Explaining Levels of Customer Satisfaction with First Contact with Jobcentre Plus: results of qualitative research with Jobcentre Plus Staff

This report is a follow up to the First Contact Customer Survey (Research Report 504). As a result of ongoing difficulties accessing data for sampling purposes, the initial plan to undertake qualitative follow-up research with customers was abandoned in favour of research with staff to explore process-related issues which might explain customer responses. The research was undertaken in September and October 2008 and included telephone interviews with senior staff combined with face-to-face interviews and structured observations with staff in Contact Centres, Jobcentres and Benefit Delivery Centres in four Jobcentre Plus regions. Findings relate specifically to staff perceptions of customer satisfaction with first contact

Study of the parameters affecting contact performance of high reliability relays

Parameters affecting contact performance of high reliability relay

Haematogenous pyogenic bone and joint sepsis – reducing avoidable morbidity

Background and objectives. Delayed presentation of haematogenous bone and joint sepsis is common in our childhood population and leads to a large burden of avoidable morbidity extending into adult life. We set out to determine causative factors in these delays. Design. A prospective study was undertaken over a 1-year period. Setting. Ngwelezane Hospital, a regional hospital in Kwa-Zulu- Natal serving 9 rural district hospitals. Subjects. Children under 15 years with their first presentation of bone and joint sepsis, comprising 80 consecutive cases. Tuberculosis cases were excluded. Outcome measures. Children were categorised at follow-up into two groups. The first group had uncomplicated recoveries, with complete return of function and no clinical or radiological signs of unresorbed sequestra. The second group had complications, with evidence of one or more of the following: chronicity of infection, pathological fracture, deformity, growth plate disturbance, avascular necrosis or joint stiffness. Results. Delay in obtaining definitive treatment correlated strongly with initial misdiagnosis. Only 4/25 septic hips were correctly diagnosed and referred expediently; 19/50 osteomyelitis cases were initially misdiagnosed and treated as cellulitis, and a further 19/50 were misdiagnosed as trauma. Predictably, delayed treatment correlated strongly with a complicated outcome. No significant associations were found between delays and distance to nearest primary health care facility, relative levels of socio-economic deprivation within the study group, maternal educational attainment, or traditional healer consultation. Conclusion. Health care professionals at all levels should be alerted to the continued high incidence of this disease. We propose some ‘red flags' to assist primary health care workers in the diagnosis of this condition. South African Medical Journal Vol. 97 (6) 2007: pp. 456-46

The contested and contingent outcomes of Thatcherism in the UK

The death of Margaret Thatcher in April 2013 sparked a range of discussions and debates about the significance of her period in office and the political project to which she gave her name: Thatcherism. This article argues that Thatcherism is best understood as a symbolically important part of the emergence of first-phase neoliberalism. It engages with contemporary debates about Thatcherism among Marxist commentators and suggests that several apparently divergent positions can help us now reach a more useful analysis of Thatcherism’s short- and long-term outcomes for British political economy. The outcomes identified include: an initial crisis in the neoliberal project in the UK; the transformation of the party political system to be reflective of the politics of neoliberalism, rather than its contestation; long-term attempts at the inculcation of the neoliberal individual; de-industrialisation and financial sector dependence; and a fractured and partially unconscious working class. In all long-term outcomes, the contribution of Thatcherism is best understood as partial and largely negative, in that it cleared the way for a longer-term and more constructive attempt to embed neoliberal political economy. The paper concludes by suggesting that this analysis can inform current debates on the left of British politics about how to oppose and challenge the imposition of neoliberal discipline today

Sexual Dimorphism in Primate Aerobic Capacity: A Phylogenetic Test

Male intrasexual competition should favour increased male physical prowess. This should in turn result in greater aerobic capacity in males than in females (i.e. sexual dimorphism) and a correlation between sexual dimorphism in aerobic capacity and the strength of sexual selection among species. However, physiological scaling laws predict that aerobic capacity should be lower per unit body mass in larger than in smaller animals, potentially reducing or reversing the sex difference and its association with measures of sexual selection. We used measures of haematocrit and red blood cell (RBC) counts from 45 species of primates to test four predictions related to sexual selection and body mass: (i) on average, males should have higher aerobic capacity than females, (ii) aerobic capacity should be higher in adult than juvenile males, (iii) aerobic capacity should increase with increasing sexual selection, but also that (iv) measures of aerobic capacity should co-vary negatively with body mass. For the first two predictions, we used a phylogenetic paired t-test developed for this study. We found support for predictions (i) and (ii). For prediction (iii), however, we found a negative correlation between the degree of sexual selection and aerobic capacity, which was opposite to our prediction. Prediction (iv) was generally supported. We also investigated whether substrate use, basal metabolic rate and agility influenced physiological measures of oxygen transport, but we found only weak evidence for a correlation between RBC count and agility.Human Evolutionary Biolog

Population Differences in Death Rates in HIV-Positive Patients with Tuberculosis.

SETTING: Randomised controlled clinical trial of Mycobacterium vaccae vaccination as an adjunct to anti-tuberculosis treatment in human immunodeficiency virus (HIV) positive patients with smear-positive tuberculosis (TB) in Lusaka, Zambia, and Karonga, Malawi. OBJECTIVE: To explain the difference in mortality between the two trial sites and to identify risk factors for death among HIV-positive patients with TB. DESIGN: Information on demographic, clinical, laboratory and radiographic characteristics was collected. Patients in Lusaka (667) and in Karonga (84) were followed up for an average of 1.56 years. Cox proportional hazard analyses were used to assess differences in survival between the two sites and to determine risk factors associated with mortality during and after anti-tuberculosis treatment. RESULTS: The case fatality rate was 14.7% in Lusaka and 21.4% in Karonga. The hazard ratio for death comparing Karonga to Lusaka was 1.47 (95% confidence interval [CI] 0.9-2.4) during treatment and 1.76 (95%CI 1.0-3.0) after treatment. This difference could be almost entirely explained by age and more advanced HIV disease among patients in Karonga. CONCLUSION: It is important to understand the reasons for population differences in mortality among patients with TB and HIV and to maximise efforts to reduce mortality

WHO Clinical Staging of HIV Infection and Disease, Tuberculosis and Eligibility for Antiretroviral Treatment: Relationship to CD4 Lymphocyte Counts.

SETTING: Thyolo district, Malawi. OBJECTIVES: To determine in HIV-positive individuals aged over 13 years CD4 lymphocyte counts in patients classified as WHO Clinical Stage III and IV and patients with active and previous tuberculosis (TB). DESIGN: Cross-sectional study. METHODS: CD4 lymphocyte counts were determined in all consecutive HIV-positive individuals presenting to the antiretroviral clinic in WHO Stage III and IV. RESULTS: A CD4 lymphocyte count of < or = 350 cells/microl was found in 413 (90%) of 457 individuals in WHO Stage III and IV, 96% of 77 individuals with active TB, 92% of 65 individuals with a history of pulmonary TB (PTB) in the last year, 91% of 89 individuals with a previous history of PTB beyond 1 year, 81% of 32 individuals with a previous history of extra-pulmonary TB, 93% of 107 individuals with active or past TB with another HIV-related disease and 89% of 158 individuals with active or past TB without another HIV-related disease. CONCLUSIONS: In our setting, nine of 10 HIV-positive individuals presenting in WHO Stage III and IV and with active or previous TB have CD4 counts of < or = 350 cells/microl. It would thus be reasonable, in this or similar settings where CD4 counts are unavailable for clinical management, for all such patients to be considered eligible for antiretroviral therapy

TRUNCATE-TB: an innovative trial design for drug-sensitive tuberculosis

Background: The number of potential regimens of drug treatment for TB is vast, meaning that evaluating each new treatment against a control in separate two-arm trials requires a huge amount of resources. There is, therefore, a need for innovative trial designs that can evaluate drug regimens simultaneously