Priority water research questions as determined by UK practitioners and policy makers

Several recent studies have emphasised the need for a more integrated process in which researchers, policy makers and practitioners interact to identify research priorities. This paper discusses such a process with respect to the UK water sector, detailing how questions were developed through inter-disciplinary collaboration using online questionnaires and a stakeholder workshop. The paper details the 94 key questions arising, and provides commentary on their scale and scope. Prioritization voting divided the nine research themes into three categories: (1) extreme events (primarily flooding), valuing freshwater services, and water supply, treatment and distribution [each >150/1109 votes]; (2) freshwater pollution and integrated catchment management [100-150 votes] and; (3) freshwater biodiversity, water industry governance, understanding and managing demand and communicating water research [50-100 votes]. The biggest demand was for research to improve understanding of intervention impacts in the water environment, while a need for improved understanding of basic processes was also clearly expressed, particularly with respect to impacts of pollution and aquatic ecosystems. Questions that addressed aspects of appraisal, particularly incorporation of ecological service values into decision making, were also strongly represented. The findings revealed that sustainability has entered the lexicon of the UK water sector, but much remains to be done to embed the concept operationally, with key sustainability issues such as resilience and interaction with related key sectors, such as energy and agriculture, relatively poorly addressed. However, the exercise also revealed that a necessary condition for sustainable development, effective communication between scientists, practitioners and policy makers, already appears to be relatively well established in the UK water sector.

School nursing: costs and potential benefits

BACKGROUND

Previous reports that variations in school nursing resources across the UK had no relationship to deprivation; controversy about the changing role of the school nursing service.

OBJECTIVES

To measure the resources allocated to school nursing, determine whether the variations can be explained by deprivation, and assess whether the allocation of school nursing time to a range of tasks is in line with current evidence and perceptions of changing needs.

STUDY DESIGN

Quantitative economic analysis; qualitative descriptive study.

SETTING

Detailed study of four English districts with diverse characteristics; staffing and service questionnaire and telephone survey of 62 districts.

MAIN MEASURES

Staff resources and their salaries; measures of population and deprivation; activity statistics.

RESULTS

There were wide variations in the cost of the school nursing service, but in contrast to previous reports 24% of the variance was explained by deprivation. There were no clear associations with any other social or educational variables. The greatest allocation of time was in routine screening and surveillance tasks. Relatively little time was allocated to other activities such as health promotion, support of special needs or unwell children, or teenage clinics. The expenditure on school nursing is only loosely related to deprivation and the results of this study offer guidance on what districts should spend to achieve equity of provision.

CONCLUSIONS

The current allocation of resources to school nursing in between districts comparisons is not equitable and the use of school nursing time is out of step with current evidence of need and effectiveness.

Creating a successful relationship with customers

In 1997, several employers commissioned an inpatient survey for a group of businesses that included hospitals in southeast Michigan. Its results indicated that the University of Michigan Health System (UMHS) needed to become more customer-focused. To meet this challenge, UMHS mandated that customer service to its patients and their families should be its first priority. A pilot project in the radiology department's pediatric division was established to recognize and reward employees for outstanding service to customers. The program is now used to reward employees throughout the radiology department, on the assumption that when employees feel special, so will their customers. Management's focus is on employees--they are the health system. The department also invested in employee development, a continuous training program that centers on customer service and teaches tools and skills for better communication. The goal of the development program at UMHS is to exceed the needs of its customers.

Socialization forces and the stability of work values from late adolescence to early adulthood

The present report is of findings from a longitudinal study of work values. The findings relate to four important areas, (a) the significance of parental socialization in the formation of intrinsic and extrinsic work values, (b) the effect of early employment on intrinsic and extrinsic work values, respectively, (c) the differential effects of these social experiences across ethnic and gender groups, (d) and the stability of intrinsic and extrinsic work values from late adolescence to the early years of adulthood. In a sample of 3290 African American and Caucasian students, young people consistently placed greater emphasis on intrinsic than on extrinsic work values. There was a decline in extrinsic work values between adolescence and the early years of adulthood. When parents held high aspirations, their children placed greater emphasis on work orientations. Race had a more significant influence on work values than either socioeconomic status or employment experience.

Triple-head SPECT with 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG): initial evaluation in oncology and comparison with FDG PET

PURPOSE

In patients with cancer, performance was assessed of a commercially available triple-head gamma camera fitted with ultra-high energy parallel-hole collimators performing single photon emission computed tomography (SPECT) with 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG). Results were compared with those of positron emission tomography (PET) with FDG.

MATERIALS AND METHODS

Performance characteristics were first determined in phantom studies for FDG PET and triple-head gamma camera SPECT systems. In 13 patients with malignancies, FDG PET was followed by SPECT of the same region, and imaging results were independently assessed.

RESULTS

Sensitivity of the PET and SPECT systems was 58.3 counts/MBq/min and 4.5 counts/MBq/min, respectively. Reconstructed spatial resolution was approximately 7 mm for PET and 20 mm for SPECT. All known cancer foci were detected at PET. SPECT depicted 11 of the 22 lesions detected at PET, but only five of the 14 lesions less than 3 cm in diameter.

CONCLUSION

FDG SPECT performed with a specially collimated triple-head gamma camera depicted some cancers but had an unacceptably low sensitivity compared with PET for lesions less than 3 cm in diameter. PET is preferable for detecting small cancers.

Note on assessing a mentor program

To clarify the literature on mentor programs, self-esteem and grade point average after such a program were assessed for 30 boys and 46 girls in Grade 11 from 2 high schools. Mixed findings were discussed in terms of possible influences.