Patients, Professionals and the Internet: Renegotiating the Healthcare Encounter

The aim of this research was to examine how patient use of internet information impinges on the utilisation of healthcare services. The research had the following objectives: + to quantify the extent, and patterns, of patients use of the internet as a health information resource and identify the factors leading to variations in behaviour. + to identify the search strategies employed by patients in accessing internet health information internet and the evaluative approaches used in assessing information quality. + to analyse the content and dynamics of virtual health communities and how participation in such communities is integrated into engagement with health services. + to document the evolving nature of patient-professional interaction arising from patient access to health information and the subsequent format of the healthcare encounter. + to assess the effect of changing patient access to information and changes in the healthcare encounter on patterns of patient decision making and health behaviours

A Cross-national Comparison of Public Project Benefits Management Practices – The Effectiveness of Benefits Management Frameworks in Application

© 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group. Benefits are the principal reason why an organization may seek to enact change through programmes and projects. The discipline of identification, definition, planning, tracking and realization of benefits is recognized to be instrumental in achieving organizational strategy. In this study, we describe the results of a cross-national comparison of public sector benefits management (BM) practices in Australia, Canada, the UK and the USA. It explores ‘BM practices in action’, considering to what extent ‘espoused’ or ‘mandated’ frameworks are actually practised and perceived by their users. Employing qualitative analysis, semi-structured interview data were analysed from 46 participants with experience in sponsoring, managing and/or reviewing government projects. The results expose considerable variation in the adoption and standardization of BM frameworks from inter and intragovernmental perspectives. We evidence a strong focus on benefits identification across the data set, specifically at the outset (the business case stage seeking project approval) and observe deterioration in focus as the project or programme progresses through the authorization (or assurance) approval gates towards close-out and operations. The results further emphasize the prominence of political interest, leadership buy-in, a benefits-driven culture and a transparent benefits reporting mechanism in the implementation of ‘effective’ BM frameworks

New Genetic Insights from Autoimmune Thyroid Disease

The autoimmune thyroid diseases (AITDs) (Graves' disease and Hashimoto's thyroiditis) are complex genetic diseases which most likely have more than 20 genes contributing to the clinical phenotypes. To date, the genes known to be contributing fall into two categories: immune regulatory genes (including HLA, CTLA4, PTPN22, CD40, CD25, and FCRL3) and thyroid-specific genes (TG and TSHR). However, none of these genes contribute more than a 4-fold increase in risk of developing one of these diseases, and none of the polymorphisms discovered is essential for disease development. Hence, it appears that a variety of different gene interactions can combine to cause the same clinical disease pattern, but the contributing genes may differ from patient to patient and from population to population. Furthermore, this possible mechanism leaves open the powerful influence of the environment and epigenetic modifications of gene expression. For the clinician, this means that genetic profiling of such patients is unlikely to be fruitful in the near future

An empirical study of assurance in the UK government major projects portfolio: from data to recommendations, to action or inaction

© 2020, Emerald Publishing Limited. Purpose: Effective and robust governance of major projects and programmes in the public sector is crucial to the accountability of the state and the transparency of state spending. The theoretical discourse on governance, in the context of projects and programmes, is not fully mature, although is now sufficiently well developed to warrant an increased scholarly focus on practice. This paper aims to contribute to the empirical literature through a study of assurance routines in the UK Government Major Projects Portfolio (GMPP). Design/methodology/approach: A framework analysis approach to the evaluation of a subset of GMPP database generates original insights into (1) the framing of assurance review recommendations, (2) the treatment of assurance review data and (3) the subsequent tracking of the implementation of actions arising from the assurance review process. Findings: The analysis reveals that the “delivery confidence” of the major projects and programmes included in this study improves during the time that they are assured on the GMPP. This would suggest that “enhanced” governance routines are desirable in programmes and projects that exhibit high degrees of complexity and scale. Originality/value: The research findings contribute to the wider conversations in this journal and elsewhere on project governance routines and governance-as-practice in the context of government and public services

Differential medial temporal lobe morphometric predictors of item- and relational-encoded memories in healthy individuals and in individuals with mild cognitive impairment and Alzheimer's disease.

INTRODUCTION:Episodic memory processes are supported by different subregions of the medial temporal lobe (MTL). In contrast to a unitary model of memory recognition supported solely by the hippocampus, a current model suggests that item encoding engages perirhinal cortex, whereas relational encoding engages parahippocampal cortex and the hippocampus. However, this model has not been examined in the context of aging, neurodegeneration, and MTL morphometrics. METHODS:Forty-four healthy subjects (HSs) and 18 cognitively impaired subjects (nine mild cognitive impairment [MCI] and nine Alzheimer's disease [AD] patients) were assessed with the relational and item-specific encoding task (RISE) and underwent 3T magnetic resonance imaging. The RISE assessed the differential contribution of relational and item-specific memory. FreeSurfer was used to obtain measures of cortical thickness of MTL regions and hippocampus volume. RESULTS:Memory accuracies for both item and relational memory were significantly better in the HS group than in the MCI/AD group. In MCI/AD group, relational memory was disproportionately impaired. In HSs, hierarchical regressions demonstrated that memory was predicted by perirhinal thickness after item encoding, and by hippocampus volume after relational encoding (both at trend level) and significantly by parahippocampal thickness at associative recognition. The same brain morphometry profiles predicted memory accuracy in MCI/AD, although more robustly perirhinal thickness for item encoding (R2 = 0.31) and hippocampal volume and parahippocampal thickness for relational encoding (R2 = 0.31). DISCUSSION:Our results supported a model of episodic memory in which item-specific encoding was associated with greater perirhinal cortical thickness, while relational encoding was associated with parahippocampal thickness and hippocampus volume. We identified these relationships not only in HSs but also in individuals with MCI and AD. In the subjects with cognitive impairment, reductions in hippocampal volume and impairments in relational memory were especially prominent

The Morphology of IRC +10420's Circumstellar Ejecta

Images of the circumstellar ejecta associated with the post-red supergiant IRC +10420 show a complex ejecta with visual evidence for episodic mass loss. In this paper we describe the transverse motions of numerous knots, arcs and condensations in the inner ejecta measured from second epoch {\it HST/WFPC2} images. When combined with the radial motions for several of the features, the total space motion and direction of the outflows show that they were ejected at different times, in different directions, and presumably from separate regions on the surface of the star. These discrete structures in the ejecta are kinematically distinct from the general expansion of the nebula and their motions are dominated by their transverse velocities. They are apparently all moving within a few degrees of the plane of the sky. We are thus viewing IRC +10420 nearly pole-on and looking nearly directly down onto its equatorial plane. We also discuss the role of surface activity and magnetic fields on IRC +10420's recent mass loss history.Comment: 16 pages, 6 figure