Evaluation of a multidisciplinary Tier 3 weight management service for adults with morbid obesity, or obesity and comorbidities, based in primary care

A multidisciplinary Tier 3 weight management service in primary care recruited patients with a body mass index ≥40 kg·m−2, or 30 kg·m−2 with obesity-related co-morbidity to a 1-year programme. A cohort of 230 participants was recruited and evaluated using the National Obesity Observatory Standard Evaluation Framework. The primary outcome was weight loss of at least 5% of baseline weight at 12 months. Diet was assessed using the two-item food frequency questionnaire, activity using the General Practice Physical Activity questionnaire and quality of life using the EuroQol-5D-5L questionnaire. A focus group explored the participants' experiences. Baseline mean weight was 124.4 kg and mean body mass index was 44.1 kg·m−2. A total of 102 participants achieved 5% weight loss at 12 months. The mean weight loss was 10.2 kg among the 117 participants who completed the 12-month programme. Baseline observation carried forward analysis gave a mean weight loss of 5.9 kg at 12 months. Fruit and vegetable intake, activity level and quality of life all improved. The dropout rate was 14.3% at 6 months and 45.1% at 1 year. Focus group participants described high levels of satisfaction. It was possible to deliver a Tier 3 weight management service for obese patients with complex co-morbidity in a primary care setting with a full multidisciplinary team, which obtained good health outcomes compared with existing services

SEED: a tool for disseminating systematic review data into Wikipedia

Wikipedia, the free-content online encyclopaedia, contains many heavily accessed pages relating to healthcare. Cochrane systematic reviews contain much high-grade evidence but dissemination into Wikipedia has been slow. New skills are needed to both translate and relocate data from Cochrane reviews to implant into Wikipedia pages. This letter introduces a programme to greatly simplify the process of disseminating the summary of findings of Cochrane reviews into Wikipedia pages

Managing the delivery of iconic football stadiums in England

The English football premier league has become the most popular sports league in the world; with ardent fans and audiences all over the world. The potential business opportunities that this growth holds have therefore attracted investors who are keen to buy shares in the clubs and sign up the best footballers that money can buy. Underpinning the growth in all of the premier league clubs is a desire to make a distinct statement of identity as part of a competitive strategy. One way to achieve this is through the design and construction of iconic football stadiums. This paper explores the specific project management challenges associated with delivery of iconic football stadiums in England and draws lessons for the management of similar iconic infrastructure projects. A study of project management best practice and some case studies shows that key issues which are common to these projects are centred on design management; choice of procurement route; client management; and stakeholder expectation management. These issues are not necessarily unique to the project management of iconic football stadiums but are amplified by the context of these projects. The emphasis on iconic status in a competitive market also means that stadium projects should be conceived and delivered in the context of other strategic projects which should be clearly understood by the project management team

Implementation : action or stalemate

Caption title"#2329"--handwritten on cover. -- Series statement handwritten on coverAt head of title: "Conference on Public Policy Issues In Nuclear Waste Management October 29, 1976."Includes bibliographical reference

What is the effect of size on the use of the EFQM excellence model?

Purpose By contrasting a contingency with a universal approach to business excellence models (BEMs), the purpose of this paper is to investigate the effect of size on the use of the European Foundation for Quality Management (EFQM) model by organizations that were officially “Recognized for Excellence” in Spain. It considers the potential differences between large organizations and SMEs on the level of adoption of EFQM criteria and on the impact that enablers-criteria may have on key performance measures. Design/methodology/approach This study uses actual sub-criteria and criteria scores attained by organizations in their assessment for EFQM recognition. Scores of a population of 216 organizations are analyzed via analysis of variance, factor and structural equations models. Findings Although there are some criteria in the EFQM model that appear to be universally adopted irrespective of size, the empirical analyses indicate that size may shape the adoption of other criteria and the impact that enablers can have on results, thus supporting a contingency perspective. Moreover, the findings call for the revision of the relationships embedded in the EFQM model. Originality/value In contrast to most previous research, which relied on surveys of managers’ perceptions, this study uses the actual scores achieved by organizations in their assessment for EFQM recognition. It addresses the effect of size on the whole model, which so far has been neglected in the literature. All in all this study contributes to the literature on contingency approaches to best practices, and more specifically to BEMs. To the practitioner, it provides guidelines for addressing perceived performance gaps in their pursuit of recognition for excellence

Private finance for the delivery of school projects in England

This paper analyses the use of the private finance initiative (PFI) approach to deliver school projects in England. The findings are based on case-study research in the Building Schools for the Future scheme (BSF), the largest single capital investment in SO years to rebuild and renew all of England's secondary schools. Up to half of the school infrastructure is to be procured by PFI contracts. A major concern has been the high cost associated with PFI procurement and any subsequent changes to scope. Furthermore, in some cases PFI-funded schools have been closed soon after completion; at great cost to the public sector. The aim of this research was therefore to understand the underlying reasons for these problems. The main conclusion is that the difficulties in BSF arise from not sorting out strategic issues and instituting appropriate organisational frameworks before engaging the private sector. The result of this is a lack of clarity about the long-term needs and end user aspirations. A brief outline of current programme management methods is given and it is suggested that this might be integral to the successful delivery of schools using private finance. A clear strategic vision that cascades into projects via programmes will ensure that the school infrastructure is appropriate for the anticipated strategic benefits and is aligned to the overall service delivery ambitions

Can processes make relationships work? The Triple Helix between structure and action

This contribution seeks to explore how complex adaptive theory can be applied at the conceptual level to unpack Triple Helix models. We use two cases to examine this issue – the Finnish Strategic Centres for Science, Technology & Innovation (SHOKs) and the Canadian Business-led Networks of Centres of Excellence (BL-NCE). Both types of centres are organisational structures that aspire to be business-led, with a considerable portion of their activities driven by (industrial) users’ interests and requirements. Reflecting on the centres’ activities along three dimensions – knowledge generation, consensus building and innovation – we contend that conceptualising the Triple Helix from a process perspective will improve the dialogue between stakeholders and shareholders

Assessment in higher education : the potential for a community of practice to improve inter-marker reliability

The design, delivery and assessment of a complete educational scheme, such as a degree programme or a professional qualification course, is a complex matter. Maintaining alignment between the stated aims of the curriculum and the scoring of student achievement is an overarching concern. The potential for drift across individual aspects of an educational scheme (teaching, learning and assessment), together with emerging criticism in extant literature of the reliability of marking processes, suggests that, in practice, maintaining alignment might be more difficult than had previously been assumed. In this paper, the concept of a Community of Practice (CoP) is employed as an analytical lens through which the notion of a markers’ standardisation meeting that focuses on maintaining alignment between the curriculum, the marking scheme and the scoring of student scripts can be critically examined. Given that the aims and subject content of management learning are both multidimensional and contextual, such meetings have the potential to develop a shared approach to the elaboration and application of the marking scheme. A further role of the CoP is in the calibration of markers to accommodate further variations in student responses as they arise in the actual marking process. In this respect, the CoP has both descriptive and prescriptive potential in terms of aiding the development of markers of professional accounting examinations and also, we suggest, within accounting education more generally

Pediatric Cushing disease: disparities in disease severity and outcomes in the Hispanic and African-American populations.

BackgroundLittle is known about the contribution of racial and socioeconomic disparities to severity and outcomes in children with Cushing disease (CD).MethodsA total of 129 children with CD, 45 Hispanic/Latino or African-American (HI/AA) and 84 non-Hispanic White (non-HW), were included in this study. A 10-point index for rating severity (CD severity) incorporated the degree of hypercortisolemia, glucose tolerance, hypertension, anthropomorphic measurements, disease duration, and tumor characteristics. Race, ethnicity, age, gender, local obesity prevalence, estimated median income, and access to care were assessed in regression analyses of CD severity.ResultsThe mean CD severity in the HI/AA group was worse than that in the non-HW group (4.9±2.0 vs. 4.1±1.9, P=0.023); driving factors included higher cortisol levels and larger tumor size. Multiple regression models confirmed that race (P=0.027) and older age (P=0.014) were the most important predictors of worse CD severity. When followed up a median of 2.3 years after surgery, the relative risk for persistent CD combined with recurrence was 2.8 times higher in the HI/AA group compared with that in the non-HW group (95% confidence interval: 1.2-6.5).ConclusionOur data show that the driving forces for the discrepancy in severity of CD are older age and race/ethnicity. Importantly, the risk for persistent and recurrent CD was higher in minority children

Radiolysis of NaCl at high and low temperatures: development of size distribution of bubbles and colloids

New experimental results are presented on low temperature irradiation (18 °C) of rock-salt samples which had been exposed to initial doses up to 320 GRad at 100 °C. Differential scanning calorimetry (DSC) shows that the latent heat of melting (LHM) of sodium colloids decreases during subsequent low-temperature irradiation, whereas the stored energy (SE) increases slowly, indicating that the process of radiolysis continues. The decrease of the LHM is due to dissolution of large colloids, because the intensities of the melting peaks decrease during the second stage irradiation at low temperature. The model is formulated to describe the nucleation kinetics and the evolution of the size distribution of chlorine precipitates and sodium colloids in NaCl under high dose irradiation. It is shown that the mechanism of dissolution of large Na colloids during low temperature irradiation can be related to melting of sodium colloids.