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BackgroundAmbulance services use multidisciplinary cross-service case management in some areas to help meet the needs of people who call 999 frequently. The STRETCHED evaluation of case management for this group in four UK ambulance service areas included a qualitative component to explore experience of care, to identify challenges and opportunities associated with using case management models, and develop theories about how case management works in this population.MethodsWe conducted semi-structured interviews with key stakeholders involved in case management, and people with experience of calling 999 frequently. All interviews were recorded and transcribed. Analysis took a data driven thematic approach, and was conducted by a sub-group including public contributors working alongside researchers. We analysed by respondent group and by site, before combining and exploring themes across the participant groups.ResultsWe interviewed 31 stakeholders and 16 people with experience of calling 999 frequently, of which 8 had received case management in one of the study sites. We developed the following themes:The work of case management - within and across organisations, administrative and support tasks, resourcing and skill mix, variation between service areasComplexity of needs – range of drivers for frequent calling, complex medical and social needs, long term nature of issues for many, tensions between cure (short term) and care (long term) models of serviceLimited availability of support services – as a driver to frequent calling, and as a limitation on case managementTolerance of risk and ownership of responsibility – response to needs shaped by local organisational culture and practice. We used insights from the analysis to refine our logic model describing how case management works.ConclusionInsight from the qualitative data collection supports interpretation of the STRETCHED quantitative findings and provides insight into how case management might be effective for people who frequently call 999.

This study investigated the effects of a HIV/AIDS module on teachers' sense of self-efficacy regarding their ability to bring about behaviours in their learners which contribute to responsible living and a reduction of the spread of HIV in their communities. The sample was 128 in-service teachers studying in nine different centres in three South African provinces in their second year of a parttime degree in education. A modified Science Teaching Efficacy Belief Instrument (STEBI) was used to generate quantitative data, while semi-structured individual and focus group interviews provided qualitative data. Statistical analyses (ANOVA and MANOVA) revealed statistically significant differences between the participants pre- and post-test self-efficacy scores. Interview data suggested that improved confidence enabled the teachers to gain a better understanding of cultural barriers to HIV/AIDS education and the impediments to developing an effective HIV/AIDS policy in their schools. The study also highlighted the importance of leadership from school management for the successful adoption and implementation of an effective HIV/AIDS policy in schools. Enhanced confidence is noted as a motivating factor for teacher participation in community efforts to support those affected by HIV/AIDS.

Communication in the battleground is very critical for the military. With U.S forces engaged in combat operations around the world in the war on terror, the need for effective and efficient communication systems has become more and more important. There are, in general, two types of communication: air conduction and bone conduction. Although air conduction is more commonly used in industry, bone conducted radio communication offers an attractive means for infantry to communicate in the battlefield because it allows radio communication to be transmitted and received without compromising the soldier's awareness of his or her surroundings. Bone conduction interfaces are also lightweight and less bulky and are therefore easy to integrate into military headgear. Based on the findings of previous study, condyle was chosen as the location for the bone vibrator placement. This research compares performance between bone conduction and air conduction using the military's Callsign Acquisition Test (CAT). Results from this study will help better design bone conduction devices for the military in the future.

The cyclogallane dipotassium tris((2,6-dimesitylphenyl)cyclogallene), K2[(Mes2C6H3)Ga]3 (Mes = 2,4,6-Me3C6H2), has been prepared by either of two distinct synthetic routes. Disproportionation of gallium(II) chloride, Ga2Cl4, in the presence of (2,6-dimesitylphenyl)lithium, (Mes2C6H3)Li, followed by potassium metal reduction in Et2O affords the title compound as large ruby red crystals. Alternatively, K2[(Mes2C6H3)Ga]3 may readily be approached by direct alkali metal reduction of (Mes2C6H3)GaCl2. The title compound was characterized by ¹H and ¹³C NMR, elemental analyses, IR spectroscopy, and single-crystal X-ray diffraction. The cyclogallane resides about the planar Ga3 triangle constituted by extremely short Ga−Ga bonds:  2.4260(5), 2.4317(5), and 2.4187(5) Å. Theoretical examination of the Ga3^2- anionic core in [GaH]3^2-, Na2[GaH]3, and K2[GaH]3 suggests a well-defined π-molecular orbital. Both experimental and theoretical results strongly support the cyclogallene dianion, [(Mes2C6H3)Ga]3^2-, as a well-defined metalloaromatic system&sbd;a metallic ring system exhibiting aromatic behavior.

BackgroundEmergency ambulance services are integral to providing a service for those with unplanned urgent and life-threatening health conditions. However, high use of the service by a small minority of patients is a concern.Aims and ObjectivesTo describe: service-wide and local policies or pathways for people classified as Frequent Caller; call volume; and results of any audit or evaluation.MethodsWe conducted a national survey of current practice in ambulance services in relation to the management of people who call the emergency ambulance service frequently using a structured questionnaire, for completion by email and telephone interview. We analysed responses using a descriptive and thematic approach.ResultsTwelve of 13 UK ambulance services responded. Most services used nationally agreed definitions for ‘Frequent Caller’, with 600 – 900 people meeting this classification each month. Service-wide policies were in place, with local variations. Models of care varied from within-service care where calls are flagged in the call centre, contact made with callers and their GP with an aim of discouraging further calls; to case management through cross-service, multi-disciplinary team meetings aiming to resolve callers’ needs. No formal audits or evaluations were reported.ConclusionsAmbulance services are under pressure to meet challenging response times for high acuity patients. Tensions are apparent in the provision of care to patients who have complex needs and call frequently. Within service care focused mainly on reducing calls whilst multi-disciplinary case management aimed to resolve clinical and emotional needs of patients. However, there is currently inadequate evidence to inform commissioning, policy or practice development.

BackgroundMulti-agency case management is being introduced by ambulance services and their partners in the UK to try to identify and address the needs of those who call 999 ambulance services frequently. However, there is a lack of evidence about what works well in this setting and how. Based on current nationally agreed definitions, calling frequently is defined as 5 or more times in a month, or 12 or more times in a three-month period. The STRETCHED study (STRategies to manage Emergency ambulance Telephone Callers with sustained High needs – an Evaluation using linked Data) study seeks to evaluate clinical and cost-effectiveness, safety, and efficiency of case management for people who frequently call the emergency ambulance service.We developed a logic model to describe key components, mechanisms of change and expected impacts of cross-sectoral case management approaches to the management of people who call 999 frequently.MethodWe conducted a stakeholder event with 37 people from Wales, England and Northern Ireland including patient representatives and professional staff involved in commissioning, planning and delivering case management for people who call 999 services frequently. The aggregated responses from the participants was used as the basis for developing a logic model.ResultsComponents:dedicated staff time for case management, availability and knowledge of relevant services for referral, multidisciplinary collaboration, organisational support, and clear information sharing protocolsMechanisms:provision of space for a clear understanding of reasons for calling, tailoring of multi–sectoral management to individual needs, offering therapeutic support and assistance in development of self–efficacyImpacts:improvement in access to appropriate and timely care, increase in efficiency and accessibility of the healthcare system, reduction in emergency calls, costs and mortalityConclusionCase management is a developing area of provision in prehospital emergency care for people who call ambulance services frequently. Our logic model provides a firm foundation for evaluation to build the urgently needed evidence base for case management of people who call ambulance services frequently.

BackgroundAmbulance services across the UK have recognised a clinical and operational problem with persistent high users of the 999 service, but there is a lack of evidence about what works in this setting and how. We aim to evaluate the effectiveness, safety and efficiency of multi-agency case management approaches to the care of people who frequently call the emergency ambulance service, and gain understanding of barriers and facilitators to implementation.MethodsWe will carry out a mixed methods evaluation using anonymised linked routine data outcomes in a ‘natural experiment’ cohort design in four UK ambulance services, with one case management intervention site and one control site within each service. We will describe the epidemiology of ‘frequent calling’; assess the effects of case management on process, outcomes, safety and costs up to six months for 300 high users per service (n-1200); and examine the views of stakeholders, including patients, through qualitative methods. We will synthesise quantitative and qualitative findings, informed by a logic model describing predicted mechanisms of change.ResultsWe received confirmation of NIHR grant funding for this study in 2018 so do not yet have results to report.ConclusionsTelephone callers with sustained high needs represent a significant, high profile policy challenge to emergency ambulance services. Such callers may be indicative of gaps elsewhere in the health care system, which could be more effectively addressed by pro-active care. The STRETCHED study provides the opportunity to contribute to the currently sparse evidence base on interventions for this patient group.

Focuses on the plight of dogs in Sarajevo, Bosnia & Hercegovina. Prevalence of inhumane techniques in exterminating stray dogs in the city; Estimates of the number of dogs stranded in the city; Assistance and aid from foreign veterinarians and humane societies. INSET: How to be a dog's best friend..