The Health and Social Care Bill is now law, but its implementation will be fraught with challenges

The real impact of the Health Care reforms depends not on their design but on their implementation. Anna Dixon argues that the government has largely failed to win the support of the medical profession for the Act – as it now is – and yet without their support it is difficult to see how they can make this work

What was the programme theory of New Labour’s health system reforms?

To examine whether the Health System Reforms delivered the promise of being a coherent and mutually supporting reform programme; to identify the underlying programme theory of the reform programme; to reflect on whether lessons have been learned. \ud \ud Documentary analysis mapping the implicit and explicit programme theories about how the reforms intended to achieve its goals and outcomes. Semi-structured interviews with policy-makers to further understand the programme theory. \ud \ud The Health System Reforms assumed a ‘one size fits all’ approach to policy implementation with little recognition that some contexts can be more receptive than others. There was evidence of some policy evolution and rebalancing between the reform streams as policy-makers became aware of some perverse incentives and unforeseen consequences. Later elements aimed to restore balance to the system. \ud \ud The Health System Reforms do not appear to comprise a coherent and mutually supportive set of levers and incentives. They appear unbalanced with the centre of gravity favouring suppliers over commissioners. However, recent reform changes have sought to redress this imbalance to some extent, suggesting that lessons have been learned and policies have been adapted over time

Interview with Anna Heriot Dixon

Anna Dixon, in her July 1974 interview with Ann Yarborough Evans, described the lifestyle and traditions she experienced during her years as a student at what is now Winthrop University (then Winthrop Normal and Industrial College). Dixon graduated in 1917 and covered topics such as being campused, the train station, education for women, uniforms, curriculum, and the training school. She also touched on what might get a girl expelled and how the students were graded. This interview was conducted for inclusion into the Louise Pettus Archives and Special Collections Oral History Program.https://digitalcommons.winthrop.edu/oralhistoryprogram/1069/thumbnail.jp

The Acquisition of Medicinal Plant Knowledge: A Cross-Cultural Survey

Purpose of Study: A 10% random sample of fertility-related plants was taken from Table III of Farnsworth et al.\u27s article, Potential Value of Plants as Sources of New Antifertility Agents I (Farnsworth et al. 1975: 547-554), one of the most extensive compilations of cross-cultural and chemical information on fertility-related plants available in the literature. A single class of medicinal plants, fertility-related medicinals, was chosen because it is possible that the attributes that lead to the identification of fertility-related plants are different than for plants used to treat other conditions. Five objective criteria related to plant morphology, chemistry and ecology were proposed as being significant in contributing to the perceptual salience of potential medicinal plants. The chemical, botanical and ethnographic literature was searched for descriptions of each plant contained in the random sample. Findings: Of the 15 plant species in the random sample, approximately 70% were found to fit one or more of the criteria related to perceptual salience, supporting the hypothesis that acquisition of medicinal plant knowledge is not the result of purely random processes. It is possible that these attributes are in some way clues to the potential bioactivity of the plant\u27s chemical constituents. Once a link between a certain odor, taste or other characteristic and a specific physiological effect was noted by humans, this may have led to experimentation with other plants with a similar odor, taste, or appearance to produce the same physiological effect

The use of refusal strategies in interlanguage speech act performance of Korean and Norwegian users of English

The present paper describes a contrastive study of interlanguage refusal strategies employed by Korean and Norwegian learners of English as an additional language. The data were collected from multilingual first-year students at an American university in South Korea and in an English-medium program at a Norwegian university by means of an online open discourse completion task and analyzed using the coding categories based on Beebe, Takahashi, and Uliss-Welts (1990), and Salazar Campillo, Safont-Jordà, and Codina Espurz (2009). The data were analyzed to compare the average frequencies of refusal strategies used by the two groups, and the types of direct, indirect, and adjunct strategies that they employed. Independent samples t-tests revealed significant differences in the use of direct and indirect strategies with small effect sizes. The differences in the use of adjunct strategies were not statistically significant, and the effect sizes were negligible. Descriptive statistics of the differences in the types of direct, indirect, and adjunct strategies also revealed interesting patterns. The findings suggest that multilinguals’ pragmatic performance is a complex phenomenon that cannot be explained by the differences in cultural and pragmatic norms of their first language alone

Deterministic and reliability-based design: veneer cover soil stability

A design chart is a graphical tool that provides solutions to different scenarios of a system. In this paper, two types of design chart are developed based on deterministic and reliability-based analyses for determining the interface shear strength required for stability of a cover system to achieve a target safety factor of 1.5 and failure probability of 1 x 10(-2). The deterministic design chart assists in the selection of different types of geosynthetic for lining materials based on the required interface shear strength for stability, and the reliability-based design chart enhances decision-making by taking into account the uncertainties in the design parameters, such as the variability of interface shear strength parameters. Additionally, the latter chart can also be used to determine the optimum slope angle for a containment facility that will satisfy both the target factor of safety and acceptable failure probability. Examples are provided to illustrate the use of the design charts in estimating the minimum required interface shear strength and their allowable variability for a given veneer cover, and the optimum slope inclination corresponding to different interface shear strengths and their associated variability

Numerical modelling of landfill lining system-waste interaction: implications of parameter variability

Numerical modelling techniques can be used to examine the serviceability limit states of landfill side-slope lining systems in response to waste placement. A study has been conducted in which the variability of significant model input parameters have been investigated within a probabilistic framework using Monte Carlo simulation. Key model parameters are treated as random variables, and the statistical information required to describe their distributions has been derived from a laboratory repeatability testing programme, a literature survey and an expert consultation process. Model outputs include relative shear displacements between lining components, and tensile strains in the geosynthetic layers that occur in response to staged placement of waste against the side slope. It was found that analyses including input parameter variability were able to identify mechanisms influencing liner performance and their probability of occurrence. These mechanisms include large (i.e. ≫100 mm) relative displacements at interfaces that can generate post-peak strengths, and mobilised tensile strains in the geomembrane and geotextile layers. Additionally, it was found that relative displacements at the controlling (i.e. weakest) liner interface are greater for landfills with a steep side slope, for stiffer waste and thicker waste lifts, while tensile strains in the geosynthetic elements are greater for steep side slopes, more compressible waste and thinner waste lifts. Outputs from probabilistic analyses such as that used in this study can guide engineers regarding geometries and materials that could produce waste-settlement-generated serviceability limit state failures, and hence can be used to support more reliable designs