Management in practice : analysing the impact of policy change on managers and doctors in general medical practice

This thesis explores the impact of changes in health policy introduced by Conservative administrations in the period 1987 to 1995 on the definition, management and control of professional work within general medical practice. The research underpinning this work combined secondary analysis, large-scale primary fieldwork and qualitative research with clinicians and managers. The first stage of primary fieldwork was conducted during the period September 1994 to June 1995 and consisted of a postal survey of 750 practices across England and Wales. This was followed up with a second phase of research involving depth interviews with managers and clinicians, delivered in the period July to November 1995. This pluralist methodology sought to connect micro and macro levels of analysis in exploring the relationship between the state, professions and managers in primary care. The research explores the extent to which a number of professional freedoms have been challenged by policy change including political, economic and technical autonomy and the extent to which this had changed the position and rewards of managers in general practice. Employing a multi-dimensional approach to the analysis of power this thesis suggests that prevailing theories of a decline in professional power, based primarily on economic relations at the macro level cannot account for the complexity of relations found in UK general practice. Further, studies focusing at the collective level of bargaining between the state and the medical profession in the UK have over-estimated the impact of policy change due to a neglect of study at the micro level. Rather this study has revealed a complex picture of both continuity and change in which general practitioners have lost, retained and in some cases extended their power as a result of policy initiatives. Whilst professional freedoms have remained relatively intact, the impact of policy change on the occupation of Practice Management has been more significant, with prevailing discourses of `managerialism' creating gendered struggles over the definition and meaning of management in primary care. This work therefore calls for a multi-dimensional account of social life which can explain the complex interaction of differing sites of power, within which a wide range of power resources are deployed. Further this work would endorse a dynamic concept of power in which 'patterns of interaction' (Bradley 1999) are fluid and changeable rather than fixed and self-sustaining systems. It is argued here that constraints on social action are created by the history of past agency, embedded in institutions and social practices that both shape, and are shaped by the agency of individuals

Management in practice : analysing the impact of policy change on managers and doctors in general medical practice

This thesis explores the impact of changes in health policy introduced by Conservative administrations in the period 1987 to 1995 on the definition, management and control of professional work within general medical practice. The research underpinning this work combined secondary analysis, large-scale primary fieldwork and qualitative research with clinicians and managers. The first stage of primary fieldwork was conducted during the period September 1994 to June 1995 and consisted of a postal survey of 750 practices across England and Wales. This was followed up with a second phase of research involving depth interviews with managers and clinicians, delivered in the period July to November 1995. This pluralist methodology sought to connect micro and macro levels of analysis in exploring the relationship between the state, professions and managers in primary care. The research explores the extent to which a number of professional freedoms have been challenged by policy change including political, economic and technical autonomy and the extent to which this had changed the position and rewards of managers in general practice. Employing a multi-dimensional approach to the analysis of power this thesis suggests that prevailing theories of a decline in professional power, based primarily on economic relations at the macro level cannot account for the complexity of relations found in UK general practice. Further, studies focusing at the collective level of bargaining between the state and the medical profession in the UK have over-estimated the impact of policy change due to a neglect of study at the micro level. Rather this study has revealed a complex picture of both continuity and change in which general practitioners have lost, retained and in some cases extended their power as a result of policy initiatives. Whilst professional freedoms have remained relatively intact, the impact of policy change on the occupation of Practice Management has been more significant, with prevailing discourses of `managerialism' creating gendered struggles over the definition and meaning of management in primary care. This work therefore calls for a multi-dimensional account of social life which can explain the complex interaction of differing sites of power, within which a wide range of power resources are deployed. Further this work would endorse a dynamic concept of power in which 'patterns of interaction' (Bradley 1999) are fluid and changeable rather than fixed and self-sustaining systems. It is argued here that constraints on social action are created by the history of past agency, embedded in institutions and social practices that both shape, and are shaped by the agency of individuals.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Management in practice : analysing the impact of policy change on managers and doctors in general medical practice

This thesis explores the impact of changes in health policy introduced by Conservative administrations in the period 1987 to 1995 on the definition, management and control of professional work within general medical practice. The research underpinning this work combined secondary analysis, large-scale primary fieldwork and qualitative research with clinicians and managers. The first stage of primary fieldwork was conducted during the period September 1994 to June 1995 and consisted of a postal survey of 750 practices across England and Wales. This was followed up with a second phase of research involving depth interviews with managers and clinicians, delivered in the period July to November 1995. This pluralist methodology sought to connect micro and macro levels of analysis in exploring the relationship between the state, professions and managers in primary care. The research explores the extent to which a number of professional freedoms have been challenged by policy change including political, economic and technical autonomy and the extent to which this had changed the position and rewards of managers in general practice. Employing a multi-dimensional approach to the analysis of power this thesis suggests that prevailing theories of a decline in professional power, based primarily on economic relations at the macro level cannot account for the complexity of relations found in UK general practice. Further, studies focusing at the collective level of bargaining between the state and the medical profession in the UK have over-estimated the impact of policy change due to a neglect of study at the micro level. Rather this study has revealed a complex picture of both continuity and change in which general practitioners have lost, retained and in some cases extended their power as a result of policy initiatives. Whilst professional freedoms have remained relatively intact, the impact of policy change on the occupation of Practice Management has been more significant, with prevailing discourses of `managerialism' creating gendered struggles over the definition and meaning of management in primary care. This work therefore calls for a multi-dimensional account of social life which can explain the complex interaction of differing sites of power, within which a wide range of power resources are deployed. Further this work would endorse a dynamic concept of power in which 'patterns of interaction' (Bradley 1999) are fluid and changeable rather than fixed and self-sustaining systems. It is argued here that constraints on social action are created by the history of past agency, embedded in institutions and social practices that both shape, and are shaped by the agency of individuals.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

MODEL PEMBELAJARAN INKUIRI DISERTAI LEMBAR KERJA SISWA (LKS) BERBASIS GAMBAR DALAM PEMBELAJARAN IPA- TEMA FISIKA DI SMP

Inquiry teaching model was a teaching model that requires student’s activeness for self-concept making by underlining a critical and analytical thinking process to search and find the answer from a questionable problem themselves. To support the implementation of inquiry teaching model, this research used experimental method so the students could find the physics phenomenon and proved it by themselves about the concept that had been thought through inquiry teaching model. The objectives of this research were to review the differences of student’s results in science learning-physics theme by using inquiry model with student’s worksheet based on pictures through direct instruction model, to know student’s responses after used inquiry teaching model with student’s worksheet based on pictures. The type of this research was experimental research that was done in SMPN 12 Jember. Data collection method used were observation, documentation , questionnare and test. Data analysis used was quantitative analysis based on the post-test results by using t-test and activeness percentage to know the learning activities and stuedent’s responses. The research result and data analysis showed sig.value (2-tailed) was 0.014 or < 0.05 and it showed that there was a significance difference of learning result between the experimental and control class. The analysis result of student’s learning activities showed active category or 72.82% in meeting 1, 75,38% in meeting 2 and 81.20% in meeting 3. Overall, the student’s learning activities from meeting 1,2 and 3 was 76.46%. The result of student’s responses analysis showed a strong category by showing 75% as the average percentag

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Twelve earthquakes off the Oregon and Northern California coasts were used in this research to study whether faulting associated with these quakes was of the San Andreas type as observed in California. The first motions of the incident P and S waves recorded at various seismic stations in the Pacific Northwest were used to obtain a fault plane solution for these earthquakes. Nine earthquakes exhibited faulting which could be consistent with San Andreas type of motion, where one of these motions was based on first P and S data, six others were consistent with either northwesterly right-lateral or northeasterly left-lateral motions, and two were recorded at so few stations that faulting could not be defined through a fault plane solution. One earthquake was located in the region of the Gorda Escarpment west of Cape Mendocino, California, and displacements appear to be associated with that zone, one earthquake had Garlock-type displacements as defined through P and S motions, and one earthquake was not associated with any of the above types of faults

RinehartVerrillJoanne1964.pdf

Twelve earthquakes off the Oregon and Northern California coasts were used in this research to study whether faulting associated with these quakes was of the San Andreas type as observed in California. The first motions of the incident P and S waves recorded at various seismic stations in the Pacific Northwest were used to obtain a fault plane solution for these earthquakes. Nine earthquakes exhibited faulting which could be consistent with San Andreas type of motion, where one of these motions was based on first P and S data, six others were consistent with either northwesterly right-lateral or northeasterly left-lateral motions, and two were recorded at so few stations that faulting could not be defined through a fault plane solution. One earthquake was located in the region of the Gorda Escarpment west of Cape Mendocino, California, and displacements appear to be associated with that zone, one earthquake had Garlock-type displacements as defined through P and S motions, and one earthquake was not associated with any of the above types of faults

Investigation of twelve earthquakes off the Oregon and northern California coasts

Twelve earthquakes off the Oregon and Northern California coasts were used in this research to study whether faulting associated with these quakes was of the San Andreas type as observed in California. The first motions of the incident P and S waves recorded at various seismic stations in the Pacific Northwest were used to obtain a fault plane solution for these earthquakes. Nine earthquakes exhibited faulting which could be consistent with San Andreas type of motion, where one of these motions was based on first P and S data, six others were consistent with either northwesterly right-lateral or northeasterly left-lateral motions, and two were recorded at so few stations that faulting could not be defined through a fault plane solution. One earthquake was located in the region of the Gorda Escarpment west of Cape Mendocino, California, and displacements appear to be associated with that zone, one earthquake had Garlock-type displacements as defined through P and S motions, and one earthquake was not associated with any of the above types of faults

A systematic review of prostate cancer heterogeneity: understanding the clonal ancestry of multifocal disease

Context Studies characterising genomic changes in prostate cancer (PCa) during natural progression have greatly increased our understanding of the disease. A better understanding of the evolutionary history of PCa would allow advances in diagnostics, prognostication, and novel therapies that together will improve patient outcomes. Objective To review the molecular heterogeneity of PCa and assess recent efforts to profile intratumoural heterogeneity and clonal evolution. Evidence acquisition We screened a total of 1313 abstracts from PubMed published between 2009 and 2020, of which we reviewed 84 full-text articles. We excluded 49, resulting in 35 studies for qualitative analysis. Evidence synthesis In studies of primary disease (16 studies, 4793 specimens), there is a lack of consensus regarding the monoclonal or polyclonal origin of primary PCa. There is no consistent mutation giving rise to primary PCa. Detailed clonal analysis of primary PCa has been limited by current techniques. By contrast, clonal relationships between PCa metastases and a potentiating clone have been consistently identified (19 studies, 732 specimens). Metastatic specimens demonstrate consistent truncal genomic aberrations that suggest monoclonal metastatic progenitors. Conclusions The relationship between the clonal dynamics of PCa and clinical outcomes needs further investigation. It is likely that this will provide a biological rationale for whether radical treatment of the primary tumour benefits patients with oligometastatic PCa. Future studies on the mutational burden in primary disease at single-cell resolution should permit the identification of clonal patterns underpinning the origin of lethal PCa. Patient summary Prostate cancers arise in different parts of the prostate because of DNA mutations that occur by chance at different times. These cancer cells and their origin can be tracked by DNA mapping. In this review we summarise the state of the art and outline what further science is needed to provide the missing answers