NHS Inquiries and the Problem of Culture

If inquiries are about learning the lessons of the past, why do they appear to find the same failings time and again? Bristol, Mid Staffordshire, Morecambe Bay, Liverpool Community Health are all examples of where culture went wrong. The lack of learning from inquiries is a prominent concern and one raised elsewhere in this issue. In this article, I explore why it might be that culture is repeatedly found to be the cause of healthcare failures. I start by reviewing perspectives on what culture is and the degree to which it is possible change it. I examine how culture was described in the Bristol, Mid Staffordshire, Morecambe Bay and Liverpool inquiries and question whether these are the same cultures, with the same problems, or whether they are different. I discuss possible explanations for apparent similarities, describe how cultural change occurs and conclude by drawing out the implications of focussing on culture as a threat to patient safety.     

Stability and Change in Rural Youths’ Educational Outcomes Through the Middle and High School Years

There is a dearth of literature that examines rural youths’ school transition and adaptation over the middle and high school years. Given rural education challenges, this study examines rural youths’ developmental trajectories of self-reported grades and affective and behavioral educational outcomes (i.e., school belonging, value of education, school misbehavior, and extracurricular activity participation). The cohort-sequential study consisted of 3,312 African American and White youth (50% female) who were surveyed over three and a half years, including the transition to high school. The results reveal significant changes in the outcomes from sixth to twelfth grade. For example, on average, school misbehavior increased over time while perceived school belonging decreased over time. Gender and race differences emerged; African American youth reported placing higher importance on education and less participation in school activities than White youth. The discussion focuses on the importance of examining rural adolescents’ educational pathways during the high school transition.     

Theoretical and Methodological Challenges of Studying Refugee Children in the Middle East and North Africa: Young Palestinian, Afghan and Sahrawi Refugees

This article aims to address a number of conceptual and methodologicalchallenges facing the study of young refugees. Much of the researchon refugees has, until recently, been focused on adults, andto a lesser degree, on young children. Those studies that doinclude children are largely carried out in the domain of psychologyand psychiatry and tend to pathologize and individualize. Thisarticle is based on observations derived from a six-year, multi-disciplinaryanthropological and participatory research programme that examinedthe impact of forced migration on young people in the MiddleEast and North Africa: Palestinian refugee youth in Lebanon,Syria, Jordan, the West Bank and Gaza, Sahrawi youth in Algeria,and Afghan youth in Iran. It argues that despite the challenges,an anthropological and participatory approach contributes toa greater, more holistic understanding of refugee youth.     

Epidemiology of homicide-suicide events: Oklahoma, 1994-2001

In Oklahoma, all nonnatural deaths must be reported to the Office of the Chief Medical Examiner (ME), whose trained investigators report cause of death using a centralized, statewide, standardized reporting system. The purpose of this study was to determine temporal trends of Oklahoma homicide-suicide events and characterize the epidemiology of these events. By reviewing all ME reports of homicides and suicides from 1994 through 2001, we identified 73 homicide-suicide events resulting in 73 suicides and 89 homicides. Suicidal perpetrators of homicide-suicide events were most often white men aged >or=30 years who killed a current or ex-spouse or intimate partner. Homicide victims tended to be younger women the same race as their killer. Firearms were the predominant method of death in both homicides and suicides, with handguns used most frequently. Divorce/estrangement was the main contributing factor to these events, and the most common relationship type was possessive. The existence of a statewide, centralized, and computerized ME system and the ability to access the detailed information in the ME narratives were critical to identifying homicide-suicide events and obtaining the type of detailed information necessary to fully investigate these events.     

Gender Crimes Jurisprudence in the ICTR: Positive Developments

Considering the magnitude of rape and other sexual crimes perpetratedduring the Rwandan genocide, gender crimes prosecutions at theInternational Criminal Tribunal for Rwanda (ICTR) have beeninadequate so far. Nonetheless, the ICTR case law must be commendedfor the impulse given, with and after Akayesu, to the criminalizationand punishment of gender-related violence. This paper pointsto the achievements of the ICTR case law in this respect.     

Enemies Everywhere: Terrorism, Moral Panic, and US Civil Society

Since the attacks of September 11th, 2001, terrorism has experienced a prominence in discourse across the U.S. The representations of terrorists and terrorism by the news media and politi have contributed to the edifice of terrorism as a moral panic. This treatise examines the social effects that have or may occur due to the social construction of a moral panic of terrorism. The thematic frame is situated within Cohens stages of a moral panic. We offer an analysis of the medias depiction and coverage of acts of terrorism, and legislative, political and legal responses in the form of social and cultural changes occurring from the creation of a moral panic. In addition, we offer an analysis of the states vested interest in the social construction of this panic, leading to increased levels of fear, targeted at the general publics consciousness. This article concludes that the presentation of terrorism and terrorists by the media and politi have contributed to unnecessary levels of panic and fear, misguided public consciousness, and the development of legislation creating negative social ramifications yet be seen.     

High prevalence of 6-acetylmorphine in morphine-positive oral fluid specimens

Identification of 6-acetylmorphine, a specific metabolite of heroin, is considered to be definitive evidence of heroin use. Although 6-acetylmorphine has been identified in oral fluid following controlled heroin administration, no prevalence data is available for oral fluid specimens collected in the workplace. We evaluated the prevalence of positive test results for 6-acetylmorphine in 77,218 oral fluid specimens collected over a 10-month period (January-October 2001) from private workplace testing programs. Specimens were analyzed by Intercept immunoassay (cutoff concentration=30 ng/ml) and confirmed by GC-MS-MS (cutoff concentrations=30 ng/ml for morphine and codeine, and 3 ng/ml for 6-acetylmorphine). Only morphine-positive oral fluid specimens were tested by GC-MS-MS for 6-acetylmorphine. A total of 48 confirmed positive morphine results were identified. An additional 107 specimens were confirmed for codeine only. Of the 48 morphine-positive specimens, 32 (66.7%) specimens were positive for 6-acetylmorphine. Mean concentrations (+/-S.E.M.) of morphine, 6-acetylmorphine and codeine in the 32 specimens were 755+/-201, 416+/-168 and 196+/-36 ng/ml, respectively. Concentrations of 6-acetylmorphine in oral fluid ranged from 3 to 4095 ng/ml. The mean ratio (+/-S.E.M.) of 6-acetylmorphine/morphine was 0.33+/-0.06. It is suggested that, based on controlled dose studies of heroin administration, ratios >1 of 6-acetylmorphine/morphine in oral fluid are consistent with heroin use within the last hour before specimen collection. The confirmation of 6-acetylmorphine in 66.7% of morphine-positive oral fluid specimens indicates that oral fluid testing for opioids may offer advantages over urine in workplace drug testing programs and in testing drugged drivers for recent heroin use.     

A developmental approach to historical causal inference

Public Choice - Empirical historical research typically falls into one of three categories: the study of major historical events; the use of “history as data” to test general theories;...