Can programme theory be used as a 'translational tool’ to optimise health service delivery in a national early years’ initiative in Scotland: a case study

Background Theory-based evaluation (TBE) approaches are heralded as supporting formative evaluation by facilitating increased use of evaluative findings to guide programme improvement. It is essential that learning from programme implementation is better used to improve delivery and to inform other initiatives, if interventions are to be as effective as they have the potential to be. Nonetheless, few studies describe formative feedback methods, or report direct instrumental use of findings resulting from TBE. This paper uses the case of Scotland’s, National Health Service, early years’, oral health improvement initiative (Childsmile) to describe the use of TBE as a framework for providing feedback on delivery to programme staff and to assess its impact on programmatic action.<p></p> Methods In-depth, semi-structured interviews and focus groups with key stakeholders explored perceived deviations between the Childsmile programme 'as delivered’ and its Programme Theory (PT). The data was thematically analysed using constant comparative methods. Findings were shared with key programme stakeholders and discussions around likely impact and necessary actions were facilitated by the authors. Documentary review and ongoing observations of programme meetings were undertaken to assess the extent to which learning was acted upon.<p></p> Results On the whole, the activities documented in Childsmile’s PT were implemented as intended. This paper purposefully focuses on those activities where variation in delivery was evident. Differences resulted from the stage of roll-out reached and the flexibility given to individual NHS boards to tailor local implementation. Some adaptations were thought to have diverged from the central features of Childsmile’s PT, to the extent that there was a risk to achieving outcomes. The methods employed prompted national service improvement action, and proposals for local action by individual NHS boards to address this.<p></p> Conclusions The TBE approach provided a platform, to direct attention to areas of risk within a national health initiative, and to agree which intervention components were 'core’ to its hypothesised success. The study demonstrates that PT can be used as a 'translational tool’ to facilitate instrumental use of evaluative findings to optimise implementation within a complex health improvement programme.<p></p&gt

Building realist programme theory for large complex and messy interventions

Programme theory, that is, the specific idea about how a programme causes the intended or observed outcomes, should be the central aspect of any realist evaluation or synthesis. The methods used for explicating or building initial rough programme theories in realist research are varied and arguably often underreported. In addition, pre-existing psychological and sociological theories, at a higher level of abstraction, could be used to a greater extent to inform their development. This article illustrates a method for building initial rough programme theories for use in realist research evaluation and synthesis. This illustration involves showing how the initial rough programme theories were developed in a realist evaluation concerning sexual health services for young people. In this evaluation, a broad framework of abstract theories was constructed early in the process to support initial rough programme theory building and frame more specific programme theories as they were developed. These abstract theories were selected to support theorising at macro, meso and micro levels of social structure. The paper discusses the benefits of using this method to build initial theories for particular types of interventions which are large, complex and messy. It also addresses challenges relating to the selection of suitable theories

A HER2 selective theranostic agent for surgical resection guidance and photodynamic therapy

In many cancers early intervention involves surgical resection of small localised tumour masses. Inadequate resection leads to recurrence whereas overzealous treatment can lead to organ damage. This work describes production of a HER2 targeting antibody Fab fragment dual conjugated to achieve both real time near-infrared fluorescent imaging and photodynamic therapy. The use of fluorescence emission from a NIR-dye could be used to guide resection of tumour bulk, for example during endoscopic diagnosis for oesophago-gastric adenocarcinoma, this would then be followed by activation of the photodynamic therapeutic agent to destroy untreated localised areas of cancer infiltration and tumour infiltrated lymph nodes. This theranostic agent was prepared from the Fab fragment of trastuzumab initially by functional disulfide re-bridging and site-specific click reaction of a NIR-dye. This was followed by further reaction with a novel pre-activated form of the photosensitiser chlorin e6 with the exposed fragments' lysine residues. Specific binding of the theranostic agent was observed in vitro with a HER2 positive cell line and cellular near-infrared fluorescence was observed with flow cytometry. Specific photo-activity of the conjugates when exposed to laser light was observed with HER2 positive but not HER2 negative cell lines in vitro, this selectivity was not seen with the unconjugated drug. This theranostic agent demonstrates that two different photo-active functions can be coupled to the same antibody fragment with little interference to their independent activities

Understanding the theoretical underpinning of the exercise component in a fall prevention programme for older adults with mild dementia: a realist review protocol

Background Older adults with mild dementia are at an increased risk of falls. Preventing those at risk from falling requires complex interventions involving patient-tailored strength- and balance-challenging exercises, home hazard assessment, visual impairment correction, medical assessment and multifactorial combinations. Evidence for these interventions in older adults with mild cognitive problems is sparse and not as conclusive as the evidence for the general community-dwelling older population. The objectives of this realist review are (i) to identify the underlying programme theory of strength and balance exercise interventions targeted at those individuals that have been identified as falling and who have a mild dementia and (ii) to explore how and why that intervention reduces falls in that population, particularly in the context of a community setting. This protocol will explain the rationale for using a realist review approach and outline the method. Methods A realist review is a methodology that extends the scope of a traditional narrative or systematic evidence review. Increasingly used in the evaluation of complex interventions, a realist enquiry can look at the wider context of the intervention, seeking more to explain than judge if the intervention is effective by investigating why, what the underlying mechanism is and the necessary conditions for success. In this review, key rough programme theories were articulated and defined through discussion with a stakeholder group. The six rough programme theories outlined within this protocol will be tested against the literature found using the described comprehensive search strategy. The process of data extraction, appraisal and synthesis is outlined and will lead to the production of an explanatory programme theory. Discussion As far as the authors are aware, this is the first realist literature review within fall prevention research and adds to the growing use of this methodology within healthcare. This synthesis of evidence will provide a valuable addition to the evidence base surrounding the exercise component of a fall intervention programme for older adults with mild dementia and will ultimately provide clinically relevant recommendations for improving the care of people with dementia

Intergenerational equity in municipal accounting: New Zealand 1910s

Accounting for fixed assets by municipalities has been discussed in the accounting history literature previously. This paper addresses two issues related to accounting for fixed assets not previously discussed; the influence of the principle of intergenerational equity on local government accounting, and the influence of users of accounting information in accounting policy making in government accounting. The paper identifies that users of accounting information have had significant influence in a debate on government accounting policy, and that the principle of intergenerational equity was given a position of high importance in the debate, but not an unchallengeable position. The motivation of the users of accounting information to engage in the debates is identified as a form of civic duty, which is consistent with the ethical imperative in ensuring intergenerational equity

Use of bioengineered human commensal gut bacteria-derived microvesicles for mucosal plague vaccine delivery and immunization

Plague caused by the Gram-negative bacterium, Yersinia pestis, is still endemic in parts of the world today. Protection against pneumonic plague is essential to prevent the development and spread of epidemics. Despite this, there are currently no licensed plague vaccines in the western world. Here we describe the means of delivering biologically active plague vaccine antigens directly to mucosal sites of plague infection using highly stable microvesicles (outer membrane vesicles; OMVs) that are naturally produced by the abundant and harmless human commensal gut bacterium Bacteroides thetaiotaomicron (Bt). Bt was engineered to express major plague protective antigens in its OMVs, specifically Fraction 1 (F1) in the outer membrane and LcrV (V antigen) in the lumen, for targeted delivery to the gastrointestinal (GI) and respiratory tracts in a non-human primate (NHP) host. Our key findings were that Bt OMVs stably expresses F1 and V plague antigens, particularly the V antigen, in the correct, immunogenic form. When delivered intranasally V-OMVs elicited substantive and specific immune and antibody responses, both in the serum [immunoglobulin (Ig)G] and in the upper and lower respiratory tract (IgA); this included the generation of serum antibodies able to kill plague bacteria. Our results also showed that Bt OMV-based vaccines had many desirable characteristics, including: biosafety and an absence of any adverse effects, pathology or gross alteration of resident microbial communities (microbiotas); high stability and thermo-tolerance; needle-free delivery; intrinsic adjuvanticity; the ability to stimulate both humoral and cell-mediated immune responses; and targeting of primary sites of plague infection

Complex, but not quite complex enough : The turn to the complexity sciences in evaluation scholarship

This document is the Accepted Manuscript version of the following article: Chris Mowles, ‘Complex, but not quite complex enough: The turn to the complexity sciences in evaluation scholarship’. The final, definitive version of this paper has been published in Evaluation, Vol. 20 (2): 160-175, April 2014, doi: https://doi.org/10.1177/1356389014527885 , published by SAGE Publishing. All rights reserved.This article offers a critical review of the way in which some scholars have taken up the complexity sciences in evaluation scholarship. I argue that there is a tendency either to over-claim or under-claim their importance because scholars are not always careful about which of the manifestations of the complexity sciences they are appealing to, nor do they demonstrate how they understand them in social terms. The effect is to render ‘complexity’ just another volitional tool in the evaluator’s toolbox subsumed under the dominant understanding of evaluation, as a logical, rational activity based on systems thinking and design. As an alternative I argue for a radical interpretation of the complexity sciences, which understands human interaction as always complex and emergent. The interweaving of intentions in human activity will always bring about outcomes that no one has intended including in the activity of evaluation itself.Peer reviewe

A discussion paper on stigmatizing features of diabetes

AimThis manuscript aims to describe stigmatizing features of diabetes.DesignThis article presents a narrative review of literature pertaining to stigma surrounding diabetes in different contexts.MethodsA literature search was conducted in CINAHL, PubMed and Web of Science for qualitative studies published between 2007–2017. The search was completed using various combinations of diabetes, T1DM, T2DM, stigma, social/public stigma, internalized/self‐stigma, stigmatization and diabetes‐related stigma in English. The reviewers then independently reviewed the eligible studies (N = 18) to extract data.ResultsFrom the 18 studies included in this narrative review, seven features related to stigma in diabetes were identified. People with diabetes were most notably considered and stigmatized as being “sick,” “death reminder,” “rejected marriage candidate,” “self‐inflicting,” “contagiousness,” “requiring a dietary modification” and “drunk or drug abuser.”Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142964/1/nop2112.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142964/2/nop2112_am.pd

A Discussion Paper on Stigmatizing Features of Diabetes

Aim This manuscript aims to describe stigmatizing features of diabetes. Design This article presents a narrative review of literature pertaining to stigma surrounding diabetes in different contexts. Methods A literature search was conducted in CINAHL, PubMed and Web of Science for qualitative studies published between 2007–2017. The search was completed using various combinations of diabetes, T1DM, T2DM, stigma, social/public stigma, internalized/self‐stigma, stigmatization and diabetes‐related stigma in English. The reviewers then independently reviewed the eligible studies (N = 18) to extract data. Results From the 18 studies included in this narrative review, seven features related to stigma in diabetes were identified. People with diabetes were most notably considered and stigmatized as being “sick,” “death reminder,” “rejected marriage candidate,” “self‐inflicting,” “contagiousness,” “requiring a dietary modification” and “drunk or drug abuser.

On the calculation of surface areas of objects reconstructed from serial sections

Abstract This paper concerns certain aspects of the calculation of the surface area of objects reconstructed from serial sections. The main points discussed are (1) the relative importance of the number of sections compared to the number of segments taken around the contour in each section; and (2) the fact that the error in the estimated surface area may actually become worse as the number of sections increases. The number of sections should be made large enough to reproduce the three-dimensional shape of the object, but not too much larger; the number of segments around the contours should then be made large enough that the segment size is similar to or smaller than the section thickness