An evaluation of the appropriateness of advice and healthcare contacts made following calls to NHS Direct Wales

Background: An evaluation of NHS Direct Wales (NHSDW), a national telephone-based healthcare advice and information service, was undertaken. A key objective was to describe the actions of callers and assess the appropriateness of advice and healthcare contacts made following calls, results of which are reported here. Methods: Postal questionnaires were sent to consecutive callers to NHSDW in May 2002 and February 2004 to determine 1) callers' actions following calls and 2) their views about the appropriateness of: advice given; and when to seek further care. An independent clinical panel agreed and applied a set of rules about healthcare sites where examinations, investigations, treatments and referrals could be obtained. The rules were then applied to the subsequent contacts to healthcare services reported by respondents and actions were classified in terms of whether they had been necessary and sufficient for the care received. Results: Response rates were similar in each survey: 1033/1897 (54.5%); 606/1204 (50.3%), with 75% reporting contacting NHSDW. In both surveys, nearly half of all callers reported making no further healthcare contact after their call to NHSDW. The most frequent subsequent contacts made were with GPs. More than four fifths of callers rated the advice given - concerning any further care needed and when to seek it - as appropriate (further care needed: survey 1: 673/729, 82.3%; survey 2: 389/421, 92.4%; when to seek further care - survey 1: 462/555, 83.2%; survey 2: n = 295/346, 85.3%). A similar proportion of cases was also rated through the rule set and backed up by the clinical panel as having taken necessary and sufficient actions following their calls to NHSDW (survey 1: 624/729, 80.6%; survey 2: 362/421, 84.4%), with more unnecessary than insufficient actions identified at each survey (survey 1: unnecessary 132/729, 17.1% versus insufficient 11/729, 1.4%; survey 2: unnecessary 47/421, 11.0% versus insufficient 14/421, 3.3%). Conclusion: Based on NHSDW caller surveys responses and applying a transparent rule set to caller actions a large majority of subsequent actions were assessed as appropriate, with insufficient contacts particularly infrequent. The challenge for NHSDW is to reduce the number of unnecessary contacts made following calls to the service, whilst maintaining safety.</p

The pH-responsive PacC transcription factor of Aspergillus fumigatus governs epithelial entry and tissue invasion during pulmonary aspergillosis

Data Availability: The authors confirm that all data underlying the findings are fully available without restriction. Raw data have been deposited in the Gene Expression Omnibus (GEO) (http://www.ncbi.nlm.nih.gov/geo/) under accession number GSE54810. Funding: This work was supported in part by grants to EMB from the MRC (G0501164) and BBSRC (BB/G009619/1), to EMB and NDR from the Wellcome Trust (WT093596MA), to MB from Imperial College London (Division of Investigative Sciences PhD Studentship), to HH from the ERA-NET PathoGenoMics project TRANSPAT, Austrian Science Foundation (FWF I282-B09), to SGF from the National Institutes of Health, USA (R01AI073829). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Peer reviewedPublisher PD

Giving Miss Marple a makeover : graduate recruitment, systems failure and the Scottish voluntary sector

The voluntary sector in Scotland, as across the globe, is becoming increasingly business like. Resultantly, there is an increasing demand for graduates to work in business and support functions. In Scotland, however, despite an oversupply of graduates in the labor market, the voluntary sector reports skills shortages for graduate-level positions; a leadership deficit was also reported in countries such as the United States. Through exploratory, mainly qualitative, case study and stakeholder research, this article proposes that one reason for this mismatch between the supply of and demand for graduates is a systems failure within the sector. Many graduates and university students remain unaware of potentially suitable paid job opportunities, in part because of the sector's voluntary label. To rectify this systems failure, thought needs to be given to the sector's nomenclature and the manner in which voluntary sector organizations attract graduate recruits, for example, through levering value congruence in potential recruits

The first legal mortgagor: a consumer without adequate protection?

This article contends that the UK government’s attempt to create a well-functioning consumer credit market will be undermined if it fails to reform the private law framework relating to the first legal mortgage. Such agreements are governed by two distinct regulatory regimes that are founded upon very different conceptions of the mortgagor. The first, the regulation of financial services overseen by the Financial Conduct Authority, derives from public law and is founded upon a conception of the mortgagor as “consumer”. The other is land law, private law regulation implemented by the judiciary and underpinned by a conception of the mortgagor as “landowner”. Evidence suggests that the operation of these two regimes prevents mortgagors from receiving fair and consistent treatment. The current reform of financial services regulation therefore will change only one part of this governance regime and will leave mortgagors heavily reliant upon a regulator that still has to prove itself. What this article argues is that reform of the rules of private law must also be undertaken with the aim of initiating a paradigm shift in the conception of the mortgagor from “landowner” to “consumer”. Cultural shifts of this kind take time but the hope is that this conceptual transformation will occur in time to deter the predicted rise in mortgage possessions

Anomalous small angle x-ray scattering simulations: proof of concept for distance measurements for nanoparticle-labelled biomacromolecules in solution.

Anomalous small angle X-ray scattering can in principle be used to determine distances between metal label species on biological molecules. Previous experimental studies in the past were unable to distinguish the label-label scattering contribution from that of the molecule, because of the use of atomic labels; these labels contribute only a small proportion of the total scattering signal. However, with the development of nanocrystal labels (of 50-100 atoms) there is the possibility for a renewed attempt at applying anomalous small angle X-ray scattering for distance measurement. This is because the contribution to the scattered signal is necessarily considerably stronger than for atomic labels. Here we demonstrate through simulations, the feasibility of the technique to determine the end-to-end distances of labelled nucleic acid molecules as well as other internal distances mimicking a labelled DNA binding protein if the labels are dissimilar metal nanocrystals. Of crucial importance is the ratio of mass of the nanocrystals to that of the labelled macromolecule, as well as the level of statistical errors in the scattering intensity measurements. The mathematics behind the distance determination process is presented, along with a fitting routine than incorporates maximum entropy regularisation

Approaches to working with children and families: a review of the evidence for practice

This paper explores a range of approaches to working with children and families within Children's Services and Children's Social Care, in a UK local authority context. There are a variety of established approaches, supported by different concepts and theories. Given the substantial recent and developing changes in the political, social and economic context for supporting families in need, collating academic and practical evidence to inform both theory and decision making is vital. The article has a practice focus for Children's Services, but it is also relevant and has implications for a much wider readership. Evidence was gathered through a purposive and rapid review, and aggregated with practice evidence from various sources. An array of issues is considered relating to the context, theory, application, implementation and evaluation of taking one or several approaches. Overall, there is a very limited evidentiary basis, either from research or local authority practice, for adopting any one, wholesale approach to working with children and families in a local authority context over another, but there is emerging evidence of the benefits that certain models and approaches could have, and anecdotally the decision to adopt one formal model appears to be increasing

Accounting students' IT applicaton skills over a 10-year period

This paper reports on the changing nature of a range of information technology (IT) application skills that students declare on entering an accounting degree over the period from 1996 to 2006. Accounting educators need to be aware of the IT skills students bring with them to university because of the implications this has for learning and teaching within the discipline and the importance of both general and specific IT skills within the practice and craft of accounting. Additionally, IT skills constitute a significant element within the portfolio of employability skills that are increasingly demanded by employers and emphasized within the overall Higher Education (HE) agenda. The analysis of students' reported IT application skills on entry to university, across a range of the most relevant areas of IT use in accounting, suggest that their skills have continued to improve over time. However, there are significant differential patterns of change through the years and within cohorts. The paper addresses the generalizability of these findings and discusses the implications of these factors for accounting educators, including the importance of recognising the differences that are potentially masked by the general increase in skills; the need for further research into the changing nature, and implications, of the gender gap in entrants' IT application skills; and the low levels of entrants' spreadsheet and database skills that are a cause for concern

Hydrometeorological, glaciological and geospatial research data from the Peyto Glacier Research Basin in the Canadian Rockies

Canada First Research Excellent Fund’s Global Water Futures Programme, the National Sciences and Engineering Research Council of Canada’s Changing Cold Regions Network and Discovery Grants programme, the Canada Foundation for Innovation’s Canadian Rockies Hydrological Observatory, the Canada Research Chairs and Canada Excellence Research Chairs programmes, the Canadian Foundation for Climate and Atmospheric Sciences IP3 and WC2N networks, Natural Resources Canada, Environment Canada, Columbia Basin Trust, BC HydroPeer ReviewedThis paper presents hydrometeorological, glaciological and geospatial data from the Peyto Glacier Research Basin (PGRB) in the Canadian Rockies. Peyto Glacier has been of interest to glaciological and hydrological researchers since the 1960s, when it was chosen as one of five glacier basins in Canada for the study of mass and water balance during the International Hydrological Decade (IHD, 1965–1974). Intensive studies of the glacier and observations of the glacier mass balance continued after the IHD, when the initial seasonal meteorological stations were discontinued, then restarted as continuous stations in the late 1980s. The corresponding hydrometric observations were discontinued in 1977 and restarted in 2013. Datasets presented in this paper include high-resolution, co-registered digital elevation models (DEMs) derived from original air photos and lidar surveys; hourly off-glacier meteorological data recorded from 1987 to the present; precipitation data from the nearby Bow Summit weather station; and long-term hydrological and glaciological model forcing datasets derived from bias-corrected reanalysis products. These data are crucial for studying climate change and variability in the basin and understanding the hydrological responses of the basin to both glacier and climate change. The comprehensive dataset for the PGRB is a valuable and exceptionally long-standing testament to the impacts of climate change on the cryosphere in the high-mountain environment. The dataset is publicly available from Federated Research Data Repository at https://doi.org/10.20383/101.0259 (Pradhananga et al., 2020)

A randomised controlled trial and cost-effectiveness evaluation of "booster" interventions to sustain increases in physical activity in middle-aged adults in deprived urban neighbourhoods

Background: Systematic reviews have identified a range of brief interventions which increase physical activity in previously sedentary people. There is an absence of evidence about whether follow up beyond three months can maintain long term physical activity. This study assesses whether it is worth providing motivational interviews, three months after giving initial advice, to those who have become more active. Methods/Design: Study candidates (n = 1500) will initially be given an interactive DVD and receive two telephone follow ups at monthly intervals checking on receipt and use of the DVD. Only those that have increased their physical activity after three months (n = 600) will be randomised into the study. These participants will receive either a "mini booster" (n = 200), "full booster" (n = 200) or no booster (n = 200). The "mini booster" consists of two telephone calls one month apart to discuss physical activity and maintenance strategies. The "full booster" consists of a face-to-face meeting with the facilitator at the same intervals. The purpose of these booster sessions is to help the individual maintain their increase in physical activity. Differences in physical activity, quality of life and costs associated with the booster interventions, will be measured three and nine months from randomisation. The research will be conducted in 20 of the most deprived neighbourhoods in Sheffield, which have large, ethnically diverse populations, high levels of economic deprivation, low levels of physical activity, poorer health and shorter life expectancy. Participants will be recruited through general practices and community groups, as well as by postal invitation, to ensure the participation of minority ethnic groups and those with lower levels of literacy. Sheffield City Council and Primary Care Trust fund a range of facilities and activities to promote physical activity and variations in access to these between neighbourhoods will make it possible to examine whether the effectiveness of the intervention is modified by access to community facilities. A one-year integrated feasibility study will confirm that recruitment targets are achievable based on a 10% sample.Discussion: The choice of study population, study interventions, brief intervention preceding the study, and outcome measure are discussed

Psychometric Evaluation of the Arabic Version of the Spiritual Well-Being Scale on a Sample of Jordanian Arab Christians

This paper assesses the psychometric properties of the Arabic version of the Spiritual Well-Being Scale (SWBS) in an Arab Christian sample by analyzing its internal structure. A convenience sample of 340 Arab Christians was recruited from the adult community population of northern Jordan. Data were collected through a self-completion, anonymous questionnaire distributed through church and community groups. Principal Components factor analysis, non-parametric bivariate statistics, and Cronbach's alpha were used to assess the psychometric properties of the total scale and its subscales. The findings broadly supported the factor structure of the SWBS in other Arab samples in that the scale consists of three factors, representing positive existential well-being, affiliation, and alienation subscales. In conclusion, these preliminary findings suggest that the Arabic version of the SWBS can be used as an instrument to measure levels of spiritual well-being in Arab Christian populations. </jats:p