An Incident Control Centre in action: Response to the Rena oil spill in New Zealand

Following the Rena grounding and oil spill in the Bay of Plenty, New Zealand, an Incident Command Centre was established which, among other tasks, coordinated a volunteer clean-up effort. We interviewed volunteers and organisers to gain insight into the efficacy of the volunteer coordination effort. Volunteers praised the system of communication and the involvement of indigenous groups. They expressed a desire for better training, more flexibility and community autonomy, a quicker uptake of volunteer support, and the use of social media. Locating the Incident Command Centre in a single site aided interaction between experts, and the sharing of resources. Overall, the volunteer coordination was considered a success

How volunteering reduced the impact of the Rena oil spill: Community responses to an environmental disaster

Following the Rena oil spill off the Bay of Plenty coast in New Zealand and subsequent volunteer clean-up programme, we interviewed 39 volunteers and 9 people involved in the volunteer organisation. We aimed to learn about people’s responses to an environmental disaster, what factors motivate people to volunteer, and how volunteering after a disaster assists individuals and communities to adjust to changing circumstances. The oil spill had an emotional, physical, cultural, social and spiritual impact on both individuals and communities. People were motivated to volunteer from a sense of duty and history of volunteering, a concern and sense of collective responsibility for the environment for current and future generations, a desire to contribute to their community, and to connect with others and cope with their negative responses. There was a strong typical New Zealand “can do” response in that volunteers expressed they had time and capability to help so they just wanted to get on with it. After volunteering, most participants reported a sense of satisfaction, renewed social ties, and renewed optimism. The clean-up programme brought communities together, resulting in timely removal of oil from beaches and coastline and demonstrating that citizen volunteers can contribute to oil spill mitigation

Fitting parametric random effects models in very large data sets with application to VHA national data

<p>Abstract</p> <p>Background</p> <p>With the current focus on personalized medicine, patient/subject level inference is often of key interest in translational research. As a result, random effects models (REM) are becoming popular for patient level inference. However, for very large data sets that are characterized by large sample size, it can be difficult to fit REM using commonly available statistical software such as SAS since they require inordinate amounts of computer time and memory allocations beyond what are available preventing model convergence. For example, in a retrospective cohort study of over 800,000 Veterans with type 2 diabetes with longitudinal data over 5 years, fitting REM via generalized linear mixed modeling using currently available standard procedures in SAS (e.g. PROC GLIMMIX) was very difficult and same problems exist in Stata’s gllamm or R’s lme packages. Thus, this study proposes and assesses the performance of a meta regression approach and makes comparison with methods based on sampling of the full data.</p> <p>Data</p> <p>We use both simulated and real data from a national cohort of Veterans with type 2 diabetes (n=890,394) which was created by linking multiple patient and administrative files resulting in a cohort with longitudinal data collected over 5 years.</p> <p>Methods and results</p> <p>The outcome of interest was mean annual HbA1c measured over a 5 years period. Using this outcome, we compared parameter estimates from the proposed random effects meta regression (REMR) with estimates based on simple random sampling and VISN (Veterans Integrated Service Networks) based stratified sampling of the full data. Our results indicate that REMR provides parameter estimates that are less likely to be biased with tighter confidence intervals when the VISN level estimates are homogenous.</p> <p>Conclusion</p> <p>When the interest is to fit REM in repeated measures data with very large sample size, REMR can be used as a good alternative. It leads to reasonable inference for both Gaussian and non-Gaussian responses if parameter estimates are homogeneous across VISNs.</p

Diabetes, Abdominal Adiposity, and Atherogenic Dyslipoproteinemia in Women Compared With Men

OBJECTIVE—To understand why atherogenic risk differs more between diabetic and nondiabetic women than between diabetic and nondiabetic men

Being the ‘med reg’: an exploration of junior doctors’ perceptions of the medical registrar role

The role of the medical registrar is a challenging one and is acknowledged as being a disincentive to a career in medicine for some junior doctors. We set out to build a broader understanding of the role through exploration of Foundation Doctors’ and Core Medical Trainees’ perceptions of the role. Data, gathered from focus groups, were analysed using a framework approach. Six key themes were identified, which were grouped under the headings ‘perceptions of the medical registrar role’ and ‘transition into the role’. Our work builds on existing literature to inform a deeper understanding of how junior doctors perceive the medical registrar role. In light of our findings we offer suggestions on possible training initiatives to tackle the issues identified. We also highlight positive perceptions of the role and emphasise the key ambassadorial role that current medical registrars have in relation to attracting tomorrows’ medical registrars to the specialty

Why geriatric medicine? A survey of UK specialist trainees in geriatric medicine

Background: There is global concern that there are insufficient numbers of geriatricians to meet the needs of the ageing population. A 2005 survey described factors that influenced why UK geriatricians had chosen to specialise in the field - in the decade since, UK postgraduate training has undergone a fundamental restructure. Objective: To explore whether the reasons for choosing a career in geriatric medicine in the UK had changed over time, with the goal of using this knowledge to inform recruitment and training initiatives. Design: An online survey was sent to all UK higher medical trainees in geriatric medicine. Methods: Survey questions that produced categorical data were analysed with simple descriptive statistics. For the survey questions that produced free-text responses, an inductive, iterative approach to analysis, in keeping with the principles of framework analysis, was employed. Results: 269 responses were received out of 641 eligible respondents. Compared with the previous survey, a substantially larger number of respondents regarded geriatric medicine to be their first-choice specialty and a smaller number regretted their career decision. A greater number chose geriatric medicine early in their medical careers. Commitments to the general medical rota and the burden of service provision were considered important downsides to the specialty. Conclusions: There are reasons to be optimistic about recruitment to geriatric medicine. Future attempts to drive up recruitment might legitimately focus on the role of the medical registrar and perceptions that geriatricians shoulder a disproportionate burden of service commitments and obligations to the acute medical take

Diabetes, Abdominal Adiposity, and Atherogenic Dyslipoproteinemia in Women Compared With Men

OBJECTIVE—To understand why atherogenic risk differs more between diabetic and nondiabetic women than between diabetic and nondiabetic men

Accessing elite nurses for research: reflections on the theoretical and practical issues of telephone interviewing

Elite groups are interesting as they frequently are powerful (in terms of position, knowledge and influence) and enjoy considerable authority. It is important, therefore, to involve them in research concerned with understanding social contexts and processes. This is particularly pertinent in healthcare, where considerable strategic development and change are features of everyday practice that may be guided or perceived as being guided, by elites. This paper evolved from a study investigating the availability and role of nurses whose remit involved leading nursing research and development within acute NHS Trusts in two health regions in Southern England. The study design included telephone interviews with Directors of Nursing Services during which time the researchers engaged in a reflective analysis of their experiences of conducting research with an `elite' group. Important issues identified were the role of gatekeepers, engagement with elites and the use of the telephone interview method in this context. The paper examines these issues and makes a case for involving executive nurses in further research. The paper also offers strategies to help researchers design and implement telephone interview studies successfully to maximise access to the views and experiences of `hard to reach groups', such as elites, while minimising the associated disruption