42228 research outputs found
Sort by
A realist approach to understanding alliancing within Local Government public health and social care service provision
Get PDFBackground
Within the current context of continued austerity and post-pandemic recovery, it remains important that Local Government services address the increasing needs of residents as cost-effectively as possible. Alliancing, whereby services work collaboratively focusing on the ‘whole-system’, has gained popularity as a tool with the potential to support collaborative whole systems approaches. This synthesis aims to identify how alliancing can be successfully operationalised in the commissioning of public health, wider National Health Service (NHS) and social care-related services.
Methods
A realist literature synthesis was undertaken in order to identify underlying generative mechanisms associated with alliancing, the contextual conditions surrounding the implementation and operationalisation of the alliancing approach mechanisms, and the outcomes produced as a result. An iterative approach was taken, using a recent systematic review of the effectiveness of Alliancing, online database searches, and grey literature searches.
Results
Three mechanistic components were identified within the data as being core to the successful implementation of alliances in public health and social care-related services within Local Government: (i) Achieving a system-level approach; (ii) placing local populations at the heart of the system; and (iii) creating a cultural shift. Programme theories were postulated within these components.
Conclusions
The alliancing approach offers an opportunity to achieve system-level change with the potential to benefit local populations. The realist synthesis approach taken within this study has provided insights into the necessary contextual and mechanistic factors of the Alliancing approach, above and beyond effectiveness outcomes typically collected through more conventional evaluation methodologies
Mechanisms affecting the gut of preterm infants in enteral feeding trials: a nested cohort within a randomised controlled trial of lactoferrin
Get PDFObjective To determine the impact of supplemental bovine lactoferrin on the gut microbiome and metabolome of preterm infants.
Design Cohort study nested within a randomised controlled trial (RCT). Infants across different trial arms were matched on several clinical variables. Bacteria and metabolite compositions of longitudinal stool and urine samples were analysed to investigate the impact of lactoferrin supplementation.
Setting Thirteen UK hospitals participating in a RCT of lactoferrin.
Patients 479 infants born <32 weeks’ gestation between June 2016 and September 2017.
Results 10 990 stool and 22 341 urine samples were collected. Analyses of gut microbiome (1304 stools, 201 infants), metabolites (171 stools, 83 infants; 225 urines, 90 infants) and volatile organic compounds (314 stools, 117 infants) were performed. Gut microbiome Shannon diversity at 34 weeks corrected age was not significantly different between infants in the lactoferrin (mean=1.24) or placebo (mean=1.06) groups (p=0.11). Lactoferrin receipt explained less than 1% variance in microbiome compositions between groups. Metabolomic analysis identified six discriminative features between trial groups. Hospital site (16%) and postnatal age (6%) explained the greatest variation in microbiome composition.
Conclusions This multiomic study identified minimal impacts of lactoferrin but much larger impacts of hospital site and postnatal age. This may be due to the specific lactoferrin product used, but more likely supports the findings of the RCT in which this study was nested, which showed no impact of lactoferrin on reducing rates of sepsis. Multisite mechanistic studies nested within RCTs are feasible and help inform trial interpretation and future trial design
Remote working in construction: assessing the affordance of digitisation
Get PDFPurpose
As remote working becomes increasingly popular, remote working could unlock new ways of working through digitisation. However, the construction sector has been slow to adopt digitisation in its processes, making digitisation difficult to assess whether this affordance may be well received and the current capabilities of digitisation to achieve this effectively. The purpose of this paper is to investigate the interest in remote working amongst construction sector personnel and to examine the factors affecting remote working through digitisation affordances.
Design/methodology/approach
Based on a case study of one of the largest contractor firms in the United Kingdom, an online questionnaire survey was used to collect responses from 125 construction professionals. Statistical package for the social sciences (SPSS) was used to do basic statistical analysis on the results.
Findings
The findings show that there is a general appetite for remote working on a flexible basis where a mix of “on-site” and “off-site” arrangement was deemed practical. This could potentially unlock significant time and cost savings as well as productivity gains. The main factors affecting remote working were the availability of interconnected systems allowing efficient communication and digital infrastructure that enable automated processes.
Research limitations/implications
The research is limited to a large contractor company and may not be appropriate for small and medium-sized companies. The findings may benefit organisations to evaluate the practical needs of ensuring effective remote working in the construction industry and unlocking efficiencies.
Originality/value
The paper adds value to understanding the affordances and constraints of digitisation for remote working from the perspective of construction professionals
The Kurdish kaçakçı on the Iran-Turkey border: corruption and survival as EU sponsored counter-smuggling effects
Get PDFThis article examines people smuggling in the Kurdish borders between Turkey and Iran, and describes how members of local Kurdish border communities use their roles as kaçakçı (smuggler in Turkish) to navigate externalised EU border controls amid internal displacement and poverty. It draws upon ethnographic data collection between 2020 and 2022 in the Turkey-Iran border that has not been considered in studies on the EU-supported external counter-smuggling. This article specifically narrows down on corruption, an often mentioned yet understudied element of smuggling, and discusses the payment of bribes to border officials, and the creation of riskier routes to facilitate border crossing. We show how unequal access to corruption allow some people smuggling attempts to result in relatively uneventful passages while others are permeated by risks and death. While vilified by governments, corruption is also widely known and accepted as a social equalizer: as a safety valve that allows marginalized Kurds – both kaçakçı and border and security guards – to navigate precarity and survive borderland enforcement regimes. Our analysis from the perspectives of Kurds working as kaçakçı in the context of conflict and internal displacement seeks to move away from the dominant lens used in the analysis of people smuggling, which has almost solely examined it as a form of transnational organized crime and/or as an element of externalised border governance
The Impact of Citizens’ Participation Level on Smart Sustainable Cities Outcomes: Evidence from Saudi Arabia
Get PDFIt is imperative to expand the concept of smart cities beyond merely focusing on technology to include human, social, and environmental capital investing to develop smart sustainable cities (SSC). In recognition of smart cities’ advantages, several cities have adopted smart city labels. Although citizens’ engagement in public urban development and decision-making has been acknowledged globally in many countries, evaluating the outcomes that allow citizens to contribute does not measure and compare with other factors. This study examines the impact between the citizens’ participation level (CPL) and the smart sustainable cities outcome (SSCO). Four factors were extracted from the literature review and interviews were conducted with 12 decision and policymakers to establish the importance of these factors and to suggest any other additional factors. In addition, a questionnaire survey was utilised to assess and validate the result by experts in the field of the built environment. The mean score (MS) ranking was used to confirm the importance of these predicted correlations with SSCO. Endogeneity tests and multivariate regression analysis were adopted to validate the causality between CLP and SSCO. The results suggest that a positive significant correlation exists between the CPL and SSCO. A higher CPL leads to a higher level of SSCO, but this does not apply the other way around. The four significant factors of CPL to engage and empower citizens are accountability and responsibility, transparency, participation, and inclusion. This paper contributes to knowledge by identifying the measures of CPL and SSCO that can support the implementation of SSC by understanding what can be expected from the government and decision-makers and what can be expected from the citizens
Introduction: Subversion, Dissent and Opposition in Communist Europe and Beyond
Get PDFThis essay introduces “Between Subversion and Opposition: Multiple Challenges to Communist Rule,” a special issue of East Central Europe. It focuses on four broader questions raised by the contributions: the different periodizations associated with communist rule; the meanings attached to different forms of subversion and dissent; the broader transnational contexts in which activists operated – including the role of contacts with activists in the West; and, finally, the different ways oppositional activity has been remembered and represented
Acceptability of wearable devices for measuring mobility remotely: Observations from the Mobilise-D technical validation study
Get PDFBackground
This study aimed to explore the acceptability of a wearable device for remotely measuring mobility in the Mobilise-D technical validation study (TVS), and to explore the acceptability of using digital tools to monitor health.
Methods
Participants (N = 106) in the TVS wore a waist-worn device (McRoberts Dynaport MM + ) for one week. Following this, acceptability of the device was measured using two questionnaires: The Comfort Rating Scale (CRS) and a previously validated questionnaire. A subset of participants (n = 36) also completed semi-structured interviews to further determine device acceptability and to explore their opinions of the use of digital tools to monitor their health. Questionnaire results were analysed descriptively and interviews using a content analysis.
Results
The device was considered both comfortable (median CRS (IQR; min-max) = 0.0 (0.0; 0–20) on a scale from 0–20 where lower scores signify better comfort) and acceptable (5.0 (0.5; 3.0–5.0) on a scale from 1–5 where higher scores signify better acceptability). Interviews showed it was easy to use, did not interfere with daily activities, and was comfortable. The following themes emerged from participants’ as being important to digital technology: altered expectations for themselves, the use of technology, trust, and communication with healthcare professionals.
Conclusions
Digital tools may bridge existing communication gaps between patients and clinicians and participants are open to this. This work indicates that waist-worn devices are supported, but further work with patient advisors should be undertaken to understand some of the key issues highlighted. This will form part of the ongoing work of the Mobilise-D consortium
Usefulness of disease surveillance data in enhanced early warning of the cholera outbreak in Southwest Cameroon, 2018
Get PDFIntroduction: This study assessed the timeliness and completeness of disease surveillance data for early warning of the cholera outbreak during the socio-political crisis of Southwest Cameroon in 2018. It determined how routine integrated disease surveillance and response (IDSR) data was used for preventative actions and the challenges faced by key health staff in IDSR based decision-making. Methods: This was a mixed-methods study conducted from June 1st to September 30th 2021. District Health Information System 2 (DHIS2) data from January 2018 to December 2020 for the Southwest region of Cameroon were analysed using simple linear regression on EPI Info 7.2 to determine a potential association of the sociopolitical crisis with timeliness and completeness of data. Qualitative data generated through in-depth interviews of key informants were coded and analyzed using NVivo 12. Results: During high conflict intensity (2018 and 2019), average data timeliness and completeness were 16.3% and 67.2%, respectively, increasing to 40.7% and 80.2%, respectively, in 2020 when the conflict intensity had reduced. There was a statistically significant weak correlation between reduced conflict intensity and increased data timeliness (R2 = 0.17, p = 0.016) and there was also a weak correlation between reduced conflict intensity and data completeness but this was not statistically significant (R2 = 0.01, p = 0.642). During high conflict intensity, the Kumba and Buea health districts had the highest data timeliness (17.2% and 96.2%, respectively) and data completeness (78.8% and 40.4%, respectively) possibly because of proximity to reporting sites and effective performance based financing. Components of IDSR that should be maintained included the electronic report aspect of the DHIS2 and the supportive supervision conducted during the outbreak. Staff demotivation, the parallel multiplicity of data entry tools, poor communication, shortage of staff and the non-usability of data generated by the DHIS2 were systemic challenges to the early alert dimension of the IDSR system. Non–systemic challenges included high levels of insecurity, far to reach outbreak sites and health personnel being targeted during the conflict. Conclusion: In general, routine IDSR data was not a reliable way of providing early warning of the 2018 cholera outbreak because of incomplete and late reports. Nonetheless, reduced conflict intensity correlated with increased timeliness and completeness of data reporting. The IDSR was substantially challenged during the crisis, and erroneous data generated by the DHIS 2 significantly undermined the efforts and resources invested to control the outbreak. The Ministry of Public Health should reinforce efforts to build a reporting system that produces people-centered actionable data that engages health risk management during socio-political crises
The impacts of multi-stakeholders collaboration on management and mitigation of oil pipeline disasters in Nigeria
Get PDFPipeline disasters have caused large losses to Nigeria in terms of economic, ecological, and human lives. A single incident can have devastating consequences for the environment, individuals, and communities. Research to date has recommended the significance of stakeholders, collaboration in overseeing these issues. This study examines the impacts of multi-stakeholders, collaboration on the management and mitigation of oil pipeline disasters in Nigeria, adopting the use of questionnaires and semi-structured interviews. The benefits of stakeholders, collaboration in the context of this study include but are not limited to: better information/intelligence sharing; improved decision-making; enhanced coordinated and timely intervention; improved response. The challenges associated with collaboration are: conflicts in shared responsibilities; inadequate resources; inadequate enforcement of environmental laws and guidelines; and inefficient communication systems. The goals of the collaborative pact will be effectively achieved if these challenges are properly addressed. This study recommends a framework for multi-stakeholders collaboration toward effective and efficient management and mitigation of oil pipeline disasters in Nigeria
Corynebacterium megadyptis sp. nov. with two subspecies, Corynebacterium megadyptis subsp. megadyptis subsp. nov. and Corynebacterium megadyptis subsp. dunedinense subsp. nov. isolated from yellow-eyed penguins
Get PDFNovel Corynebacterium strains, 3BT and 7BT, were isolated from the oral cavities of young chicks of yellow-eyed penguins (hoiho), Megadyptes antipodes. A polyphasic taxonomic characterization of these strains revealed chemotaxonomic, biochemical and morphological features that are consistent with those of the genus Corynebacterium. The 16S rRNA gene sequence similarity values between the strains and their closest phylogenetic neighbour, Corynebacterium ciconiae CCUG 47525T were 99.07 %, values that are in line with their phylogenomic positions within the evolutionary radiation of the genus Corynebacterium. Digital DNA–DNA hybridization values and average nucleotide identities between the genome sequences of the two strains and related Corynebacterium species were well below the defined threshold values (70 and 95–96 %, respectively) for prokaryotic species delineation. The genome size of these strains varied between 2.45–2.46 Mb with G+C content 62.7–62.9 mol%. Strains 3BT and 7BT were Gram-stain positive bacilli that were able to grow in presence of 0–10 % (w/v) NaCl and at temperature ranging between 20–37 °C. The major fatty acids (>15 %) were C16 : 0 and C18 : 1 ω9c, and the mycolic acid profile included 32–36 carbon atoms. We propose that these strains represent a novel species, Corynebacterium megadyptis sp. nov. with 3BT (=DSM 111184T=NZRM 4755T) as the type strain. Phylogenomically, strains 3BT and 7BT belong to two lineages with subtle differences in MALDI-TOF spectra, chemotaxonomic profiles and phenotypic properties. The fatty acid profile of strain 3BT contains C18 : 0 as a predominant type (>15 %), which is a minor component in strain 7BT. Strain 7BT can oxidize N-acetyl-d-glucosamine, l-serine, α-hydroxy-butyric acid, l-malic acid, l-glutamic acid, bromo-succinic acid and l-lactic acid, characteristics not observed in strain 3BT. Therefore, we propose that these strains represent two subspecies, namely Corynebacterium megadyptis subsp. megadyptis subsp. nov. (type strain, 3BT=DSM 111184T=NZRM 4755T) and Corynebacterium megadyptis subsp. dunedinense subsp. nov. (type strain, 7BT=DSM 111183T=NZRM 4756T)