Developing clinical leadership: a co-operative inquiry approach to evaluate the benefits of an action learning set with nursing consultants in England.

Background: As three new Consultant nurses joined two established consultants on the staff of one District General Hospital in the south of England, it was believed that an action learning set (ALS) would offer peer support to enable them to succeed. The aim is to evaluate the lessons learned from the ALS focusing on their leadership. Methodology: Co-operative inquiry is a way of researching with rather than on people, of working with those who have similar interests and who wish to collectively understand their world and create new ways of exploring it. This approach helps also to learn how to change and enhance our working practices. With all active subjects fully involved as co-researchers in all research decisions, three cycles were completed of four phases of discussion, reflection, analysis and action. The process is planned to last for 18 months. Data were analysed thematically. Findings: Four themes began to emerge from the data: development of scholarship, responding to changing need, extending networks and empowerment in role. Whilst they had grown considerably in confidence in their leadership role, they did not feel that collectively they fully embraced the four dimensions prescribed by the Department of Health for the role. Nevertheless, the co-operative inquiry helped them realise how much they had gained from their collective learning in the group (ALS) and how, from the group they feel empowered to lead. Their reflections helped them value the importance of the role for the organisation, their credibility within the organisation and were keen to retain their peer support to ensure its sustainability. Conclusion: The outcomes of the co-operative inquiry included an enhanced understanding of the importance of openness and trust of each other and a willingness to share and learn from each other in a respectful and confidential environment with a receptiveness to change. References: Department of Health (1999) Making a Difference. Strengthening the Nursing, Midwifery and Health Visiting Contribution to Health and Healthcare. Department of Health, London. Drennan V. and Goodman C. (2011) Sustaining innovation in the healthcare workforce: A case study of community nurse consultant posts in England. BMC Health Services Research, 11:200 accessed from http://www.biomedcentral.com/1472-6963/11/200 on 23.1.15 Heron J. and Reason P. (2001) The Practice of Co-operative Inquiry: Research ‘with’ rather than ‘on’ People. In: Reason P. & Bradbury H. (2001) (Editors) Handbook of Action Research: Participative Inquiry & Practice. Chapter 16, Sage Publications, London Learning objectives: The learner will be able to : Understand the importance of action learning sets in supporting and empowering self and others in their clinical leadership. Recognise the value of a co-operative inquiry methodology to learn collaboratively from peers as clinical leaders to enhance their practice. Purpose of the presentation; The purpose of the presentation is to share the lessons learned from using a co-operative inquiry methodology to understand collaboratively and more fully the lessons learned from a year’s Action Learning Set focused on the leadership development for five non-medical consultants and nursing professor. Target audience for the presentation: The target audience is anticipated to be educationalists, senior nurses and nurse researchers. Key Words: Nurse leadership, co-operative inquiry, nurse consultant

Clinical leadership: evaluating the benefits of action learning using co-operative inquiry

Background: Developing clinical leadership, to ensure the culture of care is strengthened, is the thrust of the ‘leading with compassion’ campaign by the English National Health Service (NHS) (NHS England, 2014). Senior clinicians are charged with invigorating compassionate leadership yet the roles of nurse and therapist consultants the most senior clinical role in the UK healthcare system, are often solitary ones, in which they are expected to embrace a myriad of responsibilities and where there continues to be ambiguity about their role and scope of practice. In such exposed positions in any healthcare system from a global perspective, consultant nurses and therapists are vulnerable to the vagaries of the demands made upon them and the need to strive ever harder to improve the quality of services and patient care (McIntosh & Tolson 2008). Mentorship can be seen as a way of supporting clinicians, even on a global exchange system but a system (Buckner et al 2015) where the consultants can support themselves through action learning (McGill & Beaty 2001) reinforces their commitment to each other and to the potential benefit of their organisation. The aim is to evaluate the effectiveness of an action learning set (ALS) to enhance clinical leadership and extend their scope and confidence more strategically Methodology: Using an approach advocated by Heron & Reason (2001), co-operative inquiry is a way of researching with rather than on people, of working with those who have similar interests and who wish to collectively understand their world and create new ways of exploring it. This approach helps also to learn how to change and enhance our working practices. With all active subjects fully involved as co-researchers in all research decisions, three cycles have been completed of four phases of discussion of reflection, analysis and action. The process is planned to last for 18 months. Data were analysed thematically. Findings: Four themes began to emerge from the data: development of scholarship, responding to changing need, extending networks and empowerment in role. Whilst the consultants had grown considerably in confidence in their leadership role, they did not feel that collectively they fully embraced the four dimensions prescribed by the Department of Health for the role. Nevertheless, the co-operative inquiry helped them realise how much they had gained from their collective learning in the group (ALS) and how, from the group they feel empowered to lead. The ALS has enabled them to remain focused and reflect critically both personally and within the group. Their reflections helped them value the importance of the role for the organisation, their credibility within the organisation and they have been keen to retain their peer support to ensure its sustainability. Conclusion: Whilst their motivation to ‘make a difference’ remains palpable, the outcomes of the co-operative inquiry included an enhanced understanding of the importance of openness and trust of each other and a willingness to share and learn from each other in a respectful and confidential environment with a receptiveness to change. They believe that they are more aware of their influence on others and feel more able to challenge their medical colleagues with greater conviction and now have a recognised voice within the organisation. Clinical relevance: Time away from their clinical responsibilities to consider improvement of issues challenging these autonomous practitioners has proved invaluable to the improvement of their specialist services and enhanced the confidence of those new to role. Additionally, this collaboration has improved communication across the organisation, enhanced their strategic leadership capability and given confidence to disseminate externally. Key words: leadership, action learning, co-operative inquiry, Words: 569 3 Bullet points as to how your work contributes to knowledge development in the selected theme: • The value of action learning sets for consultant therapists using a co-operative inquiry approach can lead to further empower individuals to address the complex problems in practice and lead to change. • Co-operative inquiry has been a powerful tool to engage these senior consultants in a number of cycles of reflection and evaluation, researching with each other and experiencing first hand the value of the ALS to each of them individually. • Action learning sets can help senior clinicians, early on in their leadership role, take ownership of their complex problems and commit to each other by supporting their development of creative thinking and problem solving. References: Bell M., Coen E., Coyne-Nevin A., Egenton R., Ellis A. and Moran L. (2007) Experience of an action learning set. Practice Development in Health Care 6(4) 232-241. Buckner, E.B., Anderson D.J., Garzon, N., Hafsteinsdottir, T.B., Lai, C. and Roshan, R. (2014) Perspectives on global nursing leadership: international experiences from the field. International Nursing Review, 61, 463-471. Heron, J. & Reason, P. (2001) The Practice of Co-operative Inquiry: Research ‘with’ rather than ‘on’ People. In Reason, P. & Bradbury, H. (editor) Handbook of Action Research: Participative Inquiry & Practice, pp179 -188. Sage, London Jackson C. and Thurgate C. (2011) Action learning: maximising learning in the workplace. British Journal of Healthcare Assistants, 5(9), 454-456. McGill I. And Beaty L. (2001) Action Learning: A Guide for Professional, Management and Educational Development (2nd edition). London, Kogan Page. McIntosh J. and Tolson D. (2008) Leadership as part of the nurse consultant role; banging the drum for patient care. Journal of Clinical Nursing 18, 219-227. NHS England (2014) Building and Strengthening Leadership: Leading with Compassion. NHS England, Accessed at https://www.england.nhs.uk/wp-content/uploads/2014/12/london-nursing-accessible.pdf on 22.1.16 Young S., Nixon E., Hinge D., McFadyen J., Wright V., Lambert P., Pilkington C. and Newsome C. (2009) Action learning: a tool for the development of strategic skills for Nurse Consultants? Journal of Nursing Management, 18, 105-110

The consultant practitioner: an evolving role to meet changing NHS needs.

Since the introduction of the consultant practitioner role, with its huge variability in purpose and context, it has had to evolve in response to the changing needs of the NHS to achieve sustainability and transformation of services. AIM: This article reflects on the relevance of the consultant practitioner role and the impact of an action learning set in hastening its evolution in one NHS foundation trust. METHOD: From a process of collective critical reflection on their practice, six consultant practitioners analysed the impact they have had on influencing services and empowerment of their patients. Additionally, they have analysed the impact of an externally facilitated action learning set as a catalyst for change. RESULTS: All six consultant practitioners recognised that working together through the learning set enabled them to be more influential and effective. It encouraged them to share their experiences of continuous service improvement and crystalised their views on the impact they have had in delivering the organisation's vision. CONCLUSION: From their critical reflection, the six consultant practitioners acknowledged the influence of the action learning set on accelerating their confidence and competence to lead, and evaluating new models of care delivery at scale and pace. They recognised how far they have travelled in achieving the four dimensions of the role and ultimately their impact on their local sustainability and transformation plan (STP) and their trust's vision

Overview of C/C-SiC Composite Development for the Orion Launch Abort System

Past and present efforts by the authors to further understanding of the ceramic matrix composite (CMC) material used in the valve components of the Orion Launch Abort System (LAS) Attitude Control Motor (ACM) will be presented. The LAS is designed to quickly lift the Orion Crew Exploration Vehicle (CEV) away from its launch vehicle in emergency abort scenarios. The ACM is a solid rocket motor which utilizes eight throttleable nozzles to maintain proper orientation of the CEV during abort operations. Launch abort systems have not been available for use by NASA on manned launches since the last Apollo ]Saturn launch in 1975. The CMC material, carbon-carbon/silicon-carbide (C/C-SiC), is manufactured by Fiber Materials, Inc. and consists of a rigid 4-directional carbon-fiber tow weave reinforced with a mixed carbon plus SiC matrix. Several valve and full system (8-valve) static motor tests have been conducted by the motor vendor. The culmination of these tests was the successful flight test of the Orion LAS Pad Abort One (PA ]1) vehicle on May 6, 2010. Due to the fast pace of the LAS development program, NASA Marshall Space Flight Center assisted the LAS community by performing a series of material and component evaluations using fired hardware from valve and full ]system development motor tests, and from the PA-1 flight ACM motor. Information will be presented on the structure of the C/C-SiC material, as well as the efficacy of various non ]destructive evaluation (NDE) techniques, including but not limited to: radiography, computed tomography, nanofocus computed tomography, and X-ray transmission microscopy. Examinations of the microstructure of the material via scanning electron microscopy and energy dispersive spectroscopy will also be discussed. The findings resulting from the subject effort are assisting the LAS Project in risk assessments and in possible modifications to the final ACM operational design

Differential sensitivity of target genes to translational repression by miR-17~92

MicroRNAs (miRNAs) are thought to exert their functions by modulating the expression of hundreds of target genes and each to a small degree, but it remains unclear how small changes in hundreds of target genes are translated into the specific function of a miRNA. Here, we conducted an integrated analysis of transcriptome and translatome of primary B cells from mutant mice expressing miR-17~92 at three different levels to address this issue. We found that target genes exhibit differential sensitivity to miRNA suppression and that only a small fraction of target genes are actually suppressed by a given concentration of miRNA under physiological conditions. Transgenic expression and deletion of the same miRNA gene regulate largely distinct sets of target genes. miR-17~92 controls target gene expression mainly through translational repression and 5’UTR plays an important role in regulating target gene sensitivity to miRNA suppression. These findings provide molecular insights into a model in which miRNAs exert their specific functions through a small number of key target genesCX is a Pew Scholar in Biomedical Sciences. This study is supported by the PEW Charitable Trusts, Cancer Research Institute, National Institute of Health (R01AI087634, R01AI089854, RC1CA146299, R56AI110403, and R01AI121155 to CX), National Natural Science Foundation of China (31570882 to WHL, 31570883 to NX, 31570911 to GF, 91429301 to JH, 31671428 and 31500665 to YZ), 1000 Young Talents Program of China (K08008 to NX), 100 Talents Program of The Chinese Academy of Sciences (YZ), National Program on Key Basic Research Project of China (2016YFA0501900 to YZ), the Fundamental Research Funds for the Central Universities of China (20720150065 to NX and GF), Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (NRF-2015R1C1A1A01052387 to SGK, NRF-2016R1A4A1010115 to SGK and PHK), and 2016 Research Grant from Kangwon National University (SGK)

Marine climate and hydrography of the Coralline Crag (early Pliocene, UK): isotopic evidence from 16 benthic invertebrate taxa.

The taxonomic composition of the biota of the Coralline Crag Formation (early Pliocene, eastern England) provides conflicting evidence of seawater temperature during deposition, some taxa indicating cool temperate conditions by analogy with modern representatives or relatives, others warm temperate to subtropical/tropical conditions. Previous isotopic (δ18O) evidence of seasonal seafloor temperatures from serial ontogenetic sampling of bivalve mollusk shells indicated cool temperate winter (< 10 °C) and/or summer (< 20 °C) conditions but was limited to nine profiles from two species, one ranging into and one occurring exclusively in cool temperate settings at present. We supplement these results with six further profiles from the species concerned and supply seven more from three other taxa (two supposedly indicative of warm waters) to provide an expanded and more balanced database. We also supply isotopic temperature estimates from 81 spot and whole-shell samples from these five taxa and 11 others, encompassing ‘warm’, ‘cool’ and ‘eurythermal’ forms by analogy with modern representatives or relatives. Preservation tests show no shell alteration. Subject to reasonable assumptions about water δ18O, the shell δ18O data either strongly indicate or are at least consistent with cool temperate seafloor conditions. The subtropical/tropical conditions suggested by the presence of the bryozoan Metrarabdotos did not exist. Microgrowth-increment and δ13C evidence indicate summer water-column stratification during deposition of the Ramsholt Member, unlike in the adjacent southern North Sea at present (well mixed due to shallow depth and strong tidal currents). Summer maximum surface temperature was probably about 5 °C above seafloor temperature and thus often slightly higher than now (17–19 °C rather than 16–17 °C), but only sometimes in the warm temperate range. Winter minimum surface temperature was below 10 °C and possibly the same as at present (6–7 °C). An expanded surface temperature range compared to now may reflect withdrawal of oceanic heat supply in conjunction with higher global temperature.British Geological Survey (BUFI S157), NERC Isotope Geoscience Facilities (IP-1155- 1109

Population Attributable Fractions for Late Postnatal Mother-to-Child Transmission of HIV-1 in Sub-Saharan Africa

Assess population attributable fractions (PAFs) for late postnatal transmission (LPT) of human immunodeficiency virus-1 (HIV-1) in a cohort of HIV-1-exposed infants

Morbidity and Mortality Among a Cohort of Human Immunodeficiency Virus Type 1-Infected and Uninfected Pregnant Women and Their Infants From Malawi, Zambia, and Tanzania

Morbidity and mortality patterns among pregnant women and their infants (before antiretroviral therapy was widely available) determines HIV-1 diagnostic, monitoring, and care interventions

The Lost Library of Anne Conway

The philosopher Anne Conway (1631-1679) owned a large library, and her reading and book ownership shaped her intellectual life in distinctive ways. Until now, however, almost nothing has been known about the details of her reading or her book collection. Current scholarship assumes that her library, like that of her husband, the third Viscount Conway (c. 1623–1683), was lost or dispersed after her death. This article presents previously unrecognised evidence of Conway’s book ownership, and identifies, for the first time, the only books currently known to survive from her personal library. It traces their path to their current location in the Old Library of Jesus College, Cambridge, through the library of the soldier, book collector, and Cambridge Fellow Francis Sterling (c. 1652-1692). The article demonstrates that the newly identified books reveal previously unknown patterns of intellectual exchange amongst Conway’s family, and argues that they have significant implications for our understanding of her early intellectual development