Impact of published clinical outcomes data: case study in NHS hospital trusts

Objective To examine the impact of the publication of clinical outcomes data on NHS Trusts in Scotland to inform the development of similar schemes elsewhere. Design Case studies including semistructured interviews and a review of background statistics. Setting Eight Scottish NHS acute trusts. Participants 48 trust staff comprising chief executives, medical directors, stroke consultants, breast cancer consultants, nurse managers, and junior doctors. Main outcome measures Staff views on the benefits and drawbacks of clinical outcome indicators provided by the clinical resource and audit group (CRAG) and perceptions of the impact of these data on clinical practice and continuous improvement of quality. Results The CRAG indicators had a low profile in the trusts and were rarely cited as informing internal quality improvement or used externally to identify best practice. The indicators were mainly used to support applications for further funding and service development. The poor effect was attributable to a lack of professional belief in the indicators, arising from perceived problems around quality of data and time lag between collection and presentation of data; limited dissemination; weak incentives to take action; a predilection for process rather than outcome indicators; and a belief that informal information is often more useful than quantitative data in the assessment of clinical performance. Conclusions Those responsible for developing clinical indicator programmes should develop robust datasets. They should also encourage a working environment and incentives such that these data are used to improve continuously

How Disgust, Physiological Activity and Moral Foundations May Predict Political Attitudes and Religious Beliefs: A Systematic Review

The goal of this research synthesis is to obtain evidence about a new and upcoming idea of how political ideology and religious beliefs may be predicted by disgust, moral codes and physiological activity. Previously, it was believed by some that politics and religion were a product of an individual\u27s environment and influences of an individual\u27s family and friend\u27s beliefs. Current research is trying to explain how much a person\u27s biology influences their beliefs. This thesis will aim to explain how it is possible to obtain these types of data and why this research is important

The effectiveness of the question formulation technique on open-ended, written response questions in mathematics

The purpose of this study was to determine the effectiveness of the Question Formulation Technique (QFT) on students\u27 open-ended, written response questions in mathematics in a 4th grade inclusion classroom. Four students, three male and one female, participated in the study. All students were classified with specific learning disabilities (SLD) or other health impaired (OHI). Experimental research design was used. A baseline was collected using students previous written response scores. The QFT was implemented over the course of three math chapters. Students were assessed after each chapter with three open-ended, written response problems. The results show that each students average score increased after implementation of the Question Formulation Technique. Further research is needed to determine the extent to which the Question Formulation Technique is responsible for a change in student achievement

The Predictive Utility of Competitive Trait Anxiety, Social Support, and Daily Hassles for Athletic Injury

The purpose of this study was to examine the predictive utility of competitive trait anxiety, using a multidimensional measure (Sport Anxiety Scale, Smith, Smoll, & Schutz, 1990) with an added directional component (Jones & Swain, 1992), social support (Social Provisions Scale, Russell & Cutrona, 1984), daily hassles (Daily Hassles Scale, Kanner, Coyne, Schaefer, & Lazarus, 1981), and gender for athletic injury frequency and severity. Questionnaires were administered to 10 male and female high school basketball teams (N= 103) at the beginning of the 2000 - 2001 season, and injury data was collected from that point throughout the regular season. No significant results emerged in the predictive analyses, possibly because participants were not particularly stressed. Explanations for these results and considerations for improving the quality of this research within the high school population are discussed.

Ambrosia Beetle (Coleoptera: Scolytidae) Species Attacking Chestnut and Captured in Ethanol-Baited Traps in Middle Tennessee

Ambrosia beetles can be important pests of nursery production. The beetles are difficult to control with insecticides, requiring that pesticides be closely timed before tree attack, applied repeatedly, or have long residual activity. The goal of this project was to improve management decisions for ambrosia beetle control in nurseries. This study used ethanol-baited traps, field observations of tree attacks, and emergence cages over beetle galleries to determine the following: (1) composition of ambrosia beetle fauna in middle Tennessee, (2) species responsible for attacks on chestnut (Castanea mollissima Blume), a susceptible tree species, (3) timing of tree attacks and progeny emergence, and (4) the relationship between tree attacks, progeny emergence, and beetle collections in ethanol-baited traps. Ambrosia beetles were surveyed using ethanol-baited Lindgren traps at the Tennessee State University Nursery Crop Research Station in McMinnville, TN, and at two commercial nurseries near Dibrell and Tarlton, TN, during 1998 and 1999. At the Nursery Station, species composition of ambrosia beetles attacking chestnut trees was determined in 1999. Xyleborinus saxeseni Ratzeburg, Xylosandrus crassiusculus Motschulsky, and Monarthrum fasciatum Say were the dominant ambrosia beetle species collected in traps. Xyleborinus saxeseni was the dominant species at all three locations when both 1998 and 1999 collections were totaled. Other commonly trapped species included Monarthrum mali Fitch, Xyleborus atratus Eichhoff, and Xyleborus pelliculosus Eichhoff. Tree attacks began on 2 April before trees broke dormancy. The majority of chestnut attacks occurred in April and May. Progeny emerged from 48% of the caged galleries, including 35.9, 10.3, 3.3, and 1.1% X. germanus, X. crassiusculus, Hypothenemus spp., and X. saxeseni, respectively. Beetles exhibited several unusual behaviors during this study, including emergence of female X. germanus from trees the following spring, emergence of live male X. germanus and X. crassiusculus, a staggered chronology of progeny emergence, and presence of multiple beetle species emerging from the same gallery. Xylosandrus crassiusculus and X. germanus were the dominant species attacking chestnut, but total trap collections of X. germanus were small (≤1.7%). Several findings from this study have significance to the nursery industry. The timing of peak trap collections during April (particularly collections of X. crassiusculus and X. saxeseni) coincided with peak tree attacks. The factors responsible for chestnut susceptibility to attack were not measured in this study, but since the majority of trees were attacked before dormancy break, tree phenological state probably is an important determinant of tree vulnerability. The collection of some species like X. germanus in trap collections may be a more important indicator of tree attack than abundance in the trap. Progeny emergence from chestnut trees during June and July did not coincide with increased trap collections or renewed attacks on chestnut. Therefore, traps may not always indicate ambrosia beetle abundance. Several new state records were collected during this study, including X. crassiusculus, a species capable of serious economic damage to nursery stock

Intergenerational Education: The significance of 'reciprocity' and 'place'

In this article, the case is made for greater clarity in the definition of intergenerational practice and intergenerational education. Theoretically, the effects of all-age reciprocity and the significance of attending to 'place' are explored. Taken together, they help point to what is distinctive about the scope and purpose of intergenerational education. The author argues that any intergenerational practice must always involve an educative element that is focused, at least in part, on the on-going reciprocal production of new relations between generations through the way challenges are purposefully responded to in some specific place

A re-examination of the anatomy and systematics of the tomistomine crocodylians from the Miocene of Italy and Malta

Once a much more globally widespread crocodylian clade, Tomistominae is today represented by just one species, Tomistoma schlegelii (the false gharial), restricted to south-east Asia. Although tomistomine fossil occurrences are recognized from the early Eocene (∼55 Ma) onwards, their remains are often incomplete, making appropriate taxonomic classification within the group problematic. This is especially pertinent to several taxa from the Miocene of Europe, which were historically erected from fragmentary remains. Here we re-examine and describe four approximately contemporaneous taxa from Malta and Italy to determine their taxonomy and phylogenetic affinities: Melitosaurus champsoides, Tomistoma calaritanum, Tomistoma gaudense and Tomistoma lyceense. We place them into a phylogenetic analysis for the first time, comprising 70 taxa scored for 244 characters, several of which are revised or novel, and apply a number of character weighting strategies. Whereas ‘Tomistoma lyceense’ is deemed to be an indeterminate tomistomine, a unique combination of features confirms Melitosaurus champsoides, Tomistoma calaritanum and Tomistoma gaudense as three distinct species. These three taxa are recovered as derived tomistomines, with characters such as a posterior maxillary process between the lacrimal and nasal, large supratemporal fenestrae that are wider than long, and the posteromedial alignment of the last three premaxillary teeth, suggesting a close relationship with the approximately contemporaneous European taxa, Tomistoma lusitanica and Gavialosuchus eggenburgensis. It is unlikely that any of these species belong to Tomistoma, with the possibility that they can all be classified under Melitosaurus and Gavialosuchus. However, we retain them in open nomenclature pending reassessment of the remaining European Miocene tomistomines. Our taxonomic and phylogenetic revision helps to elucidate past tomistomine diversity in the Miocene of the Mediterranean region, prior to the group’s extirpation, and is an important first step in resolving the complicated history of European tomistomine systematics