The New England Award: A Case Study of the Context, Development, Implementation and Outcomes of the New England Award in its first two years

This was a case study of the context, development and implementation of the New England Award (NEA) and an evaluation of the outcomes in its first two years of operation. The NEA was introduced at the University of New England (UNE) in 2004 for on-campus students. Its primary aim was to support UNE's Graduate Attributes Policy through the promotion and recognition of extra-curricular achievement as a means by which the UNE graduate attributes may be developed. A secondary aim of the Award was to promote the special UNE on-campus experience. The objective of the study was to make a recommendation to the university administration about whether the program should continue to be funded beyond the initial pilot period. I was the leading figure in the establishment of the NEA and its first manager and as such played a pivotal role in its development and implementation. ... The study was essentially an interpretive one within the constructivist paradigm. Action research was chosen as the most effective methodology because of my close relationship with the subject of the study and the need for evaluation and change during its rapid development and implementation. The views were sought of ten groups of stakeholders selected according to their differing associations with the NEA. They were the first two cohorts of NEA graduates; NEA graduates one year after graduation; students who commenced the NEA but did not complete it; the providers of the extracurricular activities; senior university staff; employers of students; and student participants in one example of each of the three NEA activity categories of extracurricular learning and training; preparation for employment; and community contribution. Other data sources included an interview with the Vice-Chancellor of UNE plus student journals, related correspondence and meeting minutes, and my project diary. The final product of the study is a portfolio of work, the components of which vary in genre according to the intended audience and purpose of each

Binocular coordination of eye movements – Hering’s Law of equal innervation or uniocular control?

The neurophysiological basis for binocular control of eye movements in primates has been characterized by a scientific controversy that has its origin in the historical conflict of Hering and Helmholtz in the 19th century. This review focuses on two hypotheses, linked to that conflict, that seek to account for binocular coordination – Hering’s Law vs. uniocular control of each eye. In an effort to manage the length of the review, the focus is on extracellular single‐unit studies of premotor eye movement cells and extraocular motoneurons. In the latter half of the 20th century, these studies provided a wealth of neurophysiological data pertaining to the control of vergence and conjugate eye movements. The data were initially supportive of Hering’s Law. More recent data, however, have provided support for uniocular control of each eye consistent with Helmholtz’s original idea. The controversy is far from resolved. New anatomical descriptions of the disparate inputs to multiply and singly innervated extraocular muscle fibers challenge the concept of a ‘final common pathway’ as they suggest there may be separate groups of motoneurons involved in vergence and conjugate control of eye position. These data provide a new challenge for interpretation of uniocular premotor control networks and how they cooperate to produce coordinated eye movements.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/86996/1/j.1460-9568.2011.07695.x.pd

Health inequalities in European cities: perceptions and beliefs among local policymakers

Objective: To describe the knowledge and beliefs of public policymakers on social inequalities in health and policies to reduce them in cities from different parts of Europe during 2010 and 2011. Design: Phenomenological qualitative study. Setting: 13 European cities. Participants: 19 elected politicians and officers with a directive status from 13 European cities. Main outcome: Policymaker’s knowledge and beliefs. Results: Three emerging discourses were identified among the interviewees, depending on the city of the interviewee. Health inequalities were perceived by most policymakers as differences in life-expectancy between population with economic, social and geographical differences. Reducing health inequalities was a priority for the majority of cities which use surveys as sources of information to analyse these. Bureaucracy, funding and population beliefs were the main barriers. Conclusions: The majority of the interviewed policymakers gave an account of interventions focusing on the immediate determinants and aimed at modifying lifestyles and behaviours in the more disadvantaged classes. More funding should be put towards academic research on effective universal policies, evaluation of their impact and training policymakers and officers on health inequalities in city government

Towards improved decision support in the assessment and management of pain for people with dementia in hospital: a systematic meta-review and observational study

BackgroundPain and dementia are common in older people, and impaired cognitive abilities make it difficult for them to communicate their pain. Pain, if poorly managed, impairs health and well-being. Accurate pain assessment in this vulnerable group is challenging for hospital staff, but essential for appropriate management. Robust methods for identifying, assessing and managing pain are needed.Aims and objectivesTwo studies were undertaken to inform the development of a decision support tool to aid hospital staff in the recognition, assessment and management of pain. The first was a meta-review of systematic reviews of observational pain assessment instruments with three objectives: (1) to identify the tools available to assess pain in adults with dementia; (2) to identify in which settings they were used and with what patient populations; and (3) to assess their reliability, validity and clinical utility. The second was a multisite observational study in hospitals with four objectives: (1) to identify information currently used by clinicians when detecting and managing pain in patients with dementia; (2) to explore existing processes for detecting and managing pain in these patients; (3) to identify the role (actual/potential) of carers in this process; and (4) to explore the organisational context in which health professionals operate. Findings also informed development of health economics data collection forms to evaluate the implementation of a new decision support intervention in hospitals.MethodsFor the meta-review of systematic reviews, 12 databases were searched. Reviews of observational pain assessment instruments that provided psychometric data were included. Papers were quality assessed and data combined using narrative synthesis. The observational study used an ethnographic approach in 11 wards in four UK hospitals. This included non-participant observation of 31 patients, audits of patient records, semistructured interviews with 52 staff and four carers, informal conversations with staff and carers and analysis of ward documents and policies. Thematic analysis of the data was undertaken by the project team.ResultsData from eight systematic reviews including 28 tools were included in the meta-review. Most tools showed moderate to good reliability, but information about validity, feasibility and clinical utility was scarce. The observational study showed complex ward cultures and routines, with variations in time spent with patients, communication patterns and management practices. Carer involvement was rare. No pain decision support tools were observed in practice. Information about pain was elicited in different ways, at different times, by different health-care staff and recorded in separate documents. Individual staff made sense of patients’ pain by creating their own ‘overall picture’ from available information.LimitationsGrey literature and non-English-language papers were excluded from the meta-review. Sample sizes in the observational study were smaller than planned owing to poor documentation of patients’ dementia diagnoses, gatekeeping by staff and difficulties in gaining consent/assent. Many patients had no or geographically distant carers, or a spouse who was too unwell and/or reluctant to participate.ConclusionsNo single observational pain scale was clearly superior to any other. The traditional linear concept of pain being assessed, treated and reassessed by single individuals did not ‘fit’ with clinical reality. A new approach enabling effective communication among patients, carers and staff, centralised recording of pain-related information, and an extended range of pain management interventions is proposed [Pain And Dementia Decision Support (PADDS)]. This was not tested with users, but a follow-on study aims to codesign PADDS with carers and clinicians, then introduce education on staff/patient/carer communications and use of PADDS within a structured implementation plan. PADDS will need to be tested in differing ward contexts