PIPc study: development of indicators of potentially inappropriate prescribing in children (PIPc) in primary care using a modified Delphi technique

Objective There is limited evidence regarding the quality of prescribing for children in primary care. Several prescribing criteria (indicators) have been developed to assess the appropriateness of prescribing in older and middle-aged adults but few are relevant to children. The objective of this study was to develop a set of prescribing indicators that can be applied to prescribing or dispensing data sets to determine the prevalence of potentially inappropriate prescribing in children (PIPc) in primary care settings.


Design Two-round modified Delphi consensus method.


Setting Irish and UK general practice.


Participants A project steering group consisting of academic and clinical general practitioners (GPs) and pharmacists was formed to develop a list of indicators from literature review and clinical expertise. 15 experts consisting of GPs, pharmacists and paediatricians from the Republic of Ireland and the UK formed the Delphi panel.


Results 47 indicators were reviewed by the project steering group and 16 were presented to the Delphi panel. In the first round of this exercise, consensus was achieved on nine of these indicators. Of the remaining seven indicators, two were removed following review of expert panel comments and discussion of the project steering group. The second round of the Delphi process focused on the remaining five indicators, which were amended based on first round feedback. Three indicators were accepted following the second round of the Delphi process and the remaining two indicators were removed. The final list consisted of 12 indicators categorised by respiratory system (n=6), gastrointestinal system (n=2), neurological system (n=2) and dermatological system (n=2).


Conclusions The PIPc indicators are a set of prescribing criteria developed for use in children in primary care in the absence of clinical information. The utility of these criteria will be tested in further studies using prescribing databases.

Invaluable but Invisible: an Initial Investigation of Chinese Graduate Skill Development and Subsequent Skill Use

Measures of impact of Higher Education have often neglected the Chinese student view, despite the importance of these students to the UK and Chinese economy. This research paper details the findings of a quantitative survey that was purposively distributed to Chinese graduates who enrolled at the University of Worcester on the Business Management degree between 2004-2011 (n=49). Analysis has been conducted on their skill development throughout their degree, their skill usage in different employment contexts, the value of their degree, and gender differences in skill development and usage. Discrepancies between skill development and usage, between males and females, and with previous research findings are discussed. Future research directions are also specified.

The Design and Development of Educational Immersive Environments: From Theory to Classroom Deployment

Computer game technology is poised to make a significant impact on the way our youngsters will learn. Our youngsters are ‘Digital Natives’, immersed in digital technologies, especially computer games. They expect to utilize these technologies in learning contexts. This expectation, and our response as educators, may change classroom practice and inform curriculum developments. This chapter approaches these issues ‘head on’. Starting from a review of the current educational issues, an evaluation of educational theory and instructional design principles, a new theoretical approach to the construction of “Educational Immersive Environments” (EIEs) is proposed. Elements of this approach are applied to development of an EIE to support Literacy Education in UK Primary Schools. An evaluation of a trial within a UK Primary School is discussed. Conclusions from both the theoretical development and the evaluation suggest how future teacher-practitioners may embrace both the technology and our approach to develop their own learning resources.

Developing Innovative TEL Practice in Teacher Education

This interactive symposium will focus on the use of different technologies in developing innovative practice in teacher education at one university in England. Technology Enhanced Learning (TEL) is a field of educational policy and practice that has the power to ignite diametrically opposing views and reactions amongst teachers and teacher educators, ranging across a spectrum from immense enthusiasm to untold terror. In a field where the skills and experience of individuals vary from those of digital natives (Prensky 2001) to lags and lurkers in digital spaces, the challenges of harnessing the potential of TEL are complex. The challenges include developing the IT skills of trainees and educators and the creative application of these skills to pedagogy in all areas of the curriculum. The symposium draws on examples from primary, secondary and post-compulsory teacher education to discuss issues and approaches to developing research capacity and innovative practice using different etools, many of which are freely available. The first paper offers theoretical and policy perspectives on finding spaces in busy professional lives to engage in research and develop research-informed practice. It draws on notions of teachers as researchers, practitioner research and evidenc-ebased practice to argue that engagement in research is integral to teacher education and an empowering source of creative professional learning for teachers and teacher educators. Whilst acknowledging the challenges of this stance, examples from our own research practice illustrate how e-tools can assist us in building the capacity and confidence of staff and students in researching and enhancing teaching, learning and assessment practice. The second paper discusses IT skills development through the TEL pathway for trainee teachers in secondary education across different curriculum subjects. The lead tutor for the TEL pathway will use examples of activities developed with trainee teachers and university subject tutors to enhance their skills in using e-tools, such as QR codes, Kahoot, Padlet, Pinterest and cloud based learning. The paper will also focus on how these skills and tools can be used for action Discussant - the wider use of technologies in a university centre for teacher education; course management, recruitment and mentor training. research, evaluation and feedback and for marking and administrative tasks. The discussion will finish with thoughts on widening trainee teachers’ horizons into the future direction of educational technology. The third paper considers institutional policies and strategies for promoting and embedding TEL, including an initiative called ‘The Learning Conversation’, which aims ‘to share, highlight, celebrate, discuss, problematise, find things out...’ about TEL through an online space. The lead for ‘The Learning Conversation’ will offer reflections on this and other initiatives across the institution involving trainee teachers, university subject tutors, librarians and staff in student support services who are using TEL to engage, enthuse and support students on campus and during placements in schools. The fourth paper reflects on the use of TEL to engage with trainee teachers in post-compulsory education. This sector of education and training is more fragmented than primary and secondary schools sectors and so the challenges of building a community of practice that can support the development of innovative practice are greater.

Moving together – conditions for intercultural development at a highly diverse Swedish school

This thesis is a case study of a primary school in a highly diverse urban neighbourhood in Sweden. Basic pre-conditions for intercultural school development are studied by examining the overall organisation of teaching, learning and opportunities for collaboration in the investigated case. The study focuses on the targeted support measures to enhance learning for students with an immigrant background: Mother tongue instruction, Swedish as a Second Language, and tutoring in the mother tongue, as well as looking at pedagogical support provided by the school library. The latter has a mission to promote learning and inclusion, where non-native speakers of Swedish are a prioritised group. Communities of practice linked to the work organisation at a meso-level are investigated, and the collaborative relationships between professional groups at the school involved in the various support measures. Teacher relationships and categorisations implied by support measures impact the learning spaces that are shaped for students and the teaching spaces within which teachers work. Collaborative opportunities and convergence of concerns in the teaching spaces combine to shape the overall space for intercultural development. The raw data for the case study consists of interviews, national policy documents and additional information on local work organisation gained through documents and observations. Four articles resulted from the case study, each focusing a specific support measure. An overarching analysis is then made of findings from these articles and the other dimensions of the investigation. The analysis describes the organisation in terms of monocultural or intercultural school cultures, pointing to significant characteristics of the landscapes of practice, with respect to their overall implications for the spaces of school development. In the discussion, findings are considered in relation to research on professional development in education, collaboration, democracy and inclusive schooling. The relative positioning of languages and cultures is given particular attention, to ascertain if the school culture is monocultural or intercultural in the sense given by Lahdenperä (2008), and to what extent it could enable intercultural development. Such positioning plays a role interms of affordances for identity, participation and engagement discussed by Wenger (1998). This case study should be understood against the wider background of recent social developments in Europe linked to globalisation and technological changes. It is argued that looking at the concrete specifics which facilitate or obstruct school development, and simultaneously reflecting on how the different forms of teaching interrelate in the overall organisation and in policy may provide a useful vantage point from which structural changes can be contemplated.The discussion underlines the importance of the physical localisation of activities, continuity in personal contacts and time available for joint pedagogical reflection, as basic conditions for effective intercultural dialogue in the organisation. Finally, the impact of policy is considered, looking at connections between levels of policy, expressed in official steering documents, and conditions for teaching and learning at the level of an individual school.

Having a strategy for new service development : does it really matter?

Purpose – The aim of this study is to investigate the role of key strategic factors in new service development (NSD). In particular, the role of service development strategy, a formalised development process, integrated development teams and customer co-creation were investigated and the results were compared with managers' beliefs. Design/methodology/approach – The study used a sample of more than 500 service development projects to test a NSD conceptual model. Regression analysis was used to test the relative importance of the key strategic factors, and the results were compared with managers' beliefs. Findings – The results show that managers believe that customer co-creation is most important in order to succeed with NSD. However, contrary to management belief, a service development strategy is the “missing link” in improving NSD performance. In addition, the research highlighted an interaction effect between integrated development teams and customer co-creation, which means that project managers should focus on individual competencies on the development team and how they interact with customers throughout the NSD process. Originality/value – For a long time, NSD has failed to receive the attention it deserves, not just in practice but also in service research. This study shows that the number of new services put on the market and then withdrawn because of low sales remains as high as 43 per cent. This paper contributes knowledge on how to reduce the number of failures in NSD by pointing out the key strategic factors that influence NSD performance.

Theory development in humanitarian logistics : A framework and three cases

Purpose: There is a need for theory development within the field of humanitarian logistics to understand logistics needs in different stages of a crisis and how to meet these. This paper aims to discuss three dimensions identified in logistics and organization theories and how they relate to three different cases of humanitarian logistics operations - the regional concept of the International Federation of Red Cross Red Crescent Societies, the development and working of the United Nations Joint Logistics Centre and coordination challenges of military logistics in UN mandated peacekeeping operations. The purpose is to build a framework to be used in further studies. Design/methodology/approach: A framework for the study of humanitarian logistics along three dimensions is developed, followed by a discussion of the chosen cases in relation to these dimensions. The framework will be used as basis for the case studies to be undertaken for the purpose of understanding and identification of new questions and needs for other or revised concepts from theory. Findings: The paper shows the relevance of a wide literature to the issues pertinent to humanitarian logistics. There is considerable promise in extant literature on logistics, SCM and coordination, but this needs to be confronted with the particular issues seen in the humanitarian logistics setting to achieve further theory development. Originality/value: The major contribution of the paper lies in its breadth of theoretical perspectives presented and combined in a preliminary theoretical framework. This is applied more specifically in the three case studies described in the paper.

Are coach education programmes the most effective method for coach development?

The purpose of this study is to establish whether coaches from a multi-sport context develop most effectively through coach education programmes and whether formal learning is fostering coach effectiveness. A sample of eight qualified male multi-sports’ coaches participated with an age range of 24 to 52 years (M = 32.6, ± = 8.9) and 9 to 18 years coaching experience (M = 12.6, ± = 3.8). Qualitative semi structured interviews were employed, lasting approximately 30 to 60 minutes. The data then underwent a thematic analysis process reducing the data into six overarching themes: values of the coach; the coach’s role on athlete development; forms of learning; barriers regarding coach education; role of governing bodies; coaches career pathway. The findings of the study indicated coaches access a wide range of sources to enhance their practice, but informal learning was preferred (interacting with other coaches and learning by doing). This resulted from numerous barriers experienced surrounding the delivery, cost and access to coach education programmes preventing coaches from progressing through the pathway. However, coaches in the study feel coach education should be a mandatory process for every coach. The findings have implications for policymakers and sport organisations in developing their coach education structure.

The Development of Public Finances and Role of Fiscal Constraints in a Monetary Union: Example eurozone

This thesis is about the development of public debt and deficit in the eurozone, which has been in the center of attention for much of the new millennium. The debt-to-GDP and deficit-to-GDP ratios have changed significantly during the period of the European monetary integration, with sharp increases in the levels since the beginning of the financial crisis. We view the levels both before and after the establishment of the European Central Bank. The subject is complemented by a study of the restrictions on fiscal policy in the eurozone. The thesis begins with a review of the most central agreements in the Economic and Monetary Union, namely the Maastricht Treaty, the Stability and Growth Pact and the Fiscal Compact. We study the instructions and requirements provided by these contracts, with the emphasis being on the debt and deficit values. Furthermore, we view two theories that aim to provide us with information, whether the fiscal restrictions are useful or not. The second and empirical part consists of review on the debt and deficit levels in practice. We take a close look on the values for each of the currency union members. The third and last part summarizes the findings, and analyzes the reasons behind the changes. The result of the thesis is, that even though the levels of public debt and deficit have worsened since the beginning of the financial crisis, tight rules on fiscal policy might not be the best possible solution. Private sector has played a crucial part in the increase of the debt levels, and tight rules have their impact on the long awaited economic growth in the eurozone. It is obvious, though, that some form of fiscal guidelines with scientific ground are needed in order to avoid excessive and harmful debt and deficit levels. The main task is to make these guidelines a more essential part of the fiscal policy in each of the member countries.

Proactive Marketing – Concept Development and Empirical Analysis

In this thesis, proactive marketing is suggested to be a broader concept than existing research assumes. Although the concept has been mentioned in the context of competitive advantage in previous research, it has not been comprehensively described. This thesis shows that proactive marketing is more than investing in marketing communications of a company. Proactive marketing is described as a three-phased process that contains different customer value identification, creation, and delivery activities. The purpose of proactive marketing is essentially to anticipate and pursue market opportunities that bring value to the company’s stakeholders. Ultimately, proactive marketing aims at acting first on the market, shaping the markets, and thus reaching competitive advantage. The proactive marketing process is supported by the structures of an organization. Suitable structures for proactive marketing are identified in the thesis based on existing research and through an empirical analysis. Moreover, proactive marketing is related to two management theories: the dynamic capabilities framework and the empowerment of employees. A dynamic environment requires companies that pursue proactive marketing to change continuously. Dynamic capabilities are considered as tools of the management, which enable companies to create suitable conditions for the constant change. Empowerment of employees is a management practice that creates proactive behaviors in individuals. The empirical analysis is conducted in an online company operating in the rapidly changing marketplace of the Internet. Through the empirical analysis, the thesis identifies in practice how proactiveness manifests in the marketing process of a company, how organizational structures facilitate proactive marketing, and how proactive marketing is managed. The theoretical contribution of this thesis consist of defining the proactive marketing concept comprehensively and providing further research suggestions related to proactive marketing.

The impact and compensation of offshore wind farm development: Analysing the institutional discourse from a french case study

In France, the public acceptability of marine renewable energies and their impacts on ecosystem services (ES) involves questions about compensation for stakeholders, who may perceive some of their activities and interests to be modified. This paper seeks to understand how impacts on ES are perceived by institutional stakeholders and what is expected in terms of compensation. It also seeks to identify the communities of practice affected. We focus our study on the planned offshore wind farm in the bay of Saint-Brieuc. Our results show that institutional discourse is heterogeneous, depending on sensitivities, interests, and who or what the stakeholders surveyed represent or defend. Stakeholders' discourse can be interpreted on various gradients of perception. Six distinct communities of practice have been identified, based on the impacts perceived by institutional stakeholders. Lastly, we show that the community of practice seems to be a proper level at which to study perceptions and assess the no-net-loss goal.