32 results
Time-to-hepatitis C treatment initiation among people who inject drugs in Melbourne, Australia
- Phyo T. Z. Aung, Tim Spelman, Anna L. Wilkinson, Paul M. Dietze, Mark A. Stoové, Margaret E. Hellard
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- Journal:
- Epidemiology & Infection / Volume 151 / 2023
- Published online by Cambridge University Press:
- 09 May 2023, e84
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This study aims to understand the time-to-treatment initiation pre and post DAA access to inform strategies to improve HCV care. The data for our study were derived from the SuperMIX cohort study of people who inject drugs in Melbourne, Australia. Time-to-event analysis using Weibull accelerated failure time was performed for data collected between 2009 and 2021, among a cohort of HCV-positive participants. Among 223 participants who tested positive for active hepatitis C infection, 102 people (45.7%) reported treatment initiation, with a median time-to-treatment of 7 years. However, the median time-to-treatment reduced to 2.3 years for those tested positive after 2016. The study found that treatment with Opioid Agonist Therapy (TR 0.7, 95% CI 0.6–0.9), engagement with health or social services (TR 0.7, 95% CI 0.6–0.9), and having a first positive HCV RNA test after March 2016 (TR 0.3, 95% CI 0.2–0.3) were associated with a reduced time-to-treatment initiation. The study highlights the need for strategies to improve engagement with health services, including drug treatment services into routine HCV care to achieve timely treatment.
Real-world monitoring progress towards the elimination of hepatitis C virus in Australia using sentinel surveillance of primary care clinics; an ecological study of hepatitis C virus antibody tests from 2009 to 2019 – CORRIGENDUM
- Anna Lee Wilkinson, Alisa Pedrana, Michael W Traeger, Jason Asselin, Carol El-Hayek, Long Nguyen, Victoria Polkinghorne, Joseph S Doyle, Alexander J Thompson, Jessica Howell, Nick Scott, Wayne Dimech, Rebecca Guy, Margaret Hellard, Mark Stoové
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- Journal:
- Epidemiology & Infection / Volume 150 / 2022
- Published online by Cambridge University Press:
- 04 March 2022, e44
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Real-world monitoring progress towards the elimination of hepatitis C virus in Australia using sentinel surveillance of primary care clinics; an ecological study of hepatitis C virus antibody tests from 2009 to 2019
- Anna Lee Wilkinson, Alisa Pedrana, Michael W. Traeger, Jason Asselin, Carol El-Hayek, Long Nguyen, Victoria Polkinghorne, Joseph S. Doyle, Alexander J. Thompson, Jessica Howell, Nick Scott, Wayne Dimech, Rebecca Guy, Margaret Hellard, Mark Stoové
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- Journal:
- Epidemiology & Infection / Volume 150 / 2022
- Published online by Cambridge University Press:
- 06 December 2021, e7
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To achieve the elimination of the hepatitis C virus (HCV), sustained and sufficient levels of HCV testing is critical. The purpose of this study was to assess trends in testing and evaluate the effectiveness of strategies to diagnose people living with HCV. Data were from 12 primary care clinics in Victoria, Australia, that provide targeted services to people who inject drugs (PWID), alongside general health care. This ecological study spanned 2009–2019 and included analyses of trends in annual numbers of HCV antibody tests among individuals with no previous positive HCV antibody test recorded and annual test yield (positive HCV antibody tests/all HCV antibody tests). Generalised linear models estimated the association between count outcomes (HCV antibody tests and positive HCV antibody tests) and time, and χ2 test assessed the trend in test yield. A total of 44 889 HCV antibody tests were conducted 2009–2019; test numbers increased 6% annually on average [95% confidence interval (CI) 4–9]. Test yield declined from 2009 (21%) to 2019 (9%) (χ2P = <0.01). In more recent years (2013–2019) annual test yield remained relatively stable. Modest increases in HCV antibody testing and stable but high test yield within clinics delivering services to PWID highlights testing strategies are resulting in people are being diagnosed however further increases in the testing of people at risk of HCV or living with HCV may be needed to reach Australia's HCV elimination goals.
Emotional abuse and neglect in a clinical setting: challenges for mental health professionals
- Margaret DeJong, Simon Wilkinson, Carmen Apostu, Danya Glaser
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- Journal:
- BJPsych Bulletin / Volume 46 / Issue 5 / October 2022
- Published online by Cambridge University Press:
- 21 September 2021, pp. 288-293
- Print publication:
- October 2022
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This article addresses some of the common uncertainties and dilemmas encountered by both adult and child mental health workers in the course of their clinical practice when dealing with cases of suspected emotional abuse or neglect (EAN) of children. We suggest ways of dealing with these according to current best practice guidelines and our own clinical experience working in the field of child maltreatment.
Dissociative identity disorder: a developmental perspective
- Simon Wilkinson, Margaret DeJong
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- Journal:
- BJPsych Advances / Volume 27 / Issue 2 / March 2021
- Published online by Cambridge University Press:
- 15 June 2020, pp. 96-98
- Print publication:
- March 2021
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Dissociation is a common and often overlooked symptom in traumatised children. Although there is a lack of a scientific consensus as to the nature of dissociation and very limited research about dissociative identity disorder (DID) in children, the authors have seen children given this diagnosis recently referred to their clinic and are concerned about this practice and the parenting approaches that have ensued. The diagnosis of DID in children may be rare or of doubtful validity, but repeated traumatic experiences of an interpersonal nature can have a profound effect on a child's identity, memory and self-organisation. Furthermore, abuse and neglect can increase the risk of dissociative symptoms. This brief article considers dissociation in post-traumatic stress disorder, then outlines developmental factors hypothesised to be associated with dissociation in childhood and early adulthood. It warns that clinicians should keep an open mind about how dissociation may manifest transdiagnostically, and concludes with recommendations for further research.
Policy design as co-design
- Catherine Durose, University of Birmingham, Liz Richardson, University of Manchester
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- Book:
- Designing Public Policy for Co-production
- Published by:
- Bristol University Press
- Published online:
- 01 September 2022
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- 11 November 2015, pp 157-166
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Summary
Drawing on an innovative co-design process, facilitated by the contributors, this vignette explores how practitioners have tried to make concrete the theory of co-design. The example highlights the deep challenges this presented to traditional ways of working and thinking. It concludes that a ‘leap of faith’ is sometimes needed for practitioners to see the benefits of unusual co-design processes. The illustrative example is of an attempt to redesign public services in one neighbourhood in Bradford, West Yorkshire, in the north of England. The neighbourhood is known by its postcode – BD5 – and is a place, and set of people, that had already undergone many attempts at urban renewal and regeneration. As with other stories presented in this book – in Deptford and in Birmingham for example – previous government-funded regeneration programmes had brought some improvements to the area, but not enough and not as transformatory as was needed. This contribution relates the details of a process used to bring in new thinking to longstanding issues facing local people and organisations.
A case has been presented for ‘incomplete design’ as a positive feature of alternative policy-making approaches. By presenting a rich and honest picture of the work done, this contribution allows us to glimpse some of the flavour of what incomplete design felt like for those participating in it. These designs lack the security of certainty, or at least old certainties. This example shows us that introducing new approaches is not easy, and may initially feel uncomfortable for participants, and needs facilitators to manage these feelings. The challenge it presents is to be comfortable with uncomfortableness. Fundamentally, it reminds us that creating change in policy and policy processes is often really hard. It offers a methodology to produce better policy outcomes in a more effective and inclusive way. This illustration is of some accessible facilitation tools, which are transformatory in making principles real. At its core, it advocates for reconnecting with citizens’ lived experience in policy.
Context
In many areas there is a neighbourhood similar to BD5; loved by its residents, with people who want to make a difference, a vibrant multiethnic mix, and all the potential that comes from being close to the city centre.
Contributors
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- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. Bernad, Henley Bernard, Alan E. Bernstein, Jon L. Berquist, Johannes Beutler, Ana María Bidegain, Matthew P. Binkewicz, Jennifer Bird, Joseph Blenkinsopp, Dmytro Bondarenko, Paulo Bonfatti, Riet en Pim Bons-Storm, Jessica A. Boon, Marcus J. Borg, Mark Bosco, Peter C. Bouteneff, François Bovon, William D. Bowman, Paul S. Boyer, David Brakke, Richard E. Brantley, Marcus Braybrooke, Ian Breward, Ênio José da Costa Brito, Jewel Spears Brooker, Johannes Brosseder, Nicholas Canfield Read Brown, Robert F. Brown, Pamela K. Brubaker, Walter Brueggemann, Bishop Colin O. Buchanan, Stanley M. Burgess, Amy Nelson Burnett, J. Patout Burns, David B. Burrell, David Buttrick, James P. Byrd, Lavinia Byrne, Gerado Caetano, Marcos Caldas, Alkiviadis Calivas, William J. Callahan, Salvatore Calomino, Euan K. Cameron, William S. Campbell, Marcelo Ayres Camurça, Daniel F. Caner, Paul E. Capetz, Carlos F. Cardoza-Orlandi, Patrick W. Carey, Barbara Carvill, Hal Cauthron, Subhadra Mitra Channa, Mark D. Chapman, James H. Charlesworth, Kenneth R. Chase, Chen Zemin, Luciano Chianeque, Philip Chia Phin Yin, Francisca H. Chimhanda, Daniel Chiquete, John T. Chirban, Soobin Choi, Robert Choquette, Mita Choudhury, Gerald Christianson, John Chryssavgis, Sejong Chun, Esther Chung-Kim, Charles M. A. Clark, Elizabeth A. Clark, Sathianathan Clarke, Fred Cloud, John B. Cobb, W. Owen Cole, John A Coleman, John J. Collins, Sylvia Collins-Mayo, Paul K. Conkin, Beth A. Conklin, Sean Connolly, Demetrios J. Constantelos, Michael A. Conway, Paula M. Cooey, Austin Cooper, Michael L. Cooper-White, Pamela Cooper-White, L. William Countryman, Sérgio Coutinho, Pamela Couture, Shannon Craigo-Snell, James L. Crenshaw, David Crowner, Humberto Horacio Cucchetti, Lawrence S. Cunningham, Elizabeth Mason Currier, Emmanuel Cutrone, Mary L. Daniel, David D. Daniels, Robert Darden, Rolf Darge, Isaiah Dau, Jeffry C. Davis, Jane Dawson, Valentin Dedji, John W. de Gruchy, Paul DeHart, Wendy J. Deichmann Edwards, Miguel A. De La Torre, George E. Demacopoulos, Thomas de Mayo, Leah DeVun, Beatriz de Vasconcellos Dias, Dennis C. Dickerson, John M. Dillon, Luis Miguel Donatello, Igor Dorfmann-Lazarev, Susanna Drake, Jonathan A. Draper, N. Dreher Martin, Otto Dreydoppel, Angelyn Dries, A. J. Droge, Francis X. D'Sa, Marilyn Dunn, Nicole Wilkinson Duran, Rifaat Ebied, Mark J. Edwards, William H. Edwards, Leonard H. Ehrlich, Nancy L. Eiesland, Martin Elbel, J. Harold Ellens, Stephen Ellingson, Marvin M. Ellison, Robert Ellsberg, Jean Bethke Elshtain, Eldon Jay Epp, Peter C. Erb, Tassilo Erhardt, Maria Erling, Noel Leo Erskine, Gillian R. Evans, Virginia Fabella, Michael A. Fahey, Edward Farley, Margaret A. Farley, Wendy Farley, Robert Fastiggi, Seena Fazel, Duncan S. Ferguson, Helwar Figueroa, Paul Corby Finney, Kyriaki Karidoyanes FitzGerald, Thomas E. FitzGerald, John R. Fitzmier, Marie Therese Flanagan, Sabina Flanagan, Claude Flipo, Ronald B. Flowers, Carole Fontaine, David Ford, Mary Ford, Stephanie A. Ford, Jim Forest, William Franke, Robert M. Franklin, Ruth Franzén, Edward H. Friedman, Samuel Frouisou, Lorelei F. Fuchs, Jojo M. Fung, Inger Furseth, Richard R. Gaillardetz, Brandon Gallaher, China Galland, Mark Galli, Ismael García, Tharscisse Gatwa, Jean-Marie Gaudeul, Luis María Gavilanes del Castillo, Pavel L. Gavrilyuk, Volney P. Gay, Metropolitan Athanasios Geevargis, Kondothra M. George, Mary Gerhart, Simon Gikandi, Maurice Gilbert, Michael J. Gillgannon, Verónica Giménez Beliveau, Terryl Givens, Beth Glazier-McDonald, Philip Gleason, Menghun Goh, Brian Golding, Bishop Hilario M. Gomez, Michelle A. Gonzalez, Donald K. Gorrell, Roy Gottfried, Tamara Grdzelidze, Joel B. Green, Niels Henrik Gregersen, Cristina Grenholm, Herbert Griffiths, Eric W. Gritsch, Erich S. Gruen, Christoffer H. Grundmann, Paul H. Gundani, Jon P. Gunnemann, Petre Guran, Vidar L. Haanes, Jeremiah M. Hackett, Getatchew Haile, Douglas John Hall, Nicholas Hammond, Daphne Hampson, Jehu J. Hanciles, Barry Hankins, Jennifer Haraguchi, Stanley S. Harakas, Anthony John Harding, Conrad L. Harkins, J. William Harmless, Marjory Harper, Amir Harrak, Joel F. Harrington, Mark W. Harris, Susan Ashbrook Harvey, Van A. Harvey, R. Chris Hassel, Jione Havea, Daniel Hawk, Diana L. Hayes, Leslie Hayes, Priscilla Hayner, S. Mark Heim, Simo Heininen, Richard P. Heitzenrater, Eila Helander, David Hempton, Scott H. Hendrix, Jan-Olav Henriksen, Gina Hens-Piazza, Carter Heyward, Nicholas J. Higham, David Hilliard, Norman A. Hjelm, Peter C. Hodgson, Arthur Holder, M. Jan Holton, Dwight N. Hopkins, Ronnie Po-chia Hsia, Po-Ho Huang, James Hudnut-Beumler, Jennifer S. Hughes, Leonard M. Hummel, Mary E. Hunt, Laennec Hurbon, Mark Hutchinson, Susan E. Hylen, Mary Beth Ingham, H. Larry Ingle, Dale T. Irvin, Jon Isaak, Paul John Isaak, Ada María Isasi-Díaz, Hans Raun Iversen, Margaret C. Jacob, Arthur James, Maria Jansdotter-Samuelsson, David Jasper, Werner G. Jeanrond, Renée Jeffery, David Lyle Jeffrey, Theodore W. Jennings, David H. Jensen, Robin Margaret Jensen, David Jobling, Dale A. Johnson, Elizabeth A. Johnson, Maxwell E. Johnson, Sarah Johnson, Mark D. Johnston, F. Stanley Jones, James William Jones, John R. Jones, Alissa Jones Nelson, Inge Jonsson, Jan Joosten, Elizabeth Judd, Mulambya Peggy Kabonde, Robert Kaggwa, Sylvester Kahakwa, Isaac Kalimi, Ogbu U. Kalu, Eunice Kamaara, Wayne C. Kannaday, Musimbi Kanyoro, Veli-Matti Kärkkäinen, Frank Kaufmann, Léon Nguapitshi Kayongo, Richard Kearney, Alice A. Keefe, Ralph Keen, Catherine Keller, Anthony J. Kelly, Karen Kennelly, Kathi Lynn Kern, Fergus Kerr, Edward Kessler, George Kilcourse, Heup Young Kim, Kim Sung-Hae, Kim Yong-Bock, Kim Yung Suk, Richard King, Thomas M. King, Robert M. Kingdon, Ross Kinsler, Hans G. Kippenberg, Cheryl A. Kirk-Duggan, Clifton Kirkpatrick, Leonid Kishkovsky, Nadieszda Kizenko, Jeffrey Klaiber, Hans-Josef Klauck, Sidney Knight, Samuel Kobia, Robert Kolb, Karla Ann Koll, Heikki Kotila, Donald Kraybill, Philip D. W. Krey, Yves Krumenacker, Jeffrey Kah-Jin Kuan, Simanga R. Kumalo, Peter Kuzmic, Simon Shui-Man Kwan, Kwok Pui-lan, André LaCocque, Stephen E. Lahey, John Tsz Pang Lai, Emiel Lamberts, Armando Lampe, Craig Lampe, Beverly J. Lanzetta, Eve LaPlante, Lizette Larson-Miller, Ariel Bybee Laughton, Leonard Lawlor, Bentley Layton, Robin A. Leaver, Karen Lebacqz, Archie Chi Chung Lee, Marilyn J. Legge, Hervé LeGrand, D. L. LeMahieu, Raymond Lemieux, Bill J. Leonard, Ellen M. Leonard, Outi Leppä, Jean Lesaulnier, Nantawan Boonprasat Lewis, Henrietta Leyser, Alexei Lidov, Bernard Lightman, Paul Chang-Ha Lim, Carter Lindberg, Mark R. Lindsay, James R. Linville, James C. Livingston, Ann Loades, David Loades, Jean-Claude Loba-Mkole, Lo Lung Kwong, Wati Longchar, Eleazar López, David W. Lotz, Andrew Louth, Robin W. Lovin, William Luis, Frank D. Macchia, Diarmaid N. J. MacCulloch, Kirk R. MacGregor, Marjory A. MacLean, Donald MacLeod, Tomas S. Maddela, Inge Mager, Laurenti Magesa, David G. Maillu, Fortunato Mallimaci, Philip Mamalakis, Kä Mana, Ukachukwu Chris Manus, Herbert Robinson Marbury, Reuel Norman Marigza, Jacqueline Mariña, Antti Marjanen, Luiz C. L. Marques, Madipoane Masenya (ngwan'a Mphahlele), Caleb J. D. Maskell, Steve Mason, Thomas Massaro, Fernando Matamoros Ponce, András Máté-Tóth, Odair Pedroso Mateus, Dinis Matsolo, Fumitaka Matsuoka, John D'Arcy May, Yelena Mazour-Matusevich, Theodore Mbazumutima, John S. McClure, Christian McConnell, Lee Martin McDonald, Gary B. McGee, Thomas McGowan, Alister E. McGrath, Richard J. McGregor, John A. McGuckin, Maud Burnett McInerney, Elsie Anne McKee, Mary B. McKinley, James F. McMillan, Ernan McMullin, Kathleen E. McVey, M. Douglas Meeks, Monica Jyotsna Melanchthon, Ilie Melniciuc-Puica, Everett Mendoza, Raymond A. Mentzer, William W. Menzies, Ina Merdjanova, Franziska Metzger, Constant J. Mews, Marvin Meyer, Carol Meyers, Vasile Mihoc, Gunner Bjerg Mikkelsen, Maria Inêz de Castro Millen, Clyde Lee Miller, Bonnie J. Miller-McLemore, Alexander Mirkovic, Paul Misner, Nozomu Miyahira, R. W. L. Moberly, Gerald Moede, Aloo Osotsi Mojola, Sunanda Mongia, Rebeca Montemayor, James Moore, Roger E. Moore, Craig E. Morrison O.Carm, Jeffry H. Morrison, Keith Morrison, Wilson J. Moses, Tefetso Henry Mothibe, Mokgethi Motlhabi, Fulata Moyo, Henry Mugabe, Jesse Ndwiga Kanyua Mugambi, Peggy Mulambya-Kabonde, Robert Bruce Mullin, Pamela Mullins Reaves, Saskia Murk Jansen, Heleen L. Murre-Van den Berg, Augustine Musopole, Isaac M. T. Mwase, Philomena Mwaura, Cecilia Nahnfeldt, Anne Nasimiyu Wasike, Carmiña Navia Velasco, Thulani Ndlazi, Alexander Negrov, James B. Nelson, David G. Newcombe, Carol Newsom, Helen J. Nicholson, George W. E. Nickelsburg, Tatyana Nikolskaya, Damayanthi M. A. Niles, Bertil Nilsson, Nyambura Njoroge, Fidelis Nkomazana, Mary Beth Norton, Christian Nottmeier, Sonene Nyawo, Anthère Nzabatsinda, Edward T. Oakes, Gerald O'Collins, Daniel O'Connell, David W. Odell-Scott, Mercy Amba Oduyoye, Kathleen O'Grady, Oyeronke Olajubu, Thomas O'Loughlin, Dennis T. Olson, J. Steven O'Malley, Cephas N. Omenyo, Muriel Orevillo-Montenegro, César Augusto Ornellas Ramos, Agbonkhianmeghe E. Orobator, Kenan B. Osborne, Carolyn Osiek, Javier Otaola Montagne, Douglas F. Ottati, Anna May Say Pa, Irina Paert, Jerry G. Pankhurst, Aristotle Papanikolaou, Samuele F. Pardini, Stefano Parenti, Peter Paris, Sung Bae Park, Cristián G. Parker, Raquel Pastor, Joseph Pathrapankal, Daniel Patte, W. Brown Patterson, Clive Pearson, Keith F. Pecklers, Nancy Cardoso Pereira, David Horace Perkins, Pheme Perkins, Edward N. Peters, Rebecca Todd Peters, Bishop Yeznik Petrossian, Raymond Pfister, Peter C. Phan, Isabel Apawo Phiri, William S. F. Pickering, Derrick G. Pitard, William Elvis Plata, Zlatko Plese, John Plummer, James Newton Poling, Ronald Popivchak, Andrew Porter, Ute Possekel, James M. Powell, Enos Das Pradhan, Devadasan Premnath, Jaime Adrían Prieto Valladares, Anne Primavesi, Randall Prior, María Alicia Puente Lutteroth, Eduardo Guzmão Quadros, Albert Rabil, Laurent William Ramambason, Apolonio M. Ranche, Vololona Randriamanantena Andriamitandrina, Lawrence R. Rast, Paul L. Redditt, Adele Reinhartz, Rolf Rendtorff, Pål Repstad, James N. Rhodes, John K. Riches, Joerg Rieger, Sharon H. Ringe, Sandra Rios, Tyler Roberts, David M. Robinson, James M. Robinson, Joanne Maguire Robinson, Richard A. H. Robinson, Roy R. Robson, Jack B. Rogers, Maria Roginska, Sidney Rooy, Rev. Garnett Roper, Maria José Fontelas Rosado-Nunes, Andrew C. Ross, Stefan Rossbach, François Rossier, John D. Roth, John K. Roth, Phillip Rothwell, Richard E. Rubenstein, Rosemary Radford Ruether, Markku Ruotsila, John E. Rybolt, Risto Saarinen, John Saillant, Juan Sanchez, Wagner Lopes Sanchez, Hugo N. Santos, Gerhard Sauter, Gloria L. Schaab, Sandra M. Schneiders, Quentin J. Schultze, Fernando F. Segovia, Turid Karlsen Seim, Carsten Selch Jensen, Alan P. F. Sell, Frank C. Senn, Kent Davis Sensenig, Damían Setton, Bal Krishna Sharma, Carolyn J. Sharp, Thomas Sheehan, N. Gerald Shenk, Christian Sheppard, Charles Sherlock, Tabona Shoko, Walter B. Shurden, Marguerite Shuster, B. Mark Sietsema, Batara Sihombing, Neil Silberman, Clodomiro Siller, Samuel Silva-Gotay, Heikki Silvet, John K. Simmons, Hagith Sivan, James C. Skedros, Abraham Smith, Ashley A. Smith, Ted A. Smith, Daud Soesilo, Pia Søltoft, Choan-Seng (C. S.) Song, Kathryn Spink, Bryan Spinks, Eric O. Springsted, Nicolas Standaert, Brian Stanley, Glen H. Stassen, Karel Steenbrink, Stephen J. Stein, Andrea Sterk, Gregory E. Sterling, Columba Stewart, Jacques Stewart, Robert B. Stewart, Cynthia Stokes Brown, Ken Stone, Anne Stott, Elizabeth Stuart, Monya Stubbs, Marjorie Hewitt Suchocki, David Kwang-sun Suh, Scott W. Sunquist, Keith Suter, Douglas Sweeney, Charles H. Talbert, Shawqi N. Talia, Elsa Tamez, Joseph B. Tamney, Jonathan Y. Tan, Yak-Hwee Tan, Kathryn Tanner, Feiya Tao, Elizabeth S. Tapia, Aquiline Tarimo, Claire Taylor, Mark Lewis Taylor, Bishop Abba Samuel Wolde Tekestebirhan, Eugene TeSelle, M. Thomas Thangaraj, David R. Thomas, Andrew Thornley, Scott Thumma, Marcelo Timotheo da Costa, George E. “Tink” Tinker, Ola Tjørhom, Karen Jo Torjesen, Iain R. Torrance, Fernando Torres-Londoño, Archbishop Demetrios [Trakatellis], Marit Trelstad, Christine Trevett, Phyllis Trible, Johannes Tromp, Paul Turner, Robert G. Tuttle, Archbishop Desmond Tutu, Peter Tyler, Anders Tyrberg, Justin Ukpong, Javier Ulloa, Camillus Umoh, Kristi Upson-Saia, Martina Urban, Monica Uribe, Elochukwu Eugene Uzukwu, Richard Vaggione, Gabriel Vahanian, Paul Valliere, T. J. Van Bavel, Steven Vanderputten, Peter Van der Veer, Huub Van de Sandt, Louis Van Tongeren, Luke A. Veronis, Noel Villalba, Ramón Vinke, Tim Vivian, David Voas, Elena Volkova, Katharina von Kellenbach, Elina Vuola, Timothy Wadkins, Elaine M. Wainwright, Randi Jones Walker, Dewey D. Wallace, Jerry Walls, Michael J. Walsh, Philip Walters, Janet Walton, Jonathan L. Walton, Wang Xiaochao, Patricia A. Ward, David Harrington Watt, Herold D. Weiss, Laurence L. Welborn, Sharon D. Welch, Timothy Wengert, Traci C. West, Merold Westphal, David Wetherell, Barbara Wheeler, Carolinne White, Jean-Paul Wiest, Frans Wijsen, Terry L. Wilder, Felix Wilfred, Rebecca Wilkin, Daniel H. Williams, D. Newell Williams, Michael A. Williams, Vincent L. Wimbush, Gabriele Winkler, Anders Winroth, Lauri Emílio Wirth, James A. Wiseman, Ebba Witt-Brattström, Teofil Wojciechowski, John Wolffe, Kenman L. Wong, Wong Wai Ching, Linda Woodhead, Wendy M. Wright, Rose Wu, Keith E. Yandell, Gale A. Yee, Viktor Yelensky, Yeo Khiok-Khng, Gustav K. K. Yeung, Angela Yiu, Amos Yong, Yong Ting Jin, You Bin, Youhanna Nessim Youssef, Eliana Yunes, Robert Michael Zaller, Valarie H. Ziegler, Barbara Brown Zikmund, Joyce Ann Zimmerman, Aurora Zlotnik, Zhuo Xinping
- Edited by Daniel Patte, Vanderbilt University, Tennessee
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- Book:
- The Cambridge Dictionary of Christianity
- Published online:
- 05 August 2012
- Print publication:
- 20 September 2010, pp xi-xliv
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Dyadic play behaviors of children of well and depressed mothers
- Kenneth H. Rubin, Lilly Both, Carolyn Zahn-Waxler, E. Mark Cummings, Margaret Wilkinson
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- Journal:
- Development and Psychopathology / Volume 3 / Issue 3 / July 1991
- Published online by Cambridge University Press:
- 31 October 2008, pp. 243-251
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The purpose of this study is to examine the relations among maternal depression, security of attachment, and peer interactive behaviors in early childhood. Drawing from the literature, we posited that socially inhibited play behaviors in childhood would be associated with maternal depression as well as with an insecure mother-child attachment relationship. Forty-three 5-year-olds and their mothers participated in the study. There were 21 depressed and 22 affectively well mothers. Security of attachment was assessed via a variation of the Strange Situation procedure when the children were 2 years old. At 5 years of age the children were observed during free play with a familiar same-sex agemate. Results supported the hypotheses that social inhibition is associated with maternal depression and with an insecure mother-infant attachment relationship.
Testing Theory and Debunking Stereotypes: Lawyers’ Views on the Practice of Law
- Margaret Ann Wilkinson, Christa Walker, Peter Mercer
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- Journal:
- Canadian Journal of Law & Jurisprudence / Volume 18 / Issue 1 / January 2005
- Published online by Cambridge University Press:
- 20 July 2015, pp. 165-201
- Print publication:
- January 2005
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This article is the final report of a study of legal ethics and professionalism involving in depth interviews about problem solving conducted with nearly two hundred lawyers practicing in various settings: in different sizes of firms, in different sizes of communities, in private practice and in in-house or corporate counsel positions. Previously published findings of this research project having established that lawyers rarely turn to their ethical codes to solve problems, preferring instead to rely upon informal information gleaned from within their own offices (although lawyers from smaller firms remain more often comfortable with information drawn from beyond the firm than those from larger firms), this article focuses on analysis of the interviews of those lawyers who identified themselves as concerned with issues involving their roles as lawyers. The analysis maps the lawyers' own descriptions of their situations onto the “hired gun” and “counselor” models of lawyer-client interaction taken from the literature. The findings confirm our preliminary findings that these two roles are not mutually exclusive. Although all the lawyers concerned with their roles began in a mentoring mode, most lawyers eventually relinquished their decision-making to their clients, a transition fraught with challenges for many of them. A minority, however, despite the dictates of their code of ethics, withdrew from cases or even, exceptionally, substituted their own decision-making for that of their clients. The article links the mentoring model to the care perspective in the literature of moral development and the hired gun model to the rights perspective. The findings did not establish any support for the claim that the presence of women is creating a "softer" voice in the legal profession. However, two aspects of the structure of the profession, private practice versus in-house practice and the size of the centre in which the practice is located, engendered variations in professional attitudes.
Prologue
- Margaret Attwood, Mike Pedler, Sue Pritchard, David Wilkinson
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- Book:
- Leading Change
- Published by:
- Bristol University Press
- Published online:
- 20 January 2022
- Print publication:
- 12 February 2003, pp xiii-xvi
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Summary
This book has been some time in the writing. It represents the dialogue, bothconceptual and practical, between the four of us, as consultants, researchers andwriters concerned with the integration of thinking and action across threelargely disconnected fields of activity – organisation development, communitydevelopment and the implementation of government policy on public services.Its context is one of a rapidly changing social and public policy landscape.
The pressures continue to grow for new forms and standards of delivery andfor local joining up and reconnecting of services to users, citizens andcommunities. This demands new service configurations, and new forms ofpartnership and local and neighbourhood governance. The organisationalchallenges to meet these changing requirements are considerable. In this bookour exploration of them can be summarised as a question: How canorganisations fit to house the human spirit be created and sustained such thatthey meet the needs of communities and society at large?
Our responses to this from our various experiences have driven us to despairas well as giving a sense of the emerging possibilities.
On the dark side we see organisations whose design is still based on machine-like and territorial assumptions where:
•change is equated with restructuring, with the attendant dangers of movingthe chairs around the deck of the Titanic and, in the process, setting backprogress to improve services;
•managerial attention is focused on internal silos to the detriment of a coherentapproach to stakeholder needs;
•territory is defended against the demands or wishes of partners and residents,and even against the ‘unreasonable’ demands of staff;
•the attention span is short and of the ‘let’s fix it’ variety, rather than taking alonger-term and sustainable view.
Such organisations are not usually populated by bad or even incompetentpeople. People, we believe, are the product of the circumstances, the system, inwhich they find themselves. Firing the key people will not change these designassumptions; equally, developing individual competencies alone will not changethe way things work.
On the brighter side some people and organisations are:
•working creatively with local residents to improve services;
•asking different questions about ways of organising that support-improveddelivery;
•seeing structural change as only one ingredient of sustainable development;
Bibliography
- Margaret Attwood, Mike Pedler, Sue Pritchard, David Wilkinson
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Eight - Follow-through and sticking with it
- Margaret Attwood, Mike Pedler, Sue Pritchard, David Wilkinson
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Summary
A friend used to tell the story of a great African river that started high in the mountains and became a rushing torrent sweeping all before it; but when it came to the plain, its momentum slowed and it split into many rivulets on the flat land. Soon it became a huge swamp and the mighty river had disappeared. Change efforts often start with great momentum, as attempts to tackle previously intractable problems, but then, as time passes and the terrain changes, energy for these efforts dissipates.
This analogy, however, can be viewed somewhat differently in whole systems terms. As those who took O level Geography will recall, it is the force of the river in its early course that creates steep valleys; as the river grows in volume, its energy disperses and it meanders to the sea. But the energy does not disappear. A feature of meandering rivers is the oxbow lake – a deep bend in the river, which becomes isolated as the river takes the shortest course. And of course, it is in the rich river floodplains and deltas that agriculture does best. So the river does what it needs to do to meet the sea, bending around obstacles,and can look very different in appearance from the mountain stream to the broad delta. But it is all part of a connected cycle of rainfall, water catchment,coastal and ocean systems.
In whole systems terms, follow-through is inextricably linked with the challenge of implementation, of getting things done and generating change in the long term. It does not have the same connotations as follow-up (the odd meeting to catch up with progress), rather it carries with it the somewhat old-fashioned virtues of persistence, resilience and sticking with it, alongside the more modern attributes of sensitivity to, and awareness of, the changing character of the environment in which we operate. So by follow-through we mean allof those activities and processes that help bring about change, translate strategyinto actions and make a difference. Importantly, follow-through is not a fixedtop-down process; it is an organic, dynamic process intimately connected tothe circumstances and context in which the change challenge takes place.
In this chapter, we:
• introduce and develop the idea of change architecture;
• develop the links between change architectures, the Five Keys and the otherimportant principles for leading change developed in Chapter Three (holding frameworks, middle-ground frameworks and widening circles of inclusivity);
• reiterate and develop the role and purpose of action learning within wholesystems processes;
• emphasise the continuing importance of creating ‘memories of the future’ through scenario building and wider inclusion;
• connect to the last two chapters on the newer forms of organising andworking towards local solutions with wider whole systems.
Frontmatter
- Margaret Attwood, Mike Pedler, Sue Pritchard, David Wilkinson
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Ten - Confirming cases: local problems andlocal solutions within whole systems
- Margaret Attwood, Mike Pedler, Sue Pritchard, David Wilkinson
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Summary
At 3.00am in the morning of 30 October 2000 the River Aire startedto flood the Stockbridge neighbourhood of Keighley. Stockbridge is a relatively poor, ethnically mixed community. The housing stock consists of mostlyVictorian terraced houses and budget-priced 1930s semis, privately owned or rented. There is also a small amount of relatively new housing built on the flood plain, both privately and housing association owned. For the most part, it is a relatively low paid community.
Some people had about an hour’s warning, others none at all. By 10.00am people were arriving at the Keighley Leisure Centre (about half a mileaway), where the local authority (Bradford Metropolitan District Council) had set up an emergency response centre. Some arrived without shoes and socks and many were upset and disoriented by the experience. There was also a growing realisation that many had no household insurance.
A total of 292 households were affected. It was to be between 6 and 12 months before people were back in their homes. Not only was this a traumaticevent for individuals, it was a traumatic event for a fragile community. What happened next is a very positive story of what frontline interagency collaboration and fully involving local people, can achieve.
The story of the floods at Stockbridge illustrates how global problems areexperienced locally. It is not the citizens of Stockbridge (or Bangladesh) who have created the conditions which have submerged them, but they arenonetheless the main victims and those with the greatest interest in doing something about these conditions. There is also a responsibility on the public authorities within which these events occur to ensure they also learn from theexperience. It may be said that this is a huge problem – what does it have to do with local people and local solutions? It is of course true that issues of globalwarming must be tackled at a global level, and questions of flood defence at anational level, but these problems are experienced essentially at a local level, and their local solution is critical to sustainable development. This chapter makes the case for whole systems development as a methodology for combiningthe various levels at which action is needed, with local involvement andsustainable improvements at local level where the problems are experienced.
Four - Leadership: keeping the big picture in view
- Margaret Attwood, Mike Pedler, Sue Pritchard, David Wilkinson
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Summary
Our first attempts at the definition of the guiding principles for whole systems development did not include leadership. Experience of assisting with processes of change and learning across organisational boundaries suggests that this was a gross omission. Followers often express considerable anger and frustration that powerful individuals and organisations have failed to deal with issues that impact adversely on their daily lives. They are angry when a hospital blames the local social services department for the slowness of discharge procedures. They are unimpressed with the attempts of the railway companies to distance themselves from the problems of Railtrack. Explanations by car dealers about the impact of outsourcing of parts on the time taken to repair cars fall on deaf ears. It is the reality – the delivery on the ground – that matters. Effective leadership is an essential component of this.
Systemic change will not be effective if it ignores the responsibilities and accountabilities of individual organisations. Public service organisations are the servants of the public, and they should be held accountable by the politicians we elect for the resources they use. Similarly, commercial organisations are responsible to their shareholders. Collaboration or partnership across organisational boundaries runs into the sand if these constraints are not explained to those involved. This is the job of leadership. Leaders must frame these issues within a wider context, in ways that enable managers, staff, consumers and citizens to take responsibility for and begin to tackle these things themselves. Effectiveleadership is vital to the achievement of systemic change. These requirementsare mirrored in the research on organisational renewal by Beer et al:
Each revitalisation leader had to find a way to translate external pressuresinto internalised dissatisfaction with the status quo and/or excitement abouta better way. Dissatisfaction is fuelled by awareness that the organisation isno longer meeting the demands of its competitive environment. Excitementcan be stimulated by imagining an approach to organisation and managingthat eliminates many current problems or appeals to fundamental values.(1990, p 79)
In this chapter we:
• Contend that ‘hero leadership’ cannot be successful in tackling ‘wicked’ or intractable problems.
• See leadership as something for the many rather than the few ‘top’ people.
• Explore the processes involved in leading across ‘whole systems’ – assisting sense-making, establishing ‘holding frameworks’, using collective intelligence and so on – and some of the paradoxes with which leaders must grapple.
Index
- Margaret Attwood, Mike Pedler, Sue Pritchard, David Wilkinson
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Two - How Do We Put These Fine Words Intoaction? An Overview of Whole Systems Development
- Margaret Attwood, Mike Pedler, Sue Pritchard, David Wilkinson
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Summary
Business is 5% strategy, 95% implementation.
As emphasised in Chapter One, it is implementation, and not vision or strategy, that is the biggest challenge for leaders seeking to bring about change. Whole systems development is a set of propositions, tools and practices that aims to engage all the people in the system in designing and implementing change. There is nothing magical or mysterious about this. Sustainable change, in contrast to that which is temporary and superficial, is only brought about by involving all those who are part of the problem in creating and implementingthe solutions.
In this chapter we:
•outline our practice of whole systems development at the three levels ofphilosophy, operating principles and processes;
•emphasise the importance of a pragmatic approach to change, action andlearning
•develop some principles for the whole systems way of working;
•explain how these are underpinned by five working processes, which weterm the Five Keys of whole systems development.
Philosophies – useful action and learning in the context ofthe whole system
Our standpoint is a pragmatic one: what works best in helping people bring about the changes they seek. As a philosophical movement, pragmatism flourished in the later 19th and early 20th century and is associated with people like Charles Peirce, William James, John Dewey and George Herbert Mead. Like many philosophers before them, pragmatists sought to unite reason and values, and their particular contribution was to ally scientific knowledge and the ideals of human conduct in an era characterised by rapid social and intellectual change. This led them to focus on the possibilities for, and the consequences of, human action in a changing world. They emphasised the need for experiment, reflection and learning in working out what is most useful for us, what works best.
William James tells a story that illustrates this position. While camping in the mountains with friends, James returned from a solitary walk to find them engaged in a furious metaphysical dispute:
The corpus of the dispute was a squirrel – a live squirrel supposed to be clinging to one side of a tree trunk; while over against the tree’s opposite side a human being was imagined to stand. This human witness tries to get sight of the squirrel by moving rapidly round the tree, but no matter how fast he goes, the squirrel moves as fast in the opposite direction, and always keeps the tree between himself and the man, so that never a glimpse of him is caught.
Three - The emerging practice of wholesystems development
- Margaret Attwood, Mike Pedler, Sue Pritchard, David Wilkinson
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Summary
As indicated in the values statement in the Prologue, whole systems development aims to help people get things done locally. Because it is focused on local implementation rather than on dramatic intervention, whole systems development is not a neat, predictable process. Typically drawn in by a person or an organisation with a question, it starts from the problem and develops a change methodology in partnership with people in that setting. The principles that guide the work emerge as ‘grounded theory’ in particular contexts.
Nevertheless, a broad framework or ‘change architecture’ (see Chapter Eight) for such processes can be described. This framework has three components: context, content and process. Whole systems development operates within a context of change described by such dilemmas as those discussed in Chapter One – top-down and bottom-up, consumer and citizen, treatment and prevention, and consultation and participation. Within this context, the content or focus of the work is defined by the Five Keys of whole systems development, while the process is governed by some important principles of practice (see Chapter Two, pages 28-9).
In this chapter, through the case study of a courageous effort to deconstruct the old system of local government and challenge it with a structure based onresident self-governance through neighbourhood committees, we:
• illustrate the main principles and themes of whole systems development as they emerge from practice;
• demonstrate that all whole systems development activities are a process of action learning;
• develop a number of other themes and principles through the emergingstory of Gladwell – working via ‘widening circles of inclusivity’ withinmultiple, overlapping systems, using action learning in the whole systemscontext, creating the space for leadership via ‘holding frameworks’ and ‘middle-ground frameworks’. (These ideas are developed in more depth in the lastthree chapters.)
The story that emerges is more an account of our learning, than a cause–effect change intervention of what we did. This implies starting by trying something, reflecting and learning from it, and expecting to be confounded from time totime. It is vital to keep struggling to make sense, to learn, to act and to contribute.
We have also learned that it is not easy to keep hold of values and principles change of practice where people have a natural expectation that they employ you totell them what to do.
Seven - Meeting differently: large and small group working
- Margaret Attwood, Mike Pedler, Sue Pritchard, David Wilkinson
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- Leading Change
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Summary
Question: How do you eat an elephant?
Answer: In bite-sized chunks!
At the heart of this old analogy for managing big changes lies a fallacy: that splitting a whole into parts makes the change process easier.
Consider a visual image of the elephant:
Each person sees only that part of the elephant on which they are focusing – a leg or a tusk. The whole animal is not visible. The challenge of designing whole systems development processes is to enable everyone to see the whole elephant together. Although in most cases this is an impossible aspiration, the key issue is to develop ways in which the actors can see, understand and think through their ways of working together on issues that cross organisational and community boundaries.
In this chapter we:
•examine the ways in which groups – both large and small – can meet differently to enable the principles of whole systems development to be practised;
• explore the leadership, design and logistics of big events as one key mechanism for meeting differently;
• discuss the consultancy support needed to assist these ways of working;
• encourage you to reflect and learn from personal experiences of meeting differently;
• explore the notion of ‘everyone in the room together’ as a metaphor for meeting differently as practised particularly through processes of action learning.
Drawing the boundaries for ‘meeting differently’
The more we engage in systems thinking, the more arbitrary formal organisationsseem:
• Why aren’t students seen as part of a school’s organisation?
• Or tenants, part of a housing department?
• Or customers and suppliers, part of a manufacturing company?
None of these can exist in isolation from the others. But so frequently, as with the internal departments of an organisation, formal boundaries quickly become walls and those beyond them adversaries. Ironically, these divisions have oftenbeen established to manage past changes, but then themselves have become barriers to progress. And traditional boundaries can so easily change – as therecent fashion for outsourcing has shown. In so many instances, what is technically inside an organisation and what is outside is relatively arbitrary.
From this perspective, it is artificial and unhelpful to design processes thatare confined within the ‘walls’ of a single department or organisation or, indeed,at parts of the wider systems of which organisations are but one part.
Five - Public learning
- Margaret Attwood, Mike Pedler, Sue Pritchard, David Wilkinson
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- Leading Change
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Summary
The story of Gladwell in Chapter Three illustrated that organisational learning:
… is not the same thing as individual learning, even when the individuals who learn are members of the organisation. There are too many cases in which organisations know less than their members. There are even cases in which the organisation cannot seem to learn what every member knows.(Argyris and Schon, 1978, p 9)
If this is true for the state of collective knowledge in organisations, it is even truer of systems. Separated by the boundaries of organisations, and with different ways of seeing based on culture, tradition and experience, people find it difficult,if not impossible, to create the shared meanings necessary to grapple effectively with the issues facing organisations as they strive to serve customers, communities and individual citizens more effectively. As a society, we have invested massively in transferring knowledge about how to organise health and social care, housing, education and other public services. Think about all the education and training processes devoted to these ends. However, most of this wisdom is created and disseminated through the separate silos of higher education institutions and professional bodies. Historically, academically, professionally and managerially, there has been territoriality or a tendency to look inward rather than to consider what to share with others so that understanding can be strengthened. “The world has problems, but universities have departments” (Brewer, 1999, p 328). We lack ways of connecting knowledge, which would assist understanding of ways in which changes in one part of society impact elsewhere. Yet, ironically, the need to develop this connectedness has never been greater. The ‘closely coupled’ nature of society means that changes introduced in one place quicklyhave an impact elsewhere.
This affects all of us. For example, the culture of long hours and the stressexperienced by many parents leads to the development of ‘parental time deficit’,where insufficient time is spent with children. Even when families have timetogether, parents can be tired and stressed, with obvious consequences for thedevelopment of their children. Alongside this, many schools are reportingincreased exclusions of pupils because of unacceptably disruptive behaviour.This is not just a response to the publication of league tables of examperformance.