1,140 research outputs found

    Supply chain transformation programme : prospectus

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    East Midlands Research into Ageing Network (EMRAN) Discussion Paper Series

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    Academic geriatric medicine in Leicester . There has never been a better time to consider joining us. We have recently appointed a Professor in Geriatric Medicine, alongside Tom Robinson in stroke and Victoria Haunton, who has just joined as a Senior Lecturer in Geriatric Medicine. We have fantastic opportunities to support students in their academic pursuits through a well-established intercalated BSc programme, and routes on through such as ACF posts, and a successful track-record in delivering higher degrees leading to ACL post. We collaborate strongly with Health Sciences, including academic primary care. See below for more detail on our existing academic set-up. Leicester Academy for the Study of Ageing We are also collaborating on a grander scale, through a joint academic venture focusing on ageing, the ‘Leicester Academy for the Study of Ageing’ (LASA), which involves the local health service providers (acute and community), De Montfort University; University of Leicester; Leicester City Council; Leicestershire County Council and Leicester Age UK. Professors Jayne Brown and Simon Conroy jointly Chair LASA and have recently been joined by two further Chairs, Professors Kay de Vries and Bertha Ochieng. Karen Harrison Dening has also recently been appointed an Honorary Chair. LASA aims to improve outcomes for older people and those that care for them that takes a person-centred, whole system perspective. Our research will take a global perspective, but will seek to maximise benefits for the people of Leicester, Leicestershire and Rutland, including building capacity. We are undertaking applied, translational, interdisciplinary research, focused on older people, which will deliver research outcomes that address domains from: physical/medical; functional ability, cognitive/psychological; social or environmental factors. LASA also seeks to support commissioners and providers alike for advice on how to improve care for older people, whether by research, education or service delivery. Examples of recent research projects include: ‘Local History Café’ project specifically undertaking an evaluation on loneliness and social isolation; ‘Better Visits’ project focused on improving visiting for family members of people with dementia resident in care homes; and a study on health issues for older LGBT people in Leicester. Clinical Geriatric Medicine in Leicester We have developed a service which recognises the complexity of managing frail older people at the interface (acute care, emergency care and links with community services). There are presently 17 consultant geriatricians supported by existing multidisciplinary teams, including the largest complement of Advance Nurse Practitioners in the country. Together we deliver Comprehensive Geriatric Assessment to frail older people with urgent care needs in acute and community settings. The acute and emergency frailty units – Leicester Royal Infirmary This development aims at delivering Comprehensive Geriatric Assessment to frail older people in the acute setting. Patients are screened for frailty in the Emergency Department and then undergo a multidisciplinary assessment including a consultant geriatrician, before being triaged to the most appropriate setting. This might include admission to in-patient care in the acute or community setting, intermediate care (residential or home based), or occasionally other specialist care (e.g. cardiorespiratory). Our new emergency department is the county’s first frail friendly build and includes fantastic facilities aimed at promoting early recovering and reducing the risk of hospital associated harms. There is also a daily liaison service jointly run with the psychogeriatricians (FOPAL); we have been examining geriatric outreach to oncology and surgery as part of an NIHR funded study. We are home to the Acute Frailty Network, and those interested in service developments at the national scale would be welcome to get involved. Orthogeriatrics There are now dedicated hip fracture wards and joint care with anaesthetists, orthopaedic surgeons and geriatricians. There are also consultants in metabolic bone disease that run clinics. Community work Community work will consist of reviewing patients in clinic who have been triaged to return to the community setting following an acute assessment described above. Additionally, primary care colleagues refer to outpatients for sub-acute reviews. You will work closely with local GPs with support from consultants to deliver post-acute, subacute, intermediate and rehabilitation care services. Stroke Medicine 24/7 thrombolysis and TIA services. The latter is considered one of the best in the UK and along with the high standard of vascular surgery locally means one of the best performances regarding carotid intervention

    Context Aware Computing for The Internet of Things: A Survey

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    As we are moving towards the Internet of Things (IoT), the number of sensors deployed around the world is growing at a rapid pace. Market research has shown a significant growth of sensor deployments over the past decade and has predicted a significant increment of the growth rate in the future. These sensors continuously generate enormous amounts of data. However, in order to add value to raw sensor data we need to understand it. Collection, modelling, reasoning, and distribution of context in relation to sensor data plays critical role in this challenge. Context-aware computing has proven to be successful in understanding sensor data. In this paper, we survey context awareness from an IoT perspective. We present the necessary background by introducing the IoT paradigm and context-aware fundamentals at the beginning. Then we provide an in-depth analysis of context life cycle. We evaluate a subset of projects (50) which represent the majority of research and commercial solutions proposed in the field of context-aware computing conducted over the last decade (2001-2011) based on our own taxonomy. Finally, based on our evaluation, we highlight the lessons to be learnt from the past and some possible directions for future research. The survey addresses a broad range of techniques, methods, models, functionalities, systems, applications, and middleware solutions related to context awareness and IoT. Our goal is not only to analyse, compare and consolidate past research work but also to appreciate their findings and discuss their applicability towards the IoT.Comment: IEEE Communications Surveys & Tutorials Journal, 201

    The Use of Fuzzy Clustering to Examine End User Segmentation

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    A key research theme in the field of end-user computing (EUC) is learning more about end users and their needs and designing support strategies for assisting, managing, and controlling end-user activities. Typology maps, such as those by Rockart and Flannery (1983), have been used to categorize end users into different groups based on criteria such as the skill and sophistication of EUC activity. In most such studies, users self- select themselves into one of several groups based on generic definitions provided in the study. As in most pure taxonomies, a user becomes a part of one and only one group. In this study,we provide an alternative analytical mechanism to self-selection and unitary membership: the use of fuzzy clustering, which allows for gradual membership in different groups, with membership values indicating the probability or degree of membership within a specific group or cluster. Cotterman and Kumarís (1989) classification scheme is operationalized while allowing for overlapping membership probabilities into one of three clusters: user- developer-controller (UDC), user-developer (UD), and user (U). Further, the study also examines the proposition that end users vary in their use of available support sources and also in the type of support that they require. The expectation that different categories of users have different support needs is examined at three levels: cluster level, individual level, and cluster-conjunctive level

    2013 Conference Reports

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    Making Sense of the History of Information Systems Research 1975-1999: A View of Highly Cited Papers

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    In this paper, I analyze the history of IS research through the lens of 409 highly cited papers (i.e., papers with at least 100 Reuters Thompson Web of Science citations) pub­lished between 1975 and 1999. I focus on 1) what these highly cited papers are, 2) what they study, 3) who their authors are, and 4) where they were published

    Interventions to manage use of the emergency and urgent care system by people from vulnerable groups: a mapping review

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    Background The NHS currently faces increasing demands on accident and emergency departments. Concern has been expressed regarding whether the needs of vulnerable groups are being handled appropriately or whether alternative methods of service delivery may provide more appropriate emergency and urgent care services for particular groups. Objective Our objective was to identify what interventions exist to manage use of the emergency and urgent care system by people from a prespecified list of vulnerable groups. We aimed to describe the characteristics of these interventions and examine service delivery outcomes (for patients and the health service) resulting from these interventions. Review methods We conducted an initial mapping review to assess the quantity and nature of the published research evidence relating to seven vulnerable groups (socioeconomically deprived people and families, migrants, ethnic minority groups, the long-term unemployed/inactive, people with unstable housing situations, people living in rural/isolated areas and people with substance abuse disorders). Databases, including MEDLINE and the Cumulative Index to Nursing and Allied Health Literature, and other sources were searched between 2008 and 2018. Quantitative and qualitative systematic reviews and primary studies of any design were eligible for inclusion. In addition, we searched for UK interventions and initiatives by examining press reports, commissioning plans and casebooks of ‘good practice’. We carried out a detailed intervention analysis, using an adapted version of the TIDieR (Template for Intervention Description and Replication) framework for describing interventions, and an analysis of current NHS practice initiatives. Results We identified nine different types of interventions: care navigators [three studies – moderate GRADE (Grading of Recommendations, Assessment, Development and Evaluations)], care planning (three studies – high), case finding (five studies – moderate), case management (four studies – high), front of accident and emergency general practice/front-door streaming model (one study – low), migrant support programme (one study – low), outreach services and teams (two studies – moderate), rapid access doctor/paramedic/urgent visiting services (one study – low) and urgent care clinics (one systematic review – moderate). Few interventions had been targeted at vulnerable populations; instead, they represented general population interventions or were targeted at frequent attenders (who may or may not be from vulnerable groups). Interventions supported by robust evidence (care navigators, care planning, case finding, case management, outreach services and teams, and urgent care clinics) demonstrated an effect on the general population, rather than specific population effects. Many programmes mixed intervention components (e.g. case finding, case management and care navigators), making it difficult to isolate the effect of any single component. Promising UK initiatives (front of accident and emergency general practice/front-door streaming model, migrant support programmes and rapid access doctor/paramedic/urgent visiting services) lacked rigorous evaluation. Evaluation should therefore focus on the clinical effectiveness and cost-effectiveness of these initiatives. Conclusions The review identified a limited number of intervention types that may be useful in addressing the needs of specific vulnerable populations, with little evidence specifically relating to these groups. The evidence highlights that vulnerable populations encompass different subgroups with potentially differing needs, and also that interventions seem particularly context sensitive. This indicates a need for a greater understanding of potential drivers for varying groups in specific localities. Limitations Resources did not allow exhaustive identification of all UK initiatives; the examples cited are indicative. Future work Research is required to examine how specific vulnerable populations differentially benefit from specific types of alternative service provision. Further exploration, using primary mixed-methods data and potentially realist evaluation, is required to explore what works for whom under what circumstances. Rigorous evaluation of UK initiatives is required, including a specific need for economic evaluations and for studies that incorporate effects on the wider emergency and urgent care system. Funding The National Institute for Health Research Health Services and Delivery Research programme

    Risks of user-development application in small business

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    This paper discusses the risks of developing computerised business applications by end-users particularly in the small business environment. As today’s end-users are becoming more and more sophisticated, coupled with the proliferation of Information Technology (IT) that has brought the computerisation of business activities within reach of many small firms, understanding the benefits and risks of user-developed applications would contribute towards the small firm’s effectiveness in IT adoption. This is particularly relevant in today’s managing business where businesses, including the small firms, in a volatile environment will have to compete not only locally but also globally,and IT is seen to be an enabler that can help small firms to increase their competitiveness. Relevant literature on the benefits and risks of user-developed applications were sought and summarised in this paper. Findings were also based on a case study investigation of small firms with no formal IT function where observations were made on the end-user developers who were given the responsibility to develop the firm’s computerised applications. Whilst the benefits have been enormously highlighted and at times overshadowed the risks, due attention is given to examining the risks so as to provide a more balanced report and a precautionary measure for end-user developers. Risks were categorised according to organisational and individual risks following the application development stages of planning, analysis, design and implementation

    Attachment-based family therapy for adolescents with suicidal ideation: a randomized controlled trial.

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    OBJECTIVE: To evaluate whether Attachment-Based Family Therapy (ABFT) is more effective than Enhanced Usual Care (EUC) for reducing suicidal ideation and depressive symptoms in adolescents. METHOD: This was a randomized controlled trial of suicidal adolescents between the ages of 12 and 17, identified in primary care and emergency departments. Of 341 adolescents screened, 66 (70% African American) entered the study for 3 months of treatment. Assessment occurred at baseline, 6 weeks, 12 weeks, and 24 weeks. ABFT consisted of individual and family meetings, and EUC consisted of a facilitated referral to other providers. All participants received weekly monitoring and access to a 24-hour crisis phone. Trajectory of change and clinical recovery were measured for suicidal ideation and depressive symptoms. RESULTS: Using intent to treat, patients in ABFT demonstrated significantly greater rates of change on self-reported suicidal ideation at post-treatment evaluation, and benefits were maintained at follow-up, with a strong overall effect size (ES = 0.97). Between-group differences were similar on clinician ratings. Significantly more patients in ABFT met criteria for clinical recovery on suicidal ideation post-treatment (87%; 95% confidence interval [CI] = 74.6-99.6) than patients in EUC (51.7%; 95% CI = 32.4-54.32). Benefits were maintained at follow-up (ABFT, 70%; 95% CI = 52.6-87.4; EUC 34.6%; 95% CI = 15.6-54.2; odds ratio = 4.41). Patterns of depressive symptoms over time were similar, as were results for a subsample of adolescents with diagnosed depression. Retention in ABFT was higher than in EUC (mean = 9.7 versus 2.9). CONCLUSIONS: ABFT is more efficacious than EUC in reducing suicidal ideation and depressive symptoms in adolescents. Additional research is warranted to confirm treatment efficacy and to test the proposed mechanism of change (the Family Safety Net Study).Clinical Trial Registry Information: Preventing Youth Suicide in Primary Care: A Family Model, URL: http://www.clinicaltrials.gov, unique identifier: NCT00604097
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