Measurement precision test construction and best test design

This article examines the precision of measurements obtained from using the Rasch Dichotomous Model to analyse test data. Considering tests in which the item difficulties are uniformly spaced from easiest to most difficult, permits the derivation of an alternative expression for the standard error of measurement. This expression is sufficiently simple to enable the precision properties of uniform tests to be readily described and to enable a variety of problems of test construction to be solved. One particular problem is that of best test design. Regarding measurement precision as a property of the test only, we show that the best uniform test of a given length and a given target interval is the one that satisfies a minimax condition on the standard error. We illustrate the solution to this problem and describe properties of best tests

The organisational and human resource challenges facing primary care trusts : protocol of a multiple case study

BACKGROUND: The study is designed to assess the organisational and human resource challenges faced by Primary Care Trusts (PCTs). Its objectives are to: specify the organisational and human resources challenges faced by PCTs in fulfilling the roles envisaged in government and local policy; examine how PCTs are addressing these challenges, in particular, to describe the organisational forms they have adopted, and the OD/HR strategies and initiatives they have planned or in place; assess how effective these structures, strategies and initiatives have been in enabling the PCTs to meet the organisational and human resources challenges they face; identify the factors, both internal to the PCT and in the wider health community, which have contributed to the success or failure of different structures, strategies and initiatives. METHODS: The study will be undertaken in three stages. In Stage 1 the key literature on public sector and NHS organisational development and human resources management will be reviewed, and discussions will be held with key researchers and policy makers working in this area. Stage 2 will focus on detailed case studies in six PCTs designed to examine the organisational and human resources challenges they face. Data will be collected using semi-structured interviews, group discussion, site visits, observation of key meetings and examination of local documentation. The findings from the case study PCTs will be cross checked with a Reference Group of up to 20 other PCG/Ts, and key officers working in organisational development or primary care at local, regional and national level. In Stage 3 analysis of findings from the preparatory work, the case studies and the feedback from the Reference Group will be used to identify practical lessons for PCTs, key messages for policy makers, and contributions to further theoretical development

Reflections of a “late-career” early-career researcher: An account of practice

This account of practice describes the journey of an ‘accidental academic’ through the Doctoral programme in Business Administration. It reflects on her experience of action learning and lessons learned to better embed action learning in future DBA teaching and assessment. The account is told from the perspective of a mature student straddling business and academic interests. DBA students represent a mature cohort with significant business experience and responsibility. As such, they have an implicit understanding of action learning. Action learning for these individuals should be re-activated rather than re-learned for their doctoral studies. Suggestions are made for improving the utility of action learning for DBA students and their willing engagement in the action learning process

Biophysical characteristics of human milk proteins for enhancing tear stability in dry eye

Purpose : Dry eye disease affects millions of people worldwide and is prevalent in older people, females, contact lens wearers, and increasingly in the general population due to excessive use of visual display devices. Tear instability is the characteristic pathophysiology of the disease due to the inability of tears to form a stable film on the ocular surface, which leads to drying of the ocular surface. Enhancing tear stability is known to relieve symptoms of dry eye. Human breast milk (HBM) has been shown to contain proteins that enhance ocular surface healing following injury. In healthy tears, tear proteins increase tear stability by showing surface-active properties. The aim of this project was to study the biophysical characteristics of HBM proteins and compare them with the proteins found in tears as a first step to explore the use of HBM constituents for treatment of dry eye. Methods : HBM samples were fresh frozen, then thawed, centrifuged, and aqueous recovered for lyophilisation. The aqueous containing proteins was used in the experiments. Pressure-area profiles and rheology of surface films of HBM proteins and tear proteins, namely, lysozyme and lactoferrin were studied using Langmuir trough technology on an artificial tear solution at the physiological pH and temperature of tears. Results : Pressure-area profiles indicated that HBM proteins formed a highly compressible, non-collapsible surface film with a maximum surface pressure of 32mN/m. The surface films of lysozyme and lactoferrin were also compressible with the maximum surface pressures of 23mN/m and 17mN/m, respectively. Hysteresis was observed in all proteins with smallest in lactoferrin and highest in lysozyme. Conclusions : HBM proteins are surface active and capable of reducing surface tension to increase the film stability. They are effective in smaller amounts, show higher surface pressure, and wider surface coverage than tear proteins lysozyme and lactoferrin. Overall, the biophysical experiments indicate that HBM proteins in smaller amounts would provide better protection to the tear film than the natural proteins of the tear film and can be effective in enhancing tear stability in dry eye

Engaging rural communities in health care through a paramedic expanded scope of practice

Introduction: This article explores how community engagement by paramedics in an expanded scope role contributes to both primary health care and to an overall improved emergency response capacity in rural communities. Understanding how expanded scope paramedics (ESP) can strengthen community healthcare collaborations is an important need in rural areas where low workforce numbers necessitate innovation.Methods: Four examples of Australian rural ESP roles were studied in Tasmania, New South Wales, South Australia and Victoria to gather information on consistent elements that could inform a paramedic expanded scope model. Qualitative data were collected from semi-structured interviews with key stakeholders and organisational documents. Thematic analysis within and across cases found community engagement was a key element in the varied roles. This article relies heavily on data from the Victorian and Tasmanian case studies because community engagement was a particularly strong aspect of these cases.Results: The ESP in the case studies increased interactions between ambulance services and rural communities with an overall benefit to health care through: increasing community response capacity; linking communities more closely to ambulance services; and increasing health promotion and illness prevention work at the community level. Leadership, management and communication skills are important for paramedics to successfully undertake expanded scope roles.Conclusion: ESP in rural locations can improve health care beyond direct clinical skill by active community engagement that expands the capacity of other community members and strengthens links between services and communities. As health services look to gain maximum efficiency from the health workforce, understanding the intensification of effort that can be gained from practitioner and community coalitions provides important future directions.<br /

Extending the paramedic role in rural Australia : a story of flexibility and innovation

Introduction: This article identifies trends in the evolving practice of rural paramedics and describes key characteristics, roles and expected outcomes for a Rural Expanded Scope of Practice (RESP) model.Methods: A multiple case study methodology was employed to examine the evolution of rural paramedic practice. Paramedics, volunteer ambulance officers and other health professionals were interviewed in four rural regions of south-eastern Australia where innovative models of rural paramedic practice were claimed to exist. The research team collected and thematically analysed the data using the filter of a sociological framework throughout 2005 and 2006.Results: The study found that paramedics are increasingly becoming first line primary healthcare providers in small rural communities and developing additional professional responsibilities throughout the cycle of care.Conclusions: Adoption of the RESP model would mean that paramedics undertake four broad activities as core components of their new role: (1) rural community engagement; (2) emergency response; (3) situated practice; and (4) primary health care. The model&rsquo;s key feature is a capacity to integrate existing paramedic models with other health agencies and health professionals to ensure that paramedic care is part of a seamless system that provides patients with well-organized and high quality care. This expansion of paramedics&rsquo; scope of practice offers the potential to improve patient care and the general health of rural communities.<br /

To Act and Learn: A Bakhtinian Exploration of Action Learning

This paper considers the work of the Russian social philosopher and cultural theorist, Mikhail Mikhailovich Bakhtin as a source of understanding for those involved in action learning. Drawing upon data gathered over two years during the evaluation of 20 action learning sets in the north of England, we will seek to work with the ideas of Bakhtin to consider their value for those involved in action learning. We consider key Bakhtin features such as Making Meaning, Participative Thinking, Theoreticism and Presence, Others and Outsideness, Voices and Carnival to highlight how Bakhtin's can enhance our understanding of the nature of action and learning

Developing transferable management skills through Action Learning

There has been increasing criticism of the relevance of the Master of Business Administration (MBA) in developing skills and competencies. Action learning, devised to address problem-solving in the workplace, offers a potential response to such criticism. This paper offers an insight into one university’s attempt to integrate action learning into the curriculum. Sixty-five part-time students were questioned at two points in their final year about their action learning experience and the enhancement of relevant skills and competencies. Results showed a mixed picture. Strong confirmation of the importance of selected skills and competencies contrasted with weaker agreement about the extent to which these were developed by action learning. There was, nonetheless, a firm belief in the positive impact on the learning process. The paper concludes that action learning is not a panacea but has an important role in a repertoire of educational approaches to develop relevant skills and competencies

Leadership Development, Wicked Problems and Action Learning: Provocations to a Debate

"The problem is the domain of the leader; unlike the puzzle, it is charged with unanswerable questions as well as unformulatable ones" (Revans, 1982: 712) If leadership is defined by a willingness to tackle the intractable or wicked issues - rather than the technical or procedural (Revans 1982: 712-4; Grint, 2005; 2007; 2010) - then, given that action learning is commonly employed on leadership development programmes, do the participants on these programmes address the unanswerable and unformulatable questions of leadership? This rather complex question arose in a conversation between the three of us at an editorial board meeting. It then led on to a protracted discussion over several months. We had all worked on leadership development programmes but had they actually tackled those challenges that formed the essence of leadership according to Revans, Grint and others? This felt like a straightforward query, yet we found it difficult to frame as a research question. The focus on the combination of leadership development, action learning and wicked problems proved hard to formulate; depending on which was taken as the "lead" term, different, if related, inquiries might follow. The question lay in the conjunction of these notions, and in our individual and joint experiences of trying to grasp it we found echoes of Revans' descriptions of leadership work

Fifty years of spellchecking

A short history of spellchecking from the late 1950s to the present day, describing its development through dictionary lookup, affix stripping, correction, confusion sets, and edit distance to the use of gigantic databases