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The purpose of this paper is to better understand how and why adoption and implementation of healthcare IT innovations occur. The authors examine two IT applications, computerised physician order entry (CPOE) and picture archiving and communication systems (PACS) at the meso and micro levels, within the context of the National Programme for IT in the English National Health Service (NHS).

To analyse these multi-level dynamics, the authors blend Rogers’ diffusion of innovations theory (DoIT) with Webster’s sociological critique of technological innovation in medicine and healthcare systems to illuminate a wider range of interacting factors. Qualitative data collected between 2004 and 2006 uses semi-structured, in-depth interviews with 72 stakeholders across four English NHS hospital trusts.

Overall, PACS was more successfully implemented (fully or partially in three out of four trusts) than CPOE (implemented in one trust only). Factors such as perceived benefit to users and attributes of the application – in particular speed, ease of use, reliability and flexibility and levels of readiness – were highly relevant but their influence was modulated through interaction with complex structural and relational issues.

Results reveal that combining contextual system level theories with DoIT increases understanding of real-life processes underpinning implementation of IT innovations within healthcare. They also highlight important drivers affecting success of implementation, including socio-political factors, the social body of practice and degree of “co-construction” between designers and end-users.

The originality of the study partly rests on its methodological innovativeness and its value on critical insights afforded into understanding complex IT implementation programmes.

The whole kingdom from north to south at the time of writing is enveloped in freezing Arctic weather, reminiscent of the North Russian campaign of long ago. The normal winter is relatively mild, mainly a Westerly pattern, occasionally wild and windy, wet with a rare cold “snap”. There are variations in the pattern, damp and warm in the south‐west, few frosts and rarely any snow; in the north of the country, Scotland, much colder, with the south‐east partaking of the weather pattern of the land mass of the Continent. The variations appear more of the mild weather in the South and colder, appreciably, in the North; recalling service personnel stationed at Gosport who did not need an overcoat all winter, whereas in the North, many found it necessary to wear a light overcoat tor most of the year, the south‐east corner of England, obtaining no help from the warming Gulf Stream, often gets the worst of the weather, which it has done to a very considerable extent in this winter.

Simon Cowell, the impresario behind The X Factor, a popular television talent show, has often been compared to P.T. Barnum, the legendary nineteenth century showman. This paper aims to examine the alleged parallels in detail and attempts to assess this “Barnum reborn” argument.

Putative parallels between the impresarios are considered under the aegis of two long‐standing, if contentious, historical “theories”: time's cycle and the great man thesis.

Seven broad similarities between the showmen are identified: vulgarity, hyperbole, rivalry, publicity, duplicity, liminality and history. In each case, the arguments pro and con are explored, as is humanity's propensity to personify.

In accordance with the iconic literary critic Harold Bloom, who “strikes texts together to seek if they spark”, this paper strikes two celebrated showmen together to generate historical sparks.

THE question of the advisability of exercising a censorship over literature has been much before the public of late, and probably many librarians have realised how closely the disputed question affects their own profession.