Management Of Academic Quality: A Comparison Of Online Versus Lecture Course Outcomes

This study compared the final grades of courses taught both through distance learning (online) and the traditional classroom (lecture) delivery mode. This research sought to determine if a significant difference existed between the grades of the two identified delivery modes. Four courses taught by Embry Riddle Aeronautical University were selected for the study. Grades for the 2005 and 2006 calendar years were compared to determine if significance exists between the two modes. The study found that in the case of all four classes a significant difference was found in the final grades. In each case, the mean grade for the online courses was significantly less than those of the traditional lecture classes

Patient choice at the point of GP referral: Department of Health

1 The Department of Health has a Public Service Agreement target to ensure that by the end of 2005 every hospital appointment in the National Health Service in England (the NHS) will be booked for the convenience of the patient, making it easier for patients and their General Practitioners (GPs) to choose the hospital and consultant that best meets their need. The Department aims to provide patients with the opportunity to choose between four to five healthcare providers for elective hospital treatment by December 2005. In consultation with their GP, patients should be able to choose, from a menu of NHS and independent sector healthcare providers, their preferred location for treatment. Patients should also be able to book the time and date of their initial outpatient appointment within 24 hours of the decision to refer the patient for treatment. This target will apply to around 9.4 million patients referred for hospital treatment by their GP each year, around four per cent of the total estimated 241 million GP consultations. 2 Choice at referral can contribute to a more patientfocused health service, bringing benefits to both patients and the NHS. But providing such a choice will not happen by accident. There are a number of dependencies and interactions with other policies that need to be managed. Information Technology (IT) systems need to be developed and modified and significant cultural, organisational and behavioural changes will need to be made by patients, NHS organisations and staff. 3 This report examines whether the Department is on track to deliver choice at the point of referral successfully by the target date of December 2005. Our work has found that: a Progress has been made towards delivering choice at referral through establishing the required organisational infrastructure, commissioning new IT systems and modifications to existing ones, and providing support for the NHS organisations that will deliver it. b The engagement of GPs is currently low and is a key risk which the Department must address to deliver choice successfully. The Department plans to address this risk through a campaign to inform and engage GPs during 2005 and it will need to monitor carefully the progress of this campaign. c Choice at referral will be delivered most efficiently and effectively through electronic booking (e-booking, also known as Choose and Book), in which the Electronic Booking Service, commissioned by the Department’s National Programme for IT (NPfIT), is linked to upgraded or new computer systems in hospitals and GPs’ surgeries. However, e-booking will not be universally available by December 2005. Until e-booking is fully adopted choice will have to be provided in other, less efficient, ways. d Parts of the NHS still have much to do if they are to deliver choice. A significant minority of Primary Care Trusts do not yet have adequate plans in place to manage the introduction of choice and some may struggle to manage the required new commissioning arrangements. 4 Our more detailed findings are as follows. Progress has been made towards delivering choice at referral 5 The Department believes that choice is affordable. Additional annual infrastructure and transaction costs are estimated to be £122 million – or 1.4 per cent of the current total expenditure on elective care. The main aim of introducing choice is to improve services for patients, but it should lead to increased efficiencies in primary and secondary care services worth an estimated £71 million, off-setting some of these costs. 6 It is essential that choice is supported by other elements of system reform including e-booking, payment by results, commissioning and appropriate capacity. Modelling exercises have shown that the system reforms should work in harmony with one another. Payment by results should enable the transfer of funding to follow the patient and there should be sufficient capacity across the system to enable choice to be effective. 7 Much of the organisational infrastructure that is required for choice is in place and there is clear accountability for the delivery of the programme. To strengthen detailed national programme management arrangements the Department created, on 22 December 2004, a new post of National Implementation Director for Choose and Book, with effect from 10 January 2005. The new Director will be responsible for overseeing the implementation of choice within the NHS whilst the National Programme for IT Group Programme Director for Choose and Book will continue to be responsible for Choose and Book technology development and deployment, patient access and Choose and Book contract management. 8 The Department has provided different types of support to the NHS – for example, ten pilot schemes have been run to test the policy in practice. It has set up a system for periodically measuring progress and used this to establish the position at the end of October 2004, creating a baseline against which to monitor future progress. 9 Research has identified what information patients will want to base their choices on, and the Department is seeking to provide this. While it is unlikely that full information will be available for December 2005, the majority of those aspects identified by patients as being the most important, such as waiting times and basic access information, will be in place. The Department plans to increase the information available over time. The key risk to the delivery of choice is the engagement of GPs 10 Choice cannot be delivered without support from GPs but our survey of GPs found that around half of GPs know very little about it and 61 per cent feel either very negative or a little negative. GPs’ concerns include practice capacity, workload, consultation length and fears that existing health inequalities will be exacerbated. The Department has deliberately held back its main effort to inform and engage GPs about choice until it has had a working e-booking system to show GPs, but it intends to mount a campaign to inform and engage GPs during 2005. Until e-booking is fully adopted choice will be supported by other mechanisms 11 The Department has commissioned Atos Origin to develop a national system for e-booking, which will be linked to upgraded or new Patient Administration Systems in hospitals and IT systems in GPs’ surgeries to provide an overall service known as e-booking. The National Programme for IT has planned the roll out of e-booking on an incremental basis to minimise risk, and to link it by the end of 2005 to some 60 to 70 per cent of hospital systems and GP practices. 12 E-booking is the most effective and efficient way of delivering the Department’s plans for choice, and alternative booking mechanisms offer poorer value for money. Atos Origin has delivered a functioning system and the first booking using e-booking was made in July 2004. However the roll-out of e-booking has been slower than planned and at the end of December 2004 only 63 bookings had been made. Problems have included the reluctance of users to work with an unreliable end-to-end system, limited progress in linking to GP and hospital systems, and the limited number of GPs willing to use the system. 13 The Department believes that new releases of software have addressed the reliability of the whole end-to-end system and that having a fully operational system will encourage GPs to engage with e-booking. The roll-out of changes to hospital systems to allow them to link to e-booking is gathering pace and four types of GP systems can now link to e-booking, although the largest supplier has not yet agreed an implementation plan. A combined team of Departmental and NHS personnel are working with the three main existing GP system suppliers to agree a national deployment schedule. This work should be completed by February 2005, along with a nationally negotiated commercial arrangement. The Department is also developing and trialling contingency plans against further delays, as well as alternatives to the fully integrated Choose and Book solution. Parts of the NHS still have much to do 14 Programme management arrangements in the NHS are incomplete. While most Primary Care Trusts expect to be able to deliver the choice target, there is variability in their overall performance. As many as a quarter of Primary Care Trusts currently forecast that they will not deliver the choice targets. In addition, some Primary Care Trusts may struggle to manage the new commissioning arrangements and two-thirds have yet to commission the required number of providers. The department is developing a framework of support to assist trusts to overcome these obstacles. 15 The Department needs urgently to address the low level of GP support for their plans for implementing choice at referral, and should: I Press on urgently with its plans for informing GPs about the implementation of choice at referral and its impact on GPs and patients. II Monitor the views of GPs, for example by a regular survey, repeating key questions from our own survey, to assess the rate of progress being achieved towards the level of support needed to meet its target of full implementation by December 2005. III Consider whether further action is needed to secure the required level of GP support, once GPs are fully informed on what choice at referral involves. 16 The Department should also: IV Complete its planned benefits realisation plan for choice at referral by the summer of 2005, along with a monitoring mechanism and quantified targets. V Keep under regular and close review the progress of its planned implementation of choice through implementing e-booking and consider the scope for accelerating the roll-out of e-booking to make it available everywhere by December 2005. VI If it becomes clear that it is not possible to deliver e-booking everywhere by December 2005, the Department should: a monitor closely the development of the interim solutions to ensure that they meet their delivery dates; and b ensure that the implementation of interim solutions does not detract from the priority of bringing in fully integrated e-booking systems as soon as possible. VII Establish an evaluation framework for Primary Care Trust commissioning to assist Strategic Health Authorities in assessing the capacity and skills of Primary Care Trusts in this area and securing improvements in capacity and skills where necessary

Virtual patients designed for training against medical error: Exploring the impact of decision-making on learner motivation.

OBJECTIVES: Medical error is a significant cause of patient harms in clinical practice, but education and training are recognised as having a key role in minimising their incidence. The use of virtual patient (VP) activities targeting training in medical error allows learners to practice patient management in a safe environment. The inclusion of branched decision-making elements in the activities has the potential to drive additional generative cognitive processing and improved learning outcomes, but the increased cognitive load on learning risks negatively affecting learner motivation. The aim of this study is to better understand the impact that the inclusion of decision-making and inducing errors within the VP activities has on learner motivation. METHODS: Using a repeated study design, over a period of six weeks we provided undergraduate medical students at six institutions in three countries with a series of six VPs written around errors in paediatric practice. Participants were divided into two groups and received either linearly structured VPs or ones that incorporated branched decision-making elements. Having completed all the VPs, each participant was asked to complete a survey designed to assess their motivation and learning strategies. RESULTS: Our analysis showed that in general, there was no significant difference in learner motivation between those receiving the linear VPs and those who received branched decision-making VPs. The same results were generally reflected across all six institutions. CONCLUSIONS: The findings demonstrated that the inclusion of decision-making elements did not make a significant difference to undergraduate medical students' motivation, perceived self-efficacy or adopted learning strategies. The length of the intervention was sufficient for learners to overcome any increased cognitive load associated with branched decision-making elements being included in VPs. Further work is required to establish any immediate impact within periods shorter than the length of our study or upon achieved learning outcomes

Disentangling the effects of cannabis and cigarette smoking on impulsivity

BACKGROUND: Cannabis smoking and cigarette smoking often co-occur, yet limited research has investigated the potentially different role impulsivity may play when these behaviours occur in isolation, compared with in combination. AIMS: This study examined trait and behavioural impulsivity as a function of both cigarette and cannabis smoking. METHODS: Trait impulsivity (BIS-11) was compared between 44 non-smokers, 76 cigarette only, 47 cannabis only and 58 cannabis plus cigarette smokers. The effects of cigarette and cannabis smoking on behavioural impulsivity (stop-signal and information sampling tasks) were then assessed in 87 of these participants during a laboratory session. RESULTS: Trait impulsivity was significantly higher in cigarette smokers than non-smokers, irrespective of cannabis use, except for motor impulsivity, where cigarette smoking was only associated with elevated trait impulsivity in non-smokers of cannabis. Dimensions of trait impulsivity were significantly positively related to cigarette smoking frequency and nicotine dependence, but not to cannabis smoking frequency or dependence. Smoking cigarettes or cannabis was associated with significantly impaired reflection impulsivity relative to not smoking either substance. However, no additional increases in reflection impulsivity were observed in those who smoked both cigarettes and cannabis. No group differences in response inhibition were detected. CONCLUSIONS: Heightened trait impulsivity appears to be uniquely related to cigarette smoking, whilst the smoking of cigarettes or cannabis is associated with impairments in reflection impulsivity. Improved outcomes for treating cannabis dependence may result from encouraging concomitant cigarette smokers to cease using both drugs simultaneously in order to reduce heightened impulsivity and risk of relapse

TWO NEW PLOCENE SPECIES OF CYCLOSTEPHANOS (BACILLARIOPHYCEAE) WITH COMMENTS ON THE CLASSIFICATION OF THE FRESHWATER THALASSIOSIRACEAE 1

Two new species of the diatom genus Cyclostephanos Round are described from Pliocene fossil deposits in western North America. Cyclostephanos undatus is distinguished from other Cyclostephanos species by its tangentially undulate valve face; Cyclostephanos fenestratus is distinguished by its extremely shallow alveoli. This paper records previously unreported morphological detail of Cyclostephanos and speculates that structure of the punctum, labiate process and strutted process may enhance diagnosis of the freshwater genera of the Thalassiosiraceae Lebour emend. Hasle. Cyclostephanos undatus is similar to several Cyclotella species, but its external costae are raised and its alveolar morphology is similar to that of Cyclostephanos dubius (Fricke) Round. Cyclostephanos fenestratus is similar in external view to Stephanodiscus Ehrenb. However, the two species described here have flat cribra covering the mantle puncta and the labiate processes appear to lack external tubes, whereas Stephanodiscus species have domed mantle cribra and external tubes.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65645/1/j.1529-8817.1986.tb04154.x.pd

Institutions versus market forces: Explaining the employment insecurity of European individuals during (the beginning of) the financial crisis

In reaction to the recent financial crisis, the European Commission re-stated its view that the balance between flexibility and security is the key to success for the future of the European social economy, as well as its belief in the power of institutional arrangements it deems necessary for this balance. However, do powerful institutions actually counter market forces where flexicurity is concerned? In this paper we address this question by analysing the impact of institutional configurations and market factors on perceived employment insecurity among workers in Europe. We use the 4th wave of the European Social Survey for 2008/2009, which covers 22 countries, and implement a multi-level approach where contextual effects are taken into account and individuals are considered to be embedded within a country. We find that policies that secure one’s income and employability skills, such as passive and active labour market policies, are more important for providing employment security for individuals than institutions that secure one’s current job, such as employment protection. Of the economic and labour market factors, general market conditions (measured as employment rate average) and the strength of the financial crisis (measured as gross domestic product growth rate from 2008 to 2009) are both similarly influential in explaining cross-national variance in the employment insecurity perception of individuals. More generally, and most interestingly, we find that institutional factors lose their significance when market factors are taken into account. Thus, it seems that differences in economic and labour market conditions between countries better explain why workers feel insecure about their employment, than the differences in employment and income policies. Although this result could be influenced by the time period under investigation, which is characterized by a financial crisis, results from previous studies using data from different periods suggest that it is not period-specific

An Internet “Value of Health” panel: recruitment, participation and compliance

OBJECTIVES To recruit a panel of members of the public to provide preferences in response to the needs of economic evaluators over the course of a year. METHODS A sample of members of the UK general public was recruited in a stratified random sample from the electoral roll and familiarised with the standard gamble method of preference elicitation using an internet based tool. Recruitment (proportion of people approached who were trained), participation (defined as the proportion of people trained who provided any preferences) and compliance (defined as the proportion of preference tasks which were completed) were described. The influence of covariates on these outcomes was investigated using univariate and multivariate analyses. RESULTS A panel of 112 people was recruited. The eventual panel reflected national demographics to some extent, but recruitment from areas of high socioeconomic deprivation and among ethnic minority communities was low. 23% of people who were approached (n= 5,320) responded to the invitation to take part in the study, and 24% of respondents (n=1,215) were willing to participate. However, eventual recruitment rates, following training, were low (2.1% of those approached), although significantly higher in Exeter than other cities. 18 sets of health state descriptions were presented to the panel over 14 months. 74% of panel members praticipated in at least one valuation task. Socioeconomic and marital status were significantly associated with participation. Compliance varied from 3% to 100%, with the average per set of health state descriptions being 41%. Compliance was higher in retired people but otherwise no significant predictors were identified. CONCLUSIONS It is feasible to recruit and train a panel of members of the general public to express preferences on a wide range of health states using the internet in response to the needs of analysts. In order to provide a sample which reflects the demographics of the general public, and capitalise on the increasing opportunities for the use of the internet in this field, over-sampling in areas of high socioeconomic deprivation and among ethnic minority communities is necessary.utility; Internet; public; survey

An Internet "Value of Health" panel: recruitment, participation and compliance

OBJECTIVES To recruit a panel of members of the public to provide preferences in response to the needs of economic evaluators over the course of a year. METHODS A sample of members of the UK general public was recruited in a stratified random sample from the electoral roll and familiarised with the standard gamble method of preference elicitation using an internet based tool. Recruitment (proportion of people approached who were trained), participation (defined as the proportion of people trained who provided any preferences) and compliance (defined as the proportion of preference tasks which were completed) were described. The influence of covariates on these outcomes were investigated using univariate and multivariate analyses. RESULTS A panel of 112 people was recruited. The eventual panel reflected national demographics to some extent, but recruitment from areas of high socioeconomic deprivation and among ethnic minority communities was low. 23% of people who were approached (n= 5,320) responded to the invitation to take part in the study, and 24% of respondents (n=1,215) were willing to participate. However, eventual recruitment rates, following training, were low (2.1% of those approached), although significantly higher in Exeter than other cities. 18 sets of health state descriptions were presented to the panel over 14 months. 74% of panel members praticipated in at least one valuation task. Socioeconomic and marital status were significantly associated with participation. Compliance varied from 3% to 100%, with the average per set of health state descriptions being 41%. Compliance was higher in retired people but otherwise no significant predictors were identified. CONCLUSIONS It is feasible to recruit and train a panel of members of the general public to express preferences on a wide range of health states using the internet in response to the needs of analysts. In order to provide a sample which reflects the demographics of the general public, and capitalise on the increasing opportunities for the use of the internet in this field, over-sampling in areas of high socioeconomic deprivation and among ethnic minority communities is necessary

Characterization and comparison of recombinant full-length ursine and human sex hormone-binding globulin

Sex hormone‐binding globulin (SHBG) regulates the bioavailability of sex steroid hormones in the blood. Levels of SHBG increase markedly in brown bears (Ursus arctos) during hibernation, suggesting that a key regulatory role of this protein is to quench sex steroid bioavailability in hibernation physiology. To enable characterization of ursine SHBG and a cross species comparison, we established an insect cell‐based expression system for recombinant full‐length ursine and human SHBG. Compared with human SHBG, we observed markedly lower secretion levels of ursine SHBG, resulting in a 10‐fold difference in purified protein yield. Both human and ursine recombinant SHBG appeared as dimeric proteins in solution, with a single unfolding temperature of ~ 58 °C. The thermal stability of ursine and human SHBG increased 5.4 and 9.5 °C, respectively, in the presence of dihydrotestosterone (DHT), suggesting a difference in affinity. The dissociation constants for [(3)H]DHT were determined to 0.21 ± 0.04 nm for human and 1.32 ± 0.10 nm for ursine SHBG, confirming a lower affinity of ursine SHBG. A similarly reduced affinity, determined from competitive steroid binding, was observed for most steroids. Overall, we found that ursine SHBG had similar characteristics to human SHBG, specifically, being a homodimeric glycoprotein capable of binding steroids with high affinity. Therefore, ursine SHBG likely has similar biological functions to those known for human SHBG. The determined properties of ursine SHBG will contribute to elucidating its potential regulatory role in hibernation physiology

Relativity principles in 1+1 dimensions and differential aging reversal

We study the behavior of clocks in 1+1 spacetime assuming the relativity principle, the principle of constancy of the speed of light and the clock hypothesis. These requirements are satisfied by a class of Finslerian theories parametrized by a real coefficient $\beta$, special relativity being recovered for $\beta=0$. The effect of differential aging is studied for the different values of $\beta$. Below the critical values $|\beta| =1/c$ the differential aging has the usual direction - after a round trip the accelerated observer returns younger than the twin at rest in the inertial frame - while above the critical values the differential aging changes sign. The non-relativistic case is treated by introducing a formal analogy with thermodynamics.Comment: 12 pages, no figures. Previous title "Parity violating terms in clocks' behavior and differential aging reversal". v2: shortened introduction, some sections removed, pointed out the relation with Finsler metrics. Submitted to Found. Phys. Let