Fostering reciprocity in global health partnerships through a structured, hands-on experience for visiting postgraduate medical trainees

BACKGROUND: Global health programs that allow international experiences for US learners should also enable reciprocal learning experiences for international learners, particularly if that is a need identified by the partner institution. METHODS: A partnership between Indiana University and Moi University, Kenya, has successfully hosted 41 visiting Kenyan internal medicine and pediatrics registrars at Indiana University since 2006. The program's logistics, curriculum, and evaluation are described. RESULTS: The registrars rotated through nephrology, cardiology, hematology and oncology, infectious diseases, and intensive care, as well as related ambulatory experiences, functioning on a level comparable to fourth-year medical students. They showed significant improvement in pretest and posttest scores on a standardized National Board of Medical Examiners examination (P  =  .048). International learners experienced culture shock, yet they felt the Indiana University elective was helpful and would recommend it to future participants. CONCLUSIONS: Global health programs can reciprocate the benefits derived for US students and residents by offering learning experiences to international learners if that is an expressed need from the international partner. Barriers to those experiences can be overcome, and the hands-on, elective experience has the potential to positively affect the knowledge and attitudes of participants as well as the home nation

Evaluation of community level interventions to address social and structural determinants of health: a cluster randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>In London and the rest of the UK, diseases associated with poor diet, inadequate physical activity and mental illness account for a large proportion of area based health inequality. There is a lack of evidence on interventions promoting healthier behaviours especially in marginalised populations, at a structural or ecological level and utilising a community development approach.</p> <p>The Well London project financed by the Big Lottery 'Wellbeing' Fund and implemented by a consortium of London based agencies led by the Greater London Authority and the London Health Commission is implementing a set of complex interventions across 20 deprived areas of London. The interventions focus on healthy eating, healthy physical activity and mental health and wellbeing and are designed and executed with community participation complementing existing facilities and services.</p> <p>Methods/Design</p> <p>The programme will be evaluated through a cluster randomised controlled trial. Forty areas across London were chosen based on deprivation scores. Areas were characterised by high proportion of Black and Minority Ethnic residents, worklessness, ill-health and poor physical environments. Twenty areas were randomly assigned to the intervention arm of Well London project and twenty 'matched' areas assigned as controls. Measures of physical activity, diet and mental health are collected at start and end of the project and compared to assess impact.</p> <p>The quantitative element will be complemented by a longitudinal qualitative study elucidating pathways of influence between intervention activities and health outcomes. A related element of the study investigates the health-related aspects of the structural and ecological characteristics of the project areas. The project 'process' will also be evaluated.</p> <p>Discussion</p> <p>The size of the project and the fact that the interventions are 'complex' in the sense that firstly, there are a number of interacting components with a wide range of groups and organisational levels targeted by the intervention, and secondly, a degree of flexibility or tailoring of the intervention, makes this trial potentially very useful in providing evidence of the types of activities that can be used to address chronic health problems in communities suffering from multiple deprivation.</p> <p>Trial Registration</p> <p>Current Controlled Trials ISRCTN68175121</p

Let’s sculpt it! Experiencing the role of context in coaching

This exercise aims to familiarize students with the under-discussed topic of the role of context in coaching through a physical activity. It consists of a Group Sculpture – a combination of Socio-drama, Systemic Constellation, Social Presencing Theater – drawing from a coaching case of an ethical dilemma, using the placement and arrangement of participants to represent the stakeholders and context (economic, legal, sociological, etc.). The visual and embodied representation aims to raise awareness and develop understanding of the invisible, but often felt contextual factors at play in coaching, to generate reflection about their influence, and to offer insights on how to identify and embrace them. This activity is primarily aimed for coaching educators and supervisors, but a slightly adapted version could expand its benefits to a more general audience of managers and leaders

The golden circle: A way of arguing and acting about technology in the London ambulance service

This paper analyses the way in which the London Ambulance Service recovered from the events of October 1992, when it implemented a computer-aided despatch system (LASCAD) that remained in service for less than two weeks. It examines the enactment of a programme of long-term organizational change, focusing on the implementation of an alternative computer system in 1996. The analysis in this paper is informed by actor-network theory, both by an early statement of this approach developed by Callon in the sociology of translation, and also by concepts and ideas from Latour’s more recent restatement of his own position. The paper examines how alternative interests emerged and were stabilized over time, in a way of arguing and acting among key players in the change programme, christened the Golden Circle. The story traces four years in the history of the London Ambulance Service, from the aftermath of October 1992 through the birth of the Golden Circle to the achievement of National Health Service (NHS) trust status. LASCAD was the beginning of the story, this is the middle, an end lies in the future, when the remaining elements of the change programme are enacted beyond the Golden Circle

Thinking strategically about assessment

Drawing upon the literature on strategy formulation in organisations, this paper argues for a focus on strategy as process. It relates this to the need to think strategically about assessment, a need engendered by resource pressures, developments in learning and the demands of external stakeholders. It is argued that in practice assessment strategies are often formed at the level of practice, but that this produces contradiction and confusion at higher levels. Such tensions cannot be managed away, but they can be reflected on and mitigated. The paper suggests a framework for the construction of assessment strategies at different levels of an institution. However, the main conclusion is that the process of constructing such strategies should be an opportunity for learning and reflection, rather than one of compliance

Motivators and barriers for older people participating in resistance training: A systematic review

Regular participation in resistance training is important for older people to maintain their health and independence, yet participation rates are low. The study aimed to identify motivators and barriers to older people participating in resistance training. A systematic review was conducted including quantitative, qualitative and mixed-method studies. Searches generated 15,920 citations from six databases, with 14 studies (n=1,937 participants) included. In total, 92 motivators and 24 barriers were identified. Motivators specific to participating in resistance training included preventing deterioration (disability), reducing risk of falls, building (toning) muscles, feeling more alert and better concentration. Looking too muscular and thinking participation increased the risk of having a heart attack, stroke or death, despite the minimal likelihood of these occurring, were barriers. The analysis indicates that increasing participation in resistance training among older people should focus on the specific benefits valued by older people and the dissemination of accurate information to counter misperceptions

Reasons, Coherence, and Group Rationality

Philosophy and Phenomenological Research, EarlyView

Gabriel T. Csanady : understanding the physics of the ocean

Author Posting. © Elsevier B.V., 2006. This is the author's version of the work. It is posted here by permission of Elsevier B.V. for personal use, not for redistribution. The definitive version was published in Progress In Oceanography 70 (2006): 91-112, doi:10.1016/j.pocean.2006.07.002.Gabriel T. Csanady turned 80 in December 2005 and we celebrate it with this special Progress in Oceanography issue. It comprises 20 papers covering some of the many areas that Gabe contributed significantly throughout his professional career. In this introductory paper we briefly review Gabe’s career as an engineer, meteorologist and oceanographer, and highlight some of his major contributions to oceanography, both as a scientist as well as an educator. But we also use this opportunity to remember and thank Gabe, and his wife Joyce, for being such good friends and mentors to several generations of oceanographers. The authors of the collection of papers in this volume deserve special thanks for their efforts. We also are pleased to acknowledge the support of Progress in Oceanography’s editor, Detlef Quadfasel, and the many anonymous reviewers who generously contributed their time and expertise

The Paradox of Power in CSR: A Case Study on Implementation

Purpose Although current literature assumes positive outcomes for stakeholders resulting from an increase in power associated with CSR, this research suggests that this increase can lead to conflict within organizations, resulting in almost complete inactivity on CSR. Methods A single in-depth case study, focusing on power as an embedded concept. Results Empirical evidence is used to demonstrate how some actors use CSR to improve their own positions within an organization. Resource dependence theory is used to highlight why this may be a more significant concern for CSR. Conclusions Increasing power for CSR has the potential to offer actors associated with it increased personal power, and thus can attract opportunistic actors with little interest in realizing the benefits of CSR for the company and its stakeholders. Thus power can be an impediment to furthering CSR strategy and activities at the individual and organizational level

Economic liberalization and the antecedents of top management teams: evidence from Turkish 'big' business

There has been an increased interest in the last two decades in top management teams (TMTs) of business firms. Much of the research, however, has been US-based and concerned primarily with TMT effects on organizational outcomes. The present study aims to expand this literature by examining the antecedents of top team composition in the context of macro-level economic change in a late-industrializing country. The post-1980 trade and market reforms in Turkey provided the empirical setting. Drawing upon the literatures on TMT and chief executive characteristics together with punctuated equilibrium models of change and institutional theory, the article develops the argument that which firm-level factors affect which attributes of TMT formations varies across the early and late stages of economic liberalization. Results of the empirical investigation of 71 of the largest industrial firms in Turkey broadly supported the hypotheses derived from this premise. In the early stages of economic liberalization the average age and average organizational tenure of TMTs were related to the export orientation of firms, whereas in later stages, firm performance became a major predictor of these team attributes. Educational background characteristics of teams appeared to be under stronger institutional pressures, altering in different ways in the face of macro-level change