Partnerships, Power and the "New" Politics of Community Participation in British Health Care

Multi–sectoral approaches to health improvement in its broadest sense have entailed an emphasis by the British government upon partnership working in and around community involvement in planning processes. New service planning and delivery organizations in the health service—primary care groups and primary care trusts—thus have to ensure that public and patient involvement strategies reflect a coordinated, if not integrated, multi–sectoral approach to such involvement. But how are these enforced partnership arrangements shaping the approach taken by primary care groups and trusts to the issue of public and patient involvement? More particularly, is the traditional dominance of health service managers and the medical profession in decision–making processes under challenge? This article draws on a study of primary care groups and trusts in three districts in order to gauge perceptions and calculations with regard to partnerships for involvement. Results appear to suggest that health service managers and practitioners continue to exercise considerable influence in comparison to that of patients and citizens. But, if the findings are viewed in the broader contexts of government managerialist strategies of surveillance and accountability and the growth of service–user and advocacy organizations, partnerships may offer significant scope for “lay” challenges to managerial and medical power.     

Health Policy and the Politics of Evidence

National decisions on the drugs, treatments and medical devices that should be funded through public expenditure are a fundamental element of health policy. But despite a political emphasis upon evidence‐based policy, the results of rigorous clinical trials and statistical modelling techniques rarely speak for themselves. So, does the pre‐eminence traditionally accorded to quantitative data in the medical field underpin policy decisions on a consistent basis? Or are more subtle, less transparent characteristics of context and interaction evident in the shaping of attendant decisions? This article considers these questions by drawing on a study of decision‐making in the National Institute for Health and Clinical Excellence (NICE)—an organization established by the British government in 1999 to decide whether selected health technologies should be made available throughout the National Health Service in England and Wales. In broad terms, the findings point to the primacy of arguments based on quantitatively oriented, experimentally derived data but also to a discursive hegemony of clinicians and health economists in mediating, including or debarring more qualitative, experientially based evidence. A more complex, dynamic understanding of policy governance in the field of health technology appraisal—founded on a discursive appropriation of the idea of the “common good”—goes some way to explaining the persistence of this hegemony despite an avowedly inclusive, plural approach to decision‐making.     

A semi-parametric approach to robust parameter design

Parameter design or robust parameter design (RPD) is an engineering methodology intended as a cost-effective approach for improving the quality of products and processes. The goal of parameter design is to choose the levels of the control variables that optimize a defined quality characteristic. An essential component of RPD involves the assumption of well estimated models for the process mean and variance. Traditionally, the modeling of the mean and variance has been done parametrically. It is often the case, particularly when modeling the variance, that nonparametric techniques are more appropriate due to the nature of the curvature in the underlying function. Most response surface experiments involve sparse data. In sparse data situations with unusual curvature in the underlying function, nonparametric techniques often result in estimates with problematic variation whereas their parametric counterparts may result in estimates with problematic bias. We propose the use of semi-parametric modeling within the robust design setting, combining parametric and nonparametric functions to improve the quality of both mean and variance model estimation. The proposed method will be illustrated with an example and simulations.     

Armed robbery and the meanings of money

In this study, we investigate the meanings active armed robbers give to money before, during, and after their crimes and how these meanings shape their offending. We do so by examining interviews undertaken from 1994 to 1995 with robbers in St. Louis, Missouri, USA. Prior to their robberies, the interviewees' desperation leads them to define money as essential to survival. Immediately following robberies and in looking back on them, they come to view this essential money in other ways as well—as too time-consuming to get, as “easy,” or as guilt-free. These meanings facilitate the contradictory way robbers see money as “fast” after offences. We discuss how these shifting meanings of money shape and are shaped by robbers' structural positions, cultural outlooks, and social relations. In doing so, we also help to explain how the shifting meanings of money play into criminogenic cycles of predatory offending.     

Attributions and Avowals of Motive in the Study of Deviance: Resource or Topic?

In explaining human actions, scholars and laypeople alike employ explanatory devices such as 'motives'. This paper critically reevaluates the relationship between 'professional' and 'lay' invocations of motive, proposing a general reorientation of theory and research. This reorientation emphasizes the mundane 'practical grammar' of motives, and argues that motive deployment is inextricably tied to deviance, and therefore irremediably moral. It is argued, therefore, that motives should serve as a topic for scholarship, not a resource for scholarly use. Several landmark theories of motives, deviance, and explanations are critically reviewed from the proposed vantage. Finally, a brief survey of similarly-minded work is offered, focussing on ethnomethodological arguments and findings, as illustrations of the heuristic power and promise of the outlined approach.     

Differential customer racial attitudes toward scandal and patriotism: The Mitchell Report,the Olympics,race, and baseball memorabilia

This paper investigates differential customer racial reaction to negative and positive publicity related to professional athletes. In terms of negative publicity, it analyzes the effect of mention in the Mitchell Report on the price of baseball cards. In regards to positive publicity, it considers the impact of having been identified as a member of the United States Olympic or national team. After controlling for player productivity with performance statistics, the effects of being mentioned in the Mitchell Report are isolated within regression analysis to draw conclusions concerning customer racial attitudes toward the steroids scandal. Similar analysis is conducted to see the impact of being seen as a baseball representative of the United States. Regression results are consistent with the conclusion that negative publicity devalues the cards of nonWhite players but not of White players. Positive publicity, however, increases the value of a player's card regardless of ethnicity.     

Finding Bhaskar in all the wrong places? Causation,process, and structure in Bhaskar and Deleuze

This article examines the reception of Roy Bhaskar amongst some contemporary Deleuzians. It proceeds by rejecting the all too often predilection of opposing realism to ‘postmodernism’ or ‘post‐structuralism’ arguing instead for the need to bring one into dialogue with the other. To this end, the paper explores the resonances and points of departure between the work of Gilles Deleuze and Roy Bhaskar. In particular, it examines the language of causation, object‐oriented versus process‐oriented ontologies, as well as the charge by Deleuzians that Bhaskar is an essentialist. Through this engagement it attempts to develop and rethink explanation and causation in terms of a more chaotic ontology of machines, centered around the concept of structure, process, and production in an open, heterogeneous, and dynamic world. The end result is a more chaotic concept of realism.     

Are We Playing the Same Game?: Publishing Task Environments and Research Productivity Among Management Specialists

Archival data on over 15,000 contributors to 33management journals are used to examine productivitydifferences among scholars in different areas ofmanagement. The results suggest that a fragmentedpublication network offers specialists from different areasdissimilar publication opportunities and experiences,and may contribute to varying levels of publicationproductivity among authors. The implications of our results for future research and facultyevaluation processes are explored.