Attending Physician Variability: A Model of Four Supervisory Styles

Purpose: There is wide variability in how attending physician roles on teaching teams, including patient care and trainee learning, are enacted. This study sought to better understand variability by considering how different attendings configured and rationalized direct patient care, trainee oversight, and teaching activities. 

Method: Constructivist grounded theory guided iterative data collection and analyses. Data were interviews with 24 attending physicians from two academic centers in Ontario, Canada, in 2012. During interviews, participants heard a hypothetical presentation and reflected on it as though it were presented to their team during a typical admission case review. 

Results: Four supervisory styles were identified: direct care, empowerment, mixed practice, and minimalist. Driven by concerns for patient safety, direct care involves delegating minimal patient care responsibility to trainees. Focused on supporting trainees’ progressive independence, empowerment uses teaching and oversight strategies to ensure quality of care. In mixed practice, patient care is privileged over teaching and is adjusted on the basis of trainee competence and contextual features such as patient volume. Minimalist style involves a high degree of trust in senior residents, delegating most patient care, and teaching to them. Attendings rarely discussed their styles with the team. 

Conclusions: The model adds to the literature on variability in supervisory practice, showing that the four styles reflect different ways of responding to tensions in the role and context. This model could be refined through observational research exploring the impact of context on style development and enactment. Making supervisory styles explicit could support improvement of team competence.

Unsettling modernity: Shifting values and changing housing styles in the Kathmandu Valley

Abstract

Culture has always been important for the character of the cities, as have the civic and public institutions that sustain a lifestyle and provide an identity. Substantial evidence of the unique historical, urban civilisation remains within the traditional settlements in the Kathmandu Valley in Nepal; manifested in houses, palaces, temples, rest houses, open spaces, festivals, rituals, customs and cultural institutions. Indigenous knowledge and practices prescribed the arrangement of houses, roads and urban spaces giving the city a distinctive physical form, character and a unique oriental nativeness. In technical sense, these societies did not have written rules for guiding development. In recent decades, the urban culture of the city has been changing with the forces of urbanisation and globalisation and the demand for new buildings and spaces. New residential design is increasingly dominated by distinctive patterns of Western suburban ideal comprising detached or semi-detached homes and high rise tower blocks. This architectural iconoclasm can be construed as a rather crude response to the indigenous culture and built form. The paper attempts to dismantle the current tension between traditional and contemporary ‘culture’ (and hence society) and housing (or built form) in the Kathmandu Valley by engaging in a discussion that cuts across space, time and meaning of architecture as we know it.

Dance in Handel's London Operas

In considering Handel's imaginative response to a range of contemporary theatrical dance styles and practices, this study demonstrates that dance was far from peripheral to the genre of opera seria. The importance of London as a leading centre for dance innovation, and the interaction between various theatrical genres regarding the use of dance, is also established.

Parenting practices in Northern Ireland: evidence from the Northern Ireland Household Panel Survey

The impact of parental child-rearing practices on child outcomes has been the subject of much research and debate for many years. Studies carried out within a variety of disciplines and across a number of different countries in the world have indicated that parents tend to use a different pattern of rearing their sons than their daughters, and that child-rearing practices are related to the gender of the parent, as well as to the age and developmental stage of the child. However, there has been little research in Northern Ireland on child-rearing behaviours. In order to address this shortfall, this paper presents an analysis of parents’ perceptions of their interactions with their children. Data from Wave 3 of the Northern Ireland Household Panel Survey were analysed to explore aspects of ‘‘negative’’ parenting practices (arguing, yelling and use of physical punishment) as well as ‘‘positive’’ parenting practices (talking, praising and hugging). The participants were all parents (aged 16 years and over) with children under the age of 16 years living in the same household. Each parent reported his/her interaction with each child (up to a maximum of six children), and in total 1,629 responses were recorded. The results of the research supported previous findings from the United Kingdom and elsewhere, and indicated that the parenting styles of respondents in Northern Ireland were indeed related to the gender and age of the children and to the gender of the parents. The survey found that parents in Northern Ireland tend to have a harsher, more negative style of parenting boys than girls and that children in their teenage years have fewer positive interactions with their parents than younger children. The same parents and children will be followed up in 2007 in order to provide a longitudinal analysis of parent/child relationships in Northern Ireland.

A model for developing, implementing and evaluating a strategy to improve nursing and midwifery care

Background: Health care organizations world wide are faced with the need to develop and implement strategic organizational plans to meet the challenges of modern health care. There is a need for models for developing, implementing and evaluating strategic plans that engage practitioners, and make a measurable difference to the patients that they serve. This article describes the development of such a model to underpin a strategy for nursing and midwifery in an acute hospital trust. An integrated model: The processes for strategy development (values clarification, critical companionship and focus groups) are discussed, together with the development of processes for implementation, based upon a modification of the PARIHS (Promoting Action on Research Implementation in Health Services) conceptual framework. Finally, the methods for evaluating the strategy (a pre-test/post-test approach measuring the quality of nursing care, the degree to which the organization supports professional nursing care, the leadership styles of ward managers, and patient satisfaction with care) are described. Conclusion: The model is offered as one that may be of use to others who wish to develop an integrated approach to strategic change; an approach in which the development, implementation and evaluation of strategic plans are informed by the core values of nurses and midwives.

Attachment Style in Adults who Failed to Thrive as Children: Outcomes of a 20 Year Follow-up Study of Factors Influencing Maintenance or Change in Attachment Style

A group of children identified as non-organic failure-to-thrive between 1977 and 1980 were investigated, assessed and provided with social work intervention and treatment. Those children and their families have been followed up for the last 20 years. The current paper examines the stability of an internal working model in a sample of individuals who had failed to thrive as children, by comparing each individual's adult attachment style with their childhood attachment to their mother. In this sample, several cases showed changes from insecure to secure attachment styles. Possible reasons are discussed for positive and negative changes, as well as cases when there was no change in attachment style. These include the effectiveness of intervention in addition to changes in life circumstances. The findings suggest that when appropriate support and intervention is provided, or when different circumstances or relationships are experienced, internal working models can change.

Repositioning documents in social research

In matters of social research sociologists and other social scientists have tended to view documents primarily as sources of evidence and as receptacles of inert content.The key strategies for data exploration have consequently been associated with various styles of content or thematic analysis. Even when discourse analysis has been recommended, there has been a marked tendency to deal with records, files, and the like, primarily as containers - things to be read, understood, and categorized. In this article, however, the author seeks to demonstrate that by focussing on the functioning of documents instead of content, sociology can embrace a much wider range of approaches to both data collection and analysis. Indeed, the adoption of such a programme encourages researchers to see documents as active agents in the world, and to view documentation as a key component of dynamic networks rather than as a set of static and immutable 'things'.

Leading integrated schools: a study of the multicultural perspectives of Northern Irish principals

This article is concerned with the sustained peace education initiative of integrated schooling and in particular with leadership responses to cultural diversity. Using a case study group of principals of integrated (mixed Catholic, Protestant and other) schools in Northern Ireland, the author explores how principals perceive and lead their visions of integrated education. A combined framework of multicultural and school leadership theory is employed to analyse the findings. The perceptions of the principals reported are consistent with liberal interpretations of multiculturalism, although there is also evidence of a more pluralist perspective. Core liberal values appear to be central to the leadership style of these principals, in line with values-led contingency models of leadership. The article suggests that a sole emphasis on common humanity is an inadequate approach to peace education. It tentatively suggests a relationship between leadership styles and approaches to multiculturalism, and argues that a synthesis of multicultural and leadership theory can usefully guide the development of peace education leadership.

The effect of 3D weaving and consolidation on carbon fiber tows, fabrics, and composites

This article investigates the damage imparted on load-bearing carbon fibers during the 3D weaving process and the subsequent compaction behavior of 3D woven textile preforms. The 3D multi-layer reinforcements were manufactured on a textile loom with few mechanical modifications to produce preforms with fibers orientated in the warp, weft, and through-the-thickness directions. Tensile tests were conducted on three types of commercially available carbon fibers, 12k HTA, 6k HTS, and 3k HTS in an attempt to quantify the effect of fiber damage induced during the 3D weaving process on the mechanical and physical performance of the fiber tows in the woven composite. The tests were conducted on fiber tows sampled from different locations in the manufacturing process from the bobbin, through the creel and loom mechanism, to the final woven fabric. Mechanical and physical testing were then conducted to quantify the tow geometry, orientation and the effect of compaction during manufacture of two styles of 3D woven composite by vacuumassisted resin transfer molding (VaRTM).

Cinema Lucida: Johan van der Keuken and the Meaning of Loss

Ever sceptical about the positivistic claims of ethnographic and so-called realist documentary, Johan van der Keuken’s film-making is the work of a curious, spontaneous and disorientated observer of the essential strangeness of both the foreign and the familiar, new landscapes and cities, experiences, and people. While there are various explicitly political and socially orientated films and themes across his work, it is those films and moments when what is being conveyed is a sense of him being somewhere liminal, being ‘in-between’ situations, cultures, styles and interpretations, reticent, uncertain but incorrigibly curious that constitute his most valuable contribution to documentary film aesthetics. Not surprisingly, such characteristics often come to the fore in those films where he tries to make sense of loss, the passing of lives and the legacies left behind. This article discusses questions of history and personal loss in a number of his films.

Towards a Poetics of the Cinematographic Frame

In delineating a poetics of the cinematographic frame, this article presents a typology of framing styles, and demonstrates how filmmakers use the frame as an expressive resource and how the frame uses them. The examples discussed are modernist in orientation, and each has a particular association with a city - its history, architecture, and cultural character. Although it is common practice to refer to some framing situations as instances of 'deframing', the article enquires into the problematic nature of this term, suggesting alternative visual and cinematographic contexts more amenable to its deconstructive implications. As the boundaries between cinema and the other arts continue to converge and relations between frame, image, and screen become more complex, this article offers a reassessment of some first principles of film language, especially the aesthetic integrity of the cinematographic frame.

Music, Magic, and the Mythic: The Dynamics of Visual and Aural Discourse in Souleymane Cissé’s Yeelen

The 1980s saw a wave of African films that aimed to represent, on both local and international screens, a sophisticated pre-colonial Africa, thus debunking notions of the continent as primitive. Toward this aim the films inscribed the conventions of oral performance within their visual styles, denying spectator identification with the protagonists and emphasising the presence of the narrator. However, some critics argued that these films exoticised Africa, while their use of oral performance’s distancing effect echoed the ‘scientific’ distance structured by the ethnographic film, in which African societies were represented as ‘the other’. Souleymane Cissé’s Yeelen exemplifies this tension, transposing into cinematic form oral storytelling techniques in the depiction of a power struggle within the covert cult of the komo, a Bambara initiation society unfamiliar to most non-Bambara viewers. This paper demonstrates how the film negotiates this tension via music, which interpellates the international spectator by eliciting a greater identification with the protagonists than that determined at a visual level, while encoding a verisimilitude to rituals that may otherwise be read as the superstitious practices of ‘the other’. In this way, music and image in Yeelen operate as parallel, though often overlapping, discourses, bridging the gap between the film’s culturally specific narrative and formal components, and its international spectators.

Bachowskie przebudzenie Mozarta - studium kontekstu.

In Mozart Studies, it is widely acknowledged that Bach's influence is an important factor for Mozart's artistic development. Yet when discussing how Bach's music affected the development of his compositional styles and techniques, one realizes how tenuous it has been to advance one's arguments without actually seeing in detail how Mozart engaged with Bach’s music. This paper examines what Mozart may have thought when he edited Bach’s fugues for string quartet by attempting to clarify not only what he did and did not do, but also why he did or did not do something, so as to gain some fresh insight into his Bach experience in 1782. It then outlines a more general background of Bach’s fugues in Vienna before they reached the hand of Mozart in order to distinguish what he saw and did to Bach’s fugues.