Ableness and ability: Morriss on power and counteractuals

Peter Morriss's logical ability/ableness distinction breaks down under analysis but a similar normative distinction is important for understanding power and liberty. The breakdown is demonstrated under the test case of the power of a pivotal voter in a committee. Brian Barry argues that a pivotal voter has power as ableness not ability, but the paper demonstrates that a pivotal voter has neither. Under standard measures the 'power' of the pivot is due to the chance ordering of all committee members' preference schedules. Rather than power, each has a resource which, when certain conditions obtain, can be powerfully utilized. The power of the pivot depends upon the realization that those conditions obtain thus the power index literature requires modification

Security governance and networks: New theoretical perspectives in transatlantic security

The end of the Cold War has not only witnessed the rise of new transnational threats such as terrorism, crime, proliferation and civil war; it has also seen the growing role of non-state actors in the provision of security in Europe and North America. Two concepts in particular have been used to describe these transformations: security governance and networks. However, the differences and potential theoretical utility of these two concepts for the study of contemporary security have so far been under-examined. This article seeks to address this gap. It proposes that security governance can help to explain the transformation of Cold War security structures, whereas network analysis is particularly useful for understanding the relations and interactions between public and private actors in the making and implementation of national and international security policies

Implementation and use of computerised clinical decision support (CCDS) in emergency pre-hospital care: a qualitative study of paramedic views and experience using Strong Structuration Theory

Computerised clinical decision support (CCDS) has been shown to improve processes of care in some healthcare settings, but there is little evidence related to its use or effects in pre-hospital emergency care. CCDS in this setting aligns with policies to increase IT use in ambulance care, enhance paramedic decision-making skills, reduce avoidable emergency department attendances and improve quality of care and patient experience. This qualitative study was conducted alongside a cluster randomised trial in two ambulance services of the costs and effects of web-based CCDS system designed to support paramedic decision-making in the care of older people following a fall. Paramedics were trained to enter observations and history for relevant patients on a tablet, and the CCDS then generated a recommended course of action which could be logged. Our aim was to describe paramedics' experience of the CCDS intervention and to identify factors affecting its implementation and use. We invited all paramedics who had been randomly allocated to the intervention arm of the trial to participate in interviews or focus groups. The study was underpinned by Strong Structuration Theory, a theoretical model for studying innovation based on the relationship between what people do and their context. We used the Framework approach to data analysis. Twenty out of 22 paramedics agreed to participate. We developed a model of paramedic experience of CCDS with three domains: context, adoption and use, and outcomes. Aspects of context which had an impact included organisational culture and perceived support for non-conveyance decisions. Experience of adoption and use of the CCDS varied between individual paramedics, with some using it with all eligible patients, some only with patients they thought were 'suitable' and some never using it. A range of outcomes were reported, some of which were different from the intended role of the technology in decision support. Implementation of new technology such as CCDS is not a one-off event, but an ongoing process, which requires support at the organisational level to be effective. ISRCTN Registry 10538608 . Registered 1 May 2007. Retrospectively registered