Time to move on from the 'love in' with outsourcing and PFI - here's how

Although public bodies invevitably have to make supply decisions that involve third parties, the law must allow them to impose public interest conditions, write John Tizard and David Walker. They explain why outsourcing has so far failed, and what should be done about it

Time to move on?

Designing design curricula is a wicked problem, just like any other design problem. Curricula are created to resolve the tensions and meet the aspirations of their time, but they cannot last forever. As the years go by, some of the concerns and issues that once seemed central lose some of their priority and other matters press. There can be no doubt, that current design and technology curricula are going to come under increasing pressure from the requirements of sustainability in a general sense – environmental, economic, and social dilemmas – and in the particular economic drive for a knowledge-based economy. This issue is essentially focussed on these pressures

Oxygen therapy: time to move on?

This analysis examines the roots of clinical practice regarding oxygen therapy and finds that some aspects have changed very little over the past 200 years. Oxygen is commonly prescribed and administered as a therapy across all healthcare settings, particularly for the treatment and management of respiratory conditions, both acute and chronic. Yet despite its widespread use and recent advances in understanding and guidance, poor practice and controversies regarding its use persist. This historical analysis highlights origins in practice that may suggest where the roots of these fallacies lie, highlighting potential ambiguities and myths that have permeated clinical and social contexts. It can be considered that based on clinical presumptions and speculation the prolific and injudicious use of oxygen was encouraged and the legacy for today’s practice seeded. The conjectures proposed here may enable modern day erroneous beliefs to be confronted and clinical practice to move on

Improving lung cancer survival; time to move on

Background: During the past decades, numerous efforts have been made to decrease the death rate among lung cancer patients. Nonetheless, the improvement in long-term survival has been limited and lung cancer is still a devastating disease.Discussion: With this article we would like to point out that survival of lung cancer could be strongly improved by controlling two pivotal prognostic factors: stage and treatment. This is corresponding with recent reports that show a decrease in lung cancer mortality by screening programs. In addition, modulation of the patient's immune system by immunotherapy either as monotherapy or combined with conventional cancer treatments offers the prospect of tailoring treatments much more precisely and has also been shown to lead to a better response to treatment and overall survival of non-small cell lung cancer patients.Summary: Since only small improvements in survival can be expected in advanced disease with the use of conventional therapies, more research should be focused on lung cancer screening programs and patient tailored immunotherapy with or without conventional therapies. If these approaches are clinically combined in a standard multidisciplinary policy we might be able to advance the survival of patients with lung cancer

Learning from the students: it’s time to move on!

At BLU 2009 we presented on our experience of applying a social constructivist approach through a blended learning course, for 130 first year undergraduate teacher education students at the University of Greenwich. Students' initial responses to blended learning showed positive engagement with the course structure and active involvement in collaborative working and use of formative feedback. Assessment outcomes demonstrated notable improvements in relation to previous cohorts. The case study being presented at this conference explores how students have helped us to move on. We are now using the blended approach in second and third year iterations of this and one other course and have added an expanding range of media and digital resources such as wikis, video information and lecture recordings. The involvement of students has proved an effective tool for change; enabling the move to blended learning across the department. We have become increasingly aware of the importance of maintaining engagement with students throughout the courses to ensure their learning is properly paced and that inconsistencies in the quality and regularity of tutor feedback through online submission are addressed. Staff have identified other limitations such as the lack of a wiki within our VLE and the limited options for online staff/student dialogue through discussion forum. Our findings, coupled with institutional transition to Moodle now act as drivers to embed blended models and enhance learning provision across the programme. As we move from using the VLE as a repository towards a fully fledged blended learning environment, we also move towards our aim of radicalizing the department's approach to teaching, learning and assessment using the students as agents of change. We have learnt from our students; they have told us it is time to move on

Urinalysis and pre-renal acute kidney injury: time to move on.

Urinary indices are classically believed to allow differentiation of transient (or pre-renal) acute kidney injury (AKI) from persistent (or acute tubular necrosis) AKI. However, the data validating urinalysis in critically ill patients are weak. In the previous issue of Critical Care, Pons and colleagues demonstrate in a multicenter observational study that sodium and urea excretion fractions as well as urinary over plasma ratios performed poorly as diagnostic tests to separate such entities. This study confirms the limited diagnostic and prognostic ability of urine testing. Together with other studies, this study raises more fundamental questions about the value, meaning and pathophysiologic validity of the pre-renal AKI paradigm and suggests that AKI (like all other forms of organ injury) is a continuum of injury that cannot be neatly divided into functional (pre-renal or transient) or structural (acute tubular necrosis or persistent)