Primary care-led commissioning and public involvement in the English National Health Service. Lessons from the past.

Background: Patient and Public involvement (PPI) in health care occupies a central place in Western democracies. In England, this theme has been continuously prominent since the introduction of market reforms in the early 1990s. The health care reforms implemented by the current Coalition Government are making primary care practitioners the main commissioners of health care services in the National Health Service, and a duty is placed on them to involve the public in commissioning decisions and strategies. Since implementation of PPI initiatives in primary care commissioning is not new, we asked how likely it is that the new reforms will make a difference. We scanned the main literature related to primary care-led commissioning and found little evidence of effective PPI thus far. We suggest that unless the scope and intended objectives of PPI are clarified and appropriate resources are devoted to it, PPI will continue to remain empty rhetoric and box ticking. Aim: To examine the effect of previous PPI initiatives on health care commissioning and draw lessons for future development. Method: We scanned the literature reporting on previous PPI initiatives in primary careled commissioning since the introduction of the internal market in 1991. In particular, we looked for specific contexts, methods and outcomes of such initiatives. Findings: 1. PPI in commissioning has been constantly encouraged by policy makers in England. 2. Research shows limited evidence of effective methods and outcomes so far. 3. Constant reconfi- guration of health care structures has had a negative impact on PPI. 4. The new structures look hardly better poised to bring about effective public and patient involvement

Toward a Systematic Theology of the Sanctuary: Part 1

This article is part one of an essay that offers some preliminary thoughts regarding the relationship of the sanctuary and systematic theology, focusing on just a few aspects which expose the relationship between the two. This article considers the nature of theological systems, issues related to an Adventist system of theology, and the relationship between fundamental theology and the sanctuary in particular, with attention to some broad, competing views of the sanctuary that are integrally related to the way one conceives of broader theological principles. This sets the stage for the second article, which will conclude the essay by discussing a number of important systematic elements that shed light on a potential systematic theology of the sanctuary

The Concept of Divine Love in the Context of the God-World Relationship

The love of God is central to God\u27s relationship to the world. This dissertation addresses the conflict of interpretation between the transcendent-voluntarist and immanent-experientialist models regarding divine love in the context of the God-world relationship by applying a canonical methodology. Chapter 1 introduces the background, purpose, problem, scope, and plan of study as well as the final-form canonical theological method employed in the investigation. Chapter 2 briefly surveys the historical theology of love, tracing the central conceptions of divine love and the God-world relationship by selected, highly influential thinkers. Chapter 3 presents and analyzes the irreconcilable interpretations of divine love in relation to the world, and the ontologies that ground them, in the transcendent-voluntarist and immanent-experientialist models. In the former model, divine love is a unilateral, unmotivated, willed benevolence, while in the latter model divine love is essentially relational, emotional, and primarily passive. Subsequently, a sample of recent reactions to both models demonstrates the current dissatisfaction regarding the conflict of interpretations, indicating the potential for paradigm change in the theological model of interpreting God\u27s love to the world. Chapters 4, 5, and 6 shift to the investigation of a canonical and systematic model which addresses the issues raised by the conflict ofinterpretations through the identification and explanation of five primary aspects of God\u27s love in relation to the world derived from inductive examination of the canon: the volitional, evaluative, emotional, foreconditional, and multilaterally relational aspects. Chapters 4 and 5 present the data from a canonical investigation of the data regarding divine love in the OT and NT respectively. The material from the biblical investigation of divine love is utilized to construct a model of divine love that addresses the conflict of interpretations seen in chapters 2 and 3. Chapter 6 summarizes and explains the broad outline of a canonical and systematic model of divine love in relation to the world, with implications for divine ontology and the nature of God\u27s relationship to the world. The dissertation concludes by summarizing the findings and conclusions of the study and making some recommendations for further study

The Diagnosis of Gastro-Intestinal Parasitism in Iowa Sheep, Part I: The Diagnosis Based Upon Fecal Examination

This article is the first of a series of two based upon the observations of the author while employed in the Iowa Veterinary Diagnostic Laboratory during the period of 1958 to 1961. This discussion is presented for the purpose of clarifying questions and diagnostic problems encountered during the process of examining cases submitted to this laboratory. It is not the purpose of this paper to either review the literature or to extensively discuss techniques which are described for the diagnosis of gastrointestinal parasitism. It is recommended that the reader refer to the references at the end of this article for additional or specific information on topics mentioned in this report