Sources of Major Technological Breakthroughs: Purposeful Systems with Purposeful Elements Having a Common Purpose of Global Leadership

BackgroundThere is an emerging debate that general practice in its current format is out-dated and there is a requirement to move to a federated model of provision where groups of Practices come together. The emergence of federations has developed over the past 5 years but the factors that influence how federations develop and the impact of this new model is an under researched area.AimThe study explored the rationale around why a group of independent GP practices opted to pursue an alternative business venture and the benefits that this strategy offered.MethodA single organisational case study of a federation in the North of England was conducted between 2011–2016. Mixed methods data collection included individual and group semi-structured interviews and quantitative surveys.ResultsFederations promote collaborative working, relying on strategic coherence of multiple individual GP practices through a shared vision and common purpose. Findings revealed many complexities in implementing a common strategy across multiple independent businesses. The ability of the federation to gain legitimacy was two dimensional – externally and internally. The venture had mixed successes, but their approach to quality improvement proved innovative and demonstrated outcomes on a population basis. The study identified significant pressures that practices were experiencing and the need to seek alternative ways of working but there was no shared vision or inclination to relinquish individual practice autonomy.ConclusionOrganisational development support is critical to reform General Practice. Whether central funding through the GP Five Year Forward View will achieve the scale of change required is yet to be evidenced.

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The Asian Development Bank and the Global Financial Crisis: Asian Global Leadership, 2008-2012

SSRN Electronic Journal ◽

10.2139/ssrn.2226805 ◽

2013 ◽

Author(s):

Paul Cammack

Keyword(s):

Financial Crisis ◽

Global Financial Crisis ◽

Asian Development Bank ◽

Global Leadership ◽

Development Bank ◽

Asian Development ◽

The Global Financial Crisis

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Systemic Hybridity in the Mediation of the American Presidential Campaign

10.1093/oso/9780190696726.003.0008 ◽

2017 ◽

Author(s):

Andrew Chadwick

Keyword(s):

Data Gathering ◽

Real Space ◽

Presidential Campaign ◽

Newspaper Coverage ◽

The Internet ◽

Major Theme ◽

Power Resources ◽

Electoral Outcomes ◽

Media System ◽

Common Purpose

Chapter 7 continues the revisionist approach of chapter 6, but paints the 2008 U.S. presidential campaign on a broader canvas. Through a detailed analysis of key episodes in the mediation of the campaign, the chapter shows how the real-space spectacles of candidate appearances continue to generate the important television, radio, and newspaper coverage that remains so crucial for projecting the power of a candidate and conveying enthusiasm, movement, authenticity, and common purpose to both activists and nonactivists alike. The chapter discusses how these television-fuelled spectacles now also integrate with newer media logics of data-gathering, online fundraising, tracking, monitoring, and managed volunteerism. A major theme running through this chapter is the growing systemic integration of the internet and television in presidential campaigns. It also shows how the hybrid media system can shape electoral outcomes by providing new power resources for campaigns that can create and master the system's modalities.

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P1583UTILITY OF THE GLOBAL LEADERSHIP INITIATIVE ON MALNUTRITION CRITERIA FOR THE DETECTION OF MALNUTRITION AND DECLINE IN PHYSICAL FUNCTION AND ADL IN JAPANESE AMBULATORY HEMODIALYSIS PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1583 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Haruka Ito ◽

Shohei Yamamoto ◽

Manae Harada ◽

Takaaki Watanabe ◽

Yuta Suzuki ◽

...

Keyword(s):

Physical Function ◽

Phase Angle ◽

Handgrip Strength ◽

Hemodialysis Patients ◽

Global Leadership ◽

Analysis Of Covariance ◽

Nutritional Risk ◽

Calf Circumference ◽

Risk Of Death ◽

Cumulative Score

Abstract Background and Aims In patients who undergo hemodialysis (HD), malnutrition is a frequent complication associated with higher risk of death, extended hospital stay, physical limitation, and decline of activities of daily living (ADL). Therefore, proper assessment for malnutrition in this population is important for effective disease management. The Global Leadership Initiative on Malnutrition (GLIM) released new criteria for diagnosing and grading malnutrition. Nevertheless, only very few studies have investigated malnutrition prevalence on the basis of the GLIM criteria in hemodialysis patients. Hence, the usefulness of the GLIM criteria’s application in hemodialysis patients remains unclear. The aims of this study were (1) to examine whether malnutrition diagnosed on the basis of the GLIM criteria will produce equivalent results with that diagnosed with the use of existing nutritional indicators and (2) to evaluate the association between the GLIM criteria and decline of physical function and ADL in Japanese patients on HD. Method This cross-sectional study included a total of 185 outpatients who undergo HD three times a week. We measured the existing nutritional indicators (GNRI, MNA-SF, phase angle, mid-arm muscle circumference, and calf circumference), physical function (Fried Scale, handgrip strength, usual gait speed, Short Physical Performance Battery, and physical activity), and ADL status (cumulative score of Barthel Index and instrumental ADL). On the basis of the GLIM criteria, the patients were classified into two groups (no malnutrition and malnutrition). In addition, in case of nutritional risk, nutritional assessment was performed by evaluation of the phenotypic (unintentional weight loss, low BMI, and/or reduced muscle mass) and etiologic (reduced intake or assimilation and/or inﬂammatory response) factors. Malnutrition was diagnosed if a patient has one or more of these items. The analysis of covariance (ANCOVA) was performed to examine the association between the GLIM criteria and existing nutritional indicators, physical function, and ADL status. Results Malnutrition was diagnosed in 41.1% of the participants based on the GLIM criteria. In contrast, on the basis of the existing nutritional indicators (GNRI, MNA-SF, phase angle, mid-arm muscle circumference, and calf circumference), malnutrition was diagnosed in 22.2%, 58.3%, 48.6%, 57.9%, and 54.6%, respectively. The ANCOVA results, adjusted for the patient’s characteristics, revealed that the malnutrition group had significantly lower score than the non-malnutrition group in the existing nutritional indicators (all P < 0.001) (Figure). Furthermore, the malnutrition group had significantly higher Fried Scale scores, lower handgrip strength results, and lower ADL status than the non-malnutrition group, even after potential confounder adjustment (all P < 0.05). Conclusion The GLIM criteria could be one of the useful tools for screening the risk of malnutrition, frailty, lower handgrip strength, and lower ADL status in patients who undergo HD.

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