed at introducing Social Health Insurance (SHI) but later changed to a National Health Service (NHS) type system. The NHS is financed from general taxation, provides coverage to the entire population, and pays for a basic service package purchased from independent public and private providers. In November 2013, the Cabinet of Ministers passed a draft Healthcare Financing Law, aiming at increasing public expenditures on health by introducing Compulsory Health Insurance (CHI) and linking entitlement to health services to the payment of income tax. Opponents of the reform argue that linking entitlement to health services to the payment of income tax does not have the potential to increase public expenditures on health but that it can contribute to compromising universal coverage and access to health services of certain population groups. In view of strong opposition, it is unlikely that the law will be adopted before parliamentary elections in October 2014. Nevertheless, the discussion around the law is interesting because of three main reasons: (1) it can illustrate why the concept of SHI remains attractive - not only for Latvia but also for other countries, (2) it shows that a change from NHS to SHI does not imply major institutional reforms, and (3) it demonstrates the potential problems of introducing SHI, i.e. of linking entitlement to health services to the payment of contributions.

  3. Sinking slowly: Diversity in propensity to trust predicts downward trust spirals in small groups.

    PubMed

    Ferguson, Amanda J; Peterson, Randall S

    2015-07-01

    This paper examines the phenomenon of trust spirals in small groups. Drawing on literature on the spiral reinforcement of trust, we theorize that diversity in propensity to trust has affective and cognitive consequences related to trust (i.e., feelings of frustration and perceptions of low similarity), reducing the level of experienced intragroup trust early in a group's development. Reduced experienced trust then fuels relationship conflict and lowers trust even further over time, ultimately having a negative effect on group performance. These ideas are tested using a sample of MBA student groups surveyed at 3 time periods over 4 months. Results confirm our hypothesis that diversity in propensity to trust is sufficient to trigger a downward trust spiral and poor performance in small groups. PMID:25602121

  4. Unfounded trust: a constructivist meditation.

    PubMed

    Neimeyer, R A

    2001-01-01

    From a postmodern standpoint, all trust is ultimately unfounded, in the sense that no authoritative theoretical, empirical or practical foundation exists to ground a unified, explicit, and justified framework for psychotherapeutic practice. Following a constructivist meditation on these themes, I offer five playful prescriptions for addressing this predicament that suggest a provisional way forward in a terrain that offers no firm footholds having bedrock certainty.

  5. Money and trust among strangers

    PubMed Central

    Camera, Gabriele; Casari, Marco; Bigoni, Maria

    2013-01-01

    What makes money essential for the functioning of modern society? Through an experiment, we present evidence for the existence of a relevant behavioral dimension in addition to the standard theoretical arguments. Subjects faced repeated opportunities to help an anonymous counterpart who changed over time. Cooperation required trusting that help given to a stranger today would be returned by a stranger in the future. Cooperation levels declined when going from small to large groups of strangers, even if monitoring and payoffs from cooperation were invariant to group size. We then introduced intrinsically worthless tokens. Tokens endogenously became money: subjects took to reward help with a token and to demand a token in exchange for help. Subjects trusted that strangers would return help for a token. Cooperation levels remained stable as the groups grew larger. In all conditions, full cooperation was possible through a social norm of decentralized enforcement, without using tokens. This turned out to be especially demanding in large groups. Lack of trust among strangers thus made money behaviorally essential. To explain these results, we developed an evolutionary model. When behavior in society is heterogeneous, cooperation collapses without tokens. In contrast, the use of tokens makes cooperation evolutionarily stable. PMID:23980139

  6. Money and trust among strangers.

    PubMed

    Camera, Gabriele; Casari, Marco; Bigoni, Maria

    2013-09-10

    What makes money essential for the functioning of modern society? Through an experiment, we present evidence for the existence of a relevant behavioral dimension in addition to the standard theoretical arguments. Subjects faced repeated opportunities to help an anonymous counterpart who changed over time. Cooperation required trusting that help given to a stranger today would be returned by a stranger in the future. Cooperation levels declined when going from small to large groups of strangers, even if monitoring and payoffs from cooperation were invariant to group size. We then introduced intrinsically worthless tokens. Tokens endogenously became money: subjects took to reward help with a token and to demand a token in exchange for help. Subjects trusted that strangers would return help for a token. Cooperation levels remained stable as the groups grew larger. In all conditions, full cooperation was possible through a social norm of decentralized enforcement, without using tokens. This turned out to be especially demanding in large groups. Lack of trust among strangers thus made money behaviorally essential. To explain these results, we developed an evolutionary model. When behavior in society is heterogeneous, cooperation collapses without tokens. In contrast, the use of tokens makes cooperation evolutionarily stable.

  7. From the general to the specific: How social trust motivates relational trust.

    PubMed

    Robbins, Blaine G

    2016-01-01

    When people form beliefs about the trustworthiness of others with respect to particular matters (i.e., when individuals trust), theory suggests that they rely on preexistent cognitive schemas regarding the general cooperativeness of individuals and organizations (i.e., social trust). In spite of prior work, the impact of social trust on relational trust-or what Russell Hardin (2002) calls trust as a three-part relation where actor A trusts actor B with reference to matter Y-is not well established. Four vignette experiments were administered to Amazon.com Mechanical Turk workers (N = 1388 and N = 1419) and to public university undergraduate students (N = 995 and N = 956) in order to investigate the relationship between social trust and relational trust. Measures of general social trust and particular social trust produced statistically equivalent effects that were positively associated with relational trust. Political trust, however, was statistically unrelated to relational trust. These results support the idea that people rely on schemas and stereotypes concerned with the general cooperativeness and helpfulness of others when forming beliefs about another person's trustworthiness with respect to a particular matter at hand.

  8. From the general to the specific: How social trust motivates relational trust.

    PubMed

    Robbins, Blaine G

    2016-01-01

    When people form beliefs about the trustworthiness of others with respect to particular matters (i.e., when individuals trust), theory suggests that they rely on preexistent cognitive schemas regarding the general cooperativeness of individuals and organizations (i.e., social trust). In spite of prior work, the impact of social trust on relational trust-or what Russell Hardin (2002) calls trust as a three-part relation where actor A trusts actor B with reference to matter Y-is not well established. Four vignette experiments were administered to Amazon.com Mechanical Turk workers (N = 1388 and N = 1419) and to public university undergraduate students (N = 995 and N = 956) in order to investigate the relationship between social trust and relational trust. Measures of general social trust and particular social trust produced statistically equivalent effects that were positively associated with relational trust. Political trust, however, was statistically unrelated to relational trust. These results support the idea that people rely on schemas and stereotypes concerned with the general cooperativeness and helpfulness of others when forming beliefs about another person's trustworthiness with respect to a particular matter at hand. PMID:26680285

  9. Trusted Routing Based on Dynamic Trust Mechanism in Mobile Ad-Hoc Networks

    NASA Astrophysics Data System (ADS)

    Peng, Sancheng; Jia, Weijia; Wang, Guojun; Wu, Jie; Guo, Minyi

    Due to the distributed nature, mobile ad-hoc networks (MANETs) are vulnerable to various attacks, resulting in distrusted communications. To achieve trusted communications, it is important to build trusted routes in routing algorithms in a self-organizing and decentralized fashion. This paper proposes a trusted routing to locate and to preserve trusted routes in MANETs. Instead of using a hard security mechanism, we employ a new dynamic trust mechanism based on multiple constraints and collaborative filtering. The dynamic trust mechanism can effectively evaluate the trust and obtain the precise trust value among nodes, and can also be integrated into existing routing protocols for MANETs, such as ad hoc on-demand distance vector routing (AODV) and dynamic source routing (DSR). As an example, we present a trusted routing protocol, based on dynamic trust mechanism, by extending DSR, in which a node makes a routing decision based on the trust values on its neighboring nodes, and finally, establish a trusted route through the trust values of the nodes along the route in MANETs. The effectiveness of our approach is validated through extensive simulations.

  10. The Value of Trust to Nursing.

    PubMed

    Rutherford, Marcella M

    2014-01-01

    Trust, one of nursing's intangible assets, impacts nurses' ability to form meaningful relationships with patients and this connection positively impacts health outcomes. Linking trust to the fabric of nursing and investing in its measurement will become essential to nursing's valuation and the resulting investment in nursing. Trust, as nursing's core value, should be fostered by nurse educators as they prepare the next generation of nurses. Nurse administrators should connect the trust a patient has for his or her nurse and patient cooperation and honest transparent communication between providers and the patient. Banking trust as a valuable nursing asset will substantiate nursing's marketing and support its worth. Nursing's trustworthiness is an intangible asset that warrants protection, as trust once lost is hard to recapture.

  11. Social information influences trust behaviour in adolescents.

    PubMed

    Lee, Nikki C; Jolles, Jelle; Krabbendam, Lydia

    2016-01-01

    Trust plays an integral role in daily interactions within adolescents' social environment. Using a trust game paradigm, this study investigated the modulating influence of social information about three interaction partners on trust behaviour in adolescents aged 12-18 (N = 845). After receiving information about their interaction partners prior to the task, participants were most likely to share with a 'good' partner and rate this partner as most trustworthy. Over the course of the task all interaction partners showed similar levels of trustworthy behaviour, but overall participants continued to trust and view the good partner as more trustworthy than 'bad' and 'neutral' partners throughout the game. However, with age the ability to overcome prior social information and adapt trust behaviour improved: middle and late adolescents showed a larger decrease in trust of the good partner than early adolescents, and late adolescents were more likely to reward trustworthy behaviour from the negative partner.

  12. Social information influences trust behaviour in adolescents.

    PubMed

    Lee, Nikki C; Jolles, Jelle; Krabbendam, Lydia

    2016-01-01

    Trust plays an integral role in daily interactions within adolescents' social environment. Using a trust game paradigm, this study investigated the modulating influence of social information about three interaction partners on trust behaviour in adolescents aged 12-18 (N = 845). After receiving information about their interaction partners prior to the task, participants were most likely to share with a 'good' partner and rate this partner as most trustworthy. Over the course of the task all interaction partners showed similar levels of trustworthy behaviour, but overall participants continued to trust and view the good partner as more trustworthy than 'bad' and 'neutral' partners throughout the game. However, with age the ability to overcome prior social information and adapt trust behaviour improved: middle and late adolescents showed a larger decrease in trust of the good partner than early adolescents, and late adolescents were more likely to reward trustworthy behaviour from the negative partner. PMID:26599529

  13. The Value of Trust to Nursing.

    PubMed

    Rutherford, Marcella M

    2014-01-01

    Trust, one of nursing's intangible assets, impacts nurses' ability to form meaningful relationships with patients and this connection positively impacts health outcomes. Linking trust to the fabric of nursing and investing in its measurement will become essential to nursing's valuation and the resulting investment in nursing. Trust, as nursing's core value, should be fostered by nurse educators as they prepare the next generation of nurses. Nurse administrators should connect the trust a patient has for his or her nurse and patient cooperation and honest transparent communication between providers and the patient. Banking trust as a valuable nursing asset will substantiate nursing's marketing and support its worth. Nursing's trustworthiness is an intangible asset that warrants protection, as trust once lost is hard to recapture. PMID:26267958

  14. 17 CFR 240.16a-8 - Trusts.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 17 Commodity and Securities Exchanges 3 2010-04-01 2010-04-01 false Trusts. 240.16a-8 Section 240...-8 Trusts. (a) Persons subject to section 16—(1) Trusts. A trust shall be subject to section 16 of the Act with respect to securities of the issuer if the trust is a beneficial owner, pursuant to §...

  15. 7 CFR 1400.100 - Revocable trust.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... OF AGRICULTURE GENERAL REGULATIONS AND POLICIES PAYMENT LIMITATION AND PAYMENT ELIGIBILITY FOR 2009 AND SUBSEQUENT CROP, PROGRAM, OR FISCAL YEARS Payment Limitation § 1400.100 Revocable trust....

  16. Trust in automation: designing for appropriate reliance.

    PubMed

    Lee, John D; See, Katrina A

    2004-01-01

    Automation is often problematic because people fail to rely upon it appropriately. Because people respond to technology socially, trust influences reliance on automation. In particular, trust guides reliance when complexity and unanticipated situations make a complete understanding of the automation impractical. This review considers trust from the organizational, sociological, interpersonal, psychological, and neurological perspectives. It considers how the context, automation characteristics, and cognitive processes affect the appropriateness of trust. The context in which the automation is used influences automation performance and provides a goal-oriented perspective to assess automation characteristics along a dimension of attributional abstraction. These characteristics can influence trust through analytic, analogical, and affective processes. The challenges of extrapolating the concept of trust in people to trust in automation are discussed. A conceptual model integrates research regarding trust in automation and describes the dynamics of trust, the role of context, and the influence of display characteristics. Actual or potential applications of this research include improved designs of systems that require people to manage imperfect automation.

  17. On Propagating Interpersonal Trust in Social Networks

    NASA Astrophysics Data System (ADS)

    Ziegler, Cai-Nicolas

    The age of information glut has fostered the proliferation of data and documents on the Web, created by man and machine alike. Hence, there is an enormous wealth of minable knowledge that is yet to be extracted, in particular, on the Semantic Web. However, besides understanding information stated by subjects, knowing about their credibility becomes equally crucial. Hence, trust and trust metrics, conceived as computational means to evaluate trust relationships between individuals, come into play. Our major contribution to Semantic Web trust management through this work is twofold. First, we introduce a classification scheme for trust metrics along various axes and discuss advantages and drawbacks of existing approaches for Semantic Web scenarios. Hereby, we devise an advocacy for local group trust metrics, guiding us to the second part, which presents Appleseed, our novel proposal for local group trust computation. Compelling in its simplicity, Appleseed borrows many ideas from spreading activation models in psychology and relates their concepts to trust evaluation in an intuitive fashion. Moreover, we provide extensions for the Appleseed nucleus that make our trust metric handle distrust statements.

  18. On the right track.

    PubMed

    Whyte, Alison

    2016-09-21

    Sarah Ingleby, lead nurse for the acute care and hospital at night teams at Central Manchester University Hospitals NHS Foundation Trust (CMFT), says the Patientrack handheld electronic system has helped staff to identify, manage and treat sepsis. PMID:27654539

  19. Is It a Trust Issue? Factors That Influence Trust for Persons Living With HIV/AIDS.

    PubMed

    Krause, Denise D; May, Warren L

    2016-09-01

    Trust in one's health care provider, trust in the health care system in general, and even trust in one's community affects engagement in HIV-related health care. This article examines the issue of trust among a random sample of HIV-infected individuals residing in Mississippi, an area hard-hit by the HIV/AIDS epidemic. Five constructs based on survey responses from these individuals were developed: (1) trust in one's provider to offer the best possible medical care, (2) trust in one's provider to protect patient privacy, (3) willingness to disclose HIV status to one's provider, (4) trust in the health care system, and (5) trust in one's community. Findings suggest that interventions to improve trust in providers to deliver the highest quality of care should be targeted to young people, African Americans, and the more highly educated. Interventions to increase trust in providers to protect privacy should focus on creating and strengthening social support groups or networks that build relationships and foster trust. Interventions aimed to increase community trust also should be targeted to young people. This information is useful to researchers, policy makers, health care providers, and organizations interested in prioritizing interventions and strategies that have the greatest potential to reduce health disparities in HIV diagnosis and treatment in the Deep South.

  20. Is It a Trust Issue? Factors That Influence Trust for Persons Living With HIV/AIDS.

    PubMed

    Krause, Denise D; May, Warren L

    2016-09-01

    Trust in one's health care provider, trust in the health care system in general, and even trust in one's community affects engagement in HIV-related health care. This article examines the issue of trust among a random sample of HIV-infected individuals residing in Mississippi, an area hard-hit by the HIV/AIDS epidemic. Five constructs based on survey responses from these individuals were developed: (1) trust in one's provider to offer the best possible medical care, (2) trust in one's provider to protect patient privacy, (3) willingness to disclose HIV status to one's provider, (4) trust in the health care system, and (5) trust in one's community. Findings suggest that interventions to improve trust in providers to deliver the highest quality of care should be targeted to young people, African Americans, and the more highly educated. Interventions to increase trust in providers to protect privacy should focus on creating and strengthening social support groups or networks that build relationships and foster trust. Interventions aimed to increase community trust also should be targeted to young people. This information is useful to researchers, policy makers, health care providers, and organizations interested in prioritizing interventions and strategies that have the greatest potential to reduce health disparities in HIV diagnosis and treatment in the Deep South. PMID:27095034

  1. Drawing on a Knowledge-Based Trust Perspective to Examine and Conceptualize within-School Trust Development by Principals

    ERIC Educational Resources Information Center

    Cosner, Shelby

    2010-01-01

    Research has revealed the importance of trust to schools and pointed to the central role that principals play in cultivating within-school trust, yet less is known about the ways that principals cultivate such trust. Moreover, divergent perspectives and varied contexts for examining trust have limited the transfer of trust scholarship to practice…

  2. 25 CFR 1000.352 - What are “trust resources” for the purposes of the trust evaluation process?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... assets, trust revenue, royalties, or rental, including natural resources, land, water, minerals, funds... INDIAN SELF-DETERMINATION AND EDUCATION ACT Trust Evaluation Review § 1000.352 What are “trust resources” for the purposes of the trust evaluation process? (a) Trust resources include property and...

  3. 25 CFR 1000.352 - What are “trust resources” for the purposes of the trust evaluation process?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... assets, trust revenue, royalties, or rental, including natural resources, land, water, minerals, funds... INDIAN SELF-DETERMINATION AND EDUCATION ACT Trust Evaluation Review § 1000.352 What are “trust resources” for the purposes of the trust evaluation process? (a) Trust resources include property and...

  4. An economic analysis of the limits of market based reforms in the English NHS

    PubMed Central

    2013-01-01

    Background Over the past three decades, a limited range of market like mechanisms have been introduced into the hierarchically structured English National Health Service (‘NHS’), which is a nationally tax funded, budget limited healthcare system, with access to care for all, producing structures known as a quasi market. Recently, the Health and Social Care Act 2012 (‘HSCA’) has been enacted, introducing further market elements. The paper examines the theory and effects of these market mechanisms. Methods Using neo-classical economics as a primary theoretical framework, as well as new institutional economics and socio-legal theory, the paper first examines the fundamental elements of markets, comparing these with the operation of authority and resource allocation employed in hierarchical structures. Second, the paper examines the application of market concepts to the delivery of healthcare, drawing out the problems which economic and socio-legal theories predict are likely to be encountered. Third, the paper discusses the research evidence concerning the operation of the quasi market in the English NHS. This evidence is provided by research conducted in the UK which uses economic and socio-legal logic to investigate the operation of the economic aspects of the NHS quasi market. Fourth, the paper provides an analysis of the salient elements of the quasi market regime amended by the HSCA 2012. Results It is not possible to construct a market conforming to classical economic principles in respect of healthcare. Moreover, it is not desirable to do so, as goals which markets cannot deliver (such as fairness of access) are crucial in England. Most of the evidence shows that the quasi market mechanisms used in the English NHS do not appear to be effective either. This finding should be seen in the light of the fact that the operation of these mechanisms has been significantly affected by the national political (i.e. continuingly hierarchical) and budgetary context

  5. Assessing knowledge skills in the NHS: a training needs analysis approach.

    PubMed

    Hamilton, Seona

    2013-06-01

    This feature discusses the use of a training needs analysis exercise carried out by library staff at the NHS Greater Glasgow & Clyde (NHSGGC) Library Network to support the development of a fit for purpose programme of information skills training. A survey was designed based on a well-known information skills competency framework and used to gain an understanding of the knowledge skills needed by staff and how library training could best support these. The survey received a good response rate and led to the successful writing of a training plan for the Library Network for the delivery of information skills training. H.S.

  6. Defining the Pharmacodynamic Profile and Therapeutic Index of NHS-IL12 Immunocytokine in Dogs with Malignant Melanoma

    PubMed Central

    Paoloni, Melissa; Mazcko, Christina; Selting, Kimberly; Lana, Susan; Barber, Lisa; Phillips, Jeffrey; Skorupski, Katherine; Vail, David; Wilson, Heather; Biller, Barbara; Avery, Anne; Kiupel, Matti; LeBlanc, Amy; Bernhardt, Anna; Brunkhorst, Beatrice; Tighe, Robert; Khanna, Chand

    2015-01-01

    Background Interleukin (IL)-12 is a pro-inflammatory cytokine that mediates T-helper type 1 responses and cytotoxic T-cell activation, contributing to its utility as anti-cancer agent. Systemic administration of IL-12 often results in unacceptable toxicity; therefore, strategies to direct delivery of IL-12 to tumors are under investigation. The objective of this study was to assist the preclinical development of NHS-IL12, an immunocytokine consisting of an antibody, which targets necrotic tumor regions, linked to IL-12. Specifically this study sought to evaluate the safety, serum pharmacokinetics, anti-tumor activity, and immune modulation of NHS-IL12 in dogs with naturally occurring cancers. Methodology/Principal Findings A rapid dose-escalation study of NHS-IL12 administered subcutaneously to dogs with melanoma was conducted through the Comparative Oncology Trials Consortium (COTC). Eleven dogs were enrolled in four dose-escalation cohorts; thereafter, an additional seven dogs were treated at the defined tolerable dose of 0.8 mg/m2. The expanded cohort at this fixed dose (ten dogs in total) was accrued for further pharmacokinetics and pharmacodynamics assessment. NHS-IL12 levels, serum cytokine concentrations, and peripheral blood mononuclear cell characterization (post-treatment) and draining lymph node immune profiling, and tumor biopsies (pre- and post-treatment) were collected. Adverse events included thrombocytopenia, liver enzymopathies, fever, and vasculitis. Correlation between interferon (IFN)-γ induction, adverse events, and NHS-IL12 exposure (maximum concentration and area under the concentration-time curve) were dose-dependent. Serum IL-10 levels and intratumoral CD8+ populations increased after treatment. Partial responses, according to Response Evaluation Criteria in Solid Tumors (RECIST) criteria, were observed in two dogs treated with NHS-IL12 0.8 mg/m2 and 1.6 mg/m2. Conclusions/Significance NHS-IL12 was administered safely to dogs with melanoma

  7. 25 CFR 1000.355 - How are trust evaluations conducted?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... EDUCATION ACT Trust Evaluation Review Annual Trust Evaluations § 1000.355 How are trust evaluations... allow for the Tribe's/Consortium's unique history and circumstances and the terms and conditions of...

  8. 5 CFR 2634.405 - Certification of trusts.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... of a qualified trust, or the nature or negligible value of the assets proposed for a trust's initial... the umbrella agreement is certified as a qualified trust (categorized as to value in accordance...

  9. In-gel NHS-propionate derivatization for histone post-translational modifications analysis in Arabidopsis thaliana.

    PubMed

    Chen, Jiajia; Gao, Jun; Peng, Maolin; Wang, Yi; Yu, Yanyan; Yang, Pengyuan; Jin, Hong

    2015-07-30

    Post-translational modifications (PTMs) on histone are highly correlated with genetic and epigenetic regulation of gene expression from chromatin. Mass spectrometry (MS) has developed to be an optimal tool for the identification and quantification of histone PTMs. Derivatization of histones with chemicals such as propionic anhydride, N-hydroxysuccinimide ester (NHS-propionate) has been widely used in histone PTMs analysis in bottom-up MS strategy, which requires high purity for histone samples. However, biological samples are not always prepared with high purity, containing detergents or other interferences in most cases. As an alternative approach, an adaptation of in gel derivatization method, termed In-gel NHS, is utilized for a broader application in histone PTMs analysis and it is shown to be a more time-saving preparation method. The proposed method was optimized for a better derivatization efficiency and displayed high reproducibility, indicating quantification of histone PTMs based on In-gel NHS was achievable. Without any traditional fussy histone purification procedures, we succeeded to quantitatively profile the histone PTMs from Arabidopsis with selective knock down of CLF (clf-29) and the original parental (col) with In-gel NHS method in a rapid way, which indicated the high specificity of CLF on H3K27me3 in Arabidopsis. In-gel NHS quantification results also suggest distinctive histone modification patterns in plants, which is invaluable foundation for future studies on histone modifications in plants.

  10. Price transparency: building community trust.

    PubMed

    Clarke, Richard L

    2007-01-01

    With the push from policymakers, payers, and consumers for hospitals to make their prices public, healthcare executives need to recognize two central issues related to price transparency: 1) meaningful price transparency involves helping patients and consumers understand their financial obligation for an episode of care, and 2) price transparency is key to the most critical success strategy for healthcare providers: building trust. This article reviews the history of pricing and billing practices and explores why price transparency is not easily achieved in today's environment. Pricing is a mystery even to those of us who work in the field, yet despite its complexity, the call for price transparency is not going to go away. For transparency, the goal should be to establish a rational pricing system that is easily explainable and justified to all stakeholders. Healthcare executives must make pricing a priority, understand cost, develop a pricing philosophy, understand the overall revenue requirements, examine market conditions and prices, and set up systems for review. A rational process of price setting should enhance community trust. In this matter there is nothing less at stake than the hearts of our community members. PMID:17405387

  11. A Strategic Model of Trust Management in Web Services

    NASA Astrophysics Data System (ADS)

    Sun, Junqing; Sun, Zhaohao; Li, Yuanzhe; Zhao, Shuliang

    This article examines trust and trust management in web services and proposes a multiagent model of trust relationship in web services. It looks at the hierarchical structure of trust management in web services and proposes a strategic model of trust management in web services. The proposed approach in this article will facilitate research and development of trust management in e-commerce, web services and social networking.

  12. Further Exploration of Organizational Trust Factors

    ERIC Educational Resources Information Center

    Adams, Samuel H.; Wiswell, Albert K.

    2008-01-01

    Trust facilitates individual and organizational learning, and is often misunderstood by organizations although they must continuously learn in order to attain strategic goals and survive. Furthermore, leaders of organizations often view trust defensively and their reactions may impede organizational learning. This paper builds on prior research…

  13. Development of Trust and Reciprocity in Adolescence

    ERIC Educational Resources Information Center

    van den Bos, Wouter; Westenberg, Michiel; van Dijk, Eric; Crone, Eveline A.

    2010-01-01

    We investigate the development of two types of prosocial behavior, trust and reciprocity, as defined using a game-theoretical task that allows investigation of real-time social interaction, among 4 age groups from 9 to 25 years. By manipulating the possible outcome alternatives, we could distinguish among important determinants of trust and…

  14. 26 CFR 301.7701-4 - Trusts.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... multiple classes of ownership interests is incidental to the trust's purpose of facilitating direct... classes of ownership, the multiple classes simply provide each certificate holder with a direct interest... multiple classes of trust interests merely facilitate direct investment in the assets held by the...

  15. Social Trust and the Growth of Schooling

    ERIC Educational Resources Information Center

    Bjornskov, Christian

    2009-01-01

    The paper develops a simple model to examine how social trust might affect the growth of schooling through lowering transaction costs associated with employing educated individuals. In a sample of 52 countries, the paper thereafter provides empirical evidence that trust has led to faster growth of schooling in the period 1960-2000. The findings…

  16. 43 CFR 2532.2 - Trust patent.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Trust patent. 2532.2 Section 2532.2 Public... OF THE INTERIOR LAND RESOURCE MANAGEMENT (2000) INDIAN ALLOTMENTS Allotments § 2532.2 Trust patent... patent will be suspended for a period of 2 years from date of settlement; but in those cases where...

  17. 43 CFR 2532.2 - Trust patent.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Trust patent. 2532.2 Section 2532.2 Public... OF THE INTERIOR LAND RESOURCE MANAGEMENT (2000) INDIAN ALLOTMENTS Allotments § 2532.2 Trust patent... patent will be suspended for a period of 2 years from date of settlement; but in those cases where...

  18. 43 CFR 2532.2 - Trust patent.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false Trust patent. 2532.2 Section 2532.2 Public... OF THE INTERIOR LAND RESOURCE MANAGEMENT (2000) INDIAN ALLOTMENTS Allotments § 2532.2 Trust patent... patent will be suspended for a period of 2 years from date of settlement; but in those cases where...

  19. 43 CFR 2532.2 - Trust patent.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false Trust patent. 2532.2 Section 2532.2 Public... OF THE INTERIOR LAND RESOURCE MANAGEMENT (2000) INDIAN ALLOTMENTS Allotments § 2532.2 Trust patent... patent will be suspended for a period of 2 years from date of settlement; but in those cases where...

  20. The Early Childhood Generalized Trust Belief Scale

    ERIC Educational Resources Information Center

    Betts, Lucy R.; Rotenberg, Ken J.; Trueman, Mark

    2009-01-01

    The study was designed to develop and evaluate the Early Childhood Generalized Trust Belief Scale (ECGTBS) as a method of assessing 5-8-year-olds' generalized trust. Two hundred and eleven (103 male and 108 female) children (mean age 6 years and 2 months at Time 1) completed the ECGTBS twice over a year. A subsample of participants completed the…

  1. Geographical dimensions and correlates of trust

    SciTech Connect

    Greenberg, M.R. ); Williams, B. )

    1999-04-01

    A sample of 323 residents of New Jersey stratified by neighborhood quality (excellent, good, fair, poor) was gathered to determine if trust in science and technology to protect public health and environment at the societal scale was associated with trust of the local officials, such as the mayor, health officer, developers, mass media, and legislators who are guardians of the local environment. Societal (trust of science and technology) and neighborhood (mayor, health officer) dimensions of trust were found. These societal and neighborhood trust dimensions were weakly correlated. Respondents were divided into fur trust-of-authority groups: high societal-high neighborhood, low societal-low neighborhood, high societal-low neighborhood, and low societal-high neighborhood. High societal-high neighborhood trust respondents were older, had lived in the neighborhoods for many years, were not troubled much by neighborhood or societal environmental threats, and had a strong sense of control over their environment. In strong contrast, low societal-low neighborhood trust respondents were relatively young, typically had lived in their present neighborhood for a short time, were troubled by numerous neighborhood and societal environmental threats, did not practice many personal public health practices, and felt little control over their environment.

  2. Trusting Transformational Principals: An Empirical Surprise.

    ERIC Educational Resources Information Center

    Mannion, Patrick T.

    This study explored the relationship between transformational leadership and trust in schools. The central thesis is that high levels of trust should significantly correlate with transformational leadership behaviors by school principals. The study involved a sample of 451 teachers in 39 public secondary schools located in four suburban areas…

  3. Attachment Relationships: Self-Disclosure and Trust.

    ERIC Educational Resources Information Center

    Pistole, M. Carole

    1993-01-01

    Examined differences in trust and self-disclosure associated with secure, anxious/ambivalent, and avoidant attachment. Findings from 98 undergraduate students revealed that, in general, subjects who reported themselves as securely attached also reported, in comparison with avoidant attachment, higher levels of trust in partner, amount of…

  4. Explaining Math Achievement: Personality, Motivation, and Trust

    ERIC Educational Resources Information Center

    Kilic-Bebek, Ebru

    2009-01-01

    This study investigated the statistical significance of student trust next to the well-tested constructs of personality and motivation to determine whether trust is a significant predictor of course achievement in college math courses. Participants were 175 students who were taking undergraduate math courses in an urban public university. The…

  5. Young Children and Trust in Turkey

    ERIC Educational Resources Information Center

    Alat, Zeynep

    2014-01-01

    The aim of the study was to examine differences in children's generalised trust and the maternal behaviour, child temperament, and demographic factors on the levels of trust in children. A total of 314 mothers and their children participated in the study. Results showed no evidence of sex differences in children's beliefs. Children…

  6. The Importance of Trust in Electronic Commerce.

    ERIC Educational Resources Information Center

    Ratnasingham, Pauline

    1998-01-01

    Introduces the new concept of trust and how it influences the process of managing the security of an organization operating in an electronic commerce environment. Theoretically, the study aims to develop a framework of trust and security to provide a set of guidelines for secure electronic commerce. (Author/LRW)

  7. 76 FR 60757 - Executive Branch Qualified Trusts

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-30

    ... qualified trusts provisions for the executive branch in subparts D and E of 5 CFR part 2634 (see 57 FR 11800.... 12674, 54 FR 15159, 3 CFR, 1989 Comp., p. 215, as modified by E.O. 12731, 55 FR 42547, 3 CFR, 1990 Comp... the use of a qualified blind trust is the lack of knowledge, or actual ``blindness,'' by an...

  8. New Superintendents: Trust, Networking, and Social Capital

    ERIC Educational Resources Information Center

    Ripley, Joan; Mitchell, Roxanne M.; Richman, John A.

    2013-01-01

    This instrumental case study explored how five newly appointed superintendents identified key stakeholders and built trust and social capital with stakeholders in their districts. Stakeholder, trust, and social capital theory were the lenses that guided this study. We utilized a pragmatic research design and thematic data analysis to interpret our…

  9. Perceptions of Trust in Public Examinations

    ERIC Educational Resources Information Center

    Simpson, Lucy; Baird, Jo-Anne

    2013-01-01

    Over recent years, the credibility of public examinations in England has increasingly come to the fore. Government agencies have invested time and money into researching public perceptions of the reliability and validity of examinations. Whilst such research overlaps into the conceptual domain of trust, trust in examinations remains an elusive…

  10. The Winston Churchill Memorial Trust of Australia

    ERIC Educational Resources Information Center

    Hilton, Nicolette

    2013-01-01

    The Churchill Trust was established in 1965 to honour the memory of Sir Winston Churchill by awarding overseas research Fellowships known as "Churchill Fellowships". Since its inception, The Churchill Trust has awarded Churchill Fellowships to more than 3,700 Australians who, like Churchill, are innovative, filled with a spirit of…

  11. Explaining the justice-performance relationship: trust as exchange deepener or trust as uncertainty reducer?

    PubMed

    Colquitt, Jason A; Lepine, Jeffery A; Piccolo, Ronald F; Zapata, Cindy P; Rich, Bruce L

    2012-01-01

    Past research has revealed significant relationships between organizational justice dimensions and job performance, and trust is thought to be one mediator of those relationships. However, trust has been positioned in justice theorizing in 2 different ways, either as an indicator of the depth of an exchange relationship or as a variable that reflects levels of work-related uncertainty. Moreover, trust scholars distinguish between multiple forms of trust, including affect- and cognition-based trust, and it remains unclear which form is most relevant to justice effects. To explore these issues, we built and tested a more comprehensive model of trust mediation in which procedural, interpersonal, and distributive justice predicted affect- and cognition-based trust, with those trust forms predicting both exchange- and uncertainty-based mechanisms. The results of a field study in a hospital system revealed that the trust variables did indeed mediate the relationships between the organizational justice dimensions and job performance, with affect-based trust driving exchange-based mediation and cognition-based trust driving uncertainty-based mediation.

  12. Trusting Facebook in Crisis Situations: The Role of General Use and General Trust Toward Facebook.

    PubMed

    Szymczak, Hermann; Kücükbalaban, Pinar; Lemanski, Sandra; Knuth, Daniela; Schmidt, Silke

    2016-01-01

    An important concept that has been rather neglected in research on social media is the concept of trust. Although there is a considerable amount of research on online trust in general, little has been done in the area of social media. As a situation of risk is necessary for trust, the perceived trustworthiness of Facebook in crisis situations was examined in this study. A sample of 340 European Facebook users were questioned as part of a large European study about social media in the context of emergency situations. We found that participants' general trust toward Facebook as a medium predicted to a significant degree how much they would trust Facebook in a crisis situation. General use of Facebook and dispositional trust were also significantly associated with trust toward Facebook in a crisis situation.

  13. DualTrust: A Distributed Trust Model for Swarm-Based Autonomic Computing Systems

    SciTech Connect

    Maiden, Wendy M.; Dionysiou, Ioanna; Frincke, Deborah A.; Fink, Glenn A.; Bakken, David E.

    2011-02-01

    For autonomic computing systems that utilize mobile agents and ant colony algorithms for their sensor layer, trust management is important for the acceptance of the mobile agent sensors and to protect the system from malicious behavior by insiders and entities that have penetrated network defenses. This paper examines the trust relationships, evidence, and decisions in a representative system and finds that by monitoring the trustworthiness of the autonomic managers rather than the swarming sensors, the trust management problem becomes much more scalable and still serves to protect the swarm. We then propose the DualTrust conceptual trust model. By addressing the autonomic manager’s bi-directional primary relationships in the ACS architecture, DualTrust is able to monitor the trustworthiness of the autonomic managers, protect the sensor swarm in a scalable manner, and provide global trust awareness for the orchestrating autonomic manager.

  14. Trusting Facebook in Crisis Situations: The Role of General Use and General Trust Toward Facebook.

    PubMed

    Szymczak, Hermann; Kücükbalaban, Pinar; Lemanski, Sandra; Knuth, Daniela; Schmidt, Silke

    2016-01-01

    An important concept that has been rather neglected in research on social media is the concept of trust. Although there is a considerable amount of research on online trust in general, little has been done in the area of social media. As a situation of risk is necessary for trust, the perceived trustworthiness of Facebook in crisis situations was examined in this study. A sample of 340 European Facebook users were questioned as part of a large European study about social media in the context of emergency situations. We found that participants' general trust toward Facebook as a medium predicted to a significant degree how much they would trust Facebook in a crisis situation. General use of Facebook and dispositional trust were also significantly associated with trust toward Facebook in a crisis situation. PMID:26779662

  15. The lack of integration of clinical audit and the maintenance of medical dominance within British hospital trusts.

    PubMed

    McErlain-Burns, T L; Thomson, R

    1999-08-01

    Concerns have been expressed repeatedly about the effectiveness of clinical audit. Some have argued that this is limited by the lack of integration within day-to-day practice and with other NHS policy initiatives. We aimed to explore what mechanisms were being used to develop annual clinical audit programmes within NHS Trusts, and to describe the influence of other initiatives on this; to understand how such influences are exerted; and to understand the role of key players, in order to inform future programme development. Semi-structured face-to-face interviews were performed with Chairs of Clinical Audit Committees, Clinical Audit Managers and Co-ordinators (N = 15) in the former Yorkshire Region of the NHS in England. Concerns about the development, planning and integration of clinical audit focused upon an almost exclusive medical dominance and upon how audit leadership could be delivered within the context of hospital management structures. The lack of an overall plan for the development of clinical audit in most sites was seen as enabling the doctors' agenda to dominate. Purchasing authorities were recognized as being important, but often with limited influence. Other influences on the audit agenda, such as research and development (R&D) and clinical risk management, were rarely well co-ordinated. These findings concur with previous studies in identifying a wide range of constraints on the progress of audit. Several of these constraints operate within the internal environment, for example the doctors' agenda, and concerns about management involvement. Such constraints require resolution in order to facilitate the integration of audit with other initiatives and to achieve the goals of audit effectively. Clinical effectiveness and clinical governance may offer a means of facilitating this integration.

  16. NHS values, compassion and quality indicators for relationship based person-centred healthcare

    PubMed Central

    Cox, John

    2015-01-01

    The paper by Gilbert et al. should be on the table of every politician and National Health Service (NHS) manager in the run up to the general election, when the NHS is at the hustings. They have raised profound moral dilemmas of the internal and external market in their present form, such as the practicalities of distributive justice and the enhancement of autonomy – to which are added the preservation of personhood, the values of listening, the maintenance of altruism and the origins of compassion. It is asserted that the quality of healthcare is dependent on the quality of the caring relationship between healthcare staff members, and between staff and patients. The nature of Compassionate Resilience is outlined with respect to Health Visitor training – and the contribution of faith communities to public health is also considered. The four Quality Indicators of an enabling environment first proposed by Cox and Gray are summarised, and the need for increased conceptual clarity of these key values recognised. PMID:26029903

  17. On the Efficiency of NHS Ester Cross-Linkers for Stabilizing Integral Membrane Protein Complexes

    NASA Astrophysics Data System (ADS)

    Chen, Fan; Gerber, Sabina; Korkhov, Volodymyr M.; Mireku, Samantha; Bucher, Monika; Locher, Kaspar P.; Zenobi, Renato

    2015-03-01

    We have previously presented a straightforward approach based on high-mass matrix-assisted laser desorption/ionization (MALDI) mass spectrometry (MS) to study membrane proteins. In addition, the stoichiometry of integral membrane protein complexes could be determined by MALDI-MS, following chemical cross-linking via glutaraldehyde. However, glutaraldehyde polymerizes in solution and reacts nonspecifically with various functional groups of proteins, limiting its usefulness for structural studies of protein complexes. Here, we investigated the capability of N-hydroxysuccinimide (NHS) esters, which react much more specifically, to cross-link membrane protein complexes such as PglK and BtuC2D2. We present clear evidence that NHS esters are capable of stabilizing membrane protein complexes in situ, in the presence of detergents such as DDM, C12E8, and LDAO. The stabilization efficiency strongly depends on the membrane protein structure (i.e, the number of primary amine groups and the distances between primary amines). A minimum number of primary amine groups is required, and the distances between primary amines govern whether a cross-linker with a specific spacer arm length is able to bridge two amine groups.

  18. Positron annihilation Doppler broadening spectroscopy study on Fe-ion irradiated NHS steel

    NASA Astrophysics Data System (ADS)

    Zhu, Huiping; Wang, Zhiguang; Gao, Xing; Cui, Minghuan; Li, Bingsheng; Sun, Jianrong; Yao, Cunfeng; Wei, Kongfang; Shen, Tielong; Pang, Lilong; Zhu, Yabin; Li, Yuanfei; Wang, Ji; Song, Peng; Zhang, Peng; Cao, Xingzhong

    2015-02-01

    In order to study the evolution of irradiation-induced vacancy-type defects at different irradiation fluences and temperatures, a new type of ferritic/martensitic (F/M) steel named NHS (Novel High Silicon) was irradiated by 3.25 MeV Fe-ion at room temperature and 723 K to fluences of 4.3 × 1015 and 1.7 × 1016 ions/cm2. After irradiation, vacancy-type defects were investigated with variable-energy positron beam Doppler broadening spectra. Energetic Fe-ions produced a large number of vacancy-type defects in the NHS steel, but one single main type of vacancy-type defect was observed in both unirradiated and irradiated samples. The concentration of vacancy-type defects decreased with increasing temperature. With the increase of irradiation fluence, the concentration of vacancy-type defects increased in the sample irradiated at RT, whereas for the sample irradiated at 723 K, it decreased. The enhanced recombination between vacancies and excess interstitial Fe atoms from deeper layers, and high diffusion rate of self-interstitial atoms further improved by diffusion via grain boundary and dislocations at high temperature, are thought to be the main reasons for the reversed trend of vacancy-type defects between the samples irradiated at RT and 723 K.

  19. Services for young people with attention deficit/hyperactivity disorder transitioning from child to adult mental health services: a national survey of mental health trusts in England.

    PubMed

    Hall, Charlotte L; Newell, Karen; Taylor, John; Sayal, Kapil; Hollis, Chris

    2015-01-01

    Transition from child to adult mental health services is considered to be a difficult process, particularly for individuals with neurodevelopmental disorders such as attention deficit/hyperactivity disorder (ADHD). This article presents results from a national survey of 36 mental health National Health Service (NHS) trusts across England, the findings indicate a lack of accurate data on the number of young people with ADHD transitioning to, and being seen by, adult services. Less than half of the trusts had a specialist adult ADHD service and in only a third of the trusts were there specific commissioning arrangements for adult ADHD. Half of the trusts reported that young people with ADHD were prematurely discharged from child and adolescent mental health services (CAMHS) because there were no suitable adult services. There was also a lack of written transition protocols, care pathways, commissioned services for adults with ADHD and inadequate information sharing between services. The findings advocate the need to provide a better transition service underpinned by clear, structured guidelines and protocols, routine data collection and information sharing across child and adult services. An increase in the commission of specialist adult ADHD clinics is needed to ensure individuals have access to appropriate support and care.

  20. Cystitis - acute

    MedlinePlus

    Uncomplicated urinary tract infection; UTI - acute; Acute bladder infection; Acute bacterial cystitis ... International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 ...

  1. Recommendation Based on Trust Diffusion Model

    PubMed Central

    Li, Li

    2014-01-01

    Recommender system is emerging as a powerful and popular tool for online information relevant to a given user. The traditional recommendation system suffers from the cold start problem and the data sparsity problem. Many methods have been proposed to solve these problems, but few can achieve satisfactory efficiency. In this paper, we present a method which combines the trust diffusion (DiffTrust) algorithm and the probabilistic matrix factorization (PMF). DiffTrust is first used to study the possible diffusions of trust between various users. It is able to make use of the implicit relationship of the trust network, thus alleviating the data sparsity problem. The probabilistic matrix factorization (PMF) is then employed to combine the users' tastes with their trusted friends' interests. We evaluate the algorithm on Flixster, Moviedata, and Epinions datasets, respectively. The experimental results show that the recommendation based on our proposed DiffTrust + PMF model achieves high performance in terms of the root mean square error (RMSE), Recall, and F Measure. PMID:25009827

  2. Hype and Public Trust in Science

    PubMed Central

    Resnik, David B.

    2014-01-01

    Social scientists have begun elucidating the variables that influence public trust in science, yet little is known about hype in biotechnology and its effects on public trust. Many scholars claim that hyping biotechnology results in a loss of public trust, and possibly public enthusiasm or support for science, because public expectations of the biotechnological promises will be unmet. We argue for the need for empirical research that examines the relationships between hype, public trust, and public enthusiasm/support. We discuss the complexities in designing empirical studies that provide evidence for a causal link between hype, public trust, and public enthusiasm/support, but also illustrate how this may be remedied. Further empirical research on hype and public trust is needed in order to improve public communication of science and to design evidence-based education on the responsible conduct of research for scientists. We conclude that conceptual arguments made on hype and public trust must be nuanced to reflect our current understanding of this relationship. PMID:22045550

  3. Recommendation based on trust diffusion model.

    PubMed

    Yuan, Jinfeng; Li, Li

    2014-01-01

    Recommender system is emerging as a powerful and popular tool for online information relevant to a given user. The traditional recommendation system suffers from the cold start problem and the data sparsity problem. Many methods have been proposed to solve these problems, but few can achieve satisfactory efficiency. In this paper, we present a method which combines the trust diffusion (DiffTrust) algorithm and the probabilistic matrix factorization (PMF). DiffTrust is first used to study the possible diffusions of trust between various users. It is able to make use of the implicit relationship of the trust network, thus alleviating the data sparsity problem. The probabilistic matrix factorization (PMF) is then employed to combine the users' tastes with their trusted friends' interests. We evaluate the algorithm on Flixster, Moviedata, and Epinions datasets, respectively. The experimental results show that the recommendation based on our proposed DiffTrust + PMF model achieves high performance in terms of the root mean square error (RMSE), Recall, and F Measure.

  4. Genetic Influences Are Virtually Absent for Trust

    PubMed Central

    Van Lange, Paul A. M.; Vinkhuyzen, Anna A. E.; Posthuma, Danielle

    2014-01-01

    Over the past decades, numerous twin studies have revealed moderate to high heritability estimates for individual differences in a wide range of human traits, including cognitive ability, psychiatric disorders, and personality traits. Even factors that are generally believed to be environmental in nature have been shown to be under genetic control, albeit modest. Is such heritability also present in social traits that are conceptualized as causes and consequences of social interactions or in other ways strongly shaped by behavior of other people? Here we examine a population-based sample of 1,012 twins and relatives. We show that the genetic influence on generalized trust in other people (trust-in-others: h2 = 5%, ns), and beliefs regarding other people’s trust in the self (trust-in-self: h2 = 13%, ns), is virtually absent. As test-retest reliability for both scales were found to be moderate or high (r = .76 and r = .53, respectively) in an independent sample, we conclude that all variance in trust is likely to be accounted for by non-shared environmental influences. We show that, relative to cognitive abilities, psychiatric disorders, and classic personality variables, genetic influences are smaller for trust, and propose that experiences with or observations of the behavior of other people shape trust more strongly than other traits. PMID:24709897

  5. Wolves and Big Yellow Taxis: How Would Be Know If the NHS Is at Death's Door?: Comment on "Who killed the English National Health Service?".

    PubMed

    Greener, Ian

    2015-10-01

    Martin Powell suggests that the death of the English National Health Service (NHS) has been announced so many times we are at risk of not noticing should it actually happen. He is right. If we 'cry wolf' too many times, we risk losing sight of what is important about the NHS and why. PMID:26673181

  6. Wolves and Big Yellow Taxis: How Would Be Know If the NHS Is at Death's Door?: Comment on "Who killed the English National Health Service?".

    PubMed

    Greener, Ian

    2015-10-01

    Martin Powell suggests that the death of the English National Health Service (NHS) has been announced so many times we are at risk of not noticing should it actually happen. He is right. If we 'cry wolf' too many times, we risk losing sight of what is important about the NHS and why.

  7. Integrating electronic information resources for NHS Glasgow staff at the point of need: a model of interlibrary collaboration and resource sharing.

    PubMed

    Davies, S; Wales, A

    2001-12-01

    The Glasgow NHS Libraries Consortium has harnessed the political imperative of collaboration and the capability of electronic information resources to address inequalities in access to the knowledge base across NHS Glasgow. They have negotiated consortium arrangements to an extensive range of electronic databases and journals which no single Glasgow NHS library could afford independently. A Project Officer was appointed to undertake the administration, technical work and promotion required to build a Web-based electronic library to deliver resources to all NHS Glasgow staff on an equitable basis. Close partnership with online content providers enabled the Project Officer to find solutions to problems caused by authentication systems and license restrictions. These efforts have culminated in the production of a fully integrated virtual library--the NHS Glasgow e-Library--delivering 11 major electronic databases, 440 full-text electronic journals, 48 electronic textbooks and over 5000 journal contents pages. The NHS Glasgow e-Library is without precedent within the NHS in terms of its wealth of resources, and it provides a model for Scotland-wide access to the knowledge base. The sustainability and transferability of the resource is dependent on a number of key areas-maintenance, user training, evaluation, IT infrastructure and ongoing collaboration and unification. Ongoing research will monitor how far the NHS Glasgow e-Library has strengthened the connection between research evidence and clinical practice.

  8. A SHOCKING REQUIREMENT IN THE LAW ON NEGLIGENCE LIABILITY FOR PSYCHIATRIC ILLNESS: LIVERPOOL WOMEN'S HOSPITAL NHS FOUNDATION TRUST V RONAYNE [2015] EWCA CIV 588.

    PubMed

    Burrows, Andrew S; Burrows, John H

    2016-01-01

    The Ronayne case concerned a husband who suffered a psychiatric illness, described as an adjustment disorder, in seeing the condition of his wife who was the primary victim of admitted medical negligence. His claim for compensation, as a 'secondary victim', failed because he could not satisfy the legal requirement that there must be a sudden shocking event. This commentary criticises that requirement which appears to make no medical sense. PMID:26856615

  9. Illness Induction Syndrome: Paper I--A Series of 41 Children from 37 Families Identified at the Great Ormond Street Hospital for Children NHS Trust.

    ERIC Educational Resources Information Center

    Gray, Jenny; Bentovim, Arnon

    1996-01-01

    This study reviewed the case records of 41 British children with illnesses induced by a parent, almost always the mother. Four patterns emerged: (1) failure-to-thrive through withholding of food; (2) allegation of allergy and withholding of food; (3) allegation and fabrication of medical symptoms; and (4) active interference by poisoning or…

  10. Gillick reinstated: judging mid-childhood competence in healthcare law: an NHS Trust v ABC & A Local Authority [2014] EWHC 1445 (Fam).

    PubMed

    Moreton, Kirsty L

    2015-01-01

    This case commentary discusses a recent case concerning the competence of a 13-year-old girl to consent to the termination of her pregnancy. It critically analyses four specific elements of the judgment--Gillick competence, the impact of best interests, judicial deference to medical opinion, and individualism and the construction of undue influence. It concludes by commending the approach taken by the court as a reinstatement of the law as originally intended in Gillick but is nonetheless cautious as to its likely overall effect upon child decision-making. PMID:25425326

  11. Gillick reinstated: judging mid-childhood competence in healthcare law: an NHS Trust v ABC & A Local Authority [2014] EWHC 1445 (Fam).

    PubMed

    Moreton, Kirsty L

    2015-01-01

    This case commentary discusses a recent case concerning the competence of a 13-year-old girl to consent to the termination of her pregnancy. It critically analyses four specific elements of the judgment--Gillick competence, the impact of best interests, judicial deference to medical opinion, and individualism and the construction of undue influence. It concludes by commending the approach taken by the court as a reinstatement of the law as originally intended in Gillick but is nonetheless cautious as to its likely overall effect upon child decision-making.

  12. Using scenarios to assess the future supply of NHS nursing staff in England.

    PubMed

    Buchan, James; Seccombe, Ian

    2012-01-01

    This paper examines issues related to the future supply of registered nursing staff, midwives and health visitors in the National Health Service (NHS) in England at a time when there are major public sector funding constraints and as more of these staff are reaching retirement age. Based on available workforce data, the paper reviews different possible scenarios for the supply of NHS nurses over a ten year period, assessing the impact of different numbers of new staff being trained and of varying retirement patterns from the ageing profession.The government in England has more policy levers available than is the case in many other countries. It determines the number of pre-registration training places that are commissioned and funded, it is the major employer, and it also controls the inflow of nurses from other countries through migration policies. Scenario models provide a picture of what the future might look like under various assumptions. These outcomes can be quantified and the results used to assess the risks and opportunities of alternate policy decisions. The approach used in this paper is that of the aggregate deterministic supply model.As part of this exercise, eight scenarios were selected and modelled. These were:A. "No change"- current inflows and outflowsB. "Redundancies" - current inflow with higher outflowC. "Improved retention" - current inflow with lower outflowD. "Reduced training intakes A" - lower inflows with lower outflowE. "Reduced training intakes B" - lower inflow with higher outflowsF. "Pension time-bomb"- current inflow with a higher rate of retirementG. "Pension delayed"- current inflow with a lower rate of retirementH. "Worst case" - lower inflow and higher outflow including higher retirementMost of the scenarios indicate that a reduction in the supply of nursing staff to NHS England is possible over the next ten years. Small changes in assumptions can make a substantial difference to outcomes and therefore emphasize the point that it

  13. DualTrust: A Trust Management Model for Swarm-Based Autonomic Computing Systems

    SciTech Connect

    Maiden, Wendy M.

    2010-05-01

    Trust management techniques must be adapted to the unique needs of the application architectures and problem domains to which they are applied. For autonomic computing systems that utilize mobile agents and ant colony algorithms for their sensor layer, certain characteristics of the mobile agent ant swarm -- their lightweight, ephemeral nature and indirect communication -- make this adaptation especially challenging. This thesis looks at the trust issues and opportunities in swarm-based autonomic computing systems and finds that by monitoring the trustworthiness of the autonomic managers rather than the swarming sensors, the trust management problem becomes much more scalable and still serves to protect the swarm. After analyzing the applicability of trust management research as it has been applied to architectures with similar characteristics, this thesis specifies the required characteristics for trust management mechanisms used to monitor the trustworthiness of entities in a swarm-based autonomic computing system and describes a trust model that meets these requirements.

  14. Do Reputation Systems Undermine Trust? Divergent Effects of Enforcement Type on Generalized Trust and Trustworthiness.

    PubMed

    Kuwabara, Ko

    2015-03-01

    Research shows that enforcing cooperation using contracts or tangible sanctions can backfire, undermining people's intrinsic motivation to cooperate: when the enforcement is removed, people are less trusting or trustworthy than when there is no enforcement to begin with. The author examines whether reputation systems have similar consequences for generalized trust and trustworthiness. Using a web-based experiment simulating online market transactions (studies 1 and 2), he shows that reputation systems can reinforce generalized trust and trustworthiness, unlike contractual enforcement or relational enforcement based on repeated interactions. In a survey experiment (study 3), he finds that recalling their eBay feedback scores made participants more trusting and trustworthy. These results are predicated on the diffuse nature of reputational enforcement to reinforce perceptions of trust and trustworthiness. These results have implications for understanding how different forms of governance affect generalized trust and trustworthiness. PMID:26421343

  15. Do Reputation Systems Undermine Trust? Divergent Effects of Enforcement Type on Generalized Trust and Trustworthiness.

    PubMed

    Kuwabara, Ko

    2015-03-01

    Research shows that enforcing cooperation using contracts or tangible sanctions can backfire, undermining people's intrinsic motivation to cooperate: when the enforcement is removed, people are less trusting or trustworthy than when there is no enforcement to begin with. The author examines whether reputation systems have similar consequences for generalized trust and trustworthiness. Using a web-based experiment simulating online market transactions (studies 1 and 2), he shows that reputation systems can reinforce generalized trust and trustworthiness, unlike contractual enforcement or relational enforcement based on repeated interactions. In a survey experiment (study 3), he finds that recalling their eBay feedback scores made participants more trusting and trustworthy. These results are predicated on the diffuse nature of reputational enforcement to reinforce perceptions of trust and trustworthiness. These results have implications for understanding how different forms of governance affect generalized trust and trustworthiness.

  16. 26 CFR 1.47-5 - Estates and trusts.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 1 2010-04-01 2010-04-01 true Estates and trusts. 1.47-5 Section 1.47-5... Computing Credit for Investment in Certain Depreciable Property § 1.47-5 Estates and trusts. (a) In general—(1) Disposition or cessation in hands of estate or trust. If an estate or trust disposes of...

  17. 26 CFR 8.1 - Charitable remainder trusts.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 14 2010-04-01 2010-04-01 false Charitable remainder trusts. 8.1 Section 8.1... Charitable remainder trusts. (a) Certain wills and trusts in existence on September 21, 1974. In the case of a will executed before September 21, 1974, or a trust created (within the meaning of...

  18. 24 CFR 92.500 - The HOME Investment Trust Fund.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false The HOME Investment Trust Fund. 92... Investment Trust Fund. (a) General. A HOME Investment Trust Fund consists of the accounts described in this... Investment Trust Fund United States Treasury account for each participating jurisdiction. Each...

  19. A Novel Trust Service Provider for Internet Based Commerce Applications.

    ERIC Educational Resources Information Center

    Siyal, M. Y.; Barkat, B.

    2002-01-01

    Presents a framework for enhancing trust in Internet commerce. Shows how trust can be provided through a network of Trust Service Providers (TSp). Identifies a set of services that should be offered by a TSp. Presents a distributed object-oriented implementation of trust services using CORBA, JAVA and XML. (Author/AEF)

  20. An Investigation of Teacher Trust in the Principal

    ERIC Educational Resources Information Center

    Makiewicz, Monica Kathleen

    2011-01-01

    The purpose of this work was to understand the concept of trust, its meaning, antecedents, and outcomes as they applied to teacher trust in principals. Since there are very few in-depth studies specifically on trust in a school principal, research on trust from an organizational perspective was consulted. This body of research has numerous and…

  1. Dynamic Trust Management for Mobile Networks and Its Applications

    ERIC Educational Resources Information Center

    Bao, Fenye

    2013-01-01

    Trust management in mobile networks is challenging due to dynamically changing network environments and the lack of a centralized trusted authority. In this dissertation research, we "design" and "validate" a class of dynamic trust management protocols for mobile networks, and demonstrate the utility of dynamic trust management…

  2. Teacher Trust in District Administration: A Promising Line of Inquiry

    ERIC Educational Resources Information Center

    Adams, Curt M.; Miskell, Ryan C.

    2016-01-01

    Purpose: We set out in this study to establish a foundation for a line of inquiry around teacher trust in district administration by (1) describing the role of trust in capacity building, (2) conceptualizing trust in district administration, (3) developing a scale to measure teacher trust in district administration, and (4) testing the…

  3. Trust Building via Risk Taking: A Cross-Societal Experiment

    ERIC Educational Resources Information Center

    Cook, Karen S.; Yamagishi, Toshio; Cheshire, Coye; Cooper, Robin; Matsuda, Masafumi; Mashima, Rie

    2005-01-01

    The role of risk taking in building trust relations has largely been overlooked in the burgeoning literature on trust in the social sciences; yet it is central to understanding how trust develops. We argue that a series of risk-taking behaviors is indispensable to building a trust relation. We conducted experiments in Japan and the United States…

  4. 49 CFR 1013.2 - The irrevocability of the trust.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 8 2013-10-01 2013-10-01 false The irrevocability of the trust. 1013.2 Section... BOARD, DEPARTMENT OF TRANSPORTATION GENERAL RULES AND REGULATIONS GUIDELINES FOR THE PROPER USE OF VOTING TRUSTS § 1013.2 The irrevocability of the trust. (a) The trust and the nomination of the...

  5. 49 CFR 1013.2 - The irrevocability of the trust.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 8 2012-10-01 2012-10-01 false The irrevocability of the trust. 1013.2 Section... BOARD, DEPARTMENT OF TRANSPORTATION GENERAL RULES AND REGULATIONS GUIDELINES FOR THE PROPER USE OF VOTING TRUSTS § 1013.2 The irrevocability of the trust. (a) The trust and the nomination of the...

  6. 49 CFR 1013.2 - The irrevocability of the trust.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 8 2010-10-01 2010-10-01 false The irrevocability of the trust. 1013.2 Section... BOARD, DEPARTMENT OF TRANSPORTATION GENERAL RULES AND REGULATIONS GUIDELINES FOR THE PROPER USE OF VOTING TRUSTS § 1013.2 The irrevocability of the trust. (a) The trust and the nomination of the...

  7. Trust Matters: Leadership for Successful Schools, 2nd Edition

    ERIC Educational Resources Information Center

    Tschannen-Moran, Megan

    2014-01-01

    Make your school soar by escalating trust between teachers, students, and families. Trust is an essential element in all healthy relationships, and the relationships that exist in your school are no different. How can your school leaders or teachers cultivate trust? How can your institution maintain trust once it is established? These are the…

  8. Guide to the Administration of Charitable Remainder Trusts. Third Edition.

    ERIC Educational Resources Information Center

    Clark, David W.; And Others

    This is the third edition of a workbook prepared as a kind of primer for those responsible for the administration of charitable remainder trusts in accordance with the Tax Reform Act of 1969. The topics covered include: trust administration in general; pooled income fund; unitrust; annuity trust; gift annuity; short term income (lead) trust; gift…

  9. Improving efficiency, securing savings.

    PubMed

    Baillie, Jonathan

    2016-03-01

    The NHS in England could save £1 bn annually if all NHS acute Trustsachieved the median level of estates and facilities running costs, the second (and 'final') report by Lord Carter and his team into the 'productivity and efficiency' of acute NHS Trusts across England, published on 5 February,suggests. As HEJ, editor, Jonathan Baillie reports, Lord Carter's team'songoing recent discussions with senior personnel working in a range of disciplines at 32 NHS Trusts--which followed dialogue with an initial 22 Trusts--identified 'unwarranted variation' in the use of resources ranging from staff to land and buildings on such a scale that effectively addressing this 'variation' could, the DH-commissioned team says, potentially reduce by £5 bn annually the NHS in England's costs. PMID:27132300

  10. Trust- and Location-Based Recommendations for Tourism

    NASA Astrophysics Data System (ADS)

    Hinze, Annika; Quan, Qiu

    Recommender systems in a travel guide suggest touristic sites a user may like. Typically, people are more willing to trust recommendations from people they know. We present a trust-based recommendation service for a mobile tourist guide that uses the notion of directly and indirectly trusted peers. The recommendations combine information about the peers' ratings on sights, interpersonal trust and geographical constraints. We created two trust propagation models to spread trust information throughout the traveller peer group. Our prototype supports six trust-based, location-aware recommendation algorithms.

  11. The online Managed Knowledge Network that shares knowledge for eHealth in NHS Scotland.

    PubMed

    Dallest, Kathy; Strachan, Heather; Flett, Gillian

    2009-01-01

    The Managed Knowledge Network (MKN) for Nurses, Midwives and the Allied Health Professions (NMAHPs) in NHS Scotland was launched in November 2007. The online portal supports the NMAHP network to manage its knowledge and information sources that facilitate engagement with the national eHealth programme and realisation of benefits that eHealth offers to improve healthcare and service delivery. It is an integrated change management and knowledge management initiative. Web2 technologies support the social networking side of knowledge management and learning, allowing people to contact each other and collaborate. MKN resources are managed within the e-Library also giving access to over 5,000 online journals and over 500 bibliographic databases.

  12. Helium-Implantation-Induced Damage in NHS Steel Investigated by Slow-Positron Annihilation Spectroscopy

    NASA Astrophysics Data System (ADS)

    Li, Yuan-Fei; Shen, Tie-Long; Gao, Xing; Gao, Ning; Yao, Cun-Feng; Sun, Jian-Rong; Wei, Kong-Fang; Li, Bing-Sheng; Zhang, Peng; Cao, Xing-Zhong; Zhu, Ya-Bin; Pang, Li-Long; Cui, Ming-Huan; Chang, Hai-Long; Wang, Ji; Zhu, Hui-Ping; Wang, Dong; Song, Peng; Sheng, Yan-Bin; Zhang, Hong-Peng; Hu, Bi-Tao; Wang, Zhi-Guang

    2014-03-01

    Evolutions of defects and helium contained defects produced by atomic displacement and helium deposition with helium implantation at different temperatures in novel high silicon (NHS) steel are investigated by a slow positron beam. Differences of the defect information among samples implanted by helium to a fluence of 1 × 1017 ions/cm2 at room temperature, 300°C, 450°C and 750°C are discussed. It is found that the mobility of vacancies and vacancy clusters, a recombination of vacancy-type defects and the formation of the He-V complex lead to the occurrence of these differences. At high temperature irradiations, a change of the diffusion mechanism of He atoms/He bubbles might be one of the reasons for the change of the S-parameter.

  13. Team management in the NHS--what is it all about?

    PubMed

    Haywood, S

    1979-10-01

    Multidisciplinary management teams were a significant new element in the 1974 reorganisation of the National Health Service. It was a development which in the run-up to reorganisation (and since) commanded considerable interest and, in some cases, scepticism. (R.G.S. Brown et al, 1973, 40.) Although there had been experiments in team management before the change, particularly in hospital authorities, there was no national blueprint describing their composition and method of working. This was the new factor introduced in 1974 and management teams were established at region, area and district levels. Management teams are now five years old. Most had their first meeting before the appointed day in April 1974 and there is now a fair body of experience on which to draw to make a considered evaluation of their contribution to the management of the NHS.

  14. Causes for concern: is NICE failing to uphold its responsibilities to all NHS patients?

    PubMed

    Claxton, Karl; Sculpher, Mark; Palmer, Stephen; Culyer, Anthony J

    2015-01-01

    Organisations across diverse health care systems making decisions about the funding of new medical technologies face extensive stakeholder and political pressures. As a consequence, there is quite understandable pressure to take account of other attributes of benefit and to fund technologies, even when the opportunity costs are likely exceed the benefits they offer. Recent evidence suggests that NICE technology appraisal is already approving drugs where more health is likely to be lost than gained. Also, NICE recently proposed increasing the upper bound of the cost-effectiveness threshold to reflect other attributes of benefit but without a proper assessment of the type of benefits that are expected to be displaced. It appears that NICE has taken a direction of travel, which means that more harm than good is being, and will continue to be, done, but it is unidentified NHS patients who bear the real opportunity costs. PMID:25488707

  15. Quality and professionalism in health care: a review of current initiatives in the NHS.

    PubMed Central

    Taylor, D.

    1996-01-01

    Since the start of the 1990s the NHS and the clinical professions have made significant investments in quality management in health care, and a plethora of initiatives has been aimed at service improvement. From a patient's perspective the extent to which these exercises have been cost effective is uncertain, although they have certainly involved great effort and enterprise on the part of many clinicians and managers. An important opportunity now exists to integrate this work into the mainstream of clinical and general service management. If clinicians can accept quality management concepts as central to their professional ethos and regulatory structures this could help them to maintain their professional authority and protect them and their patients from imposed decisions based on inadequate understanding of health care costs and benefits. Images p626-a PMID:8595342

  16. A Safe Place to Stay Sharp: Action Learning Meets Cooperative Inquiry in the Service of NHS OD Capacity Building

    ERIC Educational Resources Information Center

    Traeger, James; Norgate, Carolyn

    2015-01-01

    This is an account of practice. It explores the meeting point between action learning and action research, as a way of doing capacity building in organisational development (OD) in the NHS in the UK. The authors were part of a short cooperative inquiry (Heron, J. 1996. "Co-operative Inquiry: Research into the Human Condition." London:…

  17. Fast acquisition of cooperation and trust: A two-stage view of trusting behavior

    PubMed Central

    Schmid, Tom L.; Hake, Don F.

    1983-01-01

    Trustful behavior was defined in terms of the consecutive numbers of matching-to-sample problems worth money that each subject worked during sessions that ended in an equitable distribution. Two stages of acquisition are inherent in this definition; the first stage requires acquisition of an equitable method of distributing reinforcers (cooperation) to show that the within-session deviations (trust) from equity that develop during the second stage are temporary and are not part of an inequitable method of distributing reinforcers. Previous research has indicated that a contingency to trust is necessary to override the aversiveness of the inequity inherent in trusting and to produce consistent and maximal trust (half of the problems worked consecutively by each subject). The present experiment examined such a contingency. The trust contingency was an increased requirement for changing the direction of problem allocation. Only the subject who had been allocated a problem could change that allocation, by pulling a lever 45 or more times. On the other hand, no separate responses were required to allow the person who worked the last problem to also work the next one (passive trust). Hence, giving a problem was the only way to increase the distribution of problems to the other person and hence prevent oneself from receiving all of the reinforcers. All eight pairs of subjects cooperated from the outset. Trusting behavior developed for all four pairs exposed to the contingency to trust and expanded to maximal levels by the second session for three of the four pairs. PMID:16812342

  18. Maintaining standards of aesthetic practice in trainees subject to NHS restrictions.

    PubMed

    Paterson, P; Allison, K

    2006-01-01

    The Specialist Advisory Committee (SAC) in plastic surgery within the United Kingdom (UK) recommends a modular training programme to include aesthetic surgery. The intercollegiate board examinations test candidates on all aspects of aesthetic practice yet there is no formal, national aesthetic training in the UK. Closure of National Health Service (NHS) private patient facilities has reduced training opportunity [Nicolle FV. Sir Harold Gillies Memorial Lecture; Aesthetic plastic surgery and the future plastic surgeon. Br J Plast Surg 1998;51:419-24.] Calmanisation [Hospital doctors: training for the future. The Report of the Working Group on Specialist Medical Training (The Calman Report). London: HMSO; 1993.], the European Working Time Directive (EWTD) [; Phillips H, Fleet Z, Bowman K. The European Working time Directive-interim report and guidance from The Royal College of Surgeons of England working party chaired by Mr Hugh Phillips; 2003 []; Chesser S, Bowman K, Phillips H. The European Working Time Directive and the training of surgeons. BMJ Careers Focus 2002;s69-7.], and more importantly the implementation of "local" aesthetic guidelines have placed further pressures on training. Reductions of NHS case mix will ultimately lead to a reduction in trainee experience. With increasing regulatory pressure from the Commission for Healthcare Improvement, standards of aesthetic practice can only be maintained by increasing private/independent sector involvement. At present a disparity exists between the demand and provision of aesthetic surgery training in the UK. Aesthetic surgery forms part of the training curriculum for plastic surgery and as such remains a training issue. A review of aesthetic surgery training is needed in the UK through consultation with trainers and trainee representatives.

  19. Method of invitation and geographical proximity as predictors of NHS Health Check uptake

    PubMed Central

    Gidlow, Christopher; Ellis, Naomi; Randall, Jason; Cowap, Lisa; Smith, Graham; Iqbal, Zafar; Kumar, Jagdish

    2015-01-01

    Background Uptake of NHS Health Checks remains below the national target. Better understanding of predictors of uptake can inform targeting and delivery. We explored invitation method and geographical proximity as predictors of uptake in deprived urban communities. Methods This observational cohort study used data from all 4855 individuals invited for an NHS Health Check (September 2010–February 2014) at five general practices in Stoke-on-Trent, UK. Attendance/non-attendance was the binary outcome variable. Predictor variables included the method of invitation, general practice, demographics, deprivation and distance to Health Check location. Results Mean attendance (61.6%) was above the city and national average, but varied by practice (47.5–83.3%; P < 0.001). Telephone/verbal invitations were associated with higher uptake than postal invitations (OR = 2.87, 95% CI = 2.26–3.64), yet significant practice-level variation remained. Distance to Health Check was not associated with attendance. Increasing age (OR = 1.04, 95% CI = 1.03–1.04), female gender (OR = 1.48, 95% CI = 1.30–1.68) and living in the least deprived areas (OR = 1.59, 95% CI = 1.23–2.05) were all independent positive predictors of attendance. Conclusions Using verbal or telephone invitations should be considered to improve Health Check uptake. Other differences in recruitment and delivery that might explain remaining practice-level variation in uptake warrant further exploration. Geographical proximity may not be an important predictor of uptake in urban populations. PMID:25427882

  20. Complexity in the new NHS: longitudinal case studies of CCGs in England

    PubMed Central

    Checkland, Katherine; Coleman, Anna; Perkins, Neil

    2016-01-01

    Objective The reform in the English National Health Services (NHS) under the Health and Social Care Act 2012 is unlike previous NHS reorganisations. The establishment of clinical commissioning groups (CCGs) was intended to be ‘bottom up’ with no central blueprint. This paper sets out to offer evidence about how this process has played out in practice and examines the implications of the complexity and variation which emerged. Design Detailed case studies in CCGs across England, using interviews, observation and documentary analysis. Using realist framework, we unpacked the complexity of CCG structures. Setting/participants In phase 1 of the study (January 2011 to September 2012), we conducted 96 interviews, 439 h of observation in a wide variety of meetings, 2 online surveys and 38 follow-up telephone interviews. In phase 2 (April 2013 to March 2015), we conducted 42 interviews with general practitioners (GPs) and managers and observation of 48 different types of meetings. Results Our study has highlighted the complexity inherent in CCGs, arising out of the relatively permissive environment in which they developed. Not only are they very different from one another in size, but also in structure, functions between different bodies and the roles played by GPs. Conclusions The complexity and lack of uniformity of CCGs is important as it makes it difficult for those who must engage with CCGs to know who to approach at what level. This is of increasing importance as CCGs are moving towards greater integration across health and social care. Our study also suggests that there is little consensus as to what being a ‘membership’ organisation means and how it should operate. The lack of uniformity in CCG structure and lack of clarity over the meaning of ‘membership’ raises questions over accountability, which becomes of greater importance as CCG is taking over responsibility for primary care co-commissioning. PMID:26743708

  1. A Non-reductionist Approach to Trust

    NASA Astrophysics Data System (ADS)

    Castelfranchi, Cristiano; Falcone, Rino; Lorini, Emiliano

    We develop in this chapter a conceptual and logical model of social trust. We first present a modal logic of mental attitudes and action in which the concepts of plausible belief, certain belief, and a possibility order over formulas can be characterized. Then, we apply the logic to the formalization of the truster's expectation about some fundamental properties of the trustee (trustee's opportunity to accomplish a given task, his skills, abilities, and willingness to perform a given action for the accomplishment of the task). A, part of this chapter is devoted to discuss and formalize some concepts related to trust such as distrust, mistrust, lack of trust, and delegation. Finally, a concept of comparative trust is presented.

  2. Usability and trust in e-banking.

    PubMed

    Pravettoni, Gabriella; Leotta, Salvatore Nuccio; Lucchiari, Claudio; Misuraca, Raffaella

    2007-12-01

    This study assessed the role of usability in trust of e-banking services. A questionnaire was administered to 185 Italian undergraduate working students who volunteered for the experiment (M age = 30.5 yr., SD = 3.1). Participants were differentiated on computer ability (Expert, n = 104; Nonexpert, n = 81) and e-banking use (User, n = 93; Nonusers, n = 92). Analysis showed that the website usability of e-banking services did not play a very important role for the User group. Instead, institution-based trust, e.g., the trust in the security policy of the Web merchant, customers, and the overall trust of the bank were the crucial factors in the adoption of e-banking. PMID:18361127

  3. 7 CFR 46.46 - Statutory trust.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... electronic means if it can verify that the electronic data invoice or other billing statement was transmitted... buyer or third party vendor downloads or accepts the trust statement. (5) If a buyer conducts...

  4. 7 CFR 46.46 - Statutory trust.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... electronic means if it can verify that the electronic data invoice or other billing statement was transmitted... buyer or third party vendor downloads or accepts the trust statement. (5) If a buyer conducts...

  5. 7 CFR 46.46 - Statutory trust.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... electronic means if it can verify that the electronic data invoice or other billing statement was transmitted... buyer or third party vendor downloads or accepts the trust statement. (5) If a buyer conducts...

  6. 7 CFR 46.46 - Statutory trust.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... electronic means if it can verify that the electronic data invoice or other billing statement was transmitted... buyer or third party vendor downloads or accepts the trust statement. (5) If a buyer conducts...

  7. Trust Based Routing in Ad Hoc Network

    NASA Astrophysics Data System (ADS)

    Talati, Mikita V.; Valiveti, Sharada; Kotecha, K.

    Ad Hoc network often termed as an infrastructure-less, self- organized or spontaneous network.The execution and survival of an ad-hoc network is solely dependent upon the cooperative and trusting nature of its nodes. However, this naive dependency on intermediate nodes makes the ad-hoc network vulnerable to passive and active attacks by malicious nodes and cause inflict severe damage. A number of protocols have been developed to secure ad-hoc networks using cryptographic schemes, but all rely on the presence of trust authority. Due to mobility of nodes and limitation of resources in wireless network one interesting research area in MANET is routing. This paper offers various trust models and trust based routing protocols to improve the trustworthiness of the neighborhood.Thus it helps in selecting the most secure and trustworthy route from the available ones for the data transfer.

  8. Usability and trust in e-banking.

    PubMed

    Pravettoni, Gabriella; Leotta, Salvatore Nuccio; Lucchiari, Claudio; Misuraca, Raffaella

    2007-12-01

    This study assessed the role of usability in trust of e-banking services. A questionnaire was administered to 185 Italian undergraduate working students who volunteered for the experiment (M age = 30.5 yr., SD = 3.1). Participants were differentiated on computer ability (Expert, n = 104; Nonexpert, n = 81) and e-banking use (User, n = 93; Nonusers, n = 92). Analysis showed that the website usability of e-banking services did not play a very important role for the User group. Instead, institution-based trust, e.g., the trust in the security policy of the Web merchant, customers, and the overall trust of the bank were the crucial factors in the adoption of e-banking.

  9. Trust and adolescent sports: starters vs nonstarters.

    PubMed

    McGowan, S J; McGowan, R W

    1991-12-01

    Confirming earlier research, starters in basketball were found to be less trusting than nonstarters among junior high school boys (n = 12) and girls (n = 18). Researchers should explore the etiology of these differences.

  10. 26 CFR 1.401(a)-50 - Puerto Rican trusts; election to be treated as a domestic trust.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 26 Internal Revenue 5 2013-04-01 2013-04-01 false Puerto Rican trusts; election to be treated as a..., Stock Bonus Plans, Etc. § 1.401(a)-50 Puerto Rican trusts; election to be treated as a domestic trust... administrators have made the election referred to in section 1022(i)(2) are to be treated as trusts created...

  11. 26 CFR 1.401(a)-50 - Puerto Rican trusts; election to be treated as a domestic trust.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 26 Internal Revenue 5 2011-04-01 2011-04-01 false Puerto Rican trusts; election to be treated as a..., Stock Bonus Plans, Etc. § 1.401(a)-50 Puerto Rican trusts; election to be treated as a domestic trust... administrators have made the election referred to in section 1022(i)(2) are to be treated as trusts created...

  12. 26 CFR 1.401(a)-50 - Puerto Rican trusts; election to be treated as a domestic trust.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 26 Internal Revenue 5 2014-04-01 2014-04-01 false Puerto Rican trusts; election to be treated as a..., Stock Bonus Plans, Etc. § 1.401(a)-50 Puerto Rican trusts; election to be treated as a domestic trust... administrators have made the election referred to in section 1022(i)(2) are to be treated as trusts created...

  13. 26 CFR 1.401(a)-50 - Puerto Rican trusts; election to be treated as a domestic trust.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 26 Internal Revenue 5 2012-04-01 2011-04-01 true Puerto Rican trusts; election to be treated as a..., Stock Bonus Plans, Etc. § 1.401(a)-50 Puerto Rican trusts; election to be treated as a domestic trust... administrators have made the election referred to in section 1022(i)(2) are to be treated as trusts created...

  14. 26 CFR 1.401(a)-50 - Puerto Rican trusts; election to be treated as a domestic trust.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 5 2010-04-01 2010-04-01 false Puerto Rican trusts; election to be treated as a... Plans, Etc. § 1.401(a)-50 Puerto Rican trusts; election to be treated as a domestic trust. (a) In... have made the election referred to in section 1022(i)(2) are to be treated as trusts created...

  15. An Investigation of Children's Peer Trust across Culture: Is the Composition of Peer Trust Universal?

    ERIC Educational Resources Information Center

    Betts, Lucy R.; Rotenberg, Ken J.; Petrocchi, Serena; Lecciso, Flavia; Sakai, Atsushi; Maeshiro, Kazumi; Judson, Helen

    2014-01-01

    The components of children's trust in same-gender peers (trust beliefs, ascribed trustworthiness, and dyadic reciprocal trust) were examined in samples of 8-11-year-olds from the UK, Italy, and Japan. Trust was assessed by children's ratings of the extent to which same-gender classmates kept promises and kept secrets. Social relations…

  16. 43 CFR 30.180 - May I give up an inherited interest in trust or restricted property or trust personalty?

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 43 Public Lands: Interior 1 2012-10-01 2011-10-01 true May I give up an inherited interest in trust or restricted property or trust personalty? 30.180 Section 30.180 Public Lands: Interior Office of... I give up an inherited interest in trust or restricted property or trust personalty? You...

  17. 43 CFR 30.180 - May I give up an inherited interest in trust or restricted property or trust personalty?

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 43 Public Lands: Interior 1 2014-10-01 2014-10-01 false May I give up an inherited interest in trust or restricted property or trust personalty? 30.180 Section 30.180 Public Lands: Interior Office of... I give up an inherited interest in trust or restricted property or trust personalty? You...

  18. 43 CFR 30.180 - May I give up an inherited interest in trust or restricted property or trust personalty?

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 43 Public Lands: Interior 1 2013-10-01 2013-10-01 false May I give up an inherited interest in trust or restricted property or trust personalty? 30.180 Section 30.180 Public Lands: Interior Office of... I give up an inherited interest in trust or restricted property or trust personalty? You...

  19. 43 CFR 30.180 - May I give up an inherited interest in trust or restricted property or trust personalty?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false May I give up an inherited interest in trust or restricted property or trust personalty? 30.180 Section 30.180 Public Lands: Interior Office of... I give up an inherited interest in trust or restricted property or trust personalty? You...

  20. Health information privacy: why trust matters.

    PubMed

    Mancilla, Desla; Biedermann, Sue

    2009-01-01

    It is necessary to recognize the importance of gaining consumers' trust in how their health information is accessed and used. With the increased use of technology for creating, maintaining, and transmitting health information and the inherent distrust of these kinds of systems, consumer support for advantageous technology is lacking. This article addresses numerous protective measures that are in place and the role of healthcare professionals in building trust with healthcare consumers.

  1. Establishing trust in decentralized smart sensor networks

    NASA Astrophysics Data System (ADS)

    Vagts, H.; Cosar, T.; Beyerer, J.

    2011-06-01

    Smart sensors can gather all kind of information and process it. Cameras are still dominating and smart cameras can offer services for face recognition or person tracking. Operators are building collaborations to cover a larger area, to save costs and to add more and different sensors. Cryptographic methods may achieve integrity and confidentiality between operators, but not trust. Even if a partner or one of his sensors is authenticated, no statements can be made about the quality of the sensor data. Hence, trust must be established between the partners and their sensors. Trust can be built based on past experience. A reputation system collects opinions of operators about the behavior of sensors and calculates trust based on these opinions. Many reputation systems have been proposed, e.g., for authentication of files in peer-topeer networks. This work presents a new reputation system, which is designed to calculate the trustworthiness of smart sensors and smart sensor systems. A new trust model, including functions to calculate and update trust on past experiences, is proposed. When fusing information of multiple sensors, it cannot always be reconstructed, which information led to a bad result. Hence, an approach for fair rating is shown. The proposed system has been realized in a Service-Oriented Architecture for easy integration in existing smart sensor systems, e.g., smart surveillance systems. The model itself can be used in every decentralized heterogeneous smart sensor network.

  2. Interpersonal Trust across Six Asia-Pacific Countries: Testing and Extending the ‘High Trust Society’ and ‘Low Trust Society’ Theory

    PubMed Central

    Ward, Paul R.; Mamerow, Loreen; Meyer, Samantha B.

    2014-01-01

    Background Trust is regarded as a necessary component for the smooth running of society, although societal and political modernising processes have been linked to an increase in mistrust, potentially signalling social and economic problems. Fukuyama developed the notion of ‘high trust’ and ‘low trust’ societies, as a way of understanding trust within different societies. The purpose of this paper is to empirically test and extend Fukuyama’s theory utilising data on interpersonal trust in Taiwan, Hong Kong, South Korea, Japan, Australia and Thailand. This paper focuses on trust in family, neighbours, strangers, foreigners and people with a different religion. Methods Cross-sectional surveys were undertaken in 2009–10, with an overall sample of 6331. Analyses of differences in overall levels of trust between countries were undertaken using Chi square analyses. Multivariate binomial logistic regression analysis was undertaken to identify socio-demographic predictors of trust in each country. Results Our data indicate a tripartite trust model: ‘high trust’ in Australia and Hong Kong; ‘medium trust’ in Japan and Taiwan; and ‘low trust’ in South Korea and Thailand. Trust in family and neighbours were very high across all countries, although trust in people with a different religion, trust in strangers and trust in foreigners varied considerably between countries. The regression models found a consistent group of subpopulations with low trust across the countries: people on low incomes, younger people and people with poor self-rated health. The results were conflicting for gender: females had lower trust in Thailand and Hong Kong, although in Australia, males had lower trust in strangers, whereas females had lower trust in foreigners. Conclusion This paper identifies high, medium and low trust societies, in addition to high and low trusting population subgroups. Our analyses extend the seminal work of Fukuyama, providing both corroboration and

  3. Trust makers, breakers and brokers: building trust in the Australian food system

    PubMed Central

    2013-01-01

    Background The importance of consumer trust in the food supply has previously been identified, and dimensions of consumer trust in food—who they trust and the type of trust that they exhibit—has been explored. However, there is a lack of research about the mechanisms through which consumer trust in the food supply is developed, maintained, broken and repaired. This study seeks to address this gap by exploring if, and how, consumer trust in the food supply is considered by the media, food industry and governments when responding to food scares. The aim of the research is to develop models of trust building that can be implemented following food scares. Methods Semi-structured interviews will be undertaken with media, public relations officials and policy makers in Australia, New Zealand and the United Kingdom. Participants will be recruited through purposive sampling and will be asked to discuss a hypothetical case study outlining a food incident, and any experiences of specific food scares. Models of trust development, maintenance and repair will be developed from interview data. Comment on these models will be sought from experts in food-related organizations through a Delphi study, where participants will be asked to consider the usefulness of the models. Participants’ comments will be used to revise the models until consensus is reached on the suitability and usability of the models. Discussion This study will contribute to the literature about systems-based trust, and explore trust as a social and regulatory process. The protocol and results will be of interest and use to the food industry, food regulators, consumer advocate groups, media seeking to report food-related issues and policy makers concerned with public health and consumer health and well-being. This research represents an important contribution to the translation of the theoretical conceptualizations of trust into practical use in the context of food. PMID:23496819

  4. Building a Culture of Trust: Trust in the Use of Educational Technology

    ERIC Educational Resources Information Center

    Kirkman, Jacqueline

    2014-01-01

    This paper investigates the place of trust in a school context and its importance in achieving the aims of schooling, "namely high academic performance and positive affects among members of the school community" (Forsyth, 2008). The role of trust in the use of technology and technological change is examined. Literature is surveyed in the…

  5. In Public Education Expenditures We Trust: Does Trust Increase Support for Public Education Expenditures?

    ERIC Educational Resources Information Center

    Gur, Nurullah; Boyaci, Israfil; Ozcan, Yunus

    2015-01-01

    Trust is one crucial prerequisite for the welfare state. However, very few empirical studies exist that help us understand the mechanisms through which trust affects the welfare state. Influencing public support for developing friendly public policies might be one of these mechanisms. In this study, we use unique micro data from 34 countries to…

  6. Trust and Its Role in Principal Succession: A Preliminary Examination of a Continuum of Trust

    ERIC Educational Resources Information Center

    Macmillan, Robert B.; Meyer, Matthew J.; Northfield, Shawn

    2004-01-01

    Trust is a critical factor in determining whether principal-teacher working relationships are positive or negative. This article begins to explore the concept of trust and its development in twelve Canadian secondary schools that experienced frequent principal turnover in a period of eight years. The authors found that the development of trust…

  7. Acute Bronchitis

    MedlinePlus

    ... tightness. There are two main types of bronchitis: acute and chronic. Most cases of acute bronchitis get better within several days. But your ... that cause colds and the flu often cause acute bronchitis. These viruses spread through the air when ...

  8. Can one trust quantum simulators?

    PubMed

    Hauke, Philipp; Cucchietti, Fernando M; Tagliacozzo, Luca; Deutsch, Ivan; Lewenstein, Maciej

    2012-08-01

    Various fundamental phenomena of strongly correlated quantum systems such as high-T(c) superconductivity, the fractional quantum-Hall effect and quark confinement are still awaiting a universally accepted explanation. The main obstacle is the computational complexity of solving even the most simplified theoretical models which are designed to capture the relevant quantum correlations of the many-body system of interest. In his seminal 1982 paper (Feynman 1982 Int. J. Theor. Phys. 21 467), Richard Feynman suggested that such models might be solved by 'simulation' with a new type of computer whose constituent parts are effectively governed by a desired quantum many-body dynamics. Measurements on this engineered machine, now known as a 'quantum simulator,' would reveal some unknown or difficult to compute properties of a model of interest. We argue that a useful quantum simulator must satisfy four conditions: relevance, controllability, reliability and efficiency. We review the current state of the art of digital and analog quantum simulators. Whereas so far the majority of the focus, both theoretically and experimentally, has been on controllability of relevant models, we emphasize here the need for a careful analysis of reliability and efficiency in the presence of imperfections. We discuss how disorder and noise can impact these conditions, and illustrate our concerns with novel numerical simulations of a paradigmatic example: a disordered quantum spin chain governed by the Ising model in a transverse magnetic field. We find that disorder can decrease the reliability of an analog quantum simulator of this model, although large errors in local observables are introduced only for strong levels of disorder. We conclude that the answer to the question 'Can we trust quantum simulators?' is … to some extent.

  9. Effect of relationship experience on trust recovery following a breach

    PubMed Central

    Schilke, Oliver; Reimann, Martin; Cook, Karen S.

    2013-01-01

    A violation of trust can have quite different consequences, depending on the nature of the relationship in which the trust breach occurs. In this article, we identify a key relationship characteristic that affects trust recovery: the extent of relationship experience before the trust breach. Across two experiments, this investigation establishes the behavioral effect that greater relationship experience before a trust breach fosters trust recovery. A neuroimaging experiment provides initial evidence that this behavioral effect is possible because of differential activation of two brain systems: while decision making after early trust breaches engages structures of a controlled social cognition system (C-system), specifically the anterior cingulate cortex and lateral frontal cortex, decision making after later trust breaches engages structures of an automatic social cognition system (X-system), specifically the lateral temporal cortex. The present findings make contributions to both social psychological theory and the neurophysiology of trust. PMID:24003151

  10. Chimpanzees trust conspecifics to engage in low-cost reciprocity

    PubMed Central

    Engelmann, Jan M.; Herrmann, Esther; Tomasello, Michael

    2015-01-01

    Many of humans' most important social interactions rely on trust, including most notably among strangers. But little is known about the evolutionary roots of human trust. We presented chimpanzees (Pan troglodytes) with a modified version of the human trust game—trust in reciprocity—in which subjects could opt either to obtain a small but safe reward on their own or else to send a larger reward to a partner and trust her to reciprocate a part of the reward that she could not access herself. In a series of three studies, we found strong evidence that in interacting with a conspecific, chimpanzees show spontaneous trust in a novel context; flexibly adjust their level of trust to the trustworthiness of their partner and develop patterns of trusting reciprocity over time. At least in some contexts then, trust in reciprocity is not unique to humans, but rather has its evolutionary roots in the social interactions of humans' closest primate relatives. PMID:25589606

  11. Blinding trust: the effect of perceived group victimhood on intergroup trust.

    PubMed

    Rotella, Katie N; Richeson, Jennifer A; Chiao, Joan Y; Bean, Meghan G

    2013-01-01

    Four studies investigate how perceptions that one's social group has been victimized in society-that is, perceived group victimhood (PGV)-influence intergroup trust. Jewish and politically conservative participants played an economic trust game ostensibly with "partners" from their ingroup and/or a salient outgroup. Across studies, participants dispositionally or primed to be high in PGV revealed greater trust behavior with ingroup than outgroup partners. Control participants and those dispositionally low in PGV did not display such bias. Study 3 revealed, moreover, that high PGV enhanced ingroup trust even after an overt betrayal by an ingroup partner. Results were not explained by fluctuations in group identification, highlighting the novel, independent role of PGV in shaping an important aspect of intergroup relations-that is, trust. Implications of PGV for intergroup relations are discussed.

  12. Identifying and managing patients with delirium in acute care settings.

    PubMed

    Bond, Penny; Goudie, Karen

    2015-11-01

    Delirium is an acute medical emergency affecting about one in eight acute hospital inpatients. It is associated with poor outcomes, is more prevalent in older people and it is estimated that half of all patients receiving intensive care or surgery for a hip fracture will be affected. Despite its prevalence and impact, delirium is not reliably identified or well managed. Improving the identification and management of patients with delirium has been a focus for the national improving older people's acute care work programme in NHS Scotland. A delirium toolkit has been developed, which includes the 4AT rapid assessment test, information for patients and carers and a care bundle for managing delirium based on existing guidance. This toolkit has been tested and implemented by teams from a range of acute care settings to support improvements in the identification and immediate management of delirium.

  13. Opportunity seized or missed? A case study of leadership and organizational change in the creation of a Care Trust.

    PubMed

    Dickinson, Helen; Peck, Edward; Davidson, Deborah

    2007-10-01

    This paper describes an action research study which focused on an exploration of the aspirations for and initial achievements of Stratham Mental Health NHS and Social Care Trust. Local leaders perceived that Stratham had a good history of health and social care partnership working and as such, adopted an integrationist view of culture to help shape the context of the new structural form. In doing so, consistency remained a key message to staff throughout this organizational transition and the change did not appear to cause the distraction to core business which the literature suggests it would do so. However, this continuity may have come at a cost, at least initially. In the process of formalizing the previous partnership into a Care Trust, Stratham may not have produced all the beneficial effects of synergy which are usually (albeit eventually) associated with mergers in the private sector. Certainly, local actors could see opportunities that had been missed. By focusing on the structural manifestation of the relationship, the opportunities to broaden informal horizontal linkages may have been underexploited. The study of Stratham serves to confirm that the integrationist conception of culture is limited and that the differentiation of professional groupings and the ambiguity of individual experience will always make contested the meanings that are attributed to organizational change. PMID:17891624

  14. Opportunity seized or missed? A case study of leadership and organizational change in the creation of a Care Trust.

    PubMed

    Dickinson, Helen; Peck, Edward; Davidson, Deborah

    2007-10-01

    This paper describes an action research study which focused on an exploration of the aspirations for and initial achievements of Stratham Mental Health NHS and Social Care Trust. Local leaders perceived that Stratham had a good history of health and social care partnership working and as such, adopted an integrationist view of culture to help shape the context of the new structural form. In doing so, consistency remained a key message to staff throughout this organizational transition and the change did not appear to cause the distraction to core business which the literature suggests it would do so. However, this continuity may have come at a cost, at least initially. In the process of formalizing the previous partnership into a Care Trust, Stratham may not have produced all the beneficial effects of synergy which are usually (albeit eventually) associated with mergers in the private sector. Certainly, local actors could see opportunities that had been missed. By focusing on the structural manifestation of the relationship, the opportunities to broaden informal horizontal linkages may have been underexploited. The study of Stratham serves to confirm that the integrationist conception of culture is limited and that the differentiation of professional groupings and the ambiguity of individual experience will always make contested the meanings that are attributed to organizational change.

  15. Power decreases trust in social exchange.

    PubMed

    Schilke, Oliver; Reimann, Martin; Cook, Karen S

    2015-10-20

    How does lacking vs. possessing power in a social exchange affect people's trust in their exchange partner? An answer to this question has broad implications for a number of exchange settings in which dependence plays an important role. Here, we report on a series of experiments in which we manipulated participants' power position in terms of structural dependence and observed their trust perceptions and behaviors. Over a variety of different experimental paradigms and measures, we find that more powerful actors place less trust in others than less powerful actors do. Our results contradict predictions by rational actor models, which assume that low-power individuals are able to anticipate that a more powerful exchange partner will place little value on the relationship with them, thus tends to behave opportunistically, and consequently cannot be trusted. Conversely, our results support predictions by motivated cognition theory, which posits that low-power individuals want their exchange partner to be trustworthy and then act according to that desire. Mediation analyses show that, consistent with the motivated cognition account, having low power increases individuals' hope and, in turn, their perceptions of their exchange partners' benevolence, which ultimately leads them to trust.

  16. Power decreases trust in social exchange

    PubMed Central

    Schilke, Oliver; Reimann, Martin; Cook, Karen S.

    2015-01-01

    How does lacking vs. possessing power in a social exchange affect people’s trust in their exchange partner? An answer to this question has broad implications for a number of exchange settings in which dependence plays an important role. Here, we report on a series of experiments in which we manipulated participants’ power position in terms of structural dependence and observed their trust perceptions and behaviors. Over a variety of different experimental paradigms and measures, we find that more powerful actors place less trust in others than less powerful actors do. Our results contradict predictions by rational actor models, which assume that low-power individuals are able to anticipate that a more powerful exchange partner will place little value on the relationship with them, thus tends to behave opportunistically, and consequently cannot be trusted. Conversely, our results support predictions by motivated cognition theory, which posits that low-power individuals want their exchange partner to be trustworthy and then act according to that desire. Mediation analyses show that, consistent with the motivated cognition account, having low power increases individuals’ hope and, in turn, their perceptions of their exchange partners’ benevolence, which ultimately leads them to trust. PMID:26438869

  17. Power decreases trust in social exchange.

    PubMed

    Schilke, Oliver; Reimann, Martin; Cook, Karen S

    2015-10-20

    How does lacking vs. possessing power in a social exchange affect people's trust in their exchange partner? An answer to this question has broad implications for a number of exchange settings in which dependence plays an important role. Here, we report on a series of experiments in which we manipulated participants' power position in terms of structural dependence and observed their trust perceptions and behaviors. Over a variety of different experimental paradigms and measures, we find that more powerful actors place less trust in others than less powerful actors do. Our results contradict predictions by rational actor models, which assume that low-power individuals are able to anticipate that a more powerful exchange partner will place little value on the relationship with them, thus tends to behave opportunistically, and consequently cannot be trusted. Conversely, our results support predictions by motivated cognition theory, which posits that low-power individuals want their exchange partner to be trustworthy and then act according to that desire. Mediation analyses show that, consistent with the motivated cognition account, having low power increases individuals' hope and, in turn, their perceptions of their exchange partners' benevolence, which ultimately leads them to trust. PMID:26438869

  18. Trust dynamics in multi-agent coalition formation

    NASA Astrophysics Data System (ADS)

    Mikulski, Dariusz G.; Lewis, Frank L.; Gu, Edward Y.; Hudas, Greg R.

    2011-05-01

    We present a rigorous treatment of coalition formation based on trust interactions in multi-agent systems. Current literature on trust in multi-agent systems primarily deals with trust models and protocols of interaction in noncooperative scenarios. Here, we use cooperative game theory as the underlying mathematical framework to study the trust dynamics between agents as a result of their trust synergy and trust liability in cooperative coalitions. We rigorously justify the behaviors of agents for different classes of games, and discuss ways to exploit the formal properties of these games for specific applications, such as unmanned cooperative control.

  19. A proposed instrument for the assessment of job satisfaction in Greek mental NHS hospitals.

    PubMed

    Labiris, Georgios; Gitona, Kleoniki; Drosou, Vasiliki; Niakas, Dimitrios

    2008-08-01

    Since its introduction in 1983, the Greek NHS is under an almost constant reform, aiming improvement on the efficiency and the quality of provided services. The national program of psychiatric reform "Psychargos" introduced new models of therapeutic approach to the care of the mentally ill, that required expansion of the existing roles and development of new roles of the healthcare staff. Consequently, the efficient management of the healthcare workforce in Greek mental facilities was identified as a primary determinant of the successful implementation of the program. Primary objective of this study was the development of a research framework for the assessment of job satisfaction in Greek Mental Health Hospitals. Among the objectives was the evaluation of the capacity of the underlying motivators and hygiene factors and the identification of potential correlations of the global job satisfaction and the motivation and retention factors with the demographic, social and occupational characteristics of the employees. A custom questionnaire was developed, based on Herzberg two-factor theory, after a systematic review of the relevant literature. The instrument was constructed by two parts and 37 items. Ten items addressed the sociodemographic characteristics of the subjects, while the remaining 27 items were distributed in 11 subscales which addressed the global satisfaction index and the "retention" and the "motivation" variables. The instrument was validated by means of the Cronbach alpha for each subscale and by confirmatory factor analysis. The study was conducted at the Public Mental Hospital of Chania (PMHC). From the 300 employees of the PMHC, 133 subjects successfully responded to the questionnaire (response rate, 44.3%). In accordance to former surveys, subjects presented average scores in the global satisfaction index (GSI). The professional category of the employee was identified as the primary determinant of the GSI. Nurses presented statistically

  20. A proposed instrument for the assessment of job satisfaction in Greek mental NHS hospitals.

    PubMed

    Labiris, Georgios; Gitona, Kleoniki; Drosou, Vasiliki; Niakas, Dimitrios

    2008-08-01

    Since its introduction in 1983, the Greek NHS is under an almost constant reform, aiming improvement on the efficiency and the quality of provided services. The national program of psychiatric reform "Psychargos" introduced new models of therapeutic approach to the care of the mentally ill, that required expansion of the existing roles and development of new roles of the healthcare staff. Consequently, the efficient management of the healthcare workforce in Greek mental facilities was identified as a primary determinant of the successful implementation of the program. Primary objective of this study was the development of a research framework for the assessment of job satisfaction in Greek Mental Health Hospitals. Among the objectives was the evaluation of the capacity of the underlying motivators and hygiene factors and the identification of potential correlations of the global job satisfaction and the motivation and retention factors with the demographic, social and occupational characteristics of the employees. A custom questionnaire was developed, based on Herzberg two-factor theory, after a systematic review of the relevant literature. The instrument was constructed by two parts and 37 items. Ten items addressed the sociodemographic characteristics of the subjects, while the remaining 27 items were distributed in 11 subscales which addressed the global satisfaction index and the "retention" and the "motivation" variables. The instrument was validated by means of the Cronbach alpha for each subscale and by confirmatory factor analysis. The study was conducted at the Public Mental Hospital of Chania (PMHC). From the 300 employees of the PMHC, 133 subjects successfully responded to the questionnaire (response rate, 44.3%). In accordance to former surveys, subjects presented average scores in the global satisfaction index (GSI). The professional category of the employee was identified as the primary determinant of the GSI. Nurses presented statistically

  1. Rapid T2- and susceptometry-based CMRO2 quantification with interleaved TRUST (iTRUST).

    PubMed

    Rodgers, Zachary B; Englund, Erin K; Langham, Michael C; Magland, Jeremy F; Wehrli, Felix W

    2015-02-01

    Susceptometry-based oximetry (SBO) and T2-relaxation-under-spin-tagging (TRUST) are two promising methods for quantifying the cerebral metabolic rate of oxygen (CMRO2), a critical parameter of brain function. We present a combined method, interleaved TRUST (iTRUST), which achieves rapid, simultaneous quantification of both susceptometry- and T2-based CMRO2 via insertion of a flow-encoded, dual-echo gradient-recalled echo (OxFlow) module within the T1 recovery portion of the TRUST sequence. In addition to allowing direct comparison between SBO- and TRUST-derived venous oxygen saturation (Yv) values, iTRUST substantially improves TRUST temporal resolution for CMRO2 quantification and obviates the need for a separate blood flow measurement following TRUST acquisition. iTRUST was compared directly to TRUST and OxFlow alone in three resting subjects at baseline, exhibiting close agreement with the separate techniques and comparable precision. These baseline data as well as simulation results support the use of two instead of the traditional four T2 preparation times for T2 fitting, allowing simultaneous quantification of susceptometry- and T2-based Yv (and CMRO2) with three- and six-second temporal resolution, respectively. In 10 young healthy subjects, iTRUST was applied during a 5% CO2 gas mixture-breathing paradigm. T2-based Yv values were lower at baseline relative to susceptometry (62.3 ± 3.1 vs. 66.7 ± 5.1 %HbO2, P<0.05), but increased more in response to hypercapnia. As a result, T2-based CMRO2 decreased from 140.4 ± 9.7 to 120.0 ± 9.5 μMol/100g/min, a significant -14.6 ± 3.6% response (P < 0.0001), whereas susceptometry-based CMRO2 changed insignificantly from 123.4 ± 18.7 to 127.9 ± 25.7, a 3.3 ± 9.7% response (P = 0.31). These differing results are in accord with previous studies applying the parent OxFlow or TRUST sequences individually, thus supporting the reliability of iTRUST but also strongly suggesting that a systematic bias exists between the

  2. Redefining Genomic Privacy: Trust and Empowerment

    PubMed Central

    Erlich, Yaniv; Williams, James B.; Glazer, David; Yocum, Kenneth; Farahany, Nita; Olson, Maynard; Narayanan, Arvind; Stein, Lincoln D.; Witkowski, Jan A.; Kain, Robert C.

    2014-01-01

    Fulfilling the promise of the genetic revolution requires the analysis of large datasets containing information from thousands to millions of participants. However, sharing human genomic data requires protecting subjects from potential harm. Current models rely on de-identification techniques in which privacy versus data utility becomes a zero-sum game. Instead, we propose the use of trust-enabling techniques to create a solution in which researchers and participants both win. To do so we introduce three principles that facilitate trust in genetic research and outline one possible framework built upon those principles. Our hope is that such trust-centric frameworks provide a sustainable solution that reconciles genetic privacy with data sharing and facilitates genetic research. PMID:25369215

  3. Redefining genomic privacy: trust and empowerment.

    PubMed

    Erlich, Yaniv; Williams, James B; Glazer, David; Yocum, Kenneth; Farahany, Nita; Olson, Maynard; Narayanan, Arvind; Stein, Lincoln D; Witkowski, Jan A; Kain, Robert C

    2014-11-01

    Fulfilling the promise of the genetic revolution requires the analysis of large datasets containing information from thousands to millions of participants. However, sharing human genomic data requires protecting subjects from potential harm. Current models rely on de-identification techniques in which privacy versus data utility becomes a zero-sum game. Instead, we propose the use of trust-enabling techniques to create a solution in which researchers and participants both win. To do so we introduce three principles that facilitate trust in genetic research and outline one possible framework built upon those principles. Our hope is that such trust-centric frameworks provide a sustainable solution that reconciles genetic privacy with data sharing and facilitates genetic research. PMID:25369215

  4. Distributed Trust Management for Validating SLA Choreographies

    NASA Astrophysics Data System (ADS)

    Haq, Irfan Ul; Alnemr, Rehab; Paschke, Adrian; Schikuta, Erich; Boley, Harold; Meinel, Christoph

    For business workflow automation in a service-enriched environment such as a grid or a cloud, services scattered across heterogeneous Virtual Organizations (VOs) can be aggregated in a producer-consumer manner, building hierarchical structures of added value. In order to preserve the supply chain, the Service Level Agreements (SLAs) corresponding to the underlying choreography of services should also be incrementally aggregated. This cross-VO hierarchical SLA aggregation requires validation, for which a distributed trust system becomes a prerequisite. Elaborating our previous work on rule-based SLA validation, we propose a hybrid distributed trust model. This new model is based on Public Key Infrastructure (PKI) and reputation-based trust systems. It helps preventing SLA violations by identifying violation-prone services at service selection stage and actively contributes in breach management at the time of penalty enforcement.

  5. Redefining genomic privacy: trust and empowerment.

    PubMed

    Erlich, Yaniv; Williams, James B; Glazer, David; Yocum, Kenneth; Farahany, Nita; Olson, Maynard; Narayanan, Arvind; Stein, Lincoln D; Witkowski, Jan A; Kain, Robert C

    2014-11-01

    Fulfilling the promise of the genetic revolution requires the analysis of large datasets containing information from thousands to millions of participants. However, sharing human genomic data requires protecting subjects from potential harm. Current models rely on de-identification techniques in which privacy versus data utility becomes a zero-sum game. Instead, we propose the use of trust-enabling techniques to create a solution in which researchers and participants both win. To do so we introduce three principles that facilitate trust in genetic research and outline one possible framework built upon those principles. Our hope is that such trust-centric frameworks provide a sustainable solution that reconciles genetic privacy with data sharing and facilitates genetic research.

  6. Surrogate Motherhood: A Trust-Based Approach.

    PubMed

    Beier, Katharina

    2015-12-01

    Because it is often argued that surrogacy should not be treated as contractual, the question arises in which terms this practice might then be couched. In this article, I argue that a phenomenology of surrogacy centering on the notion of trust provides a description that is illuminating from the moral point of view. My thesis is that surrogacy establishes a complex and extended reproductive unit--the "surrogacy triad" consisting of the surrogate mother, the child, and the intending parents--whose constituents are bound together by mutual trustful commitments. Even though a trust-based approach does not provide an ultimate answer to whether surrogacy should be sanctioned or prohibited, it allows for at least some practical suggestions. In particular, I will argue that, under certain conditions, surrogacy is tenable within familial or other significant relationships, and I will stress the necessity of acknowledging the new relationships and moral commitments that result from this practice.

  7. Surrogate Motherhood: A Trust-Based Approach.

    PubMed

    Beier, Katharina

    2015-12-01

    Because it is often argued that surrogacy should not be treated as contractual, the question arises in which terms this practice might then be couched. In this article, I argue that a phenomenology of surrogacy centering on the notion of trust provides a description that is illuminating from the moral point of view. My thesis is that surrogacy establishes a complex and extended reproductive unit--the "surrogacy triad" consisting of the surrogate mother, the child, and the intending parents--whose constituents are bound together by mutual trustful commitments. Even though a trust-based approach does not provide an ultimate answer to whether surrogacy should be sanctioned or prohibited, it allows for at least some practical suggestions. In particular, I will argue that, under certain conditions, surrogacy is tenable within familial or other significant relationships, and I will stress the necessity of acknowledging the new relationships and moral commitments that result from this practice. PMID:26449234

  8. Who Adolescents Trust May Impact Their Health: Findings from Baltimore.

    PubMed

    Mmari, Kristin; Marshall, Beth; Lantos, Hannah; Blum, Robert Wm

    2016-06-01

    This study is one of the first to explore the relevance of trust to the health of adolescents living in a disadvantaged urban setting. The primary objectives were to determine the differences in the sociodemographic characteristics between adolescents who do and do not trust and to examine the associations between trust and health. Data were drawn from the Well-Being of Adolescents in Vulnerable Environments (WAVE) study, which is a cross-sectional global study of adolescents in very low-income urban settings conducted in 2011-2013. This paper focused on 446 adolescents in Baltimore as it was the primary site where trust was explicitly measured. For the main analyses, six health outcomes were examined: (1) self-rated health; (2) violence victimization; (3) binge drinking; (4) marijuana use; (5) post-traumatic stress disorder (PTSD); and (6) condom use at last sex. Independent variables included sociodemographic variables (age, gender, current school enrolment, perceived relative wealth, and family structure) and two dimensions of trust: community trust (trust in individuals/groups within neighborhood) and institutional trust (trust in authorities). The results show that more than half the sample had no trust in police, and a high proportion had no trust in other types of authority. Among girls, those with higher levels of community trust were less likely to be victimized and involved in binge drinking. Meanwhile, girls with higher levels of institutional trust were more likely to use a condom and less likely to have used marijuana. Among boys, those with higher levels of community trust were more likely to use a condom, while those with higher levels of institutional trust were less likely to use marijuana, but more likely binge drink. Overall, this study highlights the importance of trust for adolescent health. Most surprising were the differences in the associations between boys and girls with regard to the type of trust and specific health outcome that was

  9. Trust, conflict, and cooperation: a meta-analysis.

    PubMed

    Balliet, Daniel; Van Lange, Paul A M

    2013-09-01

    Many theories of trust emphasize that trust is most relevant to behavior in situations involving a conflict of interests. However, it is not clear how trust relates to behavior across situations that differ in the degree of conflicting interest: Does trust matter more when the conflict of interest is small or large? According to an interdependence perspective, trust becomes an especially important determinant of behavior in situations involving larger, compared to smaller, degrees of conflicting interests. To examine this perspective, we conducted a meta-analysis involving 212 effect sizes on the relation between trust (both state and dispositional trust in others) and cooperation in social dilemmas-situations that involve varying degrees of conflict between self-interest and collective interest. Results revealed that the positive relation between trust and cooperation is stronger when there is a larger, compared to smaller, degree of conflict. We also examined several other possible moderators of the relation between trust and cooperation. The relation between trust and cooperation was stronger during individual, compared to intergroup, interactions but did not vary as a function of the situation being either a one-shot or repeated interaction. We also find differences across countries in the extent that people condition their own cooperation based on their trust in others. We discuss how the results support an emerging consensus about trust being limited to situations of conflict and address some theoretical and societal implications for our understanding of how and why trust is so important to social interactions and relationships.

  10. Trust, conflict, and cooperation: a meta-analysis.

    PubMed

    Balliet, Daniel; Van Lange, Paul A M

    2013-09-01

    Many theories of trust emphasize that trust is most relevant to behavior in situations involving a conflict of interests. However, it is not clear how trust relates to behavior across situations that differ in the degree of conflicting interest: Does trust matter more when the conflict of interest is small or large? According to an interdependence perspective, trust becomes an especially important determinant of behavior in situations involving larger, compared to smaller, degrees of conflicting interests. To examine this perspective, we conducted a meta-analysis involving 212 effect sizes on the relation between trust (both state and dispositional trust in others) and cooperation in social dilemmas-situations that involve varying degrees of conflict between self-interest and collective interest. Results revealed that the positive relation between trust and cooperation is stronger when there is a larger, compared to smaller, degree of conflict. We also examined several other possible moderators of the relation between trust and cooperation. The relation between trust and cooperation was stronger during individual, compared to intergroup, interactions but did not vary as a function of the situation being either a one-shot or repeated interaction. We also find differences across countries in the extent that people condition their own cooperation based on their trust in others. We discuss how the results support an emerging consensus about trust being limited to situations of conflict and address some theoretical and societal implications for our understanding of how and why trust is so important to social interactions and relationships. PMID:23231532

  11. Treatments of low-priority and the Patient Mobility Directive 2011, an end to legal uncertainty for the English NHS?

    PubMed

    Sheppard, Maria K

    2013-06-01

    The patient mobility case law of the Court of Justice of the European Union created legal uncertainty for the healthcare systems of EU Member States. The Patient Mobility Directive setting out patients' cross-border rights was adopted to end this uncertainty. With the Directive to be transposed into national law by October 2013 this article discusses whether the Directive achieves this objective for the English NHS. It contrasts the legal position of the NHS patient under case law and under the Directive regarding the need for prior authorisation of cross-border treatment, the level of reimbursement and the ambit of the healthcare benefits basket. It is argued that the risk of legal challenge may persist under the Directive, specifically regarding treatments which are classified by health authorities as low priority, namely treatments which are either not 'generally' available or only available subject to certain clinical criteria or access thresholds.

  12. Cross section limits for the Cm248(Mg25,4n-5n)Hs268,269 reactions

    NASA Astrophysics Data System (ADS)

    Dvorak, J.; Brüchle, W.; Düllmann, Ch. E.; Dvorakova, Z.; Eberhardt, K.; Eichler, R.; Jäger, E.; Nagame, Y.; Qin, Z.; Schädel, M.; Schausten, B.; Schimpf, E.; Schuber, R.; Semchenkov, A.; Thörle, P.; Türler, A.; Wegrzecki, M.; Yakushev, A.

    2009-03-01

    We report on an attempt to produce and detect Hs268 and Hs269 in the nuclear fusion reaction Mg25+Cm248 using the gas phase chemistry apparatus COMPACT. No decay chains attributable to the decay of hassium isotopes were observed during the course of this experiment. From the nonobservation of Hs269 we derive a cross section limit of 0.4 pb (63% confidence limit) for the reaction Cm248(Mg25,4n)Hs269 at a center-of-target beam energy of 140 MeV. The evaluated cross section limit for the Cm248(Mg25,5n)Hs268 reaction depends on the assumed half-life of unknown Hs268. Current systematics of the half-lives for even-even Hs isotopes suggests a value of 0.5 s, resulting in a cross section limit of 1.3 pb.

  13. Artificial intelligence techniques to optimize the EDC/NHS-mediated immobilization of cellulase on Eudragit L-100.

    PubMed

    Zhang, Yu; Xu, Jing-Liang; Yuan, Zhen-Hong; Qi, Wei; Liu, Yun-Yun; He, Min-Chao

    2012-01-01

    Two artificial intelligence techniques, namely artificial neural network (ANN) and genetic algorithm (GA) were combined to be used as a tool for optimizing the covalent immobilization of cellulase on a smart polymer, Eudragit L-100. 1-Ethyl-3-(3-dimethyllaminopropyl) carbodiimide (EDC) concentration, N-hydroxysuccinimide (NHS) concentration and coupling time were taken as independent variables, and immobilization efficiency was taken as the response. The data of the central composite design were used to train ANN by back-propagation algorithm, and the result showed that the trained ANN fitted the data accurately (correlation coefficient R(2) = 0.99). Then a maximum immobilization efficiency of 88.76% was searched by genetic algorithm at a EDC concentration of 0.44%, NHS concentration of 0.37% and a coupling time of 2.22 h, where the experimental value was 87.97 ± 6.45%. The application of ANN based optimization by GA is quite successful.

  14. Artificial Intelligence Techniques to Optimize the EDC/NHS-Mediated Immobilization of Cellulase on Eudragit L-100

    PubMed Central

    Zhang, Yu; Xu, Jing-Liang; Yuan, Zhen-Hong; Qi, Wei; Liu, Yun-Yun; He, Min-Chao

    2012-01-01

    Two artificial intelligence techniques, namely artificial neural network (ANN) and genetic algorithm (GA) were combined to be used as a tool for optimizing the covalent immobilization of cellulase on a smart polymer, Eudragit L-100. 1-Ethyl-3-(3-dimethyllaminopropyl) carbodiimide (EDC) concentration, N-hydroxysuccinimide (NHS) concentration and coupling time were taken as independent variables, and immobilization efficiency was taken as the response. The data of the central composite design were used to train ANN by back-propagation algorithm, and the result showed that the trained ANN fitted the data accurately (correlation coefficient R2 = 0.99). Then a maximum immobilization efficiency of 88.76% was searched by genetic algorithm at a EDC concentration of 0.44%, NHS concentration of 0.37% and a coupling time of 2.22 h, where the experimental value was 87.97 ± 6.45%. The application of ANN based optimization by GA is quite successful. PMID:22942683

  15. How much can the NHS afford to spend to save a life or avoid a severe disability?

    PubMed

    Roberts, C J; Farrow, S C; Charny, M C

    1985-01-12

    A measure termed the "benefit:premium ratio" is proposed to determine whether certain screening programs or high technology procedures are too expensive for Britain's National Health Service (NHS). Given that the NHS budget is finite, some programs, though proven effective, violate the principle of equity and reduce the benefits available to all subscribers. Since programs such as cervical and breast cancer screening, and routine preoperative chest X-rays, are aimed at eliminating infrequent risks, their cost is higher than warranted for an insurance-based system of health care. On the other hand, procedures such as renal transplantation, blood pressure screening, and open heart surgery are affordable according to the benefit:premium formula.

  16. Treatments of low-priority and the Patient Mobility Directive 2011, an end to legal uncertainty for the English NHS?

    PubMed

    Sheppard, Maria K

    2013-06-01

    The patient mobility case law of the Court of Justice of the European Union created legal uncertainty for the healthcare systems of EU Member States. The Patient Mobility Directive setting out patients' cross-border rights was adopted to end this uncertainty. With the Directive to be transposed into national law by October 2013 this article discusses whether the Directive achieves this objective for the English NHS. It contrasts the legal position of the NHS patient under case law and under the Directive regarding the need for prior authorisation of cross-border treatment, the level of reimbursement and the ambit of the healthcare benefits basket. It is argued that the risk of legal challenge may persist under the Directive, specifically regarding treatments which are classified by health authorities as low priority, namely treatments which are either not 'generally' available or only available subject to certain clinical criteria or access thresholds. PMID:23984495

  17. ReTrust: attack-resistant and lightweight trust management for medical sensor networks.

    PubMed

    He, Daojing; Chen, Chun; Chan, Sammy; Bu, Jiajun; Vasilakos, Athanasios V

    2012-07-01

    Wireless medical sensor networks (MSNs) enable ubiquitous health monitoring of users during their everyday lives, at health sites, without restricting their freedom. Establishing trust among distributed network entities has been recognized as a powerful tool to improve the security and performance of distributed networks such as mobile ad hoc networks and sensor networks. However, most existing trust systems are not well suited for MSNs due to the unique operational and security requirements of MSNs. Moreover, similar to most security schemes, trust management methods themselves can be vulnerable to attacks. Unfortunately, this issue is often ignored in existing trust systems. In this paper, we identify the security and performance challenges facing a sensor network for wireless medical monitoring and suggest it should follow a two-tier architecture. Based on such an architecture, we develop an attack-resistant and lightweight trust management scheme named ReTrust. This paper also reports the experimental results of the Collection Tree Protocol using our proposed system in a network of TelosB motes, which show that ReTrust not only can efficiently detect malicious/faulty behaviors, but can also significantly improve the network performance in practice.

  18. Integrity Management Infrastructure for Trusted Computing

    NASA Astrophysics Data System (ADS)

    Munetoh, Seiji; Nakamura, Megumi; Yoshihama, Sachiko; Kudo, Michiharu

    Computer security concerns have been rapidly increasing because of repeated security breaches and leakages of sensitive personal information. Such security breaches are mainly caused by an inappropriate management of the PCs, so maintaining integrity of the platform configuration is essential, and, verifying the integrity of the computer platform and software becomes more significant. To address these problems, the Trusted Computing Group (TCG) has developed various specifications that are used to measure the integrity of the platform based on hardware trust. In the trusted computing technology, the integrity data of each component running on the platform is recorded in the security chip and they are securely checked by a remote attestation. The infrastructure working group in the TCG is trying to define an Integrity Management Infrastructure in which the Platform Trust Services (PTS) is a new key component which deals with an Integrity Report. When we use the PTS in the target platform, it is a service component that collects and measures the runtime integrity of the target platform in a secure way. The PTS can also be used to validate the Integrity Reports. We introduce the notion of the Platform Validation Authority, a trusted third party, which verifies the composition of the integrity measurement of the target platform in the Integrity Reports. The Platform Validation Authority complements the role of the current Certificate Authority in the Public Key Infrastructure which attests to the integrity of the user identity as well as to related artifacts such as digital signatures. In this paper, we cover the research topics in this new area, the relevant technologies and open issues of the trusted computing, and the detail of our PTS implementation.

  19. Environmental aspects of health care in the Grampian NHS region and the place of telehealth.

    PubMed

    Wootton, Richard; Tait, Alex; Croft, Amanda

    2010-01-01

    Detailed information about the composition of the carbon footprint of the NHS in the Grampian health region, and in Scotland generally, is not available at present. Based on the limited information available, our best guess is that travel emissions in Grampian are substantial, perhaps 49,000 tonnes CO(2) per year. This is equivalent to 233 million km of car travel per year. A well-established telemedicine network in the Grampian region, which saves over 2000 patient journeys a year from community hospitals, avoids about 260,000 km travel per year, or about 59 tonnes CO(2) per year. Therefore using telehealth as it has been used historically (primarily to facilitate hospital-to-hospital interactions) seems unlikely to have a major environmental impact--although of course there may be other good reasons for persevering with conventional telehealth. On the other hand, telehealth might be useful in reducing staff travel and to a lesser extent, visitor travel. It looks particularly promising for reducing outpatient travel, where substantial carbon savings might be made by reconfiguring the way that certain services are provided.

  20. Environmental aspects of health care in the Grampian NHS region and the place of telehealth

    PubMed Central

    Wootton, Richard; Tait, Alex; Croft, Amanda

    2010-01-01

    Detailed information about the composition of the carbon footprint of the NHS in the Grampian health region, and in Scotland generally, is not available at present. Based on the limited information available, our best guess is that travel emissions in Grampian are substantial, perhaps 49,000 tonnes CO2 per year. This is equivalent to 233 million km of car travel per year. A well-established telemedicine network in the Grampian region, which saves over 2000 patient journeys a year from community hospitals, avoids about 260,000 km travel per year, or about 59 tonnes CO2 per year. Therefore using telehealth as it has been used historically (primarily to facilitate hospital-to-hospital interactions) seems unlikely to have a major environmental impact – although of course there may be other good reasons for persevering with conventional telehealth. On the other hand, telehealth might be useful in reducing staff travel and to a lesser extent, visitor travel. It looks particularly promising for reducing outpatient travel, where substantial carbon savings might be made by reconfiguring the way that certain services are provided. PMID:20511579

  1. Influencing organisational change in the NHS: lessons learned from workplace wellness initiatives in practice.

    PubMed

    Blake, Holly; Lloyd, Scott

    2008-01-01

    This article presents a discussion of the key issues in influencing organisational change in NHS settings, in the development of workplace wellness interventions to improve employee health and wellbeing. To tackle poor public health and associated rising healthcare costs, there must be a focus on the root cause of many preventable diseases - unhealthy lifestyle choices. Workplace wellness initiatives are now an important prevention strategy adopted by socially responsible organisations to target the health and wellbeing of working age adults. Lessons learned from initiatives in secondary care suggest that effective implementation requires change in organisational 'health culture', through a combination of education, behaviour change intervention, needs-based facilities, and services and strategies for developing supportive and health-promoting work environments. Most of all, employers must demonstrate a commitment to health and wellness that is fully integrated with their mission, values and long-term vision, paving the way for sustainable lifestyle changes. Evaluation systems must be in place to measure the impact and outcomes of wellness schemes. PMID:19094421

  2. Influencing organisational change in the NHS: lessons learned from workplace wellness initiatives in practice.

    PubMed

    Blake, Holly; Lloyd, Scott

    2008-01-01

    This article presents a discussion of the key issues in influencing organisational change in NHS settings, in the development of workplace wellness interventions to improve employee health and wellbeing. To tackle poor public health and associated rising healthcare costs, there must be a focus on the root cause of many preventable diseases - unhealthy lifestyle choices. Workplace wellness initiatives are now an important prevention strategy adopted by socially responsible organisations to target the health and wellbeing of working age adults. Lessons learned from initiatives in secondary care suggest that effective implementation requires change in organisational 'health culture', through a combination of education, behaviour change intervention, needs-based facilities, and services and strategies for developing supportive and health-promoting work environments. Most of all, employers must demonstrate a commitment to health and wellness that is fully integrated with their mission, values and long-term vision, paving the way for sustainable lifestyle changes. Evaluation systems must be in place to measure the impact and outcomes of wellness schemes.

  3. The compatibility of general managers' activities and intentions in managing change in the NHS.

    PubMed

    Spurgeon, P; Barwell, F

    1990-03-01

    As Hales (1986) has observed, the problem of much of the managerial research to date has been the reluctance to ask why managers behave in the way they do. The behaviour of general managers in tackling organisational change in the NHS needs to be viewed not only with respect to what is done but also with respect to how personal and organisational objectives are construed. In other words, the implementation of organisational change ultimately rests on how general managers perceive the nature of this change and their role in structuring their own personal and organisational objectives into appropriate activities. Examining the compatibility of managerial activities and the underlying values and intentions which support them is of critical importance in any cognitively-based approach. These intentions provide an important link between perceptions (i.e. how the organisation is construed) and behaviour (i.e. what activities managers choose to perform). Understanding the conceptual frameworks which underpin managerial activities could have profound implications for assessing the performance of general managers.

  4. Assessing psychological well-being: a holistic investigation of NHS employees.

    PubMed

    Loretto, W; Popham, F; Platt, S; Pavis, S; Hardy, G; MacLeod, L; Gibbs, J

    2005-10-01

    A substantial body of research has investigated the effects of work on the psychological well-being of employees. However, there has been little assessment of the ways in which workplace factors (such as job demands, working conditions, inter-personal relations and workplace change) interact with personal factors (such as work-life balance, family circumstances, key personality traits or demographic characteristics) to affect psychological health. This article reports findings from a study which aimed to construct and test a comprehensive model of the influences on employee well-being within the UK National Health Service (NHS). The results show that psychological well-being is influenced by a complex array of personal, environmental and work factors. A key finding is that there are clear associations between workplace change and well-being and between work-life (im)balance and well-being. These effects appear to be independent of one another and therefore require separate attention from managers and employers. PMID:16194812

  5. The compatibility of general managers' activities and intentions in managing change in the NHS.

    PubMed

    Spurgeon, P; Barwell, F

    1990-03-01

    As Hales (1986) has observed, the problem of much of the managerial research to date has been the reluctance to ask why managers behave in the way they do. The behaviour of general managers in tackling organisational change in the NHS needs to be viewed not only with respect to what is done but also with respect to how personal and organisational objectives are construed. In other words, the implementation of organisational change ultimately rests on how general managers perceive the nature of this change and their role in structuring their own personal and organisational objectives into appropriate activities. Examining the compatibility of managerial activities and the underlying values and intentions which support them is of critical importance in any cognitively-based approach. These intentions provide an important link between perceptions (i.e. how the organisation is construed) and behaviour (i.e. what activities managers choose to perform). Understanding the conceptual frameworks which underpin managerial activities could have profound implications for assessing the performance of general managers. PMID:10104281

  6. A family of oculofaciocardiodental syndrome (OFCD) with a novel BCOR mutation and genomic rearrangements involving NHS.

    PubMed

    Kondo, Yukiko; Saitsu, Hirotomo; Miyamoto, Toshinobu; Nishiyama, Kiyomi; Tsurusaki, Yoshinori; Doi, Hiroshi; Miyake, Noriko; Ryoo, Na-Kyung; Kim, Jeong Hun; Yu, Young Suk; Matsumoto, Naomichi

    2012-03-01

    Oculofaciocardiodental syndrome (OFCD) is an X-linked dominant disorder associated with male lethality, presenting with congenital cataract, dysmorphic face, dental abnormalities and septal heart defects. Mutations in BCOR (encoding BCL-6-interacting corepressor) cause OFCD. Here, we report on a Korean family with common features of OFCD including bilateral 2nd-3rd toe syndactyly and septal heart defects in three affected females (mother and two daughters). Through the mutation screening and copy number analysis using genomic microarray, we identified a novel heterozygous mutation, c.888delG, in the BCOR gene and two interstitial microduplications at Xp22.2-22.13 and Xp21.3 in all the three affected females. The BCOR mutation may lead to a premature stop codon (p.N297IfsX80). The duplication at Xp22.2-22.13 involved the NHS gene causative for Nance-Horan syndrome, which is an X-linked disorder showing similar clinical features with OFCD in affected males, and in carrier females with milder presentation. Considering the presence of bilateral 2nd-3rd toe syndactyly and septal heart defects, which is unique to OFCD, the mutation in BCOR is likely to be the major determinant for the phenotypes in this family. PMID:22301464

  7. Macroeconomic Dynamics of Assets, Leverage and Trust

    NASA Astrophysics Data System (ADS)

    Rozendaal, Jeroen C.; Malevergne, Yannick; Sornette, Didier

    A macroeconomic model based on the economic variables (i) assets, (ii) leverage (defined as debt over asset) and (iii) trust (defined as the maximum sustainable leverage) is proposed to investigate the role of credit in the dynamics of economic growth, and how credit may be associated with both economic performance and confidence. Our first notable finding is the mechanism of reward/penalty associated with patience, as quantified by the return on assets. In regular economies where the EBITA/Assets ratio is larger than the cost of debt, starting with a trust higher than leverage results in the highest long-term return on assets (which can be seen as a proxy for economic growth). Therefore, patient economies that first build trust and then increase leverage are positively rewarded. Our second main finding concerns a recommendation for the reaction of a central bank to an external shock that affects negatively the economic growth. We find that late policy intervention in the model economy results in the highest long-term return on assets. However, this comes at the cost of suffering longer from the crisis until the intervention occurs. The phenomenon that late intervention is most effective to attain a high long-term return on assets can be ascribed to the fact that postponing intervention allows trust to increase first, and it is most effective to intervene when trust is high. These results are derived from two fundamental assumptions underlying our model: (a) trust tends to increase when it is above leverage; (b) economic agents learn optimally to adjust debt for a given level of trust and amount of assets. Using a Markov Switching Model for the EBITA/Assets ratio, we have successfully calibrated our model to the empirical data of the return on equity of the EURO STOXX 50 for the time period 2000-2013. We find that dynamics of leverage and trust can be highly nonmonotonous with curved trajectories, as a result of the nonlinear coupling between the variables. This

  8. Capturing Trust in Social Web Applications

    NASA Astrophysics Data System (ADS)

    O'Donovan, John

    The Social Web constitutes a shift in information flow from the traditional Web. Previously, content was provided by the owners of a website, for consumption by the end-user. Nowadays, these websites are being replaced by Social Web applications which are frameworks for the publication of user-provided content. Traditionally, Web content could be `trusted' to some extent based on the site it originated from. Algorithms such as Google's PageRank were (and still are) used to compute the importance of a website, based on analysis of underlying link topology. In the Social Web, analysis of link topology merely tells us about the importance of the information framework which hosts the content. Consumers of information still need to know about the importance/reliability of the content they are reading, and therefore about the reliability of the producers of that content. Research into trust and reputation of the producers of information in the Social Web is still very much in its infancy. Every day, people are forced to make trusting decisions about strangers on the Web based on a very limited amount of information. For example, purchasing a product from an eBay seller with a `reputation' of 99%, downloading a file from a peer-to-peer application such as Bit-Torrent, or allowing Amazon.com tell you what products you will like. Even something as simple as reading comments on a Web-blog requires the consumer to make a trusting decision about the quality of that information. In all of these example cases, and indeed throughout the Social Web, there is a pressing demand for increased information upon which we can make trusting decisions. This chapter examines the diversity of sources from which trust information can be harnessed within Social Web applications and discusses a high level classification of those sources. Three different techniques for harnessing and using trust from a range of sources are presented. These techniques are deployed in two sample Social Web

  9. Facing the future: the effects of the impending financial drought on NHS finances and how UK radiology services can contribute to expected efficiency savings.

    PubMed

    Grant, L; Appleby, J; Griffin, N; Adam, A; Gishen, P

    2012-06-01

    The recent turmoil within the banking sector has led to the development of the most significant recession since the "great depression" of the 1930s. Although the coalition government has promised to "guarantee that health spending increases in real terms in each year of Parliament", this may still not be enough to meet future needs over the coming years due to increasing demand and cost pressures. The expected mismatch between actual National Health Service (NHS) funding post-2011 and that required to satisfy increasing demand has been estimated by the Department of Health to require efficiency savings representing up to one-fifth of the overall NHS budget. This paper explains the reasons behind the anticipated slowdown in the growth of real NHS funding, and how, as a discipline, radiology can increase the efficiency of the services it provides in anticipation of future financial austerity within the NHS.

  10. Facing the future: the effects of the impending financial drought on NHS finances and how UK radiology services can contribute to expected efficiency savings

    PubMed Central

    Grant, L; Appleby, J; Griffin, N; Adam, A; Gishen, P

    2012-01-01

    The recent turmoil within the banking sector has led to the development of the most significant recession since the “great depression” of the 1930s. Although the coalition government has promised to “guarantee that health spending increases in real terms in each year of Parliament”, this may still not be enough to meet future needs over the coming years due to increasing demand and cost pressures. The expected mismatch between actual National Health Service (NHS) funding post-2011 and that required to satisfy increasing demand has been estimated by the Department of Health to require efficiency savings representing up to one-fifth of the overall NHS budget. This paper explains the reasons behind the anticipated slowdown in the growth of real NHS funding, and how, as a discipline, radiology can increase the efficiency of the services it provides in anticipation of future financial austerity within the NHS. PMID:22167516

  11. A Marketing Perspective: Try Looking at Charitable Trusts from the Donor's Point of View.

    ERIC Educational Resources Information Center

    Thoren, Linda J.

    1979-01-01

    Charitable remainder trusts and charitable income trusts are discussed as essentials in any "marketing mix" of gift-giving options. Unitrusts and annuity trusts are described and tax benefits of the charitable income trust are explained. (MLW)

  12. Trust and trust relations from the providers' perspective: the case of the healthcare system in India.

    PubMed

    Kane, Sumit; Calnan, Michael; Radkar, Anjali

    2015-01-01

    Commentators suggest that there is an erosion of trust in the relations between different actors in the health system in India. This paper presents the results of an exploratory study of the situation of providers in an urban setting in western India, the nature of their relations in terms of trust and what influences these relations. The data on relationships of trust were collected through interviews and focus group discussions with key informants, including public and private providers, regulators, managers and societal actors, such as patients/citizens, politicians and the media.

  13. Trust and trust relations from the providers' perspective: the case of the healthcare system in India.

    PubMed

    Kane, Sumit; Calnan, Michael; Radkar, Anjali

    2015-01-01

    Commentators suggest that there is an erosion of trust in the relations between different actors in the health system in India. This paper presents the results of an exploratory study of the situation of providers in an urban setting in western India, the nature of their relations in terms of trust and what influences these relations. The data on relationships of trust were collected through interviews and focus group discussions with key informants, including public and private providers, regulators, managers and societal actors, such as patients/citizens, politicians and the media. PMID:26228048

  14. Trust that binds: the impact of collective felt trust on organizational performance.

    PubMed

    Salamon, Sabrina Deutsch; Robinson, Sandra L

    2008-05-01

    The impact of employees' collective perceptions of being trusted by management was examined with a longitudinal study involving 88 retail stores. Drawing on the appropriateness framework (March, 1994; Weber, Kopelman, & Messick, 2004), the authors develop and test a model showing that when employees in an organization perceive they are trusted by management, increases in the presence of responsibility norms, as well as in the sales performance and customer service performance of the organization, are observed. Moreover, the relationship between perceptions of being trusted and sales performance is fully mediated by responsibility norms. PMID:18457488

  15. Gas-Phase Intramolecular Protein Crosslinking via Ion/Ion Reactions: Ubiquitin and a Homobifunctional sulfo-NHS Ester

    NASA Astrophysics Data System (ADS)

    Webb, Ian K.; Mentinova, Marija; McGee, William M.; McLuckey, Scott A.

    2013-05-01

    Gas-phase intra-molecular crosslinking of protein ubiquitin cations has been demonstrated via ion/ion reactions with anions of a homobifunctional N-hydroxysulfosuccinimide (sulfo-NHS) ester reagent. The ion/ion reaction between multiply-protonated ubiquitin and crosslinker monoanions produces a stable, charge-reduced complex. Covalent crosslinking is indicated by the consecutive loss of 2 molecules of sulfo-NHS under ion trap collisional activation conditions. Covalent modification is verified by the presence of covalently crosslinked sequence ions produced by ion-trap collision-induced dissociation of the ion generated from the losses of sulfo-NHS. Analysis of the crosslinked sequence fragments allows for the localization of crosslinked primary amines, enabling proximity mapping of the gas-phase 3-D structures. The presence of two unprotonated reactive sites within the distance constraint of the crosslinker is required for successful crosslinking. The ability to covalently crosslink is, therefore, sensitive to protein charge state. As the charge state increases, fewer reactive sites are available and protein structure is more likely to become extended because of intramolecular electrostatic repulsion. At high charge states, the reagent shows little evidence for covalent crosslinking but does show evidence for `electrostatic crosslinking' in that the binding of the sulfonate groups to the protein is sufficiently strong that backbone cleavages are favored over reagent detachment under ion trap collisional activation conditions.

  16. Gas-phase intramolecular protein crosslinking via ion/ion reactions: ubiquitin and a homobifunctional sulfo-NHS ester.

    PubMed

    Webb, Ian K; Mentinova, Marija; McGee, William M; McLuckey, Scott A

    2013-05-01

    Gas-phase intra-molecular crosslinking of protein ubiquitin cations has been demonstrated via ion/ion reactions with anions of a homobifunctional N-hydroxysulfosuccinimide (sulfo-NHS) ester reagent. The ion/ion reaction between multiply-protonated ubiquitin and crosslinker monoanions produces a stable, charge-reduced complex. Covalent crosslinking is indicated by the consecutive loss of 2 molecules of sulfo-NHS under ion trap collisional activation conditions. Covalent modification is verified by the presence of covalently crosslinked sequence ions produced by ion-trap collision-induced dissociation of the ion generated from the losses of sulfo-NHS. Analysis of the crosslinked sequence fragments allows for the localization of crosslinked primary amines, enabling proximity mapping of the gas-phase 3-D structures. The presence of two unprotonated reactive sites within the distance constraint of the crosslinker is required for successful crosslinking. The ability to covalently crosslink is, therefore, sensitive to protein charge state. As the charge state increases, fewer reactive sites are available and protein structure is more likely to become extended because of intramolecular electrostatic repulsion. At high charge states, the reagent shows little evidence for covalent crosslinking but does show evidence for 'electrostatic crosslinking' in that the binding of the sulfonate groups to the protein is sufficiently strong that backbone cleavages are favored over reagent detachment under ion trap collisional activation conditions. PMID:23463545

  17. Improving the trust algorithm of information in semantic web

    NASA Astrophysics Data System (ADS)

    Wan, Zong-bao; Min, Jiang

    2012-01-01

    With the rapid development of computer networks, especially with the introduction of the Semantic Web perspective, the problem of trust computation in the network has become an important research part of current computer system theoretical. In this paper, according the information properties of the Semantic Web and interact between nodes, the definition semantic trust as content trust of information and the node trust between the nodes of two parts. By Calculate the content of the trust of information and the trust between nodes, then get the final credibility num of information in semantic web. In this paper , we are improve the computation algorithm of the node trust .Finally, stimulations and analyses show that the improved algorithm can effectively improve the trust of information more accurately.

  18. Improving the trust algorithm of information in semantic web

    NASA Astrophysics Data System (ADS)

    Wan, Zong-Bao; Min, Jiang

    2011-12-01

    With the rapid development of computer networks, especially with the introduction of the Semantic Web perspective, the problem of trust computation in the network has become an important research part of current computer system theoretical. In this paper, according the information properties of the Semantic Web and interact between nodes, the definition semantic trust as content trust of information and the node trust between the nodes of two parts. By Calculate the content of the trust of information and the trust between nodes, then get the final credibility num of information in semantic web. In this paper , we are improve the computation algorithm of the node trust .Finally, stimulations and analyses show that the improved algorithm can effectively improve the trust of information more accurately.

  19. A Language for Modelling Trust in Information Systems

    NASA Astrophysics Data System (ADS)

    Bimrah, Kamaljit Kaur; Mouratidis, Haralambos; Preston, David

    It has been argued in recent research that trust is an important issue for modern information systems and that it should be considered from the early stages of the development process. Nevertheless, little effort has been put into understanding how trust can be modelled and reasoned when developing information systems. Equally little effort has been put into developing modelling languages to support trust modelling. Our motivation comes from this situation and we aim to develop a trust-aware modelling framework that will enable information system developers to consider trust and its related concepts collectively during the development of information systems. In this chapter we re-enforce the argument about the need to consider trust during information systems development and we describe a modelling language that supports trust modelling. We employ a case study from a trust critical domain to demonstrate the application of our language.

  20. 26 CFR 1.50A-6 - Estates and trusts.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 1 2010-04-01 2010-04-01 true Estates and trusts. 1.50A-6 Section 1.50A-6... Computing Credit for Expenses of Work Incentive Programs § 1.50A-6 Estates and trusts. (a) In general—(1) Termination of employment by an estate or trust. If an estate or trust terminates (in a termination subject...