The Case Study Approach

The case study approach allows in-depth, multi-faceted explorations of complex issues in their real-life settings. The value of the case study approach is well recognised in the fields of business, law and policy, but somewhat less so in health services research. Based on our experiences of conducting several health-related case studies, we reflect on the different types of case study design, the specific research questions this approach can help answer, the data sources that tend to be used, and the particular advantages and disadvantages of employing this methodological approach. The paper concludes with key pointers to aid those designing and appraising proposals for conducting case study research, and a checklist to help readers assess the quality of case study reports

Design by Radical Indigenism: Equitable Underwater & Intertidal Technologies of the Global South

This article considers the traditional water systems of indigenous cultures and explores their innovations as unique responses to the impacts of climate change in the global south. Local communities have been living with and developing water-responsive infrastructures for generations that engage and support the complex ecosystems they inhabit. Many of these innovations improve coastal resiliency, yet remain undocumented and unexplored in the evolution of contemporary solutions. Rooted in traditional ecological knowledge, or TEK, these technologies work symbiotically with, rather than against nature, and offer examples of a more comprehensive approach to underwater and intertidal design. These innovations are Lo—TEK, a term coined by designer and author Julia Watson, that is defined as resilient infrastructures developed by indigenous people through Traditional Ecological Knowledge (TEK) (Watson 2019). The movement to bring these innovations to the forefront of the design field counters the idea that Lo—TEK indigenous innovation is low-tech, a term often incorrectly applied to indigenous innovation that means unsophisticated, uncomplicated, and primitive. In actuality, Lo—TEK aligns to today’s sustainable values of low-energy, low-impact and low-cost, while producing complex nature-based innovations that are inherently sustainable. Lo-TEK expands the definition of contemporary technology by rebuilding our understanding of climate resilient design using indigenous knowledge and practices that are sustainable, adaptable, and borne out of necessity. Indigenous people have learned to live symbiotically with their environments, especially water. This essay will explore the Kuttanad Kayalnilam Farming System by the Malayalis in India, the Sangjiyutang Mulberry Dyke and Fish Ponds in China, and the Ramli Lagoon farms in Ghar El Melh, Tunisia. These innovations are inherently resilient to the stresses of the climate and are multi-functional, symbiotic structures themselves. While not directly intended for protection from the new challenge of sea level rise, they can inform how we can build circular water systems that work with the environment, rather than disrupting it

Gender relations and couple negotiations of British men's food practice changes after prostate cancer.

Nutrition plays an important role in the health of men diagnosed with prostate cancer and dietary interventions can therefore be a significant part of prostate cancer survivorship supportive care. Family food provision, however, involves complex social interactions, which shape how men engage with their diets and dietary interventions. The role that gender plays in shaping prostate cancer couples' food practices and men's diets after a prostate cancer diagnosis is thought to be important but is little understood. This study explored couples' accounts of nutrition information seeking and diet change to gain a better understanding of how gender relations shaped men's food practices after prostate cancer diagnosis. Qualitative health interviews with men and their partners were conducted and analysed using interpretive descriptive methods. Findings demonstrated how couples navigated food change journeys that involved seeking information, deciding what changes were warranted and implementing and regulating diet changes. Two overarching themes that illustrated couples' food negotiations were called 'Seeking information and deciding on food changes' and 'Monitoring food changes'. Additional sub-themes described who led food changes, women's filtering of information, and moderation or 'treats'. Throughout these food change journeys interactions between men and women were at play, demonstrating how gender relations and dynamics acted to shape couples food negotiations and men's food practices. Findings reveal that attention to gender relations and the men's family food dynamics should inform diet interventions for men with prostate cancer in order to improve uptake

Death or survival from invasive pneumococcal disease in Scotland: associations with serogroups and multilocus sequence types

We describe associations between death from invasive pneumococcal disease (IPD) and particular serogroups and sequence types (STs) determined by multilocus sequence typing (MLST) using data from Scotland. All IPD episodes where blood or cerebrospinal fluid (CSF) culture isolates were referred to the Scottish Haemophilus, Legionella, Meningococcal and Pneumococcal Reference Laboratory (SHLMPRL) from January 1992 to February 2007 were matched to death certification records by the General Register Office for Scotland. This represented 5959 patients. The median number of IPD cases in Scotland each year was 292. Deaths, from any cause, within 30 days of pneumococcal culture from blood or CSF were considered to have IPD as a contributing factor. Eight hundred and thirty-three patients died within 30 days of culture of Streptococcus pneumoniae from blood or CSF [13.95%; 95% confidence interval (13.10, 14.80)]. The highest death rates were in patients over the age of 75. Serotyping data exist for all years but MLST data were only available from 2001 onward. The risk ratio of dying from infection due to particular serogroups or STs compared to dying from IPD due to all other serogroups or STs was calculated. Fisher's exact test with Bonferroni adjustment for multiple testing was used. Age adjustment was accomplished using the Cochran-Mantel-Haenszel test and 95% confidence intervals were reported. Serogroups 3, 11 and 16 have increased probability of causing fatal IPD in Scotland while serogroup 1 IPD has a reduced probability of causing death. None of the 20 most common STs were significantly associated with death within 30 days of pneumococcal culture, after age adjustment. We conclude that there is a stronger association between a fatal outcome and pneumococcal capsular serogroup than there is between a fatal outcome and ST

Effective Feedback to Improve Primary Care Prescribing Safety (EFIPPS) a pragmatic three-arm cluster randomised trial:designing the intervention (ClinicalTrials.gov registration NCT01602705)

Peer reviewedPublisher PD

Incorporation of globally available datasets into the roving cosmic-ray neutron probe method for estimating field-scale soil water content

The need for accurate, real-time, reliable, and multi-scale soil water content (SWC) monitoring is critical for a multitude of scientific disciplines trying to understand and predict the Earth’s terrestrial energy, water, and nutrient cycles. One promising technique to help meet this demand is fixed and roving cosmic-ray neutron probes (CRNPs). However, the relationship between observed low-energy neutrons and SWC is affected by local soil and vegetation calibration parameters. This effect may be accounted for by a calibration equation based on local soil type and the amount of vegetation. However, determining the calibration parameters for this equation is labor- and time-intensive, thus limiting the full potential of the roving CRNP in large surveys and long transects, or its use in novel environments. In this work, our objective is to develop and test the accuracy of globally available datasets (clay weight percent, soil bulk density, and soil organic carbon) to support the operability of the roving CRNP. Here, we develop a 1 km product of soil lattice water over the continental United States (CONUS) using a database of in situ calibration samples and globally available soil taxonomy and soil texture data. We then test the accuracy of the global dataset in the CONUS using comparisons from 61 in situ samples of clay percent (RMSE=5.45 wt %, R2=0.68), soil bulk density (RMSE=0.173 g cm-3, R2=0.203), and soil organic carbon (RMSE=1.47 wt %, R2=0.175). Next, we conduct an uncertainty analysis of the global soil calibration parameters using a Monte Carlo error propagation analysis (maximum RMSE~0.035cm3 cm-3 at a SWC=0.40 cm3 cm-3). In terms of vegetation, fast-growing crops (i.e., maize and soybeans), grasslands, and forests contribute to the CRNP signal primarily through the water within their biomass and this signal must be accounted for accurate estimation of SWC. We estimated the biomass water signal by using a vegetation index derived from MODIS imagery as a proxy for standing wet biomass (RMSEm-2). Lastly, we make recommendations on the design and validation of future roving CRNP experiments

Patient-Specific 3D Printed Models for Education, Research and Surgical Simulation

3D printing techniques are increasingly used in engineering science, allowing the use of computer aided design (CAD) to rapidly and inexpensively create prototypes and components. There is also growing interest in the application of these techniques in a clinical context for the creation of anatomically accurate 3D printed models from medical images for therapy planning, research, training and teaching applications. However, the techniques and tools available to create 3D models of anatomical structures typically require specialist knowledge in image processing and mesh manipulation to achieve. In this book chapter we describe the advantages of 3D printing for patient education, healthcare professional education, interventional planning and implant development. We also describe how to use medical image data to segment volumes of interest, refine and prepare for 3D printing. We will use a lung as an example. The information in this section will allow anyone to create own 3D printed models from medical image data. This knowledge will be of use to anyone with little or no previous experience in medical image processing who have identified a potential application for 3D printing in a medical context, or those with a more general interest in the techniques

Investigating and learning lessons from early experiences of implementing ePrescribing systems into NHS hospitals:a questionnaire study

Background: ePrescribing systems have significant potential to improve the safety and efficiency of healthcare, but they need to be carefully selected and implemented to maximise benefits. Implementations in English hospitals are in the early stages and there is a lack of standards guiding the procurement, functional specifications, and expected benefits. We sought to provide an updated overview of the current picture in relation to implementation of ePrescribing systems, explore existing strategies, and identify early lessons learned.Methods: a descriptive questionnaire-based study, which included closed and free text questions and involved both quantitative and qualitative analysis of the data generated.Results: we obtained responses from 85 of 108 NHS staff (78.7% response rate). At least 6% (n = 10) of the 168 English NHS Trusts have already implemented ePrescribing systems, 2% (n = 4) have no plans of implementing, and 34% (n = 55) are planning to implement with intended rapid implementation timelines driven by high expectations surrounding improved safety and efficiency of care. The majority are unclear as to which system to choose, but integration with existing systems and sophisticated decision support functionality are important decisive factors. Participants highlighted the need for increased guidance in relation to implementation strategy, system choice and standards, as well as the need for top-level management support to adequately resource the project. Although some early benefits were reported by hospitals that had already implemented, the hoped for benefits relating to improved efficiency and cost-savings remain elusive due to a lack of system maturity.Conclusions: whilst few have begun implementation, there is considerable interest in ePrescribing systems with ambitious timelines amongst those hospitals that are planning implementations. In order to ensure maximum chances of realising benefits, there is a need for increased guidance in relation to implementation strategy, system choice and standards, as well as increased financial resources to fund local activitie

Community falls prevention for people who call an emergency ambulance after a fall: randomised controlled trial

Objective To evaluate whether a service to prevent falls in the community would help reduce the rate of falls in older people who call an emergency ambulance when they fall but are not taken to hospital

Quantitative Genetic Effects of Bottlenecks: Experimental Evidence from a Wild Plant Species, Nigella degenii

Understanding the genetic consequences of changes in population size is fundamental in a variety of contexts, such as adaptation and conservation biology. In the study presented here, we have performed a replicated experiment with the plant Nigella degenii to explore the quantitative genetic effects of a single-founder bottleneck. In agreement with additive theory, the bottleneck reduced the mean (co)variance within lines and caused stochastic, line-specific changes in the genetic (co)variance structure. However, a significant portion of the (co)variance structure was conserved, and 2 characters—leaf and flower (sepal) size—turned out to be positively correlated in all data sets, indicating a potential for correlated evolution in these characters, even after a severe bottleneck. The hierarchical partitioning of genetic variance for flower size was in good agreement with predictions from additive theory, whereas the remaining characters showed an excess of within-line variance and a deficiency of among-line variance. The latter discrepancies were most likely a result of selection, given the small proportion of lines (23%) that remained viable until the end of the experiment. Our results suggest that bottlenecked populations of N. degenii generally have a lower adaptive potential than the ancestral population but also highlight the idiosyncratic nature of bottleneck effects