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The purpose of this paper is to understand the barriers and enablers to lean implementation as part of an imaging quality improvement programme from a socio-cultural perspective.

An in-depth 33 month ethnographic study, using observation and qualitative interviews, examined the process of lean implementation as part of an improvement programme.

Implementation of lean was more successful compared with other reports of lean in healthcare settings. Key enablers of lean were high levels of multidisciplinary staff involvement and engagement; the professional credibility of facilitators and clinicians as early adopters, all within a wider culture of relatively strong inter-professional relationships in the imaging department. These enablers combined with the more routinised and standardised nature of imaging pathways compared to some other acute specialties suggest that imaging is fertile ground for lean, linked to the manufacturing origins of lean.

When introducing lean within healthcare settings, special attention needs to be paid to the specific healthcare context and the existing cultures of inter-professional relationships. Fostering an improvement culture and engagement with training, together with adequate financial resource, are a key to contributing to the level of acceptability of an improvement tool such as lean.

This ethnographic study, bringing together rich multi-source data, has provided a detailed insight into the cultural workings of the process of lean implementation within a complex healthcare system.

What is this tide of history that washes over the continent of Australia after 1788 destroying in its wake much of the indigenous people’s relationship with land and waters? Now only remnants, fragments of a former aboriginal inscription of law/lore remain evident in the Australian physical and metaphoric landscape.¹ In Law, the “tide of history” has been extended from its original voicing in Mabo v. Queensland [No. 2] (1992) to become a justificatory strategy for the limitation of responsibility and a concurrent apologia that simultaneously acknowledges a previous aboriginal connection with land but denies its current legitimacy.²

This study compares filmic and televisual representations of fictional black presidents to white Americans’ reactions to the advent of the United States’s first African American president. My main goal is to determine if there is convergence between these mediated representations and whites’ real-world representations of Barack Obama. I then weigh the evidence for media pundits’ speculations that Obama owes his election to positive portrayals of these fictional heads of state.

The film and television analyses examine each black president’s social network, personality, character traits, preparation for office, and leadership ability. I then compare the ideological messages conveyed through these portrayals to the messages implicated in white Americans’ discursive and pictorial representations of Barack Obama.

Both filmic and televisual narratives and public discourses and images construct and portray black presidents with stereotypical character traits and abilities. These representations are overwhelmingly negative and provide no support for the argument that there is a cause–effect relationship between filmic and televisual black presidents and Obama’s election victory.

Neither reel nor real-life black presidents can elude the representational quagmire that distorts African Americans’ abilities and diversity. Discourses, iconography, narratives, and other representations that define black presidents through negative tropes imply that blacks are incapable of effective leadership. These hegemonic representations seek to delegitimize black presidents and symbolically return them to subordinate statuses.

The essay explores the profound nature and consequences of subjectivity struggles in everyday life. W. E. B. Du Bois's concept of double consciousness and its constituent concepts of the veil, twoness, and second sight illuminate the process of racialized self-formation. Racialized self-formation contributes to understanding the cultural reproduction of domination and subjugation, the two primary concerns of radical interactionists. Double consciousness, long ignored by symbolic interactionists, cannot be neglected by radical interactionists if they are to articulate a comprehensive account of self-formation in a white-supremacist culture. Reflections on racialization, meritocracy, and subjectivity struggles in contemporary everyday life conclude the essay.

The aim of this paper is to identify factors (i.e. age, gender, ethnicity, type of medical facility, geographical location, etc.) associated with physicians' prescribing behavior when treating influenza in the USA. The study aims to examine why the number of antiviral prescriptions remains substandard.

Data were obtained from the National Ambulatory Medical Care Survey for each influenza season between the years of 2005-2008. Bivariate analyses and two models of multivariate logistic regression analyses (one with no fixed effect and the other including year as a fixed effect) were used to analyze the data.

The results from this study revealed that among family practice physicians, 40.5 percent prescribed antiviral medications to patients presenting with influenza while 59.5 percent prescribed another form of medication. Antibiotics comprised 41.3 percent of the prescriptions for treatment of influenza. Multivariable logistic regression analyses revealed that race (White; p=0.023), type of health setting (private solo/group practice; p=0.041), employment status (owner; p=0.046), and metropolitan location (metropolitan statistical area; p=0.032) were all significantly associated with prescribing antivirals. Patients' expected source of payment (private insurance) and geographical location (Midwest) of health facility were marginally associated with prescribing antivirals.

By identifying factors associated with physicians' prescribing practices of antiviral medications, a more timely diagnosis and treatment of influenza can occur. Efforts should be targeted to improve physician education and awareness of the illness. Interventions may be implemented to improve the prescribing of antiviral medications and potentially inappropriate prescribing.

I ENTERED the literary world late in the immediate post‐war years when changes of literary taste and loyalty were already in the air. The first broadcast I gave was, I remember, an attack upon Virginia Woolf. Her books had nurtured me as an adolescent, and I was in reaction against her influence.

The purpose of this paper is to document the coping styles of first tier managers in English further education (FE) colleges, in relation to the most significant stressors and to create an original, grounded scale of coping based on the data.

This study adopted a qualitative approach to coping strategies and involved semi‐structured interviews with 23 first tier managers in four colleges.

The study identified 16 distinct coping strategies employed by the first tier managers that ranged from “compliant” strategies, such as increased effort and self‐coaching, to “affective” strategies, such as exercise and tension reduction; and finally, those strategies that were “non‐compliant” such as escape and dissent.

This research presents a tentative coping scale for first tier managers that could potentially inform the design of structured development programmes according to their particular needs.

This is the first coping scale of first tier managers in FE and its findings may have implications for first tier managers in other organisational settings.

THE changes in London local government which came into operation on 1st April, 1965, cut across the existing regional library bureaux organisation.

THE proposition that British library schools should examine their own students is not a new one. As long ago as 1954, Roy Stokes put the question bluntly to the profession. In those days his was a voice crying in the wilderness. The profession at large was not ready for such a development, and continued to adhere to its long held view that the Library Association should examine the products of the schools, while the schools confined themselves to teaching.