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There are few examples of where co-design has been applied to active policy development on the scale or level of complexity of England's post-Brexit Environmental Land Management (ELM) schemes. ELM offers a fascinating 'laboratory' to analyse how co-design at this scale works in practice. This paper offers the first in-depth empirical assessment of the process from the perspectives of both the policy makers and stakeholders who were involved in the initial phase of ELM co-design from 2018 to 2020. Using interview data, we provide critical insights for both academics and government on 'pragmatic' applications of co-design to active policy development and reflect on what this tells us about the wider processes of policy development that may need to change in order to accommodate this more 'democratic' approach. Our analysis, which identified key barriers to co-design as articulated by institutional stakeholders and civil servants, revealed a mismatch between the principles and practices of 'co-design' in the initial development of ELM. These early-stage challenges included: (i) a lack of shared decision-making and empowering stakeholders to contribute to problem-definitions; (ii) confidentiality requirements that introduced barriers to information-sharing; (iii) insufficient transparency and feedback on what happened to stakeholder's contributions in terms of policy development; (iv) an absence of detail on the schemes, including proposed approaches, payment rates, advice, baseline measures, the kinds of 'outcomes' expected, and monitoring mechanisms; and (v) a repetition of themes that participants had already discussed. Many of these mismatches may be common to other policy arenas. We argue that improved application of policy co-design in government will rely on wider changes to political processes and the institutional culture and practices within the civil service. • England's Environmental Land Management (ELM) schemes are being co-designed. • This is a novel in-depth assessment of co-design applied to national policy making. • Analysis revealed mismatch between the principles and practices of ELM 'co-design'. • Co-design limited by lack of shared decision-making, feedback and details on schemes. • Policy co-design requires changes in government institutional cultures and practices. [ABSTRACT FROM AUTHOR]

Objectives: Gastrointestinal (GI) infections are common and most people do not see a physician. There is conflicting evidence of the impact of socioeconomic status (SES) on risk of GI infections. We assessed the relationship between SES and GI calls to two National Health Service (NHS) telephone advice services in England.Methods: Over 24 million calls to NHS Direct (2010-13) and NHS 111 (2013-15) were extracted from Public Health England (PHE) syndromic surveillance systems. The relationship between SES and GI calls was assessed using generalised linear models (GLM).Results: Adjusting for rurality and age-sex interactions, in NHS Direct, children in disadvantaged areas were at lower risk of GI calls; in NHS 111 there was a higher risk of GI calls in disadvantaged areas for all ages (0-4 years RR 1.27, 95% CI 1.25-1.29; 5-9 years RR 1.43, 95% CI 1.36-1.51; 10-14 years RR 1.36, 95% CI 1.26-1.41; 15-19 years RR 1.59, 95% CI 1.52-1.67; 20-59 years RR 1.50, 95% CI 1.47-1.53, 60 years and over RR 1.12, 95% CI 1.09-1.14).Conclusions: Disadvantaged areas had higher risk of GI calls in NHS 111. This may relate to differences in exposure or vulnerability to GI infections, or propensity to call about GI infections. [ABSTRACT FROM AUTHOR]

Estuaries are amongst the most socio-economically and ecologically important environments however, due to competing and conflicting demands, management is often challenging with a complex legislative framework managed by multiple agencies. To facilitate the understanding of this legislative framework, we have developed a GISbased Estuarine Planning Support System tool. The tool integrates the requirements of the relevant legislation and provides a basis for assessing the current environmental state of an estuary as well as informing and assessing new plans to ensure a healthy estuarine state. The tool ensures that the information is easily accessible for regulators, managers, developers and the public. The tool is intended to be adaptable, but is assessed using the Humber Estuary, United Kingdom as a case study area. The successful application of the tool for complex socio-economic and environmental systems demonstrates that the tool can efficiently guide users through the complex requirements needed to support sustainable development. [ABSTRACT FROM AUTHOR]

It is widely recognized that there is a global need for a transition towards more sustainable forms of agriculture. In order for such a transition to be socially sustainable, its input (problem and goal formulation), output (policy instruments), and throughput (processes) need to be perceived as legitimate. However, we currently know relatively little on how to legitimize normatively shaped transition processes and their outcomes. We aim to address this knowledge gap by examining how the governance of agricultural transitions can be shaped to improve the perceived legitimacy of the transition. Through a combined lens of normative and sociological approaches to legitimacy we investigate the English post-Brexit agricultural transition as a crucial case-study. Building on a policy analysis and semi-structured interviews we find that in order to create perceived legitimacy of agricultural transitions, both in the English case and for agricultural transitions generally, clarity and diversity in design is essential. In addition, in order to take account of the normative and political nature of agricultural transitions, our study highlights the importance of a broad problem formulation, a diverse mix of instruments, and a process that is transparent and includes stakeholders in a meaningful and equal way. We conclude that a combined lens of normative and sociological legitimacy forms a useful framework for future research to critically evaluate the normative and power dimensions of transition processes. In addition, it can support governments in their efforts to develop policies for agricultural sustainability transitions that will be accepted by society. • We need agricultural transitions but we know little on how to legitimize them. • Combining normative and sociological legitimacy helps to address this knowledge gap. • Legitimacy can be increased through clarity, diversity and meaningful inclusion. • The English agricultural transition currently falls short on the key criteria. [ABSTRACT FROM AUTHOR]

This study examines the possible benefits of using mobile phones to increase interaction and promote active learning in large classroom settings. First year undergraduate students studying Cellular Processes at the University of East London took part in a trial of a new text-based classroom interaction system and evaluated their experience by anonymous questionnaire. Learning gains were measured using pre- and post- tests and interaction with the lecturer was monitored in both Text and non-Text enabled lectures. Learning gains and class- room interactions were not increased by the introduction of the text-messaging system in this instance. However, the system was generally well received, with 71% of students reporting that they would like to see it used again. Those students in particular who were found to be more likely to fear initiating classroom interaction reported most satisfaction with the introduction of the in-class text system suggesting this mode of communication may enhance inclusivity and empower students to interact who normally would not. [ABSTRACT FROM AUTHOR]

The extensive analytical literature on human remains in museums has thus far been dominated by questions of repatriation and reburial. But how should those remains that are retained be treated? In this piece authors with different disciplinary perspectives explore the arguments for and against the display of human remains. We offer no definitive conclusion, but rather a respectful dissensus. [ABSTRACT FROM AUTHOR]

The article offers information on the youth movement and government policies for youth in Wales and England. It states that until 1999, the youth service in Wales was linked to youth service in England and its main exemptions were the development of the Curriculum Statement for Youth Work in Wales and the setting up of the independent Education and Training Standards Committee for Wales in 1994. It explains that as a result of the link to England, a number of opportunities were missed to examine variance cultivated by distinctive social, political, and economic differences between the two countries and its effect on youth service in Wales.

In the discourse on how to deploy additional adults towards the achievement of classroom learning environments that are more inclusive in Ireland, a comparative study with England is useful. This article gives an account of a completed element of a wider study comparing the work of teaching assistants in England with that of special needs assistants in Ireland. While the two educational contexts differ systemically and developmentally, many of the variables at play on this issue are common to both. [ABSTRACT FROM AUTHOR]

The article discusses the use of family workers in two secondary schools in England and considers how service users perceived such system. The author examines how the role of family workers had been developed within those schools and their impact on students, parents and the schools themselves. The responsibility of family workers appointed to the schools is described. It notes that family workers were perceived as providing valuable support to parents, students and the schools as a whole, as demonstrated in the positive comments from service users.

The growth of Foundation Degree qualifications in the UK (HEFCE, 2007) has lead to a more active view of employer engagement with Higher Education. Many full time Foundation Degree students are now taking up work placements with employers as part of their study. As a result, a three-way conversation between learners, employers and tutors needs to take place on an ongoing basis throughout placements. An online environment utilising blogs, e-portfolio and online work-based contracts can facilitate this 'conversation'. Employers can be further supported through provision of online materials to support the process of mentor training. This paper reports on an HE Academy, ICS funded mini-project to create such an environment at Hull College for students on the Foundation Degree course in Software Design and Development. The project is still underway, and is in the middle of its year-long span. The environment has been chosen, developed and tested. The next phase will be to use the system for work-placement study. This paper outlines the use of Elgg as a means of maintaining communication with students, employers and tutors and encouraging reflection during Foundation Degree work placements. We aim to present the experience of using the online environment at the 8th Annual Conference of the ICS HE Academy in August. [ABSTRACT FROM AUTHOR]

The article discusses whether mob violence in 18th-century Birmingham, England can be seen as an antecedent of the more organized English working-class radicalism of the early 19th century. A main interpretive point of reference is the work of the British historians E. J. Hobsbawm and George Rudé on crowd behavior in the pre-industrial and "pre-political" era, before the lower classes had formal political representation. Riots and other disturbances in the 18th century are compared to the organized agitation leading up to the 1832 Reform Bill.

Since the days of Karl Marx, England has been regarded as preeminently the country in which class should provide the basis of political divisions, especially in the absence of large coloured, linguistic, regional or religious minorities. Yet after passing through the crises of industrialization and the democratization of the franchise in the 19th century, there was still no working-class party. The gradual rise of the Labour Party since 1900 has been marked by two factors. 1) A lagged response to Labour among working-class electors because of the consequences of inter-generational transmission of party loyalties. This proposition about voting in the past is supported by survey data from the present. 2) A readiness of traditional elites to assimilate working-class leaders into the existing regime, and the desire of such leaders to alter themselves, rather than the basic structure of society. Analysis of contemporary elite data indicates that assimilation of Labour leaders continues on the basis of a shared professional class training. [ABSTRACT FROM AUTHOR]

The article presents a study which questioned the validity of the statistical techniques used in previous studies of delinquent generations, and suggested some alternative interpretations of the trends in crime for young males in England and Wales. The statistic analysed by Leslie T. Wilkins was the rate "number of persons found guilty of indictable offences per 100,000 population at risk." Analysis in this section will also be confined to tliis statistic as it applies to males; the statistic will be referred to as "rate found guilty" and is tabulated for single ages for the complete period 1946-1965. A.A. Walters picked out two predominant trends in these rates for the period 1946-57. These were (a) a marked decline in the rates found guilty for young males (i.e. 8-11 year olds) from 1951 to 1957; and (b) a rise in the rates found guilty for young men (i.e. 17-20 year olds) in the years 1956 and 1957. From the analyses, three observations will be made: a) The tendency for positive values to cluster in the middle of the set of birth-groups is evident, especially as the values in the first and fourth quartiles are in each case predominantly negative and those in the second and third quartiles are predominantly positive; b) The seven birth-groups 1935/6- are no exceptions to the hypothesis, and follow the pattern laid down in terms of quartiles very closely i.e. in general, when a birth-group appears in the first or fourth quartile of an analysis it has a negative average deviation, and when it appears in the second or thirt quartile it has a positive average deviation; ) For each of the birth-groups for which two or more average deviations may be compared there are considerable differences.

Background: Family history is an important risk factor for many common chronic diseases, but it remains underutilised for diagnostic assessment and disease prevention in routine primary care., Aim: To develop and validate a brief self-completed family history questionnaire (FHQ) for systematic primary care assessment for family history of diabetes, ischaemic heart disease, breast cancer, and colorectal cancer., Design and Setting: Two-stage diagnostic validation study in 10 general practices in eastern England. Method Participants aged 18-50 years were identified via random sampling from electronic searches of general practice records. Participants completed a FHQ then had a three-generational 'gold standard' pedigree taken, to determine disease risk category. In stage 1, the FHQ comprised 12 items; in stage 2 the shorter 6-item FHQ was validated against the same 'gold standard'., Results: There were 1147 participants (stage 1: 618; stage 2: 529). Overall, 32% were at increased risk of one or more marker conditions (diabetes 18.9%, ischaemic heart disease 13.3%, breast cancer 6.2%, colorectal cancer 2.2%). The shorter 6-item FHQ performed very well for all four conditions: pooled data from both stages show diabetes, sensitivity = 98%, specificity = 94%; ischaemic heart disease, sensitivity = 93%, specificity = 81%; breast cancer, sensitivity = 81%, specificity = 83%; colorectal cancer, sensitivity = 96%, specificity = 88%, with an area under the receiver operating characteristic curve of 0.90 for males and 0.89 for females., Conclusion: This brief self-completed FHQ shows good diagnostic accuracy for identifying people at higher risk of four common chronic diseases. It could be used in routine primary care to identify patients who would be most likely to benefit from a more detailed pedigree and risk assessment, and consequent management strategies.

Background: Venous thromboembolism comprising pulmonary embolism and deep vein thrombosis is a common condition with an incidence of approximately 1 per 1,000 per annum causing both mortality and serious morbidity. The principal aim of treatment of a venous thromboembolism with heparin and warfarin is to prevent extension or recurrence of clot. However, the recurrence rate following a deep vein thrombosis remains approximately 10% per annum following treatment cessation irrespective of the duration of anticoagulation therapy. Patients with raised D-dimer levels after discontinuing oral anticoagulation treatment have also been shown to be at high risk of recurrence.Post thrombotic syndrome is a complication of a deep vein thrombosis which can lead to chronic venous insufficiency and ulceration. It has a cumulative incidence after 2 years of around 25% and it has been suggested that extended oral anticoagulation should be investigated as a possible preventative measure., Methods/design: Patients with a first idiopathic venous thromboembolism will be recruited through anticoagulation clinics and randomly allocated to either continuing or discontinuing warfarin treatment for a further 2 years and followed up on a six monthly basis. At each visit D-dimer levels will be measured using a Roche Cobas h 232 POC device. In addition a venous sample will be taken for laboratory D-dimer analysis at the end of the study. Patients will be examined for signs and symptoms of PTS using the Villalta scale and complete VEINES and EQ5D quality of life questionnaires., Discussion: The primary aim of the study is to investigate whether extending oral anticoagulation treatment (prior to discontinuing treatment) beyond 3-6 months for patients with a first unprovoked proximal deep vein thrombosis or pulmonary embolism prevents recurrence. The study will also determine the role of extending anticoagulation for patients with elevated D-dimer levels prior to discontinuing treatment and identify the potential of D-dimer point of care testing for identification of high risk patients within a primary care setting., Trial Registration: ISRCTN73819751.

Background: The National Health Service Bowel Cancer Screening Programme is to be introduced in England during 2006. General Practitioners are a potentially important point of contact for participants throughout the screening process. The aims of the study were to examine GPs' attitudes and information needs with regard to bowel cancer screening, with a view to developing an information pack for primary care teams that will be circulated prior to the introduction of the programme., Methods: 32 GPs participated in semi-structured telephone interviews. 18 of these had participated in the English Bowel Screening Pilot, and 14 had not. Interviews covered attitudes towards the introduction of the Bowel Cancer Screening Programme, expected or actual increases in workload, confidence in promoting informed choice, and preferences for receiving information about the programme., Results: GPs in the study were generally positive about the introduction of the Bowel Cancer Screening Programme. A number of concerns were identified by GPs who had not taken part in the pilot programme, particularly relating to patient welfare, patient participation, and increased workload. GPs who had taken part in the pilot reported holding similar concerns prior to their involvement. However, in many cases these concerns were not confirmed through GPs experiences with the pilot. A number of specific information needs were identified by GPs to enable them to provide a supportive role to participants in the programme., Conclusion: The study has found considerable GP support for the introduction of the new Bowel Cancer Screening Programme. Nonetheless, GPs hold some significant reservations regarding the programme. It is important that the information needs of GPs and other members of the primary care team are addressed prior to the roll-out of the programme so they are equipped to promote informed choice and provide support to patients who consult them with queries regarding screening.

Objectives: To obtain prevalence rates of hip and knee pain in elderly people and compare combinations of symptoms with overall health status., Methods: We performed a cross-sectional postal survey of a random sample of 5500 Oxfordshire residents aged 65 yr and older. Prevalence estimates were based on the screening question: 'During the past 12 months, have you had pain in or around either of your hip/knee joints on most days for one month or longer?' Overall health status was assessed with the SF-36 questionnaire., Results: The response rate was 66.3% (3341/5039 eligible people), and was highest (approximately reverse similar 72%) for the 65-74 yr age-group. The percentage reporting hip pain was 19.2% [95% confidence interval (CI) 17.9-20.6], and 32.6% (95% CI 31.0-34.3) reported knee pain. The percentage reporting hip and knee pain was 11.3%, and 40.7% reported hip or knee pain. Less than half (48%) of the symptomatic respondents had unilateral problems affecting one hip or knee joint only. SF-36 scores worsened as the number of symptomatic hip and knee joints increased (P<0.001 for physical function, physical role limitation and bodily pain)., Conclusions: Patterns of hip and knee symptoms are complex in older people. Amongst the symptomatic, most have more than one hip/knee affected. This has implications for treatment and health status measurement. In the absence of hip and knee symptoms, general health status scores of elderly people are similar to those of people aged under 65 yr.

The UK government's clinical governance strategy places emphasis on the provision of evidence-based, effective and client-focused care. This provided the framework for developing nurse-led venepuncture and immunization clinics. Evidence from research and examples of good practice were used to guide the structure and ethos of the new service. The professional development required to train one staff member in venepuncture and immunization techniques was adapted from already existing training. A specific training package was then developed to facilitate professional development of further staff. Audit was used, both to identify the need for the service and to assess its quality and cost-effectiveness. Consumer views were obtained through informal discussion and interviews with parents. This article explores how the concepts of clinical governance, together with the commitment of the multi-professional team, have resulted in a transformation of care for children undergoing invasive procedures in the outpatient department.

Background: It has been suggested that primary care should become more involved in providing genetic services, such as basic risk assessment, to enable patients with a moderate/high risk to be referred and those with a low risk to receive reassurance and advice from their general practitioner (GP). However, GPs currently lack knowledge and confidence in this area., Aim: To investigate the effect of an in-practice educational session and information pack on GP management of familial breast/ovarian cancer cases., Design of Study: Cluster randomised controlled trial., Setting: GP principals in 170 practices in Oxfordshire and Northamptonshire. Of the 688 GPs, 426 (62%) participated., Method: Practices were randomised either to Group A (receiving an inpractice educational session plus information pack), Group B (receiving an information pack alone), or Group C (receiving neither an educational session nor a pack). The main study outcome was the proportion of GPs making the correct referral decision on at least five out of six family history vignettes. A secondary outcome was GPs' reported confidence in managing patients with a family history of breast/ovarian cancer, measured by a score that was generated by combining responses to four questions., Results: There was a 40% (95% CI = 30-50%, P < 0.001) improvement in the proportion of GPs who made the correct referral decision on at least five out of the six vignettes in Group A (111/140 [79%]) compared with Group C (controls) (63/162 [39%]), and a 42% (95% CI = 31-52%, P < 0.001) improvement in Group B (100/124 [81%]) compared with the control group. There was a trend in reported confidence in the management of individuals with a family history of breast/ovarian cancer from a mean confidence score of 2.3 in Group A to 2.0 in Group B and 1.5 in Group C (P < 0.001)., Conclusion: Providing GPs with an information pack significantly improved referral decisions regarding patients with a family history of breast/ovarian cancer. Although extremely well received, an in-house educational session produced no additional improvements. There were, however, greater levels of reported confidence in the group who received the educational session in addition to the information pack.

Objectives: The aim of this study was to see whether guidelines on whom to refer to a regional genetics service could improve the appropriateness of referrals to the service. It also aimed to assess whether the genetic clinic assessment of risk agreed with that described in the GP letter., Methods: Referral guidelines were sent to all Oxfordshire GPs and the subsequent content of the referral letters was analysed. A retrospective assessment of referral letters sent during the 6 months before dissemination was also made., Results: The study showed that post-guidelines, fewer "lower risk" referrals were made and that the description of the risk in the GP letter improved, so that a greater proportion of genetic clinic risks agreed with those described in the GP letter., Conclusion: The use of referral guidelines can help GPs to act as gatekeeper for referrals to secondary care.

Background: General practitioner (GP) records are increasingly being used as sources of information on potential confounders such as smoking use and alcohol intake in epidemiological studies. The aim of this study was to assess the accuracy of GP records on smoking use and alcohol intake compared with data from patient questionnaires., Methods: Patients registered with 42 practices in Oxfordshire that agreed to take part in a post-marketing surveillance study of omeprazole were sent a postal questionnaire that included questions about alcohol and tobacco use. Two years later, data on these aspects of lifestyle were abstracted from the GP records., Results: A total of 892 patients agreed to take part in the study; 804 (90 per cent) completed the postal questionnaire, and the records of 856 (96 per cent) were reviewed. Information on smoking and alcohol use was present in 74 per cent and 63 per cent of GP records, respectively. Agreement between the two data sources was moderate for both smoking (kappa = 0.50) and alcohol use (kappa = 0.52). With regard to smoking, the main discrepancy between the two data sources was that 46 per cent (94/206) of patients who reported themselves as exsmokers were recorded as being never smokers in the GP record. With regard to alcohol, there were no systematic differences between the two data sources., Conclusion: Data from GP records on smoking status and alcohol use are incomplete and subject to some misclassification. This is a source of potential failed adjustment for confounding, which should be considered in epidemiological studies that make use of these records.