Pensando e agindo estrategicamente:novos desafios para a análise estratégical

Este artigo estabelece uma postura crítica e analítica em relação às abordagens baseadas em microatividades para se entender a estratégia. Argumenta-se que tais abordagens trazem desafios teóricos e empíricos importantes. Argumenta-se também contra a tendência ao reducionismo, sem igual ênfase nas influências contextuais que configuram a estratégia em um nível micro. Finalmente, o artigo defende uma abordagem mais internacional e comparativa para os estudos da estratégia em um nível micro. This paper takes a critical and evaluative stance toward micro-activity-based approaches to understanding strategy. It argues that such approaches bring with them important theoretical and empirical challenges. The paper argues against a tendency to reductionism without equal emphasis to the contextual influences that bound micro-strategising. Finally, the paper argues for a more international and comparative approach to micro-strategy studies than has currently been the case.

The journey towards cultural competence: first interventions

Graduates worldwide are increasingly entering a global workplace which will require them to operate across national and cultural boundaries. This paper discusses the need to ensure that all students are equipped to work within this increasingly complex multi-cultural environment. It examines the issues which occur in preparing students within a UK Higher Education environment so that they are able to operate effectively within the international work situations in which they find themselves. This research builds on earlier research, which found that the effectiveness of an individual to work across cultural boundaries, in terms of work and communication, was increased by the number of international or intercultural experiences that a person has. Using this as a premise, an intervention was designed which aimed to increase students’ awareness of intercultural differences and their ability to function effectively in multicultural groups. This paper analyses the effectiveness of this highly innovative training intervention. It concludes that it was an effective way of making students aware of some of the issues around cultural competence is groups. In fact, the training was seen as most effective by students in addressing issues round group dynamics. The training obviously changed the outlook of a number students who took part it. There are, however, a number of issues which need to be addressed the re-running the training. These are notably, at what time in a student’s academic career such intervention is given, its integration into the curriculum and managing of student expectations.

Thinking and acting strategically:new challenges for interrogating strategy

This paper takes a critical and evaluative stance toward micro-activity-based approaches to understanding strategy. It argues that such approaches bring with them important theoretical and empirical challenges. The paper argues against a tendency to reductionism without equal emphasis to the contextual influences that bound micro-strategising. Finally, the paper argues for a more international and comparative approach to micro-strategy studies than has currently been the case.

Contextualising accounts of illness:Notions of responsibility and blame in white and South Asian respondents' accounts of diabetes causation

We undertook a secondary analysis of in-depth interviews with white (n = 32) and Pakistani and Indian (n = 32) respondents who had type 2 diabetes, which explored their perceptions and understandings of disease causation. We observed subtle, but important, differences in the ways in which these respondent groups attributed responsibility and blame for developing the disease. Whereas Pakistani and Indian respondents tended to externalise responsibility, highlighting their life circumstances in general and/or their experiences of migrating to Britain in accounting for their diabetes (or the behaviours they saw as giving rise to it), white respondents, by contrast, tended to emphasise the role of their own lifestyle 'choices' and 'personal failings'. In seeking to understand these differences, we argue for a conceptual and analytical approach which embraces both micro- (i.e. everyday) and macro- (i.e. cultural) contextual factors and experiences. In so doing, we provide a critique of social scientific studies of lay accounts/understandings of health and illness. We suggest that greater attention needs to be paid to the research encounter (that is, to who is looking at whom and in what circumstances) to understand the different kinds of contexts researchers have highlighted in presenting and interpreting their data. © 2007 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.

Targets and self monitoring in hypertension: randomised controlled trial and cost effectiveness analysis

OBJECTIVES: To assess whether blood pressure control in primary care could be improved with the use of patient held targets and self monitoring in a practice setting, and to assess the impact of these on health behaviours, anxiety, prescribed antihypertensive drugs, patients' preferences, and costs. DESIGN: Randomised controlled trial. SETTING: Eight general practices in south Birmingham. PARTICIPANTS: 441 people receiving treatment in primary care for hypertension but not controlled below the target of < 140/85 mm Hg. INTERVENTIONS: Patients in the intervention group received treatment targets along with facilities to measure their own blood pressure at their general practice; they were also asked to visit their general practitioner or practice nurse if their blood pressure was repeatedly above the target level. Patients in the control group received usual care (blood pressure monitoring by their practice). MAIN OUTCOME MEASURES: Primary outcome: change in systolic blood pressure at six months and one year in both intervention and control groups. Secondary outcomes: change in health behaviours, anxiety, prescribed antihypertensive drugs, patients' preferences of method of blood pressure monitoring, and costs. RESULTS: 400 (91%) patients attended follow up at one year. Systolic blood pressure in the intervention group had significantly reduced after six months (mean difference 4.3 mm Hg (95% confidence interval 0.8 mm Hg to 7.9 mm Hg)) but not after one year (mean difference 2.7 mm Hg (- 1.2 mm Hg to 6.6 mm Hg)). No overall difference was found in diastolic blood pressure, anxiety, health behaviours, or number of prescribed drugs. Patients who self monitored lost more weight than controls (as evidenced by a drop in body mass index), rated self monitoring above monitoring by a doctor or nurse, and consulted less often. Overall, self monitoring did not cost significantly more than usual care (251 pounds sterling (437 dollars; 364 euros) (95% confidence interval 233 pounds sterling to 275 pounds sterling) versus 240 pounds sterling (217 pounds sterling to 263 pounds sterling). CONCLUSIONS: Practice based self monitoring resulted in small but significant improvements of blood pressure at six months, which were not sustained after a year. Self monitoring was well received by patients, anxiety did not increase, and there was no appreciable additional cost. Practice based self monitoring is feasible and results in blood pressure control that is similar to that in usual care.

Wear of abrasion resisting materials

The wear behaviour of a series of chromium containing white irons has been investigated under conditions of high stress grinding abrasion using a specimen on track abrasion testing machine. The measured abrasion resistance of the irons has been explained in terms of microstructure and hardness and with respect to the wear damage observed at and beneath abraded surfaces. During abrasion material removal occurred by cracking and detachment from the matrix of eutectic carbides as well as by penetration and micromachining effects of the abrasive grits being crushed at the wearing surface. Under the particular test conditions used martensitic matrix structures gave higher resistance to abrasion than austenitic or pearlitic. However, no simple relationship was found between general hardness or matrix microhardness at wear surfaces and abrasion resistance, and the test yielded pessimistic results for austenitic irons. The fine structures of the 15% Cr and 30% Cr alloys were studied by thin foil transmission electron microscopy. It was found that both the matrix and carbide constituents could be thinned for examination at 100 Kv using conventional dishing followed by ion beam thinning. Flany of the rodlike eutectic N7C3 carbides were seen to consist of clusters of scalier rods with individual 117C3 crystals quite often containing central cores of matrix constituent. 3oth eutectic and secondary N7C3 carbides were found to contain stacking faults on planes normal to the basal plane. In the eutectic carbides in the 30A Cr iron there was evidence of an in-situ PI7C3 C. transition which had taken place during the hardening heat treatment of this alloy. In the as-cast austenitic matrix iron strain induced martensite was produced at the wear surface contributing to work hardening. The significance of these findings have been discussed in relation to wear performance.

Priming moral self-ambivalence heightens deliberative behaviour in self-ambivalent individuals

Background: Recent work on cognitive-behavioural models of obsessive-compulsive disorder has focused on the roles played by various aspects of self-perception. In particular, moral self-ambivalence has been found to be associated with obsessive-compulsive phenomena. Aims: In this study we used an experimental task to investigate whether artificially priming moral self-ambivalence would increase participants' deliberation on ethical problems, an index that might be analogous to obsessive-compulsive behaviour. Method: Non-clinical participants completed two online tasks designed to prime either moral self-ambivalence, general uncertainty, or neither. All participants then completed a task requiring them to consider solutions to moral dilemmas. We recorded the time participants took to respond to the dilemmas and the length of their responses; we then combined these variables to create a measure of deliberation. Results: Priming moral self-ambivalence led to increases in deliberation, but this was only significant among those participants who scored highly on a baseline measure of moral self-ambivalence. Priming general uncertainty had no significant effect upon deliberation. Conclusions: The results suggest that moral self-ambivalence may play a role in the maintenance of obsessive-compulsive behaviour. We propose that individuals who are morally self-ambivalent might respond to situations in which this ambivalence is made salient by exhibiting behaviour with obsessive-compulsive characteristics. These findings have implications for the incorporation of ideas about self-concept into theories of obsessive-compulsive disorder.

Medication review of children on long term medications:a review of the literature

INTRODUCTION: Children on long term medication may be under the care of more than one medical team including the patients GP. Children on chronic medication should be supported and their medications reviewed, especially in cases of polypharmacy. Medicines Use Reviews (MURs) were introduced into the pharmacy contract in 2005. The service was designed for community pharmacists to review patients on long term medication. The service specified that MURs were done on patients who can give consent and cannot be conducted with a parent or carer. Hence the service may be inaccessible to paediatric patients. This review aims to find studies that identify medication review services in primary care that cater for children on long term medication. METHODS: A literature search was conducted on 6th June 2015 using the keywords, ("Medication" or "review" or "Medication Review" or "Medicines use review" or "Medication use review" or "New Medicine Service") AND ("community pharmacy" OR "community pharmacist" OR "primary care" OR "General practice" OR "GP" OR "community paediatrician" OR "community pediatrician" OR "community nurse"). Bibliographic databases used were AMED, British Nursing Index, CINAHL, EMBASE, HMIC, MEDLINE, PsycINFO and Health Business Elite. Inclusion criteria were: paediatric specific medication review in primary care, for example by either a GP, community paediatrician, community nurse or community pharmacist. Exclusion criteria were studies of medication review in adults/unclear patient age and secondary care medication reviews. RESULTS: From the 417 articles, 6 relevant articles were found after abstract and full text review. 235 articles were excluded after title and abstract review (11 did not have full text in English); 96 were adult or non-age specified medication review/MUR/New Medicine Service studies; 63 referred to observational, evaluative studies of interventions in adults; 6 were non-paediatric specific systematic reviews and 17 were protocols, commentaries, news, and letters.The 6 relevant articles consisted of 1 literature review (published 2004), 3 research articles and 1 published protocol. The literature review[1] recommended that children's long term medication should be reviewed. The published protocol stated that the NMS minimum age for inclusion in the trial was for children aged over 13 years of age. The four studies were related to psychiatrists reviewing paediatric mental health patients in the USA, a pharmacist using Drug Related Problem to review patients in GP practices in Australia, a UK study based on an information prescription concept by providing children dispensed medications in community pharmacy with signposting them to health information and one GP practice based study observing pharmaceutical care issues in children and adults. CONCLUSION: The results show that there are currently no known studies on medication use reviews specific to children, whereas in adults, published evaluations are available. The terms of the MUR policy restrict children's access to the service and so more studies are necessary to determine whether children could benefit from such access.