Search

The 1944 Wartime Coalition White Paper, "A National Health Service" is unlikely to be celebrated among the spate of golden anniversaries of welfare reforms in the 1990s. However, a study of this document may be of interest for two main reasons. First, it has some parallels with the reformed National Health Service of the 1990s and, second, there have been recent calls for a local government-based health service, as was envisaged in 1944. The White Paper is examined in the context of evolving plans for the NHS, and is compared with the actual shape of the NHS as introduced by the Labour Minister of Health, Aneurin Bevan, in 1948. Four themes are drawn out. First, the White Paper should not be seen as the embodiment of a political consensus. Second, a Conservative Health Service would have differed from the NHS in fundamental aspects. Third, the conceptual advantages of a local government-based health service were outweighed by practical politics. Fourth, although the Labour Party made a difference to the shape of the NHS, that shape did not simply follow from party policy. This implies that medical pressure was successful, to some extent, in defining the limits of the new service. [ABSTRACT FROM AUTHOR]

Introduction: There is growing scientific and policy recognition that optimising health before a potential pregnancy (preconception health) improves reproductive outcomes and the lifelong health of future children. However, public awareness on this topic is low. We conducted a public consultation to develop language recommendations and identify and prioritise approaches to inform research and improve public awareness of preconception health. Methods: A public consultation was undertaken with people of any gender aged 18–50 years living in the United Kingdom who were not currently expecting a child. Public contributors were recruited through patient and public involvement, community and support groups, an existing cohort study, and an LGBTQ+ charity. An initial round of online group discussions (February/March 2021) explored public contributors' knowledge of preconception health, their recommendations for appropriate language, and ideas about public health approaches. In a subsequent discussion round (May 2021), language recommendations were refined and suggested approaches prioritised. Discussions were summarised based on notes taken by two researchers. Results: Fifty‐four people joined the initial discussion round (66% women, 21% men, 13% nonbinary or transgender; 55% aged 18–30 years, 30% 31–40 years, 15% 41–50 years). Of these, 36 people (67%) participated in the subsequent round. Very few had heard the term 'preconception health', understood what it means, or why and for whom it is important. They recommended avoiding unfamiliar terms without further explanation (e.g., preconception health, medical terms), using language that is positive, encouraging and gender‐sensitive where possible, and using messages that are specific, nonjudgmental and realistic. The phrases 'health and well‐being during the childbearing years', 'health and well‐being before pregnancy and parenthood' and 'planning for parenthood' resonated with most public contributors. School‐based education, social media campaigns and the National Health Service emerged as priority approaches/settings for raising awareness. Conclusion: This public consultation produced recommendations from a diverse group of people of reproductive age in the United Kingdom to improve language and prioritise approaches that increase public understanding of preconception health in ways that are relevant and appropriate to them. This should begin in schools and will require adaptation of curricula, alongside co‐development of public awareness campaigns and guidance for healthcare professionals. Patient or Public Contribution: This public consultation included a diverse group of members of the public. They were not involved in the original design of the project, but following the initial round of online group discussions, they contributed to the interpretation and refinement of the emerging concepts in a subsequent round of group meetings. After the consultation activity, public contributors formed a Public Advisory Group and have subsequently been involved in other studies on the same topic. Two public contributors (E.R. and F.F.) provided critical input in the preparation and revision of this manuscript and are co‐authors of the paper. [ABSTRACT FROM AUTHOR]

Qualitative research has long critiqued a simplistic association between youth parenting and poor outcomes. Despite this, the UK youth parenting policy continues to view young parents through a narrow deficit lens, focused on assumed risk rather than structural inequalities. The paper brings together the direct accounts of young parents' experiences, with ethnographic observation of practice, to argue that discrimination is the critical issue associated with being a young parent. This is then set within a wider critique of the policy framework which, it is argued, perpetuates and normalises negative ideas about young parents prevalent in political, societal and cultural processes. An integrative theoretical approach is used to highlight how a deficit lens at a policy level upholds, rather than undermines, young parents' intersectional experiences of discrimination and has ethical implications for practitioners working with them. The paper calls for a reorientation of policy which addresses and disrupts discrimination. [ABSTRACT FROM AUTHOR]

This paper critically comments on the state of affairs in the UK relating to the pandemic and explores how a focus on inequities experienced by marginalized and vulnerable groups is necessary for exposing the material realties of everyday life, but also how such a focus has been hijacked by center right politics to distract us from collective responsibilities and building alliances for systemic change. The paper critically reviews the impact of the COVID‐19 pandemic on the most marginalized and vulnerable in UK society and highlights the interconnected risk factors of COVID‐19 and its secondary impacts to demonstrate how these are linked to political ideology, policy, and practice. We conclude with recommendations informed through a looking back at the key tenants and purposes of universal healthcare to apprise what is needed in this moment of crisis and beyond. [ABSTRACT FROM AUTHOR]

Introduction: This paper is a report of an ICSH review of policies and practices for internal quality control (IQC) policy for haematology cell counters among regulatory bodies, cell counter manufacturers and diagnostic laboratories. It includes a discussion of the study findings and links to separate ICSH guidance for such policies and practices. The application of internal quality control (IQC) methods is an essential pre‐requisite for all clinical laboratory testing including the blood count (Full Blood Count, FBC, or Complete Blood Count, CBC). Methods: The ICSH has gathered information regarding the current state of practice through review of published guidance from regulatory bodies, a questionnaire to six major cell counter manufacturers (Abbott Diagnostics, Beckman Coulter, Horiba Medical Diagnostic Instruments & Systems, Mindray Medical International, Siemens Healthcare Diagnostics and Sysmex Corporation) and a survey issued to 191 diagnostic laboratories in four countries (China, Republic of Ireland, Spain and the United Kingdom) on their IQC practice and approach to use of commercial IQC materials. Results: This has revealed diversity both in guidance and in practice around the world. There is diversity in guidance from regulatory organizations in regard to IQC methods each recommends, clinical levels to use and frequency to run commercial controls, and finally recommended sources of commercial controls. The diversity in practice among clinical laboratories spans the areas of IQC methods used, derivation of target values and action limits used with control materials, and frequency of running commercial controls materials. Conclusions: These findings and their implications for IQC Practice are discussed in this paper. They are used to inform a separate guidance document, which proposes a harmonized approach to address the issues faced by diagnostic laboratories. [ABSTRACT FROM AUTHOR]

People with intellectual disabilities face health disparities, including in high‐income countries such as the United Kingdom, despite publicly funded healthcare. This paper describes the healthcare system in England (a nation of the United Kingdom) for the general population, and more specifically for people with intellectual disabilities. Key legislation that impacts the lives of people with intellectual disabilities, such as the UK Equality Act 2010 (https://www.legislation.gov.uk/ukpga/2010/15/contents), the Mental Capacity Act 2005 (https://www.legislation.gov.uk/ukpga/2005/9/contents), and the UN Convention on the Rights of Persons with Disabilities, and its implementation in the United Kingdom, is discussed. The role of deinstitutionalization and the shift to living in the community for people with intellectual disabilities is also discussed. Programmes that have been implemented to address the health disparities experienced by people with intellectual disabilities are reviewed. Finally, the recent changes to healthcare organization in the UK, the COVID‐19 pandemic, and the implementation of the Valuing People white paper are discussed. [ABSTRACT FROM AUTHOR]

UK social care policy has "traditionally" sought to minimise organisational and sector boundaries through cooperation and partnership. This discussion paper argues that there is a case for a social care system based openly on separation of powers to address the conflicts of interest that inevitably exist between the actors—notably local authorities and service providers. Such systems, with "guardrails" to separate the actors, and "checks and balances" to keep them stable, have been developed over centuries in other spheres. Furthermore, if disabled people are to be considered as participants with rights, rather than mere recipients, they should be recognised as the third main actor in the system, also with powers that are protected and constrained. This paper takes a 50‐year retrospective view of these issues in terms of policy affecting people with learning disabilities, focusing on three policy episodes in the UK. First, the 1970s, with a system unbalanced by powerful medical professions, and an absence of self‐advocacy. Second, care management in the 1990s, which ducked the spirit of Sir Roy Griffiths' vision of a lively provider market. Third, the adoption and degradation of Personal Budgets. The learning from UK and international individualised funding programmes is too complex to be certain which ingredients are the keys to success. However, there are strong arguments, and substantial evidence, to suggest that Personal Budgets will not truly succeed until they are built on a structure that determines not only what councils and providers can and should do but also where they must not interfere. Accessible summary: •It is a nice idea that everyone involved in social care—the council, the service providers and people with learning disabilities—all want the same thing. If that is true, then they all need to work together as closely as they can.•But it is not really true. Council staff who do assessments and people who run services see things from different viewpoints. A person who wants support services will see things another way. That does not mean that anyone is a bad person, and a lot of the time they will want the same thing. But we are all human, and sometimes we pretend we are doing what we should do, when actually it is what suits us.•If you need a Personal Budget, the council may try to say you do not need much support, because that will save money. The support provider may want to tell you when you will get support, because it makes life easier for them, not you.•So maybe we should be more honest, and organise the system so that people have the power to do their job, but do not have the power to interfere when they should not. Disabled people should be part of this system, so that they have some power as well. [ABSTRACT FROM AUTHOR]

Comments on David Green's analysis of the need for state provision of medical care in Great Britain, previously published in volume 5, issue 1, of the periodical 'Economic Affairs.' Justification of provisioning by the state; Assumptions about the state of the health care market.

The difficulties faced by youth with intellectual and developmental disabilities (IDDs) and their families as they move into adulthood are widely documented. The aim of the paper is to explore the current situation in terms of transition processes and outcomes in four countries (the US, UK, Australia and Czech Republic) and identify commonalities and differences that help elucidate what might determine different outcomes. Two research methods—expert knowledge and rapid literature review—were combined to identify sources from which information on transition policy, processes, support practices and outcomes was extracted and synthesised. This review identified gaps in the research evidence including inadequate collection and use of data to drive policy and determine effectiveness, limited evidence‐based models or frameworks for successful transition. There was little transition research that included the voices of young people with IDD. More research is necessary to study the practices of highly successful programmes, and to explore the impact of transition programmes and disability support services on a broader range of outcomes, capturing the experiences of young people themselves and identifying factors that determine successful outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Since non‐directed (altruistic) kidney donors do not stand to benefit from the lengthening and strengthening of a relationship that they intrinsically value, their donations are considered to constitute the most altruistic variety of living kidney donation. Methodology: This paper uses publicly‐available data to assess the expected value that accrues to the donor of altruistic kidney donation. Findings: Compared to healthy non‐donors, living kidney donors experience only marginally increased absolute risks of poor physical health outcomes, and no difference in important psychosocial health outcomes. Crucially, the chance of requiring a kidney donation is only marginally increased by becoming a living kidney donor. In the United Kingdom, previous living kidney donors that subsequently become in need of any organ donation (not only kidneys) themselves are considered priority patients for these donations. They consequently experience shorter waiting times for these organs and reduced exposure to the inherently harmful effects of dialysis therapy (if a kidney donation is required) compared to non‐donors in need of organ donation. As such, while key data points required to compute an accurate and complete expected value calculation are unavailable, it is likely that the additional risk incurred by becoming a living kidney donor is outweighed by the benefit of being considered a priority patient for the donation of any type of organ in the event that this is needed. Conclusion: Accordingly, the expected value of becoming a living kidney donor is likely to be positive, meaning the act of doing so may be considered akin to the taking out of an insurance policy. In the context of non‐directed (altruistic) kidney donation, this may diminish the extent to which such a donation is considered altruistic. [ABSTRACT FROM AUTHOR]

Whether charitable fundraising might play a part in funding Britain's ostensibly tax‐funded NHS has been a longstanding dilemma, which until recently has received only occasional scholarly attention. In 1946, Aneurin Bevan argued that one of the main goals of the reformed health care system was to liberate health care from the 'caprice of private charity'. Seven decades later, NHS Charities Together's Urgent Covid‐19 Appeal became a powerful societal rallying cry in the health emergency of the pandemic and raised £150 million in the process. This paper draws together findings from new archival research, a witness seminar with key actors in the NHS charity sector, and qualitative research based on interviews with NHS charity staff and trustees (N = 13), all conducted between 2021 and 2023. We investigate the way in which national appeals have been proposed, debated and implemented at different times in the NHS's history. We trace the recurrence of conflicting ideas about the acceptability of national fundraising for the NHS, about whether public loyalties are to their local services or the national 'brand' and about the introduction of national appeals into a complex ecology of local NHS charities. The history of charitable fundraising for the NHS is, we argue, neither a simple story of spontaneous public generosity, nor often of formal policy reform, but is an artefact of more complex dynamics between a changing cast of local and national actors over the last 75 years. [ABSTRACT FROM AUTHOR]

While there have been some studies of counterfactual analysis in history and other academic disciplines, there are very few studies in social policy and health policy. This paper explores a major critical juncture and counterfactual in the creation of the NHS. In particular, it explores the critical juncture of the discussion in the Labour Cabinet involving Bevan's proposal for nationalising the hospitals and Morrison's alternative proposal based on local government, and the counterfactual of Prime Minister Attlee summing up in favour of Morrison. It reviews the literature on the criteria for counterfactuals, and justifies the focus on the Cabinet Discussion, as this was a considered option which, with minimum change, might have led to significantly different outcomes. We consider how such an event could have come about, how credible that alternative was, and what its implications might have been. [ABSTRACT FROM AUTHOR]

Aim: The aim of this paper is to reflect upon the experiences of a senior nurse in a patient‐facing role, who led a tea providing direct care to those with coronavirus disease 2019 (covid‐19). This would establish what those experiences meant to nurses during the initial outbreak to enable their coping mechanisms to face subsequent waves in the United Kingdom. Background: The worst infectious disease outbreak of a generation rapidly made its impact known to the medical profession and its support infrastructure across the globe. It imparted unprecedented challenges, not only for managing the care of the most critically ill but for minimising its spread and protecting the workforce. Sources of evidence: Reflections of working on the covid‐19 frontline during the initial stages of the pandemic, the challenges faced, and lessons learned enabled the development of a strategy to better support nurses in the ongoing pandemic. Discussion: Visible, invested and consistent leadership was key in forming a strong foundation to support clear communication, peer support and increasing confidence. Consequently, strong bonds were forged to enable the team to face further challenges as they felt 'in it together'. Summary and implications for nursing and health policy: The experiences described in this paper are those of a senior nurse leader within a particular care context. However, the lessons learned are likely to resonate with many nurses who are facing the same challenges in very similar care contexts and who are urged to reflect upon their own experiences. Furthermore, the associated lessons may help support others and inform their strategy for coping throughout potential future admission surges of this pandemic. [ABSTRACT FROM AUTHOR]

In 2019 the For The Assessment Of Individualised Risk (FAIR) project began a review of UK blood donor selection policy to determine if a more individualised approach to donor selection could be safely implemented. An evidence base was required to inform selection policy to move from a population to a more individual based policy, specifically what sexual behaviours/indicators should be considered as screening questions to maintain the safety of the blood supply. Eight sexual behaviours/indicators were reviewed: history of bacterial sexually transmitted infections (STIs), chemsex, number of recent partners, condom use, type of sex, sexual health service (SHS) attendance, new sexual partner and exclusivity. We conducted searches in multiple databases to identify literature looking at the association between these behaviours/indicators and HIV/STI acquisition risk. A scoring system to determine strength of evidence was devised and applied to papers that passed screening. Key studies were identified which achieved the maximum score and more in‐depth reviews were conducted for these. We identified 58 studies, including 17 key studies. Strong evidence was found linking a previous bacterial STI, chemsex and increasing numbers of sexual partners to acquisition risk. Condom use, type of sex and new partners were found to have some strength of evidence for this link. SHS attendance and exclusivity had minimal evidence. We recommended that the behaviours/indicators viewed as having strong or some strength of evidence should be considered as screening questions in a more individualised approach to donor selection criteria. [ABSTRACT FROM AUTHOR]

Introduction: A range of nonpharmaceutical public health interventions has been introduced in many countries following the rapid spread of Covid‐19 since 2020, including recommendations or mandates for the use of face masks or coverings in the community. While the effectiveness of face masks in reducing Covid‐19 transmission has been extensively discussed, scant attention has been paid to the lived experience of those wearing face masks. Method: Drawing on 40 narrative interviews with a purposive sample of people in the United Kingdom, with a particular focus on marginalised and minoritized groups, our paper explores experiences of face mask use during the pandemic. Results: We find that face masks have a range of societal, health and safety impacts, and prompted positive and negative emotional responses for users. We map our findings onto Lorenc and Oliver's framework for intervention risks. We suggest that qualitative data offer particular insights into the experiences of public health interventions, allowing the potential downsides and risks of interventions to be more fully considered and informing public health policies that might avoid inadvertent harm, particularly towards marginalised groups. Patient or Public Contribution: The study primarily involved members of the public in the conduct of the research, namely through participation in interviews (email and telephone). The conception for the study involved extensive discussions on social media with a range of people, and we received input and ideas from presentations we delivered on the preliminary analysis. [ABSTRACT FROM AUTHOR]

Abstract. Over the last decade, British health policy has increasingly considered the role of information and information technologies in the provision of health care. Recently, there is a growing interest in new health applications, often referred to as telemedicine and telehealth, and incorporating a diverse range of services that can be provided in electronic form over various telecommunications networks. This paper discusses how such use of information and communication technologies (ICTs) in health acquires meanings through a policy process, and what implications it has for telehealth in particular. This is done through a hermeneutic exploration of four principal UK health policy papers published between 1989 and 1998. [ABSTRACT FROM AUTHOR]

This paper is based on Shalini Weerasooriya's Masters dissertation in Public Health at the University of Sheffield. A literature review was conducted to understand the role that orphan drug policies have played in the development of new treatments for rare diseases. The impacts of the policies were categorised as 'tangible' or 'intangible' and further synthesis identified 10 main themes such as incentives for investment, criteria for eligibility and assessment of drug applications and further guidance to industry during the drug development cycle. The review concludes that whilst policies have contributed positively towards improving the research and development of orphan drugs it has not exhausted its uses and must now shift its focus to facilitating greater accessibility and affordability of the treatments and that stakeholders are essential to the success of this process. Implications for practice are identified, for example the need to further update and refine the policy with changing demographics and advancing technologies and, in particular, greater collaboration and involvement through, for example, evidence based training programmes is recommended. It is concluded that focus must shift to address the gap between having available drugs and being able to access and afford them. F.J. [ABSTRACT FROM AUTHOR]

The article focuses on the White Paper on community care titled "Caring for People" in relation to the 1990 National Health Service and Community Care Bill pending in the House of Lords. Criticisms levelled against the White Paper, particularly the issue of grant aid, are misplaced. The White Paper's outstanding value is that it outlines a clear structure and a set of general principles which should grant local authorities greater autonomy, authority and responsibility in healthcare administration.

This paper is a description of the ICSH guidance for internal quality control (IQC) policy for blood cell counters. It follows from and links to a separate ICSH review for such policies and practices. The ICSH has gathered information regarding the current state of practice through review of published guidance from regulatory bodies, a questionnaire to six major cell counter manufacturers and a survey issued to 191 diagnostic laboratories in four countries (China, the Republic of Ireland, Spain, and the United Kingdom) on their IQC practice and approach to the use of commercial IQC materials. This has revealed diversity both in guidance and in practice around the world. There is diversity in guidance from regulatory organizations in regard to IQC methods each recommends, clinical levels to use and frequency to run commercial controls, and finally recommended sources of commercial control materials. The diversity in practice among clinical laboratories spans the areas of IQC methods used, derivation of target values, and action limits used with commercial control materials, and frequency of running commercial controls materials. These findings and their implications for IQC Practice are addressed in this guidance document, which proposes a harmonized approach to address the issues faced by diagnostic laboratories. [ABSTRACT FROM AUTHOR]

A grandfather clause is a provision whereby an old rule continues to apply to some existing situation while a new rule applies to all future cases. This paper focuses on the use of grandfather clauses in health technology appraisals (HTAs) issued by the National Institute for Health and Care Excellence (NICE) in the United Kingdom. NICE provides evidence‐based guidance on healthcare technologies and public health interventions that influence resource allocation decisions in the National Health Service (NHS) and the broader public sector in England and Wales. In this context, a grandfather clause is included when NICE does not recommend treatment with a given technology. The grandfather clause provides an exemption from the general recommendation for patients who have already started treatment with the technology in question, before the publication of the NICE guidance. In this paper we first lay out the contexts in which grandfather clauses occur in NICE guidance, and then consider ethical arguments against and in support of grandfather clauses and the continuation of treatment. We argue that NICE's current practice of automatic inclusion of a grandfather clause is ethically problematic and unfair. While the inclusion of a grandfather clause may be appropriate and justified in specific cases, we argue that inclusion of such a clause should be considered as part and parcel of the decision making process on a case by case basis, rather than adopted as the default. [ABSTRACT FROM AUTHOR]

This paper offers a five‐part framework for assessing why the United Kingdom has coped poorly compared with peer countries with the medical, social and economic challenges brought by the COVID‐19 pandemic – a surprising failure, given the strength of its scientific community and the internationally attested quality of its civil service. The paper also offers a proposal for how to shape an independent inquiry, one promised by the UK Prime Minister, of the kind that has the primary motivation to better prepare the country for future crises. The paper begins by providing various metrics that set out how the UK has, as of late 2020, been particularly adversely affected by the pandemic. It then details the five‐part framework, which is presented as a series of propositions with initial supporting evidence that require more thorough investigation, supported by a fuller record of evidence. First, we suggest that there have been problems as to how evidence about the pandemic and its anticipated effects was collected, processed and circulated, weakening policymakers' ability to evaluate the risk calculus. Second, particular structures and processes of government decision‐making appear to have been inadequate and ill‐suited to the multidimensional challenges brought by the pandemic. Third, the role of political leadership and decision‐making in the public health and broader policy responses needs thorough evaluation. Fourth, we assess some aspects of economic policymaking during the pandemic. Fifth, features of the UK's institutional make‐up may have been a driver of the suboptimal outcomes. Overall, we argue that UK policymakers may have over‐relied on the medical sciences at the expense of other (social) scientific evidence. [ABSTRACT FROM AUTHOR]

This paper provides a personal memoir of historical work at the Addiction Research Unit, in particular the genesis of the book Opium and the People. This topic had policy significance for US drug policy and a competing US study was funded. The development of the substance use history field is surveyed, and its expansion in recent times through a focused professional association and a critical mass of researchers in the area, covering a wide range of topics. The politics of using history in this area can be problematic. History now sits at the policy table more easily, but there is still a tendency for professionals in the field to use (and misuse) it, rather than calling on the interpretive and challenging approach they would obtain from professional historians. The paper calls for historians and others to move beyond a substance specific focus and to avoid the tendency for 'naive history' implicit in using only digitized industry archives as the sole source. [ABSTRACT FROM AUTHOR]

The UK National Health Service (NHS) is changing. Consecutive UK industrial strategies have supported the shift from an NHS that provides free‐at‐point‐of‐delivery healthcare to one that also facilitates research. Said to promote healthcare's triple aim of 'better health, better healthcare, and lower cost' (Wachter, 2016, 3), the digitisation of patient records is a core part in opening routine aspects of the health system to potential research. In this paper, we thematically analyse 11 policy documents and ask, how does the NHS discuss its decision to digitise patient records and what are the implications of such practices on the citizen? We document how (1) digitisation is presented as a collective endeavour for patients and NHS professionals, offering new possibilities for patients to participate in their own health and that of the population through research and, (2) digitisation contributes to the building of an efficient health system. Through this analysis we reflect on how discussions of digitisation present uncritically the potential of Electronic Health Records and big data analytics to improve care and generate wealth through research, and reconfigure patienthood, by placing research participation as a routine part of accessing NHS healthcare. [ABSTRACT FROM AUTHOR]

In a first major study, the UK's Royal Society found that 76% of people in the UK are in favour of therapeutic germline genomic editing to correct genetic diseases in human embryos, but found there was little appetite for germline genomic editing for non‐therapeutic purposes. Assuming the UK and other governments acted on these findings, can lawmakers and policymakers coherently regulate the use of biomedical innovations by permitting their use for therapeutic purposes but prohibiting their use for enhancement purposes? This paper examines the very common claim in the enhancement literature that the therapy v enhancement distinction does little meaningful work in helping us think through the ethical issues, a claim that has significant implications for these lawmakers and policymakers who may wish to regulate genomic editing techniques to reflect the findings of this important study. The focus of this paper is on germline genomic editing as one of the main themes in this special issue. [ABSTRACT FROM AUTHOR]

This paper considers the context for the development of the concept of responsive regulation, namely the transcending of the deregulation debate. It argues that claims regarding responsive regulation when allied to risk-based rationales for enforcement can, in fact, allow a 'deregulatory' momentum to develop. This argument is grounded with reference to a case study of the regulation of workplace health and safety in the UK, with a particular focus upon the period 2000-2010. The paper casts doubt on the relevance and robustness of the concept of responsive regulation. In a context that might have been fertile ground for developing genuinely responsive regulatory policy, empirically we find the development of policies that are better described as 'regulatory degradation.' Thus we argue in this paper that, whatever the intentions of its proponents, there is a logical affinity between responsive regulation, and effective de-regulation, and that it is this affinity that has provided a convenient political rationale for the emergence of a neo-liberal regulatory settlement in the UK. [ABSTRACT FROM AUTHOR]

Internal migration is one of the main drivers of local population change and therefore an important factor to consider in the provision of services across key domains such as housing, health and education. In recent years, the population of England and Wales has become increasingly ethnically diverse, with groups varying in age structure and time spent in the UK (whether at the group or individual level). However, relatively little is known about the internal migration patterns of these diverse groups, with research into internal migration propensity not accounting for the possible interplay between ethnicity, country of birth and age. Using micro‐data from the 2011 Census for England and Wales, this paper addresses this gap in knowledge, exploring whether widely reported determinants of internal migration operate differently for different ethnic groups, stratified by age and country of birth. This paper also explores whether for ethnic minority groups born overseas, time spent in the UK matters for migration propensity. When stratifying ethnic groups by age and country of birth, differences in migration propensity do not appear to be explained by socio‐economic differences, as previous research in the field suggests. However, for those born overseas, some of the differences are explained by time spent in the UK. From a policy perspective, it is evident that a more nuanced understanding of the way in which propensity to migrate may vary between ethnic groups differing in age and country of birth is needed to ensure sustained provision and equitable access across key service domains. Further research must examine the extent to which differences in migration propensity shapes the nature of migration events, whether in terms of distance or frequency of move. This paper examines differences in the propensity to move short (less than 10 km) and long (10 km or more) distance between ethnic groups differentiated by age and country of birth. It reports on whether determinants of migration vary between those groups, and whether time spent in the UK matters for foreign‐born ethnic groups. [ABSTRACT FROM AUTHOR]

The article presents information on the future of public health in Great Britain. This paper reviews the government's early commitment to, and initiatives in, public health which formed the foundations of its present policy, and examines the reasons for public health becoming an issue of almost unprecedented prominence. Finally, it looks ahead to anticipate what public health might look like in the aftermath of the White Paper expected in November 2004. Public health underwent something of a renaissance following the election of the Labor government in 1997.

Background and Aim: Public health policy development is subject to a range of stakeholders presenting their arguments to influence opinion on the best options for policy action. This paper compares stakeholders' positions in the discourse networks of two pricing policy debates in the United Kingdom: minimum unit pricing for alcohol (MUP) and the soft drinks industry levy (SDIL)., Design: Discourse analysis was combined with network visualization to create representations of stakeholders' positions across the two policy debates as they were represented in 11 national UK newspapers., Setting: United Kingdom., Observations: For the MUP debate 1924 statements by 152 people from 87 organizations were coded from 348 articles. For the SDIL debate 3883 statements by 214 people from 175 organizations were coded from 511 articles., Measurements: Network analysis techniques were used to identify robust argumentative similarities and maximize the identification of network structures. Network measures of size, connectedness and cohesion were used to compare discourse networks., Findings: The networks for both pricing debates involve a similar range of stakeholder types and form clusters representing policy discourse coalitions. The SDIL network is larger than the MUP network, particularly the proponents' cluster, with more than three times as many stakeholders. Both networks have tight clusters of manufacturers, think-tanks and commercial analysts in the opponents' coalition. Public health stakeholders appear in both networks, but no health charity or advocacy group is common to both., Conclusion: A comparison of the discourse in the UK press during the policy development processes for minimum unit pricing for alcohol and the soft drinks industry levy suggests greater cross-sector collaboration among policy opponents than proponents., (© 2020 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.)

This paper aims to utilize social theory to inform relationship-based social work practice with children, young people and families. We see 'direct relationship-based working' drawing on theory and evidence as best placed to take forward high quality, humanistic social work practice. We outline the problems with policy and practice development led by the latest high profile 'scandal' or by the overemphasis on experimental design and systematic reviews. This issue was highlighted during a recent debate about appropriate methodologies for exploring Family Group Conferences: the debate is explored as illustrative of our concerns. A flexible model is proposed, which draws on eclectic sources of evidence, social theory and professional knowledge. We propose some principles for a reflective, humanistic and responsive form of social work professionalism. [ABSTRACT FROM AUTHOR]

The subject of clinical supervision for nurses and health visitors in the UK is considered in this paper. The paper highlights recent debates in thinking and rapid developments in practice. The original concept of clinical supervision, its theoretical propositions and development, recent policy influences and current strategies for evaluation are debated. [ABSTRACT FROM AUTHOR]

Accessible summary Self Directed Support is the latest system of social care providing vulnerable people in the United Kingdom with a budget instead of direct service provision., There is a lack of evidence underpinning the strategy of Self Directed Support., There is a need to learn more about how well the policies are working., Barriers need to be identified and overcome to ensure that people who are eligible can access Self Directed Support., Summary A systematic literature review was undertaken to determine the evidence base underpinning the strategy of Self Directed Support and whether evidence demonstrates that this policy is accessible to everyone with a learning disability. It also sought to identify whether there were any barriers to Self Directed Support for people with severe or profound learning disabilities and, if so, how these barriers could be overcome. Four mixed-method research papers, two quantitative studies, seven qualitative studies and four literature reviews were identified. The findings indicated that very few studies pertain specifically to people with learning disabilities, and little account has been taken of their range of ability or the distinction between adults with legal capacity and those without. It is evident from the literature that Self Directed Support is not, as yet, attainable for everyone with a learning disability but those able to access it have reported an improvement in their quality of life. There is a need for further research to determine the extent of awareness and understanding of the policy of Self Directed Support, and the implications it will have on the future care of people with a wide range of learning disabilities. [ABSTRACT FROM AUTHOR]

The decommissioning of a health‐care service is invariably a highly complex and contentious process which faces many implementation challenges. There has been little specific theorisation of this phenomena, although insights can be transferred from wider literatures on policy implementation and change processes. In this paper, we present findings from empirical case studies of three decommissioning processes initiated in the English National Health Service. We apply Levine's (1979, Public Administration Review, 39(2), 179–183) typology of decommissioning drivers and insights from the empirical literature on pluralistic health‐care contexts, complex change processes and institutional constraints. Data include interviews, non‐participant observation and documents analysis. Alongside familiar patterns of pluralism and political partisanship, our results suggest the important role played by institutional factors in determining the outcome of decommissioning processes and in particular the prior requirement of political vulnerability for services to be successfully closed. Factors linked to the extent of such vulnerability include the scale of the proposed changes and extent to which they are supported at the macrolevel. [ABSTRACT FROM AUTHOR]

This paper explores and develops issues raised by recent debates about the cost of alcohol to England and Wales. It advances two arguments. First, that the commonly used estimates for alcohol harm in England and Wales are outdated, not fully reliable and in need of revisiting. These estimates rely on data that are between 4 and 12 years out of date and sensitive to questionable assumptions and methodological judgements. Secondly, it argues that policymakers, academics and non-governmental organizations should be more careful in their use of these numbers. In particular, it is imperative that the numbers quoted fit the argument advanced. To help guide such appropriate usage, the different types of cost of alcohol are surveyed, alongside some thoughts on the questions they help us to answer and what they imply for policy. For example, comprehensive estimates of the total social cost of alcohol provide an indication of the scale of the problem, but have limited policy relevance. External cost estimates represent a 'lowest common denominator' approach acceptable to most, but require additional assumptions to guide action. Narrower perspectives, such as fiscal, economic or health costs, may be relevant in specific contexts. However, optimal policy should take a holistic view of all the relevant costs and benefits. Similarly, focusing solely on tangible costs may be less controversial, but will result in an under-estimate of the relevant costs of alcohol. [ABSTRACT FROM AUTHOR]

The continuing global increase in the prevalence of overweight and obesity, particularly amongst children, attracts widespread public and political attention. Obesity is a complex condition, with multi‐faceted determinants, and prevention strategies require consideration of dietary and lifestyle patterns alongside a range of environmental factors. Reduction in intake of sugar‐sweetened beverages and foods is advised around the world as part of healthier dietary patterns to help reduce energy intakes, obesity risk and obesity‐related disorders. Current intakes indicate that this is challenging and will likely require a concerted approach with a broad range of interventions including fiscal measures. In recent years, after some notable success with salt and trans fats, there has been considerable focus on food reformulation to support the reduction in population intakes of free sugars from manufactured foods, often without need for consumer behaviour change. In some products, particularly sugar‐sweetened beverages, reformulation is relatively easy and has been widely achieved, as the sweetness of sugars can be replaced with low‐calorie sweeteners. However, other products, in which sugar delivers a variety of functional properties, are more challenging to reformulate to maintain consumer acceptance and achieve a reduction in energy, alongside sugar, content. This paper will look at current definitions and recommendations for free (or added) sugars, as well as key dietary sources and trends in intakes, and explore various strategies to promote population reductions in intake of sugars for public health, including the opportunities and challenges presented by reformulation using low‐calorie sweeteners. Ultimately strategies to promote sugar reduction, including reformulation, should adopt a holistic approach that considers wider dietary recommendations. [ABSTRACT FROM AUTHOR]

In this paper, we analyse the conditions under which the COVID‐19 pandemic will lead either to social order (adherence to measures put in place by authorities to control the pandemic) or to social disorder (resistance to such measures and the emergence of open conflict). Using examples from different countries (principally the United Kingdom, the United States, and France), we first isolate three factors which determine whether people accept or reject control measures. These are the historical context of state‐public relations, the nature of leadership during the pandemic and procedural justice in the development and operation of these measures. Second, we analyse the way the crisis is policed and how forms of policing determine whether dissent will escalate into open conflict. We conclude by considering the prospects for order/disorder as the pandemic unfolds. [ABSTRACT FROM AUTHOR]

The relationship between attendance at birth and maternal mortality rates: an exploration of United Nations’ data sets including the ratios of physicians and nurses to population, GNP per capita and female literacy Background. This is the third and final paper drawing on data taken from United Nations (UN) data sets. The first paper examined the global distribution of health professionals (as measured by ratios of physicians and nurses to population), and its relationship to gross national product per capita (GNP) (). The second paper explored the relationships between the global distribution of physicians and nurses, GNP, female literacy and the health outcome indicators of infant and under five mortality rates (IMR and u5MR) (). In the present paper, the global distribution of health professionals is explored in relation to maternal mortality rates (MMRs). The proportion of births attended by medical and nonmedical staff defined as ‘attendance at birth by trained personnel’ (physicians, nurses, midwives or primary health care workers trained in midwifery skills), is included as an additional independent variable in the regression analyses, together with the ratio of physicians and nurses to population, female literacy and GNP. Aim. To extend our earlier analyses by considering the relationships between the global distribution of health professionals (ratios of physicians and nurses to population, and the proportion of births attended by trained health personnel), GNP, female literacy and MMR.

This paper concerns two practices, public consultation and user involvement, whose adoption has been urged upon the UK National Health Service in recent years. Public consultation is a local attempt to seek the views of a broad constituency of persons. User involvement is a local attempt to include organized groups of service users in the planning, and occasionally the management, of such services. The paper has four objectives. First, it locates the topic in the context of several related current debates. Second, it outlines the main findings of a recent empirical study of public consultation as they relate to the above debates. Third, it summarizes the relevant findings of an empirical study of user involvement. Finally, it examines these two practices as "technologies of legitimation" which can be seen as a means by which managerial legitimacy is maintained in the context of an increasingly pluralistic policy arena. [ABSTRACT FROM AUTHOR]

This paper evaluates the possible relationships between Northern NGOs and Southern governments in light of the growing involvement of NGOs in social services in Africa. It draws on the specific case of Oxfam-UK's support to health care in Uganda, Malawi and Zambia. I propose a model for understanding NGO policy concerning the NGO–state relationship. I emphasize the importance of context in shaping NGO policy and the influence of other actors, particularly donors and Southern NGOs, on the Northern NGO–Southern government interface. In particular, the paper examines the possible consequences of NGO programming that is considered to be ‘gap-filling’, for the actual services provided, for the NGO, and for the host government. I will consider the strategic choices available as an NGO attempts to address these consequences. © 1998 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Street‐level bureaucracy is an increasingly useful way to understand how strategic policy is implemented in day‐to‐day practice. This approach has uncovered the ways that individual health and social care practitioners work within institutional constraints to influence policy implementation at the micro‐level. Nonetheless, despite the diversity of settings where these street‐level bureaucrats (SLBs) work, little attention has been focused on the impact of place on policy delivery. This paper draws on empirical research to examine the ways that delivering government domestic abuse policy in the intimate space of the family home shapes the delivery of strategic policy in the everyday. Drawing on qualitative research with Health Visitors (HVs) in the UK in 2016, the study findings illuminate the ways that the material, socio‐spatial and idealised boundaries of the family home shape the implementation of policy. Key themes in the HV's narratives emerged as they described themselves as both a danger and in danger in the family home. In challenging the ontological security of the home (Giddens 1990) – privacy, security and control are key concepts here – HVs described how they shape their actions to achieve policy outcomes while simultaneously managing threats to the home, to professional identity and to self. [ABSTRACT FROM AUTHOR]

The National Institute for Health Research (NIHR) aims to improve national 'health and wealth' by providing infrastructural support to enable clinical research in National Health Service settings in England and Wales. Cognisant of the consequences of studies' failure to achieve required numbers of participants, it also actively campaigns to promote patient awareness of research, and willingness to participate in trials. In this paper, we analyse recent NIHR campaigns and policies designed to encourage patients to participate in clinical research to interrogate how they are implicated in the national bioeconomy. In doing so we expand the notion of 'clinical labour' to include the work of patient recruitment and highlight an emergent obligation on patients to contribute to research processes. Whereas once patient knowledge and experience may have been devalued, here we draw on the concept of 'assetisation' (Birch 2012) to explore the emergent relationship between healthcare system and patient as research participant. We consider how patients' contribution goes beyond the provision of standardised objects of valuation so that patients themselves may be perceived as assets to, not only recipients of, the national healthcare system. [ABSTRACT FROM AUTHOR]

Griffith Edwards played an important role in cannabis policy debates within government advisory committees in the United Kingdom from the early 1970s until the early 1980s. This has largely been hidden from public knowledge by the confidentiality of these committee discussions. The purpose of this paper is to use Griffith's writings and the results of recent historical scholarship to outline the views he expressed, the reasons he gave for them, and to provide a brief assessment of his contribution to the development of British cannabis policy. [ABSTRACT FROM AUTHOR]

Accessible summary People with learning disabilities find it difficult to get their health checked and to get information about their health., Community learning disability nurses play an important role in supporting people with learning disabilities to stay healthy., Community learning disability nurses support people with learning disabilities to get their health checked and to get information about their health., Summary International studies have shown poor uptake of public health initiatives by people with learning disabilities. In addition, studies have shown that people with learning disabilities experience poor access to public health services. The contribution of community learning disability nurses in meeting the public health needs of people with learning disabilities has evolved differently across the UK resulting in conflicting understanding of this role. This paper reports on a study that explored and explained the contribution of community learning disability nurses in the implementation of public health policies for people with learning disabilities. The study demonstrates that community learning disability nurses are involved in health surveillance, health promotion, health facilitation, health prevention and protection, health education, and healthcare delivery. [ABSTRACT FROM AUTHOR]

Persistent health inequalities pose a continued research and policy challenge in the United Kingdom and elsewhere. Current approaches to health research and promotion are predicated on a distinction between wider, social structural causes and individual, health‐related behaviours often conceived of as lifestyle choices. Drawing on Bourdieu's theory of social practice, this paper develops an integrated perspective by observing associations between health and structured lifestyle practices. Using the UK Understanding Society household survey, a taxonomy of eight lifestyle clusters is identified, which exhibit significant health inequalities on a number of indicators. But the plurality of practices and subjective orientations inherent in the taxonomy reveals a finer, more complex differentiation of the social gradient in health. In addition, lifestyle appears to at least in parts mediate the relationship between social, material conditions and health. A feature of the taxonomy is that it admits a relational and contextual apprehension of health‐relevant, behavioural aspects within a more holistic notion of lifestyles. Based on this view, strategic approaches can be developed that respond to group‐specific situations and pathways and their varying roots in upstream or downstream domains of policy. [ABSTRACT FROM AUTHOR]

Abstract: The notion of recovery has become prominent in mental healthcare discourse in the UK, but it is often considered as if it were a relatively novel notion, and as if it represented an alternative to conventional treatment and intervention. In this paper, we explore some of the origins of the notion of recovery in the early 20th century in movements such as Alcoholics Anonymous and Recovery Inc. Whilst these phenomena are not entirely continuous with recovery in the present day, some important antecedents of the contemporary notion can be detected. These include the focus on the sufferers’ interior space as a key theatre of operations and the reinforcement and consolidation of medical ways of seeing the condition without any immediate medical supervision of the actors being necessary. This has resonance with many contemporary examples of recovery in practice where the art of living with a mental health condition is emphasised without the nature of the psychopathological condition itself being challenged. [ABSTRACT FROM AUTHOR]

Background: Healthcare and support workers play a pivotal role in delivering quality services and support to people seeking sanctuary who have experienced poor physical and mental health linked to previous trauma, relocation and loss of freedoms. However, they often encounter various challenges in their daily work, ranging from communication barriers to resource constraints. This qualitative study seeks to delve into the perspectives of healthcare and support workers' experience of workarounds, employed to overcome barriers to providing care. Aim: This study aims to describe healthcare providers', practitioners' and health and third sector support workers' views on barriers and workarounds to providing care for people seeking sanctuary, to inform policy and practice. Design: A qualitative study was carried out using semi‐structured telephone interviews. Setting: This study focused on primary, secondary, community and specialist National Health Service (NHS) support services for people seeking sanctuary in Wales, United Kingdom (2018). Method: We interviewed 32 healthcare providers, practitioners and support workers employed by primary care and third sector organisations. Our approach involved obtaining verbal informed consent before digitally recording and transcribing all interviews. To analyse the data, we used the Four Levels of Change for Improving Quality model as a guiding framework for interpretation. Results: Our study findings reveal that certain respondents expressed challenges in meeting the needs of people seeking sanctuary; notably, their experience of delivering care differed by care settings. Specifically, those involved in providing specialist NHS care believed that there was room for improvement. Mainstream primary, secondary and community health practitioners faced limitations due to resource constraints and lacked tailored information to address the unique circumstances and needs of sanctuary seekers. To address these gaps, workarounds emerged at both individual and local levels (team/departmental and organisational level). These included establishing informal communication channels between providers, fostering cross service collaboration to fill gaps and adapting existing services to enhance accessibility. Conclusion: Understanding healthcare providers', practitioners' and support workers' perspectives offers invaluable insights into ways to enhance healthcare delivery to sanctuary seekers. Acknowledging challenges and harnessing innovative workarounds can foster a more effective and compassionate service for this vulnerable population. Patient or Public Contribution: The HEAR study actively involved public contributors in the design, delivery and dissemination of the research. Two public contributors (S. M. and G. R.) who had personal experience of seeking asylum served as study co‐applicants. They played pivotal roles in shaping the research by participating in its development and securing funding. Alongside other co‐applicants, S. M. and G. R. formed the Research Management Group, overseeing study delivery. Their contributions extended to strategic decision‐making and specific feedback at critical junctures, including participant recruitment, data collection, analysis and reporting. Additionally, S. M. and G. R. were instrumental in recruiting and supporting a team of peer researchers, enhancing respondent participation among people seeking sanctuary. To facilitate effective public involvement, we provided named contacts for support (A. K. and R. F.), research training, honoraria, reimbursement of expenses and accessible information in line with best practice. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to uncover perspectives on the COVID‐19 pandemic and the responses implemented by the UK and Scottish Governments to help control the spread of infection. Such understanding could help to inform future responses to pandemics at individual, community and national levels. Method: Q methodology was used to elicit perspectives from people in England and Scotland with different experiences of the pandemic including public health officials, key workers, those on furlough, those who were unvaccinated or vaccinated to different levels, those who were 'shielding' because they were at higher risk and people with different scientific expertise. Participants rank‐ordered phrases about different aspects of COVID‐19 according to their viewpoint. Factor analysis was then conducted in conjunction with interview material from the same respondents. Results: A four‐factor solution was statistically supported and was interpretable alongside the qualitative accounts of participants loading on these factors. These four perspectives are titled Dangerous and Unaccountable Leadership, Fear and Anger at Policy and Public responses, Governing Through a Crisis and Injustices Exposed. Conclusion: The four perspectives demonstrate plurality and nuance in views on COVID‐19 and the associated policies and restrictions, going beyond a binary narrative that has been apparent in popular and social media. The four perspectives include some areas of common ground, as well as disagreement. We argue that understanding the detail of different perspectives might be used to build cohesion around policy initiatives in future. Patient or Public Contribution: The development of the statement set, which is rank‐ordered by participants in a Q study, and factor interpretations were informed by views of the general public. The statement set was initially developed using existing publicly available material based on members of the general public experiencing the pandemic first hand. It was then piloted with members of the public experiencing different challenges as a result of COVID‐19 and the subsequent lockdown and updated based on feedback. Finally, interpretations of the identified factors were presented publicly and edited according to their feedback. [ABSTRACT FROM AUTHOR]

There has been considerable momentum within the NHS over the last 10 years to develop greater patient and public involvement (PPI). This commitment has been reflected in numerous policy initiatives. In patient safety, the drive to increase involvement has increasingly been seen as an important way of building a safety culture. Evidence suggests, however, that progress has been slow and even more variable than in health care generally. Given this context, the paper analyses some of the key underlying drivers for involvement in the wider context of health and social care and makes some suggestions on what lessons can be learned for developing the PPI agenda in patient safety. To develop PPI further, it is argued that a greater understanding is needed of the contested nature of involvement in patient safety and how this has similarities to the emergence of user involvement in other parts of the public services. This understanding has led to the development of a range of critical theories to guide involvement that also make more explicit the underlying factors that support and hinder involvement processes, often related to power inequities and control. Achieving greater PPI in patient safety is therefore seen to require a more critical framework for understanding processes of involvement that can also help guide and evaluate involvement practices. [ABSTRACT FROM AUTHOR]

This paper examines the professionalising of geriatric medicine in the UK roughly between the 1940s and the 1970s and locates it in terms of the broader context of the relationship between the professions and the state. It looks at how this relationship shaped geriatric medicine's professional jurisdiction, including the discourses of expertise on the one hand and the constituting of the 'subjects' of such expertise on the other. In contrast to other sociological approaches to the professions, which highlight the negative impact of state encroachment on professional territory, this paper contends that without the backing of the Ministry of Health the specialty may never have established itself in the face of prolonged opposition from rival specialists. However, such support was predicated on the specialty's highlighting particular legitimating discourses and practices at the expense of others, and in framing this in terms of specific policy concerns around an ageing population. Whilst this imprinted the profession with the stamp of governmentality, it also contributed to the broader problematising of old age in the twentieth century. The paper concludes by considering the legacy of this context of professionalisation for the profession today. [ABSTRACT FROM AUTHOR]

Tissue derived from the aborted fetus is considered ‘the right tool for the job’ in some stem cell laboratories. Relatively little is known of the arrangements in Britain for sourcing aborted fetuses for research purposes. This paper uses data from interviews with stem cell scientists, policy makers, tissue bankers, sponsors of stem cell research, clinicians and nurses, and ‘pro-choice’ and ‘pro-life’ activists to reconstruct the work involved in reconfiguring an ‘unwanted’ pregnancy into a source of fetal stem cells. A close scrutiny of the work allows the politics of collections to emerge. Aborted fetuses undergo a process of decorporealisation that enables scientists to claim them for their professional and economic advantage. The work, however, has consequences for women rhetorically through being reconfigured into a repository of usable fetal tissue, and, in some sites, materially, through alteration in method of abortion. [ABSTRACT FROM AUTHOR]

Decentralization is a central plank of current government health policy. However, it is possible to discern both centralist and decentralist movements in the UK. This paper examines existing frameworks of decentralization in relation to identifying whether policy is decentralist or not and identifies a number of problems that limit their value. Key problems relate to the way decentralization is conceptualized and defined. Existing frameworks are also highly contextualized and are therefore of limited value when applied in different contexts. The paper then presents a new framework which, it is argued, provides a more useful way of examining centralization and decentralization by providing a way of categorizing policies and actions and avoids the problems of being contextually constrained. The paper ends with a discussion of how the framework can be applied in a health context and shows how this framework helps avoid the problems found in previous discussions of decentralization. [ABSTRACT FROM AUTHOR]