From what we know to what we do : enhancing absorptive capacity in translational health research

Background Globally, evidence about what works is slow to translate into frontline healthcare delivery. As a response, government policy has focused on translational health initiatives, such as the National Institute for Health Research funded Applied Research Collaborations in England. Concepts from organisation science prove useful to support such translational initiatives. We critique the application of two organisation science concepts linked to the broad domain of what is commonly termed ‘knowledge mobilisation’ in healthcare settings, specifically ‘knowledge brokers’ and ‘absorptive capacity’, to provide lessons for leaders of translational initiatives. Results The presence of knowledge brokers to ‘move from what we know to what we do’ in healthcare delivery appears necessary but insufficient to have a system level effect. To embed knowledge brokers in the wider healthcare system so they draw on various sources of evidence to discharge their role with greatest effect, we encourage leaders of translational health research initiatives to take account of the concept of absorptive capacity (ACAP) from the organisation science literature. Leaders should focus on enhancing ACAP though development of ‘co-ordination capabilities’. Such co-ordination capability should aim not just to acquire different types of evidence, but to ensure that all types of evidence are used to develop, implement and scale up healthcare delivery that best benefits patients. Specific co-ordination capabilities that support translation of evidence are: clinician involvement in research and its implementation; patient and public involvement in research and its implementation; business intelligence structures and processes at organisational and system level. Conclusion Attention to the dimensions and antecedents of ACAP, alongside the implementation of the knowledge brokering solution, in translational health research initiatives, is likely to better ensure the latter’s success

The capacity of health service commissioners to use evidence: a case study

Clinical Commissioning Groups (CCGs) lead a network of organisations that plan and make decisions about what services to provide through the NHS. By examining decision-making about service interventions designed to reduce potentially avoidable elderly care admissions into acute hospitals, our study explores the capacity of CCG-led commissioning networks to make decisions that are based on evidence. Empirically, we study 13 cases of representative (region, size, urban/rural) commissioning networks in England, drawing on interviews with commissioning managers, general practitioners (GPs), patient and public involvement (PPI) representatives and other relevant stakeholders. CCGs can not only draw on evidence about what is most clinically effective or cost-effective, but can also consider patient experience and local knowledge held by doctors. However, the inclusion of GPs and PPI representatives is limited, so the local knowledge of doctors and the patient experience are not considered as fully as they might be in commissioning decisions. CCGs can use government agencies, such as commissioning support units, that provide external information about local population and existing service provision, but they fail to do so adequately. The voluntary sector can play a key role in providing local knowledge about individual patients and their needs. Finally, given the need for health and social care organisations to collaborate to support older people so that they do not experience potentially avoidable admissions to acute hospitals, there is a need for organisations to develop joint evidence-based strategies and work together in real time to exchange information. From our research, in collaboration with a PPI reference group, a self-assessment questionnaire for CCG-led commissioning networks was developed, which allows CCGs to assess and develop their capacity to acquire and use different types of evidence in their decision-making.questionnaire for CCG-led commissioning networks was developed, which allows CCGs to assess and develop their capacity to acquire and use different types of evidence in their decision-making

Applying event system theory to organizational change : the importance of everyday positive and negative events

Decades of research have examined how employees experience organizational-level change events (e.g., “the merger”). However, employees can also experience “everyday change events” that occur at the individual-level as the change becomes routinized for their jobs. That is, individuals can react to organizational change events that are occurring at different hierarchical levels. Drawing on event system theory, we argue that employees’ commitment to the organizational-level change event can shape how employees anticipate and experience subsequent everyday change events. These negative and positive everyday change events can impact (a) how employees engage with their work, impacting their performance and (b) whether employees perceive that they are fairly treated, impacting their subsequent evaluations of organizational-level change. Our hypotheses were generally supported in a field sample in which employees were surveyed immediately after a merger was announced, participated in a daily diary study as the merger was implemented, and completed a second survey 2 weeks after the diary study. By applying event system theory to organizational change, we provide important theoretical and practical insights, including how an organizational-level event can exert top-down direct effects by impacting how employees anticipate and experience change on an everyday basis as well as how everyday negative and positive change events can subsequently impact employees’ commitment to the organizational-level change, creating bottom-up direct effects. We also illuminate the importance of considering the frequency and strength of both negative and positive events to understand what it is about everyday negative and positive events that has implications for employees and organizations

What seals the I-deal? Exploring the role of employees' behaviours and managers' emotions

Idiosyncratic deals (I-deals) are work arrangements between an employee and a manager, aimed at meeting the employee's specific work-related needs (Rousseau, I-deals: Idiosyncratic deals employees bargain for themselves, M. E. Sharpe, New York, NY). Studies to date have focused on the effects of successful I-deal negotiations, but have paid little attention to what determines whether negotiated I-deals are also obtained. We propose that managers play a crucial role in this process, and explore the role of managers' emotions in translating negotiation into obtainment. We suggest that I-deals are more likely to be obtained when managers feel more positive and less negative about an employee's I-deal process in the aftermath of the negotiation. We then aim to determine what shapes managers' emotions about the I-deal process. Given that I-deals are intended to be beneficial for the entire team (Rousseau, I-deals: Idiosyncratic deals employees bargain for themselves, M. E. Sharpe, New York, NY), we expect that managers feel more positive about the I-deal process of employees who engage in socially connecting behaviours following their I-deal negotiation. In contrast, managers feel more negative about the I-deal process of employees who engage in socially disconnecting behaviours. Results from a two-wave study of employees and their managers supported our hypotheses. Our findings contribute to research on I-deals by distinguishing between the negotiation and obtainment of I-deals and by highlighting the role of managers' emotions in translating negotiated I-deals into obtainment and the importance of employees' socially connecting and disconnecting behaviours following I-deal negotiations. Practitioner points: I-deals are individually negotiated work agreements between an employee and an employer about parts of their jobs or specific tasks. Previous research has predominantly focused on the negotiation of I-deals. Yet, negotiated I-deals may not always materialize. How managers feel about the I-deal process of employees in the aftermath of the negotiation is a crucial factor in translating successfully negotiated I-deals into obtained I-deals. When managers feel more positive and less negative about the I-deal process, they are more likely to facilitate the obtainment of employees' deals. Because I-deals are supposed to benefit the entire team, managers' emotions about the I-deal process are influenced by employees' behaviours following the negotiation. Managers are likely to feel more positive about an employee's I-deal process if he/she displays socially connecting behaviours and more negative when the employee disconnects from others in the aftermath of I-deal negotiations.</p

Automated analysis of slow crack growth in hydrous soda-lime silicate glasses

To explore the impact of ambient and structural water on static fatigue, the initiation and growth of 3279 Vickers induced median radial cracks were automatically recorded and analyzed. We find that humidity is more efficient in initiating cracks and promoting their growth than water, which is dissolved in the glass structure. In particular for slow crack growth (< 3 × 10−6 m s−1), tests in dry nitrogen showed a considerable decrease in the crack growth exponent with increasing water content of the glasses. On the other hand, if tests were performed in humid air, the crack growth exponent was independent of the water content of the hydrous glasses, while stress intensity decreased slightly. These observations indicate that water promotes the processes at the crack-tip regardless of its origin. However, ambient water is more efficient

Automated Analysis of Slow Crack Growth in Hydrous Soda-Lime Silicate Glasses

To explore the impact of ambient and structural water on static fatigue, the initiation and growth of 3279 Vickers induced median radial cracks were automatically recorded and analyzed. We find that humidity is more efficient in initiating cracks and promoting their growth than water, which is dissolved in the glass structure. In particular for slow crack growth (< 3 × 10–6 m s–1), tests in dry nitrogen showed a considerable decrease in the crack growth exponent with increasing water content of the glasses. On the other hand, if tests were performed in humid air, the crack growth exponent was independent of the water content of the hydrous glasses, while stress intensity decreased slightly. These observations indicate that water promotes the processes at the crack-tip regardless of its origin. However, ambient water is more efficient

Water in Alkali Aluminosilicate Glasses

To understand the influence of water and alkalis on aluminosilicate glasses, three polymerized glasses with varying ratios of Na/K were synthesized [(22. 5-x)Na2O-xK2O-22.5 Al2O3-55 SiO2 with x = 0, 7.5, and 11.25]. Subsequently, these glasses were hydrated (up to 8 wt% H2O) in an internally heated gas pressure vessel. The density of hydrous glasses linearly decreased with water content above 1 wt%, consistent with the partial molar volume of H2O of 12 cm3/mol. Near-infrared spectroscopy revealed that hydroxyl groups are the dominant species at water content of &lt;4 wt%, and molecular water becomes dominating at water content of &gt;5 wt%. The fraction of OH is particularly high in the pure Na-bearing glass compared to the mixed alkali glasses. 27Al magic angle spinning-NMR spectroscopy shows that aluminum is exclusively fourfold coordinated with some variations in the local geometry. It appears that the local structure around Al becomes more ordered with increasing K/Na ratio. The incorporation of H2O reinforces this effect. The differential thermal analysis of hydrous glasses shows a significant mass loss in the range of glass transition already during the first upscan, implying the high mobility of water in the glasses. This observation can be explained by the open structure of the aluminosilicate network and by the low dissociation enthalpy of H2O in the glasses (≈ 8 kJ/mol). The effect of the dissolved H2O on the glass transition temperature is less pronounced than for other aluminosilicate glasses, probably because of the large fraction of Al in the glasses. © Copyright © 2020 Balzer, Behrens, Waurischk, Reinsch, Müller, Kiefer, Deubener and Fechtelkord

Deconcentrating regulation in low- and middle-income country health systems: a proposed ambidextrous solution to problems with professional regulation for doctors and nurses in Kenya and Uganda

Background: Regulation can improve professional practice and patient care but is often weakly implemented and enforced in health systems in Low- and Middle-Income Countries (LMICs). Taking a de-centred and frontline perspective, we examine national regulatory actors’ and health professionals’ views and experiences of health professional regulation in Kenya and Uganda and discuss how it might be improved in LMICs more generally. Methods: We conducted large-scale research on professional regulation for doctors and nurses (including midwives) in Uganda and Kenya during 2019-2021. We interviewed 29 national regulatory stakeholders and 47 sub-national regulatory actors, doctors, and nurses. We then ran a national survey of Kenyan and Ugandan doctors and nurses, which received 3466 responses. We thematically analysed qualitative data, conducted an exploratory factor analysis of survey data, and validated findings in four focus group discussions. Results: Kenyan and Ugandan regulators were generally perceived as resource-constrained, remote, and out of touch with health professionals. This resulted in weak regulation that did little to prevent malpractice and inadequate professional education and training. However, interviewees were positive about online licencing and regulation where they had relationships with accessible regulators. Building on these positive findings, we propose an ambidextrous approach to improving regulation in LMIC health systems, which we term deconcentrating regulation. This involves developing online licencing and streamlining regulatory administration to make efficiency savings, freeing regulatory resources. These resources should then be used to develop connected subnational regulatory offices, enhance relations between regulators and health professionals, and address problems at local level. Conclusion: Professional regulation for doctors and nurses in Kenya and Uganda is generally perceived as weak. Yet these professionals are more positive about online licencing and regulation where they have relationships with regulators. Building on these positive findings, we propose deconcentrating regulation as a solution to regulatory problems in LMICs. However, we note resource, cultural and political barriers to its effective implementation

Improved temporal contrast of streak camera measurements with periodic shadowing

Periodic shadowing, a concept used in spectroscopy for stray light reduction, has been implemented to improve the temporal contrast of streak camera imaging. The capabilities of this technique are first proven by imaging elastically scattered picosecond laser pulses and are further applied to fluorescence lifetime imaging, where more accurate descriptions of fluorescence decay curves were observed. This all-optical approach can be adapted to various streak camera imaging systems, resulting in a robust technique to minimize space-charge induced temporal dispersion in streak cameras while maintaining temporal coverage and spatial information