Competitive tendering in the Scottish National Health Service Was it compulsory, and did it make a difference?(*)

This paper examines the implementation of competitive tendering in the Scottish National Health Service. Data relating to cleaning, catering and laundering services-- the three services targeted for competitive tendering--are examined. Our analysis suggests that for the first four years the request to market test was largely ignored in Scotland. In 1987 it become a management requirement, and within three years of its fresh start implementation of this policy more than matched the corresponding experience in England.

Implementing innovation in the UK National Health Service A case study in patient compliance

Missed appointments are a common form of patient non-compliance. One reason often given is they had been forgotten. We evaluate two recent innovations to address this problem introduced at one of the Scottish health boards to increase compliance at consultant-lead outpatient clinics. Patients with long waits were more likely to miss their appointment, but not, apparently, because they were more likely to forget it. Nevertheless, both innovations made a big difference and, combined, reduced recorded non-attendance rate by 90%. The administrative innovation changed the way appointments were made. At its most basic, bookings were made no more than five to seven weeks in advance, at no additional cost. Some of these patients also had to confirm their appointment. This reduced non-attendance still further, but at a cost of at least £150 per missed appointment avoided. The technological innovation used SMS and E-mail messages to send last minute reminders. It more than halved non-attendance, but the inability to collect contact details limited it applicability, and few of the patients reached provided contact details. Some fifty to one hundred messages have had to be sent to avoid one missed appointment. However, the use of the NHS network avoided significant recurrent costs.Outpatient services; Did not attend; SMS messages; Partial booking; Patient focussed booking

Do coursework summative assessments predict clinical performance? A systematic review

BACKGROUND: Two goals of summative assessment in health profession education programs are to ensure the robustness of high stakes decisions such as progression and licensing, and predict future performance. This systematic and critical review aims to investigate the ability of specific modes of summative assessment to predict the clinical performance of health profession education students. METHODS: PubMed, CINAHL, SPORTDiscus, ERIC and EMBASE databases were searched using key terms with articles collected subjected to dedicated inclusion criteria. Rigorous exclusion criteria were applied to ensure a consistent interpretation of ‘summative assessment’ and ‘clinical performance’. Data were extracted using a pre-determined format and papers were critically appraised by two independent reviewers using a modified Downs and Black checklist with level of agreement between reviewers determined through a Kappa analysis. RESULTS: Of the 4783 studies retrieved from the search strategy, 18 studies were included in the final review. Twelve were from the medical profession and there was one from each of physiotherapy, pharmacy, dietetics, speech pathology, dentistry and dental hygiene. Objective Structured Clinical Examinations featured in 15 papers, written assessments in four and problem based learning evaluations, case based learning evaluations and student portfolios each featured in one paper. Sixteen different measures of clinical performance were used. Two papers were identified as ‘poor’ quality and the remainder categorised as ‘fair’ with an almost perfect (k = 0.852) level of agreement between raters. Objective Structured Clinical Examination scores accounted for 1.4–39.7% of the variance in student performance; multiple choice/extended matching questions and short answer written examinations accounted for 3.2–29.2%; problem based or case based learning evaluations accounted for 4.4–16.6%; and student portfolios accounted for 12.1%. CONCLUSIONS: Objective structured clinical examinations and written examinations consisting of multiple choice/extended matching questions and short answer questions do have significant relationships with the clinical performance of health professional students. However, caution should be applied if using these assessments as predictive measures for clinical performance due to a small body of evidence and large variations in the predictive strength of the relationships identified. Based on the current evidence, the Objective Structured Clinical Examination may be the most appropriate summative assessment for educators to use to identify students that may be at risk of poor performance in a clinical workplace environment. Further research on this topic is needed to improve the strength of the predictive relationship. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12909-017-0878-3) contains supplementary material, which is available to authorized users

Spectral pitch distance and microtonal melodies

We present an experiment designed to test the effectiveness of spectral pitch distance at modeling the degree of “affinity” or “fit” of pairs of successively played tones or chords (spectral pitch distance is the cosine distance between salience-weighted, Gaussian-smoothed, pitch domain embeddings of spectral pitches—typically the first eight to ten partials of a tone). The results of a previously conducted experiment, which collected ratings of the perceived similarity and fit of root-position major and minor triads, suggest the model works well for pairs of triads in standard 12-tone equal temperament tunings. The new experiment has been designed to test the effectiveness of spectral pitch distance at modeling the affinity of tones in microtonal melodies where the partials of the tones can be variably tempered between being perfectly harmonic and perfectly matched to the underlying microtonal tuning. The use of microtonal tunings helps to disambiguate innate perceptual (psychoacoustical) responses from learned (cultural) responses. Participants are presented with a software synthesizer containing two unlabeled controls: one adjusts the precise tuning of the tones; the other adjusts the extent to which the spectrum is tempered to match the tuning (as set by the first control). A selection of microtonal melodies are played in different tunings, and the participants adjust one, or both, controls until they find a “sweet spot” at which the music sounds most “in-tune” and the notes best “fit” together. The results of these experiments will be presented and discussed

Metrics for pitch collections

Models of the perceived distance between pairs of pitch collections are a core component of broader models of the perception of tonality as a whole. Numerous different distance measures have been proposed, including voice-leading, psychoacoustic, and pitch and interval class distances; but, so far, there has been no attempt to bind these different measures into a single mathematical framework, nor to incorporate the uncertain or probabilistic nature of pitch perception (whereby tones with similar frequencies may, or may not, be heard as having the same pitch). To achieve these aims, we embed pitch collections in novel multi-way expectation arrays, and show how metrics between such arrays can model the perceived dissimilarity of the pitch collections they embed. By modeling the uncertainties of human pitch perception, expectation arrays indicate the expected number of tones, ordered pairs of tones, ordered triples of tones and so forth, that are heard as having any given pitch, dyad of pitches, triad of pitches, and so forth. The pitches can be either absolute or relative (in which case the arrays are invariant with respect to transposition). We provide a number of examples that show how the metrics accord well with musical intuition, and suggest some ways in which this work may be developed

Changing patterns of contraceptive use in Malta

In 1971 the first author carried out a family planning survey in Malta (Milne, 1973). 1 .. In 1993 a similar survey was carried out. This paper reports the main findings of the 1993 Survey of Family Planning in Malta and compares these findings to the 1971 survey. The main aim is to examine the changes in the extent of contraceptive use and to evaluate the degree to which more efficient modern methods of family planning have replaced traditional methods.peer-reviewe

A spectral pitch class model of the probe tone data and scalic tonality

In this paper, we introduce a small family of novel bottom-up (sensory) models of the Krumhansl and Kessler (1982) probe tone data. The models are based on the spectral pitch class similarities between all twelve pitch classes and the tonic degree and tonic triad. Cross-validation tests of a wide selection of models show ours to have amongst the highest fits to the data. We then extend one of our models to predict the tonics of a variety of different scales such as the harmonic minor, melodic minor, and harmonic major. The model produces sensible predictions for these scales. Furthermore, we also predict the tonics of a small selection of microtonal scales—scales that do not form part of any musical culture. These latter predictions may be tested when suitable empirical data have been collected

Hex Player—a virtual musical controller

In this paper, we describe a playable musical interface for tablets and multi-touch tables. The interface is a generalized keyboard, inspired by the Thummer, and consists of an array of virtual buttons. On a generalized keyboard, any given interval always has the same shape (and therefore fingering); furthermore, the fingering is consistent over a broad range of tunings. Compared to a physical generalized keyboard, a virtual version has some advantages—notably, that the spatial location of the buttons can be transformed by shears and rotations, and their colouring can be changed to reflect their musical function in different scales. We exploit these flexibilities to facilitate the playing not just of conventional Western scales but also a wide variety of microtonal generalized diatonic scales known as moment of symmetry, or well-formed, scales. A user can choose such a scale, and the buttons are automatically arranged so their spatial height corresponds to their pitch, and buttons an octave apart are always vertically above each other. Furthermore, the most numerous scale steps run along rows, while buttons within the scale are light-coloured, and those outside are dark or removed. These features can aid beginners; for example, the chosen scale might be the diatonic, in which case the piano’s familiar white and black colouring of the seven diatonic and five chromatic notes is used, but only one scale fingering need ever be learned (unlike a piano where every key needs a different fingering). Alternatively, it can assist advanced composers and musicians seeking to explore the universe of unfamiliar microtonal scales