Responsible management: Engaging moral reflexive practice through threshold concepts

YesIn this conceptual paper we argue that, to date, principles of responsible management have not impacted practice as anticipated because of a disconnect between knowledge and practice. This disconnect means that an awareness of ethical concerns, by itself, does not help students take personal responsibility for their actions. We suggest that an abstract knowledge of principles has to be supplemented by an engaged understanding of the responsibility of managers and leaders to actively challenge irresponsible practices. We argue that a form of moral reflexive practice drawing on an understanding of threshold concepts is central to responsible management, and provides a gateway to transformative learning. Our conceptual argument leads to implications for management and professional education

The implausibility of ‘usual care’ in an open system: sedation and weaning practices in Paediatric Intensive Care Units (PICUs) in the United Kingdom (UK)

Background: The power of the randomised controlled trial depends upon its capacity to operate in a closed system whereby the intervention is the only causal force acting upon the experimental group and absent in the control group, permitting a valid assessment of intervention efficacy. Conversely, clinical arenas are open systems where factors relating to context, resources, interpretation and actions of individuals will affect implementation and effectiveness of interventions. Consequently, the comparator (usual care) can be difficult to define and variable in multi-centre trials. Hence outcomes cannot be understood without considering usual care and factors that may affect implementation and impact on the intervention. Methods: Using a fieldwork approach, we describe PICU context, ‘usual’ practice in sedation and weaning from mechanical ventilation, and factors affecting implementation prior to designing a trial involving a sedation and ventilation weaning intervention. We collected data from 23 UK PICUs between June and November 2014 using observation, individual and multi-disciplinary group interviews with staff. Results: Pain and sedation practices were broadly similar in terms of drug usage and assessment tools. Sedation protocols linking assessment to appropriate titration of sedatives and sedation holds were rarely used (9 % and 4 % of PICUs respectively). Ventilator weaning was primarily a medical-led process with 39 % of PICUs engaging senior nurses in the process: weaning protocols were rarely used (9 % of PICUs). Weaning methods were variably based on clinician preference. No formal criteria or use of spontaneous breathing trials were used to test weaning readiness. Seventeen PICUs (74 %) had prior engagement in multi-centre trials, but limited research nurse availability. Barriers to previous trial implementation were intervention complexity, lack of belief in the evidence and inadequate training. Facilitating factors were senior staff buy-in and dedicated research nurse provision. Conclusions: We examined and identified contextual and organisational factors that may impact on the implementation of our intervention. We found usual practice relating to sedation, analgesia and ventilator weaning broadly similar, yet distinctively different from our proposed intervention, providing assurance in our ability to evaluate intervention effects. The data will enable us to develop an implementation plan; considering these factors we can more fully understand their impact on study outcomes

Individual leader to interdependent leadership: A case study in leadership development and tripartite evaluation

This article is available open access through the publisher’s website at the link below. Copyright @ 2013 Sage Publications.The Problem - In this case study we see a move away from orthodox views of school leadership as “headship” to a more contemporary model of educational leadership wherein we note a departure from functional, curricula-based school leadership toward more human resource development (HRD) approaches. The aim of this study was to consider the effectiveness of an educational development program for middle leaders within an educational establishment. The Solution - We examined the impact of a bespoke higher education leadership development intervention in Leadership (and Change) on the formation and cohesiveness of a newly formed innovative leadership structure. The Stakeholders - The leadership development intervention was designed through a tripartite collaboration including a university, senior school leaders, and staff. The intervention was designed to shift leadership from individual leader agency to interdependent human leadership agency. Through tripartite evaluation we uncover leadership development praxis that transcends the boundaries of conventional educational leadership and reemphasizes the benefits of bridging the academic/practitioner divide and the application of theory to praxis

Convention for the Protection of Cultural Property in the Event of Armed Conflict: 70th Anniversary Information Pack

Founded in 1996, today, the Blue Shield Movement works around the world to protect all types of threatened cultural heritage in conflict, but also in crisis, unrest, and following disaster. This anniversary is an opportunity to raise awareness about the Convention and its obligations, to push for ratification in countries which are not yet party to these vital laws, and to showcase the work and importance of the Blue Shield Movement as we reflect on 70 years of successes and challenges of the Convention, and look towards the future.This Information Pack is aimed at Blue Shield National Committees, but contains information anyone interested in the history of the Convention will find useful. It provides information about the 1954 Hague Convention and its Protocols – what they are, and why they matter? How are they linked to the Blue Shield? What are the obligations on States Parties to help protect heritage in conflict

Construction of the Sophia Observation withdrawal Symptoms-scale (SOS) for critically ill children

Objective: To construct a reliable and clinically practical instrument for monitoring opioids and benzodiazepine withdrawal symptoms in pediatric ICU patients. Design: Instrument development. Setting: Intensive care unit in an academic children's hospital. Patients and participants: 79 patients up to age 16 years on intravenous midazolam and/or opioids for ≥5 days. An expert panel of 85 physicians and nurses rated clinical relevance of withdrawal symptoms. Intervention: During drug weaning repeated observations were performed with a checklist of 24 withdrawal symptoms described in the literature. Measurements and results: For 76 children, 932 observations were obtained within 24 h after decrease and/or discontinuation of midazolam or opioids. Most frequent symptoms were tachypnea, agitation, motor disturbance, diarrhea, fever, anxiety, sleep disturbance and hypertension (14.6-29.6%). Multidimensional scaling (MDS) was performed to detect the underlying empirical structure of co-occurrences of symptoms. An expert panel judged clinical relevance of each withdrawal symptom on a four-point scale ranging from 'definitively so' to 'definitively not'. Agitation, an

Measurement of the Branching Fraction of the Decay B+→π+π−ℓ+νℓ\boldsymbol{B^{+}\to\pi^{+}\pi^{-}\ell^{+}\nu_\ell} in Fully Reconstructed Events at Belle

We present an analysis of the exclusive $B^{+}\to\pi^{+}\pi^{-}\ell^{+}\nu_{\ell}$ decay, where $\ell$ represents an electron or a muon, with the assumption of charge-conjugation symmetry and lepton universality. The analysis uses the full $\Upsilon(4S)$ data sample collected by the Belle detector, corresponding to 711 fb$^{-1}$ of integrated luminosity. We select the events by fully reconstructing one $B$ meson in hadronic decay modes, subsequently determining the properties of the other $B$ meson. We extract the signal yields using a binned maximum-likelihood fit to the missing-mass squared distribution in bins of the invariant mass of the two pions or the momentum transfer squared. We measure a total branching fraction of ${{\cal B}(B^{+}\to \pi^{+}\pi^{-}\ell^{+}\nu_{\ell})= [22.7 ^{+1.9}_{-1.6} (\mathrm{stat}) \pm 3.5(\mathrm{syst}) ]\times 10^{-5}}$, where the uncertainties are statistical and systematic, respectively. This result is the first reported measurement of this decay.Comment: 23 pages, 19 figure

Inclusive study of bottomonium production in association with an η\eta meson in e+e−e^+e^- annihilations near Υ(5S)\Upsilon(5S)

We study bottomonium production in association with an $\eta$ meson in $e^+e^-$ annihilations near the $\Upsilon(5S)$, at a center of mass energy of $\sqrt{s}=10.866\,$GeV. The results are based on the $121.4\,$fb$^{-1}$ data sample collected by the Belle experiment at the asymmetric energy KEKB collider. Only the $\eta$ meson is reconstructed and the missing-mass spectrum of $\eta$ candidates is investigated. We observe the $e^+e^-\to\eta\Upsilon_J(1D)$ process and find evidence for the $e^+e^-\to\eta\Upsilon(2S)$ process, while no significant signals of $\Upsilon(1S)$, $h_b(1P)$, nor $h_b(2P)$ are found. Cross sections for the studied processes are reported.Comment: Submitted to EPJ-

The Full Event Interpretation -- An exclusive tagging algorithm for the Belle II experiment

The Full Event Interpretation is presented: a new exclusive tagging algorithm used by the high-energy physics experiment Belle II. The experimental setup of Belle II allows the precise measurement of otherwise inaccessible $B$ meson decay-modes. The Full Event Interpretation algorithm enables many of these measurements. The algorithm relies on machine learning to automatically identify plausible $B$ meson decay chains based on the data recorded by the detector. Compared to similar algorithms employed by previous experiments, the Full Event Interpretation provides a greater efficiency, yielding a larger effective sample size usable in the measurement.Comment: 11 pages, 7 figures, 1 tabl