To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
This Element maintains that increasing strategic effectiveness involves paying greater attention to the idiosyncratic capabilities and know-how already accumulated in an organization's shared practices and the modus operandi contained therein. An organization's modus operandi describes the practiced patterned regularities that enables it to achieve a consistency of response in strategic circumstances even in the absence of any clear, formalized strategic plan. This patterned regularity known as Strategy-in-Practices (SiP) draws attention to the tacit influence of an organization's shared practices on its formal strategy-making efforts. It emphasizes the need for both these to be aligned so that the organization is better prepared to cope with the challenges and opportunities it faces.
Project ECHO is a virtual, case-based capacity-building education program for healthcare providers. It was developed in New Mexico, USA but, due to its effectiveness, the model has now spread to 40 countries around the globe. Baycrest, the Canadian Coalition for Seniors’ Mental Health and the Canadian Academy of Geriatric Psychiatry collaborated to launch a national ECHO for mental health and aging. This partnership, coordinated by a cross-Canadian Steering Group, allows for broad reach, including registration of learning partners from almost all Canadian provinces and territories. The program was funded by the RBC Foundation.
ECHO COE: Mental Health pilot consisted of 2 cycles:
6 weekly sessions focused on broader mental health topics (e.g., delirium, mood disorders)
10 weeks with more specific topics (e.g., substance use disorders, sleep disorders)
Needs assessments of healthcare providers and older adults informed the program curricula. Evaluation included weekly satisfaction surveys, and pre and post evaluations.
154 healthcare providers participated in the 6-week session
39% of registrants were nurses or nurse practitioners, 35% allied health professionals, 14% physicians and 12% others
9 out of 10 provinces, 1 territory represented
Preliminary findings (based on the first 6 sessions):
High overall satisfaction (average of 4.5 out of 5).
99% would recommend the program to others
67% had already shared information with team members and colleagues.
A national ECHO program is an effective way to bring together clinicians who work with and are interested in the mental health and wellbeing of older adults for education sessions, collaborative and mutual learning as well as for cross-jurisdictional knowledge transfer. Collaborative, cross-professional learning supports the exchange of best practice in mental health for older adults, supports the development of collegial national professional support and can address health system inequities. An international ECHO through IPA would be an exciting and valuable next step.
Recent work suggests that antihypertensive medications may be useful as repurposed treatments for mood disorders. Using large-scale linked healthcare data we investigated whether certain classes of antihypertensive, such as angiotensin antagonists (AAs) and calcium channel blockers, were associated with reduced risk of new-onset major depressive disorder (MDD) or bipolar disorder (BD).
Two cohorts of patients treated with antihypertensives were identified from Scottish prescribing (2009–2016) and hospital admission (1981–2016) records. Eligibility for cohort membership was determined by a receipt of a minimum of four prescriptions for antihypertensives within a 12-month window. One treatment cohort (n = 538 730) included patients with no previous history of mood disorder, whereas the other (n = 262 278) included those who did. Both cohorts were matched by age, sex and area deprivation to untreated comparators. Associations between antihypertensive treatment and new-onset MDD or bipolar episodes were investigated using Cox regression.
For patients without a history of mood disorder, antihypertensives were associated with increased risk of new-onset MDD. For AA monotherapy, the hazard ratio (HR) for new-onset MDD was 1.17 (95% CI 1.04–1.31). Beta blockers' association was stronger (HR 2.68; 95% CI 2.45–2.92), possibly indicating pre-existing anxiety. Some classes of antihypertensive were associated with protection against BD, particularly AAs (HR 0.46; 95% CI 0.30–0.70). For patients with a past history of mood disorders, all classes of antihypertensives were associated with increased risk of future episodes of MDD.
There was no evidence that antihypertensive medications prevented new episodes of MDD but AAs may represent a novel treatment avenue for BD.
A national need is to prepare for and respond to accidental or intentional disasters categorized as chemical, biological, radiological, nuclear, or explosive (CBRNE). These incidents require specific subject-matter expertise, yet have commonalities. We identify 7 core elements comprising CBRNE science that require integration for effective preparedness planning and public health and medical response and recovery. These core elements are (1) basic and clinical sciences, (2) modeling and systems management, (3) planning, (4) response and incident management, (5) recovery and resilience, (6) lessons learned, and (7) continuous improvement. A key feature is the ability of relevant subject matter experts to integrate information into response operations. We propose the CBRNE medical operations science support expert as a professional who (1) understands that CBRNE incidents require an integrated systems approach, (2) understands the key functions and contributions of CBRNE science practitioners, (3) helps direct strategic and tactical CBRNE planning and responses through first-hand experience, and (4) provides advice to senior decision-makers managing response activities. Recognition of both CBRNE science as a distinct competency and the establishment of the CBRNE medical operations science support expert informs the public of the enormous progress made, broadcasts opportunities for new talent, and enhances the sophistication and analytic expertise of senior managers planning for and responding to CBRNE incidents.
IR scholars have made increasingly sophisticated use of historical analysis in the last two decades. To do so, they have appealed to theories or philosophies of history, tacitly or explicitly. However, the plurality of approaches to these theories has gone largely unsystematized. Nor have their implications been compared. Such historical–theoretic orientations concern the ‘problem of history’: the theoretical question of how to make the facts of the past coherently intelligible. We aim to make these assumptions explicit, and to contrast them systematically. In so doing, we show theories of history are necessary: IR-theoretic research unavoidably has tacit or overt historical–theoretic commitments. We locate the field’s current historical commitments in a typology, along two axes. Theories of history may be either familiar to the observer or unfamiliar. They may also be linear, having a long-term trajectory, nonlinear, lacking such directionality, or multilinear, proceeding along multiple trajectories. This comparative exercise both excavates the field’s sometimes-obscured commitments and shows some IR theorists unexpectedly share commitments, while others unexpectedly do not. We argue that better awareness of historical–theoretic reasoning, embedded in all IR uses and invocations of history, may encourage the discipline become more genuinely plural.
We discuss a hierarchical probabilistic model whose predictions are similar to those of the popular language modelling procedure known as ‘smoothing’. A number of interesting differences from smoothing emerge. The insights gained from a probabilistic view of this problem point towards new directions for language modelling. The ideas of this paper are also applicable to other problems such as the modelling of triphomes in speech, and DNA and protein sequences in molecular biology. The new algorithm is compared with smoothing on a two million word corpus. The methods prove to be about equally accurate, with the hierarchical model using fewer computational resources.
‘The huts are now roofless, the fires of the hearths quenched for ever, the fortifications levelled; yet these ruins have out-lasted the erections of more civilized times, and they still remain to tell us something of the busy population who hunted, tended flocks, tilled the ground, and quarrelled and fought, at a very distant period (in the valley of the Breamish)’. George Tate (1863, 302)
This paper describes the results of the South East Cheviots Project undertaken by the former Royal Commission on the Historical Monuments of England (RCHME; now part of English Heritage) during the 1980s. An area of 66 square kilometres was analytically recorded, ranging from the Breamish Valley in the north to Alnham in the south and from Brandon in the east to Schill Moor in the west. The project recorded with metrical accuracy all forms of cultivation remains, field systems, and settlements of all periods (only the prehistoric evidence will be reviewed in this paper). This landscape approach has led to a greater understanding of settlement histories in these remarkably well-preserved uplands. Recent excavations undertaken by the Northumberland Archaeological Group (NAG) and Durham University, under the auspices of the Northumberland National Park Authority (NNPA), have helped to clarify and contextualise further aspects of the chronology of settlement and landscape change recorded by the SECP.
Space, time and power are fundamentals of physics that determine the dynamic structure of our lives. Recent publications from the Darwin College Lecture Series have addressed two of these topics: Space in the 2001 lecture series and Time in 2000. Each of those volumes included a range of perspectives that span the arts, humanities and sciences. Now, in this new volume, we have invited seven international authorities to analyse and interpret the theme of Power as it is understood in their different fields of learning. The subjects that they consider include not only the sources of power that humanity has at its disposal, but also the forms of power that are exerted over us by cultural products and societies.
Life on earth, and of course all human activity, depends on the availability of sufficient power to support that activity. Mary Archer starts our exploration of power by considering where this power comes from. Drawing both on her academic work as a researcher in chemistry and Professor of Energy Policy, and on her public life including presidency of the National Energy Foundation, Archer reviews and forecasts human power usage and supply. Her chapter on the future of sustainable power sources addresses the rate with which we consume fossil fuel resources, and the alternatives that might supply the hundreds of exajoules we consume each year.