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Guided by transactional stress theory, this study aimed to explore elite U.K. soccer coaches' perceived stressors, the situational properties, appraisals, and coping during the COVID-19 pandemic. This study also aimed to explore any variation in stress experiences across football league standards A total of 13 professional first-team male U.K. association football coaches between 38 and 59 years of age (M = 43.00, SD = 6.94) participated in telephone (n = 5) or online (n = 8) semistructured interviews. Informed by the philosophical position of critical realism, Braun et al.'s six-phase approach to thematic analysis was used to generate competitive, organizational, and personal stressor themes. Deductive thematic analysis generated themes reflective of all situational properties of stressors identified by Lazarus and Folkman and an array of appraisal and coping strategies. Future research and recommendations for supporting coach performance and well-being post-COVID-19 pandemic are offered. [ABSTRACT FROM AUTHOR]

Specialist, associate specialist and specialty (SAS) doctors constitute a marginalised professional group who can struggle to achieve the professional development they desire. Our primary objective was to understand, from a theoretically informed perspective, the ways in which the professional identity of SAS doctors influences their professional development opportunities, including through appraisal. Ten UK SAS doctors participated in indepth, narrative interviews. Participants were drawn from six medical specialities, and ranged in experience (2.5--15 years) and country of primary medical qualification. Interview transcripts were analysed via critical discourse analysis using Figured Worlds theory. The position of SAS doctors within the Figured World was at times unstable, ambiguous and context dependent. They were often relative outsiders, not immediately trusted by colleagues. Some found their development needs eclipsed by the priorities of colleagues, typically consultants and postgraduate trainees. Appraisal was often not perceived to have successfully addressed these issues. This study enhances our understanding of the lived experience of SAS doctors, which is often in stark contrast to formal policy on the range of roles that they can fulfil. The struggles and successes of SAS doctors described here suggest that there is scope to improve the professional status and professional development opportunities for SAS doctors, including through appraisal. [ABSTRACT FROM AUTHOR]

Discourse analysis has been widely applied to the study of environmental communication, highlighting how language is used to reflect and affect our attitudes towards the natural world. The potential of discourse analysis to 'reveal' the values that people attribute to nature has recently been recognized in the context of environmental debates. This paper takes a new cross-disciplinary approach to the analysis of evaluation, combining a discourse approach (specifically Appraisal analysis) and insights from environmental philosophy and environmental policy to address the following main questions: (1) Which values of nature may be embedded in discourse about nature? (2) To what extent are these values represented in people's narratives about trees and woodland in the U.K.? (3) What are the implications of the findings for the critical analysis of evaluative discourse? (4) What are the implications of the findings for environmental organizations? The analysis is applied to a sample of 514 woodland narratives collected by the U.K. charitable environmental organization Woodland Trust in 2016. The study highlights new critical perspectives that may be gained from the analysis of evaluative discourse and the importance of considering and fostering people's affective relationship with the natural world in building a strong basis for environmental action. [ABSTRACT FROM AUTHOR]

Summary: This investigation examined the relation between two sources of bias when people remember how they felt about political events: their current appraisals of the past political event and their current feelings about it. We assessed participants' memories for their emotional response to a major political event: the 2016 United Kingdom referendum on European Union membership. Participants reported their emotional experience and appraisals within 2 weeks after the outcome. After 18 months, participants reported their current appraisals and emotions concerning the referendum's outcome and their remembered past emotional response. The results showed that current negative emotions fully mediated the link between current appraisals and remembered negative emotions. We discuss this result within a feeling‐is‐for‐doing approach. [ABSTRACT FROM AUTHOR]

Informal carers are increasingly involved in supporting people with severe and enduring mental health problems, and carers' perceptions impact the wellbeing of both parties. However, there is little research on how carers actually make sense of what their loved one is experiencing. Ten carers were interviewed about how they understood a loved one's psychosis. Data were analysed using a hermeneutic-phenomenological approach. Three themes described the carers' effortful quest to understand their loved one's experiences while maintaining their relational bonds. Carers described psychosis as incomprehensible, seeing their loved one as incompatible with the shared world. To overcome this, carers developed hermeneutic 'mooring points', making sense of their loved one's unusual experiences through novel accounts that drew on material or spiritual explanations. The findings suggest that informal carers resist biomedical narratives and develop idiosyncratic understandings of psychosis, in an attempt to maintain relational closeness. We suggest that this process is effortful – it is hermeneutic labour – done in the service of maintaining the caring relationship. Findings imply that services should better acknowledge the bond between carers and care-receivers, and that more relationally oriented approaches should be used to support carers of people experiencing severe mental health problems. [ABSTRACT FROM AUTHOR]

Study Question: What are appraisals, coping strategies and emotional reactions of patients to coronavirus disease 2019 (COVID-19) fertility clinic closures?Summary Answer: Clinic closure was appraised as stressful due to uncertainty and threat to the attainability of the parenthood goal but patients were able to cope using strategies that fit the uncertainty of the situation.What Is Known Already: Psychological research on COVID-19 suggests that people are more anxious than historical norms and moderately to extremely upset about fertility treatment cancellation owing to COVID-19.Study Design, Size, Duration: The study was of cross-sectional design, comprising a mixed-methods, English language, anonymous, online survey posted from April 9 to 21 to social media. Eligibility criteria were being affected by COVID-19 fertility clinic closure, 18 years of age or older and able to complete the survey in English. In total, 946 people clicked on the survey link, 76 did not consent, 420 started but did not complete the survey and 450 completed (48% completion, 446 women, four men).Participants/materials, Setting, Methods: Overall 74.7% (n = 336) of respondents were residents in the UK with an average age of 33.6 years (SD = 4.4) and average years trying to conceive, 3.5 years (SD = 2.22). The survey comprised quantitative questions about the intensity of cognitive appraisals and emotions about clinic closure, and ability to cope with clinic closure. Open-text questions covered their understanding of COVID-19 and its effect on reproductive health and fertility plans, concerns and perceived benefits of clinic closure, and knowledge about closure. Sociodemographic information was collected. Descriptive and inferential statistics were used on quantitative data. Thematic qualitative analysis (inductive coding) was performed on the textual data from each question. Deductive coding grouped themes from each question into meta-themes related to cognitive stress and coping theory.Main Results and the Role Of Chance: Most patients (81.6%, n = 367) had tests or treatments postponed, with these being self (41.3%, n = 186) or publicly (46.4%, n = 209) funded. Patients appraised fertility clinic closure as having potential for a more negative than positive impact on their lives, and to be very or extremely uncontrollable and stressful (P ≤ 0.001). Most reported a slight to moderate ability to cope with closure. Data saturation was achieved with all open-text questions, with 33 broad themes identified and four meta-themes linked to components of the cognitive stress and coping theory. First, participants understood clinic closure was precautionary due to unknown effects of COVID-19 but some felt clinic closure was unfair relative to advice about getting pregnant given to the public. Second, closure was appraised as a threat to attainability of the parenthood goal largely due to uncertainty of the situation (e.g. re-opening, effect of delay) and intensification of pre-existing hardships of fertility problems (e.g. long time waiting for treatment, history of failed treatment). Third, closure taxed personal coping resources but most were able to cope using thought-management (e.g. distraction, focusing on positives), getting mentally and physically fit for next treatments, strengthening their social network, and keeping up-to-date. Finally, participants reported more negative than positive emotions (P ≤ 0.001) and, almost all participants reported stress, worry and frustration at the situation, while some expressed anger and resentment at the unfairness of the situation. Overall, 11.8% were not at all able to cope, with reports of intense feelings of hopelessness and deteriorating well-being and mental health.Limitations, Reasons For Caution: The survey captures patient reactions at a specific point in time, during lockdown and before clinics announced re-opening. Participants were self-selected (e.g. UK residents, women, 48% starting but not completing the survey), which may affect generalisability.Wider Implications Of the Findings: Fertility stakeholders (e.g. clinics, patient support groups, regulators, professional societies) need to work together to address the great uncertainty from COVID-19. This goal can be met proactively by setting up transparent processes for COVID-19 eventualities and signposting to information and coping resources. Future psychological research priorities should be on identifying patients at risk of distress with standardised measures and developing digital technologies appropriate for the realities of fertility care under COVID-19.Study Funding/competing Interest(s): University funded research. Outside of the submitted work, Prof. J.B. reports personal fees from Merck KGaA, Merck AB, Theramex, Ferring Pharmaceuticals A/S; grants from Merck Serono Ltd; and that she is co-developer of the Fertility Quality of Life (FertiQoL) and MediEmo apps. Outside of the submitted work, Dr R.M. reports personal or consultancy fees from Manchester Fertility, Gedeon Richter, Ferring and Merck. Outside of the submitted work, Dr S.G. reports consultancy fees from Ferring Pharmaceuticals A/S, Access Fertility and SONA-Pharm LLC, and grants from Merck Serono Ltd. The other authors declare no conflicts of interest.Trial Registration Number: N/A. [ABSTRACT FROM AUTHOR]

The requirement for statistical techniques in the appraisal process is far-reaching for every country. Market price accuracy for properties is mean in economics filed, mass appraisal, and for all users of appraisals reports. Studies were developing for econometric models that can be applied in real estate issues. Literature dominates for the USA and UK and stands a need to be tested for emerging (developing) markets. The paper aims to give some hints of the logic, the problems, benefits, and a guide of the ANN (Artificial neuronal network) technique. In the study, much practical information for ANN's representing an encouragement and a tool for other emerging countries to append the technique. We conclude that ANN is critical to be applied in property valuation for emerging countries in the global environment. [ABSTRACT FROM AUTHOR]

Background: There are ambitious overseas recruitment targets to alleviate current GP shortages in the UK. GP training in European Economic Area (EEA) countries is recognised by the General Medical Council (GMC) as equivalent UK training; non- EEA GPs must obtain a Certificate of Eligibility for General Practice Registration (CEGPR), demonstrating equivalence to UK- trained GPs. The CEGPR may be a barrier to recruiting GPs from non- EEA countries. It is important to facilitate the most streamlined route into UK general practice while maintaining registration standards and patient safety. Aim: To apply a previously published mapping methodology to four non- EEA countries: South Africa, US, Canada, and New Zealand. Design & setting: Desk- based research was undertaken. This was supplemented with stakeholder interviews. Method: The method consisted of: (1) a rapid review of 13 non- EEA countries using a structured mapping framework, and publicly available website content and country- based informant interviews; (2) mapping of five 'domains' of comparison between four overseas countries and the UK (healthcare context, training pathway, curriculum, assessment, and continuing professional development (CPD) and revalidation). Mapping of the domains involved desk- based research. A red, amber, or green (RAG) rating was applied to indicate the degree of alignment with the UK. Results: All four countries were rated 'green'. Areas of differences that should be considered by regulatory authorities when designing streamlined CEGPR processes for these countries include: healthcare context (South Africa and US), CPD and revalidation (US, Canada, and South Africa), and assessments (New Zealand). Conclusion: Mapping these four non- EEA countries to the UK provides evidence of utility of the systematic method for comparing GP training between countries, and may support the UK's ambitions to recruit more GPs to alleviate UK GP workforce pressures. [ABSTRACT FROM AUTHOR]

This paper investigates the extent to which institutional investors may have influenced independent real estate appraisals during the financial crisis. A conceptual model of the determinants of client influence on real estate appraisals is proposed. It is suggested that the extent of clients’ ability and willingness to bias appraisal outputs is contingent upon market and regulatory environments (ethical norms and legal and institutional frameworks), the salience of the appraisal(s) to the client, financial incentives for the appraiser to respond to client pressure, organisational culture, the level of moral reasoning of both individual clients and appraisers, client knowledge and the degree of appraisal uncertainty. The potential of client influence to bias ostensibly independent real estate appraisals is examined using the opportunity afforded by the market downturn commencing in 2007 in the UK. During the market turbulence at the end of 2007, the motivations of different types of owners to bias appraisals diverged clearly and temporarily provided a unique opportunity to assess potential appraisal bias. We use appraisal-based performance data for individual real estate assets to test whether there were significant ownership effects on performance during this period. The results support the hypothesis that real estate appraisals in this period reflected the differing needs of clients. [ABSTRACT FROM AUTHOR]

In UK universities, reflection is promoted not only for its intrinsic value but also for instrumental purposes, for students to gain and demonstrate skills and attributes which are valued by employers. In this paper, I examine reflective writing produced by students seeking an award offered by the careers department of one university. By looking at the evaluative language choices made by the student writers, I shed light on some of their practices regarding self-representation and their articulations of experience. I provide a critical account of what reflective writing looks like in this particular setting, and interpret this in the broader context of the goal to foster reflection among higher education students. I argue that the reflective writing engendered by this particular context and task is different in key respects from the reflection which is commonly advocated as an element of personal, professional or academic development. [ABSTRACT FROM PUBLISHER]

Background: While appraisal is a well-established process and has been a contractual obligation for GPs in Wales since 2004, revalidation is a new requirement for all doctors practising in the UK. Appraisal is an essential component of revalidation. However as appraisal is developmental, and revalidation is summative, there is concern over the potential impact revalidation may have on the appraisal process itself. Methods: This study, carried out among GPs in Wales, aimed to capture participants' perspectives of the initial impact of revalidation on appraisal. The study was commenced by conducting a basic literature review, building on existing research in this area. We employed a mixed method approach (an online survey and focus groups). The online survey was disseminated via Bristol Online Survey. Focus groups were carried out to examine the perspectives of both GP Appraisers and GPs on the study subject matter. Results: The majority of respondents felt that revalidation had had a medium-sized effect on the appraisal process. Respondents were fairly evenly divided on the nature of that impact. Some reported collecting GMC-specified information had increased time costs. Others found that collecting this information had sparked reflection and changes to their practice. GPs were fairly evenly divided on the precise extent to which the GMC data collection offered an accurate picture of their work and learning. The majority felt that it did, with 20-23% reporting a negative impact. Conclusion: The study participants reported that revalidation had impacted on appraisal, bringing increased time and costs alongside some increased individual reflection and Quality Improvement (QI) activity. The impact was felt more by appraisers than appraisees. Overall, of those GPs revalidated in 2013,62% reported it was a positive experience. [ABSTRACT FROM AUTHOR]

We conducted a national survey of Staff, Associate Specialists and Specialty (SAS) doctors working in sexual health clinics in the UK in 2013 in order to explore their career progression. The aim of the survey was to assess SAS doctors' experience in passing through the thresholds and to gather information about the adherence by SAS doctors and employers to the terms and conditions of service laid out by the new 2008 contract. Out of 185 responders, whom the authors estimate comprise 34% of the total workforce, 159 were on the new contract. Of those, most SAS doctors were women (84%), the majority (67%) worked less than nine programmed activities per week; only a few had intentions to join the consultant grade (15%), and a considerable minority (26%) were older than 54 years of age and likely to retire in the next ten years. The survey showed that most participating SAS doctors had undergone appraisal in the previous 15 months (90%), most had a job planning discussion (83%) with their employer and most had some allocated time for supporting professional activities (86%). However, a significant minority had no appraisal (10%), no job planning discussion (17%) and had no allocated supporting professional activities (14%), which allows time for career development in the specialty. Most SAS doctors, who had the opportunity, had progressed through the thresholds automatically (88%); some experienced difficulties in passing (8%) and only a few did not pass (4%). SAS doctors must ensure that they work together with their employer in order to improve adherence to the terms and conditions of service of the contract, which allow for career progression and benefit both the individual doctors and ultimately service provision. [ABSTRACT FROM AUTHOR]

Background: A portfolio of supporting information (SI) reflecting a doctor's entire medical practice is now a central aspect of UK appraisal for revalidation. Medical revalidation, introduced in 2012, is an assessment of a doctor's competence and passing results in a five yearly license to practice medicine. It assesses of a doctor's professional development, workplace performance and reflection and aims to provide assurance that doctors are up-to-date and fit to practice. The dominant assessment mechanism is a portfolio. The content of the revalidation portfolio has been increasingly prescribed and the assessment of the SI is a fundamental aspect of the appraisal process which ultimately allows Responsible Officers (ROs) to make recommendations on revalidation. ROs, themselves doctors, were the first to undergo UK revalidation. This qualitative study explored the perceptions of ROs and their appraisers about the use of this portfolio of evidence in a summative revalidation appraisal. Methods: 28 purposefully sampled London ROs were interviewed following their revalidation appraisal and 17 of their appraisers participated in focus groups and interviews. Thematic analysis was used to identify commonalities and differences of experience. Results: SI was mostly easy to provide but there were challenges in gathering certain aspects. ROs did not understand in what quantities they should supply SI or what it should look like. Appraisers were concerned about making robust judgements based on the evidence supplied. A lack of reflection from the process of collating SI and preparing for appraisal was noted and learning came more from the appraisal interview itself. Conclusions: More explicit guidance must be available to both appraisee and appraiser about what SI is required, how much, how it should be used and, how it will be assessed. The role of SI in professional learning and revalidation must be clarified and further empirical research is required to examine how best to use this evidence to make judgments as part of this type of appraisal. [ABSTRACT FROM AUTHOR]

The article focuses on formative aspect of appraisal and the need to structure the process for appraisees in areas of general practice. It mentions importance of the quality of motivation that is more important and focus on the self-determinant theory. It also highlights role for encouraging doctor competition to improve motivation.

Humans inhabit environments that are both social and physical, and in this article we investigate if and how social identity processes shape the experience and negotiation of physically demanding environmental conditions. Specifically, we consider how severe cold can be interpreted and experienced in relation to group members' social identity. Our data comprise ethnographic observation and semi-structured interviews with pilgrims attending a month-long winter Hindu religious festival that is characterized by near-freezing conditions. The analysis explores (1) how pilgrims appraised the cold and how these appraisals were shaped by their identity as pilgrims; (2) how shared identity with other pilgrims led to forms of mutual support that made it easier to cope with the cold. Our findings therefore extend theorizing on social identity processes to highlight their relevance to physical as well as social conditions. [ABSTRACT FROM AUTHOR]

Objective: To develop a questionnaire measure of appraisals for parents of children with a cleft (the Parental Appraisal of Cleft Questionnaire) and to investigate the ability of the Parental Appraisal of Cleft Questionnaire to predict variance in parental well-being. Design, Participants, Setting: The study used a cross-sectional postal and online questionnaire design with a retest component involving parents of children with a cleft lip and/or palate. Data are presented for 179 parents, predominantly women (74.9%), aged 22 to 58 years. Main Outcome Measures: Participants completed the appraisal measure under development; other measures of psychological well-being, social support, and socially desirable responding; and demographic information. Results: Overall, the Parental Appraisal of Cleft Questionnaire was found to have a coherent factor structure, good internal reliability, and good test-retest reliability. The Parental Appraisal of Cleft Questionnaire was also found to predict a significant amount of unique variance in well-being over and above the variance predicted by demographic, social support, and social desirability variables. Conclusions: Parental appraisals, measured by the Parental Appraisal of Cleft Questionnaire, were found to predict unique variance in well-being. These findings are discussed in relation to adjustment to cleft lip and/or palate for parents. Directions for future research are outlined and the implications for clinical practice and services are discussed. [ABSTRACT FROM AUTHOR]

This paper investigates the application and use of development viability models in the formation of planning policies in the United Kingdom (UK). Particular attention is paid to three key areas: the assumed development scheme in development viability models, the use of forecasts and the debate concerning Threshold Land Value. The empirical section reports on the results of an interview survey involving the main producers of development viability models and appraisals. It is concluded that, although development viability models have intrinsic limitation associated with model composition and input uncertainties, the most significant limitation is related to the ways in which they have been adapted for use in the planning system. In addition, it is suggested that the contested nature of Threshold Land Value is an example of calculative practices providing a façade of technocratic rationality in the planning system. [ABSTRACT FROM AUTHOR]

Abstract: Harold Shipman, a GP in the North West, became one of England''s most notorious serial killers when he murdered more than 200 of his patients over a 30-year period. The ensuing investigation was highly critical of the General Medical Council''s approach to managing dangerous and incompetent doctors, and called for reform. Subsequently, Sir Liam Donaldson, outlined the principles and steps of revalidation implementation in the UK, based on discussions of the proposals in the Government White Paper, ‘Trust, assurance and safety – the regulation of health professionals in the 21st century’. Many doctors may not be fully aware of the process of appraisal and revalidation as well as the documentations required for these. In addition, it can be confusing to some as doctors in training are already being workplace assessed. The aim of this article is to provide guidance and references to doctors in training in order to prepare for appraisal and revalidation. The General Medical Council, together with the health departments in Scotland, Wales, Northern Ireland and England, and NHS employers, are moving into the implementation phase and will make revalidation a reality. It is planned that revalidation will be launched in late 2012. [Copyright &y& Elsevier]

The article discusses that the data from larger mixed method study looking at the support needs of sessional general practitioners (GPs) and how they are being met through a range of formal and informal support system. This article explores the role of Self-Directed Learning Groups (SDLGs) as a model for providing support and educational for sessional GPs as well as factors that make these groups successful.

The challenge for implementing an ecosystems approach to environmental decision-making processes, such as spatial planning, is to understand the range, nature and amount of ecosystem services currently provided and the potential for such service provision in the future. The ability to spatially represent ecosystems services is a critical element of the evidence base on which to make decisions about how physical space is used most effectively and sustainably, and the way people and activities are distributed at different spatial scales. This paper reports on the outcomes of a research project originally undertaken for the UK Department for the Environment, Food and Rural Affairs which developed a methodology for mapping ecosystem services using GIS and readily available, existing land use/land cover datasets. Critical components of the methodology, in order to determine which datasets are appropriate for which services, are network analysis and stakeholder engagement techniques, to define the relevant typology of ecosystem services and their relationship to land use/land cover types. The methodology was developed and tested successfully in the context of green grid (green infrastructure) networks in a major UK regeneration area, the Thames Gateway, to the east of London, and its potential use in impact assessment further explored through a number of case studies. [ABSTRACT FROM AUTHOR]

The article presents a study which explores the perceptions by general practitioners (GPs) of the benefits of appraisal. The study has undertaken brief review of literature to highlight past studies on the benefits of appraisals as perceived by GPs. Results show that appraisal will help promote reflection by GPs in a consistent way and provide assurance of their fitness to practice.

The article presents a study which explores the perceptions by general practitioner (GP) educators on the opportunities and challenges in introducing revalidation. The study used a modified grounded theory approach in the collection and analysis of data from the appraisees. Results have led to the development of eight thematic categories reflecting the perceptions of participants, which include engaging the workforce, recognising career plurality, and accrediting of everyday practice.

The article presents a study which examines the understandings of general practitioners (GPs) as appraises and appraisers to assess learning and verify learning credits in continued professional development (CPD). The study subjected 17 GP appraiser participants into self-rating, peer-assessment, and workshop discussion for credit valuation. Result shows five similar learning credits on self-rating and peer assessment of learning credits, with four overestimate and six underestimate cases.

BackgroundMilitary service can lead to profound changes in identity, both in servicemen's perception of themselves and in their relationship to the world, but the significance of these changes for psychopathology is unclear. We investigated whether the extent and valence of identity change was related to the degree of military trauma exposure or to post-traumatic stress disorder (PTSD) and suicide attempts. We further sought to describe the nature of such changes using qualitative analysis.MethodA total of 153 veterans in receipt of a war pension for PTSD or physical disability were identified. Interviews established retrospectively DSM-IV diagnoses of PTSD and reports of suicidal ideation or behaviour since enlistment were examined.ResultsTrauma exposure alone was unrelated to any measure of identity change. By contrast, PTSD was associated with a relationship to the world that had changed in a negative direction. It was also associated with a changed perception of self, which could be either positive or negative. After controlling for trauma exposure and PTSD, suicidal behaviours were associated with more negative perceptions of the world. These perceptions of the world included disillusionment about human nature and a more specific rejection of civilian life.ConclusionsPTSD and suicidal behaviours in veterans seem not to be associated with significantly more negative views of the self but rather with more alienation from civilian life. This has serious consequences for engaging veterans in National Health Service (NHS) mental health services and for the provision of effective treatment. [ABSTRACT FROM PUBLISHER]

WHAT IS ALREADY KNOWN IN THIS AREA. Mentoring can be a useful support to doctors' personal and professional development. WHAT THIS WORK ADDS. That four sessions of action learning mentoring is a useful and positive experience for supporting a broad range of general practitioners' personal and professional development needs. That such a process can be deployed on both a one-to-one and a group basis. Reporting on the nature, intensity, frequency and adverse outcomes of the mentoring approach deployed. SUGGESTIONS FOR FUTURE RESEARCH. Further research could assess the potential impact of mentoring in action learning sets from its wider use, to seek to identify whether one-to-one and group approaches are more suited to certain issues, and to assess the cost-efficiency potential of group approaches. Future work should also aim to identify if the approach is due to action learning specifically or the more general effect of counselling. [ABSTRACT FROM AUTHOR]

The article presents a study on the appraisal guide for sessional general practitioners (GPs) and their continuing professional development (CPD) in Berkshire, England. The study used questionnaires to evaluate the GPs' strengths and weaknesses and come out with suggestions and comments about the guide that deals with working relationships, professional development plan (PDP) and 360° feedback forms. Results show a clear understanding of GPs and prospective changes in their practice.

Abstract: Numerous travel demand studies have been carried out over the past five decades, many of which produce estimates of the value of travel time. This includes a rich body of largely unpublished evidence, which can provide valuable insights into the impact of variables such as GDP, travel distance, purpose and mode on this critical parameter for transport modelling and appraisal. The work reported in this paper updates and extends our previous meta-analyses of UK values of time () by adding recent studies and widening the range of explanatory variables included. Our current research covers 226 studies carried out between 1960 and 2008, yielding a total of 1749 valuations (a 50% increase relative to our previous work) and making this the largest data set of its kind to the best of our knowledge. This is also the most comprehensive study to date of parameters other than in-vehicle time and includes valuations of walk, wait, headway, congested, free flow, late, departure time shift and search time. Exploratory analysis of the data set provides interesting insights into methodological trends in travel demand modelling. For each valuation, over thirty quantitative and categorical variables were recorded and then included in a multivariate regression model to explain variations in the value of time. A large number of statistically significant effects were obtained from this meta-analysis, some of which are in marked contrast with, or not present in, our previous work. One finding that stands out is that the estimated elasticity of the value of time with respect to GDP per capita is 0.9 and highly significant, a much closer correspondence to the widely used convention of a unit income elasticity over time than we have previously obtained. The ratio between walk and wait time and in-vehicle time was found to be substantially lower than the commonly used value of two. We also found large and significant differences between the results from studies based on different types of Stated Preference survey presentation. Other important effects include variations by mode used, mode valued, travel purpose, attribute type and distance. It is envisaged that the results are of direct relevance in the British context, as inputs to appraisal or for benchmarking, whilst the methodological implications are of broader interest and the results, in terms of time equivalents and variations in values of time, can be transferred to other contexts. [Copyright &y& Elsevier]

Abstract: 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. Prioritisation 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. [ABSTRACT FROM AUTHOR]

Background: Intervention strategies and developmental models of stress have been criticized for failing to integrate social psychological variables. This study investigates both self-referential cognitive mediators (perceived threat and control) and a social psychological moderator (ethnic/religious identity) of the effect of peer-victimization upon depressive symptomatology. Methods: Self-report questionnaires were completed by 924 students (46% female), aged 8 to 12 years. Experiences of discriminatory and non-discriminatory peer-victimization, threat and control appraisals, depressive symptoms, and strength of main identity were assessed. Results: Perceived threat partially mediated the effect of peer-victimization (regardless of whether it was discriminatory or not) on depressive symptoms. Perceived control partially mediated the effect of non-discriminatory peer-victimization on depressive symptoms. Strength of ethnic/religious identity buffered the effect of peer-victimization on depressive symptoms. Victimization perceived to be discriminatory in nature was more strongly associated with depressive symptoms than non-discriminatory victimization. Conclusions: Findings support calls for a greater emphasis to be placed on social psychological variables in explaining depressive symptomatology. For clinical, counseling and intervention purposes, it is important to examine whether victims perceive peer-victimization as discriminatory and whether their own strength of identity affects symptomatology. [ABSTRACT FROM AUTHOR]

The delivery of an effective community nursing workforce relies on competent staff. Commissioners will need to be assured that their providers employ competent, efficient staff who give value for money. The Knowledge and Skills Framework (KSF) was introduced as part of Agenda for Change to identify the competences required, but competency testing using the KSF has not been fully implemented across the UK, and measuring competency, using the KSF indicators, still leaves much room for variation and a nonstandardized approach. In the first of this two-part article, the authors discuss the process through which the provider services of one London PCT developed standardized competences using the KSF which were linked to staff performance and which provided clear areas for individual development. [ABSTRACT FROM AUTHOR]

As general practice nurses (GPNs) now perform many activities formerly undertaken by general practitioners (GPs), the paperwork and process of the Scottish GP appraisal scheme may be usefully replicated for GPN appraisal. Method Eight GPNs adapted paperwork. Ten GP appraisers in NHS Lanarkshire were invited to interview their GPN(s) using the adapted paperwork. Both groups evaluated the project from 'descriptive' (participation and process) and 'reflective' or qualitative perspectives. Results Eight GPs appraised 11 GPNs using a ten-page document. GPNs reported that the documentation was helpful in preparing for and participating in the interview, as well as the planning of future objectives and development. GPs reported that the appraisal interview incorporated GPNs' views, the content was relevant, and their approach nonjudgemental and developmental. Some expressed concern that their participation had not helped them identify ways of addressing GPN learning needs. There was clear indication from GPNs that trained colleagues rather than GP employers are preferred appraisers. Improvements in the paperwork would be required. Discussion There is potential to replicate the paperwork and processes used in GP appraisal to GPNs, subject to refinement of the paperwork and engagement of trained nurse colleagues in the process. This may reduce the effect of collusion, inhibition or conflict of interest. However, GPN personal development still must be reconciled with practice priorities and development. Conclusion The results of this pilot indicate a positive response in terms of participation and process. Further research should examine GPN appraisal using an external nurse appraiser, training issues and resource implications. [ABSTRACT FROM AUTHOR]

This paper reviews the development and use of the monetary valuation of road safety in Great Britain. The most important component of the benefit of improving road safety is the prevention of casualties. The valuation of the prevention of casualties is based on the “willingness-to-pay” approach, which was adopted for the prevention of fatalities in 1988 and for injuries in 1992. The major applications of monetary valuations of road safety are first in the general appraisal of new or improved roads, and second in the appraisal of specific road safety measures. Road casualty valuations are also sometimes used as benchmarks in other contexts, such as on other transport modes and in industrial safety. Accident savings are an important but minority component of the benefits of new or improved roads; however, specific local road accident remedial measures bring exceptionally high rates of return, typically paying for themselves in accident savings in less than a year. [ABSTRACT FROM AUTHOR]

The article discusses the use of appraisal as a tool in conducting medical revalidation scheme in Great Britain. Revalidation is considered important in the medical profession as it help in improving the services offered by doctors and healthcare organisations. The appraisal process will gather multiple source feedback, check the College-led Continuing Professional Development completion and review the progress of the doctors.

An estimated 3200 GPs work in occupational medicine (OM) on a sessional basis in addition to their primary care commitments. Most of these hold the Diploma of the Faculty of Occupational Medicine (D Occ Med). These GP occupational physicians appear to have no formal structure for their continuing medical education in OM beyond the training undertaken for this diploma, which may be accessed in a number of centres throughout the UK. The aims of this study are to explore the appraisal process for GPs working in OM and to determine the opinions about appraisal of a sample who contribute to a national reporting network for occupational disease and work-related ill health (THOR-GP). Postal questionnaires were sent to 291 GPs. Only 15% of this sample of doctors had undergone appraisal during the year of study (2006) though 22% were appraisers in general practice. The subjects' preference was for appraisal by fellow GPs working in OM. Arrangements for appraisal for GPs practising OM do not appear to have been fully addressed or implemented. [ABSTRACT FROM AUTHOR]

Background Colposcopy forms an essential part of National Health Service Cervical Screening Programme (NHSCSP). With an increased emphasis on accountability and improved performance, there is a need to identify the performance criteria that are essential to be satisfied by the colposcopists at the time of appraisal. Objective To identify the performance criteria essential for appraisal of colposcopists by two-generational Delphi survey. Design Delphi survey. Setting Annual British Society for Colposcopy and Cervical Pathology conference (BSCCP 2005, Edinburgh, UK). Population Four hundred and ninety-nine delegates attending the above conference. Method A two-generational Delphi survey was undertaken to identify the criteria needed for appraisal. The participants were asked to rate the relevance of quality items that might be considered necessary for appraisal of performance of colposcopists. After the first round, the results were presented, and the respondents were given the chance to reflect on their response and change it if necessary. Main outcome measures Criteria considered to be essential for appraisal of colposcopists in areas of training, diagnostic and therapeutic aspects and communication. Results In the first round, 306/499 (61%) participants returned the completed questionnaire. Sixty percent (187/306) of participants returned their questionnaire in the second round. In addition to BSCCP certification, four other criteria were identified, which were quality of recorded findings, biopsy rate when atypia noted, proportion of biopsies histologically adequate and proportion of normal initial posttreatment follow-up smears. Conclusion This Delphi survey has been the first to identify criteria to be used in the annual appraisal of professionals. It has resulted in a number of criteria that could be considered for the appraisal and possible revalidation of colposcopists practising in UK. [ABSTRACT FROM AUTHOR]

The article presents a study that investigates the views of appraisers and appraisees on the appraisal of the general practitioner (GP) registrars in National Health Service as well as the trainers carrying out the appraisal in Great Britain. The study found out that GP appraisers were supportive of the pre-appraisal process and were positive about their abilities to structure the appraisal interviews. Appraisers were considered as good listeners, helpful and supportive.

The article examines the future of appraisal and continuing professional development of physicians through various works in primary care medical education in Great Britain. It also offers ways to be taken by the primary care education to promote an educational approach in medical regulation. According to the author, re-licensure and re-certification are the best ways to revalidate a doctor's right to practice, which depends on the assessment and appraisal in the doctor's patient care trust.

Staff development in the NHS is integral to clinical governance and therefore important to health service providers. It is concerned with all the activities that advance knowledge, skills and attitudes of staff, embracing induction, mentorship, continuing professional development, learning beyond registration, performance appraisals, promotion, personal and professional development, and related activities. The recent contraction in nursing posts and services and competition for jobs means that only well-qualified staff with an impressive portfolio of staff development are likely to climb the career ladder. Nursing staff development and training needs in the NHS are huge and multifaceted. Healthcare providers need to invest in clear staff development strategies if they are to maintain their status as effective care delivery organizations in an increasingly competitive market-driven economy. This article examines the many features of staff development and highlights the benefits for both staff and organizations. [ABSTRACT FROM AUTHOR]

GP appraisal was introduced for all UK general practitioners (GPs) in 2004. The Department of Health in England offered no specific guidance on how the process was to be delivered, leaving PCTs to implement their own GP appraisal systems. This is in contrast to Wales and Scotland which both have centrally controlled and highly standardised appraisal systems. In 2005, the National Clinical Governance Support Team (NCGST) set up a working party to agree criteria by which appraisal systems throughout the UK could be quality assured. The Postgraduate Institute for Medicine and Dentistry (PIMD) at Newcastle University has been closely involved in delivering training for GP appraisers and providing support for GP appraisal via the GP tutor network. The PIMD decided to use the NCGST framework to review the quality of GP appraisal systems in all PCTs across the Northern Deanery. This review suggests that the NCGST checklist is a useful instrument to assess the quality of GP appraisal systems. The report shows that GP appraisal has been implemented with defined resources and clear clinical and administrative leadership in all PCTs in the Deanery. Appraisers have all been trained and receive ongoing support in their role. The review also identified areas in which the quality criteria are not fully met. Not all PCTs have a robust appraiser selection and appointment process, and few have clear methods of internal quality assurance of their appraisal system, especially in terms of actions to be taken when inadequate appraisal evidence is submitted. GP appraisal is located within clinical governance structures in some PCTs, in others it is primarily the responsibility of the GP tutor, and in some PCTs it spans both areas. This seems to have some influence on whether appraisal is seen as primarily an educational tool, or also as a means of performance review linking into clinical governance. Clarification of the links between appraisal and revalidation is awaited from the Chief Medical Officer's (CMO's) review of the Shipman Inquiry report. [ABSTRACT FROM AUTHOR]

All NHS general practitioners (GPs) are now required to undergo an annual appraisal with a fellow GP. GP appraisal cannot be wholly modelled on existing systems in the public sector because of its non-hierarchical structure and lack of clinical 'line management'. A variety of models of implementation have emerged in Northumberland and Tyne and Wear. There is little published research on how the stated aims of GP appraisal are best delivered. The study aims were to: • determine the potential strengths and weaknesses of internal and external appraisal • see whether there were critical success factors regardless of model. The main method of data collection was via 44 interviews with a stratified random sample of GP appraisers and appraisees, and primary care trust (PCT) appraisal leads. A patient reference group was established to provide the steering group with a patient's perspective on key questions to address. Data analysis was conducted using principles from grounded theory - comparative analysis of the cases to identify common concepts within the topics/ themes discussed. Internal appraisal can be robust. Either model can be cosy. GPs' goals for their appraisals varied, e.g. to be stimulating, a tick box exercise, or identifying poor performance. Success factors included a shared view of the purpose of appraisal between appraiser and appraisee. Appraisee's preparation and reflection, and the appraiser's ability to facilitate these also contributed. This study reviewed outcomes from the first year of what is an evolving process and whose function was never initially clearly defined because of its linkage to revalidation. As a tool to aid personal and professional development it has been largely welcomed by the profession despite early reservations. Emerging post 'Shipman', it is possible that appraisal will be used as a tool to also identify indicators of underperformance; if so, this will raise many additional issues about its successful delivery. [ABSTRACT FROM AUTHOR]

This paper outlines the processes of quality assurance of GP appraisal in Wales. These processes demonstrate the application of national guidance for quality assurance of medical appraisal as recommended by the National Clinical Governance Support Team (NCGST). The paper describes how defined standards of practice in the context of GP appraisal have, on a relatively large scale, been developed and demonstrated through robust internal and external quality assurance mechanisms. These quality assurance mechanisms reveal positive feedback from the vast majority of participants in the process. Both GPs and appraisers report that they benefited from their involvement in appraisal. The study demonstrates that the outputs of appraisal (summary and personal development plan) accurately reflect the content of the appraisal and help doctors to plan their learning, although further work is required with respect to specifying action plans. [ABSTRACT FROM AUTHOR]

There has been increasing interest in methods of assessing patients' experience or satisfaction with their doctor and this is particularly relevant in light of the recent publication of Good Doctors, Safer Patients by the Chief Medical Officer. Methods of assessment that measure what a doctor actually does in real-life practice, rather than what they are competent to do in a simulated environment, are particularly powerful tools that have been underutilised in the past. While there are many published patient surveys, most address the patient's whole experience of the healthcare episode rather than focusing on the doctor's performance in areas such as interpersonal skills, communication skills and professionalism. Here we describe our experience of developing a patient survey to support consultant appraisal and revalidation, in collaboration with the Royal College of Physicians' Patient and Carer Network. [ABSTRACT FROM AUTHOR]

Presents abstracts of articles related to city planning. "Promoting Retail Innovation: Knowledge Flows During the Emergence of Self-Service and Supermarket Retailing in Britain," by Andrew Alexander, Gareth Shaw and Louise Curth; "The Nature of Op Art: Bridget Riley and the Art of Nonrepresentation," by Simon Rycroft; "Was the 1937 U.S. Housing Act a Pyrrhic Victory?," by D. Bradford Hunt.

Throughout the last decade there has been an ever-expanding process of change in the culture and work practices of doctors across the NHS. One of the impacts of this change has been a concurrent growth in the development of regulation and standards for doctors in all areas of their practice. Such standards address not only statutory issues, but are also based around national regulation, local governance, professional behaviours, clinical competence, education, and training and service provision. In parallel with the growth of standards, there has been an increase in the number of stakeholder organisations interested in how healthcare is delivered across the service. The planned introduction of revalidation is one of the most significant changes in the regulation of doctors for many years. However, as revalidation draws nearer, there still seems to be considerable confusion throughout UK healthcare about the role and purpose of national regulation, how it links to the processes of appraisal and revalidation, and what it all means in practice. The aim of this paper is to consider the various types of standards and stakeholders that are relevant to doctors within the NHS and, more specifically, to consider their impact on the development of activities in support of revalidation. [ABSTRACT FROM AUTHOR]

The Genitourinary Medicine Non-Consultant Career Grade Group (GUM NCCG Group) was established for the purpose of looking at training and contractual issues for this heterogeneous group of doctors. In June 2003, 700 questionnaires were posted to NCCG doctors in the UK to enquire about various aspects of working conditions. A summary of the 244 replies (35% response) is presented. Eighty-four (34%) had a job plan and 81 (33%) had had an appraisal. Just over one-third (38%) had time allocated for continuing medical education (CME), audit and administration. The response of employers to attempts by NCCGs to upgrade was poor. In all, 195 (80%) said they were registered for the purpose of continuing professional development (CPD), 43 (18%) were not and six people did not know whether they were registered or not. These results give cause for real concern at this point regarding revalidation pathways. Our survey highlights that NCCGs are disadvantaged in terms of appraisal, CPD and career progression and some jobs will be at risk as revalidation approaches. [ABSTRACT FROM AUTHOR]

In less than 18 months, from planning to implementation, Scotland introduced a universal form of general practitioner (GP) appraisal. This feat was achieved by early involvement of the Royal College of General Practitioners (RCGP), Trust and Health Board management, Scottish Executive, the British Medical Association, researchers and educationalists. This has resulted in a widely accepted, quality controlled, peer appraisal programme delivered by well-trained appraisers, which acts as an aid to revalidation and collates both local and national GP development needs. The process provides an important illustration of the elements required for the successful management of change within the UK health service. [ABSTRACT FROM AUTHOR]

Despite recent reforms intended to restore confidence in them, appraisal practices used to develop and assess the desirability of interventions in the UK transport sector remain contested, constituting arenas where competing problem definitions are likely to come into conflict. Through a detailed case study of the first of a new generation of "multi-modal transport studies", this paper explores the politics of the "new approach to appraisal" and subsequent decision-making, examining a number of factors that contributed to the failure in this case, and more widely, to reach consensual decisions. Ambiguities in guidance documents and government policy, and mismatches in the timescales of important policy and plan development processes, combined with inherent uncertainties, are shown to have contributed to a climate in which conflicting local discourses could not be reconciled. Finally, the ultimate outcome of the Hastings study — rejection by central government of a series of bypass proposals — is discussed in terms of its implications for current debates over sustainability appraisal. [ABSTRACT FROM AUTHOR]

This paper reports research on the valuations of public transport time relative to car travel time and on the valuations of the walk time, wait time and service headway associated with public transport use. The results are derived from a meta-analysis of a very large data set of British empirical evidence and are set against a review of previous research. A large number of methodological and policy relevant results emerge, some of which challenge established conventions, and the implications for value of time recommendations, policy and further research are spelt out. [Copyright &y& Elsevier]

Appraisal and revalidation for doctors are often seen as two sides of the same coin, the currency for assuring safe standards of medical practice in the United Kingdom. Both are evidence-based processes: appraisal is formative, forward-looking, developmental and non-punitive; revalidation, on the other hand, is essentially summative, backward-looking, judgemental and potentially punitive. What they have in common is two-fold: the principles to which they work — the seven principles of Good Medical Practice, as defined by the General Medical Council (GMC) — and the information, the evidence streams, that support the process. The evidence is derived from clinical governance systems, and it is therefore these that should give the assurance of quality sought by politicians and the public. Trusts, therefore, have a duty to provide, and the Healthcare Commission a duty to verify, clinical governance systems that give doctors the information they need, to ensure that both appraisal and revalidation are sufficiently robust for supporting doctors and protecting patients. Neither appraisal nor revalidation will deliver on expectation if clinical governance arrangements are poor. [ABSTRACT FROM AUTHOR]

This paper describes the position of appraisal for doctors as it is emerging in the NHS. It discusses the tensions inherent in using appraisal as the sole vehicle for making decisions about relicensing doctors (revalidation). It suggests how these tensions might be resolved by careful distinction between appraisal and assessment, so that both can be incorporated into an overall process of continuing performance review. [ABSTRACT FROM AUTHOR]