An evaluation of staff engagement programmes in four National Health Service Acute Trusts

Purpose – The purpose of this paper is to report the findings from an evaluation project conducted to investigate the impact of two staff engagement programmes introduced to four National Health Service (NHS) hospital Trusts in England. It seeks to examine this development in the context of current policy initiatives aimed at increasing the level of staff involvement in decision-making, and the related literature. \ud \ud Design/methodology/approach – A mixed-methods approach incorporating document analysis, interviews, a survey and appreciative inquiry, informed by the principles of impact evaluation design, was used. \ud \ud Findings – The main finding to emerge was that leadership was crucial if widespread staff engagement was to be achieved. Indeed, in some of the trusts the staff engagement programmes were seen as mechanisms for developing leadership capability. The programmes had greater impact when they were “championed” by the Chief Executive. Effective communication throughout the organisations was reported to be a prerequisite for staff engagement. Problems were identified at the level of middle management where the lack of confidence in engaging with staff was a barrier to implementation. \ud \ud Practical implications – The nature of the particular organisational context is crucial to the success of efforts to increase levels of staff engagement. The measures that were found to work in the trusts would need to be adapted and applied to best meet the needs of other organisations. \ud \ud Originality/value – Many health care organisations in England will need to harness the efforts of their workforce if they are to meet the significant challenges of dealing with financial restraint and increasing patient demand. This paper provides some insights on how this can be done

Thailand: Contestation over elections, sovereignty and representation

Thailand's politics in the early twenty-first century has seen considerable contestation. Underlying the street protests, military interventions and considerable bloodshed has been a struggle over the nature of electoral politics, popular sovereignty and representation. The military and monarchy have maintained a royalist alliance that opposes elections, popular sovereignty and civilian politicians, proposing Thai-style democracy as an alternative. Those who promote elections and popular sovereignty argue that these are a basis for democratisation. On 22 May 2014, Thailand's military staged yet another coup, unseating the government elected in 2011, led by Yingluck Shinawatra. By most calculations, this was Thailand's 12th successful coup. The 11th putsch in September 2006 ousted Yingluck's brother, Thaksin Shinawatra. In considering these two most recent military interventions, it is striking that both were associated with a decade of large and sometimes aggressive street protests. As will be shown in this paper, at the core of these demonstrations has been competing ideas about democracy, elections and representation. Involving a range of actors, the most significant of the street protests have been, on the one hand, associated with the red-shirted supporters of Thaksin and, on the other hand, by their opponents, known as yellow shirts and more broadly identified—and self-identified—as royalists. Both groups have mobilised large numbers of supporters. If the leaders of Thailand's competing political groups had ever thought to peruse the pages of this journal, they would have found much that resonated with their struggles and debates of the past decade. Indeed, the Electoral Reform Society (ERS) might have been claimed as something of a model by Thailand's most recent protesters, the ‘People's Committee for Absolute Democracy with the King as Head of State’ (PCAD). The PCAD argued that what they wanted was thorough-going political reform, and so its leaders might have agreed with the ERS view that ‘the present electoral system has little to recommend it … ’. PCAD activists rejected Thailand's electoral system and opposed voting because these were considered obstacles for political reform. They would have noticed resonance with their own rhetoric when the ERS pointed to injustices associated with electoral minorities, and the PCAD would have been heartened to read that the British electoral system was sometimes described as ‘undemocratic’, a term the PCAD regularly used in criticising Yingluck's government (Electoral Reform Society 1970: 1). They would also have noticed that at times the ERS questioned electoral mandates, for the PCAD consistently rejected the substantial election victory voters delivered for Yingluck in 2011 (Electoral Reform Society 1971: 3). At the same time, Yingluck's Pheu Thai Party government and its supporters in the ‘United Front for Democracy Against Dictatorship’ (UDD) would certainly have agreed with a 1970 ERS article that lamented the ‘tendency to substitute various forms of demonstration for the ballot box … ’ (Electoral Reform Society 1970: 1). They would have recognised the sentiment expressed in the article, ‘Let the voters arbitrate’, by the ERS's ‘EL’ (1975: 37); after all, as the PCAD rallied to bring down the Yingluck government and prevented an election, her supporters repeatedly demanded that their votes and their right to vote be respected. In other words, even if the methods and outcomes may be quite different from those seen in Britain of the 1970s, the contested claims about the nature of electoral politics and about appropriate forms of representation are familiar in early twenty-first-century Thailand. In this paper, the history and development of these competing claims will be examined. This historical contextualisation of Thailand's debates over representation is critical in understanding the nature of the past decade of intense political conflict, from 2005 to 2014. This recent period has seen seven prime ministers and was punctuated by two military coups. It is a conflict that has been destructive and divisive and has thrown competing claims about political representation into stark relief. In established democracies, the nature of this representation is sometimes contested but it seldom threatens a political regime. In Thailand, contestation over representation has led to violence, military intervention and deep political division. These struggles over representation have been about the very nature of the political order in Thailand

An Integrated Telemetric Thermocouple Sensor for Process Monitoring of CFRP Milling Operations

AbstractA wireless temperature measurement system was developed and integrated into a cutting tool holder via a thermocouple embedded within the cutting tool. The primary purpose of such an embedded thermal measurement sensor/system is for online process monitoring of machining processes within which thermal damage poses a significant threat both for the environment and productivity alike – as is the case with the machining of carbon fibre reinforced polymer (CFRP) components. A full system calibration was performed on the device. Response times were investigated and thermal errors, in the form of damping and lag, were identified. Experimental temperature results are presented which demonstrate the performance of the integrated wireless telemetry sensor during the edge trimming of CFRP composite materials. Thermocouple positioning relative to heat source effect was among the statistical factors investigated during machining experiments. Initial results into the thermal response of the sensor were obtained and a statistical package was used to determine the presence of significant main effects and interactions between a number of tested factors. The potential application of the embedded wireless temperature measurement sensor for online process monitoring in CFRP machining is demonstrated and recommendations are made for future advancements in such sensor technology

Tuberculosis treatment in a refugee and migrant population: 20 years of experience on the Thai-Burmese border.

Although tuberculosis (TB) is a curable disease, it remains a major global health problem and an important cause of morbidity and mortality among vulnerable populations, including refugees and migrants

Oestrogen inactivation in the colon: analysis of the expression and regulation of 17 β -hydroxysteroidehydrogenase isozymes in normal colon and colonic cancer

Epidemiological data suggest that oestrogen contributes to the aetiology of colonic cancer. Furthermore, recent studies have suggested that local hormone metabolism may play a key role in determining colonic responsiveness to oestrogen. To further clarify this mechanism we have characterized the expression and regulation of isozymes of 17β-hydroxysteroid dehydrogenase (17β-HSD) in vitro and in situ. Immunohistochemistry was used to confirm expression of the type 2 and 4 isozymes of 17β-HSD (17β-HSD2 and 4) in normal colonic epithelial cells. Parallel studies suggested that both isozymes were abnormally expressed in colonic tumours and this was confirmed by Western blot analyses. Abnormal expression of 17β-HSD2 and 4 proteins was also observed in Caco-2, HT-29 and SW620 colonic cancer cell lines, although the overall pattern of oestrogen metabolism in these cells was similar to that seen in primary colonic mucosal tissue. The predominant activity (conversion of oestradiol to oestrone) was highest in Caco-2>SW620>HT-29, which correlated inversely with the rate of proliferation of the cell lines. Regulatory studies using SW620 cells indicated that the most potent stimulator of oestradiol to oestrone inactivation was the antiproliferative agent 1,25-dihydroxyvitamin D 3(1,25D 3), whilst oestradiol itself inhibited 17β-HSD activity. Both oestradiol and 1,25D 3 decreased mRNA for 17β-HSD2 and 4. Data indicate that the high capacity for inactivation of oestrogens in the colon is associated with the presence of 17β-HSD2 and 4 in epithelial cells. Abnormal expression of both isozymes in colonic cancer cells and the stimulation of oestrogen inactivation by the antiproliferative agent 1,25D 3 highlights a possible role for 17β-HSD isozymes as modulators of colonic cell proliferation. © 2000 Cancer Research Campaig

Habitat quality, configuration and context effects on roe deer fecundity across a forested landscape mosaic

Effective landscape-scale management of source-sink deer populations will be strengthened by understanding whether local variation in habitat quality drives heterogeneity in productivity. We related female roe deer Capreolus capreolus fecundity and body mass to habitat composition and landscape context, separately for adults and yearlings, using multi-model inference (MMI) applied to a large sample of individuals (yearlings: fecundity=202, body mass=395; adults: fecundity=908, body mass=1669) culled during 2002-2015 from an extensive (195 km2) heterogeneous forest landscape. Adults were heavier (inter-quartile, IQ, effect size=+0.5kg) when culled in buffers comprising more arable lands while contrary to our prediction no effects on body mass of grassland, young forest or access to vegetation on calcareous soil were found. Heavier adults were more fertile (IQ effect size, +12% probability of having two embryos instead of one or zero). Counter-intuitively, adults with greater access to arable lands were less fecund (IQ effect of arable: -7% probability of having two embryos, instead of one or zero), and even accounting for greater body mass of adults with access to arable, their modelled fecundity was similar to or lower than that of adults in the forest interior. In contrast, effects of grassland, young forest and calcareous soil did not receive support. Yearling body mass had an effect on fecundity twice that found in adults (+23% probability of having one additional embryo), but yearling body mass and fecundity were not affected by any candidate habitat or landscape variables. Effect of arable lands on body mass and fecundity were small, with little variance explained (Coefficient of Variation of predicted fecundity across forest sub-regions=0.03 for adults). More variance in fecundity was attributed to other differences between forest management sub-regions (modelled as random effects), suggesting other factors might be important. When analysing source-sink population dynamics to support management, an average value of fecundity can be appropriate across a heterogeneous forest landscape

Performing heritage: the use of live 'actors' in heritage presentations

This paper investigates the phenomenon of 'living history' presentations of heritage, using live 'actors' to portray historical characters. Its aim is to discuss these presentations in the context of what may be understood as 'heritage', and of the nature of 'performance'. Four case studies of heritage sites, each important as a tourist attraction, have been selected for detailed study, together with a number of other examples of heritage performance. It is clear from the empirical work that different performance strategies are employed within the heritage industry and by individual 'actors'. Most of the performers take part as a leisure activity, and many do not consider themselves to be 'performing' at all. The greatest concern of participants lies in the degree of authenticity of the performance. Through 'living history', the 'actors' are drawn into an experience of heritage which has real meaning for them, and which may contribute both to a sense of identity and to an enhanced understanding of society, past and present. The popularity of such presentations with visitors also indicates that similar benefits are perceived by the 'audience'

Democratization and foreign policy in Southeast Asia: the case of the ASEAN Inter-Parliamentary Myanmar Caucus

This is an Author's Accepted Manuscript of an article published in Cambridge Review of International Affairs Vol. 22, Iss. 3, 2009 as published in the CAMBRIDGE REVIEW OF INTERNATIONAL AFFAIRS, 2009, copyright Taylor & Francis, available online at: http://www.tandfonline.com/10.1080/09557570903104008

Provinciality and the Art World: The Midland Group 1961- 1977

This paper takes as its focus the Midland Group Gallery in order to first, make a case for the consideration of the geographies of art galleries. Second, highlight the importance of galleries in the context of cultural geographies of the sixties. Third, discuss the role of provinciality in the operation of art worlds. In so doing it explicates one set of geographies surrounding the gallery – those of the local, regional and international networks that connected to produce art works and art space. It reveals how the interactions between places and practices outside of metropolitan and regional hierarchies provides a more nuanced insight into how art worlds operated during the sixties, a period of growing internationalism of art, and how contested definitions of the provincial played an integral role in this. The paper charts the operations of the Midland Group Gallery and the spaces that it occupied to demonstrate how it was representative of a post-war discourse of provincialism and a corresponding re-evaluation of regional cultural activity

Local and systemic glucocorticoid metabolism in inflammatory arthritis

Background: Isolated, primary synovial fibroblasts generate active glucocorticoids through expression of 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1). This enzyme produces cortisol from inactive cortisone (and prednisolone from prednisone). Objective: To determine how intact synovial tissue metabolises glucocorticoids and to identify the local and systemic consequences of this activity by examination of glucocorticoid metabolism in patients with rheumatoid arthritis (RA). Methods: Synovial tissue was taken from patients with RA during joint replacement surgery. Glucocorticoid metabolism in explants was assessed by thin-layer chromatography and specific enzyme inhibitors. RT-PCR and immunohistochemistry were used to determine expression and distribution of 11β-HSD enzymes. Systemic glucocorticoid metabolism was examined in patients with RA using gas chromatography/mass spectrometry. Results: Synovial tissue synthesised cortisol from cortisone, confirming functional 11β-HSD1 expression. In patients with RA, enzyme activity correlated with donor erythrocyte sedimentation rate (ESR). Synovial tissues could also convert cortisol back to cortisone. Inhibitor studies and immunohistochemistry suggested this was owing to 11β-HSD2 expression in synovial macrophages, whereas 11β-HSD1 expression occurred primarily in fibroblasts. Synovial fluids exhibited lower cortisone levels than matched serum samples, indicating net local steroid activation. Urinary analyses indicated high 11β-HSD1 activity in untreated patients with RA compared with controls and a significant correlation between total body 11β-HSD1 activity and ESR. Conclusions: Synovial tissue metabolises glucocorticoids, the predominant effect being glucocorticoid activation, and this increases with inflammation. Endogenous glucocorticoid production in the joint is likely to have an impact on local inflammation and bone integrity