Interface management of offsite bathroom construction: process- and people-factors

Interface management (IM) in its many forms (physical, contractual and organisational) has not received the management research it warrants in the construction sector. Offsite bathroom construction is seen as a sector of offsite construction that can aid the interface problems that are common in construction. However, interface problems that occur when using offsite bathrooms are considered to be as detrimental, if not more to the overall process when compared to traditional bathroom construction. This research will focus on organisational IM, through research into the relevant process and people factors required to mitigate potential IM problems in the offsite bathroom process. A literature review of IM, offsite construction and traditional construction was conducted which identified 16 factors that could have an influence on the organisational IM of offsite bathroom construction. A further literature review was carried out for each factor to establish its connectivity to the holistic process of the IM of offsite bathrooms. A proforma was constructed which gathered quantitative and qualitative data from 82 interviewees, associated with eight case study projects. The methodology adopted was based on the pragmatism philosophical stance, which concurs with a mixed method approach to the collection and analysis of the data. The quantitative data was analysed using frequency tables and the Wilcoxon sign rank test. The quantitative data was analysed using thematic analysis. The analysis identified nine of the 16 factors as main contributors to the IM of offsite bathroom construction. These nine factors consisted of six process factors: procurement, design management, supply chain management, health and safety, tolerance and quality. Three people factors were: communication, client/design team and the role of the project manager. A conceptual model was constructed to encapsulate each of the nine factors and their sub-factors. Important findings from the research identified the procurement route as both an enabler and a constraint, depending on its ability to allow early input from the main contractor and manufacturer to the uptake of offsite bathrooms. The cross-cutting importance of the people factors to the successful implementation of the process factors identified the importance of the main contractor maintaining supervision of the manufacturer and the interface problems created from incomplete design. Further analyses of all the findings identified communication and the role of the project manager as the two most influential factors, with early and informal communication and strong leadership from the project manager relevant to all factors that affect the successful IM of offsite bathroom construction

The occurrence of Sea Lice (Lepeophtheirus salmonis Krøyer) on Farmed Salmon in Ireland (1995 to 2000)

Lepeophtheirus salmonis is the most frequently recorded ecto-parasite on farmed salmon in Europe, and parasitises only salmonid fish species. It is regarded as being commercially damaging to farmed salmon, with major economic losses to the fish farming community resulting per annum. Lepeophtheirus salmonis is a member of the Family Caligidae and has a direct life cycle. Annual data from around Ireland are analysed, as well as per region and per bay. Data is compiled up to the year 2000 and results are based on lice inspections undertaken bimonthly for the months March to May inclusive, and monthly for the remainder of the year, with one exception, December/January, when only one sample was taken. Mean ovigerous and mean mobile lice levels are presented. These estimate, respectively, successful breeding females and successful infection. Results obtained indicate, to some extent, that control methods on different farms differ in the efficacy they have on sea lice infestation, and that depending on which treatment type is used rates of reduction can be different for various life cycle stages. Overall mean ovigerous and mean mobile lice levels were lower in the year 2000 than in 1999. It was apparent that lateral transfer of sea lice during harvesting did occur at a number of sites in the country. It was also apparent that some individual bays appeared to have a greater control over lice infestation levels than others, especially during the critical spring period March to May. The decrease in the control of infestation levels can possibly be attributed to changes in treatments that occurred during the study period, and also to difficulties in achieving effective treatments due to inclement weather and low water temperatures. Since the initiation of monitoring in 1991, improved control of sea lice infestation has always been one of the goals of the programme. Single Bay Management (SBM), introduced in 1993 by the Marine Institute, implemented new measures to minimise re-infection by these parasites, with protocols agreed by all salmon producers within each bay. These plans were later extended and incorporated in 1998 into the Co-ordinated Local Aquaculture Management System (CLAMS), aiming to optimise environmental conditions within each bay for all users of the bay.Funder: Marine Institut

Acupuncture for chronic neck pain: a pilot for a randomised controlled trial

Background: Acupuncture is increasingly being used for many conditions including chronic neck pain. However the evidence remains inconclusive, indicating the need for further well-designed research. The aim of this study was to conduct a pilot randomised controlled parallel arm trial, to establish key features required for the design and implementation of a large-scale trial on acupuncture for chronic neck pain. Methods: Patients whose GPs had diagnosed neck pain were recruited from one general practice, and randomised to receive usual GP care only, or acupuncture ( up to 10 treatments over 3 months) as an adjunctive treatment to usual GP care. The primary outcome measure was the Northwick Park Neck Pain Questionnaire (NPQ) at 3 months. The primary analysis was to determine the sample size for the full scale study. Results: Of the 227 patients with neck pain identified from the GP database, 28 (12.3%) consenting patients were eligible to participate in the pilot and 24 (10.5%) were recruited to the trial. Ten patients were randomised to acupuncture, receiving an average of eight treatments from one of four acupuncturists, and 14 were randomised to usual GP care alone. The sample size for the full scale trial was calculated from a clinically meaningful difference of 5% on the NPQ and, from this pilot, an adjusted standard deviation of 15.3%. Assuming 90% power at the 5% significance level, a sample size of 229 would be required in each arm in a large-scale trial when allowing for a loss to follow-up rate of 14%. In order to achieve this sample, one would need to identify patients from databases of GP practices with a total population of 230,000 patients, or approximately 15 GP practices roughly equal in size to the one involved in this study (i.e. 15,694 patients). Conclusion: This pilot study has allowed a number of recommendations to be made to facilitate the design of a large-scale trial, which in turn will help to clarify the existing evidence base on acupuncture for neck pain

Mindfulness-based interventions for people diagnosed with a current episode of an anxiety or depressive disorder: a meta-analysis of randomised controlled trials

Objective Mindfulness-based interventions (MBIs) can reduce risk of depressive relapse for people with a history of recurrent depression who are currently well. However, the cognitive, affective and motivational features of depression and anxiety might render MBIs ineffective for people experiencing current symptoms. This paper presents a meta-analysis of randomised controlled trials (RCTs) of MBIs where participants met diagnostic criteria for a current episode of an anxiety or depressive disorder. Method Post-intervention between-group Hedges g effect sizes were calculated using a random effects model. Moderator analyses of primary diagnosis, intervention type and control condition were conducted and publication bias was assessed. Results Twelve studies met inclusion criteria (n = 578). There were significant post-intervention between-group benefits of MBIs relative to control conditions on primary symptom severity (Hedges g = −0.59, 95% CI = −0.12 to −1.06). Effects were demonstrated for depressive symptom severity (Hedges g = −0.73, 95% CI = −0.09 to −1.36), but not for anxiety symptom severity (Hedges g = −0.55, 95% CI = 0.09 to −1.18), for RCTs with an inactive control (Hedges g = −1.03, 95% CI = −0.40 to −1.66), but not where there was an active control (Hedges g = 0.03, 95% CI = 0.54 to −0.48) and effects were found for MBCT (Hedges g = −0.39, 95% CI = −0.15 to −0.63) but not for MBSR (Hedges g = −0.75, 95% CI = 0.31 to −1.81). Conclusions This is the first meta-analysis of RCTs of MBIs where all studies included only participants who were diagnosed with a current episode of a depressive or anxiety disorder. Effects of MBIs on primary symptom severity were found for people with a current depressive disorder and it is recommended that MBIs might be considered as an intervention for this population

Comparison of Pharmacopuncture, Aquapuncture and Acepromazine for Sedation of Horses

Pharmacopuncture, the injection of subclinical doses of drugs into acupoints reduces drug undesirable side effects, residues in animal consumption products and treatment costs in large animals. Acepromazine (Acp) produces several undesirable effects, such as hypotension. Previous studies with the injection of 1/10 of Acp dose in dog acupoints showed its advantage for sedation, minimizing undesirable effects. Eight horses were randomly submitted to four different treatment protocols according to a Latin Square double-blind design: (i) 0.1 ml kg−1 of saline subcutaneously injected at the cervical region, (ii) 0.1 mg kg−1 of Acp injected subcutaneously at the cervical region, (iii) 0.01 ml kg−1 of saline injected into GV1 acupoint (aquapuncture) and (iv) 0.01 mg kg−1 of Acp injected into GV1 acupoint (pharmacopuncture). Heart rate, respiratory rate, head height and degree of sedation were measured before and at 30, 60 and 90 min after treatments. Signs of sedation were observed in all treated groups at 30 min and only in 1/10Acp-GV1 at 60 min after the treatments. Only the group treated with 0.1 mg kg−1 of Acp s.c. had significantly lower values of head height at 30 min. Respiratory rate tended to reduce in all groups but was significantly lower only in horses treated with 0.1 mg kg−1 of Acp s.c. Heart rate remained unchanged in all groups. Acp-pharmacopuncture on GV1 in horses produced a mild sedation when compared with the conventional dose of Acp. More investigations are necessary to determine the optimal dosage of Acp-pharmacopuncture for sedation in horses

Marxism Lost and Found: Alasdair MacIntyre and the Contemporary Debate

This paper examines the changing nature of debates that focus on the philosophy of Alasdair MacIntyre. Whilst outlining the history of MacIntyre’s engagement with Marxism and some of his key ideas, it argues that it is only recently that such debates have begun to rightfully recognise the continued relevance of Marxism to such discussions. I note that crucial aspects of MacIntyre’s politics and philosophy, particularly his opposition to capitalism, are now integral to the contemporary debate which helps in generating a shared vision of radical politics. Nevertheless, I point out that key disagreements still remain as to the role of Marxism within such debates, the validity of MacIntyre’s critique of Marxism, as well as the potentially problematic post-Marxist practice that MacIntyre advocates in After Virtue and beyond

The Hawthorne Effect: a randomised, controlled trial

Background: The 'Hawthorne Effect' may be an important factor affecting the generalisability of clinical research to routine practice, but has been little studied. Hawthorne Effects have been reported in previous clinical trials in dementia but to our knowledge, no attempt has been made to quantify them. Our aim was to compare minimal follow- up to intensive follow-up in participants in a placebo controlled trial of Ginkgo biloba for treating mild-moderate dementia.Methods: Participants in a dementia trial were randomised to intensive follow- up (with comprehensive assessment visits at baseline and two, four and six months post randomisation) or minimal follow-up (with an abbreviated assessment at baseline and a full assessment at six months). Our primary outcomes were cognitive functioning (ADAS-Cog) and participant and carer-rated quality of life (QOL-AD).Results: We recruited 176 participants, mainly through general practices. The main analysis was based on Intention to treat (ITT), with available data. In the ANCOVA model with baseline score as a co- variate, follow-up group had a significant effect on outcome at six months on the ADAS-Cog score (n = 140; mean difference = -2.018; 95% Cl -3.914, -0.121; p = 0.037 favouring the intensive follow-up group), and on participant- rated quality of life score (n = 142; mean difference = -1.382; 95% Cl -2.642, -0.122; p = 0.032 favouring minimal follow-up group). There was no significant difference on carer quality of life.Conclusion: We found that more intensive follow-up of individuals in a placebo-controlled clinical trial of Ginkgo biloba for treating mild-moderate dementia resulted in a better outcome than minimal follow-up, as measured by their cognitive functioning

Systematic monitoring of needs for care and global outcomes in patients with severe mental illness

<p>Abstract</p> <p>Background</p> <p>It was hypothesised that the introduction of tools that allow clinicians to assess patients' needs and to negotiate treatment (Cumulative Needs for Care Monitor; CNCM), would be associated with global outcome improvements in patients diagnosed with severe mental illness.</p> <p>Methods</p> <p>The CNCM was introduced in one region in South Limburg (the Netherlands) in 1998 (REGION-1998) and in the rest of South Limburg in 2004 (REGION-2004). By comparing these two regions, changes after the introduction of the CNCM could be assessed (between-region comparison). In addition, a pre-post within-patient comparison was conducted in both regions.</p> <p>Results</p> <p>The within-patient comparison revealed that global outcomes of psychopathology and impairment improved in the first 3-5 years after the introduction of the CNCM. The between-region comparison revealed an improvement in global psychopathology but not in global impairment in REGION-2004 after 2004, while there was no such improvement in REGION-1998.</p> <p>Conclusion</p> <p>Systematic clinical monitoring of individual severe mental illness patients, in combination with provision of feedback, is associated with global improvement in psychopathology. More research is needed to determine the degree to which this association reflects a causal effect.</p

The placebo effect and its determinants in fibromyalgia: meta-analysis of randomized controlled trials

The aims of this study were to determine whether placebo treatment in randomised controlled trials (RCTs) is effective for fibromyalgia and to identify possible determinants of the magnitude of any such placebo effect. A systematic literature search was undertaken for RCTs in people with fibromyalgia that included a placebo and/or a no-treatment (observation only or waiting list) control group. Placebo effect size (ES) for pain and other outcomes was measured as the improvement of each outcome from baseline divided by the standard deviation of the change from baseline. This effect was compared with changes in the no-treatment control groups. Meta-analysis was undertaken to combine data from different studies. Subgroup analysis was conducted to identify possible determinants of the placebo ES. A total of 3912 studies were identified from the literature search. After scrutiny, 229 trials met the inclusion criteria. Participants who received placebo in the RCTs experienced significantly better improvements in pain, fatigue, sleep quality, physical function, and other main outcomes than those receiving no treatment. The ES of placebo for pain relief was clinically moderate (0.53, 95%CI 0.48 to 0.57). The ES increased with increasing strength of the active treatment, increasing participant age and higher baseline pain severity, but decreased in RCTS with more women and with longer duration of fibromyalgia. In addition, placebo treatment in RCTs is effective in fibromyalgia. A number of factors (expected strength of treatment, age, gender, disease duration) appear to influence the magnitude of the placebo effect in this condition

Evaluation of a community pharmacy-based intervention for improving patient adherence to antihypertensives: a randomised controlled trial

BackgroundThe majority of patients using antihypertensive medications fail to achieve their recommended target blood pressure. Poor daily adherence with medication regimens and a lack of persistence with medication use are two of the major reasons for failure to reach target blood pressure. There is no single intervention to improve adherence with antihypertensives that is consistently effective. Community pharmacists are in an ideal position to promote adherence to chronic medications. This study aims to test a specific intervention package that could be integrated into the community pharmacy workflow to enable pharmacists to improve patient adherence and/or persistence with antihypertensive medications - Hypertension Adherence Program in Pharmacy (HAPPY).Methods/DesignThe HAPPY trial is a multi-centre prospective randomised controlled trial. Fifty-six pharmacies have been recruited from three Australian states. To identify potential patients, a software application (MedeMine CVD) extracted data from a community pharmacy dispensing software system (FRED Dispense&reg;). The pharmacies have been randomised to either \u27Pharmacist Care Group\u27 (PCG) or \u27Usual Care Group\u27 (UCG). To check for \u27Hawthorne effect\u27 in the UCG, a third group of patients \u27Hidden Control Group\u27 (HCG) will be identified in the UCG pharmacies, which will be made known to the pharmacists at the end of six months. Each study group requires 182 patients. Data will be collected at baseline, three and six months in the PCG and at baseline and six months in the UCG. Changes in patient adherence and persistence at the end of six months will be measured using the self-reported Morisky score, the Tool for Adherence Behaviour Screening and medication refill data.DiscussionTo our knowledge, this is the first research testing a comprehensive package of evidence-based interventions that could be integrated into the community pharmacy workflow to enable pharmacists to improve patient adherence and/or persistence with antihypertensive medications. The unique features of the HAPPY trial include the use of MedeMine CVD to identify patients who could potentially benefit from the service, control for the \u27Hawthorne effect\u27 in the UCG and the offer of the intervention package at the end of six months to patients in the UCG, a strategy that is expected to improve retention.Trial RegistrationAustralian New Zealand Clinical Trial Registry ACTRN12609000705280<br /