An action research study of clinical leadership, engagement and team effectiveness in working across NHS boundaries.

Clinical leadership and engagement across organisational boundaries has been gaining significant attention over the last few years. Within the NHS, there has been an increased focus within policy directives and the literature on partnership working, collaborations, cross-organisation and cross-profession working. These innovative ways of working are a means of improving the quality and co-ordination of patient care across the pathway, thus influencing the patients’ experience. Despite this focus, the evidence of what constitutes and therefore what can deliver effective inter-organisational clinical leadership and engagement within this context is sparse. This paper identifies the characteristics and impact of effective clinical leadership, clinical engagement and team effectiveness when working across organisational boundaries. The paper demonstrates that there are significant improvements in the delivery of healthcare and patient experience when clinicians work effectively across the whole of the patient pathway, spanning organisational boundaries. Guidelines on critical areas for future development and sustainability is expounded upon as an outcome of this study

The power of research: exploring active older people participating in Creative Dance – challenging perceptions

This paper contributes to understanding the power of participating in work-based doctoral research after a fulltime career. It explores ways in which active older people choose to participate in “creative dance” activities and how this may benefit them. It draws upon the first author’s experiences in using her leadership, management, presenting and coaching skills creatively, having decided to leave her career as a senior manager and return to dancing and community activities “to see what life will bring”. This includes becoming involved with dance performance activities, founding/managing a grassroots dance organisation, advising, networking and participating in projects concerning ageing and creative arts, whilst undertaking a work-based doctorate programme. Adaptable methodological approaches are explored so that uncertain new ad-hoc paid and voluntary work could be incorporated within research processes. The paper outlines findings about active older people dancing and recommends a way forward on issues concerning ageing; creativity and older people’s creative dance becoming mainstream. There is an argument for the social, political and health benefits of dancing for all, especially older adults and the need for more choices so that all ages can lead meaningful purposeful lives. This research challenges the stereotypes of retiring and becoming marginalised, showing positive aspects of entering the next stage of life and later stages of work, using skills and experience in new ways to benefit others as well as oneself

Evaluation study of the IHM project on the evaluation of the accreditation of health and social care managers: a pilot.

This evaluation report was commissioned by the Institute of Healthcare Management (IHM) in March 2009 and is based on the accredited manager pilot project that started in May 2009. The IHM pilot project was funded by the Department of Health (Estates). The pilot project aimed to offer managers for the health and social care sectors the opportunity to gain accredited manager status based upon their previous performance and achievements towards nine core manager behaviours1. The pilot project was intended to develop and implement materials that would support the managers in completion of a portfolio of achievement to demonstrate competence in the behaviours (Sugden, 2009). The evaluation study of the pilot project has aimed to include the experiences of the main stakeholders, namely; the candidates (Healthcare and Social), the pilot project team, a representative from the Department of Health (Estates), representing the commissioning body for the project, and the assessors of the candidate portfolios and viva voce examinations. The candidates were drawn mainly from the field of estates and facilities managers within the healthcare sector, with two participants for the social care sector. The project was prompted by the recognition that many managers in the health and social care sector may encounter difficulties in finding the time to attend conventionally delivered training and development programmes. There was also recognition of the need for experienced managers to be able to demonstrate their competence towards good practice behaviours rather than have to undertake taught delivery

Release of vasopressin from isolated permeabilized neurosecretory nerve terminals is blocked by the light chain of botulinum A toxin

The intracellular action on exocytosis of botulinim A toxin and constituent chains was studied using permeabilized isolated nerve endings from the rat neural lobe. The release of the neuropeptide vasopressin was measured by radioimmunoassay. In the presence of the reducing agent dithiothreitol, the two-chain form of botulinum A toxin inhibited vasopressin release induced by 10 μM free calcium. Half maximal inhibition was obtained with 15 nM botulinum A toxin. In the absence of the heavy chain the light chain of the toxin strongly inhibited exocytosis with a half maximal effect of 2.5 nM. The inhibitory effects on secretion could be prevented by incubating the light chain with an immune serum against botulinum A toxin. The heavy chain of botulinum A toxin did not affect vasopressin release. However, it prevented the inhibitory effects of the light chain on stimulated exocytosis. It is concluded that botulinum A toxin inhibits the calcium-dependent step leading to exocytosis by interfering with a target present in the isolated and permeabilized nerve terminals. The functional domain of this neurotoxin, which is responsible for the inhibition of vasopressin release, is present in its light chain

The Tundra Microclimate During Snow-Melt at Barrow, Alaska

The microclimate of the tundra during spring of 1971 (29 May to 17 June) at Barrow, is described and analysed in terms of the heat balance at the terrestrial surface and the effects of terrain parameters on the heat balance components. Changes through the snow-melting period are large. Within 2 weeks, 35 cm of snow are removed, soil interface temperatures increase by 15°C and the dry snow environment is replaced by a saturated water-soaked tundra surface. As a result, evaporation rates are high: up to 6 mm/day occurs immediately after the snow melt. The latent heat required for this is 40 times higher than during the pre-melting period

Release of vasopressin from isolated permeabilized neurosecretory nerve terminals is blocked by the light chain of botulinum A toxin

The intracellular action on exocytosis of botulinim A toxin and constituent chains was studied using permeabilized isolated nerve endings from the rat neural lobe. The release of the neuropeptide vasopressin was measured by radioimmunoassay. In the presence of the reducing agent dithiothreitol, the two-chain form of botulinum A toxin inhibited vasopressin release induced by 10 μM free calcium. Half maximal inhibition was obtained with 15 nM botulinum A toxin. In the absence of the heavy chain the light chain of the toxin strongly inhibited exocytosis with a half maximal effect of 2.5 nM. The inhibitory effects on secretion could be prevented by incubating the light chain with an immune serum against botulinum A toxin. The heavy chain of botulinum A toxin did not affect vasopressin release. However, it prevented the inhibitory effects of the light chain on stimulated exocytosis. It is concluded that botulinum A toxin inhibits the calcium-dependent step leading to exocytosis by interfering with a target present in the isolated and permeabilized nerve terminals. The functional domain of this neurotoxin, which is responsible for the inhibition of vasopressin release, is present in its light chain

The light chain of tetanus toxin inhibits calcium-dependent vasopressin release from permeabilized nerve endings

The effects of tetanus toxin and its light and heavy chain subunits on vasopressin release were investigated in digitonin-permeabilized neurosecretory nerve terminals isolated from the neural lobe of the rat pituitary gland. Exocytosis was induced by challenging the permeabilized nerve endings with micromolar calcium concentrations. Tetanus toxin inhibited vasopressin release only in the presence of the reducing agent dithiothreitol. This effect was irreversible. The purified light chain of tetanus toxin strongly inhibited exocytosis in a dose-dependent manner with half-maximal effect at c. 10 nM. The action of the light chain was observed after only 2.5 min of preincubation. Separated heavy chain subunit had no effect on hormone secretion. Inhibition of vasopressin release could be prevented by preincubating the light chain of tetanus toxin with an immune serum against tetanus toxin. The data clearly demonstrate that in mammalian neurosecretory nerve endings tetanus toxin acts at a step downstream from the activation by Ca2+ of the exocytotic machinery and that the functional domain of this toxin is confined to its light chain

The light chain but not the heavy chain of botulinum A toxin inhibits exocytosis from permeabilized adrenal chromaffin cells

The heavy and light chains of botulinum A toxin were separated by anion exchange chromatography. Their intracellular actions were studied using bovine adrenal chromaffin cells permeabilized with streptolysin O. Purified light chain inhibited the Ca2+-stimulated [3H]noradrenaline release with a half-maximal effect at about 1.8 nM. The inhibition was incomplete. Heavy chain up to 28 nM was neither effective by itself nor did it enhance the inhibitory effect of light chain. It is concluded that the light chain of botulinum A toxin contains the functional domain responsible for the inhibition of exocytosis

Amylase release from streptolysin O-permeabilized pancreatic acinar cells. Effects of Ca2+, guanosine 5'-[gamma-thio]triphosphate, cyclic AMP, tetanus toxin and botulinum A toxin

The molecular requirements for amylase release and the intracellular effects of botulinum A toxin and tetanus toxin on amylase release were investigated using rat pancreatic acinar cells permeabilized with streptolysin O. Micromolar concentrations of free Ca2+ evoked amylase release from these cells. Maximal release was observed in the presence of 30 microM free Ca2+. Ca(2+)-stimulated, but not basal, amylase release was enhanced by guanosine 5'-[gamma-thio]triphosphate (GTP[S]) (3-4 fold) or cyclic AMP (1.5-2 fold). Neither the two-chain forms of botulinum A toxin and tetanus toxin, under reducing conditions, nor the light chains of tetanus toxin, inhibited amylase release triggered by Ca2+, or combinations of Ca2+ + GTP[S] or Ca2+ + cAMP. The lack of inhibition was not due to inactivation of botulinum A toxin or tetanus toxin by pancreatic acinar cell proteolytic enzymes, as toxins previously incubated with permeabilized pancreatic acinar cells inhibited Ca(2+)-stimulated [3H]noradrenaline release from streptolysin O-permeabilized adrenal chromaffin cells. These data imply that clostridial neurotoxins inhibit a Ca(2+)-dependent mechanism which promotes exocytosis in neural and endocrine cells, but not in exocrine cells

Managing complex fires in urban environments: a tale of two cultures

Prior research has examined how experienced fireground commanders make task related decisions under a range of unfavourable conditions, however gaps still exist in the literature when there is need to evaluate the coping strategies of incident commanders across different urban environments. There was rarely any study found to have explored cross-cultural differences that exist between two or more fire services with distinct cultural orientations. This paper reports findings from a study that compared firefighting approaches used by the UK and Nigerian firefighters. Thirty experienced officers were interviewed (UK=15, Nigeria =15) using the critical decision method, and retrospective incident reports were collected and analysed. As expected, results revealed that the UK fire service are significantly better equipped with advanced equipment compared to their Nigerian counterparts who often make improvisations using relatively unsafe methods. However, evidence was found to suggest that the Nigerian officers are culturally biased towards the use of certain firefighting equipment. The implications of these cultural differences for practice are discussed