From Hippocrates to commodities: three models of NHS governance

A series of inquiries and reports suggest considerable failings in the care provided to some patients in the NHS. Although the Bristol Inquiry report of 2001 led to the creation of many new regulatory bodies to supervise the NHS, they have never enjoyed consistent support from government and the Mid Staffordshire Inquiry in 2013 suggests they made little difference. Why do some parts of the NHS disregard patients’ interests and how we should we respond to the challenge? The following discusses the evolution of approaches to NHS governance through the Hippocratic, Managerial and Commercial models, and assesses their risks and benefits. Apart from the ethical imperative, the need for effective governance is driven both by the growth in information available to the public and the resources wasted by ineffective systems of care. Appropriate solutions depend on an understanding of the perverse incentives inherent in each model and the need for greater sensitivity to the voices of patients and the public.

Intensity perturbations due to the v3, v4 Coriolis interaction in methane

Formulas are obtained for the intensity asymmetry (Herman-Wallis) factors in the ν3 and ν4 fundamentals of methane due to the ζ34 Coriolis interaction. The results are also applicable to the ν3 and ν4 bands of SF6.

A metaphorical analysis of client organisations and the briefing process

This paper reviews and critiques the current practice of classifying building clients according to their 'type'. An alternative approach to understanding organisations is developed in accordance with the principles of naturalistic inquiry. It is contended that the complex pluralistic clients of the 1990s can only really be understood 'from the inside'. The concept of organisational metaphors is introduced as the basis for a more sophisticated way of thinking about organisations. The various strands of organisational theory are also analyzed in terms of their underlying metaphors. Different theories are seen to bring different insights. The implicit metaphors adopted by practitioners are held to be important in that they tend to dictate the adopted approach to client briefing. This contention is illustrated by analyzing three different characterisations of the briefing process in terms of their underlying metaphors. Finally, the discussion is placed in a contemporary UK context by comparing the dominant paradigm of practice during the 1980s to that of the 1990s.

Where the interaction is: collisions of the situated and mediated in living room interactions

This article presents three ethnographic tales of interactions with living room media to help recreate the experience of significant moments in time, of affective encounters at the interface in which there is a collision or confusion of situated and virtual worlds. It draws on a year-long video ethnography of the practice and performance of everyday interactions with living room media. By studying situated activity and the lived practice of (new) media, rather than taking an exclusive focus on the virtual as a detached space, this ethnographic work demonstrates how the situated and mediated clash, or are crafted into complex emotional encounters during everyday living room life.

The impact on housing supply in England of planning delay and uncertainty

The time taken to consider development proposals within the English planning system continues to provoke great policy concern despite a decade of inquiry and policy change. The results of an extensive site-based survey and hedonic modelling exercise across 45 local authorities are reported here. The analysis reveals a slow, uncertain system. It identifies planning delay as a serious problem for housing supply and its ability to respond to increases in demand. Only a relatively limited set of factors seem relevant in explaining differences in times and the results suggest that 80% of councils’ performances are statistically indistinguishable from each other. These findings question the policy emphasis put on rankings of local authorities, though some influence from local politics is apparent. Development control is consistently a lengthy and uncertain process due to its complexity. Therefore, success in lowering planning delay is only likely through radical simplification.

Mutation of toxB and a truncated version of the efa-1 gene in Escherichia coli O157 : H7 influences the expression and secretion of locus of enterocyte effacement-encoded proteins but not intestinal colonization in calves or sheep

Enterohemorrhagic Escherichia coli (EHEC) strains comprise a broad group of bacteria, some of which cause attaching and effacing (AE) lesions and enteritis in humans and animals. Non-O157:H7 EHEC strains contain the gene efa-1 (referred to in previous publications as efa1), which influences adherence to cultured epithelial cells. An almost identical gene in enteropathogenic E. coli (lifA) mediates the inhibition of lymphocyte proliferation and proinflammatory cytokine synthesis. We have shown previously that significantly lower numbers of EHEC 05 and 0111 efa-1 mutants are shed in feces following experimental infection in calves and that these mutants exhibit reduced adherence to intestinal epithelia compared with isogenic wild-type strains. E. coli O157:H7 strains lack efa-1 but encode a homolog on the pO157 plasmid (toxB/l7095) and contain a truncated version of the efa-1 gene (efa-1'/z4332 in O island 122 of the EDL933 chromosome). Here we report that E. coli O157:H7 toxB and efa-1' single and double mutants exhibit reduced adherence to cultured epithelial cells and show reduced expression and secretion of proteins encoded by the locus of enterocyte effacement (LEE), which plays a key role in the host-cell interactions of EHEC. The activity of LEE1, LEE4, and LEE5 promoters was not significantly altered in E. coli O157:H7 strains harboring toxB or efa-1' mutations, indicating that the effect on the expression of LEE-encoded secreted proteins occurs at a posttranscriptional level. Despite affecting type III secretion, mutation of toxB and efa-1' did not significantly affect the course of fecal shedding of E. coli O157:H7 following experimental inoculation of 10- to 14-day-old calves or 6-week-old sheep. Mutation of tir caused a significant reduction in fecal shedding of E. coli O157:H7 in calves, indicating that the formation of AE lesions is important for colonization of the bovine intestine.

Responsible tourism and sustainability: the case of Kumarakom in Kerala, India

This paper discusses the notion of ‘responsible tourism’ and its current use within the tourism literature. We argue that the concept as used currently means everything and therefore adds nothing to the conceptual terrain of tourism trends and nomenclatures. We then introduce our own understanding of the concept arguing that while responsible tourism is linked to sustainability initiatives such as alternative tourism, ecotourism, ethical tourism, green tourism, soft tourism, pro-poor tourism, geo-tourism, integrated tourism, community-based tourism, etc it also demarcates an analytical realm of its own. We suggest that the practical use of the term in areas where it has been adopted (such as South Africa and Kerala for instance) suggests a rather restricted use. We identified this realm as the tourism sector-specific manifestation of the corporate social responsibility (CSR) agenda. Following Flyvberg's [(2006). Five misunderstandings about case-study research. Qualitative Inquiry, 12(2), 219–245] call for exemplars and paradigmatic case studies to advance knowledge in a particular domain, the responsible tourism initiative in Kumarakon, Kerala, is presented. Discussion of the case study traces the particular governance context of Kerala and the position of tourism in the state economy. The responsible tourism initiatives at the state level and local level are then described highlighting the ‘how’ of the implementation and the impact that it has produced. Generic, non-prescriptive principles that could be said to be necessary in some form for the successful translation of responsible tourism principles to practices are then identified. Such an approach is contrasted with one that places faith in the voluntary adoption of ‘responsible’ practices by the private sector on its own. It is argued that responsible tourism can make a contribution to practice provided the conceptual terrain is delineated against other forms of tourism and if research within the terrain can unpack the particular forms of challenges that are thrown up by the delineation itself.

Teachers’ knowledge and experiences of Information Advice and Guidance: some implications for the current policy context in England

Good information and career guidance about what post-compulsory educational routes are available and where these routes lead is important in ensuring that young people make choices that are most appropriate to their needs and aspirations. Yet the Association of School and College Leaders (2011) express fears that future provision will be inadequate. This paper reports the findings from an on-line survey of 300 secondary school teachers, and follow up telephone interviews with 18 in the South East of England which explored teachers’ experiences of delivering post-compulsory educational and career guidance and their knowledge and confidence in doing so. Results suggest that teachers lack confidence in delivering information, advice and guidance outside their own area of specialism and experience. In particular, teachers knew little in relation to alternative local provision of post-16 education and lacked knowledge of more non-traditional, vocational routes. This paper will therefore raises important policy considerations with respect to supporting teachers’ knowledge, ability and confidence in delivering information in relation to future pathways and career guidance.

Comments on 'Balance and the slow quasimanifold: some explicit results'

The concept of slow vortical dynamics and its role in theoretical understanding is central to geophysical fluid dynamics. It leads, for example, to “potential vorticity thinking” (Hoskins et al. 1985). Mathematically, one imagines an invariant manifold within the phase space of solutions, called the slow manifold (Leith 1980; Lorenz 1980), to which the dynamics are constrained. Whether this slow manifold truly exists has been a major subject of inquiry over the past 20 years. It has become clear that an exact slow manifold is an exceptional case, restricted to steady or perhaps temporally periodic flows (Warn 1997). Thus the concept of a “fuzzy slow manifold” (Warn and Ménard 1986) has been suggested. The idea is that nearly slow dynamics will occur in a stochastic layer about the putative slow manifold. The natural question then is, how thick is this layer? In a recent paper, Ford et al. (2000) argue that Lighthill emission—the spontaneous emission of freely propagating acoustic waves by unsteady vortical flows—is applicable to the problem of balance, with the Mach number Ma replaced by the Froude number F, and that it is a fundamental mechanism for this fuzziness. They consider the rotating shallow-water equations and find emission of inertia–gravity waves at O(F2). This is rather surprising at first sight, because several studies of balanced dynamics with the rotating shallow-water equations have gone beyond second order in F, and found only an exponentially small unbalanced component (Warn and Ménard 1986; Lorenz and Krishnamurthy 1987; Bokhove and Shepherd 1996; Wirosoetisno and Shepherd 2000). We have no technical objection to the analysis of Ford et al. (2000), but wish to point out that it depends crucially on R 1, where R is the Rossby number. This condition requires the ratio of the characteristic length scale of the flow L to the Rossby deformation radius LR to go to zero in the limit F → 0. This is the low Froude number scaling of Charney (1963), which, while originally designed for the Tropics, has been argued to be also relevant to mesoscale dynamics (Riley et al. 1981). If L/LR is fixed, however, then F → 0 implies R → 0, which is the standard quasigeostrophic scaling of Charney (1948; see, e.g., Pedlosky 1987). In this limit there is reason to expect the fuzziness of the slow manifold to be “exponentially thin,” and balance to be much more accurate than is consistent with (algebraic) Lighthill emission.

Introduction: some notes on the generative study of L3 acquisition.

This article serves as a state-of the-science review of the blossoming field of generative third language (L3) acquisition as well as an introduction to this special issue on the same topic. We present and argue for the relevance of adult L3/Ln acquisition for many perennial questions that have sat at the core of linguistic approaches to adult language acquisition since the Principles and Parameters framework was first adopted into second language acquisition (SLA; e.g. Flynn, 1985, 1987; Liceras, 1985; White, 1985a, 1985b; Schwartz, 1986). Furthermore, we highlight the unique, specific questions that have emerged from studying L3/Ln from a generative perspective thus far while suggesting refinements to these questions and additional ones that should emerge in future inquiry.

Linguistic epistemology and the notion of monolingualism

This article has several interrelated goals, all of which relate to an attempt at understanding why monolingualism is taken to be the default norm in linguistic inquiry (from sociolinguistics to formal linguistic theorizing). With others, I will take the position that comparing instances of multilingualism to so-called monolingualism is an unfair and inevitably inaccurate comparison since, among other variables, the social environments and access to input of multilinguals compared to monolinguals is most often unavoidably different (cf. Cruz-Ferreira 2006; Edwards 2004). Additionally, I will attempt to demonstrate that even so-called monolinguals have access to a variety of grammars related to different registers of speech and, therefore, are not truly monolingual in the sense that they poses one monolithic grammatical competence. Taken together, the present discussion questions both the default status of monolingualism as well as the functional adequacy of the term monolingualism.