Stakeholder perspectives on new ways of delivering unscheduled health care: the role of ownership and organisational identity

<b>Rationale, aims and objectives</b>: To explore stakeholder perspectives of the implementation of a new, national integrated nurse-led telephone advice and consultation service (NHS 24), comparing the views of stakeholders from different health care organisations. <b>Methods</b>: Semi-structured interviews with 26 stakeholders including partner organisations located in primary and secondary unscheduled care settings (general practitioner (GP) out-of-hours co-operative; accident and emergency department; national ambulance service), members of NHS 24 and national policymakers. Attendance at key meetings, documentary review and email implementation diaries provided a contextual history of events with which interview data could be compared. <b>Results</b>: The contextual history of events highlighted a fast-paced implementation process, with little time for reflection. Key areas of partner concern were increasing workload, the clinical safety of nurse triage and the lack of communication across the organisations. Concerns were most apparent within the GP out-of-hours co-operative, leading to calls for the dissolution of the partnership. Accident and emergency and ambulance service responses were more conciliatory, suggesting that such problems were to be expected within the developmental phase of a new organisation. Further exploration of these responses highlighted the sense of ownership within the GP co-operative, with GPs having both financial and philosophical ownership of the co-operative. This was not apparent within the other two partner organisations, in particular the ambulance service, which operated on a regional model very similar to that of NHS 24. <b>Conclusions</b>: As the delivery of unscheduled primary health care crosses professional boundaries and locations, different organisations and professional groups must develop new ways of partnership working, developing trust and confidence in each other. The results of this study highlight, for the first time, the key importance of understanding the professional ownership and identity of individual organisations, in order to facilitate the most effective mechanisms to enable that partnership working

Developing reading-writing connections; the impact of explicit instruction of literary devices on the quality of children's narrative writing

The purpose of this collaborative schools-university study was to investigate how the explicit instruction of literary devices during designated literacy sessions could improve the quality of children's narrative writing. A guiding question for the study was: Can children's writing can be enhanced by teachers drawing attention to the literary devices used by professional writers or “mentor authors”? The study was conducted with 18 teachers, working as research partners in nine elementary schools over one school year. The research group explored ways of developing children as reflective authors, able to draft and redraft writing in response to peer and teacher feedback. Daily literacy sessions were complemented by weekly writing workshops where students engaged in authorial activity and experienced writers' perspectives and readers' demands (Harwayne, 1992; May, 2004). Methods for data collection included video recording of peer-peer and teacher-led group discussions and audio recording of teacher-child conferences. Samples of children's narrative writing were collected and a comparison was made between the quality of their independent writing at the beginning and end of the research period. The research group documented the importance of peer-peer and teacher-student discourse in the development of children's metalanguage and awareness of audience. The study suggests that reading, discussing, and evaluating mentor texts can have a positive impact on the quality of children's independent writing

Managerial coordination challenges in the alignment of capabilities and new subsidiary charters in MNEs

Subsidiary-level change requires the alignment of subsidiary charters and capabilities. Yet, the mechanisms through which the alignment of charters and capabilities unfolds are not yet well understood. In this paper, we investigate alignment from the perspective of managerial coordination. Drawing on a longitudinal study of a global IT firm, we identify three coordination mechanisms (charter-, experience-, and interaction-based coordination). By tracing the shifts in these coordination mechanisms over time and by specifying the implications of each mechanism for capability level change, we explain how managerial coordination influences alignment via subsidiary level capability change as well as alignment via the potential renegotiation of charters. This also allows us to provide new insights into situations of misalignment by explaining that particular mechanisms of coordination may become a source of decoupling between subsidiary actions and HQ mandates and may also result in capability level inertia. Moreover, while prior research has already acknowledged the role of interaction-based coordination for capability level change we show how and why such a mechanism of coordination emerges. ABSTRACT FROM AUTHO

Structure and composition of the incisor enamel of extant and fossil mammals with tooth pigmentation

The inclusion of iron compounds in teeth, which impart a red to orange colour to them, is a phenomenon shown by several groups of vertebrates in different periods of their evolution. Incisors from fossil and extant shrews and from extant rodents were sectioned and studied with the techniques of scanning electron microscopy (SEM), transmission electron microscopy (TEM) and scanning transmission electron microscopy (STEM) to compare their structure and the distribution of Fe. The enamel in white- and red-toothed soricids has three layers; two of them are divided into two zones in the red-toothed species. However, the most external layer varies among taxa; it is well defined in Sorex but difficult to identify in the Early Pleistocene genera Beremendia or Dolinasorex. In the arvicoline rodent Terricola, only two layers can be defined, the outer of which is divided into two zones depending on the presence or absence of Fe. The Fe proportions in the larger soricids reach up to 45%, but in rodents only up to 10% (weight % with respect to Fe + Ca + P). The STEM study shows that in a fossil soricid the Fe phases form clusters of nanometric particles of very poor crystalline oxides or hydroxides surrounding the apatite crystals that form the enamel

Detection of Potential Transit Signals in the First Three Quarters of Kepler Mission Data

We present the results of a search for potential transit signals in the first three quarters of photometry data acquired by the Kepler Mission. The targets of the search include 151,722 stars which were observed over the full interval and an additional 19,132 stars which were observed for only 1 or 2 quarters. From this set of targets we find a total of 5,392 detections which meet the Kepler detection criteria: those criteria are periodicity of the signal, an acceptable signal-to-noise ratio, and a composition test which rejects spurious detections which contain non-physical combinations of events. The detected signals are dominated by events with relatively low signal-to-noise ratio and by events with relatively short periods. The distribution of estimated transit depths appears to peak in the range between 40 and 100 parts per million, with a few detections down to fewer than 10 parts per million. The detected signals are compared to a set of known transit events in the Kepler field of view which were derived by a different method using a longer data interval; the comparison shows that the current search correctly identified 88.1% of the known events. A tabulation of the detected transit signals, examples which illustrate the analysis and detection process, a discussion of future plans and open, potentially fruitful, areas of further research are included

Neutrophil-derived alpha defensins control inflammation by inhibiting macrophage mRNA translation

Pathogenesis and treatment of chronic pulmonary disease

Plugging a hole and lightening the burden: A process evaluation of a practice education team

Aim: To investigate the perceptions of clinical and senior managers about the role of Practice Educators employed in one acute hospital in the UK. Background: Producing nurses who are fit for practice, purpose and academic award is a key issue for nurse education partnership providers in the UK. Various new models for practice learning support structures and new roles within health care institutions have been established. To sustain funding and policy support for these models, there is a need for evaluation research. Design: A process evaluation methodology was employed to determine the current value of a practice education team and to provide information to guide future direction. Methods: Data were collected through semi-structured telephone interviews using a previously designed schedule. All senior nurse managers (N=5) and a purposive sample of clinical managers (n=13) who had personal experience of and perceptions about the role of practice educators provided the data. Interview notes were transcribed, coded and a thematic framework devised to present the results. Results: A number of key themes emerged including: qualities needed for being a successful practice educator; visibility and presence of practice educators; providing a link with the university; ‘plugging a hole’ in supporting learning needs; providing relief to practitioners in dealing with ‘the burden of students’; alleviating the ‘plight of students’; and effects on student attrition. Conclusions: Findings provided evidence for the continued funding of the practice educator role with improvements to be made in dealing with stakeholder expectations and outcomes. Relevance to clinical practice: In the UK, there still remain concerns about the fitness for practice of newly registered nurses, prompting a recent national consultation by the professional regulating body. Despite fiscal pressures, recommendations for further strengthening of all systems that will support the quality of practice learning may continue to sustain practice learning support roles

Faculty members engaging in transformative PETE: a feminist perspective

The purpose of this study was to describe sport pedagogy faculty members’ (FMs) efforts at engaging in transformative physical education teacher education (T-PETE). T-PETE stresses the importance of FMs creating social change through their pedagogical approach and begins by asking preservice teachers (PTs) to reflect on their perspectives and practices (Tinning, 2017 Tinning, R. (2017). Transformative pedagogies and physical education. In C. Ennis (Ed.), The Routledge handbook of physical education pedagogies (pp. 295–306). New York: Taylor & Francis. [Google Scholar]. Transformative pedagogies and physical education. In C. Ennis (Ed.), The Routledge handbook of physical education pedagogies (pp. 295–306). New York: Taylor & Francis; Ukpokodu, 2009. The practice of transformative pedagogy. Journal on Excellence in College Teaching, 20(2), 43–67.). Participants were three white, female, able-bodied, lesbian/gay sport pedagogy FMs. The study was conducted in the United States. Feminist theory and feminist pedagogy drove data collection and analysis. Data were collected by employing a series of qualitative methods. An inductive and deductive analysis revealed that FMs had specific T-PETE goals, content, and pedagogies. Furthermore, several factors served to facilitate and limit the FMs’ effectiveness when engaging in T-PETE. The findings suggest that program-wide PETE reform is necessary in the United States for creating social change, and influencing PTs perspectives and practices. In addition, they suggest that American PETE programs might benefit from greater diversity among the FMs who staff them

Q^2 Dependence of the S_{11}(1535) Photocoupling and Evidence for a P-wave resonance in eta electroproduction

New cross sections for the reaction $ep \to e'\eta p$ are reported for total center of mass energy $W$=1.5--2.3 GeV and invariant squared momentum transfer $Q^2$=0.13--3.3 GeV$^2$. This large kinematic range allows extraction of new information about response functions, photocouplings, and $\eta N$ coupling strengths of baryon resonances. A sharp structure is seen at $W\sim$ 1.7 GeV. The shape of the differential cross section is indicative of the presence of a $P$-wave resonance that persists to high $Q^2$. Improved values are derived for the photon coupling amplitude for the $S_{11}$(1535) resonance. The new data greatly expands the $Q^2$ range covered and an interpretation of all data with a consistent parameterization is provided.Comment: 31 pages, 9 figure