A Framework to Support the Progressive Implementation of Integrated Team-based Care for the Management of Copd: a Collective Case Study

Background: In Canada, there is widespread agreement about the need for integrated models of team-based care. However, there is less agreement on how to support the scale-up and spread of successful models; there is limited empirical evidence to support this process in chronic disease management. We studied the supporting, and mitigating factors required to successfully implement and scale-up an integrated model of team-based care in primary care.Methods: We conducted a collective case study using multiple methods of data collection including interviews, document analysis, living documents, and a focus group. Our study explored a team-based model of care for chronic obstructive pulmonary disease (COPD) known as Best Care COPD (BCC) that has been implemented in primary care settings across Southwestern Ontario. BCC is a quality improvement initiative that was developed to enhance the quality of care for patients with COPD. Participants included healthcare providers involved in the delivery of the BCC program. Results: We identified several mechanisms influencing the scale-up and spread of BCC and categorized them as Foundational (e.g., evidence-based program, readiness to implement, peer-led implementation team), Transformative (adaptive process, empowerment and collaboration, embedded evaluation), and Enabling Mechanisms (provider training, administrative support, role clarity, patient outcomes). Based on these results, we developed a framework to inform the progressive implementation of integrated, team-based care for chronic disease management. Our framework builds off our empirical work and is framed by local contextual factors. Conclusions: This study explores the implementation and spread of integrated team-based care in a primary care setting. Despite the study’s focus on COPD, we believe the findings can be applied in other chronic disease contexts. We provide a framework to support the progressive implementation of integrated team-based care for chronic disease management.

Religion of Monarchs

Chapter 6 examines the socio-historical practicalities of a monarch participating in the Tantric sphere. The twelfth-century chronicle Rājataraṅgiṇī offers a useful guide. Its narratives demonstrate how practitioners who have shed caste identity through initiation still retain it in the social world. It focuses largely on monarchs, disapproving of their participation in Tantric rites. The chapter discusses literary evidence that demonstrates the widespread agreement on what qualifies as prohibited and the penalties for transgressions. It discusses evidence of royal patronage before turning to specific rites related to the king. These rites include marking the body and food of the king with preventative ritual objects and mantras and large-scale rituals that protect everything under the king’s purview. The chapter contrasts these public or semi-public rituals with the private rituals to maintain the monarch’s health.

A REVIEW OF PRACTICAL METHODS FOR REDUCING UNDERWATER NOISE POLLUTION FROM LARGE COMMERCIAL VESSELS

Underwater noise pollution from shipping is of considerable concern for marine life, particularly due to the potential for raised ambient noise levels in the 10-300Hz frequency range to mask biological sounds. There is widespread agreement that reducing shipping noise is both necessary and feasible, and the International Maritime Organization is actively working on the issue. The main source of noise is associated with propeller cavitation, and measures to improve propeller design and wake flow may also reduce noise. It is likely that the noisiest 10% of ships generate the majority of the noise impact, and it may be possible to quieten these vessels through measures that also improve efficiency. However, an extensive data set of full scale noise measurements of ships under operating conditions is required to fully understand how different factors relate to noise output and how noise reduction can be achieved alongside energy saving measures.

Managing innovation on the public frontline: three approaches to innovation leadership

Purpose For decades, there has been a call for the public sector to be more innovative, and there is widespread agreement that managers play a crucial role in meeting this goal. Most studies of innovation management focus on top-level managers, despite the fact that most innovation activities take place on the frontlines, deeply embedded in professional practice. Meanwhile, micro-level studies of innovation tend to focus on the agency of employees, which leaves a knowledge gap regarding the mobilizing role of frontline managers. This is unfortunate because frontline managers are in a unique position to advance the state of the art of their professions, in scaling public innovation and in implementing public reform.Design/methodology/approach To explore how frontline managers approach innovation, a case study has been constructed based on in-depth interviews with 20 purposely selected frontline managers, all working within the Danish public childcare sector.Findings The article explores how frontline managers perceive their role in public innovation and finds three distinct approaches to innovation leadership: a responsive, a strategic and a facilitating approach.Originality/value This paper contributes to the research on public management by applying existing research on leadership styles in order to discuss the implications of how frontline managers perceive their role in relation to public innovation.

Economic challenges and success in the post-COVID era: A CAGE Policy Report

In 2008 there was an expectation of major reform to social and economic structures following the financial crisis. The European Union (EU) referendum of 2016, and the UK’s subsequent exit from the EU in 2020, was also signalled as a turning point that would bring about epochal change. Now, in the waning of the coronavirus pandemic, we are experiencing a similar rhetoric. There is widespread agreement that the pandemic will usher in big changes for the economy and society, with the potential for major policy reform. But what will be the long-term impacts of the pandemic on the UK economy? Is the right response a “new settlement” or is some alternative approach likely to be more beneficial? This report puts forward a new perspective on the pandemic-related changes that could be ahead. The central theme is assessing the viability of epochal reform in policymaking. There seems to be a relentless desire for making big changes; however, there is arguably not enough recognition of how current settings and history can hold back these efforts. Foreword by: Dame Frances Cairncross, CBE, FRSE.

Student teachers’ knowledge integration across conceptual borders: the role of study approaches, learning strategies, beliefs, and motivation

There is widespread agreement that student teachers need to construct an integrated knowledge base across multiple domains. This study examined the contributions of intraindividual factors of self-regulated learning to explaining student teachers’ (a) integration of knowledge across topics and domains (i.e., integrative learning) and (b) disjointed processing of potentially domain-specific learning content (i.e., separative learning). The factors considered were study approaches; cognitive, metacognitive, and resource-related learning strategy use; epistemological and pedagogical beliefs; and career choice motivation. The study applied a cross-sectional survey design and examined separative and integrative learning in N = 103 student teachers by way of multiple regression analyses with backward eliminations. A key finding is that deep and strategic study approaches and certain cognitive learning strategies contributed significantly to explaining integrative learning in student teachers. Epistemological and pedagogical beliefs were not able to predict integrative learning. Regarding separative learning, the study identified the surface study approach, specific epistemological and pedagogical beliefs, and the “usefulness” motive for career choice as positive predictors and critical thinking as a negative predictor. The study demonstrates differences in how integrative and separative learning are shaped by distinct intraindividual factors. Implications are discussed with regard to student teachers’ self-regulated learning and pre-service teacher education.

Exploring concepts of compassion in care home settings: a scoping review protocol

IntroductionThere is widespread agreement that medical care without compassion cannot be patient-centred, but patients still routinely cite that they feel a lack of compassion in the care environment. There is a dearth of research on how compassion is experienced in a non-hospital setting such as a care home, not just by residents but by staff and other key stakeholders. This scoping review aims to determine the body of existing, published research that explicitly refers to compassion or empathy in the context of care homes.Methods and analysisThis scoping review will follow the methodology described by Arksey and O’Malley and the PRISMAextension for scoping reviews guideline to adhere to an established methodological framework. Relevant publications will be searched on the EMBASE, MEDLINE, PubMed, CINAHL, EBM Reviews and PsycInfo databases. Peer-reviewed literature focusing on experiences of compassion or empathy in care home settings from the perspective of either staff, residents (or clients), family members or their combined perspectives will be included. We will focus on literature published from 2000 up to 1 November 2021, in English, Spanish, Portuguese Finnish and Estonian. The review process will consist of three stages: a title review to identify articles of interest, this will be followed by an abstract review and finally, a full-text review. These three stages will be conducted by two reviewers. Data will be extracted, collated and charted and a narrative synthesis of the results will be presented.Ethics and disseminationEthical approval is not required for this scoping review. This study supports the first part of a larger programme to understand the importance of technologies in care homes. The scoping review will examine data from publicly available documentation, reports and published papers. Dissemination will be achieved through engagement with stakeholder communities, and publishing results. Our team will include representatives from the different communities involved.

What makes a journal questionable? An analysis using China’s early-warning list

There is widespread agreement that questionable journals pose a threat to the integrity of scholarly publishing and the credibility of academic research. However, there is currently no agreed upon definition of what constitutes a questionable journal. The characteristics of questionable journals have not been delineated, standardized, nor broadly accepted. A series of policy initiatives by the central Chinese government has culminated in the now Early Warning List of International Journals, released by the National Science Library of the Chinese Academy of Sciences – 65 journals that Chinese scholars should be wary of publishing in. Taking this List as a litmus test, we analyze the characteristics of each journal focusing on a definitive set of factors that may see a journal included on the List. We not only include the factors applied by the publisher of the List, such as the article processing charges, the retraction rate etc., but also investigate several other factors. Most of the factors are found to influence the List, while some are not. In fact, many of the journals on the List are highly ranked by impact factors. Our study aims to provide empirical information supporting global attempts to mitigate the pervading phenomenon of questionable journals.

The multi-dimensional nature of vocal learning

How learning affects vocalizations is a key question in the study of animal communication and human language. Parallel efforts in birds and humans have taught us much about how vocal learning works on a behavioural and neurobiological level. Subsequent efforts have revealed a variety of cases among mammals in which experience also has a major influence on vocal repertoires. Janik and Slater ( Anim. Behav. 60 , 1–11. ( doi:10.1006/anbe.2000.1410 )) introduced the distinction between vocal usage and production learning, providing a general framework to categorize how different types of learning influence vocalizations. This idea was built on by Petkov and Jarvis ( Front. Evol. Neurosci. 4 , 12. ( doi:10.3389/fnevo.2012.00012 )) to emphasize a more continuous distribution between limited and more complex vocal production learners. Yet, with more studies providing empirical data, the limits of the initial frameworks become apparent. We build on these frameworks to refine the categorization of vocal learning in light of advances made since their publication and widespread agreement that vocal learning is not a binary trait. We propose a novel classification system, based on the definitions by Janik and Slater, that deconstructs vocal learning into key dimensions to aid in understanding the mechanisms involved in this complex behaviour. We consider how vocalizations can change without learning, and a usage learning framework that considers context specificity and timing. We identify dimensions of vocal production learning, including the copying of auditory models (convergence/divergence on model sounds, accuracy of copying), the degree of change (type and breadth of learning) and timing (when learning takes place, the length of time it takes and how long it is retained). We consider grey areas of classification and current mechanistic understanding of these behaviours. Our framework identifies research needs and will help to inform neurobiological and evolutionary studies endeavouring to uncover the multi-dimensional nature of vocal learning. This article is part of the theme issue ‘Vocal learning in animals and humans’.

The Text of Eph 5.22 and the Start of the Ephesian Household Code

The widespread disagreement about where the Ephesian household code begins is largely based on an equally widespread agreement that the original text of Eph 5.22 has no verb. This article addresses the former by challenging the latter. Treating the textual problem as a choice between three rather than two readings means that ὑποτασσέσθωσαν emerges as the reading that is best attested, the more difficult, and the one that best explains the others. The result is a smooth flow throughout this section of Ephesians.