Realising benefits in primary healthcare infrastructures

Purpose: This paper focuses upon the requirements to manage change, tangible and intangible benefits in a joint approach to deliver outputs on time, to quality and cost without failing to realise the benefits of the change. The aim of the paper is to demonstrate the need for benefits driven programme/project management as well as the importance of identifying the stakeholders’ level of involvement and contribution throughout the process, and manage their expectations. Design/methodology/approach: The methodology used is based on an action research approach, combining findings from a literature review and case studies within UK’s primary healthcare sector. Findings: Findings demonstrate development of a Benefits Realisation (BeReal) approach in healthcare through looking at case studies taking place within UK’s primary and acute healthcare sector Research limitations/implications: The framework development is based upon theoretical evidence and further research is needed to test and validate its robustness. Originality/value: The application of Benefits Realisation and Management in developing and delivering primary healthcare facilities. Keywords: Benefits management, Benefits realisation, healthcare infrastructures, process and LIF

Investigation into the use of chicken manure to enhance the biodegradation of total petroleum hydrocarbons.

The use of chicken manure to enhance the biodegradation of total petroleum hydrocarbons (TPH) in composting bioremediation was investigated to help develop an improved understanding of the chemical, biological and toxicological processes involved. Treatability studies combined with an extensive suite of laboratory analyses were designed and undertaken whereby naturally contaminated oil refinery sludge was either amended with chicken manure or left unamended for a total duration of 90 days. The effects of chicken manure on the biodegradation of fractionated aliphatic and aromatic hydrocarbons, differentiation between biostimulation and bioaugmentation effects of chicken manure, and the potentially detrimental effects of chicken manure on the bioremediation process through the introduction and adverse proliferation of non-hydrocarbon degrading microorganisms and the potential introduction of compounds that may elicit toxic effects on hydrocarbon degrading microorganisms were monitored over the duration of the treatability studies using a combination of chemical, toxicity and microbial laboratory analyses. This study found that the addition of chicken manure enhanced the degradation of C9-C12 aliphatic hydrocarbons. It was found that this reflects a combination of biostimulation and bioaugmentation effects and that volatilisation was minimal. This investigation also found that the addition of chicken manure can have positive effects on bioremediation as evident by the enhancement of conditions for microbial growth and/or activity, introduction and enhanced growth of potential hydrocarbon degrading bacterial populations, and the enhanced reduction in toxicity of methanol extractable hydrocarbons. However, it was found that the addition of chicken manure was seen to cause an increase in toxicity of total leachable compounds, which may present a risk to TPH biodegradation through potential toxic effects on hydrocarbon degrading microorganisms. It is concluded from this study that there is a potential for the use of chicken manure to enhance TPH biodegradation, but that this is likely restricted to low molecular weight hydrocarbons

Stepchildren of progress : the political economy of development in an Indonesian mining town

Soroako, a village In Sulawesi, Indonesia has undergone dramatic changes in the last decade as a consequence of the establishment of a foreign-owned nickel mining and processing venture. This thesis focuses on the consequences of the new development, principally in regard to the 1,000 indigenous Soroakans whose former agricultural land is now the site for the mining town. It presents an analysis of developing capitalist relations of production in the mining town, investigating changes not only in the sphere of production manifested in daily life as new forms of work, but also in culture and ideology. New ideological forms have arisen in the context of the evolving class structure. The metaphor used in the title derives from the evaluation which the Soroakans make of the new order: they are the'stepchildren' of the progress occurring around them

A case–control study of incident rheumatological conditions following acute gastroenteritis during military deployment

Objectives The aim of this study was to assess the risk of incident rheumatological diagnoses (RD) associated with self-reported diarrhoea and vomiting during a first-time deployment to Iraq or Afghanistan. Such an association would provide evidence that RD in this population may include individuals with reactive arthritis (ReA) from deployment-related infectious gastroenteritis. Design This case–control epidemiological study used univariate and multivariate logistic regression to compare the odds of self-reported diarrhoea/vomiting among deployed US military personnel with incident RD to the odds of diarrhoea/vomiting among a control population. Setting We analysed health records of personnel deployed to Iraq or Afghanistan, including responses on a postdeployment health assessment and medical follow-up postdeployment. Participants Anonymous data were obtained from 891 US military personnel with at least 6 months of medical follow-up following a first-time deployment to Iraq or Afghanistan in 2008–2009. Cases were defined using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes; controls had an unrelated medical encounter and were representative of the study population. Main outcome measures The primary measure was an association between incident RD and self-reported diarrhoea/vomiting during deployment. A secondary measure was the overall incidence of RD in this population. Results We identified 98 cases of new onset RD, with a total incidence of 161/100 000 persons. Of those, two participants had been diagnosed with Reiter\u27s diseasei (3.3/100 000 persons) and the remainder with non-specific arthritis/arthralgia (157.5/100 000 persons). The OR for acute diarrhoea was 2.67 (p=0.03) after adjusting for important covariates. Conclusions Incident rheumatological conditions, even those classified as ‘non-specific,’ are significantly associated with prior severe diarrhoea in previously deployed military personnel, potentially indicating ReA and need for preventive measures to reduce diarrhoeagenic bacterial exposures in military personnel and other travellers to the developing regions

Mutations in the E2 glycoprotein and the 3\u27 untranslated region enhance chikungunya virus virulence in mice

Chikungunya virus (CHIKV) is a mosquito-transmitted alphavirus that causes debilitating musculoskeletal pain and inflammation and can persist for months to years after acute infection. Although studies of humans and experimentally infected animals suggest that CHIKV infection persists in musculoskeletal tissues, the mechanisms for this remain poorly understood. To evaluate this further, we isolated CHIKV from the serum of persistently infected Rag1 -/- mice at day 28. When inoculated into naive wild-type (WT) mice, this persistently circulating CHIKV strain displayed a capacity for earlier dissemination and greater pathogenicity than the parental virus. Sequence analysis revealed a nonsynonymous mutation in the E2 glycoprotein (E2 K200R) and a deletion within the 3' untranslated region (3'-UTR). The introduction of these changes into the parental virus conferred enhanced virulence in mice, although primary tropism for musculoskeletal tissues was maintained. The E2 K200R mutation was largely responsible for enhanced viral dissemination and pathogenicity, although these effects were augmented by the 3'- UTR deletion. Finally, studies with Irf3/Irf7 -/- and Ifnar1 -/- mice suggest that the E2 K200R mutation enhances viral dissemination from the site of inoculation independently of interferon regulatory factor 3 (IRF3)-, IRF7-, and IFNAR1-mediated responses. As our findings reveal viral determinants of CHIKV dissemination and pathogenicity, their further study should help to elucidate host-virus interactions that determine acute and chronic CHIKV infection

The role of the principal as viewed by North Carolina assistant principals

The purpose of this study was to investigate the views held by North Carolina assistant principals of the role of the principal. This study investigated the views of the assistant principals about the roles of principals across North Carolina, their current principal, and elementary, middle/junior high, and high school principals. The independent variables considered were the assistant principals' years of administrative experience, level of educational attainment, gender, age, and view held of their current principals as effective or ineffective. Data were obtained from 50 assistant principals from a questionnaire mailed to a stratified, proportionate, random sample of 75 assistant principals across North Carolina. The data were analyzed according to nine research questions asked by the study regarding assistant principals1 perceptions of the role of the principal, the relationship between the principal and assistant principal, and training for the assistant principal. Frequencies and percentages were tabulated to determine group views. Chi-square statistics were used to analyze the relationships between the independent variables and the dependent variable - the assistant principals' perception of the role of the principal. Variables significant at the .05 level of confidence were determined

Persistent Disparities in Smoking among Rural Appalachians: Evidence from the Mountain Air Project

BACKGROUND: Adult smoking prevalence in Central Appalachia is the highest in the United States, yet few epidemiologic studies describe the smoking behaviors of this population. Using a community-based approach, the Mountain Air Project (MAP) recruited the largest adult cohort from Central Appalachia, allowing us to examine prevalence and patterns of smoking behavior. METHODS: A cross-sectional epidemiologic study of 972 participants aged 21 years and older was undertaken 2015-2017, with a response rate of 82%. Prevalence ratios and 95% confidence intervals for current smoking (compared to nonsmokers) were computed for the entire cohort then stratified by multiple characteristics, including respiratory health. Adjusted prevalence ratios for current smoking versus not smoking were also computed. RESULTS: MAP participants reported current smoking prevalence (33%) more than double the national adult smoking prevalence. Current smoking among participants with a reported diagnosis of chronic obstructive pulmonary disease and emphysema was 51.5 and 53.3%, respectively. Compared to participants age 65 years and older, those age 45 years or younger reported double the prevalence of smoking (PR: 2.04, 95% CI: 1.51-2.74). Adjusted analyses identified younger age, lower education, unmet financial need, and depression to be significantly associated with current smoking. CONCLUSIONS: Despite declining rates of smoking across the United States, smoking remains a persistent challenge in Central Appalachia, which continues to face marked disparities in education funding and tobacco control policies that have benefitted much of the rest of the nation. Compared with national data, our cohort demonstrated higher rates of smoking among younger populations and reported a greater intensity of cigarette use

Curriculum as Social Practice: The case of Fukushima

Despite the persistent threat from disasters to human health worldwide, meaningful lessons in preparedness are rarely integrated into the health professional curricula of those likely to be first responders. Although core competencies in disaster management have been identified, little is known about how to translate those competencies into multiple curricula across diverse groups who must function together in complex, emotionally charged conditions. In an unprecedented collective response, the International Atomic Energy Agency (IAEA) (Chhem & Abdel-Wahab, Vienna, Austria) worked with the first medical responders (Hasegawa & Kumagai) at Japan’s Fukushima Medical University (FMU) on a project led by educational scholars (Hibbert, Canada and Engle-Hills, South Africa) to address needed changes to curriculum that would authentically reflect the lessons learned. Taking a qualitative approach to study experiences of the first medical responders, this study highlights the role of context as a disruptor to the best laid curricular plans, and considers a collective response to plan for our futures

Small Group Learning is Associated with Reduced Salivary Cortisol and Testosterone in Undergraduate Students

Small group learning activities have been shown to improve student academic performance and educational outcomes. Yet, we have an imperfect understanding of the mechanisms by which this occurs. Group learning may mediate student stress by placing learning in a context where students have both social support and greater control over their learning. We hypothesize that one of the methods by which small group activities improve learning is by mitigating student stress. To test this, we collected physiological measures of stress and self-reported perceived stress from 26 students in two undergraduate classes. Salivary cortisol and testosterone were measured within students across five contexts: a) pre-instructional baseline, b) following a traditional lecture, c) after participating in a structured small group learning activity, d) following completion of multiple choice, and e) essay sections of an exam. Results indicate students have lower salivary cortisol after small group learning activities, as compared to traditional lectures. Further, there is no evidence of a relationship between physiological measures of stress and self-reported perceived stress levels. We discuss how structured small group activities may be beneficial for reducing stress and improving student-learning outcomes