Negotiating the prescribing role: District Nurses reveal strategies for managing conflict.

Background: Nurse prescribing by District Nurses is well established in the United Kingdom. Although considerable work has been undertaken which discusses nurse prescribing, there is little which focuses on relationships between prescribers and those with whom they interact, in particular the ways in which prescribing can appear to question established professional boundaries. Aims: This project seeks to explain how District Nurses negotiate difficult conflicts related to prescribing. Methods: Using qualitative semi-structure interviews, District Nurses, Pharmacists and General Practitioners explained their working activities associated with prescribing. Data were analysed after Morrell’s (2004) notion of naïve functionalism. Critical realism, as espoused by McEvoy and Richards (2003) was used as a bridging strategy in order to link findings to the works of Weber and Foucault. Results: For many District Nurses, prescribing appears unproblematic; however, for others there was evidence showing that GPs were explicit in the control they exerted over prescribers, even when they had no authority to do so. Discussion: Despite having no legal ‘authority’ over nurse prescribers, some prescribers reveal practices that show a clearly authoritarian approach to nurse prescribing, by some GPs. These range from GPs stipulating times when they were available for professional dialogue, to direct supervision and (dis) approval of a nurse prescribers’s activities. Conclusions: Although nurse prescribing was expected to enhance inter-professional working and collaboration in the interest of improved service to patients, there is an indication that, for some nurses and GPs, relationships focussed on nurse prescribing are less than harmonious. Contribution to the development of knowledge and policy and practice within health and health care: As a result of these research findings, relationships within Primary Care may be re-evaluated. For educators there is an opportunity to explore inter-professional relationships from a practitioner perspective

Instantiation in Trope Theory

The concept of instantiation is realized differently across a variety of metaphysical theories. A certain realization of the concept in a given theory depends on what roles are specified and associated with the concept and its corresponding term as well as what entities are suited to fill those roles. In this paper, the classic realization of the concept of instantiation in a one-category ontology of abstract particulars or tropes is articulated in a novel way and defended against unaddressed objections

What happened to risk dispersion?

The turbulence in credit and funding markets in the second half of 2007 is disturbing evidence that risk dispersion in financial markets has been less effective than expected. Investors appear to have acquired risks that they did not understand. Much more worrisome, however, is the evidence that major financial firms did not succeed in shedding risks so much as in transferring them among their own business lines, resulting in an unintended concentration of risks on their own balance sheets. In order to restore confidence in the near term, and to put credit creation on a more sustainable path in the future, supervisory authorities, central banks and governments will first need to understand why the much-vaunted dispersion of risk fell so far short of expectations. The “reluctance to lend” which underlies these strains in money markets was widely attributed to concerns about the financial condition of borrowers, as a consequence of uncertainty about the value of assets on the borrowers’ balance sheets, and also to insuffi cient attention to liquidity management by financial firms. But the focus on uncertainty about borrowers ignores the awkward fact that the major financial intermediaries are both lenders and borrowers themselves and their reluctance to lend significantly reflects a defensive reaction to their own uncertainties about their own balance sheets. Better stress testing for liquidity as well as solvency would certainly be beneficial. Yet a major cause of the strains in credit and funding markets has been the apparent inability of many firms to anticipate the interaction of their various on- and off-balance sheet exposures and, particularly, to understand the velocity of their off-balance sheet activities and how these affected their overall exposures. In considering potential remedies to the credit market’s turbulence and to the apparent failure of risk dispersion, the authorities should first reflect on their own role in the trend of pushing risks off of bank balance sheets.

Interpretation of coronal synoptic observations

Three-dimensional reconstruction techniques used to determine coronal density distributions from synoptic data are complicated and time consuming to employ. Current techniques also assume time invariant structures and thus mix both temporal and spatial variations present in the coronal data. The observed distribution of polarized brightness, pB, and brightness, B, of coronal features observed either at eclipses or with coronagraphs depends upon both the three-dimensional distribution of electron density within the structure and the location of the feature with respect to the plane-of-the-sky. By theoretically studying the signature of various coronal structures as they would appear during a limb transit, it is possible to recognize these patterns in real synoptic data as well as estimate temporal evolutionary effects

An Evening Spent with Bill van Zwet

Willem Rutger van Zwet was born in Leiden, the Netherlands, on March 31, 1934. He received his high school education at the Gymnasium Haganum in The Hague and obtained his Masters degree in Mathematics at the University of Leiden in 1959. After serving in the army for almost two years, he obtained his Ph.D. at the University of Amsterdam in 1964, with Jan Hemelrijk as advisor. In 1965, he was appointed Associate Professor of Statistics at the University of Leiden and promoted to Full Professor in 1968. He remained in Leiden until his retirement in 1999, while also serving as Associate Professor at the University of Oregon (1965), William Newman Professor at the University of North Carolina at Chapel Hill (1990--1996), frequent visitor and Miller Professor (1997) at the University of California at Berkeley, director of the Thomas Stieltjes Institute of Mathematics in the Netherlands (1992--1999), and founding director of the European research institute EURANDOM (1997--2000). At Leiden, he was Dean of the School of Mathematics and Natural Sciences (1982--1984). He served as chair of the scientific council and member of the board of the Mathematics Centre at Amsterdam (1983--1996) and the Leiden University Fund (1993--2005).Comment: Published in at http://dx.doi.org/10.1214/08-STS261 the Statistical Science (http://www.imstat.org/sts/) by the Institute of Mathematical Statistics (http://www.imstat.org

Does the PeaceBuilders Intervention Reduce Violence in Schools?

Fisher and Pulver present a brief overview and analysis of the article, Initial behavior outcomes for the PeaceBuilders Universal School-Based Violence Prevention Program, originally published in Developmental Psychology. The authors present a summary of the key components of the article including the introduction, method and results of the study. They offer an additional analysis of implications for future practice, including a discussion of the positive impacts of PeaceBuilders on student experience and teacher perception of student social competence