Why the Critics of Poor Health Service Delivery Are the Causes of Poor Service Delivery: A Need to Train the Policy-makers Comment on "Why and How Is Compassion Necessary to Provide Good Quality Healthcare?".

This comment on Professor Fotaki's Editorial agrees with her arguments that training health professionals in more compassionate, caring and ethically sound care will have little value unless the system in which they work changes. It argues that for system change to occur, senior management, government members and civil servants themselves need training so that they learn to understand the effects that their policies have on health professionals. It argues that these people are complicit in the delivery of unethical care, because they impose requirements that contradict health professionals' desire to deliver compassionate and ethical forms of care.

Identification and organization of genes for diutan polysaccharide synthesis from Sphingomonas sp. ATCC 53159.

A cluster of genes for diutan polysaccharide synthesis was isolated from a library of Sphingomonas sp. ATCC 53159 genomic DNA by complementation of glucosyl-isoprenylphosphate transferase-deficient mutants of Sphingomonas elodea ATCC 31461 (producing gellan) and Xanthomonas campestris (producing xanthan). The synthesis of polysaccharide in these strains shares a common first step, transfer of glucose-1-phosphate from UDP-glucose to the isoprenylphosphate lipid. The cluster of 24 genes was compared to genes for biosynthesis of gellan, and S-88 sphingan from Sphingomonas sp. ATCC 31554. Diutan, gellan and S-88 sphingan have a common four-sugar backbone but different side chains, one rhamnose for S-88 sphingan, a two-rhamnose side chain for diutan and no side chain for gellan. The genes for biosynthesis of diutan, gellan and S-88 sphingan were similar in general organization but differed in location of some genes, in particular, dpsG (putative polymerase), dpsR (putative lyase) and dpsS (putative repeat unit transporter). An unidentified reading frame urf31, present in the gene clusters for diutan and S-88 sphingan but not gellan, had similarity to glycosyl transferase group 2 proteins, and was detrimental when cloned in Sphingomonas elodea producing gellan that lacks a side chain, but not in Sphingomonas ATCC 31554 producing S-88 sphingan with a rhamnose side chain. Gene urf31 could possibly encode a side-chain rhamnosyl transferase. Another gene urf31.4 was unique to the diutan gene cluster. A plasmid containing 20 of the 24 genes resulted in a slight increase in the amount of diutan produced, but a significant increase in the rheological properties of diutan.

The inception of the National Health Service: a daily managerial accomplishment.

PURPOSE: It is commonplace to talk of the UK's National Health Service (NHS) as having its inception in 1948 in an Act of Parliament which brought together many hundreds of widely dispersed organisations into one, new organisation, "the" NHS. This paper aims to challenge the concept of "a" National Health Service and to argue that the (seeming) accomplishment of this "organisation" is the daily task of health managers. DESIGN/METHODOLOGY/APPROACH: The paper develops a theoretically-based analysis of how an "organisation" is accomplished through ongoing processes of construction. First, critiques of the ontological status of this thing called "organisation" are considered. Then Laclau and Mouffe's discourse theory of political action, inspired by Derrida and Gramsci is used, to try to understand this apparent "thing" and the work of those charged with its management. FINDINGS: There has been little application of this theoretical perspective to understanding management in general and health management in particular but, given the highly politicised nature of health management, their theoretical perspective seems more than apposite. Application of Laclau and Mouffe's theory to the NHS leads to the conclusion that there is no such "thing" as the NHS. There is, rather, a presumption of the thingness of the NHS and one of the major tasks of managers working "within" this organisation is to achieve this sense of thingness. RESEARCH LIMITATIONS/IMPLICATIONS: This is "work in progress"--these ideas continue to evolve, but feedback from readers is necessary. ORIGINALITY/VALUE: This is the first time that Laclau and Mouffe's work has been used to analyse health organizations. The value of the paper is mostly for people working to develop critically-informed understandings of how organizations work.

Organization of genes required for gellan polysaccharide biosynthesis in Sphingomonas elodea ATCC 31461.

Sphingomonas elodea ATCC 31461 produces gellan, a capsular polysaccharide that is useful as a gelling agent for food and microbiological media. Complementation of nonmucoid S. elodea mutants with a gene library resulted in identification of genes essential for gellan biosynthesis. A cluster of 18 genes spanning 21 kb was isolated. These 18 genes are homologous to genes for synthesis of sphingan polysaccharide S-88 from Sphingomonas sp. ATCC 31554, with predicted amino acid identities varying from 61% to 98%. Both polysaccharides have the same tetrasaccharide repeat unit, comprised of [-->4)-alpha- l-rhamnose-(1-->3)-beta- d-glucose-(1-->4)-beta- d-glucuronic acid-(1-->4)-beta- d-glucose-(1-->]. Polysaccharide S-88, however, has mannose or rhamnose in the fourth position and has a rhamnosyl side chain, while gellan has no sugar side chain but is modified by glyceryl and acetyl substituents. Genes for synthesis of the precursor dTDP- l-rhamnose were highly conserved. The least conserved genes in this cluster encode putative glycosyl transferases III and IV and a gene of unknown function, gelF. Three genes ( gelI, gelM, and gelN) affected the amount and rheology of gellan produced. Four additional genes present in the S-88 sphingan biosynthetic gene cluster did not have homologs in the gene cluster for gellan biosynthesis. Three of these gene homologs, gelR, gelS, and gelG, were found in an operon unlinked to the main gellan biosynthetic gene cluster. In a third region, a gene possibly involved in positive regulation of gellan biosynthesis was identified.