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Drawing on in-depth qualitative interviews with 15 people who have learning disabilities, brain injuries, neurodiversity, or mental health conditions accused of a crime in Scotland, this article offers substantive and methodological insights to unpacking perceptions of justice accessibility. We explore barriers to participation in pretrial justice processes for disabled accused people, demonstrating that disabled people are systematically denied a voice and disadvantaged by poor identification and recognition of impairment, insufficient supports or adjustments, and inaccessible information. We discuss participants’ accounts of feeling excluded from, and intimidated by, systems and decisions that are not routinely explained in accessible terms, which, in turn, adversely impacts access to justice and perceptions of fairness. Informed by criminology and disability studies, we argue that the failure of criminal justice systems and practices to acknowledge disability as an equality issue creates disabling barriers that serve to further marginalise disabled people within justice settings.

Cohort studies of patients with pectus excavatum have inadequately characterised exercise dysfunction experienced. Cardiopulmonary exercise test data were delineated by maximal oxygen uptake values >80%, which was tested to examine whether patterns of exercise physiology were distinguished.MethodsSeventy-two patients considered for surgical treatment underwent assessment of pulmonary function and exercise physiology with pulmonary function tests and cardiopulmonary exercise test between 2006 and 2019. Seventy who achieved a threshold respiratory gas exchange ratio of >1.1 were delineated by maximal oxygen uptake >80%, (group A, n=33) and ResultsThe cohort was 20.8 (±SD 6.6) years of age, 60 men, with a Haller’s Index of 4.1 (±SD 1.4). Groups A and B exhibited similar demography, pulmonary function test results and Haller’s index values. Exercise test parameters of group B were lower than group A; work 79.2% (±SD 11.3) versus 97.7 (±SD 10.1), anaerobic threshold 38.1% (±SD 7.8) versus 49.7% (±SD 9.1) and O2 pulse 77.4% (±SD 9.8) versus 101.8% (±SD 11.7), but breathing reserve was higher, 54.9% (±SD 13.1) versus 44.2% (±SD 10.8), pConclusionThis study showed that patients with pectus excavatum exhibited multiple physiological characteristics of compromised exercise function. It is the first study that defines differing patterns of exercise dysfunction and provides evidence that patients with symptomatic pectus excavatum should be considered for surgical treatment.

This paper describes a programme of survey and excavation at the scheduled site of Church Place, Denny Wait in the New Forest that took place in 2016 and 2017 with a team from the University of Winchester. The extant earthworks at the site have been long considered to represent one of the royal hunting lodges built in the 14th century by command of Edward III, and is one of eight similar sites across the New Forest. While dating evidence was retrieved that confirm a 14th/15th century date for the earthworks, which share physical characteristics with other lodge sites in the forest, excavations indicate that the site was never the focus of high status activity. Of particular interest is the fact that the results do not actually support significant activity at the site of any kind, suggesting a far more temporary and occasional use of it, such as an ancillary encampment (eg for beaters), or as a meeting place. The work at the site unexpectedly also produced evidence of a previously unknown prehistoric enclosure underlying the medieval remains, probably dating to the Late Neolithic or Early Bronze Age.

Background: Anti-welfare narratives depict welfare systems as overly-permissive, open to fraud, and fundamentally unfair. Countering these supposed ills have been political appeals to evidence and reforms made to disability benefit assessments under the banner of objectivity. But objectivity is a complex construct, which entails philosophical and political choices that tend to oppress, exclude and symbolically disqualify alternative perspectives. Aims and objectives: To examine reforms made to UK disability benefits assessments in the name of objectivity. Methods: Thematic analysis of 50 in-depth qualitative interviews with UK disability benefit claimants. Findings: Reforms made in pursuit of procedural objectivity reproduce existing social order, meaning claimants without personal, social and economic resources are less likely to succeed. Data reveal an increasingly detached and impersonal assessment process, set against a broader welfare landscape in which advocacy and support have been retrenched. In this context, attaining a valid and reliable assessment was, for many, contingent upon personal, social and economic resources. Discussion and conclusions: Political appeals to evidence helped establish an impetus and a legitimising logic for welfare reform. Procedural objectivity offers superficially plausible, but ultimately specious, remedies to longstanding anti-welfare tropes. Despite connotations of methodological neutrality, procedural objectivity is not a politically neutral epistemological standpoint. To know disability in a genuinely valid and reliable way, knowledge-making practices must respect dignity and proactively counter exclusory social order. These latter principles promise outcomes that are more trustworthy by virtue of their being more just.

One challenge for the Ford chassis research team in the recent past was to investigate lightweight solutions for the upcoming Transit platform, for the end customer benefits of higher payload, reduced emission and better fuel consumption. As first application within the platform, the Camper /Motorhome was chosen. One of the promising items which was looked at were the rear longitudinal leaf springs. Replacing the standard steel springs with equivalent parts in composite material, generated a weight saving of about fifty percent, or about fifteen kilograms per vehicle. The spring had to be entirely redesigned, to obtain best in class performance, considering the new material properties and limitations. The project covered all the necessary steps, from the first research state to series implementation. Three important aspects which are discussed here are the design, the testing and finally the manufacturing process.

Transition to adulthood for young disabled people remains a major policy failure across OECD countries. The support available is often inappropriate, fails to meet young peoples’ needs and they fall through the cracks, becoming lost in the system. Much of the work on transition takes a narrow approach, focussing on the shift from paediatric to adult services in health and social care. Drawing on interviews with young disabled people, collected as part of an evaluation of a new cash-based transitions fund, we explore transitions for young disabled people in Scotland. Like the wider personalisation agenda, this fund aims to promote autonomy and individual responsibility. We examine and critique this approach and argue that while the emphasis on young people and their families as social entrepreneurs can facilitate transition, it can also act as a barrier by failing to tackle broader structural constraints faced by young disabled people. We argue that whilst it is important to promote individual agency, structural disadvantage and inequality frame the transition process and these also have to be tackled. This is harder, and arguably more expensive, but without it there is a danger that attempts to improve transition for young disabled people will fail.

The emergence of the ultralightweight wheelchair has transformed the lives of millions of disabled people. It has radically changed the principles and practices of wheelchair design, manufacture, and prescription and redefined wheelchair users and wheelchair use. Designed and built largely by wheelchair users themselves, it was driven initially by a desire to improve sport performance and later by a wish for improved access to the community and built environment. In this paper, we draw on oral histories and documentary sources to reconstruct its sociotechnical history. We employ the analytical concept of “boundary object” to illuminate how the wheelchair as a technological artifact is implicated in relations of social change and show the role of wheelchair users in the development and emergence of the ultralightweight wheelchair. We highlight the tensions and negotiations within this history and the push and pull between different social groups. The emergence of the ultralightweight wheelchair helped to reconfigure ideas about wheelchairs and their users and allowed wheelchairs to gain a foothold within broader social and technological infrastructures. What makes this account powerful is that this is a success story for a group who have historically been excluded from design processes.

There is no doubting that coproduction has led to some significant successes and that it has changed the mode of both research production and the design and delivery of our public services. It is not, however, a trouble-free area, and there are some concerns about the approach that are worthy of consideration. This chapter addresses some of these concerns. The aim of this chapter is not to debunk coproduction or to argue that it is an inappropriate methodology, but rather to point out some of the concerns and weaknesses of the approach. If people are aware of these, then action can be taken to modify them. The chapter opens with a brief overview, mapping out the emergence of coproduction and how it has become one of the driving ideas for the emancipation of disabled people. It reconstructs the concepts that have underpinned this approach and in doing so seeks to shed light on some of the challenges faced today. The chapter draws heavily on the work of Nancy Fraser, Simon Winlow and Steve Hall and argues that the changing world economy and responses to the economic collapse present new challenges to coproduction and its role in tackling disablement and promoting social justice.

Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy.Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI.After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.

School holidays can be stressful periods for children from low-income families. Poor provision of appropriate childcare, limited access to enrichment activities, and food insecurity mean that children’s health and well-being can suffer and their learning stagnate or decline. This article examines and documents the evidence that has emerged on this topic and aims to raise its profile and the impact on children’s lives. It makes the case for further academic scrutiny of this unexamined and neglected subject.

The Cotswold Hills, southwest UK, are properly described as a cuesta, with a steep, west-facing scarp slope and a plateau-like dip slope. Drainage reflects this surface morphology, with most rivers flowing southeast along topographic and stratigraphic dip. Here, we compare two superficially highly similar rivers – the Frome and Churn – whose sources are nearly coincident, but whose behaviour dramatically diverges thereafter. We examine longitudinal profiles, channel steepness, predicted discharge, and valley shapes, using digital topographic data. River discharge and water hardness/temperature values were obtained at seven sites on the Churn and nine on the Frome over a two-year sampling campaign, delineated into summer and winter phases. Nearly 100 borehole records were interrogated from the two catchments in order to assess groundwater level variations. The Frome, flowing west against regional dips, develops a steep course and has carved a deep and wide valley that exposes the full sequence of Cotswold Jurassic stratigraphy. On the other hand, discharge and channel gradients are lower for the dip-slope Churn, whose valley exposes less stratigraphy and fewer springs. Our measurements of river water hardness and temperature suggest that a greater proportion of groundwater flows into the Frome, regulating discharge and maintaining baseflow over summer. We suggest that flank uplift of the Cotswolds is at least part of the reason for the higher incision rates of the River Frome, leading to its intersecting a greater number of highly transmissive fractures that contribute to its discharge. In turn, the increased discharge could positively impact local incision rates.

In April 2014, the Social Care (Self-directed Support) (Scotland) Act 2013 (SDS Act) was implemented in Scotland. This marked a major shift in how social care is delivered and organized for both users and professionals across the country. Whilst it emerged through the personalization agenda—which has dominated international social care systems over recent years—self-directed support (SDS) represented a significant shift in thinking for service provision in Scotland. In this article, we review the initial stages of policy implementation. Drawing on two Freedom of Information requests from 2015 and 2016 and a series of interviews with local authority practitioners, we argue that, to date, SDS has yet to produce radical transformative change. We explore the reasons behind this through four key themes. First, we highlight the challenges of promoting the principles of co-production in policy and suggest that, in reality, this has been compromised through SDS implementation. Second, we suggest that SDS has been caught up in a policy overload and ultimately overshadowed by new legislation for health and social care integration. In looking at the impact of this relationship, our third theme questions the role of new partnership working. Lastly, we argue that the timing of SDS in a period of acute austerity in social care has resulted in disabled people being offered limited choice rather than increased opportunities for independent living.

Despite knowledge about the profound effects of child abuse and neglect, we know little about how best to assess whether maltreated children should return home. The effectiveness of the New Orleans Intervention Model (NIM) is being tested in a randomized controlled trial where the comparison is social work 'services as usual.' The future trial results will tell us which approach produces the best outcomes for children; meanwhile qualitative process evaluation is generating intriguing findings about the perceived impact of NIM on decision-making about childrens' futures. Interviews and focus groups were conducted with social workers, foster carers, legal decision-makers and the NIM team (n=63). Data were analysed thematically. Findings suggest that NIM is seen as bringing greater influence ('clout') to decision-making due to its depth of focus, provision of treatment for the family, health professional input and perceived objectivity. Simultaneously, the NIM approach and the detailed information it produces potentially throws judgments into doubt in the legal system. Clout/doubt perceptions permeate opinions about NIM and are inter-related with a historical discourse about 'health versus social' models of information gathering, with implications for assessment of child abuse and neglect that extend beyond the study context. The juxtaposition of 'clout versus doubt' both highlights and is strengthened by an intense focus among social workers and legal professionals on how evidence will be regarded within legal fora when making decisions about children. There is continuing uncertainty in the child welfare system about the best ways of assessing maltreated children, underscoring a continued need for the trial.

This chapter seeks to explore issues in disability research, looking in particular at the relationship between individual approaches and social or collective approaches. It examines how disability studies has sought to unpack the meaning of disability and the social relations that govern, condition and circumscribe the disability experience, and how they can be transformed. Participatory research has been criticised by those within disability studies for reinforcing the researcher/researched divide and for failing to challenge, confront or change oppressive structures and practices. The chapter shows how research can produce change and the relative roles of structure and agency. With its focus on barrier removal and the emancipation and empowerment of disabled people, emancipatory research has to aim to be transformative. A critical realist agenda enables to move beyond debates about what is disability and how is it best defined, what is, or is not, an impairment and what is the relationship between impairment and chronic illness and disablement.

Evaluation is essential to understand whether and how policies and other interventions work, why they sometimes fail, and whether they represent a good use of resources. Evaluability assessment (EA) is a means of collaboratively planning and designing evaluations, seeking to ensure they generate relevant and robust evidence that supports decision-making and contributes to the wider evidence base. This article reports on the context, the process undertaken and evidence from participants in an EA facilitated with public service workers involved in implementing a complex, area-based community improvement initiative. This is a novel context in which to conduct an EA. We show how the process allows practitioners at all levels to identify activities for evaluation and co-produce the theory of change developed through the EA. This enables evaluation recommendations to be developed that are relevant to the implementation of the programme, and which take account of available data and resources for evaluation.

In spite of new drugs, lung cancer is associated with a very poor prognosis. While targeted therapies are improving outcomes, it is not uncommon for many patients to have only a partial response, and relapse during follow-up. Thus, new drugs or re-evaluation of existing therapies used to treat other non-malignant diseases (drug repurposing) are still needed. While this research both in vitro and in vivo is being carried out, it is important to be attentive to patients where the disease responds to treatments not considered standard in clinical practice. We report here a patient with adenocarcinoma of the lung who, after declining chemotherapy and radiotherapy, presented with tumour response following self-administration of cannabidiol, a non-psychoactive compound present in Cannabis sativa. Prior work has shown that cannabidiol may have anti-neoplastic properties and enhance the immune response to cancer. The data presented here indicate that cannabidiol might have led to a striking response in a patient with lung cancer.

This article examines how Chinese disabled people use the internet to create active constituencies and the potential for this to afford the opportunity for a new form of activism. Based on a content analysis of China’s two largest disability online forums, the article documents disabled people’s online activities. These include the description of everyday activities, the build-up of social relations, and organisation and mobilisation for changes. The analysis suggests the emergence of new disability constituencies. This, the article argues, is starting to reshape dis-ability politics and develop new disability activism.

Summary Background Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding National Institute for Health Research Health Services and Delivery Research Programme.

We argue that major health and social care policy initiatives are not too complex for randomised controlled trial (RCT) methodology and illustrate this using the example of the Best Services Trial (BeST?): a RCT of an infant mental health intervention for maltreated children. We suggest that qualitative research, as a core part of the trial process from conception and development through to implementation and evaluation, is crucial in building, understanding and strengthening the partnership required to drive such a complex trial. Data pertinent to trial implementation demonstrate the iterative nature of the process whereby stakeholders are consulted and their views influence the conduct of the trial. Here we reflect on the bi-directional relationship between qualitative data collection and partnership-working in a trial. For very complex trials to be possible, significant resource needs to be available for the qualitative component. Key Practitioner Message: • Qualitative research is key to understanding, building and strengthening partnership approaches to researching complex interventions; • Qualitative research is vital to supporting randomised controlled trials involving multiple sectors; • Qualitative research provides essential explanatory power to outcome data in research.

Introduction NICE guidelines were updated in 2016 recommending cardiac CT (CTCA) as first line investigation for suspected stable angina. Meeting these guidelines has been challenging particularly due to varied access to CTCA. At University Hospital North Midlands (UHNM) we adapted our Rapid Assess Chest Pain (RACP) service and increased access to CTCA to become fully NICE compliant. Methods In November 2017 our RACP clinics became specialist cardiac nurse led. Patients were assessed and investigated in-line with 2016 NICE guidelines. We performed a service evaluation assessing 100 consecutive patient outcomes. Results Average age 61.5 years (31–84 years), 57 men. 44 patients were considered to have non-cardiac chest pain and discharged. 56 were referred for further investigation, 39 (70%) CTCA, 12 (21%) dobutamine stress echocardiography (DSE) and five (9%) referred for invasive coronary angiography. Outcomes from CTCA (mean age 57.7 years), six (15%) normal and discharged, 21 (55%) minor disease discharged with primary prevention, ten (25%) moderate/severe disease and referred for invasive angiography or functional imaging. Two (5%) patients cancelled investigations. DSE (mean age 74.8 years), six (50%) normal, four (34%) non-diagnostic, one (8%) ischaemic and one (8%) moderate left ventricular dysfunction with regional wall motion abnormality. Invasive coronary angiography, one three vessel disease with severe aortic stenosis, two underwent PCI, one had mild disease and one awaited. Conclusion Adhering to the 2016 guidelines significantly reduced the number of investigations required. Of the patients referred for CTCA 73% had normal or minor CAD and were discharged with lifestyle advice ±medication.

Normativity is a concept that is often misapplied in disability studies, especially in ‘postconventional’ accounts, where the concept is conflated with ‘normal’, ‘normate’, or ‘standard’. This article addresses this confusion, explores the meaning and use of ‘normativity’, and presents some analytic tools to discuss normative issues of right and wrong. The article finishes by discussing examples where conceptual confusions result in confused normative judgments focusing in particular on agency, responsibility and moral status. The article argues that disability research should carefully consider the use of theories and empirical knowledge in the light of their ethical implications as well as the lived experiences of disability.

The paper by Rintoul et al 1 has highlighted the radiation burden for patients undergoing imaging investigations for lung cancer and calculated the lifetime attributable risk of developing a further malignancy as a result of that radiation exposure. Patients who underwent curative-intent surgery or radical (chemo)radiotherapy received an average radiation dose of approximately 28 mSv in their work-up. As might be expected, those patients with more advanced disease, in whom radical treatment was not possible and underwent best supportive care, received approximately half the radiation dose (approximately 15 mSv). Using standard conversion factors, the authors have derived the lifetime risk of developing a second cancer as a consequence of the radiation exposure as approximately 1:1700 for all cancers and 1:5000 specifically for lung cancer in patients undergoing curative-intent surgery or radical (chemo)radiotherapy. It is important for the physician, radiologist and, of course, the patient to determine whether this risk is acceptable by evaluating the benefits gained from the diagnostic imaging undertaken and putting that risk into context of other causes of morbidity and mortality that the patient might suffer. Accurate staging is essential to identify those patients with resectable, potentially curable disease but equally to avoid undertaking …

Background: Digital health has the potential to support care delivery for chronic illness. Despite positive evidence from localized implementations, new technologies have proven slow to become accepted, integrated, and routinized at scale. Objective: The aim of our study was to examine barriers and facilitators to implementation of digital health at scale through the evaluation of a £37m national digital health program: ‟Delivering Assisted Living Lifestyles at Scale” (dallas) from 2012-2015. Methods: The study was a longitudinal qualitative, multi-stakeholder, implementation study. The methods included interviews (n=125) with key implementers, focus groups with consumers and patients (n=7), project meetings (n=12), field work or observation in the communities (n=16), health professional survey responses (n=48), and cross program documentary evidence on implementation (n=215). We used a sociological theory called normalization process theory (NPT) and a longitudinal (3 years) qualitative framework analysis approach. This work did not study a single intervention or population. Instead, we evaluated the processes (of designing and delivering digital health), and our outcomes were the identified barriers and facilitators to delivering and mainstreaming services and products within the mixed sector digital health ecosystem. Results: We identified three main levels of issues influencing readiness for digital health: macro (market, infrastructure, policy), meso (organizational), and micro (professional or public). Factors hindering implementation included: lack of information technology (IT) infrastructure, uncertainty around information governance, lack of incentives to prioritize interoperability, lack of precedence on accountability within the commercial sector, and a market perceived as difficult to navigate. Factors enabling implementation were: clinical endorsement, champions who promoted digital health, and public and professional willingness. Conclusions: Although there is receptiveness to digital health, barriers to mainstreaming remain. Our findings suggest greater investment in national and local infrastructure, implementation of guidelines for the safe and transparent use and assessment of digital health, incentivization of interoperability, and investment in upskilling of professionals and the public would help support the normalization of digital health. These findings will enable researchers, health care practitioners, and policy makers to understand the current landscape and the actions required in order to prepare the market and accelerate uptake, and use of digital health and wellness services in context and at scale. [J Med Internet Res 2017;19(2):e42]

The biopsychosocial (BPS) model of mental distress, originally conceived by the American psychiatrist George Engel in the 1970s and commonly used in psychiatry and psychology, has been adapted by Gordon Waddell and Mansell Aylward to form the theoretical basis for current UK Government thinking on disability. Most importantly, the Waddell and Aylward version of the BPS has played a key role as the Government has sought to reform spending on out-of- work disability benefits. This paper presents a critique of Waddell and Aylward’s model, examining its origins, its claims and the evidence it employs. We will argue that its potential for genuine inter-disciplinary cooperation and the holistic and humanistic benefits for disabled people as envisaged by Engel are not now, if they ever have been, fully realized. Any potential benefit it may have offered has been eclipsed by its role in Coalition/Conservative government social welfare policies that have blamed the victim and justified restriction of entitlements.

This article examines how the British press covered the debate around a prisoner's right to vote. It shows how Conservative ministers were put under pressure in early 2011 by newspapers on the right of the political spectrum to abandon proposals to end the ‘blanket ban’ on a prisoner's right to vote. Modification of the ban could have brought the UK into compliance with treaty obligations linked to the European Convention on Human Rights (ECHR) and judgments of the European Court. The focus of the debate, both in parliament and in the newspapers, was on sovereignty and judicial interference. Our research shows that very little of the media debate on a prisoner's right to vote was about human rights. Instead, outrage on the issue of prisoners' rights was linked to opposition to pro-Europeans within the coalition government and demands for a radical shake-up in Britain's relationship with the European Union (EU). The reform of human rights legislation and breaking the link with the European Convention is likely to be a centrepiece of Conservative policy at the next general election. The article is based on qualitative research of newspaper coverage in the period between February and mid-April 2011 when the prisoners' rights' issue came to the fore, and audience reception studies involving focus groups.

Risk is used to deny disabled people access to many parts of mainstream life. Using qualitative data we explore disabled people’s views and experiences of outdoor recreation, bringing together ideas from two areas of sociology – disability studies and risk using the concepts of edgework and psycho-emotional disablism. Many people felt that the outdoors represented a risky environment. For some, risk was one of the main drivers for going out into the countryside; whilst for others, risk was a major cause of their reluctance to venture into the countryside. Engaging in risk both can disable and can challenge disablist views.

Following its election in 2010 the UK’s Coalition Government has sought to implement radical restructuring of disability-related benefits justified by reference to the financial crises of 2007/08. In this article we examine how these changes have impacted on coverage of disability in the UK media comparing and contrasting coverage of disability in newspapers in 2010/11 with a similar period in 2004/05. Our analysis suggests that disabled people have become a ‘folk devil’ and that there has been a significant change in the way that disability is reported. Newspaper coverage in 2010/11 was less sympathetic and there was an increase in articles that focused on disability benefit and fraud, and an increase in the use of pejorative language to describe disabled people. An audience reception study suggests that this coverage is having an impact on the way that people think about disabled people.

This chapter was first developed from the Life As A Disabled Child project which was part of the Economic and Social Research Council’s (ESRC) Research Programme: Children 5-16 Growing Into The 21st Century Program. The project was carried out at the universities of Edinburgh and Leeds and this chapter discusses the experiences of the Edinburgh team in relation to research carried out in a special school for children with multiple impairments. By describing the gradual process through which disabled children enabled us to construct a complex understanding of their lives and identities, the chapter provides a practical illustration of how ideas concerning ethnographic, reflexive and emancipatory research influence research with disabled children. The chapter analyses the variety of research roles the ethnographer employed to learn the children’s (verbal and non-verbal) languages, and the process through which the research team questioned their own and other academic understandings of childhood and disability. In so doing, the chapter demonstrates three key points: that ethnography can help us to gain access to the meanings of ‘non-verbal’ research participants; that reflexivity enables us to uncover the diverse identities of disabled children; and that there are tensions concerning power and ethics when employing ideas from emancipatory researchPrior to our study in the late 1990s, writers in disability studies argued that images of disabled children were preoccupied with issues of care and involved narratives of dependence, vulnerability and exclusion (Watson and Shakespeare 1998, Priestley 1998). Such studies were criticised for tending to represent disabled children as a homogenous grouping, overemphasising the structural context of childhood disability (e.g. the link between disability and poverty) and only rarely discussing identity issues such as race and gender (Humphries and Gordon 1992, Lewis 1995, Middleton 1996, Norwich 1997, Priestley 1998). The ‘Life As A Disabled Child’ project encountered similar attitudes;for example, most professionals we encountered possessed a taken for granted perspective that disabled children would be unable to make choices and that they would require adults to make choices for them (Davis and Watson 2001, 2002). In contrast, the ‘Life As A Disabled Child’ project sought to investigate children’s views and was set up from a children’s and disability rights perspective.

Child maltreatment is associated with life-long social, physical, and mental health problems. Intervening early to provide maltreated children with safe, nurturing care can improve outcomes. The need for prompt decisions about permanent placement (i.e., regarding adoption or return home) is internationally recognised. However, a recent Glasgow audit showed that many maltreated children “revolve” between birth families and foster carers. This paper describes the protocol of the first exploratory randomised controlled trial of a mental health intervention aimed at improving placement permanency decisions for maltreated children. This trial compares an infant's mental health intervention with the new enhanced service as usual for maltreated children entering care in Glasgow. As both are new services, the trial is being conducted from a position of equipoise. The outcome assessment covers various fields of a child’s neurodevelopment to identify problems in any ESSENCE domain. The feasibility, reliability, and developmental appropriateness of all outcome measures are examined. Additionally, the potential for linkage with routinely collected data on health and social care and, in the future, education is explored. The results will inform a definitive randomised controlled trial that could potentially lead to long lasting benefits for the Scottish population and which may be applicable to other areas of the world. This trial is registered with ClinicalTrials.gov (NC01485510).

Obtaining informed consent can be challenging in stressful and urgent circumstances. One example is when potential participants have recently had their child removed into care; intervention is urgent and mandatory whereas participation in associated research is voluntary. Using a nested qualitative study, we examined experiences of consent processes in a randomised controlled trial (RCT) of a family assessment and intervention service for maltreated young children. Some potential participants found it difficult to use information; some believed consenting might influence the return of their child. In response to these ethical challenges, we propose reversing the typical process of securing consent, so that randomisation to an intervention occurs before inviting potential participants to consider the trial. This will avoid delays, delineate research from intervention, and make it easier to consider information. We suggest that this innovation could be useful in trials across service areas that incorporate urgent and complex interventions.

The emergence of both disability studies and the new social studies of childhood has seen a new approach in the study of disability in childhood. The focus has shifted from an exploration of impairment to one that prioritises the social with disabled children themselves placed at the centre of the research. This article concentrates on disability studies and examines its influence on the research agenda and its impact on childhood research on disability. It also critically examines recent developments in disability theory and their usefulness for providing an understanding of the lives of disabled children. The article finishes with recommendations for future research in the area.

An early Neolithic causewayed enclosure, a middle Neolithic long enclosure and an earlier Bronze Age open enclosure were among a group of prehistoric features discovered and examined by excavation at Netherfield Farm, South Petherton during archaeological mitigation work ahead of the construction of a natural gas pipeline between Ilchester and Barrington, Somerset, in 2006. Of particular interest were burnt deposits within the long enclosure ditches and a possible Bronze Age field system. Assemblages of pottery and flintwork contribute to the understanding of these features and a programme of radiocarbon dating has amplified the chronology of activity on the site. Evidence from a group of burnt and unburnt pits and a partial enclosure reveal the reuse of the site between the fifth and eighth centuries AD.

In the UK and many other European countries, there continue to be concerns about a range of social issues including the position of immigrants, the educational attainment of marginalised groups and the persistence of the gender pay gap. Increasingly, governments and NGOs assert that the promotion of equality and human rights policies are central to addressing these issues, with a view to creating societies which are both more equitable and more efficient. Over the past decade and a half, a period of economic growth followed recently by a major recession, the equality and human rights agenda enjoyed a high political profile. However, as we discuss in this review article, the social and economic optimism of the late nineties and early to mid noughties has been followed by economic retrenchment, a commitment to the shrinking of the state and the public sphere across Europe and a general move to the political right. In this article, we first review the political context which led to the rise of the equality and human rights agenda. Subsequently, we examine competing conceptualisations of equality and their operationalisation within British social policy. Finally, we assess the progress which has been made towards achieving a more equal society in the UK over recent years drawing on data gathered and analysed by the National Equality Panel (NEP, 2010).

Implemented as part of the 2005 amendments to the Disability Equality Act, the Disability Equality Duty (DED) placed new and important demands on public sector bodies. All such organisations are required to develop policies and working practices which actively promote the equality of disabled people as employees, consumers or visitors. Equality has to be proactive as opposed to reactive and disability equality has to be mainstreamed into the normal day to day activities of organisational working practice. Whilst it follows on from the framework of previous anti-discrimination legislation set in place over the last fifteen years, it represents a significant change in equality legislation since it demands that public sector bodies instigate fundamental changes in their approach towards disability and their working practices. This article reports on the initial stages of the implementation process of the DED across a range of public sector organisations in England, focussing in particular on how this policy has impacted on mainstreaming. Discussion shows that although organisations show awareness of mainstreaming and its implications for disability equality, there is limited evidence to suggest that the public sector has fully embraced this agenda.

A 75 year old woman had a computed tomography scan of the abdomen to investigate weight loss (fig 1). The scan found no abnormality. Two years later, she had a computed tomography …

In recent years, disabled people's access to the outdoors has been the subject of renewed interest. This has in part been driven by legislative developments coupled with an increasing recognition that disabled people are under-represented as users of the countryside. However, very little is actually known about disabled people's views and experiences of the outdoors. Drawing on the concept of affordances and combining this with a social barrier's approach to disability, we explore disabled people's attitudes towards and experiences of woodland and countryside leisure. We argue that disabled people's reasons for being outdoors are more complex than simply seeking 'rehabilitation'; and, like their non-disabled counterparts, access to the outdoors is perceived for some as an integral aspect of wellbeing and revitalisation. Through engagement with the outdoors, disabled people are challenging normative constructions of who they are and their purpose in being in the countryside. The paper concludes by arguing that providers of outdoor leisure services need to go beyond barrier removal and understand disabled people's uses and views of the outdoors in planning the provision of services.

This article outlines recommendations for the treatment of specific infections occurring in the setting of critical care. In the interests of brevity, a limited number of infections are discussed and recommendations are largely confined to empirical therapy. Basic principles of diagnosis and treatment apply in all cases, including appropriate de-escalation when an organism is identified. These aspects of treatment have been dealt with in part one of this article – ‘Antibiotic prescribing in critical care: general principles' published in the winter 2007 edition of JICS.