Improving appropriate polypharmacy for older people in primary care: selecting components of an evidence-based intervention to target prescribing and dispensing.

Background
The use of multiple medicines (polypharmacy) is increasingly common in older people. Ensuring that patients receive the most appropriate combinations of medications (appropriate polypharmacy) is a significant challenge. The quality of evidence to support the effectiveness of interventions to improve appropriate polypharmacy is low. Systematic identification of mediators of behaviour change, using the Theoretical Domains Framework (TDF), provides a theoretically robust evidence base to inform intervention design. This study aimed to (1) identify key theoretical domains that were perceived to influence the prescribing and dispensing of appropriate polypharmacy to older patients by general practitioners (GPs) and community pharmacists, and (2) map domains to associated behaviour change techniques (BCTs) to include as components of an intervention to improve appropriate polypharmacy in older people in primary care.

Methods
Semi-structured interviews were conducted with members of each healthcare professional (HCP) group using tailored topic guides based on TDF version 1 (12 domains). Questions covering each domain explored HCPs’ perceptions of barriers and facilitators to ensuring the prescribing and dispensing of appropriate polypharmacy to older people. Interviews were audio-recorded and transcribed verbatim. Data analysis involved the framework method and content analysis. Key domains were identified and mapped to BCTs based on established methods and discussion within the research team.

Results
Thirty HCPs were interviewed (15 GPs, 15 pharmacists). Eight key domains were identified, perceived to influence prescribing and dispensing of appropriate polypharmacy: ‘Skills’, ‘Beliefs about capabilities’, ‘Beliefs about consequences’, ‘Environmental context and resources’, ‘Memory, attention and decision processes’, ‘Social/professional role and identity’, ‘Social influences’ and ‘Behavioural regulation’. Following mapping, four BCTs were selected for inclusion in an intervention for GPs or pharmacists: ‘Action planning’, ‘Prompts/cues’, ‘Modelling or demonstrating of behaviour’ and ‘Salience of consequences’. An additional BCT (‘Social support or encouragement’) was selected for inclusion in a community pharmacy-based intervention in order to address barriers relating to interprofessional working that were encountered by pharmacists.

Conclusions
Selected BCTs will be operationalised in a theory-based intervention to improve appropriate polypharmacy for older people, to be delivered in GP practice and community pharmacy settings. Future research will involve development and feasibility testing of this intervention.

Prospects and Problems for Religious Education in England, 1967-1970: Curriculum Reform in Political Context

This article provides an historical case study of an abortive attempt to revise policy and legislation relating to Religious Education (RE) in English schools in the late 1960s and early 1970s. Drawing upon published sources, including parliamentary debates, as well as previously unutilised national archival sources from the Department of Education and Science, it comments upon events which have hitherto been omitted from the historiography of RE, but which help to contextualise significant changes in RE theory and practice at that time. Moreover, it demonstrates that the current parlous state of RE in schools is in part the result of latent and longstanding issues and problems, rather than a consequence of present-day government policy alone. Therefore, in reviewing and developing RE policies and practices, all stakeholders are urged to look more closely at both changes and continuities in the subject’s past and the contexts in which they occurred.

How the sublime became "now": time, modernity and aesthetics in Lyotard's rewriting of Kant

Writing in the late 1980s, Nancy gives as examples of the "recent fashion for the sublime" not only the theoreticians of Paris, but the artists of Los Angeles, Berlin, Rome, and Tokyo. At the beginning of the twenty-first century, the sublime may of course no longer seem quite so "now" as it did back then, whether in North America, Europe, or Japan. Simon Critchley, for one, has suggested that, at least as regards the issue of its conceptual coupling to "postmodernism," the "debate" concerning the sublime "has become rather stale and the discussion has moved on." Nonetheless, if that debate has indeed "moved on"-and thankfully so-it is not without its remainder, particularly in the very contemporary context of a resurgence of interest in explicitly philosophical accounts of art, in the wake of an emergent critique of cultural studies and of the apparent waning of poststructuralism's influence-a resurgence that has led to a certain "return to aesthetics" in recent Continental philosophy and to the work of Kant, Schelling, and the German Romantics. Moreover, as Nancy's precise formulations suggest, the "fashion" [mode] through which the sublime "offers itself"-as "a break within or from aesthetics"-clearly contains a significance that Critchley's more straightforward narration of shifts in theoretical chic cannot encompass. At stake in this would be the relation between the mode of fashion and art's "destiny" within modernity itself, from the late eighteenth century onwards. Such a conception of art's "destiny," as inextricably linked to that of the sublime, is not unique to recent French theory. In a brief passage in Aesthetic Theory, Adorno also suggests that the "sublime, which Kant reserved exclusively for nature, later became the historical constituent of art itself.... [I]n a subtle way, after the fall of formal beauty, the sublime was the only aesthetic idea left to modernism." As such, although the term has its classical origins in Longinus, its historical character for "us," both Nancy and Adorno argue, associates it specifically with the emergence of the modern. As another philosopher states: "It is around this name [of the sublime] that the destiny of classical poetics was hazarded and lost; it is in this name that ... romanticism, in other words, modernity, triumphed."

Multi-apprentice learning for meta-heuristics parameter tuning in a multi agent scheduling system

The scheduling problem is considered in complexity theory as a NP-hard combinatorial optimization problem. Meta-heuristics proved to be very useful in the resolution of this class of problems. However, these techniques require parameter tuning which is a very hard task to perform. A Case-based Reasoning module is proposed in order to solve the parameter tuning problem in a Multi-Agent Scheduling System. A computational study is performed in order to evaluate the proposed CBR module performance.

The challenges of building theory by combining lenses

The article presents a discussion of foundational issues in the field of management science, focusing on advances in management theory and research. The metaphor of explanatory lenses is used as a rubric to illustrate the theoretical challenges involved in elucidating the interrelationships of various factors in organizational behavior. The importance of clarifying such interrelationships is emphasized, from the standpoint of editing scholarly papers on such topics for publication. Topics discussed include communication and psychology in management, economics, and behavioral finance.

The shifting terrain of feminist theory and activism : university-based women's centres and third wave feminism

This thesis, based on the results of an organizational ethnography of a university-based feminist organization in Southern Ontario (the Centre), traces how third wave feminism is being constituted in the goals, initiatives, mandate, organizational structure, and overall culture of university-based feminist organizations. I argue that, from its inception, the meanings and goals of the Centre have been contested through internal critique, reflection, and discussion inspired by significant shifts in feminist theory that challenge the fundamental principles of second wave feminism. I identify a major shift in the development and direction of the Centre that occurs in two distinct phases. The first phase of the shift occurs with the emergence of an antioppression framework, which broadens the Centre's mandate beyond gender and sexism to consider multiple axes of identity and oppression that affect women's lives. The second phase of this shift is characterized by a focus on (trans) inclusion and accessibility and has involved changing the Centre's name so that it is no longer identified as a women's centre in order to reflect more accurately its focus on mUltiple axes of identity and oppression. Along with identifying two phases of a major shift in the direction of the Centre, I trace two discourses about its development. The dominant discourse of the Centre's development is one of progress and evolution. The dominant discourse characterizes the Centre as a dynamic feminist organization that consistently strives to be more inclusive and diverse. The reverse discourse undermines the dominant discourse by emphasizing that, despite the Centre's official attempts to be inclusive and to build diversity, little has actually changed, leaving women of colour marginalized in the Centre's dominant culture of whiteness. This research reveals that, while many of their strategies have unintended (negative) consequences, members of the Centre are working to build an inclusive politics of resistance that avoids the mistakes of earlier feminist movements and organizations. These members, along with other activists, actively constitute third wave feminism in a process that is challenging, contradictory, and often painful. A critical analysis of this process and the strategies it involves provides an opportunity for activists to reflect on their experiences and develop new strategies in an effort to further struggles for social justice and equity.

Native women, theory and research : contexts and contestations

In this thesis I outline a critical approach to interpreting the considerable academic literature on Aboriginal women in North America. I locate the scholarship concerning Native women within an understanding of three developments related to a philosophy of science: (I) paradigmatic shifts concerning the philosophy of science, (2) materialist-idealist debates and (3) transitions in feminist theory characterized by what is tenned the shift from second to third wave feminism. My exploration of emergent themes suggests that the elements indicated above provide overlapping frameworks within which most scholarship about Indigenous women is positioned. I illustrate my finding that employing critical discourse analysis and postcolonial feminism as both method and theory provides a useful approach in attending to intersecting experiences of 'race, class, and gender.' I view these intersecting experiences as central to the socio-political positioning of Indigenous women within contemporary feminist theorizing. I conclude my thesis by reflecting on the conceptual struggles I experienced in fonnulating and organizing the thesis and the significance of my underlying epistemological position and value-orientation as both a feminist and Native woman.

Drama in education : deconstructing the role of movement in text

The purpose of this study was to conduct a comparative textual analysis on the role of movement in 3 texts in Drama in Education in Canada. As the subject is holistic and encourages creative, active participation, movement was expected to appear, even inadvertently, in both theory and practice. It was hoped that guidelines for the use of movement within Drama in Education would emerge from the texts and that these guidelines would serve as models for others to use. A total of 26 Drama in Education experts in Canada were each asked to list the 10 most important texts in the field. Those who answered were assigned numbers and charted according to age, gender, and geography. An objective colleague helped narrow the group to 16 participants. A frequency count was used, assigning 10 points to the first text on each list, and descending to 1 point for the tenth text listed. Based on the highest number of points calculated, the 5 most frequently used texts were identified. These were compared to ascertain the widest representation ofthe authors' geographic location and gender, as well as differences in theory and practice. The final selection included 3 texts that represented differing approaches in their presentation and discussion of Drama in Education theories and practices. Analysis involved applying 5 levels of commitment to determine if,how, why, when, and with what results movement was explicitly or implicitly addressed in the 3 texts. Analysis resulted in several unexpected surprises around each of the 3 texts. The study also provided suggestions for extending and clarifying the role of movement in teaching and learning in general, as well as for Drama in Education in particular.

Response curves of deterministic and probabilistic cellular automata in one and two dimensions

One of the most important problems in the theory of cellular automata (CA) is determining the proportion of cells in a specific state after a given number of time iterations. We approach this problem using patterns in preimage sets - that is, the set of blocks which iterate to the desired output. This allows us to construct a response curve - a relationship between the proportion of cells in state 1 after niterations as a function of the initial proportion. We derive response curve formulae for many two-dimensional deterministic CA rules with L-neighbourhood. For all remaining rules, we find experimental response curves. We also use preimage sets to classify surjective rules. In the last part of the thesis, we consider a special class of one-dimensional probabilistic CA rules. We find response surface formula for these rules and experimental response surfaces for all remaining rules.

'To do justice and judgement' : the place of passion in public life

Please consult the paper edition of this thesis to read. It is available on the 5th Floor of the Library at Call Number: Z 9999 P65 F47 2003

Square Root Finding In Graphs

Abstract: Root and root finding are concepts familiar to most branches of mathematics. In graph theory, H is a square root of G and G is the square of H if two vertices x,y have an edge in G if and only if x,y are of distance at most two in H. Graph square is a basic operation with a number of results about its properties in the literature. We study the characterization and recognition problems of graph powers. There are algorithmic and computational approaches to answer the decision problem of whether a given graph is a certain power of any graph. There are polynomial time algorithms to solve this problem for square of graphs with girth at least six while the NP-completeness is proven for square of graphs with girth at most four. The girth-parameterized problem of root fining has been open in the case of square of graphs with girth five. We settle the conjecture that recognition of square of graphs with girth 5 is NP-complete. This result is providing the complete dichotomy theorem for square root finding problem.

Living in the Skin That I Am: An Organizational Autoethnography of an Adult Educator's Plight to Survive the Stigma of Invisible and Episodic Disability in an Academy of Administritiva

Through the reflective lens of an adult educator with invisible and episodic disabilities, this paper has been written as an organizational autoethnography. Through a process of autoethnographical sensemaking, it is intended to illuminate important gaps in organizational theory. Feminist/relational care ethics, critical reflection, and transformative learning serve as the educational theories that comprise its framework. In telling my story, embodied writing and performance narrative are used to convey the felt existence of a body exposed through words—where my “abled” and “disabled” professional teaching and learning identities may be studied against the backdrop of organizational policies and procedures. Words used to describe unfamiliar experiences and situations shape meaning for which new meaning may emerge. At the conclusion of this paper, an alternative frame of reference—a view from the margins—may be offered to articulate authenticity in the expectancy of workplace equity for adult educators with disabilities. Taken collectively on a larger level, it is hoped that this research may provide a source of inspiration for systemic organizational change in adult learning environments.

Aspects géométriques et intégrables des modèles de matrices aléatoires

Travail réalisé en cotutelle avec l'université Paris-Diderot et le Commissariat à l'Energie Atomique sous la direction de John Harnad et Bertrand Eynard.

Elementary School Principals in Low-Socioeconomic-Status Schools: A University-Based Research Program Designed to Support Mandated Reform

This paper presents a reform initiative, the Supporting Montreal Schools Program (SMSP), created by the government of Quebec to assist 184 low socio-economic-status schools in Montreal implement seven reform strategies prescribed by the government. On a regular basis, the professional team of the SMSP engages in reflection and research with universities concerning one or more of the strategies they are charged with helping schools implement or the functioning of the SMSP more generally. The present research programme is part of the team’s ongoing reflection on a component of Strategy 4: professional development of school administrators and the school team. In this paper, we detail results from this initial and subsequent studies on the work of principals in low-performing schools. We also describe our collaborative relationship with the SMSP team, discuss the effectiveness of the SMSP in promoting the implementation of the seven governmentmandated strategies and critique the utility of our partnership with the SMSP and our use of that programme as a vehicle for linking research to practice.

Wittgenstein And Labyrinth Of ‘Actual Infinity’: The Critique Of Transfinite Set Theory

In order to explain Wittgenstein’s account of the reality of completed infinity in mathematics, a brief overview of Cantor’s initial injection of the idea into set- theory, its trajectory (including the Diagonal Argument, the Continuum Hypothesis and Cantor’s Theorem) and the philosophic implications he attributed to it will be presented. Subsequently, we will first expound Wittgenstein’s grammatical critique of the use of the term ‘infinity’ in common parlance and its conversion into a notion of an actually existing (completed) infinite ‘set’. Secondly, we will delve into Wittgenstein’s technical critique of the concept of ‘denumerability’ as it is presented in set theory as well as his philosophic refutation of Cantor’s Diagonal Argument and the implications of such a refutation onto the problems of the Continuum Hypothesis and Cantor’s Theorem. Throughout, the discussion will be placed within the historical and philosophical framework of the Grundlagenkrise der Mathematik and Hilbert’s problems.