The need for organizational innovation as a means of improving health-care quality and containing costs is widely recognized, but while a growing body of research has improved knowledge of implementation, very little has considered the challenges involved in sustaining change – especially organizational change led ‘bottom-up’ by frontline clinicians. This study addresses this lacuna, taking a longitudinal, qualitative case-study approach to understanding the paths to sustainability of four organizational innovations. It highlights the importance of the interaction between organizational context, nature of the innovation and strategies deployed in achieving sustainability. It discusses how positional influence of service leads, complexity of innovation, networks of support, embedding in existing systems, and proactive responses to changing circumstances can interact to sustain change. In the absence of cast-iron evidence of effectiveness, wider notions of value may be successfully invoked to sustain innovation. Sustainability requires continuing effort through time, rather than representing a final state to be achieved. Our study offers new insights into the process of sustainability of organizational change, and elucidates the complement of strategies needed to make bottom-up change last in challenging contexts replete with competing priorities.

3Research highlights how co-existing institutional logics can sometimes offer opportunities for 4 agency to enterprising actors in organizational fields. But macro-and micro-level studies using 5 this framework diverge in their approach to understanding the consequences of institutional 6 complexity for actor autonomy, and correspondingly in the opportunities they identify for 7 agents to resist, reinterpret or make judicious use of institutional prescriptions. This paper seeks

In many ways, nut allergy may be considered a form of disability, because it imposes social barriers on participating fully in society.

This article outlines the racist rhetoric employed in anti-black jokes on five internet websites. It is argued that racist jokes can act as important rhetorical devices for serious racisms, and thus work in ways that can support racism in particular readings. By offering a rhetorical discourse analysis of jokes containing embodied racism – or the discursive remains of biological racism – it is shown that internet jokes express two key logics of racism. These logics are inclusion and exclusion. It is argued that inclusion usually inferiorizes and employs race stereotypes whereas exclusion often does not. The article expands this second category by highlighting exclusionary ‘black’ and ‘nigger’ jokes. These categories of non-stereotyped race or ethnic joking have been largely ignored in humour studies because of a reliance on a problematic and celebratory definition of the ethnic joke. Thus a wider definition of racist humour is offered.

This article outlines the 'reverse discourses' of black, African-American and AfroCaribbean comedians in the UK and USA. These reverse discourses appear in comic acts that employ the sign-systems of embodied and cultural racism but develop, or seek to develop, a reverse semantic effect. I argue the humour of reverse discourse is significant in relation to racism because it forms a type of resistance that can, first, act rhetorically against racist meaning and so attack racist truth claims and points of ambivalence. Second, and connected to this, it can rhetorically resolve the ambiguity of the reverse discourse itself. Alongside this, and paradoxically, reverse discourses also contain a polysemic element that can, at times, reproduce racism. The article seeks to develop a means of analysing the relationship between racist and non-racist meaning in such comedic performance. KEY WORDS ambivalence / comedy / humour / reverse discourse / rhetoric IntroductionThe article offers a basic typology of black, African-American and Afro-Caribbean comedy as a form of reverse discourse. This typology is constructed by showing some key rhetorical devices through which racial stereotypes are employed and attacked in comedy, and the potential influence that particular reverse discourses might have on both the ambivalences of racism and the ambivalences of anti-racism.