Identifying factors likely to influence compliance with diagnostic imaging guideline recommendations for spine disorders among chiropractors in North America: a focus group study using the Theoretical Domains Framework

Background: The Theoretical Domains Framework (TDF) was developed to investigate determinants of specific clinical behaviors and inform the design of interventions to change professional behavior. This framework was used to explore the beliefs of chiropractors in an American Provider Network and two Canadian provinces about their adherence to evidence-based recommendations for spine radiography for uncomplicated back pain. The primary objective of the study was to identify chiropractors’ beliefs about managing uncomplicated back pain without xrays and to explore barriers and facilitators to implementing evidence-based recommendations on lumbar spine xrays. A secondary objective was to compare chiropractors in the United States and Canada on their beliefs regarding the use of spine x-rays. Methods: Six focus groups exploring beliefs about managing back pain without x-rays were conducted with a purposive sample. The interview guide was based upon the TDF. Focus groups were digitally recorded, transcribed verbatim, and analyzed by two independent assessors using thematic content analysis based on the TDF. Results: Five domains were identified as likely relevant. Key beliefs within these domains included the following: conflicting comments about the potential consequences of not ordering x-rays (risk of missing a pathology, avoiding adverse treatment effects, risks of litigation, determining the treatment plan, and using x-ray-driven techniques contrasted with perceived benefits of minimizing patient radiation exposure and reducing costs; beliefs about consequences); beliefs regarding professional autonomy, professional credibility, lack of standardization, and agreement with guidelines widely varied (social/professional role & identity); the influence of formal training, colleagues, and patients also appeared to be important factors (social influences); conflicting comments regarding levels of confidence and comfort in managing patients without x-rays (belief about capabilities); and guideline awareness and agreements (knowledge). Conclusions: Chiropractors’ use of diagnostic imaging appears to be influenced by a number of factors. Five key domains may be important considering the presence of conflicting beliefs, evidence of strong beliefs likely to impact the behavior of interest, and high frequency of beliefs. The results will inform the development of a theorybased survey to help identify potential targets for behavioral-change strategies

Higher Education and Society: A research report

This report draws on a substantial body of research undertaken by the Open University's Centre for Higher Education Research and Information (CHERI) on the changing relationships between higher education and society. Higher education currently faces many changes, some externally driven by government policies and changing patterns of social and economic demand and some internally driven by changes in the way knowledge is produced and organised within universities and other 'knowledge organisations'. CHERI examines these changes through empirical research which is policy relevant though not policy dictated, frequently international, and broadly focused on the social impacts of higher education. Does higher education make a difference and to whom? In their different ways, the articles in this report seek to provide answers to this important but difficult question

Re-conceptualising learning-centred (instructional) leadership: an obsolete concept in need of renovation

For more than thirty years, ‘instructional leadership’ has been at the forefront of research and practice in school effectiveness and improvement. Governments, employers, universities and professional developers, all see it as a mainstay of raising school and student performance. Wave-after-wave of educational policy reforms during this period have changed school environments, widening and deepening the (instructional) leadership roles and functions of principals and other school leaders. Terminology has changed – while Americans still use ‘instructional leadership’, others prefer ‘learning-centred’ and ‘leadership-for -learning’, disputing whether they encompass the same or different meanings. Yet curiously, the concept itself – as defined and measured by academic researchers and scholars - has changed relatively little since Hallinger and Murphy’s first seminal contribution in 1985. This paper argues the case for wholesale renovation of the concept if it is to maintain relevance going forward. The case is supported by important and powerful trends in policy and practice

Eye quietness and quiet eye in expert and novice golf performance: an electrooculographic analysis

Quiet eye (QE) is the final ocular fixation on the target of an action (e.g., the ball in golf putting). Camerabased eye-tracking studies have consistently found longer QE durations in experts than novices; however, mechanisms underlying QE are not known. To offer a new perspective we examined the feasibility of measuring the QE using electrooculography (EOG) and developed an index to assess ocular activity across time: eye quietness (EQ). Ten expert and ten novice golfers putted 60 balls to a 2.4 m distant hole. Horizontal EOG (2ms resolution) was recorded from two electrodes placed on the outer sides of the eyes. QE duration was measured using a EOG voltage threshold and comprised the sum of the pre-movement and post-movement initiation components. EQ was computed as the standard deviation of the EOG in 0.5 s bins from –4 to +2 s, relative to backswing initiation: lower values indicate less movement of the eyes, hence greater quietness. Finally, we measured club-ball address and swing durations. T-tests showed that total QE did not differ between groups (p = .31); however, experts had marginally shorter pre-movement QE (p = .08) and longer post-movement QE (p < .001) than novices. A group × time ANOVA revealed that experts had less EQ before backswing initiation and greater EQ after backswing initiation (p = .002). QE durations were inversely correlated with EQ from –1.5 to 1 s (rs = –.48 - –.90, ps = .03 - .001). Experts had longer swing durations than novices (p = .01) and, importantly, swing durations correlated positively with post-movement QE (r = .52, p = .02) and negatively with EQ from 0.5 to 1s (r = –.63, p = .003). This study demonstrates the feasibility of measuring ocular activity using EOG and validates EQ as an index of ocular activity. Its findings challenge the dominant perspective on QE and provide new evidence that expert-novice differences in ocular activity may reflect differences in the kinematics of how experts and novices execute skills

"They're Really PD Today": An Exploration of Mental Health Nursing Students' Perceptions of Developing a Therapeutic Relationship With Patients With a Diagnosis of Antisocial Personality Disorder

The therapeutic relationship is of particular importance when working with patients with antisocial personality disorder, but despite this, there is a paucity of literature exploring student nurses’ perceptions of developing a therapeutic relationship with such patients. Hence, this qualitative study explored the perceptions of second-year mental health nursing students of developing a therapeutic relationship with this patient group. Student nurses from a University in the Northwest of England participated in two focus groups, to compare the perceptions of a group of student nurses who had experience in secure settings (forensic hospital) with those who had not. Four key themes emerged: diagnosis, safety, engagement, and finally environmental influences. Both groups commented on looking beyond the diagnosis and seeing the person. The student nurses cited other staff in their clinical placement areas as hugely influential in terms of the development of their perceptions of patients with antisocial personality disorder and how to relate to them

Educational policy, policy appropriation and Grameen Bank higher education financial aid policy process

The paper talks about higher educational polices and their process of policy appropriations, policy as practices, policy as symbolic, policy as rituals, policy as myths, policy backward- mapping and policy-forward mapping, multi-stage policy implementation process, street-bureaucrats planners, and policy reform process. It critically looks at pros-and-corns of different educational policy theories and their applications in education, and the higher education student financial aid different policies, strategies and products and their impact on the college students. The paper also narrates the higher educational policies and methods of need-based, merit-based, means-test-based grants allocation and loan disbursement and their impact on student academic achievements. Moreover, it discusses the policy process model that has both agendas and multiple streams that consider looking at policy designing problems, solutions of the problems and their usefulness to SES students. Additionally, the paper narrates the Grameen Bank higher education student loan policy making process, although there is no higher education student financial aid services are not exist in Bangladesh. Literature reviews, conversations with higher education students, contextual analysis, and the author personal working experience incorporate here. The study finds for policy improvement, policy analysis is vital because policy analysis can explores usefulness of the policy for public well being and for effectiveness of the policy appropriation.Center for Social Economy Learning and Workplace, University of Toronto. -- York Center for Asia Research, York University. -- Indiana University Bloomington

Examining the Effectiveness of a Therapist Training on the Reflective Exploration of Parenting Interactions Tool

The current study seeks to explore the impact of a therapist training on the Reflective Exploration of Parenting Interactions Tool (REPIT, Verona, 2015), a clinical, therapist-guided exercise that aims to improve parent insight, and in turn, facilitate a decrease in parent-child conflict. The REPIT was created as a therapy exercise in which parents are guided through a series of 19 standardized questions that build their insight into their own internal processes regarding conflict with their child. Specifically, the reflection encourages exploration of how the parental internal processes impact the parent-child relationship and interact with the child thought processes to create parent-child conflict. The purpose of this study is to develop a therapist training for the REPIT and determine appropriate training components, maximizing therapist learning while balancing training efficiency. Experimental and control groups are used, with both groups completing a pre- and post-training declarative knowledge measure. The experimental group underwent a 3-hour interactive didactic workshop, and the control group did independent review of written materials only. The results suggest that both training methods were effective in demonstrating improvements in declarative knowledge of the REPIT, but that there were no significant differences in therapist proficiency between the training conditions. A primary limitation of the study was regarding construction of the outcome measure. Item analysis indicated that the items were low in difficulty, that some items did not discriminate low- and high-scorers adequately, and that not all of the items contributed to the overall test score significantly