How can I help you help me?

Posted by Dorothy Newbury-Birch

I’ve never failed to get practitioners on board for a research project.

I’m not bragging (oh okay I am a bit). Some of the projects have been really difficult environments to do research: Accident and Emergency Departments, prisons, probation, magistrates courts, crown courts, youth offending teams, police stations, schools, GP surgeries. But I see people struggling with engaging practitioners and I wonder why. It’s by no means easy – actually getting someone to answer the phone or respond to your email can be really difficult but there are ways around that. Don’t believe what people say about it being more difficult elsewhere in England either – we’re often told that its much harder in London to engage but I don't agree: it is harder to get around London for meetings, but not harder to engage. I’ve done it – I know!

So what are my tips for success in engaging practitioners?

1. Send an email followed up by a telephone call about a week later where you tell them you’re following up on your email will probably get you somewhere. If you are a Dr. or working with a Dr. saying this helps.

2. Use current contacts to help you – however remember if you say that ‘Dorothy’ suggested I call you that you are using my reputation, so use it wisely.

3. When arranging to meet, ask what suits them best. Making it clear that you will come to them,  out of hours if necessary, usually works.

4. NEVER say you want to arrange a meeting (even though you do). Always say something like, ‘have you got time for a coffee and a chat about some research I’m working on which I think you would be really interested in’.

5. When you do meet (for a coffee!) find out very quickly if they are the right person to talk to about the research – they may be the PI but it may be someone else that you will be liaising with. Get the first person to introduce you to the next person.

6. Don’t go the meeting (coffee) with a huge list of things you need them to do. Tell them about the research and go through the main things – the list should come later (although you should never have too long a list).

7. When you get to meet the team (there is usually a team) my years of research experience tell me that ONLY providing blueberry muffins works. For some reason, chocolate ones don’t work the same.

8. Offer solutions to problems. In one trial I worked on with probation where I wanted them to fax me something each day, they said that they didn’t have time. So I offered to set the fax up to send me the list at the same time that they HAD to send it to someone else.

9. Listen to their solutions. They know their systems much better than you.

10. Keep them updated with what is going on throughout the research. THIS IS REALLY IMPORTANT not just for your research project, but for others that may come after.

11. Ok, I know I have 11 tips and 10 sounds better but this one is important. Involve the people you’re working with in the design, carrying out and the dissemination of the work (if they want to) it really makes for much better research.

Pitch paragraph - The Internet Revolutionary

Before I start my Crabbit Agony Aunt posts on Wednesday (and I already have several questions from you!), I have two pitches to offer you.

Today's is a self-published book from Beryl Kingston, who has previously had many books successfully published. She also has another publishing deal. But today we are looking at the pitch Beryl sent me.

The Internet Revolutionary by Beryl Kingston - 

This blog it is a-changing

Some recent thoughts and happenings have come together to produce a conclusion. And the conclusion affects the fundamental nature and perhaps existence of this blog. Perhaps the blog is having an existential crisis.

Thoughts and happenings

I've been doing this for three and a half years. There are over 600 posts, a million words etc etc. 
I've probably said it all. 
I'm feeling stale. Less

Audiobooks

One of my fondest memories of my time in legacy publishing was visiting Brilliance Audio in Michigan and playing a character on my first audiobook, Whiskey Sour.

I love audiobooks. And I've always maintained the belief that their popularity was directly proportional to their price--it isn't unusual for audiobooks for be twice the hardcover price of a book. This high barrier to entry has meant a lot of folks who would enjoy audiobooks (while travelling, commuting, exercising, on vacation, etc.) haven't ever purchased one. For many, audiobooks are a library checkout (or a rental--there used to be audiobook rental stores). That's a shame, because, like paper and ebooks, I think audiobooks are worth owning.

When I began self-publishing, Brilliance bought 13 of my ebook titles--an unprecedented move and a strong show of faith in my brand. These titles have done well, but even though they were less expensive than my previous titles, I felt the prices were a bit prohibitive.

I recently released my second Timecaster novel, Timecaster Supersymmetry, with the help of my agent acting as an estributor (more on that in a future blog post, but in a nutshell they did everything I needed them to and I'm pleased.) One of the things I spoke with Brilliance about was releasing Supersymmetry as a download for under five bucks.

They went one step better.

Right now, on audible.com, every Joe Konrath Brilliance Audiobook title is $4.95. http://www.audible.com/mt/konrath

Want to try an audiobook but thought they were too pricey? Now is the time to buy one.

I also encourage readers to buy the ebook version of Timecaster Supersymmetry for $3.99. This book was a true labor of love for me, written completely from the heart and without keeping anything reigned in. I had no legacy editor to tell me, "You can't do that." The result is a science-fiction thriller that I am 100% positive no publishing house would ever release in its current uncut form. Sex, violence, bad jokes, dinosaurs, talking fruit, the multiverse, robots, tons of inside jokes and parodies, insane plot twists, several major WTF moments, and a future Jack Daniels fighting zombies. It is seriously crazy, and was so much fun to write I had to see a surgeon to remove the smile on my face when I finished it.

Timecaster hasn't found its audience yet. Penguin gave it a crappy cover and priced the ebook too high ($7.99), among other mistakes. Supersymmetry is so unlike anything else anyone has ever written it is almost unclassifiable, which will no doubt limit early sales. But ebooks are forever, and forever is a long time to find an audience. Maybe it will take years, and that's okay. I have years. And hopefully I'll have the rights back to Timecaster by then (I have world rights and am releasing it soon on Amazon.co.uk among other places) so I can price it to sell.

Please spread the word on the audiobooks, and on Supersymmetry. I'd love to see a future where all audiobook downloads are priced comparably to ebooks, and where authors are free to truly unleash their creativity on readers without having to kow-tow to the narrow-minded sales-driven biases of legacy publishers.

On realist approaches

Posted by Monique Lhussier

Whilst I was originally educated as a scientist (an engineer in biological processes), many years later, I wrote a PhD thesis in… Nomadology.

This is not only about the kind of nomadism that describes the life of Bedouins in North Africa. It’s also about a flexibility of the mind, which allows us to accept that all research paradigms have a point, but rejects the fact that any single one of them could provide answers for everything at all times. The approach is postmodern and offers perspectives that most, at best, consider iconoclastic. It is as far from science as one can go, but I found it liberating. My PhD journey was one of discovery and intellectual indulgence that we rarely have the opportunity to engage in. This, for me, is what working in academia is all about. In fact, my ambition in life is to reach a stage where I am paid to think and do little else…that unlikely dream is what keeps me interested. 

The hampter wheel career stage

After my PhD, I went through a hamster-on-the-wheel stage. Work needed to be done to attract funding, deliver, attract more funding and deliver some more, with little time to build some kind of cumulative knowledge. 

Then, in the past few years I discovered realist approaches (evaluation, synthesis), which are about building theories of understanding. Understanding of how things work, for whom and in what circumstances. The kind of theory that isn’t a million miles away from the realities of life, but explains it in a way we might not have thought about before. It talks about the way in which contexts interact with underlying mechanisms to produce favourable outcomes. 

I recently attended a seminar on realist approaches, where the presenter illustrated this beautifully. Imagine a tennis ball in a hand. On earth, if the hand releases its grip, the ball falls. The action of the opening hand is only the visible part of what made the ball fall, though, as it is gravity that attracts the ball to the floor. Take that hand in outer space and, when it opens, the ball floats. The same visible thing happened (hand opening), but gravity has ceased to work. Take that hand under water and the ball goes upwards, towards the water surface. Gravity still applies, but is outweighed by buoyancy. Take the same action in three different contexts, and it leads to three different outcomes. 

How relevant is this in public health? Unless we can understand what really happens as a result of a public health intervention, we have no chance of replicating its successes and avoiding its pitfalls. I am currently undertaking a realist synthesis. Existing theories provide me with potential ‘menu’ of forces that may, in isolation or combination, explain published outcomes in any given circumstances. We constantly operate a toing and froing from theories to published data, until we feel we have developed a comprehensive enough explanatory framework. This process forces us to step out of our normal modus operandus of understanding (engaging in some kind of nomadism), to develop a new area of knowledge that can readily be translated. 

That knowledge is also beginning to instil conceptual sense in many other things I have done – whilst unfortunately not all I do, I at last am being paid to think my way out of the wheel.

Happy birthday health economics, from public health!

Guest post from Cam Donaldson, Kenny Lawson, Helen Mason and Emma McIntosh

UK Health economics is 40 years old this year. Well, more accurately, the Health Economists’ Study Group is 40 years old. This is to be celebrated in itself – few areas of applied economics have been as successful in terms of sustainability and influence, as well as contributing significantly to our parent discipline of economics.

Ironically, health economics concepts can be traced back to Adam Smith’s pronouncements on public health:

“In some parts of Lancashire it is pretended, I have been told, that bread of oatmeal is a heartier food for labouring people than wheaten bread, and I have frequently heard the same doctrine held in Scotland. I am, however, somewhat doubtful of the truth of it. The common people of Scotland, who are fed with oatmeal, are in general neither so strong nor so handsome as the same rank of people in England, who are fed with wheaten bread. They neither work so well, nor look so well; and as there is not the same difference between people of fashion in the two countries, experience would seem to show that the food of the common people of Scotland is not so suitable to the human constitution as that of their neighbours of the same rank in England.”

We say ‘ironically’ because, despite the claimed successes of health economics and public health, growing health inequalities within nations remains an outstanding societal challenge, and one with significant health economic consequences. The main challenge, of course, is in devising effective and efficient interventions to reduce such inequalities. For health economics, the question then becomes one of whether our tools, which have been so successful to date, are up to the task of economic appraisal of public health interventions.

Indeed the dominant rubric of ‘cost per quality adjusted life year’ seems to present something of a moral dilemma for health economics when it comes to assessing public health interventions. The cost-per-QALY metric has served well the assessment of health technologies, but, amongst others, has the following limitation: all that is measured (and hence valued) are health gains for health care resources expended.

Public health economics: more than just cost-per-QALY?

On the cost side this is limiting, given that many public health interventions will, by their nature, be multi-sectoral, thus requiring more of a ‘societal approach’. Likewise, on the benefit side: although one may wish to assess the output of public health interventions in QALYs, what about other outcomes such as ‘improving life chances’ as well as enhancements in quality of housing and built environment, dignity, esteem and capabilities? Many community-based public health interventions also have spill over effects on their communities which need to be captured. The reductionism of the now-dominant health economics evaluation approach does not match what needs to be measured in evaluating public health. A broader and longer time horizon is required to fully capture all impacts.

This becomes a moral dilemma because, given that so many interventions previously evaluated by bodies such as NICE have been assessed using cost-per-QALY, should we permit others to be appraised via a broader societal approach which now takes these ‘other broader attributes’ into account?

There are two answers to this question. First, if the general scientific principle of working from ‘broad to specific’ were adhered to in health economics, no such moral dilemma would exist. We could start off our evaluations by thinking broadly and then either remain so or work to something more specific (e.g. cost per QALY) depending on the issue at hand. Just because health economics has come at this principle the wrong way round - specific to general - should that be allowed to limit our evaluations by leaving out the measurement of important potential impacts?

Secondly, and following on from this, a broader societal approach actually takes us back to the origins of economic evaluation, which was designed to:

“...identify relevant options for consideration; enumerate all costs and benefits to various relevant social groups; quantify as many as can be sensibly quantified; not assume the unquantified is unimportant; use discounting where relevant to derive present values; use sensitivity analysis to test the response of net benefits to changes in assumptions; and look at the distributive impact of the options”

So, public health has given health economics a birthday present - the opportunity to return to a societal perspective, which many, even in health economics itself, have been advocating for some time.

Hopefully, we can take advantage of this coming together of health economics and public health in measuring and valuing what is relevant and so implementing effective and efficient public health solutions to reduce health inequalities in the communities we all seek to serve.


Cam, Kenny, Helen and Emma run the Economics of Public Health blog, hosted by the Glasgow Centre for Population Health

Pitch para - Your Bed of Heather

A pitch paragraph for you this morning.


YOUR BED OF HEATHER by Lorraine Blencoe  – YA historical fiction


Lorraine’s pitch
paragraph:

This is an emotive and captivating story about a teenage
German boy during World War 2. He can see the world around him changing and one
day his father tells him he must leave their hometown, using false papers, and
disappear. The only way to do this without