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Overtourism and employment outcomes for the tourism worker: impacts to labour markets
No full textPurpose
This paper aims to undertake an ideal-typical analysis of the implications of overtourism on employment at the level of the destination.
Design/methodology/approach
The paper offers a theoretical analysis that uses as a starting point a traditional labour market model to explore the employment implications of a labour demand shock as a result of overtourism at a destination level. Although a theoretical exploration, examples are provided offering empirical support for the theoretical propositions.
Findings
Overtourism may lower nominal and real wages, further deepen divisions in an already divided labour market (particularly between local and migrant workers), increase productivity without its benefits accruing to the worker and result in deterioration of working conditions. The study also sets tourism employment within a broader politico-economic framework of neoliberalism.
Research limitations/implications
This study offers scope for further empirical testing of hypothesized relationships. It also provides a platform to adopt and adapt the theoretical propositions to suit different contexts.
Originality/value
This study uses overtourism as an ideal-type, combined with an analysis of the labour market to theorise the impacts of a labour demand shoc
Predicting the Postoperative Addition Power of a Multifocal Intraocular Lens at the Spectacle Plane
No full textPURPOSE: To establish a simple clinical method of predicting addition power achieved with a multifocal intraocular lens (IOL).
METHODS: In this prospective cohort study, 41 patients were bilaterally implanted with the Bi-Flex MY multifocal IOL (Medicontur) with +3.50 diopters (D) near addition power. Monocular defocus curves were plotted for each patient and effective addition power was calculated as the dioptric difference between the distance and near inflection points of the defocus curve. Six biometry formulas (Haigis, Holladay, SRK/T, Hill RBF, Barrett Universal II, and Holladay 2) were used to predict the addition power at the spectacle plane.
RESULTS: Mean effective addition power was 2.60 ± 0.29 D, with significant (P < .01) differences between the prediction methods. Significant differences were found between predicted and effective addition when the Holladay, SRK/T, Hill RBF, and Holladay 2 formulas were used. A moderate but significant correlation (r = 0.342, P = .033) was found with the Barrett formula, and this was also the method to show the least proportional bias with Bland-Altman analysis.
CONCLUSIONS: The study demonstrates that the effective addition power can be predicted using the proposed simple clinical method derived using the Barrett Universal II formula. The proposed technique may have significant clinical value in screening for patients where ocular biometry may lead to aberrant addition power
Content Analysis of Patient Safety Incident Reports for Older Adult Patient Transfers, Handovers, and Discharges: Do They Serve Organizations, Staff, or Patients?
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The aim of the study was to analyze content of incident reports during patient transitions in the context of care of older people, cardiology, orthopedics, and stroke.
Methods
A structured search strategy identified incident reports involving patient transitions (March 2014–August 2014, January 2015–June 2015) within 2 National Health Service Trusts (in upper and lower quartiles of incident reports/100 admissions) in care of older people, cardiology, orthopedics, and stroke. Content analysis identified the following: incident classifications; active failures; latent conditions; patient/relative involvement; and evidence of individual or organizational learning. Reported harm was interpreted with reference to National Reporting and Learning System criteria.
Results
A total 278 incident reports were analyzed. Fourteen incident classifications were identified, with pressure ulcers the modal category (n = 101,36%), followed by falls (n = 32, 12%), medication (n = 31, 11%), and documentation (n = 29, 10%). Half (n = 139, 50%) of incident reports related to interunit/department/team transfers. Latent conditions were explicit in 33 (12%) reports; most frequently, these related to inadequate resources/staff and concomitant time pressures (n = 13). Patient/family involvement was explicit in 61 (22%) reports. Patient well-being was explicit in 24 (9%) reports. Individual and organizational learning was evident in 3% and 7% of reports, respectively. Reported harm was significantly lower than coder-interpreted harm (P < 0.0001).
Conclusions
Incident report quality was suboptimal for individual and organizational learning. Underreporting level of harm suggests reporter bias, which requires reducing as much as practicable. System-level interventions are warranted to encourage use of staff reflective skills, emphasizing joint ownership of incidents. Co-producing incident reports with other clinicians involved in the transition and patients/relatives could optimize organizational learning
Influence of Public Health England’s Change4Life Disney Branded 10-minute Shake Ups on Children’s Post Activity Affective Response
Get PDFPhysical activity (PA) is considered essential to overall health, yet it is consistently reported that children worldwide are failing to meet the recommended levels. Affective responses are a potential predictor of long-term PA engagement due to their bidirectional relationship with PA. One way to influence the affective response to PA may be to influence the environment in which it takes place; a method of doing this is to immerse children using a narrative with characters. The aim of this research was to compare the effects of using a Disney branded, compared to a non-branded, PA session on children’s post activity affective responses and perceived effort of PA. 32 children participated (aged between 4-11 years) and they each completed four sessions of branded activities, and four sessions of unbranded activities. The results showed that children had similar positive affective responses and perceived effort to branded and unbranded activities, and qualitative feedback from parents supported this. However, a secondary finding from qualitative thematic analysis was that parents considered branding a key contributing factor to children’s enjoyment and the effort they put into the PA sessions. Future research into influencing the affective response through the environment should carefully consider how to capture this during the activity. Lastly, the research was conducted during the period of the COVID-19 lockdown and so should be interpreted in this context. Conceptual replication outside of this should be an aim of future research
Content Analysis of Patient Safety Incident Reports for Older Adult Patient Transfers, Handovers and Discharges: Do they Serve Organisations, Staff or Patients?
Get PDFObjectives: Analyse content of incident reports during patient transitions in the context of care of older people, cardiology, orthopaedics and stroke.
Methods: A structured search strategy identified incident reports involving patient transitions (March 2014 – August 2014, January 2015 – June 2015) within two NHS Trusts (in upper and lower quartiles of incident reports/100 admissions) in care of older people, cardiology, orthopaedics and stroke. Content analysis identified: incident classifications; active failures; latent conditions; patient/relative involvement; and evidence of individual or organisational learning. Reported harm was interpreted with reference to National Reporting and Learning System criteria.
Results: A total 278 incident reports were analysed. Fourteen incident classifications were identified, with pressure ulcers the modal category (n=101; 36%) followed by falls (n=32, 12%), medication (n=31, 11%) and documentation (n=29, 10%). Half (n=139; 50%) of incident reports related to inter-unit/department/team transfers. Latent conditions were explicit in 33 (12%) reports; most frequently, these related to inadequate resources/staff and concomitant time pressures (n=13). Patient/family involvement was explicit in 61 (22%) reports. Patient well-being was explicit in 24 (9%) reports. Individual and organisational learning was evident in 3% and 7% of reports respectively. Reported harm was significantly lower than coder-interpreted harm (p<0.0001).
Conclusions: Incident report quality was sub-optimal for individual and organisational learning. Under-reporting level of harm suggests reporter bias, which requires reducing as much as practicable. System-level interventions are warranted to encourage use of staff reflective skills, emphasising joint ownership of incidents. Co-producing incident reports with other clinicians involved in the transition and patients/relatives could optimise organisational learning
Teacher as commodity versus teacher as professional: An international status-based crisis in teacher supply
No full textThere is a discord internationally between the ‘agencies’ that control the supply and quality (teacher status) of the school ‘workforce’, such as the Department for Education on behalf of the government in England and the government and Swedish Association for Local Authorities and Regions (SALAR) in Sweden, and experts experienced in providing teacher training and professional development, such as university teacher education departments in Canada and Israel (Ovenden-Hope and Passy, 2020). The disagreement is bound to perceptions of teacher as predominantly either commodity or professional
Behaviour change practices in exercise referral schemes: developing realist programme theory of implementation
Get PDFBackground: Exercise Referral Schemes have been delivered worldwide in developed countries to augment physical activity levels in sedentary patients with a range of health issues, despite their utility being questioned. Understanding the implementation mechanisms of behaviour change practices is important to avoid inappropriate decommissioning and support future service planning. The aim of this study was to develop initial theories to understand what influences the behaviour change practices of Exercise Referral practitioners within the United Kingdom.
Methods: An eight-month focused ethnography was undertaken, to carry out the first phase of a realist evaluation, which included participant observation, interviews, document analysis, and reflexive journaling. A comprehensive implementation framework (Consolidated Framework for Implementation Research) was adopted providing an extensive menu of determinants. Mechanisms were categorised based on the Theoretical Domains Framework (within the Capability, Opportunity, Motivation, Behaviour model) providing an explanatory tool linking the levels of the framework.
Results: Three programme theories are proposed. Firstly, motivation and capability are influenced when behaviour change oriented planning and training are in place. Secondly, motivation is influenced if leadership is supportive of behaviour change practice. Lastly, integration between health professionals and practitioners will influence motivation and capability. The conditions necessary to influence motivation and capability include a person-centred climate, cognizant practitioners, and established communities of practice.
Conclusions: The findings are the first to articulate the necessary elements for the implementation of behaviour change practices in Exercise Referral services. These results outline emerging theories about the conditions, resources, and explanations of behaviour change implementation that can inform service development
Acute L-Glutamine Supplementation does not improve Gastrointestinal Permeability, Injury or Microbial Translocation in Response to Exhaustive High Intensity Exertional-Heat Stress
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Exertional-heat stress adversely distrupts (GI) barrier integrity and, through subsequent microbial translocation (MT), can result in potentially fatal exertional-heat stroke. Acute glutamine (GLN) supplementation is a potential nutritional countermeasure, although the practical value of current supplementation regimens is questionable. Method: Ten males completed two high-intensity exertional-heat stress tests (EHST) involving running in the heat (40°C and 40% relative humidity) at lactate threshold to volitional exhaustion. Participants ingested GLN (0.3 g·kg·FFM-1) or a non-calorific placebo (PLA) one hour prior to the EHST. Venous blood was drawn pre-, post- and one-hour post-EHST. GI permeability was assessed using a serum dual-sugar absorption test (DSAT) and small intestinal epithelial injury using plasma Intestinal Fatty-Acid Binding Protein (I-FABP). MT was assessed using the Bacteroides/total 16S DNA ratio. Results: Volitional exhaustion occurred after 22:19 ± 2:22 (minutes: seconds) in both conditions, during which whole-body physiological responses and GI symptoms were not different (p ˃ 0.05). GI permeability (serum DSAT) was greater following GLN (0.043 ± 0.020) than PLA (0.034 ± 0.019) (p = 0.02; d = 0.47), but small intestine epithelial injury (I-FABP) increased comparably (p = 0.22; η2p = 0.16) following the EHST in both trials (GLN Δ = 1.25 ± 0.63 ng·ml-1; PLA Δ= 0.92 ± 0.44 ng·ml-1). GI MT (Bacteroides/total 16S DNA ratio) was unchanged in either condition following the EHST (p = 0.43). Conclusion: Acute low-dose (0.3 g·kg-1 fat free mass) GLN supplementation ingested one hour before high-intesity exertional-heat stress worsened GI permeability, but did not influence either small intestinal epithilial injury or microbial translocation.
Highlights:
The pathophysiology of exertional-heat stroke is widely hypothesised to be at least in part attributable to a systemic inflammatory response caused by the leak of gastrointestinal microbes into the circulating blood.
Acute high-dose (0.9 g·kg·FFM-1) L-glutamine supplementation is widely promoted as a practical strategy to protect gastrointestinal barrier integrity during exertional-heat stress. However, previously validated doses are often poorly tolerated and cannot be recommended for widespread implementation.
This study examined the efficacy of low-dose (0.30 g·kg·FFM-1; ∼20 grams) acute L-glutamine supplementation on small intestinal injury, permeability, and microbial translocation in response a high-intensity exertional-heat stress test to exhaustion (20 – 30 minutes). This type of exercise accounts for the majority of exertional-heat stroke cases in the military.
Despite being universally well-tolerated across all participants, acute low-dose L-glutamine supplementation worsened gastrointestinal permeability, without influencing either small intestinal injury or microbial translocation. These findings do not support the application of low-dose L-glutamine supplementation to help prevent exertional-heat stroke
Preliminary development of a questionnaire to measure the extra-pulmonary symptoms of severe asthma
Get PDFBackground: Research into the effects of asthma treatments on the extra-pulmonary symptoms of severe asthma is limited by the absence of a suitable questionnaire. The aim was to create a questionnaire suitable for intervention studies by selecting symptoms that are statistically associated with asthma pathology and therefore may improve when pathology is reduced.
Methods: Patients attending a specialist asthma clinic completed the 65-item General Symptom Questionnaire (GSQ-65), a questionnaire validated for assessing symptoms of people with multiple medically unexplained symptoms. Lung function (FEV1%) and cumulative oral corticosteroids (OCS) calculated from maintenance dose plus exacerbations were obtained from clinic records. Pathology was represented by the two components of a principal component analysis (PCA) of FEV1% and OCS. LASSO regression was used to select symptoms that had high coefficients with these two principal components and occurred frequently in severe asthma.
Results: 100 patients provided data. PCA revealed two components, one where FEV1% and OCS were inversely related and another where they were directly related. LASSO regression revealed 39 symptoms with non-zero coefficients on one or more of the two principal components from which 16 symptoms were selected for the GSQ-A on the basis of magnitude of coefficient and frequency. Asthma symptoms measured by asthma control questionnaires were excluded. The GSQ-A correlated 0.33 and − 0.34 (p = 0.001) with the two principal components.
Conclusion: The GSQ-A assesses the frequency of 16 heterogenous non-respiratory symptoms that are associated with asthma severity using the statistical combination of FEV1% and OCS
Comparison of the sensitivity of patient-reported outcomes for detecting the benefit of biologics in severe asthma
Get PDFBackground: The sensitivity ofpatient-reported outcomes (PROs) to detect the effects of treatment change dependson the match between the change in items of the PRO and the change that takes place in a sample of people. The aim of this study is to compare the sensitivity of different PROs in detecting changes following the initiation of biologic treatment in asthma.
Methods: Patients starting a biologic treatment as part of clinical care completed the Asthma Control Questionnaire (ACQ-6), the Severe Asthma Questionnaire (SAQ and SAQ-global scores) and the EQ5D (EQ-5D-5L and EQ5D-VAS)atbaseline.TheycompletedtheACQ-6,SAQ,SAQ-globalandaretrospectiveglobalratingofchange(GRoC) scaleatweeks4,8and16andcompletedtheEQ-5D-5LandEQ5D-VASatweek16.TheSAQ-globalandEQ5D-VASdiffer but both are single item 100-point questions. Sensitivity was measured by Cohen’s D effect size at each of the three time points.
Results: 110 patients were recruited. Depending on the time of assessment, effect size varied between 0.45 and 0.64fortheSAQ,between0.50and0.77fortheSAQ-global;between0.45and0.69forACQ-6;between0.91and1.22for GRoC; 0.32 for EQ-5D-5L and 0.49 for EQ5D-VAS.
Conclusion: The sensitivity to change of a questionnaire varies with the time of measurement. The three asthma-specific prospective measures (SAQ, SAQ-global and ACQ-6) have similar sensitivitytochange.Thesingle-itemEQ5D-VASwaslesssensitivethantheasthmaspecificmeasuresandlesssensitivethan the single-item SAQ-global. The EQ-5D-5L was least sensitive