Lymph Node Harvest in Dukes' A Cancer Pathologist May Need to Consider Fat Dissolving Technique: An Observational Study

Background. National institute of clinical excellence (NICE) recommends that a median of 12 lymph nodes be examined in patients operated on with curative intent- to- treat colorectal cancer (CRC). Patients with lymph node harvest less than this may be considered under staged and may receive adjuvant chemotherapy. The aim of our study was to ascertain median number of lymph nodes examined in early colorectal cancers. Method. Patients undergoing colorectal resection between June 2007 and May 2008 were identified and pathological staging obtained using pathology database. Results. 146 patients underwent standardised laparoscopic or open resection of colorectal cancers during this period. Overall median number of lymph nodes harvested/patient was 14 (3–40). When analysed by stage, median number of lymph nodes harvested in Dukes' A, B, and C cancers was 10, 14, and 15, respectively. 11/18 (61%) patients with Dukes' A carcinoma had lymph node harvest of less than 12 compared with 15/55 (27%) patients with Dukes' B. Conclusion. Lymph node harvest in Dukes' A cancers using standard techniques tends to be low. Pathologists may have to consider special techniques in harvesting lymph nodes for early colorectal cancers

Human Resource Information Systems in Healthcare: a Systematic Review (Protocol)

Background: Compared with the eHealth literature as a whole, there has been relatively little published research on the use and impacts of Information and Communication Technologies (ICT) designed to support business functions within health organizations. Human Resource Information Systems (HRIS) have the potential to improve organizational efficiency and effectiveness through facilitating workforce planning, financial and operational administration, staff training, and management analytics. However the evidence-base on HRIS in healthcare is widely distributed across disciplinary boundaries and previous reviews have been somewhat limited in scope. This rigorous systematic review will identify, appraise and synthesize existing international research on the implementation and impacts of HRIS in health organizations, in order to provide insights and recommendations that may guide future purchasers, commissioners, implementers, evaluators and users of such systems. Objective: 1. To determine the prevalence and scope of existing research and evaluation pertaining to HRIS in health organisations. 2. To analyse, classify and synthesise existing evidence on the processes and impacts of HRIS development, implementation and adoption. 3. To generate recommendations for HRIS research, practice and policy, with reference to the needs of different stakeholders and communities of practice. Methods: A high level scoping review was first undertaken to inform a draft search strategy, which was refined through several cycles of piloting and iteration in order to optimize its sensitivity and specificity. This is currently being used by the first author, with the help of a medical librarian, to interrogate international electronic databases indexing Medical, Business, ICT and Multi-disciplinary research. Sources of grey literature and reference lists of included studies will also be searched. There will be no restrictions on language or publication year. Two reviewers will screen and code titles and abstracts for potentially eligible studies, for which full text articles will be retrieved. Reasons for exclusion will be noted for the remaining articles. A structured form will be used to summarise and classify the articles. Any disagreements between the reviewers will be resolved through consensus or arbitration by a third reviewer. A PRISMA flow diagram will illustrate the study selection process and ensure transparency of the review. Finally, content experts will be consulted to ensure that important articles have not been missed. Results: A comprehensive search strategy has been piloted and the initial database searches are underway. The review is expected to be complete and published by the end of 2015. Conclusions: By synthesising the existing evidence-base, identifying areas where knowledge is currently lacking and generating recommendations for research and practice, the review will provide a useful resource for decision makers and managers considering or already implementing HRIS, as well as encouraging new research in this area

White-faced Darter distribution is associated with coniferous forests in Great Britain

Abstract 1) Understanding of dragonfly distributions is often geographically comprehensive but less so in ecological terms. 2) White-faced darter (Leucorhinnia dubia) is a lowland peatbog specialist dragonfly which has experienced population declines in Great Britain. White-faced darter are thought to rely on peat-rich pool complexes within woodland but this has not yet been empirically tested. 3) We used dragonfly recording data collected by volunteers of the British Dragonfly Society from 2005 to 2018 to model habitat preference for white-faced darter using species distribution models across Great Britain and, with a more detailed landcover dataset, specifically in the North of Scotland. 4) Across the whole of Great Britain our models used the proportion of coniferous forest within 1km as the most important predictor of habitat suitability but were not able to predict all current populations in England. 5) In the North of Scotland our models were more successful and suggest that habitats characterised by native coniferous forest and areas high potential evapotranspiration represent the most suitable habitat for white-faced darter. 6) We recommend that future white-faced darter monitoring should be expanded to include areas currently poorly surveyed but with high suitability in the North of Scotland. 7) Our results also suggest that white-faced darter management should concentrate on maintaining Sphagnum rich pool complexes and the maintenance and restoration of native forests in which these pool complexes occur

From toothpick legs to dropping vaginas: Gender and sexuality in Joan Rivers' stand-up comedy performance

This is the author's accepted manuscript. The final published article is available from the link below. Copyright @ 2011 Intellect.This article employs sociocultural analysis to examine Joan Rivers’ stand-up comedy performances in order to reveal how she successfully operates in a sphere of artistic expression that has been, and continues to be, male-dominated. The analysis uncovers how Rivers’ stand-up comedy performance involves a complex combination of elements and how it fuses features that are regarded as ‘traditionally masculine’, such as aggression, with features frequently used by other female stand-up comedians, such as self-deprecating comedy and confessional comedy. Furthermore, the analysis exposes the complex ways in which constructions of gender and sexuality are negotiated and re-negotiated in Rivers’ stand-up comedy performance, and illustrates how dominant ideological identity constructions can be simultaneously reinforced and subverted within the same comic moment

The golden circle: A way of arguing and acting about technology in the London ambulance service

This paper analyses the way in which the London Ambulance Service recovered from the events of October 1992, when it implemented a computer-aided despatch system (LASCAD) that remained in service for less than two weeks. It examines the enactment of a programme of long-term organizational change, focusing on the implementation of an alternative computer system in 1996. The analysis in this paper is informed by actor-network theory, both by an early statement of this approach developed by Callon in the sociology of translation, and also by concepts and ideas from Latour’s more recent restatement of his own position. The paper examines how alternative interests emerged and were stabilized over time, in a way of arguing and acting among key players in the change programme, christened the Golden Circle. The story traces four years in the history of the London Ambulance Service, from the aftermath of October 1992 through the birth of the Golden Circle to the achievement of National Health Service (NHS) trust status. LASCAD was the beginning of the story, this is the middle, an end lies in the future, when the remaining elements of the change programme are enacted beyond the Golden Circle

Cost-effectiveness of telecare for people with social care needs: the Whole Systems Demonstrator cluster randomised trial

Purpose of the study: to examine the costs and cost-effectiveness of ‘second-generation’ telecare, in addition to standard support and care that could include ‘first-generation’ forms of telecare, compared with standard support and care that could include ‘first-generation’ forms of telecare. Design and methods: a pragmatic cluster-randomised controlled trial with nested economic evaluation. A total of 2,600 people with social care needs participated in a trial of community-based telecare in three English local authority areas. In the Whole Systems Demonstrator Telecare Questionnaire Study, 550 participants were randomised to intervention and 639 to control. Participants who were offered the telecare intervention received a package of equipment and monitoring services for 12 months, additional to their standard health and social care services. The control group received usual health and social care. Primary outcome measure: incremental cost per quality-adjusted life year (QALY) gained. The analyses took a health and social care perspective. Results: cost per additional QALY was £297,000. Cost-effectiveness acceptability curves indicated that the probability of costeffectiveness at a willingness-to-pay of £30,000 per QALY gained was only 16%. Sensitivity analyses combining variations in equipment price and support cost parameters yielded a cost-effectiveness ratio of £161,000 per QALY. Implications: while QALY gain in the intervention group was similar to that for controls, social and health services costs were higher. Second-generation telecare did not appear to be a cost-effective addition to usual care, assuming a commonly accepted willingness to pay for QALYs

From "Infant Hercules" to "Ghost Town":Industrial collapse and social harm on Teesside

This article explicates the harms associated with deindustrialization in Teesside in the North East of England in the context of neoliberalism. Drawing on in-depth qualitative interviews (n = 25), the article explores how ongoing industrial collapse, typified by Sahaviriya Steel Industries’ (SSI) closure in 2015, has generated various harms. First, the article examines industrialism’s socioeconomic security and stability. It then explores the negative impact of SSI’s closure in 2015, including a sense of loss and unemployment. Next, it demonstrates how the absence of economic stability produces harmful outcomes, namely insecurity, mental health problems and bleak visions of the future. The article concludes by casting industrial ruination as an impediment to human flourishing; the normal functioning of capitalism represents a “negative motivation to harm” that prevents the stability and security necessary for individual and collective flourishin

IT-adoption and the interaction of task, technology and individuals: a fit framework and a case study

BACKGROUND: Factors of IT adoption have largely been discussed in the literature. However, existing frameworks (such as TAM or TTF) are failing to include one important aspect, the interaction between user and task. METHOD: Based on a literature study and a case study, we developed the FITT framework to help analyse the socio-organisational-technical factors that influence IT adoption in a health care setting. RESULTS: Our FITT framework ("Fit between Individuals, Task and Technology") is based on the idea that IT adoption in a clinical environment depends on the fit between the attributes of the individual users (e.g. computer anxiety, motivation), attributes of the technology (e.g. usability, functionality, performance), and attributes of the clinical tasks and processes (e.g. organisation, task complexity). We used this framework in the retrospective analysis of a three-year case study, describing the adoption of a nursing documentation system in various departments in a German University Hospital. We will show how the FITT framework helped analyzing the process of IT adoption during an IT implementation: we were able to describe every found IT adoption problem with regard to the three fit dimensions, and any intervention on the fit can be described with regard to the three objects of the FITT framework (individual, task, technology). We also derive facilitators and barriers to IT adoption of clinical information systems. CONCLUSION: This work should support a better understanding of the reasons for IT adoption failures and therefore enable better prepared and more successful IT introduction projects. We will discuss, however, that from a more epistemological point of view, it may be difficult or even impossible to analyse the complex and interacting factors that predict success or failure of IT projects in a socio-technical environment