What makes an effective PCT pharmacist? A study of training and development needs

This research was commissioned by the Shropshire and Staffordshire Workforce Development Confederation, to undertake a review of the education and training needs of pharmacists working at a strategic level within primary care trusts.

A comparison of antibiotic prescribing indicators and medicines management scoring in secondary care

Poster: - Robust prescribing indicators analogous to those used in primary care are not available currently in NHS hospital trusts - The Department of Health has recently implemented a scheme for self-assessment scoring medicines management processes (maximum 23) in NHS hospitals - There is no clear relationship between average values for two antibiotic prescribing indicators obtained in ten NHS hospital trusts in the West Midlands - There is no clear relationship between either indicator value and the corresponding self-assessment medicines management score - This study highlights the difficulties involved in assessing the medicines management processes in NHS hospitals; better medicines management evaluation systems are needed

Investigating mental health risk assessment in primary care and the potential role of a structured decision support tool, GRiST

Aim: To explore current risk assessment processes in general practice and Improving Access to Psychological Therapies (IAPT) services, and to consider whether the Galatean Risk and Safety Tool (GRiST) can help support improved patient care. Background: Much has been written about risk assessment practice in secondary mental health care, but little is known about how it is undertaken at the beginning of patients' care pathways, within general practice and IAPT services. Methods: Interviews with eight general practice and eight IAPT clinicians from two primary care trusts in the West Midlands, UK, and eight service users from the same region. Interviews explored current practice and participants' views and experiences of mental health risk assessment. Two focus groups were also carried out, one with general practice and one with IAPT clinicians, to review interview findings and to elicit views about GRiST from a demonstration of its functionality. Data were analysed using thematic analysis. Findings Variable approaches to mental health risk assessment were observed. Clinicians were anxious that important risk information was being missed, and risk communication was undermined. Patients felt uninvolved in the process, and both clinicians and patients expressed anxiety about risk assessment skills. Clinicians were positive about the potential for GRiST to provide solutions to these problems. Conclusions: A more structured and systematic approach to risk assessment in general practice and IAPT services is needed, to ensure important risk information is captured and communicated across the care pathway. GRiST has the functionality to support this aspect of practice.

Development and psychometric evaluation of a new team effectiveness scale for all types of community adult mental health teams:a mixed-methods approach

Defining 'effectiveness' in the context of community mental health teams (CMHTs) has become increasingly difficult under the current pattern of provision required in National Health Service mental health services in England. The aim of this study was to establish the characteristics of multi-professional team working effectiveness in adult CMHTs to develop a new measure of CMHT effectiveness. The study was conducted between May and November 2010 and comprised two stages. Stage 1 used a formative evaluative approach based on the Productivity Measurement and Enhancement System to develop the scale with multiple stakeholder groups over a series of qualitative workshops held in various locations across England. Stage 2 analysed responses from a cross-sectional survey of 1500 members in 135 CMHTs from 11 Mental Health Trusts in England to determine the scale's psychometric properties. Based on an analysis of its structural validity and reliability, the resultant 20-item scale demonstrated good psychometric properties and captured one overall latent factor of CMHT effectiveness comprising seven dimensions: improved service user well-being, creative problem-solving, continuous care, inter-team working, respect between professionals, engagement with carers and therapeutic relationships with service users. The scale will be of significant value to CMHTs and healthcare commissioners both nationally and internationally for monitoring, evaluating and improving team functioning in practice.

How trust affects the use of information obtained through intra- and extraorganizational relationships?

We have limited knowledge on the potential pattern similarities/differences of trust’s role that may exist in information use obtained through intra- and extra-organizational relationships. This study addresses this question by investigating how trust leads to information use. Data from 338 intra-organizational and a sub-ample of 158 interorganizational dyadic information exchange-relationships showed that trust is an important driver of the utilization of market information in both cases. Trust has no direct relationship to information use, instead has a strong indirect effect through a mediator, perceived quality of information. The effects of trust on the use of information obtained through inter- and extra-organizational dyadic relationships proved to be similar.

Bizalom és vállalati teljesítmény. A bizalom szerepe az aszimmetrikus információk minőségének vállalati észlelésében és azok vezetői döntéshozatalban való felhasználásában = Trust and corporate performance

A kutatás azt a kérdéskört vizsgálja, hogyan járul hozzá a bizalom a vállalatok piaci teljesítményéhez. A vállalatok azon képessége, hogy felhasználják a rendelkezésükre álló piaci információkat nehezen másolható, tartós versenyelőnyt biztosít. A marketingmenedzserek a piaci információk hitelességét nehezen tudják objektív módon megítélni, mivel azokat jellemzően mások gyűjtik és rendszerezik számukra. A szerző kutatásában a menedzserek vállalaton belüli és vállalaton kívüli piaci informálódást célzó kapcsolatai esetén modellezte és empirikusan tesztelte a bizalom hatásait. Eredményei szerint a bizalom a vállalaton belüli és vállalaton kívüli kapcsolatok esetében is fontos mozgatórugója az információfelhasználásnak, jóllehet közvetlenül nincs hatással arra. Minél jobban bízik a döntéshozó az információ forrásában, annál jobb minőségűnek fogja észlelni a tőle származó információt. Az információ észlelt minősége meghatározza, hogy arra támaszkodnak-e a vezetők a döntések meghozatalánál. Azok a marketingmenedzserek, akik képesek bizalmi kapcsolatok kiépítésére, szélesebb körű, hiteles piaci információkra támaszkodhatnak a döntéshozatal során, amely hozzájárul a vállalat piaci teljesítményéhez. ____ We have limited knowledge on the potential pattern similarities/differences of trust’s role that may exist in information use obtained through intra- and extra-organizational relationships. This study addresses this question by investigating how trust leads to information use. Data from 338 intra-organizational and a sub-ample of 158 inter-organizationaldyadic information exchange relationships showed that trust is an important driver of the utilization of market information in both cases. Trust has no direct relationship to information use, instead has a strong indirect effect through a mediator, perceived quality of information. The effects of trustontheuse of information obtained throughinter- and extra-organizational dyadic relationships proved to be similar.

Spic'ing into Existence: Epitaph, Epithet, and the Ethnopoetic Imagination

Quién Es, Quién Somos? Spic’ing into Existence claims a four-fold close-reading: first, analysis of texts: from theoretical meditations to (prison) memoir and film. Second, a half dozen central figures appear, largely Latinx and black American. They cut across a score of registers, socio-economics, ideological reservations, but all are, as Carl Carlton sang, poetry in motion. Writers, poets, theologians, pathologists, artists, comedians, actors, students whose vocation is invocation, the inner surge of their calling. Third, the manuscript draws from a series of historical moments—from radical liberation of the late 60s, to contemporary student activism. Finally, this body of work is movement, in all its social, gestural, and kinesthetic viscera. From this last heading, we peel away layers of what I call the ethnopoet, the fascia undoing that reveals its bio-political anatomy, dressing its bare life with kinship speech. First, the social revolutions of the Civil Rights, Black Power, abolitionism, the Black Panthers and Young Lords, boycotts and jarring artistic performances. These events are superficial not in vain sense, but key epicenters of underground murmurings, the workings of a cunning assailant. She robs not lavish estates, but another day to breathe. Gesturally, as perhaps the interlocutor, lies this author, interspersing his own diatribes to conjure her presence. The final branch is admittedly the most intangible. Kinesthetically, we map the nimbleness, footwork lígera of what I call the ethnopoet. Ethnopoet is no mere aggregate of ethnicity and poetry, but like chemical reaction, the descriptor for its behavior under certain pressures, temperatures, and elements. Elusive and resisting confinement, and therefore definition, the ethnopoet is a shapeshifting figure of how racialized bodies [people of color] respond to hegemonic powers. She is, at bottom, however, a native translator, the plural-lensed subject whose loyalty is only to the imagination of a different world, one whose survival is not contingent upon her exploitation. The native translator’s constant re-calibrations of oppressive power apparatuses seem taxing at best, and near-impossible, at worst. To effectively navigate through these polarized loci, she must identify ideologies that in turn seek “affective liberatory sances” in relation to the dominant social order (43). In a kind of performative contradiction, she must marshall the knowledge necessary to “break with ideology” while speaking within it. Chicana Studies scholar, Chela Sandoval, describes this dual movement as “meta-ideologizing”: the appropriation of hegemonic ideological forms in order to transform them (82). Nuestros padres se subieron encima de La Bestia, y por eso somos pasageros a ese tren. Y ya, dentro su pansa, tenemos que ser vigilantes cuando plantamos las bombas. In Methodology of the Oppressed, Sandoval schematizes this oppositional consciousness around five principle categories: “equal rights,” “revolutionary,” “supremacist,” “separatist,” and “differential.” Taken by themselves, the first four modes appear mutually exclusive, incapable of occupying the same plane, until a fifth pillar emerges. Cinematographic in nature, differential consciousness, as Sandoval defines it, is “a kinetic motion that maneuvers, poetically transfigures, and orchestrates while demanding alienation, perversion, and reformation in both spectators and practitioners” (44). For Sandoval, then, differential consciousness is a methodology that privileges an incredible sense mobility, one reaching artistic sensibilities. Our fourth and final analytic of movement serves an apt example of this dual meaning. Lexically speaking, ‘movement’ may be regarded as a political mobilization of aggrieved populations (through sustained efforts), or the process of moving objects (people or otherwise) from one location to another. Praxis-wise, it is both action and ideal, content and form. Thus, an ethnic poetics must be regarded less as a series of stanzas, shortened lyric, or even arrangement of language, but as a lens through which peripheralized peoples kaleidecope ideological positions in an “original, eccentric, and queer sight” (43). Taking note of the advantages of postponing identifications, the thesis stands its ground on the term ethnopoet. Its abstraction is not dewey-eyed philosophy, but an anticipation of poetic justice, of what’s to come from callused hands. This thesis is divided into 7.5 chapters. The first maps out the ethnopoet’s cartographies of struggle. By revisiting that alleged Tío Tomas, Richard Rodriguez, we unearth the tensions that negatively, deny citizenship to one silo, but on the flipside, engender manifold ways of seeing, hearing, and moving . The second, through George Jackson’s prison memoirs, pans out from this ethnography of power, groping for an apparatus that feigns an impervious prestige: ‘the aesthetic regime of coercion.’ In half-way cut, the thesis sidesteps to spic into existence, formally announcing, through Aime Cesaire, myself, and Pedro Pietri, the poeticization of trauma. Such uplift denies New Age transcendence of self, but a rehearsal of our entrapment in these mortal envelopes. Thirdly, conscious of the bleeding ethnic body, we cut open the incipient corpse to observe her pathologist. Her native autopsies offer the ethnic body’s posthumous recognition, the ethnopoetics ability to speak for and through the dead. Chapter five examines prolific black artists—Beyonce and Kendrick Lamar—to elide the circumvention of their consumption via invoking radical black hi/her-stories, ones fragmenting the black body. Sixth, the paper compares the Black Power Salute of the 1968 Mexico City Olympics to Duke’s Mi Gente Boycott of their Latino Student Recruitment Weekend. Both wielded “silent gestures,” that shrewdly interfered with white noise of numbed negligence. Finally, ‘taking the mask off’ that are her functionalities, the CODA expounds on ethnopoet’s interiority, particularly after the rapid re-calibration of her politics. Through a rerun of El Chavo del Ocho, one of Mexican television’s most cherished shows, we tune into the heart-breaking indigence of barrio residents, only to marvel at the power of humor to, as Friday’s John Witherspoon put it, “fight another day.” This thesis is the tip of my tongue. Y por una vez, déjala que cante.

Market reforms and privatisation in the English National Health Service

The article examines developments in the marketisation and privatisation of the English National Health Service, primarily since 1997. It explores the use of competition and contracting out in ancillary services and the levering into public services of private finance for capital developments through the Private Finance Initiative. A substantial part of the article examines the repeated restructuring of the health service as a market in clinical services, initially as an internal market but subsequently as a market increasing opened up to private sector involvement. Some of the implications of market processes for NHS staff and for increased privatisation are discussed. The article examines one episode of popular resistance to these developments, namely the movement of opposition to the 2011 health and social care legislative proposals. The article concludes with a discussion of the implications of these system reforms for the founding principles of the NHS and the sustainability of the service.

Social Transformations and Survivals in the Spanish Navy: The Midshipmen’s Access Requirements (1717-1869)

This work studies the creation, development and evolution of the Spanish midshipmen, through their requirements, from the early 18th century to the second third of the 19th century. The aims are: to know deeply an essential post in the Navy –naval cadet- that still requires an exhaustive review; and, primarily, to link the transformations of the candidates’ requirements to the social debates which were proposed in Spain during this two centuries. The so-called transition from the estates society to the class society, or the step from a society of inheriting criteria to a society based on achieving variables, did not occur linearly; changes and inertia went hand in hand with contradictions and conflicts, thus in this paper the Spanish midshipmen are analysed by several relationally variables.

Transitions in Contentious Behaviour in Infancy and Later Aggressive Conduct Problems

Background. Individual trajectories toward aggression originate in early infancy, before there is intent to harm. We focused on infants who were contentious, i.e., prone to engage in anger and use of physical force with other people, and examined change in levels of contentiousness between 6 and 12 months of age with reference to later aggressive conduct problems.
Sample. The CCDS is a nationally representative sample of 321 firstborn children whose families were recruited from antenatal clinics in two National Health Service Trusts.
Method. Mothers, fathers, and a third family member or friend who knew infants well completed the Cardiff Infant Contentiousness Scale (CICS) at 6 months, which was stable form 6 to 12 months, and validated by direct observation of infants’ use of force against peers. Primary caregivers again completed the CICS at 12 months, and up to three informants completed the Child Behaviour Check List at mean ages of 36 and 84 months. We used Latent Transition Analysis to identify different groups of infants in respect to their patterns of contentiousness from 6 to 12 months.
Results
Three ordered classes of contentiousness from low to high were found at 6 and 12 months. Infants exposed to greater family adversity were more likely to move into the high-contentious class from 6 to 12 months. Higher contentiousness in infancy predicted more aggressive conduct problems at 33 months and thereafter.
Conclusions
Infants exposed to family adversity are already at disadvantage by 6 months and likely to escalate in their anger and aggressiveness over time.

REITs: Structure and Performance

[Excerpt] REITs are attractive to investors, particularly institutional investors, due to their high dividend payouts and ability to provide more liquidity to the underlying market for direct real estate investment. This chapter analyzes the performance of real estate investment trusts (REITs). It compares the returns on REITs with those on more traditional asset classes, specifically bonds and mid-cap equities, and surveys the academic literature dealing with the diverse issues related to valuation. The chapter also examines the linkages between REIT performance and the behavior of the underlying real estate market. Because the chapter takes the perspective of a U.S.-based investor, it does not directly address the broader issues of global REITs.

Evaluation of a Brief Intervention to Assist Health Visitors and Community Practitioners to Engage with Fathers as Part of the Healthy Child Initiative

Aims: To improve engagement of Health Visitors and Community Practitioners delivering the Healthy Child Programme with fathers. To evaluate a one-day, father-focused workshop with a supporting handbook for Practitioners. To identify institutional and organisational barriers to engagement with fathers. Background: The UK government policy encourages health professionals to engage with fathers. This derives from robust evidence that fathers’ early involvement with their children impacts positively on emotional, behavioural and educational development. Yet, there is little evidence that the importance of engaging fathers is reflected in Health Visitor training or that primary-care services are wholly embracing father-inclusive practice. The Fatherhood Institute (FI), a UK charity, has developed a workshop for Practitioners delivering the Healthy Child Programme. Method: A ‘before and after’ evaluation study, comprising a survey followed by telephone interviews, evaluated the impact of the FI workshop on Health Visitors’ and Community Practitioners’ knowledge, attitudes and behaviour in practice. A total of 134 Health Visitors and Community Practitioners from eight NHS Trusts in England attended the workshop from November 2011 to January 2014 at 12 sites. A specially constructed survey, incorporating a validated questionnaire, was administered before the workshop, immediately afterwards and three months later. Telephone interviews further explored participants’ responses. Findings: Analysis of the questionnaire data showed that the workshop and handbook improved participants’ knowledge, attitudes and behaviour in practice. This was sustained over a three-month period. In telephone interviews, most participants said that the workshop had raised their awareness of engaging fathers and offered them helpful strategies. However, they also spoke of barriers to engagement with fathers. NHS Trusts need to review the training and education of Health Visitors and Community Practitioners and take a more strategic approach towards father-inclusive practice and extend services to meet the needs of fathers.

Agency, Financial Flexibility, and Firm Value: Evidence from REITs

We show empirically that the use of unsecured debt, whose standard covenants commit management to the preservation of debt capacity, leads to lower and more stable leverage. We then show that firm value is sensitive to leverage levels and leverage stability, decreasing in the former and increasing in the latter. Our results support a liquidity-centric version of Jensen's (1986) free cash flow argument. In this version, self-serving managerial tendencies are reigned in without raising leverage indiscriminately, so that financial flexibility is preserved.

Joint Leverage and Maturity Choices in Real Estate Firms: The Role of the REIT Status

We explore the interdependence of leverage and debt maturity choices in Real Estate Investment Trusts (REITs) and unregulated listed real estate investment companies in the U.S. for the period 1973-2011. We find that the leverage and maturity choices of all listed real estate firms are interdependent, but in contrast to industrial firms, they are not made simultaneously. Across the different types of real estate firms considered, we find substantial differences in the nature of the relationship between leverage and maturity. Leverage determines maturity in non-REITs, whereas maturity is a determinant of leverage in REITs. We suggest that the observed differences reflect the effects of the REIT regulation, rather than solely being a function of real estate as the underlying asset class. We also present novel evidence that the relationship between leverage and maturity in both firm types can be used to moderate the effects of other exogenous financing policies.

Perpetual private land conservation: the case for outdoor recreation and functional leisure

As natural areas, agricultural lands, and open spaces continue to be developed at unprecedented rates, it is important for land conservation professionals to understand the individuals who might play a role in permanently protecting these lands and their ecological services. Many factors have been shown to influence land protection decisions among private owners, including land-use activities, demographic characteristics, and environmental intention and behavior. With the hypothesis that individuals already involved in land conservation programs would be candidates for permanent protection, we set out to model conservation easement decisions within a group of participants in southern Indiana’s Classified Forest and Wildlands Program (ICFWP). We used a mailed questionnaire to survey 500 landowners, garnering 308 responses, about their interest in conservation easements. Our results indicated significant positive relationships between interest in conservation easements with variables representing perception of landscape change, outdoor recreation behavior as an adult, and environmental organization membership. By better understanding the ways these factors promote permanent land-use decisions, land conservation professionals can better allocate limited resources through strategic investments in targeting and outreach.