FrAmework for Multi-Agency Environments (FAME) : Final Report of the Learning & Evaluation Strand

Framework for Multi-agency Environments (FAME) was one of the Local Government On-Line funded National Projects sponsored by the Office of the Deputy Prime Minister (ODPM). Within FAME there were six local projects (known as strands) led by English local authorities in partnership with service providers. Each strand aimed to improve a particular set of services (for example, to vulnerable older people or disabled children) through effective and appropriate exchange of information. These local projects worked with IT suppliers (known as technology partners) to produce a technical system to facilitate the exchange and management of client / patient information across agency boundaries. Not all the outputs of FAME were in the form of IT systems. Improvements to business processes and information sharing practices were also expected. Newcastle University led two further strands, the Generic Framework and Learning & Evaluation. The Generic Framework identifies and describes nine building blocks that are essential to effective multi-agency working. The FAME website http://www.fame-uk.org contains details of these building blocks, together with a ‘how to’ guide and a toolkit to support local authorities and their partners in assessing their ‘readiness’ for multi-agency working. This is the report of the Learning & Evaluation strand. The Learning & Evaluation team worked closely with the local FAME project teams, who were supportive of our work and generous with their time. Throughout the project we reported back to the local teams both individually and collectively. Evaluation was thoroughgoing and critical, not an exercise in public relations or advocacy. It is important to stress that learning is likely to be gained from what did not work as well as from what did. Problems and setbacks, as well as successes, are therefore documented and analysed in the report

A study of residual stresses and their effect on thermo mechanical fatigue in complex geometries

It is known that residual stresses within engine components, such as turbine housings, can combine with service generated stresses and cause unexpected failures during operation, therefore it is important that all the stresses (residual and induced, compressive and tensile) are fully characterised and understood. The use of neutrons as a tool to measure the strains within a material is well established; however, applying this technique to complex engineering components can prove challenging. This research investigates the measurement of residual stresses in complex geometries found within the turbine housing component of a turbocharger using neutron diffraction. The effect of various production methods on residual stress distributions is also explored. Successful strain measurements were taken using the Engin-X instrument at the ISIS spallation source from three turbine housings selected from various stages in the manufacturing process, allowing a study of the effect of heat treatment and machining on stress magnitudes and direction. The turbine housing consists of various sections greater than the maximum 60mm path length of the neutrons, therefore path lengths must be carefully chosen to achieve acceptable neutron count rates. Engin-X benefits from an automated experimental setup to make the selection of this limited path length easier on complex shapes. The turbine housings were mounted on to a positioning table allowing translation in X, Y, Z directions and also rotation in , . Each of the housings were scanned using laser scanners and this in conjunction with the virtual path length measurement software SScanSS allowed automated measurements of acceptable path lengths to be made. On this occasion measurements in one principal direction were measured and the correct measurement methodology established. Continuation of this work was then carried out on SALSA at the ILL reactor source. Measurements were made on turbine housings, one as cast and one heat treated. The internal divider wall of each turbine housing was examined as this is an area where crack initiation can occur. The results showed that, heat treatment can reduce compressive residual stresses. However, compressive stresses are thought to slow the onset of crack initiation and could be beneficial in the material, this will be investigated further in future work. It is hoped that this information will be used to improve production methods and result in improved simulation methodologies to allow accurate predictions of thermal fatigue and fracture locations to be established. The authors wish to thank Dr Jon James (Open University) for his help in setting up the experiment and for the use of the SScanSS software

Synthesis and cellular penetration properties of new phosphonium based cationic amphiphilic peptides

A new category of phosphonium based cationic amphiphilic peptides has been developed and evaluated as potential antimicrobial peptides and cell penetrating peptides. The required building blocks were conveniently accessible from cysteine and could be applied in a solid phase peptide synthesis protocol for incorporation into peptide sequences. Evaluation of the antimicrobial properties and cellular toxicity of these phosphonium based peptides showed that these “soft” cationic side-chain containing peptides have poor antimicrobial properties and most of them were virtually non toxic (on HEK cells tested at 256 and 512 μM) and non-haemolytic (on horse erythrocytes tested at 512 μM), hinting at an interesting potential application as cell penetrating peptides. This possibility was evaluated using fluorescent peptide derivatives and showed that these phosphonium based peptide derivatives were capable of entering HEK cells and depending on the sequence confined to specific cellular areas

The Evolution of Successful Service-Learning Courses in the Computing Curriculum: From Infancy to innovation

The purpose of this paper is to relate the evolution of successful service-learning courses in a school of computer science and information systems spanning over a 20-year period. The authors share their experiences in developing technology-based service-learning courses for both majors and non-majors. Most recently, these courses have enabled undergraduate first-year students to be exposed to exciting technologies, such as robotics and mobile app development. The challenges, benefits, and lessons learned are discussed

Perceptions And Validation Of Key Information Technology Competencies From An IT Alumni Viewpoint: Another Stakeholder In The Curriculum Design Process

The objective of this research was to determine the perceptions of End-user Information Systems graduates from selected universities (now alumni status) regarding an updated Organizational & End-user Information Systems (OEIS) curriculum sponsored by the Organizational Systems Research Association now referred to as AIS-SIG OSRA.  The study included the following research objectives:  (1) to determine the perceived level of importance of the OEIS curriculum content in today’s global workforce and (2) to ascertain the information systems (IS) personnel viewpoints on the overall importance of the specific course objectives.  Survey findings revealed specific topics are of critical and/or considerable importance upon graduation from an end-user information systems-related program.  An understanding of the systems development life cycle (SDLC) including planning and implementation of end-user support systems in combination with troubleshooting skills were perceived to be noted essential components of an IT curriculum.  Moreover, an experiential learning/internship experience—similar to a clinical practicum--was deemed to be of critical importance for information technology (IT) professionals.  To further validate the model, it is recommended that universities in other regions of the United States survey their alumni to assess what specific IS & IT objectives and skill sets are currently needed, especially given the exponential demand for trained personnel in emerging areas of health information technology, enterprise systems, project management, virtualization,  and information assurance

Potent and highly selective inhibitors of the proteasome trypsin-like site by incorporation of basic side chain containing amino acid derived sulfonyl fluorides

A unique category of basic side chain containing amino acid derived sulfonyl fluorides (SFs) has been synthesized for incorporation into new proteasome inhibitors targeting the trypsin-like site of the 20S proteasome. Masking the former α-amino functionality of the amino acid starting derivatives as an azido functionality allowed an elegant conversion to the corresponding amino acid derived sulfonyl fluorides. The inclusion of different SFs at the P1 site of a proteasome inhibitor resulted in 14 different peptidosulfonyl fluorides (PSFs) having a high potency and an excellent selectivity for the proteolytic activity of the β2 subunit over that of the β5 subunit. The results of this study strongly indicate that a free N-terminus of PSFs inhibitors is crucial for high selectivity toward the trypsin-like site of the 20S proteasome. Nevertheless, all compounds are slightly more selective for inhibition of the constitutive over the immunoproteasome

Influence of residual stresses on thermo-mechanical fatigue in turbine housings

This poster presents the results of a neutron investigation of the residual stresses generated during the production of the turbine housing component of a turbocharger with the aim of improving simulation methodologies to predict the locations of thermal fatigue and fracture locations and hence improve the performance of the turbochargers. Initial strain measurements were made on ENGIN-X (Rutherford Appleton Laboratory, UK) on three turbine housings selected from various stages in the manufacturing process. Measurements were made on a region of the housing where failures (cracks) have been recorded after accelerated durability tests, although these have never been predicted by FEA. Measurements were also made using SALSA (ILL, France) on two turbine housings, one as cast and one heat treated. In this experiment the internal divider wall was examined in detail as this is an area where crack initiation can occur during operation. Our results show that heat treatment can reduce compressive residual stresses. However, as compressive stresses are thought to slow the onset of crack initiation and could be beneficial in the material, questions about the efficacy of current production methods have now been raised. These results will be compared with the results of FEA simulations, and suggestions for modifying the simulation methodology and/or production route will be discussed. The authors wish to thank Dr Jon James (Open University) for his help in setting up the ENGIN-X experiment and for the use of the SScanSS software

Predicting the immediate impact of national lockdown on neovascular age-related macular degeneration and associated visual morbidity: an INSIGHT Health Data Research Hub for Eye Health report

OBJECTIVE: Predicting the impact of neovascular age-related macular degeneration (nAMD) service disruption on visual outcomes following national lockdown in the UK to contain SARS-CoV-2. METHODS AND ANALYSIS: This retrospective cohort study includes deidentified data from 2229 UK patients from the INSIGHT Health Data Research digital hub. We forecasted the number of treatment-naïve nAMD patients requiring anti-vascular endothelial growth factor (anti-VEGF) initiation during UK lockdown (16 March 2020 through 31 July 2020) at Moorfields Eye Hospital (MEH) and University Hospitals Birmingham (UHB). Best-measured visual acuity (VA) changes without anti-VEGF therapy were predicted using post hoc analysis of Minimally Classic/Occult Trial of the Anti-VEGF Antibody Ranibizumab in the Treatment of Neovascular AMD trial sham-control arm data (n=238). RESULTS: At our centres, 376 patients were predicted to require anti-VEGF initiation during lockdown (MEH: 325; UHB: 51). Without treatment, mean VA was projected to decline after 12 months. The proportion of eyes in the MEH cohort predicted to maintain the key positive visual outcome of ≥70 ETDRS letters (Snellen equivalent 6/12) fell from 25.5% at baseline to 5.8% at 12 months (UHB: 9.8%-7.8%). Similarly, eyes with VA <25 ETDRS letters (6/96) were predicted to increase from 4.3% to 14.2% at MEH (UHB: 5.9%-7.8%) after 12 months without treatment. CONCLUSIONS: Here, we demonstrate how combining data from a recently founded national digital health data repository with historical industry-funded clinical trial data can enhance predictive modelling in nAMD. The demonstrated detrimental effects of prolonged treatment delay should incentivise healthcare providers to support nAMD patients accessing care in safe environments. TRIAL REGISTRATION NUMBER: NCT00056836

Location of care for people with serious mental illness (LOCAPE) : implications for service use and costs using a mixed-methods approach

BackgroundThis study focuses on health care received by people with serious mental illness (SMI). The aim is to examine the economic implications of different locations of management of care and the views of service users and staff regarding services set up as alternatives to secondary care.ObjectivesSpecific objectives are to (1) identify people with SMI managed in primary or secondary care; (2) identify those who could be potentially transferred to primary care; (3) compare the characteristics of these groups; (4) compare service use and costs; (5) generate models to estimate cost changes following transfer between settings; (6) identify characteristics associated with time to transition to secondary care; (7) investigate experiences of patients receiving support from community-based interventions; and (8) assess the economic impact of interventions to facilitate transfer of care management.Methods(1) Quantitative component – using linked primary and secondary care data we examined differences between those discharged to primary care (n = 1410) and those still in secondary care (n = 1629). Service use and costs were compared and predictors of costs were identified using regression models. (2) Qualitative component – interviews following a topic guide were conducted at two time points with 31 people using and 10 people working in services set up as alternatives to secondary care. (3) Economic modelling – an analysis of the health-care costs of the above services compared with usual care was conducted using decision modelling. Data were obtained from local services where possible, and the time horizon was 12 months.Results(1) Quantitative component – characteristics of those discharged to primary care (n = 1410) were similar to those still in secondary care (n = 1629). Costs for those discharged to primary care were 48% lower than for those remaining in secondary care. Other variables strongly associated with costs were a history of violence and a diagnosis of schizophrenia or bipolar disorder. Few patients in secondary care had a high probability of primary care management and, therefore, excess costs were only around £150,000 across the sample. (2) Qualitative component – service users’ views about a community options team and a primary care support service were positive and compared favourably to services used previously. Views about peer support were slightly less consistent. Staff had concerns with regard to caseload sizes and staff turnover. (3) Economic modelling – services to help transition had costs that were 40% of those for standard care. The results of this showed that triaging patients into these services would save £1578 over a 1-year period and that the results were robust to changes in most parameters.LimitationsAnalysis was hindered by the extent to which data were available. Qualitative analyses were limited by the fact that most of the participants did not have a SMI as usually defined and that many had been out of contact with secondary services for a long period of time.ConclusionsCosts are substantially lower in primary care than secondary care, even after controlling for service-user patient differences. Generally, there is satisfaction with services to help facilitate primary care provision and these appear to be cost saving. Future work should continue the analysis of linked data and involve a more comprehensive evaluation of the specific services investigated here.FundingThe National Institute for Health Research Health Services and Delivery Research programme

Learning while evaluating: the use of an electronic evaluation portfolio in a geriatric medicine clerkship

BACKGROUND: Electronic evaluation portfolios may play a role in learning and evaluation in clinical settings and may complement other traditional evaluation methods (bedside evaluations, written exams and tutor-led evaluations). METHODS: 133 third-year medical students used the McGill Electronic Evaluation Portfolio (MEEP) during their one-month clerkship rotation in Geriatric Medicine between September 2002 and September 2003. Students were divided into two groups, one who received an introductory hands-on session about the electronic evaluation portfolio and one who did not. Students' marks in their portfolios were compared between both groups. Additionally, students self-evaluated their performance and received feedback using the electronic portfolio during their mandatory clerkship rotation. Students were surveyed immediately after the rotation and at the end of the clerkship year. Tutors' opinions about this method were surveyed once. Finally, the number of evaluations/month was quantified. In all surveys, Likert scales were used and were analyzed using Chi-square tests and t-tests to assess significant differences in the responses from surveyed subjects. RESULTS: The introductory session had a significant effect on students' portfolio marks as well as on their comfort using the system. Both tutors and students reported positive notions about the method. Remarkably, an average (± SD) of 520 (± 70) evaluations/month was recorded with 30 (± 5) evaluations per student/month. CONCLUSION: The MEEP showed a significant and positive effect on both students' self-evaluations and tutors' evaluations involving an important amount of self-reflection and feedback which may complement the more traditional evaluation methods