Research and evaluation into the role of asynchronous computer-mediated conferencing and virtual learning environments to improve hospitality and tourism supervision and peer support whilst on placement.

PEDAGOGIC RESEARCH PROJECT REPORTThis report explores the contribution that networked technologies can make to support learning during work placements. An educational case study is presented which evaluates the development and implementation of a Virtual Learning Environment (VLE) amongst a group of undergraduate students studying hospitality and tourism management at Queen Margaret University College, Edinburgh. The case study reveals that it is feasible to create an online facility that can be beneficial to both students and placement tutors. Moreover, it is revealed that the development of a VLE for placement learning can serve as an effective means of introducing both placement tutors and students to use of computer mediated conferencing as a means of communication. However, it has been found that a number of barriers do exist which prevent the potential of such a facility being fully realised. Principal amongst these barriers were restrictions on student access, and student and staff unfamiliarity with using computer mediated conferencing as a pedagogic tool. It was also found that the preferred use of computer mediated conferencing was to support informal discussion between students and tutors. A more formal use in respect of making connections between placement experience and classroom learning was not in evidence. This is considered to be a missed opportunity. The study concludes that more needs to be done to promote a more 'formal' use of computer mediated conferencing as a mechanism to abstract learning from experience (reflection).div_MCaPAAdelman, C Kemmis, S and Jenkins, D (1976) Rethinking case study: notes from the Second Cambridge Conference, Cambridge Journal of Education, 6(3), 47-61. Barnes, D and Todd, F (1977) Communication and Learning in Small Groups. London: Routledge and Kegan Paul (cited in McConnell, D (2000) Implementing Computer Supported Collaborative Learning (second edition). London: Kogan Page). Bassey, M (1999). Case Study Research in Educational Settings, Buckingham: Open University Press Blackwell, A, Bowes, L, Harvey, L, Hesketh, A J and Knight, P T (2001) Transforming Work Experience in Higher Education. British Educational Research Journal, 27(3), 269-285. Biggs, J (1985) The role of metalearning in study processes. British Journal of Educational Psychology 55(3),185-212 (cited in Salmon, G (2000) E-Moderating: The Key to Teaching and Learning Online London: Kogan Page). Britain, S and Liber, S (1999) A Framework for Pedagogical Evaluation of Virtual Learning Environments. Joint Information Systems Committee Technology Applications Programme: Report 41. Online - http://www.jtap.ac.uk/ Daugherty, M and Funke, B L (1998) University faculty and student perceptions of web-based instruction, Journal of Distance Education, 13(1), 21-39. Dede, C (1995) The transformation of distance education to distributed learning, International Technology Research. Online - http://www.gsu.edu/wwwitr/docs/distlearn/index.html Dutton, C, Parfitt, G, and Woodward, K (2001). Responding to Dearing through Innovative Learning Strategies: the mentoring of hospitality students by service industry professionals. Proceedings of the 4th Annual CHME Learning, Teaching and Assessment Conference, Sheffield Hallam University, 48-60. Feenberg, A (1989) The Written World: On the Theory and Practice of Computer Conferencing. In R Mason and A Kaye (eds.) Mindweave, Communication, Computers and Distance Education. Oxford: Pergamon, 22-39. Garnett J (1997) Quality Assurance in Work-based Learning in UACE work-based learning network conference 1997 (cited in Gray D (2001) A Briefing on Work-based Learning. LTSN Generic Assessment Series No 11, York: Learning and Teaching Support Network). Glick, J (1995) Intellectual and manual labour. In L Martin et al (eds) Socio-cultural Psychology: theory and practice of doing and knowing, New York: Cambridge University Press, 357-382. Guile, D and Griffiths, T (2001) Learning through work experience, Journal of Education and Work, 14(1), 113-131. Grabinger, S, Dunlap, J and Duffield, J (1997) Rich environments for active learning in action: problem based learning. ALT- J 7(2), 66-77. Gray, D (2001). A Briefing on Work-based Learning. LTSN Generic Assessment Series No 11, York: Learning and Teaching Support Network. Harasim, L, Hiltz, S R, Teles, L and Turoff, M (1995) Learning network: a field guide to teaching and learning online. Cambridge, MA: MIT Press. Harvey, L, Geall, V and Moon S (1998) Work Experience: Expanding Opportunities for Undergraduates, Centre for Research into Quality. Online - http://www.uce.ac.uk/crq/publications/we/index.html Hiltz, S R (1994) The virtual classroom: learning without limits via computer networks. Norwood NJ: Ablex Publishing Corporation. Jonassen, D, Davidson, M, Collins, M, Campbell, C and Haag, B (1995) Constructivism and computer-mediated communication in distance education. American Journal of Distance Education 9(2), 7-25. Jung, I, Choi, S, Lim, C and Leem, J (2002) Effects of different types of interaction on learning achievement, satisfaction and participation in Web-based instruction, Innovations in Education and Teaching International 39(2), 153-162. Muirhead, W (2000) Online education in schools. International Journal of Educational Management 14(7), 314-324. McConnell, D (2000) Implementing Computer Supported Collaborative Learning (second edition). London: Kogan Page. Naidu, S (1997) Collaborative reflective practice: an instructional design architecture for the Internet, Distance Education, 18(2) 257-83. National Committee of Inquiry into Higher Education (1997), Higher Education in the Learning Society. London: HMSO (The Dearing Report). Parker, D R (1997) Increasing faculty use of technology in teaching and teacher education, Journal of Technology and Teacher Education, 5(2/3), 105-115. Preece, J (1999) Empathic communities: balancing emotional and factual communication. Interacting With Computers 12, 63-77 (cited in Salmon, G (2000) E-Moderating: The Key to Teaching and Learning Online London: Kogan Page). Preece, J (2000) Online Communities: Supporting sociability and designing usability. Chichester: John Wiley & Sons (cited in Salmon, G (2000) E-Moderating: The Key to Teaching and Learning Online London: Kogan Page). Quality Assurance Agency (2001) Code of practice for the assurance of academic quality and standards in higher education: placement learning. Online http://www.qaa.ac.uk/public/cop/COPplacementFinal/precepts.htm Raelin, J A (2000) Work-Based Learning: The New Frontier of Management Development. Prentice Hall: New Jersey (quoted in Gray, D (2001) A Briefing on Work-based Learning. LTSN Generic Assessment Series No 11, York: Learning and Teaching Support Network). Rowntree, D (1995) Teaching and learning online: a correspondence education for the 21st century? British Journal of Educational Technology 26(3), 205-215. Salmon, G (2000) E-Moderating: The Key to Teaching and Learning Online London: Kogan Page. Simons, H (1996) The Paradox of Case Study. Cambridge Journal of Education 26(2), 225-240. Springboard UK, (2001) The Impact of Student Placements: Valued Experience or Missed Opportunity, Festival 2001 Research Findings. Steel, J and Hudson A (2001) Educational Technology in Learning and Teaching: The Perceptions and Experiences of Teaching Staff, Innovations in Education and Teaching International 38(2), 103-111.pub848pu

The resource allocation consequences of the new NHS needs formula

The NHS Executive has recently implemented modifications to the weighted capitation formula for distributing Hospital and Community Health Service funds to health authorities in England. A major contribution to the changes was an analysis of the relative needs of geographical areas undertaken by a team of researchers from the University of York. That work investigated the link between social and economic circumstances and the use of NHS inpatient facilities, and resulted in the development of separate needs indices for acute and psychiatric inpatient services. This report first documents the resource allocation consequences of each of these indices, and finds that the acute index is slightly more redistributive than the previous formula, and that the psychiatric index is very much more redistributive, in particular redirecting resources into the inner cities. In implementing the work, the Department of Health had to make a judgement about which needs index to use for distributing funds not relating to inpatient use, In the event, they have chosen to allocate 64% of the total budget according to the acute index, 12% according to the psychiatric index, and 24% according to no needs index. The report notes that the use of no needs weighting for such a large block of services, which includes community and mental handicap services, can be challenged. It illustrates the importance of the issue by comparing the Department’s preferred formula with an alternative, in which the 24% is allocated using the York acute index. It is found that this option would redirect amounts of up to 5% away from the home counties towards the inner cities. While not necessarily advocating this change, the report argues that the large sums involved highlight the urgent necessity for research on the relative need for health care in non-inpatient services.RAWP, HCHS funds, SMR

Understanding Contextual Factors in Cost, Quality and Priority Setting Decisions in Health Comment on “Contextual Factors Influencing Cost and Quality Decisions in Health and Care: A Structured Evidence Review and Narrative Synthesis”

Abstract There is growing recognition in the academic literature that critical decisions concerning resource allocation and resource management in health and care are influenced by a range of contextual factors. In their paper in this journal, Williams et al define these ‘decisions of value’ as being characterized by a significant and demonstrable impact on quality and resources in health and care. ‘Decisions of value’ are key functions of health and care organizations, yet relatively little is known about how contextual factors (such as different sources and types of evidence used, organizational context and decision-making structures, and the wider interests of patients, the public and politicians) influence those decisions. In this commentary we offer some reflections on our international experiences in capacity building, developing and implementing priority setting and resource allocation (PSRA) mechanisms in the health and care sectors in a range of low-, middle-, and high-income countries. We focus on the role of organizational culture, the relationship to government including political and regulatory environments, and the potential for patient and public engagement in PSRA mechanisms

Construction of the descriptive system for the assessment of quality of life AQoL-6D utility instrument

BackgroundMulti attribute utility (MAU) instruments are used to include the health related quality of life (HRQoL) in economic evaluations of health programs. Comparative studies suggest different MAU instruments measure related but different constructs. The objective of this paper is to describe the methods employed to achieve content validity in the descriptive system of the Assessment of Quality of Life (AQoL)-6D, MAU instrument.MethodsThe AQoL program introduced the use of psychometric methods in the construction of health related MAU instruments. To develop the AQoL-6D we selected 112 items from previous research, focus groups and expert judgment and administered them to 316 members of the public and 302 hospital patients. The search for content validity across a broad spectrum of health states required both formative and reflective modelling. We employed Exploratory Factor Analysis and Structural Equation Modelling (SEM) to meet these dual requirements.Results and DiscussionThe resulting instrument employs 20 items in a multi-tier descriptive system. Latent dimension variables achieve sensitive descriptions of 6 dimensions which, in turn, combine to form a single latent QoL variable. Diagnostic statistics from the SEM analysis are exceptionally good and confirm the hypothesised structure of the model.ConclusionsThe AQoL-6D descriptive system has good psychometric properties. They imply that the instrument has achieved construct validity and provides a sensitive description of HRQoL. This means that it may be used with confidence for measuring health related quality of life and that it is a suitable basis for modelling utilities for inclusion in the economic evaluation of health programs.<br /

Serum 25-Hydroxyvitamin D and Intact Parathyroid Hormone Influence Muscle Outcomes in Children and Adolescents

Increases in 25-hydroxyvitamin D concentrations are shown to improve strength in adults; however, data in pediatric populations are scant and equivocal. In this ancillary study of a larger-scale, multi-sited, double-blind, randomized, placebo-controlled vitamin D intervention in US children and adolescents, we examined the associations between changes in vitamin D metabolites and changes in muscle mass, strength, and composition after 12 weeks of vitamin D3 supplementation. Healthy male and female, black and white children and adolescents between the ages of 9 and 13 years from two US states (Georgia 34°N and Indiana 40°N) were enrolled in the study and randomly assigned to receive an oral vitamin D3 dose of 0, 400, 1000, 2000, or 4000 IU/d for 12 weeks between the winter months of 2009 to 2011 (N = 324). Analyses of covariance, partial correlations, and regression analyses of baseline and 12-week changes (post-baseline) in vitamin D metabolites (serum 25(OH)D, 1,25(OH)2 D, intact parathyroid hormone [iPTH]), and outcomes of muscle mass, strength, and composition (total body fat-free soft tissue [FFST], handgrip strength, forearm and calf muscle cross-sectional area [MCSA], muscle density, and intermuscular adipose tissue [IMAT]) were assessed. Serum 25(OH)D and 1,25(OH)2 D, but not iPTH, increased over time, as did fat mass, FFST, forearm and calf MCSA, forearm IMAT, and handgrip strength (p < 0.05). Vitamin D metabolites were not associated with muscle strength at baseline nor after the 12-week intervention. Changes in serum 25(OH)D correlated with decreases in forearm IMAT, whereas changes in serum iPTH predicted increases in forearm and calf MCSA and IMAT (p < 0.05). Overall, increases in 25(OH)D did not influence muscle mass or strength in vitamin D-sufficient children and adolescents; however, the role of iPTH on muscle composition in this population is unknown and warrants further investigation

Assessing the capacity of the health services research community in Australia and New Zealand

BACKGROUND: In order to profile the health services research community in Australia and New Zealand and describe its capacity, a web-based survey was administered to members of the Health Services Research Association of Australia and New Zealand (HSRAANZ) and delegates of the HSRAANZ's Third Health Services Research and Policy Conference. RESULTS: Responses were received from 191 individuals (68%). The responses of the 165 (86%) who conducted or managed health services research indicated that the health services research community in Australia and New Zealand is characterised by highly qualified professionals who have come to health services research via a range of academic and professional routes (including clinical backgrounds), the majority of whom are women aged between 35 and 54 who have mid- to senior- level appointments. They are primarily employed in universities and, to a lesser extent, government departments and health services. Although most are employed in full time positions, many are only able to devote part of their time to health services research, often juggling this with other professional roles. They rely heavily on external funding, as only half have core funding from their employing institution and around one third have employment contracts of one year or less. Many view issues around building the capacity of the health services research community and addressing funding deficits as crucial if health services research is to be translated into policy and practice. Despite the difficulties they face, most are positive about the support and advice available from peers in their work settings, and many are actively contributing to knowledge through academic and other written outputs. CONCLUSION: If health services research is to achieve its potential in Australia and New Zealand, policy-makers and funders must take the concerns of the health services research community seriously, foster its development, and contribute to maximising its capacity through a sustainable approach to funding. There is a clear need for a strategic approach, where the health services research community collaborates with competitive granting bodies and government departments to define and fund a research agenda that balances priority-driven and investigator-driven research and which provides support for training and career development

Real world costs and cost-effectiveness of Rituximab for diffuse large B-cell lymphoma patients: a population-based analysis.

BackgroundCurrent treatment of diffuse-large-B-cell lymphoma (DLBCL) includes rituximab, an expensive drug, combined with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy. Economic models have predicted rituximab plus CHOP (RCHOP) to be a cost-effective alternative to CHOP alone as first-line treatment of DLBCL, but it remains unclear what its real-world costs and cost-effectiveness are in routine clinical practice.MethodsWe performed a population-based retrospective cohort study from 1997 to 2007, using linked administrative databases in Ontario, Canada, to evaluate the costs and cost-effectiveness of RCHOP compared to CHOP alone. A historical control cohort (n = 1,099) with DLBCL who received CHOP before rituximab approval was hard-matched on age and treatment intensity and then propensity-score matched on sex, comorbidity, and histology to 1,099 RCHOP patients. All costs and outcomes were adjusted for censoring using the inverse probability weighting method. The main outcome measure was incremental cost per life-year gained (LYG).ResultsRituximab was associated with a life expectancy increase of 3.2 months over 5 years at an additional cost of $16,298, corresponding to an incremental cost-effectiveness ratio of$61,984 (95% CI $34,087-$135,890) per LYG. The probability of being cost-effective was 90% if the willingness-to-pay threshold was $100,000/LYG. The cost-effectiveness ratio was most favourable for patients less than 60 years old ($31,800/LYG) but increased to $80,600/LYG for patients 60-79 years old and$110,100/LYG for patients ≥ 80 years old. We found that post-market survival benefits of rituximab are similar to or lower than those reported in clinical trials, while the costs, incremental costs and cost-effectiveness ratios are higher than in published economic models and differ by age.ConclusionsOur results showed that the addition of rituximab to standard CHOP chemotherapy was associated with improvement in survival but at a higher cost, and was potentially cost-effective by standard thresholds for patients &lt;60 years old. However, cost-effectiveness decreased significantly with age, suggesting that rituximab may be not as economically attractive in the very elderly on average. This has important clinical implications regarding age-related use and funding decisions on this drug