993 resultados para Referral practices


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This chapter examines encounters between international institutions that frame their objectives through a global policy language, and people whose lives are the focus for change heralded by these institutions. It explores how a global policy language, which seeks consensus and equality, can be at odds with local understandings, conflict and intentions.

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Aim: To examine the causes of prescribing and monitoring errors in English general practices and provide recommendations for how they may be overcome. Design: Qualitative interview and focus group study with purposive sampling and thematic analysis informed by Reason’s accident causation model. Participants: General practice staff participated in a combination of semi-structured interviews (n=34) and six focus groups (n=46). Setting: Fifteen general practices across three primary care trusts in England. Results: We identified seven categories of high-level error-producing conditions: the prescriber, the patient, the team, the task, the working environment, the computer system, and the primary-secondary care interface. Each of these was further broken down to reveal various error-producing conditions. The prescriber’s therapeutic training, drug knowledge and experience, knowledge of the patient, perception of risk, and their physical and emotional health, were all identified as possible causes. The patient’s characteristics and the complexity of the individual clinical case were also found to have contributed to prescribing errors. The importance of feeling comfortable within the practice team was highlighted, as well as the safety of general practitioners (GPs) in signing prescriptions generated by nurses when they had not seen the patient for themselves. The working environment with its high workload, time pressures, and interruptions, and computer related issues associated with mis-selecting drugs from electronic pick-lists and overriding alerts, were all highlighted as possible causes of prescribing errors and often interconnected. Conclusion: This study has highlighted the complex underlying causes of prescribing and monitoring errors in general practices, several of which are amenable to intervention.

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Pesticide use among smallholder coffee producers in Jamaica has been associated with significant occupational health effects. Research on pesticide handling practices, however, has been scarce, especially in eastern Jamaica. This explorative study aims at filling this gap and provides a first basis to develop effective interventions to promote a safer pesticide use. A random sample of 81 coffee farmers was surveyed. The majority of farmers reported to suffer from at least one health symptom associated with pesticide handling, but safety practices were scarcely adopted. There was also the risk that other household members and the wider local community are exposed to pesticides. The lack of training on pesticide management, the role of health services and the cost for protective equipment seemed to be the most significant factors that influence current pesticide handling practices in eastern Jamaica. Further research is recommended to develop a systemic understanding of farmer’s behaviour to provide a more solid basis for the development of future intervention programmes.

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This article presents an ongoing study of educational policy enactment in Singapore lower primary English classrooms. It explores how teachers react to and interpret educational reforms in their classroom practices against a backdrop ofvtraditional cultural values. Using a prescribed coding scheme, the article presents the instructional organisational patterns and participation structures of the lessons.Through a systematic analysis of the enacted curricula, the paper examines classroom practices as well as teaching and learning activities in Primary 1 (7–8 years) and Primary 2 (8–9 years) English lessons in Singapore. The results suggest that there are cultural clashes between major educational reforms which emphasise independent/critical thinking and ‘Asian values’ which promote respect for authority and conformity.

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An updated empirical approach is proposed for specifying coexistence requirements for genetically modified (GM) maize (Zea mays L.) production to ensure compliance with the 0.9% labeling threshold for food and feed in the European Union. The model improves on a previously published (Gustafson et al., 2006) empirical model by adding recent data sources to supplement the original database and including the following additional cases: (i) more than one GM maize source field adjacent to the conventional or organic field, (ii) the possibility of so-called “stacked” varieties with more than one GM trait, and (iii) lower pollen shed in the non-GM receptor field. These additional factors lead to the possibility for somewhat wider combinations of isolation distance and border rows than required in the original version of the empirical model. For instance, in the very conservative case of a 1-ha square non-GM maize field surrounded on all four sides by homozygous GM maize with 12 m isolation (the effective isolation distance for a single GM field), non-GM border rows of 12 m are required to be 95% confident of gene flow less than 0.9% in the non-GM field (with adventitious presence of 0.3%). Stacked traits of higher GM mass fraction and receptor fields of lower pollen shed would require a greater number of border rows to comply with the 0.9% threshold, and an updated extension to the model is provided to quantify these effects.

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This paper reports on an exploratory study of segmentation practices of organisations with a social media presence. It investigates whether traditional segmentation approaches are still relevant in this new socio-technical environment and identifies emerging practices. The study found that social media are particularly promising in terms of targeting influencers, enabling the cost-effective delivery of personalised messages and engaging with numerous customer segments in a differentiated way. However, some problems previously identified in the segmentation literature still occur in the social media environment, such as the technical challenge of integrating databases, the preference for pragmatic rather than complex solutions and the lack of relevant analytical skills. Overall, a gap has emerged between marketing theory and practice. While segmentation is far from obsolete in the age of the social customer, it needs to adapt to reflect the characteristics of the new media.

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This article explores the reasons that affect the decisions of managers of firms to adopt management practices in order to green their supply chain management. Under the context of environmental policy, the relationship between policy instruments (‘command and control’, market-based, and self-regulated) and the decisions of managers to adopt green supply chain management (G-SCM) practices is examined. The results show that in some cases the environmental legislation, market-based instruments and self-regulated incentives could play a critical role in the decisions of managers to adopt some specific G-SCM practices, while in other cases environmental policy instruments have not seemed to affect the decisions of managers regarding some other G-SCM practices.

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Recent studies have indicated that research practices in psychology may be susceptible to factors that increase false-positive rates, raising concerns about the possible prevalence of false-positive findings. The present article discusses several practices that may run counter to the inflation of false-positive rates. Taking these practices into account would lead to a more balanced view on the false-positive issue. Specifically, we argue that an inflation of false-positive rates would diminish, sometimes to a substantial degree, when researchers (a) have explicit a priori theoretical hypotheses, (b) include multiple replication studies in a single paper, and (c) collect additional data based on observed results. We report findings from simulation studies and statistical evidence that support these arguments. Being aware of these preventive factors allows researchers not to overestimate the pervasiveness of false-positives in psychology and to gauge the susceptibility of a paper to possible false-positives in practical and fair ways.

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This thesis is concerned with development of improved management practices in indigenous chicken production systems in a research process that includes participatory approaches with smallholder farmers and other stakeholders in Kenya. The research process involved a wide range of activities that included on-station experiments, field surveys, stakeholder consultations in workshops, seminars and visits, and on-farm farmer participatory research to evaluate the effect of some improved management interventions on production performance of indigenous chickens. The participatory research was greatly informed from collective experiences and lessons of the previous activities. The on-station studies focused on hatching, growth and nutritional characteristics of the indigenous chickens. Four research publications from these studies are included in this thesis. Quantitative statistical analyses were applied and they involved use of growth models estimated with non-linear regressions for the growth characteristics, chi-square determinations to investigate differences among different reciprocal crosses of indigenous chickens and general linear models and covariance determination for the nutrition study. The on-station studies brought greater understanding of performance and production characteristics of indigenous chickens and the influence of management practices on these characteristics. The field surveys and stakeholder consultations helped in understanding the overarching issues affecting the productivity of the indigenous chickens systems and their place in the livelihoods of smallholder farmers. These activities created strong networking opportunities with stakeholders from a wide spectrum. The on-farm farmer participatory research involved selection of 200 farmers in five regions followed by training and introduction of interventions on improved management practices which included housing, vaccination, deworming and feed supplementation. Implementation and monitoring was mainly done by individual farmers continuously for close to one and half years. Six quarterly visits to the farms were made by the research team to monitor and provide support for on-going project activities. The data collected has been analysed for 5 consecutive 3-monthly periods. Descriptive and inferential statistics were applied to analyse the data collected involving treatment applications, production characteristics and flock demography characteristics. Out of the 200 farmers initially selected, 173 had records on treatment applications and flock demography characteristics while 127 farmers had records on production characteristics. The demographic analysis with a dissimilarity index of flock size produced 7 distinct farm groups from among the 173 farms. Two of these farm groups were represented in similar numbers in each of the five regions. The research process also involved a number of dissemination and communication strategies that have brought the process and project outcomes into the domain of accessibility by wider readership locally and globally. These include workshops, seminars, field visits and consultations, local and international conferences, electronic conferencing, publications and personal communication via emailing and conventional posting. A number of research and development proposals were also developed based on the knowledge and experiences gained from the research process. The thesis captures the research process activities and outcomes in 8 chapters which include in ascending order – introduction, theoretical concepts underpinning FPR, research methodology and process, on-station research output, FPR descriptive statistical analysis, FPR inferential statistical analysis on production characteristics, FPR demographic analysis and conclusions. Various research approaches both quantitative and qualitative have been applied in the research process indicating the possibilities and importance of combining both systems for greater understanding of issues being studied. In our case, participatory studies of the improved management of indigenous chickens indicates their potential importance as livelihood assets for poor people.