Whose health, whose care, whose say? Some comments on public involvement in new NHS commissioning arrangements

Recent health policy in England has demanded greater involvement of patients and the public in the commissioning of health and social care services. Public involvement is seen as a means of driving up service quality, reducing health inequalities and achieving value in commissioning decisions. This paper presents a summary and analysis of the forms that public involvement in commissioning are to take, along with empirical analysis from a qualitative study of service-user involvement. It is argued that the diversity of constituencies covered by the notion of ‘public involvement’, and the breadth of aims that public involvement is expected to achieve, require careful disaggregation. Public involvement in commissioning may encompass a variety of interest groups, whose inputs may include population needs assessment, evaluation of service quality, advocacy of the interests of a particular patient group or service, or a combination of all of these. Each of these roles may be legitimate, but there are significant tensions between them. The extent to which the structures for public involvement proposed recognize these possible tensions is arguably limited. Notably, new Local Involvement Networks (LINks), which will feed into commissioning decisions, are set as the arbiters of these different interests, a demanding role which will require considerable skill, tenacity and robustness if it is to be fulfilled effectively.

Resilience to Climate Change: An Ethnographic Approach

Global projections for climate change impacts produce a startling picture of the future for low-lying coastal communities. The United States’ Chesapeake Bay region and especially marginalized and rural communities will be severely impacted by sea level rise and other changes over the next one hundred years. The concept of resilience has been theorized as a measure of social-ecological system health and as a unifying framework under which people can work together towards climate change adaptation. But it has also been critiqued for the way in which it does not adequately take into account local perspective and experiences, bringing into question the value of this concept as a tool for local communities. We must be sure that the concerns, weaknesses, and strengths of particular local communities are part of the climate change adaptation, decision-making, and planning process in which communities participate. An example of this type of planning process is the Deal Island Marsh and Community Project (DIMCP), a grant funded initiative to build resilience within marsh ecosystems and communities of the Deal Island Peninsula area of Maryland (USA) to environmental and social impacts from climate change. I argue it is important to have well-developed understandings of vulnerabilities and resiliencies identified by local residents and others to accomplish this type of work. This dissertation explores vulnerability and resilience to climate change using an engaged and ethnographic anthropological perspective. Utilizing participant observation, semi-structured and structured interviews, text analysis, and cultural domain analysis I produce an in-depth perspective of what vulnerability and resilience means to the DIMCP stakeholder network. Findings highlight significant vulnerabilities and resiliencies inherent in the local area and how these interface with additional vulnerabilities and resiliencies seen from a nonlocal perspective. I conclude that vulnerability and resilience are highly dynamic and context-specific for the local community. Vulnerabilities relate to climate change and other social and environmental changes. Resilience is a long-standing way of life, not a new concept related specifically to climate change. This ethnographic insight into vulnerability and resilience provides a basis for stronger engagement in collaboration and planning for the future.

Desarrollo de un método para la evaluación de la gestión de mantenimiento de edificios multifamiliares ubicados en la ciudad de Cuenca

El deterioro es un proceso que afecta a toda edificación y una de sus causas es el mantenimiento deficiente. El mantenimiento involucra a actividades técnicas, administrativas y de gestión necesarias para conservar a una edificación o devolverle a un estado en el que pueda realizar la función requerida. Identificar cuál es el desempeño de un edificio en el área de la gestión de mantenimiento resulta preciso. Por lo cual el objetivo de este estudio es desarrollar un método para la evaluación de la gestión de mantenimiento en edificios multifamiliares ubicados en la ciudad de Cuenca. Para el efecto, es necesario responder las preguntas ¿cuáles son los requerimientos y criterios para la evaluación de la gestión de mantenimiento de edificios multifamiliares? y ¿cuáles son sus ponderaciones?, considerando el contexto local de la ciudad de Cuenca. La investigación se desarrolla en tres fases, empieza por la determinación de los criterios de evaluación; priorización de los requerimientos y criterios seleccionados, para lo cual se emplea el método AnalyticHierarchyProcess a través de la consulta a expertos: arquitectos, administradores de edificios y profesionales con grado de maestría en gestión de mantenimiento, se finaliza desarrollando el método de evaluación. El estudio determina que los requerimientos más importantes de la gestión de mantenimiento de edificios multifamiliares, en el área local son: el diseño del edificio, los riesgos laborales en el mantenimiento y la planificación, programación y control del mantenimiento. La metodología ha sido aplicada satisfactoriamente a un edificio multifamiliar en la ciudad de Cuenca.

Modeling, Simulation, and Characterization of Space Debris in low-Earth Orbit

Every space launch increases the overall amount of space debris. Satellites have limited awareness of nearby objects that might pose a collision hazard. Astrometric, radiometric, and thermal models for the study of space debris in low-Earth orbit have been developed. This modeled approach proposes analysis methods that provide increased Local Area Awareness for satellites in low-Earth and geostationary orbit. Local Area Awareness is defined as the ability to detect, characterize, and extract useful information regarding resident space objects as they move through the space environment surrounding a spacecraft. The study of space debris is of critical importance to all space-faring nations. Characterization efforts are proposed using long-wave infrared sensors for space-based observations of debris objects in low-Earth orbit. Long-wave infrared sensors are commercially available and do not require solar illumination to be observed, as their received signal is temperature dependent. The characterization of debris objects through means of passive imaging techniques allows for further studies into the origination, specifications, and future trajectory of debris objects. Conclusions are made regarding the aforementioned thermal analysis as a function of debris orbit, geometry, orientation with respect to time, and material properties. Development of a thermal model permits the characterization of debris objects based upon their received long-wave infrared signals. Information regarding the material type, size, and tumble-rate of the observed debris objects are extracted. This investigation proposes the utilization of long-wave infrared radiometric models of typical debris to develop techniques for the detection and characterization of debris objects via signal analysis of unresolved imagery. Knowledge regarding the orbital type and semi-major axis of the observed debris object are extracted via astrometric analysis. This knowledge may aid in the constraint of the admissible region for the initial orbit determination process. The resultant orbital information is then fused with the radiometric characterization analysis enabling further characterization efforts of the observed debris object. This fused analysis, yielding orbital, material, and thermal properties, significantly increases a satellite’s Local Area Awareness via an intimate understanding of the debris environment surrounding the spacecraft.

Library, Archives and Museum Annual Assessment Report, 2004-2005

The Library, Archives and Museum are a major component of South Carolina’s only state-assisted military college, The Citadel. They participate in the teaching, research, and public service programs of The Citadel: by providing scholarly information; by the acquisition, organization, management, preservation, and arrangement of collections for access and use; by provision of supportive reference and instruction services; and by a variety of cooperative and reciprocal programs in the local area, the region and the state. This annual report discusses their activities for the year 2004/05.

South Carolina's employment situation-April 2010

The South Carolina Department of Employment and Workforce publishes news releases with monthly statistics about the employment situation of the state, including unemployment rate, employment by industry, and local area unemployment by county and MSA.

South Carolina's employment situation-May 2010

The South Carolina Department of Employment and Workforce publishes news releases with monthly statistics about the employment situation of the state, including unemployment rate, employment by industry, and local area unemployment by county and MSA.

South Carolina's employment situation-July 2010

The South Carolina Department of Employment and Workforce publishes news releases with monthly statistics about the employment situation of the state, including unemployment rate, employment by industry, and local area unemployment by county and MSA.

South Carolina's employment situation-October 2010

The South Carolina Department of Employment and Workforce publishes news releases with monthly statistics about the employment situation of the state, including unemployment rate, employment by industry, and local area unemployment by county and MSA.

South Carolina's employment situation-December 2010

The South Carolina Department of Employment and Workforce publishes news releases with monthly statistics about the employment situation of the state, including unemployment rate, employment by industry, and local area unemployment by county and MSA.

South Carolina's employment situation-January 2011

The South Carolina Department of Employment and Workforce publishes news releases with monthly statistics about the employment situation of the state, including unemployment rate, employment by industry, and local area unemployment by county and MSA.

South Carolina's employment situation-February 2011

The South Carolina Department of Employment and Workforce publishes news releases with monthly statistics about the employment situation of the state, including unemployment rate, employment by industry, and local area unemployment by county and MSA.

South Carolina's employment situation-March 2011

The South Carolina Department of Employment and Workforce publishes news releases with monthly statistics about the employment situation of the state, including unemployment rate, employment by industry, and local area unemployment by county and MSA.

South Carolina's employment situation-April 2011

The South Carolina Department of Employment and Workforce publishes news releases with monthly statistics about the employment situation of the state, including unemployment rate, employment by industry, and local area unemployment by county and MSA.

South Carolina's employment situation-May 2011

The South Carolina Department of Employment and Workforce publishes news releases with monthly statistics about the employment situation of the state, including unemployment rate, employment by industry, and local area unemployment by county and MSA.