The telehealth skills, training, and implementation project: an evaluation protocol

Background: Telehealth appears to be an ideal mechanism for assisting rural patients and doctors and medical students/registrars in accessing specialist services. Telehealth is the use of enhanced broadband technology to provide telemedicine and education over distance. It provides accessible support to rural primary care providers and medical educators. A telehealth consultation is where a patient at a general practice, with the assistance of the general practitioner or practice nurse, undertakes a consultation by videoconference with a specialist located elsewhere. Multiple benefits of telehealth consulting have been reported, particularly those relevant to rural patients and health care providers. However there is a paucity of research on the benefits of telehealth to medical education and learning.

Objective: This protocol explains in depth the process that will be undertaken by a collaborative group of universities and training providers in this unique project.

Methods: Training sessions in telehealth consulting will be provided for participating practices and students. The trial will then use telehealth consulting as a real-patient learning experience for students, general practitioner trainees, general practitioner preceptors, and trainees.

Results: Results will be available when the trial has been completed in 2015.

Conclusions: The protocol has been written to reflect the overarching premise that, by building virtual communities of practice with users of telehealth in medical education, a more sustainable and rigorous model can be developed. The Telehealth Skills Training and Implementation Project will implement and evaluate a theoretically driven model of Internet-facilitated medical education for vertically integrated, community-based learning environments

Paths of professional development in music therapy: training, professional identity and practice

Music therapy is listed as a profession in the EU Regulated Professions Database. This has assisted the next steps towards recognition in relevant countries and regions. The author’s experience as an academic leader in music therapy training over more than two decades is used to reflect on the profession of music therapy within Europe through interrogation of concepts underpinning professional identity, training, and professional practice. Potential tensions between recognition and regulation of healthcare professions are presented and discussed. As all practice takes place in context, balancing training needs between techniques and skills, systemic national and regional policy, and institutional knowledge is crucial. Achieving this balance is not easy but is key to successful growth of practitioner knowledge, seeding student’s curiosity about context and systems from the dawn of training.

The emergence of the private entrepreneur in reform era China: re-birth of an earlier tradition, or a more recent product of development and change?

A private sector that now dominates economic activity has emerged in China since 1978, even though many of the essential institutions for market competition have been lacking or are under-developed. We find that there is no evidence that this upsurge of entrepreneurship is a re-birth of an earlier tradition. Instead, the dynamics of entrepreneurial emergence can be attributed to reforms and institutional changes that have occurred since 1949, both before and after the introduction of economic reforms in late 1978. We find that these institutional changes have been evolutionary, adapting to, as well as shaping, emerging forms of economic activity, including entrepreneurship. Our conclusion is that these dynamics of adaptation and evolution produce ‘rule ambiguities’ within the institutional framework that create opportunities for entrepreneurs as well as making these opportunities vulnerable to further institutional change.

Power, regulation and physically active identities : the experiences of rural and regional living adolescent girls

Drawing on interpretations of Foucault's techniques of power, we explored the discourses and power relations operative between groups of girls that appeared to influence their participation in Physical Education (PE) and outside of school in sport and physical activity (PA) in rural and regional communities. Interviews and focus groups were conducted in eight secondary schools with female students from Year 9 (n = 22) and 10 (n = 116). Dominant gendered and performance discourses were active in shaping girls’ construction of what it means to be active or ‘sporty’, and these identity positions were normalised and valued. The perceived and real threat of their peer's gaze as a form of surveillance acted to further perpetuate the power of performance discourses; whereby girls measured and (self) regulated their participation. Community settings were normalised as being exclusively for skilled performers and girls self-regulated their non-participation according to judgements made about their own physical abilities. These findings raise questions about the ways in which power relations, as forged in broader sociocultural and institutional discourse–power relations, can infiltrate the level of the PE classroom to regulate and normalise practices in relation to their, and others, PA participation.

Transition to specialty practice program characteristics and professional development outcomes

BACKGROUND: Transition to Specialty Practice Programs was introduced to facilitate the transition of nurses to specialty practice, and is recognised as preparatory for emergency nurses. Emergency nursing Transition to Specialty Practice Programs and their characteristics have developed locally in response to unit needs. OBJECTIVE: The aim of this study was to examine the characteristics of emergency nursing Transition to Specialty Practice Programs in Australia, and identify which characteristics were associated with improved professional development outcomes. METHODS: An explanatory sequential design was used. Data were collected via online surveys and interviews of emergency Nurse Managers and Nurse Educators. Transition to Specialty Practice Program characteristics were compared using Mann Whitney U and Chi-Square tests. Content analysis was used to analyse qualitative data. RESULTS: Survey data were collected from 118 emergency departments, and 13 interviews were conducted. Transition to Specialty Practice Programs were offered in most emergency departments (n=80, 72.1%), with one or two intakes per year. Transition to Specialty Practice Program characteristics varied; duration ranged from 5-12months, clinical preparation time ranged from 7-22days, and the number of study days provided ranged from 2-6. When Transition to Specialty Practice Programs of 6 and 12months duration were compared, there was no difference in the content covered. Emergency departments with 12month Transition to Specialty Practice Programs had lower percentages of Clinical Specialists (9% vs 18%, p=0.03) and postgraduate qualified nurses (30.5% vs 43.8%, p=0.09). CONCLUSION: The target participants, duration and clinical preparation of Transition to Specialty Practice Programs participants varied, impeding workforce mobility and articulation to postgraduate study and there were no professional development advantages from longer programs. There is an urgent need for a nationally consistent, evidence-based and fiscally responsible approach to Transition to Specialty Practice Programs.

Performance assessment, vulnerability, human capital, and the allocation of aid among developing countries

Developing country performance with respect to economic policies and institutional behavior is a common criterion for the allocation of aid among recipient countries. This paper examines how performance is used, arguing that performance is too narrowly defined. A more appropriate definition is one that controls for the economic vulnerability and human capital of developing countries. Econometric analysis of cross-section and panel data is presented that supports this contention. The paper also contends that performance and exogenous economic shocks are likely to be pro-cyclical. This implies a double punishment when aid is allocated according to performance. Evidence of such punishment is also provided. The paper concludes by arguing that economic vulnerability and human capital variables should augment performance measures in aid allocation decision-making.

A Retrospective-Longitudinal Examination of the Relationship between Apportionment of Seat Time in Community-College Algebra Courses and Student Academic Performance

During the past decade, there has been a dramatic increase by postsecondary institutions in providing academic programs and course offerings in a multitude of formats and venues (Biemiller, 2009; Kucsera & Zimmaro, 2010; Lang, 2009; Mangan, 2008). Strategies pertaining to reapportionment of course-delivery seat time have been a major facet of these institutional initiatives; most notably, within many open-door 2-year colleges. Often, these enrollment-management decisions are driven by the desire to increase market-share, optimize the usage of finite facility capacity, and contain costs, especially during these economically turbulent times. So, while enrollments have surged to the point where nearly one in three 18-to-24 year-old U.S. undergraduates are community college students (Pew Research Center, 2009), graduation rates, on average, still remain distressingly low (Complete College America, 2011). Among the learning-theory constructs related to seat-time reapportionment efforts is the cognitive phenomenon commonly referred to as the spacing effect, the degree to which learning is enhanced by a series of shorter, separated sessions as opposed to fewer, more massed episodes. This ex post facto study explored whether seat time in a postsecondary developmental-level algebra course is significantly related to: course success; course-enrollment persistence; and, longitudinally, the time to successfully complete a general-education-level mathematics course. Hierarchical logistic regression and discrete-time survival analysis were used to perform a multi-level, multivariable analysis of a student cohort (N = 3,284) enrolled at a large, multi-campus, urban community college. The subjects were retrospectively tracked over a 2-year longitudinal period. The study found that students in long seat-time classes tended to withdraw earlier and more often than did their peers in short seat-time classes (p < .05). Additionally, a model comprised of nine statistically significant covariates (all with p-values less than .01) was constructed. However, no longitudinal seat-time group differences were detected nor was there sufficient statistical evidence to conclude that seat time was predictive of developmental-level course success. A principal aim of this study was to demonstrate—to educational leaders, researchers, and institutional-research/business-intelligence professionals—the advantages and computational practicability of survival analysis, an underused but more powerful way to investigate changes in students over time.

The Survival and Stock Performance of Emerging Country Firms in the United States

Many firms from emerging markets flocked to developed countries at high cost with hopes of acquiring strategic assets that are difficult to obtain in home countries. Adequate research has focused on the motivations and strategies of emerging country firms' (ECFs') internationalization, while limited studies have explored their survival in advanced economies years after their venturing abroad. Due to the imprinting effect of home country institutions that inhibit their development outside their home market, ECFs are inclined to hire executives with international background and affiliate to world-wide organizations for the purpose of linking up with the global market, embracing multiple perspectives for strategic decisions, and absorbing the knowledge of foreign markets. However, the effects of such orientation on survival are under limited exploration. Motivated by the discussion above, I explore ECFs’ survival and stock performance in a developed country (U.S.). Applying population ecology, signaling theory and institutional theory, the dissertation investigates the characteristics of ECFs that survived in the developed country (U.S.), tests the impacts of global orientation on their survival, and examines how global-oriented activities (i.e. joining United Nations Global Compact) affect their stock performance. The dissertation is structured in the form of three empirical essays. The first essay explores and compares different characteristics of ECFs and developed country firms (DCFs) that managed to survive in the U.S. The second essay proposes the concept of global orientation, and tests its influences on ECFs’ survival. Employing signaling theory and institutional theory, the third essay investigates stock market reactions to announcements of United Nation Global Compact (UNGC) participation. The dissertation serves to explore the survival of ECFs in the developed country (U.S.) by comparison with DCFs, enriching traditional theories by testing non-traditional arguments in the context of ECFs’ foreign operation, and better informing practitioners operating ECFs about ways of surviving in developed countries and improving stockholders’ confidence in their future growth.

Book review: Glamour in the Pacific. Cultural internationalism and race politics in the women's Pan-Pacific

Since the publication of Leila J. Rupp’s Worlds of Women: The Making of an International Women’s Movement in 1997, historians have begun to investigate the myriad ways in which women, largely excluded from formal, government-based international relations, nonetheless forged significant personal and institutional relationships across national and cultural boundaries. As a result, women’s international activism has become an increasingly popular field of scholarly enquiry.

Determinants of the Design and Use of PMS in Portuguese Government Agencies: A Complementary Theoretical Approach

Performance measurement is seen as a main pillar of public management reforms. However, prior research did not mitigate the level of ambiguity on PMS development and use and many questions left unanswered. Our findings provide knowledge on the design and use of PMS in the public sector answer- ing to calls for a complementary approach among institutional and contingency factors. The authors find that the design of PMS and the use of performance information for external purposes are increased to legitimate the organizational’ work and to obtain external support. Moreover, structural variables such as type of agency and management autonomy are also determinants on the organizational responses. Finally, the authors find some coupling between the design of PMS and outcomes. So, both contingent and institutional approaches play an important role on the empirical model.

Staff and students co-creating curricula in UK higher education: exploring process and evidencing value

Student engagement in learning and teaching is receiving a growing level of interest from policy makers, researchers, and practitioners. This includes opportunities for staff and students to co-create curricula, yet there are few examples within current literature which describe and critique this form of staff-student collaboration (Bovill (2013a), Healey et al (2014), Cook-Sather et al (2014). The competing agendas of neoliberalism and critical, radical pedagogies influence the policy and practice of staff and students co-creating curricula and, consequently, attempt to appropriate the purpose of it in different ways. Using case-based research methodology, my study presents analysis of staff and students co-creating curricula within seven universities. This includes 17 examples of practice across 14 disciplines. Using an inductive approach, I have examined issues relating to definitions of practice, conceptualisations of curricula, perceptions of value, and the relationship between practice and institutional strategy. I draw upon an interdisciplinary body of literature to provide the conceptual foundations for my research. This has been necessary to address the complexity of practice and includes literature relating to student engagement in learning and teaching, conceptual models of curriculum in higher education, approaches to evidencing value and impact, and critical theory and radical pedagogies. The study makes specific contributions to the wider scholarly debate by highlighting the importance of dialogue and conversational scholarship as well as identifying with participants what matters as well as what works as a means to evidence the value of collaborations. It also presents evidence of a new model of co-creating curricula and additional approaches to conceptualising curricula to facilitate collaboration. Analysis of macro and micro level data shows enactment of dialogic pedagogies within contexts of technical-rational strategy formation and implementation.

Integrated soil fertility management in eastern and western Africa: The role of knowledge and innovation systems, its adoption and impact

The rise in population growth, as well as nutrient mining, has contributed to low agricultural productivity in Sub-Saharan Africa (SSA). A plethora of technologies to boost agricultural production have been developed but the dissemination of these agricultural innovations and subsequent uptake by smallholder farmers has remained a challenge. Scientists and philanthropists have adopted the Integrated Soil Fertility Management (ISFM) paradigm as a means to promote sustainable intensification of African farming systems. This comparative study aimed: 1) To assess the efficacy of Agricultural Knowledge and Innovation Systems (AKIS) in East (Kenya) and West (Ghana) Africa in the communication and dissemination of ISFM (Study I); 2) To investigate how specifically soil quality, and more broadly socio-economic status and institutional factors, influence farmer adoption of ISFM (Study II); and 3) To assess the effect of ISFM on maize yield and total household income of smallholder farmers (Study III). To address these aims, a mixed methodology approach was employed for study I. AKIS actors were subjected to social network analysis methods and in-depth interviews. Structured questionnaires were administered to 285 farming households in Tamale and 300 households in Kakamega selected using a stratified random sampling approach. There was a positive relationship between complete ISFM awareness among farmers and weak knowledge ties to both formal and informal actors at both research locations. The Kakamega AKIS revealed a relationship between complete ISFM awareness among farmers and them having strong knowledge ties to formal actors implying that further integration of formal actors with farmers’ local knowledge is crucial for the agricultural development progress. The structured questionnaire was also utilized to answer the query pertaining to study II. Soil samples (0-20 cm depth) were drawn from 322 (Tamale, Ghana) and 459 (Kakamega, Kenya) maize plots and analysed non-destructively for various soil fertility indicators. Ordinal regression modeling was applied to assess the cumulative adoption of ISFM. According to model estimates, soil carbon seemed to preclude farmers from intensifying input use in Tamale, whereas in Kakamega it spurred complete adoption. This varied response by farmers to soil quality conditions is multifaceted. From the Tamale perspective, it is consistent with farmers’ tendency to judiciously allocate scarce resources. Viewed from the Kakamega perspective, it points to a need for farmers here to intensify agricultural production in order to foster food security. In Kakamega, farmers with more acidic soils were more likely to adopt ISFM. Other household and farm-level factors necessary for ISFM adoption included off-farm income, livestock ownership, farmer associations, and market inter-linkages. Finally, in study III a counterfactual model was used to calculate the difference in outcomes (yield and household income) of the treatment (ISFM adoption) in order to estimate causal effects of ISFM adoption. Adoption of ISFM contributed to a yield increase of 16% in both Tamale and Kakamega. The innovation affected total household income only in Tamale, where ISFM adopters had an income gain of 20%. This may be attributable to the different policy contexts under which the two sets of farmers operate. The main recommendations underscored the need to: (1) improve the functioning of AKIS, (2) enhance farmer access to hybrid maize seed and credit, (3) and conduct additional multi-locational studies as farmers operate under varying contexts.

Mobilizing Greater Crop and Land Potentials Sustainably

The supply side of the food security engine is the way we farm. The current engine of conventional tillage farming is faltering and needs to be replaced. This presentation will address supply side issues of agriculture to meet future agricultural demands for food and industry using the alternate no-till Conservation Agriculture (CA) paradigm (involving no-till farming with mulch soil cover and diversified cropping) that is able to raise productivity sustainably and efficiently, reduce inputs, regenerate degraded land, minimise soil erosion, and harness the flow of ecosystem services. CA is an ecosystems approach to farming capable of enhancing not only the economic and environmental performance of crop production and land management, but also promotes a mindset change for producing ‘more from less’, the key attitude towards sustainable production intensification. CA is now spreading globally in all continents at an annual rate of 10 Mha and covers some 157 Mha of cropland. Today global agriculture produces enough food to feed three times the current population of 7.21 billion. In 1976, when the world population was 4.15 billion, world food production far exceeded the amount necessary to feed that population. However, our urban and industrialised lifestyle leads to wastage of food of some 30%-40%, as well as waste of enormous amount of energy and protein while transforming crop-based food into animal-derived food; we have a higher proportion of people than ever before who are obese; we continue to degrade our ecosystems including much of our agricultural land of which some 400 Mha is reported to be abandoned due to severe soil and land degradation; and yields of staple cereals appear to have stagnated. These are signs of unsustainability at the structural level in the society, and it is at the structural level, for both supply side and demand side, that we need transformed mind sets about production, consumption and distribution. CA not only provides the possibility of increased crop yields for the low input smallholder farmer, it also provides a pro-poor rural and agricultural development model to support agricultural intensification in an affordable manner. For the high output farmer, it offers greater efficiency (productivity) and profit, resilience and stewardship. For farming anywhere, it addresses the root causes of agricultural land degradation, sub-optimal ecological crop and land potentials or yield ceilings, and poor crop phenotypic expressions or yield gaps. As national economies expand and diversify, more people become integrated into the economy and are able to access food. However, for those whose livelihoods continue to depend on agriculture to feed themselves and the rest of the world population, the challenge is for agriculture to produce the needed food and raw material for industry with minimum harm to the environment and the society, and to produce it with maximum efficiency and resilience against abiotic and biotic stresses, including those arising from climate change. There is growing empirical and scientific evidence worldwide that the future global supplies of food and agricultural raw materials can be assured sustainably at much lower environmental and economic cost by shifting away from conventional tillage-based food and agriculture systems to no-till CA-based food and agriculture systems. To achieve this goal will require effective national and global policy and institutional support (including research and education).

Analysis of Needs and Resources

The initial aim of the CareMan project was to develop a joint degree programme that combined and utilised the strengths of the five collaborating universities that were already involved in delivering social and health care management education. Because the project was to be implemented in collaboration between education- al institutions, the collaboration had to be based on a detailed understanding of the national and institutional specifics of each of the individual academic enti- ties. During this process it was recognised that, due to a number of regulation issues, achieving the original aim would not be possible; ultimately, following a series of analytical works, which are presented below, it was decided that a set of three master’s level modules should be developed. One of the reasons was that the Finnish law on master’s degrees at universities of applied sciences (UAS) stated that the requirement for entry to a UAS master’s programme was a bachelor degree from a UAS or equivalent, plus a minimum of three years of work experience in an appropriate field. The three years’ work experience is also required from international students. In practice this meant that the participating Finnish UASs, Lahti and HAMK, could not award a diploma for foreign students without this work experience. The other European universities do not have the work experience requirement, although some take it as a bonus for admission (FHS UK). There were also other differences in law (e.g., requirements for mini - mum standards in Social Work education at FHS UK) that could not have been overcome during the period of project realisation. Consequently, the outcome was the development of only three common educational modules, each for 10 ECTS, which were developed, delivered and assessed during the lifetime of the project. The intention was that these would be integrated into the current masters’ level provision in each of the universities

Summary and Conclusion

This monograph outlines the process and results of development of a common educational programme at masters level in health and social care management, which was supported by the Erasmus Life Long Education project CareMan (Cul- ture and Care Management). The CareMan project brought together university partners actively involved in educating social and health care professionals in leadership and management at master’s level in Europe. The five partners of the consortium were Lahti University of Applied Sciences – Lahti UAS (administra- tive and academic coordinator, Finland), Charles University – CU (the Czech Republic), Edinburgh Napier University – ENU (Scotland), Hammeline University of Applied Sciences – HAMK (Finland), and University of Évora – UoE (Portugal). The objectives of the project were to achieve lower -level educational goals that included the development through education cultural and value -driven leadership, quality of care and quality management to effectively manage an integrated health and social care service. Through mapping the situation in the field and comparing curricula of all participating universities the overall aim was to develop a joint masters programme in social and healthcare management. After the detailed understanding of national and institutional specifics of each of the individual academic entities it was recognised that, due to a number of regulation issues, the original aim was not achievable. Following subsequent analytical work, it was decided to develop a set of three master’s level modules. At the end of the project it was intended that all created modules would be available virtually to the participating programmes and would contribute some added value to existing curricula. In the future these ready -to -use modules are intended to be taught in cooperation with the participating universities or as a separate module in each university. The chosen theoretical framework of the project that underpinned the devel- opment, management and evaluation of the inter -cultural educational provision relied on the combination of two learning theories – ‘cooperative collaborative and social learning’ and ’transformational’ (Mezirow, 2009). This theoretical framework helped to align with European collaborative policy and its application on all levels of implementation of the project.