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Principal-agent theory (PAT) has been used to understand relationships among different professional groups and explain performance management between organisations, but is rarely used for research within primary care. The purpose of this paper is to explore whether PAT can be used to attain a better understanding of performance management in primary care.

Purposive sampling was used to identify a range of general practices in the North-west of England. Interviews were carried out with directors, managers and clinicians in commissioning and regional performance management organisations and within general practices, and the data analysed using matrix analysis techniques to produce a case study of performance management.

There are various elements of the principal-agent framework that can be applied in primary care. Goal alignment is relevant, but can only be achieved through clear, strategic direction and consistent interpretation of objectives at all levels. There is confusion between performance measurement and performance management and a tendency to focus on things that are easy to measure whilst omitting aspects of care that are more difficult to capture. Appropriate use of incentives, good communication, clinical engagement, ownership and trust affect the degree to which information asymmetry is overcome and goal alignment achieved. Achieving the right balance between accountability and clinical autonomy is important to ensure governance and financial balance without stifling innovation.

The principal-agent theoretical framework can be used to attain a better understanding of performance management in primary care; although it is likely that only partial goal alignment will be achieved, dependent on the extent and level of alignment of a range of factors.

Manufacturing companies today are part of a dynamic, globalized system of production and consumption. Globally dividing labor is now the predominant way of organizing business, but it is clear that the resource demands of linear supply chains have created vulnerability and harm in the system and beyond. The authors draw inspiration from ecology to explore the role of manufacturers in the transition from linear to circular supply chains. Borrowing the adaptive cycle model, originally developed to describe dynamic ecological systems, they employ case examples to illustrate the ways that supply chain management is being reimagined in the shift to a circular economy. This conceptualization uses the adaptive cycle to consider the transition from linear to circular supply chains as part of broader systems change, and the opportunities for manufacturers to play a transformative role in shaping a sustainable future.

A circular economy perspective embraces a systemic, cradle-to-cradle notion that everything is designed to be reused as long as possible and then recaptured and repurposed when reuse is no longer possible. Designing for a circular economy ecosystem requires a holistic, integrative viewpoint, spanning all aspects of design and development and considering many supply chain actors, far beyond that of traditional supply chains. This edited book adopts a biomimetic lens, highlighting the need for cross-industry flows and need for different actors (beyond producers and consumers) in circular value cycles. Enablers such as incentives and/or legislation are also discussed. While biomimicry provides the structure for organizing this book, individual chapters build on other theoretical lenses and concepts, such as stakeholder theory, etc. The intent is to move beyond a dyadic (buyer–supplier) view, embracing a holistic network or ecosystem view, to consider a cross-industry system perspective, where there is a diversity of actors (covering four actor groups: producers, consumers, scavengers, and decomposers) needed for a working ecosystem. This edited book offers a comprehensive overview of system components and actors, including how the circular economy adds value, the role of producers and consumers, the spectrum of recovery possibilities to return products back to the consumption supply chain, and the essential role of information management.

Clearance rates for nonfatal shootings, especially cases involving gang- and drug-related violence, are disturbingly low in many US cities. Using data from a previously completed project in Boston, we explore the prospects for improving gang/drug nonfatal shooting cases by investing the same investigative effort found in similar gang/drug gun murder cases.

Our analyses primarily focus on a sample of 231 nonfatal shootings that occurred in Boston from 2010 to 2014. Logistic regressions are first used to analyze differences in the likelihood of case clearance for gang/drug nonfatal shooting cases relative to other nonfatal shooting cases. Independent samples t-tests are then used to compare the investigative characteristics of these two different kinds of nonfatal shootings. Next, independent samples t-tests are used to compare the investigation of gang/drug gun assaults relative to the investigation of very similar gang/drug gun homicides.

Results demonstrate that the odds of clearing gang/drug nonfatal shootings are 77.2% less likely relative to the odds of clearing nonfatal shootings resulting from other circumstances. This stark difference in clearance rates is not driven by diminished investigative effort, but investigative effort does matter. Relative to gang/drug gun assaults, gang/drug gun homicides have much higher clearance rates that are the result of greater investigative resources and effort that produces significantly more witnesses and evidence, and generate more forensic tests and follow-up investigative actions.

Gang- and drug-related violence generates a bulk of urban nonfatal shootings. Low clearance rates for nonfatal shootings undermine police efforts to hold offenders accountable, disrupt cycles of gun violence, and provide justice to victims. Police should make investments to improve investigative effort such as handling these cases with the same vigor as homicide cases.

Since the beginning of the 20th century environmental health researchers have known about the association between toxicant exposure and disease. However, that knoweldge has not been well integrated into mainstream medicine. Shedding light on why is the focus of this chapter.

To shed light on this issue I analyze the 2011 American Academy of Pediatrics’ clinical practice guidelines for Attention Deficit/Hyperactivity Disorder (ADHD), focusing specifically on the omission of environmental health research pertaining to ADHD symptoms and exposures, such as lead and mercury.

I found that while environmental researchers have been documenting the link between lead and ADHD for over forty years, the American Academy of Pediatrics has completely omitted this research from its 2012 clinical practice guidelines. Moreover, I argue this omission can be traced to competitive pressures to protect medical jurisdiction, and a reductionist worldview that emphasizes treatment over prevention.

This is the first attempt to analyze the way clinical practice guidelines help reinforce and perpetuate dominant medical perspectives. Moreover, to shed explanatory light, this chapter offers a synthetic explanation that combines materialist and ideological factors.

Beyond the specific case of ADHD, this chapter has implications for understanding how and why environmental health research is omitted from other materials produced by mainstream medicine, such as materials found in the medical school curriculum, continuing medical education, medical journals, and on the medical association web sites.