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In emerging healthcare markets, user organizations, conceived as patient organizations, self‐help groups, and customer services, now face the challenge of acting as both change agents and service providers. On the one hand, they are expected to push for user‐oriented healthcare reforms; on the other hand, they are urged to facilitate users' healthcare consumption by supporting them in their decisions regarding healthcare providers and treatments, relationships to physicians, and concerning the promotion of health literacy. This plurality of tasks, which must be carried out against a backdrop of scant resources, means that many user organizations are in danger of losing their corrective civil society‐based influence vis‐à‐vis the power of healthcare professionals and providers. User organizations, having criticized the system in the past, may thus become 'ordinary' service agencies operating at arm's length from established healthcare providers and administrators. Given these developments, this contribution scrutinizes how different types of user organizations are responding to systemic change and the resulting conflicts. Drawing on an empirical study of the German healthcare system, two research interests are pursued. First, how do user organizations reshape their profiles in a more marketized healthcare system? Second, what strategies can a user organization adopt to minimize the risk of becoming a 'jack‐of‐all‐trades'?

The unique properties of nanotextiles based on poly(vinyl-alcohol) (PVA) manufactured using electrospinning method have been known and exploited for many years. Recently, the enrichment of nanofiber textiles with nanoparticles, such as ions or nanodiamond particles (NDP), has become a popular way to modify the textile mechanical, chemical and physical properties. The aim of our study is to investigate the macromechanical properties of PVA nanotextiles enriched with NDP, silver (Ag) and copper (Cu) ions. The nanofiber textiles of a various surface weight were prepared from 16% PVA solution, while glyoxal and phosphoric acid were used as cross-linking agents. The copper and silver ions were diluted in aqueous solution and NDP were dispersed into the fibers by ultrasound homogenization. All but one set of samples were exposed to the temperature of 140 °C for 10 minutes. The samples without thermal stabilization exhibited significantly lower elastic stiffness and tensile strength. Moreover, the results of tensile testing indicate that the addition of dispersed nanoparticles has a minor effect on the mechanical properties of textiles and contributes rather to their reinforcement. On the other hand, the lack of thermal stabilization results in a poor interconnection of individual nanofiber layers and the non-stabilized textiles exhibit a lower elastic stiffness and reduced tensile strength.

Based on the testimonios of 16 social justice healing practitioners from the greater San Francisco Bay Area, this article examines the principles and practices guiding their healing praxis when working with urban youth of color, particularly of Chican@/Latin@ background. I identify social justice healing practitioners as community educators who center healing and social justice when engaging youth in transformative social change. As a methodological tool, testimonios provide great insights into the life experiences and reflexivity of these community educators. By explicitly making a commitment to restoring and renewing young people's social well-being, as well as their own, these practitioners promote more holistic practices that are inclusive of young people's mind, body, and spirit. Social justice healing practitioners seek to facilitate healing spaces that provide a context for young people to reconceptualize individual challenges as a politicized collective struggle, and through this process create a platform for both youth and educators to collectively engage in healing and transformative praxis. The findings from these testimonios suggest that social justice healing practitioners strive to create community healing practices to support young people in their individual and collective processes of healing with the goal of cultivating their resilience, hope, and capacity to see themselves as agents of change.

Abstract Background Salmonella enterica , serovar Typhi (S. Typhi), a causative agent of enteric fever (typhoid fever), predominately affects populations in developing regions with poor access to clean food and water. In addition, travelers to these regions are at risk of exposure. Methods We report the epidemiological characteristics of S. Typhi cases among active duty United States military personnel from 1998 to 2011 using data obtained from the Defense Medical Surveillance System. Cases were identified based on International Classification for Disease Ninth Edition - Clinical Modification codes. Results We identified a total of 205 cases S. Typhi for an incidence of 1.09 per 100,000 person-years. Cases were on average 31.7 years old, predominately married ( n = 129, 62.9 %), Caucasian ( n = 142, 69.3 %), male ( n = 176, 85.9 %), and had a high school education ( n = 101, 49.3 %). Of the identified cases, 122 had received a Typhoid vaccination within 4 years of diagnosis. Conclusion This study provides an overview of enteric fever in the United States military. The incidence was similar to the general U.S. population except for increased incidence from 1998 to 2000, perhaps attributable to operational deployments in that period. Given that vaccination is an effective primary prevention measure against typhoid fever, active monitoring of pre-deployment vaccine history is warranted.

Altres ajuts: This is an investigator-initiated RCT that has been up to now funded by the European Renal Association (Research Programme, ERA-EDTA), the Instituto de Salud Carlos III (Spanish Government) through specific research projects and the Spanish Renal Research Network (REDINREN, RD 012/0021). ; Patients with primary membranous nephropathy (MN) and persistent nephrotic syndrome have a high risk of progression to end-stage renal disease. The Ponticelli protocol (steroids with alkylating agents) is the most effective immunosuppressive therapy for this condition, but it has severe adverse effects. Tacrolimus and rituximab have demonstrated efficacy for remission of nephrotic syndrome in MN with a safer profile. However, the published evidence is largely based on small or short-term observational studies, historical cohorts, comparisons with conservative therapy or clinical trials without appropriate control groups, and there is no head-to-head comparison with the Ponticelli protocol. The STARMEN randomized clinical trial will compare the efficacy of sequential tacrolimus-rituximab therapy with a modified Ponticelli protocol (steroids plus cyclophosphamide). The trial will also evaluate the role of antibodies against the M-type phospholipase A receptor (anti-PLAR) and other antibodies as markers of response to treatment and long-term prognosis. The trial has already started with 23 patients having been enrolled as of 1 April 2015, an estimated 21.7% of the estimated sample.

Purpose – The purpose of this paper is to explore and explain the change process in Northern Ireland policing through an analysis of temporally bracketed change phases and key change delivery themes ranging from 1996 to 2012. Design/methodology/approach – The research approach adopted is process based, longitudinal and multi-method, utilising "temporal bracketing" to determine phases of change and conjunctural reasoning to unravel the systematic factors interacting over time, within the case. Findings – The paper identifies and temporally brackets four phases of change: "Tipping point"; "Implementation, Symbolic Modification and Resistance"; "Power Assisted Steering"; and "A Return to Turbulence", identifies four themes that emerge from RUC-PSNI experience: the role of adaptive leadership; pace and sequencing of change implementation; sufficient resourcing; and the impact of external agents acting as boundary spanners, and comments on the prominence of these themes through the phases. The paper goes on to reflect upon how these phases and themes inform our understanding of organisational change within policing organisations generally and within politically pressurised transition processes. Originality/value – The contribution of the paper lies in the documentation of an almost unique organisational case in an environmentally forced change process. In this it contains lessons for other organisations facing similar, if less extreme challenges and presents an example of intense change analysed longitudinally.

International audience ; Our research examines the roles of management tools in a workforce reduction. The three functions of the organization involved in this process, namely the management accounting, human resources and production have different referents, even contradictory to the concept of staffing. The article is interested in conventions in workforce planning tools that allow to co-ordinate representations and behaviors of different actors. The article shows, based on a single case, that the management tools can be the vectors of a accepted co-ordination. All agents adhere to a accounting convention that incorporate downsizing in how to plan and staff the number of jobs. ; Notre recherche étudie les rôles de l'instrumentation de gestion dans une politique de réduction des effectifs. Les trois fonctions de l'organisation qui interviennent dans ce processus, à savoir les fonctions contrôle, ressources humaines et production, ont des référents différents, voire contradictoires de la notion d'effectif. L'article s'intérresse donc aux conventions présentes dans les outils de pilotage du volume d'emplois, qui permettent de coordonner les représentations et les comportements des différents acteurs. L'article montre, en s'appuyant sur le cas EtaForm, que les outils de gestion peuvent être les vecteurs d'une coordination admise. Tous les acteurs adhèrent à une convention comptable qui intègre la réduction des effectifs dans la manière de prévoir et de suivre le volume d'emplois.

Public policies are the result of efforts made by governments to alter aspects of behaviour—both that of their own agents and of society at large—in order to carry out some end or purpose. They are comprised of arrangements of policy goals and policy means matched through some decision-making process. These policy-making efforts can be more, or less, systematic in attempting to match ends and means in a logical fashion or can result from much less systematic processes. "Policy design" implies a knowledge-based process in which the choice of means or mechanisms through which policy goals are given effect follows a logical process of inference from known or learned relationships between means and outcomes. This includes both design in which means are selected in accordance with experience and knowledge and that in which principles and relationships are incorrectly or only partially articulated or understood. Policy decisions can be careful and deliberate in attempting to best resolve a problem or can be highly contingent and driven by situational logics. Decisions stemming from bargaining or opportunism can also be distinguished from those which result from careful analysis and assessment. This article considers both modes and formulates a spectrum of policy formulation types between "design" and "non-design" which helps clarify the nature of each type and the likelihood of each unfolding.

Based on a qualitative study, the present article examines the social organisation of knowledge production in the software work in India. The two sample firms located in Chennai city, India representing contrasting images about nature of software work were studied: a branch of a large domestic software services company—low-end programming/Fordist production model; and an Indian subsidy of a multinational software product firm—high-end software product development/flexible production model. The social organisation of software production in the two software firms are hierarchically organised, but demonstrated differential flexibility to meet the emerging market or client demands, and exhibited autonomy at the employees' level to use craft and technological knowledge through organisational procedures and routines, mediated through the project managers. It appears that prolonged engagement with the same technologies or projects works as impediment to the learning process or new knowledge production. The self-interest of the programmers motivates to engage in new knowledge production despite being directed by the organisations. The accumulated knowledge is kept within the organisations by retaining the employees through periodic pecuniary and non-pecuniary rewards, and possibilities of career leaps through technological breakthroughs. The external agents are brought in for new knowledge acquisition either through informal learning by doing or through upgradation of technological skills through training.

This article examines how the introduction of a mix of state and market-based regulatory mechanisms representing formal and informal institutional elements, respectively, impacts disclosure level of director and executive remuneration in Australia. In doing so, our study steps beyond the simple state versus market dichotomy that the extant literature is primarily concerned with and proposes a symbiotic relationship between the two. The results of our study reveal that both state regulation and self-regulation as bundles of corporate governance can potentially join forces to ease agency conflicts. What is more, certain well-institutionalized organizational practices that guide agents toward self-regulation remain highly relevant and significant, even in the presence of pervasive state regulation. The synthesis of constructs borrowed from agency and institutional theories and its testing in an empirical setting of Australia verifies the significance of formal (state regulation) and informal (self-regulation) institutional aspects in addressing moral hazard agency conflicts. Our research provides insights for public policy makers as to how policies can be developed for good corporate governance. Particularly, in the context of current global economic crises, policy makers would be better off choosing those institutional mechanisms of corporate governance that complement the state regulation with self-regulation for the management and regulation of the modern global economy.

Public policies are the result of efforts made by governments to alter aspects of behaviour—both that of their own agents and of society at large—in order to carry out some end or purpose. They are comprised of arrangements of policy goals and policy means matched through some decision-making process. These policy-making efforts can be more, or less, systematic in attempting to match ends and means in a logical fashion or can result from much less systematic processes. "Policy design" implies a knowledge-based process in which the choice of means or mechanisms through which policy goals are given effect follows a logical process of inference from known or learned relationships between means and outcomes. This includes both design in which means are selected in accordance with experience and knowledge and that in which principles and relationships are incorrectly or only partially articulated or understood. Policy decisions can be careful and deliberate in attempting to best resolve a problem or can be highly contingent and driven by situational logics. Decisions stemming from bargaining or opportunism can also be distinguished from those which result from careful analysis and assessment. This article considers both modes and formulates a spectrum of policy formulation types between "design" and "non-design" which helps clarify the nature of each type and the likelihood of each unfolding.

Background: Mortality rate is one of indicators andrepresentations of welfare of an area. In order to solve highmortality rate problem, the government of Daerah IstimewaYogyakarta (DIY), including District of Sleman, is carrying outthe policy of alert village.Method: The study used literature review based onreferences and field data which were issued by Health Office.Result: The policy of alert village has less positive impact indecreasing maternal mortality rate and neonatal mortality rate,because health assurance scheme still does not meet theneeds of the people, both physical and non-physical. Thedegree of health still has not improved significantly. The policyof alert village needs inter-sectoral financial support. Financialallocation is still mistargeting. People needs vary from onevillage to another, so it is necessary to have competent andsmart health workers as the implementing agents of HealthDepartment. The policy of alert village is still not able to satisfyall stakeholders (government, health workers, and people),because the concept of satisfaction is closely related to theprinciple of justice.Conclusion: The policy of alert village is an effort to empowerthe people to be independent in overcoming their healthproblems. But, in District of Sleman the policy of alert village isclassified into unsuccessfull policy. This failure is caused byinsufficiet support in implementating the policy.Keyword: Policy of alert village, Health Office of District Sleman

In this paper we explore the effects of alternative combinations of fiscal and monetary policies under different income distribution regimes. In particular, we aim at evaluating fiscal rules in economies subject to banking crises and deep recessions. We do so using an agent-based model populated by heterogeneous capital- and consumption-good firms, heterogeneous banks, workers/consumers, a central bank and a government. We show that the model is able to reproduce a wide array of macro and micro empirical regularities, including stylized facts concerning financial dynamics and banking crises. Simulation results suggest that the most appropriate policy mix to stabilize the economy requires unconstrained anti-cyclical fiscal policies, where automatic stabilizers are free to dampen business cycles fluctuations, and a monetary policy targeting also employment. Instead,``discipline-guided'' fiscal rules such as the Stability and Growth Pact or the Fiscal Compact in the eurozone always depress the economy, without improving public finances, even when escape clauses in case of recessions are considered. Consequently, austerity policies appear to be in general self-defeating. Furthermore, we show that the negative effects of austere fiscal rules are magnified by conservative monetary policies focused on inflation stabilization only. Finally, the effects of monetary and fiscal policies become sharper as the level of income inequality increases.

Competence fields are conceptualised as an alternative to the median-voter approach to the relationship between political leaders and constituencies. The notion of competence fields assumes that prospective political leaders need be regarded as competent in order to convince constituencies of their leadership abilities. It is argued that competence is a constructivist concept – political actors invoke claims of competence, backed by more or less strong, contextually dependent reasons in speech acts, by means of which they attempt to convince the audience of their leadership abilities. It is also argued that the construction of competence becomes particularly problematic in times of crisis, when pressures from the social context onto the prospective leaders make their claims of competence generally less convincing. Leaders are then expected to resort to all sorts of rhetorical devices and draw public attention to those competence fields in which minimal costs are to be incurred in order to establish themselves as competent in front of the constituencies. An example of an agent-based model of ethnicity as one such competence field is provided. It is argued that competence fields can be further investigated by a combination of traditional social-scientific methods and various methods and techniques from the fields of information retrieval and computer modeling, which can be particularly helpful in providing empirical evidence of competence fields.

Developing health professional clinical educators able to meet the shifting health care requirements of this century is a current government priority. To change practices in the clinic, those who teach need to change and that is best achieved by specific curricula designed for faculty development. Principles revealed during an investigation of a successful community-based medical education program underpin the Master of Clinical Education (MCE) course, a new faculty development curriculum. After six years, it is timely to evaluate whether the educational goals of the MCE course are being met. The MCE faculty employed an independent research officer to conduct the study. A two-phase approach used semi-structured interviews and content analysis to develop and assess outcomes against an outcomes logic model. The program achieved all short-term goals: understanding the symbiotic model; commitment to self as teacher; and changes in the way to give feedback. It achieved two of three medium-term goals: belief of transformation; and relationship development. One medium-term goal was not met: developing a sense of community. This evaluation of the MCE course shows the program develops clinicians as committed educators and also as change agents who see building relationships as the key to operating effectively within complex health services and systems.