399 research outputs found

    Integration of patient-reported outcome measures with key clinical outcomes after immediate latissimus dorsi breast reconstruction and adjuvant treatment

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    Background: linical evidence on patient-reported outcome measures (PROMS) in breast reconstruction is lacking. The aim of this study was to evaluate PROMs in implant-assisted latissimus dorsi (LDI) or tissue-only autologous latissimus dorsi (ALD) flap reconstruction in relation to complications and adjuvant treatments.Methods: this was a prospective cohort study involving six UK centres. Eligible patients had primary early-stage breast cancer. The European Organization for Research and Treatment of Cancer quality-of-life questionnaire (QLQ)-C30 and QLQ-BR23, Functional Assessment of Cancer Therapyā€”Breast Cancer scale (FACT-B), Body Image Scale, and Hospital Anxiety and Depression Scale were completed before operation and at 3, 6 and 12 months after surgery.Results: a total of 182 patients (82 LDI and 100 ALD) were recruited between 2007 and 2010 with symptomatic (59Ā·9 per cent) or screen-detected (39Ā·6 per cent) cancers. Some 64Ā·3 per cent had lymph node-negative disease; 30 per cent of the LDI group had radiotherapy, compared with 53Ā·0 per cent in the ALD group (P = 0Ā·004). Early complications up to 3 months after surgery were reported in 66 and 51Ā·0 per cent of patients in the LDI and ALD groups respectively (P = 0Ā·062) and long-term complications (4ā€“12 months) in 48 and 45Ā·0 per cent (P = 0Ā·845). Role functioning and pain (P = 0Ā·002 for both) were adversely affected in the ALD group compared with results in the LDI group, with no significant effects of radiotherapy on any health-related quality of life (HRQL). Chemotherapy and early complications adversely affected HRQL, which improved between 3 and 12 months after surgery (P < 0Ā·010 for all).Conclusion: there is evidence of similar HRQL between types of latissimus dorsi breast reconstruction for up to a year after surgery. There appear to be no overarching effects for radiotherapy after mastectomy on the specific HRQL domains studied in the short term. The identification of variables that affect HRQL is important, including their integration into the analysis of PROM

    The prospects of zero-packaging grocery stores to improve the social and environmental impacts of the food supply chain

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    Increasing consumer awareness of the environmental and social externalities of food supply chains in developed countries instigates the opening of grocery stores that renounce the use of disposable plastic packaging for their entire product range. The opportunities these novel stores offer in moving to an alternative, more sustainable retail system are currently not well understood. Semi-structured interviews with representatives of seven stores across Europe and six food supply chain experts were conducted in order to address this gap. Findings suggest that these stores may induce more resource-efficient behaviour in suppliers and consumers due to the reduction of packaging and food waste. Social benefits range from the support of small, regional farmers, to higher transparency along the supply chain and better informed consumers. However, these benefits come at the expense of consumer convenience due to slower shopping operations and limited product variety. A wider adoption of zero packaging will require influencing consumer behaviour, convincing suppliers to change their packaging practices, and solving the dependency of food logistics on packaging. In order to achieve wide-ranging, significant environmental and social benefits, zero-packaging stores will ultimately have to offer service levels that are comparable to conventional supermarkets. Potential pathways illustrating how zero-packaging could overcome current market limitations are presented

    Scenarios for the development of smart grids in the UK: synthesis report

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    ā€˜Smart gridā€™ is a catch-all term for the smart options that could transform the ways society produces, delivers and consumes energy, and potentially the way we conceive of these services. Delivering energy more intelligently will be fundamental to decarbonising the UK electricity system at least possible cost, while maintaining security and reliability of supply. Smarter energy delivery is expected to allow the integration of more low carbon technologies and to be much more cost effective than traditional methods, as well as contributing to economic growth by opening up new business and innovation opportunities. Innovating new options for energy system management could lead to cost savings of up to Ā£10bn, even if low carbon technologies do not emerge. This saving will be much higher if UK renewable energy targets are achieved. Building on extensive expert feedback and input, this report describes four smart grid scenarios which consider how the UKā€™s electricity system might develop to 2050. The scenarios outline how political decisions, as well as those made in regulation, finance, technology, consumer and social behaviour, market design or response, might affect the decisions of other actors and limit or allow the availability of future options. The project aims to explore the degree of uncertainty around the current direction of the electricity system and the complex interactions of a whole host of factors that may lead to any one of a wide range of outcomes. Our addition to this discussion will help decision makers to understand the implications of possible actions and better plan for the future, whilst recognising that it may take any one of a number of forms

    A transition process from information systems acceptance to infusion behaviour in online brand communities : a socialization process perspective

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    Social media such as Facebook, Youtube, Twitter, and online communities plays an important role for knowledge production and diffusion as well as discussions among people. Among social media, online brand communities (OBCs) have recently received attention from both academics and practitioners due to the practical benefits of OBCs for consumers and companies. For consumers, knowledge sharing and its collective activities help them to make purchase decisions and to protect themselves against firmsā€™ monopoly and oligopoly or collusion and anticompetitive actions. For companies, new ideas and feedback on brand products created by OBC members are useful input to develop new products and enhance existing product lines. Therefore, active content generation by community members is one of the critical success factors of OBCs. However, many scholars argue that only a few members who are more devoted to a community are tending to engage in OBC activities and many community members tend to remain in the periphery (sometimes called ā€˜lurkers') of the community by using OBCs merely for gathering information without any contributions. Therefore, it is important to make members in the periphery of the community transit to the core to increase membersā€™ intentions and ā€˜devoted membersā€™ to produce more valuable benefits for both consumers and firms. In spite of its importance, the literature is lacking in efforts to explain how and when community members in the periphery transit to the core of the community in a long-term perspective. This study aims to reveal how and why OBC members transit from the periphery to the core of the community and how to increase their intention to use OBC from a long-term perspective. OBC use behaviour is classified into, largely, two categories according to the purposes of an OBC: behaviour with a brand product consumption purpose; and behaviour with a social relationship building purpose. This study classifies OBC members as three clusters by social identity theory: tourists, minglers, and devoted members (devotees and insiders). The devoted members have valuable consumption knowledge of brand and strong social bonds in the OBC and the OBC members become a devoted member by accumulated brand knowledge and experiences through long-term OBC use. Therefore, from a socialisation aspect, this study adopts organisational socialisation theory as the theoretical lens to explain how and why the members evolve from novice members as tourist to devoted members in OBC contexts. Socialisation theories argue that there are usually three sequential stages for a member to gain full membership in a community: pre-entry, accommodation, and affiliation. In addition, this study adopts IS implementation theory to understand OBC user behaviours from an IS use behaviour perspective: acceptance in the pre-entry stage and routinisation in the accommodation stage and infusion in the affiliation stage. By reviewing socialisation theory and IS implementation theory, this study finds four significant motivations, those of information quality, trust, sense of belonging, and brand loyalty for intention of OBC use from the acceptance (pre-entry) to infusion (affiliation) stages. To integrate the socialisation perspective with the IS use perspective, this study adopts a technology acceptance model (TAM) as a theoretical framework to link to motivators in different OBC use behaviour from the acceptance to infusion stages. As a result, this study proposes a conceptual framework to explain the OBC membersā€™ transition process from acceptance (pre-entry) to infusion (affiliation). The aim of this study is to predict and explain the transition of motivators for OBC use from pre-entry to affiliation and how to improve membersā€™ intention of OBC use from a long-term perspective ultimately to foster ā€˜devoted membersā€™. This study adopts an online survey targeting 518 participants who belong to 17 OBCs in South Korea and the conceptual framework is validated. The results show that all factors (i.e. information quality, trust, sense of belonging, brand loyalty) are significant determinants to increase intention to use OBCs and the factors have a causal relationship with each other to form a transition process from the acceptance (pre-entry) to infusion (affiliation) stages. This study also reveals that brand loyalty has a significant role to explain the transition process and directly influence user intention to use OBCs. The sense of belonging also directly affects membersā€™ intention to use OBCs but has less impact than brand loyalty. In addition, the results indicate that TAM is an appropriate model to predict user behaviours in a long-term perspective to explain the change of OBC use behaviour from the acceptance to infusion stage and confirms that perceived usefulness and perceived ease of use have significant impact on the intention to use OBCs as in other IS studies. Understanding the transition process within OBCs has theoretical and practical implications. Theoretically, it will extend our understanding of how IS end users transit from acceptance behaviour to continued use and extended use of information systems in virtual community contexts. For managers, this study will provide them with insight on how to retain potential consumers in OBCs and facilitate their activities to gain consumer feedback on existing and new products.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

    FAR out? An examination of converging, diverging and intersecting smart grid futures in the United Kingdom

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    We describe a novel application of the field anomaly relaxation (FAR) method of scenario construction to the complex problem of smart grid development. We augment the FAR methodology with extensive expert input through all four steps to incorporate detailed knowledge of the technical, economic and policy issues relevant to informing scenarios for smart grid development in the United Kingdom. These steps inform scenarios useful to policymakers, regulators and the energy industry. We found this extended method to be flexible and reliable. Analysis of smart grid development yielded seven dimensions, allowing for portrayal of a complex and informed set of scenarios. The expert input and feedback identified branching points allowing switching between scenarios ā€“ a powerful dynamic feature to assist policy development for a fast-changing technological and regulatory landscape
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