Culture and behaviour in the English National Health Service:overview of lessons from a large multimethod study

Background - Problems of quality and safety persist in health systems worldwide. We conducted a large research programme to examine culture and behaviour in the English National Health Service (NHS). Methods - Mixed-methods study involving collection and triangulation of data from multiple sources, including interviews, surveys, ethnographic case studies, board minutes and publicly available datasets. We narratively synthesised data across the studies to produce a holistic picture and in this paper present a highlevel summary. Results - We found an almost universal desire to provide the best quality of care. We identified many 'bright spots' of excellent caring and practice and high-quality innovation across the NHS, but also considerable inconsistency. Consistent achievement of high-quality care was challenged by unclear goals, overlapping priorities that distracted attention, and compliance-oriented bureaucratised management. The institutional and regulatory environment was populated by multiple external bodies serving different but overlapping functions. Some organisations found it difficult to obtain valid insights into the quality of the care they provided. Poor organisational and information systems sometimes left staff struggling to deliver care effectively and disempowered them from initiating improvement. Good staff support and management were also highly variable, though they were fundamental to culture and were directly related to patient experience, safety and quality of care. Conclusions - Our results highlight the importance of clear, challenging goals for high-quality care. Organisations need to put the patient at the centre of all they do, get smart intelligence, focus on improving organisational systems, and nurture caring cultures by ensuring that staff feel valued, respected, engaged and supported.

The Ghana National Service Scheme: Perceptions of former educational personnel, students and guardians

The purpose of this inquiry was to investigate the perceptions of former service personnel, students and their parents about the organizational effectiveness of the Ghana National Service Scheme (GNSS). The inquiry addressed the following questions: How do the participants perceive the effectiveness of the national service program on the Ghanaian society? What are the perceptions of school administrators who worked with service personnel, parents and students vis-à-vis the over all impact of the GNSS on the educational system? What are the perceptions of former service personnel, students and their parents in regard to the impact of the GNSS on them? ^ The GNSS is a part within the ministry of education, which is also part in the Ghanaian social structure. Hence, a systems theory approach which asks, “How and why a system as a whole functions as it does” (Patton, 1990), was utilized in the study. Methodologies included purposive sampling; interviews; participant observation, and follow-up interviews. The study was conducted over a six-moth period. ^ A cross-sectional survey design was used to generate data. The survey was followed up with an ethnographic study where in-depth, face-to-face interviews were conducted together with observations. The results were described and interpreted. ^ The summary of findings concludes that perceptional determinants of the effectiveness of the GNSS were biased by the age and zone of origin but not gender. This partially agrees with Marenin's (1990) except for gender. A significant difference was detected between the responses of those who were officials of the National service Secretariat and of former service personnel. The administrators defended the status quo and demonstrated their deeper knowledge about the scheme. The former personnel and parents freely criticized the program when necessary and did not seem to know much about the GNSS. Respondents mostly stressed the need for the secretariat to focus on the following areas: (1) involvement in the agricultural sector of the economy, (2) involvement in rural mass, civic and health education, (3) adequacy of remuneration and personnel welfare, and (4) ensuring posting of personnel to areas of their expertise. Recommendation for further research concluded the study. ^

The rodent fauna of Long Pine Key, Everglades National Park: a comparison of habitat types

Rodents are often involved at several stages of trophic dynamics. Consequently they often play crucial roles in the structure and function of many complex ecological systems. This study sought to address the lack of baseline data concerning rodents in tropical areas, and south Florida in particular. Live trapping took place in the four major habitat types of the Long Pine Key area of Everglades National Park over the course of one year. I compared population structures and abundance of murid rodents in the four habitat types, and tested multiple weather variables for their effectiveness as predictors of rodent abundance. I found the Long Pine Key area to be depauperate in terms of species diversity. Each of the four species of rodent encountered favored a particular habitat type. The density of the understory vegetation and the avoidance of avian predators in particular appear to be the most important factors in the distribution and abundance of rodents in the Long Pine Key area of Everglades National Park.

Georeferenced standardized apparent wave power along the coastline of Cabrera National Park for analysis of essential habitats of littoral species

Wind- induced exposure is one of the major forces shaping the geomorphology and biota in coastal areas. The effect of wave exposure on littoral biota is well known in marine environments (Ekebon et al., 2003; Burrows et al., 2008). In the Cabrera Archipelago National Park wave exposure has demostrated to have an effect on the spatial distribution of different stages of E.marginatus (Alvarez et al., 2010). Standarized average wave exposures during 2008 along the Cabrera Archipelago National park coast line were calculated to be applied in studies of littoral species distribution within the archipelago. Average wave exposure (or apparent wave power) was calculated for points located 50 m equidistant on the coastline following the EXA methodology (EXposure estimates for fragmented Archipelagos) (Ekebon et al., 2003). The average wave exposures were standardized from 1 to 100 (minimum and maximum in the area), showing coastal areas with different levels of mea wave exposure during the year. Input wind data (direction and intensity) from 2008 was registered at the Cabrera mooring located north of Cabrera Archipelago. Data were provided by IMEDEA (CSIC-UIB, TMMOS http://www.imedea.uib-csic.es/tmoos/boyas/). This cartography has been developed under the framework of the project EPIMHAR, funded by the National Park's Network (Spanish Ministry of Environment, Maritime and Rural Affairs, reference: 012/2007 ). Part of this work has been developed under the research programs funded by "Fons de Garantia Agrària i Pesquera de les Illes Balears (FOGAIBA)".

Measuring the sustainability of a national economy. The application of three measures of sustainability to Ireland

An assessment of the sustainability of the Irish economy has been carried out using three methodologies, enabling comparison and evaluation of the advantages and disadvantages of each, and potential synergies among them. The three measures chosen were economy-wide Material Flow Analysis (MFA), environmentally extended input-output (EE-IO) analysis and the Ecological Footprint (EF). The research aims to assess the sustainability of the Irish economy using these methods and to draw conclusions on their effectiveness in policy making both individually and in combination. A theoretical description discusses the methods and their respective advantages and disadvantages and sets out a rationale for their combined application. The application of the methods in combination has provided insights into measuring the sustainability of a national economy and generated new knowledge on the collective application of these methods. The limitations of the research are acknowledged and opportunities to address these and build on and extend the research are identified. Building on previous research, it is concluded that a complete picture of sustainability cannot be provided by a single method and/or indicator.

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013 : a systematic analysis for the Global Burden of Disease Study 2013

Global, regional, and national comparative risk assessment of 79 behavioral, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015 : a systematic analysis for the Global Burden of Disease Study 2015

Does gender make a difference? Gender-related fairness of high-stakes testing in A-level examinations in English as foreign language in the German state of North Rhine-Westphalia in the context of Educational Governance

The shift from decentralized to centralized A-level examinations (Abitur) was implemented in the German school system as a measure of Educational Governance in the last decade. This reform was mainly introduced with the intention of providing higher comparability of school examinations and student achievement as well as increasing fairness in school examinations. It is not known yet if these ambitious aims and functions of the new centralized examination format have been achieved and if fairer assessment can be guaranteed in terms of providing all students with the same opportunities to pass the examinations by allocating fair tests to different student subpopulations e.g., students of different background or gender. The research presented in this article deals with these questions and focuses on gender differences. It investigates gender-specific fairness of the test items in centralized Abitur examinations as high school exit examinations in Germany. The data are drawn from Abitur examinations in English (as a foreign language). Differential item functioning (DIF) analysis reveals that at least some parts of the examinations indicate gender inequality. (DIPF/Orig.)

The Integration of Foreign Students in the Portuguese School of the 1st Cycle of Basic Education: the Case of a School Grouping in the Municipality of Viseu

The present study aims to understand whether the foreign students who have different nationalities but the Portuguese are integrated into the school of the 1st Cycle of Basic Education. With this purpose, a descriptive and phenomenological research was conducted, making use of documental analysis, as well as semi-structured interviews and sociometric tests. These two data collecting tools were applied to students attending from the 1st to the 4th school years, in three 1st Cycle of Basic Education schools, within a school grouping in Viseu. The data obtained through the interviews allow us to conclude that foreign students, in general, feel integrated both in the school and in the class they belong to. However, the analysis of the results of the sociometric tests reveals other data, allowing us to conclude that one of the students is neither integrated in the school, nor in the class he is part of.

Studio della gestione integrata dei rifiuti urbani nell'ambito della provincia di Bologna

This work is an analysis of integrated urban waste management in the province of Bologna. It consists of five chapters and one enclosure. Primarily, it focuses on the legislative framework at european, national and local level. Then the study analyses the situation of urban waste system adopted in the reference territory from 2003 to 2007 to show its evolution process. Chapter 3 is based on considerations about the percentage of effective recover of materials derived from separate collection that has been reached in the province of Bologna in 2006. The following chapter describes the urban waste management at national level using dates of 2005 and 2006 by APAT (National Agency for environmental protection). Then, it has been made a comparison with Emilia-Romagna and district of Bologna. Chapter 5 focuses on the description of innovative strategies introduced in the district of Bologna to increase separate collection level and optimize waste management. In particular, it analyses two sperimental projects: one based on door to door collection and the other founded on an integrated collection system which provides the application of two collection models (door to door collection in industrial areas and collection by containers in urban ones). Finally, in the enclosure, it is also descrided best practices of waste management sector about collection models, treatment plants and innovative strategies available at that moment in Europe.

Actores y factores del contexto institucional que permiten entender la discusión y aprobación de la Ley 975 de 2005

El trabajo de investigación es un estudio de caso que pretende analizar la forma en que factores del contexto institucional y la capacidad de influencia de ciertos actores se reflejan en la discusión y aprobación de la Ley 975 de 2005. Factores del contexto institucional y la capacidad de influencia sobre las posiciones asumidas por los actores políticos y sociales en las diferentes etapas del proceso legislativo y sobre las decisiones que se tomaron para la aprobación de la Ley, en torno a dos elementos fundamentales de ésta que son el delito político y la rebaja de penas. Para ello, se tiene en cuenta el enfoque neo-institucional y el concepto de agencia.