Devolution and Patient Choice: Policy Rhetoric versus Experience in Practice

Background: market reforms in England have been identified as making a clear distinction between English health policy and health policy in the devolved systems in Northern Ireland, Scotland and Wales. Patient choice is a high profile policy in the English National Health Service that constitutes significant changes to the demand side of health care. It is not clear what national differences this has led to regarding implementation of policy. This article presents the findings from a large UK‐wide study on the development and implementation of policies related to patient choice of provider. The findings reported here relate specifically to the policy development and organizational implementation of choice in order to examine the impact of devolution on health care policy. Aim: this study examines patient choice of provider across all four countries of the UK to understand the effect of differences in national policies on the organization and service how choice of provider presented to patients. Methods: at the macro‐level, we interviewed policymakers and examined policy and guidance documents to analyze the provenance and determinants of national policy in each UK nation. At the Primary Care Trust or Health Board level, we interviewed a range of public and private health service providers to identify the range of referral pathways and where and when choices might be made. Finally, we interviewed ear, nose and throat, and orthopaedics patients to understand how such choices were experienced. Findings: while we found that distinct rhetorical differences were identifiable at a national policy level, these were less visible at the level of service organization and the way choices were provided to patients. Conclusion: historical similarities in both the structure and operation of health care, coupled with common operational objectives around efficient resource use and waiting times, mediate how strategic policy is implemented and experienced in the devolved nations of the UK.     

Drivers of soil carbon in residential ‘pure lawns’ in Auburn,Alabama

Urban land area is expanding worldwide and may contribute to long-term carbon (C) storage; however, little is known about potential drivers of soil C in urban areas. Residential areas are one of the largest urban land use zones and lawns can provide stable chronosequences for studying soil C dynamics. In residential lawns containing no trees (n?=?23), the relationships between soil C and four potential drivers [home age (1–51 years), yard maintenance practices (fertilization, irrigation, and bagging or mulching lawn clippings), soil nitrogen (N) and soil texture] were investigated. Soil C increased with home age at 0–15 cm depth by 0.026 kg C m^?2?yr^?1, declined by ?0.011 kg C m^?2?yr^?1 at 15–30 cm depth, and was stable at 30–50 cm depth. Soil C had a positive relationship with soil N (R ²?=?0.55) at the 0–15 cm depth. Soil C and N were not related to yard maintenance practices or soil texture. The low soil C sequestration rate and limited relationships between soil C and home age, yard maintenance, soil N and soil texture may have resulted from the positive influence of Auburn’s humid, subtropical climate on residue decomposition.     

Family Therapy and Young Children A Case of Potential Child Abuse

Parental distress often places young children in grave danger of physical abuse. In this paper a family therapy approach is used with a single parent family with young children where physical abuse is a distinct possibility. The paper outlines some of the basic concepts used in the therapy and focuses on the effective use of relabelling as a means to diffuse anger and open the way for constructive change within the family system.     

Everyday terrorism: Campus sexual violence and the neoliberal university

This article investigates the ways sexual violence experienced on college campuses in the United States is situated within the neoliberal university. Feminist theories are utilized to explore the relationship between sexual violence and neoliberal ideologies. The authors evaluate how neoliberal tenets imbedded in higher education have contributed to, and exacerbated, an environment where sexual victimization is common. An institutional level of analysis is utilized to examine the neoliberal influence on campus sexual violence and investigate the utility of the term everyday terrorism. The authors also address “crimes of omission”, institutional betrayal, and the significance of institutional bravery/courage. The authors provide recommendations for future research in the areas of everyday terrorism and campus violence.     

Paying for Sex While Traveling As Tourists: The Experiences of Israeli Men

This qualitative study explored the experiences of 15 Israeli men who paid for sex while traveling as tourists abroad, based on in-depth, semistructured interviews with them. The findings focus on three major aspects of the participants’ experiences: the meaning of sex for them and their reasons for wanting to pay for it; the problems involved in paying for sex; and paying for sex while traveling abroad as a preferable option to paying for sex in Israel. The discussion offers sociological and psychological intersubjective explanations for the men’s preference to pay for sex as tourists overseas.     

Influence of aboveground tree biomass,home age,and yard maintenance on soil carbon levels in residential yards

With the rapid urbanization of natural lands, researchers have begun to examine the capacity of urban soils to store carbon (C), with recent attention to residential yards. We performed a case study to examine four potential influences on soil C levels in residential yards. In 67 yards containing trees, we examined the relationship of soil C (kg m^?2) to tree aboveground biomass, home age (3–87 years), yard maintenance (fertilization, irrigation, mulching or bagging lawn clippings), and soil texture (% clay, % sand, % silt), at three depths (0–15 cm, 15–30 cm, and 30–50 cm). Six tree aboveground biomass data sets were developed: 1) biomass, 2) biomass*(1/distance from tree), 3) biomass?≤?15 m from sample site, 4) biomass?≤?10 m, 5) biomass?≤?5 m, and 6) biomass?≤?4 m. Biomass?≤?5 m and biomass?≤?4 m had the greatest explanatory power for soil C at 30–50 cm depth (P?=?0.001, R²?=?0.28; P?=?0.05 R²?=?0.39, respectively). The relationship between soil C and home age was positive at 0–15 cm (P?=?0.0003, R²?=?0.19), but constant at the two lower depths. Yard maintenance had no significant influence on soil C levels across home age. At 0–15 cm, soil C increased with % silt (P?=?0.006, R²?=?0.12). Overall, trees in turfgrass yards may have a stabilizing effect on soil C levels below 15 cm but minimal influence above 15 cm.     

Automobility reconfigured? Ironic seductions and mundane freedoms in 16–21 year olds’ accounts of car driving and ownership

In the light of the ‘peak-car’ thesis, this paper explores the driving-related desires and practices of adults aged 16–21 and their parents from the UK. Tropes of freedom and independence were commonly evoked; but were pragmatically framed by concerns of finance, utility and risk. Car ownership was prized only for instrumental reasons, and as one tool in a mixed, collective transport network: it had been decoupled from automobility. Environmental sustainability was notably absent from discussions. It may be too early to herald the end of automobility but, for these participants, its seductions have been rendered ironic, rather than aspirational.     

Mental Health Policy in Northern Ireland

Mental health policy in Northern Ireland has moved through a number of phases during the past seventy years. This article examines some of the developments during each of these phases in the context of political factors which had an effect on policy formation and implementation. The services which existed in 1921 were deeply rooted in the lunacy legislation and provision of nineteenth century Ireland. The political uncertainty and financial stringency, which characterized the following two decades, resulted in a situation of almost complete stagnation in those services. The contribution of Northern Ireland during the Second World War guaranteed a financial commitment by Britain to the building of a comprehensive health service in the post-war era. The expansion in mental health services was unprecedented. The relative stability of this era was shattered by the political “troubles” of the 1970s and the imposition of “direct rule” from Westminster. Though advantageous to health service development at first, this has now led to tighter central controls and the further loss of local autonomy. In policies dictated from Westminster, Area Boards moved towards a reduction in psychiatric beds to 1,500—the level of provision in 1870. History tells us that the needs of mentally ill people have not had a significant impact on services in the past. Will the future be any different?