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Risk management which assesses and mitigates risks such as suicide and violence is under scrutiny, particularly within psychiatric inpatient settings. Restrictive practices, which result from risk assessment, such as observations, physical restraint and ward seclusion can impact negatively on patient recovery, hindering abilities to develop a meaningful life that emphasizes purpose, hope and autonomy, despite experiencing mental distress. Yet, less is known about the impact from the patient's perspective when first admitted to hospital, a period which among other reasons may come with increasing risk management practices owing to the clinical uncertainties about patient risks. In this grounded theory study, we explore the impact on recovery, interviewing 15 adult participants with patient experiences of being in an acute hospital. The main theme of the study, termed a core category with a grounded theory, was identified as "ontological insecurity of inattentiveness". This highlighted a staff inattentiveness with involving patients with risk management and explaining the purposes of the practice, which raised insecurities about what was happening to the patients when admitted to hospital. Four subcategories support the core category; discounting the patients' experiences to gain a meaningful grasp of risk management, ambiguity about risk management rules, particularly the reasons around their use, forebodingness to the hospital environment and, management from afar, with patients feeling scrutinized from observations without a voice to offer different views. It is hoped these findings will add to the field of patient involvement in psychiatric inpatient settings, proposing attempts to raise understanding and inclusivity of risk management, starting when first admitted to hospital. [ABSTRACT FROM AUTHOR]

Background and aims: Ontologies are ways of representing information that improve clarity and the ability to connect different data sources. This paper proposes an initial version of an ontology of tobacco, nicotine and vaping products with the aim of reducing ambiguity and confusion in the field. Methods: Terms related to tobacco, nicotine and vaping products were identified in the research literature and their usage characterised. Basic Formal Ontology was used as a unifying upper‐level ontology to describe the domain, and classes with definitions and labels were developed linking them to this ontology. Labels, definitions and properties were reviewed and revised in an iterative manner until a coherent set of classes was agreed by the authors. Results: Overlapping, but distinct classes were developed: 'tobacco‐containing product', 'nicotine‐containing product' and 'vaping device'. Subclasses of tobacco‐containing products are 'combustible tobacco‐containing product', 'heated tobacco product' and 'smokeless tobacco‐containing product'. Subclasses of combustible tobacco‐containing product include 'cigar', 'cigarillo', 'bidi' and 'cigarette' with further subclasses including 'manufactured cigarette'. Manufactured cigarettes have properties that include 'machine‐smoked nicotine yield' and 'machine‐smoked tar yield'. Subclasses of smokeless tobacco product include 'nasal snuff', 'chewing tobacco product', and 'oral snuff' with its subclass 'snus'. Subclasses of nicotine‐containing product include 'nicotine lozenge' and 'nicotine transdermal patch'. Subclasses of vaping device included 'electronic vaping device' with a further subclass, 'e‐cigarette'. E‐cigarettes have evolved with a complex range of properties including atomiser resistance, battery power, properties of consumables including e‐liquid nicotine concentration and flavourings, and the ontology characterises classes of product accordingly. Conclusions: Use of an ontology of tobacco, nicotine and vaping products should help reduce ambiguity and confusion in tobacco control research and practice. [ABSTRACT FROM AUTHOR]

With a focus on 'screen and team' family therapy, we tentatively explore possible practice implications associated with family therapy moving from in‐person to online delivery, with the intention of developing questions for further empirical research. By examining some of the affordances and constraints of the online medium in relation to the use of triadic questioning, we set forth a number of the epistemological and ontological consequences of this move. We argue that online therapy has particular features of a dialogical approach and method. We then examine the concept of joint action, the nature of the conversational processes, and the utterance chains that seem to be more likely to emerge when working online. We posit that a major advantage of the move to online delivery of family therapy is the medium's particular utility for generating more invitational, collaborative, and dialogical practices. [ABSTRACT FROM AUTHOR]

The United Kingdom Government are planning to issue guidance on sleep duration. Whilst sleep is clearly important for health, offering such guidance is not the answer. Within this commentary we put forward three arguments to support this claim: (i) sleep is liminal and beyond the limits of voluntary agency; (ii) sleep is linked to structural inequality; and (iii) sleep is multiple. The first two points are now well established. However, the third encourages a considerable break from established thinking. Recent research has highlighted that we need to move away from viewing sleep as a singular, objectively defined phenomenon, and instead position it as many different practices woven together. Sleep is situated, contingent and is enacted in multiple ways. Public health would be better served by a ground-up approach which explores good and poor sleep across these three axes: liminality, social position, and ontology. [ABSTRACT FROM AUTHOR]

Anthropologists have generally found it reasonable to understand the Industrial Revolution in Britain as a product of global historical processes including colonialism and the structure of world trade. The extent to which the industrialization of British textile production was contingent on global processes has been illuminated in detail by historians such as Joseph Inikori. Andre Gunder Frank proposed that we should reconceptualize technological development as a 'world economic process, which took place in and because of the structure of the world economy'. Yet the theoretical implications of understanding industrial technological systems as global and unevenly distributed phenomena have, by and large, not contaminated mainstream conceptions of technologies as politically neutral and fundamentally innocent manifestations of enlightenment, detachable from the societal contexts in which they have emerged. Social theory nevertheless offers perspectives for a radical rethinking of this conventional ontology of modern technology. If the premises of actor–network theory, material culture studies, Marxism and poststructuralist critiques of power and inequalities are combined with the perspectives of ecological economics on global social metabolism, the fossil-fuelled textile factories of 19th-century Britain can be reinterpreted as social instruments for appropriating embodied human labour and natural space from elsewhere in the global system. A renewed 'anthropology of technology' might focus on the observation that technology is not simply a matter of putting nature to work, but a strategy of putting other sectors of global society to work. 1 [ABSTRACT FROM AUTHOR]

This article addresses the role of data in the analysis of racial diversity in the UK film industry. Due to the prolonged poor representation of racial difference, academic researchers increasingly identify the UK film sector as a particular site of multi-dimensional structural inequalities. This article will assess the impact of data-led interventions made by the UK film industry to increase the presence of BAME individuals within the sector. It will do this through an analysis of the policy approach of the UK's lead body for film, the British Film Institute, examining how one major policy initiative, the BFI's Diversity Standards launched in 2016 as an industry intervention into prevailing sector inequalities, has sought to achieve racial diversity and inclusion across its Film Fund-supported film productions between 2016 and 2019. Analysing cross-sectional data from 235 films which is aggregated across differing film genres, budgets and regions, the study assesses how the outcomes of the Diversity Standards have offered a representation of racial diversity across these production areas. [ABSTRACT FROM AUTHOR]

Introduction: PBC registries in the UK focus on data from secondary care without clear coordinated contribution from primary care. The Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) receives data from > 500 primary care practices (PCPs). Notably, the Lancet commissioning group is extracting data from the RCGP RSC database to shape UK policy on liver disease. Aims: To create a novel ontology to facilitate PBC case finding from primary care provider (PCP) records. Methods: RCGP RSC data were collected from participating PCPs in the county of Surrey, UK. PBC diagnostic criteria of the AASLD and EASL guidelines were used to develop 725 data codes to facilitate patient record searches. A scoring system built into the ontology allowed categorization of cases as PBC definite, PBC probable, and PBC unlikely. Results: A total of 218,099 records were searched from participating PCPs. Of these, there were 58 PBC definite, 2317 PBC probable, and 215,724 PBC unlikely patients. There were 32 PBC definite patients who did not match to our regional PBC database and were henceforth included as new-found cases. Two of these cases were not labeled as PBC by the PCP. From the PBC unlikely group, 7/215,724 (0.003%) patients were labeled as PBC in secondary care records; however, none of them were coded as having PBC by their PCPs. Conclusions: Utilization of the UK National RCGP RSC database supported by novel ontology score has successfully helped us identify (i) new cases of PBC not known to local/regional secondary care providers and (ii) de novo PBC cases. There are many PBC probable cases whose data merit further careful evaluation. [ABSTRACT FROM AUTHOR]

Across the UK, wide‐ranging efforts have been made to enhance citizen access to psychological therapy. Clinical psychologists are key providers of and gatekeepers for therapy. This article is concerned with how clinical psychologists foster access (or not) to psychological care. More specifically, it interrogates how psychologists manage, and make decisions around, patient referrals. Following a referral, psychologists must resolve an uncertain situation: should they accept a referral and continue with an assessment? Thereafter, they must decide whether a patient is suitable for their service – and for therapy more generally. Certainty is synthesised against a backdrop of sometimes powerful pressures to meet service targets. Taking cues from medical sociology and science and technology studies (STS), this article interrogates some of the uncertainties around access to psychological therapy, and how decisions made by clinical psychologists involve negotiations of patient, service and professional ontologies. To do so, it draws on interviews with 40 psychologists across England and Scotland. The paper spotlights a professional group that is often absent from or only dimly lit within sociological observation and analysis: clinical psychology. Through attending to the discourses of psychologists, I extend conversations about uncertainty through a distinctive case study. [ABSTRACT FROM AUTHOR]

Continuity is a long-established and fiercely-defended value in primary care. Traditional continuity, based on a one-to-one doctor-patient relationship, has declined in recent years. Contemporary general practice is organisationally and technically complex, with multiple staff roles and technologies supporting patient access (e.g. electronic and telephone triage) and clinical encounters (e.g. telephone, video and electronic consultations). Re-evaluation of continuity's relational, organisational, socio-technical and professional characteristics is therefore timely. We developed theory in parallel with collecting and analysing data from case studies of 11 UK general practices followed from 2021 to 2023 as they introduced (or chose not to introduce) remote and digital services. We used strategic, immersive ethnography, interviews, and material analysis of technologies (e.g. digital walk-throughs). Continuity was almost universally valued but differently defined across practices. It was invariably situated and effortful, influenced by the locality, organisation, technical infrastructure, wider system and the values and ways of working of participating actors, and often requiring articulation and 'tinkering' by staff. Remote and digital modalities provided opportunities for extending continuity across time and space and for achieving—to a greater or lesser extent—continuity of digital records and shared understandings of a patient and illness episode across the clinical team. Delivering continuity for the most vulnerable patients was sometimes labour-intensive and required one-off adaptations. Building on earlier work by Haggerty et al. we propose a novel ontology of four analytically distinct but empirically overlapping kinds of continuity—of the therapeutic relationship (based on psychodynamic and narrative paradigms), of the illness episode (biomedical-interpretive paradigm), of distributed work (sociotechnical paradigm), and of the practice's commitment to a community (political economy and ethics of care paradigm). This ontology allowed us to theorise and critique successes (continuity achieved) and failures (breaches of continuity and fragmentation of care) in our dataset. • We propose a quadripartite ontology of continuity in general practice today. • These include psychodynamic, biomedical, sociotechnical, and political economy. • We empirically explore the manifestation of these continuities in practice. • This will help conceptualise 'continuity' and its achievement in practice. [ABSTRACT FROM AUTHOR]

The Philippines remains the world's largest exporter of nurses, with over 22,000 employed in the NHS (Baker, 2020). In this article, we analyse the migratory rationales and choices of Filipino nurses either about to embark or already working in the UK's National Health Service (NHS), through an ontological security framework. Qualitative interviews and focus groups were undertaken with 24 nurses in the Philippines and UK one element of which set out to understand why, in the context of high global demand for overseas nurses the nurses had chosen the UK as their destination. Findings highlight how collective imageries of 'home' and of different overseas destinations are rooted in shared understandings of underlying social structures, and their perceived capacity to generate ontological security for their citizens. Social and institutional pressures in the Philippines engendered a generalised insecurity that was corrosive to the nurses' identity and sense of agency and undermined the ability to meet cultural norms of family support. The nurses favoured the UK due to the comparative ease of moving there; a prevailing perception of social stability and of its political and institutional structures as being based on transparency and meritocracy, facilitating professional development and social mobility. The findings extend 'culture of migration' perspectives by illuminating why nurses migrate to where they do by emphasising place as a source of ontological security, with migratory preferences influenced by the perceived capacity of different national systems to minimise social risks. This also implies that as global social risks and volatilities intensify, plugging nursing gaps in the economically developed world with nurses from the developing world will become increasingly unpredictable as the ability of governments in destination countries to guarantee ontological security becomes more uncertain. • Explores why Filipino nurses move to the UK given high global demand for nurses. • Images of migratory destinations reflect shared understandings of its society. • Perceptions of comparative ontological security shapes migratory choices. [ABSTRACT FROM AUTHOR]