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The aim of this study was to devise a simple proforma for reporting staging CT scans of the thorax, to ensure that all essential information is included on the report, in a logical manner, and that a TNM classification and tumour stage is given. Once the design of the proforma had been agreed, its utilisation and effectiveness was audited. In an initial six month period, every proforma filled in had resulted in a TNM classification being given, although in only 20 out of 40 (50 per cent) had a tumour stage been given. In a subsequent six month period, 39 out of 44 patients (89 per cent) with lung cancer undergoing a staging CT scan had proformas completed, and a TNM classification and tumour stage given (95 per cent CI is (0.75, 0.96)). Therefore, a proforma can be a useful aid to reporting staging scans, and is an effective method of ensuring that tumours are staged as fully as possible, radiologically. In addition, relevant information is presented in a clear format that allows accurate collection of data for audit purposes.

Policymakers push online health services delivery, relying on consumers to independently engage with online services. Yet, a growing cluster of vulnerable patients do not engage with or disengage from these innovative services. There is a need to understand how to resolve the tension between the push of online health service provision and unengagement by a contingent of health-care consumers. Thus, this study aims to explore the issue of digital unengagement (DU) (i.e. the active or passive choice to engage or disengage) with online health services to better inform service design aligned to actual consumer need.

Adopting a survey methodology, a group of 486 health services consumers with a self-declared (acute or chronic) condition were identified. Of this group, 110 consumers were classified as digitally unengaged and invited to write open-ended narratives about their unengagement with online health services. As a robustness check, these drivers were contrasted with the drivers identified by a group of digitally engaged consumers with a self-declared condition (n = 376).

DU is conceptualized, and four levels of DU drivers are identified. These levels represent families of interrelated drivers that in combination shape DU: subjective incompatibility (misalignment of online services with need, lifestyle and alternative services); enactment vulnerability (personal vulnerabilities around control, comprehension and emotional management of online services); sharing essentiality (centrality of face-to-face co-creation opportunities plus conflicting social dependencies); and strategic scepticism (scepticism of the strategic value of online services). Identified challenges at each level are the mechanisms through which drivers impact on DU. These DU drivers are distinct from those of the digitally engaged group.

Adding to a nascent but growing literature on consumer unengagement, and complementing the engagement literature, the authors conceptualize DU, positioning it as distinct from, not simply a lack of, consumer engagement. The authors explore the drivers of DU to provide insight into how DU occurs. Encapsulating the dynamic nature of DU, these drivers map the building blocks that could help to address the issue of aligning the push of online service provision with the pull from consumers.

This paper offers insights on how to encourage consumers to engage with online health services by uncovering the drivers of DU that, typically, are hidden from service designers and providers impacting provision and uptake.

There is a concern that there will be an unintentional disenfranchisement of vulnerable segments of society with a generic policy emphasis on pushing online services. The paper sheds light on the unforeseen personal and social issues that lead to disenfranchisement by giving voice to digitally unengaged consumers with online health services.

Offering a novel view from a hard-to-reach digitally unengaged group, the conceptualization of DU, identified drivers and challenges inform policymakers and practitioners on how to facilitate online health service (re)engagement and prevent marginalization of segments of society.

Three years ago I became part of the guideline development group for the new national guide for prescribing medication for problem behaviours in people with learning disabilities (Deb et al, 2006). I was asked to join this group as a parent, and also in my role of family services manager with a regional autism charity. The following personal account was presented in the series of conferences that were held in the UK in 2006 to launch the national guide.

The purpose of this paper is to focus on the changing nature of healthcare service encounters by studying the phenomenon of triadic engagement incorporating interactions between patients, local and virtual networks and healthcare professionals.

An 18-month longitudinal ethnographic study documents interactions in naturally occurring healthcare consultations. Professionals (n=13) and patients (n=24) within primary and secondary care units were recruited. Analysis of observations, field notes and interviews provides an integrated picture of triadic engagement.

Triadic engagement is conceptualised against a two-level framework. First, the structure of triadic consultations is identified in terms of the human voice, virtual voice and networked voice. These are related to: companions’ contributions to discussions and the virtual network impact. Second, evolving roles are mapped to three phases of transformation: enhancement; empowerment; emancipation. Triadic engagement varied across conditions.

These changing roles and structures evidence an increasing emphasis on the responsible consumer and patients/companions to utilise information/support in making health-related decisions. The nature and role of third voices requires clear delineation.

Structures of consultations should be rethought around the diversity of patient/companion behaviours and expectations as patients undertake self-service activities. Implications for policy and practice are: the parallel set of local/virtual informational and service activities; a network orientation to healthcare; tailoring of support resources/guides for professionals and third parties to inform support practices.

Contributions are made to understanding triadic engagement and forwarding the agenda on patient-centred care. Longitudinal illumination of consultations is offered through an exceptional level of access to observe consultations.

Detective work is a mainstay of modern law enforcement, but its effectiveness has been much less evaluated than patrol work. To explore what is known about effective investigative practices and to identify evidence gaps, the authors assess the current state of empirical research on investigations.

The authors assess the empirical research about the effectiveness of criminal investigations and detective work in resolving cases and improving clearance rates.

The authors’ analysis of the literature produced 80 studies that focus on seven categories of investigations research, which include the impact that case and situational factors, demographic and neighborhood dynamics, organizational policies and practices, investigative effort, technology, patrol officers and community members have on case resolution. The authors’ assessment shows that evaluation research examining the effectiveness of various investigative activities is rare. However, the broader empirical literature indicates that a combination of organizational policies, investigative effort and certain technologies can be promising in improving investigative outcomes even in cases deemed less solvable.

From an evidence-based perspective, this review emphasizes the need for greater transparency, evaluation and accountability of investigative activities given the resources and importance afforded to criminal investigations.

This review is currently the most up-to-date review of the state of the research on what is known about effective investigative practices.

Criticisms of the Library Association have no value which do not take account of all the circumstances. We are told that for some years past nothing constructive for librarianship or for its technique has been done. Our correspondent Callimachus makes this assertion by implication on another page. It must be remembered, however, that until quite recently the Library Association was a very small body which exercised an influence out of all proportion to its size and income. It has grown by direct membership and by affiliation in an extraordinary manner in the past year, a result which is due to goodwill on the part of librarians, but more immediately to the wise direction of Messrs. Jast and Savage and the untiring patience and tacful activity of Mr. Guy Keeling. Our readers know that Mr. Keeling has actually had to rest owing to the effects of overwork. This being so, it is quite clear that the demand for more must be tempered by a willingness to work on the part of the critics. The Association is only an embodiment of the membership; what the members want of the Association they must give to it.

16th APRIL 1958 is one of the most important dates in the history of hovercraft for it was on that day that Sir Christopher Cockerell (he was knighted in 1969) first visited the offices of the National Research Development Corporation, then located in Tilney Street, London. During this visit he gave a presentation of his hovercraft invention and showed a film of a model hovercraft engaged in ‘round the pole’ tests to his audience of two key NRDC executives: Lord Halsbury, NRDC's Managing Director, and Mr R. A. E. Walker, its Secretary. Both were impressed with the thoroughness of Cockerell's brief on his invention. The next day, when the inventor had returned to his Suffolk home, he received a telephone call from Mr Walker telling him that Lord Halsbury's on‐the‐spot decision to finance foreign patent applicatiois on the hovercraft invention had been endorsed. NRDC's links with the hovercraft had been forged. The foresight of that decision is impressive, particularly now, some twenty years later, when the hovercraft invention has developed into a wide range of applications well beyond the scope of hovercraft ferries. Indeed, few people — even the inventor himself — could have imagined that so many products might result from those early experiments using a pair of empty food tins, an industrial blower and a pair of iron kitchen scales!

THE outline programme of the Library Association Conference at Cambridge has now been circulated. It is eloquent of the change that has come over the Library Association in recent years. Twenty years ago technical papers on cataloguing, binding, classification, class lists and similar matters were frequent. In this Cambridge programme questions of policy and organisation on the larger scale appear to be dominant. County libraries continue to occupy a large share of the programme. It must not be supposed, however, that the programme is not very varied, because that is its main characteristic. Literature, library architecture, publishing and bookselling from the points of view of the author, publisher, bookseller and librarian, university libraries, modern branch libraries, the place of reading in national life, and other subjects, combine very nicely with a civic reception, a garden party in a college garden, the annual dinner, and visits, at choice, to Peterborough, Bedford and Ely.

As a result of increasingly pervasive public social media use over the past decade, brands and marketers have begun to use internet memes as digital advertising vehicles, with some using specialized professionals to create memetic ad content. Despite this, little scholarly research on the phenomenon has appeared. This study aims to provide exploratory evidence for how older members of Generation Z (Gen-Z), a digitally native cohort, perceive and regard brands’ use of internet memes as advertisements.

A series of six focus groups conducted with older Gen-Z undergraduates at a large Western US university yields consonant and dissonant beliefs and perspectives about this emergent and conceivably powerful advertising and marketing practice.

Participants express that memetic advertising has potential for nonserious, lighthearted brands with a consistent social media presence but less potential for serious brands or brands that try to appropriate meme culture for financial gain. The importance of humor, cultural narratives and social connections as they relate to internet meme culture is inherent in these discussions.

This study joins a small body of work examining the effectiveness, viability and limitations of memetic advertising as an online advertising venture. Implications and prescriptive advice are offered.

The purpose is to assess the impact of clinical costing approaches on the quality of cost information in seven countries (Denmark, England, France, Germany, Ireland, the Netherlands and Portugal).

Costing practices in seven countries were analysed via questionnaires, interviews and relevant published material.

Although clinical costing is intended to support a similar range of purposes, countries display considerable diversity in their approaches to costing in terms of the level of detail contained in regulatory guidance and the percentage of providers subject to such guidance for tariff setting. Guidance in all countries involves a mix of costing methods.

The authors propose a two-dimensional Materiality and Quality Score (2D MAQS) of costing systems that can support the complex trade-offs in managing the quality of cost information at both policy and provider level, and between financial and clinical concerns.

The authors explore the trade-offs between different dimensions of the quality (accuracy, decision relevance and standardization) and the cost of collecting and analysing cost information for disparate purposes.