The analysis of perception via preference: A strategy for studying how the environment is experienced

Systematic approaches to the management of the visual resource tend to be based on categorizations, and on assumptions of what is valued or preferred. Underlying these distinctions is an implicit view of the perception of the environment. The expert's perceptions, however, may be quite different from the perceptions of those who lack specialized training. While direct questioning regarding environmental perception is unlikely to be fruitful, it has been shown that the use of preference reactions to photographic material is a highly effective procedure for deriving salient perceptual categories. A series of studies focusing on diverse land uses and land covers has generated considerable insight into the way the environment is experienced by the general public. It is safe to say that these empirical results neither match the categories that are the provinces of professional groups assigned with the management of the visual resource, nor do they correspond directly to the attributes assumed to be important in preference. Rather, environmental perception is finely tuned in certain kinds of environments and much less differentiated in others. Equally preferred scenes may fit distinctly different categories. The neglect of the public's categorizations and valuation may lead to approaches that are apparently rational and systematic, but inconsistent with such prevailing perceptions.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/25604/1/0000151.pd

Evidence-Based Health Services Management for Nurse Leaders: An Intracampus Partnership and Curriculum

ABSTRACT OBJECTIVE: In 2008, the New York University Graduate School of Public Service and NYU Libraries faculty partnered to offer a credit course to prepare nurse managers in a graduate program to use the evidence-based paradigm as a framework for locating and filtering best quality evidence to support decision making in the workplace. METHODS: Using lecture, demonstration, hands-on exercises, online tutorials, and readings, the students gained a theoretical basis for framing answerable research questions and exploiting the structure of bibliographic databases to retrieve evidence for management challenges such as medication administration, patient safety, reducing nursing turnover, among many research topics focused on healthcare quality, cost, and access. Critically appraising the literature in the context of the evidence pyramid is introduced along with sources for both free and fee-based data, statistics, and government information. RESULTS: Nurse managers gained competence in navigating, citing, and communicating; they demonstrated an understanding of the evidence hierarchy, assessing methodological quality, and the social and ethical issues related to the provision, dissemination, and sharing of information. CONCLUSIONS: Nurse leaders, in their critical role in contemporary healthcare organizations, have a pressing need to locate evidence-based research. Information literacy embedded in a framework of evidence empowers nurse managers with strategies to retrieve research to support decision making and practice changes in the workplace. A credit course dedicated to an evidence-based approach to the profusion of available information provides a foundation for lifelong professional competence in the use of health services management research

The evolution of public relations measurement and evaluation

The measurement and evaluation of public relations effectiveness has long been a major professional and research issue. In the first half of the 20th century, there were two research methods applied, opinion polls and basic media analysis. These were used to plan campaigns and monitor progress of media relations activities. In the second half of the century, as the practices of public relations expanded, greater emphasis was given to media analysis but the evidence of many practitioner studies was that measurement and evaluation was more discussed than undertaken. In the final 25 years of the century, the academic voice began to become more prominent in the discussion and development of methodologies and in nationally-based education programmes aimed at practitioners. The Internet and social media also began to change practices. There were mixed results from this clamour: more practitioners began to evaluate public relations activity (but many still applied discredited measures) whilst new techniques began to be introduced. Document analysis has prepared a timeline of the development of public relations measurement and evaluation. This paper explores the academic and professional themes that have characterised the development of this important public relations practice over the past 110 years

Imaging Modality and Frequency in Surveillance of Stage I Seminoma Testicular Cancer: Results From a Randomized, Phase III, Noninferiority Trial (TRISST)

PURPOSE: Survival in stage I seminoma is almost 100%. Computed tomography (CT) surveillance is an international standard of care, avoiding adjuvant therapy. In this young population, minimizing irradiation is vital. The Trial of Imaging and Surveillance in Seminoma Testis (TRISST) assessed whether magnetic resonance images (MRIs) or a reduced scan schedule could be used without an unacceptable increase in advanced relapses. METHODS: A phase III, noninferiority, factorial trial. Eligible participants had undergone orchiectomy for stage I seminoma with no adjuvant therapy planned. Random assignment was to seven CTs (6, 12, 18, 24, 36, 48, and 60 months); seven MRIs (same schedule); three CTs (6, 18, and 36 months); or three MRIs. The primary outcome was 6-year incidence of Royal Marsden Hospital stage ≥ IIC relapse (> 5 cm), aiming to exclude increases ≥ 5.7% (from 5.7% to 11.4%) with MRI (v CT) or three scans (v 7); target N = 660, all contributing to both comparisons. Secondary outcomes include relapse ≥ 3 cm, disease-free survival, and overall survival. Intention-to-treat and per-protocol analyses were performed. RESULTS: Six hundred sixty-nine patients enrolled (35 UK centers, 2008-2014); mean tumor size was 2.9 cm, and 358 (54%) were low risk (< 4 cm, no rete testis invasion). With a median follow-up of 72 months, 82 (12%) relapsed. Stage ≥ IIC relapse was rare (10 events). Although statistically noninferior, more events occurred with three scans (nine, 2.8%) versus seven scans (one, 0.3%): 2.5% absolute increase, 90% CI (1.0 to 4.1). Only 4/9 could have potentially been detected earlier with seven scans. Noninferiority of MRI versus CT was also shown; fewer events occurred with MRI (two [0.6%] v eight [2.6%]), 1.9% decrease (-3.5 to -0.3). Per-protocol analyses confirmed noninferiority. Five-year survival was 99%, with no tumor-related deaths. CONCLUSION: Surveillance is a safe management approach-advanced relapse is rare, salvage treatment successful, and outcomes excellent, regardless of imaging frequency or modality. MRI can be recommended to reduce irradiation; and no adverse impact on long-term outcomes was seen with a reduced schedule

This is a platform alteration: a trial management perspective on the operational aspects of adaptive and platform and umbrella protocols.

Background There are limited research and literature on the trial management challenges encountered in running adaptive platform trials. This trial design allows both (1) the seamless addition of new research comparisons when compelling clinical and scientific research questions emerge, and (2) early stopping of accrual to individual comparisons that do not show sufficient activity without affecting other active comparisons. Adaptive platform design trials also offer many potential benefits over traditional trials, from faster time to accrual to contemporaneously recruiting multiple research comparisons, added flexibility to focus on more promising research comparisons via pre-planned interim analyses and potentially shorter time to primary results. We share here our experiences from a trial management perspective, highlighting the challenges and successes.Methods We evaluated the operational aspects of making changes to these adaptive platform trials and identified both common and trial-specific challenges. The operational steps and challenges linked to both the addition of new research comparisons and stopping recruitment following pre-planned interim analysis were considered in our evaluation.Results Specific operational challenges in these adaptive platform protocols, additional to those in traditional two-arm trials, were identified. Key lessons are presented describing some of the solutions and considerations over conducting these trials. Careful consideration on the practicality of the protocol structure (modular versus single protocol), the longevity and continuity of trial oversight committees, and having clear clinical and scientific criteria for the addition of new research comparisons were identified as some of the most common challenges.Conclusions Understanding the operational complexities associated with running adaptive platform protocols is paramount for their conduct, adaptive platform trials offer an efficient model to run randomised controlled trials and we are continuing to work to reduce further the effort required from an operational perspective.Trial registration FOCUS4: ISRCTN Registry, ISRCTN90061546 . Registered on 16 October 2013.Stampede ISRCTN Registry, ISRCTN78818544 . Registered on 2 February 2004

Association of predicted 10 years cardiovascular mortality risk with duration of HIV infection and antiretroviral therapy among HIV-infected individuals in Durban, South Africa

Background: South Africa has the largest population of human immunodeficiency virus (HIV) infected patients on antiretroviral therapy (ART) realising the benefits of increased life expectancy. However, this population may be susceptible to cardiovascular disease (CVD) development, due to the chronic consequences of a lifestyle-related combination of risk factors, HIV infection and ART. We predicted a 10-year cardiovascular mortality risk in an HIV-infected population on long-term ART, based on their observed metabolic risk factor profile. Methods: We extracted data from hospital medical charts for 384 randomly selected HIV-infected patients aged ≥ 30 years. We defined metabolic syndrome (MetS) subcomponents using the International Diabetes Federation definition. A validated non-laboratory-based model for predicting a 10-year CVD mortality risk was applied and categorised into five levels, with the thresholds ranging from very low-risk ( 30%). Results: Among the 384 patients, with a mean (± standard deviation) age of 42.90 ± 8.20 years, the proportion of patients that were overweight/obese was 53.3%, where 50.9% had low high-density lipoprotein (HDL) cholesterol and 21 (17.5%) had metabolic syndrome. A total of 144 patients with complete data allowed a definitive prediction of a 10-year CVD mortality risk. 52% (95% CI 44-60) of the patients were stratified to very low risk ( 30%) of 10-year CVD mortality. The CVD risk grows with increasing age (years), 57.82 ± 6.27 among very high risk and 37.52 ± 4.50; p < 0.001 in very low risk patients. Adjusting for age and analysing CVD risk mortality as a continuous risk score, increasing duration of HIV infection (p = 0.002) and ART (p = 0.007) were significantly associated with increased predicted 10 year CVD mortality risk. However, there was no association between these factors and categorised CVD mortality risk as per recommended scoring thresholds. Conclusions: Approximately 1 in 10 HIV-infected patients is at very high risk of predicted 10-year CVD mortality in our study population. Like uninfected individuals, our study found increased age as a major predictor of 10-year mortality risk and high prevalence of metabolic syndrome. Additional CVD mortality risk due to the duration of HIV infection and ART was seen in our population, further studies in larger and more representative study samples are encouraged. It recommends an urgent need for early planning, prevention and management of metabolic risk factors in HIV populations, at the point of ART initiation

The building information modelling trajectory in facilities management: A review

There is a paucity of literature that examines building information modelling (BIM) for asset management within the architecture, engineering, construction and owner-operated (AECO) sector. This paper therefore presents a thorough review of published literature on the latest research and standards development that impact upon BIM and its application in facilities management (FM) during the operations and maintenance (O&M) phase of building usage. The purpose is to generate new ideas and provide polemic clarity geared to intellectually challenge readers from across a range of academic and industrial disciplines. The findings reveal that significant challenges facing the FM sector include the need for: greater consideration of long-term strategic aspirations; amelioration of data integration/interoperability issues; augmented knowledge management; enhanced performance measurement; and enriched training and competence development for facilities managers to better deal with the amorphous range of services covered by FM. Future work is also proposed in several key areas and includes: case studies to observe and report upon current practice and development; and supplementary research related to concepts of knowledge capture in relation to FM and the growing use of BIM for asset management

An evidence-based approach to the use of telehealth in long-term health conditions: development of an intervention and evaluation through pragmatic randomised controlled trials in patients with depression or raised cardiovascular risk

Background: Health services internationally are exploring the potential of telehealth to support the management of the growing number of people with long-term conditions (LTCs). Aim: To develop, implement and evaluate new care programmes for patients with LTCs, focusing on two common LTCs as exemplars: depression or high cardiovascular disease (CVD) risk. Methods Development: We synthesised quantitative and qualitative evidence on the effectiveness of telehealth for LTCs, conducted a qualitative study based on interviews with patients and staff and undertook a postal survey to explore which patients are interested in different forms of telehealth. Based on these studies we developed a conceptual model [TElehealth in CHronic disease (TECH) model] as a framework for the development and evaluation of the Healthlines Service for patients with LTCs. Implementation: The Healthlines Service consisted of regular telephone calls to participants from health information advisors, supporting them to make behaviour change and to use tailored online resources. Advisors sought to optimise participants’ medication and to improve adherence. Evaluation: The Healthlines Service was evaluated with linked pragmatic randomised controlled trials comparing the Healthlines Service plus usual care with usual care alone, with nested process and economic evaluations. Participants were adults with depression or raised CVD risk recruited from 43 general practices in three areas of England. The primary outcome was response to treatment and the secondary outcomes included anxiety (depression trial), individual risk factors (CVD risk trial), self-management skills, medication adherence, perceptions of support, access to health care and satisfaction with treatment. Trial results Depression trial: In total, 609 participants were randomised and the retention rate was 86%. Response to treatment [Patient Health Questionnaire 9-items (PHQ-9) reduction of ≥ 5 points and score of < 10 after 4 months] was higher in the intervention group (27%, 68/255) than in the control group (19%, 50/270) [odds ratio 1.7, 95% confidence interval (CI) 1.1 to 2.5; p = 0.02]. Anxiety also improved. Intervention participants reported better access to health support, greater satisfaction with treatment and small improvements in self-management, but not improved medication adherence. CVD risk trial: In total, 641 participants were randomised and the retention rate was 91%. Response to treatment (maintenance of/reduction in QRISK®2 score after 12 months) was higher in the intervention group (50%, 148/295) than in the control group (43%, 124/291), which does not exclude a null effect (odds ratio 1.3, 95% CI 1.0 to 1.9; p = 0.08). The intervention was associated with small improvements in blood pressure and weight, but not smoking or cholesterol. Intervention participants were more likely to adhere to medication, reported better access to health support and greater satisfaction with treatment, but few improvements in self-management. The Healthlines Service was likely to be cost-effective for CVD risk, particularly if the benefits are sustained, but not for depression. The intervention was implemented largely as planned, although initial delays and later disruption to delivery because of the closure of NHS Direct may have adversely affected participant engagement. Conclusion: The Healthlines Service, designed using an evidence-based conceptual model, provided modest health benefits and participants valued the better access to care and extra support provided. This service was cost-effective for CVD risk but not depression. These findings of small benefits at extra cost are consistent with previous pragmatic research on the implementation of comprehensive telehealth programmes for LTCs