Book Reviews

Felice Davidson Perlmutter; Darlyne Bailey; F. Ellen Netting: Managing Human Resources in the Human Services: Supervisory Challenges. Oxford, Oxford University Press, 2000. 221 pp, 0 19 513707 8, £15.99     

Diagnostics of age‐graded linguistic behaviour: The case of the quotative system1

This article presents a cross‐variety investigation of quotatives be like and go in apparent and real time. Distributional and attitudinal evidence points to a change in progress as the underlying process for the distribution of be like. However, there is also evidence of life‐span change (Sankoff to appear). The patterning of go across age is much less clear‐cut. It could be interpreted as age grading or as a change in progress. This paper discusses seemingly contradictory findings from U.S. and British English. It will be suggested that the distribution of go is due to unstable behaviour at both the individual and the community level. Furthermore, there is evidence that go has a latent presence in the linguistic repertoire and was picked up again after its frequency dipped due to the introduction of be like. This finding ties in with other reported cases of recycling of variables ( Dubois and Horvath 1999 ).     

Firms,Destinations, and Aggregate Fluctuations

This paper uses a data base covering the universe of French firms for the period 1990–2007 to provide a forensic account of the role of individual firms in generating aggregate fluctuations. We set up a simple multisector model of heterogeneous firms selling to multiple markets to motivate a theoretically founded decomposition of firms' annual sales growth rate into different components. We find that the firm‐specific component contributes substantially to aggregate sales volatility, mattering about as much as the components capturing shocks that are common across firms within a sector or country. We then decompose the firm‐specific component to provide evidence on two mechanisms that generate aggregate fluctuations from microeconomic shocks highlighted in the recent literature: (i) when the firm size distribution is fat‐tailed, idiosyncratic shocks to large firms directly contribute to aggregate fluctuations, and (ii) aggregate fluctuations can arise from idiosyncratic shocks due to input–output linkages across the economy. Firm linkages are approximately three times as important as the direct effect of firm shocks in driving aggregate fluctuations.     

Assessing efficacy in important subgroups in confirmatory trials: An example using Bayesian dynamic borrowing

Assessment of efficacy in important subgroups – such as those defined by sex, age, race and region – in confirmatory trials is typically performed using separate analysis of the specific subgroup. This ignores relevant information from the complementary subgroup. Bayesian dynamic borrowing uses an informative prior based on analysis of the complementary subgroup and a weak prior distribution centred on a mean of zero to construct a robust mixture prior. This combination of priors allows for dynamic borrowing of prior information; the analysis learns how much of the complementary subgroup prior information to borrow based on the consistency between the subgroup of interest and the complementary subgroup. A tipping point analysis can be carried out to identify how much prior weight needs to be placed on the complementary subgroup component of the robust mixture prior to establish efficacy in the subgroup of interest. An attractive feature of the tipping point analysis is that it enables the evidence from the source subgroup, the evidence from the target subgroup, and the combined evidence to be displayed alongside each other. This method is illustrated with an example trial in severe asthma where efficacy in the adolescent subgroup was assessed using a mixture prior combining an informative prior from the adult data in the same trial with a non-informative prior.     

Developing a Core Competency Model and Educational Framework for Primary Maternity Services: a national consensus approach

BackgroundAn appropriately educated and competent workforce is crucial to an effective health care system. The National Health Workforce Taskforce (now Health Workforce Australia) and the Maternity Services Inter-Jurisdictional Committee funded a project to develop Core Competencies and Educational Framework for Primary Maternity Services in Australia. These competencies recognise the interdisciplinary nature of maternity care in Australia where care is provided by general practitioners, obstetricians and midwives as well as other professionals.ParticipantsKey stakeholders from professional organisations and providers of services related to maternity care and consumers of services.MethodsA national consensus approach was undertaken using consultation processes with a Steering Committee, a wider Reference Group and public consultation.FindingsA national Core Competencies and Educational Framework for Primary Maternity Services in Australia was developed through an iterative process with a range of key stakeholders. There are a number of strategies that may assist in the integration of these into primary maternity service provider professional groups’ education and practice.ConclusionsThe Core Competencies and Educational Framework are based on an interprofessional approach to learning and primary maternity service practice. They have sought to value professional expertise and stimulate awareness and respect for the roles of all primary maternity service providers. The competencies and framework described in this paper are now a critical component of Australian maternity services as they are included in actions in the newly released National Maternity Services Plan and thus have relevance for all providers of Australian maternity services.     

The self reported confidence of newly graduated midwives before and after their first year of practice in Sydney, Australia

BackgroundGraduates from a new, 3-year Bachelor of Midwifery program joined those educated through the 1 year, postgraduate route (for those already qualified as nurses) for the first time in New South Wales (NSW) Australia in 2007. Many hospitals offer transition support programs for new graduates during their first year of practice though there is little evidence available to inform these programs.ObjectivesTo establish the new midwife's confidence in working to the 14 “National Competency Standards for the Midwife”¹ and the International Confederation of Midwives (ICM) Definition of a Midwife and to explore whether the new midwife's confidence changed over the new graduate year. In particular the study set out to determine whether there were any differences in the confidence of new graduates from undergraduate or postgraduate programs.DesignPre and post survey with comparisons longitudinally and within undergraduate and postgraduate cohorts.SettingsThree Area Health Services in Sydney and surrounding areas, Australia.ParticipantsA convenience sample of all new graduate midwives employed in the three Area Health Services in the early months of 2008.MethodsNew graduate midwives rated their level of confidence (1–10) in working to the 14 National Competency Standards for the Midwife and the ICM Definition of a Midwife during their first weeks of employment and after the completion of their first year of practice.ResultsMidwives prepared through the undergraduate and postgraduate routes commenced their first year of practice with similar levels of confidence. The confidence of these midwives increased modestly over the first year of practice. Those from postgraduate programs were significantly more confident than those from undergraduate programs on four competencies after the first year of practice. Participant's self reported confidence in working to the ICM Definition of a Midwife was low.ConclusionsOur profession and community need strong, confident midwives and it is in all our interests to look to ways we can best achieve this. While the findings of this study should be treated with caution, this study suggests that there is room for improvement in the way we support newly graduated midwives to build their confidence over their first year of practice. Further research is needed to identify the needs of newly graduated midwives and how best we can support them to develop as strong and confident practitioners through their first year of practice.