Using activity based costing and simulation to reduce cost at a Police communications centre

Purpose: This study is based at a police force’s communications centre which undertakes a vital role in receiving and processing emergency and non-emergency telephone calls from the public and other agencies. The purpose of this paper is to evaluate a method for addressing the conflict between the need to reduce cost and the requirement to meet national standards in terms of a timely response to customer calls. Design/methodology/approach: In a two-stage methodology an activity-based costing (ABC) approach is used as a framework to show how costs are generated by the three “drivers” of cost which relate to the design efficiency of the process, the demand on the process and the cost of resources used to undertake the process. The study then provides an analysis from a resource driver perspective using discrete-event simulation to model workforce staffing scenarios. Findings: Cost savings within the police communications centre are identified from an analysis of the three drivers of cost. Further analysis from a resource driver viewpoint using a simulation study of an alternative workforce schedule predicted an overall reduction in staffing cost of 9.4 per cent. Originality/value: The study outlines an innovative method that identifies where cost can be reduced using ABC and then provides an assessment of strategies that aim to reduce cost whilst maintaining service levels in a police operation using simulation

A profile of enzalutamide for the treatment of advanced castration resistant prostate cancer.

Recent advances in understanding the mechanisms underlying the development and progression of castration resistant prostate cancer from androgen-sensitive prostate cancer have provided new avenues exploring efficacious therapies in a disease which is the second leading cause of cancer deaths among men in the western world. In the evolution of second generation anti-androgens, enzalutamide, a novel androgen-receptor signaling inhibitor, has emerged targeting multiple steps within the androgenic stimulation pathway. This review discusses what is currently known of the mechanisms surrounding castration resistant prostate cancer development and the current human clinical trials to determine whether enzalutamide presents a new hope for men with advanced prostate cancer. The issues of therapy resistance, withdrawal effects and cross-resistance are briefly touched upon

Mixtapes and Turntablism: DJs’ Perspectives on Musical Shape

The notion of musical shape is widely used by performing musicians, but most studies have focussed on classical performing contexts. This paper extends this research to DJs performing on turntables, chosen in light of existing evidence from a questionnaire study suggesting that shape may be a useful concept for some DJs. This paper presents an interview study investigating the use and understanding of musical shaping by three professional DJs with varied backgrounds. Interpretative Phenomenological Analysis was used to analyse the data. Findings suggest that DJs do use the notion of shape implicitly when planning and executing their sets, and that playing sets without any shaping involves playing the music badly. DJs reported using the idea of shaping to modify a track while it was playing; to help control the transition between tracks; and in relation to the overall trajectory of a set. There was evidence that participants understood musical shaping multi-modally, through gesture and visual representation as well as sound; and results show ways in which DJs draw on heuristics to signify complex combinations of technical devices that create a particular musical shape or sound. The findings are considered in relation to existing work on performers’ use of musical shape as well as work on the practice of DJs

Mindfulness for musicians: A mixed methods study investigating the effects of 8-week mindfulness courses on music students at a leading conservatoire

Mindfulness courses are beneficial in clinical domains for anxiety and depression and are becoming more prevalent as interventions in education. However, little is known about what effects mindfulness might have on musicians. In an exploratory study, 25 music students, who completed one of four 8-week MBSR/MBCT mindfulness courses adapted for musicians at the Guildhall School of Music and Drama, completed the validated Five Facet Mindfulness Questionnaire and a bespoke Mindfulness for Musicians questionnaire pre- and post-intervention. Twenty-one music students also took part in a post-intervention one-to-one semi-structured interview. Post-intervention mindfulness scores for both questionnaires increased significantly in comparison to pre-intervention scores. In interviews, participants were reportedly more aware and focused in instrumental lessons, were less self-critical, and developed increased body awareness, which improved their learning of instrumental technique. Participants also described enhanced teacher/pupil communication. In instrumental practice sessions, participants reported more efficient, effective and creative practice, and said that mindfulness exercises helped them deal with problems experienced while practising. Participants also described enhanced listening skills and improved socio-collaboration in ensemble rehearsals. They reported that mindfulness strategies had positive effects on music performance anxiety and described changes in time perception, enhanced expressivity, and positive post-performance effects. Future researchers could adopt a more robust methodology, such as a randomised controlled trial, and incorporate further design elements, such as longitudinal follow-up. Providing more systematic evidence of the beneficial role of mindfulness for conservatoire music students as learners and performers may encourage greater provision of such opportunities in musical settings in the future

System Engineering for J-2X Development: The Simpler, the Better

The Ares I and Ares V Vehicles will utilize the J-2X rocket engine developed for NASA by the Pratt and Whitney Rocketdyne Company (PWR) as the upper stage engine (USE). The J-2X is an improved higher power version of the original J-2 engine used for Apollo. System Engineering (SE) facilitates direct and open discussions of issues and problems. This simple idea is often overlooked in large, complex engineering development programs. Definition and distribution of requirements from the engine level to the component level is controlled by Allocation Reports which breaks down numerical design objectives (weight, reliability, etc.) into quanta goals for each component area. Linked databases of design and verification requirements help eliminate redundancy and potential mistakes inherent in separated systems. Another tool, the Architecture Design Description (ADD), is used to control J-2X system architecture and effectively communicate configuration changes to those involved in the design process. But the proof of an effective process is in successful program accomplishment. SE is the methodology being used to meet the challenge of completing J-2X engine certification 2 years ahead of any engine program ever developed at PWR. This paper describes the simple, better SE tools and techniques used to achieve this success

Expert opinion on the management of pain in hospitalised older patients with cognitive impairment: A mixed methods analysis of a national survey

Background: Hospitalised older patients are complex. Comorbidity and polypharmacy complicate frailty. Significant numbers have dementia and/or cognitive impairment. Pain is highly prevalent. The evidence base for pain management in cognitively impaired individuals is sparse due to methodological issues. A wealth of expert opinion is recognised potentially providing a useful evidence base for guiding clinical practice. The study aimed to gather expert opinion on pain management in cognitively impaired hospitalised older people. Methods: Consultant Geriatricians listed as dementia leads in the National Dementia Audit were contacted electronically and invited to respond. The questionnaire sought information on their role, confidence and approach to pain management in cognitively impaired hospitalised patients. Responses were analysed using a mixed methods approach. Results: Respondents considered themselves very confident in the clinical field. Awareness of potential to do harm was highly evident. Unequivocally responses suggested paracetamol is safe and should be first choice analgesic, newer opiates should be used preferentially in renal impairment and nefopam is unsafe. A grading of the safety profile of specific medications became apparent, prompting requirement for further evaluation and holistic assessment. Conclusion: The lack of consensus reached highlights the complexity of this clinical field. The use of paracetamol first line, newer opiates in renal impairment and avoidance of nefopam are immediately transferrable to clinical practice. Further review, evaluation and comparison of the risks associated with other specific analgesics are necessary before a comprehensive clinical guideline can be produced

Interventions for promoting habitual exercise in people living with and beyond cancer

Background: This is an updated version of the original Cochrane Review published in the Cochrane Liibrary 2013, Issue 9. Despite good evidence for the health benefits of regular exercise for people living with or beyond cancer, understanding how to promote sustainable exercise behaviour change in sedentary cancer survivors, particularly over the long term, is not as well understood. A large majority of people living with or recovering from cancer do not meet current exercise recommendations. Hence, reviewing the evidence on how to promote and sustain exercise behaviour is important for understanding the most effective strategies to ensure benefit in the patient population and identify research gaps. Objectives: To assess the effects of interventions designed to promote exercise behaviour in sedentary people living with and beyond cancer and to address the following secondary questions: Which interventions are most effective in improving aerobic fitness and skeletal muscle strength and endurance? Which interventions are most effective in improving exercise behaviour amongst patients with different cancers? Which interventions are most likely to promote long-term (12 months or longer) exercise behaviour? What frequency of contact with exercise professionals and/or healthcare professionals is associated with increased exercise behaviour? What theoretical basis is most often associated with better behavioural outcomes? What behaviour change techniques (BCTs) are most often associated with increased exercise behaviour? What adverse effects are attributed to different exercise interventions? Search methods: We used standard methodological procedures expected by Cochrane. We updated our 2013 Cochrane systematic review by updating the searches of the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, Embase, AMED, CINAHL, PsycLIT/PsycINFO, SportDiscus and PEDro up to May 2018. We also searched the grey literature, trial registries, wrote to leading experts in the field and searched reference lists of included studies and other related recent systematic reviews. Selection criteria: We included only randomised controlled trials (RCTs) that compared an exercise intervention with usual care or 'waiting list' control in sedentary people over the age of 18 with a homogenous primary cancer diagnosis. Data collection and analysis: In the update, review authors independently screened all titles and abstracts to identify studies that might meet the inclusion criteria, or that could not be safely excluded without assessment of the full text (e.g. when no abstract is available). We extracted data from all eligible papers with at least two members of the author team working independently (RT, LS and RG). We coded BCTs according to the CALO-RE taxonomy. Risk of bias was assessed using the Cochrane's tool for assessing risk of bias. When possible, and if appropriate, we performed a fixed-effect meta-analysis of study outcomes. If statistical heterogeneity was noted, a meta-analysis was performed using a random-effects model. For continuous outcomes (e.g. cardiorespiratory fitness), we extracted the final value, the standard deviation (SD) of the outcome of interest and the number of participants assessed at follow-up in each treatment arm, to estimate the standardised mean difference (SMD) between treatment arms. SMD was used, as investigators used heterogeneous methods to assess individual outcomes. If a meta-analysis was not possible or was not appropriate, we narratively synthesised studies. The quality of the evidence was assessed using the GRADE approach with the GRADE profiler. Main results: We included 23 studies in this review, involving a total of 1372 participants (an addition of 10 studies, 724 participants from the original review); 227 full texts were screened in the update and 377 full texts were screened in the original review leaving 35 publications from a total of 23 unique studies included in the review. We planned to include all cancers, but only studies involving breast, prostate, colorectal and lung cancer met the inclusion criteria. Thirteen studies incorporated a target level of exercise that could meet current recommendations for moderate-intensity aerobic exercise (i.e.150 minutes per week); or resistance exercise (i.e. strength training exercises at least two days per week). Adherence to exercise interventions, which is crucial for understanding treatment dose, is still reported inconsistently. Eight studies reported intervention adherence of 75% or greater to an exercise prescription that met current guidelines. These studies all included a component of supervision: in our analysis of BCTs we designated these studies as 'Tier 1 trials'. Six studies reported intervention adherence of 75% or greater to an aerobic exercise goal that was less than the current guideline recommendations: in our analysis of BCTs we designated these studies as 'Tier 2 trials.' A hierarchy of BCTs was developed for Tier 1 and Tier 2 trials, with programme goal setting, setting of graded tasks and instruction of how to perform behaviour being amongst the most frequent BCTs. Despite the uncertainty surrounding adherence in some of the included studies, interventions resulted in improvements in aerobic exercise tolerance at eight to 12 weeks (SMD 0.54, 95% CI 0.37 to 0.70; 604 participants, 10 studies; low-quality evidence) versus usual care. At six months, aerobic exercise tolerance was also improved (SMD 0.56, 95% CI 0.39 to 0.72; 591 participants; 7 studies; low-quality evidence). Authors' conclusions: Since the last version of this review, none of the new relevant studies have provided additional information to change the conclusions. We have found some improved understanding of how to encourage previously inactive cancer survivors to achieve international physical activity guidelines. Goal setting, setting of graded tasks and instruction of how to perform behaviour, feature in interventions that meet recommendations targets and report adherence of 75% or more. However, long-term follow-up data are still limited, and the majority of studies are in white women with breast cancer. There are still a considerable number of published studies with numerous and varied issues related to high risk of bias and poor reporting standards. Additionally, the meta-analyses were often graded as consisting of low- to very low-certainty evidence. A very small number of serious adverse effects were reported amongst the studies, providing reassurance exercise is safe for this population. © 2018 The Cochrane Collaboration

The Potential Roles of Osmotic and Nonosmotic Sodium Handling in Mediating the Effects of Sodium-Glucose Cotransporter 2 Inhibitors on Heart Failure

Concomitant type 2 diabetes and chronic kidney disease increases the risk of heart failure. Recent studies demonstrate beneficial effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors on chronic kidney disease progression and heart failure hospitalization in patients with and without diabetes. In addition to inhibiting glucose reabsorption, SGLT2 inhibitors decrease proximal tubular sodium reabsorption, possibly leading to transient natriuresis. We review the hypothesis that SGLT2 inhibitor’s natriuretic and osmotic diuretic effects mediate their cardioprotective effects. The degree to which these benefits are related to changes in sodium, independent of the kidney, is currently unknown. Aside from effects on osmotically active sodium, we explore the intriguing possibility that SGLT2 inhibitors could also modulate nonosmotic sodium storage. This alternative hypothesis is based on emerging literature that challenges the traditional 2-compartment model of sodium balance to provide support for a 3-compartment model that includes the binding of sodium to glycosaminoglycans, such as those in muscles and skin. This recent research on nonosmotic sodium storage, as well as direct cardiac effects of SGLT2 inhibitors, provides possibilities for other ways in which SGLT2 inhibitors might mitigate heart failure risk. Overall, we review the effects of SGLT2 inhibitors on sodium balance and sensitivity, cardiac tissue, interstitial fluid and plasma volume, and nonosmotic sodium storage

A survey study to gather requirements for designing a mobile service to enhance learning from cultural heritage

This study was carried out to gather user requirements using a questionnaire survey. The study has investigated how people may use mobile location-aware technologies for learning purposes in cultural heritage contexts. This paper presents the results of this survey study and outlines a number of challenges for further development

Influence of the initial chemical conditions on the rational design of silica particles

The influence of the water content in the initial composition on the size of silica particles produced using the Stöber process is well known. We have shown that there are three morphological regimes defined by compositional boundaries. At low water levels (below stoichiometric ratio of water:tetraethoxysilane), very high surface area and aggregated structures are formed; at high water content (>40 wt%) similar structures are also seen. Between these two boundary conditions, discrete particles are formed whose size are dictated by the water content. Within the compositional regime that enables the classical Stöber silica, the structural evolution shows a more rapid attainment of final particle size than the rate of formation of silica supporting the monomer addition hypothesis. The clearer understanding of the role of the initial composition on the output of this synthesis method will be of considerable use for the establishment of reliable reproducible silica production for future industrial adoption