‘Creating NHS Local’: The Relationship between English Local Government and the National Health Service

Following recent reforms of both local government and the National Health Service, there is significant emphasis in both services on improving inter‐agency collaboration, user involvement and strategic commissioning. In response, this article reviews historical debates about the relationship between local government and health care, before arguing that these two ‘partners’ need each other now more than ever. If local government is to be a ‘place‐shaper’, then it needs significant influence over local health services, while the NHS needs to learn from the best of local government if it is to gain sufficient local legitimacy to take the difficult decisions it needs to take. Against this background, the article reviews different options for future joint working, exploring various options for enacting a new relationship between local government and the NHS.     

High Performance Work Practices and Firm Performance: A Longitudinal Case Study

Accumulating research suggests that the adoption of high performance work practices (HPWPs) is related to organizations' performance. The evidence base is limited by its reliance on retrospective survey reports. This study uses an intervention, including longitudinal interview and survey reports, of the implementation and outcomes of the introduction of HPWPs alongside time series data of objective performance metrics recorded before and after the intervention. The results showed that the implementation of HPWPs was associated with subsequent and sustained increases in productivity and safety performance. The study suggests that a specifically designed intervention involving HPWPs can have beneficial effects both on productivity and safety, but other intermediary variables associated with the implementation process may be critical in mitigating potentially detrimental worker welfare effects arising from work intensification.     

Pregnant and Postpartum Adolescents' Perceptions of the Consequences of Child Abuse

A study of 263 pregnant and postpartum indigent and minority teens was conducted in order to examine their perceptions of the consequences of child abuse and their own child abuse history. Teens identified drug and alcohol abuse and teen suicide as the most serious consequences of abuse. Interestingly, they did not identify pregnancy as a consequence. Twenty-seven percent reported a history of abuse. Identifying behavioral and emotional consequences of abuse is important because it affects both the well-being of the adolescent mother and her child. An experience of abuse and its behavioral consequences may interfere with a teen's ability to benefit from parenting intervention programs. Therefore, parenting programs may wish to consider the necessity of screening for a history of abuse as well as adding components on behavioral problems adolescent mothers are concerned about. Additionally, there is a need to reach out to pregnant, parenting and future parents in other settings such as prisons, psychiatric, and residential centers, since issues of abuse may coexist with other behaviors.     

Effects of Provocation on Maltreated and Nonmaltreated Preschoolers' Understanding of Moral Transgressions

This study examined maltreated and nonmaltreated preschool children's judgments regarding hypothetical provoked and unprovoked moral transgressions. Maltreated children (17 physically abused and 19 neglected) and 19 matched nonmaltreated children rated the severity and deserved punishment and evaluated affective responses to six hypothetical moral transgressions which were depicted as both unprovoked and provoked by another child's actions. All children rated unprovoked transgressions as more serious and deserving of punishment and as eliciting more happiness and fear and less anger than transgressions that were depicted as provoked by another's actions. No gender or maltreatment status differences in ratings of transgression severity and deserved punishment were found; however, patterns of affective responses to hypothetical transgressions differed as a function of maltreatment subtype. Findings are discussed in terms of previous research on maltreatment and moral judgment development.     

Quantitative Risk Assessment from Farm to Fork and Beyond: A Global Bayesian Approach Concerning Food-Borne Diseases

A novel approach to the quantitative assessment of food-borne risks is proposed. The basic idea is to use Bayesian techniques in two distinct steps: first by constructing a stochastic core model via a Bayesian network based on expert knowledge, and second, using the data available to improve this knowledge. Unlike the Monte Carlo simulation approach as commonly used in quantitative assessment of food-borne risks where data sets are used independently in each module, our consistent procedure incorporates information conveyed by data throughout the chain. It allows "back-calculation" in the food chain model, together with the use of data obtained "downstream" in the food chain. Moreover, the expert knowledge is introduced more simply and consistently than with classical statistical methods. Other advantages of this approach include the clear framework of an iterative learning process, considerable flexibility enabling the use of heterogeneous data, and a justified method to explore the effects of variability and uncertainty. As an illustration, we present an estimation of the probability of contracting a campylobacteriosis as a result of broiler contamination, from the standpoint of quantitative risk assessment. Although the model thus constructed is oversimplified, it clarifies the principles and properties of the method proposed, which demonstrates its ability to deal with quite complex situations and provides a useful basis for further discussions with different experts in the food chain.     

Municipal Waste Management: Inequities and the Role of Deliberation

Like radioactive waste, municipal solid waste (MSW) requires consideration of a complex mix of intergenerational and intragenerational risks surrounded by uncertain science. Unlike radioactive waste, MSW is a common problem and hence one often perceived to be controllable, at least until a required facility is proposed in a particular community. The intragenerational risks focused on local communities rouse intense public pressures for management. Although some of the risks can be quantified, the risk assessment process cannot deal with all questions. This article examines the multiple dimensions of the decisions required to be made and the weaknesses of a number of decision tools traditionally used. A case is made for the need to integrate decision tools appropriate to the risks into reflexive and iterative decision processes open to public involvement. It is argued that this presents the best hope of both optimizing decisions about the intragenerational risks as well as raising public debate about the importance of sustainable waste management in transgenerational terms.     

Uncertainty and forecasting local health professional shortages

We used a utilization-based scenario-forecasting model toassess the evidence for current and future imbalances between health professional supply and demand in Memphis-Shelby County, Tennessee. The scenario-forecasting model, based on qualitativeinformation collected from local health industry leaders, was shaped and limited by the types of current local area data available. This paper discusses methods that may prove useful to applied demographers making forecasts, given uncertain system change and poor data.     

Gender in Management: Theorizing Gender as Heterogender

Research on gendered identities in management has exploded over the past three decades. The focus on gender obscures the place of sexuality in gendered theory. In this article theories of gender as ‘object’, ‘subject’ and as social processes are used as interpretative frames to explore the ways in which gender and sexuality are enacted by lesbian managers. Their narratives demonstrate that managing gender was experienced primarily as managing heterosexuality. Disjunctions in identity positions revealed that heterosexual assumptions provide the foundation of gender. Reframing gender as ‘heterogender’ foregrounds heterosexuality and gender as intertwined and provides another layer to understanding how gender is ‘done’ in management.