85 research outputs found

    Networks and problem recognition::advancing the Multiple Streams Approach

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    The manuscript miscellany in early Stuart England : a study of British Library Manuscript Additional 22601 and related texts

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    PhDThis thesis is an intensive study of a manuscript miscellany dating from the early years of the reign of James VI and 1: British Library Manuscript Additional 22601. Compiled by someone who had close links to the court, but who was also likely to have been associated with the Inns of Court and possibly with the south-west of England, the miscellany contains verse (including that of King James) and prose in a wide range of genres, with a particular interest in the political culture of the period. My thesis provides a description of the manuscript's contents as a whole and then goes on to focus on texts from three specific genres: the letter, political prose, and poetry. Studying these individually and in their immediate context, it goes on to trace their appearance in a number of other contemporary miscellanies held in British and North American archives. The two primary contentions of the thesis are (1) that manuscript miscellanies need to be treated as coherent wholes, whose arrangement to some extent determines the meaning of the texts they contain and (2) that in the process of transmission from one manuscript to another texts and their meanings are significantly modified. The act of transcription is thus also an act of interpretation. Building on work by Peter Beal, Mary Hobbs, Harold Love, Henry Woudhuysen and others, the thesis aims to expand our understanding both of the culture of scribal publication and of the ways in which that culture engaged with the political, religious and literary life of the nation

    The challenges associated with using measures of ‘happiness’ for public policy purposes cannot be ignored by government

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    The growing acceptance of subjective wellbeing (or ‘happiness’) measures for public policy purposes has proved controversial. Ian Bache and Louise Reardon review the issues and argue that the extent to which this agenda has taken hold is overstated and concerns are mostly based on a particular (narrow) interpretation of the purpose of the wellbeing agenda

    Barriers and enablers to paramedicine research in Australasia – A cross-sectional survey

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    There has been exponential growth in paramedicine research activity and capacity over the last decade. With a strong academic culture emerging from its tertiary-based paramedicine education pathways, Australasia sits comfortably amongst the leading regions for paramedicine research. In the absence of clear paramedicine research priorities, there is concern that inadequate support infrastructure is in place to guide researchers, academics, paramedics, and policymakers within the profession to produce meaningful research capable of triggering change and advancement. The identification of paramedicine research priorities in Australasia, along with the barriers and enablers to research in this field, will prove invaluable to support the paramedicine profession, and improve healthcare systems, and patient outcomes in Australia and New Zealand. The study used a cross-sectional survey design which aimed to identify perceived barriers and enablers to the conduct of paramedicine research in Australasia and describe the demographic profiles and characteristics of respondents across professional, academic and research themes. Of the 341 respondents, 223 (65.4%) were male, 114 (33.4%) were female, and all geographical areas were represented. Approximately 60% of participants worked for a jurisdictional ambulance service in a clinical role. The median number of years of experience in paramedicine was 13 (IQR: 6, 24), with 52.8% having less than 15 years of experience. The analysis resulted in the identification of three themes for research barriers (system, process and human) and enablers, (work conditions, worker profile, and workplace). This study identifies the disconnect between stakeholders and the provision of resources such as funding, time, training, roles and data as major barriers to conducting paramedicine research. The ability or capacity of paramedics, as health professionals, to lead and undertake their own research was not questioned. The value of evidence-based research and autonomous paramedic-led research was identified as likely to empower future capacity within the profession

    Research agenda and priorities for Australian and New Zealand paramedicine : A Delphi consensus study

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    Introduction: The systematic development of a research agenda is essential for coordinated, collaborative, and efficient research endeavours in any discipline. The aim of this study was to create and prioritise a stakeholder-informed, consensus-derived paramedicine research agenda for Australia and New Zealand. Methods: The study utilised a modified Delphi consensus method consisting of three phases. Phase 1, the findings of which were previously published, consisted of a survey of Australian and New Zealand paramedicine stakeholders to inform the subsequent consensus process. Phase 2 contained three Delphi rounds involving key paramedicine profession stakeholders to generate a research agenda. Panellists were asked to rate their agreement with the inclusion of each item using a 5-point Likert scale. Consensus was defined as 80% agreement signalled by ‘Strongly Agree’ and ‘Agree’ responses. Phase 3 involved one additional round of voting to determine the importance and thus establish priorities amongst the final list of agenda items. Results: There were 341 responses to the survey in Phase 1 and thematic analysis produced a provisional agenda consisting of 109 perceived research priorities. Sixty-three key paramedicine profession stakeholders were invited to Phases 2 and 3, of which 56 (88.9%) completed all three rounds in Phase 2, and 43 (68.3%) completed the final Phase 3. Thirty-seven items achieved consensus and were subsequently prioritised constituting the final research agenda. Panellists gave the highest priority to ‘Paramedics role in broader healthcare system’, ‘New and emerging roles in for paramedics’, ‘Patient safety’, ‘System improvement’, and ‘Clinical reasoning processes and models’. Conclusion: Using a modified Delphi consensus method and drawing from a broad range of stakeholders, a 37-item Australian and New Zealand paramedicine research agenda with item prioritisation was developed. The agenda serves to inform industry and other key stakeholders to guide their research endeavours ultimately leading to meaningful and tangible impact within the paramedicine profession

    Development and refinement of patient care recommendations in brachytherapy for locally advanced cervical cancer using nominal group technique workshops

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    Purpose: Patient experiences of brachytherapy for locally advanced cervical cancer (LACC) are widely variable, with reports of difficult and traumatic experiences and aspects of care requiring improvement. The aim of this study was to develop patient care recommendations and consult with key stakeholders to review, refine and prioritise recommendations. Methods: Phase 1: Patient care recommendations were developed from qualitative exploratory study data. Phase 2: Service users and providers with recent experience of brachytherapy for LACC were recruited to online nominal group technique (NGT) workshops. Four NGT stages were followed: (1) initial voting and silent generation; (2) round robin; (3) clarification; and (4) prioritisation. Voting data were summed across the workshops, deriving inter-group scores. Qualitative data were analysed through content analysis. Results: Phase 1: Fifty-one patient care recommendations were developed. Phase 2: Thirteen participants took part in three online NGT workshops, with a combination of service users and providers. Initial recommendations were voted on; four new recommendations were added; minor changes were made and second voting was undertaken. Recommendations were positively received with 25 recommendations scoring maximum points from all participants. An importance score above 90% was given to 46 recommendations. The remaining recommendations received scores between 74 and 90%. Conclusions: NGT workshops facilitated collaboration between key stakeholders, discussing, refining and prioritising patient care recommendations, leading to verification of achievable and relevant recommendations. These provide a foundation for future development of guidelines and subsequent implementation into clinical practice, aiming to improve consistency of care and patient experiences of brachytherapy for LACC

    Commuting and wellbeing: A critical overview of the literature with implications for policy and future research

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    © 2019, © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This review provides a critical overview of what has been learnt about commuting’s impact on subjective wellbeing (SWB). It is structured around a conceptual model which assumes commuting can affect SWB over three time horizons: (i) during the journey; (ii) immediately after the journey; and (iii) over the longer term. Our assessment of the evidence shows that mood is lower during the commute than other daily activities and stress can be induced by congestion, crowding and unpredictability. People who walk or cycle to work are generally more satisfied with their commute than those who travel by car and especially those who use public transport. Satisfaction decreases with duration of commute, regardless of mode used, and increases when travelling with company. After the journey, evidence shows that the commute experience “spills over” into how people feel and perform at work and home. However, a consistent link between commuting and life satisfaction overall has not been established. The evidence suggests that commuters are generally successful in trading off the drawbacks of longer and more arduous commute journeys against the benefits they bring in relation to overall life satisfaction, but further research is required to understand the decision making involved. The evidence review points to six areas that warrant policy action and research: (i) enhancing the commute experience; (ii) increasing commute satisfaction; (iii) reducing the impacts of long duration commutes; (iv) meeting commuter preferences; (v) recognising flexibility and constraints in commuting routines and (vi) accounting for SWB impacts of commuting in policy making and appraisal

    Factors influencing implementation of digital cardiac rehabilitation: A qualitative analysis of health workers perspectives [version 1; peer review: 1 approved, 2 approved with reservations]

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    Background Despite growing evidence for the effectiveness of digital cardiac rehabilitation (CR) uptake of this technology remains low. Understanding the factors that influence implementation of digital CR in clinical practice is a growing area of research. The aim of this nested qualitative study was to explore health worker perspectives on factors influencing implementation of a digital CR programme. Methods Using convenience sampling, semi-structured interviews were conducted with health workers, including health care professionals (nurses, dietitians, physiotherapists) and those in administrative and managerial roles who were involved in delivering and referring patients to CroĂ­ MySlĂĄinte, a 12-week digital CR intervention delivered during the Coronavirus 2019 pandemic. The updated Consolidated Framework for Implementation Research (CFIR) guided data collection and framework analysis. Results Interviews were conducted with 14 health workers. Factors influencing implementation of CroĂ­ MySlĂĄinte were multiple, with some operating independently and others in combination. They related to: (i) characteristics of individuals (e.g., senior leadership support, commitment and motivation of Health workers to meet patient needs, technical capability, workload and perceived fit with role); (ii) features of the programme (e.g., accessibility and convenience for patients, the digital platform, patient self- monitoring tools, the multidisciplinary team and core components); (iii) the external environment (e.g., partnership and connections between organisations, broadband and COVID-19); (iv) the internal environment (e.g., organisational culture, teamwork, resources including funding, digital infrastructure and staffing); and (v) the implementation process (e.g., engaging patients through provision of technical support). Conclusion The study findings suggest that factors influencing implementation of digital CR operate at multiple levels. Therefore, multi-level implementation strategies are required if the true potential of digital health in improving equitable cardiac rehabilitation access, participation and patient outcomes is to be realised

    Organisational barriers to the facilitation of overseas volunteering and training placements in the NHS

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    Background Undertaking a period of voluntary work or a professional placement overseas has long been a feature of medical training in the UK. There are now a number of high profile National Health Service (NHS) initiatives aimed at increasing access to such opportunities for staff at all levels. We present findings from a qualitative study involving a range of NHS staff and other stakeholders which explored barriers to participation in these activities. Methods A grounded theory methodology was drawn upon to conduct thematic based analysis. Our data included in-depth, semi-structured interviews with a range of returned volunteers, non-volunteers and other stakeholders (n=51) who were, or had been, employed by the NHS. Results There are significant barriers to placement and volunteering activity stemming from structural and organisational shortcomings within the NHS. Difficulties in filling clinical roles has a significant impact on the ability of staff to plan and undertake independent placements. There is currently no clearly defined pathway within the NHS by which the majority of grades can apply for, or organise, a period of overseas voluntary or professional placement activity. There were divergent views on the relevance and usefulness of overseas professional placements. Conclusions We argue that in the context of current UK policy initiatives aimed at facilitating overseas volunteer and professional placement activity, urgent attention needs to be given to the structural and organisational framework within which such initiatives will be required to work
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