Managing Cultural Diversity in Healthcare Partnerships: The Case of LIFT

Purpose: The National Health Service (NHS) Local Improvement Finance Trust (LIFT) programme was launched in 2001 as an innovative public-private partnership to address the historical under-investment in local primary care facilities in England. The organisations from the public and private sector that comprise a local LIFT partnership each have their own distinctive norms of behaviour and acceptable working practices - ultimately different organisational cultures. The purpose of this article is to assess the role of organisational culture in facilitating (or impeding) LIFT partnerships and to contribute to an understanding of how cultural diversity in public-private partnerships is managed at the local level. Design/methodology/approach: The approach taken was qualitative case studies, with data gathering comprising interviews and a review of background documentation in three LIFT companies purposefully sampled to represent a range of background factors. Elite interviews were also conducted with senior policy makers responsible for implementing LIFT policy at the national level. Findings: Interpreting the data against a conceptual framework designed to assess approaches to managing strategic alliances, the authors identified a number of key differences in the values, working practices and cultures in public and private organisations that influenced the quality of joint working. On the whole, however, partners in the three LIFT companies appeared to be working well together, with neither side dominating the development of strategy. Differences in culture were being managed and accommodated as partnerships matured. Research limitations/implications: As LIFT develops and becomes the primary source of investment for managing, developing and channelling funding into regenerating the primary care infrastructure, further longitudinal work might examine how ongoing partnerships are working, and how changes in the cultures of public and private partners impact upon wider relationships within local health economies and shape the delivery of patient care. Originality/value: To the authors' knowledge this is the first study of the role of culture in mediating LIFT partnerships and the findings add to the evidence on public-private partnerships in the NHS

British Film in the 1970s: Capital, Culture and Creativity

Throughout the 1970s the British film industry struggled to produce films which performed well at the box office and appealed to audiences. As a result the decade has often been considered as one of the low points of British cinema. But was this really the case? Conventional film histories of the decade have emphasised key texts and specific genres, such as the Bond films, the Carry On series or low budget horror. Yet British cinema in this period offered a great deal more to audiences and careful study of original documents demonstrates the diversity and variety of an industry, and a decade, typically perceived as limited and unimaginative. An examination of important material – much of it newly discovered or previously underused – offers an insight into the industry in this decade while key case studies present a detailed picture of the eclectic, diverse and often challenging film culture of the period.

Uniformity and diversity in religious education in Northern Ireland

This paper considers the tension that can exist in the aims of religious education between the desire to encourage open-minded, critical thinking through exposure to diverse traditions, ideas and cultures and the encouragement, overt or otherwise, into uniformity whereby learners take on the values of a particular tradition, culture or ideology (say of a religion, family or school). The particular situation of teaching religious education to post-primary school pupils in Northern Ireland is considered, and evidence cited to suggest that the Northern Ireland Core Syllabus in Religious Education has tried to impose a particular non-denominational Christian uniformity on pupils and teachers through its use of religious language. This has contributed to a culture of 'avoidance' in relation to the teaching of broad Christian diversity. The article concludes that there is a need for an ongoing and meaningful dialogue to discover what kind of balance between uniformity and diversity is best in teaching religious education in Northern Ireland, and notes that this also requires the reassessment of fundamental issues such as the aims of education and the relationship between secular and religious values in publicly funded schools. © 2004 Christian Education.

Possibilities for change? Diversity in Post-Conflict Belfast

Belfast is often presented as an exemplary divided or post-conflict city. However, this focus can be limiting and an exploration of alternative narratives for Belfast is needed. This paper investigates the diversification of post-conflict Belfast in light of the substantial migration which has occurred in the last decade, outlining the complexities of an emerging narrative of diversity. We note discrepancies in how racial equality is dealt with at an institutional level and report on the unevenness of migrant geographies, issues which require future consideration. We also raise questions that problematize the easy assumption that cultural diversity ameliorates existing sectarian divisions.

S21 Culture Independent Identification Of Bacterial Communities In The Respiratory Tract Of Patients With Copd, Healthy Non-smokers And Healthy Smokers

Introduction and aims: The role bacteria play in the development and progression of Chronic Obstructive Pulmonary Disease (COPD) is unclear. We used culture-independent methods to describe differences and/or similarities in microbial communities in the lower airways of patients with COPD, healthy non-smokers and smokers.

Methods: Bronchial wash samples were collected from patients with COPD (GOLD 1–3; n = 18), healthy non-smokers (HV; n = 11) and healthy smokers (HS; n = 8). Samples were processed using the Illumina MiSeq platform. The Shannon-Wiener Index (SW) of diversity, lung obstruction (FEV1/FVC ratio) and ordination by Non-Metric Multidimensional Scaling (NMDS) on Bray-Curtis dissimilarity indices were analysed to evaluate how samples were related. Principal component analysis (PCA) was performed to assess the effect specific taxa had within each cohort. Characteristics of each cohort are shown in Table 1.

Results: There was no difference in taxa richness between cohorts (range: 69–71; p = 0.954). Diversity (SW Index) was significantly lower in COPD samples compared to samples from HV and HS (p = 0.009 and p = 0.033, respectively). There was no significant difference between HV and HS (p = 0.186). The FEV1/FVC ratio was significantly lower for COPD compared to HV (p = 9*10–8) and HS (p = 2*10–6), respectively. NMDS analysis showed that communities belonging to either of the healthy groups were more similar to each other than they were to samples belonging to the COPD group. PCA analysis showed that members of Streptococcus sp. and Haemophilus sp. had the largest effect on the variance explained in COPD. In HS, Haemophilus sp., Fusobaterium sp., Actinomyces sp., Prevotella sp. and Veillonella sp. had the largest effect on the variance explained, while in HV Neisseria sp., Porphyromonas sp., Actinomyces sp., Atopobium sp., Prevotella and Veillonella sp. had the largest effect on the variance explained.

Conclusions: The study demonstrates that microbial communities in the lower airways of patients with COPD are significantly different from that seen in healthy comparison groups. Patients with COPD had lower microbial diversity than either of the healthy comparison groups, higher relative abundance of members of Streptococcus sp. and lower relative abundance of a number of key anaerobes.Characteristics

Understanding breast health awareness in an Arabic culture: qualitative study protocol

AIM: To explore breast health awareness and the early diagnosis and detection methods of breast cancer from the perspective of women and primary healthcare providers in the Jizan region of the Kingdom of Saudi Arabia.

BACKGROUND: Although there is a high incidence of advanced breast cancer in young women in the Kingdom of Saudi Arabia, there is no standardized information about breast self-examination, or is there a national screening programme involving clinical breast examination and mammography available.

DESIGN: Qualitative exploratory study.

METHODS: Data collection will consist of 36 face-to-face semi-structured interviews: 12 with general practitioners; 12 with nurses at primary healthcare centres and with 12 women who attend the health centres. This study will be carried out in eight states across the Jizan region (four rural and four urban) to reflect the cultural diversity of Jizan. The data will be analysed using thematic content analysis. Research Ethics Committee approval was obtained in June 2015.

DISCUSSION: While we understand the enablers and barriers to breast health awareness outside of Saudi culture, in the Kingdom of Saudi Arabia, particularly in rural populations such as Jizan, there is a lack of research. This study will add positively to the international knowledge base of this topic. The findings will give evidence and inform policy about women and healthcare providers' experiences in Jizan, in a society where such topics are taboo.

Molecular diversity and transferability of integrons from wastewaters

Na evolução bacteriana, a capacidade de explorar novos ambientes e de responder a diferentes pressões selectivas deve-se principalmente à aquisição de novos genes por transferência horizontal. Integrões são elementos genéticos bacterianos que constituem sistemas naturais de captura e expressão de cassetes de genes, sendo um dos principais mecanismos bacterianos envolvidos na aquisição de resistências a antibióticos. Estudos recentes suportam a hipótese de que os ambientes naturais constituem importantes reservatórios de integrões e cassetes de genes. Uma vez que as águas residuais são descarregadas em receptores naturais, torna-se fundamental conhecer a presença e dispersão de integrões nestes ambientes, assim como a sua associação a outros elementos genéticos móveis e a genes de resistências a antibióticos. Neste trabalho, pretendeu-se avaliar a prevalência e diversidade de integrões em águas residuais de origem animal e doméstica, bem como a sua associação a plasmídeos conjugativos, usando metodologias dependentes e independentes do cultivo de microrganismos em laboratório. Os resultados obtidos sustentam assim a hipótese de que ambientes particularmente ricos em matéria orgânica, como é o caso das águas residuais, constituem ambientes propícios à presença de integrões e à ocorrência de transferência horizontal de genes de resistência a antibióticos, embora a sua prevalência e diversidade seja influenciada pelo tipo de efluente em questão. A presença de integrões em estações de tratamento de águas residuais, e em especial nos efluentes tratados, constitui assim um factor preocupante, uma vez que tal contribui para a sua disseminação e dispersão por outros ecossistemas aquáticos, nomeadamente rios e mares. Os métodos utilizados permitiram também detectar uma elevada diversidade de cassetes de genes associadas a integrões, sendo possível que algumas dessas sequências codifiquem para proteínas que desempenhem um importante papel na adaptação bacteriana às intensas pressões selectivas características deste tipo de ambientes. Assim, é possível concluir que as comunidades bacterianas presentes em águas residuais reúnem diferentes tipos de elementos geneticamente móveis que desempenham um importante papel não só na adaptação bacteriana, mas também na disseminação de determinantes genéticos de resistência para ambientes naturais. Adicionalmente, a presença de potenciais proteínas com possíveis aplicações biotecnológicas reforça a importância das águas residuais como fontes de diversidade funcional. Este trabalho incluiu também a criação e implementação da base de dados INTEGRALL, desenvolvida com o intuito de congregar informação acerca de integrões e de uniformizar a nomenclatura de cassetes de genes.

Phylogenetic and functional diversity of estuarine bacterioneuston

A micro-camada superficial da água (SML) é caracterizada pela ocorrência de grandes quantidades de compostos orgânicos, pela acumulação de contaminantes antropogênicos e é submetida a uma intensa radiação solar, extrema mudança de temperatura e, no caso dos estuários, flutuação de salinidade. Estas propriedades físico-químicas estão, provavelmente, a modular a comunidade bacteriana (bacterioneuston) com propriedades filogenéticas e funcionais específicas. Neste estudo, as abordagens dependentes e independentes do cultivo foram aplicadas para avaliar a estrutura e dinâmica das comunidades bacterioneuston e bacterioplâncton em três localizações geográficas ao longo do estuário da Ria de Aveiro. Além disso, comparámos a diversidade filogenética de grupos específicos (Aeromonas, Pseudomonas e Psychrobacter) presentes em bacterioneuston e bacterioplâncton. Finalmente, as duas comunidades foram comparadas em termos de prevalência e diversidade de bactérias resistentes aos antibióticos e respetivos genes de resistência. Bactérias heterotróficas cultiváveis foram enriquecidas em SML. Eletroforese em gel de gradiente desnaturante (DGGE) permitiu a identificação de filotipos específicos em SML. Além disso, a análise de agrupamento dos perfis de DGGE de ambas as comunidades revelou uma ligeira tendência de agrupamento de acordo com a camada amostrada. As diferenças entre as duas comunidades variaram de acordo com factores espaciais e temporais. Em termos de diversidade filogenética de grupos específicos, não foram identificadas diferenças consistentes entre SML e UW com relação às comunidades de Aeromonas. Com relação ao género Pseudomonas, uma unidade operacional taxonómica cultivável foi consistentemente hiper-representada nas amostras de SML. Metodologias dependentes e independentes do cultivo revelaram a presença de populações de Psychrobacter complexas e muito estáveis em todos os sítios e datas de amostragens, com diferenças significativas entre as comunidades de Psychrobacter presentes em SML e UW. Estirpes representativas de prováveis novas espécies também foram cultivadas. Em termos de resistência aos antibióticos, a prevalência de bactérias resistentes em SML foi alta sugerindo selecção pelas condições presentes em SML. É preciso enfatizar que a resistência aos antibióticos foi incomum entre as bactérias estuarinas e os mecanismos de resistência foram, predominantemente, intrínsecos. Pela combinação de abordagens inovadoras dependentes e independentes do cultivo, este estudo forneceu novas e consistentes informações com relação às diferenças em ambas as comunidades bacterianas e em relação a alguns dos fatores que contribuem para a sua formação.

Communicating culture: strategic communication management of the contemporary art museums in the XXIth century, in Portugal: case studies: Museu Nacional de Arte Contemporânea: Lisboa; Museu de Arte Contemporânea de Serralves, no Porto; Museu de Arte Contemporânea de Elvas

Throughout the year and half of research developed during the times of crisis or economic crisis in Portugal due to the austerity measures, this thesis focuses on the cultural communication and museology in the area of cultural management in Portugal. With an ever growing number of research being developed over the world, this study is unique as it studies managerial diversity and organisational structures of Contemporary Art Museums that exist in Portugal but more importantly how they communicate their organizations within and beyond the Museum walls such as online or other technological media. As the communication management of the museums is one of aspects of culture in which cultural management intends to intervene. The research study that I proposed to analyse has at the forefront the intention to understand how the Contemporary Art Museums in Portugal manage their communication and respective organizations, whether they be a Public-Private/Foundation, State or Council run organizations but also understand if a strategic plan is designed and implemented in times of crisis, to withstand disruptive economic scenarios projected on a daily basis. The following Museums were selected due to the fact of being Contemporary Art Museums but also their respective diverse territorial distribution, one in the city capital of Portugal, Lisbon: MNAC – Museu Nacional de Arte Contemporânea, a stately run organisation; the second, in the north of Portugal: MACS – Museu de Arte Contemporânea de Serralves, a public/private organisation under the Foundation organics and the third Museum in interior central region of Portugal, Alentejo: MACE – Museu de Arte Contemporânea de Elvas, managed by the Elvas City Council.

Does more cycling mean more diversity in cycling?

In low-cycling countries, cycling is not evenly distributed across genders and age groups. In the UK, men are twice as likely as women to cycle to work and cycling tends to be dominated by younger adults. By contrast, in higher cycling countries and cities, gender differences are low, absent, or in the opposite direction. Such places also lack the UK's steady decline in cycling among those aged over 35 years. Over the past fifteen years some UK local areas have seen increases in cycling. This paper analyses data from the English and Welsh Census 2001 and 2011 to examine whether such increases are associated with greater diversity among cyclists. We find that in areas where cycling has increased, there has been no increase in the representation of females, and a decrease in the representation of older adults. We discuss potential causes and policy implications. Importantly, simply increasing cycling modal share has not proved sufficient to create an inclusive cycling culture. The UK's culturally specific factors limiting female take-up of cycling seem to remain in place, even where cycling has gone up. Creating a mass cycling culture may require deliberately targeting infrastructure and policies towards currently under-represented groups.

Identification and ethnic diversity underlie support for multicultural rights : a multilevel analysis in Bulgaria

Bulgaria is historically a multicultural society, composed of the Bulgarian (ethnic) majority and a number of ethnic minorities among which Bulgarian Turks and Roma are the largest. Both minority communities are stigmatized in contemporary Bulgaria, though to different degrees and for different reasons. Ethnic minorities' rights to preserve their culture, customs, and language are a topic of contentious debate. The purpose of this study was to examine individual- and context-level antecedents of the ethnic Bulgarian majority's support for multicultural rights of ethnic minorities. Multilevel regression analyses were conducted with International Social Survey Programme ISSP 2003 data (N = 920 in 28 Bulgarian districts). At the individual-level, an ethnic conception of the nation and anti-Roma symbolic prejudice were negatively related to support for multicultural rights, whereas national identification was positively related to the support of these rights. Over and above individual-level effects, and in line with recent extensions of intergroup contact theory, thepercentage ofBulgarianTurks withindistricts was positively related to support for multicultural rights. Importantly, support for multicultural rights was particularly high in districts characterized by ethnic diversity, that is, in districts with high proportions of both Bulgarian Turks and Roma. The beneficial effects of ethnic diversity and theoretical implications of findings are discussed.

The Supreme Court’s Understanding of Federalism: Efficiency at the Expense of Diversity

This paper is an examination of the Supreme Court of Canada's interpretation of federalism since constitutional repatriation in 1982. It argues that the lure of centralist efficiency is overpowering a fundamentally important part of our federal order: regionalism. The author contends that changes made by the Court to certain fundamental concepts of Canadian constitutional law now provide Parliament with greater latitude than before in the exercise of its legislative powers. According to the author, these changes are disturbing because they are structured so as to preclude consideration of the legitimate concerns of regional polities. Furthermore, he argues that the Court has reinforced the central government's power to regulate the economy, including intraprovincial matters affecting trade, by resorting to highly functional tests that emphasize economic efficiency over other criteria. This, he claims, makes it more difficult to invoke legitimate regional interests that would lead to duplication, overlapping and even, in the eyes of some, inefficiency. The author the focuses on the Court's treatment of environmental protection in an attempt to show the tension between the Court's desire to use a functional approach and the need to recognize regional interests. Finally, through an examination of recent case law, he attemps to demonstrate that the Court's dominant perspective remains functional despite its endorsement of a more community-oriented undestanding of federalism in Secession Reference. If the Court chooses to proceed in this manner, it will alienate regional polities and may encourage them to choose more radical means of asserting their differences. Further, the author argues that strict adherence to the functional effectiveness approach will undermine the very values that federalism is meant to promote.

Rawlsian justice and the challenge of diversity

Ce mémoire examine le rôle de la diversité dans une conception de la justice. Je débute en considérant l’abstraction de la différence impliquée dans le raisonnement utilisé pour arriver à une conception de la justice. Par la suite j’évalue le rôle des différences des groupes sociaux dans l’application des principes de justice, en considérant si la justice exige des droits individuels ou si les groupes peuvent revendiquer des droits différenciés. Ce mémoire utilise la position originale de John Rawls pour évaluer la première question, et sa conception de la personne et des groupes sociaux pour examiner la deuxième. Je soutiens que nous pouvons et devrions utiliser l’abstraction de la position originale, tant que nous sommes conscients de ses limites. Bien que sa conception politique de la personne soit également utile pour la défense des droits individuels, sa conception du groupe social n’est pas appropriée pour les groupes culturels ou historiquement opprimés, car il repose trop lourdement sur la notion d’association volontaire. J’analyse l’argument de Will Kymlicka concernant les droits minoritaires et j’enrichis la théorie de Rawls en ajoutant l’inégalité entre groupes. Je termine en examinant les problèmes concernant les minorités à l’intérieur des groupes minoritaires et conclue que les droits minoritaires ne sont justifiées que lorsqu’ils sont compatibles avec les droits individuels, et non pas quand ils renforcent une autre inégalité. Par conséquent, même si l’abstraction au niveau théorique est justifiée, les droits des groupes minoritaires exigeront qu’on porte une attention aux différences entres groupes, ainsi qu’à l’intérieur de ceux-ci.

Je qui devient Nous et Nous qui devient Je : sens unitaire de la culture chez Hegel

Le thème de la culture (Bildung) se caractérise d’abord, dans l’ensemble de l’œuvre de Hegel, par sa diversité contextuelle. Bien que la culture y soit définie spécifiquement comme un mode de développement propre à l’humain, à la différence de l’usage usuel du terme en allemand, cette diversité fait en sorte qu’on la retrouve aussi bien dans les remarques anthropologiques les plus anodines que dans les passages s’intéressant à l’histoire de l’esprit du monde ou encore les textes de nature politique. Il s’agit donc, dans le présent travail, d’étudier pour eux-mêmes les différents contextes généraux dans lesquels la notion apparaît (Phénoménologie de l’esprit, philosophie politique et philosophie de l’histoire) pour en arriver à retracer le fil conducteur donnant à la culture hégélienne son unité de sens. Loin d’être un concept indéterminé, la culture désigne, à tous les niveaux où il se manifeste, le dynamisme propre à l’esprit.

Cultural diversity and toleration

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal