'This is what democracy looks like' : New Labour's blind spot and peripheral vision

New Labour in government since 1997 has been roundly criticized for not possessing a clear, coherent and consistent democratic vision. The absence of such a grand vision has resulted, from this critical perspective, in an absence of 'joined-up' thinking about democracy in an evolving multi-level state. Tensions have been all too apparent between the government's desire to exert central direction - manifested in its most pathological form as 'control freakery' - and its democratising initiatives derived from 'third-way' obsessions with 'decentralising', 'empowering' and 'enabling'. The purpose of this article is to examine why New Labour displayed such apparently impaired democratic vision and why it appeared incapable of conceiving of democratic reform 'in the round'. This article seeks to explain these apparent paradoxes, however, through utilising the notion of 'macular degeneration'. In this analysis, the perceived democratic blind spot of New Labour at Westminster is connected to a democratic peripheral vision, which has envisaged innovative participatory and decentred initiatives in governance beyond Westminster

Tony Blair and John Howard: comparative predominance and 'Institution Stretch' in the UK and Australia

It has recently been argued that the UK premier enjoys a level of executive power unavailable to US presidents, but how does he or she compare to another prime minister operating within a broadly similar system? Commonalities of intra-executive influence and capacity exist under the premierships in the UK and Australia. Discrete institutional constraints and deviations are evident, but trends and similarities in resource capacity can be clearly identified. These include: the growth of the leaders' office; broadening and centralising of policy advice and media operations; and strengthening of the role and function of ministerial advisers. I contend that this amounts to 'institution stretch', with new structures, processes and practices becoming embedded in the political system by the incumbents. © 2007 The Author. Journal compilation © 2007 Political Studies Association

Strategic change, leadership and accounting:A triptych of organizational reform

Strategic change in public sector organizations – especially in the form of increasing infiltration of ideas and practices emanating from the private sector – has been well documented. This paper argues that accounting and other calculative practices have only been accorded limited roles in extant accounts of public sector strategic change initiatives. This paper suggests that public management research would benefit from a greater appreciation of how calculative practices are deeply imbricated and constitutive of organizational life. In turn, the paper argues that the field of interdisciplinary accounting has much to learn from public administration, especially in terms of leadership. The overarching argument is that understanding strategic change in public organizations can be enhanced by bringing together insights from the academic fields of Public Administration and Interdisciplinary Accounting. This is particularly the case where an accounting innovation is central to a strategic change programme. In this respect, organizational reform can be understood as a triptych, involving strategic change, leadership and accounting practices. We illustrate this thesis through a case study of strategic change in the world’s largest public service broadcaster – The British Broadcasting Corporation (BBC). It is shown how, during the tenure of one organizational leader – John Birt - accounting technologies increasingly territorialized spaces, subjectivized individuals, was used to mediate between the organization and the State, and permitted adjudication on what was efficient and value for money within the organization and what was not

The utility and predictive value of combinations of low penetrance genes for screening and risk prediction of colorectal cancer

Despite the fact that colorectal cancer (CRC) is a highly treatable form of cancer if detected early, a very low proportion of the eligible population undergoes screening for this form of cancer. Integrating a genomic screening profile as a component of existing screening programs for CRC could potentially improve the effectiveness of population screening by allowing the assignment of individuals to different types and intensities of screening and also by potentially increasing the uptake of existing screening programs. We evaluated the utility and predictive value of genomic profiling as applied to CRC, and as a potential component of a population-based cancer screening program. We generated simulated data representing a typical North American population including a variety of genetic profiles, with a range of relative risks and prevalences for individual risk genes. We then used these data to estimate parameters characterizing the predictive value of a logistic regression model built on genetic markers for CRC. Meta-analyses of genetic associations with CRC were used in building science to inform the simulation work, and to select genetic variants to include in logistic regression model-building using data from the ARCTIC study in Ontario, which included 1,200 CRC cases and a similar number of cancer-free population-based controls. Our simulations demonstrate that for reasonable assumptions involving modest relative risks for individual genetic variants, that substantial predictive power can be achieved when risk variants are common (e.g., prevalence > 20%) and data for enough risk variants are available (e.g., ~140–160). Pilot work in population data shows modest, but statistically significant predictive utility for a small collection of risk variants, smaller in effect than age and gender alone in predicting an individual’s CRC risk. Further genotyping and many more samples will be required, and indeed the discovery of many more risk loci associated with CRC before the question of the potential utility of germline genomic profiling can be definitively answered

Variable size computer-aided detection prompts and mammography film reader decisions

Introduction: The purpose of the present study was to investigate the effect of computer-aided detection (CAD) prompts on reader behaviour in a large sample of breast screening mammograms by analysing the relationship of the presence and size of prompts to the recall decision.Methods: Local research ethics committee approval was obtained; informed consent was not required. Mammograms were obtained from women attending routine mammography at two breast screening centres in 1996. Films, previously double read, were re-read by a different reader using CAD. The study material included 315 cancer cases comprising all screen-detected cancer cases, all subsequent interval cancers and 861 normal cases randomly selected from 10,267 cases. Ground truth data were used to assess the efficacy of CAD prompting. Associations between prompt attributes and tumour features or reader recall decisions were assessed by chi-squared tests.Results: There was a highly significant relationship between prompting and a decision to recall for cancer cases and for a random sample of normal cases (P <0.001). Sixty-four per cent of all cases contained at least one CAD prompt. In cancer cases, larger prompts were more likely to be recalled (P = 0.02) for masses but there was no such association for calcifications (P = 0.9). In a random sample of 861 normal cases, larger prompts were more likely to be recalled (P = 0.02) for both mass and calcification prompts. Significant associations were observed with prompting and breast density (p = 0.009) for cancer cases but not for normal cases (P = 0.05).Conclusions: For both normal cases and cancer cases, prompted mammograms were more likely to be recalled and the prompt size was also associated with a recall decision. © 2008 Gilbert et al.; licensee BioMed Central Ltd

Breast cancer in young women

Although uncommon, breast cancer in young women is worthy of special attention due to the unique and complex issues that are raised. This article reviews specific challenges associated with the care of younger breast cancer patients, which include fertility preservation, management of inherited breast cancer syndromes, maintenance of bone health, secondary prevention, and attention to psychosocial issues