Daniel Taylor and Dawn Goodwin present a case study of the Morecambe Bay Inquiry (MBI), which examined the high rate of maternal and neonatal deaths over a period of 9 years (2004–2013), within the small maternity unit of Furness General Hospital (FGH), one of the three hospitals comprising Morecambe Bay Hospitals Trust.1 They examine this through a conceptual lens, and provide a solution involving changes in medical education. This commentary explores both these elements. First, they use the lens of ‘Normalisation (...) of Deviance’ (NoD) to explain organisational failure. However, other available lenses such as ‘Sociology of Disasters’, ‘Organisational Silence’ and ‘Comfort-seeking Behaviour’ may point to different problems and solutions. More justification for their choice of the lens of NoD would have been useful. Similarly, more justification for their focus on a cluster of five ‘serious untoward incidents’ (SUIs) occurring in 2008 would also have been useful. They suggest that before 2008, the perinatal mortality rate was low, patient satisfaction was high and recent level 2 accreditation of maternity services by the Clinical Negligence Scheme for Trusts all suggested standards of care within the obstetric department were adequate. This stream of positive signals is likely to have contributed towards a genuine belief of safe operation within the maternity unit by staff and board members. However, as they acknowledge, the first problem can be seen in 2004. According to the MBI,2 there were SUIs in the years before and after 2008, but this …. (shrink)

Mechanisms to engage lay citizens in science and technology are currently in vogue worldwide. While some engagement exercises aim to influence policy making, research suggests that they have had little discernable impacts in this regard. We explore the potentials and challenges of facilitating citizen engagement in nanotechnology from the “topdown,” addressing the following questions: Can academics and others within institutions initiate meaningful engagement with unorganized lay citizens from the top-down? Can they facilitate effective engagement among citizens, scientists, and policy makers (...) while building citizen engagement capacities? Is it possible to create independent bottom-up citizen engagement in scientific and technological issues from the top-down, and what are the challenges in doing so? Our experiences show that although academics can build citizens' individual, collective, and political capacities to engage with each other, scientists, and policy makers, this work is enormously time and energy intensive, and institutional support is needed to sustain it. (shrink)

A widely touted approach to involving laypeople in science and technology policy-related decisions is the consensus conference. Virtually nothing written on the topic provides detailed discussion of the many steps from citizen recruitment to citizen report. Little attention is paid to how and why the mechanics of the consensus conference process might influence the diversity of the participants in theses fora, the quality of the deliberation in the citizen sessions, the experiences of the participants and organizers, and other outcomes that (...) affect democratic decision making within the conference and more broadly over the long term. As an aid to those interested in utilizing the consensus conference format, the authors outline in detail how they set about organizing their consensus conference on nanotechnology in the spring of 2005. They discuss what specific aspects of their consensus conference worked, and why, and also consider what they learned of relevance to future application. (shrink)

I have vigorously absorbed the negative element of the age in which I live, an age that is, of course, very close to me, which I have no right ever to fight against, but as it were a right to represent. The slight amount of the positive, and also of the extreme negative, which capsizes into the positive, are something in which I have had no hereditary share. I have not been guided into life by the hand of Christianity – (...) admittedly now slack and failing – as Kierkegaard was, and have not caught the hem of the Jewish prayer shawl – now flying away from us – as the Zionists have. I am an end or a beginning.1. (shrink)

When forecasting events, multiple types of uncertainty are often inherently present in the modeling process. Various uncertainty typologies exist, and each type of uncertainty has different implications a scientist might want to convey. In this work, we focus on one type of distinction betweendirect quantitative uncertaintyandindirect qualitative uncertainty. Direct quantitative uncertainty describes uncertainty about facts, numbers, and hypotheses that can be communicated in absolute quantitative forms such as probability distributions or confidence intervals. Indirect qualitative uncertainty describes the quality of knowledge (...) concerning how effectively facts, numbers, or hypotheses represent reality, such as evidence confidence scales proposed by the Intergovernmental Panel on Climate Change. A large body of research demonstrates that both experts and novices have difficulty reasoning with quantitative uncertainty, and visualizations of uncertainty can help with such traditionally challenging concepts. However, the question of if, and how, people may reason with multiple types of uncertainty associated with a forecast remains largely unexplored. In this series of studies, we seek to understand if individuals can integrate indirect uncertainty about how “good” a model is (operationalized as a qualitative expression of forecaster confidence) with quantified uncertainty in a prediction (operationalized as a quantile dotplot visualization of a predicted distribution). Our first study results suggest that participants utilize both direct quantitative uncertainty and indirect qualitative uncertainty when conveyed as quantile dotplots and forecaster confidence. In manipulations where forecasters were less sure about their prediction, participants made more conservative judgments. In our second study, we varied the amount of quantified uncertainty (in the form of the SD of the visualized distributions) to examine how participants’ decisions changed under different combinations of quantified uncertainty (variance) and qualitative uncertainty (low, medium, and high forecaster confidence). The second study results suggest that participants updated their judgments in the direction predicted by both qualitative confidence information (e.g., becoming more conservative when the forecaster confidence is low) and quantitative uncertainty (e.g., becoming more conservative when the variance is increased). Based on the findings from both experiments, we recommend that forecasters present qualitative expressions of model confidence whenever possible alongside quantified uncertainty. (shrink)

This paper examines some of the key characteristics of a socialist health care system using the example of the British National Health Service (NHS). It has been claimed that the NHS has socialist principles, and represents an island of socialism in a capitalist sea. However, using historical analysis, this paper argues that while the NHS claims some socialist ends, they could never be fully achieved because of the lack of socialist means. The socialist mechanisms which were associated with earlier plans (...) for a national health service such as a salaried service, health centres, elected health authorities and divorcing private practice from the public service were discarded in negotiation. Moreover, even these would have achieved socialism merely in the sense of distributing health care, without any deeper transformation associated with doctor-patient relationships and prevention. In short, the NHS is more correctly seen as nationalised rather than socialised medicine, achieving the first three levels of a socialist health service identified here. It can be said to have socialist principles in the limited distributional sense and has some socialist means to achieve these. However, it lacks the stronger means to fully achieve its distributional goals, and is very distant from the third level of a radical transformation of health care. (shrink)

To ascertain the theology of the Gospels lies within the purview of both narrative and historical criticism, and narrative criticism also obligates the interpreter to deal with historical questions. To say this, however, is not to deny the distinctiveness of each method. Each method poses different questions, pursues different goals, and obtains different results. To observe this, one may note how each deals with such major questions as the purpose of Luke's Gospel, the role Luke's infancy narrative plays within his (...) story, and the relationship of Luke's Gospel to Acts. (shrink)

This essay focuses upon the controversy surrounding Lord George Townshends appointment as Irish viceroy in 1767. He was the first viceroy to be made constantly resident and therefore it was a shift that could be seen as part of a process of imperial centralization, akin to assertive British policy-making for the American colonies and India. Up until this point there has been some doubt as to whether Townshend himself or the British Government was the prime mover behind this key decision. (...) This article uses the Caldwell-Shelburne correspondence in the John Rylands Library,to shed further light on this policy-making process, as well as commenting on the importance of Sir James Caldwell, landowner, hack writer and place-hunter extraordinaire, and the Earl of Shelburne, Irish-born Secretary of State and later Prime Minister, and reflecting on the historiography,of the Townshend administration and Anglo-Irish relations more generally. (shrink)

It has recently been pointed out that the 1989 White PaperWorking for Patients, which provides the basis for the current reforms of the British National Health Service, has some common features with the 1944 White PaperA National Health Service, which was the unadopted model for the service produced by the Wartime Coalition Government. Moreover, it is likely that the Conservatives, if elected in the 1945 General Election, would have introduced a service based on a modified version of the 1944 document. (...) We can compare these two blueprints to shed some light on Conservative thinking on health care over a period of nearly 50 years. There are some similarities in terms of the notions of purchaser and provider, contracts and pluralism. However, there are striking contrasts, notably in their attitude towards planning versus competition and local democracy versus patronage. It is claimed that the profound differences outweigh the apparent similarities and consequently the two blueprints show the discontinuity rather than the continuity of Conservative thinking on health care. (shrink)

I have vigorously absorbed the negative element of the age in which I live, an age that is, of course, very close to me, which I have no right ever to fight against, but as it were a right to represent. The slight amount of the positive, and also of the extreme negative, which capsizes into the positive, are something in which I have had no hereditary share. I have not been guided into life by the hand of Christianity – (...) admittedly now slack and failing – as Kierkegaard was, and have not caught the hem of the Jewish prayer shawl – now flying away from us – as the Zionists have. I am an end or a beginning.1. (shrink)