Do steering committees and boards constitute good project governance?

One could argue that good project governance positively influences productivity, and that this shapes the economy in a sustainable way. However, there is a prevailing perception in the corporate and government environment that steering committees and boards in some way constitutes good project governance. This perception appears to be based in part upon the presumption that the corporate sector always performs better than government; the corporate sector assures good corporate governance through boards; Ergo everyone else, including government, would perform better if they did the same. The paper argues that this presumption is indefensible as there is no scientific or rational basis to support it. Moreover, the concept of governance as steering committees and boards can diffuse responsibility and accountability in the hierarchical structures of government departments and large organisations that initiate their own projects and this can lead to project delay, confusion and uncertainty. The paper reviews the literature on governance and project steering committees and concludes that establishing project advisory rather than steering committees removes the potential for organisational power play and provides an effective consultation mechanism that facilitates 'best for project' outcomes

Social trajectories or disrupted identities? : Changing and competing models of teacher professionalism under New Labour

Since the 1988 Education Reform Act, the teacher’s role in England has changed in many ways, a process which intensified under New Labour after 1997. Conceptions of teacher professionalism have become more structured and formalized, often heavily influenced by government policy objectives. Career paths have become more diverse and specialised. In this article, three post-1997 professional roles are given consideration as examples of these new specialised career paths: Higher Level Teaching Assistants, Teach First trainees and Advanced Skills Teachers. The article goes on to examine such developments within teaching, using Bourdieu’s concept of habitus to inform the analysis, as well as Bernstein’s theories of knowledge and identity. The article concludes that there has been considerable specialization and subsequent fragmentation of roles within the teaching profession, as part of workforce remodelling initiatives. However, there is still further scope for developing a greater sense of professional cohesion through social activism initiatives, such as the children's agenda. This may produce more stable professional identities in the future as the role of teachers within the wider children’s workforce is clarified

What should an index of school segregation measure?

The article aims to make a methodological contribution to the education segregation literature, providing a critique of previous measures of segregation used in the literature, as well as suggesting an alternative approach to measuring segregation. Specifically, the paper examines Gorard, Fitz and Taylor's finding that social segregation between schools, as measured by free school meals (FSM) entitlement, fell significantly in the years following the 1988 Education Reform Act. Using Annual Schools Census data from 1989 to 2004, the paper challenges the magnitude of their findings, suggesting that the method used by Gorard et al. seriously overstates the size of the fall in segregation. We make the case for a segregation curve approach to measuring segregation, where comparisons of the level of segregation are possible regardless of the percentage FSM eligibility. Using this approach, we develop a new method for describing both the level and the location of school segregation

Early high flow nasal cannula therapy in bronchiolitis, a prospective randomised control trial (protocol): A Paediatric Acute Respiratory Intervention Study (PARIS)

Background Bronchiolitis imposes the largest health care burden on non-elective paediatric hospital admissions worldwide, with up to 15 % of cases requiring admission to intensive care. A number of previous studies have failed to show benefit of pharmaceutical treatment in respect to length of stay, reduction in PICU admission rates or intubation frequency. The early use of non-invasive respiratory support devices in less intensive scenarios to facilitate earlier respiratory support may have an impact on outcome by avoiding progression of the disease process. High Flow Nasal Cannula (HFNC) therapy has emerged as a new method to provide humidified air flow to deliver a non-invasive form of positive pressure support with titratable oxygen fraction. There is a lack of high-grade evidence on use of HFNC therapy in bronchiolitis. Methods/Design Prospective multi-centre randomised trial comparing standard treatment (standard subnasal oxygen) and High Flow Nasal Cannula therapy in infants with bronchiolitis admitted to 17 hospitals emergency departments and wards in Australia and New Zealand, including 12 non-tertiary regional/metropolitan and 5 tertiary centres. The primary outcome is treatment failure; defined as meeting three out of four pre-specified failure criteria requiring escalation of treatment or higher level of care; i) heart rate remains unchanged or increased compared to admission/enrolment observations, ii) respiratory rate remains unchanged or increased compared to admission/enrolment observations, iii) oxygen requirement in HFNC therapy arm exceeds FiO2 ≥ 40 % to maintain SpO2 ≥ 92 % (or ≥94 %) or oxygen requirement in standard subnasal oxygen therapy arm exceeds >2L/min to maintain SpO2 ≥ 92 % (or ≥94 %), and iv) hospital internal Early Warning Tool calls for medical review and escalation of care. Secondary outcomes include transfer to tertiary institution, admission to intensive care, length of stay, length of oxygen treatment, need for non-invasive/invasive ventilation, intubation, adverse events, and cost. Discussion This large multicenter randomised trial will allow the definitive assessment of the efficacy of HFNC therapy as compared to standard subnasal oxygen in the treatment of bronchiolitis

The incidence and make up of ability grouped sets in the UK primary school

The adoption of setting in the primary school (pupils ability grouped across classes for particular subjects) emerged during the 1990s as a means to raise standards. Recent research based on 8875 children in the Millennium Cohort Study showed that 25.8% of children in Year 2 were set for literacy and mathematics and a further 11.2% of children were set for mathematics or literacy alone. Logistic regression analysis showed that the best predictors of being in the top set for literacy or mathematics were whether the child was born in the Autumn or Winter and cognitive ability scores. Boys were significantly more likely than girls to be in the bottom literacy set. Family circumstances held less importance for setting placement compared with the child’s own characteristics, although they were more important in relation to bottom set placement. Children in bottom sets were significantly more likely to be part of a long-term single parent household, have experienced poverty, and not to have a mother with qualifications at NVQ3 or higher levels. The findings are discussed in relation to earlier research and the implications for schools are set out

Cost-effectiveness of malaria diagnosis using rapid diagnostic tests compared to microscopy or clinical symptoms alone in Afghanistan

Background Improving access to parasitological diagnosis of malaria is a central strategy for control and elimination of the disease. Malaria rapid diagnostic tests (RDTs) are relatively easy to perform and could be used in primary level clinics to increase coverage of diagnostics and improve treatment of malaria.<p></p> Methods A cost-effectiveness analysis was undertaken of RDT-based diagnosis in public health sector facilities in Afghanistan comparing the societal and health sector costs of RDTs versus microscopy and RDTs versus clinical diagnosis in low and moderate transmission areas. The effect measure was ‘appropriate treatment for malaria’ defined using a reference diagnosis. Effects were obtained from a recent trial of RDTs in 22 public health centres with cost data collected directly from health centres and from patients enrolled in the trial. Decision models were used to compare the cost of RDT diagnosis versus the current diagnostic method in use at the clinic per appropriately treated case (incremental cost-effectiveness ratio, ICER).<p></p> Results RDT diagnosis of Plasmodium vivax and Plasmodium falciparum malaria in patients with uncomplicated febrile illness had higher effectiveness and lower cost compared to microscopy and was cost-effective across the moderate and low transmission settings. RDTs remained cost-effective when microscopy was used for other clinical purposes. In the low transmission setting, RDTs were much more effective than clinical diagnosis (65.2% (212/325) vs 12.5% (40/321)) but at an additional cost (ICER) of US$4.5 per appropriately treated patient including a health sector cost (ICER) of US$2.5 and household cost of US$2.0. Sensitivity analysis, which varied drug costs, indicated that RDTs would remain cost-effective if artemisinin combination therapy was used for treating both P. vivax and P. falciparum. Cost-effectiveness of microscopy relative to RDT is further reduced if the former is used exclusively for malaria diagnosis. In the health service setting of Afghanistan, RDTs are a cost-effective intervention compared to microscopy.<p></p> Conclusions RDTs remain cost-effective across a range of drug costs and if microscopy is used for a range of diagnostic services. RDTs have significant advantages over clinical diagnosis with minor increases in the cost of service provision.<p></p&gt

EQ-5D-3L Derived Population Norms for Health Related Quality of Life in Sri Lanka

Background Health Related Quality of Life (HRQoL) is an important outcome measure in health economic evaluation that guides health resource allocations. Population norms for HRQoL are an essential ingredient in health economics and in the evaluation of population health. The aim of this study was to produce EQ-5D-3L-derived population norms for Sri Lanka. Method A population sample (n =  780) was selected from four districts of Sri Lanka. A stratified cluster sampling approach with probability proportionate to size was employed. Twenty six clusters of 30 participants each were selected; each participant completed the EQ-5D-3L in a face-to-face interview. Utility weights for their EQ-5D-3L health states were assigned using the Sri Lankan EQ-5D-3L algorithm. The population norms are reported by age and socio-economic variables. Results The EQ-5D-3L was completed by 736 people, representing a 94% response rate. Sixty per cent of the sample reported being in full health. The percentage of people responding to any problems in the five EQ-5D-3L dimensions increased with age. The mean EQ-5D-3L weight was 0.85 (SD 0.008; 95%CI 0.84-0.87). The mean EQ-5D-3L weight was significantly associated with age, housing type, disease experience and religiosity. People above 70 years of age were 7.5 times more likely to report mobility problems and 3.7 times more likely to report pain/discomfort than those aged 18-29 years. Those with a tertiary education were five times less likely to report any HRQoL problems than those without a tertiary education. A person living in a shanty was 4.3 more likely to have problems in usual activities than a person living in a single house. Conclusion The population norms in Sri Lanka vary with socio-demographic characteristics. The socioeconomically disadvantaged have a lower HRQoL. The trends of population norms observed in this lower middle income country were generally similar to those previously reported in high income countries

Patterns of Public Participation: Opportunity Structures and Mobilization from a Cross-National Perspective

PURPOSE: The paper summarizes data from twelve countries, chosen to exhibit wide variation, on the role and place of public participation in the setting of priorities. It seeks to exhibit cross-national patterns in respect of public participation, linking those differences to institutional features of the countries concerned. DESIGN/METHODOLOGY/APPROACH: The approach is an example of case-orientated qualitative assessment of participation practices. It derives its data from the presentation of country case studies by experts on each system. The country cases are located within the historical development of democracy in each country. FINDINGS: Patterns of participation are widely variable. Participation that is effective through routinized institutional processes appears to be inversely related to contestatory participation that uses political mobilization to challenge the legitimacy of the priority setting process. No system has resolved the conceptual ambiguities that are implicit in the idea of public participation. ORIGINALITY/VALUE: The paper draws on a unique collection of country case studies in participatory practice in prioritization, supplementing existing published sources. In showing that contestatory participation plays an important role in a sub-set of these countries it makes an important contribution to the field because it broadens the debate about public participation in priority setting beyond the use of minipublics and the observation of public representatives on decision-making bodies

Is the pharmacy profession innovative enough?: meeting the needs of Australian residents with chronic conditions and their carers using the nominal group technique

Background Community pharmacies are ideally located as a source of support for people with chronic conditions. Yet, we have limited insight into what innovative pharmacy services would support this consumer group to manage their condition/s. The aim of this study was to identify what innovations people with chronic conditions and their carers want from their ideal community pharmacy, and compare with what pharmacists and pharmacy support staff think consumers want. Methods We elicited ideas using the nominal group technique. Participants included people with chronic conditions, unpaid carers, pharmacists and pharmacy support staff, in four regions of Australia. Themes were identified via thematic analysis using the constant comparison method. Results Fifteen consumer/carer, four pharmacist and two pharmacy support staff groups were conducted. Two overarching themes were identified: extended scope of practice for the pharmacist and new or improved pharmacy services. The most innovative role for Australian pharmacists was medication continuance, within a limited time-frame. Consumers and carers wanted improved access to pharmacists, but this did not necessarily align with a faster or automated dispensing service. Other ideas included streamlined access to prescriptions via medication reminders, electronic prescriptions and a chronic illness card. Conclusions This study provides further support for extending the pharmacist’s role in medication continuance, particularly as it represents the consumer’s voice. How this is done, or the methods used, needs to optimise patient safety. A range of innovative strategies were proposed and Australian community pharmacies should advocate for and implement innovative approaches to improve access and ensure continuity of care

Developing diversity through specialisation in secondary education: comparing approaches in New Zealand and England

The paper compares approaches to curriculum specialisation in secondary education in New Zealand and England. In both countries there have been movements towards increased specialisation, though these have been quite different in form and scope. In both countries specialisation cannot be divorced from broader education policies designed to increase devolution and choice and the paper discusses these contexts before analysing the different approaches to specialisation and attempting an explanation. The authors of the paper draw on findings from research undertaken in New Zealand schools. The paper identifies three dimensions that have played a part in influencing curriculum specialisation in both countries. These are opportunity, source of impetus and support. It is argued that while local initiative is possible in New Zealand, central planning and guidance is inadequate. In England while central planning is strong and support is available, it is far from clear that real specialisation is encouraged by existing curriculum and assessment frameworks. In these circumstances in both countries it seems likely that vertical, rather than horizontal, diversity will continue to hold sway