Reconfiguring or reproducing intra-professional boundaries? Specialist expertise, generalist knowledge and the ‘modernization’ of the medical workforce

Efforts to ‘modernize’ the clinical workforce of the English National Health Service have sought to reconfigure the responsibilities of professional groups in pursuit of more effective, joined-up service provision. Such efforts have met resistance from professions eager to protect their jurisdictions, deploying legitimacy claims familiar from the insights of the sociology of professions. Yet to date few studies of professional boundaries have grounded these insights in the specific context of policy challenges to the inter- and intra-professional division of labour, in relation the medical profession and other health-related occupations. In this paper we address this gap by considering the experience of newly instituted general practitioners (family physicians) with a special interest (GPSIs) in genetics, introduced to improve genetics knowledge and practice in primary care. Using qualitative data from four comparative case studies, we discuss how an established intra-professional division of labour within medicine—between clinical geneticists and GPs—was opened, negotiated and reclosed in these sites. We discuss the contrasting attitudes towards the nature of genetics knowledge and its application of GPSIs and geneticists, and how these were used to advance conflicting visions of what the nascent GPSI role should involve. In particular, we show how the claims to knowledge of geneticists and GPSIs interacted with wider policy pressures to produce a rather more conservative redistribution of power and responsibility across the intra-professional boundary than the rhetoric of modernization might suggest.

THE AGING OF AFRICA: CHALLENGES TO AFRICAN DEVELOPMENT

The purpose of this brief discussion is to highlight issues of demographic changes associated with an aging population in Africa and what, I believe, must happen to avoid the next social crisis among African nations.

Quality of life in institutionalized elderly undergoing an active aging program

Living with quality is a growing concern of the old population. There is an increasing institutionalization of the elderly, and it is in this context that active aging programs assume relevance, allowing the elderly the contact with experiences that allow them to age with quality of life, by maintaining their autonomy and promoting their physical, mental and emotional well-being. This study aims to assess the quality of life of institutionalized elderly undergoing to an active aging program. Methods: We have developed a semi-experimental study that considers the quantitative methodology in which the following instruments were used to measure the quality of life: Eurohis-Qol-8 (Pereira, Melo, Gameiro, & Canavarro, 2011) and Whoqol-Old (Vilar et al., 2010), to which sociodemographic and clinical questions were added. Assessments were made in two different moments, before and after the intervention program, in a sample of 37 institutionalized elderly. Results: Concerning the assessment of quality of life related to health (Eurohis-Qol-8), significant higher scores were obtained in the second moment (p = 0.004). Regarding the quality of life related to the elderly significant better scores were also obtained in the second assessment (p = 0.001). Conclusions: The results obtained allow us to conclude that using either of the measuring scales of Eurohis-Qol-8 or Whoqol-old, there is a perceived improvement in quality of life in those using the active aging program. Thus, institutionalized elderly must be the main target in the design and implementation of active aging programs.

South Carolina State Plan on Aging 2017-2021

The Lieutenant Governor’s Office on Aging hereby submits the Federal Fiscal Year 2017 – 2021 State Plan on Aging for the State of South Carolina to the Assistant Secretary on Aging of the United States Department of Health and Human Services. The plan is effective for the period of October 1, 2016 through September 30, 2020. This document lays out a long-term strategic blueprint that focuses on how the state will modernize its service delivery system, while expanding the service options available for older South Carolinians, adults with disabilities, and their families. It also sets goals for consumer choice, and person centered and self-directed services. It addresses marketing, outreach, and advocacy issues, as well as the development of initiatives geared toward promoting evidence-based, consumer-directed, and community-based long-term services and supports.

Influence of shade, curing mode, and aging on the color stability of resin cements

The color stability of resin cements is essential for aesthetic restorations. Aim: To evaluate the influence of shade and aging time on the color stability of two light-cured and two dual-cured resin cements. Methods: The CIE-Lab color parameters (n=6) were measured immediately after sample preparation and at 7, 30 and 90 days of aging in distilled water. The color difference (ΔE) was calculated and then analyzed by three-way ANOVA for repeated measures and Tukey’s HSD test (α=0.05). Results: ΔE was higher for transparent resin colors, followed by dark and light colors. The mean values of ΔE were lower for both light-cured resin cements compared to the dual-cured cements. As the aging time increased, ΔE values increased. Conclusions: The light-cured resin cements showed greater color stability. The lighter shades of luting were more likely to display a greater color change.

Heavy metal release due to aging effect during zero valent iron nanoparticles remediation

Zero valent iron nanoparticles (nZVI) represent a promising agent for environmental remediation. Nevertheless, their application presents some limitations regarding their rapid oxidation and aggregation in the media. The aim of this study was to determine the effect that nZVI aging has in heavy metal remediation in water. Contaminants studied were Zn, Cd, Ni, Cu and Cr, which are typical elements found in ground and wastewater. Results show a high contaminant removal capacity by the nZVI in the first 2 h of reaction. Nevertheless, for longer reaction times, some of the metal ions that had already been adsorbed in the nZVI were delivered to the water. Cd and Ni show the maximum delivery percentages (65 and 27% respectively after 21 days of contact time). The starting delivery time was shortened when applying lower nZVI amounts. No re-dissolution of Cr was observed in any circumstance because it was the only element incorporated into the nanoparticles core, as TEM images showed. Contaminant release from nZVI is probably due to nanoparticles oxidation caused by aging, which produced a pH decrease and nZVI surface crystallization.

The old and the oldest-old: Do they have different perspectives on adjustment to aging?

Background: Older adults experience varying challenges in old age. This study aims to explore the indicators of adjustment to aging (AtA) and to examine the potential explanatory mechanisms of a correlational model for AtA for the old and oldest-old adults. Methods: This qualitative study comprised demographics and semistructured interviews. Complete information on 152 older adults aged between 75 years and 102 years (mean ¼ 83.76 years; standard deviation ¼ 6.458). Data was subjected to content analysis. The correlational model of indicators of AtA was analyzed using a multiple correspondence analysis. Results: “Occupation and achievement” was the most mentioned indicator of AtA by the old participants (17.7%), whereas “existential meaning and spirituality” was the most verbalized indicator of AtA for the oldest-old participants (16.9%). AtA was explained by a three-factor model for each age group. For the old participants, the largest factor “occupational and social focus” accounted for 33.6% of total variance, whereas for the oldest-old participants, “spirituality and health focus” represented 33.5% of total variance. Conclusion: The outcomes presented in this paper stressed the varied perspectives concerning AtA, contoured in two different models, and the need of considering these when designing and implementing programs in health care for the old and the oldest-old.

Predicting Successful Aging at One Hundred Years of Age

The present study is based upon a multidimensional model of successful aging. It aims to identify subgroups of centenarians sharing communalities in successful aging profiles, and determine the role of sociodemographic factors and psychological, social, and economic resources on successful aging.

Successful aging at 100 years: the relevance of subjectivity and psychological resources

Very old individuals seem to present an admirable capacity to overcome adversities and adapt to the challenges of advanced age. However, studies focusing successful pattern of centenarians found that they may easily fail to be categorized as successful agers when objective criteria are applied. The present study examines if centenarians can be considered successful agers. Following Rowe and Kahn's successful aging model, the primary goal was to clarify whether centenarians are able to be successful agers according to objective and subjective criteria of no major disease and disability, high cognitive and physical functioning and engagement with life. The second goal was to investigate whether socio-demographic factors, psychological, social, and economic resources are related to objective and subjective successful aging profiles.

Successful Aging with Illness

In twenty years almost one in four Canadians will be over the age of 65. How successfully these people age will influence their quality of life and contribute to their physical health. Illness and disease are frequent components of aging; however, ‘successful aging’ research normally excludes people with illness. Older people living with illness, even life threatening illness, often self-report a good quality of life and continue to experience psychological well-being and a significant engagement in social life. This dissertation uses a three manuscript approach to examine successful aging among people with illness. The first manuscript employed a scoping review to examine the models used in recent successful aging research, compiling the most frequently used constructs which included: engagement, optimism and/or positive attitude, resilience, spirituality and/or religiosity, self-efficacy and/or self-esteem, and gerotranscendence. The second manuscript utilized data gathered via interviews (online or in person) with people over the age of 65 years living with illness. The majority of these participants reported success in aging; only resilience was predictive in the binomial regression analysis. The third manuscript examined the role of social determinants of health on successful aging. The analysis revealed that disengagement from community-activities showed a significant association with higher self-reported successful aging. The best fitting model for predicting rate of successful aging with illness was a linear combination of participants’ ageism score and community activity score, while controlling for gender and age. When considered together, the results from these three manuscripts suggest that successful aging can be experienced by older adults aging with illness. And that, among these older adults, resilience, community interaction and ageism may all play a part in determining the extent to which aging is experienced as successful. Recommendations include the suggestion that we embrace the idea that people with illness can self-define as successful agers. Further, since some of the associated constructs (e.g. resilience) can be fostered, successful aging could be bolstered by education or programs to build skills along with the usual treatment modalities for the illnesses that co-exist.

Digital literacy matters. Increasing workforce productivity through blended English language programmes

Current workplace demands newer forms of literacies that go beyond the ability to decode print. These involve not only competence to operate digital tools, but also the ability to create, represent, and share meaning in different modes and formats; ability to interact, collaborate and communicate effectively using digital tools, and engage critically with technology for developing one’s knowledge, skills, and full participation in civic, economic, and personal matters. This essay examines the application of the ecology of resources (EoR) model for delivering language learning outcomes (in this case, English) through blended classroom environments that use contextually available resources. The author proposes the implementation of the EoR model in blended learning environments to create authentic and sustainable learning environments for skilling courses. Applying the EoR model to Indian skilling instruction contexts, the article discusses how English language and technology literacy can be delivered using contextually available resources through a blended classroom environment. This would facilitate not only acquisition of language and digital literacy outcomes, but also consequent content literacy gain to a certain extent. This would ensure satisfactory achievement of not only communication/language literacy and technological literacy, but also active social participation, lifelong learning, and learner autonomy.

Status of the Iowa Workforce and Economy, November 2016

Iowa Workforce Development's newsletter.

Status of the Iowa Workforce and Economy, December 2016

Iowa Workforce Development's newsletter.