Developing ODP student placements

In a similar way to nursing and other health professions, elements of the education of operating department practitioners (ODPs) can only be contextualised by clinical practice involvement (Stockhausen and Strutt, 2005; Higginson, 2006; Morgan, 2006). The importance of high-quality placement experiences for all UK health professions is widely acknowledged (Quality Assurance Agency, 2001). Prior to 2009, students on the Diploma in Higher Education ODP programme undertook four clinical placements in the same Trust or organisation. At the time of the project there was a shortfall in the number of placements available and, although the university explored placing students in different clinical areas, such as private healthcare providers and new areas in the NHS, none could provide the full learning experience for students to achieve the required competencies. The course team developed a system that uses placements in a variety of settings and ensures students can gain the required outcomes. The new approach involves auditing for individual placements, instead of for the full course duration. Students are now informed throughout recruitment and selection events that they should be undertaking placements in a minimum of three different organisations. Students now move to a different organisation with every experience, to gain a variety of clinical knowledge. This has resulted in the greater use of clinical placements and the development of new areas for students to gain experience. The benefits of students’ experiences have increased, as they can develop skills and understanding of the ODP role from different perspectives

Analyzing Macroeconomic Effects of Environmental Taxation in the Czech Republic with the Econometric E3ME Model

Market-based instruments have gradually become a significant tool of environmental policy in central European countries. By using the structural macroeconometric E3ME model the authors compare two alternative green tax based policy frameworks in the Czech Republic. While the first imposes a tax on emissions of classical pollutants (particulates, sulphur dioxide, nitrous oxides, and volatile organic compounds), the second consists of carbon taxation intentionally set at the level equalizing environmental effect measured by externalities that are avoided as result of both reductions in emissions subject to taxation and ancillary effects. The authors also analyze impacts of revenue recycling. The comparison of economic impacts of both considered policy set ups indicates that policy aimed at the taxation of classical pollutants outperforms carbon policies in cases without revenue recycling. On the other hand, mainly due to significantly higher revenues from carbon taxation, when the revenues are recycled, a carbon taxation framework appears to be a better option.environmental taxation; structural models; macro-econometric model; E3ME

Immobilization of Gold Nanoparticles for Colourimetric and Ratiometric Refractive Index Sensing

The development of refractive index sensors is an expanding field of research, with applications in fields including medical diagnostics, food safety and public health. Nanotechnology has become widely implemented in various refractive index sensing techniques, resulting in substantial progress in detecting minute changes of refractive index. A literature review of the current refractive index sensing techniques which incorporate nanotechnology demonstrates that two main strategies for refractive index sensors have been developed, those that provide highly sensitive measurements and those that provide visual colourimetric measurements that can be detected by the naked eye. All colourimetric sensors based on gold nanoparticles offer a red to blue shift, however, this thesis outlines the development of a ratiometric colourimetric refractive index sensor that provides a unique blue to red shift. The development began with controlling the deposition of the various gold nanoparticle populations which are immobilized via electrostatic interactions between a weak polyelectrolyte and the gold nanoparticles. It was determined that by altering the pH of the polyelectrolyte as well as the size and concentration of the gold nanoparticles, modulation of the nanoparticle populations could be achieved. The nanoplasmonic surfaces were then shown to be effective sensors for the refractive index range of 1.00 to 1.47, providing both red to blue and blue to red colourimetric shifts, depending on the ratio of the different immobilized nanoparticle ensembles. The sensor surfaces were shown to be reusable, however the electrostatic interactions responsible for immobilizing the nanoparticles were weakened when exposed to various cleaning solutions and common solvents, resulting in nanoparticle loss from the sensor surface. Lastly, the optical response achieved by the refractive index sensors was simulated using COMSOL Multiphysics, which provided insight on the properties that resulted in the unique colourimetric shifts

Investigación, políticas y desarrollo en el Perú

El propósito de este trabajo es analizar la siguiente proposición: las diferencias en la calidad de vida y, más específicamente, las que afectan el desarrollo psicobiológico entre los 0 y los 5 años de edad de niñas, niños y adolescentes en el Perú, contribuyen a la variación de sus logros educativos. Nos motiva la preocupación ante el riesgo de que la actual situación socioeconómica del Perú —y, concretamente, la extensión de la pobreza crónica— afecte el desarrollo infantil de forma tal que interfiera con los fines del sistema educativo estatal.Child development, Academic achievement, Education, Peru

An economic evaluation of vagus nerve stimulation as an adjunctive treatment to anti-seizure medications for the treatment of drug-resistant epilepsy in England.

INTRODUCTION: Anti-seizure medications (ASMs) are commonly used to prevent recurring epileptic seizures, but around a third of people with epilepsy fail to achieve an adequate response. Vagus nerve stimulation (VNS) is clinically recommended for people with drug-resistant epilepsy (DRE) who are not suitable for surgery, but the cost-effectiveness of the intervention has not recently been evaluated. The study objective is to estimate costs and quality-adjusted life-years (QALYs) associated with using VNS as an adjunct to ongoing ASM therapy, compared to the strategy of using only ASMs in the treatment of people with DRE, from an English National Health Service perspective. METHODS: A cohort state transition model was developed in Microsoft Excel to simulate costs and QALYs of the VNS + ASM and ASM only strategies. Patients could transition between five health states, using a 3-month cycle length. Health states were defined by an expected percentage reduction in seizure frequency, derived from randomized control trial data. Costs included the VNS device as well as its installation, setup, and removal; ASM therapy; adverse events associated with VNS (dyspnea, hoarseness, and cough); and health-state costs associated with epilepsy including hospitalizations, emergency department visits, neurologist visits, and primary care visits. A range of sensitivity analyses, including probabilistic sensitivity analysis, were run to assess the impact of parameter and structural uncertainty. RESULTS: In the base case, VNS + ASM had an estimated incremental cost-effectiveness ratio (ICER) of £17,771 per QALY gained compared to ASMs alone. The cost-effective ICER was driven by relative reductions in expected seizure frequency and the differences in health care resource use associated therewith. Sensitivity analyses found that the amount of resource use per epilepsy-related health state was a key driver of the cost component. CONCLUSIONS: VNS is expected to be a cost-effective intervention in the treatment of DRE in the English National Health Service

A cost-effectiveness analysis of endoscopic eradication therapy for management of dysplasia arising in patients with Barrett's oesophagus in the United Kingdom

BACKGROUND AND AIMS: Endoscopic eradication therapy (EET) is the first line approach for treating Barrett's Esophagus (BE) related neoplasia globally. The British Society of Gastroenterology (BSG) recommend EET with combined endoscopic resection (ER) for visible dysplasia followed by endoscopic ablation in patients with both low and high grade dysplasia (LGD and HGD). The aim of this study is to perform a cost-effectiveness analysis for EET for treatment of all grades of dysplasia in BE patients. METHODS: A Markov cohort model with a lifetime time horizon was used to undertake a cost effectiveness analysis. A hypothetical cohort of United Kingdom (UK) patients diagnosed with BE entered the model. Patients in the treatment arm with LGD and HGD received EET and patients with non-dysplastic BE (NDBE) received endoscopic surveillance only. In the comparator arm, patients with LGD, HGD and NDBE received endoscopic surveillance only. A UK National Health Service (NHS) perspective was adopted and the incremental cost effectiveness ratio (ICER) was calculated. Sensitivity analysis was conducted on key input parameters. RESULTS: EET for patients with LGD and HGD arising in BE is cost-effective compared to endoscopic surveillance alone (lifetime ICER £3,006 per QALY gained). The results show that as the time horizon increases, the treatment becomes more cost-effective. The five year financial impact to the UK NHS of introducing EET is £7.1m. CONCLUSIONS: EET for patients with low and high grade BE dysplasia, following updated guidelines from the BSG has been shown to be cost-effective for patients with BE in the UK

How is the New Public Management applied in the occupational health care system? - decision-makers' and OH personnel's views in Finland

<p>Abstract</p> <p>Background</p> <p>In many countries occupational health care system is in change. Occupational health studies are mainly focused on occupational health substance and content. This study offers new perspectives on municipal OHS and its operations from management perspective.</p> <p>Aim</p> <p>The aim of this study is to analyse how New Public Management (NPM) doctrines are applied in the Finnish occupational health care system (OHS). The main focus is to describe and compare the views of decision-makers' and OH workers within the framework of NPM.</p> <p>Methods</p> <p>The data were collected by semi-structured interviews from 17 municipal decision-makers' and 26 municipal OH workers. Data was analyzed by examining coded data in a theory-driven way according to Hood's doctrine of NPM.</p> <p>Results</p> <p>The doctrines were not as compatible with the OH personnel view as with the decision-makers' view. Decision-makers and OH personnel highlighted the strict criteria required for operation evaluation. Moreover, decision-makers strongly accentuated professional management in the public sector and the reorganization of public sector units. These were not equally relevant in OH personnel views. In OH personnel views, other doctrines (more attention to performance and accomplishments, emphasizing and augmentation of the competition and better control of public expense and means test) were not similarly in evidence, only weak evidence was observed when their importance viewed as medium by decision-makers. Neither of the respondents group kept the doctrine of management models of the private sector relevant.</p> <p>Conclusions</p> <p>The NPM and Hoods doctrine fitted well with OH research. The doctrine brought out view differences and similarities between decision-makers and OH personnel. For example, policymakers highlighted more strongly the structural change by emphasizing professional management compared to OH personnel. The need for reorganization of municipal OH, regardless of different operational preconditions, was obvious for both decision-makers and OH personnel. The adaptation of more clarify management to a municipal context is not trouble-free. The municipality systemic structure, complex operational environment, and reconciliation of political and officer authority set challenges to management of municipalities.</p

Enhancing Joined-Up Government and Outcome-Based Performance Management through System Dynamics Modelling to Deal with Wicked Problems: The Case of Societal Ageing

The paper by Auping et al. (2015) focuses on the topic of societal 'ageing', that is, 'a population process, caused by declining fertility and mortality rates, which manifests itself in the growing number of older persons in society' (Huber, 2005). A broader definition frames societal ageing as a 'demographic, structural, cultural and economic transformation resultant from the increase in the number and proportion of " older " people within society' (Victor, 2005, p. 5). 'Double societal ageing' today characterizes most developed countries, which experience both an increase in the percentage of older people and in their life expectancy. In terms of public policy and finance, the relevance of this phenomenon is related to its effects on healthcare budgets, pension costs and fiscal sustainability. From the very beginning of the paper, the topic is clearly framed in the broad context of 'wicked problems', which characterize most of governmental planning, with a specific concern with social issues (Rittel and Webber, 1973, p. 160). These are complex policy problems featured by high risk and uncertainty and a high interdepen-dency among variables affecting them. 'Wicked problems', as in the context analysed in the paper, cannot be clustered within the boundaries of a single organization, or referred to specific administrative levels or ministerial areas. They are characterized by dynamic complexity, involving multi-level, multi-actor and multi-sectoral challenges. Other examples of such problems include social cohesion, climate change, unemployment, crime, homelessness, healthcare, poverty, education and immigration (Laegreid and Rykkja, 2014; Bianchi and Williams, 2015). Such problems are usually ingrained in major social issues of modern life, whose interpretation is not univocal, because it depends on the adopted value perspectives. Therefore, by simply gathering more information can be insufficient to understand and resolve them. This implies that there is not a definitive (i.e. true or false) solution to them; there can be rather a 'good' or 'bad' way to frame them and to profile one or more consistent (or inconsistent) alternative decision sets (Head and Alford, 2013)

AI for the Public Sector: Opportunities and challenges of cross-sector collaboration

Public sector organisations are increasingly interested in using data science and artificial intelligence capabilities to deliver policy and generate efficiencies in high uncertainty environments. The long-term success of data science and AI in the public sector relies on effectively embedding it into delivery solutions for policy implementation. However, governments cannot do this integration of AI into public service delivery on their own. The UK Government Industrial Strategy is clear that delivering on the AI grand challenge requires collaboration between universities and public and private sectors. This cross-sectoral collaborative approach is the norm in applied AI centres of excellence around the world. Despite their popularity, cross-sector collaborations entail serious management challenges that hinder their success. In this article we discuss the opportunities and challenges from AI for public sector. Finally, we propose a series of strategies to successfully manage these cross-sectoral collaborations