The benefits of interprofessional education 10 years on.

Interprofessional education (IPE) was first conceived in 1973 by a World Health Organization (WHO) expert group in Geneva. WHO member states were then charged with implementing medical education IPE pilot projects and from then to today there has a been a rapid proliferation in the number of publications on the subject. IPE has generated research into its use, conferences specific to IPE, organisations dedicated to it and policy championing it. The authors question whether there has been any major shift in the silos in which different professions might be working. The authors published an article on the benefits of IPE ( Illingworth and Chelvanayagam, 2007 ). Ten years have now passed and many changes have been implemented and experienced in health and social care and therefore a review of the literature is required. Also, it is 7 years since the publication of WHO's report outlining the role of IPE in the preparation of health professionals ( WHO, 2010 ) and, increasingly, UK Government policy champions collaborative and integrated working. The conclusions from the 2007 article acknowledged the development of IPE; however, it highlighted the need for empirical evidence to demonstrate the effectiveness of IPE in service user and carer outcomes. This article will explore whether IPE has achieved the benefits discussed in the previous article and what developments have occurred since it was published

Efficient Bayesian inference for COM-Poisson regression models

COM-Poisson regression is an increasingly popular model for count data. Its main advantage is that it permits to model separately the mean and the variance of the counts, thus allowing the same covariate to affect in different ways the average level and the variability of the response variable. A key limiting factor to the use of the COM-Poisson distribution is the calculation of the normalisation constant: its accurate evaluation can be time-consuming and is not always feasible. We circumvent this problem, in the context of estimating a Bayesian COM-Poisson regression, by resorting to the exchange algorithm, an MCMC method applicable to situations where the sampling model (likelihood) can only be computed up to a normalisation constant. The algorithm requires to draw from the sampling model, which in the case of the COM-Poisson distribution can be done efficiently using rejection sampling. We illustrate the method and the benefits of using a Bayesian COM-Poisson regression model, through a simulation and two real-world data sets with different levels of dispersion

Evaluation of seismic demand for substandard reinforced concrete structures

Background: Reinforced Concrete (RC) buildings with no seismic design exhibit degrading behaviour under severe seismic loading due to non-ductile brittle failure modes. The seismic performance of such substandard structures can be predicted using existing capacity demand diagram methods through the idealization of the non-linear capacity curve of the degrading system, and its comparison with a reduced earthquake demand spectrum. Objective: Modern non-linear static methods for derivation of capacity curves incorporate idealization assumptions that are too simplistic and do not apply for sub-standard buildings. The conventional idealisation procedures cannot maintain the true strength degradation behaviour of such structures in the post-peak part, and thus may lead to significant errors in seismic performance prediction especially in the cases of brittle failure modes dominating the response. Method: In order to increase the accuracy of the prediction, an alternative idealisation procedure using equivalent elastic perfectly plastic systems is proposed herein that can be used in conjunction with any capacity demand diagram method. Results: Moreover, the performance of this improved equivalent linearization procedure in predicting the response of an RC frame is assessed herein. Conclusion: This improved idealization procedure has been proven to reduce the error in the seismic performance prediction as compared to seismic shaking table test results [1] and will be further investigated probabilistically herein

Editors' introduction: neoliberalism and/as terror

The articles in this special issue are drawn from papers presented at a conference entitled “Neoliberalism and/as Terror”, held at the Nottingham Conference Centre at Nottingham Trent University by the Critical Terrorism Studies BISA Working Group (CSTWG) on 15-16 September 2014. The conference was supported by both a BISA workshop grant and supplementary funds from Nottingham Trent University’s Politics and International Relations Department and the Critical Studies on Terrorism journal. Papers presented at the conference aimed to extend research into the diverse linkages between neoliberalism and terrorism, including but extending beyond the contextualisation of pre-emptive counterterrorism technologies and privatised securities within relevant economic and ideological contexts. Thus, the conference sought also to stimulate research into the ways that neoliberalism could itself be understood as terrorism, asking - amongst other questions - whether populations are themselves terrorised by neoliberal policy. The articles presented in this special issue reflect the conference aims in bringing together research on the neoliberalisation of counterterrorism and on the terror of neoliberalism

Security (studies) and the limits of critique: why we should think through struggle

This paper addresses the political and epistemological stakes of knowledge production in post-structuralist Critical Security Studies. It opens a research agenda in which struggles against dominant regimes of power/knowledge are entry-points for analysis. Despite attempts to gain distance from the word ‘security’, through interrogation of wider practices and schemes of knowledge in which security practices are embedded, post-structuralist CSS too quickly reads security logics as determinative of modern/liberal forms of power and rule. At play is an unacknowledged ontological investment in ‘security’, structured by disciplinary commitments and policy discourse putatively critiqued. Through previous ethnographic research, we highlight how struggles over dispossession and oppression call the very frame of security into question, exposing violences inadmissible within that frame. Through the lens of security, the violence of wider strategies of containing and normalizing politics are rendered invisible, or a neutral backdrop against which security practices take place. Building on recent debates on critical security methods, we set out an agenda where struggle provokes an alternative mode of onto political investment in critical examination of power and order

Intelligence, reason of state and the art of governing risk and opportunity in early modern Europe

Drawing upon primary and secondary historical material, this paper explores the role of intelligence in early modern government. It focuses upon developments in seventeenth- and early-eighteenth-century England, a site-specific genealogical moment in the broader history of state power/knowledges. Addressing a tendency in Foucauldian work to neglect pre-eighteenth-century governance, the analysis reveals a set of interrelated processes which gave rise to an innovative technique for anticipating hazard and opportunity for the state. At the intersection of raison d’État, the evolving art of government, widespread routines of secrecy and a post-Westphalia field of European competition and exchange, intelligence was imagined as a fundamental solution to the concurrent problems of ensuring peace and stability while improving state forces. In the administrative offices of the English Secretary of State, an assemblage of complex and interrelated procedures sought to produce and manipulate information in ways which exposed both possible risks to the state and potential opportunities for expansion and gain. As this suggests, the art of intelligence played an important if largely unacknowledged role in the formation and growth of the early modern state. Ensuring strategic advantage over rivals, intelligence also limited the ability of England's neighbours to dominate trade, control the seas and master the colonies, functioning as a constitutive feature of European balance and equilibrium. As the analysis concludes, understanding intelligence as a form of governmental technique – a way of doing something – reveals an entirely novel way of thinking about and investigating its myriad (historical and contemporary) formations

An Exploration into Coach Experiences of the England DNA – A New Initiative Outlined by the Football Association

The current study has two main aims. Firstly, the predominant aim of this research is to identify the experiences of FA Skills coaches working within the EDNA framework. Secondly, this hopes to contribute to the understanding and knowledge of English coaches working at the foundation phase (ages 5-11) of participation by providing recommendations for future dissemination of the initiative. The main purposes of this study were researched using an Interpretive Description methodology, adopting semi-structured interviews to collect the findings. A total of nine participants (7 males, 2 females) were interviewed across four English County FA’s, located in three separate geographic regions. The semi-structured interviews were able to outline 6 main categories in the findings: 1) Being an FA Skills Coach; 2) Developmental Philosophy; 3) Embedding DNA within Sessions; 4) Impact of EDNA; 5) Benefits and Challenges of EDNA; 6) Future Enhancement. The main findings detailed how coaches regarded the initiative as a positive impact on coaching as it provided a vision and framework for coaches to follow. However, the participants also stated how CPD must become more accessible and relatable to a grassroots audience if it is to achieve ‘buy-in’. The core findings of this study provide an insight into coaches working full-time for The FA, with the responsibility of delivering the EDNA framework. This study has also highlighted areas that need greater focus in order to educate coaches on the benefits of the initiative. Future research must continue to establish English football coaches as a focal point if The FA is to improve the professional development of this cohort

Fatigue performance of flexible steel fibre reinforced rubberised concrete pavements

Recycled rubber particles and steel fibres from end-of-life tyres have the potential to enhance the flexibility and ductility of concrete pavements and produce more sustainable pavement solutions. However, the fatigue behaviour of such pavements is not fully understood. This article investigates the mechanical and fatigue performance of steel fibre reinforced concrete (SFRC) and steel fibre reinforced rubberised concrete (SFRRuC). Specimens tested were cast using rubber particles as replacement of natural aggregates (0%, 30% and 60% by volume), and using a blend of manufactured and recycled tyre steel fibres (40 kg/m3). Prisms were subjected to four-point flexural cyclic load (f = 15 Hz) at stress ratios of 0.5, 0.7, 0.8 and 0.9. The results show that, compared to plain concrete, the addition of steel fibres alone improves the fatigue stress resistance of concrete by 11% (at 25% probability of failure). The replacement of natural aggregates with rubber particles improves the flexibility of SFRRuC (from 51 GPa elastic modules for plain concrete to 13 GPa for SFRRuC), but reduces its fatigue stress resistance by 42% (at 25% probability of failure). However, a probabilistic analysis of the fatigue life data and overall design considerations show that the flexible SFRRuC can be used for pavements. To account for the effect of fatigue load, the Concrete Society approach included in TR34 is modified to account for SFRRuC pavements. Finite element analyses show that flexible SFRRuC pavements can accommodate large subgrade movements and settlements and result in much smaller cracks (up to 24 times) compared to SFRC pavements

Genotype Is Associated to the Degree of Virilization in Patients With Classic Congenital Adrenal Hyperplasia

Background: Molecular defects of CYP21A2 consistently decrease 21-hydroxylase activity and result in a variable expression of disease severity in patients with congenital adrenal hyperplasia (CAH).Aim: The genotype and biochemical findings were examined in an attempt to reveal any association to the degree of virilization in classic CAH patients.Methods: The study included 18 CAH patients with complete characterization of CYP21A2 mutations and were sorted based on the severity of the inherited mutations and the expected percentage of 21-hydroxylase enzyme activity.Results: Eleven out of the 18 patients manifested the SW form with the remaining seven exhibiting the SV form. The most frequent genetic defect in the classic salt-wasting (SW) and simple virilising (SV) forms was the IVS2-13A/C>G (36.1%) mutation, followed by delEX1-3 (19.4%) and p.Ile172Asn (19.4%). Four patients, who shared a combination of two mutations belonging to the most severe type, manifested only the SW form. Four out of five patients who shared homozygosity in the IVS2-13A/C>G mutation, demonstrated the SW form and only one demonstrated the SV form. All four patients who shared the p.Ile172Asn mutation, either in the homozygous or compound heterozygous state, manifested the SV form. Interestingly, a female neonate with SW, bearing the IVS2-13A/C>G/Large del, exhibited complete male virilisation (Prader 5). The remaining four affected female new-borns also exhibited the SW form, with two of them virilised as Prader 3 and the other two as Prader 4. Virilisation with clitoromegaly was also observed in one female, who presented premature adrenarche and carried the least severe p.Pro30Leu mutation.Conclusion: The frequency of the underlying mutations in our patients, with the classic form of CAH, varies but were quite similar to the ones reported in the Mediterranean region. Therefore, the identification of severe CYP21A2 defects in Cypriot patients and their comparison with the incidence and severity in different populations, will create a valuable diagnostic tool for genetic counseling in the classic form of CAH