The next phase of healthcare improvement: what can we learn from social movements?

To date, improvement in health care has relied mainly on a "top down" programme by programme approach to service change and development. This has spawned a multitude of different and often impressive improvement schemes and activities. We question whether what has been happening will be sufficient to achieve the desired scale of change within the time scales set. Is it a case of "more of the same" or are there new and different approaches that might now be usefully implemented? Evidence from the social sciences suggests that other perspectives may help to recast large scale organisational change efforts in a new light and offer a different, though complementary, approach to improvement thinking and practice. Particularly prominent is the recognition that such large scale change in organisations relies not only on the "external drivers" but on the ability to connect with and mobilise people?s own "internal" energies and drivers for change, thus creating a "bottom up" locally led "grass roots" movement for improvement and change

Towards a million change agents. A review of the social movements literature: implications for large scale change in the NHS.

This review explores 'social movements' as a new way of thinking about large-scale systems change and assesses the potential contribution of applying this new perspective to NHS improvement

Exchange Rate Regimes and Revenue Performance in Sub-Saharan Africa

It has been argued that the institutions of the CFA Franc zone may have reduced inflation but that they also induced misalignment of the real exchange rate and that this is the explanation for their dismal revenue performance. This paper uses a panel of 22 countries in sub-Saharan Africa to estimate revenue performance over the period from 1980 to 1996. It finds that the poor cumulative relative revenue performance of the franc zone countries is mainly attributable to differences in environmental and structural factors, and to their different responses to changes in the equilibrium real exchange rate, but that the misalignment of the real exchange rate also played a part.

Concrete buys time : art and anthropology in the Anthropocene

Recent engagements with deep time within anthropology have urged an expansion of our time horizons in order to confront the contemporary ecological crisis. Here, we explore this theme by considering concrete’s material properties as a substance that reveals the troubled relationship between the present and deep time. We combine discussion of the life cycle of concrete in Orkney, Scotland, with reflection on sculptural interventions that seek to capture concrete’s character as both solid and fluid—the pouring of concrete has the potential to congeal a fleeting moment in time. Yet, recognising the impact of the production of concrete, understood at the geological level, we see a pernicious feedback loop: attempts to secure the land/water boundary contribute to the climatic changes which threaten those very environments. The task of tracing concrete’s place within the geological record illustrates both the challenge and the necessity of recognising humanity within deep time.Publisher PDFPeer reviewe

Real space first-principles derived semiempirical pseudopotentials applied to tunneling magnetoresistance

In this letter we present a real space density functional theory (DFT) localized basis set semi-empirical pseudopotential (SEP) approach. The method is applied to iron and magnesium oxide, where bulk SEP and local spin density approximation (LSDA) band structure calculations are shown to agree within approximately 0.1 eV. Subsequently we investigate the qualitative transferability of bulk derived SEPs to Fe/MgO/Fe tunnel junctions. We find that the SEP method is particularly well suited to address the tight binding transferability problem because the transferability error at the interface can be characterized not only in orbital space (via the interface local density of states) but also in real space (via the system potential). To achieve a quantitative parameterization, we introduce the notion of ghost semi-empirical pseudopotentials extracted from the first-principles calculated Fe/MgO bonding interface. Such interface corrections are shown to be particularly necessary for barrier widths in the range of 1 nm, where interface states on opposite sides of the barrier couple effectively and play a important role in the transmission characteristics. In general the results underscore the need for separate tight binding interface and bulk parameter sets when modeling conduction through thin heterojunctions on the nanoscale.Comment: Submitted to Journal of Applied Physic

Trajectory generation for road vehicle obstacle avoidance using convex optimization

This paper presents a method for trajectory generation using convex optimization to find a feasible, obstacle-free path for a road vehicle. Consideration of vehicle rotation is shown to be necessary if the trajectory is to avoid obstacles specified in a fixed Earth axis system. The paper establishes that, despite the presence of significant non-linearities, it is possible to articulate the obstacle avoidance problem in a tractable convex form using multiple optimization passes. Finally, it is shown by simulation that an optimal trajectory that accounts for the vehicle’s changing velocity throughout the manoeuvre is superior to a previous analytical method that assumes constant speed