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This article focuses on young low-income mothers’ engagement with, and management of, potentially conflicting discourses within the context of maternal foodwork. Findings from qualitative, longitudinal interviews with 13 UK women illustrate the performance of identity and family work, in relation to infant feeding and wider maternal practices. Each participant was interviewed twice, once prior to, and then following, the birth of their first baby. We identify three rhetorical strategies. Adopting and resisting allow for the acceptance or rejection of prominent infant feeding discourses. Under reframing, young women transform the encouragement to breastfeed, subverting or reversing official discourses. Reframing thus provides an alternative means to appropriate and deploy versions of good motherhood, drawing on women’s lived realities and local maternal cultures, alongside wider experiences of building and managing family relationships.

Neoliberalism, austerity and health responsibilisation are increasingly informing policies and practices designed to encourage older patients to take responsibility for the management of their own healthcare. Combined with an ageing population, novel ways to address the increasing healthcare needs of older people have become a priority, with the emergence in recent years of new models of integrated care enhanced by combinatorial health technologies (CHTs). This paper presents qualitative findings from the evaluation of one programme, the Lancashire and Cumbria Innovation Alliance (LCIA) Test Bed, a programme funded by NHS England and conducted in England between 2016 and 2018.Drawing on data from patients, family carers, and staff members involved in the programme, this paper explores the extent to which CHTs, as part of the LCIA Test Bed programme, contributed to health responsibilisation amongst older people with complex health conditions. Through this programme, we find that relationships between patients, family carers and healthcare professionals combined to create a sense of reassurance and shared responsibility for all parties. Our findings suggest the need for a more nuanced approach to responsibilisation and self-management for older people living with complex health conditions. By focusing on co-management – and recognising the potential of CHTs to facilitate this approach – there is potential to increase patient confidence in managing their health condition, reduce carer burden, and enhance clinician satisfaction in their work roles. While neoliberal agendas are focused on self-management and self-responsibility of one's own health care, with technology as a facilitator of this, our findings suggest that the successful use of CHTs for older people with complex health conditions may instead be rooted in co-management. This paper argues that co-management may be a more successful model of care for patients, carers and clinicians.

Our objective was to determine the efficacy and feasibility of a new approach for identifying candidate biomarkers for knee osteoarthritis (OA), based on selecting promising candidates from a range of high-frequency acoustic emission (AE) measurements generated during weight-bearing knee movement. Candidate AE biomarkers identified by this approach could then be validated in larger studies for use in future clinical trials and stratified medicine applications for this common health condition. A population cohort of participants with knee pain and a Kellgren-Lawrence (KL) score between 1-4 were recruited from local NHS primary and secondary care sites. Focusing on participants’ self-identified worse knee, and using our established movement protocol, sources of variation in AE measurement and associations of AE markers with other markers were explored. Using this approach we identified 4 initial candidate AE biomarkers, of which “number of hits” showed the best reproducibility, in terms of within-session, day to day, week to week, between-practitioner, and between-machine variation, at 2 different machine upper frequency settings. “Number of hits” was higher in knees with KL scores of 2 than in KL1, and also showed significant associations with pain in the contralateral knee, and with body weight. “Hits” occurred predominantly in 2 of 4 defined movement quadrants. The protocol was feasible and acceptable to all participants and professionals involved. This study demonstrates how AE measurement during simple sit-stand-sit movements can be used to generate novel candidate knee OA biomarkers. AE measurements probably reflect a composite of structural changes and joint loading factors. Refinement of the method and increasing understanding of factors contributing to AE will enable this approach to be used to generate further candidate biomarkers for validation and potential use in clinical trials.

Background: The recent development of techniques to measure high-frequency acoustic emission (AE) from knees has opened up the possibility of identifying AE features which reflect the integrity of interactions between joint components during weight bearing movement. The objective of this study was to determine whether novel candidate biomarkers, based on AE measurements, can be identified for future use in clinical trials and stratified medicine applications for knee osteoarthritis (OA). We focused on testing the reproducibility of candidate AE biomarkers and their association with other markers, using a cohort approach. Methods: Participants with knee pain and KL scores between 1-4 were recruited from local NHS primary and secondary care organisations. AE data were collected and analysed from the worse knee, as identified by each participant, using our established sit-stand-sit movement protocol. Variation in AE measurement was analysed in 45 participants by fitting two linear mixed effects models. In addition to random effects terms for practitioners and visits, respectively, both models included a fixed effect term for the AE machines and random effects terms to capture between-participant variability and residual error. Associations with other markers were tested in 68 participants by fitting a linear mixed effects model for each candidate biomarker. The model included fixed effects for the covariates of interest, a participant-specific random effect that accounts for correlation between repeated measurements within the same individual, and a residual error term. A multiple regression model was developed using forward selection based on the likelihood ratio test with a cut-off for significance of p < 0.1. Results: Of four candidate AE biomarkers tested, AE number of hits showed the best reproducibility profile regarding variation within session, day to day, week to week, between practitioner, and between machines. AE number of hits was higher in people with KL2, 3 or 4 scores than in those with KL1. Hits occurred predominantly in two of the four pre-defined sit-stand movement quadrants. AE number of hits also showed significant associations with contralateral knee pain, and with body weight. The protocol used was feasible and acceptable to all participants and health professionals involved. Conclusion: Measurement of AE hits using a simple sit-stand-sit movement protocol offers a novel and convenient approach for assessing the integrity of interactions between joint components during weight bearing movement. AE number of hits offers a novel potential knee OA biomarker for use in large multicentre clinical trials of knee OA treatments. AE measurement may reflect a composite of knee structural changes and joint loading factors. Refinement of the method may further strengthen the utility of the AE approach for clinical trials. This approach may also have applications for monitoring knee OA in primary care.

Intensive parenting debates reflect the critical importance of a child’s early years, and parents’ roles in determining later developmental outcomes. Mothers are usually assigned primary responsibility for facilitating their infants’ cognitive development through adequate and appropriate sensory stimulation. Drawing on Foucault’s technologies of the self, this article explores how new mothers shape their mothering practices in order to provide appropriately stimulating interactions. Using findings from 64 interviews (31 women were interviewed twice, 2 women were interviewed only once) three main positions are identified of how mothers function in relation to their infants’ development: mother as committed facilitator, creative provider and careful/caring monitor. The study considers the perceived normative nature of these positions and the impact they can have on middle-class women’s subjectivities as new mothers. This analysis of parental agendas and infant cognitive development suggests that a continued focus on the mother’s role within early infant development reflects and upholds ideologies of child-centred, intensive mothering, which risks precluding ‘alternative’ maternal subjectivities and promotes conservative feminine identities.

Ways to address the increasing healthcare needs of older people are a priority for the National Health Service (NHS) in England. The NHS England Test Bed programme was designed to trial new models of care that are supported by digital health technologies. This paper reports on findings from one Test Bed programme, the Lancashire and Cumbria Innovation Alliance (LCIA) – a partnership between NHS England, industry and Lancaster University, which ran from 2016 to 2018. A key aim of the LCIA Test Bed was to explore the extent to which supported self-care telehealth technology helped older people with long-term conditions to better self-manage their own care, promoting independence and enabling them to remain at home for longer. Each patient received a combination of health technologies over a six-month period. This paper presents results from the qualitative data that formed part of a large-scale mixed-methods evaluation. Specifically it draws on the analysis of 34 observational interviews with 17 participants with chronic obstructive pulmonary disease (COPD) to understand the role of these technologies in the self-management of their care. The data revealed that the majority of participants felt more confident about self-managing COPD as a result of their participation in the programme. These increases in confidence were the result of participants’ increased knowledge and skills in managing their COPD. The paper demonstrates how patients learned to better manage their respiratory condition, the impact of this learning on their daily lives and that of their family carers, and the implications for healthcare practice.

Risk assessment forms an integral part of clinical practice. Traditionally, risk has been portrayed as a binary concept, and its assessment regarded as a test that can be correctly or incorrectly classified. However, this article discusses how risk assessments are less straightforward than is commonly perceived and are often complicated by multiple forms of uncertainty. These uncertainties arise where psychiatrists are unsure about their interpretation of information, where information is missing, or where interpretation of the risk situation is open to challenge. They centre on doubts about the accuracy and the defensibility of assessment of patients' risk status and the need for risk containment. Like other professionals, psychiatrists adopt a range of strategies to resolve uncertainties. These strategies, which often involve some ‘risk-taking’, enable the practising clinician to make a more confident decision. There is an argument for including ‘certainty’ as a theoretical feature of risk assessment in psychiatry and for recognising it as a multifaceted phenomenon. There is also an argument for considering with greater precision the manner in which uncertainty is managed within psychiatric risk assessments.

Teenage mothers find themselves caught between two discourses: the irresponsibility of youth and the responsibility of motherhood. We unravel some of the complexities surrounding the performance of socially approved ‘good mothering’, from a social position of restricted resources. We demonstrate the relevance of Skeggs’ (1997) notion of respectability in order to forge a deeper understanding of how young, low-income new mothers seek to secure social value and legitimacy via the marketplace. We identify a number of consumption strategies centred around identification and dis-identification, yet we recognize that young mothers’ careful marshalling of resources, in relation to consumption, risk being misread and could leave young women open to further scrutiny and negative evaluation, ultimately limiting their opportunity to secure a legitimate maternal identity.

The formal justifications for all detentions under s.2 of the Mental Health Act 1983 within an inner-city mental health trust were examined over a 12-month period. The study explored: the nature of the justifications for detention; the extent to which these were associated with patient characteristics; and the extent to which the two medical practitioners involved in each case agreed on the justifications. The justifications reflected a greater emphasis on the protection of the individual concerned rather than the protection of others. A content analysis of the textual justifications revealed five broad themes: the nature of the risk posed by the patient; the patient's capacity to provide informed consent; their need for hospitalization; their lack of consent to informal admission; and their reliability or likely compliance. There was a significant association between patients' sex, ethnic group, diagnosis and the nature of risk indicated in the documentation, but further research is needed to clarify the nature of this association. The study found that in nearly a quarter of cases, the two professionals did not agree about whether or not the patient presented a danger to others. This lack of agreement was not associated with any patient or professional characteristics, and may reflect the complexity of this area of risk assessment. The authors suggest that the issue of ‘risk’ needs to be addressed in a more sophisticated manner within the Mental Health Act. Specifically, further guidance is needed as to the nature and levels of risk that constitute grounds for detention. Further guidance is also needed regarding the issues that need to be recorded on the legal documentation for detention.

A retrospective case note study explored readmissions to an acute psychiatric in-patient unit within six months of discharge. The study aimed to calculate a hospital readmission rate, to investigate the timing of readmissions, and to identify risk factors associated with readmission. The readmission rate was 27% with the majority of readmissions occurring within three months after discharge, suggesting the need for investigation of such early readmissions. The three factors found to predict readmission were: discharge against medical advice, number of previous admissions, and living alone or with family rather than in care. Implications for hospital service planning are considered.