Some political implications of service provision: roads and schools and health services

This paper outlines the results of some research into three former county council services - primary education, minor roads and rural health services - taken over by the central government in 1970. It describes the organization of these services under the county councils and examines the financial relationships between the councils, and the centre, drawing attention to the way in which the system worked to encourage "crisis financing" on the part of the councils. It then considers the impact of the transfer of functions on each of the three services, and relates this to the general pattern of service provision in rural Kenya, and the interaction between local initiatives ("self-help") and government action

Prospects for progress on health inequalities in England in the post-primary care trust era : professional views on challenges, risks and opportunities

Background - Addressing health inequalities remains a prominent policy objective of the current UK government, but current NHS reforms involve a significant shift in roles and responsibilities. Clinicians are now placed at the heart of healthcare commissioning through which significant inequalities in access, uptake and impact of healthcare services must be addressed. Questions arise as to whether these new arrangements will help or hinder progress on health inequalities. This paper explores the perspectives of experienced healthcare professionals working within the commissioning arena; many of whom are likely to remain key actors in this unfolding scenario. Methods - Semi-structured interviews were conducted with 42 professionals involved with health and social care commissioning at national and local levels. These included representatives from the Department of Health, Primary Care Trusts, Strategic Health Authorities, Local Authorities, and third sector organisations. Results - In general, respondents lamented the lack of progress on health inequalities during the PCT commissioning era, where strong policy had not resulted in measurable improvements. However, there was concern that GP-led commissioning will fare little better, particularly in a time of reduced spending. Specific concerns centred on: reduced commitment to a health inequalities agenda; inadequate skills and loss of expertise; and weakened partnership working and engagement. There were more mixed opinions as to whether GP commissioners would be better able than their predecessors to challenge large provider trusts and shift spend towards prevention and early intervention, and whether GPs’ clinical experience would support commissioning action on inequalities. Though largely pessimistic, respondents highlighted some opportunities, including the potential for greater accountability of healthcare commissioners to the public and more influential needs assessments via emergent Health & Wellbeing Boards. Conclusions - There is doubt about the ability of GP commissioners to take clearer action on health inequalities than PCTs have historically achieved. Key actors expect the contribution from commissioning to address health inequalities to become even more piecemeal in the new arrangements, as it will be dependent upon the interest and agency of particular individuals within the new commissioning groups to engage and influence a wider range of stakeholders.</p

Re-visiting Meltsner: Policy Advice Systems and the Multi-Dimensional Nature of Professional Policy Analysis

10.2139/ssrn.15462511-2

Asymmetric vestibular evoked myogenic potentials in unilateral Menière patients

Vestibular evoked myogenic potentials (VEMPs) were measured in 22 unilateral Menière patients with monaural and binaural stimulation with 250 and 500 Hz tone bursts. For all measurement situations significantly lower VEMP amplitudes were on average measured at the affected side compared to the unaffected side. Unilateral Menière patients have, in contrast to normal subjects, asymmetric VEMPs, indicating a permanently affected vestibular (most likely otolith) system at the side of hearing loss. The diagnostic value of VEMP amplitude asymmetry measurement in individual patients is low, because of the large overlap of the VEMP amplitude asymmetry range for unilateral Menière patients with that for normal subjects

Case report: Down syndrome regression disorder, catatonia, and psychiatric and immunomodulatory interventions

Down syndrome regression disorder (DSRD) is a rare condition involving subacute cognitive decline, loss of previously acquired developmental skills, and prominent neuropsychiatric symptoms, particularly catatonia, in people with Down syndrome. It is thought to involve both autoimmune and neuropsychiatric mechanisms. Research, however, is largely restricted to case studies and retrospective case series and is particularly limited in terms of prospective longitudinal follow-up. We report a case study of a person with DSRD who received both immunomodulatory (intravenous immunoglobulin; IVIG) and psychiatric interventions (electroconvulsive therapy, ECT) over two years with regular assessments using caregiver and clinician ratings. This revealed a small, unsustained response to IVIG and a rapid, sustained response once ECT was introduced. The case highlights the importance of multimodal assessment involving multiple medical specialties, the need to trial different therapies due to the condition’s complexity, and the significant barriers that patients and their families face in accessing care

The Enactment of Professional Learning Policies: Performativity and Multiple Ontologies

While teacher learning has become a locus of school reform across many international settings, there is relatively little examination of the idiosyncratic ways in which policy discourses on teacher learning are enacted in schools. In this paper, we aim to investigate how these policy discourses are translated and configured into practices and thus, enacted into concrete realities. Using the conceptual notion of multiple ontologies proposed by Mol (1999; 2004), we argue that teacher learning is actualized in a multiplicity of socio-material entanglements, not as a single reality, but as a multiplicity of realities that coexist, simultaneously, in the mesh of assemblages that we call “school”. In this study, we describe and trace how particular socio-material configurations of teacher learning produce concrete realities of practice that mobilize and generate specific networked effects. We conclude that the postulation of multiple ontologies of teacher learning prompts a shift in how policy makers could conceive of and develop strategies aimed at transforming teaching practices

Neurobehavioural Changes in a Patient with Bilateral Lesions of the Globus Pallidus

This study has characterized the long-term neurobehavioural changes in a woman who, following the intake of an unidentified substance, sustained subtotal bilateral lesions of the globus pallidus and small lesions at selective sites adjacent to it. Associated with these lesions was a significantly reduced blood flow in multiple frontal cortical regions, most prominently in area 10, the anterior cingulate and the supplementary motor cortex. Her cognitive deficits were generally consistent with those found in patients with frontal lobe dysfunction but some deficits, i.e. in visual memory and learning, were more compatible with temporal lobe dysfunction. Incapacitating personality or obsessive compulsive changes as reported by others with similar lesions were absent and she could live independently. The cognitive changes are consistent with the view that the globus pallidus has important functions in mediating how internal representations of stimulus input are converted into various forms of action, for example, in planning solutions to problems and in working memory.</jats:p

Judgements during information seeking: a naturalistic approach to understanding the assessment of enough information

In this article, theories of human judgement and decision making are reviewed and their use by library and information science researchers examined. A different perspective on judgement and decision making is offered by the field of naturalistic decision making (NDM) and the implications of this approach are considered for an expanded understanding of how judgements and decisions are made during information seeking. This discussion is illustrated by a case from a recent emperical investigation into how judgements of enough information are made in the workplace. The article concludes with a critical evaluation of the NDM approach. It is argued that NDM, a recent development in decision theory, offers a new perspective from which to investigate judgements and decisions during information seeking