Culture, compassion and clinical neglect: probity in the NHS after Mid Staffordshire

Speaking of the public response to the deaths of children at the Bristol Royal Infirmary before 2001, the BMJ commented that the NHS would be 'all changed, changed utterly'. Today, two inquiries into the Mid Staffordshire Foundation Trust suggest nothing changed at all. Many patients died as a result of their care and the stories of indifference and neglect there are harrowing. Yet Bristol and Mid Staffordshire are not isolated reports. In 2011, the Health Services Ombudsman reported on the care of elderly and frail patients in the NHS and found a failure to recognise their humanity and individuality and to respond to them with sensitivity, compassion and professionalism. Likewise, the Care Quality Commission and Healthcare Commission received complaints from patients and relatives about the quality of nursing care. These included patients not being fed, patients left in soiled bedding, poor hygiene practices, and general disregard for privacy and dignity. Why is there such tolerance of poor clinical standards? We need a better understanding of the circumstances that can lead to these outcomes and how best to respond to them. We discuss the findings of these and other reports and consider whether attention should be devoted to managing individual behaviour, or focus on the systemic influences which predispose hospital staff to behave in this way. Lastly, we consider whether we should look further afield to cognitive psychology to better understand how clinicians and managers make decisions?

La monarquia francesa y los financieros en el Antiguo Régimen. El ejemplo de los traitants durante la Guerra de los Nueve Años, 1689-1697 = The French Monarchy and the financiers during the Old Regime. The case of the traitants during the Nine Years War, 1689-1697

This article explores the relationship between the Crown, the French society and the king's financiers. It starts with a brief review of the discourses on the financiers and a survey of the work done by historians. Further to a description of the various groups of financiers, it analyses the nature of the contracts passed between the king and the traitants to pay for the Nine Years War, as well as the latter’s activities and profits. The article argues that the government supervised effectively the traitants and that, given the constraints of the Old Regime, these financiers provided essential services, but too costly to be sustainable.

Frames and the interpreter in the Imperial War Museum photographic archive

Using Azoulay's frame of the civil gaze, this chapter examines selected Second World War images, catalogued under 'interpreter' in the IWM's photographic archive, looking at representative situations in which interpreters typically operate in wartime - communicating with clandestine forces, liaising between the army and civilians, and dealing with the aftermath of war.

Virgil's fourth Eclogue and the visual arts

Virgil's poetry has frequently appeared in illustrated editions, and has regularly provided subjects for other works of art, including some of the most celebrated masterpieces of the western tradition. In view of its constant appropriation in literary contexts over the course of the centuries, we might expect the famous fourth Eclogue (the so-called ‘messianic’ eclogue) to have exerted more of an impact on visual culture than it appears to have done. This paper considers some of the possible reasons for the apparent scarcity of engagement with Virgil's poem beyond the literary sphere, and examines the uses to which the poet's text is put when it does make an appearance in visual media — perhaps more often than has sometimes been supposed.

The Italian academies 1525-1700: networks of culture, innovation and dissent

The intellectual societies known as Academies played a vital role in the development of culture, and scholarly debate throughout Italy between 1525-1700. They were fundamental in establishing the intellectual networks later defined as the ‘République des Lettres’, and in the dissemination of ideas in early modern Europe, through print, manuscript, oral debate and performance. This volume surveys the social and cultural role of Academies, challenging received ideas and incorporating recent archival findings on individuals, networks and texts. Ranging over Academies in both major and smaller or peripheral centres, these collected studies explore the interrelationships of Academies with other cultural forums. Individual essays examine the fluid nature of academies and their changing relationships to the political authorities; their role in the promotion of literature, the visual arts and theatre; and the diverse membership recorded for many academies, which included scientists, writers, printers, artists, political and religious thinkers, and, unusually, a number of talented women. Contributions by established international scholars together with studies by younger scholars active in this developing field of research map out new perspectives on the dynamic place of the Academies in early modern Italy. The publication results from the research collaboration ‘The Italian Academies 1525-1700: the first intellectual networks of early modern Europe’ funded by the Arts and Humanities Research Council and is edited by the senior investigators.

Resources, staff beliefs and organizational culture: factors in the use of information and communication technology for adults with intellectual disabilities

Background  Access to, and the use of, information and communication technology (ICT) is increasingly becoming a vital component of mainstream life. First-order (e.g. time and money) and second-order factors (e.g. beliefs of staff members) affect the use of ICT in different contexts. It is timely to investigate what these factors may be in the context of service provision for adults with intellectual disabilities given the role ICT could play in facilitating communication and access to information and opportunities as suggested in Valuing People. Method  Taking a qualitative approach, nine day service sites within one organization were visited over a period of 6 months to observe ICT-related practice and seek the views of staff members working with adults with intellectual disabilities. All day services were equipped with modern ICT equipment including computers, digital cameras, Internet connections and related peripherals. Results  Staff members reported time, training and budget as significant first-order factors. Organizational culture and beliefs about the suitability of technology for older or less able service users were the striking second-order factors mentioned. Despite similar levels of equipment, support and training, ICT use had developed in very different ways across sites. Conclusion  The provision of ICT equipment and training is not sufficient to ensure their use; the beliefs of staff members and organizational culture of sites play a substantial role in how ICT is used with and by service users. Activity theory provides a useful framework for considering how first- and second-order factors are related. Staff members need to be given clear information about the broader purpose of activities in day services, especially in relation to the lifelong learning agenda, in order to see the relevance and usefulness of ICT resources for all service users.

The politics of slowness and the traps of modernity

This chapter re-evaluates the diachronic, evolutionist model that establishes the Second World War as a watershed between classical and modern cinemas, and ‘modernity’ as the political project of ‘slow cinema’. I will start by historicising the connection between cinematic speed and modernity, going on to survey the veritable obsession with the modern that continues to beset film studies despite the vagueness and contradictions inherent in the term. I will then attempt to clarify what is really at stake within the modern-classical debate by analysing two canonical examples of Japanese cinema, drawn from the geidomono genre (films on the lives of theatre actors), Kenji Mizoguchi’s Story of the Late Chrysanthemums (Zangiku monogatari, 1939) and Yasujiro Ozu’s Floating Weeds (Ukigusa, 1954), with a view to investigating the role of the long take or, conversely, classical editing, in the production or otherwise of a supposed ‘slow modernity’. By resorting to Ozu and Mizoguchi, I hope to demonstrate that the best narrative films in the world have always combined a ‘classical’ quest for perfection with the ‘modern’ doubt of its existence, hence the futility of classifying cinema in general according to an evolutionary and Eurocentric model based on the classical-modern binary. Rather than on a confusing politics of the modern, I will draw on Bazin’s prophetic insight of ‘impure cinema’, a concept he forged in defence of literary and theatrical screen adaptations. Anticipating by more than half a century the media convergence on which the near totality of our audiovisual experience is currently based, ‘impure cinema’ will give me the opportunity to focus on the confluence of film and theatre in these Mizoguchi and Ozu films as the site of a productive crisis where established genres dissolve into self-reflexive stasis, ambiguity of expression and the revelation of the reality of the film medium, all of which, I argue, are more reliable indicators of a film’s political programme than historical teleology. At the end of the journey, some answers may emerge to whether the combination of the long take and the long shot are sufficient to account for a film’s ‘slowness’ and whether ‘slow’ is indeed the best concept to signify resistance to the destructive pace of capitalism.

The Lieber Code and the regulation of civil war in international law

In this paper, we consider one particularly interesting feature of the Lieber Code, which is the fact that it was drawn up by the U.S. Government to regulate the conduct of its armed forces in a civil war. In so doing, we hope to explore the extent to which there may be links between the Lieber Code and the contemporary regulation of non-international armed conflicts. In particular, we explore some similarities and contrasts between the views on the regulation of civil war that existed at the time of the drafting of the Lieber Code and the position that exists today.

The bubbles or the boiling pot? An ecosystemic approach to culture, environment and quality of life

For the diagnosis and prognosis of the problems of quality of life, a multidisciplinary ecosystemic approach encompasses four dimensions of being-in-the-world, as donors and recipients: intimate, interactive, social and biophysical. Social, cultural and environmental vulnerabilities are understood and dealt with, in different circumstances of space and time, as the conjugated effect of all dimensions of being-in-the-world, as they induce the events (deficits and assets), cope with consequences (desired or undesired) and contribute for change. Instead of fragmented and reduced representations of reality, diagnosis and prognosis of cultural, educational, environmental and health problems considers the connections (assets) and ruptures (deficits) between the different dimensions, providing a planning model to develop and evaluate research, teaching programmes, public policies and field projects. The methodology is participatory, experiential and reflexive; heuristic-hermeneutic processes unveil cultural and epistemic paradigms that orient subject-object relationships; giving people the opportunity to reflect on their own realities, engage in new experiences and find new ways to live better in a better world. The proposal is a creative model for thought and practice, providing many opportunities for discussion, debate and development of holistic projects integrating different scientific domains (social sciences, psychology, education, philosophy, etc.).

Melatonin and the time window for the expression of the alpha 8 nicotinic acetylcholine receptor in the membrane of chick retinal cells in culture

We have previously shown that melatonin influences the development of alpha 8 nicotinic acetylcholine receptor (nAChR) by measurement of the acetylcholine-induced increase in the extracellular acidification rate (ECAR) in chick retinal cell cultures. Cellular differentiation that takes place between DIV (days in vitro) 4 and DIV 5 yields cells expressing alpha 8 nAChR and results in a significant increase in the ECAR acetylcholine-induced. Blocking melatonin receptors with luzindole for 48 h suppresses the development of functional alpha 8 nAChR. Here we investigated the time window for the effect of melatonin on retinal cell development in culture, and whether this effect was dependent on an increase in the expression of alpha 8 nAChR. First, we confirmed that luzindole was inhibiting the effects of endogenous melatonin, since it increases 2-[(125)I] iodomelatonin (23 pM) binding sites density in a time-dependent manner. Then we observed that acute (15, 60 min, or 12 h) luzindole treatment did not impair acetylcholine-induced increase in the ECAR mediated by activation of alpha 8 nAChR at DIV 5, while chronic treatment (from DIV 3 or DIV 4 till DIV 5, or DIV 3.5 till DIV 4.5) led to a time-dependent reduction of the increase in the acetylcholine-induced ECAR. The binding parameters for [(125)I]-alpha-bungarotoxin (10 nM) sites in membrane were unaffected by melatonin suppression that started at DIV 3. Thus, melatonin surges in the time window that occurs at the final stages of chick retinal cell differentiation in culture is essential for development of the cells expressing alpha 8 nAChR subtype in full functional form. (C) 2010 ISDN. Published by Elsevier Ltd. All rights reserved.

The mass media destabilizes the cultural homogenous regime in Axelrod`s model

An important feature of Axelrod`s model for culture dissemination or social influence is the emergence of many multicultural absorbing states, despite the fact that the local rules that specify the agents interactions are explicitly designed to decrease the cultural differences between agents. Here we re-examine the problem of introducing an external, global interaction-the mass media-in the rules of Axelrod`s model: in addition to their nearest neighbors, each agent has a certain probability p to interact with a virtual neighbor whose cultural features are fixed from the outset. Most surprisingly, this apparently homogenizing effect actually increases the cultural diversity of the population. We show that, contrary to previous claims in the literature, even a vanishingly small value of p is sufficient to destabilize the homogeneous regime for very large lattice sizes.

Videography as production nexus : digital film cameras, media mangement and the distribution of creativity

This thesis is about new digital moving image recording technologies and how they augment the distribution of creativity and the flexibility in moving image production systems, but also impose constraints on how images flow through the production system. The central concept developed in this thesis is ‘creative space’ which links quality and efficiency in moving image production to time for creative work, capacity of digital tools, user skills and the constitution of digital moving image material. The empirical evidence of this thesis is primarily based on semi-structured interviews conducted with Swedish film and TV production representatives.This thesis highlights the importance of pre-production technical planning and proposes a design management support tool (MI-FLOW) as a way to leverage functional workflows that is a prerequisite for efficient and cost effective moving image production.

Historical Consciousness, Historical Media, and History Education

This thesis by publication contains an introductory summary chapter and three papers. The first paper presents a study of how the concept of historical consciousness has been defined, applied, and justified in Swedish history didactical research. It finds that there is consensus regarding the definition of what a historical consciousness is, but that there is variation in how the concept is applied. It is suggested that this variation makes historical con­sciousness a complex and vague concept.      The second paper uses the results presented in the first paper as a point of departure and from thence argues for a broadened understanding of the concept of historical consciousness that incorporates its definition, applica­tion, development, and significance. The study includes research about his­torical consciousness primarily from Sweden, the UK, the USA and Canada. The paper presents a typology of historical consciousness and argues that level of contextualisation is what distinguishes different types of historical consciousnesses and that an ability to contextualise is also what makes his­torical consciousness an important concept for identity constitution and morality.      The third paper proposes a methodological framework of historical con­sciousness based on the theory of historical consciosusness presented in the second paper. It presents arguments for why the framework of historical consciousness proposed can be useful for the analysis of historical media and it discusses how aspects of the framework can be applied in analysis. It then presents a textbook analysis that has been performed according to the stipulated framework and discusses its results regarding how textbooks can be used to analyse historical consciousness and its development.

'Moving On' and Transitional Bridges : Studies on migration, violence and wellbeing in encounters with Somali-born women and the maternity health care in Sweden

During the latest decade Somali-born women with experiences of long-lasting war followed by migration have increasingly encountered Swedish maternity care, where antenatal care midwives are assigned to ask questions about exposure to violence. The overall aim in this thesis was to gain deeper understanding of Somali-born women’s wellbeing and needs during the parallel transitions of migration to Sweden and childbearing, focusing on maternity healthcare encounters and violence. Data were obtained from medical records (paper I), qualitative interviews with Somali-born women (II, III) and Swedish antenatal care midwives (IV). Descriptive statistics and thematic analysis were used. Compared to pregnancies of Swedish-born women, Somali-born women’s pregnancies demonstrated later booking and less visits to antenatal care, more maternal morbidity but less psychiatric treatment, less medical pain relief during delivery and more emergency caesarean sections and small-for-gestational-age infants (I). Political violence with broken societal structures before migration contributed to up-rootedness, limited healthcare and absent state-based support to women subjected to violence, which reinforced reliance on social networks, own endurance and faith in Somalia (II). After migration, sources of wellbeing were a pragmatic “moving-on” approach including faith and motherhood, combined with social coherence. Lawful rights for women were appreciated but could concurrently risk creating power tensions in partner relationships. Generally, the Somali-born women associated the midwife more with providing medical care than with overall wellbeing or concerns about violence, but new societal resources were parallel incorporated with known resources (III). Midwives strived for woman-centered approaches beyond ethnicity and culture in care encounters, with language, social gaps and divergent views on violence as potential barriers in violence inquiry. Somali-born women’s strength and contentment were highlighted, and ongoing violence seldom encountered according to the midwives experiences (IV). Pragmatism including “moving on” combined with support from family and social networks, indicate capability to cope with violence and migration-related stress. However, this must be balanced against potential unspoken needs at individual level in care encounters.With trustful relationships, optimized interaction and networking with local Somali communities and across professions, the antenatal midwife can have a “bridging-function” in balancing between dual societies and contribute to healthy transitions in the new society.