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The purpose of this paper is to summarise practice-based evidence from an analysis of outcomes from a county-wide pilot study of a specialised primary care clinic employing an original approach for patients with medically unexplained symptoms (MUS). Conditions with persistent bodily symptoms for which tests and scans come back negative are termed MUS. Patients are generic, high health-utilising and for most there is no effective current treatment pathway. The solution is a proven service based on proof of concept, cost-effectiveness and market research studies together with practice-based evidence from early adopters. The research was transferred from a university into a real-world primary care clinical service which has been delivering in two clinical commissioning groups in a large county in England.

Clinical data calculated as reliable change from the various clinics were aggregated as practice-based evidence pre- and post-intervention via standardised measurements on anxiety, depression, symptom distress, functioning/activity, and wellbeing. It is not a research paper.

At post-course the following percentages of people report reliable improvement when compared to pre-course: reductions in symptom distress 63 per cent (39/62), anxiety 42 per cent (13/31) and depression 35 per cent (11/31); increases in activity levels 58 per cent (18/31) and wellbeing 55 per cent (17/31) and 70 per cent felt that they had enough help to go forward resulting in the self-management of their symptoms which decreases the need to visit the GP or hospital.

Without a full clinical trial the outcomes must be interpreted with caution. There may be a possible Hawthorne or observer effect.

Despite the small numbers who received this intervention, preliminary observations suggest it might offer a feasible alternative for many patients with MUS who reject, or try and find unsatisfying, cognitive behaviour therapy.

Many patients suffering MUS feel isolated and that they are the only one for whom their doctor cannot find an organic cause for their condition. The facilitated group has a beneficial effect on this problem, for example they feel a sense of belonging and sharing of their story.

The BodyMind Approach is an original intervention mirroring the new wave of research in neuroscience and philosophy which prides embodiment perspectives over solely cognitive ones preferred in the “talking” therapies. There is a sea change in thinking about processes and models for supporting people with mental ill-health where the need to include the lived body experience is paramount to transformation.

Over the last few years several projects have been procured under the Private Finance Initiative, which brought with them some challenging, often novel, legal issues. A new statutory framework has been established creating new legal entities and regulating the powers and obligations of those new entities. The public procurement regime of the European Union has had to be carefully considered by both the public and private sector parties as failure by either to adhere to the strict rules and procedures can result in the imposition of sanctions. Attitudes to the way in which contracts are structured have had to change. The public sector had to step back from the more traditional involvement and control it has exercised in the past, and permit the private sector to come up with innovative solutions to the public sector's output requirements. The issues of force majeure and change of law have had to be looked at very closely and mechanisms for the sharing of the risk negotiated between the public and private sectors. A uniform approach to these legal issues would be welcomed along with some standarization of fundamental terms.

In 2000, a national initiative “Enhancing the Healing Environment” (EHE) was launched by the King's Fund to celebrate the millennium. This aimed to support nurse‐led teams to undertake an environment improvement programme in their National Health Service (NHS) hospital. Sheffield Care Trust (SCT) decided to carry out this project in its intensive treatment suite, a psychiatric intensive care unit (PICU) providing care for up to six patients. There were no known examples of an EHE project being undertaken in a PICU elsewhere in the NHS. The purpose of this paper is to examine the impact of EHE design principles in improving the patient experience, from the perspectives of staff and patients.

A focus group and individual interviews were used as the primary method of data collection. Secondary data comprised sets of statistics related to pre‐ and post‐refurbishment periods.

It was found that staff and patients liked many aspects of the changed environment. Staff felt improved openness of space, natural light, fresh air, reduced noise levels and greater choice of spaces to provide care, were most important. Patients cited a high quality, comfortable and homely environment (not like a typical NHS ward) as important; they also valued high standards of cleanliness, tidiness, choice and being able to view the outside, open windows and let in fresh air. Experiencing high quality clinical care was equally important. Incidence of physical assaults decreased markedly in the new environment.

NHS mental health services trusts will understand the benefits of applying EHE principles in PICUs or similar environments. Some project management shortcomings are identified and improvements suggested.

This paper is of value to NHS mental health trusts which need to decide on the effectiveness of different design principles for PICUs or similar environments.

This article examines the educational decision-making of hearing parents for their deaf children born during a period (1970–1990s) before the introduction of new-born hearing screening in New South Wales, where the study was conducted, and prior to the now near-universal adoption of cochlear implants in Australia.

We present findings from an oral history study in which parents were invited to recall how they planned for the education of their deaf children.

We propose that these oral histories shed light on how the concept, early intervention – a child development principle that became axiomatic from about the 1960s – significantly shaped the conduct of parents of deaf children, constituting both hope and burden, and intensifying a focus on early decision-making. They also illustrate ways in which parenting was shaped by two key structural shifts, one, being the increasing enrolment of deaf children in mainstream rather than separate classrooms and the other being the transformation of deafness itself by developments in hearing assistance technology.

The paper contributes to a sociological/historical literature of “parenting for education” that almost entirely lacks deaf perspectives and a specialist literature of parental decision-making for deaf children that is almost entirely focussed on the post cochlear implant generation. The paper is distinctive in its treatment of the concept of “early intervention” as a historical phenomenon rather than a “common sense” truth, and proposes that parents of deaf children were at the leading edge of late-20th and early-21st century parenting intensification.

The motivation for this study comes from decision making related to strategic marketing orientations in international markets. The authors examine if customer orientation and customer relationship orientation perform as two distinct constructs in driving firm innovativeness, and how together they support business growth among export firms. This study aims to suggest a customer-centric strategy for export firms that drive innovativeness and growth.

An international corporation specialized in company information services provided a list of the contact information of Italian companies. The authors sent an email request to respond to an online survey and received 416 effective responses from firms operating in export markets. The authors propose and empirically test a model in which customer orientation, customer relationship orientation and innovativeness predict business growth. This model controls for the effects of firm size, industry and customer type (B2B vs. B2C).

The study findings suggest that customer orientation and customer relationship orientation are two distinct strategic orientations driving innovativeness. However, they do not directly affect business growth. Instead, they require the innovativeness of an exporter to materialize as business growth.

The results of the study recommend business strategies focusing not only on customer needs and satisfaction but also on retaining current customers and building customer relationships in international markets. Firms can learn from international customers and develop effective customer-centric strategies to spread the acquired information into the internal decision-making as it contributes to firm innovativeness and business growth in international markets.

This study is one of the pioneering studies combining customer orientation and customer relationship orientation, showing their theoretical and empirical divergence. This study is also among the first which tests how the two strategic orientations together with innovativeness promote business growth among export firms. The authors add understanding of the synergistic effects both of using customer information and developing deeper relationships on firm innovativeness and performance among exporters.

Previous research has focused on how trustworthiness can be evoked by the physical design of on‐screen characters (OSCs) within the e‐commerce interface. The purpose of this study is to investigate whether or not the OSCs representation, along with user differences, influence, how likeable, appropriate and trustworthy they are.

A web site was created for a simulated online bookseller and 183 people from various countries participated in the experiments. OSC representations were tested under four conditions in the main experiment: facial appearance (human‐like vs cartoon‐like) and gender (male vs female).

The results suggest that the human‐like characters are more likeable, appropriate and trustworthy in general terms. However, when perceived capabilities of OSCs are measured, a mismatch can occur between expectations and capabilities of the human‐like OSCs. In fact, cartoon‐like OSCs, especially female, had more positive effects on the web site interface.

This study was limited to simulations of on‐screen scenarios. Future work, with access to the huge database required, could investigate the effects of truly interactive OSCs. Larger national sub‐samples would permit generalisations about cross‐cultural differences.

For e‐tailers and web designers, this study suggests critical design variables and response‐moderating variables that mediate the effects of OSCs in e‐retailing. It helps to understand customers' interaction needs in establishing and maintaining para‐social relationships, potentially increasing purchase intentions and persuasion.

The efficacy of different representations of OSCs to retail situations has been little investigated previously; this study measured how likeable, appropriate and trustworthy different OSC design formats are to different customer types.

The purpose of this paper is to examine the co-creation of small and medium enterprise (SME) designer fashion brands during internationalisation.

As an exploratory study, this research utilises grounded theory methodology and incorporates the use of 38 semi-structured in-depth interviews with designer fashion enterprises (DFEs) and their support network of sales and PR agencies.

Co-creation was identified as an important element for the successful integration of the entrepreneurial DFE into the global fashion industry network. Within relationship marketing, the concept of co-creation emphasises consumer experience, influence and power in the development of brand value. However current understanding of co-creation inadequately explains the development of the entrepreneurial designer fashion brand, requiring examination of the concept using grounded theory. The findings of this research highlight how these SMEs react and respond to the interpretation of their brand identity through the co-creation process as they seek to introduce and grow their firms within the global fashion marketplace.

This paper identifies the influence of industry stakeholders on the process of fashion brand co-creation. Additionally, by identifying the process by which the entrepreneurial DFE navigates the introduction of their collections to the industry’s network, and responds to interpretations of the firm’s brand identity, this paper recognises the influence of the firm throughout the co-creation process.

One in six people globally are affected by infertility, and many turn to fertility treatment in a bid to have a child(ren). While many countries offer work-related legislative protections and provisions for those who are successful in conceiving a child, in the form of maternity and paternity-related supports and protection again discrimination – the same cannot be said for those struggling to conceive. There are similar inequalities when it comes to workplace policy and support. Drawing on data from our two-year research study on “complex fertility journeys” and employment, this chapter sets out the work-life challenges that arise when individuals find themselves navigating the considerable “reproductive work” of fertility treatment alongside the demands of paid employment, and how affected employees respond. It also touches on the challenges experienced by line managers tasked with offering support. The chapter concludes with implications for practice in terms of making organizations more “fertility friendly,” which should extend beyond support for attending fertility treatment appointments to include awareness raising, manager training, and support for the varied outcomes of treatment cycles, including involuntary childlessness.

Life studies are a rich source for further research on the role of the Afro‐American woman in society. They are especially useful to gain a better understanding of the Afro‐American experience and to show the joys, sorrows, needs, and ideals of the Afro‐American woman as she struggles from day to day.

The purpose of this paper is to present a critical review of the use of safety performance indicators in the construction industry. The authors consider the strengths, limitations and managerial consequences associated with commonly used indicators.

The authors combine two separate data sets in this critical review. These include 32 semi-structured interviews with construction industry representatives involved in the collection and reporting of safety indicators, as well as a multi-level safety climate survey that was conducted at 12 construction sites across Australia.

The analysis provides new evidence that, in their current use, commonly used H&S indicators are subject to manipulation and misinterpretation. Their usefulness as tools to support safety management activities in construction projects and organisations needs to be understood in the context of their limitations. In particular, safety indicators do not reflect the full set of factors that affect workplace safety and there will always be disagreement about what should be counted and how.

As a result of the substantial shortcomings of safety indicators, great care needs to be taken when using them to determine or evaluate organisational safety policy and practices.