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Background The Medical Certificate of Stillbirth (MCS) records data about a baby's death after 24 weeks of gestation but before birth. Major errors that could alter interpretation of the MCS were widespread in two UK-based regional studies. Methods A multicentre evaluation was conducted, examining MCS issued 1 January 2018 to 31 December 2018 in 76 UK obstetric units. A systematic case-note review of stillbirths was conducted by Obstetric and Gynaecology trainees, generating individual 'ideal MCSs' and comparing these to the actual MCS issued. Anonymized central data analysis described rates and types of error, agreement and factors associated with major errors. Results There were 1120 MCSs suitable for assessment, with 126 additional submitted data sets unsuitable for accuracy analysis (total 1246 cases). Gestational age demonstrated 'substantial' agreement [K = 0.73 (95% CI 0.70–0.76)]. Primary cause of death (COD) showed 'fair' agreement [K = 0.26 (95% CI 0.24–0.29)]. Major errors [696/1120; 62.1% (95% CI 59.3–64.9%)] included certificates issued for fetal demise at <24 weeks' gestation [23/696; 3.3% (95% CI 2.2–4.9%)] or neonatal death [2/696; 0.3% (95% CI 0.1–1.1%)] or incorrect primary COD [667/696; 95.8% (95% CI 94.1–97.1%)]. Of 540/1246 [43.3% (95% CI 40.6–46.1%)] 'unexplained' stillbirths, only 119/540 [22.0% (95% CI 18.8–25.7%)] remained unexplained; the majority were redesignated as either fetal growth restriction [FGR: 195/540; 36.1% (95% CI 32.2–40.3%)] or placental insufficiency [184/540; 34.1% (95% CI 30.2–38.2)]. Overall, FGR [306/1246; 24.6% (95% CI 22.3–27.0%)] was the leading primary COD after review, yet only 53/306 [17.3% (95% CI 13.5–22.1%)] FGR cases were originally attributed correctly. Conclusion This study demonstrates widespread major errors in MCS completion across the UK. MCS should only be completed following structured case-note review, with particular attention on the fetal growth trajectory. [ABSTRACT FROM AUTHOR]

As an increasing number of British universities are now requiring/encouraging mathematics applicants to have taken ‘extension papers’ such as the Mathematics Admissions Test (MAT), Advanced Extension Award (AEA) and Sixth Term Examination Paper (STEP), current students were asked how useful they were in preparation for their degree. The MAT was most commonly described as good preparation for undergraduate mathematics, whilst most participants who had taken the AEA were indifferent regarding its usefulness. Participants were positive about STEP, commending its similarity to undergraduate-style assessment and its challenging questions. The students’ views suggested that those wishing to be well prepared for tertiary mathematics should take one of these papers, preferably STEP. However, whilst universities may not necessarily wish to require applicants to pass extension papers, it may be beneficial for universities to recommend students to take them in order to improve their mathematical thinking and expectations of undergraduate mathematics study. [ABSTRACT FROM AUTHOR]

The humble ballot paper is a defining technology of elections throughout the world. This article interrogates its contested past by demonstrating - over a long period and in the context of three contrasting countries - how and why it emerged in the early modern period and how it was then used, abused and regulated in the context of the expanded, and eventually mass, electoral arenas of the nineteenth and twentieth centuries. Ironically, by the time that the ballot paper was firmly established, its monopoly was already being challenged by mechanical and then electronic media, which may eventually condemn it to extinction. [ABSTRACT FROM AUTHOR]

It is well documented in both the British press and mathematics education literature that many considerA-levels (qualifications for secondary school leavers in England,Wales and Northern Ireland) to be insufficient preparation for undergraduate mathematics study in theUK. A-levelMathematics and FurtherMathematics are not solely intended for those wishing to go on to study undergraduatemathematics, though this is often the onlymathematics study and preparation available to, and done by, most students. A number of British universities now require applicants to perform well on entrance examinations or 'extension' papers in addition to achieving certain grades in A-level Mathematics and, sometimes, Further Mathematics. This article outlines research which used the Mathematical Assessment Task Hierarchy (Smith et al., 1996) and builds upon the work of Darlington (2014) to describe the mathematical skills required to answer the questions in extension papers.These are then contrasted with skills required at A- and undergraduate level. Each of the three extension papers analysed (Advanced Extension Awards, Sixth Term Examination Papers and university admissions tests) were found to differ from each other, as well as from A-level and undergraduate examinations. This suggests that there are benefits for students doing such papers before university mathematics study. The advantages of doing these papers are not only for admissions tutors, who can use them as additional indicators of candidates'aptitudes, but also for the students themselves as they gain insights into the nature of undergraduatemathematics and related furthermathematical challenges. [ABSTRACT FROM AUTHOR]

This article performs a close reading of a newly discovered archive of letters to and from Charles de Gaulle, written between 1941 and 1944, to show how de Gaulle engaged in a process of auto-mythification. The archive features wartime correspondence between de Gaulle and various leaders of the British government, intelligence, and military, such as Prime Minister Winston Churchill, Secretary of State for Foreign Affairs (1941) Anthony Eden, and Chief of the Imperial General Staff General Alan Brooke. The study illuminates the problematic nature of Anglo-French collaboration in terms of shifting cultural perspectives, particularly with regard to the notion of authority. Such notions are inevitably contested, and this collection of letters is an unusually effective resource to reconstruct the essentially dialogic aspects of this contestation. Through contextualization of the correspondence, including both contemporary and retrospective accounts of the war, the article enriches our understanding of the implicit and explicit conflicts between British and French forces and the rhetorical strategies utilized to further each writer's aims. [ABSTRACT FROM AUTHOR]

China has become an impactful science superpower, but it is asserted that its influence provides it with disproportionate benefits that some national research policies have not thus far appreciated. To create context, Web of Science data are used to analyse research collaborations between the UK and China: trends in volume of output between 1981 and 2019; citation impact; and comparative performance across research fields. UK–China collaboration increased from fewer than 100 co-authored papers before 1990, to 750 per year in 2000, 3,324 in 2010, and 16,267 papers (10.9 per cent of UK output) in 2019. UK–China collaboration is concentrated in technology-based fields: in some (e.g. telecommunication), over 30 per cent of UK papers are in collaboration with Chinese-based researchers. The paper discusses the policy consequences to the UK of this indicative dependency, arguing that exiting from such collaborations is ill advised, provided the risks, perceived or real, are mapped, managed, and mitigated. [ABSTRACT FROM AUTHOR]

The article talks about the Working Paper published by the Modern British Studies (MBS) research centre on new ways of thinking about the transformation of British society, culture, politics and economy between 19th century and 2015. It highlights the cultures of democracy and the rising political, social and cultural change. It states that the paper can be used as a study material for understanding the state of history in present times.

In this article I begin by discussing the persistent problem of relations between educational inequality and the attainment gap in schools. Because benefits accruing from an education are substantial, the 'gap' leads to large disparities in the quality of life many young people can expect to experience in the future. Curriculum knowledge has been a focus for debate in England in relation to educational equality for over 40 years. Given the contestation surrounding views about curriculum knowledge and equality I consider the thinking of two philosophers, Jacques Derrida and Emmanuel Levinas, and their work on justice, to trouble the curriculum framework and discourse of knowledge promoted through the policy text of The Importance of Teaching: The Schools White Paper (2010) and later associated policy reforms to the General Certificate of Secondary Education ( GCSE) curriculum in England. The Schools White Paper aims to make the curriculum more challenging to students by introducing tight controls in terms of the assessment framework and curriculum knowledge. I argue that, when considered through Derrida's perspective on language and meaning and Levinas' view on the ethical responsibility for the other, the reforms present obstacles to the search for a just curriculum. I look to the work of Sharon Todd and Paul Standish for a re-imagination of curriculum as or through relations in the light of Derrida's and Levinas' philosophies. [ABSTRACT FROM AUTHOR]

As people age they are at increased risk of cardiovascular disease, the leading cause of mortality and morbidity worldwide. Understanding cardiovascular ageing is essential to preserving healthy ageing and preventing serious health outcomes. This collection of papers published in Age and Ageing since 2011 cover key themes in cardiovascular ageing, with a separate collection on stroke and atrial fibrillation planned. Treating high blood pressure remains important as people age and reduces strokes and heart attacks. That said, a more personalised approach to blood pressure may be even more important as people age to lower blood pressure to tight targets where appropriate but avoid overtreatment in vulnerable groups. As people age, more people experience blood pressure drops on standing (orthostatic hypotension), particularly as they become frail. This can predispose them to falls. The papers in this collection provide an insight into blood pressure and orthostatic hypotension. They highlight areas for further research to understand blood pressure changes and management in the ageing population. Inpatient clinical care of older people with heart attacks differs from younger people in UK national audit data. People aged over 80 had improved outcomes in survival after heart attack over time, but had lower rates of specialist input from cardiology compared with younger people. This may partly reflect different clinical presentations, with heart attacks occurring in the context of other health conditions, frailty and multimorbidity. The care and outcomes of acute and chronic cardiovascular disease are impacted by the frailty and health status of an individual at baseline. The research included in this collection reinforces the wide variations in the ageing population and the necessity to focus on the individual needs and priorities, and provide a person-centred multidisciplinary approach to care. [ABSTRACT FROM AUTHOR]

The article refers to a June 1753 letter written by English author Samuel Richardson to British poet Elizabeth Carter, as well as Carter's letter in response, which discuss the British Jewish naturalization Act of 1753. Richardson refers to a "little paper" which he included with his letter to Carter. The article argues that this was a pamphlet attributed to Philip Carteret Webb having the abbreviated title "The Bill, Permitting Jews to be Naturalized by Parliament, Having Been Misrepresented in the London Gazetteer, of Friday the 18th May."

Service user and carer involvement in social work education is well established in the UK and other countries. There has however been limited research on the outcomes of this for social work practice and its subsequent impact on service users and carers. This has been noted in a previous systematic review involving one of the current authors. The current review aimed to synthesise literature from the previous decade (2011–2020) and follows on from the earlier review. PRISMA scoping review guidelines were followed and twenty-eight papers met the inclusion criteria that were framed. Data were extracted and tabulated according to the framework for the evaluation of educational programmes used in the previous review and analysed using narrative synthesis. A ten-item critical appraisal checklist was used to assess the rigour of all papers. The findings were similar to the earlier review. Most studies were from the UK and few evaluated change in students' skills or subsequent practice; none evaluated subsequent outcomes for service users and carers. All stakeholders were positive about the perceived benefits of service user and care involvement. Future research needs to use more robust evaluation methodologies and evaluate skills development for students and outcomes for service users and carers. [ABSTRACT FROM AUTHOR]

This paper introduces a set of papers analysing the likely economic impact of Brexit across key aspects of the UK economy as the country comes to the end of its first full year outside the European Union. The Brexit vote in 2016 was not just a vote on the UK's relations with the institutions of the European Union but was also a referendum on the fractured state of the UK as a nation. The resulting conflation of Brexit with domestic economic policy debates is reflected in this issue. A first cluster of papers focuses on the consequences of choosing to abandon the 'four freedoms' enshrined in the Treaty of Europe, the free movement of goods, services, capital, and labour across the EU, and a second is concerned with the indirect effects of Brexit in those areas of domestic policy that have been opened up by the Brexit decision. The economic consequences of Brexit are only just emerging, but these papers provide an informed perspective on the state of debate, and the likely implications of Brexit across a range of policy areas, both international and domestic. [ABSTRACT FROM AUTHOR]

In Victorian Britain rags were not only associated with the inadequate clothing of the poor, they were also viewed as a valuable commodity, widely collected for recycling into paper. This essay examines rags as simultaneously despised and precious objects, tracing the connections between Victorian accounts of poverty, the industrial recycling of rags into paper, and the redemption narratives created by Charles Dickens about rescued children. A supporter of Ragged Schools and champion of rags recycling, Dickens drew on the idea of the transformation of dirty rags into clean paper in his representations of ragged children. To him, the recycling of rags indicated the civilizing forces of modernity, and reading Dickens's representations of ragged children in this context reveals how cloth recycling became a paradigm for society's duties towards destitute children. This essay explains Dickens's juxtaposition of ragged children with references to rag-dealing in his novels; by this means he suggested that street children, like their ragged clothing, were capable of being purified and transformed into social usefulness. [ABSTRACT FROM PUBLISHER]

Background There is a challenging lack of evidence to inform best practice in the routine clinical care of juvenile idiopathic arthritis (JIA). Wide inter-centre variation in the definition and documentation of clinical data items is a major barrier to improvement. In response, we have developed a consensus agreed standardised core dataset called CAPTURE-JIA (n = 62 data items and a 'data dictionary' including agreed definitions of terms) designed to support routine collection of high-quality clinical data. The feasibility and acceptability of CAPTURE-JIA in clinical practice is not yet known and was the focus of this pilot study. Methods A purposeful sample of six paediatric rheumatology centres across England was invited to collect the CAPTURE-JIA dataset using paper collection forms (n = 20 patients/centre). The dataset was analysed for missing data. Six focus groups (n = 3-10) explored clinicians' views on acceptability and feasibility. Results One hundred and twenty-one patients were recruited over three months. The completeness of the dataset was similar across centres, with minor variations. The majority of data items (eg demographics, dates, ILAR type and examination) were >80% completed. However, 14/62 data items received >40% missing data. (Table 1) Further descriptive analyses highlighted incorrect completion of paper forms. Three themes emerged from the focus groups: problematic data items (missing from >10% forms at > 1 centre), format of clinician data forms and the role of digital data collection. Suggested solutions included minor changes to data item definitions and formatting. There were no refinements to the data items. Development of a digital data collection system was identified by all as essential. Due to a lack of clear consensus, the original CAPTURE forms included a number of ways to record joint count data. This proved confusing and a unanimous decision was taken to collect joint count data on all 83 joints in a tabular format. P10 Table 1: CAPTURE JIA data items with >40% missing data Data item  % forms with data item missing (if item required)  Relevant co-morbidities?  60  Macrophage activation syndrome?  100  Has the ILAR subtype changed?  50  Morning stiffness lasting >15 minutes?  42  History of any form of uveitis?  52  Date started uveitis mediation?  50  Strength of uveitis medication?  83  Counselled prior to new DMARD / biologic?  56  Enrolled in BECS/BCRD if new DMARD / biologic?  48  Joint count (homunculus or table format)  48  Physician assessment of systemic disease activity (VAS)  75  ESR  74  CRP  92  Plasma viscosity  100  Data item  % forms with data item missing (if item required)  Relevant co-morbidities?  60  Macrophage activation syndrome?  100  Has the ILAR subtype changed?  50  Morning stiffness lasting >15 minutes?  42  History of any form of uveitis?  52  Date started uveitis mediation?  50  Strength of uveitis medication?  83  Counselled prior to new DMARD / biologic?  56  Enrolled in BECS/BCRD if new DMARD / biologic?  48  Joint count (homunculus or table format)  48  Physician assessment of systemic disease activity (VAS)  75  ESR  74  CRP  92  Plasma viscosity  100  P10 Table 1: CAPTURE JIA data items with >40% missing data Data item  % forms with data item missing (if item required)  Relevant co-morbidities?  60  Macrophage activation syndrome?  100  Has the ILAR subtype changed?  50  Morning stiffness lasting >15 minutes?  42  History of any form of uveitis?  52  Date started uveitis mediation?  50  Strength of uveitis medication?  83  Counselled prior to new DMARD / biologic?  56  Enrolled in BECS/BCRD if new DMARD / biologic?  48  Joint count (homunculus or table format)  48  Physician assessment of systemic disease activity (VAS)  75  ESR  74  CRP  92  Plasma viscosity  100  Data item  % forms with data item missing (if item required)  Relevant co-morbidities?  60  Macrophage activation syndrome?  100  Has the ILAR subtype changed?  50  Morning stiffness lasting >15 minutes?  42  History of any form of uveitis?  52  Date started uveitis mediation?  50  Strength of uveitis medication?  83  Counselled prior to new DMARD / biologic?  56  Enrolled in BECS/BCRD if new DMARD / biologic?  48  Joint count (homunculus or table format)  48  Physician assessment of systemic disease activity (VAS)  75  ESR  74  CRP  92  Plasma viscosity  100  Conclusion Paper collection of the CAPTURE-JIA data items is feasible and acceptable in the routine clinical setting, but unlikely to be sustainable in the longer term if collected in duplicate with medical notes. A digital tool in the clinical domain, ideally interlocking with local systems, would offer many advantages, including more complete and time-efficient data collection. Conflicts of Interest The authors declare no conflicts of interest. [ABSTRACT FROM AUTHOR]

Background Obesity is the greatest health issue for this generation; schools have improved food offered within their grounds. The built environment surrounding schools and pupils' journeys home have not received the same level of attention. This review identified papers on impacts of hot food takeaways surrounding schools in the UK. Methods Methods were informed by the PRISMA (QUORUM) guidelines for systematic reviews. Searches were completed in 12 databases. Results A total of 14 papers were included and quality assured before data extraction. Three descriptive themes were found; descriptions of hot food takeaway's geography and impacts concerning schools, strategic food policy and pupils reported food behaviour. Conclusions Most included studies compared anthropometric measures with geographical location of hot food takeaways to find correlations between environment and childhood obesity. There was good evidence of more hot food takeaways in deprived areas and children who spend time in deprived neighbourhoods tend to eat more fast food and have higher BMIs. Few studies were able to quantify the correlation between school's environment and obesity amongst pupils. This lack of evidence is likely a factor of the studies' ability to identify the correlation rather than lack of a correlation between the two variables. [ABSTRACT FROM AUTHOR]

Background: Surgical waiting lists have risen dramatically across the UK as a result of the COVID-19 pandemic. The effective use of operating theatres by optimal scheduling could help mitigate this, but this requires accurate case duration predictions. Current standards for predicting the duration of surgery are inaccurate. Artificial intelligence (AI) offers the potential for greater accuracy in predicting surgical case duration. This study aimed to investigate whether there is evidence to support that AI is more accurate than current industry standards at predicting surgical case duration, with a secondary aim of analysing whether the implementation of the models used produced efficiency savings. Method: PubMed, Embase, and MEDLINE libraries were searched through to July 2023 to identify appropriate articles. PRISMA extension for scoping reviews and the Arksey and O'Malley framework were followed. Study quality was assessed using a modified version of the reporting guidelines for surgical AI papers by Farrow et al. Algorithm performance was reported using evaluation metrics. Results: The search identified 2593 articles: 14 were suitable for inclusion and 13 reported on the accuracy of AI algorithms against industry standards, with seven demonstrating a statistically significant improvement in prediction accuracy (P < 0.05). The larger studies demonstrated the superiority of neural networks over other machine learning techniques. Efficiency savings were identified in a RCT. Significant methodological limitations were identified across most studies. Conclusion: The studies suggest that machine learning and deep learning models are more accurate at predicting the duration of surgery; however, further research is required to determine the best way to implement this technology. Waiting lists for elective surgeries are rising in the UK. We conducted a scoping review with the aim to understand if artificial intelligence has the potential to improve the utilization of operating theatre resources through improved scheduling. [ABSTRACT FROM AUTHOR]

Decision makers in adult social care are increasingly interested in using evidence from research to support or shape their decisions. The scope and nature of the current landscape of adult social care research (ASCR) need to be better understood. This paper provides a bibliometric assessment of ASCR outputs from 1996 to 2011. ASCR papers were retrieved using three strategies: from key journals; using keywords and noun phrases; and from additional papers preferentially citing or being cited by other ASCR papers. Overall, 195,829 ASCR papers were identified in the bibliographic database Scopus, of which 16 per cent involved at least one author from the UK. The UK output increased 2.45-fold between 1996 and 2011. Among selected countries, those with greater research intensity in ASCR generally had higher citation impact, such as the USA, UK, Canada and the Netherlands. The top five UK institutions in terms of volume of papers in the UK accounted for 26 per cent of total output. We conclude by noting the limitations to bibliometric analysis of ASCR and examine how such analysis can support the strategic development of the field. [ABSTRACT FROM AUTHOR]

Background: Students must be proficient in surgical skills according to General Medical Council and Royal College of Surgeons of England guidelines. If these skills are not appropriately taught, there is a risk of an incoming junior workforce with inadequate surgical skills. This paper aimed to review the literature relating to undergraduate teaching of surgical skills in the UK and summarize future suggested training methods. Methods: The databases MEDLINE, Embase and SCOPUS were searched, and the existing literature relating to methodology of undergraduate teaching of surgical skills in the UK over the past 10 years was summarized. The Medical Education Research Quality Instrument was used to assess research quality. Results: A total of 19 papers were included. Cross-sectional evaluations and survey-based studies highlight a clear deficit in surgical skills teaching in the UK. Medical students are currently unable to fulfil their own learning needs and meet requirements set out by the General Medical Council. This lack of surgical teaching appears to negatively affect student desire to pursue a surgical career. The three main themes for improvement are extracurricular surgical skills days, near-peer teaching and simulation. Each method appeared to improve learning, although no studies utilized medium- to long-term follow-up to demonstrate efficacy and there lacks a clear consensus as to the 'standard' of undergraduate surgical skill education. There was also potential for selection bias and response shift bias in many of the studies assessing pre- and postintervention confidence and opinions. Conclusion: There is a concerning lack of surgical skills teaching that has resulted in medical students and junior doctors not having the necessary surgical skills as per General Medical Council guidance and students feel that their own learning needs are not met. This failure to address the learning deficit may be responsible for the fall in surgical competition ratios. While surgical skills teaching must be improved urgently, more robust evidence is required to evaluate the optimal ways of approaching this issue. Undergraduate medical students must be proficient in certain surgical skills as set out by General Medical Council and Royal College regulations. There appears a deficit in such teaching which we have discussed and attempted to address in terms of alternative methodology reported in the literature that can be used to teach these basic surgical skills. [ABSTRACT FROM AUTHOR]

This paper analyses the Trade and Cooperation Agreement (TCA) between the EU and the UK. We focus on two specific features: rules of origin and non-tariff barriers. The putative purpose of the TCA was to promote free trade between the signatories, and both of the features identified have 'level-playing-field' objectives which are designed to promote that purpose. However, both can also be used for covert protectionism against the other party to the agreement. The paper recommends that rules of origin and non-tariff barriers should be recrafted where possible, and there is a description of how this might be done. The aim of such action would be to make transparent the role of these features in preserving a level playing field. Doing this would also make clear that any residual unadulterated rules of origin and non-tariff barriers existed for purely protectionist reasons and jeopardized open borders. Hopefully, the exposure of such protectionism would encourage its dismantlement. [ABSTRACT FROM AUTHOR]

Aims The literature review aimed to identify the barriers the Punjabi and/or Sikh community have in accessing support for alcohol addiction. Method A systematic review of the literature was undertaken of four scholarly databases, Google Scholar and grey literature on UK-based research conducted after 1980 into alcohol addiction in the Punjabi and/or Sikh community. Fourteen papers met the inclusion criteria outlined in the paper and were included in the review. Results Ten main barriers to accessing support were found; stigma, religion, lack of understanding of addiction, over reliance on a medical model of treatment and disregard of therapy, cultural implications of being a member of the Punjabi and/or Sikh community and the addiction community, gender and generational differences and a lack of government commitment to alcohol support for BME communities with a lack of culturally specific services. Conclusion Despite the many barriers explored, the role of stigma remained a powerful theme throughout often underpinning other barriers. A key recommendation across many papers was the need for culturally sensitive support services. Several areas for future research were identified. [ABSTRACT FROM AUTHOR]

This paper explores the gentry response to disease and illness in the fifteenth century. It examines the private letter collections of the Paston, the Stonor and the Plumpton families through a comparative methodology. The first section, focusing upon disease terminology in the letters, explores the diagnostic understanding of these families. Analysis of incidences of particular diseases, such as malaria and sciatica, is used to demonstrate their comprehension of illness through symptomatic observation. The second section examines the methods used for treating disease, analysing the various remedies used by the families. Important emphasis is placed upon the choice between using medical professionals and home healing. Finally, the role of female family members is assessed, determining whether it was medicinal matriarchs or male physicians who dominated in the sphere of family medicine. Ultimately this paper will uncover the complex and sophisticated ways gentry families managed and treated disease in this period. [ABSTRACT FROM AUTHOR]

This volume contains a small sample of papers presented to the fiftieth UK History of Economic Thought Conference, held at Balliol College, Oxford, on 29–31 August 2018. Over forty papers were presented, and this special issue contains nine of the thirty-one submitted for possible publication. [ABSTRACT FROM AUTHOR]

Motivation Polygenic risk scores (PRSs) predict individuals' genetic risk of developing complex diseases. They summarize the effect of many variants discovered in genome-wide association studies (GWASs). However, to date, large GWASs exist primarily for the European population and the quality of PRS prediction declines when applied to other ethnicities. Genetic profiling of individuals in the discovery set (on which the GWAS was performed) and target set (on which the PRS is applied) is typically done by SNP arrays that genotype a fraction of common SNPs. Therefore, a key step in GWAS analysis and PRS calculation is imputing untyped SNPs using a panel of fully sequenced individuals. The imputation results depend on the ethnic composition of the imputation panel. Imputing genotypes with a panel of individuals of the same ethnicity as the genotyped individuals typically improves imputation accuracy. However, there has been no systematic investigation into the influence of the ethnic composition of imputation panels on the accuracy of PRS predictions when applied to ethnic groups that differ from the population used in the GWAS. Results We estimated the effect of imputation of the target set on prediction accuracy of PRS when the discovery and the target sets come from different ethnic groups. We analyzed binary phenotypes on ethnically distinct sets from the UK Biobank and other resources. We generated ethnically homogenous panels, imputed the target sets, and generated PRSs. Then, we assessed the prediction accuracy obtained from each imputation panel. Our analysis indicates that using an imputation panel matched to the ethnicity of the target population yields only a marginal improvement and only under specific conditions. Availability and implementation The source code used for executing the analyses is this paper is available at https://github.com/Shamir-Lab/PRS-imputation-panels. [ABSTRACT FROM AUTHOR]

Background Alcohol increases cancer risk, but less is known about public awareness of this link. This scoping review summarizes recent findings on the public awareness of alcohol as a cancer risk factor in European Union and UK. Methods Four databases (Web of Science, MEDLINE, PsycInfo, CINAHL) were searched for papers containing data on awareness of alcohol as cancer risk factor in EU or UK published between January 2017 and December 2022, and complemented with grey literature searches. Results In total, 45 studies were included covering 18 EU countries (Austria, Belgium, Cyprus, Czechia, Denmark, Finland, France, Germany, Hungary, Ireland, Italy, Netherlands, Poland, Romania, Slovakia, Slovenia, Spain, Sweden) and UK, presenting data collected between 2009 and 2022. Studies covered general population (17 studied a nationally representative sample), women, health professionals, patients and young people. Awareness of alcohol causing cancer in general was higher and studied more often than awareness of alcohol's impact on specific cancers. Among the EU general population, awareness of the link between alcohol and breast cancer ranged between 10% and 20%, head and neck cancer 15–25%, colorectal and oesophagus cancer 15–45% and liver cancer 40%. Awareness was higher among young people and specialized health professions and lower among women (the latter specifically for the breast cancer). Conclusions While awareness rates varied depending on the exact question wording, many studies showed low awareness of the alcohol-cancer link, especially for specific types such as breast and colon cancer. Public should be better informed about alcohol consumption-related cancer risk. [ABSTRACT FROM AUTHOR]

The UK is, like its peers in the EU, just under 80% dependent on fossil fuels. This figure has come down just over 10% since the 1970s, a period when the UK had major energy-intensive industries, most of which are now gone. The government is committed to achieving net zero for the electricity sector by 2035 on the pathway to net zero for the whole economy by 2050.. The Labour opposition has set 2030 as its electricity target. Setting out the scale of this challenge, this paper demonstrates how implausible the 2035 target is. On present policies there is little prospect that the 2035 target will be met (and virtually none for the Labour 2030 target). This paper reviews the multiple current policies and the capacity objectives and explores what would have to happen to meet the target. It sets out some of the consequences of failure to deliver, and the expectation of that failure. [ABSTRACT FROM AUTHOR]

Amid escalating apprehensions surrounding content regulation, the USA has discreetly integrated provisions reminiscent of its Communications Decency Act Section 230 (CDA 230) into trade agreements, offering broad immunity. This scholarly analysis critically assesses this manoeuvre by juxtaposing such CDA 230-like provisions against the UK's established legal framework governing online content and freedom of expression. Utilizing a comparative legal methodology, the paper underscores the pronounced differences between the USA and UK stances on intermediary liability for third-party content, moulded by their unique constitutional foundations and jurisprudential interpretations of free speech rights. The insertion of CDA 230-aligned clauses into trade agreements poses a potential threat to the UK's nuanced equilibrium between safeguarding free speech and upholding other paramount interests, such as privacy and reputation. An scrutiny of UK defamation statutes and content regulation protocols reveals inherent challenges in transplanting CDA 230 provisions into trade contexts. In summation, the paper ardently supports a diversified approach to online content governance and cautions against standardizing intermediary liability laws via trade agreements, especially between nations with divergent foundational beliefs. It fervently endorses a cross-disciplinary discourse involving both trade and legal specialists to ensure the preservation of free expression while concurrently recognizing the intricacies of crafting universally applicable standards for online platforms and content regulation. [ABSTRACT FROM AUTHOR]

The use of bibliometric indicators would simplify research assessments. The 2014 Research Excellence Framework (REF) is a peer review assessment of UK universities, whose results can be taken as benchmarks for bibliometric indicators. In this study, we use the REF results to investigate whether the e p index and a top percentile of most cited papers could substitute for peer review. The probability that a random university's paper reaches a certain top percentile in the global distribution of papers is a power of the e p index, which can be calculated from the citation-based distribution of university's papers in global top percentiles. Making use of the e p index in each university and research area, we calculated the ratios between the percentage of 4-star-rated outputs in REF and the percentages of papers in global top percentiles. Then, we fixed the assessment percentile so that the mean ratio between these two indicators across universities is 1.0. This method was applied to four units of assessment in REF: Chemistry, Economics and Econometrics joined to Business and Management Studies, and Physics. Some relevant deviations from the 1.0 ratio could be explained by the evaluation procedure in REF or by the characteristics of the research field; other deviations need specific studies by experts in the research area. These results indicate that in many research areas the substitution of a top percentile indicator for peer review is possible. However, this substitution cannot be made straightforwardly; more research is needed to establish the conditions of the bibliometric assessment. [ABSTRACT FROM AUTHOR]

This paper considers whether pricing algorithms present novel issues that existing merger control frameworks and practices are inadequate to address, particularly in relation to pre-merger disclosure of pricing algorithms and the suitability of current tests and remedies for addressing coordinated effects. Through a comparative and critical analysis of the merger control regimes and practices of the European Union, United Kingdom, and Australia, this paper finds that whilst such regimes and practices are broadly adequate for dealing with algorithmic transactions, there are nonetheless potential areas for improvement. Disclosure of a pricing algorithm may contravene prohibitions on the sharing of competitively sensitive information. As such, merger parties may need to rethink aspects of their usual due diligence procedures. Pricing algorithms may also increase the potential for coordinated effects to arise in some markets that would ordinarily have been considered too complex, asymmetric, opaque, or insufficiently concentrated for tacit coordination to occur, or be used to retaliate more effectively against deviations from a coordinated equilibrium, or to raise the height of barriers to entry. Competition authorities may therefore need to amend their standard approach to investigating and assessing coordinated effects, as well as their traditional approach to remedies. [ABSTRACT FROM AUTHOR]

This paper explores the co-evolution of product and industry architecture by drawing on a longitudinal study of the UK personal pensions industry between 2005 and 2020. It provides qualitative evidence for the way in which institutional structures, particularly regulation, entwine with firm strategic choices to shape the contours of an industry value chain (IVC). We draw upon modularity theory and the literature on industry architecture to consider how strategic bottlenecks emerged and how value shifted between layers of the IVC. Furthermore, we examine the interplay between the agendas of the regulator and firm strategic responses to unpack how firms (product providers) responded by pursuing integrative innovation and less specialization to mitigate the effects of value migration to strategic bottlenecks. Our findings extend recent work on product and industry architecture, highlighting how markets evolve toward less modular product configurations and less industry specialization in response to these dynamics. [ABSTRACT FROM AUTHOR]

We exploit a U.K. government-sponsored product and provide evidence on shared equity mortgages. The analysis shows how the interaction of house price growth and leverage regulation promotes product adoption. Following an increase in the equity limit, households use the additional financing to buy more expensive properties rather than reduce leverage. Equity used as a complement to debt is likely less beneficial for financial stability than when used as a substitute. Equity borrowers are less likely to change lenders when refinancing their senior debt. Finally, we measure the equity provider returns, which are affected by selection and undervaluation at repayment. Authors have furnished an Internet Appendix , which is available on the Oxford University Press Web site next to the link to the final published paper online. [ABSTRACT FROM AUTHOR]

This paper documents that a large-scale government subsidy aimed at encouraging people to eat out in restaurants in the wake of the first 2020 COVID-19 wave in the United Kingdom has had a significant causal impact on new cases, accelerating the subsequent second COVID-19 wave. The scheme subsidised 50% off the cost of food and non-alcoholic drinks for an unlimited number of visits in participating restaurants on Mondays–Wednesdays from 3–31 August 2020. Areas with higher take-up saw both a notable increase in new COVID-19 infection clusters within a week of the scheme starting and a deceleration in infections within two weeks of the program ending. Similarly, areas that exhibited notable rainfall during the prime lunch and dinner hours on the days the scheme was active record lower infection incidence—a pattern that is also measurable in mobility data—and non-detectable on days during which the discount was not available or for rainfall outside the core lunch and dinner hours. [ABSTRACT FROM AUTHOR]

The UK left the European single market in energy on 31 December 2020, having been a leading light in its promotion. It entered into a new energy relationship with the EU-27 as outlined in the EU–UK Trade and Cooperation Agreement (TCA) on 1 January 2021. This paper discusses what has happened to the UK energy sector since the Brexit referendum of June 2016. Since our previous paper on this topic in 2017, there has been a significant clarification in the impact of Brexit on the energy sector in the UK. We outline what the TCA says about energy. We then discuss the current and potential future effects of Brexit on the UK electricity and gas systems in turn. We observe that the likely economic welfare impacts on electricity are larger than the impacts on gas, but the overall microeconomic impact appears likely to be modest (but negative). We offer a number of concluding observations. [ABSTRACT FROM AUTHOR]

There has been increasing interest in recent years in monopsony in the labour market. This paper discusses how we can measure monopsony power by combining insights from models based on both frictions and idiosyncrasies. It presents some evidence from the United Kingdom and the United States about how monopsony power varies across the wage distribution within markets, over the business cycle and over time. [ABSTRACT FROM AUTHOR]

Although health education programmes have been implemented in higher music education (HME) and their evaluations published in peer-reviewed journals, guidelines as to what ought to be included in these programmes are still missing. This study aimed to document expert discussions on the content of an ideal health education curriculum for HME students in the UK, integrating critical thinking. Four interdisciplinary workshops were conducted, where 67 experts in relevant fields took part, and were asked to discuss four lists of topics and concepts created based on literature reviews (cognitive biases, logical fallacies, critical appraisal tools and health topics). Only the list on health topics is relevant here. Notes taken by the participants and ourselves were thematically analysed. Four themes were identified, two of which are reported in this paper: (i) The health education curriculum and (ii) A settings-based approach to health. Part I of this project (published elsewhere) is focussed on the critical thinking content of health education for conservatoire students. The present paper focusses on the ideal health education curriculum and its implications for the wider context of health promotion. [ABSTRACT FROM AUTHOR]

While recent debates about the professions have noted the pervasive influence of organizations, less is known about how this plays out at the macro or occupational level. In this paper, we address this concern, focusing on corporate professionalism (CP) as an emergent form which appears to be shaped by organizational interests. Drawing on relational perspectives of professions, we focus on the strategies of two associations in the UK management consultancy field over a 50-year period. Our analysis of archival and interview data reveals how, over time, both associations substantially modified their strategies in response to shifting priorities of firms employing large numbers of consultants—abandoning early commitments to occupational professionalism in favor of a corporate form. A key contribution of the paper is to develop a process model for understanding how and why CP emerges. We also highlight the need to pay more attention to the often neglected role of employing organizations in accounts of professional formation in contemporary society. [ABSTRACT FROM AUTHOR]

Interpellation, the production and hailing of subjectivities, is key to poststructuralist international relations (IR) theory and yet with some notable exceptions interpellation/hailing as an analytical concept remains somewhat undertheorized. This paper presents a Lacanian–Žižekian psychoanalytical theorization of interpellation in IR, while engaging with the ontology and epistemology of belonging. More specifically, this paper develops four major psychoanalytical concepts: void/lack, fantasy, jouissance, and desire, as it argues that void/lack at the subjective and objective levels renders interpellation possible and destabilises it, thus accounting for the im/possibility of belonging. This paper illustrates the psychoanalytical framework of interpellation by analyzing national-populism as manifested in the Brexit discourse in the UK as well as the interpellation in homonationalism. [ABSTRACT FROM AUTHOR]

This paper explains the background to the notion of the 'geography of discontent' in the context of UK interregional inequalities and political shocks. The paper then examines how the geography of discontent has bound conflicting political and economic narratives together in ways, which makes the correcting for these regional imbalances all the more difficult, and results in ambiguity and a lack of clarity regarding the nature and form which Levelling Up processes should take. [ABSTRACT FROM AUTHOR]

The current paper is motivated by longitudinal progress tests given to medical students in the United Kingdom, which are used to assess students' applied medical knowledge during their learning programme. The main analytic interest is the maximum competency each student achieves on the assessment and the point in the programme at which each student attains this competency. Direct estimates of maximum competency and the time at which students realised this competency are useful for optimising allocation of classroom and hands‐on experiences, as well as to inform curriculum development. Models have been developed for estimating the timing of a threshold or cut‐off common across people or for estimating different rates of change that occur for different phases of time. However, less attention has been paid to models interested in the timing of a value that can change across people—such as maximum competency—and where growth is flat in some phases of time. In this paper, we build a model that borrows pieces from various existing methods such as reparameterisations of polynomial models, splines for ceiling effects, time‐to‐criterion models, dynamic measurement and non‐linear mixed‐effect models to allow the motivating questions to be addressed from these data. [ABSTRACT FROM AUTHOR]

Taking the idea of refugee 'journeys to health' (Newbold and McKeary, 2018) as a point of departure this paper examines the case of Chilean exiles in the UK. Reflecting on interviews conducted with Chilean exiles the analysis highlights how the health-related challenges that many people have experienced change over time. For some the passing of time has enabled people to make sense of what happened to them following the military coup in Chile in 1979 and this has helped them to 'move on'. For others, on-going challenges remain, for example a number of people still experienced PTSD. The paper also reflects on the difficulties encountered by refugees when dealing with formal health providers. While all of the respondents had full entitlements to NHS services the paper reflects on the informal barriers that continue to shape refugees' engagement with health care providers and limit their ability to address health concerns. [ABSTRACT FROM AUTHOR]

There has been a renewed interest in professional and academic discourse in the reconceptualisation of social work with adults as a human rights-based approach. This is compatible with the social model of disability, which philosophically adult social workers make claims to align with. This was recently argued for when the Department of Health in England piloted a named social worker for adults with learning disabilities, whose behaviour challenged services. This paper discusses the conceptualisation of rights-based practice, its relevance and appropriateness for contemporary social work policy. Drawing on the recognition theory literature, it shall be shown that the meta-theory of rights-based practice may have relevance to contemporary social work practice with adults with learning disabilities. The paper shall also consider the renewed interest in normative reconstruction in social work practice and influencing factors such as drives towards individualism and marketisation. It will consider how these impacted on the adoption into UK policy of social work as a positive intervention to address structural inequalities, perhaps more accurately described as disablism, experienced by adults with learning disabilities, which ultimately is concluded to be a 'wicked problem'. [ABSTRACT FROM AUTHOR]

Reviews of official statistics for UK housing have noted that developments have not kept pace with real‐world change, particularly the rapid growth of private renting. This paper examines the potential value of big data in this context. We report on the construction of a dataset from the on‐line adverts of one national lettings agency, describing the content of the dataset and efforts to validate it against external sources. The paper specifically examines what these data might add to our understanding of changing volumes and rents in the private rented sector. Fluctuations in market share across advertising platforms make assessment of volume problematic, while rental prices appear more robust through comparison with other reference information. Focussing on one urban area, we illustrate how the dataset can shed new light on local changes. Lastly, we discuss the issues involved in making more routine use of this kind of data. [ABSTRACT FROM AUTHOR]

The Research Excellence Framework (REF) is the main research assessment for universities in the UK. It informs university league tables and the allocation of government research funding. This paper analyses the evaluations of the REF 2014 for Economics, Business, Politics and History. First, we analyse from which journals articles have been submitted; second, to what extent journal ratings and journal impact factors predict the REF's evaluations; third, how many articles from heterodox economics journals have been submitted. We find that a small group of journals dominate the outputs submitted. Journal ratings and impact factors explain 80% of the variation in the output evaluations for Economics. These values are lower but still substantial for other disciplines. Few papers from heterodox economics journals were submitted to Economics. Overall, the REF in its present form marginalises heterodox economics, pushes it out of the discipline and endangers pluralism in economics research. [ABSTRACT FROM AUTHOR]

This paper aims to present the first Frequentist framework on signal region detection in high-resolution and high-order image regression problems. Image data and scalar-on-image regression are intensively studied in recent years. However, most existing studies on such topics focussed on outcome prediction, while the research on region detection is rather limited, even though the latter is often more important. In this paper, we develop a general framework named Sparse Kronecker Product Decomposition (SKPD) to tackle this issue. The SKPD framework is general in the sense that it works for both matrices and tensors represented image data. Our framework includes one-term, multi-term, and nonlinear SKPDs. We propose nonconvex optimization problems for one-term and multi-term SKPDs and develop path-following algorithms for the nonconvex optimization. Under a Restricted Isometric Property, the computed solutions of the path-following algorithm are guaranteed to converge to the truth with a particularly chosen initialization even though the optimization is nonconvex. Moreover, the region detection consistency could also be guaranteed. The nonlinear SKPD is highly connected to shallow convolutional neural networks (CNN), particularly to CNN with one convolutional layer and one fully-connected layer. Effectiveness of SKPD is validated by real brain imaging data in the UK Biobank database. [ABSTRACT FROM AUTHOR]

Modern computed tomography (CT) databases are becoming an accepted resource for the practice and development of identification methods in forensic anthropology. However, the utility of 3D models created using free and open-source visualization software such as 3D Slicer has not yet been thoroughly assessed for morphoscopic biological profiling methods where virtual methods of analysis are becoming more common. This paper presents a study that builds on the initial findings from Robles et al. (2020) to determine the feasibility of estimating sex on stereolithic (STL) 3D cranial models produced from CT scans from a modern, living UK population (n  = 80) using equation 2 from the Walker's (2008) morphoscopic method. Kendall's coefficients of concordance (KCC) indicated substantial agreement using cranial features scores in an inter-observer test and a video-inter-observer test. Fleiss' Kappa scores showed moderate agreement (0.50) overall between inter-observer sex estimations, and for observer sex estimations in comparison to recorded sexes (0.56). It was found that novice users could virtually employ morphoscopic sex estimation methods effectively on STL 3D cranial models from modern individuals. This study also highlights the potential that digital databases of modern living populations can offer forensic anthropology. Key points First example of Walker's (2008) method applied to a living UK population. Open-source software is a valuable resource for crime reconstruction approaches. Male scoring bias was observed in method application. Forensic anthropologists would benefit from virtual anthropology training to use and interpret 3D models. Digital databases offer more ethical, diverse, modern populations for future research. [ABSTRACT FROM AUTHOR]

The 'As Low As Reasonably Achievable' (ALARA) principle is one of the three fundamental elements of radiation protection. Noting that ionising radiation is both encountered naturally in the environment as part of everyday life, and artificially as part of a range of practices, the ALARA principle aims to provide a means of optimising radiation exposures. Historically, the stakeholders involved in the application of the ALARA process have primarily been assumed to be internal to an organisation, except for regulatory 'buy in'. However, could there be instances when the public should be a key stakeholder? This paper explores the area of perceived risk with reference to a particular case study in which the dredging of non-hazardous sediment in the UK near a now decommissioned nuclear power station raised substantial public concern about radiological exposure. This turned what was a straightforward construction activity into a complex public engagement and reassurance task, at a significant cost disproportionate to the level of radiological risk. Learning from this case study is used to highlight the key lessons learnt and the importance of public engagement, and how perceived risk and the associated societal stress could be incorporated into the ALARA process. The paper also highlights the ongoing work and guidance produced by the Society for Radiological Protection in the UK on the development of Guidance for Practitioners to support the Communication of Radiation Risk. [ABSTRACT FROM AUTHOR]

Background Older people are often explicitly or implicitly excluded from research, in particular clinical trials. This means that study findings may not be applicable to them, or that older people may not be offered treatments due to an absence of evidence. Aims The aim of this work was to develop recommendations to guide all research relevant to older people. Methods A diverse stakeholder group identified barriers and solutions to including older people in research. In parallel, a rapid literature review of published papers was undertaken to identify existing papers on the inclusion of older people in research. The findings were synthesised and mapped onto a socio-ecological model. From the synthesis we identified themes that were developed into initial recommendations that were iteratively refined with the stakeholder group. Results A range of individual, interpersonal, organisational, community and policy factors impact on the inclusion of older people in research. A total of 14 recommendations were developed such as removing upper age limits and comorbidity exclusions, involving older people, advocates and health and social care professionals with expertise in ageing in designing the research, and considering flexible or alternative approaches to data collection to maximise opportunities for participation. We also developed four questions that may guide those developing, reviewing and funding research that is inclusive of older people. Conclusion Our recommendations provide up to date, practical advice on ways to improve the inclusion of older people in health and care research. [ABSTRACT FROM AUTHOR]

Reflective supervision (RS) is a crucial component of social work practice but little is known about how RS works within the UK context and what the outcomes of RS are for social workers and their service users. A rapid literature review comprised searching four databases for academic and grey literature on the topic of social work RS. The Mixed Methods Appraisal Tool and the University College London's literature assessment method were employed in an expedited quality appraisal for all included papers. Twenty-seven papers were included. Findings suggest that a supportive, available manager or a peer-group enables reflective practice. Regularity of supervisory sessions and acknowledgement of a social worker's autonomy are seen as enablers of reflexivity. In contrast, task-oriented approach that is overly focused on accountability and hindered by the sparsity of resources proves problematic for both social workers and service users. Whilst theoretical papers were available, RS was not defined in a uniform fashion and there was limited evidence pertaining to supervisory practice. More research focusing on what works and what improvements are needed in RS, including adopting a participatory approach would help to bridge this gap and further inform policy and practice. [ABSTRACT FROM AUTHOR]

A growing body of research emphasizes the importance of institutions for megaproject performance. Extant studies focus on understanding the characteristics of favourable institutional environments and the governance structures that projects can adopt to navigate both favourable and unfavourable environments. This paper contributes to this research by foregrounding the link between megaprojects and changes in the institutional environments within which they are embedded. Building on a case study of the Thames Tideway Tunnel—the UK's largest water and sewerage infrastructure project since the privatization of the industry in 1989—the paper presents two distinct ways that projects can interact with formal institutions: institutional compliance and institutional change. A more holistic understanding of the latter is essential because megaprojects can reconfigure production and consumption patterns to the benefit of some and the detriment of others. By contributing to changes in the institutional environment, megaprojects can further entrench these reconfigured patterns into long-enduring formal rules and practices. [ABSTRACT FROM AUTHOR]

This paper explores the possibility of the classroom as an exilic space of subversion in which we can pursue anarchist notions of personal transformation, relationships and society. Classroom environments in higher education institutions in Britain, particularly following the introduction of the Teaching Excellence Framework in September 2016, are premised upon relationships shaped by specific external standards: Employability, the instrumental pursuit of degrees, provider/consumer exchange, among others. Any notions of personal transformation are economic, and the broader goal is the pursuit of economic gain for individual, company and country. In an act of subversion of these external standards, I propose theorising the classroom as an exilic space: a temporally and spatially bracketed space in which participants and their relationships are not beholden to these various external referents. Instead, I put forward the exilic classroom as an anarchic space in which the interactions of the participants are not pre-defined but are formed in the process of the interactions themselves. In theorising the exilic classroom I draw on the work of Obika Gray, and push his notion of exilic space further by integrating the works of Michel de Certeau, Jamie Heckert and Gustav Landauer to help propose a classroom defined as a positive subversive everyday space that is not bound by its opposition to wider structures. The creation of such an exilic classroom assists the participants in stepping out of their expected roles as 'provider' and 'consumer', or 'teacher' and 'student', and allows the creation of a space of possibilities for our relationships [ABSTRACT FROM AUTHOR]

The Department of Education and Science, led by then Secretary of State Margaret Thatcher, published a White Paper in December 1972 calling for a dramatic expansion of public nursery education, so that it might be available within a decade to all families with 3- and 4-year-old children who chose to utilize it. While this failed policy is seldom remembered today, and Thatcher's efforts to promote the care and education of young children are not considered part of her considerable legacy, the White Paper's policy propositions challenge understandings about the formation and consistency of both Britain's child care policy and 'Thatcherism'. During this period, Thatcher believed that extending the frontiers of the state was appropriate to promote child welfare during the crucial first years of life. She conceived of nursery education as serving a developmental and educational purpose for all children, quite separate from welfare provisions for poor families or work supports for women. It is this crucial, albeit arbitrary, distinction which explains how nursery education was envisaged as an exception to her advocacy of cutting welfare spending. [ABSTRACT FROM AUTHOR]