Crossing cultures: Analysing the experiences of NZ returnees from the EU (UK vs. non-UK)

While there is growing scholarly interest in returned and cyclical migration, and on young adult cultural or adventure seeking migration, there is still a lack of systematic empirical insights into how the experiences of being abroad, and after return, are mediated by exposure to different cultural environments. Addressing this conceptual and empirical gap, the paper analyses the experiences of New Zealand return migrants, or sojourners, who lived and worked in European countries (other than the UK) for more than one year and compares them with the experiences of NZ returnees from the UK. Drawing on 20 ‘non-UK’ and 22 ‘UK’ in-depth interviews, the paper revisits [Rhinesmith, 1975] and [Rhinesmith, 1986] typology of cross-cultural, or intercultural, adjustment (largely ignored in studies of return migration) to assess sojourners’ experiences throughout the migration cycle and serve as a useful tool for identifying and reporting psychological and socio-cultural elements in the returnees stories. The findings of sojourners’ possible identity shifts during intercultural transition are discussed with reference to the four-member paradigm of Cultural Identity Model (CIM) (Sussman, 2010) while addressing Sussman's (2002) argument that overseas adaptation and repatriation experiences are not directly associated. This paper demonstrates the need to understand first that the costs and benefits of circular migration or sojourning are country-specific, and that they do not ‘just happen’ at a particular moment or in one phase but are forged through a veritable rollercoaster of experiences of intercultural adjustment.     

Using clinical guidelines to assess the potential value of laboratory medicine in clinical decision-making

IntroductionIt is often quoted that 70% of clinical decisions are based on laboratory results, but the evidence to substantiate this claim is lacking. Since clinical guidelines aim to document best-practice decision making for specific disease conditions, inclusion of any laboratory test means that the best available evidence is recommending clinicians use it. Cardiovascular disease (CVD) is the world’s most common cause of mortality, so this study reviewed all CVD guidelines published by five national/international authorities to determine what proportion of them recommended laboratory testing.Materials and methodsFive leading CVD guidelines were examined, namely the European Society of Cardiology (ESC), the UK National Institute for Health and Clinical Excellence (NICE), the American College of Cardiology (ACC), the Australian Heart Foundation (AHF) and the Cardiac Society of Australia and New Zealand (CSANZ).ResultsA total of 101 guidelines were reviewed. Of the 33 individual ESC guidelines relating to CVD, 24/33 made a direct reference to the use of clinical laboratory tests in either diagnosis or follow-up treatment. The same applied to 15/20 of NICE guidelines, 24/32 from the ACC and 15/16 from the AHF/CSANZ. Renal function and blood count testing were the most recommended (39 and 26 times), with lipid, troponin and natriuretic peptide measurement advocated 25, 19 and 19 times respectively.ConclusionsThis study has shown that laboratory testing is advocated by between 73% and 94% of individual CVD guideline recommendations from five national/international authorities. This provides an index to assess the potential value of laboratory medicine to healthcare.     

The other exit: The definitive statement on management theory and practice in our time

As part of an investigation into the progress of the appraisal of primary school headteachers in three LEAs in the Midlands, the three LEA appraisal coordinators concerned were interviewed in advance of a sample of the headteachers. From the three semi-structured interviews it was possible to detect interesting differences, as well as similarities, in the procedures adopted in the LEAs. In one case the advisers were unable to meet the statutory obligation for there to be an LEA officer involved in each appraisal and reporting back to the LEA appeared to be very patchy. This stemmed from resource constraints which were also seen as a looming problem by the other coordinators. In all three cases the coordinators had tried to ensure that the implementation of headteacher appraisal was as non-threatening as possible. This had led in some cases to a level of reciprocity of appraisal together with a degree of choice which might be seen as a more comfortable set of arrangements than many managers outside education or, for that matter, class teachers might encounter. The outcomes were, however, seen as very positive staff development for the heads concerned. (This is being confirmed by the overwhelming majority of the heads themselves in the interviews with them which have taken place subsequently.) Although appraisal reports on heads are available by law to the chairpersons of governing bodies, there was evidence that such feedback as there was tended to be perfunctory in many cases. There is evidence that this is not through carelessness. Appraisal of headteachers may not be following the lines of accountability originally favoured by the government. This may account for some evidence of government disenchantment with the appraisal process in education as it currently operates.