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The independent sector domiciliary care market has always been an integral part of the social care system in England, but has become especially important in recent years. Its smooth running is crucial for the delivery of an effective community care policy. This paper argues that the motivations of these providers is an important aspect of this system's functioning, and derives a typology which captures the most important ingredients which theory and practice suggest should be taken into account in this regard. Four provider types are identified; they can be labelled satisfied team players; demoralised isolates; ambivalence-experiencing go-getters; and ambivalence-experiencing quiet lifers. The categories reflect both the balance of intrinsic and extrinsic motivations, and these providers' situational contexts, including the nature of the relationships developed with local authority purchasers. The latter exert exceptional power and influence in social care markets in England. [ABSTRACT FROM AUTHOR]

This paper sets out to investigate the origins and legacy of a significant 1960s modernist public housing estate in the North East of England. This estate at Kenton Bar remains virtually intact, and as such represents a unique example in Newcastle upon Tyne. Its architects, Ryder and Yates, had personal contact with Le Corbusier, Georges Braque, Berthold Lubetkin, Ove Arup and Clive Entwistle; and the influence and mentorship of these individuals is clearly evident in the design. Being selected to join the small team at Peterlee New Town in 1948, provided the opportunity for Ryder and Yates to work together for the first time. The experience enriched their architectural vocabulary and modernist values; and ultimately led to the establishment of their business partnership in 1953. By the time of Kenton Bar, it was by far the largest project that their architectural practice had undertaken. The office was greatly appreciative of Eric Lyons and Span Developments, and their work appears as a distinct precedent in the layout. With a pyramid in its central square, and an assortment of innovative design installations, the estate resonated strongly and immediately with residents.Today, even the pyramid that was removed some years ago, lives on in the collective memory of residents, past and present. Recently, weblogs have been established; and collages and models produced by artists, as well as adults and children from the Estate, in the style of the original design presentations. Fifty years after it was conceived, the interest of local artists and galleries, the tenants’ association, former residents, and pupils of the primary school specifically designed to be at the heart of the estate may not be unprecedented but it is certainly rare. Ryder and Yates have created a living monument to twentieth-century ideas. [ABSTRACT FROM AUTHOR]

This paper assesses provision for older people affected by homelessness in England, giving regard to research findings, such as those developed through a pathways model, which show that the experiences of this group are qualitatively distinct when compared to younger households. Current conceptualisations of older age held by Local Authority Housing Option Service professionals are considered, alongside factors relating to government policy and resource issues. It was found that some practitioners adopted an age-blind approach when assessing older groups, despite this being contrary to policy guidance on assessing vulnerability in England. Further, services and housing options aimed at older groups were viewed as inadequate due to a mixture of lack of awareness, targeting and resources. It is concluded that assessment of vulnerability based on older age is complex, as whilst gerontological discourse may discourage viewing age as a number, homelessness scholars stress that rooflessness causes poor health conditions consistent with premature ageing. It is therefore asserted that policy makers must focus greater attention to developing suitable provision for older service users and look to incorporate a richer conceptualisation of how older age may impact upon the homelessness experience. [ABSTRACT FROM PUBLISHER]

Objective: Conducting research with the bereaved presents an immediate ethical challenge, as they are undoubtedly a vulnerable group, associated with high levels of distress and susceptible to both physical and mental health issues. A comprehensive understanding of the potential therapeutic benefits for bereaved relatives participating in palliative care research is limited, and therefore the ethics of engaging this group remain questionable.Method: This paper describes a secondary analysis of qualitative data collected in the Care of the Dying Evaluation (CODE) project, examining the experiences of patients who died at home. It explores the motivations and potential benefits for bereaved relatives participating in research with reference to the recently developed concepts in bereavement theory. Cognitive interviews were conducted with 15 bereaved relatives and secondary analysis using a content analysis framework was employed to classify the data.Results: The results center around six recurring concepts identified as adaptive in current bereavement theory: an opportunity to share the narrative accounts of the final hours of their relative's life; a search for sense and meaning in loss; an ongoing bond/attachment with the deceased; altruistic motivations; oscillation between loss and restorative orientations; and a sense of resilience. Overall, the participants found that taking part in the research was valuable and that it could be described as offering therapeutic benefits.Significance Of Results: The need for bereaved relatives to take part in research studies should be encouraged, as they provide an accurate proxy for the patient's experience of end-of-life care while also providing a valuable account of their own perspective as family member and carer. In addition, we highlight the need for ethics committees to be aware of the potential benefits for bereaved relatives participating in research of this kind. [ABSTRACT FROM AUTHOR]

Background: Acute epistaxis can be a life-threatening airway emergency, requiring in-patient admission. The coronavirus disease 2019 pandemic placed significant strain on hospital resources, and management has shifted towards an out-patient-centred approach. Methods: A five-month single-centre retrospective study was undertaken of all epistaxis patients managed by the ENT department. A pre-coronavirus disease 2019 pandemic group was managed with pre-existing guidelines, compared to new guidelines for the coronavirus disease 2019 pandemic group. A telephone survey was performed on out-patients with non-dissolvable packs to assess patient comfort and satisfaction. Results: A total of 142 patients were seen. The coronavirus disease 2019 pandemic group had significantly more patients aged over 65 years (p = 0.004), an increased use of absorbable dressings and local haemostatic agents (Nasopore and Surgiflo), and fewer admissions (all p < 0.0005). Rates of re-presentation and morbidity, and length of hospital stay were similar. The telephone survey revealed out-patient management to be efficacious and feasible. Conclusion: The coronavirus disease 2019 pandemic has shifted epistaxis management towards local haemostatic agents and out-patient management; this approach is as safe and effective as previously well-established regimens. [ABSTRACT FROM AUTHOR]

Focuses on the painting of the Pantheon Opera in London, England from 1790 to 1792. Significance of the Bedford Opera papers in calculating the number of painters of varying ranks and salaries in scene paintings; Demonstration of the hierarchy of the painting room; Purchases made by painters and colormen.

The Elizabethan and Jacobean lute song (1597–1622) represents one of the most iconic genres of all early music. Although much literature has been dedicated to this repertory, the issue of the voices for which this music was probably intended still remains surprisingly underexplored. This subject has, moreover, acquired greater significance in light of research undertaken by Simon Ravens (2014) and Andrew Parrott (2015), which has challenged the plausibility of the falsetto voice in Medieval and Renaissance Europe, particularly in sacred music. This paper explores the issue of the types of voices that most likely performed the Elizabethan and Jacobean lute song in three ways. Firstly, contemporary English evidence for lutes and viols is analyzed together with information regarding tuning and transposition. Secondly, the music itself is investigated, including the part names and clefs used alongside the tessitura of the melodic line. Finally, a detailed examination of evidence for the tenor and falsetto voice is presented, including a critical examination of the word 'faine' (usually assumed to mean 'falsetto'). The collective results are then brought together to refine current ideas regarding the voices used in the Elizabethan and Jacobean lute song. [ABSTRACT FROM AUTHOR]

This work quantitatively assesses the potential reasons behind the difference in prices paid by care home residents in England. Evidence suggests that the price paid by private payers is higher than that paid for publicly supported residents, and this is often attributed to the market power wielded by local authorities as the dominant purchaser in local markets. Estimations of private prices at the local authority level are used to assess the difference in price paid between private and public prices, the fees gap, using data from 2008 to 2010. Controlling for local area and average care home characteristics, the results indicate that both care home and local authority market power play a role in the price determination of the market. [ABSTRACT FROM AUTHOR]

Explores the way and extent in which the criminal law was used to control the motorist in England during the first third of the twentieth century. Problem in the development of motor vehicles travelling at greater speeds; Issue between the police and the middle classes; Whiggish view of law making; Concept of the `policeman state'; `The road hog' scapegoat.

This paper presents qualitative evidence about managers' perceptions of retrenchment in the National Health Service in England. It outlines the financial situation of six case-study district health authorities during the expenditure crisis of 1987/8, and presents the results of an interview survey of district general managers and directors of finance about the implementation of cutbacks. Similar policies of cost-containment and service reduction are mirrored by similarity in the views held by managers and treasurers. Key concerns included the need for a reconstruction of local priorities in service provision, and the advocacy of an extension of managerial control over hospital consultants. These issues are discussed briefly in the context of the recent government proposals to introduce market mechanisms into the NETS, and wider arguments about medical dominance and bureaucratic/professional conflicts. [ABSTRACT FROM AUTHOR]

The paper presents the results of five polymorphic systems in a sample of 999 individuals from Nottinghamshire. The results are classified by the socio-economic grouping of parents and self.The results show that social class differences for the genetic attributes exist and are almost linear when aggregated distances are computed. There are differences, however, between parental and offspring results. These differences may be the result of changes in social class over the last generation. This social mobility is investigated and it is shown that an upward movement in social class is associated with characteristic genotype groupings. [ABSTRACT FROM PUBLISHER]

Uncertainty about what constitutes work in the past has led to the labour of care occupying a shadowy place in the histories of both medicine and the economy. This article takes a microhistorical approach to shed new light on care in early modern England. Using depositions and other surviving records of a testamentary dispute heard in the Hereford diocesan church court in 1674–5, the article reconstructs the care received by a single, labouring man named Richard Howell. Focusing on forms of care that lay outside institutions, it unpicks the varieties of informal labour that society understood as care work in early modern England, including maintenance (provision of economic support for the sick, including lodging, food, and drink); physical or practical care (watching or attending the sick); and the emotional labour of care. The article challenges the idea that care work was simply undertaken by the family or carried out within a system of social obligation. It demonstrates that all forms of care in this pre-industrial society implicitly (and sometimes explicitly) held economic value, which could be leveraged as grounds for economic recompense in the early modern courts. [ABSTRACT FROM AUTHOR]

Background: Tightly connected symptom networks have previously been linked to treatment resistance, but most findings come from small-sample studies comparing single responder v. non-responder networks. We aimed to estimate the association between baseline network connectivity and treatment response in a large sample and benchmark its prognostic value against baseline symptom severity and variance. Methods: N = 40 518 patients receiving treatment for depression in routine care in England from 2015–2020 were analysed. Cross-sectional networks were constructed using the Patient Health Questionnaire-9 (PHQ-9) for responders and non-responders (N = 20 259 each). To conduct parametric tests investigating the contribution of PHQ-9 sum score mean and variance to connectivity differences, networks were constructed for 160 independent subsamples of responders and non-responders (80 each, n = 250 per sample). Results: The baseline non-responder network was more connected than responders (3.15 v. 2.70, S = 0.44, p < 0.001), but effects were small, requiring n = 750 per group to have 85% power. Parametric analyses revealed baseline network connectivity, PHQ-9 sum score mean, and PHQ-9 sum score variance were correlated (r = 0.20–0.58, all p < 0.001). Both PHQ-9 sum score mean (β = −1.79, s.e. = 0.07, p < 0.001), and PHQ-9 sum score variance (β = −1.67, s.e. = 0.09, p < 0.001) had larger effect sizes for predicting response than connectivity (β = −1.35, s.e. = 0.12, p < 0.001). The association between connectivity and response disappeared when PHQ-9 sum score variance was accounted for (β = −0.28, s.e. = 0.19, p = 0.14). We replicated these results in patients completing longer treatment (8–12 weeks, N = 22 952) and using anxiety symptom networks (N = 70 620). Conclusions: The association between baseline network connectivity and treatment response may be largely due to differences in baseline score variance. [ABSTRACT FROM AUTHOR]

While debate on how best to pay for social care in England continues, information about public attitudes on this issue is limited. We asked representative samples of the public whether care costs for older people should be met by the state, met by the service user or shared between state and user. We used an online survey of people aged 18–75 (n = 3,000) and interview survey of people aged 65 and over (n = 466). Respondents were given four vignettes (two home care, two residential care) and asked who should pay at different levels of user resources; and how much users should contribute when costs were shared. Fewer than one-fifth of the online sample and one-quarter of the interview sample considered that the state should meet the full costs whatever users' resources; considerably lower proportions believed that users should meet the full costs in all cases. Two-thirds of the online sample and half the interview sample thought costs should be shared. The proportion of costs that users should contribute was relatively low (20–50 per cent, varying by user resources). The study illustrates that public views elicited through vignettes can provide evidence to inform policy on social care funding. [ABSTRACT FROM AUTHOR]

With demographic changes and the growing numbers of older people living alone, concerns have been raised about the care of the ageing population. Increasingly, developments in technology are being seen as the solution to these concerns. For those who do not see themselves as old or frail enough to require personal care provision, and who prefer to maintain their identity as autonomous and independent individuals, the development of assistive technologies such as ambient home monitoring systems is one answer. However, this involves careful negotiations with older people's understandings of safety and privacy, and their experiences and relationships with technology, their carers and relevant service-providers. In two trials of a home monitoring system funded by the United Kingdom Technology Strategy Board, older people were interviewed pre-trial and post-trial about their perspectives on these issues. This paper presents a conceptual analysis of the qualitative data using a sociological framework of trust that considers habitual action, and relationships with kin and with wider institutions. The research found that older people's habits and norms do not need to be disrupted by the ambient system. What was of more importance was relationships between the older person and her or his ‘monitor’ based on trust, as well as institutional providers who need to instil or earn trust. [ABSTRACT FROM PUBLISHER]

This paper argues that trade specialization played an indispensable role in supporting the Industrial Revolution. We calibrate a two-good and two-sector overlapping generations model for England's historical development and investigate how much different England's development path would have been if it had not globalized in 1840. The open-economy model is able to match the data closely, but the closed-economy model cannot explain the fall in the value of land relative to wages observed in the nineteenth century. Without globalization, the transition period in the British economy would have been considerably longer than that observed in the data and key variables, such as the share of labor force in agriculture, would have converged to figures very distant from the actual ones. [ABSTRACT FROM PUBLISHER]

In this paper, we examine the injunction issued by the prominent politician, broadcaster and older people's advocate, Baroness Joan Bakewell, to engage in ‘death talk’. We see positive ethical potential in this injunction, insofar as it serves as a call to confront more directly the prospects of death and dying, thereby releasing creative energies with which to change our outlook on life and ageing more generally. However, when set against a culture that valorises choice, independence and control, the positive ethical potential of such injunctions is invariably thwarted. We illustrate this with reference to one of Bakewell's interventions in a debate on scientific innovation and population ageing. In examining the context of her intervention, we affirm her intuition about its positive ethical potential, but we also point to an ambivalence that accompanies the formulation of the injunction – one that ultimately blunts the force and significance of her intuition. We suggest that Gilleard and Higgs' idea of the third age/fourth age dialectic, combined with the psycho-analytic concepts of fantasy and mourning, allow us to express this intuition better. In particular, we argue that the expression ‘loss talk’ (rather than ‘death talk’) better captures the ethical negotiations that should ultimately underpin the transformation processes associated with ageing, and that our theoretical contextualisation of her remarks can help us see this more clearly. In this view, deteriorations in our physical and mental capacities are best understood as involving changes in how we see ourselves, i.e. in our identifications, and so what is at stake are losses of identity and the conditions under which we can engage in new processes of identification. [ABSTRACT FROM PUBLISHER]

Improving responsiveness to the needs of older people from minority ethnic communities has been emphasised as a goal in England since the publication of the National Service Framework for Older People in 2001. Despite this, people from minority ethnic groups consistently give poorer ratings of their health services than ‘majority’ populations, both in England and across many other health-care systems. Language barriers have been shown to play a particularly important role, and appear to be a stronger predictor of perceived quality of care than ethnic origin per se. This paper reports findings from a larger study exploring older people's experiences of care transitions, focusing on the findings from one case study area which explored the hospital and discharge experiences of older people from minority ethnic communities. A participatory approach was adopted, with older people from the local area collaborating in the design, delivery and analysis of the research as ‘co-researchers’. Twenty-four in-depth narrative interviews were carried out with people who had experienced a recent hospital stay as a patient or a family member providing care and support. Our findings show that many aspects of the hospital experience, including the desire for personalised and humanistic approaches to care, are important to older people irrespective of ethnic background. However, older people from minority ethnic communities can also face language and cultural barriers which negatively affect the quality and experience of care. People who had limited English proficiency struggled to understand, communicate and participate in their care. Where professional services were not available or requested, interpreting was provided informally by other patients, family members, hospital staff in clinical and domestic roles, or not at all. We conclude that targeted strategies are required to ensure appropriate and effective hospital services for a multicultural population. [ABSTRACT FROM PUBLISHER]

Background.Depression and anxiety persist within and across diagnostic boundaries. The manner in which common v. disorder-specific genetic and environmental influences operate across development to maintain internalizing disorders and their co-morbidity is unclear. This paper investigates the stability and change of etiological influences on depression, panic, generalized, separation and social anxiety symptoms, and their co-occurrence, across adolescence and young adulthood.Method.A total of 2619 twins/siblings prospectively reported symptoms of depression and anxiety at mean ages 15, 17 and 20 years.Results.Each symptom scale showed a similar pattern of moderate continuity across development, largely underpinned by genetic stability. New genetic influences contributing to change in the developmental course of the symptoms emerged at each time point. All symptom scales correlated moderately with one another over time. Genetic influences, both stable and time-specific, overlapped considerably between the scales. Non-shared environmental influences were largely time- and symptom-specific, but some contributed moderately to the stability of depression and anxiety symptom scales. These stable, longitudinal environmental influences were highly correlated between the symptoms.Conclusions.The results highlight both stable and dynamic etiology of depression and anxiety symptom scales. They provide preliminary evidence that stable as well as newly emerging genes contribute to the co-morbidity between depression and anxiety across adolescence and young adulthood. Conversely, environmental influences are largely time-specific and contribute to change in symptoms over time. The results inform molecular genetics research and transdiagnostic treatment and prevention approaches. [ABSTRACT FROM PUBLISHER]

Art historians usually find little evidence for the nature of communication between patrons and architects in the Middle Ages. Scholarly opinion has often placed the burden of new design with masons, but over the course of the later twentieth century this claim has been revised and nuanced. This paper uses the evidence of wills and contracts in order to answer two questions: what techniques did medieval patrons use to describe their wishes to their masons; and how prescriptive were their requirements? Its conclusions suggest that patrons, even of local or parochial projects, could make highly specific and creative demands for new works, based on critical and perceptive judgements of recently constructed buildings in their local area. It recreates the discursive and disputatious design process adopted in several parishes as they planned, contracted and executed new church buildings. [ABSTRACT FROM PUBLISHER]

Presents an abstract of a conference paper on the public health externalities of private water-supply in London, England.

Over the past decade, provision of cognitive behaviour therapy has expanded massively in the UK, both within the private sector and through the Improving Access to Psychological Therapies (IAPT) programme. Our aim in this study was to explore and compare the brand names adopted by IAPT and private CBT services. We obtained the names of all the IAPT and private services in England and created a word cloud for each sector. There was no significant difference in the proportion of services that adopted a brand name (72% of IAPT services vs 67% of the private services). In those with a brand name, IAPT services were significantly more likely than private services to contain positive words, and to have a theme of togetherness and collaboration. However, private services were more likely to include a psychological therapy in their name and have a theme of efficacy compared with IAPT. The most common keywords in IAPT services were 'talking' and 'thinking'. IAPT services use a variety of euphemisms such as 'talking' for a psychological therapy. There is no theme for 'doing' in the IAPT or private services, despite behavioural interventions being one of the most common therapeutic components. The brand names in IAPT are overwhelmingly positive and convey the hope of a good outcome. They do not include the experience of difficult emotions, such as sadness and fear during therapy. We found just one private service that evoked the history of CBT named after Vic Meyer. Perhaps we will have some Clark and Layard centres in the years to come! Key learning aims: After reading this paper, the reader should: (1) Recognise the importance of a brand name in shaping service user expectations. (2) Understand the differences between how private CBT and IAPT services present themselves to the public. (3) Recognise the omission of words conveying an active 'doing' theme in IAPT and private CBT service names. [ABSTRACT FROM AUTHOR]

Objective: Wide-ranging outcomes have been reported for surgical and non-surgical management of T3 laryngeal carcinomas. This study compared the outcomes of T3 tumours treated with laryngectomy or (chemo)radiotherapy in the northeast of England. Methods: The outcomes of T3 laryngeal carcinoma treatment at three centres (2007–2016) were retrospectively analysed using descriptive statistics and survival curves. Results: Of 179 T3 laryngeal carcinomas, 68 were treated with laryngectomies, 57 with chemoradiotherapy and 32 with radiotherapy. There was no significant five-year survival difference between treatment with laryngectomy (34.1 per cent) and chemoradiotherapy (48.6 per cent) (p = 0.184). The five-year overall survival rate for radiotherapy (12.5 per cent) was significantly inferior compared to laryngectomy and chemoradiotherapy (p = 0.003 and p < 0.001, respectively). The recurrence rates were 22.1 per cent for laryngectomy, 17.5 per cent for chemoradiotherapy and 50 per cent for radiotherapy. There were significant differences in recurrence rates when laryngectomy (p = 0.005) and chemoradiotherapy (p = 0.001) were compared to radiotherapy. Conclusion: Laryngectomy and chemoradiotherapy had significantly higher five-year overall survival and lower recurrence rates compared with radiotherapy alone. Laryngectomy should be considered in patients unsuitable for chemotherapy, as it may convey a significant survival advantage over radiotherapy alone. [ABSTRACT FROM AUTHOR]

Despite the growing interest amongst gerontologists and literary and cultural scholars alike, in arts participation, ageing and the artistic outputs of older people, comparatively little attention has yet been paid to theatre and drama. Likewise, community or participatory theatre has long been used to address issues affecting marginalised or excluded groups, but it is a presently under-utilised medium for exploring ageing or for conveying positive messages about growing older. This paper seeks to address this lack of attention through a detailed case study of the place of one particular theatre – the Victoria/New Victoria Theatre in North Staffordshire, England – in the lives of older people. It provides an overview of the interdisciplinary Ages and Stages project which brought together social gerontologists, humanities scholars, psychologists, anthropologists and theatre practitioners, and presents findings from: the archival and empirical work exploring the theatre's pioneering social documentaries and its archive; individual/couple and group interviews with older people involved with the theatre (as audience members, volunteers, employees and sources); and ethnographic data gathered throughout the study. The findings reaffirm the continuing need to challenge stereotypes that the capacity for creativity and participation in later life unavoidably and inevitably declines; show how participation in creative and voluntary activities shapes meanings associated with key life transitions such as bereavement and retirement; and emphasise the positive role that theatre and drama can play as a medium for the inclusion of both older and younger people. [ABSTRACT FROM PUBLISHER]

London today hosts more than 200,000 Italian people. A traditional point of arrival for Italian migrants since the nineteenth century, London is a setting characterised by the presence of the ‘old’ classic economic migration – of those who left Italy mainly in the 1950s and 1960s, and the ‘new’ migration, made up mainly of highly-educated people in the professional, academic and arts sectors. These two groups differ as regards their time of arrival, socio-economic characteristics and educational background, and they rarely have the chance or find the need to interact. This paper is based on interviews with representatives of Italian institutions and associations, and with ‘old’ and ‘new’ Italian migrants; participant observation of Italian events happening in London; and some elements of discourse analysis. By means of this empirical material, I aim to show that, besides their well-known differences, the ‘old’ and ‘new’ communities present striking similarities in their migration narratives. [ABSTRACT FROM PUBLISHER]

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Personalisation has now become centre-stage in adult social care and continues to have an enduring level of political commitment and on-going appeal for many disabled people. And yet its roll-out has taken place during a time of austerity where central governments in many neo-liberal countries are re-imagining (read: shrinking) their role in social care provision. This paper reports on findings from an empirical study of relevant government officials from different countries which have advanced personalisation: Canada, England and the US. It reports on their views on personalisation and the remaking of adult social care, and managing expectations for change. Despite the relative success of personalisation, the findings reveal a tempered, cautious account, with respondents aware of the pitfalls and risks inherent in self-led support, government limitations in changing systems and an end to the primary involvement by the state in the creation of a social care market. With this in mind, the study's findings make a strong case for forms of ‘progressive localism’, as imagined by Featherstone et al. (2012), in galvanising local community resources alongside more radical politics in order to make self-led support achieve its desired outcomes on the ground. [ABSTRACT FROM PUBLISHER]

The article reports on the 2008 conference of the Architectural Humanities Research Association (AHRA) that was held in Oxford, England. The event was entitled "The Politics of Making" and was focused on whether politics is still a vital part of the agenda of architectural research. It was observed that the concepts of "making" and "politics" have almost unlimited flexibility.

Background: The Nottingham and Nottinghamshire Hospital for Diseases of the Throat, Ear and Nose existed in Nottingham for over 60 years, but there is little knowledge or documentation regarding its existence. Methods: The following resources were searched to find out more about the hospital: the Nottinghamshire Archives; Manuscripts and Special Collections at the University of Nottingham Libraries; and Nottingham Central Library. Information was also obtained from the founders' relatives. Results: The hospital was founded in 1886, by Dr Donald Stewart, supported by political and clerical leaders. Initially, it treated out-patients only; in-patients were admitted for surgical treatment from 1905. Suitable accommodation was purchased in 1925, on Goldsmith Street, but required much building extension and alteration. Building restrictions during and following World War II prevented expansion. The National Hospital Survey conducted in 1945 considered the clinical work undertaken to be of a minor character, and recommended closure and amalgamation with the services provided by the Nottingham General Hospital. The hospital closed in 1947. Conclusion: The specialist hospital was deemed unfit and unsuitable to compete with the comprehensive service provided by the Nottingham General Hospital. [ABSTRACT FROM AUTHOR]

Background: Mastoiditis is the most common intra-temporal complication of acute otitis media. Despite potentially lethal sequelae, optimal management remains poorly defined. Method: A retrospective case review was conducted of children diagnosed with mastoiditis at a tertiary referral centre, in North East England, between 2010 and 2017. Results: Fifty-one cases were identified, 49 without cholesteatoma. Median patient age was 42 months (2 months to 18 years) and median hospital stay was 4 days (range, 0–27 days). There was no incidence trend over time. Imaging was conducted in 15 out of 49 cases. Surgery was performed in 29 out of 49 cases, most commonly mastoidectomy with (9 out of 29) or without (9 out of 29) grommets. Complications included sigmoid sinus thrombosis (3 out of 49) and extradural abscess (2 out of 51), amongst others; no fatalities occurred. Conclusion: A detailed contemporary description of paediatric mastoiditis presentation and management is presented. The findings broadly mirror those published by other UK centres, but suggest a higher rate of identified disease complications and surgical interventions. [ABSTRACT FROM AUTHOR]

It is widely recognised that a diagnosis of a long-term physical health condition (LTC) is likely to have a significant impact on a person's mental health. This is highlighted in the Five Year Forward View for Mental Health (NHS England, 2016) where significant numbers of patients projected to be seen through the expansion of Improving Access to Psychological Therapies (IAPT) services are to come from within the LTC community. IAPT services offer evidence-based therapeutic interventions for common mental health issues – anxiety disorders and depression. The South East Staffordshire IAPT services have developed an integrated pathway as a Wave 2 site for the delivery of cognitive behavioural therapy (CBT) adaptations for LTC. The main themes outlined in this paper focus on the innovations and service developments of IAPT-LTC including: the importance of engagement between mental health and medical healthcare professionals, identifying the key professionals in medical healthcare to enhance engagement, extended training for clinicians with in-house continued professional development, as an extension to the National IAPT-approved top-up training for LTC, and developments in clinical supervision structures and practice, along with future developments in the field of IAPT-LTC. These themes have direct relevance to CBT practitioners working within the LTC community in IAPT services. The four contrasting case studies demonstrate how the application of CBT can successfully be adapted to condition related beliefs and behaviours, despite the complexity of the medical condition. Findings show how integrated services and engaging with medical healthcare professionals had profound benefits for the patients, IAPT therapists and medical healthcare professionals. Key learning aims: (1) The good practice points in the development of the IAPT-LTC pathway within South East Staffordshire IAPT services. (2) The successful design and implementation of the IAPT-LTC pathway within South East Staffordshire IAPT services. (3) The key considerations of the interaction for patients between their physical and mental health symptoms. (4) The application of CBT adaptations for people with complex LTCs can be effective in improving psychological wellbeing and physical condition management. [ABSTRACT FROM AUTHOR]

Background: Balloon Eustachian tuboplasty is a surgical management option for Eustachian tube dysfunction; it has shown promising results in studies worldwide, but has had limited uptake in the UK. This study reports long-term outcomes for patients offered balloon Eustachian tuboplasty for chronic dilatory and baro-challenge-induced Eustachian tube dysfunction, and describes practical experience gained from its implementation. Methods: Balloon Eustachian tuboplasty was conducted in 25 patients (36 ears) with Eustachian tube dysfunction over three years. Information on presenting symptoms and signs, audiometric findings, tympanometry, and Eustachian Tube Dysfunction Questionnaire-7 scores were recorded pre- and post-operatively with a minimum follow up of one year. Results: Sixteen (64 per cent) of the 25 patients demonstrated symptom resolution after balloon Eustachian tuboplasty according to the Eustachian Tube Dysfunction Questionnaire-7. Fourteen (64 per cent) of the 22 patients with a type B or C tympanogram pre-operatively, had a type A trace post-operatively. Fifteen (75 per cent) of 20 patients with pre-operative conductive hearing loss showed improvement post-operatively, and 11 (50 per cent) of 22 patients with pre-operative middle-ear effusion or tympanic membrane retraction showed resolution. Conclusion: Balloon Eustachian tuboplasty can improve subjective and objective measures of Eustachian tube dysfunction, and provide longer-term resolution. [ABSTRACT FROM AUTHOR]

Objective: Religious/spiritual beliefs and behaviours (RSBB) have been associated with health outcomes, with diet a potential mediator of this relationship. We therefore explored whether RSBB were associated with differences in diet. Design: Dietary patterns and nutrient intakes were derived from food frequency questionnaire completed by pregnant women in 1991–1992 (mean age = 28·3 years, range = 15–46) and by the mothers and partners 4 years post-partum (mothers mean age = 32·3, range = 19–49; partners mean age = 34·5, range = 18–74). RSBB exposures measured in pregnancy included religious belief, affiliation and attendance. We first explored whether RSBBs were associated with dietary patterns in confounder-adjusted linear regression models. If associations were found, we examined whether RSBB were associated with nutrient intake (linear regression) and following nutrient intake guidelines (logistic regression). Setting: Prospective birth cohort study in Southwest England (Avon Longitudinal Study of Parents and Children; ALSPAC). Participants: 13 689 enrolled mothers and their associated partners. Results: In pregnant women, RSBB were associated with higher 'traditional' (i.e. 'meat and two veg') and lower 'vegetarian' dietary pattern scores. Religious attendance and non-Christian religious affiliation were associated with higher 'health-conscious' dietary pattern scores. Religious attendance was associated with increased micronutrient intake and following recommended micronutrient intake guidelines, with weaker effects for religious belief and affiliation. Comparable patterns were observed for mothers and partners 4 years post-partum, although associations between RSBB and nutrient intakes were weaker for partners. Conclusions: RSBBs are associated with broad dietary patterns and nutrient intake in this cohort. If these reflect causal relationships, diet may potentially mediate the pathway between RSBB and health. [ABSTRACT FROM AUTHOR]

Cross sections of coal prices in England for 1695, 1795, and 1842 are used to infer transportation rates by sea, river, canal, and road. The effectiveness of monopolies, the degree of market integration, and the patterns of regional supply of each mining district are then established. The growth rates of productivity in sea, river, and road transport from 1695–1842 are computed and combined with a social savings assessment of canals to measure the overall growth in the productivity of shipping coal. Productivity growth was substantial but had a surprisingly limited impact on the geography of production and consumption. [ABSTRACT FROM AUTHOR]

Tolls were not only fundamental to the operation of early modern English markets, but also had the capacity to generate tensions that belied their seemingly unremarkable role in contemporary economic affairs. Yet, tolls and toll disputes have received little attention in studies of market regulation and have also been neglected in studies of the politics of grain supply and marketing. This article revives tolls as an object of enquiry and suggests that they occupied an ambiguous position within early modern English economic culture. Tolls raised complex questions about how self-interest operated in a society that conceptualized bargaining primarily in communal terms and emphasized the social and moral obligations that should underpin it. While this was arguably true of tolls on all goods, it was especially true of tolls on grain – a commodity that occupied a singular place in contemporary socio-economic relations. By examining how competing parties in toll disputes articulated and sought to defend their interests, and how their respective tactics changed over time, this article sheds new light on the dynamics involved in England's transition from one way of thinking about economic activity to another. [ABSTRACT FROM AUTHOR]

Informality has long been valued in England, and this is true of the political process as well as the institution of the judiciary. In both cases, it is assumed that the senior figures will have absorbed unwritten conventions and will by osmosis naturally understand their respective role in the UK constitution. Much is now starting to change, at least as far as the English judiciary is concerned. It is, first, argued that informal judicial institutions did not become redundant when the separation of powers was formally introduced with a program of modernization of the judiciary in the Constitutional Reform Act 2005. Selected illustrations of persisting informal judicial institutions are then discussed in relation to the deliberative processes in senior courts; to judicial selection and appointments; and to the disciplinary process. Second, informal judicial institutions are deeply connected with the UK constitutional tradition. The Brexit litigation laid bare the challenges of containing political behavior within certain boundaries, and the unwritten conventions which have bound the judiciary and the executivemight now be instinctively understood and shared by only one of these two parties. [ABSTRACT FROM AUTHOR]

This article surveys a range of work on the later medieval English countryside published since 2000, and offers some predictions and suggestions about future research. It shows that the field of 'rural history' has rarely been closely defined, and indeed has tended to be treated as a broad church that can accommodate many different kinds of approach, themselves drawing on a variety of disciplinary traditions. The article identifies and discusses recent and current innovation and creativity in research within two such broad approaches, one mainly 'economic', the other 'cultural'. It concludes by arguing for the gains that can be enjoyed through the combination of elements of the two approaches, and especially through a renewed emphasis on the illumination of the general through an intensive focus on the local. [ABSTRACT FROM AUTHOR]

Background: Cannabis has been associated with poorer mental health, but little is known of the effect of synthetic cannabinoids or cannabidiol (often referred to as CBD). Aims: To investigate associations of cannabis, synthetic cannabinoids and cannabidiol with mental health in adolescence. Method: We conducted a cross-sectional analysis with 13- to 14-year-old adolescents across England and Wales in 2019–2020. Multilevel logistic regression was used to examine the association of lifetime use of cannabis, synthetic cannabinoids and cannabidiol with self-reported symptoms of probable depression, anxiety, conduct disorder and auditory hallucinations. Results: Of the 6672 adolescents who participated, 5.2% reported using of cannabis, 1.9% reported using cannabidiol and 0.6% reported using synthetic cannabinoids. After correction for multiple testing, adolescents who had used these substances were significantly more likely to report a probable depressive, anxiety or conduct disorder, as well as auditory hallucinations, than those who had not. Adjustment for socioeconomic disadvantage had little effect on associations, but weekly tobacco use resulted in marked attenuation of associations. The association of cannabis use with probable anxiety and depressive disorders was weaker in those who reported using cannabidiol than those who did not. There was little evidence of an interaction between synthetic cannabinoids and cannabidiol. Conclusions: To our knowledge, this study provides the first general population evidence that synthetic cannabinoids and cannabidiol are associated with probable mental health disorders in adolescence. These associations require replication, ideally with prospective cohorts and stronger study designs. [ABSTRACT FROM AUTHOR]

The delivery of personalised support to vulnerable older people is largely contingent on those staff who provide direct care. These care workers play an invaluable role in supporting vulnerable older people that may have increasingly complex needs either at home or in care homes. Internationally, concern has been raised both about the recruitment and retention of care workers; and their skills and competencies because of their importance in the delivery of quality care services. Using both primary and secondary data, this paper explores commissioning and contracting arrangements for domiciliary care and care home provision in England and their influence on the recruitment and retention of staff in these services. The implications of the findings are discussed in the context of two factors which influence continuity of care, a proxy for quality services for older people: training opportunities for staff and factors affecting the supply of labour from which direct carers are traditionally recruited. It is suggested that some of the drivers of quality in the provision of care may not be susceptible to the influence of commissioners and providers. Nevertheless, training may aid the recruitment and retention of care workers and provide one way in which they can promote a higher standard of care for older people. [ABSTRACT FROM PUBLISHER]

The debate on privatisation is central to social policy, yet it tends to generate more heat than light as definitions and operationalisations of ‘privatisation’ are often implicit, unclear and conflicting. This paper aims to explore the extent of privatisation in the NHS over three periods of government through the lens of three approaches of Mixed Economy of Welfare, Wheels of Welfare and Publicness. All have two dimensions of provision and finance in common, but Mixed Economy of Welfare and Publicness stress the third dimension, that of regulation, while Wheels of Welfare stresses decision. All three approaches agree that some policies in the NHS constitute privatisation, but there is some disagreement largely stemming from their differential stress on regulation or decision. It is important to introduce a degree of transparency in the debate which provides clear definitions and rationales. However, all approaches require further development which focuses on the important but neglected point of how different types of privatisation lead to different impacts on patients. [ABSTRACT FROM PUBLISHER]

Background: Improving access to psychological therapies, and in particular cognitive behavioural therapy (CBT), has been a health service priority in England and Wales over the past decade. The delivery of CBT has been limited by a scarcity of resources and further limited by the inequitable geographic distribution of CBT therapists. Aims: The current study replicates and extends our previous analysis of the geography of British Association of Behavioural and Cognitive Psychotherapies (BABCP) membership (Shapiro, Cavanagh and Lomas, 2003) 10 years later in order to evaluate the progress made in improving equitable access to CBT. Method: This paper presents the absolute and comparative geographic distribution of current BABCP members, accredited CBT practitioners, and BABCP members who are nurses or clinical psychologists in England and Wales. Results: Efforts to improve the availability of CBT in England and Wales are reflected in the doubling of total membership, and a 4.5 fold increase in accredited membership over the last 10 years. There is evidence that the magnitude of inequity in the geographic availability of CBT therapists has decreased, but that inequity is still evident. Limitations of using BABCP membership data as a proxy measure of CBT availability are acknowledged. Conclusions: A five-fold discrepancy in accredited CBT practitioners between the best and least well-served population decile indicates ongoing “postcode availability” of the best qualified CBT practitioners. Possible strategies to improve the availability of CBT and remedy this inequity are discussed. [ABSTRACT FROM AUTHOR]

BackgroundIdentifying patients with chronic musculoskeletal pain using database searches is difficult, as chronic pain is not represented with a unique diagnostic code in electronic primary care records.AimThis paper describes the development and implementation of a search strategy to identify patients with chronic musculoskeletal pain in primary care databases to invite them to participate in a randomised controlled trial.MethodsWe used an exploratory, iterative approach. The first phase involved consultations with IT specialists, practice managers and doctors to gain an understanding about the processes and issues of electronic coding. In the second and third phases, we determined the most appropriate search terms and strategies. In the final phase, we tested, modified and re-tested the search strategy until the quantity and quality of the output appeared good enough to be used in general practices with different IT systems. This strategy was then implemented to recruit participants for a trial.FindingsWe identified three main search ‘domains’: prescribing, coding and attendance. We found the most useful identifier for chronic pain was the use of repeat medication. Wide variations in coding terms for chronic pain were seen between practices and individuals. Understanding ‘coding cultures’ were necessary to inform the electronic searches. In the case of chronic pain, searching on repeat medication for analgesia, low dose antidepressants and carefully selected coding terms captured most relevant patients. [ABSTRACT FROM AUTHOR]

As an increasing number of Government services have moved away from traditional modes of provision to online formats, there has been a corresponding need to ensure greater access to the internet. Although older people (those over 60) are least likely of all age groups to have access to the internet in their homes, the internet holds much potential as an information and advice resource for those older people who may find it difficult to access advice over the telephone or in person. Realising this potential extends beyond issues of physical access; consideration must necessarily be given to issues of internet literacy and the inclination of this cohort to utilise what may be new and unfamiliar technology. This paper examines these matters in the context of the resolution of everyday problems with a legal dimension. Looking first at the use of the internet for information and advice seeking related to such problems, we find that those aged over 60 demonstrate the least use of the internet for problems with a legal dimension. Simultaneously, those aged over 60 are also the group with the lowest level of home access – a particular issue given that for over 60-year-olds, home access is a far stronger determinant of internet use for problems than it is for other age groups. Examining use of the internet for advice seeking over the last decade, findings demonstrate the existence of a general increase in use amongst all age groups over time, albeit with a lower rate of growth amongst those currently over 60. As an indication of future growth, this will have implications for the provision of services. Whilst the ‘young old’ will utilise the internet to a greater degree and will require websites which are tailored to their needs, those individuals at the older end of the age spectrum may best be served by continued access to face-to-face or outreach advice. The implications these findings pose for policy makers in setting priorities in the remit of online service provision are discussed, with results having particular relevance in England and Wales given planned changes to civil legal aid. [ABSTRACT FROM PUBLISHER]

This paper investigates the prevalence of incapacity in performing daily activities and the associations between household composition and availability of family members and receipt of care among older adults with functioning problems in Spain, England and the United States of America (USA). We examine how living arrangements, marital status, child availability, limitations in functioning ability, age and gender affect the probability of receiving formal care and informal care from household members and from others in three countries with different family structures, living arrangements and policies supporting care of the incapacitated. Data sources include the 2006 Survey of Health, Ageing and Retirement in Europe for Spain, the third wave of the English Longitudinal Study of Ageing (2006), and the eighth wave of the USA Health and Retirement Study (2006). Logistic and multinomial logistic regressions are used to estimate the probability of receiving care and the sources of care among persons age 50 and older. The percentage of people with functional limitations receiving care is higher in Spain. More care comes from outside the household in the USA and England than in Spain. The use of formal care among the incapacitated is lowest in the USA and highest in Spain. [ABSTRACT FROM PUBLISHER]

In the Statute of Westminster II (1285) c. 34, it was enacted that a widow could lose her action of dower, and the possibility of claiming the usual proportion of her deceased husband's real property, if, while he was alive, she had left him for a lover, and the married couple had not been reconciled during the husband's life.[Statutes o] This new exception to the action of dower represented an important change in the balance between a widow and her husband's heir, or others with an interest in lands she might claim as her dower, and is therefore of great significance to the history of women, law and property in the common law world. The exception remained part of the law of England until dower itself was abolished in 1925,[Administra] but, although the early years of the exception have been explored,[P Brand ''] its later history is less well known. As this paper will show, there was a slow and contested move away from the early literal and relatively 'widow-friendly' interpretation of c. 34 to a purposive, more moralising and much more 'widow-unfriendly' view, influenced by the opinion of Sir Edward Coke (1552-1634), and encouraged by a number of other legal and social factors. [ABSTRACT FROM AUTHOR]

For over 300 years, criminal courts have regarded sexual infidelity as sufficiently grave provocation as to provide a warrant, indeed a 'moral warrant', for reducing murder to manslaughter. While the warrant has spilled over into diminished responsibility defences, wounding, grievous bodily harm and attempted murder cases, it is provocation cases that have provided the precedents enshrining a defendant's impassioned homicidal sexual infidelity tale as excusatory. Periodically, judges and law reformers attempt to reign in provocation defences, most recently in England and Wales where provocation has been replaced by a loss of control defence that, most controversially, specifically excludes sexual infidelity as a trigger for loss of control. This paper reflects on this reform and its reception, glossing Shakespeare's scathing critique of warrants for murder in Titus Andronicus. [ABSTRACT FROM AUTHOR]

BackgroundAutism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), and associated subclinical traits, regularly co-occur with one another. However, the aetiology of their co-occurrence remains poorly understood. This paper provides the first genetically informative, longitudinal analysis of the interaction between traits of ASD and ADHD, and explores their genetic and environmental overlap.MethodParents of approximately 5000 twin pairs completed questionnaires assessing traits of ASD and ADHD when twins were aged 8 and 12 years. Cross-lagged longitudinal modelling explored their developmental association, enabling a consideration of phenotypic-driven processes. Overlapping aetiological influences on traits at age 12 years were explored using bivariate twin modelling.ResultsTraits of ADHD at age 8 years were more strongly predictive of traits of ASD at 12 years than traits of ASD at 8 years were of traits of ADHD at 12 years. Analysis of traits by subscales assessing specific symptom domains suggested that communication difficulties were most strongly associated with traits of ADHD. Bivariate modelling suggested moderate genetic overlap on traits in males (genetic correlation = 0.41), and a modest degree of overlap in females (genetic correlation = 0.23) at age 12 years.ConclusionsTraits of ADHD at age 8 years significantly influence traits of ASD at age 12 years, after controlling for their initial relationship at age 8 years. In particular, early ADHD traits influenced later communication difficulties. These findings demonstrate the dynamic nature of co-occurring traits across development. In addition, these findings add to a growing body of literature suggesting that traits of ASD and ADHD may arise via similar aetiological processes. [ABSTRACT FROM AUTHOR]

Cash-for-care schemes offering cash payments in place of conventional social services are becoming commonplace in developed welfare states; however, there is little evidence about the impact of such schemes on older people. This paper reports on the impact and outcomes for older people of the recent English Individual Budget (IB) pilot projects (2005–07). It presents quantitative data on outcome measures from structured interviews with 263 older people who took part in a randomised controlled trial and findings from semi-structured interviews with 40 older people in receipt of IBs and with IB project leads in each of the 13 pilot sites. Older people spent their IBs predominantly on personal care, with little resources left for social or leisure activities; and had higher levels of psychological ill-health, lower levels of wellbeing, and worse self-perceived health than older people in receipt of conventional services. The qualitative interviews provide insights into these results. Potential advantages of IBs included increased choice and control, continuity of care worker, and the ability to reward some family carers. However, older people reported anxieties about the responsibility of organising their own support and managing their budget. For older people to benefit fully from cash-for-care schemes they need sufficient resources to purchase more than basic personal care; and access to help and advice in planning and managing their budget. [ABSTRACT FROM PUBLISHER]

AimTo undertake a service evaluation of the NHS East of England Supporting Self-Care in General Practice programme.BackgroundThe number of people purported to live with long-term conditions continues to rise generating increasing policy emphasis on the importance of self-care. Previous work has highlighted barriers to implementing self-care interventions in general practice, including a lack of organisational approaches to providing self-care and limited engagement and training of healthcare professionals. In response to these barriers and policy drivers, NHS East of England Strategic Health Authority developed and commenced the Supporting Self-care in General Practice (SSCiGP) programme, which seeks to transform the relationships between people with long-term conditions and primary care practitioners.MethodsThis was a mixed methods study, carried out over two phases, which included interviews, survey work and practice-based case studies.ResultsThis paper focuses on findings related to clinician and practice level change. Clinicians reported changes in their perceptions and in consultation practices following attendance on the SSCiGP programme. These changes were linked to empathy and patient-centredness that mirrored what patients valued in interactions with clinicians. There were qualitative and descriptive differences, but no statistically significant differences between clinicians who had and had not attended the SSCiGP programme. Time was recognised as a significant barrier to implementing, and sustaining skills learnt from the SSCiGP programme.Greater impact at practice level could be achieved when there was whole practice commitment to values that underpinned the SSCiGP programme. There was evidence that such approaches are being incorporated to change practice systems and structures to better facilitate self-care, particularly in practices who were early programme adopters.ConclusionThis evaluation demonstrates that training around clinician change can be effective in shifting service delivery when sat within a cultural framework that genuinely situates patients at the centre of consultations and practice activity. [ABSTRACT FROM AUTHOR]

This paper explores certain questions regarding whether the law concerning relief upon the dissolution of civil partnership and cohabitation should parallel that of marriage. It will be contended that while the principle of compensation does have an important role to play in the aftermath of de facto relationships, there remain reasons not to assimilate cohabitation fully with marriage - and in particular, not to apply the key principle of equal sharing that now informs divorce settlements in many jurisdictions, including England. On the other hand, an argument against assimilating marriage with civil partnership can be grounded in the fact that a civil partnership involves two parties of the same gender. This point generates room to argue that a presumption of equal sharing - to the extent that it rests upon compensatory rationales - may be less powerful in civil partnerships. Nonetheless, that claim can be circumnavigated by the argument for equal sharing as an independent principle - one applicable to civil partnership just as much as to marriage. [ABSTRACT FROM AUTHOR]