Quality care, public perception and quick-fix service management: a Delphi study on stressors of hospital doctors in Ireland.

OBJECTIVES: To identify and rank the most significant workplace stressors to which consultants and trainees are exposed within the publicly funded health sector in Ireland. DESIGN: Following a preliminary semistructured telephone interview, a Delphi technique with 3 rounds of reiterative questionnaires was used to obtain consensus. Conducted in Spring 2014, doctors were purposively selected by their college faculty or specialty training body. SETTING: Consultants and higher specialist trainees who were engaged at a collegiate level with their faculty or professional training body. All were employed in the Irish publicly funded health sector by the Health Services Executive. PARTICIPANTS: 49 doctors: 30 consultants (13 male, 17 female) and 19 trainees (7 male, 12 female). Consultants and trainees were from a wide range of hospital specialties including anaesthetics, radiology and psychiatry. RESULTS: Consultants are most concerned with the quality of healthcare management and its impact on service. They are also concerned about the quality of care they provide. They feel undervalued within the negative sociocultural environment that they work. Trainees also feel undervalued with an uncertain future and they also perceive their sociocultural environment as negative. They echo concerns regarding the quality of care they provide. They struggle with the interface between career demands and personal life. CONCLUSIONS: This Delphi study sought to explore the working life of doctors in Irish hospitals at a time when resources are scarce. It identified both common and distinct concerns regarding sources of stress for 2 groups of doctors. Its identification of key stressors should guide managers and clinicians towards solutions for improving the quality of patient care and the health of care providers

Relationship between childhood socioeconomic position and adverse childhood experiences (ACEs): a systematic review

BACKGROUND: 'Adverse childhood experiences' (ACEs) are associated with increased risk of negative outcomes in later life: ACEs have consequently become a policy priority in many countries. Despite ACEs being highly socially patterned, there has been very little discussion in the political discourse regarding the role of childhood socioeconomic position (SEP) in understanding and addressing them. The aim here was to undertake a systematic review of the literature on the relationship between childhood SEP and ACEs. METHODS: MEDLINE, PsycINFO, ProQuest and Cochrane Library databases were searched. Inclusion criteria were: (1) measurement of SEP in childhood; (2) measurement of multiple ACEs; (3) ACEs were the outcome; and (4) statistical quantification of the relationship between childhood SEP and ACEs. Search terms included ACEs, SEP and synonyms; a second search additionally included 'maltreatment'. Overall study quality/risk of bias was calculated using a modified version of the Hamilton Tool. RESULTS: In the ACEs-based search, only 6 out of 2825 screened papers were eligible for qualitative synthesis. The second search (including maltreatment) increased numbers to: 4562 papers screened and 35 included for synthesis. Eighteen papers were deemed 'high' quality, five 'medium' and the rest 'low'. Meaningful statistical associations were observed between childhood SEP and ACEs/maltreatment in the vast majority of studies, including all except one of those deemed to be high quality. CONCLUSION: Lower childhood SEP is associated with a greater risk of ACEs/maltreatment. With UK child poverty levels predicted to increase markedly, any policy approach that ignores the socioeconomic context to ACEs is therefore flawed

A question of impact: Exploring knowledge utilisation within the UK low carbon innovation system

Successful innovation requires organisations to promote the utilisation of both technology and knowledge amongst the diverse actors who operate within innovation eco-systems. Many of these programmes utilise public funds to drive innovation and engage stakeholders. These public funded programmes come under increasing scrutiny to demonstrate impact as a return on research investment. Knowledge generated within the UK low carbon energy innovation system has the potential to facilitate the achievement of national and supra-national emission targets. Research and practical application in this field has historically centred on technology transfer whilst under-emphasising the crucial role of knowledge within this complex, socio-technical innovation system. This paper presents the results of a qualitative case study undertaken within a knowledge intensive public-private partnership as a component of its knowledge management strategy. The study aimed to explore the perceptions of staff relating to the organisation’s knowledge activities prior to a planned stakeholder engagement event. Fourteen semi-structured interviews were undertaken, and thematic network analysis applied to reveal four major themes. The analysis shows that wider system influences affect how actors perceive their role within the innovation system. Implications for the organisation’s managers are herein suggested which could add value to the organisation and increase knowledge utilisation amongst stakeholder groups. Implications include: clarifying utilisation objectives; tailoring knowledge activities; and introducing ongoing feedback cycles. This paper provides a foundation for future empirical work, which aims to compare knowledge utilisation within different organisational structures and identify best practice within the UK low carbon innovation system

A topography of knowledge transfer and low carbon innovation

The growth of the knowledge economy and the changing relationship between science and society, have triggered the emergence of a ‘new role’ for universities as catalysts for innovation within national innovation policy frameworks. The Triple Helix concept of knowledge generation and innovation introduces triadic relationships between government, academia and industry. These often incorporate state driven aims of innovation development and diffusion for greater societal and economic benefit as conditions of the funding programmes. This concept is witnessed in the UK low carbon energy innovation system, where collaborative relationships are formed to develop new technologies for application by industry and society. The dynamics of the Triple Helix model bring many challenges to policy makers and those engaged in knowledge transfer relationships, stemming from the inherent nature of knowledge and the complex human interactions involved with inter-organisational knowledge transfer. Low carbon innovation has an increased need for inter-disciplinary knowledge transfer where specialised pools of knowledge are brought together for the purposes of innovation, in environments typified by uncertainty and unclear user impacts. Obstacles are compounded by the complexity of defining knowledge transfer processes and the debate surrounding the transferability of knowledge. Significant additional challenges exist within low carbon innovation, where influencing technology adoption by the public is seen as a multifaceted problem with no easy solution and requires innovation outputs to be transformed to societal outcomes. This paper aims to explore the nature of these challenges through a review of the literature on knowledge transfer, the continuing transition of academia, government and industry within knowledge generation frameworks and the specific dilemmas faced by the low carbon innovation system. This literature review provides a foundation for future research which aims to explore the concept of knowledge transfer within the UK low carbon innovation system and gather empirical data pertaining to the optimisation of collaborative project performance

Sensitivity of predicted bioaerosol exposure from open windrow composting facilities to ADMS dispersion model parameters

Bioaerosols are released in elevated quantities from composting facilities and are associated with negative health effects, although dose-response relationships are not well understood, and require improved exposure classification. Dispersion modelling has great potential to improve exposure classification, but has not yet been extensively used or validated in this context. We present a sensitivity analysis of the ADMS dispersion model specific to input parameter ranges relevant to bioaerosol emissions from open windrow composting. This analysis provides an aid for model calibration by prioritising parameter adjustment and targeting independent parameter estimation. Results showed that predicted exposure was most sensitive to the wet and dry deposition modules and the majority of parameters relating to emission source characteristics, including pollutant emission velocity, source geometry and source height. This research improves understanding of the accuracy of model input data required to provide more reliable exposure predictions

Online patient safety education programme for junior doctors: is it worthwhile?

BACKGROUND: Increasing demand exists for blended approaches to the development of professionalism. Trainees of the Royal College of Physicians of Ireland participated in an online patient safety programme. AIMS: Study aims were: (1) to determine whether the programme improved junior doctors\u27 knowledge, attitudes and skills relating to error reporting, open communication and care for the second victim and (2) to establish whether the methodology facilitated participants\u27 learning. METHODS: 208 junior doctors who completed the programme completed a pre-online questionnaire. Measures were \u22patient safety knowledge and attitudes\u22, \u22medical safety climate\u22 and \u22experience of learning\u22. Sixty-two completed the post-questionnaire, representing a 30 % matched response rate. RESULTS: Participating in the programme resulted in immediate (p \u3c 0.01) improvement in skills such as knowing when and how to complete incident forms and disclosing errors to patients, in self-rated knowledge (p \u3c 0.01) and attitudes towards error reporting (p \u3c 0.01). Sixty-three per cent disagreed that doctors routinely report medical errors and 42 % disagreed that doctors routinely share information about medical errors and what caused them. Participants rated interactive features as the most positive elements of the programme. CONCLUSIONS: An online training programme on medical error improved self-rated knowledge, attitudes and skills in junior doctors and was deemed an effective learning tool. Perceptions of work issues such as a poor culture of error reporting among doctors may prevent improved attitudes being realised in practice. Online patient safety education has a role in practice-based initiatives aimed at developing professionalism and improving safety

Effects of Feeding Bt Maize to Sows during Gestation and Lactation on Maternal and Offspring Immunity and Fate of Transgenic Material

peer-reviewedBackground: We aimed to determine the effect of feeding transgenic maize to sows during gestation and lactation on maternal and offspring immunity and to assess the fate of transgenic material. Methodology/Principal Findings: On the day of insemination, sows were assigned to one of two treatments (n = 12/treatment); 1) non-Bt control maize diet or 2) Bt-MON810 maize diet, which were fed for ~143 days throughout gestation and lactation. Immune function was assessed by leukocyte phenotyping, haematology and Cry1Ab-specific antibody presence in blood on days 0, 28 and 110 of gestation and at the end of lactation. Peripheral-blood mononuclear cell cytokine production was investigated on days 28 and 110 of gestation. Haematological analysis was performed on offspring at birth (n = 12/treatment). Presence of the cry1Ab transgene was assessed in sows' blood and faeces on day 110 of gestation and in blood and tissues of offspring at birth. Cry1Ab protein presence was assessed in sows' blood during gestation and lactation and in tissues of offspring at birth. Blood monocyte count and percentage were higher (P<0.05), while granulocyte percentage was lower (P<0.05) in Bt maize-fed sows on day 110 of gestation. Leukocyte count and granulocyte count and percentage were lower (P<0.05), while lymphocyte percentage was higher (P<0.05) in offspring of Bt maize-fed sows. Bt maize-fed sows had a lower percentage of monocytes on day 28 of lactation and of CD4+CD8+ lymphocytes on day 110 of gestation, day 28 of lactation and overall (P<0.05). Cytokine production was similar between treatments. Transgenic material or Cry1Ab-specific antibodies were not detected in sows or offspring. Conclusions/Significance: Treatment differences observed following feeding of Bt maize to sows did not indicate inflammation or allergy and are unlikely to be of major importance. These results provide additional data for Bt maize safety assessment.The research leading to these results has received funding from the European Union's Seventh Framework Programme (FP7/2007–2013) under grant agreement number 211820 and the Teagasc Walsh Fellowship Programme

Right Here Right Now (RHRN) pilot study: testing a method of near-real-time data collection on the social determinants of health

Background: Informing policy and practice with up-to-date evidence on the social determinants of health is an ongoing challenge. One limitation of traditional approaches is the time-lag between identification of a policy or practice need and availability of results. The Right Here Right Now (RHRN) study piloted a near-real-time data-collection process to investigate whether this gap could be bridged. Methods: A website was developed to facilitate the issue of questions, data capture and presentation of findings. Respondents were recruited using two distinct methods – a clustered random probability sample, and a quota sample from street stalls. Weekly four-part questions were issued by email, Short Messaging Service (SMS or text) or post. Quantitative data were descriptively summarised, qualitative data thematically analysed, and a summary report circulated two weeks after each question was issued. The pilot spanned 26 weeks. Results: It proved possible to recruit and retain a panel of respondents providing quantitative and qualitative data on a range of issues. The samples were subject to similar recruitment and response biases as more traditional data-collection approaches. Participants valued the potential to influence change, and stakeholders were enthusiastic about the findings generated, despite reservations about the lack of sample representativeness. Stakeholders acknowledged that decision-making processes are not flexible enough to respond to weekly evidence. Conclusion: RHRN produced a process for collecting near-real-time data for policy-relevant topics, although obtaining and maintaining representative samples was problematic. Adaptations were identified to inform a more sustainable model of near-real-time data collection and dissemination in the future