Changing practice to support self-management and recovery in mental illness: application of an implementation model

Author Version made available in accordance with the publisher's policyHealth services introducing practice changes need effective implementation methods. Within the setting of a community mental health service offering recovery-oriented psychosocial support for people with mental illness, we aimed to (a) identify a well-founded implementation model and (b) assess its practical usefulness in introducing a new program for recovery-oriented self-management support. We reviewed the literature to identify implementation models applicable to community mental health, and having corresponding measurement tools. We used one of these models to inform organisational change strategies. The literature review showed few models with corresponding tools. The Promoting Action on Research Implementation in Health Services (PARIHS) model and the related Organizational Readiness to Change Assessment (ORCA) tool were used. PARIHS proposes prerequisites for health service change and the ORCA measures the extent to which these prerequisites are present. Application of the ORCA at two time points during implementation of the new program showed strategy-related gains for some prerequisites but not for others, reflecting observed implementation progress. Additional strategies to address target prerequisites could be drawn from the PARIHS model. The PARIHS model and ORCA tool have potential in designing and monitoring practice change strategies in community mental health. Further practical use and testing of implementation models appears justified in overcoming barriers to change

Winning and losing in the creative industries: an analysis of creative graduates' career opportunities across creative disciplines

Following earlier work looking at overall career difficulties and low economic rewards faced by graduates in creative disciplines, the paper takes a closer look into the different career patterns and economic performance of “Bohemian” graduates across different creative disciplines. While it is widely acknowledged in the literature that careers in the creative field tend to be unstructured, often relying on part-time work and low wages, our knowledge of how these characteristics differ across the creative industries and occupational sectors is very limited. The paper explores the different trajectory and career patterns experienced by graduates in different creative disciplinary fields and their ability to enter creative occupations. Data from the Higher Education Statistical Agency (HESA) are presented, articulating a complex picture of the reality of finding a creative occupation for creative graduates. While students of some disciplines struggle to find full-time work in the creative economy, for others full-time occupation is the norm. Geography plays a crucial role also in offering graduates opportunities in creative occupations and higher salaries. The findings are contextualised in the New Labour cultural policy framework and conclusions are drawn on whether the creative industries policy construct has hidden a very problematic reality of winners and losers in the creative economy

Greening Capitalism? A Marxist Critique of Carbon Markets

Climate change is increasingly being recognized as a serious threat to dominant modes of social organization, inspiring suggestions that capitalism itself needs to be transformed if we are to ‘decarbonize’ the global economy. Since the Kyoto Protocol in 1997, carbon markets have emerged as the main politico-economic tools in global efforts to address climate change. Newell and Paterson (2010) have recently claimed that the embrace of carbon markets by financial and political elites constitutes a possible first step towards the transformation of current modes of capitalist organization into a new form of greener, more sustainable ‘climate capitalism.’ In this paper, we argue that the institutionalization of carbon markets does not, in fact, represent a move towards the radical transformation of capitalism, but is better understood as the most recent expression of ongoing trends of ecological commodification and expropriation, driving familiar processes of uneven and crisis-prone development. In this paper, we review four critical Marxist concepts: metabolic rift (Foster, 1999), capitalism as world ecology (Moore, 2011a), uneven development and accumulation through dispossession (Harvey, 2003, 2006), and sub-imperialism (Marini, 1972, 1977), developing a framework for a Marxist analysis of carbon markets. Our analysis shows that carbon markets form part of a longer historical development of global capitalism and its relation to nature. Carbon markets, we argue, serve as creative new modes of accumulation, but are unlikely to transform capitalist dynamics in ways that might foster a more sustainable global economy. Our analysis also elucidates, in particular, the role that carbon markets play in exacerbating uneven development within the Global South, as elites in emerging economies leverage carbon market financing to pursue new strategies of sub-imperial expansion. </jats:p

A Socio-Technical and Co-Evolutionary Framework for Reducing Human-Related Risks in Cyber Security and Cybercrime Ecosystems

The focus on cyber security as an interaction between technical elements and humans has typically confined consideration of the latter to practical issues of implementation, conventionally those of `human performance factors' of vigilance etc., 'raising awareness' and/or 'incentivization' of people and organizations to participate and adapt their behavior. But this is far too narrow a view that seriously constrains the ability of cyber security as a whole to adapt and evolve to keep up with adaptive, innovative attackers in a rapidly-changing technological, business and social landscape, in which personal preferences of users are also dynamically evolving. While there is isolated research across different research areas, we noticed the lack of a \emph{holistic} framework combining a range of applicable theoretical concepts (e.g., cultural co-evolution such as technological arms races, opportunity management, behavioral and business models) and technological solutions on reducing human-related risks in the cyber security and cybercrime ecosystems, which involve multiple groups of human actors including offenders, victims, preventers and promoters. This paper reports our ongoing work in developing such a socio-technical framework 1) to allow a more comprehensive understanding of human-related risks within cyber security and cybercrime ecosystems and 2) to support the design of more effective approaches to engaging individuals and organizations in the reduction of such risks. We are in the process of instantiating this framework to encourage behavioral changes in two use cases that capture diverse and complicated socio-technical interactions in cyber-physical systems

Implementation of a knowledge mobilization model to prevent peripheral venous catheter-related adverse events: PREBACP study-a multicenter cluster-randomized trial protocol.

BACKGROUND: Peripheral venous catheters are the most commonly used invasive devices in hospitals worldwide. Patients can experience multiple adverse events during the insertion, maintenance, and management of these devices. Health professionals aim to resolve the challenges of care variability in the use of peripheral venous catheter through adherence to clinical practice guidelines. The aim of this cluster-randomized controlled trial is to determine the efficacy of a multimodal intervention on incidence of adverse events associated with the use of peripheral venous catheters in adult hospital patients. Additional aims are to analyze the fidelity of nurses and the relationship between contextual factors on the use of best available and the outcomes of the intervention. METHODS: Five public hospitals in the Spanish National Health System, with diverse profiles, including one university hospital and four second-level hospitals, will be included. In total, 20 hospitalization wards will be randomized for this study by ward to one of two groups. Those in the first group receive an intervention that lasts 12 months implementing evidence-based practice in healthcare related to peripheral catheters through a multimodal strategy, which will contain updated and poster protocols insertion, maintenance and removal of peripheral venous catheters, technologies applied to e-learning, feedback on the results, user and family information related to peripheral catheter, and facilitation of the best evidence by face-to-face training session. PRIMARY OUTCOME MEASURES: Incidence of adverse events associated with the use of peripheral venous catheters is measured by assessing hospital records. SECONDARY OUTCOME MEASURES: Nurses' adherence to clinical practice guidelines, clinical outcomes, and the cost of implementing the multimodal intervention. DISCUSSION: Clinical implementation is a complex, multifaceted phenomenon which requires a deep understanding of decision-making, knowledge mobilization, and sense making in routine clinical practice. Likewise, the inclusion of strategies that promote fidelity to recommendations through multicomponent and multimodal intervention must be encouraged. The use of a transfer model could counterbalance one of the greatest challenges for organizations, the evaluation of the impact of the implementation of evidence in the professional context through quality indicators associated with prevention and control of infections. TRIAL REGISTRATION: Current Controlled Trials ISRCTN10438530 . Registered 20 March 2018

Europe and the political: from axiological monism to pluralistic dialogism

“The political” represents a moment in which actors recognise autonomy and equality as constitutive values in the agonistic search for appropriate open-ended political outcomes. The tutelary, pedagogical and disciplinary practices of the depoliticised European Union (EU) undermine the foundations of equality in diplomatic and political engagement between continental actors. The relationship becomes axiological, where issues are deemed to have been resolved through some sort of anterior pre-political arrangement. This is a type of ahistorical political monism that ultimately claims to speak for all of Europe. The return of “the political” allows a more generous and pluralistic politics to emerge based on genuine dialogical foundations in which self and other engage as equals and are mutually transformed by that engagement

At the Crossroads of Sustainability: The Natural Recompositioning of Architecture

It is widely acknowledged that the mantra of sustainability has triggered a fundamental reversal in the core of design practice: If the original purpose of architecture was to protect humans from the destructive actions of nature,today it should protect nature from the damaging actions of humans. But sustainable design is far from being a coherent body of fully totalized ideas:it has a broad spectrum of disputing interpretations that oscillate between the deterministic models of energy control and technological efficiencies, and the moralistic and romantic approaches that attempt to see in nature and natural processes a fundamental way to de-escalate the global urban footprint and its associated patterns of consumption. However, mainstream green design has been evolving by progressively absorbing the narrative of deep ecology. Nature has been being integrated into architecture literally, by inserting vegetation onto buildings; digitally, by bringing environmental data into the design process (climate records, wind streams, sun rotation and air flows are computed, modelled and effectually shape architectures), and transcendentally, by claiming that sustainable architecture nurtures “the existing and evolving connections between spiritual and material consciousness.” The acknowledgement of the inexorable affiliation between architecture and the environment is, of course, not exactly new. What is distinctive today is the reification of the role of nature in architecture as an ideological stance, now totally intertwined with state-of-art data processing and the market-driven tools brought by Natural Capitalism. This paper will examine emblematic “green” buildings produced by leading architects such as Pelli Clarke Pelli, William McDonough, Stefano Boeri, Norman Foster and BIG in the light of Tim Morton’s, Slavoj Zizek and Bruno Latour’s critique of nature. It will illustrate how, despite being able to successfully forge new creative freedoms by exploring hybridizations between the domains of design and science, sustainability’s self-righteous “naturalistic” narrative is enabling a vision of the architect as an “expert manager” focused on producing projects of ecologic “beautification” while assumed to be “saving the world,” effectively depoliticizing the architectural practice. Nevertheless, these examples attest that there is a vast and fertile field of ideas to be explored and in this regard it is important to underline that we are still in the embryonic outset of the engagement of architecture with sustainability

A necessary practice parameter: Nursing and Midwifery Board of Australia Midwife standards for practice

Introduction: The NMBA Development of Midwife standards for practice project has reviewed the National competency standards for the midwife (Nursing and Midwifery Board Australia, 2006) to inform the drafting of Midwife standards for practice. Midwife standards for practice set out the expectations of the midwife’s practice and inform midwifery education accreditation standards, the regulation of midwives and determination of the midwife’s capability for practice. The Standards guide consumers, employers and other stakeholders on what to reasonably expect from a midwife regardless of the area of practice or the years of experience. Aim: Present the research and consultation outcomes that have informed the development of the current draft Midwife standards for practice. Methods: The methods in this three phase study include literature and evidence reviews, interviews, consultations, surveys and observations of midwives practice. Unike clinical guidelines the knowledge to inform standards for practice is not discrete and bounded by specific sets of information with technical solutions. The current relevant evidence has been integrated with the knowledge, experiences and views of midwives across Australia who practice in various jurisdictions, sectors and models of care as well as in clinical and non-clinical roles as well as consumers and individuals who represent professional, government and regulatory authorities. Results: Midwifery practice in this project is apparent as the promotion of health and wellbeing in relation to childbearing, with inherent responsibilities and accountabilities for safety and quality that occurs in the context of respectful collaborative relationships. The current draft Standards acknowledge the involvement of others while clearly positioning midwifery practice as focused on the needs of the woman. Conclusion and implications: The final project phase will test these draft standards through a second round of observations of midwives practicing in clinical and non-clinical settings to ensure that the standards reflect current (not aspirational) evidence-based midwifery practice, are up-to-date, meet legislative requirements and align with the other NMBA standards for practice