Examining the uptake of low-carbon approaches within the healthcare sector: case studies from the National Health Service in England

The National Health Service (NHS) in the UK, is one of the largest organisations in Europe and indeed the world. It therefore has a significant ecological footprint. As a result there are key corporate, financial and environmental targets that the organisation is expected to meet as a means of reducing resource consumption. Using a case study approach, this manuscript examines best practice examples for the uptake of low-carbon strategies for energy conservation. These strategies included sustainable procurement, use of renewable energy technologies, supply chain management, use of building management systems, renegotiating energy contracts, undertaking energy audits, and behaviour change, to realise significant financial, as well as energy and carbon savings. A key focus was management of water resources, including the use of recycling and recovery of heat. The implications of the findings for building ecological and financial resilience within the organisation are also discussed

EXPLORING STUDENT PARENT EXPERIENCES WITH UNIVERSITY POLICIES AND PRACTICES

This thesis explores the experiences of student parents from the University of Mississippi and examines their perceptions of university policies and practices. In addition, this study gathers the perceptions from university staff members that occupy student support roles across the university on the types of issues they think student parents at this university face and the support that is available to student parents through policies and practices. I focus on one case study, the University of Mississippi. A total of 10 semi-structed, in-depth interviews were conducted with one current student parent, four recently graduated student parents, and five university staff members. I conducted an extensive review of the existing policies at the University of Mississippi in search of any policy that might relate to or impact a student parent’s experience. The policy review contributed to the institutional analysis of this study significantly. I found the school-family balance and lack of affordable childcare are the biggest issues student parents in this study face. It showcases specific barriers student parents encounter most often and how they are embedded into the structure of this organization. This thesis discusses how supporting student parents is something that is deemed essential and valued by the staff members I interviewed. However, these staff members are limited in the support that they are available to provide. The experiences student parents in this study had reveal how the “ideal student” culture is constructed, maintained, and reinforced through policies and practices. This study found that the University of Mississippi does not consider students “care taking” responsibilities when it comes to making policies and practices. Therefore, student parents must adjust their caretaking practices around it. Lastly, this thesis concludes with a discussion on the implications and recommendations for the University and potential future studies

Barriers to Tour Operator Sustainable Supply Chain Management

Tour operators requesting their contracted overseas accommodations providers to apply, measure and report their sustainability actions are facing a number of barriers when trying to ensure the effective implementation of environmental sustainability criteria in particular. This article reviews how sustainability systems are being challenged by organizational habit and perceptions rather than analytical decision-making with respect to the relationship between health and safety, quality and sustainability. Environmental indicators are identified as the most conflictive; the key findings demonstrate that most challenges require a change in human behaviour rather than a technical solution. The data suggests that tour operators need to develop sustainability auditing tools that consider the impacts upon health, safety and quality within the accommodations. The Travelife sustainability auditing system provides a useful case study to demonstrate the necessary requirement for a complementary approach when conducting accommodations audits

Supporting the UN's Sustainable Development Goals: reconceptualising a 'sustainable development assessment tool' for the health and care system in England

Aims: As one of the biggest organisations in the world, the NHS in England can contribute considerably to the United Nations’ Global Sustainable Development Goals (SDGs). In order to optimise this, this study evaluated and reconceptualised a sustainable development assessment tool for health and care settings in England. Methods: A quantitative survey and user/expert discussion panels were conducted to evaluate and reconceptualise the existing sustainable development assessment tool used by the NHS in England, the so-called ‘Good Corporate Citizenship Assessment Tool’, between 2007 and 2016 including potential improvements such as the integration of the UN SDGs. Results: A reconceptualised self-assessment tool integrating the UN’s SDGs was developed and implemented online as the ‘Sustainable Development Assessment Tool (SDAT)’. Further improvements included a process orientated redesign and the creation of new modules and cross-sections aligning them with the leads responsible for the implementation of key initiatives in NHS organisations, which would contribute to achieving the targets of the SDGs. Conclusions: User/expert involvement has enabled an informed approach to a reconceptualisation of a sustainable assessment tool for health and care settings. The tool will support organisations to build their mandatory Sustainable Development Management Plans, as part of the national Public Health Outcomes Framework. Alignment of the tool to the UN Sustainable Development Goals provides an opportunity for health and care organisations to demonstrate accountability and progress against the UN’s set of transformational goals. Furthermore, the tool could be adapted to other public service providers

The prevalence, clinical features, risk factors and outcome associated with cryptococcal meningitis in HIV positive patients in Kenya

Objectives: To determine the prevalence, clinical features, risk factors and outcomes associated with cryptococcal meningitis (CM) in human immunodeficiency virus (HIV) positive patients at two referral hospitals in Nairobi, Kenya.Design: Prospective, observational study.Setting: Kenyatta National Hospital (KNH) and Mbagathi District Hospital (MDH), Nairobi, KenyaSubjects: Three hundred and forty HIV patients presenting with suspected CM.Results: Of three hundred and forty suspected CM patients, 111 (33%) were diagnosed with CM by CrAg. Among CM patients, in-hospital mortality was 36% (38/106), median age was 35 years (range, 19-60 years) and median CD4 count was 41 cells/μL (n=89, range 2-720 cells/μL). Common clinical manifestations among CM patients included headache 103 (93%), neck stiffness 76 (69%) and weight loss 53 (48%). Factors independently associated with CM were male sex, headache, blurred vision and previous antifungal drug use. Night sweats and current use of anti-retroviral therapy were associated with reduced risk for CM.Conclusions: There is a high prevalence of CM and CM-associated mortality in HIV patients at KNH and MDH despite treatment with antifungal and anti-retroviral drugs. This study demonstrates the need to address the existing inadequacies of CM patient outcomes in Kenya

Mortality After Clinical Management of Aids-Associated Cryptococcal Meningitis in Kenya

Background: Cryptococcal meningitis (CM) is an increasingly prevalent  infection among HIV/AIDS patients and is becoming a leading cause of  morbidity and mortality in Africa. The short-term prognosis and  management of patients with CM may be improved by identifying factors leading to mortality in patients with CM.Objective: To assess the clinical management and mortality associated with cryptococcal meningitis (CM) in patients with acquired  immunodeficiency syndrome (AIDS) in Kenya.Design: A retrospective study.Setting: Kenyatta National Hospital and Mbagathi District Hospital, between August 2008 and March 2009.Subjects: Seventy six HIV-infected patients confirmed to be CM positive.Results: Results show that 30 (40%) of 76 patients diagnosed with CM died during hospitalisation after a median hospital stay of ten days (range, 2-73 days). Significant predictors of mortality in the univariate model were Mycobacterium tuberculosis (TB) co-infection (P = 0.04), having been diagnosed with a co-morbid condition such as diabetes mellitus, oral candidiasis and hypertension (P = 0.01), and a low median CD4+ T lymphocyte count (P < 0.001). The multivariable model revealed that male sex, previous or current anti-retroviral therapy (ART) at admission and CD4+ T lymphocyte count less than 50 were significant predictors of mortality. Conversely, a minimum of two weeks of amphotericin B treatment (P < 0.001), initiation of ART (P = 0.007) and monitoring of creatinine and electrolyte levels (P = 0.02) were significantly associatedwith survival in the univariate model.Conclusions: CM-associated mortality in Kenya is high; there is an  opportunity to improve the management and the short-term outcomes of hospitalised HIV positive patients with CM in Kenya

Management of histoplasmosis by infectious disease physicians

BACKGROUND: The Infectious Diseases Society of America (IDSA) guidelines for the management of histoplasmosis were last revised 15 years ago. Since those guidelines were compiled, new antifungal treatment options have been developed. Furthermore, the ongoing development of immunomodulatory therapies has increased the population at increased risk to develop histoplasmosis. METHODS: An electronic survey about the management practices of histoplasmosis was distributed to the adult infectious disease (ID) physician members of the IDSA\u27s Emerging Infections Network. RESULTS: The survey response rate was 37% (551/1477). Only 46% (253/551) of respondents reported seeing patients with histoplasmosis. Regions considered endemic had 82% (158/193) of physicians report seeing patients with histoplasmosis compared to 27% (95/358) of physicians in regions not classically considered endemic ( CONCLUSIONS: Though there are increased reports of histoplasmosis diagnoses outside regions classically considered endemic, a majority of ID physicians reported not seeing patients with histoplasmosis. Most respondents reported adherence to IDSA guidelines recommending itraconazole in each clinical situation. New histoplasmosis guidelines need to reflect the growing need for updated general guidance, particularly for immunocompromised populations