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Healthcare quality improvement is a key concern for policy makers, regulators, carers and service users. Despite a contemporary consensus among policy makers that integrated care represents a means to substantially improve service outcomes, progress has been slow. Difficulties achieving sustained improvement at scale imply that methods employed are not sufficient and that healthcare improvement attributes may be different when compared to prior reference domains. The purpose of this paper is to examine and synthesise key improvement attributes relevant to a complex healthcare change process, specifically integrated care.

This study is based on an integrative literature review on systemic improvement in healthcare.

A central theme emerging from the literature review indicates that implementing systemic change needs to address the relationship between vision, methods and participant social dynamics.

Accommodating personal and professional network dynamics is required for systemic improvement, especially among high autonomy individuals. This reinforces the need to recognise the change process as taking place in a complex adaptive system where personal/professional purpose/meaning is central to the process.

Shared personal/professional narratives are insufficiently recognised as a powerful change force, under-represented in linear and rational empirical improvement approaches.

OUR readers do not need the reminder that 1952 is the 75th year of Library Association history. Some opportunity may be found at the Bournemouth Conference to celebrate this fact, in however modest a manner. The American Library Association, older by a year, celebrated its anniversary at Philadelphia last October, on which occasion Mr. F. G. B. Hutchings represented this country and spoke at a luncheon meeting to three hundred of the guests with acceptance. That celebration, however, appears to us to have been most significant for the comment on the Carnegie library gifts which was made by Mr. Ralph Munn, librarian of Pittsburgh Carnegie Library, in some ways the most spectacular one founded by the great Scot. Munn said:—

LIBRARIES of late have not had the radio publicity that was agreeably frequent at an earlier time. Occasionally there are broadcasts that are useful and, we believe, effective. A good example was that given by Mr. Charles Nowell on the centenary celebrations on September 2 of the Manchester Public Libraries. He told in a familiar conversational manner of the achievements of the past and the work now being done, with what seemed to this listener to be excellent effect, his voice being, like his manner, admirable for the microphone. Another useful, well balanced broadcast was that given on October 8th on the Home Service programme by Mr. Daniel George on the National Central Library in which an outline of the part played in the library life of the country was put over with simplicity and, again, confidential familiarity. We hope the L.A. and others who can influence the matter will keep the advantages of radio still well in mind. There is also T.V. and what that may do for libraries, or reading in connection with the use of libraries.

HOW quickly a year of office passes. On December 31st, Dr. S. C. Roberts retired from the Presidency of the Library Association having won the full appreciation of the members. As scholar, librarian, library committee member, publisher and university chief he was essentially the sort of leader that an Association concerned with books rejoices to have; and, as leader, he proved to be all we desired in his presidential address, his handling of the Annual Meeting and the various tasks that fall to the President. We have been well served.

LIBRARY Association elections occur shortly and this impels us to repeat the somewhat musty axiom that men, and women now, get the government they deserve. Such axioms, however, apply perhaps more to political and other public elections in a democracy than to those of professional bodies, or semi‐professional ones like our own. Libraries should have their policies framed and pursued by the best minds available to them. It may be that these come to us through the Branches and Sections for, clearly, the candidates who leap to the mind as having national status, and compel our votes, must be a limited number. Our voting is not much assisted in many cases by the bare list of candidates' names and those of their nominators—even when the latter are known names—which are issued officially but it is not clear how this can be bettered. The A.A.L. usually issues a sort of Who's Who of its candidates and other sections might well do the same. There is still a danger that one type of librarianship may dominate the L.A. merely because it attracts a large number of the votes of junior members. It is not so great as it was; the University and Research Section, for example, commands about one thousand votes we are told, enough, if cast for their chosen candidates, to make their election probable. The Section, we note, invites its members to consider individually whether he or she could be a candidate and adds, “It is not compulsory to cast all the votes available … members who do not know enough candidates may still make effective use of their votes by supporting the candidates they do know.” In any case what is rather depressing in past experience is that not more than 12% of voters use their votes for any candidate; no elected candidate for some years past has represented the L.A. at large. We hope librarians will alter this state of affairs.

This paper aims to present recently published resources on library instruction and information literacy providing an introductory overview and a selected annotated bibliography of publications covering all library types.

This paper introduces and annotates English-language periodical articles, monographs, dissertations, reports and other materials on library instruction and information literacy published in 2018.

The paper provides a brief description of all 422 sources, and highlights sources that contain unique or significant scholarly contributions.

The information may be used by librarians and anyone interested as a quick reference to literature on library instruction and information literacy.

The two islands of Trinidad and Tobago were made one administrative unit in the year 1889. The total area is something under two thousand square miles— that of an ordinary English county. The climate is tropical and healthy, the soil extremely fertile. With the exception of the asphalt of La Brea the population is mainly concerned with the forest products and with the care of and development of the sugar and cocoa plantations. The population is mixed—East Indians; people of negro stock, and a small proportion of people of European descent. With a population exhibiting widely different cultural levels the authorities responsible for public health are confronted with correspondingly complex administrative problems. The Government Chemical Department is occupied not only with the administration proper to such a department, but acts in an advisory capacity when matters relating to plantation or local manufactured products are brought to its notice. It is satisfactory to learn of the “notable developments which have taken place in the Department in recent years.” The extent of this development may be partly judged by the estimates, which in 1945 amounted to about twenty‐nine thousand dollars, to those for 1946: these were some forty‐three thousand dollars. This increase led to the enlarging of the Departmental buildings, the purchasing of special apparatus—where this came from is not stated, but if from this country its source of origin is suggested by “the extreme slowness of delivery,” and this it seems is, or let us hope was, delaying the benefits expected from the increase in expenditure. The library, too, was enlarged. Nor are the activities of the Department limited to Trinidad alone. Reference is made to the submission of samples from various islands in the British West Indies. In a word, the Chemical Department is in close and constant touch with all social and industrial developments in the island, and the hope is expressed, and it will no doubt be justified, that the laboratory will stand comparison with any laboratory of its kind and size in the Empire. With regard to the work of the Department, it seems that 5,193 samples were examinend and reported on during the year. Of these, 4,776 were official. The bulk of the work relates to Customs (1,509 samples) and Police (2,577 samples). Among the samples submitted by the police for examination by the Department were nine cases of suspected ground glass in foodstuffs, and 255 of viscera and other articles for poison. The Port of Spain City Council submitted 407 samples of potable water. It is observed that the capital city “appears for the first time as an appreciable source of work.” Only five samples were submitted in each of the two previous years. The result of the analyses showed that the samples submitted were uniformly satisfactory from a chemical point of view. The Customs examination of 146 samples were mainly for the purpose of determining the alcohol content of medical preparations and essences. The Excise examinations for duty purposes—1,314 samples in all—were almost exclusively concerned with samples of rum, bitters, brandy, and so forth. These were all of local manufacture, and they constitute an important item in local manufacture. Angostura and other bitters are too well known to require more than passing mention. The Preventive branch had to consider twelve cases for the possession of prepared opium. Eight prosecutions were successful, and fines, amounting to $925, were inflicted. As remarked above, all the major sources of water supply of the city are now examined each month. Other sources of water supply outside the city are now also subject to examination under the supervision of the Medical Services. The Colonial Secretary, to whom this report was submitted for the information of the Governor of the Colony, had informed the Town Clerk of the Port of Spain in June, 1945, that the Chemist's Department was in a position to carry out analyses of foodstuffs and drugs submitted by the City Council. In spite of this, the amount of work done for the City Council had not been on the scale that was anticipated, for up to the end of the year 1946 no samples of the kind had been sent in for purposes of analysis. On the other hand, we notice that 1,753 food samples were examined in 1946, as against 1,394 in 1945, but these were from areas outside the area under the control of the Port of Spain Authorities, but no drug samples were submitted, nor, it seems, have any been submitted under the Food and Drug Ordinance (chap. 12, No. 3) for several years! We are, therefore, not surprised to read that “it is impossible to say to what extent (if any) these important articles are sold in an adulterated or unsatisfactory condition.” It is true that adulteration of foodstuffs— nobody can say anything about drugs—would seem to be on the decrease as the percentage figure for 1944 was 10·8, that for 1945 was 9·3, and for 1946, 7. The figures, however, refer to foodstuffs in general. If, however, we turn to figures that relate to the purity of the domestic milk supply, we find that they tell in some respects a different tale. Out of the 1,753 samples sent in for analysis 454 were milk samples. Of these, 118, or 25·9 per cent., were reported against. It is true that the figure just given is less than that of the two preceding years—1944, 37·3 per cent., and 1945, 29·5 per cent.—but the chief chemist, writing with a full knowledge of the circumstances and making, no doubt, full allowance for administrative difficulties, calls the 1946 figure “outstandingly bad,” and this percentage of adulteration still does not tell the whole tale. It seems that the larger dairies are not to blame, but “it must be a matter for continued concern that one‐quarter of the milk sold by the smaller retailers is adulterated,” for they number among their customers those “who can least afford the nutritional loss involved.” The figures, it will be noted, show a decrease, and this, it is observed, is due to “greater vigilance” on the part of the police and “other competent authorities.” In the unadulterated samples the average fat content was 3·9 per cent., and of solids not fat 8·6 per cent., so there seems to be nothing wrong with the livestock as far as these figures go, but the average figures for the adulterated samples were 3·2 per cent. of fat and 7·6 per cent. of solids not fat. Of the 118 samples reported against, 69 were deficient in solids not fat, 17 in fat content, 32 were deficient in both. The standards laid down by law for the composition of milk are 8·5 per cent. solids not fat, and 3 per cent. fat. Fines amounting to $2,460 were imposed. It was pointed out that a remedy for the present state of things is to take more samples at more frequent intervals. This has been done, but the percentage of adulteration is still abnormally high. Increased vigilance by the police, who are, it appears, the sampling officers, is certainly demanded. The percentage of adulteration for other foodstuffs is very low. It calls for no special comment.

This paper aims to present new evidence from the Cambridge Study in Delinquent Development (CSDD) showing the extent to which obstetric (e.g. abnormal birth weight, confinement at birth, severe abnormality of pregnancy, etc.) and early childhood and family factors (illegitimate child, unwanted conception, family overcrowding, etc.) have predictive effects on psychopathic traits measured later in life at age 48 years.

Data collected in the CSDD are analysed. This is a prospective longitudinal study of 411 London men from age 8 to age 61 years.

The results suggest that none of the obstetric problems were predictive of adult psychopathy. However, some other early childhood factors were significant. Unwanted conception (by the mother) was significantly associated with high psychopathy. The likelihood of being an unwanted child was higher when the mother was younger (19 years or less), and when the child was illegitimate. The poor health of the mother and living in an overcrowded family were also significant in predicting psychopathy in adulthood, as well as both psychopathic personality (F1) and psychopathic behaviour (F2).

These findings suggest the influence of very early emotional tensions and problematic social background in predicting psychopathic traits in adulthood (at age 48 years). They also emphasise the importance of investigating further the very early roots of psychopathic traits.

This paper aims to explore the sexuality of individuals with psychopathic traits. Sexuality is not only a physiological need but also a way by which people connect to others. According to a Darwinian perspective, psychopathic traits are seen as adaptive responses to environmental conditions, and as a nonpathological and reproductively viable life history strategy, although superficial emotionality and a detached interpersonal style characterise individuals who are high on psychopathic traits.

Data from the Cambridge Study in Delinquent Development are analysed. This is a prospective longitudinal study of 411 London males, with face-to-face interviews from 8 to 48 years of age.

Men who are high on psychopathic traits were likely to drift from one relationship to another, without a particular attachment to any of them, and to be sexually promiscuous. They never used contraception, which increased their likelihood of having several children from different partners.

Findings provide an insight into the non-criminal sexual behaviour of males with high psychopathic traits; evidence on a pattern of unsafe/risky sexual relations by males with high psychopathic traits; information on targeting risk factors to prevent the intergenerational transmission of psychopathy.

These findings are significant in highlighting the impact of psychopathic traits upon interpersonal and family dynamics in community samples, as detecting the impact of problematic intimate relationships is difficult in the absence of evident criminality. Rather than completely neglecting their children, men with psychopathic traits spent time with their sons but not with their daughters.