155 research outputs found

    Introduction to the themed issue - Corporate power : agency, communication, influence and social policy

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    This paper introduces this themed issue of Critical Social Policy on the question of corporate power. Corporate power is recognized as an important agent in social policy making and delivery. However, to date there has been comparatively little attention to the crucial role that lobbying and corporate 'spin' play in helping to shape policy making contexts. This special issue of Critical Social Policy is concerned to bring such issues to the mainstream of social policy analysis. It is argued here that the rise of spin and public relations is a key feature of neoliberalism in the past two decades. These have worked to reshape policy making, resulting in pronounced changes in the content and process of policy making and it is argued that these have tended to marginalize or undermine democratic processes

    Liver transplantation for alcoholic cirrhosis: Long term follow-up and impact of disease recurrence

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    Background. Alcoholic liver disease has emerged as a leading indication for hepatic transplantation, although it is a controversial use of resources. We aimed to examine all aspects of liver transplantation associated with alcohol abuse. Methods. Retrospective cohort analysis of 123 alcoholic patients with a median of 7 years follow-up at one center. Results. In addition to alcohol, 43 (35%) patients had another possible factor contributing to cirrhosis. Actuarial patient and graft survival rates were, respectively, 84% and 81% (1 year); 72% and 66% (5 years); and 63% and 59% (7 years). After transplantation, 18 patients (15%) manifested 21 noncutaneous de novo malignancies, which is significantly more than controls (P=0.0001); upper aerodigestive squamous carcinomas were over-represented (P=0.03). Thirteen patients had definitely relapsed and three others were suspected to have relapsed. Relapse was predicted by daily ethanol consumption (P=0.0314), but not by duration of pretransplant sobriety or explant histology. No patient had alcoholic hepatitis after transplantation and neither late onset acute nor chronic rejection was significantly increased. Multiple regression analyses for predictors of graft failure identified major biliary/vascular complications (P=0.01), chronic bile duct injury on biopsy (P=0.002), and pericellular fibrosis on biopsy (P=0.05); graft viral hepatitis was marginally significant (P=0.07) on univariate analysis. Conclusions. Alcoholic liver disease is an excellent indication for liver transplantation in those without coexistent conditions. Recurrent alcoholic liver disease alone is not an important cause of graft pathology or failure. Potential recipients should be heavily screened before transplantation for coexistent conditions (e.g., hepatitis C, metabolic diseases) and other target-organ damage, especially aerodigestive malignancy, which are greater causes of morbidity and mortality than is recurrent alcohol liver disease

    Capitalism and Earth System Governance: An Ecological Marxist Approach

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    Growing recognition of the Anthropocene era has led to a chorus of calls for Earth System Governance (ESG). Advocates argue that humanity's newfound sociotechnical powers require institutional transformations at all scales of governance to wield these powers with wisdom and foresight. Critics, on the other hand, fear that these initiatives embody a technocratic impulse that aims to subject the planet to expert management without addressing the political-economic roots of the earth system crisis. This article proposes a more affirmative engagement with existing approaches to ESG while also building on these critiques. While advocates of ESG typically ignore the capitalistic roots of the earth system crisis and propose tepid reforms that risk authoritarian expressions, their critics also have yet to systematically consider the potential for more democratic and postcapitalist forms of ESG. In response, I propose an ecological Marxist approach based on a structural analysis of capitalism as the primary driver of the earth system crisis and an "ecosocialist" vision of ESG that subordinates the market to democratic planning at multiple scales. I argue that an ecological Marxist perspective is needed to foreground the structural political-economic constraints on earth system stability, though existing approaches to ESG can in turn inform ecosocialist strategies for global institutional design and democratization

    Change in physical activity level and clinical outcomes in older adults with knee pain: a secondary analysis from a randomised controlled trial

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    BACKGROUND: Exercise interventions improve clinical outcomes of pain and function in adults with knee pain due to osteoarthritis and higher levels of physical activity are associated with lower severity of pain and higher levels of physical functioning in older adults with knee osteoarthritis in cross-sectional studies. However, to date no studies have investigated if change in physical activity level during exercise interventions can explain clinical outcomes of pain and function. This study aimed to investigate if change in physical activity during exercise interventions is associated with future pain and physical function in older adults with knee pain. METHODS: Secondary longitudinal data analyses of a three armed exercise intervention randomised controlled trial. Participants were adults with knee pain attributed to osteoarthritis, over the age of 45 years old (n = 514) from Primary Care Services in the Midlands and Northwest regions of England. Crude and adjusted associations between absolute change in physical activity from baseline to 3 months (measured by the self-report Physical Activity Scale for the Elderly (PASE)) and i) pain ii) physical function (Western Ontario and McMaster Universities Osteoarthritis Index) and iii) treatment response (OMERACT-OARSI responder criteria) at 3 and 6 months follow-up were investigated using linear and logistic regression. RESULTS: Change in physical activity level was not associated with future pain, function or treatment response outcomes in crude or adjusted models at 3 or 6 months (P > 0.05). A 10 point increase in PASE was not associated with pain β = - 0.01 (- 0.05, 0.02), physical function β = - 0.09 (- 0.19, 0.02) or likelihood (odds ratio) of treatment response 1.02 (0.99, 1.04) at 3 months adjusting for sociodemographics, clinical covariates and the trial intervention arm. Findings were similar for 6 month outcome models. CONCLUSIONS: Change in physical activity did not explain future clinical outcomes of pain and function in this study. Other factors may be responsible for clinical improvements following exercise interventions. However, the PASE may not be sufficiently responsive to measure change in physical activity level. We also recommend further investigation into the responsiveness of commonly used physical activity measures. TRIAL REGISTRATION: ( ISRCTN93634563 ). Registered 29th September 2011

    Prisoners of the Capitalist Machine: Captivity and the Corporate Engineer

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    This chapter will focus on how engineering practice is conditioned by an economic system which promotes production for profit and economic growth as an end in itself. As such it will focus on the notion of the captivity of engineering which emanates from features of the economic system. By drawing on Critical Realism and a Marxist literature, and by focusing on the issues of safety and sustainability (in particular the issue of climate change), it will examine the extent to which disasters and workplace accidents result from the economic imperative for profitable production and how efforts by engineers to address climate change are undermined by an on-going commitment to growth. It will conclude by arguing that the structural constraints on engineering practice require new approaches to teaching engineers about ethics and social responsibility. It will argue that Critical Realism offers a framework for the teaching of engineering ethics which would pay proper attention to the structural context of engineers work without eliminating the possibility of engineers working for radical change
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