Making the most of community energies:Three perspectives on grassroots innovation

Grassroots innovations for sustainability are attracting increasing policy attention. Drawing upon a wide range of empirical research into community energy in the UK, and taking recent support from national government as a case study, we apply three distinct analytical perspectives: strategic niche management; niche policy advocacy; and critical niches. Whilst the first and second perspectives appear to explain policy influence in grassroots innovation adequately, each also shuts out more transformational possibilities. We therefore argue that, if grassroots innovation is to realise its full potential, then we need to also pursue a third, critical niches perspective, and open up debate about more socially transformative pathways to sustainability

Communication, Collaboration and Enhancing the Learning Experience: Developing a Collaborative Virtual Enquiry Service in University Libraries in the North of England

This paper uses the case study of developing a collaborative ‘out of hours’ virtual enquiry service by members of the Northern Collaboration Group of academic libraries in the north of England to explore the importance of communication and collaboration between academic library services in enhancing student learning. Set within the context of a rapidly changing UK higher education sector the paper considers the benefits and challenges of collaboration and the contribution of library services to the student experience. The project demonstrated clear benefits to student learning and evidence of value for money to individual institutions as well as showing commitment to national shared services agendas. Effective communication with students, with colleagues and stakeholders in our own and other Northern Collaboration member institutions, and with OCLC, our partner organisation, was a critical success factor in the development, promotion and uptake of the new service

Additional Shear Wall Values for Light Weight Steel Framing (draft)

AlSI sponsored research at Santa Clara University (Serrette, 1996) led to the development of shear values for plywood, oriented strand board (OSB), and gypswn wallboard (GWB) sheathed light weight steel framed wall assemblies. The scope of the 1996 work was, however, limited to plywood, OSB. and GWB on 0.033 in. (20 gauge) framing. To provide a wider range of design options and clarify some of the values from the 1996 test program. a new test program was initialed. The new program included the following wall assemblies: flat strap X-braced walls. steel sheathed walls, high aspect ratio walls, and walls framed with 0.054 in. and 0.043 in. (16 gauge and 18 gauge, respectively} studs. As in the I 996 test program, the new assemblies were tested under static and cyclic loading. For each wall assembly configuration tested in the current program, the applied load, lateral displacement (at the top plate), slip, uplift, and mode of failure were monitored and recorded. Based on the test results, maximum loads (and corresponding displacements) were interpreted for design

A modified Delphi process to establish research priorities in hernia surgery

Funding British Hernia Society.Peer reviewedPublisher PD

A national survey of practice for the emergency fixation of testis

Introduction: Scrotal exploration for suspected testicular torsion is a common emergency procedure in the United Kingdom (UK). There is no universally agreed practice for how the testis should be fixed, or whether a nontorted testis should receive fixation. This survey aims to describe the methods used for emergency scrotal exploration and testicular fixation in the UK. // Methods: An online survey was distributed to urologists, general surgeons and specialist paediatric surgeons in approved NHS trusts, and via the email lists of collaborating organisations. The survey questioned surgeons on their operative management of a variety of common diagnoses encountered during scrotal exploration using multiple choice and free-text answers. // Results: A total of 340 responses were received from 83 institutions. Respondents included urologists (consultants, 33%; trainees, 24%), paediatric surgeons (consultants, 12%; trainees, 16%) and general surgeons. In cases of torsion, respondents predominantly perform sutured fixation (74%); however, sutureless dartos pouch fixation was used frequently (37%) by paediatric surgeons. The finding of ‘bell-clapper’ anatomy without torsion prompts 69% of respondents to undertake sutured fixation, but alternative nontorsion diagnoses frequently prompt use of sutureless methods (53–66%). // Conclusion: This study is the largest survey of methods for emergency scrotal exploration and describes current UK practice. The majority of surgeons prefer sutured fixation in cases of torsion and/or bell-clapper anomalies, and sutureless methods in the absence of it

Epidemiology of invasive cutaneous melanoma

Data are presented on the current incidence of melanoma with recent and predicted future trends illustrating a likely continuing increase in incidence. Risk factors for developing melanoma are discussed, including current known melanoma susceptibility genes. Phenotypic markers of high-risk subjects include high counts of benign melanocytic naevi. Other risk factors considered include exposure to natural and artificial ultraviolet radiation, the effect of female sex hormones, socioeconomic status, occupation, exposure to pesticides and ingestion of therapeutic drugs including immunosuppressives and non-steroidal anti-inflammatory drugs. Aids to earlier diagnosis are considered, including public education, screening and use of equipment such as the dermatoscope. Finally, the current pattern of survival and mortality is described

Can Rationing Through Inconvenience Be Ethical?

In this article, we provide a comprehensive analysis and a normative assessment of rationing through inconvenience as a form of rationing. By “rationing through inconvenience” in the health sphere, we refer to a non-financial burden (the inconvenience) that is either intended to cause or has the effect of causing patients or clinicians to choose an option for health‐related consumption that is preferred by the health system for its fairness, efficiency, or other distributive desiderata beyond assisting the immediate patient. We argue that under certain conditions, rationing through inconvenience may turn out to serve as a legitimate and, compared to direct rationing, even a preferable tool for rationing; we propose a research agenda to identify more precisely when that might be the case and when, alternatively, rationing through inconvenience remains ethically undesirable. After defining and illustrating rationing through inconvenience, we turn to its moral advantages and disadvantages over other rationing methods.We take it as a starting assumption that rationing, understood as scarce‐resource prioritization, is inevitable and, in a society that has goals beyond optimizing health care for individual patients—such as improving societal health care, education, or overall welfare—prudent and fair

Is This Relevant? Physician Perceptions, Clinical Relevance, and Religious Content in Clinical Interactions

Despite wide support among physicians for practicing patient-centered care, clinical interactions are primarily driven by physicians’ perception of relevance. While some will perceive a connection between religion and patient health, this relevance will be less apparent for others. I argue that physician responses when religious/spiritual topics come up during clinical interactions will depend on their own religious/spiritual background. The more central religion is for the physician, the greater his or her perception of religion\u27s impact on health outcomes and his or her inclusion of religion/spirituality within clinical interactions. Using a nationally representative sample of physicians in the United States and mediated path models, I estimate models for five different physician actions to evaluate these relationships. I find that a physician\u27s religious background is strongly associated with whether or not he or she thinks religion impacts health outcomes, which is strongly predictive of inclusion. I also find that not all of the association between inclusion and physicians’ religious background is mediated by thinking religion impacts health outcomes. Issues of religion\u27s relevance for medicine are important to the degree that religious beliefs are an important dimension of patients’ lives

Against Permitted Exploitation in Developing World Research Agreements

<p>This paper examines the moral force of exploitation in developing world research agreements. Taking for granted that some clinical research which is conducted in the developing world but funded by developed world sponsors is exploitative, it asks whether a third party would be morally justified in enforcing limits on research agreements in order to ensure more fair and less exploitative outcomes. This question is particularly relevant when such exploitative transactions are entered into voluntarily by all relevant parties, and both research sponsors and host communities benefit from the resulting agreements. I show that defenders of the claim that exploitation ought to be permitted rely on a mischaracterization of certain forms of interference as unjustly paternalistic and two dubious empirical assumptions about the results of regulation. The view I put forward is that by evaluating a system of constraints on international research agreements, rather than individual transaction-level interference, we can better assess the alternatives to permitting exploitative research agreements.</p