Improving Storage with Stackable Extensions

Storage is a central part of computing. Driven by exponentially increasing content generation rate and a widening performance gap between memory and secondary storage, researchers are in the perennial quest to push for further innovation. This has resulted in novel ways to "squeeze" more capacity and performance out of current and emerging storage technology. Adding intelligence and leveraging new types of storage devices has opened the door to a whole new class of optimizations to save cost, improve performance, and reduce energy consumption. In this dissertation, we first develop, analyze, and evaluate three storage extensions. Our first extension tracks application access patterns and writes data in the way individual applications most commonly access it to benefit from the sequential throughput of disks. Our second extension uses a lower power flash device as a cache to save energy and turn off the disk during idle periods. Our third extension is designed to leverage the characteristics of both disks and solid state devices by placing data in the most appropriate device to improve performance and save power. In developing these systems, we learned that extending the storage stack is a complex process. Implementing new ideas incurs a prolonged and cumbersome development process and requires developers to have advanced knowledge of the entire system to ensure that extensions accomplish their goal without compromising data recoverability. Futhermore, storage administrators are often reluctant to deploy specific storage extensions without understanding how they interact with other extensions and if the extension ultimately achieves the intended goal. We address these challenges by using a combination of approaches. First, we simplify the storage extension development process with system-level infrastructure that implements core functionality commonly needed for storage extension development. Second, we develop a formal theory to assist administrators deploy storage extensions while guaranteeing that the given high level goals are satisfied. There are, however, some cases for which our theory is inconclusive. For such scenarios we present an experimental methodology that allows administrators to pick an extension that performs best for a given workload. Our evaluation demostrates the benefits of both the infrastructure and the formal theory.

Improving caches in consolidated environments

Memory (cache, DRAM, and disk) is in charge of providing data and instructions to a computer's processor. In order to maximize performance, the speeds of the memory and the processor should be equal. However, using memory that always match the speed of the processor is prohibitively expensive. Computer hardware designers have managed to drastically lower the cost of the system with the use of memory caches by sacrificing some performance. A cache is a small piece of fast memory that stores popular data so it can be accessed faster. Modern computers have evolved into a hierarchy of caches, where a memory level is the cache for a larger and slower memory level immediately below it. Thus, by using caches, manufacturers are able to store terabytes of data at the cost of cheapest memory while achieving speeds close to the speed of the fastest one.^ The most important decision about managing a cache is what data to store in it. Failing to make good decisions can lead to performance overheads and over-provisioning. Surprisingly, caches choose data to store based on policies that have not changed in principle for decades. However, computing paradigms have changed radically leading to two noticeably different trends. First, caches are now consolidated across hundreds to even thousands of processes. And second, caching is being employed at new levels of the storage hierarchy due to the availability of high-performance flash-based persistent media. This brings four problems. First, as the workloads sharing a cache increase, it is more likely that they contain duplicated data. Second, consolidation creates contention for caches, and if not managed carefully, it translates to wasted space and sub-optimal performance. Third, as contented caches are shared by more workloads, administrators need to carefully estimate specific per-workload requirements across the entire memory hierarchy in order to meet per-workload performance goals. And finally, current cache write policies are unable to simultaneously provide performance and consistency guarantees for the new levels of the storage hierarchy.^ We addressed these problems by modeling their impact and by proposing solutions for each of them. First, we measured and modeled the amount of duplication at the buffer cache level and contention in real production systems. Second, we created a unified model of workload cache usage under contention to be used by administrators for provisioning, or by process schedulers to decide what processes to run together. Third, we proposed methods for removing cache duplication and to eliminate wasted space because of contention for space. And finally, we proposed a technique to improve the consistency guarantees of write-back caches while preserving their performance benefits.^

From the Grassroot to the Tree Tops: How One Library has become Embedded in Online Learning

This presentation will show how a grassroots initiative has budded into the Florida International University (FIU) Libraries being an instrumental part of online learning. It will describe some of the marketing and outreach efforts that have been successful and share ideas on how to build alliances and networks with online faculty and students. Along with outreach efforts, the presentation will demonstrate some of the successful tools used to meet the needs of online students. Some of the these tools include becoming embedded in courses, building course and program specific Libguides, using Adobe Connect to reach students, creating simple YouTube videos, and creating more professional videos with FIU Online. The presentation will conclude with sharing some tips on how to keep the workload manageable when distance-learning programs are growing at the same time as library budgets and resources are shrinking.

Fuzzy Modeling and Control Based Virtual Machine Resource Management

Virtual machines (VMs) are powerful platforms for building agile datacenters and emerging cloud systems. However, resource management for a VM-based system is still a challenging task. First, the complexity of application workloads as well as the interference among competing workloads makes it difficult to understand their VMs’ resource demands for meeting their Quality of Service (QoS) targets; Second, the dynamics in the applications and system makes it also difficult to maintain the desired QoS target while the environment changes; Third, the transparency of virtualization presents a hurdle for guest-layer application and host-layer VM scheduler to cooperate and improve application QoS and system efficiency. This dissertation proposes to address the above challenges through fuzzy modeling and control theory based VM resource management. First, a fuzzy-logic-based nonlinear modeling approach is proposed to accurately capture a VM’s complex demands of multiple types of resources automatically online based on the observed workload and resource usages. Second, to enable fast adaption for resource management, the fuzzy modeling approach is integrated with a predictive-control-based controller to form a new Fuzzy Modeling Predictive Control (FMPC) approach which can quickly track the applications’ QoS targets and optimize the resource allocations under dynamic changes in the system. Finally, to address the limitations of black-box-based resource management solutions, a cross-layer optimization approach is proposed to enable cooperation between a VM’s host and guest layers and further improve the application QoS and resource usage efficiency. The above proposed approaches are prototyped and evaluated on a Xen-based virtualized system and evaluated with representative benchmarks including TPC-H, RUBiS, and TerraFly. The results demonstrate that the fuzzy-modeling-based approach improves the accuracy in resource prediction by up to 31.4% compared to conventional regression approaches. The FMPC approach substantially outperforms the traditional linear-model-based predictive control approach in meeting application QoS targets for an oversubscribed system. It is able to manage dynamic VM resource allocations and migrations for over 100 concurrent VMs across multiple hosts with good efficiency. Finally, the cross-layer optimization approach further improves the performance of a virtualized application by up to 40% when the resources are contended by dynamic workloads.

Improving Storage Performance Through Layout Optimizations

Disk drives are the bottleneck in the processing of large amounts of data used in almost all common applications. File systems attempt to reduce this by storing data sequentially on the disk drives, thereby reducing the access latencies. Although this strategy is useful when data is retrieved sequentially, the access patterns in real world workloads is not necessarily sequential and this mismatch results in storage I/O performance degradation. This thesis demonstrates that one way to improve the storage performance is to reorganize data on disk drives in the same way in which it is mostly accessed. We identify two classes of accesses: static, where access patterns do not change over the lifetime of the data and dynamic, where access patterns frequently change over short durations of time, and propose, implement and evaluate layout strategies for each of these. Our strategies are implemented in a way that they can be seamlessly integrated or removed from the system as desired. We evaluate our layout strategies for static policies using tree-structured XML data where accesses to the storage device are mostly of two kinds - parent-tochild or child-to-sibling. Our results show that for a specific class of deep-focused queries, the existing file system layout policy performs better by 5-54X. For the non-deep-focused queries, our native layout mechanism shows an improvement of 3-127X. To improve performance of the dynamic access patterns, we implement a self-optimizing storage system that performs rearranges popular block accesses on a dedicated partition based on the observed workload characteristics. Our evaluation shows an improvement of over 80% in the disk busy times over a range of workloads. These results show that applying the knowledge of data access patterns for allocation decisions can substantially improve the I/O performance.

Condições de trabalho e terceiro setor: implicações contemporâneas para o serviço social

In the contemporaneity, due to the implementation of the neoliberal project in which one verifies the withdrawal of the State in regard to the development of social policies, it is observed a new way of responding to the multifaceted expressions of the social issue, which is the emergence and expansion of a supposed "third sector" in society. Thus, the productive restructuring process has led to the deterioration of labor relations, as well as a super exploration of human labor power, also triggering structural unemployment. By being delineated in classist interests, the emergence of the "third sector" brings contradictory aspects to the society, one of these being the very concept of "third sector", more ideological than real. By seeking to answer the expressions of the social issue, demands the intervention of social workers in the institutions that "composes it". This way, arises the interest in researching what are the current conditions and labor relations of the social workers who work in the institutions of the "third sector" in Mossoró-RN. Therefore, this study is constituted by a survey for the conclusion of a Master's degree in Social Service at the Universidade Federal do Rio Grande do Norte. Therefore, it was listed out as general objective to identify and analyze the conditions and labor relations of the social workers entered in the institutions of the "third sector" in Mossoró-RN. And by specific objectives: to map the institutions that are part of the "third sector" in the city of Mossoró, which have social workers on its professional staff, in order to profile the same; and, analyze the main challenges presented to the work of the social worker in these institutions. We used the bibliographic and documental research to enlighten the knowledge of the topic approached and the development of the field research, in which for the analysis of the data obtained, through field research, it was used the quantitative and qualitative approach. The search results confirmed that half of the institutions was identified as philanthropics, and most of them are funded by the federal government and that such organizations develop activities in several areas, particularly health and welfare. Concerning the conditions and labor relations, was highlighted the fact that half of the professionals insert themselves within the institutions by appointment; regarding the salary, 57.1% of employees receive between 3 and 4 minimum wages, which is considered relatively low. Was satisfactory the analysis related to the labor rights, because almost all offer a formal contract, which ensures, in great measure, the effectuation of such rights. Now with regard to the workload, 5 of 6 institutions implemented the Law Nº. 12.317/2010 ensuring 30 hours a week for social workers. However, it were cited many challenges relating the reality of the "third sector" to the conditions and labor relations, among them stands out: the delay of salary and non-salary adjustment; the realization of activities that do not relate to professionals, functions and duties; the development of many activities by a single professional. Two important data are the not incentive to a postgraduate and the charging of the fulfillment of the goals for the professional productivity. Here, it is worth to reflect that, although this study presents elements that provide to identify some aspects of labor relations and conditions of social workers in the "third sector" in Mossoró- RN, as well as some challenges that permeate this space of professional insertion, is meant that there is much to be unveiled, and other studies can later do so in an attempt to a better understanding of the complexity of processes that permeate the "third sector"

O laboratório de ensino de matemática temático centrado nos instrumentos de navegação: uma proposta para o IFRN de Mossoró-RN

This work presents a proposal to build a Mathematics Teaching Laboratory (MTL) whose main theme is the study, construction and use of instruments for navigation and location of mathematical content in an interdisciplinary way approach, and develop a notebook of activities focused on navigational instruments. For this it was necessary a literature review to understand the different conceptions of MTL and its pedagogical implications. The methodology used was literature research, construction and handling of instruments, and pedagogical experimentation. Lorenzato (2006) highlights the importance of an environment and suitable for a professional who can do a good job instruments. The implementation of an LEM can find some obstacles. The lack of support from other teachers or the management, the lack of a suitable place to store the materials produced, the lack of time in the workload of the teacher to prepare the lab activity, etc. Even in unfavorable or adverse conditions, according Lorenzato (2006), its implementation will benefit teachers and students. The lack of teacher training in their initial and continuing education, to use materials, and the lack of manuals with lab activities are also mentioned as factors that keep teachers from MTL. With propóposito assist the teacher of elementary or middle school in building a theme MTL prepared and we are providing a notebook of activities that provides a didactic sequence involving History and Mathematics. The book consists of four accompanied by suggestions for teachers activities, however the teacher has full autonomy to adapt the activities to the reality of your school. Among the instruments of navigation presented in this study chose to build the quadrant due to its simplicity, low cost of material and great teaching potential that this instrument has. But a theme lab is always being built and rebuilt as it is a research environment

Influência do horário de trabalho, do gênero e de um programa de educação sobre o sono no ciclo sono/vigília de professores do ensino fundamental e médio

The teaching profession is often associated with extensive workload inside and outside the classroom, poor teaching conditions, among other challenges that can cause sleep problems. These problems may be even greater in women, due to the professional and domestic work hours and to the major sleep necessity. Considering that sleeping problems may result from the practice of poor sleep habits, sleep education programs are conducted with the aim to reduce sleep deprivation, irregularity on sleep schedules, daytime sleepiness and improve sleep quality. In this sense, the objective of this study is to evaluate the influence of working hours, gender and a sleep education program on sleeping habits, quality of sleep, daytime sleepiness and the level of stress in teachers of elementary and secondary education. For that, teachers filled the questionnaires that assessed: 1. Sleeping habits (Sleep & Health), 2. Chronotype (Horne & Ostberg), 3. Daytime sleepiness (Epworth Sleepiness Scale), 4. Sleep Quality (Pittsburgh Sleep Quality Index), 5. Level of stress (The Inventory of Stress for Adults of Lipp) and 6. Daily pattern of sleep/wake cycle (Sleep Diary). The questionnaires 1, 4, 5 and 6 were repeated 3 weeks after the sleep education program. Teachers who begin work in the morning (7:11 ± 0:11 h) wake up earlier in the week and often have poor sleep quality compared to those who start in the afternoon (13:04 ± 00:12 h). Among those who begin work in the morning, the intermediate types and those with an evening tendency were more irregular in the wake up time than morning types and increased sleep duration on weekend. In relation to gender, women had longer sleep duration than men, although the majority presented excessive daytime sleepiness and poor sleep quality. However, when work schedule and age are similar between genders, the difference in sleep duration becomes a tendency and the difference in the percentage of excessive daytime sleepiness disappears, but the poor sleep quality persists in women. With respect to teachers who have gone through the sleep education program, there was an increase in knowledge about the subject, which may have contributed to the reduction in the frequency of coffee consumption close to bedtime and to the sleep quality improved in 18 % of participants. In the control group, there were random differences in knowledge in 3rd stage, and sleep quality improved in only 9% of teachers. The participation in the sleep education program was not enough to change the hours of sleep and decrease stress of teachers. Therefore, the start time school in the morning was preponderant in determining the wake up time of teachers, especially for intermediates types and those with an evening tendency. Furthermore, the poor quality of sleep was more common in women, and the sleep education program contributed to increase knowledge on the subject and to improve sleep quality.

Nursing Activities Score: avaliação da carga de trabalho de enfermagem em unidade de terapia intensiva adulto

The sizing of nursing human resources is an essential management tool to meet the needs of the patients and the institution. Regarding to the Intensive Care Unit, where the most critical patients are treated and the most advanced life-support equipments are used, requiring a high number of skilled workers, the use of specific indicators to measure the workload of the team becomes necessary. The Nursing Activities Score is a validated instrument for measuring nursing workload in the Intensive Care Unit that has demonstrated effectiveness. It is a cross-sectional study with the primary objective of assessing the workload of nursing staff in an adult Intensive Care Unit through the application of the Nursing Activities Score. The study was conducted in a private hospital specialized in the treatment of patients with cancer, which is located in the city of Natal (Rio Grande do Norte – Brazil). The study was approved by the Research Ethics Committee of the hospital (Protocol number 558.799; CAAE 24966013.7.0000.5293). For data collection, a form of sociodemographic characteristics of the patients was used; the Nursing Activities Score was used to identify the workload of nursing staff; and the instrument of Perroca, which classifies patients and provides data related to the their need for nursing care, was also used. The collected data were analyzed using a statistical package. The categorical variables were described by absolute and relative frequency, while the number by median and interquartile range. Considering the inferential approach, the Spearman test, the Wald chi-square, Kruskal Wallis and Mann-Whitney test were used. The statistically significant variables were those with p values <0.05. The evaluation of the overall averages of NAS, considering the first 15 days of hospitalization, was performed by the analysis of Generalized Estimating Equations (GEE), with adjust for the variable length of hospitalization. The sample consisted of 40 patients, in the period of June to August 2014. The results showed a mean age of 62,1 years (±23,4) with a female predominance (57,5%). The most frequent type of treatment was clinical (60,0%), observing an average stay of 6,9 days (±6,5). Considering the origin, most patients (35%) came from the Surgical Center. There was a mortality rate of 27,5%. 277 measures of NAS score and Perroca were performed, and the averages of 69,8% (±24,1) and 22,7% (±4.2) were obtained, respectively. There was an association between clinical outcome and value of the Nursing Activities Score in 24 hours (p <0.001), and between the degree of dependency of patients and nursing workload (rp 0,653, p<0,001). The achieved workload of the nursing staff, in the analyzed period, was presented high, showing that hospitalized patients required a high demand for care. These findings create subsidies for sizing of staff and allocation of human resources in the sector, in order to achieve greater safety and patient satisfaction as a result of intensive care, as well as an environment conducive to quality of life for the professionals

Perfis e práticas dos profissionais de saúde mental em dois hospitais psiquiátricos de grande porte

In the Brazilian network of psychosocial care, health professionals are important actors in the process of transformation of mental health public policies among various services. In the reality of psychiatric hospitals, one should understand the need to expand the debate about the current context of practices developed. This study aimed at analyzing the process of psychiatric reform and the mental health policy in the State of Rio Grande do Norte (RN) from the profiles and practices of higher-level professionals in two psychiatric hospitals. This is a cross-sectional and descriptive research, with quantitative and qualitative data, conducted in two psychiatric hospitals of RN. The universe of the target population was 95 professionals, taking into account the margin of error of 8%, non-response rate and the inclusion criteria: holding effective link with the institution by means of approval in public examination for, at least, six months, being state or municipal servant; having a minimum weekly workload of 20 hours in service; participating in care and/or activities with patients and families in a direct way. The final sample consisted of 60 professionals. The tool for data collection was a questionnaire with closed and semi-open questions about socioeconomic profile, and mental health policies, practices and training. Quantitative data were tabulated in the statistical software SPSS, and simple and bivariate statistics, chi-square type, was used for analysis by adopting the significance level with the value p<0,05. In order to analyze data, the content analysis of Bardin was used. The qualitative findings obtained with the semi-open questions in Analyse Lexicale par Context d'un Ensemble de Segments de Texte (ALCESTE) were grouped into four thematic axes: Professional action in mental health; Mental health training; Scenarios of psychiatric reform and psychiatric hospitals; Mental health policies and practices: challenges for professionals in hospitals. The profile of professionals has revealed the majority of women (89,7%), nurses (36,7%), aged 50-59 years (42,9%), weekly workload of 40 hours (52,4% ), time of completion of graduation from six to 15 years (57%), and 21,4% reported to have specialization in mental health. Regarding the practices developed in individual care, it was found an association between those who do not build or partially conducts the therapeutic project and those who conduct care related to observation and annotation. In family care, it was obtained care consultation during crisis; and, in group care, recreational activities. In the analysis of thematic axes, it was noted that, despite changes identified in the profiles and practices of higher-level professionals in care services for mental health, with the implementation of new public policies for this field, the findings indicate the confluence of asymmetries and divergences in the actions of the teams in psychiatric hospitals, difficulties in managing services, frequent readmissions, reduced quantitative of available services and equipment, high demand of users, disarticulation of the network of psychosocial care, and the very shortage of skilled human resources to compose these services. Accordingly, the evidenced scenarios partially outline the current political and ideological mismatch of the national process of psychiatric reform that denies the role of care actions conducted within hospitals, although it has not gone far enough with the creation of new services that justify the total extinction of this institution

A reforma psiquiátrica e a política de saúde mental do Rio Grande do Norte: papéis e funções de profissionais e gestores

This study arose from an interest in knowing the reality of mental health care in Rio Grande do Norte (RN) on the advances and challenges in the intersectoral agreements paths and consolidation of the Psychosocial Care Network (RAPS) from the state. Considering problematic and concerns were defined as objectives: Identify the knowledge of managers of Rio Grande do Norte on the National Mental Health Policy (PNSM) in the RN State; Describe the activities developed by health professionals in the individual service offered in the CAPS from RN; Understanding the relationship of managers’ knowledge on national mental health policy in professionals’ practice working in the the CAPS from the countryside. It is a descriptive study with a quantitative and qualitative approach, carried out in 30 CAPS from RN’s countryside, where 183 professionals answered a structured questionnaire with closed questions about the activities they do in individual care; and 19 mental health coordinators of municipalities and the state coordinator of RAPS were interviewed about their knowledge on the Mental Health Policy. Data were collected after approval by the Research Ethics Committee of the Federal University of Rio Grande do Norte, with the number 508.430 CAAE: 25851913.7.0000.5537 from August through October of 2014 in 26 municipalities with CAPS from the state. Quantitative data were tabulated and analyzed using a descriptive statistics aided by the software Statistical Package for the Social Scienses (SPSS) version 20.0. The qualitative data were prepared in a corpus and analyzed through software Analyse Lexicale par Contexte d’um Ensemble de Segments de Texte (ALCESTE) that allow to perform textual statistical analysis and categorization from their comments, submitted to Bardin content analysis. Five categories were generated approaching the managers’ knowledge, namely: Back to society: leadership and users’ role and autonomy; The gap between policy and practice; Barriers that affect the service; Structuring the Psychosocial Care Network; Multidisciplinary team: attribuitios and activities. The CAPS professionals’ ages ranged from 20 to 58 years, prevailing females, with 76.5% of the total, the majority were social workers (16.8%), psychologists (15.3%), nurses (14.8%) and nursing technicians (14.8%). The results showed precariousness in care associated with physical workload regard to high workload and low wages of the CAPS professionals' and, also, it was possible to observe a large involvement of professionals in care delivery, despite the difficulties encountered in services. It was found little knowledge in managers regarding the National Mental Health Policy having as causes of this reality the poor education and training of these professionals. The responses of professionals working in care reveals strong consistency with what is expected of a psychosocial care service. Points up as a thesis of this study that the psychiatric reform and mental health policy in Rio Grande do Norte is following a structural expansion process, but with precariousness of services from a still unprepared management to act in a psychosocial context.

História da matemática na formação de professores: sistemas de numeração antigos

This essay aims to present and describe a proposal of insertion of Mathematics History into teachers undergraduation. Such addition proposal is expected to take place as curricular component to be taught on initial undergraduation for mathematics teachers. The selection of contents for the proposal has been based on the national Curriculum Guidelines (DCN, 2001, acronym in portugueses) for bachelor’s degree in Mathematics; the National Curricular Guidelines for Elementary School (PCNEF, 1998, acronym in Portuguese); and the National Curricular Guidelines for High School (PCNEM, 1999, acronym in Portuguese). The curricular component now presented is supposed to take a 60 hour workload, and includes the following topics: History of Ancient Numbering Systems, History of Trigonometriy and History of fuctions. For the sake of exemplification, the topic History of Ancient Numbering Systems is discussed and analysed in detail as practice for the new curricular component.

Learning from a deceptively spacious policy discourse

In this chapter, the way in which varied terms such as Networked learning, e-learning and Technology Enhanced Learning (TEL) have each become colonised to support a dominant, economically-based world view of educational technology is discussed. Critical social theory about technology, language and learning is brought into dialogue with examples from a corpus-based Critical Discourse Analysis (CDA) of UK policy texts for educational technology between1997 and 2012. Though these policy documents offer much promise for enhancement of people’s performance via technology, the human presence to enact such innovation is missing. Given that ‘academic workload’ is a ‘silent barrier’ to the implementation of TEL strategies (Gregory and Lodge, 2015), analysis further exposes, through empirical examples, that the academic labour of both staff and students appears to be unacknowledged. Global neoliberal capitalist values have strongly territorialised the contemporary university (Hayes & Jandric, 2014), utilising existing naïve, utopian arguments about what technology alone achieves. Whilst the chapter reveals how humans are easily ‘evicted’, even from discourse about their own learning (Hayes, 2015), it also challenges staff and students to seek to re-occupy the important territory of policy to subvert the established order. We can use the very political discourse that has disguised our networked learning practices, in new explicit ways, to restore our human visibility.

The potential for pharmacists to manage children attending emergency departments

AIM: There have been concerns about maintaining appropriate clinical staff levels in Emergency Departments in England.1 The aim of this study was to determine if Emergency Department attendees aged from 0-16 years could be managed by community pharmacists or hospital independent prescriber pharmacists with or without further advanced clinical practice training. METHOD: A prospective, 48 site, cross-sectional, observational study of patients attending Emergency Departments (ED) in England, UK was conducted. Pharmacists at each site collected up to 400 admissions and paediatric patients were included in the data collection. The pharmacist independent prescribers (one for each site) were asked to identify patient attendance at their Emergency Department, record anonymised details of the cases-age, weight, presenting complaint, clinical grouping (e.g. medicine, orthopaedics), and categorise each presentation into one of four possible categories: CP, Community Pharmacist, cases which could be managed by a community pharmacist outside an ED setting; IP-cases that could be managed at ED by a hospital pharmacist with independent prescriber status; IPT, Independent Prescriber Pharmacist with additional training-cases which could be managed at ED by a hospital pharmacist independent prescriber with additional clinical training; and MT, Medical Team only-cases that were unsuitable for the pharmacist to manage. An Impact Index was calculated for the two most frequent clinical groupings using the formula: Impact index=percentage of the total workload of the clinical grouping multiplied by the percentage ability of pharmacists to manage that clinical group. RESULTS: 1623 out of 18,229 (9%) attendees, from 45 of the 48 sites, were children aged from 0 to 16 years of age (median 8 yrs, range 0-16), 749 were female and 874 were male. Of the 1623 admissions, 9% of the cases were judged to be suitable for clinical management by a community pharmacist (CP), 4% suitable for a hospital pharmacist independent prescriber (IP), 32% suitable for a hospital independent pharmacist prescriber with additional training (IPT); and the remaining 55% were only suitable for the Medical Team (MT). The most frequent clinical groups and impact index for the attendees were General Medicine=10.78 and orthopaedics=10.60. CONCLUSION: Paediatric patients attending Emergency Departments were judged by pharmacists to be suitable for management outside a hospital setting in approximately 1 in 11 cases, and by hospital independent prescriber pharmacists in 4 in 10 cases. With further training, it was found that the total proportion of cases that could be managed by a pharmacist was 45%. The greatest impact for pharmacist management occurs in general medicine and orthopaedics.

Team reflexivity and innovation:the moderating role of team context

We developed and tested a team level contingency model of innovation, integrating theories regarding work demands, team reflexivity - the extent to which teams collectively reflect upon their working methods and functioning -, and team innovation. We argued that highly reflexive teams will be more innovative than teams low in reflexivity when facing a demanding work environment. The relationships between team reflexivity, a demanding work environment (i.e. quality of the physical work environment and work load) and team innovation was examined among 98 primary health care teams (PHCTs) in the UK, comprised of 1137 individuals. Results showed that team reflexivity is positively related to team innovation, and that there is an interaction between team reflexivity, team level workload, and team innovation, such that when team level workload is high, combined with a high level of team reflexivity, team innovation is also higher. The complementary interaction between team reflexivity, quality of physical work environment, and team innovation, showed that when the quality of the work environment is low, combined with a high level of team reflexivity, team innovation was also higher. These results are discussed in the context of the need for team reflexivity and team innovation among teams at work facing high work demands.