Keeping the voice fit in the group fitness industry: a qualitative study to determine what instructors want in a voice education program

This study aimed to provide a descriptive summary of (1) group fitness instructors' (GFIs') experiences of occupational voice use and education, and (2) the content and mode of delivery desired by GFIs in an education and training program.This is a qualitative inductive approach using a semi-structured interview.Semi-structured interviews were conducted with eight GFIs recruited via self-selection sampling. Participants were asked to comment on their experiences of voice use, voice education, and their preferences for future education and training.Participants reported experiencing occupational voice difficulties, and cited inadequate voice education, faulty equipment, and apathetic fitness industry attitudes as core barriers to vocal health. Content focusing on vocal hygiene, safe occupational voice use, use of amplification equipment, and addressing industry attitudes to voice was desired by participants. A combination of face-to-face, web-based, and app-based delivery options was suggested.The data from this study should be considered when designing a vocal education and training package tailored to the needs of GFIs and the fitness industry

The Dark Side of Visionary Leadership in Strategy Implementation:Strategic Alignment, Strategic Consensus, and Commitment

Drawing from visionary leadership and strategy process research, we theorize and test the mechanism through which middle and lower-level managers’ visionary leadership affects their teams’ strategic commitment. The management literature extols the virtues of visionary leadership. In contrast to this positive stance, we reveal a dark side to visionary leadership. Our theoretical framework suggests that team manager visionary leadership harms team strategic consensus when the manager is not strategically aligned with the CEO, which in turn diminishes team commitment to the strategy. In contrast, when a team manager is strategically aligned with the CEO, team manager visionary leadership is positively related to team strategic consensus and subsequently to team strategic commitment. Data from 136 teams from two organizations support our moderated mediation model. A supplemental analysis of the content of strategic consensus and additional qualitative interviews with managers and employees in one of these organizations provide additional insights concerning the meaning of the theorized relations in practice

Revisiting Lynam's notion of the "fledgling psychopath": are HIA-CP children truly psychopathic-like?

<p>Abstract</p> <p>Background</p> <p>In his developmental model of emerging psychopathy, Lynam proposed that the "fledgling psychopath" is most likely to be located within a subgroup of children elevated in both hyperactivity/inattention/impulsivity (HIA) and conduct problems (CP). This approach has garnered some empirical support. However, the extent to which Lynam's model captures children who resemble psychopathy with regard to the core affective and interpersonal features remains unclear.</p> <p>Methods</p> <p>In the present study, we investigated this issue within a large community sample of youth (<it>N </it>= 617). Four groups (non-HIA-CP, HIA-only, CP-only, and HIA-CP), defined on the basis of teacher reports of the Strengths and Difficulties Questionnaire (SDQ), were compared with respect to parent-reported psychopathic-like traits and subjective emotional reactivity in response to unpleasant, emotionally-laden pictures from the International Affective Pictures System (IAPS).</p> <p>Results</p> <p>Results did not support Lynam's model. HIA-CP children did not appear most psychopathic-like on dimensions of callous-unemotional and narcissistic personality, nor did they report reduced emotional reactivity to the IAPS relative to the other children. Post-hoc regression analyses revealed a significant moderation such that elevated HIA weakened the association between CP and emotional underarousal.</p> <p>Conclusions</p> <p>Implications of these findings with regard to the development of psychopathy are discussed.</p

High performing hospitals: a qualitative systematic review of associated factors and practical strategies for improvement.

BACKGROUND: High performing hospitals attain excellence across multiple measures of performance and multiple departments. Studying high performing hospitals can be valuable if factors associated with high performance can be identified and applied. Factors leading to high performance are complex and an exclusive quantitative approach may fail to identify richly descriptive or relevant contextual factors. The objective of this study was to undertake a systematic review of qualitative literature to identify methods used to identify high performing hospitals, the factors associated with high performers, and practical strategies for improvement. METHODS: Methods used to collect and summarise the evidence contributing to this review followed the 'enhancing transparency in reporting the synthesis of qualitative research' protocol. Peer reviewed studies were identified through Medline, Embase and Cinahl (Jan 2000-Feb 2014) using specified key words, subject terms, and medical subject headings. Eligible studies required the use of a quantitative method to identify high performing hospitals, and qualitative methods or tools to identify factors associated with high performing hospitals or hospital departments. Title, abstract, and full text screening was undertaken by four reviewers, and inter-rater reliability statistics were calculated for each review phase. Risk of bias was assessed. Following data extraction, thematic syntheses identified contextual factors important for explaining success. Practical strategies for achieving high performance were then mapped against the identified themes. RESULTS: A total of 19 studies from a possible 11,428 were included in the review. A range of process, output, outcome and other indicators were used to identify high performing hospitals. Seven themes representing factors associated with high performance (and 25 sub-themes) emerged from the thematic syntheses: positive organisational culture, senior management support, effective performance monitoring, building and maintaining a proficient workforce, effective leaders across the organisation, expertise-driven practice, and interdisciplinary teamwork. Fifty six practical strategies for achieving high performance were catalogued. CONCLUSIONS: This review provides insights into methods used to identify high performing hospitals, and yields ideas about the factors important for success. It highlights the need to advance approaches for understanding what constitutes high performance and how to harness factors associated with high performance

Coccolithophore ecology in the tropical and subtropical Atlantic Ocean: New perspectives from the Atlantic Meridional Transect (AMT) programme

Coccolithophore species composition was determined in 199 samples collected from the upper 300 m of the Atlantic Ocean, spanning temperate, tropical and subtropical waters in both hemispheres during four Atlantic Meridional Transect (AMT) cruises over the period 2003 to 2005. Of the 171 taxa observed, 140 consistently represented less than 5% of total cell numbers, and were classed as rare. Multivariate statistical techniques were used on the common taxa to assess variability in community composition vertically in the water column, horizontally across hydrographic provinces (subtropical gyres, equatorial waters, temperate waters), and temporally between cruises. Sharper gradients of statistical dissimilarity in species composition occurred vertically over a few tens of metres than horizontally over hundreds of kilometres. Three floral groups were identified from analysis of the depth of normalised abundance maxima in the subtropical gyres and equatorial waters: the upper euphotic zone (UEZ, >10% surface irradiance); the lower euphotic zone (LEZ, 10-1% surface irradiance); and the sub-euphotic zone (SEZ, <1% surface irradiance). The LEZ includes the deep chlorophyll maximum (DCM) and nutricline, and was characterised by species such as Emiliania huxleyi and Gephyrocapsa ericsonii which were also abundant at higher latitudes. It is suggested that this pattern reflects similarities in the light (and inorganic nutrient) conditions between the LEZ and temperate waters. The SEZ is below the depth where light is thought to be sufficient to support photosynthesis, suggesting that deep-dwelling species such as Florisphaera profunda and Gladiolithus spp. may be mixotrophic or phagotrophic, although conclusive proof will need to be gained experimentally. Mixotrophy could also be an important nutritional strategy for species abundant (Umbellosphaera spp., holococcolithophores) in the UEZ where inorganic nutrient concentrations are depleted and limiting to growth, although other nutritional strategies, such as the use of organic nutrients, are also possible. Statistical differences were also found in the species composition between the different cruises, with high levels of similarity for similar timed cruises (May or September-October). Few individual taxa showed significant variability in abundance over the time-span of sampling, except species such as E. huxleyi and G. ericsonii at higher latitudes. In subtropical and equatorial waters, high levels of species richness and low levels of species dominance remained throughout the sampling period indicating that seasonal fluctuations reflected differences in the whole coccolithophore community rather than in just one or a few species. Multivariate analyses of the taxa classified as rare also indicated some level of temporal, as well as vertical, zonation. Such insights into coccolithophore ecology and community composition provide important new perspectives that require innovative research to fully understand their impact on ocean biogeochemistry

Carbapenem resistance expressed by Gram-negative bacilli isolated from a cohort of Libyan patients

Background and objectives: Carbapenem-resistant Enterobacteriaceae (CRE) and other Gram-negative bacteria are among the most common pathogens responsible for both community and hospital acquired infection. The global spread of cephalosporinases in Enterobacteriaceae has led to the increased use of carbapenems resulting in the emergence and rapid spread of CRE. This has become an alarming public health concern, yet the condition in Libya remains unclear. The aim of this study was to obtain a better understanding of CRE strains prevalent in Libyan patients by investigating their phenotypic characteristics and antibiograms. Methods: Gram-negative bacterial species were collected from Misrata Central Hospital, Misrata Cancer Centre and Privet Pathology Laboratories. Clinical samples and swabs were obtained from hospitalised and non-hospitalised patients and from mechanical ventilation and suction machines. Patients who had received antibiotic therapy for at least three days prior to the study were excluded. The identification and characterization of the isolated species were achieved using the growth characteristics on MacConkey and blood agar, spot tests and API 20E or API 20NE biochemical testing systems. Screening for carbapenem resistance was performed using the disk diffusion method with carbapenem 10 μg and cephalosporin 30 μg disks and minimum inhibitory concentrations (MIC) determined using the Sensititre Gram-negative Xtra plate format (GNX2F). All strains demonstrating resistance or reduced susceptibility to one of the four carbapenems were subjected to carbapenememase activity detection using the RAPIDEC CARBA NP test, Modified Hodge test and carbapenem inactivation methods. Results: A total of one hundred and forty isolates representing fourteen bacterial species were isolated from 140 non-duplicated specimens. Clinical specimens included urine samples (96/140, 68.57%), sputum (15/140, 10.71%), surgical wound swabs (18/140, 12.85%), foot swabs from diabetes mellitus (DM) patients (6/140, 4.29%), ear swabs (3/140, 2.14%) and wound swabs (2/140, 1.43%). Thirty-four (24.29%) isolates demonstrated resistance to at least one of the four carbapenems with Klebsiella pneumoniae representing 73.53% (25 isolates) of all carbapenem resistant species, followed by 8.82% for Pseudomonas aeruginosa (3 isolates), 5.88% for both Proteus mirabilis (2 isolates) and Escherichia coli (2 isolates) and 2.94% for both Citrobacter koseri (1 isolate) and Rahnella aquatilis (1 isolate). The other isolates were either susceptible or cephalosporinase producers. Conclusion: This study has revealed the high rate of carbapenem resistance amongst Libyan patients and emphasizes the crucial need for accurate screening, identification and susceptibility testing to prevent further spread of nosocomial and community acquired resistance. This may be achieved through the establishment of antibiotic stewardship programmes along with firm infection control practices.National Research Foundation of South Africa; Libyan GovernmentWeb of Scienc

Exploring UK medical school differences: the MedDifs study of selection, teaching, student and F1 perceptions, postgraduate outcomes and fitness to practise.

BACKGROUND: Medical schools differ, particularly in their teaching, but it is unclear whether such differences matter, although influential claims are often made. The Medical School Differences (MedDifs) study brings together a wide range of measures of UK medical schools, including postgraduate performance, fitness to practise issues, specialty choice, preparedness, satisfaction, teaching styles, entry criteria and institutional factors. METHOD: Aggregated data were collected for 50 measures across 29 UK medical schools. Data include institutional history (e.g. rate of production of hospital and GP specialists in the past), curricular influences (e.g. PBL schools, spend per student, staff-student ratio), selection measures (e.g. entry grades), teaching and assessment (e.g. traditional vs PBL, specialty teaching, self-regulated learning), student satisfaction, Foundation selection scores, Foundation satisfaction, postgraduate examination performance and fitness to practise (postgraduate progression, GMC sanctions). Six specialties (General Practice, Psychiatry, Anaesthetics, Obstetrics and Gynaecology, Internal Medicine, Surgery) were examined in more detail. RESULTS: Medical school differences are stable across time (median alpha = 0.835). The 50 measures were highly correlated, 395 (32.2%) of 1225 correlations being significant with p < 0.05, and 201 (16.4%) reached a Tukey-adjusted criterion of p < 0.0025. Problem-based learning (PBL) schools differ on many measures, including lower performance on postgraduate assessments. While these are in part explained by lower entry grades, a surprising finding is that schools such as PBL schools which reported greater student satisfaction with feedback also showed lower performance at postgraduate examinations. More medical school teaching of psychiatry, surgery and anaesthetics did not result in more specialist trainees. Schools that taught more general practice did have more graduates entering GP training, but those graduates performed less well in MRCGP examinations, the negative correlation resulting from numbers of GP trainees and exam outcomes being affected both by non-traditional teaching and by greater historical production of GPs. Postgraduate exam outcomes were also higher in schools with more self-regulated learning, but lower in larger medical schools. A path model for 29 measures found a complex causal nexus, most measures causing or being caused by other measures. Postgraduate exam performance was influenced by earlier attainment, at entry to Foundation and entry to medical school (the so-called academic backbone), and by self-regulated learning. Foundation measures of satisfaction, including preparedness, had no subsequent influence on outcomes. Fitness to practise issues were more frequent in schools producing more male graduates and more GPs. CONCLUSIONS: Medical schools differ in large numbers of ways that are causally interconnected. Differences between schools in postgraduate examination performance, training problems and GMC sanctions have important implications for the quality of patient care and patient safety

The Analysis of Teaching of Medical Schools (AToMS) survey: an analysis of 47,258 timetabled teaching events in 25 UK medical schools relating to timing, duration, teaching formats, teaching content, and problem-based learning.

BACKGROUND: What subjects UK medical schools teach, what ways they teach subjects, and how much they teach those subjects is unclear. Whether teaching differences matter is a separate, important question. This study provides a detailed picture of timetabled undergraduate teaching activity at 25 UK medical schools, particularly in relation to problem-based learning (PBL). METHOD: The Analysis of Teaching of Medical Schools (AToMS) survey used detailed timetables provided by 25 schools with standard 5-year courses. Timetabled teaching events were coded in terms of course year, duration, teaching format, and teaching content. Ten schools used PBL. Teaching times from timetables were validated against two other studies that had assessed GP teaching and lecture, seminar, and tutorial times. RESULTS: A total of 47,258 timetabled teaching events in the academic year 2014/2015 were analysed, including SSCs (student-selected components) and elective studies. A typical UK medical student receives 3960 timetabled hours of teaching during their 5-year course. There was a clear difference between the initial 2 years which mostly contained basic medical science content and the later 3 years which mostly consisted of clinical teaching, although some clinical teaching occurs in the first 2 years. Medical schools differed in duration, format, and content of teaching. Two main factors underlay most of the variation between schools, Traditional vs PBL teaching and Structured vs Unstructured teaching. A curriculum map comparing medical schools was constructed using those factors. PBL schools differed on a number of measures, having more PBL teaching time, fewer lectures, more GP teaching, less surgery, less formal teaching of basic science, and more sessions with unspecified content. DISCUSSION: UK medical schools differ in both format and content of teaching. PBL and non-PBL schools clearly differ, albeit with substantial variation within groups, and overlap in the middle. The important question of whether differences in teaching matter in terms of outcomes is analysed in a companion study (MedDifs) which examines how teaching differences relate to university infrastructure, entry requirements, student perceptions, and outcomes in Foundation Programme and postgraduate training