Culture and behaviour in the English National Health Service:overview of lessons from a large multimethod study

Background - Problems of quality and safety persist in health systems worldwide. We conducted a large research programme to examine culture and behaviour in the English National Health Service (NHS). Methods - Mixed-methods study involving collection and triangulation of data from multiple sources, including interviews, surveys, ethnographic case studies, board minutes and publicly available datasets. We narratively synthesised data across the studies to produce a holistic picture and in this paper present a highlevel summary. Results - We found an almost universal desire to provide the best quality of care. We identified many 'bright spots' of excellent caring and practice and high-quality innovation across the NHS, but also considerable inconsistency. Consistent achievement of high-quality care was challenged by unclear goals, overlapping priorities that distracted attention, and compliance-oriented bureaucratised management. The institutional and regulatory environment was populated by multiple external bodies serving different but overlapping functions. Some organisations found it difficult to obtain valid insights into the quality of the care they provided. Poor organisational and information systems sometimes left staff struggling to deliver care effectively and disempowered them from initiating improvement. Good staff support and management were also highly variable, though they were fundamental to culture and were directly related to patient experience, safety and quality of care. Conclusions - Our results highlight the importance of clear, challenging goals for high-quality care. Organisations need to put the patient at the centre of all they do, get smart intelligence, focus on improving organisational systems, and nurture caring cultures by ensuring that staff feel valued, respected, engaged and supported.

The value of intellectual property to firms and society

Economists view intellectual property rights (IPRs) as policy tools for encouraging innovation, but they recognize that they can also inhibit competition. There are many types of IPRs and institutions concerned with their administration. We begin by outlining how these complex and varied rights are supposed to work and how they interact with other characteristics of firms and markets. We then survey the available literature on patents, trade marks, and copyright to assess the value of these IPRs to firms and the costs to firms of acquiring and defending their rights. The paper concludes with suggestions for topics requiring further research to inform public policy better.

Low gravity rotational culture and the integration of immunomodulatory stem cells reduce human islet allo-reactivity

Modification of human islets prior to transplantation may improve long-term clinical outcome in terms of diabetes management, by supporting graft function and reducing the potential for allo-rejection. Intragraft incorporation of stem cells secreting beta (β)-cell trophic and immunomodulatory factors represents a credible approach, but requires suitable culture methods to facilitate islet alteration without compromising integrity. This study employed a three-dimensional rotational cell culture system (RCCS) to achieve modification, preserve function, and ultimately influence immune cell responsiveness to human islets. Islets underwent intentional dispersal and rotational culture-assisted aggregation with amniotic epithelial cells (AEC) exhibiting intrinsic immunomodulatory potential. Reassembled islet constructs were assessed for functional integrity, and their ability to induce an allo-response in discrete T-cell subsets determined using mixed islet:lymphocyte reaction assays. RCCS supported the formation of islet:AEC aggregates with improved insulin secretory capacity compared to unmodified islets. Further, the allo-response of peripheral blood mononuclear cell (PBMC) and purified CD4+ and CD8+ T-cell subsets to AEC-bearing grafts was significantly (p < 0.05) attenuated. Rotational culture enables pre-transplant islet modification involving their integration with immunomodulatory stem cells capable of subduing the allo-reactivity of T cells relevant to islet rejection. The approach may play a role in achieving acute and long-term graft survival in islet transplantation.

Agitation conditions for the culture and detachment of hMSCs from microcarriers in multiple bioreactor platforms

In our recent work in different bioreactors up to 2.5L in scale, we have successfully cultured hMSCs using the minimum agitator speed required for complete microcarrier suspension, N JS. In addition, we also reported a scaleable protocol for the detachment from microcarriers in spinner flasks of hMSCs from two donors. The essence of the protocol is the use of a short period of intense agitation in the presence of enzymes such that the cells are detached; but once detachment is achieved, the cells are smaller than the Kolmogorov scale of turbulence and hence not damaged. Here, the same approach has been effective for culture at N JS and detachment in-situ in 15mL ambr™ bioreactors, 100mL spinner flasks and 250mL Dasgip bioreactors. In these experiments, cells from four different donors were used along with two types of microcarrier with and without surface coatings (two types), four different enzymes and three different growth media (with and without serum), a total of 22 different combinations. In all cases after detachment, the cells were shown to retain their desired quality attributes and were able to proliferate. This agitation strategy with respect to culture and harvest therefore offers a sound basis for a wide range of scales of operation.

The influence of culture and market orientation on services brands:insights from Irish banking and retail firms

Purpose: This paper aims to examine the influence of the culture of the service firm on its interpretation of the role of the brand and on the development and implementation of its brand values. Design/methodology/approach: A grounded theory approach was used. Interviews were conducted with 20 managers within two leading banking firms in Ireland and two leading grocery retailers in Ireland. Findings: The development of the brand, and its role within the firm, is closely related to the firm's culture. The research shows obstacles and opportunities created by the cultural context of firms wishing to disseminate and embed a set of brand values. The paper presents an "involvement model" of brand values implementation and outlines changes required to implement brand values. Research limitations/implications: The study was bound by access to firms, and managers' availability. The authors sought an insight into the relationship between each firm's culture and its brands. They advocate quantitative research to further investigate the findings within these service sectors and to test proposed antecedents (transformational leadership, employee involvement) and outcomes (employee-based brand equity and consumer-based brand equity) of values adoption. Practical implications: The paper identifies aspects of retail and banking cultures which support or detract from brand development. In particular, it presents the learnings from successful brand values implementation in a clan culture, aspects of which are applicable across other cultures. Originality/value: The paper provides valuable insights into the role of the brand within the service firm and the positive and negative influence of context on brand values and their development and implementation. © Emerald Group Publishing Limited.

Mixing theory for culture and harvest in bioreactors of human mesenchymal stem cells on microcarriers

The use of human mesenchymal stem cells (hMSCs) in regenerative medicine is a potential major advance for the treatment of many medical conditions, especially with the use of allogeneic therapies where the cells from a single donor can be used to treat ailments in many patients. Such cells must be grown attached to surfaces and for large scale production, it is shown that stirred bioreactors containing ~200 μm particles (microcarriers) can provide such a surface. It is also shown that the just suspended condition, agitator speed NJS, provides a satisfactory condition for cell growth by minimizing the specific energy dissipation rate, εT, in the bioreactor whilst still meeting the oxygen demand of the cells. For the cells to be used for therapeutic purposes, they must be detached from the microcarriers before being cryopreserved. A strategy based on a short period (~7 min) of very high εT, based on theories of secondary nucleation, is effective at removing >99% cells. Once removed, the cells are smaller than the Kolmogorov scale of turbulence and hence not damaged. This approach is shown to be successful for culture and detachment in 4 types of stirred bioreactors from 15 mL to 5 L.

(Para)translated ideologies in Simone de Beauvoir's 'Le deuxième sexe': the (para)translator's role

At the beginning of the 80s new approaches to translation were emerging in such a way that, in the global context of postmodernism and poststructuralism, they provoked a reassessment of Translation Studies (TS), acknowledging ideologies as a relevant concept to TS and considering the political and visible role of the translator. This introduction aims to establish a basic theoretical framework in which we can develop an analysis of the ‘alterations’ that, consciously or unconsciously, translators have imposed on Le deuxième sexe (1949, Gallimard) by Simone de Beauvoir for the last fifty years. Furthermore, it is essential to examine the divergences of the censoring attitude adopted by the first male translators (Parshley, Palant and Milliet) who considered this text to be a sex manual, and the one adopted by more recent female translators (Martorell and Simons) who considered it to be a philosophical book on feminism. Nevertheless, despite this tendency to consider that translators are the only professionals responsible for the translation process, it is necessary to bear in mind the work carried out by the paratranslator, who is the real censor and ‘decider’ of the way a work is presented to the translation community. Paratranslators work with paratexts (also known as ‘analysis-spaces’), and this makes it possible to study the ideological adaptation that a cultural object undergoes when it is incorporated into a new culture and society (covers, volumes, tables of contents, titles, iconic or visual elements and so forth). In short, the analysis of the texts and paratexts of Le deuxième sexe, along with its subsequent translations and rewritings into Spanish, Portuguese and English, will help reveal the function of the censoring apparatus and demonstrate the essential role that –without exception– ideologies play in the professional work of translation and paratranslation, since they have a decisive influence on the reception of the cultural (and ideological) object, in both the society in which it is created and that in which it is received.

An enigma still: Poujadism fifty years on

Few names resonate more loudly from the French Fourth Republic than that of Pierre Poujade, and few terms exude such a sulfurous odour as le poujadisme. Between 1953 and 1958, the Poujadists secured their place in modern French history, winning 52 seats in the National Assembly and inscribing a lasting entry in the lexicon of political protest. Taking as its starting point the fiftieth anniversary of Poujade’s movement held in its birthplace of Saint-Céré in July 2003, this article reassesses Poujadism fifty years on from its heyday. It considers Poujadism as the first important anti-globalisation movement in post-war France, a locus for the conflict between ‘stalemate’ traditionalism and socio-economic modernisation. It examines the trajectory of the Poujadists from anti-tax movement to political party, arguing the difficulty of defining Poujadism in classic political terms. In particular, the article takes issue with the perception of Poujadism as an extreme-right ideology and interprets it instead as a form of populist protest lacking a solid doctrinal core and opportunistic in its exploitation of political issues and allies. As such, it is argued, Poujadism represents a complex synthesis of both right-wing and left-wing values and discourses, as impervious to definition today as it was fifty years ago. The article considers the brief alliance of convenience between Poujade and Le Pen, and locates in Le Pen’s early Poujadist experience some of the methods and even some of the arguments used by the FN today. It concludes by discussing Poujade’s political activities after 1958, tracing his long-term conversion from violent opposition to the State under the Fourth Republic to co-operation under the Fifth. The author draws here on correspondence with Pierre Poujade up until his death in August 2003.

Political radicalism in France:perspectives on a protean concept

This introductory article reflects on the new momentum that political radicalism has taken on in France. The ebb and flow of radical aspiration featured regularly in French politics under the Fourth and early Fifth Republics, before the failure of the "Socialist experiment" in the early 1980s brought about a paradigm shift. In the wake of this failure and with the "end of ideology" supposedly in sight, political leaders and parties tempered their appeals to radical solutions and conspired, not least through recurrent power-sharing, to vacate mainstream political discourse of much of its former radicalism. Since the presidential election of 2007, however, there has been a marked return to promises of radical change as the common currency of political discourse across the full left-right spectrum in France. This article introduces a special issue of French Politics, Culture & Society that brings together scholars from France, Britain, and Canada to discuss some of the meanings, expressions, and prospects of political radicalism in France today.

Radical or not so radical? Tactical variation in core policy formation by the Front National

Starting from a number of general tenets about radical political parties, this article examines the Front National (FN) in relation to its core policy issue of immigration. To what extent has FN immigration policy been defined from the outset by its radicalism? Has that radicalism been constant or variable over time? And how far can a reciprocal influence be detected between the FN and the center Right in immigration policy formulation? Focusing on election campaigns, manifestos, and key moments in the FN's evolution, the article assesses how the party has tailored its radicalism to contextual factors and tactical considerations. It reveals an FN less bound to a fixed policy and more ready to seek accommodation (with circumstance, public opinion, or the center Right) than is generally acknowledged. Conversely, it also assesses how the FN's mobilization of strong support on the immigration issue has had radicalizing effects on the center Right. The article concludes by considering whether the change of leadership in January 2011 might confine the FN to the radical Right or see it adopt a more center-oriented course.

The far right vote in France:from consolidation to collapse?

The presidential and legislative elections of 2007 are widely seen to have marked the end of the far right as a major political force in France. How could this occur only five years after Le Pen’s qualification for the presidential run-off, and with his party seemingly in the ascendant? This article discusses recent fluctuations in far-right electoral performance in France. It focuses largely on the presidential elections of 2002 and 2007, re-examining the (supposed) upswell of far-right support in 2002 and its (supposed) subsidence in 2007. Both elections require nuanced interpretation. Both confounded poll predictions, which in 2007 failed to measure the effect of Sarkozy’s hard-right campaign and, crucially, the extent to which the border between “mainstream right” and “far right” had shifted since 2002. This allowed Sarkozy to drain part of Le Pen’s electorate, and raises questions over the longer-term impact of Le Pen and the FN on the political agenda in France.

Specialist business skills of international students

This paper follows on from that presented at the last BEST conference in Edinburgh (Higson & Hamilton-Jones(2004)). At that stage, the authors outlined their initial research work with students studying on the yearlong International Foundation programmes. at three local FE Colleges allied to Aston University. The research (funded by the University's Teaching Quality Enhancement Funds (TQEF) involved questionnaires and interviews with staff and students (the latter all from overseas). it aimed to identify ways to improve the learning experience of students on the International Foundation programmes, to aid their smooth transition to full degree programmes in Business and Management and to improve the progression rates of such students while studying at Aston. The initial research findings were used to design a module for those students' progress to degree programmes in Aston Business School. This paper discusses how the module was designed, its content and the assessment methods used to help determine whether students are achieving the learning outcomes. The basic principle was to identify areas of study where the International Foundation Programme students needed help in order to improve their learning styles to assist them with the requirements of other modules that they would be studying during their time at Aston. Particular emphasis was put on the need to develop active learners who were not disadvantaged by their lack of awareness of UK culture and society and who were as comfortable performing written work under examination conditions or presenting orally as their UK counterparts. An additional aim was to prepare these students for the placement year which was a compulsory part of their degree. The module, therefore, comprises a range of inputs for a number of staff, a company visit, weekly reflective learning leading to Personal Development Plan (PDP) work, formal examinations, presentations, group work •and individual case studies. This paper also reports on the initial reaction of the students and tutors to the new learning experience with currently 30 participants undertaking the module. Provisional findings suggest that the International Foundation programme has prepared the students well for degree-level work and that as a group of international students they are much more analytical and, after studying the module interactive than their counterparts who have come directly onto Aston degrees. It has shown them still to be quite passive learners, comfortable with facts and lecture-style learning environments, but less comfortable when asked to use their own initiatives. Continuing progress needs to be made in terms of encouraging them to develop a reflective approach to learning with the students taking some time to feel comfortable with an analytical approach to learning. In addition, im account of the students' reactions to having to work through a formal (PDP) and the results of their first assessments will be provided. At Aston, this work is being used as a pilot to recognise good practice with regards to work with further groups of international students. it is hoped that this would have widespread application across the sector.

Intellectual alienation in a fragmented society and universe, as illustrated in the work of Wolfgang Koeppen (1906- )

This text is concerned with the intellectual and social alienation experienced by a twentieth century German writer (1906 - ).·the alienation begins in the context of German society, but this context is later globalised. The thesis first discusses the social and· intellectual origins and the salient features of this alienated stance, before proceeding to a detailed analysis of its recurring symptoms and later intensification in each of the author's main works, chronologically surveyed, supported by reference to minor writings. From the novels of the thirties' showing the burgher-artist conflict, and its symbolic dichotomies, the renunciation of traditional German values, and the ambiguous confrontation with new disruptive socio-political forces, we move to the post-war trilogy (1951-54), with its roots in the German social and political experience of the thirties' onwards. The latter, however, is merely a background for the presentation of a much more comprehensive view of the human condition:- a pessimistic vision of the repetitiveness and incorrigibility of this condition, the possibility of the apocalypse, the bankruptcy and ineffectiveness of European religion and culture, the 'absurd' meaninglessness of history, the intellectual artist's position and role(s) in mass-culture and an abstract, technologised mass-society, the central theme of fragmentation - of the structure of reality, society and personality, the artist's relation to this fragmentation, intensified in the twentieth,century. Style and language are consonant with this world-picture. Many of these features recur in the travel-books (1958-61); diachronic as well as synchronic approaches characterise the presentation of various modes of contemporary society in America, Russia, France and other European countries. Important features of intellectual alienation are:- the changelessness of historical motifs (e.g. tyranny, aggression), the conventions of burgher society, both old and new forms, the qualitative depreciation and standardisation of living, industrialisation and technology in complex, vulnerable and concemtrated urban societies, ambiguities of fragmented pluralism. Reference is made .to other travel-writers.