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Purpose The purpose of this paper is to provide insight into the capital budgeting decision-making of Canadian and Mexican entrepreneurs in small businesses in the food sector. The objective is to understand the capital budgeting decisions through the lens of bounded rationality and how these decisions are affected by different (national) contexts. Design/methodology/approach This is a comparative study in which the use of constructivist grounded theory allowed deep conversations about capital budgeting decisions. Data was collected from forty semi-structured interviews with entrepreneurs/managers in two regions, Mexico and Canada. Findings Insights from this study suggest that entrepreneurs’ capital budgeting decisions are not only taken under conditions of bounded rationality but also suggest a prominent role of context in how bounded rationality is applied differently towards investment decisions. Research limitations/implications While the findings cannot simply be generalized, exploring how capital budgeting decisions are made differently across two regional contexts adds to the understanding of the nexus of context, bounded rationality and capital budgeting decision-making. Practical implications Using a bounded rationality lens, this study contrasts and explains similarities and differences in the entrepreneur’s capital budgeting decision-making within small businesses. The insights add to the body of knowledge and help entrepreneurs to reflect on their approach to decision-making. Originality/value The paper uses a less commonly applied approach to understand two under-researched regional contexts. We use constructivist grounded theory to explore entrepreneurs’ capital budgeting decision-making in small businesses in two regions, Canada and Mexico. The comparative approach and the findings add to the understanding of decision-making, highlight the prominent role of context and also challenge some insights from previous research.

Widespread, and sometimes inappropriate use of psychotropics in adults with intellectual disability has been an international concern. These medicines have been used to treat mental health conditions, but also, controversially, some types of behaviours not necessarily associated with the diagnosis or in the absence of a relevant diagnosis. Results from the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA) study of older adults with intellectual disability in Ireland revealed that 60% were taking psychotropics in 2010. In the intervening decade changes in regulations, policy, and increased decongregation of people with intellectual disability have taken place likely influencing the use of psychotropics. The HSE National Clinical Programme for People with Disability (NCPDD) established in the 2020 has medicines optimisation as a key priority. Existing multi-wave data from the IDS-TILDA study and the HSE national prescribing database offers an opportunity to better understand psychotropic use and prescribing patterns. This is a novel collaboration on lived experience, research, practice and policy. The aim of this research is to examine the quality and trends of psychotropic use of older adults with intellectual disability over a ten-year period in Ireland to evaluate the effects of and to inform both practice and policy to optimise medicines use and health outcomes. Health and medication data from ten years (four waves) of the IDS-TILDA study and corresponding medicines data from the HSE-PCRS prescribing database are available. Descriptive and longitudinal analysis will examine association between long-term psychotropic use, changes in trends of use, and the impact of decongregation on medicines use. This research will inform the development of national guidance on medicines optimisation for older people with intellectual disability and has the potential to change prescribing practices and improve health and wellbeing for older people with intellectual disability.

Healthcare worldwide faces severe quality and cost issues, and the search for sustainability in healthcare establishes a grand challenge. Public interest is growing in a systemic re-conceptualising of healthcare, from primarily a consumerist problem of individual need for treatment to a need for communities themselves to become more effective in systemic prevention, coping and caring. In community led approaches, scarce resources are moved away from ever-increasing consumerist services to empower, develop and enable communities to plan their own health and community improvements in mutually interdependent patterns of care often seen as ‘co-production’. This approach is exemplified by the innovative NUKA system of community led healthcare which originated in Alaska and which was trialled in Scotland in 2012, where it did not achieve similar acclaim as in the United States. In the Scottish NUKA trial opposition from professionals meant the trial was ended early. Our research found that omitting to account for the strong professional identity of GPs and other practice staff was instrumental in the failure of the trial. Beyond deficiencies inadequately considering professional identities, the trial also failed to engage the community and its patients as owners and architects of the system. We argue that the root cause of these problems was a more general critical systemic failure to manage participatory boundaries and associated identities. Community Operational Research practitioners have developed relevant theories, methodologies and methods to address issues of participation and identity, so could make a significant contribution to opening up new solutions for community led healthcare.

This paper offers an alternative paradigm to healthcare, and its delivery, by introducing the concepts of mutuality and empowerment into the existing NHS model of a public health system. In this paper, we will: revisit what is meant by mutuality; advance the meaning of the ‘public interest’ in this context; explore empowerment and community empowerment and their relationship to health; and introduce leading for the public good, which links these concepts and terms together via a dual development approach. It is suggested that this dual development approach will enable policy makers, practitioners in the NHS, and citizens to explore and evolve ways of leading and managing a mutual NHS, with public interest fora becoming the engines that will lead the development of mutuality. Our approach has not been taken from an observation of practice as such; rather, we suggest it as something to pursue as a consequence of theoretical reasoning applied to observations of practice in terms of policy ideas and outcomes of varied healthcare models that suggest inadequacies with existing approaches. It is hoped that this analysis will help researchers and practitioners alike to appreciate further the important concept of mutuality, and to suggest the importance of empowerment and leadership into the existing public health system paradigm.

Work is good for both physical and mental health, and access to work is a basic human right. People with mental health conditions want to work and with the right support can work but are often excluded from the workplace. We explored factors influencing individual's perceptions of their readiness for employment. Participants' narratives focused particularly on personal causation and it's inter-reactions with other aspects of volition, habituation and the environment and highlight a number of key areas, which are discussed in relation to service provision. Sheltered workshops offer support and some structure and routine but may limit an individual's readiness for employment. Services should be evidence based and focused on real work opportunities which fit with individual's interests and values. Occupational therapy theory offers a unique and valuable perspective in understanding perceptions of readiness for employment and occupational therapists offer valid and useful assessments and interventions for vocational rehabilitation.

Driving home the other day I noticed Suffolk ewes and their bedraggled lambs in the fields around Penrith, rather like fleecy islands amongst the large portions of the Irish Sea which currently fill up the rest of the low lying fields.

The mental health and wellbeing of personnel is a major concern for police occupational health departments. This article explains the work of a UK police force in educating officers about the risks of burnout and Post Traumatic Stress Disorder (PTSD). Key elements of that work include the Trauma Risk Management (TRiM) tool (developed in the British Army) to assess the risk of PTSD and the use of Visual-Kinesthetic Disassociation (Rewind) therapy for officers who have been identified as badly affected by traumatic work experiences. The force provides a series of workshops on burnout for officers in order to support their mental health and wellbeing. These workshops utilize an innovative multimedia virtual community educational tool (Stilwell) developed by the local university to explore burnout, the use of TRiM, and Rewind. This article explains the use of these techniques and presents evaluative research data showing a positive response to this approach from officers.

Research purpose: Vocational rehabilitation (VR) has been the focus of recent UK government policy, which outlines objectives to support individuals with mental illness into work. To provide such support, individual placement and support (IPS) as one approach, is frequently referred to. This has ignited both discussion and research within the occupational therapy (OT) profession to re-examine its contribution to VR and consider IPS as part of its practice. Aim: To explore occupational therapists’ (OTs) perceptions about their role within mental health (MH) VR and IPS. Method: Semi-structured interviews were used to generate data in this qualitative study. The interview transcripts were subject to thematic framework analysis. Findings: The findings revealed similarities and compatibility with OT and IPS. Participants acknowledged the value of IPS for clients who wish to obtain paid employment but also recognized the value of all worker roles which is in keeping with the professions values. Conclusion: The findings are congruent with discursive literature regarding OT and VR. Consideration given by OTs to the uniqueness and complexities of work as an occupation reinforces their distinct contribution to VR and could extend to IPS. Further research is needed to verify and extend this study's findings.

As various agencies increasingly advocate interprofessional care (IPC), it is paramount that the educational implications of this approach are considered. Interprofessional learning (IPL) is necessary for IPC and this paper argues that an emerging educational model, narrative-based virtual communities (VCs), meets this goal. We therefore argue for the fusion of narrative pedagogy with the VC approach to further the IPL agenda. Using stories to teach is not new. Technological innovations now make the possibility of using narrative, a way to enable students to experience greater reality in complex situations. Recently, two multimedia VCs have been developed. Here, we review the use of "The Neighborhood" and "Stilwell", as IPL tools. Early evaluation of these communities has been very positive and they offer a unique and innovative approach to IPL in ways that immerse learners from many professions into the context of the lives of individuals requiring health and social care, and the people who provide that service. Thus, it is possible to more fully realize and teach about collaboration and partnerships among professionals and patients.

Child sexual abuse is a highly emotive subject and nurses have a key role to play in caring for survivors. Educating students about this role is difficult because a conventional classroom approach does not prepare students adequately or give them sufficient insight into the experiences of victims. The Stilwell virtual simulation model is a radical new approach which aims to assist learning by immersing students in a realistic multimedia simulation of a typical community. This model allows insightful learning about difficult areas such as child sexual abuse. Its use and contribution to learning in this area are discussed.

Narrative pedagogy has been developed over the last decade in nursing as a means of complementing a conventional content and competency driven pedagogy. It focuses attention on the human experience of health care by deriving shared meanings from interpretation of stories. This allows students to explore the different perspectives of those involved. The emotional experiences of participants can be understood, conventional wisdom challenged and new knowledge emerge as students work together to construct their learning. Individual stories are embedded within the narrative and teachers have successfully used literature and film as narratives to help them explore the meaning of health care with students. Modern technology has opened up a new range of electronic narratives such as virtual simulation. These are considered and rejected as devices for a health care narrative due to their dehumanized and unrealistic nature. However it is argued that a multimedia online simulation of a typical neighbourhood can achieve the goal of providing a suitable narrative. Human actors replace avatars and real world settings replace gaming environments as the stories of people in this community are related and used to support narrative pedagogy. An example of such a narrative developed jointly in the UK and Canada is discussed.

Aim. This paper presents the results of a review of literature relating to knowledge transfer and exchange in healthcare. Background. Treatment, planning and policy decisions in contemporary nursing and healthcare should be based on sound evidence wherever possible, but research knowledge remains generally underused. Knowledge transfer and exchange initiatives aim to facilitate the accessibility, application and production of evidence and may provide solutions to this challenge. This review was conducted to help inform the design and implementation of knowledge transfer and exchange activities for a large healthcare organization. Data sources. Databases: ASSIA, Business Source Premier, CINAHL, PsychInfo, Medline and the Cochrane Database of Systematic Reviews. Review methods. An integrative literature review was carried out including an extensive literature search. English language systematic reviews, literature reviews, primary quantitative and qualitative papers and grey literature of high relevance evaluating, describing or discussing knowledge transfer or exchange activities in healthcare were included for review (January 1990-September 2009). Findings. Thirty-three papers were reviewed (four systematic reviews, nine literature reviews, one environmental scan, nine empirical studies and ten case studies). Conclusion. Robust research into knowledge transfer and exchange in healthcare is limited. Analysis of a wide range of evidence indicates a number of commonly featured characteristics but further evaluation of these activities would benefit their application in facilitating evidence-based practice in nursing. © 2011 The Authors. Journal of Advanced Nursing © 2011 Blackwell Publishing Ltd.

Narrative pedagogy has emerged in the last decade as a new approach designed to complement the conventional approaches to education. It is concerned with understanding the meaning of events to people, appreciating multiple perspectives and the emotional content of health care. However there is a paucity of evaluative research concerning its impact. We have used narrative pedagogy to create Stilwell, a realistic narrative telling the stories of 60 characters living in a typical community. Stilwell is a real place (fictional name) and our multimedia model brings the community to life as a virtual practicum for a wide range of health professional students. This paper presents the results of our initial focus group evaluation of student learning experiences with Stilwell. The data indicates students found it a very different way of learning which allowed them to relate theory to practice in ways they had never done before. The realism of Stilwell was a challenge and generated considerable student emotional involvement with the characters, leading to significant novel learning activity.We reflect on how student feedback has allowed us to shape and improve Stilwell as it develops.

Over the past decade, there have been significant changes in nursing education, particularly in teaching practice. This change has fueled interest in developing new and innovative approaches to teaching and curriculum. This article describes the shared experiences of two nurse educators on opposite sides of the Atlantic Ocean who have spent the past 4 years immersed in the process of developing and diffusing virtual communities for nursing education. Diffusion of innovations theory is used as a framework for this narrative. Nurse educators should have an awareness of the phases, steps, and challenges that can be expected during the process of innovation diffusion, including implications for education practice.

Stilwell is a simulation environment designed for postgraduate emergency care staff. It encourages participants to make less obvious diagnoses of patients who have presented to emergency departments, and to consider a wide range of factors when making treatment and management decisions.

Innovation will play a crucial role in shaping the future of England's care and support system. The eyes of the local government world are on the launch of a pioneering organisation, created by Essex County Council, which offers support to thousands of people across the county. This paper describes the 'birth' of the project and the challenges facing the new social care services model as it evolves. It describes how the process leading to the transfer of in-house social care provider services appears to have elicited a greater level of motivation and morale, and helped to change long-standing cultures, especially within management throughout the business.

The National Health Service in Scotland published a best practice framework to support occupational therapists and physiotherapists to deliver effective services for children with developmental co-ordination disorder (DCD); however, adherence is variable. To highlight areas for development, this study compared the care pathway within a paediatric DCD service against the NHS Scotland framework.A partnership of researchers and clinicians based in the United Kingdom conducted a qualitative study with 37 participants (N = 13 interview participants, N = 24 workshop participants). In-depth interviews and/or workshops were used to map the DCD service against the NHS framework. Identified gaps were aligned with four key stages of the care pathway. Qualitative analysis software was used to analyse the data.Core principles to guide future development were identified for each phase of the pathway. These core principles related to the NHS framework and focused on issues such as involving the family, defining clear pathways and enhancing children's participation. Participants identified potential strategies for service improvement such as developing community-based interventions and information provision.Challenges when providing services for children with DCD include confusing service pathways and poor partnership working. It is, therefore, important that clinicians utilise collaborative working strategies that support children's participation.There are numerous challenges related to the implementation of best practice principles into the provision of therapy services for children with developmental coordination disorder (DCD). It is important that AHPs seek ways of engaging parents and educational professionals at all stages of the care pathway in order to ensure optimum service provision for the child. Addressing participation is an important aspect and community-based strategies may be particularly beneficial, both as a preventative activity and as an intervention approach.

Two examples of Community OR (COR) applied to public and patient involvement in improving health services in the UK are described—the Hull and East Riding Impact project and Trailblazers. These projects are consumer controlled but professionally facilitated. The team members have or have had mental illnesses but are committed to improving mental health services by applying COR methods. These projects illustrate how COR can contribute to the improvement of health services by enabling service users to take the lead in facilitating multi-stakeholder planning and problem solving. The Impact team produced a tool based around Ulrich's critical heuristics and have used this in several successful consultations in the NHS. The Trailblazer project used an idealized planning approach in a novel way to produce a distance method of consultation aimed at enabling stakeholders to negotiate commitments to action. Longer-term evaluation of these approaches is planned.

The requirements of the Texas State Implementation Plan of the U.S. Clean Air Act for the Houston-Galveston Ozone Nonattainment Area stipulate large reductions in oxides of nitrogen (NO(x)) emissions. A large number of sources at Dow Chemical Co. sites within the nonattainment area may require the addition of continuous emission monitoring systems (CEMS) for online analysis of NO(x), CO, and O2. At the outset of this work, it was not known whether the analyzers could accurately measure NO(x) as low as 2 ppm. Therefore, NO(x) CEMS analyzers from five different companies were evaluated for their ability to reliably measure NO(x) in the 2-20 ppm range. Testing was performed with a laboratory apparatus that accurately simulated different mixtures of flue gas and, on a limited basis, simulated a dual-train sampling system on a gas turbine. The results indicate that this method is a reasonable approach for analyzer testing and reveal important technical performance aspects for accurate NO(x) measurements. Several commercial analyzers, if installed in a CEMS application with sampling conditioning components similar to those used in this study, can meet the U.S. Environmental Protection Agency's measurement data quality requirements for accuracy.

This paper assesses the level of poverty in Ghana after three decades of successive implementation of numerous poverty reduction strategies including Structural Adjustment Program (SAP) by various governments of Ghana. The Keta municipality in the Volta region, where artisanal fishing thrives, was chosen as a representative sample of the whole country. The authors identified eleven artisanal fishing communities in the selected area using systematic sampling. Data were collected on household consumption patterns. This process was used to determine the profile of poverty using the latest upper poverty line of Ghana and the Greer and Thorbecke (1984) poverty formula. Research findings show that the various poverty alleviation methods implemented over three decades by the Government of Ghana, the World Bank, and the International Monetary Fund (IMF) significantly failed as they have not produced any meaningful effect on poverty reduction in the sample area. Finally, this paper offers further suggestions regarding how this poverty gap may be bridged using alternative methods.

The following key facts emerge which are relevant to an accident prevention strategy. HIGH RISK TIMES: Just before lunch and late afternoon. HIGH RISK PLACES: Those places which are most familiar to the farmer, his/her own farm, especially the yard and farm buildings. HIGH RISK ACTIVITY: Working at heights (falls) or with moving objects, tractors and cattle. HIGH RISK PEOPLE: Younger men, especially when not working on their own farm or older farmers working with livestock. The majority of these accidents could have been prevented with the correct use of protective clothing or taking more care. Once an accident has happened, the first aid response is likely to be inadequate. The project team are now working on a strategy to persuade farmers that accidents could happen to them personally and of the seriousness of the consequences if they do. This will be coupled with producing accident prevention materials outlining simple precautions that can be taken to prevent accidents. The final stage is to disseminate these materials through a range of channels involving both NHS, farming and school networks. That is the next stage of the project.

The recent growth of the nurse practitioner (NP) movement has coincided with rising interest in the area of professional development. Nurse practitioners have been criticised for moving away from nursing and becoming 'mini-doctors', a charge which they hotly deny, pointing out that they are actually trying to become 'maxi-nurses'. How do nurses and nurse practitioners see their future professional development? If NPs really are intent on becoming 'mini-doctors', might there be evidence of this in their aspirations for professional development? In the second of two articles comparing the perspectives of nurses with those of nurse practitioners, this study investigates opinions about future professional development.

The main argument of this paper is that personal social services, including probation, at both a policy and practice level are increasingly focused on issues of risk. We postulate that risk assessment, risk management, the monitoring of risk and risk-taking itself are rapidly becoming the dominant raison d'etre of such agencies, thus supplanting ideologies of meeting need or welfare provision. In turn they have become key to priority setting and rationing, the basis for organizational rationales and structures, the central focus for professional activity and accountability, and measuring quality. Thus an analysis of risk as an organizing principle offers fundamental insights into the rapidly changing nature and organization of statutory social work and probation. There is very little literature that focuses on risk across the spectrum of services. Risk analysis, as such, is most developed in the criminal justice and child protection fields. However, the mental health literature, being centrally preoccupied with notions of dangerousness, is quickly adopting risk terminology. Apart from work on elder abuse, literature on child welfare and community care has been framed in terms of need, issues of risk only coming to the fore around potential admission to residential care. We contend that as issues of rationing and accountability become more dominant, so do concerns with risk. Thus we predict the extension of notions of risk as central organizing principles throughout the social services and probation.

This article follows up a previous article on community nurses' perceived barriers to implementing research (Walsh 1997). Here the author examines the perceived barriers to research use among a sample of 63 hospital and 78 community nurses. The major barriers identified relate to the clinical setting and understanding research reports. The results have significant implications for managers of the service and educators who seek to promote research-based practice.

Modern cities depend on individualism and the process of contracting. Contracts between individuals contribute to stability and order in cities. However, this is challenged by risks and uncertainties especially those relating to vulnerable individuals who are unable or unwilling to enter into contractual relations. This paper focuses on the role of caring professions and the impact of new strategies for managing risks related to vulnerable adults and children, especially the shift from managing risk in institutions to managing risk in the community. This paper is based on research funded through the ESRC Risk and Human Behaviour Programme.

This article focuses on risk management in services for people with learning disabilities. It identifies the issue of risk as central to many historical and current care practices. It illustrates this through three examples that raise questions of risk in relationship to people with learning disabilities: on community care, alcohol and sexuality. It concludes that risk has often been negatively associated with danger, but that sensitive risk management has the potential to improve or maintain the quality of care services.

This paper presents the results of a review of literature relating to knowledge transfer and exchange in healthcare.Treatment, planning and policy decisions in contemporary nursing and healthcare should be based on sound evidence wherever possible, but research knowledge remains generally underused. Knowledge transfer and exchange initiatives aim to facilitate the accessibility, application and production of evidence and may provide solutions to this challenge. This review was conducted to help inform the design and implementation of knowledge transfer and exchange activities for a large healthcare organization.Databases: ASSIA, Business Source Premier, CINAHL, PsychInfo, Medline and the Cochrane Database of Systematic Reviews.An integrative literature review was carried out including an extensive literature search. English language systematic reviews, literature reviews, primary quantitative and qualitative papers and grey literature of high relevance evaluating, describing or discussing knowledge transfer or exchange activities in healthcare were included for review (January 1990-September 2009).Thirty-three papers were reviewed (four systematic reviews, nine literature reviews, one environmental scan, nine empirical studies and ten case studies).Robust research into knowledge transfer and exchange in healthcare is limited. Analysis of a wide range of evidence indicates a number of commonly featured characteristics but further evaluation of these activities would benefit their application in facilitating evidence-based practice in nursing.

A previously described reversed-phase HPLC (RP-HPLC) method based on fast separations on a non-porous silica stationary phase [1] was optimized and qualified for the quantitative determination of hemagglutinin (HA) in influenza vaccine preparations. Optimization of the gradient elution conditions led to improved separation of the HA1 subunit from other vaccine constituents. The sensitivity of the method was significantly increased by using native fluorescence detection, resulting in an approximately 10-fold increase as compared to UV–vis detection. This enabled the elimination of the concentration step described in the original method and allowed direct analysis of vaccine preparations. The method was qualified for linearity, range, limit of detection, limit of quantitation and precision. Overall, it was found to be linear over the range of 2.5–100 μg HA/mL for all subtypes examined. This range covered 50–150% of the concentration found for individual strains in seasonal influenza vaccines and in the pandemic H1N1 vaccine. The limit of detection and limit of quantitation for each subtype were found to be suitable for the method's intended purpose and compared well to values found by the single radial immunodiffusion (SRID). The repeatability of the method gave RSD values below 5% for both retention time and peak areas. As expected for intermediate precision, larger RSD values for peak area were obtained but were below 10% and deemed acceptable. The RP-HPLC results were compared to Western blot analysis using a HA universal antibody for a set of 15 monovalent A/California H1N1 preparations and showed good correlation. Similarly, the quantitative nature of the RP-HPLC method was assessed in relation to the SRID assay currently used for the determination of the HA content in bulk antigen and final vaccine preparations. Thus, for a series of 23 monovalent A/Brisbane/59/2007 H1N1 bulks, ranging between 12.7 and 15.9 μg HA/mL by SRID, the RP-HPLC values were found to be in very good agreement, ranging between 11.9 and 14.1 μg HA/mL (n = 5) for five determinations carried out on 5 different days. During the 2009–10 H1N1 influenza pandemic the quantitative RP-HPLC method was used alongside several other test methods for the analysis of pandemic H1N1 vaccine preparations that included bulk antigen and final vaccines. The HA content of vaccines formulated at 15 or 30 μg/mL was measured by RP-HPLC and SRID and results showed that the HA content determined by RP-HPLC correlated well to that determined by SRID and to values determined by Western blot. Overall, the results provided further evidence of the usefulness of RP-HPLC for the detection and quantitation of the HA content once a reference standard has been established.

Stilwell is a simulation environment designed for postgraduate emergency care staff. It encourages participants to make less obvious diagnoses of patients who have presented to emergency departments, and to consider a wide range of factors when making treatment and management decisions.

In the fourth and final part of his series, Mike Walsh explores the reasons for patients choosing to attend AE patient and staff definitions of what constitutes 'appropriate' can be very different. The series closes with the author suggesting that increased responsibilities placed upon GPs by the Government's reforms require health service managers to urgently review why a significant proportion of attenders did not have any kind of GP cover.