1,782 research outputs found
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Role of Virtual Reality in Geography and Science Fieldwork Education
Fieldwork has a long tradition in geography, and in certain sciences, notably geology, biology and environmental sciences. Fieldwork involves leaving the classroom and engaging in learning and teaching through first-hand experience of phenomena in outdoor settings. Exploration in natural habitats introduces students to the complexity and unpredictability of the real world, stimulates their curiosity, and increases their interest in scientific inquiry. However, over the last decade, there has been a decline in field-study opportunities in schools.
This policy paper describes the first extensive user-centered research programme into the role of technology-enabled virtual field trips as a means for improving the effectiveness of the outdoor fieldwork experience. It draws on a year-long research project that investigated how Google Expeditions, a smartphone-driven mobile virtual reality application, bridges virtual fieldwork with physical field trips and facilitates inquiry-based fieldwork and experiential learning. It examines the role of Google Expeditions in primary and secondary school science and geography, outlining the opportunities and challenges of integrating mobile virtual reality in schools and the practical implications of our research for fieldwork education in further and higher education
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A uniform Time Trade Off method for states better and worse than dead: feasibility study of the ālead timeā approach
The way Time Trade Off (TTO) values are elicited for states of health considered āworse than being deadā has important implications for the mean values used in economic evaluation. Conventional approaches to TTO, as used in the UKās āMVHā value set, are problematic because they require fundamentally different tradeoffs tasks for the valuation of
states better and worse than dead. This study aims to refine and test the feasibility of a new approach described by Robinson and Spencer (2006), and to explore the characteristics of the valuation data it generates. The approach introduces a ālead timeā into the TTO, producing a uniform procedure for generating values either >0 or <0. We used this lead time TTO to value 10 moderate to severe EQ-5D states using a sample of the general public (n=109). We conclude that the approach is feasible for use in valuation studies, and appears to overcome the discontinuity in values around 0 evident in conventional methods. However, further research is required to resolve the issue of how to handle participants who āuse upā all lead time; to develop ways of controlling for individual time preferences; and to better understand the implications for valuations of states better than dead
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Does the value of quality of life depend on duration?
The aims of this study are to investigate the feasibility of eliciting Time Trade Off (TTO) valuations using short durations; to determine the effect of contrasting durations on individualsā responses to the TTO; to examine variations within and between respondentsā values with respect to duration; and to consider the insights provided by participantsā comments and explanations regarding their reaction to duration in the valuation task. 27 participants provided TTO values using short and long durations for three EQ-5D states. Feedback was sought using a series of open ended questions. Of the 81 opportunities to observe it, strict constant proportionality was satisfied twice. 11 participants had no systematic relationship between duration and value; 11 provided consistently lower valuations in long durations, while 5 had higher valuations in long durations. Comments provided by participants were consistent with the values they provided. Mean TTO values did not differ markedly between alternative durations. We conclude that it is feasible to elicit TTO values for short durations. There is considerable heterogeneity in individualsā responses to the time frames used to elicit values. Further research is required to ensure that the values used in cost effectiveness analysis adequately represent preferences about quality and length of life
Reducing inappropriate hypnotic prescribing using a quality improvement initiative in a rural practice
Context
This improvement project was set in a single general practice in rural Lincolnshire, East Midlands, UK. All doctors and practice staff were actively engaged in reducing inappropriate long term prescribing of hypnotic drugs in the practice population as part of a Quality Improvement Collaborative (QIC).
Problem
Hypnotic drugs are only licensed for short term use but inappropriate long-term prescribing of hypnotics is common. Evidence from previous studies shows that hypnotics have limited therapeutic value and potential for significant adverse cognitive and psychiatric effects. Although there is evidence for hypnotic drug withdrawal programmes there have been few improvement projects showing whether and how this might work in practice.
Assessment of problem and analysis of its causes
Baseline rates of hypnotic prescribing were analysed and charted using statistical process control (SPC) methods. Patients on repeat prescriptions of hypnotic drugs were identified from the practice database. Causes, solutions and barriers were determined using surveys and focus groups of patients and staff. A withdrawal programme was implemented for all patients on long term hypnotics by writing to patients, arranging a consultation, making a detailed assessment and using techniques such as tapering doses of drugs and using cognitive behavioural therapy for insomnia (CBTi) during general practice consultations. The improvement was supported by a QIC called REST (Resources for Effective Sleep Treatment) which supported the practice team to implement sleep assessment and management tools using plan-do-study-act cycles, process mapping and new protocols.
Strategy for change
The change was coordinated in the practice over six months, with each practitioner maintaining an agreed and consistent approach for managing sleep problems. All staff including doctors, nurses, administrative staff and practice manager took part. Patients were informed of the planned alteration to their treatment for their sleeping problem via a letter detailing exactly how the new regime would be implemented alongside the reasons for this. Patients were offered an appointment to discuss the proposed changes with their GP and all did so.
Measurement of improvement
We measured improvement by analysing prescribing rates using statistical process control charts. We also surveyed patients and conducted a focus group to explore the patientsā personal experiences of the new service the support they received during the withdrawal programme and how they manage their sleep now.
Effects of changes
There was a significant reduction in hypnotic prescribing of benzodiazepines (664.9 to 62.0 ADQ per 1000-STAR-PU) and Z drugs (2156.7 to 120.1A ADQ per STAR-PU) in the practice over the six months of the project and this improvement has been sustained since the initiative. Some patients were initially unhappy about being taken off sleeping tablets but with the approach described were successfully withdrawn. No patients are now prescribed long term benzodiazepines or Z drugs for sleep difficulties in the practice. Psychological treatments for the management of sleep problems are used first-line instead of hypnotics. The transition from hypnotics to psychological treatments is evidence of improvement in patient care.
Lessons learnt
It is possible to implement a hypnotic withdrawal programme over a relatively short period of time in general practice using a carefully constructed programme applied consistently by staff comprising a letter to patients, tapering of drugs and CBTi supported through education of practitioners in sleep management and quality improvement methods.
Message for others
Key factors for success in this improvement project were a motivated practice team, a range of solutions which could be adapted locally, expert support on sleep management and quality improvement methods and feedback of results. We will present further data on the experience of patients in this improvement project
Using mixed methods for evaluating the effect of a quality improvement collaborative for management of sleep problems presenting to primary care
Context
This improvement project was set in Lincolnshire, a large rural county in the East Midlands with high prescribing rates of hypnotic drugs compared with the rest of England. Eight general practices volunteered to participate in a Quality Improvement Collaborative (QIC) designed to improve management of sleep problems in patients presenting to primary care.
Problem
Sleep problems are common affecting around 40% of adults in the UK. Insomnia has considerable resource implications in terms of disability, impaired quality of life and health service utilisation. Up to half of individuals with Insomnia seek help from primary care and hypnotic drugs are often inappropriately prescribed for long term use. Non-pharmacological treatment measures are rarely implemented in practice despite guidance supporting their use. A lack of training as well as limited availability of resources for effective sleep assessment and treatment in primary care are possible explanations for this. It is clear that there is considerable scope for improving management of sleep problems in general practice
Assessment of problem and analysis of its causes
We used a Quality Improvement Collaborative to introduce practitioners to sleep assessment tools including the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI) and Sleep Diaries and non-pharmacological interventions such as Cognitive Behavioural Therapy for Insomnia (CBTi). Practitioners from participating practices were asked to begin using these where appropriate within their day to day practice.
Strategy for change
The project team met bi-monthly with practice teams to share learning. We used adult learning techniques to promote rapid experimentation (Plan, Do, Study, Act) cycles, process redesign and monthly feedback of prescribing rates and costs of hypnotic drugs using statistical control charts. Data were collected from the collaborative meetings to understand the facilitators, barriers and changes that practices were making as a result of the Quality Improvement Collaborative (QIC).
Measure of improvement
Qualitative data were collected via audio recordings of practice and collaborative meetings with practitioners and practice staff. This data was then transcribed verbatim. Thematic analysis was carried out supported by computer software MaxQDA using a framework method. Nine themes emerged which were then reviewed by five members of the evaluation steering group to assess inter-rater reliability of the themes. We used statistical process control charts and an interrupted time series design to analyse prescribing data for the two year period preceding the establishment of the collaborative and for the six months of its operation.
Effects of changes
There was a significant reduction in hypnotic prescribing of benzodiazepines and Z drugs in the practices over the six months of the project and this improvement has been sustained since the initiative.
Nine themes emerged from the qualitative data: -
Engagement of staff: Most practitioners showed enthusiasm to incorporate changes in their practice and encouraged other members of the practice to become involved by demonstrating use of the tools and reminders during meetings
āItās brought up at every practice meeting and so itās always fresh in people minds. Itās not something thatās then forgotten.ā
Practitioner views of the tools: Practitioners tried the tools and techniques and overall seemed to favour the Sleep diary and Insomnia Severity Index (ISI) over the Pittsburgh Sleep Quality Index (PSQI)
āGenerally we found that the ISI was easy to complete, score and interpret and can be used in general practiceā
Practitioner preconceptions: Practitioners came with preconceptions about the feasibility of sleep tools and techniques. Patientsā age and intellect were factors that practitioners thought might affect whether tools were completed correctly or at all.
Needs & educational needs of patients & staff: Before this project hypnotics had been seen as the solution to most sleep problems by both patients and practitioners.
āWhen people come in it was so easy to give them a prescriptionā
"As GPs weāre overly limited and actually to have a slightly more sophisticated response would actually be better for us but also for the patientā.
Barriers to implementing tools & techniques: This related to systems (of care) practitioners and patients
Systems: āOnce the psychiatrist says you should have this, it is really hard as a GP to go against it because you know they say the psychiatrist has asked me to take this.ā
Practitioner: āWe come down to the cognitive behaviour therapy approach; itās a bit thin on my part, weāve not got great skills in thatā.
Patient: āI think the key is also definitely how to communicate itā¦the minute you start even trying to approach the subject that the tablets are not really very good and what about thinking about alternative ways, they will kind of glare very rudely and be like I have been there before doc[tor]. So you have got to kind of approach it in a kind of a fresh way to make them thing they are trying something new. You have got to be a salesmanā.
Changes initiated by practices: Some practices had taken other measures to try and reduce hypnotic prescribing including implementing withdrawal programmes and limiting repeat prescriptions which let to improvement is patient and practitioner experience
GP-Patient treatment & expectations: Practitioners revealed what they thought patients expected and made suggestions of how consultations could be improved to meet patientsā needs and increase successful outcomes from a sleep consultation.
Importance of tailored approach: Each patient with Insomnia would need to have their treatment tailored to their individual requirements therefore every consultation could potentially have very different solutions
Lack of feedback from patients: Receiving feedback from patients was difficult for some practitioners when patients didnāt return for their follow-up consultation or didnāt complete and return their sleep assessment tools. This lead practitioners to feel unsure as to whether patients had read and absorbed the information provided to them
Lessons learnt
Qualitative methods for collecting and analysing data were invaluable in understanding the factors which helped bring about change, how change happened and the effect of the change on process of care and patient and practitioner experience
Message for others
Quality improvement collaboratives benefit from careful analysis using qualitative as well as quantitative methods.
Further information
www.restproject.org.uk
Project manager: [email protected]
Project lead: [email protected]
The critical role of volcano monitoring in risk reduction
International audienceData from volcano-monitoring studies constitute the only scientifically valid basis for short-term forecasts of a future eruption, or of possible changes during an ongoing eruption. Thus, in any effective hazards-mitigation program, a basic strategy in reducing volcano risk is the initiation or augmentation of volcano monitoring at historically active volcanoes and also at geologically young, but presently dormant, volcanoes with potential for reactivation. Beginning with the 1980s, substantial progress in volcano-monitoring techniques and networks ? ground-based as well space-based ? has been achieved. Although some geochemical monitoring techniques (e.g., remote measurement of volcanic gas emissions) are being increasingly applied and show considerable promise, seismic and geodetic methods to date remain the techniques of choice and are the most widely used. Availability of comprehensive volcano-monitoring data was a decisive factor in the successful scientific and governmental responses to the reawakening of Mount St. elens (Washington, USA) in 1980 and, more recently, to the powerful explosive eruptions at Mount Pinatubo (Luzon, Philippines) in 1991. However, even with the ever-improving state-of-the-art in volcano monitoring and predictive capability, the Mount St. Helens and Pinatubo case histories unfortunately still represent the exceptions, rather than the rule, in successfully forecasting the most likely outcome of volcano unrest
Protocols for TTO valuations of health states worse than dead: A literature review and framework for systematic analysis
Company Characteristics and Occupational Health and Safety Disclosures: A quantitative review of Australian annual reports
This paper uses binary logistic regression to develop two models of firmsā Occupational Health and Safety disclosures, one based on disclosure / non-disclosure, the other based on above / below the median levels of disclosure. Industry and auditor are found to be important components of both models, whilst operating revenue contributes to the former and company age to the latter. These findings support to some extent previous studies into Corporate Social and Environmental Disclosure, but also identify new factors that need to be further investigated. The paper contributes to our current understanding of Corporate Social Disclosure through its focus on the little considered area of Occupational Health and Safety and also raising the possibility of non-parametric statistics as a better statistical methodology for such research
Communication at the Edge: Voluntary social and environmental reporting in the annual report of a legitimacy threatened corporation
This paper examines the voluntary social and environmental disclosures made in the annual reports of Rothmans Ltd between the years of 1955 and 1999. The first part of the paper focuses on defining legitimacy theory as it has been used in accounting research and discusses the potential of a resource based approach to testing the theory. The study then considers legitimacy theory in light of the disclosures made by Rothmans. An initial qualitative analysis certainly provides examples of expected attempts to legitimatize the corporation given the threat posed by the smoking and health debate. Initial quantitative findings contradict those expected when compared to previous studies. However, it is concluded that when the fairly extreme circumstances faced by the tobacco industry are taken into account, legitimacy theory does provide a good explanation to both the nature and amount of the disclosures observed
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