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

Synthesis and Characterization of a Model Nickel Superoxide Dismutase Metallopeptide Functionalized for Hydrogen Production

Hydrogenases (H2ase) are naturally occuring enzymes that reversibly catalyze the oxidation and production of H2 from protons at low overpotential with very high catalytic activity. As a result these enzymes have gained increased attention over recent years as potential models for technological materials in the industrial production of hydrogen as a stock fuel. Despite the many attempts to replicate the properties of these enzymes synthetically, very few synthetic models have shown catalytic activity comparable to that of the native enzyme. This project seeks to utilize key features from the coordination environment selected by nature for the seemingly unrelated NiSOD (nickel-superoxide dismutase) metalloenzyme to produce a biological mimic of [NiFe]H2ase. A metallopeptide consisting of the 12 N-terminal residues from the NiSOD primary sequence, which has been extensively studied by the Shearer group, was used as the basis for constructing this mimic because it is a structurally and mechanistically welldefined system. Careful consideration of the requirements necessary for nickel coordination to the NiSOD apopeptide and the influence of structure on the reactivity of the nickel containing metallopeptide provided a guide for its modification resulting in properties that may be useful in the construction of an H2ase active metallopeptide. Substitution of the N-terminal histidine residue with the phosphine PTA (1,3,5-triaza-7-phosphatricyclo[3.3.1.1]decane) is proposed to optimize the active site of this enzyme toward H2 production while maintaining redox activity and stability. The synthesis and characterization by nuclear magnetic resonance, electronic absorption and X-ray absorption spectroscopy of this modified maquette are reported herein. It will be shown that this novel metallopeptide [Ni(H2aseM1)] contains NiII in square pyramidal environment with ligands derived from the PTA (P atom), Cys(2) and Cys(6) (S atoms), the Cys(2) amidate (N atom) and water (H2O). Further studies of this system will be aimed at understanding the functional properties of the metallopeptide as a hydrogenase

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