Assessing the impact of the New Student Support Arrangements (NSSA) on higher education institutions (BIS research paper no.12)

"The research explores the impact on the policies, planning and behaviours of universities nearly four years after the introduction of new arrangements for student support in higher education (known as NSSA). It is set within the context of continued policy focus on increasing and widening participation, rising importance of university performance indicators in student choices, and a challenging economic climate. The research uses qualitative evidence collected from over 120 staff in 15 case studies across England..." - exec. summary

Making soft intelligence hard: a multi-site qualitative study of challenges relating to voice about safety concerns.

BACKGROUND: Healthcare organisations often fail to harvest and make use of the 'soft intelligence' about safety and quality concerns held by their own personnel. We aimed to examine the role of formal channels in encouraging or inhibiting employee voice about concerns. METHODS: Qualitative study involving personnel from three academic hospitals in two countries. Interviews were conducted with 165 participants from a wide range of occupational and professional backgrounds, including senior leaders and those from the sharp end of care. Data analysis was based on the constant comparative method. RESULTS: Leaders reported that they valued employee voice; they identified formal organisational channels as a key route for the expression of concerns by employees. Formal channels and processes were designed to ensure fairness, account for all available evidence and achieve appropriate resolution. When processed through these formal systems, concerns were destined to become evidenced, formal and tractable to organisational intervention. But the way these systems operated meant that some concerns were never voiced. Participants were anxious about having to process their suspicions and concerns into hard evidentiary facts, and they feared being drawn into official procedures designed to allocate consequence. Anxiety about evidence and process was particularly relevant when the intelligence was especially 'soft'-feelings or intuitions that were difficult to resolve into a coherent, compelling reconstruction of an incident or concern. Efforts to make soft intelligence hard thus risked creating 'forbidden knowledge': dangerous to know or share. CONCLUSIONS: The legal and bureaucratic considerations that govern formal channels for the voicing of concerns may, perversely, inhibit staff from speaking up. Leaders responsible for quality and safety should consider complementing formal mechanisms with alternative, informal opportunities for listening to concerns

A systematic review investigating the behaviour change strategies in interventions to prevent misuse of anabolic steroids.

We examined intervention effectiveness of strategies to prevent image- and performance-enhancing drug use. Comprehensive searches identified 14 interventions that met review inclusion criteria. Interventions were predominantly educational and delivered within school sport settings, but targeted a wide range of mediating factors. Identification of effective components was limited across studies by brief or imprecise descriptions of intervention content, lack of behavioural outcome measures and short-term follow-up times. However, studies with components in addition to information provision may be more promising. Interventions outside of sport settings are required to reflect the transition of this form of substance use to the general population

Point of care testing for urinary tract infection in primary care (POETIC): protocol for a randomised controlled trial of the clinical and cost effectiveness of FLEXICULT (TM) informed management of uncomplicated UTI in primary care

BACKGROUND: Urinary tract infections (UTI) are the most frequent bacterial infection affecting women and account for about 15% of antibiotics prescribed in primary care. However, some women with a UTI are not prescribed antibiotics or are prescribed the wrong antibiotics, while many women who do not have a microbiologically confirmed UTI are prescribed antibiotics. Inappropriate antibiotic prescribing unnecessarily increases the risk of side effects and the development of antibiotic resistance, and wastes resources. POETIC is a randomised controlled trial of a Point Of Care Test (POCT) (Flexicult™) guided UTI management strategy for use in primary care, which may help General Practitioners more effectively decide both whether or not to prescribe antibiotics, and if so, to select the most appropriate antibiotic. METHODS/DESIGN: 614 adult female patients will be recruited from four primary care research networks (Wales, England, Spain, the Netherlands) and individually randomised to either POCT guided care or the guideline-informed ‘standard care’ arm. Urine and stool samples (where possible) will be obtained at presentation (day 1) and two weeks later for microbiological analysis. All participants will be followed up on the course of their illness and their quality of life, using a 2 week self-completed symptom diary. At 3 months, a primary care notes review will be conducted for evidence of further evidence of treatment failures, recurrence, complications, hospitalisations and health service costs. The primary objective is to compare appropriate antibiotic use on day 3 between the POCT and standard care arms using multi-level logistic regression to produce an odds ratio and associated 95% confidence interval. Costs of the two management approaches will be assessed in terms of the primary outcome. DISCUSSION: Although the Flexicult™ POCT is used in some countries in routine primary care, it’s clinical and cost effectiveness has never been evaluated in a randomised clinical trial. If shown to be effective, the use of this POCT could benefit individual sufferers and provide evidence for health care authorities to develop evidence based policies to combat the spread and impact of the unprecedented rise of infections caused by antibiotic resistant bacteria in Europe. TRIAL REGISTRATION NUMBER: ISRCTN65200697 (Registered 10 September 2013)

Accessibility of Health Data Representations for Older Adults: Challenges and Opportunities for Design

Health data of consumer off-the-shelf wearable devices is often conveyed to users through visual data representations and analyses. However, this is not always accessible to people with disabilities or older people due to low vision, cognitive impairments or literacy issues. Due to trade-offs between aesthetics predominance or information overload, real-time user feedback may not be conveyed easily from sensor devices through visual cues like graphs and texts. These difficulties may hinder critical data understanding. Additional auditory and tactile feedback can also provide immediate and accessible cues from these wearable devices, but it is necessary to understand existing data representation limitations initially. To avoid higher cognitive and visual overload, auditory and haptic cues can be designed to complement, replace or reinforce visual cues. In this paper, we outline the challenges in existing data representation and the necessary evidence to enhance the accessibility of health information from personal sensing devices used to monitor health parameters such as blood pressure, sleep, activity, heart rate and more. By creating innovative and inclusive user feedback, users will likely want to engage and interact with new devices and their own data

“What does THIS Mean?”: A Collaborative Expert Evaluation of Health Data Representations for Older Adults

Health Data Representations (HDRs) pose significant accessibility problems for people with disabilities and older adults, particularly those with visual, hearing, speech, motor and cognitive impairments, as well as literacy problems. While methodologies like heuristic evaluation and visualisation literacy are valuable, they have limitations in addressing the varied and nuanced range of data representations and perceptual matching issues. This paper presents findings from a collaborative expert evaluation that strategically bridges the gap between domain experts and non-experts. By scoping out representative HDRs, our approach significantly expands the research space for accessibility issues within the designated scope, narrowing critical gaps in existing independent guidelines. Using this methodology, we carefully examined common conventional HDRs, collaborating with experts to identify 179 potential issues specific to older adults. Categorisation strategies highlighted key issues within this broad problem space, showing that existing guidelines fail to effectively address all of the predominant categories. Our paper presents a set of emerging impairment-agnostic recommendations in response, embedding crucial steps towards mitigating these problems. Our study not only identifies challenges but also provides a model for iterative evaluation and adaptation of critical HDR. Beyond informing more accessible system design, we also highlight innovative opportunities for future HDRs

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Evaluation of Learner Support Funds: final report 2003

"This report is the culmination of a two year evaluation of the Learner Support Funds for the Department for Education and Skills (DfES). These funds are available to students across the FE sector and are designed to support disadvantaged individuals with the additional costs of studying (eg books, equipment, transport, childcare and the costs of residential study) in order to encourage participation, retention, achievement and progression." - Page 8

SEX DIFFERENCES ASSOCIATED WITH MIP-3α-ANTIGEN FUSION DNA VACCINE IN TUBERCULOSIS MODEL

Background: Tuberculosis (TB) remains a major cause of global mortality. A therapeutic DNA vaccine targeting RelMtb has been shown to increase the efficacy of antitubercular drugs, and fusing macrophage-inflammatory protein 3α (MIP-3α to RelMtb) further increases the vaccine’s therapeutic efficacy. A previous study in the laboratory found that overall MIP-3α enhanced vaccine uptake and cell activation by iDCs. Female mice showed greater levels of antigen presentation, especially in DCs able to cross present antigen, explaining why they had the best outcomes. The current study hypothesizes that females compared to males will show enhancement of genes associated with CD8+ T cell recruitment and cross-presentation that are more pronounced with MIP 3α-antigen fusion vaccines and that females will have higher levels of immune cell infiltration and Yae+ dendritic cells that are more pronounced with the vaccine construct including MIP-3α. Methods: To determine which genes might be contributing to the sex difference phenotype qRT-PCR analysis was performed. Additionally, fluorescence microscopy of the muscle was utilized to determine the amounts of GFP, Yae vaccine antigen, and Cd11c+ dendritic cells at the site of vaccination. Results: Most of the genes upregulated in MIP-3α females were chemokines involved in immune cell motility and attracting cells to the node, while many of the genes that are upregulated in males are important in monocyte-derived DC-driven T cell responses or signal DC maturation. At the site of vaccination, Mip-EαGFP females had higher ii amounts of Cd11c+ signal, DAPI+ signal, and a higher percentage of DAPI+ signal that is also Cd11c+ when compared to EαGFP females. Conclusions: The Rel vaccine enhances TB bacterial clearance by antibiotics with a female bias, and that fusion of MIP-3α enhances both the overall response and the sex bias. The data supports the hypotheses that fusing MIP-3α to the antigen leads to better targeting and activation of APCs at the vaccination site, and more dendritic cell and immune cell infiltration in females. More research studying the mechanisms involved in the sex differences is pivotal to fully understanding how vaccination elicits a more robust immune response and how to best treat persistent TB