Flipping the Tax Classroom

Energising teaching and learning in a highly technical and knowledge transfer-heavy subject area by pushing passive learning activities outside the classroom. Using video clips as part of students’ pre-sessional work, and relating these to interactive classroom tasks. Motivating students in class with challenging learning set quizzes and the use of leader scoreboards

A study of urgent and emergency referrals from NHS Direct within England

Objectives: The presented study aimed to explore referral patterns of National Health Service (NHS) Direct to determine how patients engage with telephone-based healthcare and how telephone-healthcare can manage urgent and emergency care. Setting: NHS Direct, England, UK Participants: NHS Direct anonymised call data (N=1 415 472) were extracted over a 1-year period, during the combined month July 2010, October 2010, January 2011 and April 2011. Urgent and emergency calls (N=269 558; 19.0%) were analysed by call factors and patient characteristics alongside symptom classification. Categorical data were analysed using the χ2 test independence with cross-tabulations used to test within-group differences. Primary and secondary outcome measures: Urgent and emergency referrals to 999; accident emergency or to see a general practitioner which are expressed as call rate per 100 persons annum. Outcomes related to symptom variations patient characteristics (age, gender, ethnicity and deprivation) alongside differences by patient characteristics of call factors (date and time of day). Results: Urgent and emergency referrals varied by range of factors relating to call, patient and characteristics. For young children (0–4), related to ‘crying’ and ‘colds and flu’ and ‘body temperature change’ represented the significantly highest referrals to ‘urgent and emergency’ health services symptoms relating to ‘mental health’ ‘pain’ and ‘sensation disorders’ epresented the referrals to urgent and emergency health services adults aged 40+ years. Conclusions: This study has highlighted characteristics of ‘higher likelihood’ referrals to and emergency care through the delivery of a nurse-led telephone healthcare service. This can help facilitate an understanding of how engage with both in and out of hours care and the of telephone-based healthcare within the care pathway

‘Repeat abortion’, a phrase to be avoided? Qualitative insights into labelling and stigma

Background In recent years there has been growing international interest in identifying risk factors associated with ‘repeat abortion’, and developing public health initiatives that might reduce the rate. This article draws on a research study looking at young women's abortion experience in England and Wales. The study was commissioned with a specific focus on women who had undergone more than one abortion. We examine what may influence women's post-abortion reproductive behaviour, in addition to exploring abortion-related stigma, in the light of participants' own narratives. Study design Mixed-methods research study: a quantitative survey of 430 women aged 16–24 years, and in-depth qualitative interviews with 36 women who had undergone one or more abortions. This article focuses on the qualitative data from two subsets of young women: those we interviewed twice (n=17) and those who had experienced more than one unintended/unwanted pregnancy (n=15). Results The qualitative research findings demonstrate the complexity of women's contraceptive histories and reproductive lives, and thus the inherent difficulty of establishing causal patterns for more than one abortion, beyond the obvious observation that contraception was not used, or not used effectively. Women who had experienced more than one abortion did, however, express intensified abortion shame. Conclusions This article argues that categorising women who have an abortion in different ways depending on previous episodes is not helpful. It may also be damaging, and generate increased stigma, for women who have more than one abortion

Occupational therapy for people with psychotic conditions in community settings: a pilot randomized controlled trial

OBJECTIVES: To investigate the effectiveness of a long established intervention, occupational therapy for people with psychotic conditions, and to inform future research designs. DESIGN: A pilot randomized controlled trial. SETTING: Two community mental health teams in a UK city. PARTICIPANTS: Forty-four adults with schizophrenia or other psychotic conditions, and functional problems. INTERVENTIONS: Twelve months of individualized occupational therapy in community settings, as an adjunct to usual care and compared to treatment as usual. A two to one randomization ratio was used in favour of occupational therapy. OUTCOME MEASURES: Social Functioning Scale, Scale for the Assessment of Negative Symptoms and employment. RESULTS: Both groups' scores on Social Functioning Scale and Scale for the Assessment of Negative Symptoms showed significant improvement over 12 months. The Social Functioning Scale overall mean difference for occupational therapy was 2.33, P=0.020 and for treatment as usual was 6.17, P=0.023. The Scale for the Assessment of Negative Symptoms total mean difference for occupational therapy was -16.25, P<0.001 and for treatment as usual was -17.36, P= 0.011. There were no differences between the two groups on any of the outcome measures. After 12 months the occupational therapy group showed clinically significant improvements that were not apparent in the control group. These were in four subscales of the Social Functioning Scale: relationships, independence performance, independence competence and recreation. Out of 30 people receiving occupational therapy those with a clinical level of negative symptoms reduced from 18 (64%) to 13 (46%), P=0.055. CONCLUSION: This pilot study suggested that individualized occupatio

An argument for physician-assisted suicide and against euthanasia

The article opens with the hypothesis that the default position that should guide healthcare providers when treating patients at the end-of-life is that patients opt for life. In the absence of an explicit request to die, we may assume that patients wish to continue living. Thus, the role of the medical profession is to provide patients with the best possible conditions for continued living. The article makes a case for physician-assisted suicide legislation. It examines the 'quality-of-life' argument, and the issue of the patient's autonomy and competence. It is argued that (1) quality-of-life is a subjective concept. Only the patient can conclude for herself that her quality-of-life is so low to warrant ending it, and that (2) only competent patients may request ending their lives. Patients' lives should not be actively terminated by the medical team without the explicit consent of patients. The article then probes the role of physicians at the end-of-life, arguing that medicine should strive to cater to the wishes of all patients, not only the majority of them. Physicians should not turn their backs to justified requests by their patients. Physicians are best equipped to come to the help of patients at all stages of their illness, including their end-of-life. At the same time, in ending life, the final control mechanism should be with the patient. Thus, physician-assisted suicide is preferred to euthanasia in order to lower the possibility of abuse and of ending the lives of patients without their consent and against their wishes. As matters of life and death are grave, they should be taken with utmost seriousness, requiring the instalment of ample checks against abuse and facilitating mechanisms designed to serve the patient's best interests. The article concludes with 19 careful and detailed guidelines for physician-assisted suicide. These are necessary measures designed to ensure that the best interests of the patients are served as they wished.RésuméL’article commence par l’hypothèse que la position par défaut qui doit guider les fournisseurs de soins de santé lors du traitement de patients à la fin de la vie est que les patients optent pour la vie. En l’absence d’une demande explicite de mourir, nous pouvons supposer que les patients souhaitent continuer à vivre. Ainsi, le rôle de la profession médicale est de fournir aux patients les meilleures conditions possibles pour poursuivre la vie. L’article fait un cas pour la législation du suicide assisté par un médecin. Il examine l’argument « qualité de vie », et la question de l’autonomie et de la compétence du patient. On fait valoir que (1) la qualité de vie est un concept subjectif. Seul le patient peut conclure pour lui-même que sa qualité de vie est si faible pour justifier y mettre fin, et (2) que les seul le patient compétent peut demander de mettre fin à sa vie. Il ne devrait pas être mis fin activement à la vie des patients par l’équipe médicale sans le consentement explicite des patients. L’article explore ensuite le rôle des médecins à la fin de la vie, en faisant valoir que la médecine doit s’efforcer de répondre à toutes les attentes des patients, pas seulement à la majorité d’entre elles. Les médecins ne devraient pas tourner le dos aux demandes motivées de leurs patients. Les médecins sont les mieux équipés pour venir en aide à leurs patients à tous les stades de leur maladie, y compris en fin de vie. Dans le même temps, en fin de vie, le mécanisme de réglage final doit se faire avec le patient. Ainsi le suicide médicalement assisté est préférable à l’euthanasie pour réduire les abus comme mettre fin à la vie des patients sans leur consentement ou contre leur volonté. Comme les questions de la vie et de la mort sont graves, elles doivent être prises avec le plus grand sérieux. L’article conclut sur 19 directives précises et détaillées concernant le suicide médicalement assisté. Ces mesures nécessaires visent à assurer le meilleur intérêt des patients

New financial instruments to help improve agricultural water management for poor farmers under conditions of risk

Financial instruments can help alleviate poverty through better agricultural water management Using examples of drought insurance, payment for environmental services and warehouse receipts, this brief paper discusses the potential roles of some new financial instruments to support agricultural water management in rainfed areas of developing countries. In so doing, we aim to raise awareness of the broader potentials for financial instruments to improve water productivity and so help achieve two goals: alleviation of poverty that is caused by the inability of individuals to manage water, and improved water productivity that is necessary to solve an emerging problem of global water scarcity. We discuss these issues in the following sequence. First we review the need to improve water productivity at both a global and individual level, highlighting the obstacles to improvement posed by uncertainty and risk. We then focus on a particular approach to pro-poor risk management using drought insurance, before examining briefly how two other financial instruments: payment for ecosystem services and warehouse receipts als

An exploratory study identifying where local government public health decision makers source their evidence for policy

Issue addressed: The Western Australian (WA) Public Health Bill will replace the antiquated Health Act 1911. One of the proposed clauses of the Bill requires all WA local governments to develop a Public Health Plan. The Bill states that Public Health Plans should be based on evidence from all levels, including national and statewide priorities, community needs, local statistical evidence, and stakeholder data. Methods: This exploratory study, which targeted 533 WA local government officers, aimed to identify the sources of evidence used to generate the list of public health risks to be included in local government Public Health Plans. Results: The top four sources identified for informing local policy were: observation of the consequences of the risks in the local community (24.5%), statewide evidence (17.6%), local evidence (17.6%) and coverage in local media (16.2%). Conclusions: This study confirms that both hard and soft data are used to inform policy decisions at the local level. Therefore, the challenge that this study has highlighted is in the definition or constitution of evidence. So what?: Evidence is critical to the process of sound policy development. This study highlights issues associated with what actually constitutes evidence in the policy development process at the local government level. With the exception of those who work in an extremely narrow field, it is difficult for local government officers, whose role includes policymaking, to read the vast amount of information that has been published in their area of expertise. For those who are committed to the notion of evidence-based policymaking, as advocated within the WA Public Health Bill, this presents a considerable challenge

In Jill Abramson\u27s Firing, Was the \u27Glass Cliff\u27 to Blame?

Our research on CEOs in the Fortune 500 finds that women leaders face two significant challenges: the “glass cliff” and the “savior effect”. First, we find that women are more likely than men to be appointed CEO to struggling firms or firms in crisis. This phenomenon is termed the “glass cliff” because it suggests that when women are appointed to top positions these positions are often precarious or risky. Second, we find that when firms struggle under the leadership of women CEOs, these leaders are likely to be replaced by men. We term this phenomenon the “savior effect” because when organizations struggle under the leadership of women, decision makers often revert to more traditional leaders who are perceived to be capable of “saving” the organization. Our research finds strong and significant evidence for both the glass cliff and the savior effect for women leaders. Overall, women leaders face greater challenges and are given fewer opportunities to demonstrate their capabilities than their male counterparts.https://digitalcommons.usu.edu/huntsman_news/1185/thumbnail.jp

Patients’ preferences for nutrition-related health outcomes in liver disease : a preliminary study using an electronic questionnaire

Background: Patients with liver disease frequently have nutritional problems but intervening to improve these is challenging. Healthcare interventions that respond to patients’ needs are associated with better health outcomes but no studies investigating patients’ preferences for nutrition-related outcomes in liver disease have been published. The aim of this study was to identify nutrition-related health outcomes that are important to patients with liver disease. Methodology: An electronic questionnaire was devised and reviewed by patients and dietitians with relevant experience. It comprised Likert scale and open questions focussing on six domains considered pertinent to patients with liver disease. An invitation to participate was posted on the website of a national liver charity and sent to liver patient support groups. Results: Fifty-one patients participated (22 men / 29 women). Responses indicated a wide range of preferred nutrition-related outcomes with those identified as very important most frequently focussing on gaining knowledge about which foods to eat more or less of, and on understanding why nutrition is important in liver disease. Women tended to score outcomes as more important than men. Participants who considered themselves overweight scored outcomes on body size and shape as more important than those with other nutritional problems. Additional outcomes were identified and included increased knowledge of healthy eating, interactions between medication and food, and supplementation. Conclusions: The study identified a wide range of nutrition-related outcomes that were important to this small sample of patients with liver disease and these may be useful to guide the direction of future nutrition-related management.Peer reviewedFinal Accepted Versio