Delivering reform in English healthcare: an ideational perspective

A variety of perspectives has been put forward to understand reform across healthcare systems. Recently, some have called for these perspectives to give greater recognition to the role of ideational processes. The purpose of this article is to present an ideational approach to understanding the delivery of healthcare reform. It draws on a case of English healthcare reform – the Next Stage Review led by Lord Darzi – to show how the delivery of its reform proposals was associated with four ideational frames. These frames built on the idea of “progress” in responding to existing problems; the idea of “prevailing policy” in forming part of a bricolage of ideas within institutional contexts; the idea of “prescription” as top-down structural change at odds with local contexts; and the idea of “professional disputes” in challenging the notion of clinical engagement across professional groups. The article discusses the implications of these ideas in furthering our understanding of policy change, conflict and continuity across healthcare settings

Modeling geoelectric fields in Ireland and the UK for space weather applications

Geoelectric fields at the Earth’s surface caused by geomagnetic storms have the potential to disrupt and damage ground-based infrastructure such as electrical power distribution networks, pipelines, and railways. Here we model geoelectric fields in Ireland and the UK during both quiet and active time intervals of geomagnetic conditions using measurements from magnetic observatories and electromagnetic tensor relationships. The analysis focused on (1) defining periods of the magnetic field variations that are largely affected by the geomagnetic storms, between 30 and 30,000 s; (2) constraining the electromagnetic tensor relationships that defines the Earth’s response to magnetic field variations; (3) implementing and validating two approaches for modeling geoelectric fields based on measurements from magnetic observatories and local and interstation electromagnetic transfer functions; and (4) estimating uncertainties when modeling geoelectric fields. The use of interstation tensor relationships allowed us to differentiate between regional and local geomagnetic sources. We found coherence values of 0.5–0.95, signal-to-noise ratio of 1–15 dB, normalized root-mean-square values of 0.8–3.4, and root-mean-square values of 0.7–84 mV/km. Within these ranges of values, sites in close proximity (<100 km) to a magnetic observatory and not affected by local storms will provide the most accurate results, while sites located at further distances and affected by spatially localized features of the storm will be less accurate. These methods enable us to more accurately model geomagnetically induced currents, and their associated uncertainties, in the British and Irish power networks

The combined influence of distance and neighbourhood deprivation on Emergency Department attendance in a large English population: a retrospective database study

YesThe frequency of visits to Emergency Departments (ED) varies greatly between populations. This may reflect variation in patient behaviour, need, accessibility, and service configuration as well as the complex interactions between these factors. This study investigates the relationship between distance, socio-economic deprivation, and proximity to an alternative care setting (a Minor Injuries Unit (MIU)), with particular attention to the interaction between distance and deprivation. It is set in a population of approximately 5.4 million living in central England, which is highly heterogeneous in terms of ethnicity, socio-economics, and distance to hospital. The study data set captured 1,413,363 ED visits made by residents of the region to National Health Service (NHS) hospitals during the financial year 2007/8. Our units of analysis were small units of census geography having an average population of 1,545. Separate regression models were made for children and adults. For each additional kilometre of distance from a hospital, predicted child attendances fell by 2.2% (1.7%-2.6% p<0.001) and predicted adult attendances fell by 1.5% (1.2% -1.8%, p<0.001). Compared to the least deprived quintile, attendances in the most deprived quintile more than doubled for children (incident rate ratio (IRR) = 2.19, (1.90-2.54, p<0.001)) and adults (IRR 2.26, (2.01-2.55, p<0.001)). Proximity of an MIU was significant and both adult and child attendances were greater in populations who lived further away from them, suggesting that MIUs may reduce ED demand. The interaction between distance and deprivation was significant. Attendance in deprived neighbourhoods reduces with distance to a greater degree than in less deprived ones for both adults and children. In conclusion, ED use is related to both deprivation and distance, but the effect of distance is modified by deprivation

Regulatory Constructivism: Application of Q Methodology in Italy and China

Conventional view holds that beliefs play an important role in the development of regulations but there is little evidence to support this claim. We use Comparative Q Methodology to systematically map out and compare the beliefs of public officers in China and Italy, two countries with contrasting sets of institutions but have both adopted similar ideas about integrated water resource management. We find some similarities and differences in the beliefs of public officers in both countries. In particular, we find that in both countries beliefs on the regulation of water utilities are diverse and fragmented on issues such as ownership structure of water utilities, how water infrastructure development should be funded, and how tariffs should be regulated. Our findings have two implications for theory, methods and practice. First, the Q methodology is a useful tool for systematically mapping out the beliefs of regulators and managers. Second, systematically mapping out beliefs will help facilitate the development of an alternative regime of regulation such as negotiated rule making. This alternative regime can provide substantial benefits such as more efficient rule making, more cost effective enforcement and compliance, and more equitable in terms of balancing the interests of stakeholders

Political Mediation and American Old-Age Security Exceptionalism

Debates over America’s heavy reliance on employer-provided private pensions have understated the profound role organized labor played after World War II. Archival evidence from prominent unions and business associations suggests that the shift in organized labor’s strategy after the New Deal toward electoral activity helps explain critical interventions by Northern Democrats into the system of private pensioning in the postwar period that laid the foundation for America’s old-age security system. Such a strategy was insufficient, however, to expand Social Security. This article offers a political mediation account of electoral activity as a source of labor influence on social policy that draws on political institutionalist and class power theories

Classification of Ventricular Septal Defects for the Eleventh Iteration of the International Classification of Diseases—Striving for Consensus: A Report From the International Society for Nomenclature of Paediatric and Congenital Heart Disease

The definition and classification of ventricular septal defects have been fraught with controversy. The International Society for Nomenclature of Paediatric and Congenital Heart Disease is a group of international specialists in pediatric cardiology, cardiac surgery, cardiac morphology, and cardiac pathology that has met annually for the past 9 years in an effort to unify by consensus the divergent approaches to describe ventricular septal defects. These efforts have culminated in acceptance of the classification system by the World Health Organization into the 11th Iteration of the International Classification of Diseases. The scheme to categorize a ventricular septal defect uses both its location and the structures along its borders, thereby bridging the two most popular and disparate classification approaches and providing a common language for describing each phenotype. Although the first-order terms are based on the geographic categories of central perimembranous, inlet, trabecular muscular, and outlet defects, inlet and outlet defects are further characterized by descriptors that incorporate the borders of the defect, namely the perimembranous, muscular, and juxta-arterial types. The Society recognizes that it is equally valid to classify these defects by geography or borders, so the emphasis in this system is on the second-order terms that incorporate both geography and borders to describe each phenotype. The unified terminology should help the medical community describe with better precision all types of ventricular septal defects

Terrestrial laser scanning for plot-scale forest measurement

Plot-scale measurements have been the foundation for forest surveys and reporting for over 200 years. Through recent integration with airborne and satellite remote sensing, manual measurements of vegetation structure at the plot scale are now the basis for landscape, continental and international mapping of our forest resources. The use of terrestrial laser scanning (TLS) for plot-scale measurement was first demonstrated over a decade ago, with the intimation that these instruments could replace manual measurement methods. This has not yet been the case, despite the unparalleled structural information that TLS can capture. For TLS to reach its full potential, these instruments cannot be viewed as a logical progression of existing plot-based measurement. TLS must be viewed as a disruptive technology that requires a rethink of vegetation surveys and their application across a wide range of disciplines. We review the development of TLS as a plotscale measurement tool, including the evolution of both instrument hardware and key data processing methodologies. We highlight two broad data modelling approaches of gap probability and geometrical modelling and the basic theory that underpins these. Finally, we discuss the future prospects for increasing the utilisation of TLS for plot-scale forest assessment and forest monitoring