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PurposeThe purpose of this paper is to explore the barriers that inhibit the development of female entrepreneurship in the West Midlands. This region is characterised by pronounced low levels of participation in higher education and entrepreneurship. With the support of funding from the Lifelong Learning Network (LLN), the paper contributes to a re‐evaluation of the current support available to women entrepreneurs and informs and aligns the provision of services to the needs of women across the region and beyond.Design/methodology/approachA study was commissioned by the LLN to identify the main barriers to female entrepreneurship in the Staffordshire, Telford & Wrekin and Shropshire areas. The main business support provision available to assist female entrepreneurs in June 2009 was mapped and these data were used in an online questionnaire to identify the level of awareness of this support provision amongst women in the target area, as part of the larger pilot study. An extensive online questionnaire consisting of 44 questions was designed in Version 1.82 of LimeSurvey, an open source PHP based survey tool. The survey was designed to capture information on the relationship between aspirations to start a business, demographic information, past experience of entrepreneurship, current skills levels, perceived barriers and knowledge of current business support provision.FindingsWhilst for many women accessibility to training was a major issue, an area of greater concern was found to be financial risk and the belief that women are less likely to start a business if they have a friend or family member with a business. The research findings suggested that even vicarious exposure to the pressures of running a business was a positive deterrent to entrepreneurship.Social implicationsThe research findings suggest that the mechanisms (business support agencies) through which information and support are provided to potential entrepreneurs needs to be reviewed. This preliminary research suggests that the existing infrastructure is inadequate and as business support is becoming more streamlined as a result of the public sector spending review, it could inform the nature and range of support provided to women entrepreneurs within the region and beyond.Originality/valueIn addition to contributing to development of strategy within the region, the authors feel that the research could have wider implication for regions with a similar economic profile to the West Midlands.

Abstract: Support of family is paramount to reducing the impact of highly stressful work on firefighters. Yet the degree of stress encountered by the family members, particularly spouses, resulting from ongoing job demands and exposure to traumatic situations is unclear. This qualitative study examined the effects of emergency service work on spouses of firefighters. While participants were highly supportive and proud of their spouse's work, they nevertheless encountered several challenges. Specific areas of challenge were (a) the effects of shift work on family life, (b) the transfer of firefighters' reactions to dangerous and traumatic events to family, and (c) the social atmosphere associated with the fire service. Suggestions for the development of support services for firefighters and their families are offered.

Patients with mental illness carry risk factors that predispose them to excess cardiovascular mortality from an acute myocardial infarction (AMI) compared to the general population. The aim of this study was to determine if patients with AMI and charted mental illness (CMI) received less reperfusion therapy following an AMI, compared to AMI patients without CMI in a recent sample population from Florida. A secondary analysis of data was conducted using the Florida Agency for Health Care Administration (FL-AHCA) hospital discharge registry. Adults hospitalized with an AMI from 01/01/2010 to 12/31/2015 were included for the analysis. The dependent variable was administration of reperfusion therapy (thrombolytic, percutaneous coronary intervention [PCI], and coronary artery bypass graft [CABG]), and the independent variable was the presence of CMI (depression, schizophrenia, and bipolar disorder). Multivariate logistic regression models were used to test the association controlling for age, gender, ethnicity, race, health insurance, and comorbidities. The database included 61,614 adults (31.3% women) hospitalized with AMI in Florida. The CMI population comprised of 1036 patients (1.7%) who were on average 5 years younger than non-CMI (60.2 ±12.8 versus 65.2 ±14.1; P < .001). Compared with patients without CMI, patients with CMI had higher proportions of women, governmental health insurance holders, and those with more comorbidities. The adjusted odds ratio indicated that patients with CMI were 30% less likely to receive reperfusion therapy compared with those without CMI (OR = 0.7; 95% CI = 0.6–0.8). Within the AMI population including those with and without CMI, women were 23% less likely to receive therapy than men; blacks were 26% less likely to receive reperfusion therapy than whites; and those holding government health insurances were between 20% and 40% less likely to receive reperfusion therapy than those with private health insurance. Patients with AMI and CMI were statistically significantly less likely to receive reperfusion therapy compared with patients without CMI. These findings highlight the need to implement AMI management care aimed to reduce disparities among medically vulnerable patients (those with CMI, women, blacks, and those with governmental health insurance).

Purpose
The purpose of this paper is to discuss a novel life cycle approach to education for sustainable development (ESD) where the students become "design thinkers".


Design/methodology/approach
A case study on the creation, development and utilisation of educational games by university students is presented. The paper discusses the case study in the context of Kolb's experiential learning and dynamic matching model, Perry's stages of intellectual development and Beech and Macintosh's processual learning model. The data used were from questionnaire feedback from the pupils who played the games and students who designed the games. Further qualitative feedback was collected from local schools involved in playing the games created by the students.


Findings
Overall, the students responded positively to the assessment and would like to see more of this type of assessment. They enjoyed the creativity involved and the process of developing the games. For the majority of the skill sets measured, most students found that their skills improved slightly. Many students felt that they had learnt a lot about effectively communicating science. The school children involved in playing the student-created games found them accessible with variable degrees of effectiveness as engaging learning tools dependent on the game.


Originality/value
This paper contributes a new approach to ESD which incorporates learner-centred arrangements within a full life cycle of game creation, delivery, playing and back to creation. The games can be used as a tool for enhancing knowledge and influencing behaviours in school children whilst enhancing ESD capacity in schools. The assessment also helps forge important links between the academic and local communities to enhance sustainable development.

OBJECTIVES: To more accurately determine coverage and timeliness of the second dose of measles-mumps-rubella vaccine (MMR2), while identifying factors associated with low MMR2 vaccination uptake among children in Saint Lucia. METHODS: A survey was conducted in October - November 2015 targeting children born in 2004 – 2009. At 86 preschools and primary schools, two children from each grade were randomly selected, yielding an effective sample of 836 children. Health records were reviewed to assess vaccination coverage and timeliness. Parents and/or guardians and principals of all 86 schools were interviewed regarding knowledge, attitudes, and practices related to vaccination. RESULTS: Of 767 children included, 75% were vaccinated with MMR2 (n = 572); 46.7% were vaccinated in a timely manner, i.e., by 5 years of age. Cohorts born in 2004, 2005, and 2008 reported the lowest proportion. 'Mothers as caregivers' was positively associated with timely MMR2 vaccination. Although 97% of principals surveyed considered vaccination important, 48.8% were not aware of national legislation requiring complete vaccination prior to school entry. Survey results concurred with the low MMR2 administrative coverage rates reported by Saint Lucia, much lower than the recommended 95%. CONCLUSIONS: Based on the results of this survey, Saint Lucia's national immunization program has lowered the age of MMR2 to 18 months in 2016, increased advocacy with schools to enforce the school-entry law, and is working to vaccinate the cohorts of children who have not received timely MMR2.