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In this article, we explore how women in different social classes had differential access to resources and services to enhance their 'wellness'-resulting in classed roles in alcohol consumption. We analyse data from a qualitative study on alcohol by midlife women in South Australia and employ the analogy of a 'toolkit' in order to understand the structural patterning of 'wellness tools'. Bourdieu's relational model of class guides our exploration of women's inequitable opportunities for wellness. Higher social class women had 'choices' facilitated by bulging wellness toolkits, such as yoga, exercise and healthy eating regimens-alcohol consumption was not essential to promoting 'wellness' and did not have an important place in their toolkits. Middle-class women had less well-stocked toolkits and consumed alcohol in a 'compensation approach' with other wellness tools. Alcohol consumption received positive recognition and was a legitimised form of enjoyment, fun and socialising, which needed counterbalancing with healthy activities. Working-class women had sparse toolkits-other than alcohol-which was a tool for dealing with life's difficulties. Their focus was less on 'promoting wellness' and more on 'managing challenging circumstances'. Our social class-based analysis is nestled within the sociology of consumption and sociological critiques of the wellness industry.

Background Smoking and resulting health problems disproportionately impact low socioeconomic status (SES) individuals. Building resilience presents an approach to ‘closing the gap’. Mindfulness-based interventions and setting realistic goals are preferred in low socioeconomic communities. We aim to test if these interventions, delivered online and consolidated with peer support offered via ex-smokers, are successful in promoting smoking cessation and resilience. Our conceptualisation of resilience encompasses the inner capacity/skills and external resources (e.g., social support) which smokers utilise to bounce back from adversity. We include a process evaluation of barriers/facilitators to interventions and cost-effectiveness analysis (from health system perspective). Methods We plan a four-arm parallel 12-month RCT with a 6-month follow-up to test the efficacy of three group-based interventions each followed by peer support. Arm 1: mindfulness-integrated cognitive behavioural therapy; Arm 2: mindfulness training; Arm 3: setting realistic goals; Arm 4: active control group directed to quit services. All interventions will be administered online. Participants are adult smokers in Australia (N = 812) who have an average weekly household income less than $457AUD or receive welfare benefits. Group-based interventions will occur over 6 months, followed by 6 months of forum-based peer support. Primary outcome: self-reported 14-day period prevalence of smoking abstinence at 6 months, with remote biochemical verification of saliva cotinine ( Discussion This study is the first to compare resilience interventions for low SES smokers which have been identified by them as acceptable. Our various repeated measures and process evaluation will facilitate exploration of mechanisms of impact. We intervene within the novel framework of the Psychosocial Model of Resilience, applying a promising paradigm to address a critical and inequitable public health problem. Trial registration Australian New Zealand Clinical Trials Registry ID: ACTRN12621000445875, registered 19 April 2021 (https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=381007&isReview=true). The Universal Trial Number is U1111-1261–8951

Government responses to COVID-19 have dramatically altered the social quality of daily circumstances. Consequently, theoretical questions about social cohesion require recalibration as we explore new models of social quality. Central to this article is trust, one of the fundamental tenets of social cohesion. We present data from interviews with 40 women in midlife (45–64 years) regarding their everyday experiences of “life in lockdown” during the pandemic. Key themes focus on women’s (dis)trust in individuals (e.g., politicians, public health experts, family, themselves) and systems (e.g., politics, medicine, the media). This study provides insights into the differential impact of the pandemic in shaping public trust and hence social cohesion—in authority, institutions, and “each other”—with important lessons for how future efforts can rebuild trust in post-pandemic times.

Background: Evidence-based practice in social care and health is widely promoted. Making it a reality remains challenging, partly because practitioners generally see practice-based knowledge as more relevant than empirical research. A further challenge regarding the creative, contextual use of research and other evidence including lived experience and practice-based knowledge is that practitioners, especially in frontline care services, are often seen not as innovators, but recipients of rules and guidelines or followers of pre-determined plans. Likewise, older people are not generally recognised as co-creators of knowledge, learning and development but as passive recipients of care, or objects of research. Aims: This study aimed to address the above issues, through a collaborative and appreciative endeavour involving researchers; social care and health practitioners; managers; older people and carers in 6 sites across Wales and Scotland. Methods: We used participatory action research methodology, applying a dialogic storytelling approach, which enabled participants to explore and address 7 already published research-based ‘Challenges’ regarding what matters most to older people with high-support needs. Findings: Participants discovered and addressed five elements required in developing evidence-enriched practice; the creation of supportive and relationship-centred research and practice environments; the valuing of diverse types of evidence; the use of engaging narratives to capture and share evidence; the use of dialogue-based approaches to learning and development; and the recognition and resolution of systemic barriers to development. Discussion and conclusion: Although existing literature covers each element, this project was novel in collectively exploring and addressing all five elements together, and in its use of multiple forms of story, which engaged hearts and minds, positive outcomes were achieved.

Background: Late linkage to care and delay in antiretroviral therapy (ART) initiation threaten the clinical and public health benefits of ART such as: preventing acquired immunodeficiency syndrome (AIDS) and non-AIDS related morbidities and mortality, as well as reducing new infections. The prevalence of both of these poor care outcomes remains high in sub-Saharan African (SSA) countries. Quantitative synthesises of the existing data are lacking, which would help ascertain the best evidence-based interventions. This review aimed to systematically synthesise the available literature on factors affecting linkage to care and ART initiation amongst HIV infected adults in SSA. Methods: Systematic searches were undertaken of the following databases: Emcare, Medline, PubMed and Web of Science. In our review, we included observational studies that analysed factors affecting linkage to HIV care and ART initiation amongst adults (age ≥19 years) in SSA, and were published between January 1, 2015 and June 1, 2021. All included studies were assessed for risk of bias using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies. RevMan-5 software was used to conduct meta-analyses and Mantel-Haenszel statistics to pool outcomes with 95% confidence interval and Results: Forty-six studies were included in the systematic review, of which 18 fulfilled requirements for meta-analysis. Health care delivery, psychosocial, behavioural and sociodemographic factors were identified as determinants of late linkage to care and delay in ART initiation. The meta-analyses showed that people of a younger age group (2 = 74%) and 45% (OR: 0.55; 95%CI: 0.49-0.63, I2 = 0%) less likely to be linked to care and initiate ART respectively compared to people of an older age group (≥35 years). Employed people and people who travelled for more than an hour to reach a clinic were more than 1.3 (OR: 1.32; 95%CI: 1.14-1.52, I2 = 14%) and 1.2 (OR: 1.27; 95%CI: 1.15-1.39, I2 = 57%) times more likely to be presented late for care, respectively. The likelihood of linkage to care decreased by 26% (OR: 0.74; 95%CI: 0.62-0.87, I2 = 25%) for people who were unable to disclose their HIV status and 50% (OR: 0.50; 95%CI: 0.42-0.60, I2 = 0%) for those who had a baseline CD4 count >350cells/mm3 compared to CD4 count ≤350cells/mm3, but increased by 65% (OR: 1.65; 95%CI: 1.16-2.34, I2 = 0%) for those who were diagnosed through health facility-based testing approaches compared to community-based approaches. Conclusion: This systematic review and meta-analyses identified a range of risk factors for late linkage to care and delayed ART initiation amongst HIV infected adults in SSA including: health service delivery, psychosocial, behavioural and sociodemographic circumstances. We recommend implementation of patient-centred intervention approaches to alleviate these barriers.

Breast cancer is one of the most frequently diagnosed cancers in women globally. Sex and advancing age represent the dominant risk factors, with strong evidence of alcohol as a modifiable risk factor. The carcinogenic nature of alcohol has been known for over twenty years; however, this has failed to translate into significant behavioural, practice, or policy change. As a result, women have not benefitted from this research and, by extension, have been exposed to unnecessary breast cancer risk. Participatory research presents a solution to research translation in public health through the collaboration of impacted populations with academics in research. This systematic review examines peer-reviewed research studies where participants were involved in the research process and the outcomes related to breast cancer prevention (either alcohol or broader lifestyle modification). Seven of the eight studies reported positive effects, and the collaboration between academic researchers and impacted populations may have supported positive outcomes. Women were receptive and responsive to participatory approaches, and their participation is important to address socially entrenched behaviours such as alcohol consumption. Participatory research presents opportunities for future interventions to improve (or address) modifiable risk factors for breast cancer.

Background The practices of transnational corporations (TNCs) affect population health through unhealthy products, shaping social determinants of health, or influencing the regulatory structures governing their activities. There has been limited research on community exposures to TNC policies and practices. The aim of this paper was to adapt existing Health Impact Assessment methods that were previously used for both a fast food and an extractives industry corporation in order to assess Carlton and United Breweries (CUB) operations within Australia. CUB is an Australian alcohol company owned by a large transnational corporation Asahi Group Holdings. Data identifying potential impacts were sourced through document analysis, including corporate literature; media analysis, and 12 semi-structured interviews. The data were mapped against a corporate health impact assessment framework which included CUB’s political and business practices; products and marketing; workforce, social, environmental and economic conditions; and consumers’ adverse health impacts. We also conducted an ecological study for estimating alcohol attributable fractions and burdens of death due to congestive heart disease, diabetes mellitus, stroke, breast cancer, bowel cancer and injury in Australia. Beer attributable fractions and deaths and CUB’s share were also estimated. Results We found both positive and adverse findings of the corporation’s operations across all domains. CUB engage in a range of business practices which benefit the community, including sustainability goals and corporate philanthropy, but also negative aspects including from taxation arrangements, marketing practices, and political donations and lobbying which are enabled by a neoliberal regulatory environment. We found adverse health impacts including from fetal alcohol spectrum disorder and violence and aggression which disproportionately affect Indigenous and other disadvantaged populations. Conclusion Our research indicates that studying a TNC in a rapidly changing global financialised capitalist economy in a world which is increasingly being managed by TNCs poses methodological and conceptual challenges. It highlights the need and opportunity for future research. The different methods revealed sufficient information to recognise that strong regulatory frameworks are needed to help to avoid or to mediate negative health impacts.

Narrative recording in case records and individual plans within social services represents the means by which stories can be constructed with and about the people with whom services work, influencing relationship building and outcomes. Identities and decision-making are forged in records, shaping people’s lives. Yet, limited attention is paid to narrative recording in research and practice. Indeed, recording, which increasingly veers towards ‘box-ticking’, is viewed by practitioners as a bureaucratic burden, limiting time for the ‘real job’ of face-to-face work. Drawing on Ricoeur’s narrative hermeneutics in exploring qualitative data from a carer support organisation, we identify the potential contribution of narrative recording. Carers often seek support when their sense of identity and quality of life is diminished by their unpaid caring role. We explore practitioners’ views about the role of the narrative record in holding memories, feeding into recognition of capable agency, clarifying possibilities for action, restoration of identity and wellbeing. Applying a Ricoeurian lens demonstrates how attaining these benefits require recording practice which supports recognition through relational practice, in pursuit of better outcomes for carers. Carer benefits could be enhanced by carers holding a copy of and being able to reflect on and further contribute to their own plan.

UNSTRUCTURED Safety issues for researchers conducting and disseminating research on social media have been inadequately addressed in institutional policies and practice globally, despite posing significant challenges to research staff and student well-being. In the context of the COVID-19 pandemic and given the myriad of advantages that web-based platforms offer researchers over traditional recruitment, data collection, and research dissemination methods, developing a comprehensive understanding of and guidance on the safe and effective conduct of research in web-based spaces has never been more pertinent. In this paper, we share our experience of using social media to recruit participants for a study on abortion stigma in Australia, which brought into focus the personal, professional, and institutional risks associated with conducting web-based research that goes viral. The lead researcher (KV), a postgraduate student, experienced a barrage of harassment on and beyond social media. The supportive yet uncoordinated institutional response highlighted gaps in practice, guidance, and policy relating to social media research ethics, researcher safety and well-being, planning for and managing web-based and offline risk, and coordinated organizational responses to adverse events. We call for and provide suggestions to inform the development of training, guidelines, and policies that address practical and ethical aspects of using social media for research, mental and physical health and safety risks and management, and the development of coordinated and evidence-based institutional- and individual-level responses to cyberbullying and harassment. Furthermore, we argue the case for the urgent development of this comprehensive guidance around researcher safety on the web, which would help to ensure that universities have the capacity to maximize the potential of social media for research while better supporting the well-being of their staff and students.

We present an overview of Gossypium genome evolution and the implications of this understanding for targeted breeding objectives. The cotton genus (Gossypium) contains more than 50 species distributed in arid to semiarid regions of the tropic and subtropics. Following the genus origin approximately 10–15 million years ago, a rapid global radiation leads to eight major genome groups (A through G and K) of diploids (n = 13). Allopolyploid cottons appeared within the last 1–2 million years, as a consequence of transoceanic dispersal of an A-genome taxon to the New World and subsequent hybridization with an indigenous D-genome diploid. The nascent allopolyploid radiated into three modern lineages of seven described species, including the agronomically important species G. hirsutum L. and G. barbadense L. These two allopolyploids, together with two A-genome diploids from Africa-Asia, G. arboreum L. and G. herbaceum L., were independently domesticated for their seed fiber, representing a remarkable case of human-driven parallel evolution. Recent investigations have clarified many aspects of this evolutionary history of Gossypium with genomic insights, including the paleopolyploid history of diploid species, a surprisingly high frequency of natural interspecific hybridization within and among genome groups, myriad interactions of molecular mechanisms underlying allopolyploid genome evolution, and a much-refined evolutionary relationship among gene pools of each of the four cultivated species. The extraordinary natural diversity in Gossypium in fiber morphology, stress tolerance, and other agronomic characteristics provides ample resources for breeders to develop new cotton varieties.

Background: Qualitative studies evaluating maternal mental health services are lacking in Ethiopia, and the available evidence targets severe mental illnesses in the general population. We conducted a qualitative study to explore barriers to, enablers of, or opportunities for perinatal depression health services implementations in Ethiopia.Methods: We conducted a total of 13 face to face interviews with mental and maternal health service administrators from different levels of the Ethiopian healthcare system. We interviewed in Amharic (a local language), transcribed and translated into English, and imported into NVivo. We analysed the translated interviews inductively using thematic framework analysis. Results: The study identified: (i) health administrators’ low literacy about perinatal depression as individual level barriers; (ii) community low awareness, health-seeking behaviours and cultural norms about perinatal depression as socio-cultural level barriers; (iii) lack of government capacity, readiness, and priority of screening and managing perinatal depression as organisational level barriers; and (iv) lack of mental health policy, strategies, and healthcare systems as structural level barriers of perinatal mental health implementation in Ethiopia. The introduction of the new Mental Health Gap Action Programme (mhGap), health professionals’ commitment, and simplicity of screening programs were identified enablers of, or opportunities for, perinatal mental health service implementation.Conclusions: This qualitative inquiry identified important barriers and potential opportunities that could be used to address perinatal depression in Ethiopia. Building the capacity of policy makers and planners, strengthening the mental healthcare system and governance should be a priority issue for an effective integration of maternal mental health care with the routine maternal health services in Ethiopia.

Therapist self‐disclosure (TSD) usage varies greatly among different psychotherapy orientations. Anecdotal evidence seems to suggest that there are reasons for its judicious use, and a small number...

Collaborative, person-centered approaches to care planning are increasingly recognized as instrumental in supporting attainment of personal recovery outcomes. Yet, while much is known about factors which support person-centered planning, successful implementation often remains an elusive goal. This paper reviews international efforts to promote Person-Centered Care Planning (PCCP) in the context of a randomized clinical trial in the United States and in the “Meaningful and Measurable” initiative, a collaborative action research project involving diverse provider organizations in Scotland. The authors review the history of international efforts to implement PCCP and offer preliminary evidence regarding its positive impact on both process outcomes (i.e., the nature of the primary therapeutic relationship and the service-user’s experience) and personal recovery outcomes (e.g., quality of life, community belonging, and valued roles). PCCP will be defined through description of key principles and practices as they relate to both relational aspects (i.e., shifts in stakeholder roles and conversations) and documentation/recording aspects (i.e., how person-centered relationships are captured in written or electronic records). Similarities and differences across the US and Scottish experience of person-centered care planning will be highlighted and a series of recommendations offered to further implementation of this essential recovery-oriented practice.

Purpose The purpose of this paper is to examine the gap between recovery-oriented processes and clinical outcomes in peer support, an exemplar of recovery-oriented services, and offer suggestions for bridging this gap. Design/methodology/approach This viewpoint is a brief review of literature on peer support services and gaps in outcome measurement towards building an evidence base for recovery-oriented services. Findings Clinical outcomes like hospitalizations or symptoms remain a focus of research, practice and policy in recovery-oriented services and contribute to a mixed evidence base for peer support services, in which recovery-oriented outcomes like empowerment, self-efficacy and hopefulness have more evidentiary support. One approach is to identify the theoretical underpinnings of peer support services and the corresponding change mechanisms in models that would make these recovery-oriented outcomes mediators or process outcomes. A better starting point is to consider which outcomes are valued by the people who use services and develop an evaluation approach according to those stated goals. User driven measurement approaches and more participatory types of research can improve both the quality and impact of health and mental health services. Originality/value This viewpoint provides a brief review of peer support services and the challenges of outcome measurement in establishing an evidence base and recommends user driven measurement as a starting point in evaluation of recovery-oriented services.

Evaluating Outcomes in Health and Social Care is the fifth in a series of five books on health and social care partnerships, recently updated to take account of new studies and changing policy developments since first published in 2008. The book is aimed at students, practitioners, managers and policy-makers in health and social work/care. Health and social care partnership is in itself a topic which has presented considerable challenges to policy and practice in different countries for decades. In addition, this book also aims to tackle the complex issues of evaluation and outcomes, which is no mean feat. The authors usefully blend context and history, an overview of evaluation methods, theoretical approaches, practical examples and links to reading and resources in pursuing their quest.

After qualifying, completing house jobs, and doing a short service commission in the Royal Navy, Frank Martin Hull, always known as Robin, entered rural general practice in Wellesbourne, Warwickshire in 1960. In 1973 he took a sabbatical from the practice as visiting professor in general practice at the University of North Carolina, Chapel Hill, USA. On returning to the practice, alongside his clinical work, …

This paper reports on a ten year programme of collaborative action research supporting the development and implementation of a personal outcomes approach in health and social care, culminating in the recent Economic and Social Research Council (ESRC) funded ‘Meaningful and Measurable’ project. The research brought together academic researchers with practice partners from statutory adult health and social care services, children and families, and third sector carer and mental health organisations. Our primary focus has been working together to find ways to make best use of routinely collected outcomes data, recorded for each service user in the form of a proportionate narrative, to inform individual and collective decision making. Our methodology combined local action research projects in diverse settings with a series of audio-recorded dialogic ‘data retreats’ for all partners, and knowledge exchange events with wider stakeholders, including commissioning and regulatory bodies. Alongside this, a series of focused workshops were co-created and delivered in response to emergent practice needs, addressing issues including having outcomes focused conversations, outcomes recording practices and pragmatic approaches to qualitative outcomes data analysis and reporting. This paper focuses on the ‘how’ questions, examining the collaborative mechanisms that proved critical in: ‘lifting the rock’ to expose hidden assumptions and challenges, including conceptual ambiguities and the subtle yet pervasive nature of positivist influences; learning from local and sectoral differences in establishing the value of different forms of knowledge; appreciating the hermeneutic circularity of shared understanding; and triggering those ‘light bulb’ moments. The importance of attending to different and at times conflicting perspectives is underscored.

Background: Bioactive compounds are the constituents of foods, especially functional foods, that provide beneficial health properties. For example, these benefits include antioxidants, anti-inflammatory, antifungal, and various additional preventative properties, which illustrates how bioactive compounds are the real-life example of Hippocrates’ notion “let thy food be thy medicine” [1]. Originally, many definitions of functional foods neglected to acknowledge the importance of bioactive compounds [2]. Bioactive compounds are the constituents that enhance functional foods and therefore are necessary to incorporate under the umbrella of functional foods. Functional foods are able to provide health benefits though bioactive compounds, as these compounds target mechanisms that manage, prevent, and/or treat disease [2]. The Functional Food Center asserts that bioactive compounds are quintessential of functional foods and essential for optimal health, thereby leading to the inclusion of bioactive compounds in the most recent definition of functional foods [1].

There is currently much policy emphasis on both partnership working between health and social services in the UK and on the outcomes delivered by services. This article provides an account of two consecutive projects centred on these two themes. The first project, at the University of Glasgow, sought to address the lack of evidence about the outcomes delivered to service users by partnerships. Following from this project, the Joint Improvement Team of the Scottish Government commissioned the researchers to develop a toolkit to involve users and unpaid carers in performance management in community care in Scotland. The remit of this second project expanded during 2007 as it became linked with the development of the emerging National Outcomes Framework for community care in Scotland. This article outlines the outcomes‐based piloting work currently under way in Scotland.

Policy and practice documents are increasingly adopting a focus on outcomes. This article seeks to clarify what is meant by the term ‘outcome’, the outcomes that have been highlighted in key policy documents, and the extent to which they reflect the outcomes prioritised by service users. The discussion will draw on the early stages of a DoH‐funded project exploring the effectiveness of health and social care partnerships from the perspectives of service users.

The dipole interaction model (assembled into the computer package DInaMo) uses a classical electromagnetic theory for calculating the far UV circular dichroism (CD) of peptides and proteins. DInaMo reduces all amide chromophores to a single point with anisotropic polarizability and all nonchomophoric aliphatic atoms to points with isotropic polarizability. By determining interactions among the chomophoric and nonchromoporic parts of the molecule using empirically derived polarizabilities, the rotational and dipole strengths are determined leading to the calculation of CD. Polarizabilities are largest for the chromophoric points and smaller for the nonchromophoric points with hydrogens having the smallest polarizabilities. It is possible to collapse hydrogen polarizability onto the atom to which it is bound or ignore it in the CD calculation creating a united atom approach. Ignoring CH3 group hydrogens and treating only the π-π∗ transition reproduces experiment in the region of 180 to 210 nm well, showing bands with similar morphology and absorption maxima for the π-π∗ transition. Recent calculations on small peptides and proteins in which both CH3 and CH2 group hydrogens have been ignored seem to produce better CD results than ignoring only the CH3 group hydrogens. Also, preliminary calculations using the mean polarizability values of the CH3 and CH2 groups show some good prospects of further improving the CD calculations with the DinaMo package. In addition, initial calculations indicate that DInaMo has the potential of including the n-π∗ transition in the CD calculations.

H G Wells’s obituary in The Times states that he was ‘never anything but successful as a writer, and at one time he was possibly the most widely read author in the world’.1 His obituary in the Times Literary Supplement describes him, as an ‘educator’, who ‘spoke more clearly than any other man to the youth of the world’.2 Such accolades may, when taken together, offer an insight into Wells’s creative vision, and the choices he made to be both artistically and socially viable. This chapter will examine this dual purpose in relation to The Sea Lady (1902), a work that depicts the influence of both the Victorian popular taste for the fey and the gothic, while also looking forward to many of the concerns that would come to be associated with modernism: the dissatisfaction with the direction of modern life, in particular the commodification of human beings, the desire for a greater spiritual and sexual freedom, and the move away from the traditional novelistic conclusion to reflect the ongoing nature of life. It will consider Wells as an author driven by his social ideals to reach as wide a readership as possible, and to find a means to consider complex political and cultural tropes in a way that would be popular, but would also be artistically sound. Through a text that was both entertaining and through its depiction of the fantastic, apparently removed from the everyday existence of his reading public, Wells sought to seduce his readers to consider the possibility of what his heroine describes as ‘better dreams’.3 The middlebrow then becomes for Wells a potential siren call, with which to entice his readership to consider another way of life.

Working in partnership, both across social care and health and with serviceusers, has been a persistent theme of the health and social care modernisationagenda in the United Kingdom. Despite a relatively underdevelopedevidence base, the development of health and social care partnerships hascontinued to feature in recent policy and legislative initiatives in the UnitedKingdom. At the same time there has been a major shift in focus towardsthe outcomes that support services deliver. A central question remaining iswhether the policy initiatives driving the development of health and socialcare partnerships are delivering improved outcomes, particularly theoutcomes valued by people who use services. This article outlines researchdesigned to explore this issue across 15 health and social care partnershipsin England and Scotland, building from previous research by the SocialPolicy Research Unit based at the University of York. It sought to assess theextent to which health and social care partnerships deliver the outcomesthat people who use services value, and to determine the features of partnershipworking associated with the delivery of these outcomes. A robustoutcomes framework was defined, which provided the basis for interviewswith those receiving support from partnerships. Working with three userresearcherorganisations, interviews were completed with 230 individualsin 2006. On the basis of this, some service users were able to identifyfeatures of partnership that particularly contributed to improved outcomes.These included continuity of staff and sufficient staff and a range ofresources, including the availability of long-term and preventative services.Given the definitional and methodological complexity surrounding partnershipworking, and the challenges of attribution, the study faced somelimitations in its ability to make wider inferences about partnership andoutcomes. A theory of change should be employed in future studies of thistype.

UK policy promotes third sector organisations as providers of NHS funded health and social care. We examine the evidence for this policy through a systematic literature review. Our results highlight several problems of studies comparing non-profits with other provider forms, questioning their usefulness for drawing lessons outside the place of study. Most studies deem contextual factors and the regulatory framework in which providers operate as much more important than ownership form. We conclude that the literature does not support the policy of a larger role for the third sector in healthcare, let alone a switch to a market-based system.

Over the past 10 years, each of the four countries in the UK has attempted to resolve continuing difficulties with duplication of assessment and lack of shared information in community care, by developing approaches to shared assessment. Relevant literature reviews have previously focused on challenges to partnership working between health and social care, and on different approaches to assessment. The literature review described here differs in three key respects. Firstly, the literature was selected on the basis that it addressed shared assessment specifically. Secondly, it included evidence from the four countries within the UK, providing a cross-national basis to the evidence. Thirdly, this study was undertaken to identify whether benefits from shared assessment were evident, in addition to the challenges. While the evidence of benefits at this stage is relatively limited, it is clear that some have emerged, including two relating directly to relevant policy objectives: improved communication, service user and carer involvement; improved partnership and joined up working. As approaches to shared assessment are currently under review in Scotland, England and Wales, and implementation underway in Northern Ireland, and in light of the economic recession and demographic challenges, consideration of key aspects of the evidence may be timely.

Within The Good Apprentice and The Message to the Planet, Iris Murdoch appears to be consciously manipulating both Harold Bloom’s Anxiety of Influence, and Sandra Gilbert and Susan Gubar’s feminist response to Bloom, The Madwoman in the Attic, in order to challenge both her readership’s presuppositions on madness in general, and more specifically how the depiction of madness in literature can be seen to relate to sexuality, religion and gender. Bloom writes that modern authors (specifically male authors) are concerned about their ability to resist the influences of their literary forefathers in order to achieve an original work of their own, with no mention of how a female author might be challenged to create in response to such a male dominated literary past. Bloom relates his theory to Freud’s Oedipus complex and the male child’s desire to overthrow his father in order to establish his own supremacy. The Madwoman in the Attic looks at Bloom’s argument from a female viewpoint, with readings of a number of female authors in the nineteenth century examining how it was impossible for them to follow Bloom’s theory and identify with the authors who have superseded them in order to respond with their own creations.

Changes to primary care have shifted clinical control away from general practitioners and financial control away from government, argue Allyson Pollock and colleagues

The teacher of language should do everything in her power to introduce a feeling of interest, even of enjoyment, into her work. As the end of the year approaches, it is profitable to take up certain groups of words for review. Among these groups those with the diphthongs ph, th, and ch are especially important, because such words are usually hard and many of them are puzzling. I shall divide this discussion into sections dealing with the varying lengths of words from one to six syllables, respectively. Teachers can then select the parts most suited to their classes. The diphthong ph is from the Greek letter phi, the twenty-first letter of the Greek alphabet, and the English equivalent ph is pronounced f. Tell your pupils about this Greek origin of the ph combination, even draw it on the board (q), and let them expect to find most of these words coming from the Greek language. There is one exception to this rule of pronouncing the ph as fthe word Stephen, which is pronounced as if written Sti'v'n. In British usage the word nephew is pronounced with the soft sound of v (nev'u); here in America the preference is for the accepted sound of ph--nef' u. In dealing with these separate groups of words, place the list upon the blackboard where all can see it. Next, pronounce each word carefully, and have the class as a whole and as individuals pronounce it. Then define the words, where possible drawing attention to the derivation and illustrating the most common use in a sentence-example. It always pays to introduce into the discussion something interesting about the origin of the word, its application, or just an interesting story that touches it. This helps greatly to deepen the class memory of the word.

Assessment, planning and review are at the heart of the provision of services and support in health and social care in the community, providing key means through which professionals interact with people using their services. These interactions provide opportunities for relationship building, with evidence that involving the person in identifying their priorities and required support can itself improve outcomes. At the same time, professionals use assessment to assess eligibility for support, and assessment has also increasingly become a mechanism for data gathering, to inform a range of requirements at local and national level including planning, commissioning, inspection and performance management. Despite attempts to move assessment from being service-led to person-centred, meeting such a broad range of objectives and requirements can create tensions at the front line, influencing both how interactions are conducted, and the resulting decisions. More recently, there has been an increasing emphasis on outcomes for individuals using health and social care services, including a shift from needs-led to outcomes-focused assessment. This paper considers a recent literature review about shared health and social care assessment, including emerging evidence from the implementation of outcomes-focused assessment in the UK. It concludes that there are promising signs that the recent shift to outcomes-focused assessment might resolve longstanding tensions around assessment, delivering on person-centred objectives and resulting in more efficient and effective use of resources.