How was it for you? Experiences of participatory design in the UK health service

Improving co-design methods implies that we need to understand those methods, paying attention to not only the effect of method choices on design outcomes, but also how methods affect the people involved in co-design. In this article, we explore participants' experiences from a year-long participatory health service design project to develop ‘Better Outpatient Services for Older People’. The project followed a defined method called experience-based design (EBD), which represented the state of the art in participatory service design within the UK National Health Service. A sample of participants in the project took part in semi-structured interviews reflecting on their involvement in and their feelings about the project. Our findings suggest that the EBD method that we employed was successful in establishing positive working relationships among the different groups of stakeholders (staff, patients, carers, advocates and design researchers), although conflicts remained throughout the project. Participants' experiences highlighted issues of wider relevance in such participatory design: cost versus benefit, sense of project momentum, locus of control, and assumptions about how change takes place in a complex environment. We propose tactics for dealing with these issues that inform the future development of techniques in user-centred healthcare design

37P. Knowledge Management Success: Some Lessons Learned

With the developed economies now firmly based on the power of information, the need to effectively harness, manage, and exploit organizational knowledge for competitive advantage has not been greater. Knowledge management initiatives have been undertaken by various organizations, with varying levels of success. The definitions of “knowledge,” “knowledge management,” and “knowledge management systems” are fluid at best, leading to a certain amount of confusion for organizations wishing to exploit their institutional knowledge. Nevertheless, several success stories (and a few failures) have been reported in the literature about organizations that have implemented knowledge management systems. It is the objective of this paper to identify some of the lessons learned from these experiences, with the expectation that some direction and guidance can emerge for organizations contemplating this endeavor. As a research-in-progress, the ultimate objective is to expand on the case studies and, eventually, incorporate the lessons learned into a comprehensive strategic framework for organizational knowledge management

Influence of growth temperature on the thermal resistance of some bacteria from evaporated milk

Keeping quality of evaporated milk depends primarily on the destruction of the contained organisms by heat. Normally, the heat treatment used is entirely satisfactory, but, occasionally, organisms survive. Some of these are species that do not cause changes ill evaporated milk in cans, while others are species that bring about conspicuous defects. Spoilage sometimes occurs when there has been no intentional or discernible modification of a heat treatment that has been employed successfully over extended periods. Outbreaks are frequently spasmodic but during their brief existence may cause extensive financial losses

Migrations and development policies in Nigeria.

The authors of this book chapter conclude that increased urbanization in Nigeria is a product of natural growth and migration. Rural-to-rural migration dominated during the colonial period. Independence was marked by rural-urban urban-urban and return migration streams. The authors posit that the problems of inadequate supplies of housing and clean water in urban centers led to overcrowding and the resulting urban social and health hazards. Urban in-migration was the cause of urban growth. The rural population structure was related to the availability of labor and food production. Rural development depended upon the availability of a resourceful willing and capable young population and reduced out-migration. Urban migrants increased the demand for educational services and strained existing resources. Rapid social changes have led to homelessness and changes in marriage and the family. Nigeria has a variety of climates and geography and abundant natural resources including oil. About 50% of the population is comprised of ethnic groups i.e. Hausa in the north Ibo in the southeast and the Yuroba in the west. During colonial periods large scale migration movements were fueled by social conflicts. Colonial practices increased the demand for labor in colonial agriculture and mining industries forced taxation on the adult population and produced a wage earning labor force. Traditional forms of social organization based on kinship and political or tribal rights were substituted with the European mode of social organization. The colonial regime created new urban centers and a population shift to developing areas in the north

Environmental effects of crude oil spill on the physicochemical and hydrobiological characteristics of the Nun River, Niger Delta

Oil spill pollution has remained a source of several international litigations in the Niger Delta region of Nigeria. In this paper, we examined the impacts of small recurrent crude oil spills on the physicochemical, microbial and hydrobiological properties of the Nun River, a primary source of drinking water, food and recreational activities for communities in the region. Samples were collected from six sampling points along the stretch of the lower Nun River over a 3-week period. Temperature, pH salinity, turbidity, total suspended solids, total dissolved solids, dissolved oxygen, phosphate, nitrate, heavy metals, BTEX, PAHs and microbial and plankton contents were assessed to ascertain the quality and level of deterioration of the river. The results obtained were compared with the baseline data from studies, national and international standards. The results of the physicochemical parameters indicated a significant deterioration of the river quality due to oil production activities. Turbidity, TDS, TSS, DO, conductivity and heavy metals (Cd, Cr, Cu, Pb, Ni and Zn) were in breach of the national and international limits for drinking water aquatic health. They were also significantly higher than the initial baseline conditions of the river. Also, there were noticeable changes in the phytoplankton, zooplankton and microbial diversities due to oil pollution across the sampling zones.<br/

The Afrikander Bond and other causes of the war

leyds-47-3456.pdf created from original pamphlet in the WJ Leyds Collection held in the Africana Section of the Stellenbosch University Library and Information Service.Pamphlet on Theophilus Lyndall Schreiner's view of the Afrikaner Bond and why the war declared by the two Dutch Republics against England has sprung from more than one source

The causes of the war in South Africa

leyds-p65-498.pdf created from original pamphlet in the WJ Leyds Collection held in the Africana Section of the Stellenbosch University Library and Information Service.An address delivered by Mr Theophilus Lyndall Schreiner on the causes of the Anglo-Boer War

Surgical Management of Massive Pericardial Effusion and Predictors for Development of Constrictive Pericarditis in a Resource Limited Setting

Background. The diagnosis and treatment of massive pericardial effusion and cardiac tamponade have evolved over the years with a tendency towards a more comprehensive diagnostic workup and less traumatic intervention. Method. We reviewed and analysed the data of 32 consecutive patients who underwent surgery on account of massive pericardial effusion and cardiac tamponade in a semiurban university hospital in Nigeria from February 2010 to February 2016. Results. The majority of patients (34.4%) were between 31 and 40 years. Fourteen patients (43.8%) presented with clinical and echocardiographic feature of cardiac tamponade. The majority of patients (59.4%) presented with haemorrhagic pericardial effusion and the average volume of fluid drained intraoperatively was 846 mL  ± 67 mL. Pericardium was thickened in 50% of cases. Subxiphoid pericardiostomy was performed under local anaesthesia in 28 cases. No postoperative recurrence was observed; however 5 patients developed features of constrictive pericarditis. The relationship between pericardial thickness and development of pericardial constriction was statistically significant (p=0.004). Conclusion. Subxiphoid pericardiostomy is a very effective way of treating massive pericardial effusion. Removing tube after adequate drainage (50 mL/day) and treatment of primary pathology are key to preventing recurrence. There is also a need to follow up patients to detect pericardial constriction especially those with thickened pericardium

Assessment of the mode of occurrence and radiological impact of radionuclides in Nigerian coal and resultant post-combustion fly ash using scanning electron microscopy and gamma-ray spectroscopy

Natural radionuclide concentrations in coal and coal ash can occur at levels sufficient to raise potential health and environmental concerns when (re)suspended or disposed into the environment. To evaluate such concerns, this study characterized coal and simulant coal ash samples obtained from two Nigerian coal mines (Okaba and Omelewu) using high resolution gamma spectroscopy combined with scanning electron microscopy and energy dispersive spectroscopy. Discrete uraninite particles were observed dispersed within the coal ash samples, alongside U and Th containing mineral grains (monazite and zircon) with monazite the most abundant radioactive mineral particles. The pitted and cracked surface morphologies of these radioactive particles (with sizes between 10 &mu;m and 80 &mu;m) indicate their susceptibility for disintegration into more harmful and readily inhalable PM2.5 aerosol particles, with the potential to deliver a localized dose and cause chronic respiratory diseases. The results of activity concentrations and radiological hazard indices for the coal ash samples from both mines were between three and five times higher than world average in soil, which imply that these coal ash materials should be suitably contained in slurry ponds to prevent hazards due to increased risk of prolonged indoor exposure to gamma radiation, radon gas, and inhalation of liberated radioactive particles

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication