A manifesto for a socio-technical approach to NHS and social care IT-enabled business change - to deliver effective high quality health and social care for all

80% of IT projects are known to fail. Adopting a socio-technical approach will help them to succeed in the future. The socio-technical proposition is simply that any work system comprises both a social system (including the staff, their working practices, job roles, culture and goals) and a technical system (the tools and technologies that support and enable work processes). These elements together form a single system comprising interacting parts. The technical and the social elements need to be jointly designed (or redesigned) so that they are congruent and support one another in delivering a better service. Focusing on one aspect alone is likely to be sub-optimal and wastes money (Clegg, 2008). Thus projects that just focus on the IT will almost always fail to deliver the full benefits

The clinical effectiveness and cost-effectiveness of ablative therapies in the management of liver metastases: systematic review and economic evaluation

Background: Many deaths from cancer are caused by metastatic burden. Prognosis and survival rates vary, but survival beyond 5 years of patients with untreated metastatic disease in the liver is rare. Treatment for liver metastases has largely been surgical resection, but this is feasible in only approximately 20–30% of people. Non-surgical alternatives to treat some liver metastases can include various forms of ablative therapies and other targeted treatments.Objectives: To evaluate the clinical effectiveness and cost-effectiveness of the different ablative and minimally invasive therapies for treating liver metastases.Data sources: Electronic databases including MEDLINE, EMBASE and The Cochrane Library were searched from 1990 to September 2011. Experts were consulted and bibliographies checked.Review methods: Systematic reviews of the literature were undertaken to appraise the clinical effectiveness and cost-effectiveness of ablative therapies and minimally invasive therapies used for people with liver metastases. Studies were any prospective study with sample size greater than 100 participants. A probabilistic model was developed for the economic evaluation of the technologies where data permitted.Results: The evidence assessing the clinical effectiveness and cost-effectiveness of ablative and other minimally invasive therapies was limited. Nine studies of ablative therapies were included in the review; each had methodological shortcomings and few had a comparator group. One randomised controlled trial (RCT) of microwave ablation versus surgical resection was identified and showed no improvement in outcomes compared with resection. In two prospective case series studies that investigated the use of laser ablation, mean survival ranged from 41 to 58 months. One cohort study compared radiofrequency ablation with surgical resection and five case series studies also investigated the use of radiofrequency ablation. Across these studies the median survival ranged from 44 to 52 months. Seven studies of minimally invasive therapies were included in the review. Two RCTs compared chemoembolisation with chemotherapy only. Overall survival was not compared between groups and methodological shortcomings mean that conclusions are difficult to make. Two case series studies of laser ablation following chemoembolisation were also included; however, these provide little evidence of the use of these technologies in combination. Three RCTs of radioembolisation were included. Significant improvements in tumour response and time to disease progression were demonstrated; however, benefits in terms of survival were equivocal. An exploratory survival model was developed using data from the review of clinical effectiveness. The model includes separate analyses of microwave ablation compared with surgery and radiofrequency ablation compared with surgery and one of radioembolisation in conjunction with hepatic artery chemotherapy compared with hepatic artery chemotherapy alone. Microwave ablation was associated with an incremental cost-effectiveness ratio (ICER) of £3664 per quality-adjusted life-year (QALY) gained, with microwave ablation being associated with reduced cost but also with poorer outcome than surgery. Radiofrequency ablation compared with surgical resection for solitary metastases < 3 cm was associated with an ICER of –£266,767 per QALY gained, indicating that radiofrequency ablation dominates surgical resection. Radiofrequency ablation compared with surgical resection for solitary metastases ? 3 cm resulted in poorer outcomes at lower costs and a resultant ICER of £2538 per QALY gained. Radioembolisation plus hepatic artery chemotherapy compared with hepatic artery chemotherapy was associated with an ICER of £37,303 per QALY gained.Conclusions: There is currently limited high-quality research evidence upon which to base any firm decisions regarding ablative therapies for liver metastases. Further trials should compare ablative therapies with surgery, in particular. A RCT would provide the most appropriate design for undertaking any further evaluation and should include a full economic evaluation, but the group to be randomised needs careful selection.Source of funding: Funding for this study was provided by the Health Technology Assessment programme of the National Institute for Health Research

Transfer of Escherichia coli to water from drained and undrained grassland after grazing.

The aim of this study was to determine the load of Escherichia coli transferred via drainage waters from drained and undrained pasture following a grazing period. Higher concentrations (ranging between 104 and 103 CFU g-1) of E. coli persisted in soil for up to 60 days beyond the point where cattle were removed from the plots, but these eventually declined in the early months of spring to concentrations less than 102 CFU g-1. The decline reflects the combined effect of cell depletion from the soil store through both wash-out and die-off of E. coli. No difference (P 0.05) was observed in E. coli loads exported from drained and undrained plots. Similarly, no difference (P 0.05) was observed in E. coli concentrations in drainage waters of mole drain flow and overland plus subsurface interflow. Intermittent periods of elevated discharge associated with storm events mobilised E. coli at higher concentrations (e.g. in excess of 400 CFU ml-1) than observed during low flow conditions (often <25 CFU ml-1). The combination of high discharge and cell concentrations resulted in the export of E. coli loads from drained and undrained plots exceeding 106 CFU L-1 s-1. The results highlight the potential for drained land to export E. coli loads comparable to those transferred from undrained pasture

Exploring the role of need for cognition, field independence and locus of control on the incidence of lucid dreams during a 12 week induction study

This article reports an investigation of two proposed theories, the predispositional and experiential, regarding the association of personality variables to lucid dreaming incidence during a 12-week lucid dreaming induction programme. The study found no differences between those who did and did not report lucid dreams during the programme on baseline measures of Field Independence, Locus of Control or Need for Cognition. There was an observed significant change towards a Field Independent orientation between baseline and post tests for those successful at inducing a lucid dream; with no statistically significant differences for either Locus of Control or Need for Cognition. Results suggest that Field Independence may not be a predispositional characteristic for the successful induction of lucid dreaming, but an experiential result of having lucid dream experiences. We conclude that experiences within a dream state may have appreciable effects on waking cognition

Using coupled micropillar compression and micro-Laue diffraction to investigate deformation mechanisms in a complex metallic alloy Al13Co4

In this investigation, we have used in-situ micro-Laue diffraction combined with micropillar compression of focused ion beam milled Al13Co4 complex metallic alloy to study the evolution of deformation in Al13Co4. Streaking of the Laue spots showed that the onset of plastic flow occured at stresses as low as 0.8 GPa, although macroscopic yield only becomes apparent at 2 GPa. The measured misorientations, obtained from peak splitting, enabled the geometrically necessary dislocation density to be estimated as 1.1 x 1013 m-2

Revitalising Collyweston limestone slate production by artificial freeze/thaw splitting

Extraction of limestone roofing slate from Collyweston was an industry which was considered extinct by the early 1990′s, with building repairs relying on wholesale recycling of roofing from demolished buildings. Traditionally stone extracted from the mines was exposed to natural cycles of freeze/thaw to facilitate splitting. Work was undertaken over several years to investigate the resources available and whether these could be artificially frozen to produce slates. The work identified a freeze/thaw regime which could be used to produce roofing slates for historic buildings and which were used in the Historic England restoration of Apethorpe Palace. Mining of the Collyweston limestone stone has now resumed and uses artificial freezing to achieve production of slates which is economically feasible due to the faster process time

Lucid dreaming incidence: a quality effects meta-analysis of 50 years of research

We report a quality effects meta-analysis on studies from the period 1966–2016 measuring either (a) lucid dreaming prevalence (one or more lucid dreams in a lifetime); (b) frequent lucid dreaming (one or more lucid dreams in a month) or both. A quality effects meta-analysis allows for the minimisation of the influence of study methodological quality on overall model estimates. Following sensitivity analysis, a heterogeneous lucid dreaming prevalence data set of 34 studies yielded a mean estimate of 55%, 95% C. I. [49%, 62%] for which moderator analysis showed no systematic bias for suspected sources of variability. A heterogeneous lucid dreaming frequency data set of 25 studies yielded a mean estimate of 23%, 95% C. I. [20%, 25%], moderator analysis revealed no suspected sources of variability. These findings are consistent with earlier estimates of lucid dreaming prevalence and frequent lucid dreaming in the population but are based on more robust evidence

The challenge of ageing populations and patient frailty: can primary care adapt?

Health care systems worldwide are having to adapt to ageing populations and increasing numbers of older people with frailty with complex health and social needs, and in the UK primary care is at the frontline of policy attempts to meet this challenge, but achieving the goal of making frailty an integral part of primary care practice is not without considerable challenge