Resistance or Resilience? Tracking the Pathway of Recent Arrivals to a ‘New’ Rural Destination

Recent patterns of migration indicate that international migrants are not confined to urban gateways. Instead many migrants have settled in new destination areas located in rural and small town areas. While this might appear to be a positive phenomenon for rural areas struggling with decline and stagnation, the reality is that many of these areas are ill-equipped to manage the rate and pace of change that has been witnessed in recent years. Migration to established, typically urban areas has been the subject of extensive research. However, little is known about the way in which migrants navigate their way through social structures as they settle into destinations with little experience of immigration. Using empirical research, this article considers the way in which migrants navigate their way through social structures to establish life in a so-called ‘new’ migration destination. It analyses the way in which government and civil society respond to their needs of recent arrivals, showing how both NGO’s and the statutory sector play an important role in this process. It considers the ramifications for these different sectors and the implications for so-called ‘new’ destinations as they become more established or ‘mature’ areas of immigration.

The legacy of past manuring practices on soil contamination in remote rural areas

This paper demonstrates that there can be a legacy of contamination on former arable land in remote rural areas as a result of past manuring practices. In the first part of the study four farms abandoned in the late 19th to mid-20th century were investigated with samples collected from residual material in domestic hearths, the midden heaps, kailyards (walled garden for vegetables), infields (intensively managed arable land) and outfields (less intensively managed land for cropping or grazing). Consistent sequences in concentration values were found for such elements as Pb, Zn, Cu and P in the order hearth>midden>kailyard>infield>outfield. Such patterns can in part be explained in terms of atmospheric deposition on peat and turf which were subsequently burnt in hearths to result in enhanced elemental concentrations. The ash then was deposited in midden heaps and subsequently on kailyards or infields. In the second part, microanalytical results from St. Kilda are discussed. Enhanced loadings of Pb and Zn were found in the old arable land. The highest levels of Zn were found in small fragments of carbonised and humified material and bone fragments; in contrast Pb tended to be more uniformly distributed. Seabird waste was extensively applied to the arable land and some of the Zn may have accumulated in the soil by this pathway. The retention of Zn in bone is likely to have been very minor given the rarity of bone fragments as evident in thin sections (0.3%); this compares with 6.8% for black carbonised particles which are likely to provide the main storage sites for Zn.

The influence of evidence-based medicine training on decision-making in relation to over-the-counter medicines: a qualitative study

Objectives
To explore the role of evidence of effectiveness when making decisions about over-the-counter (OTC) medication and to ascertain whether evidence-based medicine training raised awareness in decision-making. Additionally, this work aimed to complement the findings of a previous study because all participants in this current study had received training in evidence-based medicine (unlike the previous participants).

Methods
Following ethical approval and an e-mailed invitation, face-to-face, semi-structured interviews were conducted with newly registered pharmacists (who had received training in evidence-based medicine as part of their MPharm degree) to discuss the role of evidence of effectiveness with OTC medicines. Interviews were recorded and transcribed verbatim. Following transcription, all data were entered into the NVivo software package (version 8). Data were coded and analysed using a constant comparison approach.

Key findings
Twenty-five pharmacists (7 males and 18 females; registered for less than 4 months) were recruited and all participated in the study. Their primary focus with OTC medicines was safety; sales of products (including those that lack evidence of effectiveness) were justified provided they did no harm. Meeting patient expectation was also an important consideration and often superseded evidence. Despite knowledge of the concept, and an awareness of ethical requirements, an evidence-based approach was not routinely implemented by these pharmacists. Pharmacists did not routinely utilize evidence-based resources when making decisions about OTC medicines and some felt uncomfortable discussing the evidence-base for OTC products with patients.

Conclusions
The evidence-based medicine training that these pharmacists received appeared to have limited influence on OTC decision-making. More work could be conducted to ensure that an evidence-based approach is routinely implemented in practice

The City as Laboratory and the Urban-Rural Divide: the Revival of Private Property and its Limits in Post-Mao China

This paper focuses on the revival of private property and its limits in urban China. It explores the emergence of urban property markets; urban property-holding in relation to the complexity of urban governance; “minor property rights apartments” that form a de facto real estate market and cross over the urban-rural divide; the “grey areas” of blurring legal and administrative boundaries in modern China; and recent changes to the rural land system and the rural-urban divide. The conclusion flags the theme of the city as laboratory with regard to the blurring legal and governmental urban-rural distinction.

The End of the Urban-Rural Divide?

The urban-rural divide in China was an entrenched feature of Chinese society in the Maoist era. This divide generated and continues to generate inequality as between the rural population and the urban population. In post-Deng China, legal and administrative distinctions between urban and rural have become blurred, especially with the development of rural-urban migration. Nevertheless, the urban-rural divide still exists, and the income of farmers is below that of urban residents. In this paper, it is argued that the emergence of the phenomenon of “quasi-commons” in rural China, crossing the “borders” of the urbanrural divide, may increase farmers’ income in the future and bridge this divide. The paper focuses on different forms of “quasi-commons” (the sharing and use of communal land) emerging in rural areas, including the farmland shareholding cooperatives and transforming rural land management rights into shares in joint ventures. There are divergent views held by Chinese academics and policy makers about “quasi-commons” in rural China, as well as the direction of change in the rural land system. However, most of the proposals for reform have been polarized between nationalization and privatization of rural land. Looking beyond this “boundary thinking” and drawing on the discourses of “the commons” (for example, the writings of Hardin, Heller and Ostrom), this paper analyses the theoretical models of both the nationalization and privatization schemes and their shortcomings. The present essay also analyses the prospect for, and the barriers to the emerging commons in rural China.

Rural Support Networks in the UK and Canada: The Influence of the Patrilineal Culture of Family Farming

Rural support organisations have emerged since agricultural restructuring of the 1980s. The paper draws on research from the UK and Canada to suggest that the support in both countries is derived from a patrilineal culture that still dominates family farming. The paper begins by outlining a conceptual basis for arguing that such a culture can be understood as comprising of male and female relational gender identities capable of explaining farm relationships, farm survival and adjustment strategies and community engagement. These components, it is argued, are facets of the patrilineal farming culture which must be understood if its impacts on all its members are to be appropriately comprehended and supported.

The paper has two key aims, therefore. Firstly it suggests that a more nuanced understanding of farming „culture? which is persistently patrilineal in nature is now required which is capable of addressing the realities of farming individuals?
lives as they perceive them. The conceptualisation of such a culture is informed
by drawing on insights from gender theory, agricultural geography and rural studies. This conceptual discussion provides the context for the paper?s second aim which is to demonstrate how rural support in both the UK and Canada is derived „from? and is influenced by such a patrilineal culture . Findings are
presented identifying five key themes from this conceptualization which influence the support of such organisations. Thus, it is suggested, that the nature of rural support can be better understood and the appropriateness of the support interrogated when such conceptualization is taken on board.

Hierarchy as a barrier to advancement for women in academic medicine

Background: Research on barriers to professional advancement for women in academic medicine has not adequately considered the role of environmental factors and how the structure of organizations affects professional advancement and work experiences. This article examines the impact of the hierarchy, including both the organization's hierarchical structure and professionals' perceptions of this structure, in medical school organization on faculty members' experience and advancement in academic medicine. Methods: As part of an inductive qualitative study of faculty in five disparate U.S. medical schools, we interviewed 96 medical faculty at different career stages and in diverse specialties, using in-depth semistructured interviews, about their perceptions about and experiences in academic medicine. Data were coded and analysis was conducted in the grounded theory tradition. Results: Our respondents saw the hierarchy of chairs, based on the indeterminate tenure of department chairs, as a central characteristic of the structure of academic medicine. Many faculty saw this hierarchy as affecting inclusion, reducing transparency in decision making, and impeding advancement. Indeterminate chair terms lessen turnover and may create a bottleneck for advancement. Both men and women faculty perceived this hierarchy, but women saw it as more consequential. Conclusions: The hierarchical structure of academic medicine has a significant impact on faculty work experiences, including advancement, especially for women. We suggest that medical schools consider alternative models of leadership and managerial styles, including fixed terms for chairs with a greater emphasis on inclusion. This is a structural reform that could increase opportunities for advancement especially for women in academic medicine. © 2010 Copyright Mary Ann Liebert, Inc.

A study of the relational aspects of the culture of academic medicine

PURPOSE: The impact of medical school culture on medical students has been well studied, but little documentation exists regarding how medical faculty experience the culture in which they work. In an ongoing project, the National Initiative on Gender, Culture and Leadership in Medicine, the authors are investigating how the existing culture of academic medical institutions supports all faculty members' ability to function at their highest potential. METHOD: The authors conducted a qualitative study of faculty in five disparate U.S. medical schools. Faculty in different career stages and diverse specialties were interviewed regarding their perceptions and experiences in academic medicine. Analysis was inductive and data driven. RESULTS: Relational aspects of the culture emerged as a central theme for both genders across all career categories. Positive relationships were most evident with patients and learners. Negative relational attributes among faculty and leadership included disconnection, competitive individualism, undervaluing of humanistic qualities, deprecation, disrespect, and the erosion of trust. CONCLUSIONS: The data suggest that serious problems exist in the relational culture and that such problems may affect medical faculty vitality, professionalism, and general productivity and are linked to retention. Efforts to create and support trusting relationships in medical schools might enhance all faculty members' efforts to optimally contribute to the clinical, education, and research missions of academic medicine. Future work will document the outcomes of a five-school collaboration to facilitate change in the culture to support the productivity of all medical faculty. © 2009 Association of American Medical Colleges.

Collaboration in academic medicine:Reflections on gender and advancement

Purpose: Collaboration in academic medicine is encouraged, yet no one has studied the environment in which faculty collaborate. The authors investigated how faculty experienced collaboration and the institutional atmosphere for collaboration. Method: In 2007, as part of a qualitative study of faculty in five disparate U.S. medical schools, the authors interviewed 96 medical faculty at different career stages and in diverse specialties, with an oversampling of women, minorities, and generalists, regarding their perceptions and experiences of collaboration in academic medicine. Data analysis was inductive and driven by the grounded theory tradition. Results: Female faculty expressed enthusiasm about the potential and process of collaboration; male faculty were more likely to focus on outcomes. Senior faculty experienced a more collaborative environment than early career faculty, who faced numerous barriers to collaboration: the hierarchy of medical academe, advancement criteria, and the lack of infrastructure supportive of collaboration. Research faculty appreciated shared ideas, knowledge, resources, and the increased productivity that could result from collaboration, but they were acutely aware that advancement requires an independent body of work, which was a major deterrent to collaboration among early career faculty. Conclusions: Academic medicine faculty have differing views on the impact and benefits of collaboration. Early career faculty face concerning obstacles to collaboration. Female faculty seemed more appreciative of the process of collaboration, which may be of importance for transitioning to a more collaborative academic environment. A reevaluation of effective benchmarks for promotion of faculty is warranted to address the often exclusive reliance on individualistic achievement. © 2009 The Association of American Medical Colleges.

Infection systems biology:from reactive to proactive (P4) medicine

This short review establishes the conceptual bases and discusses the principal aspects of P4-shorthand for predictive, preventive, personalized and participatory medicine-medicine, in the framework of infectious diseases. P4 medicine is a new way to approach medical care; instead of acting when the patient is sick, physicians will be able to detect early warnings of disease to take early action. Furthermore, people might even be able to adjust their lifestyles to prevent disease. P4 medicine is fuelled by systems approaches to disease, including methods for personalized genome sequencing and new computational techniques for building dynamic disease predictive networks from massive amounts of data from a variety of OMICs. An excellent example of the effectiveness of the P4 medicine approach is the change in cancer treatments. Emphasis is placed on early detection, followed by genotyping of the patient to use the most adequate treatment according to the genetic background. Cardiovascular diseases and perhaps even neurodegenerative disorders will be the next targets for P4 medicine. The application of P4 medicine to infectious diseases is still in its infancy, but is a promising field that will provide much benefit to both the patients and the health-care system.

Resource utilization and cost analyses of home-based palliative care service provision:The Niagara West End-of-Life Shared-Care Project

Background: Increasing emphasis is being placed on the economics of health care service delivery - including home-based palliative care. Aim: This paper analyzes resource utilization and costs of a shared-care demonstration project in rural Ontario (Canada) from the public health care system's perspective. Design: To provide enhanced end-of-life care, the shared-care approach ensured exchange of expertise and knowledge and coordination of services in line with the understood goals of care. Resource utilization and costs were tracked over the 15 month study period from January 2005 to March 2006. Results: Of the 95 study participants (average age 71 years), 83 had a cancer diagnosis (87%); the non-cancer diagnoses (12 patients, 13%) included mainly advanced heart diseases and COPD. Community Care Access Centre and Enhanced Palliative Care Team-based homemaking and specialized nursing services were the most frequented offerings, followed by equipment/transportation services and palliative care consults for pain and symptom management. Total costs for all patient-related services (in 2007 CAN) were 1,625,658.07 - or 17,112.19 per patient/117.95 per patient day. Conclusion: While higher than expenditures previously reported for a cancer-only population in an urban Ontario setting, the costs were still within the parameters of the US Medicare Hospice Benefits, on a par with the per diem funding assigned for long-term care homes and lower than both average alternate level of care and hospital costs within the Province of Ontario. The study results may assist service planners in the appropriate allocation of resources and service packaging to meet the complex needs of palliative care populations. © 2012 The Author(s).