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Sample records for nhs direct wales

  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. 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

  3. National community pharmacy NHS influenza vaccination service in Wales: a primary care mixed methods study

    PubMed Central

    Evans, Andrew M; Wood, Fiona C; Carter, Ben

    2016-01-01

    Background Influenza is a significant cause of morbidity and excess mortality, yet vaccine coverage in the UK remains below target. Community pharmacies are increasingly being promoted as an alternative to vaccination by GPs. Aim To explore and verify the factors that influence the relative performance of pharmacies providing NHS influenza vaccinations. Design and setting A mixed methods study utilising qualitative, semi-structured interviews and quantitative analysis of predictors of vaccination numbers in community pharmacies in Wales. Method Interviews were conducted with 16 pharmacists who participated in the Welsh national pharmacy influenza service in 2013–2014. A purposive sampling strategy was used. Qualitative findings were analysed using framework analysis. Potential predictors of vaccination numbers were identified from interviews and a literature review, and included in a multivariable regression model. Results The contribution of community pharmacies towards vaccination in Wales is small. Findings suggest that community pharmacies reach younger at-risk individuals, in whom vaccine uptake is low, in greater proportion than influenza vaccination programmes as a whole. Extended opening hours and urban locations were positively associated with the number of vaccinations given, although pharmacists reported that workload, vaccine costs, unforeseen delays, lack of public awareness, and GPs’ views of the service limited their contribution. Pharmacists, aware of the potential for conflict with GPs, moderated their behaviour to mitigate such risk. Conclusion Before community pharmacies take greater responsibility for delivering healthcare services, obstacles including increasing pharmacist capacity, vaccine procurement, health service delays, managing GP–pharmacy relationships, and improving public awareness must be overcome. PMID:26965025

  4. 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.

  5. Exploring the role of communications in quality improvement: A case study of the 1000 Lives Campaign in NHS Wales

    PubMed Central

    Cooper, Andrew; Gray, Jonathon; Willson, Alan; Lines, Chris; McCannon, Joe; McHardy, Karina

    2015-01-01

    Introduction Effective communication is critical to successful large-scale change. Yet, in our experience, communications strategies are not formally incorporated into quality improvement (QI) frameworks. The 1000 Lives Campaign (‘Campaign’) was a large-scale national QI collaborative that aimed to save an additional 1000 lives and prevent 50 000 episodes of harm in Welsh health care over a 2-year period. We use the Campaign as a case study to describe the development, application, and impact of a communications strategy embedded in a large-scale QI initiative. Methods A comprehensive communications strategy guided communications work during the Campaign. The main aims of the communications strategy were to engage the hearts and minds of frontline National Health Service (NHS) staff in the Campaign and promote their awareness and understanding of specific QI interventions and the wider patient safety agenda. We used qualitative and quantitative measures to monitor communications outputs and assess how the communications strategy influenced awareness and knowledge of frontline NHS staff. Results The communications strategy facilitated clear and consistent framing of Campaign messages and allowed dissemination of information related to the range of QI interventions. It reaffirmed the aim and value of the Campaign to frontline staff, thereby promoting sustained engagement with Campaign activities. The communications strategy also built the profile of the Campaign both internally with NHS organizations across Wales and externally with the media, and played a pivotal role in improving awareness and understanding of the patient safety agenda. Ultimately, outcomes from the communications strategy could not be separated from overall Campaign outcomes. Conclusion and recommendations Systematic and structured communications can support and enhance QI initiatives. From our experience, we developed a ‘communications bundle’ consisting of six core components. We

  6. 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

  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. Establishing a people-centered health service in Gwent, Wales.

    PubMed

    Wilson, B

    1992-01-01

    The Welsh Health Planning Forum has developed a "Strategic Intent and Direction for the NHS in Wales." The aim is "to take the people of Wales into the 21st Century with a level of health on course to compare with the best in Europe" (Welsh Office NHS Directorate, The Welsh Health Planning Forum, 1989). Gwent Health, one of the nine health authorities in Wales, provides a comprehensive health service to its population of 445,000 and was chosen to develop a prototype for the provision of cancer services. Gwent residents were invited to seminars to express their opinions of the health service that was provided and describe the type of service they would like to have in the future. The response was encouraging enough to engender the planning of future seminars. PMID:10119895

  9. 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.

  10. 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

  11. 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

  12. Site-directed immobilization of antibody using EDC-NHS-activated protein A on a bimetallic-based surface plasmon resonance chip

    NASA Astrophysics Data System (ADS)

    Sohn, Young-Soo; Lee, Yeon Kyung

    2014-05-01

    The characteristics of a waveguide-coupled bimetallic surface plasmon resonance (WcBiM SPR) sensor using (3-dimethylaminopropyl)-3-ethylcarbodiimide(EDC)-N-hydroxysuccinimide(NHS)-activated protein A was investigated, and the detection of IgG using the EDC-NHS-activated protein A was studied in comparison with protein A and a self-assembled monolayer (SAM). The WcBiM sensor, which has a narrower full width at half maximum (FWHM) and a steeper slope, was selected since it leads to a larger change in the reflectance in the intensity detection mode. A preparation of the EDC-NHS-activated protein A for site-directed immobilization of antibodies was relative easily compared to the engineered protein G and A. In antigen-antibody interactions, the response to IgG at the concentrations of 50, 100, and 150 ng/ml was investigated. The results showed that the sensitivity of the WcBiM sensor using the EDC-NHS-activated protein A, protein A, and SAM was 0.0185 [%/(ng/ml)], 0.0065 [%/(ng/ml)], and 0.0101 [%/(ng/ml)], respectively. The lowest detectable concentrations of IgG with the EDC-NHS-activated protein A, protein A, and SAM were 4.27, 12.83, and 8.24 ng/ml, respectively. Therefore, the increased sensitivity and lower detection capability of the WcBiM SPR chip with the EDC-NHS-activated protein A suggests that it could be used in early diagnosis where the trace level concentrations of biomolecules should be detected.

  13. First evaluation of the NHS Direct Online Clinical Enquiry Service: A Nurse-led Web Chat Triage Service for the Public

    PubMed Central

    Wyatt, Jeremy C; Tarpey, Aideen M; Murray, Gerard; Ingrams, Grant J

    2004-01-01

    Background NHS Direct is a telephone triage service used by the UK public to contact a nurse for any kind of health problem. NHS Direct Online (NHSDO) extends NHS Direct, allowing the telephone to be replaced by the Internet, and introducing new opportunities for informing patients about their health. One NHSDO service under development is the Clinical Enquiry Service (CES), which uses Web chat as the communication medium. Objective To identify the opportunities and possible risks of such a service by exploring its safety, feasibility, and patient perceptions about using Web chat to contact a nurse. Methods During a six-day pilot performed in an inner-city general practice in Coventry, non-urgent patients attending their GP were asked to test the service. After filling out three Web forms, patients used a simple Web chat application to communicate with trained NHS Direct triage nurses, who responded with appropriate triage advice. All patients were seen by their GP immediately after using the Web chat service. Safety was explored by comparing the nurse triage end point with the GP's recommended end point. In order to check the feasibility of the service, we measured the duration of the chat session. Patient perceptions were measured before and after using the service through a modified Telemedicine Perception Questionnaire (TMPQ) instrument. All patients were observed by a researcher who captured any comments and, if necessary, to assisted with the process. Results A total of 25 patients (mean age 48 years; 57% female) agreed to participate in the study. An exact match between the nurse and the GP end point was found in 45% (10/22) of cases. In two cases, the CES nurse proposed a less urgent end point than the GP. The median duration of Web chat sessions was 30 minutes, twice the median for NHS Direct telephone calls for 360 patients with similar presenting problems. There was a significant improvement in patients' perception of CES after using the service (mean

  14. An assessment of the nonmarket benefits of the Water Framework Directive for households in England and Wales

    NASA Astrophysics Data System (ADS)

    Metcalfe, Paul J.; Baker, William; Andrews, Kevin; Atkinson, Giles; Bateman, Ian J.; Butler, Sarah; Carson, Richard T.; East, Jo; Gueron, Yves; Sheldon, Rob; Train, Kenneth

    2012-03-01

    Results are presented from a large-scale stated preference study designed to estimate the nonmarket benefits for households in England and Wales arising from the European Union Water Framework Directive (WFD). Multiple elicitation methods (a discrete choice experiment and two forms of contingent valuation) are employed, with the order in which they are asked randomly varied across respondents, to obtain a robust model for valuing specified WFD implementation programs applied to all of the lakes, reservoirs, rivers, canals, transitional, and coastal waters of England and Wales. The potential for subsequent policy incorporation and value transfer was enhanced by generating area-based values. These were found to vary from £2,263 to £39,168 per km2 depending on the population density around the location of the improvement, the ecological scope of that improvement, and the value elicitation method employed. While the former factors are consistent with expectations, the latter suggests that decision makers need to be aware of such methodological effects when employing derived values.

  15. A national syndromic surveillance system for England and Wales using calls to a telephone helpline.

    PubMed

    Smith, G E; Cooper, D L; Loveridge, P; Chinemana, F; Gerard, E; Verlander, N

    2006-01-01

    Routine primary care data provide the means to monitor a variety of syndromes which could give early warning of health protection issues. In the United Kingdom, a national syndromic surveillance system, operated jointly by the UK Health Protection Agency (HPA) and NHS Direct (a national telephone health helpline), examines symptoms reported to NHS Direct. The aim of the system is to identify an increase in syndromes indicative of common infections and diseases, or the early stages of illness caused by the deliberate release of a biological or chemical agent. Data relating to 11 key symptoms/syndromes are received electronically from all 22 NHS Direct call centres covering England and Wales and analysed by the HPA on a daily basis. Statistically significant excesses in calls are automatically highlighted and assessed by a multi-disciplinary team. Although the surveillance system has characterised many sudden rises in syndromes reported to NHS Direct, no evidence of a biological or chemical attack has been detected. Benefits of this work, however, are early warning and tracking of rises in community morbidity (e.g. influenza-like illness, heatstroke); providing reassurance during times of perceived high risk (e.g. after the 7 July 2005 London bombs and December 2005 Buncefield oil depot fire); and timely surveillance data for influenza pandemic planning and epidemic modeling. PMID:17370968

  16. 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.

  17. United Kingdom (Wales): Health system review.

    PubMed

    Longley, Marcus; Riley, Neil; Davies, Paul; Hernandez-Quevedo, Cristina

    2012-01-01

    Wales is situated to the west of England, with a population of approximately 3 million (5% of the total for the United Kingdom), and a land mass of just over 20 000 km2. For several decades, Wales had a health system largely administered through the United Kingdom Governments Welsh Office, but responsibility for most aspects of health policy was devolved to Wales in a process beginning in 1999. Since then, differences between the policy approach and framework in England and Wales have widened. The internal market introduced in the United Kingdom National Health Service (NHS) has been abandoned in Wales, and seven local health boards (LHBs; supported by three specialist NHS trusts) now plan and provide all health services for their resident populations. Wales currently has more than 120 hospitals as part of an overall estate valued at 2.3 billion pounds. Total spending on health services increased in the first decade of the 21st century, but Wales now faces a period of financial retrenchment greater than in other parts of the United Kingdom as a result of the Welsh Governments decision not to afford the same degree of protection to health spending as that granted elsewhere. The health system in Wales continues to face some structural weaknesses that have proved resistant to reform for some time. However, there has been substantial improvement in service quality and outcomes since the end of the 1990s, in large part facilitated by substantial real growth in health spending. Life expectancy has continued to increase, but health inequalities have proved stubbornly resistant to improvement.

  18. Training for the future NHS: training junior doctors in the United Kingdom within the 48-hour European working time directive

    PubMed Central

    2014-01-01

    Since August 2009, the National Health Service of the United Kingdom has faced the challenge of delivering training for junior doctors within a 48-hour working week, as stipulated by the European Working Time Directive and legislated in the UK by the Working Time Regulations 1998. Since that time, widespread concern has been expressed about the impact of restricted duty hours on the quality of postgraduate medical training in the UK, particularly in the “craft” specialties – that is, those disciplines in which trainees develop practical skills that are best learned through direct experience with patients. At the same time, specialist training in the UK has experienced considerable change since 2007 with the introduction of competency-based specialty curricula, workplace-based assessment, and the annual review of competency progression. The challenges presented by the reduction of duty hours include increased pressure on doctors-in-training to provide service during evening and overnight hours, reduced interaction with supervisors, and reduced opportunities for learning. This paper explores these challenges and proposes potential responses with respect to the reorganization of training and service provision. PMID:25560369

  19. Training for the future NHS: training junior doctors in the United Kingdom within the 48-hour European working time directive.

    PubMed

    Datta, Shreelatta T; Davies, Sally J

    2014-01-01

    Since August 2009, the National Health Service of the United Kingdom has faced the challenge of delivering training for junior doctors within a 48-hour working week, as stipulated by the European Working Time Directive and legislated in the UK by the Working Time Regulations 1998. Since that time, widespread concern has been expressed about the impact of restricted duty hours on the quality of postgraduate medical training in the UK, particularly in the "craft" specialties--that is, those disciplines in which trainees develop practical skills that are best learned through direct experience with patients. At the same time, specialist training in the UK has experienced considerable change since 2007 with the introduction of competency-based specialty curricula, workplace-based assessment, and the annual review of competency progression. The challenges presented by the reduction of duty hours include increased pressure on doctors-in-training to provide service during evening and overnight hours, reduced interaction with supervisors, and reduced opportunities for learning. This paper explores these challenges and proposes potential responses with respect to the reorganization of training and service provision. PMID:25560369

  20. 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.

  1. New South Wales

    Atmospheric Science Data Center

    2013-04-16

    ... city of Sydney was clouded with smoke when more than 80 wildfires raged across the state of New South Wales. These images were captured ... at JPL December 30, 2001 - Smoke from wildfires covers New South Wales. project:  MISR ...

  2. 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.

  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. 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

  6. 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.

  7. 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

  8. 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

  9. 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.

  10. 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

  11. 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

  12. Perinatal and infant mortality in Wales: inter-district variations and associations with socio-environmental characteristics.

    PubMed

    West, R R

    1988-06-01

    Stillbirth rates, perinatal death rates, early and late neonatal death rates and (post-neonatal) infant death rates are reported for Wales since local government and NHS reorganization in 1974. The time trends in these rates show declining mortality, in full weight and in low birthweight babies. Analysis of average rates for the period 1974-81 inclusive in the 37 local authority districts within Wales demonstrate wide variations, with PMRs ranging from 11.5 to 22.5 per 1000. Many highly statistically significant associations were evident between socioeconomic characteristics of the districts and stillbirth rates but few with neonatal death rates and none with infant death rates.

  13. 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

  14. 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

  15. Morality and values in support of universal healthcare must be enshrined in law. Comment on "Morality and Markets in the NHS".

    PubMed

    Pollock, Allyson M

    2015-06-01

    This is a commentary on Gilbert and colleagues' (1) paper on morality and markets in the National Health Service (NHS). Morality and values are not ephemeral qualities and universal healthcare is not simply an aspiration; it has to be enshrined in law. The creation of the UK NHS in 1948 was underpinned by core legal duties which required a system of public funding and delivery to follow. The moral values of the citizens in support of social solidarity were thus transformed into a political and legal contract for citizens. The NHS still survives in Scotland, Wales and Northern Ireland but the coalition government abolished it in England in 2012, reducing the NHS to a funding stream, a logo and a set of market regulators. This paper describes and explains the Health and Social Care (HSC) Act 2012 in England and how the NHS is withering away and health services are being remodeled along US Health Maintenance Organization (HMO) lines. There was nothing moral about this extraordinary act of savagery and violence against the public in England, and against common values and widely held beliefs in public ownership funding and provision of universal healthcare. The public health consequences will be catastrophic which is why after the election on May seventh a new Bill is required to Reinstate the NHS and the Secretary of State's legal duty to provide listed health services throughout England.

  16. Creation and development of an All-Wales Health Library Catalogue.

    PubMed

    John, Jennifer; Wright, Helen M

    2004-06-01

    This article focuses on the collaboration between the University of Wales College of Medicine (UWCM) libraries and the Welsh National Health Service (NHS) libraries to create a joint library catalogue. The goal was to create an all-Wales resource that gave users one access point to search for the location and availability of health-related material in any Welsh medical library. This venture grew out of the existing collaborative scheme, the All-Wales Health Information and Library Extension Services (AWHILES). Currently, all seven UWCM libraries and 17 NHS libraries contribute to the catalogue. Four more libraries are due to join in late 2003 or early 2004. All UWCM and AWHILES libraries would then be contributing members of the joint catalogue. The article discusses the background and motivation to the creation of the database. It explores the positives and negatives of the project plus what was learnt as the venture progressed. It reviews the establishment and operations of the Welsh Health Voyager User Group (WHVUG) created to involve all contributing members in the running and future development of the library catalogue.

  17. 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

  18. 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

  19. 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

  20. 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

  1. 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.

  2. Education in Wales and Welsh Language Teaching.

    ERIC Educational Resources Information Center

    Parker, Franklin; Parker, Betty J.

    Brief annotations are presented for 72 entries on education in Wales and on teaching the Welsh language in Wales. Entries include books, government reports, and journal articles. Several citations compare bilingual teaching in Wales, Canada, the USSR, the United States, Scotland, Ireland, and the Province of Brittany in France. The collection…

  3. Co-operation and conflict under hard and soft contracting regimes: case studies from England and Wales

    PubMed Central

    2013-01-01

    Background This paper examines NHS secondary care contracting in England and Wales in a period which saw increasing policy divergence between the two systems. At face value, England was making greater use of market levers and utilising harder-edged service contracts incorporating financial penalties and incentives, while Wales was retreating from the 1990s internal market and emphasising cooperation and flexibility in the contracting process. But there were also cross-border spill-overs involving common contracting technologies and management cultures that meant that differences in on-the-ground contracting practices might be smaller than headline policy differences suggested. Methods The nature of real-world contracting behaviour was investigated by undertaking two qualitative case studies in England and two in Wales, each based on a local purchaser/provider network. The case studies involved ethnographic observations and interviews with staff in primary care trusts (PCTs) or local health boards (LHBs), NHS or Foundation trusts, and the overseeing Strategic Health Authority or NHS Wales regional office, as well as scrutiny of relevant documents. Results Wider policy differences between the two NHS systems were reflected in differing contracting frameworks, involving regional commissioning in Wales and commissioning by either a PCT, or co-operating pair of PCTs in our English case studies, and also in different oversight arrangements by higher tiers of the service. However, long-term relationships and trust between purchasers and providers had an important role in both systems when the financial viability of organisations was at risk. In England, the study found examples where both PCTs and trusts relaxed contractual requirements to assist partners faced with deficits. In Wales, news of plans to end the purchaser/provider split meant a return to less precisely-specified block contracts and a renewed concern to build cooperation between LHB and trust staff

  4. 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.

  5. '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

  6. 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.

  7. '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.

  8. The ManVan: a mobile cancer support service for men with prostate, testicular and penile cancer in Wales

    PubMed Central

    Iredale, Rachel; Skilton, Rhiannon; Pugh, Richard; Blake, Heather

    2015-01-01

    The ManVan commenced service delivery on 1st April 2014 and is the United Kingdom’s first dedicated mobile support service for men affected by prostate, testicular, and penile cancer. It is delivered in partnership with Prostate Cancer UK and Movember and fully funded by the Movember Foundation. It brings nursing care, counselling for individuals and couples, group support and welfare rights advice, directly to men living with prostate, testicular and penile cancer in communities across Wales. The ManVan has travelled extensively across Wales during its first year, visiting 94 different locations, across all seven Local Health Board areas. The first half of the year began with a Roadshow where we welcomed thousands of visitors on board, including men and women worried by all sorts of cancer symptoms; their family and friends; health and social care professionals and politicians. The variety of venues the ManVan has visited has included hospitals, supermarkets, social clubs, caravan fairs and rugby grounds to help raise awareness of the ManVan service and identify potential clients. As expected the greatest proportion of visitors are male, particularly older men. In the second half of the year, we focussed on our target audience – men diagnosed with prostate, testicular, or penile cancer and their families. Using a targeted approach to urology clinics across NHS Wales, as well as community-based activity encouraging men from ethnic minorities to visit, we have now taken on 161 clients, many of whom have received more than one ManVan service, and attended on more than one occasion. Most of our clients have prostate cancer, are over the age of 55 years, and are married. Analysis of the early data around the clinical and psychosocial benefits of the services offered on the ManVan is positive and the annualised value of the benefits obtained for ManVan clients equates to more than £300,000 in this first year. There were 3,319 visitors to the ManVan in total during

  9. The ManVan: a mobile cancer support service for men with prostate, testicular and penile cancer in Wales.

    PubMed

    Iredale, Rachel; Skilton, Rhiannon; Pugh, Richard; Blake, Heather

    2015-01-01

    The ManVan commenced service delivery on 1st April 2014 and is the United Kingdom's first dedicated mobile support service for men affected by prostate, testicular, and penile cancer. It is delivered in partnership with Prostate Cancer UK and Movember and fully funded by the Movember Foundation. It brings nursing care, counselling for individuals and couples, group support and welfare rights advice, directly to men living with prostate, testicular and penile cancer in communities across Wales. The ManVan has travelled extensively across Wales during its first year, visiting 94 different locations, across all seven Local Health Board areas. The first half of the year began with a Roadshow where we welcomed thousands of visitors on board, including men and women worried by all sorts of cancer symptoms; their family and friends; health and social care professionals and politicians. The variety of venues the ManVan has visited has included hospitals, supermarkets, social clubs, caravan fairs and rugby grounds to help raise awareness of the ManVan service and identify potential clients. As expected the greatest proportion of visitors are male, particularly older men. In the second half of the year, we focussed on our target audience - men diagnosed with prostate, testicular, or penile cancer and their families. Using a targeted approach to urology clinics across NHS Wales, as well as community-based activity encouraging men from ethnic minorities to visit, we have now taken on 161 clients, many of whom have received more than one ManVan service, and attended on more than one occasion. Most of our clients have prostate cancer, are over the age of 55 years, and are married. Analysis of the early data around the clinical and psychosocial benefits of the services offered on the ManVan is positive and the annualised value of the benefits obtained for ManVan clients equates to more than £300,000 in this first year. There were 3,319 visitors to the ManVan in total during the

  10. 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

  11. 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.

  12. Sunshine, Sea, and Season of Birth: MS Incidence in Wales.

    PubMed

    Balbuena, Lloyd D; Middleton, Rod M; Tuite-Dalton, Katie; Pouliou, Theodora; Williams, Kate Elizabeth; Noble, Gareth J

    2016-01-01

    Maternal sun exposure in gestation and throughout the lifetime is necessary for vitamin D synthesis, and living near the sea is a population level index of seafood consumption. The aim of this study was to estimate the incidence rate of multiple sclerosis (MS) in Wales and examine its association with sun exposure, coastal living, and latitude. The study used a database of MS hospital visits and admissions in Wales between 2002 and 2013. For the 1,909 lower layer super output areas (LSOAs) in Wales, coastal status, population, longitude/latitude, and average sunshine hours per day were obtained. Age-specific and age-standardised MS incidence were calculated and modelled using Poisson regression. The distribution of births by month was compared between MS cases and the combined England and Wales population. There were 3,557 new MS cases between 2002 and 2013, with an average annual incidence of 8.14 (95% CI: 7.69-8.59) among males and 12.97 (95% CI: 12.44-13.50) among females per 100,000 population. The female-to-male ratio was 1.86:1. For both sexes combined, the average annual incidence rate was 9.10 (95% CI: 8.80-9.40). All figures are age-standardized to the 1976 European standard population. Compared to the combined England and Wales population, more people with MS were born in April, observed-to-expected ratio: 1.21 (95% CI: 1.08-1.36). MS incidence varied directly with latitude and inversely with sunshine hours. Proximity to the coast was associated with lower MS incidence only in easterly areas. This study shows that MS incidence rate in Wales is comparable to the rate in Scotland and is associated with environmental factors that probably represent levels of vitamin D. PMID:27182982

  13. 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

  14. 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

  15. 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.

  16. 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

  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. 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.

  19. 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.

  20. 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.

  1. Health research access to personal confidential data in England and Wales: assessing any gap in public attitude between preferable and acceptable models of consent.

    PubMed

    Taylor, Mark J; Taylor, Natasha

    2014-12-01

    England and Wales are moving toward a model of 'opt out' for use of personal confidential data in health research. Existing research does not make clear how acceptable this move is to the public. While people are typically supportive of health research, when asked to describe the ideal level of control there is a marked lack of consensus over the preferred model of consent (e.g. explicit consent, opt out etc.). This study sought to investigate a relatively unexplored difference between the consent model that people prefer and that which they are willing to accept. It also sought to explore any reasons for such acceptance.A mixed methods approach was used to gather data, incorporating a structured questionnaire and in-depth focus group discussions led by an external facilitator. The sampling strategy was designed to recruit people with different involvement in the NHS but typically with experience of NHS services. Three separate focus groups were carried out over three consecutive days.The central finding is that people are typically willing to accept models of consent other than that which they would prefer. Such acceptance is typically conditional upon a number of factors, including: security and confidentiality, no inappropriate commercialisation or detrimental use, transparency, independent overview, the ability to object to any processing considered to be inappropriate or particularly sensitive.This study suggests that most people would find research use without the possibility of objection to be unacceptable. However, the study also suggests that people who would prefer to be asked explicitly before data were used for purposes beyond direct care may be willing to accept an opt out model of consent if the reasons for not seeking explicit consent are accessible to them and they trust that data is only going to be used under conditions, and with safeguards, that they would consider to be acceptable even if not preferable.

  2. Public Library Development in New South Wales

    ERIC Educational Resources Information Center

    Jones, David J.

    2005-01-01

    Today every citizen in New South Wales has access to public library services through a sophisticated network, a partnership between local and State Government. In fact, free public libraries in New South Wales only began to operate in any numbers after the end of World War II--not even sixty years ago. Why did it take so long here, bearing in mind…

  3. Children's Perceptions of National Identity in Wales

    ERIC Educational Resources Information Center

    Murphy, Alison; Laugharne, Janet

    2013-01-01

    The project forms part of a larger doctoral study which examines children's perceptions of national identity and its construction and importance in the world of the child in Wales. The research took place in a primary school class in the South Wales valleys, in a class of 27 children aged 7-8 years. Following an introductory activity, children…

  4. 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.

  5. 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

  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.

  7. 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

  8. 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.

  9. 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.

  10. 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

  11. The New Wales: A Learning Country?

    ERIC Educational Resources Information Center

    Francis, Hywel

    2000-01-01

    To develop Wales as a "learning country," clear definitions of poverty, social partnership, and cultural diversity are needed. Addressing these questions can lead to a broad enabling vision of learning for all. (SK)

  12. Wales as a Setting for Children's Fantasy.

    ERIC Educational Resources Information Center

    Kiefer, Barbara Z.

    1982-01-01

    Examines three works of fantasy that have been awarded the Newbery or Carnegie Medal during the last 15 years ("The High King,""The Owl Service," and "The Grey King") and that have used Wales as their setting. (HOD)

  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. 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. 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

  18. The Lightening Veil: Language Revitalization in Wales

    ERIC Educational Resources Information Center

    Williams, Colin H.

    2014-01-01

    The Welsh language, which is indigenous to Wales, is one of six Celtic languages. It is spoken by 562,000 speakers, 19% of the population of Wales, according to the 2011 U.K. Census, and it is estimated that it is spoken by a further 200,000 residents elsewhere in the United Kingdom. No exact figures exist for the undoubted thousands of other…

  19. 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.

  20. 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

  1. 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

  2. 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

  3. People's Collection Wales: Online Access to the Heritage of Wales from Museums, Archives and Libraries

    ERIC Educational Resources Information Center

    Tedd, Lucy A.

    2011-01-01

    Purpose: The People's Collection Wales aims to collect, interpret, distribute and discuss Wales' cultural heritage in an online environment. Individual users or local history societies are able to create their own digital collections, contribute relevant content, as well as access digital resources from heritage institutions. This paper aims to…

  4. Clinical and lay preferences for the explicit prioritisation of elective waiting lists: survey evidence from Wales.

    PubMed

    Edwards, Rhiannon Tudor; Boland, Angela; Wilkinson, Clare; Cohen, David; Williams, John

    2003-03-01

    Waiting lists are a persistent feature of public health care systems. The United Kingdom National Health Service (NHS) is considering priority scoring systems as a means of ensuring that patients are treated according to clinical need rather than maximum waiting time targets. Our objective was to elicit the preferences of those involved in the finance, delivery and receipt of elective health care regarding the clinical and social factors that should and should not determine waiting time. We conducted a postal survey of 750 general practitioners, 500 consultants, 29 health authority commissioners and 1000 members of the general public across Wales. We found both professional and lay support for a more explicit system of rationing access to elective health care by waiting list. The majority of each of the survey groups believe that level of pain, rate of deterioration of disease, level of distress and level of disability should play the most influential role in determining waiting times. They agree that age, ability to pay, cost of treatment, evidence of cost-effectiveness, existence of dependants, and self-inflicted ill health should have little or no influence on patient priority. In conclusion, were the NHS to widen its use of waiting list priority scoring systems, our study suggests that there may be some degree of consensus as to the criteria to be used.

  5. 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.

  6. 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

  7. Health needs of detainees in police custody in England and Wales. Literature review.

    PubMed

    Rekrut-Lapa, Tatyana; Lapa, Alexander

    2014-10-01

    The aim of this systematic is to review and analyse the literature concerned with the health needs of detainees in police custody in England and Wales. The healthcare of detainees in police custody is regulated by the England and Wales Police and Criminal Evidence Act 1984. The Faculty of Forensic and Legal Medicine of the Royal College of Physicians also sets quality standards for the provision of custodial healthcare. The provision of healthcare in custody presents a number of challenges including the patient group, the setting and the overlap between the legal and medical concerns that are addressed by the medical team. Currently, care to the detainees in custody is delivered by a mixture of private organisations, police-led forensic medical services and the NHS. A search of the PUBMED, EMBASE and PsycINFO databases undertaken using the search terms: (police custody) OR (detainees) OR (police detainees) yielded 830 publications. All of the titles were screened to identify potentially relevant publications concerned with the health needs of detainees in police custodies in England and Wales. There were no design specific criteria set for inclusion of the studies in this literature review. 77 articles were initially identified as relevant and obtained in full. After further analysis 28 publications were included in this literature review. A total sample of over 12,000 detainees was examined in this literature review. Approximately 20% of detainees seen by health care teams suffer from psychiatric conditions. On average, 50% of patients claim that they have problems with drugs and alcohol. Physical health conditions are also highly prevalent with up to 74% of detainees requiring regular medication. Forensic medical issues included the management of detainees who were restrained using handcuffs, irritant sprays and TASER. Detainees who are suspected of internal drug concealment also require intensive medical input. Injury documentation in custody is often requested

  8. 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.

  9. 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.

  10. 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

  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. 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.

  16. 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

  17. Adult Education in England and Wales.

    ERIC Educational Resources Information Center

    Lowe, John

    This survey of adult education in England and Wales includes a brief historical review, and chapters on the role of the state and local authorities; evening institutes and adult centers; residential colleges; the "responsible bodies" (i.e. the universities and the Workers Education Association); education in the military, prisons, and other…

  18. Further Education in England and Wales.

    ERIC Educational Resources Information Center

    Cantor, Leonard M.; Roberts, I. Francis

    Major features of further education in England and Wales are analyzed, and ways are suggested in which it might profitably develop during the 1970's. Major activities and legislation from the 1944 Education Act through the Industrial Training Act of 1964 are reviewed. Although strictly a part of higher education, the training and the supply of…

  19. New South Wales School Design Projects.

    ERIC Educational Resources Information Center

    Wilson, Cecilia

    2003-01-01

    Australia's New South Wales Education Facilities Research Group, a joint initiative between the Department of Education and Training and the Department of Public Works and Services, provides action research into issues which impact on school design. This article describes a few of the initiatives which have resulted, such as an educational video…

  20. A View from England and Wales

    ERIC Educational Resources Information Center

    Ingham, Roger

    2016-01-01

    This commentary outlines developments regarding Sex and Relationships Education (SRE, akin to Comprehensive Sex Education) in England and Wales over the past 15 years or so. BZgA has been a WHO/Europe collaborating centre for sexual and reproductive health since 2003. In this capacity, BZgA contributes to the development and dissemination of WHO…

  1. Our Vision for a Sustainable Wales

    ERIC Educational Resources Information Center

    Davidson, Jane

    2010-01-01

    The Welsh Assembly Government is committed to putting sustainable development at the heart of all it does. In May 2009, the Assembly launched its latest scheme, "One Wales: One Planet," which sets out a clear definition of sustainable development as enhancing the economic, social and environmental wellbeing of people and communities, achieving a…

  2. 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

  3. 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.

  4. 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.

  5. A new fetal RHD genotyping test: Costs and benefits of mass testing to target antenatal anti-D prophylaxis in England and Wales

    PubMed Central

    2011-01-01

    Background Postnatal and antenatal anti-D prophylaxis have dramatically reduced maternal sensitisations and cases of rhesus disease in babies born to women with RhD negative blood group. Recent scientific advances mean that non-invasive prenatal diagnosis (NIPD), based on the presence of cell-free fetal DNA in maternal plasma, could be used to target prophylaxis on "at risk" pregnancies where the fetus is RhD positive. This paper provides the first assessment of cost-effectiveness of NIPD-targeted prophylaxis compared to current policies. Methods We conducted an economic analysis of NIPD implementation in England and Wales. Two scenarios were considered. Scenario 1 assumed that NIPD will be only used to target antenatal prophylaxis with serology tests continuing to direct post-delivery prophylaxis. In Scenario 2, NIPD would also displace postnatal serology testing if an RhD negative fetus was identified. Costs were estimated from the provider's perspective for both scenarios together with a threshold royalty fee per test. Incremental costs were compared with clinical implications. Results The basic cost of an NIPD in-house test is £16.25 per sample (excluding royalty fee). The two-dose antenatal prophylaxis policy recommended by NICE is estimated to cost the NHS £3.37 million each year. The estimated threshold royalty fee is £2.18 and £8.83 for Scenarios 1 and 2 respectively. At a £2.00 royalty fee, mass NIPD testing would produce no saving for Scenario 1 and £507,154 per annum for Scenario 2. Incremental cost-effectiveness analysis indicates that, at a test sensitivity of 99.7% and this royalty fee, NIPD testing in Scenario 2 will generate one additional sensitisation for every £9,190 saved. If a single-dose prophylaxis policy were implemented nationally, as recently recommended by NICE, Scenario 2 savings would fall. Conclusions Currently, NIPD testing to target anti-D prophylaxis is unlikely to be sufficiently cost-effective to warrant its large scale

  6. 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.

  7. Orientations of linear stone arrangements in New South Wales

    NASA Astrophysics Data System (ADS)

    Hamacher, Duane W.; Fuller, Robert S.; Norris, Ray P.

    2012-12-01

    We test the hypothesis that Aboriginal linear stone arrangements in New South Wales (NSW) are oriented to cardinal directions. We accomplish this by measuring the azimuths of stone arrangements described in site cards from the NSW Aboriginal Heritage Information Management System. We then survey a subset of these sites to test the accuracy of information recorded on the site cards. We find a preference recorded in the site cards for cardinal orientations among azimuths. The field surveys show that the site cards are reasonably accurate, but the surveyors probably did not correct for magnetic declinations. Using Monte Carlo statistics, we show that these preferred orientations did not occur by chance and that Aboriginal people deliberately aligned these arrangements to the approximate cardinal directions. We briefly explore possible reasons for these preferred orientations and highlight the need for future work.

  8. Re-organisation of oesophago-gastric cancer services in England and Wales: a follow-up assessment of progress and remaining challenges

    PubMed Central

    2014-01-01

    Background This study is an update on an earlier article in 2007 to assess the implementation of the Cancer Plan reform strategy in England and Wales. Findings A national online survey to upper gastro-intestinal leads at network and trust level. The questionnaire was designed based on existing clinical practice guidelines and addressed governing principles and operational procedures related to the delivery of cancer care. It was sent in January 2012 to upper gastro-intestinal network and trusts leads at all cancer networks and acute NHS organisations in England and Wales. Responses were received from 100% of Cancer Networks and 91% of NHS organisations. Centralisation of surgery has improved with all but two trusts (5.4%) now meeting the minimum staffing level for oesophago-gastric cancer surgery. This is a substantial improvement since the 2007 survey when 21 trusts (46.7%) did not meet this requirement. The use of formal assessment for nutritional needs has improved, too. In 2007, the involvement of the palliative care team in multi-disciplinary teams was poor. While this has improved, 27 trusts (19.7%) still report that none of the palliative care team members routinely attend the multi-disciplinary team discussion. Conclusions The survey demonstrates improved compliance with organisational recommendations since the last assessment in 2007. Centralisation of surgery has improved and is nearly fully compliant with the reform strategy. Areas that require further improvement are nutritional support and inclusion of palliative care in multi-disciplinary team meetings. PMID:24406032

  9. Various Stone-Wales defects in phagraphene

    NASA Astrophysics Data System (ADS)

    Openov, L. A.; Podlivaev, A. I.

    2016-08-01

    Various Stone-Wales defects in phagraphene, which is a graphene allotrope, predicted recently are studied in terms of the nonorthogonal tight-binding model. The energies of the defect formation and the heights of energy barriers preventing the formation and annealing of the defects are found. Corresponding frequency factors in the Arrhenius formula are calculated. The evolution of the defect structure is studied in the real-time mode using the molecular dynamics method.

  10. 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

  11. 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

  12. 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.

  13. 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.

  14. 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

  15. 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

  16. 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.

  17. 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

  18. 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.

  19. Making the economic case for prevention – a view from Wales

    PubMed Central

    2012-01-01

    Background It is widely acknowledged that adverse lifestyle behaviours in the population now will place an unsustainable burden on health service resources in the future. It has been estimated that the combined cost to the NHS in Wales of overweight and obesity, alcohol and tobacco is in excess of £540 million. In the current climate of financial austerity, there can be a tendency for the case for prevention efforts to be judged on the basis of their scope for cost savings. This paper was prompted by discussion in Wales about the evidence for the cost savings from prevention and early intervention and a resulting concern that these programmes were thus being evaluated in policy terms using an incorrect metric. Following a review of the literature, this paper contributes to the discussion of the potential role that economics can play in informing decisions in this area. Discussion This paper argues that whilst studies of the economic burden of diseases provide information about the magnitude of the problem faced, they should not be used as a means of priority setting. Similarly, studies discussing the likelihood of savings as a result of prevention programmes may be distorting the arguments for public health. Prevention spend needs to be considered purposefully, resulting in a strategic commitment to spending. The role of economics in this process is to provide evidence demonstrating that information and support can be provided cost effectively to individuals to change their lifestyles thus avoiding lifestyle related morbidity and mortality. There is growing evidence that prevention programmes represent value for money using the currently accepted techniques and decision making metrics such as those advocated by NICE. Summary The issue here is not one of arguing that the economic evaluation of prevention and early intervention should be treated differently, although in some instances that may be appropriate, rather it is about making the case for these

  20. Use of programme budgeting and marginal analysis as a framework for resource reallocation in respiratory care in North Wales, UK

    PubMed Central

    Charles, J.M.; Brown, G.; Thomas, K.; Johnstone, F.; Vandenblink, V.; Pethers, B.; Jones, A.; Edwards, R.T.

    2016-01-01

    Background Since the global financial crisis, UK NHS spending has reduced considerably. Respiratory care is a large cost driver for Betsi Cadwaladr University Health Board, the largest health board in Wales. Under the remit of ‘prudent healthcare’ championed by the Welsh Health Minister, a Programme Budgeting Marginal Analysis (PBMA) of the North Wales respiratory care pathway was conducted. Methods A PBMA panel of directors of medicines management, therapies finance, planning, public health and healthcare professionals used electronic voting to establish criteria for decision-making and vote on candidate interventions in which to disinvest and invest. Results A sum of £86.9 million was spent on respiratory care in 2012–13. Following extensive discussion of 13 proposed candidate interventions facilitated by a chairperson, 4 candidates received recommendations to disinvest, 7 to invest and 2 to maintain current activity. Marginal analysis prioritized mucolytics and high antibiotic prescribing as areas for disinvestment, and medicines waste management and pulmonary rehabilitation for investment. Conclusions This exercise demonstrates the potential for health boards to use evidence-based approaches to reach potentially controversial disinvestment and investment decisions. Initial progress has begun with communication from the Medical Director in relation to the disinvestment in mucolytics prescribing and possible redirection of funding options being explored. PMID:26377991

  1. 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

  2. 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.

  3. 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.

  4. 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.

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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

  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. A synthetic Longitudinal Study dataset for England and Wales.

    PubMed

    Dennett, Adam; Norman, Paul; Shelton, Nicola; Stuchbury, Rachel

    2016-12-01

    This article describes the new synthetic England and Wales Longitudinal Study 'spine' dataset designed for teaching and experimentation purposes. In the United Kingdom, there exist three Census-based longitudinal micro-datasets, known collectively as the Longitudinal Studies. The England and Wales Longitudinal Study (LS) is a 1% sample of the population of England and Wales (around 500,000 individuals), linking individual person records from the 1971 to 2011 Censuses. The synthetic data presented contains a similar number of individuals to the original data and accurate longitudinal transitions between 2001 and 2011 for key demographic variables, but unlike the original data, is open access. PMID:27656667

  14. A synthetic Longitudinal Study dataset for England and Wales.

    PubMed

    Dennett, Adam; Norman, Paul; Shelton, Nicola; Stuchbury, Rachel

    2016-12-01

    This article describes the new synthetic England and Wales Longitudinal Study 'spine' dataset designed for teaching and experimentation purposes. In the United Kingdom, there exist three Census-based longitudinal micro-datasets, known collectively as the Longitudinal Studies. The England and Wales Longitudinal Study (LS) is a 1% sample of the population of England and Wales (around 500,000 individuals), linking individual person records from the 1971 to 2011 Censuses. The synthetic data presented contains a similar number of individuals to the original data and accurate longitudinal transitions between 2001 and 2011 for key demographic variables, but unlike the original data, is open access.

  15. Mental hospital regime in England and Wales.

    PubMed

    Andoh, B

    1996-01-01

    Although non-private conventional mental hospitals in England and Wales have been in existence for about two centuries, the literature on the actual regimes in those hospitals is not enormous. Since Goffman's Asylums, things have changed in North America, the United Kingdom and elsewhere. However, not much has been written about the present position. This article (based on qualitative data collected over 12 months) describes the regimes in three conventional mental hospitals in S.E. England. It covers hospital policy on the admission of a patient, daily ward routine, the open-door policy, fire precautions, close observation, seclusion, search of patients and their belongings and the handling of patients' correspondence. It concludes that the regimes are reasonable.

  16. Reemergence of Canine Echinococcus granulosus Infection, Wales

    PubMed Central

    Buishi, Imad; Walters, Tom; Guildea, Zoë; Palmer, Stephen

    2005-01-01

    As a consequence of large-scale outdoor slaughter of sheep during the 2001 foot and mouth disease (FMD) outbreak in the United Kingdom and the possibility of increased risk for transmission of Echinococcus granulosus between sheep and dogs, a large survey of canine echinococcosis was undertaken in mid-Wales in 2002. An Echinococcus coproantigen-positive rate of 8.1% (94/1,164) was recorded on 22% of farms surveyed, which compares to a rate of 3.4% obtained in the same region in 1993. Positivity rates between FMD-affected properties and unaffected ones did not differ significantly. Significant risk factors for positive results in farm dogs were allowing dogs to roam free and the infrequent dosing (>4-month intervals) of dogs with praziquantel. When these data are compared to those of a previous pilot hydatid control program in the area (1983–1989), an increase in transmission to humans appears probable. PMID:15829195

  17. 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).

  18. 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

  19. 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

  20. 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

  1. 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.

  2. 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

  3. 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

  4. Law and Order...and the Prince of Wales

    ERIC Educational Resources Information Center

    Bernard, Thomas L.

    1970-01-01

    Brief historical account setting forth the manner of fusion of a number of races to become the British, and the significant part played by the very first Prince of Wales in initiating this process. (RJ)

  5. Courses in Physics in England, Wales and Northern Ireland.

    ERIC Educational Resources Information Center

    Physics Education, 1980

    1980-01-01

    Presents a description of the curricula in physics at 124 universities, colleges, and polytechnical institutes in England, Wales, and Northern Ireland. General information is provided on examination requirements for admission and procedures for making application to the schools. (SA)

  6. Topological anisotropy of stone-wales waves in graphenic fragments.

    PubMed

    Ori, Ottorino; Cataldo, Franco; Putz, Mihai V

    2011-01-01

    Stone-Wales operators interchange four adjacent hexagons with two pentagon-heptagon 5|7 pairs that, graphically, may be iteratively propagated in the graphene layer, originating a new interesting structural defect called here Stone-Wales wave. By minimization, the Wiener index topological invariant evidences a marked anisotropy of the Stone-Wales defects that, topologically, are in fact preferably generated and propagated along the diagonal of the graphenic fragments, including carbon nanotubes and graphene nanoribbons. This peculiar edge-effect is shown in this paper having a predominant topological origin, leaving to future experimental investigations the task of verifying the occurrence in nature of wave-like defects similar to the ones proposed here. Graph-theoretical tools used in this paper for the generation and the propagation of the Stone-Wales defects waves are applicable to investigate isomeric modifications of chemical structures with various dimensionality like fullerenes, nanotubes, graphenic layers, schwarzites, zeolites. PMID:22174641

  7. 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.

  8. 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

  9. 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.

  10. GIS Applied to Landslide Hazard Mapping and Evaluation in North-East Wales

    NASA Astrophysics Data System (ADS)

    Miller, S. A.; Degg, M.

    2009-04-01

    regression) approach. The resulting models divide the landscape of North-East Wales into areas of ‘low', ‘moderate' and ‘high' landslide susceptibility using calculated probability values. These models indicate that 8% of the surface exposure of drift deposits and 12% of the area of solid geology are classified as being of high or very high susceptibility to slope instability. Validation of the models indicates that they have success rates of up to 80% in predicting the location of known (documented and mapped) landslides. This compares very favourably to models produced elsewhere. The usefulness of the models as a landslide management tool has also been explored by carrying out a landslide impact survey for built-up areas of Holywell and Greenfield Valley in the north of the study area, where there are a number of well defined (‘known') landslides. The landslide impact survey highlights that damage to the built environment extends beyond these known landslides into areas indicated by the models as being of high and very high susceptibility to slope instability. This emphasises the value of GIS techniques, incorporating direct and indirect landslide mapping, in landslide susceptibility modelling and associated landslide management.

  11. Flood Forecasting in Wales: Challenges and Solutions

    NASA Astrophysics Data System (ADS)

    How, Andrew; Williams, Christopher

    2015-04-01

    With steep, fast-responding river catchments, exposed coastal reaches with large tidal ranges and large population densities in some of the most at-risk areas; flood forecasting in Wales presents many varied challenges. Utilising advances in computing power and learning from best practice within the United Kingdom and abroad have seen significant improvements in recent years - however, many challenges still remain. Developments in computing and increased processing power comes with a significant price tag; greater numbers of data sources and ensemble feeds brings a better understanding of uncertainty but the wealth of data needs careful management to ensure a clear message of risk is disseminated; new modelling techniques utilise better and faster computation, but lack the history of record and experience gained from the continued use of more established forecasting models. As a flood forecasting team we work to develop coastal and fluvial forecasting models, set them up for operational use and manage the duty role that runs the models in real time. An overview of our current operational flood forecasting system will be presented, along with a discussion on some of the solutions we have in place to address the challenges we face. These include: • real-time updating of fluvial models • rainfall forecasting verification • ensemble forecast data • longer range forecast data • contingency models • offshore to nearshore wave transformation • calculation of wave overtopping

  12. Smoke Blankets New South Wales, Australia

    NASA Technical Reports Server (NTRS)

    2002-01-01

    Australia's largest city of Sydney was clouded with smoke when more than 70 wildfires raged across the state of New South Wales. These images were captured on the morning of December 30, 2001, by the Multi-angle Imaging SpectroRadiometer (MISR) instrument aboard NASA's Terra spacecraft. The left-hand image is from the instrument's 26-degree forward-viewing camera, and the right-hand image is from the 60-degree forward-viewing camera. The vast extent of smoke from numerous fires is visible, particularly in the more oblique view. Sydney is located just above image center.

    Dubbed the 'black Christmas' fires, the blazes destroyed more than 150 homes and blackened over 5000 square kilometers (about 1.24 million acres) of farmland and wilderness between December 23, 2001 and January 3, 2002. Many of the fires are believed to have been caused by arsonists, with only one fire linked to natural causes. The fires were aggravated by gusty winds and hot dry weather conditions. Approximately 20,000 people have worked to contain the blazes. No people have lost their lives or been seriously injured. Nevertheless, the fires are considered to be the most prolonged and destructive of any in Australia since the Ash Wednesday conflagration of 1983 that claimed 72 lives.

    The images represent an area 322 kilometers x 374 kilometers and were captured during Terra orbit 10829.

  13. 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

  14. Protein quantitation using Ru-NHS ester tagging and isotope dilution high-pressure liquid chromatography-inductively coupled plasma mass spectrometry determination.

    PubMed

    Liu, Rui; Lv, Yi; Hou, Xiandeng; Yang, Lu; Mester, Zoltan

    2012-03-20

    An accurate, simple, and sensitive method for the direct determination of proteins by nonspecies specific isotope dilution and external calibration high-performance liquid chromatography-inductively coupled plasma mass spectrometry (HPLC-ICPMS) is described. The labeling of myoglobin (17 kDa), transferrin (77 kDa), and thyroglobulin (670 kDa) proteins was accomplished in a single-step reaction with a commercially available bis(2,2'-bipyridine)-4'-methyl-4-carboxybipyridine-ruthenium N-succinimidyl ester-bis(hexafluorophosphate) (Ru-NHS ester). Using excess amounts of Ru-NHS ester compared to the protein concentration at optimized labeling conditions, constant ratios for Ru to proteins were obtained. Bioconjugate solutions containing both labeled and unlabeled proteins as well as excess Ru-NHS ester reagent were injected onto a size exclusion HPLC column for separation and ICPMS detection without any further treatment. A (99)Ru enriched spike was used for nonspecies specific ID calibration. The accuracy of the method was confirmed at various concentration levels. An average recovery of 100% ± 3% (1 standard deviation (SD), n = 9) was obtained with a typical precision of better than 5% RSD at 100 μg mL(-1) for nonspecies specific ID. Detection limits (3SD) of 1.6, 3.2, and 7.0 fmol estimated from three procedure blanks were obtained for myoglobin, transferrin, and thyroglobulin, respectively. These detection limits are suitable for the direct determination of intact proteins at trace levels. For simplicity, external calibration was also tested. Good linear correlation coefficients, 0.9901, 0.9921, and 0.9980 for myoglobin, transferrin, and thyroglobulin, respectively, were obtained. The measured concentrations of proteins in a solution were in good agreement with their volumetrically prepared values. To the best of our knowledge, this is the first application of nonspecies specific ID for the accurate and direct determination of proteins using a Ru-NHS ester

  15. 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.

  16. The Climate Change Consortium of Wales (C3W)

    NASA Astrophysics Data System (ADS)

    Hendry, K. R.; Reis, J.; Hall, I. R.

    2011-12-01

    In response to the complexity and multidisciplinary nature of climate change research, the Climate Change Consortium of Wales (C3W) was formed in 2009 by the Welsh universities of Aberystwyth, Bangor, Cardiff and Swansea. Initially funded by Welsh Government, through the Higher Education Funding Council for Wales, the Countryside Council for Wales and the universities, C3W aims to bring together climate change researchers from a wide range of disciplines to explore scientific and sociological drivers, impacts and implications at local, national and international scale. The specific aims are to i) improve our fundamental understanding of the causes, nature, timing and consequences of climate change on Planet Earth's environment and on humanity, and ii) to reconfigure climate research in Wales as a recognisable centre of excellence on the world stage. In addition to improving the infrastructure for climate change research, we aim to improve communication, networking, collaborative research, and multidisciplinary data assimilation within and between the Welsh universities, and other UK and international institutions. Furthermore, C3W aims to apply its research by actively contributing towards national policy development, business development and formal and informal education activities within and beyond Wales.

  17. 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.

  18. 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

  19. 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.

  20. 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

  1. Hereditary pancreatitis in England and Wales.

    PubMed Central

    Sibert, J R

    1978-01-01

    Information from 72 patients from 7 families in England and Wales confirms that hereditary pancreatitis is inherited as an autosomal dominant conditions with limited penetrance. The degree of penetrance is approximately 80%. These patients have had recurrent attacks of abdominal pain starting from childhood or young adult life. The mean age of onset in the 7 families studied was 13.6 years. There were two peaks, with maximum numbers at 5 years and 17 years. The second peak was thought to represent genetically susceptible individuals having pain brought on by alcohol rather than representing evidence of genetic heterogeneity. Five of the 7 families had members with both childhood and adult ages of onset. Only 4 patients out of 72 had life-threatening disease and in the majority of cases the attacks of pain were of nuisance value only. Hereditary pancreatitis was implicated in only 1 patient's death and this was not definite. Patients appear to get better after a period of symptoms usually as they approach middle age, or after a severe attack. In older patients alcohol, emotional upsets, and fatty food appear to precipitate attacks. Pancreatic insufficiency (5.5%), diabetes mellitus (12.5%), pseudocysts (5.5%), and haemorrhagic pleural effusion are uncommon complications. Portal vein thrombosis occurred definitely in 2 patients and was suspected in 3 others. Carcinoma of the pancreas was not found in any of 72 patients studied in detail; however, 2 members from a family not visited personally had chronic pancreatitis and malabsorption going on to carcinoma. They may have suffered from a different disease. Genetic linkage information was too slight for many definite conclusions. However, there was no suggestion of linkage with any of the markers tested. PMID:671483

  2. A micro costing of NHS cancer genetic services

    PubMed Central

    Griffith, G L; Tudor-Edwards, R; Gray, J; Butler, R; Wilkinson, C; Turner, J; France, B; Bennett, P

    2004-01-01

    This paper presents the first full micro costing of a commonly used cancer genetic counselling and testing protocol used in the UK. Costs were estimated for the Cardiff clinic of the Cancer Genetics Service in Wales by issuing a questionnaire to all staff, conducting an audit of clinic rooms and equipment and obtaining gross unit costs from the finance department. A total of 22 distinct event pathways were identified for patients at risk of developing breast, ovarian, breast and ovarian or colorectal cancer. The mean cost per patient were £97–£151 for patients at moderate risk, £975–£3072 for patients at high risk of developing colorectal cancer and £675–£2909 for patients at high risk of developing breast or ovarian cancer. The most expensive element of cancer genetic services was labour. Labour costs were dependent upon the amount of labour, staff grade, number of counsellors used and the proportion of staff time devoted to indirect patient contact. With the growing demand for cancer genetic services and the growing number of national and regional cancer genetic centers, there is a need for the different protocols being used to be thoroughly evaluated in terms of costs and outcomes. PMID:15583691

  3. Current Practice in the Referral of Individuals with Suspected Dementia for Neuroimaging by General Practitioners in Ireland and Wales

    PubMed Central

    Ciblis, Aurelia S.; Butler, Marie-Louise; Quinn, Catherine; Clare, Linda; Bokde, Arun L. W.; Mullins, Paul G.; McNulty, Jonathan P.

    2016-01-01

    Objectives While early diagnosis of dementia is important, the question arises whether general practitioners (GPs) should engage in direct referrals. The current study investigated current referral practices for neuroimaging in dementia, access to imaging modalities and investigated related GP training in Ireland and North Wales. Methods A questionnaire was distributed to GPs in the programme regions which included approximately two thirds of all GPs in the Republic of Ireland and all general practitioners in North Wales. A total of 2,093 questionnaires were issued. Results 48.6% of Irish respondents and 24.3% of Welsh respondents directly referred patients with suspected dementia for neuroimaging. Irish GPs reported greater direct access to neuroimaging than their Welsh counterparts. A very small percentage of Irish and Welsh GPs (4.7% and 10% respectively) had received training in neuroimaging and the majority who referred patients for neuroimaging were not aware of any dementia-specific protocols for referrals (93.1% and 95% respectively). Conclusions The benefits of direct GP access to neuroimaging investigations for dementia have yet to be established. Our findings suggest that current GP speciality training in Ireland and Wales is deficient in dementia-specific and neuroimaging training with the concern being that inadequate training will lead to inadequate referrals. Further training would complement guidelines and provide a greater understanding of the role and appropriateness of neuroimaging techniques in the diagnosis of dementia. PMID:27007435

  4. MISR Stereo Imagery of Blue Mountain Fires in New South Wales, Australia

    Atmospheric Science Data Center

    2013-12-17

    article title:  MISR Stereo Imagery of Blue Mountain Fires in New South Wales, Australia     ... October 24, 2013 - MISR Stereo Imagery of Blue Mountain Fires in New South Wales, Australia project:  MISR ...

  5. 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.

  6. 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

  7. 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

  8. 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.

  9. 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

  10. Juridification, medicalisation, and the impact of EU Law: patient mobility and the allocation of scarce NHS resources.

    PubMed

    Veitch, Kenneth

    2012-01-01

    This article explores the relationship between EU Law and the allocation of scarce NHS resources in the context of the EU's objective of facilitating access to health care for patients within the EU. Focusing on the Watts case and the recently adopted EU Patients' Rights Directive, the article addresses the political and economic aspects of the implications of EU Law for, inter alia, domestic law, medicine, and the NHS. It does so through developing an analytical framework comprising the notions of juridification and medicalisation. Those notions, which are drawn here from the work of Jürgen Habermas, Ivan Illich, and Sheila McLean, are not only helpful as means of thinking through the nature of the specific EU laws considered in the article; by virtue of their broader focus on, and critique of, the welfare state, they offer an opportunity to reflect more generally on the implications of these laws for the role of the welfare state and medical and legal professionals in the development of the EU's internal market in health care services. Having undertaken this analysis, the article argues that, in order to capture the developments and implications of EU Law on patient mobility, it is necessary to update and partially reformulate the notions of medicalisation and juridification. PMID:22535326

  11. Juridification, medicalisation, and the impact of EU Law: patient mobility and the allocation of scarce NHS resources.

    PubMed

    Veitch, Kenneth

    2012-01-01

    This article explores the relationship between EU Law and the allocation of scarce NHS resources in the context of the EU's objective of facilitating access to health care for patients within the EU. Focusing on the Watts case and the recently adopted EU Patients' Rights Directive, the article addresses the political and economic aspects of the implications of EU Law for, inter alia, domestic law, medicine, and the NHS. It does so through developing an analytical framework comprising the notions of juridification and medicalisation. Those notions, which are drawn here from the work of Jürgen Habermas, Ivan Illich, and Sheila McLean, are not only helpful as means of thinking through the nature of the specific EU laws considered in the article; by virtue of their broader focus on, and critique of, the welfare state, they offer an opportunity to reflect more generally on the implications of these laws for the role of the welfare state and medical and legal professionals in the development of the EU's internal market in health care services. Having undertaken this analysis, the article argues that, in order to capture the developments and implications of EU Law on patient mobility, it is necessary to update and partially reformulate the notions of medicalisation and juridification.

  12. Class, gender and insanity in nineteenth-century Wales.

    PubMed

    Michael, Pamela

    2004-01-01

    This chapter shows how class and gender defined the experiences of patients admitted to the North Wales Lunatic Asylum during the late-nineteenth and early-twentieth centuries. Although not lending support to the notion that the asylum was predominantly an instrument of class and gender oppression, it does illustrate how threats of banishment to the asylum could be utilised to reinforce norms of social behaviour outside the institution in far-flung communities across north Wales. It suggests that lay rather than professional encounters were critical in the social construction of madness and the enforcement of social control.

  13. 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

  14. Myxomatosis in farmland rabbit populations in England and Wales.

    PubMed Central

    Ross, J.; Tittensor, A. M.; Fox, A. P.; Sanders, M. F.

    1989-01-01

    The overall pattern and consequences of myxomatosis in wild rabbit populations were studied at three farmland sites in lowland southern England and upland central Wales between 1971 and 1978. When results from all years were combined, the disease showed a clear two-peaked annual cycle, with a main autumn peak between August and January, and a subsidiary spring peak during February to April. Rabbit fleas, the main vectors of myxomatosis in Britain, were present on full-grown rabbits in sufficient numbers for transmission to occur throughout the year, but the observed seasonal pattern of the disease appeared to be influenced by seasonal mass movements of these fleas. However other factors were also important including the timing and success of the main rabbit breeding season, the proportion of rabbits which had recovered from the disease and the timing and extent of autumn rabbit mortality from other causes. Significantly more males than females, and more adults and immatures than juveniles, were observed to be infected by myxomatosis. Only 25-27% of the total populations were seen to be infected during outbreaks. Using two independent methods of calculation, it was estimated that between 47 and 69% of infected rabbits died from the disease (much lower than the expected 90-95% for fully susceptible rabbits with the partly attenuated virus strains that predominated). Thus it was estimated that 12-19% of the total rabbit populations were known to have died directly or indirectly from myxomatosis. Although the effects of myxomatosis were much less than during the 1950s and 1960s, it continued to be an important mortality factor. It may still have a regulatory effect on rabbit numbers, with autumn/winter peaks of disease reducing the numbers of rabbits present at the start of the breeding season. PMID:2806418

  15. 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.

  16. 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

  17. Sediment geochemistry of streams draining abandoned lead/zinc mines in central Wales - the Afon Twymyn

    NASA Astrophysics Data System (ADS)

    Byrne, P.; Reid, I.; Wood, P. J.

    2009-04-01

    Catchment disturbances occur at a range of spatial and temporal scales. Polluted discharge from abandoned metal mines and spoil heaps can persist for centuries after the closure of a mine and leave a legacy of heavy metal contamination in sediment systems. Following the decline of metal mining in Wales during the 20th century, there are over 1 300 abandoned metal mines, many of which discharge metal rich waters to river systems. In some cases these discharges have been occurring for over a century resulting in severe impacts on sediment quality. Poor sediment quality is likely to impede the achievement of 'good' chemical and ecological status for surface waters under the European Union Water Framework Directive. This paper examines the legacy of the Dylife lead/zinc mine (central Wales) on the Afon Twymyn and associated sedimentary, water quality and ecological characteristics; and highlights the importance of incorporating sediment quality in the overall assessment of river ecosystem status. Sediment heavy metal concentrations are elevated throughout the Afon Twymyn with metal concentrations upstream of Dylife mine exceeding values downstream by up to 260 times. Lead concentrations are up to 100 times greater than levels predicted to have deleterious effects on aquatic ecology (draft Environment Agency of England and Wales predicted effect level guidelines). At the mine site, 54% of lead, 53% of zinc, 52% of cadmium and 19% of copper exist in the easily exchangeable and carbonate-bound geochemical phases. These metal species are unstable and can be absorbed by aquatic organisms or released into solution given changes in pH, ionic strength, redox conditions and/or the concentration of complexing agents. Downstream of the mine, sediment metal concentrations decrease sharply however, there is an increase in the proportion found in more mobile geochemical phases. Metal levels remain elevated above background concentrations for at least 20 km from the point of

  18. The Politics of Education and the Misrecognition of Wales

    ERIC Educational Resources Information Center

    Power, Sally

    2016-01-01

    This paper examines the positioning of the Welsh education system within contemporary policy debate and analysis. It begins by outlining some of the ways in which education policy and provision in Wales differs from that of its neighbour, England, and then goes on to critique how these differences have been represented in both the media and by…

  19. New Labour, Communitarianism and Citizenship Education in England and Wales

    ERIC Educational Resources Information Center

    Dunn, Andrew; Burton, Diana

    2011-01-01

    This article posits a connection between the influence of communitarianism on New Labour's ideology and the content of citizenship education in England and Wales. We first describe and problematize communitarianism, drawing on both UK and US thinkers, and then relate our findings to literature on citizenship education. We conclude by suggesting…

  20. Courses in Physics in England, Wales, and Northern Ireland.

    ERIC Educational Resources Information Center

    Physics Education, 1988

    1988-01-01

    Includes honors degree courses; special entry requirements; course structure; courses regularly available; notes; and how to obtain further information on 42 universities, 28 polytechnics, 12 colleges of technology, and 13 colleges of education in England, Wales, and Northern Ireland. Some schools have advertisements listing additional…

  1. Is regional paediatric surveillance useful? Experience in Wales

    PubMed Central

    Sibert, J; Morgan, R; O'Connell, H; Lynn, R; Guildea, Z; Palmer, S; group, t. W.

    2001-01-01

    The Welsh Paediatric Surveillance Unit was established in 1994 to monitor the incidence and prevalence of a number of uncommon disorders of childhood in Wales. Its work complements that of the British Paediatric Surveillance Unit. Information from consultant paediatricians is obtained by means of a monthly card return system; return rate is over 90%.

 PMID:11369563

  2. Education and Nationhood in Wales: An Historiographical Analysis

    ERIC Educational Resources Information Center

    Jones, Gareth Elwyn

    2006-01-01

    Throughout the centuries, a sense of national identity in Wales has manifested itself in a variety of ways--aspirations to statehood, a unique language, cultural distinctiveness, religious affiliation, sporting achievement and, most recently, political devolution. Educational institutions in myriad forms have reflected aspects of these…

  3. The Wales Region: Microelectronics Education to the Mid Eighties.

    ERIC Educational Resources Information Center

    Taylor, Lionel

    1982-01-01

    Discusses developments which should occur in the Wales region by the end of the Microelectronics Education Programme (1984). Indicates that a major curriculum project has been started to enable developments in information technology to be reflected in classrooms, focusing on the production of software and resource materials. (Author/JN)

  4. Development of a Senior Physics Syllabus in New South Wales

    ERIC Educational Resources Information Center

    Binnie, Anna

    2004-01-01

    In 2000, the New South Wales Board of Studies introduced new syllabi for Junior Science (years 7-10) and Senior Science subjects (years 11 and 12), i.e. Physics, Chemistry, Biology, and Earth and Environmental Science (Geology). The structure of these courses is similar: it is based on a contextual perspective and is underpinned by a number of…

  5. Embracing the UNCRC in Wales (UK): Policy, Pedagogy and Prejudices

    ERIC Educational Resources Information Center

    Lyle, Sue

    2014-01-01

    Most countries are signatories to the United Nations Convention on the Rights of the Child (UNCRC). In 1999, the Government of Wales was devolved from the UK, and in 2011 the "Children and Young Persons Rights Measure" put the UNCRC as the basis of all its work. Any programme introduced in schools should therefore promote the UNCRC. To…

  6. Dental prescribing in Wales and associated public health issues.

    PubMed

    Karki, A J; Holyfield, G; Thomas, D

    2011-01-01

    Dental prescribing data in Wales have not been studied in detail previously. The analysis of national data available from Health Solutions Wales showed that dental prescribing in Wales accounted for 9% of total antibacterial prescribing in primary care in 2008. Penicillin and metronidazole constituted the bulk of antibiotics prescribed by dentists. Since the publication of National Institute for Health and Clinical Excellence (NICE) guidance (March 2008) on prophylaxis against infective endocarditis, dental prescriptions for amoxicillin 3g sachets and clindamycin capsules have decreased. Dental prescriptions for fluoride preparations increased in number from 2007 to 2008. Dental prescribing of controlled drugs raises no concern. The figure for antibiotic prescribing in Wales is similar to that of England. Nevertheless, the figure seems a little high, indicating potential inappropriate prescribing behaviour among dentists. Antibiotic resistance is a major public health issue and many patients each year die from infections from bacterial strains that are resistant to one or more antibiotics. Inappropriate use of antibiotics is a major cause of antibiotic resistance and every effort should be made to reduce the number of inappropriate antibiotic prescriptions in dental practice. PMID:21164522

  7. Youth Justice in England and Wales: A Risky Business

    ERIC Educational Resources Information Center

    Paylor, Ian

    2011-01-01

    Risk factor research dominates explanatory models of youth offending and "evidence-based" policy and practice with young people in the youth justice system in England and Wales. Asset is the product of these actuarial ideas and has put the risk factor prevention paradigm into practice. This article evaluates the impact that an actuarial approach…

  8. Inclusive Policy and Exclusionary Practice in Secondary Education in Wales

    ERIC Educational Resources Information Center

    Selleck, Charlotte L. R.

    2013-01-01

    This article reports on a study of two contrasting secondary schools, serving the same "community" in south-west Wales; a bilingual school (Welsh and English) and an English-medium school (English only). Data were gathered using ethnographic methods, with this study focusing primarily on data elicited through "ethnographic chats". The analysis is…

  9. Shakespeare in New South Wales Secondary Schools: A Brief History.

    ERIC Educational Resources Information Center

    Watson, Ken

    2003-01-01

    Explains that throughout the past one hundred years, the question of how Shakespeare plays should be taught has been a point of contention in the New South Wales secondary English curriculum. Outlines the two main stances, the traditional literature-based approach and the active approach with emphasis on the text as play script. Discusses the…

  10. Some traditional treatments of hearing problems in Brittany and Wales.

    PubMed

    Stephens, D

    1993-05-01

    The traditions of the healing of deafness associated with the Celtic saints in Brittany and Wales are discussed. Many more have survived in Brittany because of the religious continuity in that country. Three Saints Cadoc (of Welsh origin), Egarec (of Irish origin) and Meriadec (of Breton origin) are associated with such traditions in a number of different locations.

  11. 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.

  12. The benefits of drinking water quality regulation--England and Wales.

    PubMed

    May, A

    2006-01-01

    This paper aims to demonstrate that the regulation of drinking water quality in England and Wales has been successful in securing the improvements to drinking water quality resulting in better performance against EU and national standards. The water industry in England and Wales went through a major change in 1989 when suppliers were privatised and the government set up a robust regulatory regime. The regime was necessary as the industry was, as a result of privatisation, a monopoly with customers having no choice of supplier, unlike what was later available with other utilities such as gas or electricity. The regime would protect the interests of the consumer, the environment and public health through the quality of the product. The Drinking Water Inspectorate (DWI), as established in 1990, had to ensure the implementation of the European Drinking Water Directive (DWD) that had been transposed into national legislation. The aim of the DWD is to ensure that all EU Member States provide drinking water of a prescribed quality. In England and Wales, a body was required to oversee the performance of the industry against those standards, reporting to the Government and the European Commission. Through acts and legislation, the set up of the industry, the duties of the suppliers and regulators and the powers available to the regulators were established. The improvements to drinking water quality since privatisation were achieved by massive investment of the privatised water industry overseen by an independent regulator with clear duties and the powers to inspect, enforce and prosecute. The DWI's achievements show that to improve quality performance with the ability to report in detail how the improvements were made with extensive data evidence, a special regulator is required. The DWI advises policy departments and Ministers and when there are serious concerns regarding a threat to human health through drinking water, the highest level of regulatory power is the creation

  13. 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

  14. 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.

  15. 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.

  16. 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

  17. 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.

  18. Economic growth and health progress in England and Wales: 160 years of a changing relation.

    PubMed

    Tapia Granados, José A

    2012-03-01

    Using data for England and Wales during the years 1840-2000, a negative relation is found between economic growth--measured by the rate of growth of gross domestic product (GDP)--and health progress--as indexed by the annual increase in life expectancy at birth (LEB). That is, the lower is the rate of growth of the economy, the greater is the annual increase in LEB for both males and females. This effect is much stronger, however, in 1900-1950 than in 1950-2000, and is very weak in the 19th century. It appears basically at lag zero, though some short-lag effects of the same negative sign are found. In the other direction of causality, there are very small effects of the change in LEB on economic growth. These results add to an emerging consensus that in the context of long-term declining trends, mortality oscillates procyclically during the business cycle, declining faster in recessions. Therefore, LEB increases faster during recessions than during expansions. The investigation also shows how the relation between economic growth and health progress changed in England and Wales during the study period. No evidence of cointegration between income--as indexed by GDP or GDP per capita--and health--as indexed by LEB--is found.

  19. 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

  20. 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.

  1. Attitudes and intentions of homeless people towards service provision in South Wales.

    PubMed

    Christian, Julie; Armitage, Christopher J

    2002-06-01

    The theory of planned behaviour (TPB: Ajzen, 1988, 1991) was used as a framework to investigate homeless people's participation in outreach service programmes. In total, 104 homeless people from South Wales were interviewed using a schedule based on the TPB. Congruent with previous research on the TPB, attitude was the dominant predictor of behavioural intentions, and intention and perceived behavioural control were predictive of behaviour. Contrary to predictions, subjective norms also exerted a direct effect on behaviour. The discussion focuses on two issues: first, the utility of social cognition models in explaining the relationship between demographic variables and behaviour in homelessness research; second, the direct effects of norms on behaviour and the extent to which work on social groups might usefully extend research on models such as the TPB to aid understanding of behaviour amongst stigmatized populations. PMID:12133225

  2. Structural and electronic properties of zigzag InP nanoribbons with Stone-Wales type defects.

    PubMed

    Longo, R C; Carrete, J; Varela, L M; Gallego, L J

    2016-02-17

    By means of density-functional-theoretic calculations, we investigate the structural and electronic properties of a hexagonal InP sheet and of hydrogen-passivated zigzag InP nanoribbons (ZInPNRs) with Stone-Wales (SW)-type defects. Our results show that the influence of this kind of defect is not limited to the defected region but it leads to the formation of ripples that extend across the systems, in keeping with the results obtained recently for graphene and silicene sheets. The presence of SW defects in ZInPNRs causes an appreciable broadening of the band gap and transforms the indirect-bandgap perfect ZInPNR into a direct-bandgap semiconductor. An external transverse electric field, regardless of its direction, reduces the gap in both the perfect and defective ZInPNRs.

  3. Structural and electronic properties of zigzag InP nanoribbons with Stone-Wales type defects

    NASA Astrophysics Data System (ADS)

    Longo, R. C.; Carrete, J.; Varela, L. M.; Gallego, L. J.

    2016-02-01

    By means of density-functional-theoretic calculations, we investigate the structural and electronic properties of a hexagonal InP sheet and of hydrogen-passivated zigzag InP nanoribbons (ZInPNRs) with Stone-Wales (SW)-type defects. Our results show that the influence of this kind of defect is not limited to the defected region but it leads to the formation of ripples that extend across the systems, in keeping with the results obtained recently for graphene and silicene sheets. The presence of SW defects in ZInPNRs causes an appreciable broadening of the band gap and transforms the indirect-bandgap perfect ZInPNR into a direct-bandgap semiconductor. An external transverse electric field, regardless of its direction, reduces the gap in both the perfect and defective ZInPNRs.

  4. AJ Cronin and The Citadel: did a work of fiction contribute to the foundation of the NHS?

    PubMed

    O'Mahony, S

    2012-06-01

    AJ Cronin (1896-1981) was a Scottish-born doctor-turned-novelist whose most famous novel is The Citadel, published in 1937. The book describes the struggles of an idealistic young doctor working in Wales and London in the 1920s and 30s. The novel was a global bestseller and its portrayal of a largely ineffective, corruption-ridden system of healthcare is thought to have directly influenced the foundation of the National Health Service in 1948. The Citadel anticipates such phenomena as evidence-based medicine and continuing medical education. This paper argues that the novel was never intended as propaganda for a state-controlled national health service. On the contrary, Cronin was against state control. Analysis of the novel is informed by recent biographical revelations about Cronin and the blurring of the margin between fact and fiction in Cronin's life and work is examined. PMID:22693705

  5. AJ Cronin and The Citadel: did a work of fiction contribute to the foundation of the NHS?

    PubMed

    O'Mahony, S

    2012-06-01

    AJ Cronin (1896-1981) was a Scottish-born doctor-turned-novelist whose most famous novel is The Citadel, published in 1937. The book describes the struggles of an idealistic young doctor working in Wales and London in the 1920s and 30s. The novel was a global bestseller and its portrayal of a largely ineffective, corruption-ridden system of healthcare is thought to have directly influenced the foundation of the National Health Service in 1948. The Citadel anticipates such phenomena as evidence-based medicine and continuing medical education. This paper argues that the novel was never intended as propaganda for a state-controlled national health service. On the contrary, Cronin was against state control. Analysis of the novel is informed by recent biographical revelations about Cronin and the blurring of the margin between fact and fiction in Cronin's life and work is examined.

  6. 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,…

  7. 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

  8. Immobilization strategy for enhancing sensitivity of immunosensors: L-Asparagine-AuNPs as a promising alternative of EDC-NHS activated citrate-AuNPs for antibody immobilization.

    PubMed

    Raghav, Ragini; Srivastava, Sudha

    2016-04-15

    This paper addresses the question - Is EDC-NHS activated gold nanoparticles modified electrode surface the best available option for antibody immobilization for immunosensor fabrication? Is there any other alternative covalent immobilization strategy for orthogonal orientation of antibody, ensuring enhanced sensitivity of immunosensors? Does EDC-NHS activation of carboxyl functionalized nanoparticles surface really leads to orthogonal or directed immobilization of antibody? Gold nanoparticles synthesized using L-Asparagine as reducing and stabilization agent were employed for orthogonal immobilization of antibody for immunosensor fabrication. Anti-CA125 antibody was used as a model system for immunosensor fabrication. A comparative evaluation of immunosensors fabricated using L-Asparagine stabilized gold nanoparticles and citrate stabilized gold nanoparticles via different immobilization strategies/chemistries was done. The three strategies involved immobilization of Anti-CA125 antibody - (1) after EDC-NHS activation of citrate stabilized gold nanoparticles, (2) directly onto citrate stabilized gold nanoparticles and (3) directly onto L-Asparagine stabilized gold nanoparticles modified electrode surfaces. Comparative evaluation of Impedimetric response characteristics showed 2.5 times increase in sensitivity (349.36 Ω/(IU/mL)/cm(2)) in case of third strategy as compared to first (147.53 Ω/(IU/mL)/cm(2)) and twice that of second strategy (166.24 Ω/(IU/mL)/cm(2)). Additionally, an extended dynamic range of 0-750 IU/mL was observed while for others it was up to 500 IU/mL. Amino acid coated gold nanoparticles ensured orthogonal immobilization, lesser randomization, with 88% of active antibody available for antigen binding as opposed to other two strategies with less than 30% active antibody.

  9. Estimated daily mortality during July 2006 in England and Wales.

    PubMed

    2006-01-01

    During July 2006, temperatures in England and Wales triggered the Government to initiate its Heatwave Plan and issue advice to the public on how to keep healthy during hot weather, and guidance to health care professionals on minimising heat-related health risks. This report presents provisional daily mortality during July by age and region, and estimates excess deaths at the hottest times. The high temperatures during July 2006 did not affect mortality in England and Wales to the extent seen in August 2003--the first hot period of July 2006 showed no increase in mortality nationally and there was a 4 per cent increase over baseline mortality in the second hot period (680 excess deaths). This compares to a 16 per cent increase during the August 2003 heat wave. PMID:17165473

  10. The legal status of the fetus in New South Wales.

    PubMed

    Uppal, Talat; Pickering, A; Erasmus, K; Pardey, J; Beran, Roy G

    2012-09-01

    The issue of how to define the legal status of the fetus is complex. Three clinical cases with fetal losses following motor vehicle accidents raise important issues regarding the legal status of the unborn child. Legislation was submitted to the New South Wales Parliament in the form of the Crimes Amendment (Grievous Bodily Harm) Bill 2005 (NSW) but was subsequently repealed. Medical technological advances make the viability of a fetus a shifting standard and encourage the comparison between newborns and late-term fetuses, offer increased fetal health status information and provide greater capacity to maintain the life of babies born prematurely. In view of the sophisticated state of medical care available in New South Wales, the three cases reviewed highlight the discrepancy between the medical recognition of the fetus as a patient and its lack of legal recognition.

  11. Salmonella enterica Serovar Enteritidis, England and Wales, 1945–2011

    PubMed Central

    Lane, Christopher R.; LeBaigue, Susan; Esan, Oluwaseun B.; Awofisyo, Adedoyin A.; Adams, Natalie L.; Fisher, Ian S.T.; Grant, Kathie A.; Peters, Tansy M.; Larkin, Lesley; Davies, Robert H.

    2014-01-01

    In England and Wales, the emergence of Salmonella enterica serovar Enteritidis resulted in the largest and most persistent epidemic of foodborne infection attributable to a single subtype of any pathogen since systematic national microbiological surveillance was established. We reviewed 67 years of surveillance data to examine the features, underlying causes, and overall effects of S. enterica ser. Enteritidis. The epidemic was associated with the consumption of contaminated chicken meat and eggs, and a decline in the number of infections began after the adoption of vaccination and other measures in production and distribution of chicken meat and eggs. We estimate that >525,000 persons became ill during the course of the epidemic, which caused a total of 6,750,000 days of illness, 27,000 hospitalizations, and 2,000 deaths. Measures undertaken to control the epidemic have resulted in a major reduction in foodborne disease in England and Wales. PMID:24960614

  12. Invasive pneumococcal disease in England and Wales: vaccination implications.

    PubMed

    Sleeman, K; Knox, K; George, R; Miller, E; Waight, P; Griffiths, D; Efstratiou, A; Broughton, K; Mayon-White, R T; Moxon, E R; Crook, D W

    2001-01-15

    Knowledge of the epidemiology of invasive pneumococcal disease (IPD) will aid in planning the use of pneumococcal vaccines. A United Kingdom (UK)-based surveillance in England and Wales (1995-1997) of 11,528 individuals with IPD and a local enhanced surveillance in the Oxford (UK) area (1995-1999) have been analyzed. IPD has a high attack rate in children, with 37.1-48.1 cases per 100,000 infants <1 year old per year, and in older persons, with 21.2-36.2 cases per 100,000 persons >65 years old per year, for England, Wales, and Oxford. The 7-valent conjugate vaccine includes serotypes causing < or =79% of IPD in children <5 years old, but only 66% in adults >65 years old. The data also indicate that IPD varies by serotype, age, and country, emphasizing that the epidemiology of IPD is heterogeneous and requires continued surveillance. PMID:11120930

  13. Euthanasia: a summary of the law in England and Wales.

    PubMed

    Simillis, Constantinos

    2008-07-01

    When medical treatment becomes futile, or the patient's suffering is intractable, doctors face the agonising dilemma of whether to proceed with euthanasia. It is important for a doctor to be familiar with the law surrounding euthanasia, in order to avoid prosecution. This paper explores the law in England and Wales regarding the different categories of euthanasia: voluntary euthanasia, nonvoluntary euthanasia, passive euthanasia, and active euthanasia. PMID:18754203

  14. Ordovician "sphinctozoan" sponges from Prince of Wales Island, southeastern Alaska

    USGS Publications Warehouse

    Rigby, J.K.; Karl, S.M.; Blodgett, R.B.; Baichtal, J.F.

    2005-01-01

    A faunule of silicified hypercalcified "sphinctozoan" sponges has been recovered from a clast of Upper Ordovician limestone out of the Early Devonian Karheen Formation on Prince of Wales Island in southeastern Alaska. Included in the faunule are abundant examples of the new genus Girtyocoeliana, represented by Girtyocoeliana epiporata (Rigby and Potter), and Corymbospongia adnata Rigby and Potter, along with rare Corymbospongia amplia n. sp., and Girtyocoelia(?) sp., plus common Amblysiphonella sp. 1 and rare Amblysiphonella(?) sp. 2. The assemblage is similar to that from Ordovician clasts from the eastern Klamath Mountains of northern California. This indicates that the Alexander terrane of southeastern Alaska is related paleogeographically to the lithologically and paleontologically similar terrane of the eastern Klamath Mountains. This lithology and fossil assemblage of the clast cannot be tied to any currently known local rock units on Prince of Wales Island. Other clasts in the conglomerate appear to have been locally derived, so it is inferred that the limestone clasts were also locally derived, indicating the presence of a previously undocumented Ordovician limestone unit on northern Prince of Wales Island. 

  15. Nasal cancer in England and Wales: an occupational survey.

    PubMed Central

    Acheson, E D; Cowdell, R H; Rang, E H

    1981-01-01

    A national survey of the incidence of nasal cancer in England and Wales during the period 1963-7 with special reference to occupation confirmed the well-known increases in incidence of nasal cancer in cabinet makers and wood machinists, together with the absence of any significant increase in carpenters and joiners, and the increases in boot and shoe operatives and repairers, and in nickel smelters in South Wales. The significant excesses of cases found among coalminers, furnacemen in the gas, coke, and chemical industry, and furnacemen and labourers in foundries may be associated with exposure to coal and coke dust or may be spurious. No excess of nasal cancer was found among male textile workers. Excesses of uncertain significance were found among tailors and dressmakers, bakers and pastry cooks, and printers. Apart from the well-known relationships between adenocarcinoma and work in the furniture and footwear industries there is no definite indication in this survey of any association between a particular histological type of nasal tumour and occupation in England and Wales. PMID:7272233

  16. 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…

  17. 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

  18. 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

  19. 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.

  20. 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

  1. 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

  2. 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.

  3. 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…

  4. 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

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. Assessing risk of non-compliance of phosphorus standards for lakes in England and Wales

    NASA Astrophysics Data System (ADS)

    Duethmann, D.; Anthony, S.; Carvalho, L.; Spears, B.

    2009-04-01

    High population densities, use of inorganic fertilizer and intensive livestock agriculture have increased phosphorus loads to lakes, and accelerated eutrophication is a major pressure for many lakes. The EC Water Framework Directive (WFD) requires that good chemical and ecological quality is restored in all surface water bodies by 2015. Total phosphorus (TP) standards for lakes in England and Wales have been agreed recently, and our aim was to estimate what percentage of lakes in England and Wales is at risk of failing these standards. With measured lake phosphorus concentrations only being available for a small number of lakes, such an assessment had to be model based. The study also makes a source apportionment of phosphorus inputs into lakes. Phosphorus loads were estimated from a range of sources including agricultural loads, sewage effluents, septic tanks, diffuse urban sources, atmospheric deposition, groundwater and bank erosion. Lake phosphorus concentrations were predicted using the Vollenweider model, and the model framework was satisfactorily tested against available observed lake concentration data. Even though predictions for individual lakes remain uncertain, results for a population of lakes are considered as sufficiently robust. A scenario analysis was carried out to investigate to what extent reductions in phosphorus loads would increase the number of lakes achieving good ecological status in terms of TP standards. Applying the model to all lakes in England and Wales greater than 1 ha, it was calculated that under current conditions roughly two thirds of the lakes would fail the good ecological status with respect to phosphorus. According to our estimates, agricultural phosphorus loads represent the most frequent dominant source for the majority of catchments, but diffuse urban runoff also is important in many lakes. Sewage effluents are the most frequent dominant source for large lake catchments greater than 100 km². The evaluation in terms of

  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. Identifying Probable Suicide Clusters in Wales Using National Mortality Data

    PubMed Central

    Jones, Phillip; Gunnell, David; Platt, Stephen; Scourfield, Jonathan; Lloyd, Keith; Huxley, Peter; John, Ann; Kamran, Babar; Wells, Claudia; Dennis, Michael

    2013-01-01

    Background Up to 2% of suicides in young people may occur in clusters i.e., close together in time and space. In early 2008 unprecedented attention was given by national and international news media to a suspected suicide cluster among young people living in Bridgend, Wales. This paper investigates the strength of statistical evidence for this apparent cluster, its size, and temporal and geographical limits. Methods and findings The analysis is based on official mortality statistics for Wales for 2000–2009 provided by the UK's Office for National Statistics (ONS). Temporo-spatial analysis was performed using Space Time Permutation Scan Statistics with SaTScan v9.1 for suicide deaths aged 15 and over, with a sub-group analysis focussing on cases aged 15–34 years. These analyses were conducted for deaths coded by ONS as: (i) suicide or of undetermined intent (probable suicides) and (ii) for a combination of suicide, undetermined, and accidental poisoning and hanging (possible suicides). The temporo-spatial analysis did not identify any clusters of suicide or undetermined intent deaths (probable suicides). However, analysis of all deaths by suicide, undetermined intent, accidental poisoning and accidental hanging (possible suicides) identified a temporo-spatial cluster (p = 0.029) involving 10 deaths amongst 15–34 year olds centred on the County Borough of Bridgend for the period 27th December 2007 to 19th February 2008. Less than 1% of possible suicides in younger people in Wales in the ten year period were identified as being cluster-related. Conclusions There was a possible suicide cluster in young people in Bridgend between December 2007 and February 2008. This cluster was smaller, shorter in duration, and predominantly later than the phenomenon that was reported in national and international print media. Further investigation of factors leading to the onset and termination of this series of deaths, in particular the role of the media, is required. PMID

  12. New 48-inch line gives Wales more gas supplies

    SciTech Connect

    Not Available

    1982-11-01

    A new 11-mile, 48-in pipeline will not only supply an even flow of gas from the British Gas national grid to towns in the Wales Gas district but also serve as a daily storage facility by means of nightime linepacking at 700 psi. The largest diameter gas line to be constructed in the UK, the pipeline is confined to a 165-ft wide corridor leading through wet and dry moorland, farms, reclaimed colliery tips, and bogs. Construction engineers took care to protect archeological features along the route and to restore the land to its original condition.

  13. HLA and multiple sclerosis in south east Wales.

    PubMed Central

    Swingler, R J; Kirk, P F; Darke, C; Compston, D A

    1987-01-01

    A stronger association has been found between multiple sclerosis and HLA-DR2 than -DQwl in south east Wales (prevalence c 113/10(5)) in contrast to recent observations in north east Scotland (prevalence 178/10(5). The complex relationship between the HLA system and multiple sclerosis, demonstrated in this and other studies, is explained more easily under a polygenic model of inheritance, in which environmental events and genes interact, than by the presence of a single susceptibility gene. PMID:3499485

  14. Changing Policy, Legislation and Its Effects on Inclusive and Special Education: A Perspective from Wales

    ERIC Educational Resources Information Center

    Ware, Jean

    2014-01-01

    This article, by Jean Ware of Bangor University School of Education, examines policy developments in education in Wales since devolution, and their implications for inclusive and special education. This is set in the context of the demographics of Wales, which, it is argued, have a significant influence on policy and on the nature of educational…

  15. Building the Capacity of Local Education Authorities in Wales: Context, Processes and Developments

    ERIC Educational Resources Information Center

    Avery, Graham; Colebourne, David; James, Chris; Florek, Anton

    2004-01-01

    Recent policy developments are requiring local education authorities (LEAs) in Wales to undertake a more significant role in improving the Welsh education service. This article reports some of the outcomes of a Welsh Assembly government-funded initiative that addressed aspects of the development of the capacity of LEAs in Wales to fulfil this…

  16. Trends in Examination Performance and Exposure to Standardised Tests in England and Wales

    ERIC Educational Resources Information Center

    Goldstein, Harvey; Leckie, George

    2016-01-01

    Schools in England and Wales since the late 1980s have been compared in terms of their performances in public examinations and standardised test scores in the form of "school league tables", with Wales ceasing to produce these after 2001. One of the factors related to performance in examinations is the choice of the examination board,…

  17. An Analysis of the Changing Shape of Initial Teacher Education and Training in Wales since Devolution

    ERIC Educational Resources Information Center

    Reid, Ken; Tanner, Howard

    2012-01-01

    After a sustained period of relative calm, initial teacher education and training (ITET) in Wales has seen much change in recent times since devolution and all the indications are that this change agenda is likely to escalate in both the short and long term. In order to understand what has been happening in the ITET field in Wales, our paper sets…

  18. Sexual Difficulties for Persons with Multiple Sclerosis in New South Wales, Australia

    ERIC Educational Resources Information Center

    Redelman, Margaret Juliet

    2009-01-01

    This 1992 study was conducted to ascertain the incidence of sexual difficulties in individuals diagnosed with multiple sclerosis (MS) living in New South Wales, Australia. New South Wales is a state lying roughly 29-36 [degrees] south of the equator. This is currently the largest study conducted. The anonymous questionnaire completed by 283…

  19. Harbingers of Feminism? Gender, Cultural Capital and Education in Mid-Twentieth-Century Rural Wales

    ERIC Educational Resources Information Center

    Baker, Sally; Brown, Brian

    2009-01-01

    This paper reports the results of a small-scale narrative study of men and women who grew up in mid-twentieth-century rural Wales, and their reminiscences regarding women and education. Although the dominant image of Wales during that era is that of a male-dominated society, all of our participants remembered influential independent women and…

  20. The Induction Experiences of Newly Qualified Secondary Teachers in England and Wales

    ERIC Educational Resources Information Center

    Parkinson, John; Pritchard, Janet

    2005-01-01

    Since 1999 all newly qualified teachers (NQTs) in England have been required to complete a statutory induction year. In Wales the induction year became statutory in 2003. This article reports on the experiences of NQTs during the year 2000-2001. All of the NQTs received their initial training in Wales, but some obtained employment in England and…

  1. Tackling Behaviour and Attendance Issues in Schools in Wales: Implications for Training and Professional Development

    ERIC Educational Resources Information Center

    Reid, Ken

    2011-01-01

    In 2009, the Welsh Assembly Government published its Report on the review of behaviour and attendance in schools in Wales. The National Behaviour and Attendance Review (NBAR) in Wales was chaired by the author of this paper. Both the Review and the Welsh Assembly Government's response contained recommendations related to the training and…

  2. 78 FR 32367 - Approval of Subzone Status; Teva Pharmaceuticals USA, Inc.; North Wales, Chalfont, Kutztown and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-30

    ... Federal Register inviting public comment (78 FR 17634-17635, 3-22-2013). The FTZ staff examiner reviewed... Foreign-Trade Zones Board Approval of Subzone Status; Teva Pharmaceuticals USA, Inc.; North Wales... of Teva Pharmaceuticals USA, Inc., in North Wales, Chalfont, Kutztown and Sellersville,...

  3. Former director of RCN Wales Liz Hewett began at Ty Maeth in 1998.

    PubMed

    Lenzy, Tracy

    2016-06-01

    Great story in Nursing Standard about the book Nursing Matters, which delves into the 50th anniversary of the RCN headquarters in Wales, Ty Maeth (features, May 18). However, Liz Hewett began working at the RCN in Wales in 1998 - not in 1988 as stated in the article.

  4. 33 CFR 334.1330 - Bering Strait, Alaska; naval restricted area off Cape Prince of Wales.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 33 Navigation and Navigable Waters 3 2014-07-01 2014-07-01 false Bering Strait, Alaska; naval restricted area off Cape Prince of Wales. 334.1330 Section 334.1330 Navigation and Navigable Waters CORPS OF....1330 Bering Strait, Alaska; naval restricted area off Cape Prince of Wales. (a) The area. An area...

  5. 33 CFR 334.1330 - Bering Strait, Alaska; naval restricted area off Cape Prince of Wales.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 3 2010-07-01 2010-07-01 false Bering Strait, Alaska; naval restricted area off Cape Prince of Wales. 334.1330 Section 334.1330 Navigation and Navigable Waters CORPS OF....1330 Bering Strait, Alaska; naval restricted area off Cape Prince of Wales. (a) The area. An area...

  6. 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.

  7. 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

  8. 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.

  9. 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

  10. 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.

  11. 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…

  12. 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

  13. 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

  14. 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.

  15. 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.

  16. 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

  17. 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

  18. 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.

  19. 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.

  20. 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

  1. 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

  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. PMID:25445111

  3. 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

  4. 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.

  5. Botulism in New South Wales, 1980-1981.

    PubMed

    Murrell, W G; Stewart, B J

    1983-01-01

    The isolation of Clostridium botulinum from the home environment of New South Wales patients with infant botulism is reported. Of the three cases of infant botulism type B, the bacteria were isolated from soil around the dwelling in one, and from tank rainwater in another. In one case with type A, the bacteria were present in the soil, vacuum-cleaner dust, and tank rainwater. The bacteria were not detected in the environment of two adult patients and a child with C. botulinum in their stools. The home location of the patients with infant botulism, and the frequency of isolation of the bacteria from rainwater, soil and vacuum-cleaner dust in Cobar, Nyngan, some Sydney suburbs, and at five pastoral homesteads suggest that infants in rural areas are more at risk than those in large metropolitan areas. The age of the infants with diagnosed botulism in New South Wales, compared with those reported in the United States data, strongly suggests that the disease is not being fully recognised in younger infants.

  6. Patterns of municipal health expenditure in interwar England and Wales.

    PubMed

    Levene, Alysa; Powell, Martin A; Stewart, John

    2004-01-01

    This article aims to fill a gap in the history of medical services in England and Wales in the interwar period by focusing on the historiographically neglected municipal sector--a relative neglect that is particularly unjustified given that this sector provided an increasingly wide array of medical services over the period. Focusing on the highly urbanized county boroughs, this article investigates whether and how expenditure on municipal health services changed over the interwar period, and whether these patterns were replicated by boroughs across England and Wales. It is found that many of the largest personal health services were experiencing a common pattern of growing investment over the period, but that county boroughs did not act uniformly in their spending decisions. Considered regionally, the Northeast and the West Midlands were found to perform poorly in expenditure terms compared to the data set as a whole, while the large conurbations of Leeds, Manchester, and Liverpool raised the average performance of the Northwest and Yorkshire. Regional patterns are found to be less consistent in the south of the country, where voluntary provision and demands arising from the boroughs' geographical position (for example, seaside resorts) may have exerted significant influences over levels of expenditure on health.

  7. Anisotropic compressive response of Stone-Thrower-Wales defects in graphene: A molecular dynamics study

    NASA Astrophysics Data System (ADS)

    Rajasekaran, G.; Parashar, Avinash

    2016-09-01

    The mechanical properties of graphene sheet can be tailored with the help of topological defects. In this research article, the effects of Stone-Thrower-Wales (STW) defects on the mechanical properties of graphene sheet was investigated with the help of molecular dynamics based simulations. Authors has made an attempt to analyse the stress field developed in and around the vicinity of defect due to bond reorientation and further systematic evaluation has been carried out to study the effect of these stress fields against the applied axial compressive load. The results obtained with the pristine graphene were made to compare with the available open literature and the results were reported to be in good agreement with theoretical and experimental data. It was predicted that graphene with STW defect cannot able to bear compressive strength in zigzag direction, whereas on the other hand it was predicted that graphene sheet containing STW defect can bear higher compressive load in armchair direction, which shows an anisotropic response of STW defects in graphene. From the obtained results it can be observed that orientation of STW defects and the loading direction plays an important role to alter the strength of graphene under axial compression.

  8. A national framework for flood forecasting model assessment for use in operations and investment planning over England and Wales

    NASA Astrophysics Data System (ADS)

    Moore, Robert J.; Wells, Steven C.; Cole, Steven J.

    2016-04-01

    -wide coverage across the fluvial rivers of England and Wales, which can be assessed at gauged sites. Thus the performance of the national G2G model forecasts can be directly compared with that from the local models. The Performance Summary for each site model is complemented by a national spatial analysis of model performance stratified by model-type, geographical region and forecast lead-time. The map displays provide an extensive evidence-base that can be interrogated, through a Flood Forecasting Model Performance web portal, to reveal fresh insights into comparative performance across locations, lead-times and models. This work was commissioned by the Environment Agency in partnership with Natural Resources Wales and the Flood Forecasting Centre for England and Wales.

  9. Multi-decadal climate variability, New South Wales, Australia.

    PubMed

    Franks, S W

    2004-01-01

    Traditional hydrological risk estimation has treated the observations of hydro-climatological extremes as being independent and identically distributed, implying a static climate risk. However, recent research has highlighted the persistence of multi-decadal epochs of distinct climate states across New South Wales (NSW), Australia. Climatological studies have also revealed multi-decadal variability in the magnitude and frequency of El Niño/Southern Oscillation (ENSO) impacts. In this paper, examples of multi-decadal variability are presented with regard to flood and drought risk. The causal mechanisms for the observed variability are then explored. Finally, it is argued that the insights into climate variability provide (a) useful lead time for forecasting seasonal hydrological risk, (b) a strong rationale for a new framework for hydrological design and (c) a strong example of natural climate variability for use in the testing of General Circulation Models of climate change.

  10. Multi-decadal climate variability, New South Wales, Australia.

    PubMed

    Franks, S W

    2004-01-01

    Traditional hydrological risk estimation has treated the observations of hydro-climatological extremes as being independent and identically distributed, implying a static climate risk. However, recent research has highlighted the persistence of multi-decadal epochs of distinct climate states across New South Wales (NSW), Australia. Climatological studies have also revealed multi-decadal variability in the magnitude and frequency of El Niño/Southern Oscillation (ENSO) impacts. In this paper, examples of multi-decadal variability are presented with regard to flood and drought risk. The causal mechanisms for the observed variability are then explored. Finally, it is argued that the insights into climate variability provide (a) useful lead time for forecasting seasonal hydrological risk, (b) a strong rationale for a new framework for hydrological design and (c) a strong example of natural climate variability for use in the testing of General Circulation Models of climate change. PMID:15195429

  11. Developing and implementing the community nursing research strategy for Wales.

    PubMed

    Kenkre, Joyce; Wallace, Carolyn; Davies, Robyn; Bale, Sue; Thomas, Sue

    2013-11-01

    In order to obtain the best patient outcomes in community nursing, practice needs to be underpinned by robust research-based evidence. This article describes a Community Nursing Research Strategy developed and implemented in Wales to provide the nursing profession with the evidence to support future organisational and professional change in achieving excellence in the community. This was developed in partnership with education, research, health services, workforce planning and Government using consensus methodology (specifically, a nominal group technique). Consequently, the process was inclusive and included three steps: escalating presentation of ideas, topic debate and topic rating. The result was a strategy with four implementation strands, including a virtual network, research portfolio, application to practice and leadership.

  12. Prison suicide in England and Wales, 1972-87.

    PubMed

    Dooley, E

    1990-01-01

    The case notes of 295 suicides (98.3% of the total) in prisons in England and Wales between 1972 and 1987 were studied. This period has witnessed an increase in the suicide rate far in excess of the rate of rise in the prison population. The most common method of suicide was by hanging, usually at night. There was a frequent past history of psychiatric treatment and self-injury. People charged or convicted of violent or sexual offences were over-represented, as were those serving life sentences. There was an association between suicide and both guilt for the offence and being charged or convicted of a homicide offence. Some suicides occurred many years after reception into prison. Routine enquiry about previous suicide attempts must be implemented, along with better, ongoing, active communication between staff and inmates.

  13. The use of neuroscientific evidence in the courtroom by those accused of criminal offenses in England and Wales

    PubMed Central

    Catley, Paul; Claydon, Lisa

    2015-01-01

    This examination of the extent of the use of neuroscientific evidence in England and Wales identifies 204 reported cases in which such evidence has been used by those accused of criminal offenses during the eight-year period from 2005–12. Based on the number of reported cases found, the use of such evidence appears well established with those accused of criminal offenses utilizing such evidence in approximately 1 per cent of cases in the Court of Appeal (Criminal Division). Neuroscientific evidence is used to quash convictions, to lead to convictions for lesser offenses and to lead to reduced sentences. In addition, cases are identified where neuroscientific evidence is used to avoid extradition, to challenge bail conditions and to resist prosecution appeals against unduly lenient sentences. The range of uses identified is wide: including challenging prosecution evidence as to the cause of death or injury, challenging the credibility of witnesses and arguing that those convicted were unfit to plead, lacked mens rea or were entitled to mental condition defenses. The acceptance of such evidence reflects the willingness of the courts in England and Wales to hear novel scientific argument, where it is valid and directly relevant to the issue(s) to be decided. Indeed, in some of the cases the courts expressed an expectation that structural brain scan evidence should have been presented to support the argument being made. PMID:27774211

  14. 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

  15. 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

  16. 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.

  17. 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.

  18. Trends in suicide among migrants in England and Wales 1979–2003

    PubMed Central

    Maynard, Maria J.; Rosato, Michael; Teyhan, Alison; Harding, Seeromanie

    2012-01-01

    Objective. Trends in suicide death rates among migrants to England and Wales 1979–2003 were examined. Methods. Age-standardised rates derived for eight country of birth groups. Results. For men born in Jamaica, suicide death rates increased in 1999–2003. There were declines in rates for men and women from India and from Scotland, men from East Africa and Northern Ireland and women from the Republic of Ireland. For both men and women born in Scotland or the Irish Republic, despite declines for some, rates remained higher than for England and Wales born. Rates among men from Pakistan were consistently lower than men born in England and Wales. Conclusion. These analyses indicate declining trends for most migrant groups and for England and Wales-born women, but adverse trends in death rates for some country of birth groups. PMID:22288722

  19. 33 CFR 334.1330 - Bering Strait, Alaska; naval restricted area off Cape Prince of Wales.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... feet wide extending from a point on Cape Prince of Wales marked by a triangular cable marker located... due west of the cable marker with the axis of the area passing through the two points. (b)...

  20. 33 CFR 334.1330 - Bering Strait, Alaska; naval restricted area off Cape Prince of Wales.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... feet wide extending from a point on Cape Prince of Wales marked by a triangular cable marker located... due west of the cable marker with the axis of the area passing through the two points. (b)...

  1. 33 CFR 334.1330 - Bering Strait, Alaska; naval restricted area off Cape Prince of Wales.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... feet wide extending from a point on Cape Prince of Wales marked by a triangular cable marker located... due west of the cable marker with the axis of the area passing through the two points. (b)...

  2. 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

  3. 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.

  4. 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.

  5. 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?

  6. 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.

  7. 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.

  8. 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

  9. 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.

  10. A history of Soil Survey in England and Wales

    NASA Astrophysics Data System (ADS)

    Hallett, S.; Deeks, L.

    2012-04-01

    Early soil mapping in Britain was dominated, as in the USA, by soil texture with maps dating back to the early 1900's identifying surface texture and parent rock materials. Only in the 1920's did Dokuchaev's work in Russia involving soil morphology and the development of the soil profile start to gain popularity, drawing in the influence of climate and topography on pedogenesis. Intentions to create a formal body at this time responsible for soil survey were not implemented and progress remained slow. However, in 1939 definite steps were taken to address this and the soil survey was created. In 1947, its activities were transferred from Bangor to the research branch of the Rothamsted experimental station in Hertfordshire under Professor G.W. Robinson. Soon after, a number of regional offices were also established to act as a link with the National Agricultural Advisory Service. At this time a Pedology Department was established at Rothamsted, focussing on petrological, X-ray, spectrographic and chemical analyses. Although not a Rothamsted Department itself, the Survey did fall under the 'Lawes Agricultural Trust'. A Soil Survey Research Advisory Board was also formed to act as a liaison with the Agricultural Field Council. In Scotland by contrast, soil survey activities became centred on the Macaulay Institute in Aberdeen. Developments in the survey of British soils were accompanied in parallel by the development of soil classification systems. In 1930 a Soils Correlation Committee had been formed to ensure consistency in methods and naming of soil series and to ensure the classification was applied uniformly. In England and Wales the zonal system adopted was similar to that used in the USA, where soil series were named after the location where they were first described. American soil scientists such as Veitch and Lee provided stimulus to the development of mapping methods. In Scotland a differing classification was adopted, being similar to that used in Canada

  11. Designing a national soil erosion monitoring network for England and Wales

    NASA Astrophysics Data System (ADS)

    Lark, Murray; Rawlins, Barry; Anderson, Karen; Evans, Martin; Farrow, Luke; Glendell, Miriam; James, Mike; Rickson, Jane; Quine, Timothy; Quinton, John; Brazier, Richard

    2014-05-01

    Although soil erosion is recognised as a significant threat to sustainable land use and may be a priority for action in any forthcoming EU Soil Framework Directive, those responsible for setting national policy with respect to erosion are constrained by a lack of robust, representative, data at large spatial scales. This reflects the process-orientated nature of much soil erosion research. Recognising this limitation, The UK Department for Environment, Food and Rural Affairs (Defra) established a project to pilot a cost-effective framework for monitoring of soil erosion in England and Wales (E&W). The pilot will compare different soil erosion monitoring methods at a site scale and provide statistical information for the final design of the full national monitoring network that will: provide unbiased estimates of the spatial mean of soil erosion rate across E&W (tonnes ha-1 yr-1) for each of three land-use classes - arable and horticultural grassland upland and semi-natural habitats quantify the uncertainty of these estimates with confidence intervals. Probability (design-based) sampling provides most efficient unbiased estimates of spatial means. In this study, a 16 hectare area (a square of 400 x 400 m) positioned at the centre of a 1-km grid cell, selected at random from mapped land use across E&W, provided the sampling support for measurement of erosion rates, with at least 94% of the support area corresponding to the target land use classes. Very small or zero erosion rates likely to be encountered at many sites reduce the sampling efficiency and make it difficult to compare different methods of soil erosion monitoring. Therefore, to increase the proportion of samples with larger erosion rates without biasing our estimates, we increased the inclusion probability density in areas where the erosion rate is likely to be large by using stratified random sampling. First, each sampling domain (land use class in E&W) was divided into strata; e.g. two sub

  12. Stone-Wales defects in silicene: Formation, stability, and reactivity of defect sites

    NASA Astrophysics Data System (ADS)

    Sahin, H.; Sivek, J.; Li, S.; Partoens, B.; Peeters, F. M.

    2013-07-01

    During the synthesis of ultrathin materials with hexagonal lattice structure Stone-Wales (SW) type of defects are quite likely to be formed and the existence of such topological defects in the graphenelike structures results in dramatic changes of their electronic and mechanical properties. Here we investigate the formation and reactivity of such SW defects in silicene. We report the energy barrier for the formation of SW defects in freestanding (˜2.4 eV) and Ag(111)-supported (˜2.8 eV) silicene and found it to be significantly lower than in graphene (˜9.2 eV). Moreover, the buckled nature of silicene provides a large energy barrier for the healing of the SW defect and therefore defective silicene is stable even at high temperatures. Silicene with SW defects is semiconducting with a direct band gap of 0.02 eV and this value depends on the concentration of defects. Furthermore, nitrogen substitution in SW-defected silicene shows that the defect lattice sites are the least preferable substitution locations for the N atoms. Our findings show the easy formation of SW defects in silicene and also provide a guideline for band gap engineering in silicene-based materials through such defects.

  13. Evidence for recent changes in sexual behaviour in homosexual men in England and Wales.

    PubMed

    Johnson, A M; Gill, O N

    1989-09-01

    Over 80% of cases of Acquired Immune Deficiency Syndrome (AIDS) in England and Wales have occurred in homosexual men. Changes in sexual behaviour in this group may have a substantial influence on the incidence of Human Immunodeficiency Virus (HIV) infection and will therefore be crucial in determining future cases of AIDS. This paper critically weighs the indirect and direct evidence for changes in behaviour in homosexual men since the advent of the AIDS epidemic. The paper reports on falling incidence of gonorrhoea, hepatitis B and syphilis in homosexual men, the changes being most marked from 1985 onwards. Data on temporal trends in HIV prevalence and incidence in homosexual men are reviewed. These suggest that the maximum incidence of HIV infection occurred in 1982-84 and may have fallen since then. Evidence for a concomitant change in sexual behaviour is reported from several sources. This points towards a recent change in sexual behaviour characterized by reduction in the numbers of partners and adoption of safer sexual practices. In some places change may have occurred as early as 1983. A change became apparent generally in 1985 and this appears to have been sustained in 1986-87. Nevertheless, a substantial proportion of homosexual men studied continue to practice high risk sexual practices, such as anal intercourse, including relationships with casual partners.

  14. The Stone-Wales transformation: from fullerenes to graphite, from radiation damage to heat capacity.

    PubMed

    Heggie, M I; Haffenden, G L; Latham, C D; Trevethan, T

    2016-09-13

    The Stone-Wales (SW) transformation, or carbon-bond rotation, has been fundamental to understanding fullerene growth and stability, and ab initio calculations show it to be a high-energy process. The nature and topology of the fullerene energy landscape shows how the Ih-C60 must be the final product, if SW transformations are fast enough, and various mechanisms for their catalysis have been proposed. We review SW transformations in fullerenes and then discuss the analogous transformation in graphite, where they form the Dienes defect, originally posited to be a transition state in the direct exchange of a bonded atom pair. On the basis of density functional theory calculations in the local density approximation, we propose that non-equilibrium concentrations of the Dienes defect arising from displacing radiation are rapidly healed by point defects and that equilibrium concentrations of Dienes defects are responsible for the divergent ultra-high-temperature heat capacity of graphite.This article is part of the themed issue 'Fullerenes: past, present and future, celebrating the 30th anniversary of Buckminster Fullerene'. PMID:27501968

  15. 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

  16. 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.

  17. 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.

  18. Empirical determinants of measles metapopulation dynamics in England and Wales.

    PubMed Central

    Finkenstädt, B; Grenfell, B

    1998-01-01

    A key issue in metapopulation dynamics is the relative impact of internal patch dynamics and coupling between patches. This problem can be addressed by analysing large spatiotemporal data sets, recording the local and global dynamics of metapopulations. In this paper, we analyse the dynamics of measles meta-populations in a large spatiotemporal case notification data set, collected during the pre-vaccination era in England and Wales. Specifically, we use generalized linear statistical models to quantify the relative importance of local influences (birth rate and population size) and regional coupling on local epidemic dynamics. Apart from the proportional effect of local population size on case totals, the models indicate patterns of local and regional dynamic influences which depend on the current state of epidemics. Birth rate and geographic coupling are not associated with the size of major epidemics. By contrast, minor epidemics--and especially the incidence of local extinction of infection--are influenced both by birth rate and geographical coupling. Birth rate at a lag of four years provides the best fit, reflecting the delayed recruitment of susceptibles to school cohorts. A hierarchical index of spatial coupling to large centres provides the best spatial model. The model also indicates that minor epidemics and extinction patterns are more strongly influenced by this regional effect than the local impact of birth rate. PMID:9493407

  19. Developing better casemix education for rural New South Wales.

    PubMed

    Bridges, J F; Mazevska, D; Haas, M

    2001-08-01

    Casemix is now an important mechanism for the planning, evaluation and funding of health services in Australia. In New South Wales (NSW) it was believed that while staff from most hospitals in metropolitan Sydney had become both literate and vocal about casemix, staff from rural areas were less familiar and much less likely to participate in casemix initiatives. In conjunction with the NSW Casemix Clinical Committee (NCCC), NSW Health considered a special program of casemix education for rural NSW. Before an education program was attempted, NSW Health inquired into the specific needs for casemix education in rural NSW. Qualitative and quantitative methods of analysis were used. Results of the quantitative analysis indicate that the understanding of casemix classifications is highest among managers. Of concern were the relatively low proportion of Allied Health staff who had more than a vague understanding of the Sub- and Non-Acute Patient (SNAP) classification; the lack of any knowledge of the Mental Health Costing And Service Classification (MH-CASC) by nursing staff; and the lack of any knowledge of the emergency department classification: Urgency, Disposition and Age-related Groups (UDAG), either by clinical or nursing staff. The results of the qualitative analysis show that casemix education for rural areas needs to differ from metropolitan education programs. The analysis also highlights the perception of casemix in rural areas and the special circumstances in rural hospitals that place limits on the ability to use casemix more fully. PMID:11488704

  20. Exposure survey of motorcyclists in New South Wales.

    PubMed

    Harrison, Warren A; Christie, Ron

    2005-05-01

    This paper reports the results of an exposure survey of 794 registered motorcycle riders, with an average of 18.1 years of riding experience, in the State of New South Wales, Australia. Respondents completed two postal surveys, separated by about 6 months, that included items relating to their crash history, riding patterns, characteristics of their motorcycle, and its odometer reading. Odometer readings indicated that respondents rode a mean of 5208 km each year, and that annual exposure was related to gender, motorcycle type, and dominant riding location, time of week, and purpose. The amount of riding reported for different purposes changed with age, with older riders more likely than younger riders to ride for recreational reasons and on weekends. The mean crash rate (based on self-reported crash involvement) was 0.96 crashes/100,000 km. The crash rate declined with age, was highest in the Sydney metropolitan area, was lowest for motorcycles with large engines, and was highest for trail and dual-use motorcycles. There was a relationship between annual exposure and crash risk such that riders who rode relatively little had higher crash risks (per 100,000 km travelled) than riders who rode more often. A cluster analysis identified three groups of riders with higher-than-average risks of crash involvement. PMID:15784198

  1. Lichenometric dating of slope movements, Nant Ffrancon, North Wales

    NASA Astrophysics Data System (ADS)

    Winchester, Vanessa; Chaujar, Ravinder K.

    2002-09-01

    Over the last 50 years, frequent debris flows on the oversteepened slopes crossed by the main A5 road in Nant Ffrancon, North Wales, have presented a significant traffic hazard. This study uses two approaches to lichenometry to date earlier debris flows. The first approach provides dating estimates based on size/age correlations of the lichen Rhizocarpon geographicum subspecies prospectans growing in two local churchyards. The correlations supplied a growth rate of 1.47 mm year -1 for the species over a 140-year period, with a delay before colonization of 18 years. Remeasurement of the same lichens after a 4.25-year interval confirmed the growth and colonization rates in the churchyards. The second lichenometric approach, based on population size frequency distributions with size increments dated using the churchyard growth rate, provided controls for the Nant Ffrancon study site, with peaks in Rhizocarpon population size frequency distributions correlating with debris flow dates recorded by Gwynedd Council Highways Department. Circumstantial evidence supporting adoption of the growth rate on the Nant Ffrancon slopes was also supplied by data from archival and meteorological sources. The lichenometric dating estimates suggest that these slopes have a history of periodic debris flows covering at least the last 110 years, with major flows occurring in the 1890s followed by further flows in the early decades of the twentieth century.

  2. The atmosphere in England and Wales: an environmental management review

    NASA Astrophysics Data System (ADS)

    Weatherley, N. S.; Timmis, R. J.

    Air pollution in England and Wales is reviewed to identify priorities for management and research. The main human drivers of emissions are the production and consumption of energy and materials, disposal of waste, transport and land use. Pollutants are assigned to seven types: (i) nuisance (e.g. odour, noise), (ii) toxic, (iii) acidifying/eutrophying, (iv) photochemical oxidant precursors, (v) radionuclides, (vi) stratospheric ozone depleting substances and (vii) greenhouse gases. Dominant trends in activity and emissions are highlighted. New technologies and fuels are partially decoupling emissions from activity in power generation, industry and transport, but the gains are being offset by growth in demand and output in all major sectors. The evidence for impacts on human health, the atmosphere and other environmental systems is discussed. Priorities for management are climate change, ground-level ozone, acidification and eutrophication by nitrogen, urban air quality and nuisance pollution. Management responses require greater foresight, technological improvements and new instruments to control polluting activities. More scientific information is needed on the impacts on human health, quality of life and ecosystems, and on the links between different types of pollution. The policy challenges include generating energy sustainably, reducing transport impacts, devising effective economic instruments, improving societal awareness and contributing to cleaner global development.

  3. Modeling chloride transport using travel time distributions at Plynlimon, Wales

    NASA Astrophysics Data System (ADS)

    Benettin, Paolo; Kirchner, James W.; Rinaldo, Andrea; Botter, Gianluca

    2015-05-01

    Here we present a theoretical interpretation of high-frequency, high-quality tracer time series from the Hafren catchment at Plynlimon in mid-Wales. We make use of the formulation of transport by travel time distributions to model chloride transport originating from atmospheric deposition and compute catchment-scale travel time distributions. The relevance of the approach lies in the explanatory power of the chosen tools, particularly to highlight hydrologic processes otherwise clouded by the integrated nature of the measured outflux signal. The analysis reveals the key role of residual storages that are poorly visible in the hydrological response, but are shown to strongly affect water quality dynamics. A significant accuracy in reproducing data is shown by our calibrated model. A detailed representation of catchment-scale travel time distributions has been derived, including the time evolution of the overall dispersion processes (which can be expressed in terms of time-varying storage sampling functions). Mean computed travel times span a broad range of values (from 80 to 800 days) depending on the catchment state. Results also suggest that, in the average, discharge waters are younger than storage water. The model proves able to capture high-frequency fluctuations in the measured chloride concentrations, which are broadly explained by the sharp transition between groundwaters and faster flows originating from topsoil layers. This article was corrected on 22 JUN 2015. See the end of the full text for details.

  4. Impacts of climate change on wheat in England and Wales

    PubMed Central

    Semenov, Mikhail A.

    2008-01-01

    The frequency and magnitude of extreme weather events are likely to increase with global warming. However, it is not clear how these events might affect agricultural crops and whether yield losses resulting from severe droughts or heat stress will increase in the future. The aim of this paper is to analyse changes in the magnitude and spatial patterns of two impact indices for wheat: the probability of heat stress around flowering and the severity of drought stress. To compute these indices, we used a wheat simulation model combined with high-resolution climate scenarios based on the output from the Hadley Centre regional climate model at 18 sites in England and Wales. Despite higher temperature and lower summer precipitation predicted in the UK for the 2050s, the impact of drought stress on simulated wheat yield is predicted to be smaller than that at present, because wheat will mature earlier in a warmer climate and avoid severe summer drought. However, the probability of heat stress around flowering that might result in considerable yield losses is predicted to increase significantly. Breeding strategies for the future climate might need to focus on wheat varieties tolerant to high temperature rather than to drought. PMID:18682360

  5. Private health care expenditure and quality in Beveridge systems: cross-regional differences in the Italian NHS.

    PubMed

    Del Vecchio, Mario; Fenech, Lorenzo; Prenestini, Anna

    2015-03-01

    Private health care expenditure ranges from 15% to 30% of total healthcare spending in OECD countries. The literature suggests that there should be an inverse correlation between quality of public services and private expenditures. The main objective of this study is to explore the association between quality of public healthcare and private expenditures in the Italian Regional Healthcare Systems (RHSs). The institutional framework offered by the Italian NHS allows to investigate on the differences among the regions while controlling for institutional factors. The study uses micro-data from the ISTAT Household Consumption Survey (HCS) and a rich set of regional quality indicators. The results indicate that there is a positive and significant correlation between quality and private spending per capita across regions. The study also points out the strong association between the distribution of private consumption and income. In order to account for the influence of income, the study segmented data in three socio-economic classes and computed cross-regional correlations of RHSs quality and household healthcare expenditure per capita, within each class. No correlation was found between the two variables. These findings are quite surprising and call into question the theory that better quality of public services crowds out private spending, or, at the very least, it undermines the simplistic notions that higher levels of private spending are a direct consequence of poor quality in the public sector. This suggests that policies should avoid to simplistically link private spending with judgements or assessments about the functioning or efficacy of the public system and its organizations. PMID:25467792

  6. 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

  7. Trends in the levels of Escherichia coli in commercially harvested bivalve shellfish from England and Wales, 1999-2008.

    PubMed

    Campos, Carlos J A; Acornley, Richard; Morgan, Owen C; Kershaw, Simon

    2013-02-15

    Temporal trends in Escherichia coli concentrations in bivalve shellfish were examined using data collected from 57 production areas around the coast of England and Wales during 1999-2008. Downward trends were detected in annual geometric means of E. coli in shellfish from 12% of the sampling points. The percentage of class B areas (E. coli ≤ 4600/100 g shellfish in 90% of samples) increased from 69% to 86% during the 10-year period. The improvement in the microbial quality of shellfish is associated with sewerage improvement schemes largely implemented during 2000-2005. Upward trends were detected in 9% of the points. The causes of these increases are not known. It is recommended that quantitative sanitary profiling of shellfish waters and cost-benefit appraisal over long-term planning horizons are considered as part of sewerage investment programmes under the Water Framework Directive. This would allow greater scope to secure protection and improvement of shellfish water quality.

  8. 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.

  9. 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.

  10. 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.

  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. 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

  13. 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.

  14. 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

  15. 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.

  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. PMID:25595009

  17. 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:…

  18. 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

  19. 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

  20. The population prevalence of Down's syndrome in England and Wales in 2011.

    PubMed

    Wu, Jianhua; Morris, Joan K

    2013-09-01

    There is uncertainty over the population prevalence of people with Down's syndrome in England and Wales. This study aimed to estimate the population prevalence of Down's syndrome in England and Wales in 2011. A meta-analysis of published survival rates of people with Down's syndrome from 1938 to 2010 was conducted and the results were applied to the estimated numbers of babies born with Down's syndrome since 1938 in England and Wales. An estimated 37 090 people had Down's syndrome in England and Wales in 2011, a population prevalence of 0.66 per 1000 people; 650 under 1, 2673 aged 1-5, 7115 aged 5-18, 12819 aged 19-40, 10 626 aged 41-55 and 3207 aged 56 and older. The average life expectancy for babies with Down's syndrome born in 2011 was 51 years and the median life expectancy was 58 years. This study provides clarity on the number of people with Down's syndrome in England and Wales. Owing to sudden increases in the survival of babies with Down's syndrome in the 1950s there are a large proportion of people with Down's syndrome who are in their 40s. These people have an increased risk of developing dementia in the future and services should be aware of their potential needs.

  1. Cancer incidence in Asian migrants to New South Wales, Australia.

    PubMed Central

    Grulich, A. E.; McCredie, M.; Coates, M.

    1995-01-01

    Cancer incidence during 1972-90 in Asian migrants to New South Wales, Australia, is described. Overall cancer incidence was lower than in the Australia born in most migrant groups, and this reached significance in migrants born in China/Taiwan, the Philippines, Vietnam and India/Sri Lanka, and in male migrants born in Indonesia. For the majority of cancers, rates were more similar to those in the Australia born than to those in the countries of birth. For cancers of the breast, colorectum and prostate, rates were relatively low in the countries of birth, but migrants generally exhibited rates nearer those of the Australia born. For cancers of the liver and cervix and, in India/Sri Lanka-born migrants, of the oral cavity, incidence was relatively high in the countries of birth but tended to be lower, nearer Australia-born rates, in the migrants. For these cancers, environmental factors related to the migrant's adopted country, and migrant selection, appeared to have a major effect on the risk of cancer. For certain other cancers, incidence was more similar to that in the countries of birth. Nasopharyngeal cancer, and lung cancer in females, had high rates in both the countries of birth and in migrants to Australia. Nasopharyngeal cancer rates were highest in China/Taiwan and Hong Kong-born migrants, and were also significantly high in migrants from Malaysia/Singapore, Vietnam and the Philippines. Rates of lung cancer were significantly high in women born in China/Taiwan, and the excess was greater for adenocarcinoma than for squamous cell carcinoma. Melanoma had low rates in both the migrants and in the countries of birth. For these cancers, it was probable that genetic factors, or environmental factors acting prior to migration, were important in causation. PMID:7841061

  2. Expanded newborn screening in New South Wales: missed cases.

    PubMed

    Estrella, Jane; Wilcken, Bridget; Carpenter, Kevin; Bhattacharya, Kaustuv; Tchan, Michel; Wiley, Veronica

    2014-11-01

    There have been few reports of cases missed by expanded newborn screening. Tandem mass spectrometry was introduced in New South Wales, Australia in 1998 to screen for selected disorders of amino acid, organic acid and fatty acid metabolism. Of 1,500,000 babies screened by 2012, 1:2700 were diagnosed with a target disorder. Fifteen affected babies were missed by testing, and presented clinically or in family studies. In three cases (cobalamin C defect, very-long-chain acyl-CoA dehydrogenase deficiency and glutaric aciduria type 1), this led to modification of analyte cut-off values or protocols during the first 3 years. Two patients with intermittent MSUD, two with β-ketothiolase deficiency, two with citrin deficiency, two siblings with arginosuccinic aciduria, two siblings with homocystinuria, and one with cobalamin C defect had analyte values and ratios below the action limits which could not have been detected without unacceptable false-positive rates. A laboratory interpretation error led to missing one case of cobalamin C defect. Reference ranges, regularly reviewed, were not altered. For citrin deficiency, while relevant metabolites are detectable by tandem mass spectrometry, our cut-off values do not specifically screen for that disorder. Most of the missed cases are doing well and with no acute presentations although eight of 15 are likely to have been somewhat adversely affected by a late diagnosis. Analyte ratio and cut-off value optimisations are important, but for some disorders occasional missed cases may have to be tolerated to maintain an acceptable specificity, and avoid harm from screening.

  3. Experience with spinal injuries in New South Wales.

    PubMed

    Selecki, B R; Berry, G; Kwok, B; Mandryk, J A; Ring, I T; Sewell, M F; Simpson, D A; Vanderfield, G K

    1986-07-01

    Two hundred and two patients with acute and severe spinal injuries were treated in various hospitals in New South Wales during 1977 and 1978. Of these, 132 (65%) were cervical, 60 (30%) thoracic, eight (4%) lumbar and two were inadequately recorded. A major concurrent injury to the head was present in every third patient, to the chest in every fourth patient, and to the limbs in every fifth patient. The outcomes of patients reported in this series make it one of the worst in the literature. Sixty-nine (34%) patients died in hospital; of the 133 survivors, only 22 (11%) have resumed work, the remainder being partially or totally disabled. It is estimated that another 302 patients died before arrival in hospital. In country areas, the time lags between accident and ambulance notification, and between notification and arrival at hospital, were uncertain in many cases, but periods in excess of 2 hours were recorded in 28 (14%). One-man ambulances or private vehicles were used in at least 43 cases (21%). After admission, 139 patients were transferred to other hospitals for definitive treatment, arriving after an average time of 22 h (median time 9 h); for such patients, the original hospital presumably served as a first aid station. A case control study suggests that preventable delay in transport, inappropriate treatment, and failure to correct shock may have been causative factors in 16 deaths in this series. Reduction of the time lag between accident and institution of definitive treatment will save lives, and may avoid some crippling neurological deficits.(ABSTRACT TRUNCATED AT 250 WORDS)

  4. Observations on the NHS internal market: will the dodo get the last laugh?

    PubMed

    Royce, R G

    1995-08-12

    Distinguishing between the theory and practice of the internal market has been obscured by the considerable controversy generated by the reforms themselves. In such an environment both the advocates and the opponents of a market based solution have tended to promote their respective claims by reference to underlying political philosophies and economic theories rather than practical experience. Royce gives his observations of the actual operation of the internal market with particular reference to the commissioning function in Wales. He highlights inadequacies and inequities in the current system and proposes some remedial actions. Central to these are the importance of ensuring equitable funding for all purchasers, acknowledging the necessity of rationing, and promoting efficient and effective health care, sometimes at the expense of patient choice and guaranteed local service provision. PMID:7640593

  5. Beyond decentralization: the evolution of population distribution in England and Wales, 1961-1981.

    PubMed

    Robert, S; Randolph, W G

    1983-01-01

    "Using preliminary figures from the 1981 Census, this paper details recent population shifts at a variety of areal scales in England and Wales. It compares trends in the 1971-1981 period with those in the previous decade and assesses the relative contributions of net migration and natural change. Within its broad descriptive objectives, the paper considers whether England and Wales has kept abreast of patterns of counter-urbanization that have been claimed for other industrialized nations." The authors propose some definitions for various terms, including decentralization, deconcentration, and counter-urbanization. "The conclusion is drawn that even if the postulated international continuum of changes ranging from urbanization through to counter-urbanization is valid, the limited geographical size of England and Wales will preclude this country from reaching the final stages of such a model. Finally, some policy implications which stem from the recent population redistributions are introduced and some themes for future research are considered."

  6. The effect of long-term migration dynamics on population structure in England & Wales and Scotland.

    PubMed

    Murphy, Michael

    2016-07-01

    We investigated the effect of migration on population dynamics in England & Wales and Scotland from the mid-nineteenth century to the present by comparing actual population size and structure with estimates based on zero net migration from a range of starting dates. In this period, Scotland had the largest net outflow among countries in Europe for which detailed information is available, whereas overall net migration in England & Wales was close to zero. In the absence of migration, population would have been over twice as large in Scotland in 2013 as the actual value, but similar to its actual value in England & Wales. Levels and pace of population ageing have been broadly similar in both countries, so the major impact of differential migration has been on population size rather than structure. We discuss these findings in relation to the debate on migration policy between political parties supporting and opposing independence in the 2014 Scottish referendum. PMID:27294474

  7. Testing, Training and Tensions: The Expression of Health within Physical Education Curricula in Secondary Schools in England and Wales

    ERIC Educational Resources Information Center

    Harris, Jo; Leggett, Gemma

    2015-01-01

    This paper utilises critical discourse analysis to explore and discuss the expression of health within physical education (PE) curricula in secondary schools in England and Wales. The study adopted a case study approach, involving three state secondary schools in England and two in Wales. Data were drawn from interviews with PE teachers and…

  8. The Current Provision for Further and Higher Education in Wales. Coombe Lodge Working Paper. Information Bank Number 1627.

    ERIC Educational Resources Information Center

    Marsh, D. T.

    Provision for postsecondary higher education in Wales, the nature of the Welsh system, and future concerns are discussed. The roles of the Welsh Office and the Welsh Joint Education Committee contrast greatly with central organizations in England. There is one university in Wales, comprising seven constituent colleges. Additional institutions in…

  9. The National Professional Qualification for Headship in Wales: Issues for Policy and Practice in Educational Leadership Development--Part 1

    ERIC Educational Resources Information Center

    James, Chris; Williams, Alun

    2005-01-01

    Since devolution in the UK in 1999, many aspects of social policy in Wales have been developed to respond more distinctively to the needs and requirements of those who live and work in Wales. In education and life-long learning, the Welsh Assembly Government has set out intended policy developments for the first ten years of devolved government in…

  10. Development of integrated high-resolution geophysical, photogrammetric and GPS surveying applied to landslides in the South Wales coalfield

    NASA Astrophysics Data System (ADS)

    Taboga, Alessia

    The aim of this research is to develop an integrated and cost-effective site investigation approach for slow moving landslides or potentially unstable slopes found within the South Wales Coalfield, an area of complex geology and hydrogeology. The research was based on the use and assessment of a wide range of surface geophysical techniques, supported by GPS and Digital Photogrammetry surveying, and the joint interpretation of the results which such techniques provide. The South Wales Coalfield has one of the highest concentrations of urban landslides in the UK due to its layered Carboniferous geology. Quaternary / Holocene geomorphology, coal mining history and relatively high rainfall. Mynydd yr Eglwys landslide (Ystrad, Rhondda Cynon Taff) was selected as the field study site because it can be considered representative of the active landslides found within the area. In autumn 1998, following an exceptional heavy rainfall period, a new compound deep- seated failure developed in a previously mined hillslope. This deep-seated failure then caused the reactivation of ancient periglacial debris slides downslope creating a serious risk to the modern housing estate located close to the toe. Electromagnetic (GEM-2), self potential, electrical resistivity tomography, seismic refraction tomography, MASW and induced polarization geophysical data were all acquired on the landslide. This combination of techniques provided information on lithology, faulting, degree of rock fracturing/weathering, thickness of displaced material, spatial distribution of areas with high water/clay content and the direction of groundwater flow. The repetition of a few ERT and SP profiles showed the applicability of geophysical monitoring in detecting changes in groundwater content and defining preferential groundwater pathways within the hillslope. Digital Photogrammetry from Helium balloon can provide a 3D landslide topographic model with 10cm-level accuracy. Topcon HiPer Pro GPS+ instrument can

  11. Seasonal variation and time trends in childhood asthma in England and Wales 1975-81.

    PubMed Central

    Khot, A; Burn, R; Evans, N; Lenney, C; Lenney, W

    1984-01-01

    In England and Wales hospital admissions for childhood asthma almost trebled over the period 1975-81. This may have reflected a true increase in the incidence of acute asthma, a swing from primary to hospital care, or both. The trend was not due to a change in diagnostic fashion. Monthly admissions showed a pronounced seasonal variation with fewest admissions in winter, rising in spring and early summer to peak in the autumn. A deep admission trough was present in August. The monthly admission profile was very similar throughout England and Wales, suggesting that major "trigger" factors were responsible. PMID:6430420

  12. International Study of Health Care Organization and Financing of renal services in England and Wales.

    PubMed

    Nicholson, Tricia; Roderick, Paul

    2007-12-01

    In England and Wales, the quantity and quality of renal services have improved significantly in the last decade. While acceptance rates for renal replacement therapy appear low by international standards, they are now commensurate with many other northern European countries. The major growth in renal services has been in hemodialysis, especially at satellite units. Health care is predominantly publicly funded through a tax-based National Health Service, and such funding has increased in the last 10 years. Improvements in health outcomes in England and Wales are expected to continue due to the recent implementation of standards, initiatives, and monitoring mechanisms for renal transplantation, vascular access, and patient transport. PMID:17653861

  13. 3D Local Earthquake Tomography of England and Wales

    NASA Astrophysics Data System (ADS)

    Hardwick, A.; England, R.; Maguire, P.; Baptie, B.; Ottemoller, L.

    2006-12-01

    For the past three decades crustal studies of the British Isles have been restricted to the interpretation of 2-D seismic reflection and refraction profiles, mostly aquired offshore. The British Geological Survey (BGS) seismic monitoring network has grown substantially over the past twenty years to a density and quality unprecedented for an aseismic region. Recently, this has made it possible to undertake teleseismic studies to image the seismic velocity of the mantle via 3-D tomography and 1-D receiver functions for the crust and uppermost mantle. Whilst the British Isles can be considered an aseismic region by world standards, the BGS network typically records 40 local events of over 2.0 on the local magnitude scale every year. Irrespective of an intra-plate setting, the width of seismogenic zone is exceptional, ranging from the surface to in excess of 30 kilometres depth despite no surface ruptures ever having been observed. For the first time we utilise these locally generated seismic events within the BGS digital catalogue recorded over the past two decades to produce a model of seismic P- and S- velocity to depths of 70 km beneath England, Wales and the Irish Sea at an unmatched resolution. A high quality subset of over 1,000 local events and 18,000 arrival times has been extracted from the entire digital catalogue. This has been used to relocate the events with a 1-D seismic P-velocity model extracted from a regional 2-D model derived by extrapolation of wide-angle refraction profiles. The initial locations and 1-D model have been simultaneously updated and refined using VELEST to produce a consistent set of station corrections for the BGS network which is in good agreement with known geology. The updated locations and 1-D model acts as the reference model for a 3-D tomographic model developed with the SIMULPS inversion code. Our 3-D model will compliment teleseismic and controlled source studies which demonstrate seismic anomalies thought to be associated

  14. The late devensian and holocene evolution of Barmouth Bay, Wales

    NASA Astrophysics Data System (ADS)

    Larcombe, Piers; Jago, Colin F.

    1994-03-01

    A marine seismic and sedimentological investigation of the Late-Devensian and Holocene sediments of Barmouth Bay, North Wales, was undertaken to reconstruct late-glacial and Holocene sedimentary environments, and to evaluate post-glacial sedimentation rates. In the last glacial, the Devensian, many Welsh estuaries were the sites of valley glaciers flowing from the Welsh Ice cap onto the modern inner-shelf. At Barmouth, the Mawddach valley glacier flowed into the present inner-shelf of Cardigan Bay. The modern courses of the Mawddach Estuary and the river Gwril were overdeepened by erosive sub-glacial flows, and are later infilled by a coarse-grained sub-glacial and pro-glacial infill sequence. With late-glacial relative sea-level rise and retreat of the Welsh Ice, the Mawddach valley tidewater glacier became grounded and confined to the valley. Re-equilibration of the ice profile occurred, and a morainal complex was formed at its toe. In the early Holocene, the morainal complex formed the seaward boundary of a sheltered nearshore basin where fine-grained, partly organic, sediments were deposited in a lagoonal or estuarine environment. Holocene reworking of the sediments by shallow-marine processes has formed a lag surface to the morainal complex, and has introduced gravel of Irish Sea Ice character from offshore. Wave action has formed a shingle coastal barrier, narrowing the mouth of the modern estuary. A shoreface-attached sand wedge, which attains a maximum thickness of 4 m beneath the modern ebb-tidal delta, overlies the lag surface and onlaps the coastal barrier. Since 8-9 ky BP, the mean sediment accumulation rate of estuarine and shallow-marine sediments has been 2.3-3.1 mm/yr, roughly equivalent to the long-term mean rate of sea-level rise for Cardigan Bay. This mean rate masks rapidly increasing accumulation rates in the Mawddach Estuary in the last 5-6 ky, which now may be 82 mm/yr, and which are due to reworking of shoreface and barrier sands into the

  15. 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

  16. 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

  17. Simulating the effect of land use and climate change on upland soil carbon stock of Wales using ECOSSE

    NASA Astrophysics Data System (ADS)

    Rani Nayak, Dali; Gottschalk, Pia; Evans, Chris; Smith, Pete; Smith, Jo

    2010-05-01

    Within Wales soils hold between 400-500 MtC, over half of this carbon is stored in organic and organo-mineral soil which cover less than 20% of the land area of Wales. It has been predicted that climate change will increasingly have an impact on the C stock of soils in Wales. Higher temperatures will increase the rate of decomposition of organic matter, leading to increased C losses. However increased net primary production (NPP), leading to increased inputs of organic matter, may offset this. Land use plays a major role in determining the level of soil C and the direction of change in status (soil as a source or sink). We present here an assessment of the effect of land use change and climate change on the upland soil carbon stock of Wales in 3 different catchments i.e. Migneint, Plynlimon and Pontbren using a process-based model of soil carbon and nitrogen dynamics, ECOSSE. The uncertainties introduced in the simulations by using only the data available at national scale are determined. The ECOSSE model (1,2) has been developed to simulate greenhouse gas emissions from both organic and mineral soils. ECOSSE was derived from RothC (3) and SUNDIAL (4,5) and predicts the impacts of changes in land use and climate on emissions and soil carbon stock. Simulated changes in soil C are dependent on the type of land use change, the soil type where the land use change is occurring, and the C content of soil under the initial and final land uses. At Migneint and Plynlimon, the major part of the losses occurs due to the conversion of semi-natural land to grassland. Reducing the land use change from semi-natural to grassland is the main measure needed to mitigate losses of soil C. At Pontbren, the model predicts a net gain in soil C with the predicted land use change, so there is no need to mitigate. Simulations of future changes in soil C to 2050 showed very small changes in soil C due to climate compared to changes due to land use change. At the selected catchments, changes

  18. Enter the Madcap Prince of Wales: Students Directing "Henry IV, Part I."

    ERIC Educational Resources Information Center

    Earthman, Elise Ann

    1993-01-01

    Argues that William Shakespeare's "Henry IV, Part I" is an appropriate and useful text for secondary English classrooms. Shows how the play lends itself to performance-based instruction. Outlines ways of accomplishing student engagement, using film versions, and assigning written work. (HB)

  19. 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.

  20. 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.

  1. 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

  2. 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.

  3. 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.

  4. Mapping bare soil in South West Wales, UK, using high resolution colour infra-red aerial photography for water quality and flood risk management applications

    NASA Astrophysics Data System (ADS)

    Sykes, Helena; Neale, Simon; Coe, Sarah

    2016-04-01

    Natural Resources Wales is a UK government body responsible for environmental regulation, among other areas. River walks in Water Framework Directive (WFD) priority catchments in South West Wales, UK, identified soil entering water courses due to poaching and bank erosion, leading to deterioration in the water quality and jeopardising the water quality meeting legal minimum standards. Bare soil has also been shown to cause quicker and higher hydrograph peaks in rural catchments than if those areas were vegetated, which can lead to flooding of domestic properties during peak storm flows. The aim was to target farm visits by operational staff to advise on practices likely to improve water quality and to identify areas where soft engineering solutions such as revegetation could alleviate flood risk in rural areas. High resolution colour-infrared aerial photography, 25cm in the three colour bands and 50cm in the near infrared band, was used to map bare soil in seven catchments using supervised classification of a five band stack including the Normalised Difference Vegetation Index (NDVI). Mapping was combined with agricultural land use and field boundary data to filter out arable fields, which are supposed to bare soil for part of their cycle, and was very successful when compared to ground truthing, with the exception of silage fields which contained sparse, no or unproductive vegetation at the time the imagery was acquired leading to spectral similarity to bare soil. A raindrop trace model was used to show the path sediment from bare soil areas would take when moving through the catchment to a watercourse, with hedgerows inserted as barriers following our observations from ground truthing. The findings have been used to help farmers gain funding for improvements such as fencing to keep animals away from vulnerable river banks. These efficient and automated methods can be rolled out to more catchments in Wales and updated using aerial imagery acquired more recently to

  5. 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.

  6. 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.

  7. 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

  8. 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

  9. 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

  10. 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.

  11. 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.

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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

  18. Young Offenders in New South Wales, Australia and the Need for Remedial Sexual Health Education

    ERIC Educational Resources Information Center

    Mistler, Grant; Kirkwood, Kristie; Potter, Emily; Cashin, Andrew

    2008-01-01

    The 2005-2008 Australian National Sexually Transmissible Infections Strategy identifies young people as a key target group in need of sexual health education, screening and management. For young people who are in contact with the New South Wales (NSW) juvenile justice system, a dire need for remedial sexual health education exists. NSW young…

  19. Density and abundance of badger social groups in England and Wales in 2011-2013

    NASA Astrophysics Data System (ADS)

    Judge, Johanna; Wilson, Gavin J.; MacArthur, Roy; Delahay, Richard J.; McDonald, Robbie A.

    2014-01-01

    In the United Kingdom, European badgers Meles meles are a protected species and an important wildlife reservoir of bovine tuberculosis. We conducted a survey of badger dens (main setts) in 1614 1 km squares across England and Wales, between November 2011 and March 2013. Using main setts as a proxy for badger social groups, the estimated mean density of badger social groups in England and Wales was 0.485 km-2 (95% confidence interval 0.449-0.521) and the estimated abundance of social groups was 71,600 (66,400-76,900). In the 25 years since the first survey in 1985-88, the annual rate of increase in the estimated number of badger social groups was 2.6% (2.2-2.9%), equating to an 88% (70-105%) increase across England and Wales. In England, we estimate there has been an increase of 103% (83-123%) in badger social groups, while in Wales there has been little change (-25 to +49%).

  20. Multiagency Protocols in Intellectual Disabilities Transition Partnerships: A Survey of Local Authorities in Wales

    ERIC Educational Resources Information Center

    Kaehne, Axel

    2010-01-01

    The paper presents the findings of a study of transition protocols (for adolescents leaving school and entering the general marketplace) in place for intellectual disability partnerships in 22 local authorities in Wales. The study consisted of a survey of existing protocols and a documentary analysis of the content of the obtained protocols. The…

  1. Diagnostic Trends in Autistic Spectrum Disorders in the South Wales Valleys

    ERIC Educational Resources Information Center

    Latif, A. H. A.; Williams, W. R.

    2007-01-01

    This study provides an analysis of the diagnostic trends in autistic spectrum disorder (ASD) for children aged under 17 years in the Rhondda and Taff Ely districts of South Wales. In the period 1988-2004, 336 children received a diagnosis of ASD and represent the case registry data of one community pediatric team. For the period 1994-2003, the…

  2. Missions Statements in Wales: The Impact of Markets and Policy on Congruence between Institutions

    ERIC Educational Resources Information Center

    James, Helen; Huisman, Jeroen

    2009-01-01

    This study seeks to compare the mission statements of higher education institutions in Wales as well as to compare these with regional level policy statements and demands from the market. The underlying idea is to reveal the extent to which mission statements actually differ and are (or are not) in line with such regional policies and market…

  3. An Evaluation of the Effectiveness of the Education Welfare Service in Wales

    ERIC Educational Resources Information Center

    Reid, Ken; Smith, Robert; Powell, Robat; Reakes, Angharad; Jones, Gareth

    2007-01-01

    This article presents the findings from a sponsored research project funded by the Welsh Assembly Government on the effectiveness of the education welfare service in Wales. Findings were obtained from the use of three semi-structured questionnaires with local education authority and welfare service staff and with selected primary and secondary…

  4. Passages to Literature: Essays on Teaching in Australia, Canada, England, the United States, and Wales.

    ERIC Educational Resources Information Center

    Milner, Joseph O'Beirne, Ed.; Milner, Lucy Floyd Morcock, Ed.

    Representing Australia, Canada, England, the United States, and Wales, this collection of essays focuses on ways in which teachers can adapt classroom activities and modify writing assignments to encourage personal response and exploration of texts. Essays, their authors, and nationalities are as follows: (1) "The River and Its Banks: Response and…

  5. When School Is Not Enough: New Initiatives in Intergenerational Language Transmission in Wales

    ERIC Educational Resources Information Center

    Edwards, Viv; Newcombe, Lynda Prichard

    2005-01-01

    This paper examines language reproduction in the family in the context of a highly innovative project in Wales, where the Welsh language has been in decline for over a century. Although Welsh-medium schooling has played a pivotal role in slowing and even reversing language shift in recent decades, there is mounting evidence of the dangers of …

  6. Vocational Rehabilitation in Wales: A Mixed Method Evaluation of Condition Management Programmes

    ERIC Educational Resources Information Center

    Reagon, Carly

    2011-01-01

    Condition management programmes (CMPs) are vocational rehabilitation schemes, which aim to address the needs of disability-related benefit claimants in the UK. The aim of this evaluation was to investigate the extent to which three CMPs in Wales enable individuals to manage health conditions and move closer towards work. Outcome measurements for…

  7. Implementation of an Integrated Information Management System at the National Library of Wales: A Case Study

    ERIC Educational Resources Information Center

    Evans, Manon Foster; Thomas, Sian

    2007-01-01

    Purpose: This paper aims to describe the experiences of the National Library of Wales in implementing an integrated information management system. Design/methodology/approach: Discusses the stages involved in the procurement process, data migration and general system implementation. Findings: Emphasises the need for a well-prepared yet flexible…

  8. Indigenous Bilingual EC Programmes in Aotearoa, Wales and the U.S.

    ERIC Educational Resources Information Center

    Holmes, Tony

    This paper examines bilingual early childhood programs in Aotearoa, New Zealand, in Wales, and among the indigenous people of the United States. The first section of the paper describes bicultural programs as programs that promote an acknowledgement of the ways people of each culture live, communicate with one another, and understand their world.…

  9. Knowledge for What? Wales, Militarisation and the Endless Promotion of the Knowledge Economy

    ERIC Educational Resources Information Center

    Tannock, Stuart

    2009-01-01

    The "knowledge economy" has become the buzzword of development policy in the early twenty-first century. Nations and regions around the world are all told that they must transform themselves into knowledge economies to survive and prosper. This article uses the example of Wales and its recent embrace of a massive military privatisation project in…

  10. The Effects of National Testing in Science at Key Stage 2 in England and Wales

    ERIC Educational Resources Information Center

    Collins, Sue; Reiss, Michael; Stobart, Gordon

    2009-01-01

    In this article, the authors describe a research project designed to explore the effects of science testing in Year 6 (age 11) in England and implications of the abolition of testing in Wales since 2004. The research was commissioned by the Welcome Trust in association with the ASE to inform representation to the House of Commons Select Committee…

  11. Ethical analysis of the new proposed mental health legislation in England and Wales.

    PubMed

    Lepping, Peter

    2007-01-01

    This paper ethically analyses arising out the proposed changes to the Mental Health Act for England and Wales. It looks in particular at thea shift in philosophy that the author claims has occurred with the proposals away from rights-focused principles to more utilitarian or outcome-focused principles. It gives examples of these changes and explores its their consequences.

  12. Refugee Children in Wales: Coping and Adaptation in the Face of Adversity

    ERIC Educational Resources Information Center

    Maegusuku-Hewett, Tracey; Dunkerley, David; Scourfield, Jonathan; Smalley, Nina

    2007-01-01

    This article aims to makes a contribution to redressing a methodological and theoretical imbalance in existing research on refugee and asylum-seeking children. It draws on two qualitative studies from Wales with children and young people. The samples include unaccompanied minors and children living with families as well as both children who are…

  13. The Communities Providing Religious Education and Catechesis to Polish Immigrants in England and Wales

    ERIC Educational Resources Information Center

    Makosa, Pawel

    2015-01-01

    Since Poland's accession to the European Union in 2004, hundreds of thousands of Polish citizens have arrived in the UK in search of work, of which the majority landed in England and Wales. This process, although not as fast now, is still ongoing. The majority of immigrants from Poland are young people who start families and have children. Many of…

  14. Historical Child Sexual Abuse in England and Wales: The Role of Historians

    ERIC Educational Resources Information Center

    Bingham, Adrian; Delap, Lucy; Jackson, Louise; Settle, Louise

    2016-01-01

    This article reflects on methodological and ethical issues that have shaped a collaborative project which aims to chart social, legal and political responses to child sexual abuse in England and Wales across the twentieth century. The etymological problem of searching for child sexual abuse in the historical archive is discussed, given that the…

  15. Language Policy and Governmentality in Businesses in Wales: A Continuum of Empowerment and Regulation

    ERIC Educational Resources Information Center

    Barakos, Elisabeth

    2016-01-01

    In this paper, I examine how language policy acts as a means of both empowering the Welsh language and the minority language worker and as a means of exerting power over them. For this purpose, the study focuses on a particular site: private sector businesses in Wales. Therein, I trace two major discursive processes: first, the Welsh Government's…

  16. Remove, Rehabilitate, Return? The Use and Effectiveness of Behaviour Schools in New South Wales, Australia

    ERIC Educational Resources Information Center

    Granite, Elizabeth; Graham, Linda J.

    2012-01-01

    Research indicates that enrolments in separate special educational settings for students with disruptive behaviour have increased in a number of educational jurisdictions internationally. Recent analysis of school enrolment data has identified a similar increase in the New South Wales (NSW) government school sector; however, questions have been…

  17. Prison Education in England and Wales. (2nd Revised Edition). Mendip Papers MP 022.

    ERIC Educational Resources Information Center

    Ripley, Paul

    In response to prison disturbances in England and Wales in the late 1980s, the education program for prisoners was improved and more prisoners were given access to educational services. Although education is a relatively new phenomenon in the English and Welsh penal system, by the 20th century, education had become an integral part of prison life.…

  18. Mortality among a Cohort of Persons with an Intellectual Disability in New South Wales, Australia

    ERIC Educational Resources Information Center

    Florio, Tony; Trollor, Julian

    2015-01-01

    Objectives: The main objective of the study was to compare mortality for people with an intellectual disability (ID) to the general population in New South Wales (NSW), Australia. A second objective was to provide mortality data for people with an intellectual disability from NSW in a standardized format, which allows for international comparisons…

  19. Brief Report: Multilevel Analysis of School Smoking Policy and Pupil Smoking Behaviour in Wales

    ERIC Educational Resources Information Center

    Wiium, Nora; Burgess, Stephen; Moore, Laurence

    2011-01-01

    A multilevel analysis of cross-sectional data from a survey involving 1941 pupils (in grades 10 and 11) and policy indicators developed from interviews with staff from 45 secondary schools in Wales examined the hypotheses that pupil smoking prevalence would be associated with: restrictive staff and pupil smoking policies; dissemination of school…

  20. University Patenting in Wales, Scotland and Northern Ireland: A Comparative Analysis

    ERIC Educational Resources Information Center

    Beale, Andrew; Blackaby, David; Mainwaring, Lynn

    2008-01-01

    Using data on the patent portfolios of UK universities, the paper compares the levels of patenting activity (filings), success (grants) and quality (patents with commercial co-assignees and patent citations) at Welsh, Scottish and Northern Irish institutions. Patent activity, per researcher, in Wales is on a par with that in Scotland and about…

  1. The Dark Figure of Infanticide in England and Wales: Complexities of Diagnosis

    ERIC Educational Resources Information Center

    Brookman, Fiona; Nolan, Jane

    2006-01-01

    Infants aged younger than 12 months have the highest homicide victimization rate of any single age group in England and Wales. In addition, there are good grounds for believing that the official homicide statistics for this particular age group are an underestimate and subject to distortion. At the same time there is evidence mounting in the…

  2. Changes in Academic Library Space: A Case Study at the University of New South Wales

    ERIC Educational Resources Information Center

    Bailin, Kylie

    2011-01-01

    As the digital environment continues to become more pervasive in our lives, academic libraries have had to adapt to ensure that services remain relevant to users' needs. Research was conducted to examine the 2009-2011 refurbishment at the University of New South Wales (UNSW) Library and evaluate its success in meeting users' needs in terms of…

  3. A calibration of the lamb airflow classification model to predict past precipitation in Wales

    NASA Astrophysics Data System (ADS)

    Beaumont, Peter; Hawksworth, Kevin

    1997-11-01

    Daily precipitation data from 146 sites for the period 1982 to 1991 inclusive have been analysed in conjunction with the 27 Lamb airflow types. An areal mean precipitation (AMP) series for Wales is constructed for the period 1861 to 1995 by summing the mean daily AMP values associated with each Lamb airflow type. The results reveal that the use of coherent precipitation regions together with seasonal AMP values are more likely to provide a better estimate of mean annual precipitation than those combining a simple unweighted summation with non-seasonal values. The mean annual series for Wales compares favourably with that provided by Wigley et al. and Woodley for England and Wales. Finally, the importance of the major Lamb airflow types are considered in relation to periods of the record when dry and wet phases occur. Anticyclonic and cyclonic Lamb types are shown to be better predictors of mean annual precipitation than Lamb westerlies. In part, this reflects the fact that at the regional scale non-westerly Lamb airflow types can be embedded within a mobile westerly circulation. These non-westerly airflow types often produce high precipitation totals over Wales.

  4. An Assessment of Higher Education Spin-off Enterprises in Wales.

    ERIC Educational Resources Information Center

    Brooksbank, David; Thomas, Brychan

    2001-01-01

    Research on academic spin-off enterprises in Wales shows that 26 were established from 1990-1999, a lower rate than in the United Kingdom overall. They made a significant contribution to local economic development. A critical challenge is to ensure proper management and structural support so they can realize their potential. (SK)

  5. Serials Solutions and LinkFinderPlus at the University of Wales Swansea

    ERIC Educational Resources Information Center

    Brown, Andrew; Smyth, Neil

    2005-01-01

    Purpose: To provide practical information on two electronic journal-related products implemented in Library and Information Services at University of Wales Swansea. Design/methodology/approach: An overview is provided of the evaluation of electronic journal management products undertaken and subsequent implementation. Findings: Serials Solutions…

  6. Work and Leaving Home: The Experience of England and Wales, 1850-1920. Working Paper.

    ERIC Educational Resources Information Center

    Schurer, K.

    Data from the 1811 and 1851 census in England and Wales as well as other data from those countries in 1891 and 1921 were analyzed to investigate individuals' timing and extent of departure from the parental home. The authors found the following: (1) there was a gradual increase in the ages at which children left the parental home; (2) the pace of…

  7. Indigenous Gambling Motivations, Behaviour and Consequences in Northern New South Wales, Australia

    ERIC Educational Resources Information Center

    Breen, Helen M.; Hing, Nerilee; Gordon, Ashley

    2011-01-01

    Against a background of public health, we sought to examine and explain gambling behaviours, motivations and consequences of Indigenous Australians in northern New South Wales. Adhering to national Aboriginal and ethical guidelines and using qualitative methods, 169 Indigenous Australians were interviewed individually and in small groups using…

  8. The Decline and Revival of Music Education in New South Wales Schools, 1920-1956

    ERIC Educational Resources Information Center

    Chaseling, Marilyn; Boyd, William E.

    2014-01-01

    This paper overviews the decline and revival of music education in New South Wales schools from 1920 to 1956. Commencing with a focus on vocal music during the period up to 1932, a time of decline in music teaching, the paper examines initiatives introduced in 1933 to address shortcomings in music education, and the subsequent changes in…

  9. The Management of Professional Development of Staff in Secondary Schools in Wales

    ERIC Educational Resources Information Center

    Turner, Chris; Mitchell, Sue

    2004-01-01

    The purpose of this article is to present the findings from some empirical research carried out in 2002 among 200 staff working in 13 secondary schools in South Wales, concerning their views of the management of professional development. The findings indicated many of the significant differences between staff were gender-based. Female staff…

  10. Differences in Univariate Values versus Multivariate Relationships: Findings from a Study of Diana, Princess of Wales.

    ERIC Educational Resources Information Center

    Basil, Michael D.; Brown, William J.; Bocarnea, Mihai C.

    2002-01-01

    Addresses the question of whether use of student samples jeopardizes the validity of research. Examines the distinction between univariate and multivariate relationships in a study of identification with Diana, Princess of Wales. Shows that although the estimates of univariate values differed across three samples, the multivariate relationships…

  11. Technological Innovation, Entrepreneurship, Higher Education and Economic Regeneration in Wales: A Policy Study

    ERIC Educational Resources Information Center

    Thomas, Brychan; Packham, Gary; Miller, Christopher

    2006-01-01

    This paper presents the views of key policy makers concerning innovation and entrepreneurship in Wales. The development of innovation in SMEs and the policy implications for economic regeneration are also analysed. The role of a variety of actors (including users and suppliers) is considered, as is the impact of networks of SMEs linked together in…

  12. Changes in Maternal Age in England and Wales--Implications for Down Syndrome

    ERIC Educational Resources Information Center

    Crane, Elizabeth; Morris, Joan K.

    2006-01-01

    The risk of having a pregnancy with Down syndrome increases with maternal age. The percentage of all births in England and Wales to mothers aged 35 and over increased from 9% in 1989 to 19% in 2003. A 51% increase in the numbers of pregnancies with Down syndrome has been observed over the same time period (from 954 to 1440). Due to improvements in…

  13. Deprivation and mortality in non-metropolitan areas of England and Wales.

    PubMed Central

    Jessop, E G

    1996-01-01

    OBJECTIVE: To test the hypothesis that the relationship between deprivation and mortality is weaker among residents of non-metropolitan areas of England and Wales than among residents of metropolitan areas. DESIGN: This study compared mortality, expressed as standardised mortality ratios (SMRs), in residents of metropolitan and non-metropolitan districts at three levels of deprivation classified by an electoral ward deprivation score and by home and car ownership. SMRs were computed for all causes of death, for bronchitis and asthma (ICD9 codes 490-493), and for accident, violence, and poisoning (ICD9 codes 800-999). SETTING: England and Wales. PARTICIPANTS: Members of the longitudinal study of the Office of Population Censuses and Surveys, a quasi-random 1% sample of the population of England and Wales. MAIN RESULTS: There was an association between deprivation and mortality which was clear for all cause mortality, more noticeable for respiratory disease, and less clear for deaths from accident, violence, and poison. In general, the results showed a remarkable similarity between metropolitan and non-metropolitan areas. CONCLUSIONS: This study does not support the hypothesis that the relationship between mortality and deprivation differs between residents of metropolitan and non-metropolitan areas of England and Wales. PMID:8944858

  14. Implementing Curriculum Reform in Wales: The Case of the Foundation Phase

    ERIC Educational Resources Information Center

    Taylor, Chris; Rhys, Mirain; Waldron, Sam

    2016-01-01

    The Foundation Phase is a Welsh Government flagship policy of early years education (for 3-7 year-old children) in Wales. Marking a radical departure from the more formal, competency-based approach associated with the previous Key Stage 1 National Curriculum, it advocates a developmental, experiential, play-based approach to teaching and learning.…

  15. An Analysis of Misconceptions in Science Textbooks: Earth Science in England and Wales

    ERIC Educational Resources Information Center

    King, Chris John Henry

    2010-01-01

    Surveys of the earth science content of all secondary (high school) science textbooks and related publications used in England and Wales have revealed high levels of error/misconception. The 29 science textbooks or textbook series surveyed (51 texts in all) showed poor coverage of National Curriculum earth science and contained a mean level of one…

  16. Teacher and Counsellor Perceptions of a School-Based Counselling Service in South Wales

    ERIC Educational Resources Information Center

    Hamilton-Roberts, Amy

    2012-01-01

    This small-scale study, based in a semi-rural South Wales Local Authority, sought to explore how both school-based counsellors and link-teachers perceive their school-based counselling services. The research aimed to answer three research questions: 1) what are the perceived impacts of the service? 2) what are the perceived attributes of the…

  17. Numbers Talk--Words Count: Language Policy and Adult Numeracy Education in Wales and New Zealand

    ERIC Educational Resources Information Center

    Coben, Diana; Miller-Reilly, Barbara

    2014-01-01

    In this paper we review and compare language policy in relation to adult numeracy education in Wales and New Zealand with respect to the Maori and Welsh languages in the latest stage of our international comparative study of adult numeracy education. While much has been written about the relationship between language and literacy, the relationship…

  18. Changes to Educational Policy and Management in Wales: Facing the "Cuts" and New Strategic Challenges

    ERIC Educational Resources Information Center

    Reid, Ken

    2011-01-01

    Like the rest of the United Kingdom, Wales is facing a new challenge from the implementation of the Coalition Government's cuts. The Welsh Assembly Government [WAG, renamed Welsh Government (WG), in May 2011] budget was reduced by 1.8 billion British Pounds over the next four years. WAG responded by introducing its own revised austerity budget…

  19. Profession, "Performance", and Policy: Teachers, Examinations, and the State in England and Wales, 1846-1862

    ERIC Educational Resources Information Center

    Knudsen, Andrew T.

    2016-01-01

    When historians discuss the impact of examinations on elementary education in mid-Victorian England and Wales they typically focus on the Revised Code of 1862. The Revised Code is famous for instituting a policy of "payment-by-results" for teachers in state-supported voluntary schools. "Payment-by-results" made government…

  20. The Landscape of Gifted and Talented Education in England and Wales: How Are Teachers Implementing Policy?

    ERIC Educational Resources Information Center

    Koshy, Valsa; Pinheiro-Torres, Catrin; Portman-Smith, Carole

    2012-01-01

    This paper explores the evidence relating to how primary schools are responding to the "gifted and talented" initiative in England and Wales. A questionnaire survey which invited both closed and open-ended responses was carried out with a national sample of primary schools. The survey indicated an increasing proportion of coordinators, compared…

  1. School Expenditure and School Performance: Evidence from New South Wales Schools Using a Dynamic Panel Analysis

    ERIC Educational Resources Information Center

    Pugh, G.; Mangan, J.; Blackburn, V.; Radicic, D.

    2015-01-01

    This article estimates the effects of school expenditure on school performance in government secondary schools in New South Wales, Australia over the period 2006-2010. It uses dynamic panel analysis to exploit time series data on individual schools that only recently has become available. We find a significant but small effect of expenditure on…

  2. Rhetoric or Reality? Ethnic Monitoring in the "Threshold Assessment" of Teachers in England and Wales

    ERIC Educational Resources Information Center

    Menter, Ian; Hextall, Ian; Mahony, Pat

    2003-01-01

    Following the 1998 Green Paper on teachers' work, the UK government introduced Threshold Assessment of teachers in England and Wales in 2000. Teachers who met the Threshold standards were rewarded with a pay rise and access to an upper pay spine. At the time ministers gave assurances that equal opportunities would be taken very seriously in the…

  3. School Outcomes in New South Wales and Queensland: A Regression Discontinuity Approach

    ERIC Educational Resources Information Center

    Miller, Paul W.; Voon, Derby

    2014-01-01

    This paper examines the differences in school (NAPLAN) outcomes between New South Wales and Queensland. It shows that there are pronounced differences in Year 3 NAPLAN results between these states, though these dissipate when later class years are considered. The reasons for these state effects in school outcomes are explored using an empirical…

  4. Improvements to Suicide Prevention Training for Prison Staff in England and Wales

    ERIC Educational Resources Information Center

    Hayes, Adrian J.; Shaw, Jenny J.; Lever-Green, Gillian; Parker, Dianne; Gask, Linda

    2008-01-01

    Suicide prevention training for the prison service in England and Wales has been criticized. STORM is a package emphasizing the practice and review of interactions with suicidal persons and was evaluated in a pilot study for use in prisons. Trainees completed questionnaires immediately before and after training and at 6 to 8 months follow-up.…

  5. The Individual Inventor and the Implications for Innovation and Entrepreneurship: A View of Wales

    ERIC Educational Resources Information Center

    Thomas, Brychan; Gornall, Lynne; Packham, Gary; Miller, Christopher

    2009-01-01

    This paper investigates, through quantitative and qualitative analysis, inventive activity in the modern technological setting of Wales in the 21st century. The paper reports on the barriers, motivations and drivers to inventors becoming entrepreneurs in exploiting their ideas and taking them to market, and indicates the outcomes of a pilot phase…

  6. Cost-Effectiveness Analysis of the New South Wales Adult Drug Court Program

    ERIC Educational Resources Information Center

    Shanahan, Marian; Lancsar, Emily; Haas, Marion; Lind, Bronwyn; Weatherburn, Don; Chen, Shuling

    2004-01-01

    In New South Wales, Australia, a cost-effectiveness evaluation was conducted of an adult drug court (ADC) program as an alternative to jail for criminal offenders addicted to illicit drugs. This article describes the program, the cost-effectiveness analysis, and the results. The results of this study reveal that, for the 23-month period of the…

  7. The Slow Process of Modernising Teacher Training in Music in New South Wales, 1920-1956

    ERIC Educational Resources Information Center

    Chaseling, Marilyn; Boyd, William E.

    2014-01-01

    The need for appropriately trained teachers to teach in its schools has been a priority for the Department of Education (hereafter referred to as the Department) since the beginning of public education in New South Wales in the 1850s. This paper presents an overview of the provisions made by the Department for the musical development of its…

  8. Genetic linkage between Huntington's disease and the DNA polymorphism G8 in South Wales families.

    PubMed

    Harper, P S; Youngman, S; Anderson, M A; Sarfarazi, M; Quarrell, O; Tanzi, R; Shaw, D; Wallace, P; Conneally, P M; Gusella, J F

    1985-12-01

    Analysis of the polymorphism shown by the DNA probe G8 in eight South Wales families with Huntington's disease has confirmed close genetic linkage between this marker and the disorder, the most likely genetic distance being two centimorgans (cM). The closeness of the linkage suggests that G8 may have clinical applications in genetic prediction for this condition.

  9. Counter-Geographies: The Campaign against Rationalisation of Agricultural Research Stations in New South Wales, Australia

    ERIC Educational Resources Information Center

    Gibson, Chris; Dufty, Rae; Phillips, Samantha; Smith, Heather

    2008-01-01

    This paper discusses an example of community action mounted in a rural region of New South Wales, Australia, in response to proposals by the State Government to rationalise agricultural research stations operated by the Department of Primary Industries. Informed by a Foucaultian understanding of power and the concept of governmentality,…

  10. Educational Enrolment of Students with a Disability in New South Wales and Victoria.

    ERIC Educational Resources Information Center

    Dempsey, Ian; Foreman, Phil; Jenkinson, Josephine

    2002-01-01

    This article discusses the impact of legislative and special education policy on the educational enrollment of students with a disability across Australia. Enrollment trends in New South Wales and Victoria are examined and discussed within the context of their respective special education policies, disability discrimination legislation, and…

  11. The Role of Trust in the Development of Connectivities amongst Rural Elders in England and Wales

    ERIC Educational Resources Information Center

    Curry, Nigel; Fisher, Rhiannon

    2012-01-01

    Using Simmel's notion of sociation, the way in which rural elders in England and Wales relate to, or connect with, each other and others within their community, can be seen to be conflictual as well as consensual. As a vehicle for exploiting this relationship, social capital also can be antithetic as well as convergent and an important element of…

  12. Children of the Killing Fields: Cambodian Adolescents in New South Wales. Occasional Paper No. 19.

    ERIC Educational Resources Information Center

    Boua, Chanthou

    This study investigates the settlement of Cambodian adolescents in New South Wales (Australia). It looks at their participation in education and employment, the effects the Pol Pot regime in Cambodia had on those who lived through it, and the identity problems that usually occur in young people as a result of migration. According to the 1986…

  13. 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.

  14. 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

  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. 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.

  18. Duncan Tanner Essay Prize Winner 2014. Against the 'Sacred Cow': NHS Opposition and the Fellowship for Freedom in Medicine, 1948-72.

    PubMed

    Seaton, Andrew

    2015-01-01

    This essay recovers organized opposition to the National Health Service (NHS) by considering the Fellowship for Freedom in Medicine (FFM), a conservative organization of doctors who challenged the 'Sacred Cow' of nationalized healthcare in the 1950s and 1960s. While there has been little interest in anti-NHS politics because of shortcomings in the institution's historiography, this study suggests ways a new history of the service can be written. Central to that project is taking the broader ideological and emotive quality of the NHS seriously, and appreciating the way, for all sides of the political spectrum, as well as the general public, the service has always been a contested symbol of post-war British identity. This essay argues that two NHS 'crises'--panics over costs, and disillusionment within general practice--were not merely disagreements over budgets and pay-packets but politically charged moments infused with conservative anxieties over Britain's post-war trajectory. The FFM imagined the NHS as an economically dangerous bureaucratic machine that crushed medical independence and risked pushing the country towards dictatorship. Allies within the Conservative Party, private health insurance industry, and free-market 'think-tanks' worked with the FFM to challenge defences of both the service's operation and meaning. To appreciate why the NHS remains 'the closest thing the English have to a religion', one must consider the apostates as well as the faithful.

  19. Duncan Tanner Essay Prize Winner 2014. Against the 'Sacred Cow': NHS Opposition and the Fellowship for Freedom in Medicine, 1948-72.

    PubMed

    Seaton, Andrew

    2015-01-01

    This essay recovers organized opposition to the National Health Service (NHS) by considering the Fellowship for Freedom in Medicine (FFM), a conservative organization of doctors who challenged the 'Sacred Cow' of nationalized healthcare in the 1950s and 1960s. While there has been little interest in anti-NHS politics because of shortcomings in the institution's historiography, this study suggests ways a new history of the service can be written. Central to that project is taking the broader ideological and emotive quality of the NHS seriously, and appreciating the way, for all sides of the political spectrum, as well as the general public, the service has always been a contested symbol of post-war British identity. This essay argues that two NHS 'crises'--panics over costs, and disillusionment within general practice--were not merely disagreements over budgets and pay-packets but politically charged moments infused with conservative anxieties over Britain's post-war trajectory. The FFM imagined the NHS as an economically dangerous bureaucratic machine that crushed medical independence and risked pushing the country towards dictatorship. Allies within the Conservative Party, private health insurance industry, and free-market 'think-tanks' worked with the FFM to challenge defences of both the service's operation and meaning. To appreciate why the NHS remains 'the closest thing the English have to a religion', one must consider the apostates as well as the faithful. PMID:26502665

  20. Electronic structures of Stone-Wales defective chiral (6,2) silicon carbide nanotubes: First-principles calculations

    NASA Astrophysics Data System (ADS)

    Song, Jiuxu; Liu, Hongxia; Guo, Yingna; Zhu, Kairan

    2015-11-01

    By using first-principle calculations based on density functional theory, the geometries and electronic structures of the Stone-Wales defective chiral (6,2) silicon carbide nanotubes (SiCNTs) are investigated. Independent on their orientations, Stone-Wales defects form two asymmetric pentagons and heptagons coupled in pairs (5-7-7-5) and a defect energy level in the band gap of the SiCNT. By applying transverse electric fields, significant differences in the electronic structures of the defective (6,2) SiCNTs are achieved, which may provide the foundation of identifying the orientation of Stone-Wales defects in chiral SiCNTs.

  1. Health care reform in Portugal: an evaluation of the NHS experience.

    PubMed

    Oliveira, Mónica Duarte; Pinto, Carlos Gouveia

    2005-09-01

    Since 1979, the Portuguese health care system has been based on a National Health Service structure that is expected to promote equity, efficiency, quality, accountability and the devolution of power. In this article, we analyse the content and impact of policies designed to reform the system between 1979 and 2002. This article differs from previous studies in that it uses a stage-based framework to evaluate the policy-making process and the impact of health care reform throughout different political cycles. We show that the NHS model has never been fully implemented and that many policies have diverted the system from its original objectives. Different governments have endorsed a progressive split between financing and provision and the institution of 'new public management' rules in public providers. We conclude that most policies put forward by Social Democratic governments have aimed at influencing demand, while Socialist governments have targeted the supply side. These policies have led to increases in health expenditure that have been comparatively more cost-shared by the State under Socialist governments. We show some overriding trends, namely as follows: despite huge improvements in health outcomes, the system is nonetheless lasting to meet its goals, particularly in terms of the equity of access and utilisation; accountability problems, inadequacies in the use of operational reforming tools (such as resource allocation mechanisms) and a lack of mechanisms to promote efficient behaviour, are all associated with cost containment problems. Structural reforms have been undertaken since 2002 and these have offered some potential for improving accountability and efficiency. Nonetheless, the success of these reforms calls for certain conditions that do not seem to have been fulfilled.

  2. The SF36 health survey questionnaire: an outcome measure suitable for routine use within the NHS?

    PubMed Central

    Garratt, A M; Ruta, D A; Abdalla, M I; Buckingham, J K; Russell, I T

    1993-01-01

    OBJECTIVE--To assess the validity, reliability, and acceptability of the short form 36 (SF 36) health survey questionnaire (a shortened version of a battery of 149 health status questions) as a measure of patient outcome in a broad sample of patients suffering from four common clinical conditions. DESIGN--Postal questionnaire, followed up by two reminders at two week intervals. SETTING--Clinics and four training practices in north east Scotland. SUBJECTS--Over 1700 patients aged 16-86 with one of four conditions--low back pain, menorrhagia, suspected peptic ulcer, or varicose veins--and a comparison sample of 900 members of the general population. MAIN OUTCOME MEASURES--The eight scales within the SF36 health profile. RESULTS--The response rate exceeded 75% in the patient population (1310 respondents). The SF36 satisfied rigorous psychometric criteria for validity and internal consistency. Clinical validity was shown by the distinctive profiles generated for each condition, each of which differed from that in the general population in a predictable manner. Furthermore, SF36 scores were lower in referred patients than in patients not referred and were closely related to general practitioners' perceptions of severity. CONCLUSIONS--These results provide support for the SF36 as a potential measure of patient outcome within the NHS. The SF36 seems acceptable to patients, internally consistent, and a valid measure of the health status of a wide range of patients. Before it can be used in the new health service, however, its sensitivity to changes in health status over time must also be tested. PMID:8518640

  3. Exploring experiences of cancer care in Wales: a thematic analysis of free-text responses to the 2013 Wales Cancer Patient Experience Survey (WCPES)

    PubMed Central

    Bracher, Michael; Corner, Dame Jessica; Wagland, Richard

    2016-01-01

    Objectives To provide the first systematic analysis of a national (Wales) sample of free-text comments from patients with cancer, to determine emerging themes and insights regarding experiences of cancer care in Wales. Design Thematic analysis of free-text data from a population-based survey. Setting and participants Adult patients with a confirmed cancer diagnosis treated within a 3-month period during 2012 in the 7 health boards and 1 trust providing cancer care in Wales. Main outcome measures Free-text categorised by theme, coded as positive or negative, with ratios. Overarching themes are identified incorporating comment categories. Methods 4672 respondents (of n=7352 survey respondents) provided free-text comments. Data were coded using a multistage approach: (1) coding of comments into general categories (eg, nursing, surgery, etc), (2) coding of subcategories within main categories (eg, nursing care, nursing communication, etc), (3) cross-sectional analysis to identify themes cutting across categories, (4) mapping of categories/subcategories to corresponding closed questions in the Wales Cancer Patient Experience Survey (WCPES) data for comparison. Results Most free-text respondents (82%, n 3818) provided positive comments about their cancer care, with 49% (n=2313) giving a negative comment (ratio 0.6:1, negative-to-positive). 3172 respondents (67.9% of free-text respondents) provided a comment mapping to 1 of 4 overarching themes: communication (n=1673, 35.8% free-text respondents, a ratio of 1.0:1); waiting during the treatment and/or post-treatment phase (n=923, 19.8%, ratio 1.5:1); staffing and resource levels (n=671, 14.4% ratio 5.3:1); speed and quality of diagnostic care (n=374, 8.0%, ratio 1.5:1). Within these areas, constituent subthemes are discussed. Conclusions This study presents specific areas of concern for patients with cancer, and reveals a number of themes present across the cancer journey. While the majority of comments were positive

  4. Use of a service evaluation and lean thinking transformation to redesign an NHS 111 refer to community Pharmacy for Emergency Repeat Medication Supply Service (PERMSS)

    PubMed Central

    Nazar, Hamde; Nazar, Zachariah; Simpson, Jill; Yeung, Andre; Whittlesea, Cate

    2016-01-01

    Objectives To demonstrate the contribution of community pharmacy from NHS 111 referrals out of hours (OOH) for emergency supply repeat medication requests via presentation of service activity, community pharmacist feedback and lean thinking transformation. Design Descriptive service evaluation using routine service activity data over the pilot period; survey of community pharmacists, and service redesign through lean thinking transformation. Setting North East of England NHS 111 provider and accredited community pharmacies across the North East of England. Participants Patients calling the North East of England NHS 111 provider during OOH with emergency repeat medication supply requests. Interventions NHS 111 referral to community pharmacies for assessment and if appropriate, supply of emergency repeat medication. Main outcome measures Number of emergency repeat medication supply referrals, completion rates, reasons for rejections, time of request, reason for access, medication(s), pharmaceutical advice and services provided. Secondary outcomes were community pharmacist feedback and lean thinking transformation of the patient pathway. Results NHS 111 referred 1468 patients to 114 community pharmacies (15/12/2014–7/4/2015). Most patients presented on Saturdays, with increased activity over national holidays. Community pharmacists completed 951 (64.8%) referrals providing 2297 medications; 412 were high risk. The most common reason for rejecting referrals was no medication in stock. Community pharmacists were positive about the provision of this service. The lean thinking transformation reduced the number of non-added value steps, waits and bottlenecks in the patient pathway. Conclusions NHS 111 can redirect callers OOH from urgent and emergency care services to community pharmacy for management of emergency repeat medication supply. Existing IT and community pharmacy regulations allowed patients to receive a medication supply and pharmaceutical advice. Community

  5. Crohn's disease in Wales, 1967-1976; an epidemiological survey based on hospital admissions.

    PubMed Central

    Mayberry, J. F.; Rhodes, J.; Newcombe, R. G.

    1980-01-01

    One thousand and ninety-eight patients from Wales were treated in hospital for Crohn's disease between 1967 and 1976, which gave an overall 'period prevalence' for the disease of 40 cases/10(5) of the total population. The data were analysed for each of the 8 counties and for rural as well as urban populations of different sizes. The disease was significantly more common in the urban counties of Gwent and the 3 parts of Glamorgan compared with the remainder of Wales. The highest prevalence was in South Glamorgan (54 cases/10(5)) and the lowest in Dyfed (30/10(5)). There was a relatively small but highly significant difference in the prevalence for urban populations larger than 10 000 (47/10(5)) compared with smaller communities which were chiefly rural (34/10(5)). PMID:6969396

  6. Lead in livers and gizzards of waterfowl shot in New South Wales, Australia.

    PubMed

    Kingsford, R T; Kacprzak, J L; Ziaziaris, J

    1994-01-01

    Few data exist on lead in waterfowl within New South Wales, Australia, despite global concern about lead poisoning in this group of birds. The gizzards and livers from 716 ducks (seven species) were collected from six sites within New South Wales during the 1992 duck shooting season. Six birds had ingested shot in their gizzards (<1%); four waterfowl had high concentrations of lead in their livers (>6 mg kg(-1) wet-weight (ww)) and a further three had elevated concentrations of lead in their livers (>2 mg kg(-1) ww). Mean lead concentrations in the livers of birds were low (range 0.11-0.28 mg kg(-1) ww; among six sites). Lead concentrations in livers of the herbivorous maned duck Chenonetta jubata were generally lower than in other omnivorous or carnivorous species. Low lead concentrations in tissues reflected low hunting pressure at all sites (0-0.27 hunters ha(-1) year(-1)).

  7. Timing effects on first marriage: twentieth-century experience in England and Wales and the USA.

    PubMed

    Schoen, Robert; Canudas-Romo, Vladimir

    2005-07-01

    Recent substantial declines in first marriage in Western countries have been accompanied by increases in the average age at first marriage. Since the period proportion ever marrying, PEM, is sensitive to cohort tempo changes, the recent fall in the PEM may simply reflect cohort delays in marriage. The importance of timing factors is examined in the light of twentieth-century experience of first marriage in England and Wales and the USA. Using a variant of the Timing Index developed in research on fertility, we measure cohort timing effects for marriage and calculate an adjusted PEM. After examining twentieth-century trends in nuptiality for men and women, we find substantial tempo effects on the period PEM. Adjusted PEM values show a real decline in marriage for cohorts, but that decline is considerably smaller than the one shown by the unadjusted figures. This is especially true for England and Wales, where the decline in marriage was much greater.

  8. The dark figure of infanticide in England and Wales: complexities of diagnosis.

    PubMed

    Brookman, Fiona; Nolan, Jane

    2006-07-01

    Infants aged younger than 12 months have the highest homicide victimization rate of any single age group in England and Wales. In addition, there are good grounds for believing that the official homicide statistics for this particular age group are an underestimate and subject to distortion. At the same time there is evidence mounting in the United Kingdom that some parents have been incorrectly convicted of infanticide. This article first explores all recorded cases of infanticide in England and Wales for the period 1995-2002 (298 cases in total). Characteristics of the offenders, victims, offense, and court outcomes are examined. The second part of the article takes a critical gaze at the complexities involved in distinguishing infanticide from sudden infant death syndrome (SIDS) and other sudden unexplained deaths in infancy (SUDI). The article ends by considering in what ways infant deaths might be more effectively investigated.

  9. Fitness to stand trial, human rights and possibilities from England and Wales.

    PubMed

    Stewart, Jeanette; Woodward, Mary; Hepner, Flana

    2015-06-01

    The capacity of individuals with disability, including cognitive or mental health impairments, to access justice on an equal basis has been considered recently in several Australian jurisdictions. Impairments can render individuals vulnerable in the legal system, affecting their reliability as a witness or their fitness to be tried, especially when limited support is available to help these individuals meet the test and criteria for fitness to stand trial. This article considers the situation in Australia in light of human rights perspectives and compares it with the England and Wales approach where special support measures have been introduced to help individuals access justice. The article recommends that better support measures be introduced in Australia that would be consistent with a human rights framework calling for support to enable individuals with disability to access justice. In particular, the introduction of intermediaries, as used in England and Wales, would go some way towards helping vulnerable individuals to access justice.

  10. Leprosy in England and Wales 1953–2012: surveillance and challenges in low incidence countries

    PubMed Central

    Fulton, Nicholas; Anderson, Laura F; Watson, John M; Abubakar, Ibrahim

    2016-01-01

    Objective To review all notified cases of leprosy in England and Wales between 1953 and 2012. Design National surveillance study of all reported cases. Setting England and Wales. Outcome Number and characteristics of reported cases. Results During this period, a total of 1449 leprosy cases were notified. The incidence fell from 356 new cases notified between 1953 and 1962 to 139 new cases between 2003 and 2012. Where data were available, leprosy was more common in men, 15–45 year olds and those from the Indian subcontinent. There was considerable undernotification in 2001–2012. Conclusions The high level of under-reporting indicates a need for improved surveillance in the UK. Public Health England, in collaboration with the UK Panel of Leprosy opinion, has revised the UK Memorandum on Leprosy in order to provide updated guidance on diagnostic procedures, treatment, case management, contact tracing and notification. PMID:27142858

  11. The cost-effectiveness of pentavalent rotavirus vaccination in England and Wales.

    PubMed

    Atkins, Katherine E; Shim, Eunha; Carroll, Stuart; Quilici, Sibilia; Galvani, Alison P

    2012-11-01

    Rotavirus vaccines have shown great potential for reducing the disease burden of the major cause of severe childhood gastroenteritis. The decision regarding whether rotavirus vaccination will be introduced into the national immunization program is currently being reviewed. The conclusions of previous evaluations of rotavirus vaccination cost-effectiveness contradict each other. This is the first analysis to incorporate a dynamic transmission model to assess the cost-effectiveness of rotavirus vaccination in England and Wales. Most previously reported models do not include herd protection, and thus may underestimate the cost-effectiveness of vaccination against rotavirus. We incorporate a dynamic model of rotavirus transmission in England and Wales into a cost-effectiveness analysis to determine the probability that the pentavalent rotavirus vaccination will be cost-effective over a range of full-course vaccine prices. This novel approach allows the cost-effectiveness analysis to include a feasible level of herd protection provided by a vaccination program. Our base case model predicts that pentavalent rotavirus vaccination is likely to be cost-effective in England and Wales at £ 60 per course. In some scenarios the vaccination is predicted to be not only cost-effective but also cost-saving. These savings could be generated within ten years after vaccine introduction. Our budget impact analysis demonstrates that for the realistic base case scenarios, 58-96% of the cost outlay for vaccination will be recouped within the first four years of a program. Our results indicate that rotavirus vaccination would be beneficial to public health and could be economically sound. Since rotavirus vaccination is not presently on the immunization schedule for England and Wales but is currently under review, this study can inform policymakers of the cost-effectiveness and budget impact of implementing a mass rotavirus vaccine strategy.

  12. International trends in health science librarianship Part 9: the UK - Scotland and Wales.

    PubMed

    Wales, Ann; Bruch, Sarah; Foster, Wendy; Gorman, Meg; Peters, Janet

    2014-03-01

    This is the 9th in a series of articles exploring international trends in health science librarianship. The previous article in this series looked at Northern Ireland and the Republic of Ireland. In this issue the focus is Scotland and Wales. There will be three or four more articles this year tracking trends in the Far East, Africa, South Asia and the Middle East. JM.

  13. Anthropogenic greenhouse gas contribution to flood risk in England and Wales in autumn 2000.

    PubMed

    Pall, Pardeep; Aina, Tolu; Stone, Dáithí A; Stott, Peter A; Nozawa, Toru; Hilberts, Arno G J; Lohmann, Dag; Allen, Myles R

    2011-02-17

    Interest in attributing the risk of damaging weather-related events to anthropogenic climate change is increasing. Yet climate models used to study the attribution problem typically do not resolve the weather systems associated with damaging events such as the UK floods of October and November 2000. Occurring during the wettest autumn in England and Wales since records began in 1766, these floods damaged nearly 10,000 properties across that region, disrupted services severely, and caused insured losses estimated at £1.3 billion (refs 5, 6). Although the flooding was deemed a 'wake-up call' to the impacts of climate change at the time, such claims are typically supported only by general thermodynamic arguments that suggest increased extreme precipitation under global warming, but fail to account fully for the complex hydrometeorology associated with flooding. Here we present a multi-step, physically based 'probabilistic event attribution' framework showing that it is very likely that global anthropogenic greenhouse gas emissions substantially increased the risk of flood occurrence in England and Wales in autumn 2000. Using publicly volunteered distributed computing, we generate several thousand seasonal-forecast-resolution climate model simulations of autumn 2000 weather, both under realistic conditions, and under conditions as they might have been had these greenhouse gas emissions and the resulting large-scale warming never occurred. Results are fed into a precipitation-runoff model that is used to simulate severe daily river runoff events in England and Wales (proxy indicators of flood events). The precise magnitude of the anthropogenic contribution remains uncertain, but in nine out of ten cases our model results indicate that twentieth-century anthropogenic greenhouse gas emissions increased the risk of floods occurring in England and Wales in autumn 2000 by more than 20%, and in two out of three cases by more than 90%.

  14. Balanced scorecard investment appraisal in the water industry of England and Wales.

    PubMed

    Tebbutt, P J; Gochin, R J; Lester, J N

    2003-07-01

    Previous work has shown that while most conventional investment appraisal techniques appear ill-suited for use in the water industry of England and Wales, the Balanced Scorecard (BSC) offers considerable potential as an investment decision making tool. This study accounts for much of the criticism of the BSC technique, proposing methodological changes to overcome these difficulties. A more comprehensive treatment of the modified methodology, illustrated by BSC development and application flowcharts, demonstrates how this technique might operate in practice. PMID:12926403

  15. A survey of local health promotion initiatives for older people in Wales

    PubMed Central

    Hendry, Maggie; Williams, Nefyn H; Wilkinson, Clare

    2008-01-01

    Background As the demographic profile of the UK changes, policy makers and practitioners have to respond to health challenges presented by a progressively ageing population. The health promotion plan for older people, aged over 50 years, in Wales included eight key areas: physical activity, healthy eating, home safety and warmth, emotional health, health protection, smoking, alcohol and sexual health. The aim of this study was to describe the extent, content and regional variation of existing health promotion initiatives for older people in Wales, provided by statutory, voluntary and private sector agencies. Method A questionnaire was sent to senior health promotion specialists employed in the 22 local authority areas in Wales to ascertain details of all projects promoting health and wellbeing in the eight key areas where the priority population was aged over 50, or the majority of users were older people. Additional information was sought from project leads and websites. Results Eighteen questionnaires were returned; not all were fully completed. Four areas did not return a questionnaire. Additional information was obtained from internet searches but this mainly concerned national initiatives rather than local projects. In all, 120 projects were included, 11 were throughout Wales. Best provision was for physical activity, with 3 national and 42 local initiatives, but local provision was patchy. Healthy eating, and home safety and warmth had far fewer initiatives, as did health protection, which comprised two national immunisation campaigns. Smoking and alcohol misuse were poorly provided for, and there was no provision for older people's sexual health. Evaluation arrangements were poorly described. Half of those who responded identified unmet training needs. Conclusion The reasons for patchy provision of services were not clear. Increased efforts to improve the coverage of interventions known to be effective should be made. Rigorous evaluation of projects is

  16. Linking NHS data for pediatric pharmacovigilance: Results of a Delphi survey

    PubMed Central

    Hopf, Y.M.; Francis, J.; Helms, P.J.; Haughney, J.; Bond, C.

    2016-01-01

    Background Adverse drug events are a major cause of patient safety incidents. Current systems of pharmacovigilance under-report adverse drug reactions (ADRs), especially in children, leading to delays in their identification. This is of particular concern, as children especially have an increased vulnerability to ADRs. Objectives The objective was to seek consensus among healthcare professionals (HCPs) about barriers and facilitators to the linkage of routinely collected health data for pediatric pharmacovigilance in Scotland. Methods A Delphi survey was conducted with a random sample of HCPs including nurses, pharmacists and doctors, working in primary or secondary care, in Scotland. Participants were identified from sampling frames of the target professionals such as an NHS workforce list for general practitioners and recruited by postal invitation. A total of 819 HCPs were invited to take part. Those agreeing to participate were given the option of completing the questionnaires online or as hard copy. Reminders were sent twice at a fortnightly interval. Questions content included description of professional role as well as testing for the willingness to support the proposed project and was informed by the Theoretical Domains Framework of Behavior Change (TDF) and earlier qualitative work. Three Delphi rounds were administered, including a first round for item generation. Results 121 of those invited agreed to take part (15%). The first round of the Delphi study included 21 open questions and generated over a 1000 individual statements from 61 participants that returned the questionnaires (50.4%). These were rationalized to 149 items for the second round in which participants rated their views on the importance (or not) of each item on a 9-point Likert scale (strongly disagree – strongly agree). After the third round, there was consensus on items that focused on professional standards, and practical requirements, overall there was support for data linkage and a

  17. Making change last: applying the NHS institute for innovation and improvement sustainability model to healthcare improvement.

    PubMed

    Doyle, Cathal; Howe, Cathy; Woodcock, Thomas; Myron, Rowan; Phekoo, Karen; McNicholas, Chris; Saffer, Jessica; Bell, Derek

    2013-10-26

    The implementation of evidence-based treatments to deliver high-quality care is essential to meet the healthcare demands of aging populations. However, the sustainable application of recommended practice is difficult to achieve and variable outcomes well recognised. The NHS Institute for Innovation and Improvement Sustainability Model (SM) was designed to help healthcare teams recognise determinants of sustainability and take action to embed new practice in routine care. This article describes a formative evaluation of the application of the SM by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Northwest London (CLAHRC NWL). Data from project teams' responses to the SM and formal reviews was used to assess acceptability of the SM and the extent to which it prompted teams to take action. Projects were classified as 'engaged,' 'partially engaged' and 'non-engaged.' Quarterly survey feedback data was used to explore reasons for variation in engagement. Score patterns were compared against formal review data and a 'diversity of opinion' measure was derived to assess response variance over time. Of the 19 teams, six were categorized as 'engaged,' six 'partially engaged,' and seven as 'non-engaged.' Twelve teams found the model acceptable to some extent. Diversity of opinion reduced over time. A minority of teams used the SM consistently to take action to promote sustainability but for the majority SM use was sporadic. Feedback from some team members indicates difficulty in understanding and applying the model and negative views regarding its usefulness. The SM is an important attempt to enable teams to systematically consider determinants of sustainability, provide timely data to assess progress, and prompt action to create conditions for sustained practice. Tools such as these need to be tested in healthcare settings to assess strengths and weaknesses and findings disseminated to aid development. This

  18. 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

  19. Human trafficking and health: a cross-sectional survey of NHS professionals’ contact with victims of human trafficking

    PubMed Central

    Ross, Claire; Dimitrova, Stoyanka; Howard, Louise M; Dewey, Michael; Zimmerman, Cathy; Oram, Siân

    2015-01-01

    Objectives (1) To estimate the proportion of National Health Service (NHS) professionals who have come into contact with trafficked people and (2) to measure NHS professionals’ knowledge and confidence to respond to human trafficking. Design A cross-sectional survey. Setting Face-to-face mandatory child protection and/or vulnerable adults training sessions at 10 secondary healthcare provider organisations in England, and meetings of the UK College of Emergency Medicine. Participants 782/892 (84.4%) NHS professionals participated, including from emergency medicine, maternity, mental health, paediatrics and other clinical disciplines. Measures Self-completed questionnaire developed by an expert panel. Questionnaire asks about prior training and contact with potential victims of trafficking, perceived and actual human trafficking knowledge, confidence in responding to human trafficking, and interest in future human trafficking training. Results 13% participants reported previous contact with a patient they knew or suspected of having been trafficked; among maternity services professionals this was 20.4%. However, 86.8% (n=679) reported lacking knowledge of what questions to ask to identify potential victims and 78.3% (n=613) reported that they had insufficient training to assist trafficked people. 71% (n=556), 67.5% (n=528) and 53.4% (n=418) lacked confidence in making appropriate referrals for men, women and children, respectively, who had been trafficked. 95.3% (n=746) of respondents were unaware of the scale of human trafficking in the UK, and 76.5% (n=598) were unaware that calling the police could put patients in more danger. Psychometric analysis showed that subscales measuring perceived knowledge, actual knowledge and confidence to respond to human trafficking demonstrated good internal consistency (Cronbach's αs 0.93, 0.63 and 0.64, respectively) and internal correlations. Conclusions NHS professionals working in secondary care are in contact with potential

  20. Epidemiology and Pathogenesis of C. difficile and MRSA in the Light of Current NHS Control Policies: A Policy review.

    PubMed

    Agha, Maliha

    2012-01-01

    Healthcare associated infections (HCAIs) cause significant morbidity and mortality, and are estimated to cost the United Kingdom National Health Service £1 billion annually. The current health care infection rates suggest that the level of performance to avoid HCAIs is not maintained consistently. Increasing screening, improving local accountability and performance management, careful use of antibiotics in the management of emergency patients, health economy wide approaches, and improved hand washing will be effective in lowering the rate of HCAIs. This paper reviews current NHS Control Policies in place for Methicillin Resistant Staphylococcus Aureus (MRSA) and C. difficile.

  1. 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.

  2. Short rotation willow coppice in Wales: High production under adverse environmental conditions?

    SciTech Connect

    Slater, F.M.; Hodson, R.W.; Randerson, P.F.

    1995-11-01

    The production of short rotation willow coppice in central Wales was once regarded as a vain hope rather than a distinct possibility. Research at the University of Wales, Cardiff, Field Station at Llysdinam in mid-Wales over the last four years has proven that it is possible to produce a commercially viable crop on very poor upland soils and at an altitude of almost 300m provided that lime and inorganic fertilizers are added. Because of the national need to find new routes for the disposal of sewage sludge, its addition to short rotation coppice serves the dual purpose of disposal and nutrient addition. Over the first two years of the sludging experiment, it was found that the addition of 300 m{sup 3}ha{sup -1} of digested sewage sludge significantly increased crop weight, at least in the first year. Unfortunately, the crop yields did not reach those obtained using inorganic fertilizers at the same site but it is suggested that a repeated application regime might improve overall crop yield.

  3. Evaluating Long-term Outcomes of NHS Stop Smoking Services (ELONS): a prospective cohort study.

    PubMed Central

    Dobbie, Fiona; Hiscock, Rosemary; Leonardi-Bee, Jo; Murray, Susan; Shahab, Lion; Aveyard, Paul; Coleman, Tim; McEwen, Andy; McRobbie, Hayden; Purves, Richard; Bauld, Linda

    2015-01-01

    BACKGROUND NHS Stop Smoking Services (SSSs) provide free at the point of use treatment for smokers who would like to stop. Since their inception in 1999 they have evolved to offer a variety of support options. Given the changes that have happened in the provision of services and the ongoing need for evidence on effectiveness, the Evaluating Long-term Outcomes for NHS Stop Smoking Services (ELONS) study was commissioned. OBJECTIVES The main aim of the study was to explore the factors that determine longer-term abstinence from smoking following intervention by SSSs. There were also a number of additional objectives. DESIGN The ELONS study was an observational study with two main stages: secondary analysis of routine data collected by SSSs and a prospective cohort study of service clients. The prospective study had additional elements on client satisfaction, well-being and longer-term nicotine replacement therapy (NRT) use. SETTING The setting for the study was SSSs in England. For the secondary analysis, routine data from 49 services were obtained. For the prospective study and its added elements, nine services were involved. The target population was clients of these services. PARTICIPANTS There were 202,804 cases included in secondary analysis and 3075 in the prospective study. INTERVENTIONS A combination of behavioural support and stop smoking medication delivered by SSS practitioners. MAIN OUTCOME MEASURES Abstinence from smoking at 4 and 52 weeks after setting a quit date, validated by a carbon monoxide (CO) breath test. RESULTS Just over 4 in 10 smokers (41%) recruited to the prospective study were biochemically validated as abstinent from smoking at 4 weeks (which was broadly comparable with findings from the secondary analysis of routine service data, where self-reported 4-week quit rates were 48%, falling to 34% when biochemical validation had occurred). At the 1-year follow-up, 8% of prospective study clients were CO validated as abstinent from smoking

  4. Updating the Phase 1 habitat map of Wales, UK, using satellite sensor data

    NASA Astrophysics Data System (ADS)

    Lucas, Richard; Medcalf, Katie; Brown, Alan; Bunting, Peter; Breyer, Johanna; Clewley, Dan; Keyworth, Steve; Blackmore, Philippa

    The Phase 1 Survey is the most comprehensive and widely used national level map of semi-natural habitats in Wales. However, the survey was based largely on field survey and was conducted over several decades, before being completed in 1997. Given that resources for a repeat survey were limited, this study has used an object-orientated rule-based classification implemented within eCognition of multi-temporal satellite sensor data acquired between 2003 and 2006 to map semi-natural habitats and agricultural land across Wales, thereby allowing a progressive update of the Phase 1 Survey. The classification of objects to Phase 1 habitat classes was undertaken in two steps; firstly the landscape of Wales was divided into objects using orthorectified SPOT-5 High Resolution Geometric (HRG) reflectance data (10 m spatial resolution) and Land Parcel Information System (LPIS) boundaries. A rule-base was then developed to progressively discriminate and map the distribution of 105 sub-habitats across Wales based on time-series of SPOT HRG, Terra-1 Advanced Spaceborne Thermal Emission and Reflection Radiometer (ASTER) and Indian Remote Sensing Satellite (IRS) LISS-3 data, derived datasets (e.g., vegetation indices, fractional images) and ancillary information (e.g., topography). The rules coupled knowledge of ecology and the information content of these remote sensing data using a combination of thresholds, Boolean operations and fuzzy membership functions. A second rule-base was then developed to translate the more detailed sub-habitat classification to Phase 1 habitat classes. Indicative accuracies of the revised Phase 1 mapping, based on comparisons with the later Phase 2 survey (for selected habitats), were >80% overall and typically between 70% and 90% for many classes. Through this exercise, Wales has become the first country in Europe to produce a national map of habitats (as opposed to land cover) through object-orientated classification of satellite sensor data

  5. Climatic sensitivity of river temperature regimes within England and Wales (Invited)

    NASA Astrophysics Data System (ADS)

    Hannah, D. M.; Garner, G.; Sadler, J. P.; Orr, H.

    2013-12-01

    Water temperature is often referred to as the ';master water quality parameter' due to its critical importance for physical, chemical, and biological processes in rivers and streams. To better manage land and water resources for ecosystem and societal benefit, it is essential to improve knowledge of drivers of stream temperature dynamics across multiple scales. Most river temperature studies are conducted at the (sub-)basin scale. Hence, there is a paucity of wider perspectives on factors determining space-time variation: (1) to identify of the most sensitive hydrological regions/ basins to changing climate, and (2) to inform setting of thermal standards and development of assessment tools. To address these knowledge gaps, this observational study presents (for the first time) a quantitative assessment of spatial patterns, inter-annual variability and climatic sensitivity of the shape (form) and magnitude (size) of annual river temperature regimes across England and Wales. Classification of long-term average (1989-2006) annual river (air) temperature regime dynamics at 88 (39) temperature stations within England and Wales identifies spatially differentiable temperature regions. Emergent river temperature regions are used to structure detailed hydroclimatological analyses of a subset of 39 paired river and air temperature stations. The form and stability of air and water temperature regimes is classified for individual station-years; and a sensitivity index (SI, based on conditional probability) is used to quantify the strength of associations between water-air temperature regimes. Selected river basin properties are also employed in analyses to infer modification of air-river temperature links by catchment hydrological processes. The nature and strength of river and air temperature regime associations differ between regions across England and Wales. Physically meaningful catchment processes, namely groundwater contributions to river flow and water exposure time to

  6. Health information technology and sociotechnical systems: a progress report on recent developments within the UK National Health Service (NHS).

    PubMed

    Waterson, Patrick

    2014-03-01

    This paper summarises some of the research that Ken Eason and colleagues at Loughborough University have carried out in the last few years on the introduction of Health Information Technologies (HIT) within the UK National Health Service (NHS). In particular, the paper focuses on three examples which illustrate aspects of the introduction of HIT within the NHS and the role played by the UK National Programme for Information Technology (NPfIT). The studies focus on stages of planning and preparation, implementation and use, adaptation and evolution of HIT (e.g., electronic patient records, virtual wards) within primary, secondary and community care settings. Our findings point to a number of common themes which characterise the use of these systems. These include tensions between national and local strategies for implementing HIT and poor fit between healthcare work systems and the design of HIT. The findings are discussed in the light of other large-scale, national attempts to introduce similar technologies, as well as drawing out a set of wider lessons learnt from the NPfIT programme based on Ken Eason's earlier work and other research on the implementation of large-scale HIT.

  7. The index of orthognathic functional treatment need accurately prioritises those patients already selected for orthognathic surgery within the NHS.

    PubMed

    Shah, Rupal; Breeze, John; Chand, Mohit; Stockton, Peter

    2016-06-01

    The index of orthognathic functional treatment need (IOFTN) is a newly-proposed system to help to prioritise patients for orthognathic treatment. The five categories are similar to those used in orthodontics, but include additional parameters such as sleep apnoea and facial asymmetry. The aim of this audit was to validate the index and find out the potential future implications, should such a system ever be adopted by commissioners. We calculated the IOFTN category of 100 consecutive patients who had orthognathic surgery between 2010-14 using clinical notes, photographs, study models, and radiographs, and determined the number in categories 4 or 5, analogous to the current indications for orthodontic treatment within the NHS. Sufficient clinical information was available to categorise 59/100 patients, and 56 of the 59 (95%) were in either category 4 or 5. All three of the remaining patients (in categories 1-3) who were operated on were treated because of the anticipated favourable impact on their quality of life. The IOFTN has been proposed for use in future commissioning of orthognathic services within the NHS, and this study has confirmed its efficacy in prioritising treatment accurately, with 95% of patients being in categories 4 or 5. We recommend that the orthognathic treatment index be adapted to include additional psychosocial assessment so that patients who fall into the lower functional categories are not automatically excluded from this potentially life-changing treatment.

  8. NHS Health Checks in a primary care dental setting - an opportunity for the profession to maximise uptake for public health partners?

    PubMed

    McGrady, M G; Pickford, J; Hawthorn, E; Waterall, J; Bridgman, C

    2015-08-14

    This opinion piece considers an opportunity for primary dental care practitioners to work in partnership with public health teams to maximise the uptake of the NHS Health Check. Public Health England and Local Authority partners remain committed to offering the NHS Health Check to those aged 40-74 years old. The programme previously explored alternative points of delivery - such as community pharmacists. This piece discusses and reflects on the efforts within Manchester to use skill mix in primary dental care services and widen access to target individuals eligible for an NHS Health Check. The pilot schemes in Manchester illustrated the willingness and enthusiasm for primary care dentists to embrace change and work alongside new partners to deliver patient benefit beyond the provision of dental care. However, substantial barriers to implementation prevented the desired level of progress.

  9. Thermal comfort and lactation yields of dairy cows grazed on farms in a pasture-based feed system in eastern New South Wales, Australia

    NASA Astrophysics Data System (ADS)

    Dragovich, D.

    1981-06-01

    A temperature-humidity index (THI) was used to associate varying degrees of “thermal comfort” for livestock with milk yields from dairy herds in eastern New South Wales. A pasture-based feed system was used on farms in the various environments occurring between 28°S and 37°S Lat. Low dairy cow productivity was registered in high-stress (high THI) areas, where the indirect effects of climate on pasture quality and availability compounded the direct stress on livestock; districts recording high lactation yields were located in low-stress areas, as anticipated by the biometeorological index. Fluctuations in lactation yields at THI values between the high and low stress areas were explained in terms of rainfall and temperature effects on pasture species and pasture growth patterns.

  10. The role of the nurse lecturer in the supervision of students' essays, projects and assignments: results of an all Wales questionnaire survey.

    PubMed

    Mansell, Ian; Bennett, Glynis; Torrance, Colin; Fairbairn, Gavin

    2002-10-01

    This study explores the role of the lecturer in nursing and midwifery education in the supervision of students' essays, projects and assignments. Three methods were used within the study; semi-structured interviews, questionnaires and focus groups. The results from the semi-structured interviews were used to develop a questionnaire which was distributed to the population of lecturers in nursing and midwifery education (n=285) within Wales. This article reports some of the key findings of the questionnaire survey. Lecturers report a directive style of supervision with a considerable amount of time being invested in the supervision process. The production of guidelines for good supervision practice is recommended as a way of providing consistent and fair supervision for students.

  11. The role of the nurse lecturer in the supervision of students' essays, projects and assignments: results of an all Wales questionnaire survey.

    PubMed

    Mansell, Ian; Bennett, Glynis; Torrance, Colin; Fairbairn, Gavin

    2002-10-01

    This study explores the role of the lecturer in nursing and midwifery education in the supervision of students' essays, projects and assignments. Three methods were used within the study; semi-structured interviews, questionnaires and focus groups. The results from the semi-structured interviews were used to develop a questionnaire which was distributed to the population of lecturers in nursing and midwifery education (n=285) within Wales. This article reports some of the key findings of the questionnaire survey. Lecturers report a directive style of supervision with a considerable amount of time being invested in the supervision process. The production of guidelines for good supervision practice is recommended as a way of providing consistent and fair supervision for students. PMID:12384031

  12. Impact of managed clinical networks on NHS specialist neonatal services in England: population based study

    PubMed Central

    Gale, C; Santhakumaran, S; Nagarajan, S; Statnikov, Y

    2012-01-01

    Objective To assess the impact of reorganisation of neonatal specialist care services in England after a UK Department of Health report in 2003. Design A population-wide observational comparison of outcomes over two epochs, before and after the establishment of managed clinical neonatal networks. Setting Epoch one: 294 maternity and neonatal units in England, Wales, and Northern Ireland, 1 September 1998 to 31 August 2000, as reported by the Confidential Enquiry into Stillbirths and Sudden Deaths in Infancy Project 27/28. Epoch two: 146 neonatal units in England contributing data to the National Neonatal Research Database at the Neonatal Data Analysis Unit, 1 January 2009 to 31 December 2010. Participants Babies born at a gestational age of 27+0-28+6 (weeks+days): 3522 live births in epoch one; 2919 babies admitted to a neonatal unit within 28 days of birth in epoch two. Intervention The national reorganisation of neonatal services into managed clinical networks. Main outcome measures The proportion of babies born at hospitals providing the highest volume of neonatal specialist care (≥2000 neonatal intensive care days annually), having an acute transfer (within the first 24 hours after birth) and/or a late transfer (between 24 hours and 28 days after birth) to another hospital, assessed by change in distribution of transfer category (“none,” “acute,” “late”), and babies from multiple births separated by transfer. For acute transfers in epoch two, the level of specialist neonatal care provided at the destination hospital (British Association of Perinatal Medicine criteria). Results After reorganisation, there were increases in the proportions of babies born at 27-28 weeks’ gestation in hospitals providing the highest volume of neonatal specialist care (18% (631/3495) v 49% (1325/2724); odds ratio 4.30, 95% confidence interval 3.83 to 4.82; P<0.001) and in acute and late postnatal transfers (7% (235) v 12% (360) and 18% (579) v 22% (640), respectively

  13. Hydrogeochemical variations in Hafren forest stream waters, Mid-Wales

    NASA Astrophysics Data System (ADS)

    Neal, Colin; Smith, Christopher J.; Walls, James; Billingham, Peter; Hill, Susan; Neal, Margaret

    1990-08-01

    Results are presented for a study attempting to assess the effects of conifer planting/harvesting and acidic oxide deposition on streamwater quality in a 25 to 45-year-old sitka spruce plantation on acid moorland. This is undertaken to demonstrate the application of a multi-element survey in providing 'chemical fingerprints' for describing hydrological and hydrochemical controls within catchments. Hafren forest streamwater chemistry varies for different components: nitrate, bromide, total iodine and total organic carbon show seasonal oscillations varying in phase and amplitude; aluminium and hydrogen ion concentrations vary as a function of flow; manganese and cobalt remain approximately constant except under very dry conditions when concentrations reduce by up to 10 fold. No direct link exists between rain and streamwater chemistry: streamwater chemistry variations are determined primarily by hydrological and chemical reactions in the surface organicrich soils and the underlying inorganic soils/bedrock. Reactions in the organic-rich horizons involve the generation of acidic conditions and the mobilization/transport of transition metals that can be easily hydrolysed. Biologically mediated breakdown processes determine, in part, the hydrochemical behaviour of dissolved organic carbon, the nutrients, bromine and iodine. Reactions in the inorganic zones involve hydrogen ion consumption and the release of calcium and magnesium. Bicarbonate ions are generated by deprotonation of biogenically derived H 2 CO 3 and the decompostion of calcium carbonate in the bedrock. The initial effects of forest clearfelling are demonstrated; increases in nitrate and potassium occur. A simple mixing model is presented to show that either a large proportion of the storm water is derived from 'non-hillslope', 'groundwater', sources, or major modifications occur as soil water passes rapidly to the stream; whichever process is operative, it has not been identified directly within the

  14. Human polyclonal immunoglobulin labelled with technetium-99m via NHS-MAG3: a comparison of radiochemical behavior and biological efficacy with other labelling methods.

    PubMed

    Gano, L; Patrício, L; Marques, E; Cantinho, G; Pena, H; Martins, T; Hnatowich, D J

    1998-05-01

    The aim of this study was to evaluate the radiochemical behavior, biological distribution, and localization in infection sites in mice of a human polyclonal immunoglobulin (HIG) labelled with 99mTc by a novel MAG3-labelling method. The resulting [99mTc]MAG3-HIG was compared with [99mTc]HIG preparations radiolabelled directly via 2-mercaptoethanol (2-Me) or stannous ion (Sn) reduction and indirectly via 2-iminothiolane (2-Im) conjugation. All preparations showed similar UV and radioactivity HPLC profile to that of native HIG except for 2-Im-HIG, which showed aggregates. The stabilities of the label to challenge with cysteine were similar for all the preparations. By nondenaturing SDS-PAGE, all preparations other than MAG3-HIG showed evidence of lower molecular weight fragments. The tissue distribution 4 and 24 h after intravenous administration of the four preparations were compared in mice previously administered with an isolate of Staphylococcus aureus in one thigh. The pharmacokinetics varied among the different preparations. When prepared via 2-Me, Sn, and 2-Im, both blood clearance and urinary excretion were faster than that of labelled MAG3-HIG. The absolute uptake in the infected thigh at 24 h was significantly higher for HIG labelled via MAG3 and 2-Me vs. the remaining methods. The infected thigh/normal thigh radioactivity ratios were similar at both time points for labelled HIG prepared via 2-Me, 2-Im, and NHS-MAG, methods but was significantly lower at 24 h for HIG prepared via Sn. The radioactive HPLC profiles of serum at 4 and 24 h were similar to that of the radiolabelled injectates. Based on these data we conclude that each radiolabelled HIG preparation studied showed increased localization in infectious foci although [99Tc]MAG3-HIG showed superior radiochemical and biological characteristics under the conditions of this investigation.

  15. Assessing options for the development of surface water flood warning in England and Wales.

    PubMed

    Priest, S J; Parker, D J; Hurford, A P; Walker, J; Evans, K

    2011-12-01

    This paper explores the technical options for warning of surface water flooding in England and Wales and presents the results of an Environment Agency funded project. Following the extensive surface water flooding experienced in summer 2007 a rainfall threshold-based Extreme Rainfall Alert (ERA) was piloted by the Met Office and Environment Agency providing initial steps towards the establishment of a warning for some types of surface water flooding. The findings of this paper are based primarily on feedback on technical options from a range of professionals involved in flood forecasting and warning and flood risk management, about the current alerts and about the potential options for developing a more targeted surface water flood warning service. Providing surface water flooding warnings presents a set of technical, forecasting and warning challenges related to the rapid onset of flooding, the localised nature of the flooding, and the linking of rainfall and flood forecasts to flood likelihood and impact on the ground. Some examples of rainfall alerting and surface water flood warning services from other countries are evaluated, as well as a small number of recently implemented local services in England and Wales. Various potential options for implementation of a service are then explored and assessed. The paper concludes that development of a surface water flood warning service for England and Wales is feasible and is likely to be useful to emergency responders and operational agencies, although developing such a service for the pluvial components of this type of flooding is likely to be feasible sooner than for other components of surface water flooding such as that caused by sewers. A targeted surface water flood warning service could be developed for professional emergency responders in the first instance rather than for the public for whom such a service without further operational testing and piloting would be premature.

  16. Emergence of pregnancy-related listeriosis amongst ethnic minorities in England and Wales.

    PubMed

    Mook, P; Grant, K A; Little, C L; Kafatos, G; Gillespie, I A

    2010-07-08

    Listeriosis is a rare but severe food-borne disease that predominantly affects pregnant women, the unborn, newborns, the elderly and immunocompromised people. Following a large outbreak in the 1980s, specific food safety advice was provided to pregnant women and the immunocompromised in the United Kingdom. Following two coincident yet unconnected cases of pregnancy-related listeriosis in eastern European women in 2008, a review of the role of ethnicity in pregnancy-related listeriosis in England and Wales was undertaken in 2009. Cases reported to the national listeriosis surveillance scheme were classified as 'ethnic', belonging to an ethnic minority, or 'non-ethnic' based on their name, and trends were examined. Between 2001 and 2008, 1,510 cases of listeriosis were reported in England and Wales and, of these, 12% were pregnancy-related cases. The proportion of pregnancy-related cases classified as ethnic increased significantly from 16.7% to 57.9% (chi-square test for trend p=0.002). The reported incidence among the ethnic population was higher than that among the non-ethnic population in 2006, 2007 and 2008 (Relative Risk: 2.38, 95% confidence interval: 1.07 to 5.29; 3.82, 1.82 to 8.03; 4.33, 1.74 to 10.77, respectively). This effect was also shown when analysing data from January to September 2009, using extrapolated live births as denominator. Increased immigration and/or economic migration in recent years appear to have altered the population at risk of pregnancy-related listeriosis in England and Wales. These changes need to be taken into account in order to target risk communication strategies appropriately.

  17. Assessing options for the development of surface water flood warning in England and Wales.

    PubMed

    Priest, S J; Parker, D J; Hurford, A P; Walker, J; Evans, K

    2011-12-01

    This paper explores the technical options for warning of surface water flooding in England and Wales and presents the results of an Environment Agency funded project. Following the extensive surface water flooding experienced in summer 2007 a rainfall threshold-based Extreme Rainfall Alert (ERA) was piloted by the Met Office and Environment Agency providing initial steps towards the establishment of a warning for some types of surface water flooding. The findings of this paper are based primarily on feedback on technical options from a range of professionals involved in flood forecasting and warning and flood risk management, about the current alerts and about the potential options for developing a more targeted surface water flood warning service. Providing surface water flooding warnings presents a set of technical, forecasting and warning challenges related to the rapid onset of flooding, the localised nature of the flooding, and the linking of rainfall and flood forecasts to flood likelihood and impact on the ground. Some examples of rainfall alerting and surface water flood warning services from other countries are evaluated, as well as a small number of recently implemented local services in England and Wales. Various potential options for implementation of a service are then explored and assessed. The paper concludes that development of a surface water flood warning service for England and Wales is feasible and is likely to be useful to emergency responders and operational agencies, although developing such a service for the pluvial components of this type of flooding is likely to be feasible sooner than for other components of surface water flooding such as that caused by sewers. A targeted surface water flood warning service could be developed for professional emergency responders in the first instance rather than for the public for whom such a service without further operational testing and piloting would be premature. PMID:21862203

  18. Remediation of contaminated land and groundwater: experience in England and Wales.

    PubMed

    Rivett, M O; Petts, J; Butler, B; Martin, I

    2002-07-01

    Remediation of contaminated land and groundwater is of common international concern. The context and approach taken to the problem are, however, country-specific. A survey of remedial activity occurring within England and Wales over the period 1996-1999 was commissioned by the Environment Agency (for England and Wales) to establish a baseline against which future trends in remedial activity could be judged. This paper: explains the context of contaminated land and groundwater remediation in England and Wales (Britain); provides an overview of the 1996-1999 survey of remedial activity, discussing its findings within its legislative and institutional context; and, discusses the survey results of significance to the management of contaminated land and groundwater internationally. The survey obtained specific data from 367 remediated sites supplemented by general data from a further 1189 contaminated (not necessarily remediated) sites. The survey aimed to be, and was indicative of remediation practice, and did not seek to identify every remediation scheme operating. Previous anecdotal evidences were generally confirmed. Civil engineering-based techniques dominated and were used at 94% of sites with in situ techniques (predominantly vapour extraction-based) on 16% and ex situ on just 5%. Although disposal to landfill was dominant and occurred at over 80% of sites, integrated use of multiple techniques was common. Remediation was predominantly of soil (rather than water), development-based, designed to protect human health and reflected national development-led and 'suitable for use' policies. Lessons of international relevance from the survey and general British experience are drawn concerning remediation technique selection, regulatory and financial support of innovative remediation techniques and demonstration sites, competent use of risk-based approaches to allow pragmatic remediation and effective use of quality guidelines, need for effective guidance to highlight

  19. Inter-annual rainfall variations and suicide in New South Wales, Australia, 1964-2001

    NASA Astrophysics Data System (ADS)

    Nicholls, Neville; Butler, Colin D.; Hanigan, Ivan

    2006-01-01

    The suicide rate in New South Wales is shown to be related to annual precipitation, supporting a widespread and long-held assumption that drought in Australia increases the likelihood of suicide. The relationship, although statistically significant, is not especially strong and is confounded by strong, long-term variations in the suicide rate not related to precipitation variations. A decrease in precipitation of about 300 mm would lead to an increase in the suicide rate of approximately 8% of the long-term mean suicide rate.

  20. The struggle for recognition: The nurse practitioner in New South Wales, Australia.

    PubMed

    Appel, A L; Malcolm, P

    1999-09-01

    Recognition of clinical expertise seems to be a worldwide struggle for nurses. In New South Wales (NSW), Australia, nurse practitioners (NPs) are currently struggling for formal recognition of their position. The role of NP is seen as a means of fulfilling the desire of expert nurses for optimal autonomy and recognition in the health care system. This article examines advanced nursing practice within the context of the Australian health care system and the NP movement in NSW, including the pilot projects conducted. Discussion includes contentious issues such as nurse-prescribed medications, Medicare funding, and support for the NP role from within the nursing and medical professions. PMID:11188555

  1. Cancer mortality in small areas around nuclear facilities in England and Wales.

    PubMed Central

    Baron, J. A.

    1984-01-01

    Cancer mortality trends were examined for the small areas around fourteen nuclear and five non-nuclear facilities in England and Wales. Using routine OPCS mortality data, standardized mortality ratios (SMRs) for these areas were computed for selected causes of death. Changes in the SMRs were then sought by comparing the SMRs for the five years before the facility opened with the period 10 (in some cases 15) years after start-up, and by computing the weighted regression of the SMRs on calendar year. These analyses indicate no overall pattern of increasing cancer SMRs around nuclear facilities. PMID:6498079

  2. Getting it Right? Lessons from the Interwar Years on Pulmonary Tuberculosis Control in England and Wales

    PubMed Central

    Bowden, Sue; Sadler, Alex

    2015-01-01

    This paper examines morbidity and mortality patterns in interwar England and Wales, using previously under-explored primary archival source materials. These materials help us understand not only what local authorities could and did do, but also the reasons for the marked variations in the ability of different authorities to manage the problem. We identify where and why there were problems and also how and why some authorities were more successful than others in dealing with the disease. Wealth was not an issue. We find a combination of pro-active preventative measures was significant. PMID:25498440

  3. Rock art at the 'Mini-Yengo' site near Kulnura, New South Wales

    NASA Astrophysics Data System (ADS)

    Hamacher, Duane W.; Clegg, John K.; Pankhurst, Robert S.

    2012-11-01

    The "Mini-Yengo" rock art site is located in Mangrove Creek Dam Park on Kyola Road, near the corner of Kyola Road and George Downes Drive, approximately 1.8 km to the northwest of Kulnura, New South Wales, Australia. No records of this site were identified in the published literature (Sim 1966; Needham 1981; McCarthy 1983; Gordon 1993; McDonald 1993) but it was included in site card 45-3-0528 from the Aboriginal Heritage Information Management System (AHIMS). The site card contained unpublished surveys by V. Attenbrow in 1980 and I.M. Sim in 1976.

  4. Description of Caurinus tlagu, new species, from Prince of Wales Island, Alaska (Mecoptera, Boreidae, Caurininae)

    PubMed Central

    Sikes, Derek S.; Stockbridge, Jill

    2013-01-01

    Abstract A new species of the cryptic, minute, wingless, and enigmatic taxon Caurinus, and the second for the subfamily Caurininae,is described from Prince of Wales Island in the Alexander Archipelago, Alaska. It is distinguished from its only congener, Caurinus dectes Russell, 1979b, which occurs 1,059 km southeast in Oregon and Washington, based on external morphology and sequences of the mitochondrial gene cytochrome oxidase II. These two species are probably evolutionary relicts – the only known members of a clade dating to the Late Jurassic or older. PMID:23878513

  5. Capacity withholding in wholesale electricity markets: The experience in England and Wales

    NASA Astrophysics Data System (ADS)

    Quinn, James Arnold

    This thesis examines the incentives wholesale electricity generators face to withhold generating capacity from centralized electricity spot markets. The first chapter includes a brief history of electricity industry regulation in England and Wales and in the United States, including a description of key institutional features of England and Wales' restructured electricity market. The first chapter also includes a review of the literature on both bid price manipulation and capacity bid manipulation in centralized electricity markets. The second chapter details a theoretical model of wholesale generator behavior in a single price electricity market. A duopoly model is specified under the assumption that demand is non-stochastic. This model assumes that duopoly generators offer to sell electricity at their marginal cost, but can withhold a continuous segment of their capacity from the market. The Nash equilibrium withholding strategy of this model involves each duopoly generator withholding so that it produces the Cournot equilibrium output. A monopoly model along the lines of the duopoly model is specified and simulated under the assumption that demand is stochastic. The optimal strategy depends on the degree of demand uncertainty. When there is a moderate degree of demand uncertainty, the optimal withholding strategy involves production inefficiencies. When there is a high degree of demand uncertainty, the optimal monopoly quantity is greater than the optimal output level when demand is non-stochastic. The third chapter contains an empirical examination of the behavior of generators in the wholesale electricity market in England and Wales in the early 1990's. The wholesale market in England and Wales is analyzed because the industry structure in the early 1990's created a natural experiment, which is described in this chapter, whereby one of the two dominant generators had no incentive to behave non-competitively. This chapter develops a classification methodology

  6. The age difference at marriage in England and Wales: a century of patterns and trends.

    PubMed

    Ni Bhrolcháin, Máire

    2005-01-01

    In the last 100 years the mean age difference at marriage in England and Wales has fluctuated in the range 2-3 years, but without exhibiting any long-run trend. Nevertheless, an age gap of 2-3 years is not typical. A 1-year gap is the most common in recent years and there is a good deal of variation between couples. Marriage partners are closer in age than would be predicted if men and women were matched at random by age. There is little evidence that the age difference is governed by strong social norms. Some explanations for diversity and change in the age difference are discussed.

  7. Severe head injury in children: intensive care unit activity and mortality in England and Wales

    PubMed Central

    TASKER, ROBERT C; FLEMING, THOMAS J; YOUNG, AMBER ER; MORRIS, KEVIN P; PARSLOW, ROGER C

    2011-01-01

    Objective To explore the relationship between volume of paediatric intensive care unit (PICU) head injury (HI) admissions, specialist paediatric neurosurgical PICU practice, and mortality in England and Wales. Methods Analysis of HI cases (age 516 years) from the Paediatric Intensive Care Audit Network national cohort of sequential PICU admissions in 27 units in England and Wales, in the 5 years 2004-2008. Risk-adjusted mortality using the Paediatric Index of Mortality (PIM) model was compared between PICUs aggregated into quartile groups, first to fourth based on descending number of HI admissions/year: highest volume, medium-higher volume, medium-lower volume, and lowest volume. The effect of category of PICU interventions - observation only, mechanical ventilation (MV) only, and intracranial pressure (ICP) monitoring - on outcome was also examined. Observations were reported in relation to specialist paediatric neurosurgical PICU practice. Results There were 2575 admissions following acute HI (4.4% of non-cardiac surgery PICU admissions in England and Wales). PICU mortality was 9.3%. Units in the fourth-quartile (lowest volume) group did not have significant specialist paediatric neurosurgical activity on the PICU; the other groups did. Overall, there was no effect of HI admissions by individual PICU on risk-adjusted mortality. However, there were significant effects for both intensive care intervention category (p<0.001) and HI admissions by grouping (p<0.005). Funnel plots and control charts using the PIM model showed a hierarchy in increasing performance from lowest volume (group IV), to medium-higher volume (group II), to highest volume (group I), to medium-lower volume (group III) sectors of the health care system. Conclusions The health care system in England and Wales for critically ill HI children requiring PICU admission performs as expected in relation to the PIM model. However, the lowest-volume sector, comprising 14 PICUs with little or no paediatric

  8. Low formation energy and kinetic barrier of Stone-Wales defect in infinite and finite silicene

    NASA Astrophysics Data System (ADS)

    Manjanath, Aaditya; Singh, Abhishek K.

    2014-01-01

    Stone-Wales (SW) defects in materials having hexagonal lattice are the most common topological defects that affect the electronic and mechanical properties. Using first principles density functional theory based calculations, we study the formation energy and kinetic barrier of SW-defect in infinite and finite sheets of silicene. The formation energies as well as the barriers in both the cases are significantly lower than those of graphene. Furthermore, compared with the infinite sheets, the energy barriers and formation energies are lower for finite sheets. However, due to low barriers these defects are expected to heal out of the finite sheets.

  9. Phage typing and drug resistance of Shigella sonnei isolated in England and Wales.

    PubMed Central

    Bentley, C. A.; Frost, J. A.; Rowe, B.

    1996-01-01

    Phage typing of Shigella sonnei has been used to examine isolates from the 1991-2 sonnei dysentery outbreak in England and Wales and compare them with strains isolated during and following a widespread foodborne outbreak in 1994 which was associated with consumption of imported lettuce. The distribution of phage types was different in the three periods studied with PT 3 predominating during 1991-2, PT 2 during the 'lettuce' outbreak in the summer months and PT 6 during the subsequent months. PT 6 was frequently associated with travel outside the UK. Variation was also seen in the distribution of drug resistance patterns. PMID:8666073

  10. Ophthalmic genetics: a genealogical guide to sources in England and Wales.

    PubMed Central

    Jay, M

    1995-01-01

    Large pedigrees are fundamental to seeking new genes; they can be constructed on the basis of a family history but can frequently be enlarged considerably from public records. Genealogical sources in England and Wales consist of public records such as civil registration of births, marriages, and deaths, census returns, wills, and church records. Details are given as to their use and where they are to be found. In addition, examples are given of how archival material and pathology reports may be used to compile extensive pedigrees which can span 10 generations. Images PMID:8825921

  11. Bayesian conditional-independence modeling of the AIDS epidemic in England and Wales

    NASA Astrophysics Data System (ADS)

    Gilks, Walter R.; De Angelis, Daniela; Day, Nicholas E.

    We describe the use of conditional-independence modeling, Bayesian inference and Markov chain Monte Carlo, to model and project the HIV-AIDS epidemic in homosexual/bisexual males in England and Wales. Complexity in this analysis arises through selectively missing data, indirectly observed underlying processes, and measurement error. Our emphasis is on presentation and discussion of the concepts, not on the technicalities of this analysis, which can be found elsewhere [D. De Angelis, W.R. Gilks, N.E. Day, Bayesian projection of the the acquired immune deficiency syndrome epidemic (with discussion), Applied Statistics, in press].

  12. A neighbourhood level mortality classification of England and Wales, 2006-2009.

    PubMed

    Green, Mark A; Vickers, Daniel; Dorling, Danny

    2014-11-01

    The paper provides an overview of a neighbourhood level classification of mortality for England and Wales (2006-2009). Standardised mortality ratios for 63 causes of death were calculated for middle super output areas (weighted by prevalence). A k-means partitional method was used to classify the data. An eight cluster solution was found to best segment mortality patterns. Clusters mostly differentiated in terms of prevalence, however the importance of neurodegenerative diseases and causes related to unhealthy behaviours were important. The results describe a neighbourhood classification that can be an important tool to help inform policy development, resource allocation and targeting of services.

  13. Influenza activity in England and Wales: October 1998 to June 1999.

    PubMed

    Whiting, P; Joseph, C A; Zambon, M; Nunn, M; Fleming, D; Watson, J M

    1999-12-01

    Influenza activity in England and Wales in the winter of 1998/1999 reached the highest weekly levels seen since the epidemic of 1989/1990. Activity peaked at Christmas and the New Year, adding to the winter pressures on general practitioner and hospital services. Adults aged 65 years and over consulted with general practitioners at the highest rates. Outbreaks of influenza or flu-like illness occurred in several schools and nursing homes and, in June 1999, on a British cruise ship in the Mediterranean. Deaths from all causes reached a higher peak in week 1 of 1999 than occurred in the peak week of the influenza epidemic of 1989/90.

  14. Cancer mortality in Indian and British ethnic immigrants from the Indian subcontinent to England and Wales.

    PubMed Central

    Swerdlow, A. J.; Marmot, M. G.; Grulich, A. E.; Head, J.

    1995-01-01

    Risk of cancer mortality from 1973 to 1985 in persons born in the Indian subcontinent who migrated to England and Wales was analysed by ethnicity, and compared with cancer mortality in the England and Wales native population, using data from England and Wales death certificates. There were substantial highly significant raised risks in Indian ethnic migrants for cancers of the mouth and pharynx, gall bladder, and liver in each sex, larynx and thyroid in males, and oesophagus in females. There were also substantial raised risks in these migrants of each sex for non-Hodgkin's lymphoma and myeloma. For the mouth and pharynx, and liver in each sex, and gall bladder in females, there were also raised risks of lesser magnitude in British ethnic migrants. For colon and rectal cancer and cutaneous melanoma in each sex, ovarian cancer in women and bladder cancer in men, there were appreciable significantly reduced risks in the Indian ethnic migrants not shared by those of British ethnicity. Appreciable raised risks in British ethnic migrants not shared by those of Indian ethnicity occurred for nasopharyngeal cancer in males, soft tissue malignancy in both sexes and non-melanoma skin cancer in males. In migrants of both ethnicities there were appreciable significantly raised risks in each sex for leukaemia and decreased risks in each sex for gastric cancer, for lung cancer except in females of British ethnicity and in males for testicular cancer. The results suggest the need for public health measures to combat the high risks of oral and pharyngeal cancers and liver cancer in the Indian ethnic immigrant population of England and Wales, by prevention of betel quid chewing and hepatitis transmission respectively. The data also imply that early exposures or early acquired behaviours in India, or exposures during migration, may increase the risk of leukaemia and reduce the risks of gastric and testicular cancers in the migrants irrespective of their ethnicity. Aetiological

  15. The Contribution of the New South Wales Primary Schools Sports Association towards Developing Talent in Australian 12-Year-Old Female Swimmers

    ERIC Educational Resources Information Center

    Light, Richard

    2012-01-01

    This article reports on a case study that inquired into the influence of the New South Wales Primary Schools Sports Association competitive swimming structure on the development of talented 12-year old female swimmers. The study focused on ten 12-year old girls in the New South Wales team that contested the 2009 national swimming championships…

  16. Modeling Water Utility Investments and Improving Regulatory Policies using Economic Optimisation in England and Wales

    NASA Astrophysics Data System (ADS)

    Padula, S.; Harou, J. J.

    2012-12-01

    Water utilities in England and Wales are regulated natural monopolies called 'water companies'. Water companies must obtain periodic regulatory approval for all investments (new supply infrastructure or demand management measures). Both water companies and their regulators use results from least economic cost capacity expansion optimisation models to develop or assess water supply investment plans. This presentation first describes the formulation of a flexible supply-demand planning capacity expansion model for water system planning. The model uses a mixed integer linear programming (MILP) formulation to choose the least-cost schedule of future supply schemes (reservoirs, desalination plants, etc.) and demand management (DM) measures (leakage reduction, water efficiency and metering options) and bulk transfers. Decisions include what schemes to implement, when to do so, how to size schemes and how much to use each scheme during each year of an n-year long planning horizon (typically 30 years). In addition to capital and operating (fixed and variable) costs, the estimated social and environmental costs of schemes are considered. Each proposed scheme is costed discretely at one or more capacities following regulatory guidelines. The model uses a node-link network structure: water demand nodes are connected to supply and demand management (DM) options (represented as nodes) or to other demand nodes (transfers). Yields from existing and proposed are estimated separately using detailed water resource system simulation models evaluated over the historical period. The model simultaneously considers multiple demand scenarios to ensure demands are met at required reliability levels; use levels of each scheme are evaluated for each demand scenario and weighted by scenario likelihood so that operating costs are accurately evaluated. Multiple interdependency relationships between schemes (pre-requisites, mutual exclusivity, start dates, etc.) can be accounted for by

  17. Deploying a culture change programme management approach in support of information and communication technology developments in Greater Glasgow NHS Board.

    PubMed

    Frame, Joanne; Watson, Janice; Thomson, Katie

    2008-06-01

    This article reports on the project management and Culture Change Programme adopted by the NHS Greater Glasgow Health Board to deliver an electronic patient record (EPR) to support cardiology and stroke clinical services. To achieve its vision for the EPR (;to "really make a difference" to patient care by providing to the right person, the right information, under the right safeguards') the Board recognized that attending to social and organizational issues is at least of equal importance to addressing strictly technical concerns. Consequently, an ICT Culture Change Programme (ICT CCP) was devised and implemented to assist in the management of change, and in particular to facilitate a visionary clinical and cultural environment operating in conjunction with the evolving technical environment. In this article we describe the key components of this approach, outline the benefits we believe have accrued, and describe the steps being taken to build upon lessons learned. PMID:18477599

  18. The process of EDC-NHS Cross-linking of reconstituted collagen fibres increases collagen fibrillar order and alignment

    PubMed Central

    Shepherd, D.V.; Shepherd, J.H.; Ghose, S.; Kew, S.J.; Cameron, R.E.; Best, S.M.

    2014-01-01

    We describe the production of collagen fibre bundles through a multi-strand, semi-continuous extrusion process. Cross-linking using an EDC (1-ethyl-3-(3-dimethylaminopropyl)carbodiimide), NHS (N-hydroxysuccinimide) combination was considered. Atomic Force Microscopy (AFM) and Raman spectroscopy focused on how cross-linking affected the collagen fibrillar structure. In the cross-linked fibres, a clear fibrillar structure comparable to native collagen was observed which was not observed in the non-cross-linked fibre. The amide III doublet in the Raman spectra provided additional evidence of alignment in the cross-linked fibres. Raman spectroscopy also indicated no residual polyethylene glycol (from the fibre forming buffer) or water in any of the fibres. PMID:25506518

  19. The process of EDC-NHS cross-linking of reconstituted collagen fibres increases collagen fibrillar order and alignment

    SciTech Connect

    Shepherd, D. V. Shepherd, J. H.; Cameron, R. E.; Best, S. M.; Ghose, S.; Kew, S. J.

    2015-01-01

    We describe the production of collagen fibre bundles through a multi-strand, semi-continuous extrusion process. Cross-linking using an EDC (1-ethyl-3-(3-dimethylaminopropyl)carbodiimide), NHS (N-hydroxysuccinimide) combination was considered. Atomic Force Microscopy and Raman spectroscopy focused on how cross-linking affected the collagen fibrillar structure. In the cross-linked fibres, a clear fibrillar structure comparable to native collagen was observed which was not observed in the non-cross-linked fibre. The amide III doublet in the Raman spectra provided additional evidence of alignment in the cross-linked fibres. Raman spectroscopy also indicated no residual polyethylene glycol (from the fibre forming buffer) or water in any of the fibres.

  20. Preparation of thin film nanofibrous composite NF membrane based on EDC/NHS modified PAN-AA nanofibrous substrate

    NASA Astrophysics Data System (ADS)

    Yang, Y.; Wang, X.; Hsiao, B. S.

    2016-07-01

    A novel kind of thin-film nanofibrous composite (TFNC) nanofiltration (NF) membranes consisting of a polyamide (PA) barrier layer were successfully fabricated by interfacial polymerization (IFP) based on electrospun double-layer nanofibrous substrates, which have an ultrathin poly (acrylonitrile-co-acrylic acid) (PAN-AA) nanofibrous layer as top layer and a thicker polyacrylonitrile (PAN) nanofiber layer as bottom porous support layer. Immersing PAN/PAN-AA nanofibrous substrates into 1-ethyl-(3-3-dimethylaminopropyl) carbodiimide hydrochloride/N-hydroxysuccinimide (EDC/NHS) aqueous solution and piperazine (PIP) aqueous solution (0.20 wt%) sequentially for a period of time, the carboxyl groups on PAN-AA nanofibers were activated by carbodiimide and then reacted with the amide groups. The as prepared composite membrane has an integrated structure with high rejection rate (98.0%); high permeate flux (40.4 L/m2h) for MgSO4 aqueous solution (2 g/L).

  1. 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…

  2. The Role of the NHS in the Development of Revans' Action Learning: Correspondence and Contradiction in Action Learning Development and Practice

    ERIC Educational Resources Information Center

    Brook, Cheryl

    2010-01-01

    In adapting Bowles' and Gintis's correspondence principle of education, this paper suggests that there are ways in which the theory and practice of action learning developed "in correspondence" with the NHS. In doing so, the paper draws, in part, upon an historical assessment of Revans' Hospital Internal Communications Project of the 1960s,…

  3. Potential for advice from doctors to reduce the number of patients referred to emergency departments by NHS 111 call handlers: observational study

    PubMed Central

    Anderson, Andrew; Roland, Martin

    2015-01-01

    Objective To determine the effect of using experienced general practitioners (GPs) to review the advice given by call handlers in NHS 111, a national service giving telephone advice to people seeking medical care. Design Observational study following the introduction of GPs to review call handlers’ decisions which had been made using decision support software. Setting NHS 111 call centre covering Cambridgeshire and Peterborough. Intervention When a call handler using standard NHS 111 decision support software would have advised the caller to attend the hospital accident and emergency (A&E) department, the decision was reviewed by an experienced GP. Main outcome measures Percentage of calls where an outcome other than A&E attendance was recommended by the GP. Results Of 1474 cases reviewed, the GP recommended A&E attendance in 400 cases (27.1%). In the remainder of cases, the GP recommended attendance at a primary care out-of-hours centre or minor injury unit in 665 cases (45.2%) and self-management or some alternative strategy in 409 (27.8%). Conclusions Fewer callers to NHS 111 would be sent to emergency departments if the decision was reviewed by an experienced GP. Telephone triage services need to consider whether using relatively unskilled call handlers supported by computer software is the most cost-effective way to handle requests for medical care. PMID:26614624

  4. A feasible approach to evaluate the relative reactivity of NHS-ester activated group with primary amine-derivatized DNA analogue and non-derivatized impurity.

    PubMed

    Dou, Shuping; Virostko, John; Greiner, Dale L; Powers, Alvin C; Liu, Guozheng

    2015-01-01

    Synthetic DNA analogues with improved stability are widely used in life science. The 3'and/or 5' equivalent terminuses are often derivatized by attaching an active group for further modification, but a certain amount of non-derivatized impurity often remains. It is important to know to what extent the impurity would influence further modification. The reaction of an NHS ester with primary amine is one of the most widely used options to modify DNA analogues. In this short communication, a 3'-(NH2-biotin)-derivatized morpholino DNA analogue (MORF) was utilized as the model derivatized DNA analogue. Inclusion of a biotin concomitant with the primary amine at the 3'-terminus allows for the use of streptavidin to discriminate between the products from the derivatized MORF and non-derivatized MORF impurity. To detect the MORF reaction with NHS ester, S-acetyl NHS-MAG3 was conjugated to the DNA analogue for labeling with (99m)Tc, a widely used nuclide in the clinic. It was found that the non-derivatized MORF also reacted with the S-acetyl NHS-MAG3. Radiolabeling of the product yielded an equally high labeling efficiency. Nevertheless, streptavidin binding indicated that under the conditions of this investigation, the non-derivatized MORF was five times less reactive than the amine-derivatized MORF. PMID:25621701

  5. A FEASIBLE APPROACH TO EVALUATE THE RELATIVE REACTIVITY OF NHS-ESTER ACTIVATED GROUP WITH PRIMARY AMINE-DERIVATIZED DNA ANALOGUE AND NON-DERIVATIZED IMPURITY

    PubMed Central

    Dou, Shuping; Virostko, John; Greiner, Dale L.; Powers, Alvin C.; Liu, Guozheng

    2015-01-01

    Synthetic DNA analogues with improved stability are widely used in life science. The 3′ and/or 5′ equivalent terminuses are often derivatized by attaching an active group for further modification, but a certain amount of non-derivatized impurity often remains. It is important to know to what extent the impurity would influence further modification. The reaction of an NHS ester with primary amine is one of the most widely used options to modify DNA analogues. In this short communication, a 3′-(NH2-biotin)-derivatized morpholino DNA analogue (MORF) was utilized as the model derivatized DNA analogue. Inclusion of a biotin concomitant with the primary amine at the 3′-terminus allows for the use of streptavidin to discriminate between the products from the derivatized MORF and non-derivatized MORF impurity. To detect the MORF reaction with NHS ester, S-acetyl NHS-MAG3 was conjugated to the DNA analogue for labeling with 99mTc, a widely used nuclide in the clinic. It was found that the non-derivatized MORF also reacted with the S-acetyl NHS-MAG3. Radiolabeling of the product yielded an equally high labeling efficiency. Nevertheless, streptavidin binding indicated that under the conditions of this investigation, the non-derivatized MORF was five times less reactive than the amine-derivatized MORF. PMID:25621701

  6. Accountable to whom, for what? An exploration of the early development of Clinical Commissioning Groups in the English NHS

    PubMed Central

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

    2013-01-01

    Objective One of the key goals of the current reforms in the English National Health Service (NHS) under the Health and Social Care Act, 2012, is to increase the accountability of those responsible for commissioning care for patients (clinical commissioning groups (CCGs)), while at the same time allowing them a greater autonomy. This study was set out to explore CCG's developing accountability relationships. Design We carried out detailed case studies in eight CCGs, using interviews, observation and documentary analysis to explore their multiple accountabilities. Setting/participants We interviewed 91 people, including general practitioners, managers and governing body members in developing CCGs, and undertook 439 h of observation in a wide variety of meetings. Results CCGs are subject to a managerial, sanction-backed accountability to NHS England (the highest tier in the new organisational hierarchy), alongside a number of other external accountabilities to the public and to some of the other new organisations created by the reforms. In addition, unlike their predecessor commissioning organisations, they are subject to complex internal accountabilities to their members. Conclusions The accountability regime to which CCGs are subject to is considerably more complex than that which applied their predecessor organisations. It remains to be seen whether the twin aspirations of increased autonomy and increased accountability can be realised in practice. However, this early study raises some important issues and concerns, including the risk that the different bodies to whom CCGs are accountable will have differing (or conflicting) agendas, and the lack of clarity over the operation of sanction regimes. PMID:24327362

  7. 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

  8. Significant differences of monooxotungsten(IV) and dioxotungsten(VI) benzenedithiolates containing two intramolecular NHS hydrogen bonds from molybdenum analogues.

    PubMed

    Okamura, Taka-aki; Okamura, A Taka-Aki; Omi, Yui; Fujii, Manami; Tatsumi, Miki; Onitsuka, Kiyotaka

    2015-11-01

    A monooxotungsten(iv) benzenedithiolate complex containing two intramolecular NHS hydrogen bonds, (NEt4)2[W(IV)O(1,2-S2-3-t-BuNHCOC6H3)2] (1-W), was synthesized via a ligand-exchange reaction between a new starting complex, (NEt4)2[W(IV)O(SC6F5)4], and a partially deprotonated dithiol. When dithiol was used in solution, the oxo ligand was protonated and removed to afford (NEt4)2[W(IV)(1,2-S2-3-t-BuNHCOC6H3)3]. The trans isomer, trans-1-W, was crystallized, and the molecular structure was determined via X-ray analysis. Trans-1-W was gradually isomerized by heating it in solution and it eventually achieved an approximately 1 : 1 mixture of trans/cis isomers after 48 days. However, a slightly excess amount of trans isomer remained, so the isomerization rate was considerably slower than that of the molybdenum analogue. In the presence of NEt4BH4, deuteration of the NH protons was observed in acetonitrile-d3. The oxidation of both trans- and cis-1-W by Me3NO afforded the corresponding dioxotungsten(vi) complex, (NEt4)2[W(VI)O2(1,2-S2-3-t-BuNHCOC6H3)2] (2-W), as a single isomer. The contributions of the NHS hydrogen bonds to the bond distances, vibrational data, and electrochemical properties are described via comparisons with their molybdenum analogues. The results of this comparative study yielded insights into both tungsten and molybdenum enzymes.

  9. 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

  10. 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

  11. Mortality among immigrants in England and Wales by major causes of death, 1971-2012: A longitudinal analysis of register-based data.

    PubMed

    Wallace, Matthew; Kulu, Hill

    2015-12-01

    Recent research has found a migrant mortality advantage among immigrants relative to the UK-born population living in England and Wales. However, while all-cause mortality is useful to show differences in mortality between immigrants and the host population, it can mask variation in mortality patterns from specific causes of death. This study analyses differences in the causes of death among immigrants living in England and Wales. We extend previous research by applying competing-risks survival analysis to study a large-scale longitudinal dataset from 1971 to 2012 to directly compare causes of death. We confirm low all-cause mortality among nearly all immigrants, except immigrants from Scotland, Northern Ireland and the Republic of Ireland (who have high mortality). In most cases, low all-cause mortality among immigrants is driven by lower mortality from chronic diseases (in nearly all cases by lower cancer mortality and in some cases by lower mortality from cardiovascular diseases (CVD)). This low all-cause mortality often coexists with low respiratory disease mortality and among non-western immigrants, coexists with high mortality from infectious diseases; however, these two causes of death contribute little to mortality among immigrants. For men, CVD is the leading cause of death (particularly among South Asians). For women, cancer is the leading cause of death (except among South Asians, for whom CVD is also the leading cause). Differences in CVD mortality over time remain constant between immigrants relative to UK-born, but immigrant cancer patterns shows signs of some convergence to the cancer mortality among the UK-born (though cancer mortality is still low among immigrants by age 80). The study provides the most up-to-date, reliable UK-based analysis of immigrant mortality.

  12. "Persons that live remote from London": apothecaries and the medical marketplace in seventeenth-and eighteenth-century Wales.

    PubMed

    Withey, Alun

    2011-01-01

    This article uses evidence from Welsh apothecary shops as a means to access the mechanisms of the "medical marketplace" in seventeenth- and eighteenth-century Wales. As a country physically remote from large urban medical centers, and with few large towns, Wales has often been overlooked in terms of medical commerce. Nevertheless, evidence suggests that Welsh apothecaries participated in broad and sophisticated networks of trade with London suppliers. Moreover, their shops contained a wide range of medicines from herbal simples to exotic ingredients and chemical preparations, highlighting the availability of such goods far from large urban centers. PMID:21804184

  13. "Persons That Live Remote from London": Apothecaries and the Medical Marketplace in Seventeenth-and Eighteenth-Century Wales

    PubMed Central

    Withey, Alun

    2011-01-01

    Summary This article uses evidence from Welsh apothecary shops as a means to access the mechanisms of the "medical marketplace" in seventeenth- and eighteenth-century Wales. As a country physically remote from large urban medical centers, and with few large towns, Wales has often been overlooked in terms of medical commerce. Nevertheless, evidence suggests that Welsh apothecaries participated in broad and sophisticated networks of trade with London suppliers. Moreover, their shops contained a wide range of medicines from herbal simples to exotic ingredients and chemical preparations, highlighting the availability of such goods far from large urban centers. PMID:21804184

  14. [Efficiency versus quality in the NHS, in Portugal: methodologies for evaluation].

    PubMed

    Giraldes, Maria do Rosário

    2008-01-01

    To proceed to the evaluation of the efficiency and quality in the NHS, based in methodologies of evaluation of management, indicators of benchmarking and indicators of process and outcome. The 1980 and 1990 decades have seen the proliferation of all forms of process indicators as a way to control health services. It is not a coincidence that the increase in managed care has been accompanied by an explosion of process indicators, as it has happened in the health system of the USA. More recently the attention has turned away from measures of performance, which measure the process (what has been done) to those which measure outcomes (what was the result). Quality indicators have been developed in Europe, first to be used in hospitals, but also to be used in primary health care. Conceptually the justification for the introduction of process indicators comes from the principle that their use will reinforce a modification in the quality of the proceedings, which will give origin to better outcomes as well at population level, as resource saving. Outcome indicators compared with process indicators in health care shows that process indicators have the advantage of being more sensitive than outcome indicators to differences in the quality. Optimizing health care quality has the objective of establishing a quantitative relationship between the quality of the health services and cost-effectiveness. To identify quality indicators and benchmarking and to implement plans to measure the quality of health care. In a study made in a group of senior GP, in the UK, with the objective of determining which process indicators better reflect the quality of the services in primary health care services a Delphi method was used. Only seven indicators were chosen by 75% of the respondents: the percentage of eligible patients receiving cervical screening; the percentage of generic prescribing; the percentage of eligible patients receiving childhood immunization; the percentage of eligible

  15. Down syndrome birth weight in England and Wales: Implications for clinical practice.

    PubMed

    Morris, Joan K; Cole, Tim J; Springett, Anna L; Dennis, Jennifer

    2015-12-01

    The aim of this study was to determine if syndrome-specific birth weight charts were beneficial for babies with Down syndrome in England and Wales. Birth weights of 8,825 babies with Down syndrome born in England and Wales in 1989-2010 were obtained from the National Down Syndrome Cytogenetic Register. Birth weight centiles for 30-42 weeks gestation by sex were fitted using the LMS method and were compared to those for unaffected babies from the UK-WHO growth charts. For babies born with Down syndrome the median birth weight from 37 to 42 weeks was 2,970 g (10th-90th centile: 2,115-3,680) for boys and 2930 g (2,100-3,629) for girls, and the modal age of gestation was 38 weeks, 2 weeks earlier than for unaffected babies. At 38 weeks gestation they were only slightly lighter than unaffected babies (159 g for boys and 86 g for girls). However at 40 weeks gestation the shortfall was much greater (304 g and 239 g, respectively). In neonates with Down syndrome there is little evidence of growth restriction before 38 weeks gestation, so up to this age it is appropriate to use the UK-WHO birth weight charts. Thereafter birth weight is below that of unaffected babies and it should be plotted on the UK Down syndrome growth charts.

  16. Shiga Toxin–Producing Escherichia coli O157, England and Wales, 1983–2012

    PubMed Central

    Byrne, Lisa; Smith, Geraldine A.; Elson, Richard; Harris, John P.; Salmon, Roland; Smith, Robert; O’Brien, Sarah J.; Adak, Goutam K.; Jenkins, Claire

    2016-01-01

    We evaluated clinical Shiga toxin–producing Escherichia coli O157 infections in England and Wales during 1983–2012 to describe changes in microbiological and surveillance methods. A strain replacement event was captured; phage type (PT) 2 decreased to account for just 3% of cases by 2012, whereas PT8 and PT21/28 strains concurrently emerged, constituting almost two thirds of cases by 2012. Despite interventions to control and reduce transmission, incidence remained constant. However, sources of infection changed over time; outbreaks caused by contaminated meat and milk declined, suggesting that interventions aimed at reducing meat cross-contamination were effective. Petting farm and school and nursery outbreaks increased, suggesting the emergence of other modes of transmission and potentially contributing to the sustained incidence over time. Studies assessing interventions and consideration of policies and guidance should be undertaken to reduce Shiga toxin–producing E. coli O157 infections in England and Wales in line with the latest epidemiologic findings. PMID:26982243

  17. High liver content of polybrominated diphenyl ether (PBDE) in otters (Lutra lutra) from England and Wales.

    PubMed

    Pountney, Angela; Filby, Amy L; Thomas, Gareth O; Simpson, Vic R; Chadwick, Elizabeth A; Stevens, Jamie R; Tyler, Charles R

    2015-01-01

    Polybrominated diphenyl ethers (PBDEs), used as flame retardants since the 1970s, are being phased out of use, but are persistent and widespread in the environment. Historical declines in Eurasian otter (Lutra lutra) populations have been associated with exposure to dieldrin and polychlorinated biphenyls (PCBs), but links with other persistent organic pollutants have not been explored. In this study, liver samples from 129 otters, collected across England and Wales from 1995-2006, were analysed for PBDEs, together with PCBs, DDT breakdown products, and hexachlorobenzene. Associations with geographical location and life history parameters were explored. Concentrations of PBDEs in otters (∑BDE 12-70000ngg(-1) lipid) paralleled those measured in marine mammals, with PBDE-47 the dominant congener and high levels of PBDE-99 and -100. Otter livers contained high concentrations of PBDE-153 and -209, typical of terrestrial top predators. Inter-individual variation in PBDE concentrations was high and correlated with geographical location. ∑PBDE was 25% of ∑PCB, and comparable with ∑DDT, identifying PBDEs as a major contaminant in otter populations in England and Wales.

  18. Population Accessibility to Radiotherapy Services in New South Wales Region of Australia: a methodological contribution

    NASA Astrophysics Data System (ADS)

    Shukla, Nagesh; Wickramasuriya, Rohan; Miller, Andrew; Perez, Pascal

    2015-05-01

    This paper proposes an integrated modelling process to assess the population accessibility to radiotherapy treatment services in future based on future cancer incidence and road network-based accessibility. Previous research efforts assessed travel distance/time barriers affecting access to cancer treatment services, as well as epidemiological studies that showed that cancer incidence rates vary with population demography. It is established that travel distances to treatment centres and demographic profiles of the accessible regions greatly influence the demand for cancer radiotherapy (RT) services. However, an integrated service planning approach that combines spatially-explicit cancer incidence projections, and the RT services accessibility based on patient road network have never been attempted. This research work presents this novel methodology for the accessibility assessment of RT services and demonstrates its viability by modelling New South Wales (NSW) cancer incidence rates for different age-sex groups based on observed cancer incidence trends; estimating the road network-based access to current NSW treatment centres; and, projecting the demand for RT services in New South Wales, Australia from year 2011 to 2026.

  19. Koi herpesvirus: distribution and prospects for control in England and Wales.

    PubMed

    Taylor, N G H; Dixon, P F; Jeffery, K R; Peeler, E J; Denham, K L; Way, K

    2010-03-01

    Koi herpesvirus (KHV) causes a highly virulent disease affecting carp, Cyprinus carpio L., and poses a serious socio-economic threat to the UK carp industry. This study aimed to determine the geographic distribution and prevalence of KHV exposed fish in England and Wales through ELISA antibody testing. Only three of the 82 farms sampled produced positive results, suggesting fish farms provide a relatively safe source of fish. Of the 71 'high-risk' fisheries tested, 26 were positive. All eight geographic areas within England and Wales studied had at least one KHV positive site. Twelve consignments of imported koi carp from seven S.E. Asian countries were tested for KHV antibody. Six consignments from six different countries were positive. Although a high proportion of consignments were positive, the results indicate that lower risk stocks of fish exist that could be sourced by the ornamental carp sector. The study provides evidence that KHV is widespread and prevalent in 'high-risk' fisheries. There are, however, prospects for controlling KHV as English and Welsh farms appear to be relatively free of the virus, and in most cases fish are not moved from fisheries to other waters.

  20. Rainbow channeling of protons in very short carbon nanotubes with aligned Stone-Wales defects

    NASA Astrophysics Data System (ADS)

    Ćosić, M.; Petrović, S.; Bellucci, S.

    2016-01-01

    In this paper proton channeling through armchair single-walled-carbon-nanotubes (SWCNTs) with aligned Stone-Wales defects has been investigated. The energy of the proton beam was 1 GeV, while the lengths of the SWCNTs have been varied from 200 nm up to 1000 nm. The linear density of aligned defects has been varied in the whole range, from minimally up to maximally possible values. Here are presented results of a detailed morphological analysis concerning: the formation, evolution and interaction of the nanotube rainbows. The potential of the SWCNT has been constructed from Molère's expression of the Thomas-Fermi's proton-carbon interaction-energy, using the approximation of the continuous atomic string. Trajectories of the channeled protons were obtained by solving the corresponding classical equations of motions. Distributions of the transmitted protons were obtained by the Monte-Carlo simulation. The shape of angular distributions has been explained in the framework of the theory of nanotube rainbows. The aim of this study is also to investigate the applicability of the proton rainbow channeling for the characterization of nanotubes with aligned Stone-Wales defects.