Medicines reconciliation in comparison with NICE guidelines across secondary care mental health organisations

Background Medicines reconciliation-identifying and maintaining an accurate list of a patient's current medications-should be undertaken at all transitions of care and available to all patients. Objective A self-completion web survey was conducted for chief pharmacists (or equivalent) to evaluate medicines reconciliation levels in secondary care mental health organisations. Setting The survey was sent to secondary care mental health organisations in England, Scotland, Northern Ireland and Wales. Method The survey was launched via Bristol Online Surveys. Quantitative data was analysed using descriptive statistics and qualitative data was collected through respondents free-text answers to specific questions. Main outcomes measure Investigate how medicines reconciliation is delivered, incorporate a clear description of the role of pharmacy staff and identify areas of concern. Results Forty-two (52 % response rate) surveys were completed. Thirty-seven (88.1 %) organisations have a formal policy for medicines reconciliation with defined steps. Results show that the pharmacy team (pharmacists and pharmacy technicians) are the main professionals involved in medicines reconciliation with a high rate of doctors also involved. Training procedures frequently include an induction by pharmacy for doctors whilst the pharmacy team are generally trained by another member of pharmacy. Mental health organisations estimate that nearly 80 % of medicines reconciliation is carried out within 24 h of admission. A full medicines reconciliation is not carried out on patient transfer between mental health wards; instead quicker and less exhaustive variations are implemented. 71.4 % of organisations estimate that pharmacy staff conduct daily medicine reconciliations for acute admission wards (Monday to Friday). However, only 38 % of organisations self-report to pharmacy reconciling patients' medication for other teams that admit from primary care. Conclusion Most mental health organisations appear to be complying with NICE guidance on medicines reconciliation for their acute admission wards. However, medicines reconciliation is conducted less frequently on other units that admit from primary care and rarely completed on transfer when it significantly differs to that on admission. Formal training and competency assessments on medicines reconciliation should be considered as current training varies and adherence to best practice is questionable.

Language policy and governmentality in businesses in Wales:a continuum of empowerment and regulation

In this paper, I examine how language policy acts as a means of both empowering the Welsh language and theminority language worker and as a means of exerting power over them. For this purpose, the study focuses on a particular site: private sector businesses in Wales. Therein, I trace two major discursive processes: first, the Welsh Government’s national language policy documents that promote corporate bilingualism and bilingual employees as value-added resources; second, the practice and discourse of company managers who sustain or appropriate such promotional discourses for creating and promoting their own organisational values. By drawing on concepts from governmentality, critical language policy and discourse studies, I show that promoting bilingualism in business is characterised by local and global governmentalities. These not only bring about critical shifts in valuing language as symbolic entities attached to ethnonational concerns or as promotional objects that bring material gain. Language governmentalities also appear to shape new forms of ‘languaging’ the minority language worker as selfgoverning, and yet, governed subjects who are ultimately made responsible for ‘owning’ Welsh.

Discursive approaches to language policy

This book brings together the fields of language policy and discourse studies from a multidisciplinary theoretical, methodological and empirical perspective. The chapters in this volume are written by international scholars active in the field of language policy and planning and discourse studies. The diverse research contexts range from education in Paraguay and Luxembourg via businesses in Wales to regional English language policies in Tajikistan. Readers are thereby invited to think critically about the mutual relationship between language policy and discourse in a range of social, political, economic and cultural spheres. Using approaches that draw on discourse-analytic, anthropological, ethnographic and critical sociolinguistic frameworks, the contributors in this collection explore and refine the ‘discursive’ and the ‘critical’ aspects of language policy as a multilayered, fluid, ideological, discursive and social process that can operate as a tool of social change as well as reinforcing established power structures and inequalities.

Language policy and critical discourse studies:towards an integrated approach

This chapter offers a framework for combining critical language policy with critical discourse studies (CDS) to analyse language policy as a process in the context of minority language policy in Wales. I propose a discursive approach to language policy, which starts from the premise that language policy is constituted, enacted, interpreted and (re)contextualised in and through language. This approach extends the critical language policy framework provided by Shohamy (Language policy: hidden agendas and new approaches. Routledge, London, 2006) and integrates perspectives from the context-sensitive discourse-historical approach in CDS. It incorporates discourse as an essential lens through which policy mechanisms, ideologies and practices are constituted and de facto language policy materialises. This chapter argues that conceptualising and analysing language policy as a discursive phenomenon enables a better understanding of the multi-layered nature of language policy that shapes the management and experience of corporate bilingualism in Wales.

Introduction : why are discursive approaches to language policy necessary?

This volume is a series of explorations of language policy from a discursive perspective. Its chief aim is to systematically explore the interconnectedness of language policy and discourse through what we are terming ‘discursive approaches to language policy’ (DALP). We show that language policy is a multilayered phenomenon that is constituted and enacted in and through discourse (which is defined more closely in Sect. 1.2). Language policy is a fast-growing, vibrant, and interdisciplinary field of inquiry that offers a variety of theoretical frameworks, methodologies, analytic approaches, and empirical findings: the framing sections at the beginning of each part of this volume and the commentary at the end frame the discussion of developments in language policy and especially the role of DALP therein.

The National Literacy Strategy and knowledge about language in the English school curriculum

In “The English Patient: English Grammar and teaching in the Twentieth Century”, Hudson and Walmsley (2005) contend that the decline of grammar in schools was linked to a similar decline in English universities, where no serious research or teaching on English grammar took place. This article argues that such a decline was due not only to a lack of research, but also because it suited educational policies of the time. It applies Bernstein’s theory of pedagogic discourse (1990 & 1996) to the case study of the debate surrounding the introduction of a national curriculum in English in England in the late 1980s and the National Literacy Strategy in the 1990s, to demonstrate the links between academic theory and educational policy.

Beyond the formal/informal economy binary hierarchy

Purpose – This paper aims to evaluate critically the conventional binary hierarchical representation of the formal/informal economy dualism which reads informal employment as a residual and marginal sphere that has largely negative consequences for economic development and needs to be deterred. Design/methodology/approach – To contest this depiction, the results of 600 household interviews conducted in Ukraine during 2005/2006 on the extent and nature of their informal employment are reported. Findings – Informal employment is revealed to be an extensively used form of work and, through a richer and more textured understanding of the multiple roles that different forms of informal employment play, a form of work that positively contributes to economic and social development, acting both as an important seedbed for enterprise creation and development and as a primary vehicle through which community self-help is delivered in contemporary Ukraine. Research limitations/implications – This survey reveals that depicting informal employment as a hindrance to development and deterring engagement in this sphere results in state authorities destroying the entrepreneurial endeavour and active citizenship that other public policies are seeking to nurture. The paper concludes by addressing how this public policy paradox might start to be resolved. Originality/value – This paper is one of the first to document the role of informal employment in nurturing enterprise creation and development as well as community exchange.

Development of real-time process control systems using formal techniques

A major application of computers has been to control physical processes in which the computer is embedded within some large physical process and is required to control concurrent physical processes. The main difficulty with these systems is their event-driven characteristics, which complicate their modelling and analysis. Although a number of researchers in the process system community have approached the problems of modelling and analysis of such systems, there is still a lack of standardised software development formalisms for the system (controller) development, particular at early stage of the system design cycle. This research forms part of a larger research programme which is concerned with the development of real-time process-control systems in which software is used to control concurrent physical processes. The general objective of the research in this thesis is to investigate the use of formal techniques in the analysis of such systems at their early stages of development, with a particular bias towards an application to high speed machinery. Specifically, the research aims to generate a standardised software development formalism for real-time process-control systems, particularly for software controller synthesis. In this research, a graphical modelling formalism called Sequential Function Chart (SFC), a variant of Grafcet, is examined. SFC, which is defined in the international standard IEC1131 as a graphical description language, has been used widely in industry and has achieved an acceptable level of maturity and acceptance. A comparative study between SFC and Petri nets is presented in this thesis. To overcome identified inaccuracies in the SFC, a formal definition of the firing rules for SFC is given. To provide a framework in which SFC models can be analysed formally, an extended time-related Petri net model for SFC is proposed and the transformation method is defined. The SFC notation lacks a systematic way of synthesising system models from the real world systems. Thus a standardised approach to the development of real-time process control systems is required such that the system (software) functional requirements can be identified, captured, analysed. A rule-based approach and a method called system behaviour driven method (SBDM) are proposed as a development formalism for real-time process-control systems.

An expert system for the development of a health and safety policy/risk assessment in the plastics industry

Health and safety policies may be regarded as the cornerstone for positive prevention of occupational accidents and diseases. The Health and Safety at Work, etc Act 1974 makes it a legal duty for employers to prepare and revise a written statement of a general policy with respect to the health and safety at work of employees as well as the organisation and arrangements for carrying out that policy. Despite their importance and the legal equipment to prepare them, health and safety policies have been found, in a large number of plastics processing companies (particularly small companies), to be poorly prepared, inadequately implemented and monitored. An important cause of these inadequacies is the lack of necessary health and safety knowledge and expertise to prepare, implement and monitor policies. One possible way of remedying this problem is to investigate the feasibility of using computers to develop expert system programs to simulate the health and safety (HS) experts' task of preparing the policies and assisting companies implement and monitor them. Such programs use artificial intelligence (AI) techniques to solve this sort of problems which are heuristic in nature and require symbolic reasoning. Expert systems have been used successfully in a variety of fields such as medicine and engineering. An important phase in the feasibility of development of such systems is the engineering of knowledge which consists of identifying the knowledge required, eliciting, structuring and representing it in an appropriate computer programming language.

An investigation into formal and functional characteristics of qualifications in legislative writing and its application to English for academic legal purposes.

The present investigation is based on a linguistic analysis of the 'Housing Act 1980' and attempts to examine the role of qualifications in the structuring of the legislative statement. The introductory chapter isolates legislative writing as a "sub-variety “of legal language and provides an overview of the controversies surrounding the way it is written and the problems it poses to its readers. Chapter two emphasizes the limitations of the available work on the description of language-varieties for the analysis of legislative writing and outlines the approach adopted for the present analysis. This chapter also gives some idea of the information-structuring of legislative provisions and establishes qualification as a key element in their textualisation. The next three chapters offer a detailed account of the ten major qualification-types identified in the corpus, concentrating on the surface form they take, the features of legislative statements they textualize and the syntactic positions to which they are generally assigned in the statement of legislative provisions. The emerging hypotheses in these chapters have often been verified through a specialist reaction from a Parliamentary Counsel, largely responsible for the writing of the ‘Housing Act 1980’• The findings suggest useful correlations between a number of qualificational initiators and the various aspects of the legislative statement. They also reveal that many of these qualifications typically occur in those clause-medial syntactic positions which are sparingly used in other specialist discourse, thus creating syntactic discontinuity in the legislative sentence. Such syntactic discontinuities, on the evidence from psycholinguistic experiments reported in chapter six, create special problems in the processing and comprehension of legislative statements. The final chapter converts the main linguistic findings into a series of pedagogical generalizations, offers indications of how this may be applied in EALP situations and concludes with other considerations of possible applications.

An investigation of managerial skills:Implications for personnel policy

This research explores the conceptual basis in adopting a skills approach to management development. The literature reveals a number of development approaches but only a limited appreciation of how the manager does his job i.e. of the skills that he needs. An investigation of managerial skills was conducted with 10 manager s mainly occupying middle and senior positions. The principal source of evidence was the manager's thoughts on what he did and how he did it, although the interviews were supplemented by formal and informal observation. There was also a dialectic value from discussions with other analysts/managers and empathy between analyst and practitioner also played a part. Each manager was invited to comment upon his own skills analysis as a check upon validity. The study supports the view that the manager similar to other skilled practitioners, is conceptually a model builder and operationally a navigator (Singleton 1978b) . The manager variously holds enactive, pictorial, symbolic and hybrid models that enable him to understand his world and act in it. The universal managerial function is decision making and the study presents a preliminary nomenclature in classifying decision processes or perceptual skills. Managerial skills are also reflected in interpersonal interaction where the hallmark is mutual construction and attribution and in 'self-management’ where the requirement is to cope with the inner rather than the outer world. Differences between the managers are most evident in perceptual skills, the more senior manager requiring increasing ability to process abstract information and take account of environmental uncertainty. He will also make greater use of 'off- line’ information. The practical purpose in studying managerial skills is to facilitate the improvement of managerial performance and the implications of the research for training, selection and appraisal are explored.

Variation in spoken discourse in and beyond the english foreign language classroom : a comparative study

This study is concerned with one of the most interesting and the least well-researched areas in contemporary research on classroom interaction: that of the discourse variability exhibited by participants. It investigates the way in which the language of native speakers (NSs) as well as that of non-native speakers (NNSs) may vary according to the circumstances under which it is produced. The study, therefore, attempts to characterise the performance of both NSs and NNSs (with particular emphasis placed on the latter) in various types of interaction in and beyond the EFL classroom. These are: Formal Interview (FI), Formal Classroom Interaction (FCI), Informal Classroom Interaction (ICI), Informal Classroom Discussion (ICD), and Informal Conversation (IC). The corpus of the study consisted of four NSs and fifteen NNSs. Both a video and a tape recording was made for each type of interaction, with the exception of the IC which was only audio-recorded so as not to inhibit the natural use of language. Each lasted for 35 minutes. The findings of the study mark clearly the distinction between the `artificiality' of classroom interaction and the `naturalness' or `authenticity' of non-classroom discourse. Amongst the most interesting findings are the following: Unlike both FCI and ICI, in the FI, ICD, and IC, the language of NNSs was characterised by: greater quantity of oral output, a wider range of errors, the use of natural discourse strategies such as holding the floor and self-correction, and a greater number of initiations in both ICD and IC. It is suggested that if `natural' or `authentic' discourse is to be promoted, the incorporation of FI, ICD, and IC into the EFL classroom activities is much needed. The study differs from most studies on classroom interaction in that it attempts to relate work in the EFL classroom to the `real' world as its prime objective.

The role of the English language in the context of national development vision 2025 with specific reference to agriculture in Tanzania

After thirty years of vacillation, the Tanzanian government has made a firm decision to Swahilize its secondary education system. It has also embarked on an ambitious economic and social development programme (Vision 2025) to transform its peasant society into a modern agricultural community. However, there is a faction in Tanzania opposed to Kiswahili as the medium of education. Already many members of the middle and upper class their children to English medium primary schools to avoid the Kiswahili medium public schools and to prepare their children for the English medium secondary system presently in place. Within the education system, particularly at university level, there is a desire to maintain English as the medium of education. English is seen to provide access to the international scientific community, to cutting edge technology and to the global economy. My interest in this conflict of interests stems from several years' experience teaching English to students at Sokoine University of Agriculture. Students specialise in agriculture and are expected to work with the peasant population on graduation. The students experience difficulties studying in English and then find their Kiswahili skills insufficient to explain to farmers the new techniques and technologies that they have studied in English. They are hampered by a complex triglossic situation in which they use their mother tongue with family and friends, Kiswahili, the national language for early education and most public communication within Tanzania, and English for advanced studies. My aim in this thesis was - to study the language policy in Tanzania and see how it is understood and implemented; - to examine the attitudes towards the various languages and their various roles; - to investigate actual language behaviour in Tanzanian higher education. My conclusion is that the dysfunctionality of the present study has to be addressed. Diglossic public life in Tanzania has to be accommodated. The only solution appears to be a compromise, namely a bilingual education system which supports from all cases of society by using Kiswahili, together with an early introduction of English and its promotion as a privileged foreign language, so that Tanzania can continue to develop internally through Kiswahili and at the same time retain access to the globalising world through the medium of English.

The role of science in policy making

This thesis aims to consider the role played by science in policy making. Firstly, two decision models are considered, synoptic rationality which depends heavily on formal information and comprehensive planning, and disjointed incrementalism, under which decisions are made in a fragmented and remedial manner via the interaction of interested partisans and with little necessity for formal information. Secondly, different descriptions of scientific activity are discussed and a broadly Kuhnian view of science is supported, with what is regarded as a `fact' being heavily influenced by social factors. It is suggested that scientific controversies are more likely to occur in policy related science but for reasons that are intrinsic to science rather than due to some correctable aberration. A number of case studies, including two `in-depth' studies into maternal deprivation and the relationship between hyperactivity and food additives, support this contention and also show that whilst scientific findings can raise issues they cannot aid in the resolution of these as the synoptic model suggests that they should. Instead information supports and legitimates value based policy views, with actual policy decisions arrived at via negotiation and aiming at a balancing of partisan pressures, as suggested by the incremental model. Not only does information not aid the resolution of policy disputes, it cannot do so. When policy is disputed, scientific findings are also likely to be disputed and further research merely attracts more highly destructive criticism. This is termed the over critical model. When policy is decided then there is reduced impetus to critically test scientific ideas; this is termed the under critical model. Both of these situations act to the detriment of science. The main conclusion drawn is that the belief that science is essential to decision making is misleading and may serve to mask rather than illuminate areas of dispute.

ALEX:mobile language assistant for low-literacy adults

Basic literacy skills are fundamental building blocks of education, yet for a very large number of adults tasks such as understanding and using everyday items is a challenge. While research, industry, and policy-making is looking at improving access to textual information for low-literacy adults, the literacy-based demands of today's society are continually increasing. Although many community-based organizations offer resources and support to adults with limited literacy skills, current programs have difficulties reaching and retaining those that would benefit most from them. To address these challenges, the National Research Council of Canada is proposing a technological solution to support literacy programs and to assist low-literacy adults in today's information-centric society: ALEX© – Adult Literacy support application for EXperiential learning. ALEX© has been created together with low-literacy adults, following guidelines for inclusive design of mobile assistive tools. It is a mobile language assistant that is designed to be used both in the classroom and in daily life, in order to help low-literacy adults become increasingly literate and independent.