Acceptability of physician associate interns in primary care: results from a service evaluation

Background Physician associates (PA) form part of the policy-driven response to increased primary care demand and a general practitioner (GP) recruitment and retention crisis. However, they are novel to the primary care workforce and have limitations, for example, they cannot prescribe. The novel 1 year Staffordshire PA Internship (SPAI) scheme, introduced in 2017, was established to support the integration of PAs into primary care. PA interns concurrently worked in primary and secondary care posts, with protected weekly primary care focussed education sessions. This evaluation established the acceptability of PA interns within primary care. Methods All ten PAs from the first two SPAI cohorts, the nine host practices (supervising GPs and practice managers) and host practice patients were invited to participate in the evaluation. A conceptual framework for implementing interventions in primary care informed data collection and analysis. Data were gathered at three time points over the internship from practices, through discussions with the supervising GP and/or practice manager, and from the PAs via discussion groups. To enrich discussion data, PA and practices were sent brief surveys requesting information on PA/practice characteristics and PA primary care roles. Patient acceptability data were collected by the host practices. Participation at every stage was optional. Results By evaluation end, eight PAs had completed the internship. Seven PAs and six practices provided data at every time point. Five practices provided patient acceptability data. Overall PA interns were acceptable to practices and patients, however ambiguity about the PA role and how best to communicate and operationalise PA roles was revealed. An expectation-preparedness gap resulted in PAs needing high levels of supervision early within the internship. SPAI facilitated closure of the expectation-preparedness gap and its funding arrangements made the high supervision requirements more acceptable to practices. Conclusions The test-of-concept SPAI successfully integrated new PAs into primary care. However, the identified challenges risk undermining PAs roles in primary care before they have attained their full potential. Nationally, workforce leaders should develop approaches to support new PAs into primary care, including commitments to longer-term, sustainable, cohesive and appropriately funded schemes, including structured and standardised education and supervision.

Implementation of lean practices facilitated by BIM functionalities in the construction phase: advances and opportunities

Over the past few decades, construction productivity has been at a standstill. Lean and Building Information Modelling (BIM) is attracting increasing interest in the construction industry as a way to increase construction productivity. This paper aims to contribute to the body of knowledge by identifying hitherto unexplored opportunities for the use of BIM functionalities as a support and as facilitators of the application of lean practices in the construction phase. A systematic literature review was adopted as the methodological approach in this research, and reported case studies related to the scope of this paper were searched. The results show that lean practices can be classified into four degrees of BIM support based on the level of current exploration. Just one lean practice (the last planner system) has been extensively explored, three have been reasonably explored, and five have just been preliminarily explored. Five practices have not been explored at all. This research summarises the already studied and the potential additional uses of BIM functionalities to support each lean practice, showing that lean practices supported by BIM functionalities are still underused and that further studies can explore additional ways to support these practices. This study holds great value for a broader practical application of lean practices, bringing faster and easier results with more extensive BIM support.

Exemplary leadership practices in early childhood education in preparing the golden generations for Indonesia

Purpose: This study aimed to investigate the ideal quality of inclusive early childhood education, an effective leadership style and five practices of exemplary leadership. Research methodology: This is a review article. The review process began with a search engine (Google Scholar) to search and review early childhood education and leadership articles. Results: The results suggest that it is important to hold quality inclusive early childhood educations since, in this level of education, six developmental areas are well stimulated. The key success of maintaining quality inclusive early childhood education is a collaboration among education parties (government, school, parents and community). A school needs a principal who can perform five exemplary leadership practices to help “Golden Indonesia 2045” become true. Limitations: First, the scope of articles reviewed is still very limited to the literature review in the Indonesian context. This and other limitations will be opportunities for further empirical studies about five practices of exemplary leadership in the Indonesian education area. Contribution: This study can be useful for the early childhood education level.

Health Professions Students’ Knowledge of and Attitude toward Complementary and Alternative Medicine

Respondents reported an overall positive attitude toward and interest in CAM. Ninety percent had heard of and three-quarters reported previous experience with CAM practices. Respondents alluded to personal experience but also to knowledge gained about CAM in classes and clinical assignments. Acupuncture, yoga, massage therapy, meditation, cupping, aromatherapy, and chiropractic care were the CAM practices most respondents had heard about; yoga, meditation, massage therapy, aromatherapy, and chiropractic care were the CAM practices most respondents reported personal experience with. The top five practices students planned on making part of their career were yoga, meditation, massage therapy, diet-based therapy, and music therapy. Graduating health professions students had a more positive attitude toward CAM than pre-health professions students. They also had a higher average score for their interest in learning about CAM practices. Three-quarters of respondents planned on making CAM part of their career.

Healthassist, Inc.: leading through a pandemic

Case study abstract The purpose of this case study is to illustrate how Dianne Savastano, founder and CEO of Healthassist, Inc., a US-based health-care advocacy firm, successfully led her clients and team through the COVID-19 pandemic of 2020. To gather the data for this case study, the authors interviewed the protagonists, the members of her team and two clients. The authors read Healthassist Newsletters and the firm’s documents; and in fact, they included one Newsletter and several documents in the Exhibits of the case study. The authors conducted a literature review for articles in newspapers and journals about the newly developing field of “health-care advocacy,” a field which Savastano helped to create. Findings of the case study The authors illustrate how Savastano, using the five practices of exemplary leadership by Kouzes and Posner, in The Leadership Challenge, led her team through the pandemic of 2020. This is a story of a woman leader, using traits such as warmth, empathy, analysis and decisiveness, keeps her small business afloat when so many other firms collapsed in 2020. Research The authors conducted seven interviews and literature searches on the topics of health-care advocacy; women leaders; leading through a crisis; and COVID-19. Practical implications The case study illustrates how a woman founder and CEO can lead her firm through a crisis. Value of the case study This is an example of how a woman leader managed through the 2020 pandemic. Subject code CSS 3: Entrepreneurship

Localizing ECRR: Alaska Wildlife Touts Five Practices

When we think of storytime, we think of sharing a love of books with children, having a good time, and modeling early literacy behaviors for caregivers. We share early literacy tips and demonstrate activities, but we also display early literacy posters on the walls of the storytime rooms.

Sugary drinks taxation: industry’s lobbying strategies, practices, and arguments in the Brazilian legislature

Objective: to assess the strategies, practices, and arguments used by the industry to lobby legislators against sugary drinks taxation in Brazil. Design: we performed a content analysis of arguments put forward by sugary drink and sugar industries against sugary drinks taxation, using the framework developed by the International Network for Food and Obesity/NCD Research, Monitoring and Action Support to assess corporate political activity of the food industry. Setting: two public hearings held in 2017 and 2018 in the Brazilian Legislature. Participants: representatives from two prominent industry associations – one representing Big Soda and the other representing the main sugar, ethanol, and bioelectricity producers. Results: the ‘Information and messaging’ and ‘Policy substitution’ strategies were identified. Five practices were identified in the ‘Information and messaging’ strategy (four described in the original framework and an additional practice, ‘Stress the environmental importance of the industry’). Mechanisms not included in the original framework identified were ‘Stress the reduction of CO2 emissions promoted by the industry’; ‘Question the effectiveness of regulation’; ‘Suggest public-private partnerships’; ‘Shift the blame away from the product’; and ‘Question sugary drinks taxation as a public health recommendation’. No new practices or mechanisms to the original framework emerged in the ‘Policy substitution’ strategy. Conclusions: the strategies and practices are used collectively and complement each other. Arguments hereby identified are in line with those reported in other countries under different contexts and using different methodologies. Future research should address whether and under what conditions lobbying from this industry sector is effective in the Brazilian Legislature.

Promoting Discourse: Fractions on Number Lines

Examine fourth graders’ thinking about the unit, partitioning, order, and equivalence on the number line and consider ways to orchestrate mathematical discussions through the Five Practices.

A Qualitative Case Study of Exemplary Principal Leadership in the United States Virgin Islands: An Application of Kouzes and Posner’s Five Practices of Exemplary Leadership

Effective leadership is foundational to the success of all organizations. This qualitative case study aimed to explore exemplary principal leadership in the United States Virgin Islands (USVI). The study was based on Kouzes and Posner’s model of exemplary leadership. Interviews were held with school principals, teachers, and nonteaching staff members in three schools in USVI. The principal leaders in the USVI were found to exhibit the five practices of exemplary leadership as postulated by Kouzes and Posner. The study recommends that the Education department in USVI should develop guidelines and professional development opportunities to enhance exemplary leadership practices among principals.