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This paper describes the development of a theoretically based sex education programme currently undergoing a randomized controlled trial in the UK. It considers some of the practical difficulties involved in translating research-based conclusions into acceptable, replicable and potentially effective classroom lessons. The discussion acknowledges that the implications of social psychological research and the requirements of rigorous evaluation may conflict with accepted principles inherent in current sex education practice. It also emphasizes that theoretical ideas must be carefully embedded in lessons which are informed by an awareness of classroom culture, and the needs and skills of teachers. For example, the use of same-sex student groups to reflect on the gendered construction of sexuality may be problematic. Materials must be tailored to recipients' circumstances, which may require substituting for limited experience with the use of detailed scripts and scenarios. Furthermore, role-play techniques for sexual negotiation that work elsewhere may not be effective in the UK. The use of trigger video sessions and other techniques are recommended. Finally, the problems involved in promoting condom-related skills are discussed. The paper concludes that, if an intervention is to be sustainable beyond the research stage, it must be designed to overcome such problems while remaining theoretically informed. [ABSTRACT FROM AUTHOR]

This paper describes the development of occupational mental health in the United Kingdom. It looks at the increasing involvement of occupational health staff in this aspect of the workplace and the role played by organizational psychologists in exploring the relationship between work and mental well-being. It provides a background for the reviews of current knowledge described in the other papers in this issue of Occupational Medicine. [ABSTRACT FROM PUBLISHER]

References 1 Raahimi M, Sheppeard R, Livesey A. Monitoring for methotrexate induced liver fibrosis in many UK dermatology centres is out of date and needs reform. Comment on: 'Monitoring for methotrexate-induced liver fibrosis in many UK dermatology centres is out of date and needs reform' Dear Editor, I read with great interest the recent paper by Raahimi I et al i . in I Clinical and Experimental Dermatology i on the subject of noninvasive monitoring for methotrexate-induced liver fibrosis.1 The British Association of Dermatologists (BAD) guidelines, which advocate monitoring of Type III procollagen peptide (PIIINP) in patients taking methotrexate, are out of alignment not just with the British Society of Gastroenterology (BSG)2 but also with the European Association for the Study of the Liver (EASL)3 and the American Academy of Dermatology (AAD)4, all of which recommend serial measurement of the Fibrosis (Fib)-4 score for patients at risk of liver fibrosis. [Extracted from the article]

Eczema is a common skin condition that affects around one in five children and one in ten adults. Qualitative research uses methods such as interviews to find out people's views and experiences. Pulling together the findings of qualitative research studies can make it easier to understand what lots of people commonly think about conditions like eczema and what they find easy or difficult about using treatments. This can help researchers find effective ways to support people managing conditions like eczema. This study, from the UK, aimed to pull together all available qualitative studies on the views and experiences of eczema and eczema treatments from people with eczema and parents or carers of children with eczema. We searched four online databases containing lists of research papers from academic journals covering medicine, nursing, healthcare and psychology. We found 39 research papers from 13 different countries. We used an analytical technique called thematic synthesis to pull together the findings of these studies. Our paper highlights four themes. (1) Eczema is not always viewed as a long‐term condition. People may unrealistically seek a 'cure' or not appreciate the need for long‐term treatment. (2) People with eczema and their carers find it frustrating that eczema is often seen by others as mundane, even though it can have a huge impact on daily life. (3) Hesitancy or concerns about eczema treatments made the condition more difficult to manage. (4) People often felt they received conflicting or insufficient information and advice about eczema treatments. Doctors could help people with eczema and their carers by addressing their concerns and understandings about treatment, acknowledging the impacts of eczema, and providing clear and consistent advice and information. Linked Article: Teasdale et al. Br J Dermatol 2021; 184:627–637. Linked Article: Teasdale et al. Br J Dermatol 2021; 184:627–637. [ABSTRACT FROM AUTHOR]

This paper considers policy issues arising in the design, regulation and taxation of lotteries, focusing on the market for an on-line lottery game. Demand determines who buys lottery tickets and in what quantities. The design of lotteries affects the terms on which tickets are supplied. UK data suggest that its lottery may be priced too high to maximize lottery revenue more revenue might be raised if the proportion of sales allocated to tax and other levies were smaller. Having established the positive economics of lotteries, the paper then assesses their welfare implications. Pari-mutuel lotteries enjoy scale economies and, as natural monopolies, are invariably run either by government agencies or a regulated licensee. I estimate consumer surplus and identify the excess burden that arises from existing (over) taxation of lotteries. The large price elasticity of demand implies that revenue raised from the lottery is raised very inefficiently. Moreover, the demand for lottery tickets is inferior (and there is some evidence that such games are contagious and addictive). So using lotteries as a vehicle for raising revenue is extremely regressive. Finally, I consider other policy implications: induced effects on charitable giving and on other forms of gambling; the impact on the government budget; perceptions of risk; and distributional considerations. [ABSTRACT FROM AUTHOR]

This paper considers an approach to addressing the decline in the level of achievement of British pupils in mathematics. It looks in detail at the differences between the teaching methods of Britain and Hungary, as research studies have indicated the high level of achievement of Hungarian pupils in mathematics. The paper outlines three theoretical perspectives (radical constructivism, social constructivism and Vygotsky's zone of proximal development) that are helpful in considering the important differences. The major differences are considered under four categories: expectation and consistency, assessment, continuity and differentiated teaching. The paper proposes the method of whole-class interactive teaching as a way forward that would improve pupils' achievement, and gives practical suggestions for developing such a teaching strategy. [ABSTRACT FROM PUBLISHER]

Great Britain has had statutory regulation of minimum pay for most of this century but never previously had a national minimum wage (NMW). This paper outlines the history of minimum wage regulation culminating in 1997 with the establishment of the Low Pay Commission (LPC). The three key debates within the LPC are analysed, namely the definition of the wage, what to do about youngsters, and the level to set the NMW. The impact of the NMW on the pay distribution, employment, family incomes and exchequer finances is set out. The paper concludes that the LPC is a fine example of successful social partnership. [ABSTRACT FROM AUTHOR]

This paper focuses upon conflict between professional and managerial values in an occupational health setting. Findings are presented which suggest that the guidelines issued by UK occupational health professional bodies (describing the duties and responsibilities of occupational health professionals), have been perceived by professionals as being impractical because they tend to focus on the theoretical role of the professional at the expense of the reality of the experienced role. The paper concludes that the problem does not actually lie with the guidelines, but with the perception of the guidelines. It is suggested that this problem can be addressed by empowering occupational health professionals to interpret and tailor the guidelines to suit their particular working environment. In addition, encouraging occupational health professionals to pro-actively market their role, will result in awareness raising amongst the managers for whom they work who often have inappropriate expectations of the occupational health professionals. [ABSTRACT FROM PUBLISHER]

This paper examines care management arrangements in services for people with learning disabilities. Its perspective is informed by research on the long-term outcomes and costs of care in the community for people with learning disabilities (Cambridge et al., 1994) and by earlier experimental approaches to care management in Britain. Building on arguments developed by the author in a position paper in 1992 (Cambridge, 1992), the focus here shifts to the performance of mainstream care management in services for people with learning disabilities, with an identification and review of critical dimensions for reviewing competence. Lessons from earlier experimental and demonstration approaches are used to inform the analysis and to construct pointers for commissioners or providers who are looking to assess the effectiveness of care management arrangements in learning disability within their own service systems. [ABSTRACT FROM AUTHOR]

This paper is based on the External Audit-Ethnically Sensitive Practice (EA-ESP) project which was undertaken within six primary and secondary health care settings. This project is used as an example of how the clinical audit model can be used to monitor and review health and social work practice in the UK. The paper examines quality, compares approaches to evaluation, and suggests that audit can be a useful tool for agencies in obtaining user and staff views on many areas of practice but in particular on equal opportunities, anti-racism and anti-oppression. Attention is drawn to audit within broader evaluative and review approaches already employed by social work academics and practitioners. The issue of quality and how it can be measured is considered through an analytical comparison with approaches which employ action research and other evaluative means in the process of review. Audit is explored in the context of a growing need for the development of monitoring and review systems which provide evidence to support and develop professionalism within social work. External audit is explored and compared to internal audit. Finally, the need for the development of quality services in anti-racist and anti-oppressive work is highlighted and it is suggested that audit can be a cost-effective and efficient way of achieving this. [ABSTRACT FROM AUTHOR]

This paper focuses on black children with a white parent in Britain. It is based on historical, research and theoretical material deriving largely from anti-racist and psychological frameworks and synthesizes and critically reappraises the existing research on black children with a white parent, living with their original families, in Britain.. The objective is to ‘normalize’ black children with a white parent by identifying and rejecting the forces that pathologize them. The paper therefore highlights the racism, marginalization and alienation which are likely to impact on their world so that action may be taken to combat these. A lack of clarity as to the personal and political complexity of identity has hampered professional perspectives and intervention. The paper consequently explores, from a postmodernist black perspective, the ‘racial’ self-concepts that are available to this group, identifying their underlying agendas and their consequences. It concludes that the availability of the self-concept ‘black, with a white parent’, offered in the framework of change, multiplicity and individuality, is beneficial. However any consideration of ‘racial’ self-concept or identity is deemed productive only when combined with efforts to reduce racism, marginalization and alienation. [ABSTRACT FROM AUTHOR]

The 1990 National Health Service and Community Care Act appeared to herald a new dawn for social work with older people, which had previously been a relatively neglected and undervalued area of social work practice. The legislation proposed a new role for social workers as case managers', with considerable autonomy and flexibility about the way in which the 'case manager' responded to need. By the time community care policy was implemented, the role of 'case manager' had been transformed into that of 'care manager', with a focus which emphasized procedural and managerial requirements rather than a more flexible professional practice. This paper explores the extent to which this shift has substantively altered the nature of social work practice with older people. It outlines key theories of professions and their applicability to social work, and critically analyses the impact of the 'new managerialism' within social services departments. The paper also examines the nature of social workers' practice with older people following the impact of community care legislation, and concludes that the impact on the social work profession has been to locate an increasing control of practice with social work managers, with potentially serious consequences for the continuation of a distinctive social work role in relation to services for older people. [ABSTRACT FROM AUTHOR]

This paper is a reappraisal of the Christian origins of social work and, as such, is a contribution to writing the profession's history. It examines the competing ideological roots of the concept of 'social work' which emerged in late nineteenth-century Britain, and the extent to which they are derived from the Christian charitable tradition or its secular transformation. Two features of early social work are examined in particular depth: its moral purpose in relation to the Evangelical belief in charity as an instrument of spiritual revival; and its rational methods in relation to secular beliefs about the possibility of personal and social change. Much of the paper focuses on the ideological and institutional relationship between the emerging activity of social work and Evangelical revivalism which formed the context for most late nineteenth-century philanthropy. The crisis of faith experienced by Victorian intellectuals is a significant motif throughout this period. This is not an attempt to rewrite the history of social work, but to re-examine neglected features in its origins: Evangelical Christianity and its secular humanist transformation. In doing so, it is hoped to throw light on the recent revival of interest in the importance of religion to social work. [ABSTRACT FROM AUTHOR]

The CASMIN Project is arguably the most influential contemporary study of class mobility in the world. However, CASMIN results with respect to weak vertical status effects on class mobility have been extensively criticized. Drawing on arguments about how to model vertical mobility, Hout and Hauser (1992) show that class mobility is strongly determined by vertical socioeconomic differences. This paper extends these arguments by estimating the CASMIN model while explicitly controlling for individual determinants of socioeconomic attainment. Using the 1972 Oxford Mobility Data and the 1979 and 1983 British Election Studies, the paper employs mixed logit models to show how individual socioeconomic factors and categorical differences between classes shape inter- generational mobility. The findings highlight the multidimensionality of class mobility and its irreducibility to vertical movement up and down a stratification hierarchy. [ABSTRACT FROM AUTHOR]

Social work with adults with learning disabilities or intellectual disability may be organised as a discrete or specialist area of practice in the UK. Little is known about contemporary social work practitioners’ views of their work with adults with learning disabilities and whether these differ from those of social workers in practice with different user groups or working in other specialities. This paper reports findings from a national survey of UK social workers undertaken in 2015 that measured burnout using the Maslach Burnout Inventory, across three domains: Emotional Exhaustion (EE), depersonalisation and personal accomplishment. A total of 1,359 social workers responded to the invitation to participate, of whom seventy-seven reported predominantly working with adults with learning disabilities and 358 reported working in child protection social work. Comparisons are drawn between responses from social workers working in these distinct practice areas showing high levels of EE co-existing with high levels of personal accomplishment in both areas of practice. Other important distinctions and similarities are reported. [ABSTRACT FROM AUTHOR]

Although numerous international studies point to large variations in child welfare interventions, comparative analysis has tended to focus either solely on England or the UK as a whole, discounting differences across the four UK countries. This paper compares trends in national statistics relating to the operation of child protection systems across England, Scotland, Wales and Northern Ireland between 2004/05 and 2013/14. Despite a number of legislative, operational and definitional differences between nations, a number of trends are apparent. All systems show an increasing orientation towards child protection as evidenced by rising rates of child protection investigation and children subject to child protection planning. Increasingly, this relates to emotional abuse and involves younger children aged from birth to four years. However, the way cases are processed can differ, with only one in ten referrals resulting in a child protection investigation in Northern Ireland compared to one in five in England. Potential reasons for these differences are discussed and questions raised as to why, more than a quarter-century after the introduction of the 1989 Children Act, we still have no clear picture of the circumstances of families who come into contact with social services or the services provided to support them. [ABSTRACT FROM AUTHOR]

Objectives. Pain assessment in older adults with cognitive impairment is often challenging, and paramedics are not given sufficient tools/training to assess pain. The development of a mobile app may improve pain assessment and management in this vulnerable population. We conducted usability testing of a newly developed iPhone pain assessment application with potential users, in this case as a tool for clinical paramedic practice to improve pain assessment of older adults with cognitive impairment. Methods. We conducted usability testing with paramedic students and a Delphi panel of qualified paramedics. Participants studied the app and paper-based algorithm from which the app was developed. The potential use for the app was discussed. Usability testing focus groups were recorded, transcribed verbatim, and analyzed using a thematic approach. Proposed recommendations were disseminated to the Delphi panel that reviewed and confirmed them. Results. Twenty-four paramedic students from two UK ambulance services participated in the focus groups. Usability of the app and its potential were viewed positively. Four major themes were identified: 1) overall opinion of the app for use in paramedic services; 2) incorporating technological applications into the health care setting; 3) improving knowledge and governance; and 4) alternative uses for the app. Subthemes were identified and are presented. Discussion. Our results indicate that the pain assessment app constitutes a potentially useful tool in the prehospital setting. By providing access to a tool specifically developed to help identify/assess pain in a user-friendly format, paramedics are likely to have increased knowledge and confidence in assessing pain in patients with dementia. [ABSTRACT FROM AUTHOR]

Background: Ventricular assist devices (VADs) are a relatively new development in the management of advanced heart failure. In the UK, VAD recipients comprise a unique group of less than 200 patients. This is the first paper to explore the experience of VAD communities, the extent to which communities are developed around the device, and how these influence the experience of living with the VAD. Methods: Qualitative interviews were conducted with 20 VAD recipients (implanted as a bridge to transplantation), 11 interviews also included the VAD recipients’ partners. Interpretive phenomenology was employed as the theoretical basis guiding the analysis of the interviews. Results: Four key themes emerged from the data: the existence of VAD communities; experiential knowledge and understanding; social comparisons; and the impacts of deaths within the VAD community. Many of the interviewees valued the VAD communities and the relationships they had formed with fellow recipients. The beneficial impacts of the VAD communities included offering recently implanted patients a realistic view of what to expect from life with a VAD; this could aid them in accepting and adapting to the changes imparted by the device. However, negative impacts of the VAD communities were also reported, in particular following deaths within the group, which were a source of distress for many of the interviewees. Conclusions: In general, the VAD communities appeared to be a beneficial source of support for the majority of interviewees. Consideration should be given to how these communities could be supported by clinicians. [ABSTRACT FROM AUTHOR]

Over recent years, there has been growing interest in Healthy Universities, evidenced by an increased number of national networks and the participation of 375 participants from over 30 countries in the 2015 International Conference on Health Promoting Universities and Colleges, which also saw the launch of the Okanagan Charter. This paper reports on research exploring the use and impact of the UK Healthy Universities Network's self review tool, specifically examining whether this has supported universities to understand and embed a whole system approach. The research study comprised two stages, the first using an online questionnaire and the second using focus groups. The findings revealed a wide range of perspectives under five overarching themes: motivations; process; outcomes/benefits; challenges/suggested improvements; and future use. In summary, the self review tool was extremely valuable and, when engaged with fully, offered significant benefits to universities seeking to improve the health and wellbeing of their communities. These benefits were felt by institutions at different stages in the journey and spanned outcome and process dimensions: not only did the tool offer an engaging and user-friendly means of undertaking internal benchmarking, generating an easy-to-understand report summarizing strengths and weaknesses; it also proved useful in building understanding of the whole system Healthy Universities approach and served as a catalyst to effective cross-university and cross-sectoral partnership working. Additionally, areas for potential enhancement were identified, offering opportunities to increase the tool's utility further whilst engaging actively in the development of a global movement for Healthy Universities. [ABSTRACT FROM AUTHOR]

This article examines debates about the design and provision of post-war housing within the papers and report of the Parker Morris committee. It does so to show how the models of citizens' rights and expectations which underpinned post-war welfare provision were transformed by mass affluence and the dynamic sphere of commercial consumption. Parker Morris's deliberations demonstrate that, as early as the 1950s, the citizen-subject was reimagined as a consuming individual, with requirements based on their expressive needs and consuming desires, and that this had far-reaching consequences for social democratic systems of universal welfare provision. The introduction of consumerist imperatives into publicly defined models of citizens' needs enhanced the political and cultural authority of the commercial domain, prompted a heightened role for commercial experts and market logics within public governance, and served to devalue socialized forms of provision in favour of consumer choice in the private market. The article thus engages with the growing scholarship on the politics of mass consumerism by showing how the material and emotional comforts of post-war affluence came to be constructed as critical to social democratic citizenship and selfhood. Situating this uneasy entanglement of social democratic rights with consumer satisfaction as part of a wider trajectory of political change, the piece suggests that Parker Morris marks an early but significant moment in the transition from post-war welfarism and social democracy to the consumer- and market-oriented forms of governance which came to dominate British politics and society in the latter part of the twentieth century. [ABSTRACT FROM AUTHOR]

The New Economics Foundation and the Adam Smith Institute are at opposite ends of the British think tank scene. As such, their policy proposals following the 2008 financial crisis could hardly be more different. Whereas NEF saw the crisis as an opportunity to advance substantial reforms to the British economic model, the ASI sought to combat surging criticisms of market deregulation and found the root of the crisis in state intervention. Given these contrasts, this article traces these organisations’ intellectual and institutional transformations between 2007 and 2013. Based on interviews and documentary analysis, this paper compares their organisational structure, sponsors, output and perceived policy impact. Overall, the financial crisis had substantial effects on these think tanks’ research and funding, but perhaps the most significant transformation relates to their efforts to reposition themselves to reach and construct new publics. By 2013, NEF promoted alternative narrative frames to the austerity discourse, while the ASI sought to reach those ‘not already convinced’ of the advantages of free markets. [ABSTRACT FROM AUTHOR]

Introduction: The cost of treatment and follow-up of cancer patients in the UK is substantial. In a budget-constrained system such as the NHS, it is necessary to consider the cost-effectiveness of the range of management strategies at different points on cancer patients' care pathways to ensure that they provide adequate value for money. Sources of data: We conducted a systematic literature review to explore the cost-effectiveness of follow-up strategies of patients previously treated for cancer with the aim of informing UK policy. All papers that were considered to be economic evaluations in the subject areas described above were extracted. Areas of agreement: The existing literature suggests that intensive followup of patients with colorectal disease is likely to be cost-effective, but the opposite holds for breast cancer. Areas of controversy: Interventions and strategies for follow-up in cancer patients were variable across type of cancer and setting. Drawing general conclusions about the cost-effectiveness of these interventions/strategies is difficult. Growing points: The search identified 2036 references but applying inclusion/exclusion criteria a total of 44 articles were included in the analysis. Breast cancer was the most common (n = 11) cancer type followed by colorectal (n = 10) cancer. In general, there were relatively few studies of cost-effectiveness of follow-up that could influence UK guidance. Where there was evidence, in the most part, NICE guidance broadly reflected this evidence. Areas timely to develop research: In terms of future research around the timing, frequency and composition of follow-ups, this is dependent on the type of cancer being considered. Nevertheless, across most cancers, the possibility of remote follow-up (or testing) by health professionals other than hospital consultants in other settings appears to warrant further work. [ABSTRACT FROM AUTHOR]

Across OECD countries productivity growth has slowed, not just in recent years but over the past four decades: the so-called productivity puzzle. This paper examines the differing productivity growth paths of some 85 British cities since the beginning of the 1970s, and explores how far these paths reflect differences across cities in the pace and nature of structural change. We find that while northern cities led productivity growth over 1971-91 southern cities then led after 1991. However, at the same time, the rate of productivity growth slowed across almost all cities between these two periods. We find evidence of considerable structural convergence across cities and a general tendency for the degree of specialisation to fall. This then leads to a decomposition analysis which identifies the relative contribution of between-sector (structural change) and within-sector effects to city productivity growth. The analysis reveals that structural change -- and especially the shift from manufacturing to services -- has had a negative impact on productivity growth across all cities, but that within-sector productivity developments while positive and outweighing structural change effects, have also declined over the past 45 years, as well as varying across cities. These findings point to the need for further research on the causes of this slowdown in 'within-sector 'productivity growth and why those causes appear to differ from city to city. They also point to the need for a 'place-based' dimension to policies aimed at improving national productivity performance. [ABSTRACT FROM AUTHOR]

Currently in the United Kingdom, anyone donating gametes has the status of an open-identity donor. This means that, at the age of 18, persons conceived with gametes donated since April 1, 2005 have a right to access certain pieces of identifying information about their donor. However, in early 2015, the UK Parliament approved new regulations that make mitochondrial donors anonymous. Both mitochondrial donation and gamete donation are similar in the basic sense that they involve the contribution of gamete materials to create future persons. Given this similarity, this paper presumes that both types of donor should be treated the same and made open-identity under the law, unless there is a convincing argument for treating them differently. I argue that none of the existing arguments that have been made so far in favor of mitochondrial donor anonymity are convincing and mitochondrial donors should therefore be treated as open-identity donors under UK law. [ABSTRACT FROM AUTHOR]

Background: Most studies of the psychological impact of military deployment focus on the negative and traumatic aspects. Less is known about the full range of deployment experiences nor how these may impact on career intentions. Aims: To examine subjective operational experiences and career intentions in deployed UK military personnel using data gathered toward the end of an operational deployment. Methods: Data were gathered during deployment in Iraq and Afghanistan. A self-report survey collected data on sociodemographic, operational and military factors. Respondents provided their strength of agreement or disagreement with six potentially positive deployment experiences and their endorsement or rejection of six possible career intentions. Two mental health measures assessed symptoms of common mental disorder and post-traumatic stress disorder. Results: Responses were 681 in Iran 2009 (100% response rate); 1421 in Afghanistan in 2010 (100%), 1362 in 2011 (96%) and 860 in 2015 (91%). Five of the potentially positive outcomes were endorsed by >50% of the sample: confidence about remaining healthy after returning home, pride in accomplishments, increased confidence in abilities, improved unit cohesion and experiencing a positive life effect. Ninety per cent of respondents planned to continue in service after returning home. Fewer positive deployment experiences, poorer mental health, lesser unit cohesion and more negative impressions of leadership were significantly associated with intention to leave service. Conclusions: Contrary to the popular belief that UK military personnel deployed to Iraq or Afghanistan experience negative outcomes, this paper shows that deployment can be a positive experience for a substantial majority of deployed personnel. [ABSTRACT FROM AUTHOR]

Post-election socialisation has frequently been identified as a source of parliamentarians' disposition towards party loyalty. Yet a recent study of the socialisation experiences of new members in the British Parliament, using tenure as proxy for socialisation, found little evidence of an effect on party loyalty (Rush and Giddings, 2011, Parliamentary Socialisation: Learning the Ropes or Determining Behaviour? London, Springer). This paper develops a new model of parliamentary socialisation and uses the same data to demonstrate that post-entry socialisation did in fact change legislators reported likeliness to behave in accordance with their party leadership's wishes. Specifically, a framework based on information exchange (advice giving) is used to show that positive interactions with party actors are associated with increased loyalty. Controlling for initial levels of loyalty, members who received more useful advice from party actors were more likely to rate themselves as highly influenced by the party leadership. [ABSTRACT FROM AUTHOR]

Objectives: Primary care practices in England differ in antibiotic prescribing rates, and, anecdotally, prescribers justify high prescribing rates based on their individual case mix. The aim of this paper was to explore to what extent factors such as patient comorbidities explain this variation in antibiotic prescribing.Methods: Primary care consultation and prescribing data recorded in The Health Improvement Network (THIN) database in 2013 were used. Boosted regression trees (BRTs) and negative binomial regression (NBR) models were used to evaluate associations between predictors and antibiotic prescribing rates. The following variables were considered as potential predictors: various infection-related consultation rates, proportions of patients with comorbidities, proportion of patients with inhaled/systemic corticosteroids or immunosuppressive drugs, and demographic traits.Results: The median antibiotic prescribing rate was 65.6 (IQR 57.4-74.0) per 100 registered patients among 348 English practices. In the BRT model, consultation rates had the largest total relative influence on antibiotic prescribing rate (53.5%), followed by steroid and immunosuppressive drugs (31.6%) and comorbidities (12.2%). Only 21% of the deviance could be explained by an NBR model considering only comorbidities and age and gender, whereas 57% of the deviance could be explained by the model considering all variables.Conclusions: The majority of practice-level variation in antibiotic prescribing cannot be explained by variation in prevalence of comorbidities. Factors such as high consultation rates for respiratory tract infections and high prescribing rates for corticosteroids could explain much of the variation, and as such may be considered in determining a practice's potential to reduce prescribing. [ABSTRACT FROM AUTHOR]

Background: The effects of exposure to chemical warfare agents in humans are topical. Porton Down is the UK's centre for research on chemical warfare where, since WWI, a programme of experiments involving ~30 000 participants drawn from the UK armed services has been undertaken. Objectives: Our aim is to report on exposures to nerve agents, particularly sarin, using detailed exposure data not explored in a previous analysis. Methods: In this paper, we have used existing data on exposures to servicemen who attended the human volunteer programme at Porton Down to examine exposures to nerve agents in general and to sarin in particular. Results: Six principal nerve agents were tested on humans between 1945 and 1987 Of all 4299 nerve agent tests recorded, 3511 (82%) were with sarin, most commonly in an exposure chamber, with inhalation being the commonest exposure route (85%). Biological response to sarin exposure was expressed as percentage change in cholinesterase activity and, less commonly, change in pupil size. For red blood cell cholinesterase, median inhibition for inhalation tests was 41% (interquartile range 28-51%), with a maximum of 87%. For dermal exposures the maximum inhibition recorded was 99%. There was a clear association between increasing exposure to sarin and depression of cholinesterase activity but the strength and direction of the association varied by exposure route and the presence of chemical or physical protection. Pupil size decreased with increased exposure but this relationship was less clear when modifiers, such as atropine drops, were present. Conclusions: These results, drawn from high quality experimental data, offer a unique insight into the effects of these chemical agents on humans. [ABSTRACT FROM AUTHOR]

This paper reports on a novel longitudinal study of local variation in the decline of recorded crime in Greater Glasgow, United Kingdom. We deploy group trajectory analysis (exploring spatial autocorrelation with Local Moran's I) and comparison of means to explore the underlying characteristics and trajectories of neighbourhoods over time. The research finds marked distinction in the level of crime and trajectories of different neighbourhood crime groups. Neighbourhood crime trajectories with high or low levels of crime exhibit spatial clustering and significant distinction in their characteristics. There is more limited spatial patterning, though still clear distinction between the characteristics of neighbourhood crime groups that exhibit different crime trajectories. We consider the research and policy implications of these findings. [ABSTRACT FROM AUTHOR]

Part of the rationale for introducing elected Police and Crime Commissioners (PCCs) was a suggestion that the police and public needed to be 'reconnected', with the public more readily able to shape the type of policing they wished to receive. Apparently underpinning this intention was a perception that a single public view about policing priorities could, and would, make itself apparent to PCCs. This paper considers how PCCs assess their public mandate by focusing on an often contested policing activity--roads policing. It considers why this particular issue is particularly likely to be understood by PCCs as a contested topic and, furthermore, how PCCs go about accessing and representing diverse views within this 'consumer-led' approach to the provision of policing. [ABSTRACT FROM AUTHOR]

Longitudinal data sources offer new opportunities for the evaluation of sequential interventions. To adjust for time-dependent confounding in these settings, longitudinal targeted maximum likelihood based estimation (TMLE), a doubly robust method that can be coupled with machine learning, has been proposed. This paper provides a tutorial in applying longitudinal TMLE, in contrast to inverse probability of treatment weighting and g-computation based on iterative conditional expectations. We apply these methods to estimate the causal effect of nutritional interventions on clinical outcomes among critically ill children in a United Kingdom study (Control of Hyperglycemia in Paediatric Intensive Care, 2008-2011). We estimate the probability of a child's being discharged alive from the pediatric intensive care unit by a given day, under a range of static and dynamic feeding regimes. We find that before adjustment, patients who follow the static regime "never feed" are discharged by the end of the fifth day with a probability of 0.88 (95% confidence interval: 0.87, 0.90), while for the patients who follow the regime "feed from day 3," the probability of discharge is 0.64 (95% confidence interval: 0.62, 0.66). After adjustment for time-dependent confounding, most of this difference disappears, and the statistical methods produce similar results. TMLE offers a flexible estimation approach; hence, we provide practical guidance on implementation to encourage its wider use. [ABSTRACT FROM AUTHOR]

This paper examines human-nature interaction and how therapeutic this relationship is by investigating the efficacy of structured outdoor experience. Two walking and solo experience (WSEs) explored university students' (aged 20--43 years) perceptions of walking through and being with nature. The first was a 5-day journey (n = 4; 3 females and 1 male) and the second (n = 5; 3 females and 2 males) took place over two weekends, with a 2-week interval in-between. Pre- and post-experience interviews, journal writing, group discussions and a 9-month follow-up interviews were used to collect data and thematic analysis [Braun and Clarke (Using thematic analysis in psychology. Qual Res Psychol 2006;3:77-101.)] was applied. Both WSEs were considered together during analysis, as well as comparisons made between the two, in order to evaluate implications for practice. Benefits of the WSE that contributed to a general sense of well-being were: (i) gaining a sense of freedom and escape; (ii) gaining a sense of awareness and sensitivity to one's environment and its influence (iii) gaining confidence in being able to cope and take action; (iv) gaining a sense of perspective on and appreciation for life. Furthermore, the meaning participants formed in relation to their environment before, during and after the WSE, and the activity within that environment, played a role in their sense of well-being and in their motivations to re-access nature in other places. Findings suggest that WSEs are a cost effective way to give rise to beneficial and durable experiences, but a more holistic approach to policy is needed. [ABSTRACT FROM AUTHOR]

In a legal 'first', the UK removed a prohibition against modifying embryos in human reproduction, to enable mitochondrial replacement techniques (MRTs), a move the Government distanced from 'germline genetic modification', which it aligned with modifying the nuclear genome. This paper (1) analyzes the uses and meanings of this term in UK/US legal and policy debates; and (2) evaluates related ethical concerns about identity. It shows that, with respect to identity, MRTs and nuclear genome editing techniques such as CRISPR/Cas-9 (now a policy topic), are not as different as has been supposed. While it does not follow that the two should be treated exactly alike, one of the central reasons offered for treating MRTs more permissively than nuclear genetic modification, and for not regarding MRTs as 'germline genetic modification', is thereby in doubt. Identity cannot, by itself, do the work thus far assigned to it, explicitly or otherwise, in law and policy. [ABSTRACT FROM AUTHOR]

In order to practise social work in England, all social workers must register with the Health and Care Professions Council (HCPC). Only those who are registered can legally work as or call themselves a social worker. Once registered, if concerns about their practice are raised, social workers may find they are then made subject to a 'Fitness to Practise' (FTP) process. This article reports on the findings from interviews with social workers who were referred to the HCPC for practice issues. Our rationale was to hear and report on the lived experience of those going through the investigatory process. We carried out semi-structured interviews with eight social workers and used thematic analysis to analyse our data. The three main themes to emerge from our findings were organisational issues, representation and cost and emotional toll. This paper discusses these findings in detail. We suggest that the current regulatory system situates social workers in a position of disadvantage during the FTP process, and conclude by making a number of recommendations for consideration if future changes are to be made to the social work regulatory process. [ABSTRACT FROM AUTHOR]

Background The NHS Five Year Forward View identifies a range of approaches for addressing the NHS's challenges. The Transition movement helps communities to reframe and rebuild their world by working on issues such as climate change, food, community relationships and localizing the economy. Methods This paper describes Transition using five short example projects and, informed by these, identifies mechanisms by which Transition could potentially help reduce pressure on the NHS. Results Transition is characterized by people self-organizing to address local challenges with benefits arising from both the outcomes and the process of the projects. Transition may be able to help the NHS reframe change, prevent disease, improve staff well-being and increase local economic resilience. Discussion The evidence base for the relationship between Transition and health is growing but is not yet well developed. This reflects the complexity of establishing an evidence base for wider determinants of health. There is substantial potential learning for those in the NHS about change outside formal institutional structures. Conclusions Transition provides new ways of thinking and acting to develop greater 'community intelligence', which could help the NHS in the face of increasing pressures. [ABSTRACT FROM AUTHOR]

BACKGROUND We examine why dementia prevention and risk reduction are relatively underfunded and suggest potential remediation strategies. The paper is aimed at researchers, funders and policy-makers, both within dementia and also the wider health prevention field. METHODS A discussion-led workshop, attended by 58 academics, clinicians, funders and policy-makers. RESULTS The key barriers identified were the gaps in understanding the basic science of dementia; the complex interplay between individual risk factors; variations in study methodology; disincentives to collaboration; a lack of research capacity and leadership and the broader stigma of the condition. Recommendations were made to encourage strategic leadership, provide greater support for grant applications, promote collaboration and support randomized control trials for the research field. CONCLUSION Having identified the barriers, the key challenge is how to implement the potential solutions. This will require engagement with decision-makers within funding, policy and research to ensure that action takes place. [ABSTRACT FROM AUTHOR]

Chain event graphs (CEGs) are a graphical representation of a statistical model derived from event trees. They have previously been applied to cohort studies but not to case-control studies. In this paper, we apply the CEG framework to a Yorkshire, United Kingdom, case-control study of childhood type 1 diabetes (1993-1994) in order to examine 4 exposure variables associated with the mother, 3 of which are fully observed (her school-leaving-age, amniocenteses during pregnancy, and delivery type) and 1 with missing values (her rhesus factor), while incorporating previous type 1 diabetes knowledge. We conclude that the unknown rhesus factor values were likely to be missing not at random and were mainly rhesus-positive. The mother's school-leaving-age and rhesus factor were not associated with the diabetes status of the child, whereas having at least 1 amniocentesis procedure and, to a lesser extent, birth by cesarean delivery were associated; the combination of both procedures further increased the probability of diabetes. This application of CEGs to case-control data allows for the inclusion of missing data and prior knowledge, while investigating associations in the data. Communication of the analysis with the clinical expert is more straightforward than with traditional modeling, and this approach can be applied retrospectively or when assumptions for traditional analyses are not held. [ABSTRACT FROM AUTHOR]

Abuse directed at visible and audible women demonstrates that cyberspace, once heralded as a new, democratic, public sphere, suffers similar gender inequalities as the offline world. This paper reports findings from a national UK study about experiences of online abuse among women who debate feminist politics. It argues that online abuse is most usefully conceived as a form of abuse or violence against women and girls, rather than as a form of communication. It examines the experiences of those receiving online abuse, thereby making a valuable contribution to existing research which tends to focus on analysis of the communications themselves. [ABSTRACT FROM AUTHOR]

This article explores a perplexing line from Rousseau's Emile: his suggestion that the 'most important rule' for the educator is 'not to gain time but to lose it'. An analysis of what Rousseau meant by this line, the article argues, shows that Rousseau provides the philosophical groundwork for a radical critique of the contemporary cultural framework that supports homework, standardised testing, and the competitive extracurricular activities that consume children's time. He offers important insights to contemporary parents and educators wishing to reimagine an educational system that is currently fuelled more by familial and international amour propre than by children's interests and needs. Not the least of these is his recognition that to reimagine children's education would require a new configuration of the very terms of modern life. Problematically, however, Rousseau's alternative to mechanised clock-time depends on the labour of Sophie, whose time is also reconfigured. For the next generation of children to be educated according to natural time, Sophie's labour needs to be off the clock too, which is just as much a linchpin of her removal from the public sphere of citizenship and the paid workforce as it is of Emile's education for public life, or so the final section of this paper argues. [ABSTRACT FROM AUTHOR]

A tension has been identified between the acquisition and participation metaphors for learning, and it is generally agreed that this tension has still not been adequately resolved. In this paper, we offer an alternative to the acquisition and participation metaphors for learning: the metaphor of mastering. Our claim is that the mastering metaphor, as grounded in inferentialism, allows one to treat both the acquisition and participation dimensions of learning as complementary and mutually constitutive. Inferentialism is a semantic theory which explains concept formation in terms of the inferences individuals make in the context of an intersubjective practice of acknowledging, attributing, and challenging one another's commitments. We first introduce the key concepts of inferentialism and consider the perspective on learning that inferentialism inspires. Then, we condense the lessons of the inferentialist concepts into a single mastering metaphor for learning and argue that learning consists in the process by which learners come to master concepts and practices. We conclude by discussing how the mastering metaphor could be put to work in a theoretical reconciliation of the cognitive and sociocultural dimensions of learning. [ABSTRACT FROM AUTHOR]

This article takes up Arendt's 'aporetic' framing of human rights as well as Rancière's critique and suggests that reading them together may offer a way to re-envision human rights and human rights education (HRE)-not only because they make visible the perplexities of human rights, but also in that they call for an agonistic understanding of rights; namely, the possibility to make new and plural political and ethical claims about human rights as practices that can be evaluated critically rather than taken on faith. The paper contributes to ongoing discussions about the need for a renewal of HRE by suggesting that the paradoxes of human rights-such as the disparity between the reality of the human condition and the abstract ideal of human rights-can be politically and pedagogically invigorating by rethinking human rights in agonistic terms and formulating more robust practices of HRE. [ABSTRACT FROM AUTHOR]

Pre-college philosophy has proliferated greatly over the last few decades, including in the form of 'philosophy across the curriculum'. However, there has been very little sustained examination of the nature of philosophy as a subject relative to other standard pre-college subjects and the kinds of expertise an effective philosophy teacher at this level should possess. At face value, the minimal academic preparation expected for competence in secondary philosophy instruction, compared to the high standards for teaching other subjects, raises questions and concerns. In this paper I make some provisional observations about the subject of philosophy and how it is taught from p4c through to the post-secondary level. I begin by examining the concept of 'philosophy across the curriculum' and offer a working analysis of the main features of philosophy's form and content that enable us to determine its relevance to, and difference from, other subjects. Next, I examine and critique what I term the 'populist' conception of philosophy, which correlates to lower expectations of teacher training, and use my own experience of teaching philosophy across the curriculum to shed doubt on the viability of this approach. In the third section I consider what I term the 'autonomous' conception of philosophy, which correlates to more stringent expectations of teacher capacity, and explain why it is preferable to the populist conception with some qualifications. I conclude by reflecting on how philosophy compares to other subjects that are advanced cross-curricularly and argue for more training of high school philosophy teachers. [ABSTRACT FROM AUTHOR]

In this Spinozist defence of the educational promotion of students' autonomy I argue for a deterministic position where freedom of will is deemed unrealistic in the metaphysical sense, but important in the sense that it is an undeniable psychological fact. The paper is structured in three parts. The first part investigates the concept of autonomy from different philosophical points of view, looking especially at how education and autonomy intersect. The second part focuses on explicating the philosophical position of causal determinism and it seeks to open up a way to conceive of education for autonomy without relying on the notion of free will in a metaphysical sense. The concluding part attempts to outline a Spinozistic understanding of education for autonomy where autonomy is grounded in the student's acceptance and understanding of the necessary constraints of natural causation rather than processes of self-causation. [ABSTRACT FROM AUTHOR]

Market authorities in the UK now have almost a decade of collective experience in interpreting and applying the principles of behavioural economics. Those entities have sought to use insights from the field that show why consumer behaviour sometimes diverges from wealth-maximising predictions as a tool to improve their abilities to diagnose and address problematic market features. This paper reviews the first era of behaviourally-informed case work to derive a series of lessons learned that should inform future applications of the theory. This review begins with a discussion of how authorities have interpreted the findings of behavioural research to be of relevance for their strategic approach to case work. The centrepiece is a survey of recent case work in which the analysis has been driven by the application of behavioural theory. A major lesson that emerges is that behavioural research has facilitated authorities to undertake more nuanced and comprehensive examinations of possible demand-side issues. Currently, however, behavioural theory is not capable of providing robust a priori predictions for the purposes of remedy design; therefore, adequate testing of behavioural remedies is likely to prove crucial for their effectiveness. [ABSTRACT FROM AUTHOR]

During the past two decades, there has been an increasing international trend towards giving users of health and social care more choice and control in the provision of services. Whilst the policy of promoting personalised support through Direct Payments in the UK has evoked strong feelings, for and against, successive governments have remained committed to expanding such schemes. However, the effectiveness and efficiency of Direct Payments in health and social care have been under-researched. Also, previous studies have tended to focus on adult provision. This study, which focused on the experiences of parents/carers of children with disabilities in one of the five health and social care trusts in Northern Ireland, highlights both opportunities and concerns about using Direct Payments. Among the strengths identified by parents/carers were increased control and greater flexibility in securing services tailored to children's individual needs. However, the findings also highlighted problems with inadequate information, difficulties with administrative support, inconsistencies in funding arrangements and concerns about safeguarding vulnerable children. The paper concludes by considering the implications of the findings for users of services, and highlights key strategic challenges for agencies seeking to further develop Direct Payments as a method of meeting the needs of children with disabilities. [ABSTRACT FROM AUTHOR]

Adult Serious Case Reviews (SCRs) investigate situations in which harm to or death of a vulnerable adult has occurred, or where abuse or neglect was suspected and local agencies' responses were deemed in need of scrutiny. Under the 2014 Care Act, in England, SCRs have moved to a statutory footing, being renamed Safeguarding Adults Reviews (SARs). This paper reports an analysis of SCRs concerning older residents of care homes conducted in 2015. While there is a clear forensic methodology for investigating single cases that indicate multi-agency failings of safeguarding, 'whole home' or 'collective abuse' investigations are difficult to undertake, requiring review of numerous records and consultations. Failure to recognise abuse may reflect professionals' uncertainties about thresholds for action when encountering poor care quality or abuse and the exclusion of social workers from involvement with the care and support of care home residents. SCRs sometimes comment on sub-optimal support for care home residents from local social work practitioners or hint at missed opportunities. Reflections on what needs to change in local systems of care and support may include new scope for the development of gerontological social work practice. [ABSTRACT FROM AUTHOR]

Drawing together institutional papers, the trade- and national-press, and Mass- Observation documents, this article examines the changing ways that the Advertising Association justified commercial advertising from 1939 to 1951. It argues that the ability to repeatedly re-conceptualize the social and economic purposes of advertising was central to the industry's survival and revival during the years of war and austerity. This matters because the survival and revival of commercial advertising helps to explain the composition of the post-war mixed economy and the emergence of a consumer culture that became the 'golden age' of capitalism. While commercial advertising's role in supporting periods of affluence is well documented, much less is known about its relationship with war and austerity. This omission is problematic. Advertising was only able to shape the 1950s and 1960s economy because its corporate structures remained intact during the 1940s, as the industry withstood the challenges of wartime and the difficulties presented under Attlee's government. Recognizing the deliberate attempts of advertising people to promote a role for commercial advertising invites us to reconsider the inevitability of post-war affluence, while offering fresh insight into the debate around consumer education, freedom of choice, and the centrality of advertising and communication in democratic society: issues central to the society Britain was, and hoped to become. [ABSTRACT FROM AUTHOR]

This paper will examine how the physical reality behind Tallis’s illustrations can be illuminated to explore the commercial, domestic and social dimensions of Tallis’s London. It will explore the range of material culture available, and how this can be used to analyse interior space, in particular through English Heritage’s Architectural Study Collection. Two preliminary case studies will investigate the future potential for looking behind the façades of early Victorian London. [ABSTRACT FROM AUTHOR]

This theoretical paper addresses fundamental questions raised by a four-nation comparison of child welfare interventions in the UK, the Child Welfare Inequalities Project, which has highlighted differences between and within countries. The project analysed administrative data to examine the relationship between deprivation and state intervention. This project builds on research by Coventry University which established both a social gradient in child welfare interventions and an inverse intervention effect similar to the inverse health law (better health care in more affluent areas). These empirical findings raise the question of, but do not fully answer, whether such inequalities in child welfare interventions should be addressed. In order to consider this complex question, this article aims to explore theoretical ideas from other disciplines to provide important perspectives on such inequalities. These perspectives include ideas from political theory, psychology and moral philosophy. They suggest that child welfare should be: structured in a fairer way (based on Rawls's work on justice); that people think society is more equitable than it is and would prefer it to be more equally distributed (based on Norton and Ariely's work on attitudes to inequality); and that it is ethically irrational not to address this (based on Singer's work on moral distance). [ABSTRACT FROM AUTHOR]

This paper reviews progress and competence in HIV prevention work for people with intellectual disabilities in Britain. It identifies key challenges for specialist residential support and sex education services for people with intellectual disabilities, as well as for mainstream health promotion services. The discussion is informed by research and practice evidence and explores ways to develop competence in safer sex education, offering suggestions for HIV risk assessment and risk management. While the paper demonstrates that the politics of sexuality and HIV are difficult for services to manage, the rights of people with intellectual disabilities to information and support for sexuality and sexual health should be put first. Key words: HIV; prevention; sex education [ABSTRACT FROM AUTHOR]