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The concept of resilience, loosely defined as the ability to withstand or to bounce back from adversity and disruption, is attracting increasing attention within the social sciences. Within the policy arena, local and community based resilience strategies are playing an important part in responses to the challenge of unpredictable and disruptive events. This short exploratory paper looks to add to the literature on community resilience by exploring the work of the Local Resilience Forums in England. The Local Resilience Forums are multi-agency partnerships made up of a range of agencies including the police authority, local authorities, the fire and rescue services, the National Health Service and the Environment Agency, that serve communities defined by the boundaries of police areas. The paper outlines definitions of resilience and of community resilience, provides an exploratory review of the characteristics and workings of the Local Resilience Forums and offers some concluding reflections on the employment of the concept at the community level and by the LRF's. [ABSTRACT FROM AUTHOR]

Cross-national collaboration has been shaped by internationalization of scientific relationships. To study the synergic network of high quality research patterns, this paper collects a total of 300 top 50 items, in each indicator from the big database, Essential Science Indicators, which lists top-ranking papers, scientists and institutions from 2005 to 2015. First, the country level relations of co-authorship addresses in five indicator variables are extracted in the field of social sciences to build international collaboration networks. The social network analysis (SNA) method was applied to calculate the metrics of vertices, edges, average degree, average shortest path, diameter, clustering coefficient and betweenness centrality to illuminate the structural characters and collaboration patterns. Based on the international collaboration similarities, this paper also visualizes the endemic clustering groups of six networks, as cluster dendrograms, using Hierarchical Clustering (HC) method. Findings illustrate that USA, England and Canada are outstanding countries in the international collaboration networks of five indicators. There are geographical groups in European countries in the collaboration networks of scientists, institutes and countries/territories. It is also found that international collaboration contributes to both highly cited papers in the recent 10 years and hot papers in the recent 2 years in this field, rather than geographical similarity does. Those conclusions are critical for policy makers to produce guidelines on how to encourage researchers to build collaboration networks with high-level scholars in different countries. [ABSTRACT FROM AUTHOR]

This paper examines the treatment of ontology offered by critical realism. It addresses much of the material elaborated upon in two editions of this journal. Three main groups of criticisms are made here of the critical realist treatment of open systems. It is argued that critical realism, particularly in the project in economics emanating from Cambridge, UK, tends to define systems in terms of events. This definition is shown to be problematic. The exemplar of a closed system provided by critical realism of the solar system is shown to be flawed in that it is not closed according to the closure conditions identified by critical realism. Second, the negativity of the definitions adopted is problematic for heterodox traditions attempting to build positive programmes. Furthermore, the dualism of the definitions is also inconsistent with Dow's approach, which has ramifications for the coherence of post Keynesianism. Third, the definitions tend to polarize open and closed systems and ignore the degrees of openness evident in reality. The polarization of systems leads to polarized methodology and unsustainable arguments to reject so-called “closed-systems methods.” [ABSTRACT FROM AUTHOR]

For pilot or experimental employment programme results to apply beyond their test bed, researchers must select ‘clusters’ (i.e. the job centres delivering the new intervention) that are reasonably representative of the whole territory. More specifically, this requirement must account for conditions that could artificially inflate the effect of a programme, such as the fluidity of the local labour market or the performance of the local job centre. Failure to achieve representativeness results in Cluster Sampling Bias (CSB). This paper makes three contributions to the literature. Theoretically, it approaches the notion of CSB as a human behaviour. It offers a comprehensive theory, whereby researchers with limited resources and conflicting priorities tend to oversample ‘effect-enhancing’ clusters when piloting a new intervention. Methodologically, it advocates for a ‘narrow and deep’ scope, as opposed to the ‘wide and shallow’ scope, which has prevailed so far. The PILOT-2 dataset was developed to test this idea. Empirically, it provides evidence on the prevalence of CSB. In conditions similar to the PILOT-2 case study, investigators (1) do not sample clusters with a view to maximise generalisability; (2) do not oversample ‘effect-enhancing’ clusters; (3) consistently oversample some clusters, including those with higher-than-average client caseloads; and (4) report their sampling decisions in an inconsistent and generally poor manner. In conclusion, although CSB is prevalent, it is still unclear whether it is intentional and meant to mislead stakeholders about the expected effect of the intervention or due to higher-level constraints or other considerations. [ABSTRACT FROM AUTHOR]

This paper examines the magnitude of urban-rural differentials in infant mortality in England during the nineteenth and early twentieth centuries and also compares the timing of decline for a selection of towns of varying size, and their immediate rural hinterlands. Most towns continued to experience short-term fluctuations in infant mortality until the very end of the nineteenth century; however, in some of the adjacent rural communities - where levels of infant mortality were much lower - conditions were sufficiently favourable to allow a continuous decline in infant mortality from at least the 1860s, if not before. The final part of the paper considers the causes of these patterns and their implications for explanations of infant mortality decline. [ABSTRACT FROM AUTHOR]

Background: Patient and public involvement (PPI) is a requirement for UK health and social care research funding. Evidence for how best to implement PPI in research programmes, such as National Institute for Health Research (NIHR) Collaborations for Applied Health Research and Care (CLAHRCs), remains limited. This paper reports findings from an action research (AR) project called IMPRESS, which aims to strengthen PPI within CLAHRC East of England (EoE). IMPRESS combines AR with Normalisation Process Theory (NPT) to explore PPI within diverse case study projects, identifying actions to implement, test and refine to further embed PPI. Methods: We purposively selected CLAHRC EoE case study projects for in-depth analysis of PPI using NPT. Data were generated from project PPI documentation, semi-structured qualitative interviews with researchers and PPI contributors and focus groups. Transcripts and documents were subjected to abductive thematic analysis and triangulation within case. Systematic across case comparison of themes was undertaken with findings and implications refined through stakeholder consultation. Results: We interviewed 24 researchers and 13 PPI contributors and analysed 28 documents from 10 case studies. Three focus groups were held: two with researchers (n = 4 and n = 6) and one with PPI contributors (n = 5). Findings detail to what extent projects made sense of PPI, bought in to PPI, operationalised PPI and appraised it, thus identifying barriers and enablers to fully embedded PPI. Conclusion: Combining NPT with AR allows us to assess the embeddedness of PPI within projects and programme, to inform specific local action and report broader conceptual lessons for PPI knowledge and practice informing the development of an action framework for embedding PPI in research programmes. To embed PPI within similar programmes teams, professionals, disciplines and institutions should be recognised as variably networked into existing PPI support. Further focus and research is needed on sharing PPI learning and supporting innovation in PPI. [ABSTRACT FROM AUTHOR]

Given the centrality of regions in social movements, politics and public administration, here we aim to quantitatively study regional identity, cross-region communication and sentiment. This paper presents a new methodology to study social interaction within and between social-geographic regions, and then applies the methodology to a case study of England and Wales. We use a social network, built from geo-located Twitter data, to identify contiguous geographical regions with a shared social identity and then investigate patterns of communication within and between them. In contrast to other approaches (e.g. using phone call data records or online friendship networks), use of Twitter data provides message contents as well as social connections. This allows us to investigate not only the volume of communication between locations, but also the sentiment and vocabulary used in the messages. For example, our case study shows: a significant dialect difference between England and Wales; that regions tend to be more positive about themselves than about others, with the South being more ‘self-regarding’ than the North; and that people talk politics much more between regions than within. This study demonstrates how social media can be used to quantify regional identity and inter-region communications and sentiment, exposing these previously hard-to-observe geographic concepts to analysis. [ABSTRACT FROM AUTHOR]

Earthworms are primary candidates for national soil health monitoring as they are ecosystem engineers that benefit both food production and ecosystem services associated with soil security. Supporting farmers to monitor soil health could help to achieve the policy aspiration of sustainable soils by 2030 in England; however, little is known about how to overcome participation barriers, appropriate methodologies (practical, cost-effective, usefulness) or training needs. This paper presents the results from a pilot #60minworms study which mobilised farmers to assess over >1300 ha farmland soils in spring 2018. The results interpretation framework is based on the presence of earthworms from each of the three ecological groups at each observation (20 x 20 cm x 20 cm pit) and spatially across a field (10 soil pits). Results showed that most fields have basic earthworm presence and abundance, but 42% fields may be over-worked as indicated by absence/rarity of epigeic and/or anecic earthworms. Tillage had a negative impact (p < 0.05) on earthworm populations and organic matter management did not mitigate tillage impacts. In terms of farmer participation, Twitter and Farmers Weekly magazine were highly effective channels for recruitment. Direct feedback from participants included excellent scores in trust, value and satisfaction of the protocol (e.g. 100% would do the test again) and 57% would use their worm survey results to change their soil management practices. A key training need in terms of earthworm identification skills was reported. The trade-off between data quality, participation rates and fieldwork costs suggests there is potential to streamline the protocol further to #30minworms (5 pits), incurring farmer fieldwork costs of approximately £1.48 ha-1. At national scales, £14 million pounds across 4.7 M ha-1 in fieldwork costs per survey could be saved by farmer participation. [ABSTRACT FROM AUTHOR]

This paper considers relationships between landscape, transport technology and mobility in order to explore how the making of landscape, engineering practice and geographical knowledge are mutually constituted in landscapes of improvement. It examines work by the engineer William Jessop (1745–1814) and focuses specifically on his plans to make the River Trent navigable in the period 1781–91. The paper adopts metaphors of region, fluid and network from the sociology of mobility. It argues that these metaphors usefully inform the study of transport technologies and their related practices and knowledges, in the context of landscape as a mode of governance. [ABSTRACT FROM AUTHOR]

This paper was transcribed from a talk presented by David Kynaston at a seminar on Social Science Data Archives for Social Historians: creating, depositing and using qualitative data, organised jointly by the Economic and Social Data Service (ESDS) and the Institute of Historical Research (IHR), held at the Institute of Historical Research, University of London on 25 November 2003. This paper presents the author's experience of doing research for a social history of Britain between 1945 and 1979 using data and documentary evidence drawn from some of the classic sociology studies archived at ESDS Qualidata (University of Essex). [ABSTRACT FROM AUTHOR]

Many governments have introduced policies aimed at improving social mix, particularly in urban areas. In this article we develop a model of moving and location decisions, which demonstrates how cumulative processes of growth, decline and segregation occur that conflict with the aims of policies aimed at improving social mix. A nested multinomial logit model is estimated, using a micro data set for London and South East England to illustrate the likely outcomes. [ABSTRACT FROM AUTHOR]

Focuses on the presence of anthropological reports and data in the National Archives at Kew in England. Preservation of unpublished materials in the archive that provide some interesting sidelights on the history of anthropological studies in Great Britain; Proliferation of items relating to anthropology in the Colonial Office papers; Relationship between anthropologists and government officials in the country.

Creative industries development has been underway in the city of Stoke-on-Trent for the past fifteen years. Two urban quarters, a creative industries network, 'design-led' regeneration initiatives, and live-work spaces for craft businesses are some of the main projects undertaken in this period. In the past year, this raft of developments has been augmented by a creative industries mapping exercise, and a subsequent funding bid that seeks to draw on UK government and European structural funds in order to act on the research findings, and to put their recommendations into operation. This paper reviews this process both in terms of the political, economic, social, cultural and spatial context of the city, and in terms of broader urban agendas. It provides something of a corrective to the rather 'rose-tinted' picture often drawn of the role and significance of the creative industries for future economic and cultural well-being. [ABSTRACT FROM AUTHOR]

Constrained by estimated population totals and observed totals of births and deaths, estimates of age-structures from inverse projection have been widely used in historical demography. Back Projection attempted, by using hypothetical constraints on net- migration, to estimate the population totals as well, and has been used to derive `censuses' for England from 1541 to 1871. A wider formulation, called Generalised Inverse Projection, is proposed in this paper, which replaces back-projection and establishes its relation to Inverse Projection more clearly. Under the same assumptions as back projection, but using the new method, the estimates for England are virtually unchanged. This new method is capable of performing population projections, subject to a wide variety of hypothetical and empirical constraints, for contemporary as well as historical data. [ABSTRACT FROM AUTHOR]

Most of the papers in this symposium were presented at a conference on the economics of information held at Stanford in April 1975, under the auspices of the National Science Foundation—National Bureau of Economic Research (four of the papers, those by Heal, Salop, Spence and Stiglitz, had been submitted to the Review earlier, but because of the similarity of topic, are published with the conference papers). The papers, though all related to the problems arising from costly information, are diverse both with respect to the question addressed, the techniques of analysis employed and the particular markets investigated. A basic theme running through most of the papers is that imperfect information alters, in a fundamental way, the conventional notion of a market, with buyers and sellers coming together to trade; in a full information equilibrium there is a single price, markets clear and all individuals and firms view themselves as price takers. The price charged is independent of the quantity purchased. Although the notion of the market-place is often thought of as an idealization, even when there is not a single market-place at which all transactions occur, the economy behaves as if there were a single market-place; this will be true so long as there are some arbitrageurs to make sure that the "law of single price" prevails. Finally, conventional theory has shown that under fairly weak conditions such a competitive equilibrium exists and is Pareto Optimal. Recent developments in the economics of information, including the papers presented here, have shown that ail of these statements are questionable. In the papers presented here, there is not a single price in equilibrium; firms do not act as price takers; prices do more than just clear markets—they convey information; prices charged may depend on the quantity purchased; competitive equilibrium may not exist and may not be Pareto Optimal. The basic character of how we ought to view the competitive economy is altered if we take seriously imperfections of information. [ABSTRACT FROM AUTHOR]

European conference on fieldwork for graduate students and junior researchers, will be held at the University of Oxford, from December 17-19, 2003. This conference on anthropological fieldwork organized by the Oxford University Anthropological Society and Anthropology Matters, drew over 70 postgraduate students from more than 25 British and European universities. There were 36 papers addressing a variety of issues and methodological problems, dominant among which were questions of place and ethical issues. Ethical issues were also raised in accounts of research in conflict situations. In her keynote lecture Judith Okely argued that textbooks and methodology courses often leave the people underprepared for the complexity of life and learning "in the field."

Introduction: Antibiotic resistance poses a threat to public health and healthcare systems. Escherichia coli causes more bacteraemia episodes in England than any other bacterial species. This study aimed to estimate the burden of E. coli bacteraemia and associated antibiotic resistance in the secondary care setting. Materials and methods: This was a retrospective cohort study, with E. coli bacteraemia as the main exposure of interest. Adult hospital in-patients, admitted to acute NHS hospitals between July 2011 and June 2012 were included. English national surveillance and administrative datasets were utilised. Cox proportional hazard, subdistribution hazard and multistate models were constructed to estimate rate of discharge, rate of in-hospital death and excess length of stay, with a unit bed day cost applied to the latter to estimate cost burden from the healthcare system perspective. Results: 14,042 E. coli bacteraemia and 8,919,284 non-infected inpatient observations were included. E. coli bacteraemia was associated with an increased rate of in-hospital death across all models, with an adjusted subdistribution hazard ratio of 5.88 (95% CI: 5.62–6.15). Resistance was not found to be associated with in-hospital mortality once adjusting for patient and hospital covariates. However, resistance was found to be associated with an increased excess length of stay. This was especially true for third generation cephalosporin (1.58 days excess length of stay, 95% CI: 0.84–2.31) and piperacillin/tazobactam resistance (1.23 days (95% CI: 0.50–1.95)). The annual cost of E. coli bacteraemia was estimated to be £14,346,400 (2012 £), with third-generation cephalosporin resistance associated with excess costs per infection of £420 (95% CI: 220–630). Conclusions: E. coli bacteraemia places a statistically significant burden on patient health and the hospital sector in England. Resistance to front-line antibiotics increases length of stay; increasing the cost burden of such infections in the secondary care setting. [ABSTRACT FROM AUTHOR]

Background: Funding shortages and an ageing population have increased pressures on state or insurance funded end of life care for older people. Across the world, policy debate has arisen about the potential role volunteers can play, working alongside health and social care professionals in the community to support and care for the ageing and dying. Aims: The authors examined self-reported levels of care for the elderly by the public in England, and public opinions of community volunteering concepts to care for the elderly at the end of life. In particular, claimed willingness to help and to be helped by local people was surveyed. Methods: A sample of 3,590 adults in England aged 45 or more from an online access panel responded to a questionnaire in late 2017. The survey data was weighted to be representative of the population within this age band. Key literature and formative qualitative research informed the design of the survey questionnaire, which was further refined after piloting. Results: Preferences for different models of community volunteering were elicited. There was a preference for ‘formal’ models with increased wariness of ‘informal’ features. Whilst 32% of adults said they ‘might join’ depending on whom the group helped, unsurprisingly more personal and demanding types of help significantly reduced the claimed willingness to help. Finally, willingness to help (or be helped) by local community carers or volunteers was regarded as less attractive than care being provided by personal family, close friends or indeed health and care professionals. Conclusion: Findings suggest that if community volunteering to care for elderly people at the end of life in England is to expand it may require considerable attention to the model including training for volunteers and protections for patients and volunteers as well as public education and promotion. Currently, in England, there is a clear preference for non-medical care to be delivered by close family or social care professionals, with volunteer community care regarded only as a back-up option. [ABSTRACT FROM AUTHOR]

Aims: To explore adolescents’ experiences of consenting to, and participating in, alcohol intervention trials when attending for emergency care. Methods: In-depth semi-structured interviews with 27 adolescents (16 males; aged 14–17 years (Mage = 15.7)) who had taken part in one of two linked brief alcohol intervention trials based in 10 accident and emergency departments in England. Interviews were transcribed verbatim and subject to thematic analysis. Results: Research and intervention methods were generally found to be acceptable though confidentiality was important and parental presence could hinder truthful disclosures regarding alcohol use. Participants discussed the importance of being involved in research that was relevant to them and recognised alcohol consumption as a normative part of adolescence, highlighting the importance of having access to appropriate health information. Beyond this, they recognised the benefits and risks of trial participation for themselves and others with the majority showing a degree of altruism in considering longer term implications for others as well as themselves. Conclusions: Alcohol screening and intervention in emergency care is both acceptable and relevant to adolescents but acceptability is reliant on confidentiality being assured and may be inhibited by parental presence. Trial registration: [ABSTRACT FROM AUTHOR]

Objective: To examine cross-sectional and prospective associations between perceived discrimination in daily life (based on a range of attributes), sexual orientation discrimination, and health and wellbeing in middle-aged and older lesbian, gay and bisexual (LGB) people. Methods: Data were from 304 LGB men and women aged 41–85 years participating in the English Longitudinal Study of Ageing. Perceived discrimination in daily life was reported in 2010/11. Participants could attribute their discrimination experience to characteristics including age, sex, race, physical disability, and sexual orientation. Self-rated health, limiting long-standing illness, depressive symptoms, quality of life, life satisfaction and loneliness were assessed in 2010/11 and 2016/17. Analyses adjusted for age, sex, ethnicity, partnership status and socioeconomic position. Results: Perceived discrimination in daily life was reported by 144 (47.4%) participants. Cross-sectionally, perceived discrimination in daily life was associated with increased odds of depressive symptoms (OR = 2.30, 95% CI 1.02 to 5.21), loneliness (OR = 3.37, 95% CI 1.60 to 7.10) and lower quality of life (B = -3.31, 95% CI -5.49 to -1.12). Prospectively, perceived discrimination in daily life was associated with increased odds of loneliness (OR = 3.12, 95% CI 1.08 to 8.99) and lower quality of life (B = -2.08, 95% CI -3.85 to -0.31) and life satisfaction (B = -1.92, 95% CI -3.44 to -0.39) over six-year follow-up. Effect sizes were consistently larger for participants who attributed experiences of discrimination to their sexual orientation compared with those who attributed experiences of discrimination to other reasons (e.g. age, sex, race). Conclusion: These results provide cross-sectional and prospective evidence of associations between perceived discrimination in daily life and health and wellbeing outcomes in middle-aged and older LGB adults in England. [ABSTRACT FROM AUTHOR]

Given the high prevalence of common mental disorders (CMDs) and individuals living alone in the United Kingdom, the goal of this study using English nationally representative data was to examine the association between living alone and CMDs, and to identify potential mediating factors of this association. The data were drawn from the 1993, 2000 and 2007 National Psychiatric Morbidity Surveys. CMDs were assessed using the Clinical Interview Schedule-Revised (CIS-R), a questionnaire focusing on past week neurotic symptoms. The presence of CMDs was defined as a CIS-R total score of 12 and above. Multivariable logistic regression and mediation analyses were conducted to analyze the association between living alone and CMDs, and to identify mediators in this association. The prevalence of CMDs was higher in individuals living alone than in those not living alone in all survey years. Multivariable analysis showed a positive association between living alone and CMDs in all survey years (1993: odds ratio [OR] = 1.69; 2000: OR = 1.63; and 2007: OR = 1.88). Overall, loneliness explained 84% of the living alone-CMD association. Living alone was positively associated with CMDs. Interventions addressing loneliness among individuals living alone may be particularly important for the mental wellbeing of this vulnerable population. [ABSTRACT FROM AUTHOR]

Background: Despite the relative ease with which breech presentation can be identified through ultrasound screening, the assessment of foetal presentation at term is often based on clinical examination only. Due to limitations in this approach, many women present in labour with an undiagnosed breech presentation, with increased risk of foetal morbidity and mortality. This study sought to determine the cost effectiveness of universal ultrasound scanning for breech presentation near term (36 weeks of gestational age [wkGA]) in nulliparous women.Methods and Findings: The Pregnancy Outcome Prediction (POP) study was a prospective cohort study between January 14, 2008 and July 31, 2012, including 3,879 nulliparous women who attended for a research screening ultrasound examination at 36 wkGA. Foetal presentation was assessed and compared for the groups with and without a clinically indicated ultrasound. Where breech presentation was detected, an external cephalic version (ECV) was routinely offered. If the ECV was unsuccessful or not performed, the women were offered either planned cesarean section at 39 weeks or attempted vaginal breech delivery. To compare the likelihood of different mode of deliveries and associated long-term health outcomes for universal ultrasound to current practice, a probabilistic economic simulation model was constructed. Parameter values were obtained from the POP study, and costs were mainly obtained from the English National Health Service (NHS). One hundred seventy-nine out of 3,879 women (4.6%) were diagnosed with breech presentation at 36 weeks. For most women (96), there had been no prior suspicion of noncephalic presentation. ECV was attempted for 84 (46.9%) women and was successful in 12 (success rate: 14.3%). Overall, 19 of the 179 women delivered vaginally (10.6%), 110 delivered by elective cesarean section (ELCS) (61.5%) and 50 delivered by emergency cesarean section (EMCS) (27.9%). There were no women with undiagnosed breech presentation in labour in the entire cohort. On average, 40 scans were needed per detection of a previously undiagnosed breech presentation. The economic analysis indicated that, compared to current practice, universal late-pregnancy ultrasound would identify around 14,826 otherwise undiagnosed breech presentations across England annually. It would also reduce EMCS and vaginal breech deliveries by 0.7 and 1.0 percentage points, respectively: around 4,196 and 6,061 deliveries across England annually. Universal ultrasound would also prevent 7.89 neonatal mortalities annually. The strategy would be cost effective if foetal presentation could be assessed for £19.80 or less per woman. Limitations to this study included that foetal presentation was revealed to all women and that the health economic analysis may be altered by parity.Conclusions: According to our estimates, universal late pregnancy ultrasound in nulliparous women (1) would virtually eliminate undiagnosed breech presentation, (2) would be expected to reduce foetal mortality in breech presentation, and (3) would be cost effective if foetal presentation could be assessed for less than £19.80 per woman. [ABSTRACT FROM AUTHOR]

Objective: To explore pregnant women’s preferences for birth setting in England. Design: Labelled discrete choice experiment (DCE). Setting: Online survey. Sample: Pregnant women recruited through social media and an online panel. Methods: We developed a DCE to assess women’s preferences for four hypothetical birth settings based on seven attributes: reputation, continuity of care, distance from home, time to see a doctor, partner able to stay overnight, chance of straightforward birth and safety for baby. We used a mixed logit model, with setting modelled as an alternative-specific constant, and conducted a scenario analysis to evaluate the impact of changes in attribute levels on uptake of birth settings. Main outcome measures: Women’s preferences for birth setting. Results: 257 pregnant women completed the DCE. All birth setting attributes, except ‘time to see doctor’, were significant in women’s choice (p<0.05). There was significant heterogeneity in preferences for some attributes. Changes to levels for ‘safety for the baby’ and ‘partner able to stay overnight’ were associated with larger changes from baseline uptake of birth setting. If the preferences identified were translated into the real-world context up to a third of those who reported planning birth in an obstetric unit might choose a midwifery unit assuming universal access to all settings, and knowledge of the differences between settings. Conclusions: We found that ‘safety for the baby’, ‘chance of a straightforward birth’ and ‘can the woman’s partner stay overnight following birth’ were particularly important in women’s preferences for hypothetical birth setting. If all birth settings were available to women and they were aware of the differences between them, it is likely that more low risk women who currently plan birth in OUs might choose a midwifery unit. [ABSTRACT FROM AUTHOR]

Quantifying the value of investment in medical research can inform decision-making on the prioritisation of research programmes. Existing methodologies to estimate the rate of return of medical research are inappropriate for early-phase translational research due to censoring of health benefits and time lags. A strategy to improve the process of translational research for patient benefit has been initiated as part of the UK National Institute for Health Research (NIHR) investment in Biomedical Research Centres (BRCs) in England. By providing a platform for partnership between universities, NHS trusts and industry, successful BRCs should reduce time lags within translational research whilst also providing an impetus for local economic growth through industry collaboration. We present a novel contribution in the assessment of early-phase biomedical research by estimating the impact of the Oxford Biomedical Research Centre (OxBRC) on income and job creation following the initial NIHR investment. We adopt a macroeconomic assessment approach using Input-Output Analysis to estimate the value of medical research in terms of income and job creation during the early pathway towards translational biomedical research. Inter-industry linkages are assessed by building a model economy for the South East England region to estimate the return on investment of the OxBRC. The results from the input-output model estimate that the return on investment in biomedical research within the OxBRC is 46%. Each £1 invested in the OxBRC generates an additional £0.46 through income and job creation alone. Multiplicative employment effects following a marginal investment in the OxBRC of £98m during the period 2007-2017 result in an estimated additional 196 full time equivalent positions being created within the local economy on top of direct employment within OxBRC. Results from input-output analyses can be used to inform the prioritisation of biomedical research programmes when compared against national minimum thresholds of investment. [ABSTRACT FROM AUTHOR]

England’s national Improving Access to Psychological Therapies (IAPT) programme advocates stepped care as its organizational delivery of psychological therapies to common mental health problems. There is limited evidence regarding the efficacy of stepped care as a service delivery model, heterogeneity of definition and differences in model implementation in both research and routine practice, hence outcome comparison in terms of effectiveness of model is difficult. Despite sound evidence of the efficacy of low intensity interventions there appears to be a perpetuation of the notion that severity and complexity should only be treated by a high intensity intervention through the continuation of a stratified care model. Yet no psychotherapy treatment is found to be more superior to another, and not enough is known about what works for whom to aid the matching of treatment decision. In the absence of understanding precise treatment factors optimal for recovery, it may be useful to better understand the impact of a service delivery model, and whether different models achieve different outcomes. This study aims to contribute to the discussion regarding the stepped care definition and delivery, and explores the impact on clinical outcomes where different types of stepped care have been implemented within the same service. An observational cohort study analysed retrospective data (n = 16,723) over a 4 year period, in a single IAPT service, where delivery changed from one type of stepped care model to another. We compared the outcomes of treatment completers with a stratified care model and a progression care model. We also explored the assumption that patients who score severe on psychological measures, and therefore are potentially complex, would achieve better outcomes in a stratified model. Outcomes in each model type were compared, alongside baseline factor variables. A significant association was observed between a recovery outcome and model type, with patients 1.5 times more likely to recover in the progression delivery model. The potential implications are that with a progression stepped care model of service delivery, more patients can be treated with a lower intensity intervention, even with initial severe presentations, ensuring that only those that need high intensity CBT or equivalent are stepped up. This could provide services with an effective clinical model that is efficient and potentially more cost effective. [ABSTRACT FROM AUTHOR]

Many disciplines of scholarship are interested in the Relative Age Effect (RAE), whereby age-banding confers advantages on older members of the cohort over younger ones. Most research does not test this relationship in a manner consistent with theory (which requires a decline in frequency across the cohort year), instead resorting to non-parametric, non-directional approaches. In this article, the authors address this disconnect, provide an overview of the benefits associated with Poisson regression modelling, and two managerially useful measures for quantifying RAE bias, namely the Indices of Discrimination and Wastage. In a tutorial-like exposition, applications and extensions of this approach are illustrated using data on professional soccer players competing in the top two tiers of the “Big Five” European football leagues in the search to identify paragon clubs, leagues, and countries from which others may learn to mitigate this form of age-discrimination in the talent identification process. As with OLS regression, Poisson regression may include more than one independent variable. In this way we test competing explanations of RAE; control for unwanted sources of covariation; model interaction effects (that different clubs and countries may not all be subject to RAE to the same degree); and test for non-monotonic versions of RAE suggested in the literature. [ABSTRACT FROM AUTHOR]

Background: The patient's interpretation of the events and decisions leading up to consultation with a healthcare professional for symptoms of brain cancer is under researched. The aim of this study was to document responses to noticing the changes preceding a diagnosis of brain cancer and living with them, focusing on appraisal of changes and the decision to seek (and re-seek) help, with attention to the psychological processes underpinning the appraisal and help-seeking intervals. Method: In this qualitative study set in Eastern and NW England, in-depth interviews with adult patients recently diagnosed with primary brain cancer and their family members were analysed thematically, using the Model of Pathways to Treatment as a conceptual framework. Results: 39 adult patients were interviewed. Regarding the appraisal interval, cognitive heuristics were found to underpin explanations of changes/symptoms. The subtlety and normality of changes often suggested nothing serious was wrong. Common explanations included stress or being busy at work, or age and these did not seem to warrant a visit to a doctor. Explanations and the decision to seek help were made within the social context, with friends, family and work colleagues contributing to appraisal and help-seeking decisions. Regarding the help-seeking interval, barriers to seeking help reflected components of Social Cognitive Theory, and included having other priorities, outcome expectations (e.g. 'feeling silly', not sure much can be done about it, not wanting to waste doctors' time) and accessibility of a preferred healthcare professional. Conclusion: Application of psychological theory facilitated understanding of the influences on cognition and behaviour. The study highlights implications for theory, awareness campaigns and potential opportunities promoting more timely help-seeking. [ABSTRACT FROM AUTHOR]

Methods: A cross-sectional survey of men attending antenatal care with their partners at three London Maternity Units. We assessed level of pregnancy planning using the partner version of the London Measure of Unplanned Pregnancy (LMUP), preconception health behaviours, and whether they had sought information and health professional advice before conception. Main results: We recruited 573 men (91% response rate). Mean age was 34 years, 86% were in employment or full time education and 66% had a degree. Half were overweight or obese, 16% were still smoking and 79% had consumed alcohol in the three months before conception. Of 250 men answering questions about medication, a third were taking medication with potentially adverse effects on male reproductive health, while 23% reported taking pre-pregnancy vitamins. 46.9% had looked at information about pregnancy from a variety of sources, including online, before their partner became pregnant. Assessed by the LMUP, 74% of pregnancies were planned. Male 'planners' were more likely than other men to reduce smoking, reduce alcohol consumption and to eat more healthily in preparation for pregnancy. However, 57% took no action to improve their health. Significance of the findings: In a sample of relatively educated men accompanying their partners on an antenatal visit, nearly half had made at least one positive health behaviour change before pregnancy, but half were overweight or obese and a third were on medication that could impair male reproductive health. These findings, together with a high prevalence of alcohol consumption and smoking, indicate the need for greater paternal preconception health awareness and care. Innovative ways to promote positive messages about fatherhood, including medication review as part of preconception care, should be evaluated for impact on improving paternal reproductive health and pregnancy and neonatal outcomes. [ABSTRACT FROM AUTHOR]

Background: The Healthy Living Pharmacy (HLP) project, launched in England, UK in 2009 was a novel approach of introducing public health services within community pharmacy to tackle local health inequalities. A national roll-out followed a reported successful pilot; subsequent local evaluations ensued. Objectives: To summarise reported outcomes and investigate contextual factors that indicate the presence, absence and maturity of implementation determinants, thus offering useful lessons to stakeholders in implementing future initiatives to achieve successful outcomes. Methods: A systematic review was conducted to identify all publications reporting on the HLP project. All HLP articles and conference abstracts were considered for inclusion and were assessed for methodological quality. The Consolidated Framework for Implementation Research (CFIR) was utilised to identify potential implementation determinants reported. Each article was then analysed to identify reported economic, humanistic or clinical outcomes. Results: The review included six peer-reviewed journal articles and 12 conference abstracts. Joanna Briggs Institute Qualitative Assessment and Review Instrument indicated deficiencies in methodological quality. Through adoption of the CFIR framework, the implementation determinants relevant to the implementation of HLP into community pharmacy were identified. A resonating issue emerged in that the absence of adopting an evidence-based implementation process limited the ability to capture meaningful outcome data. This resulted in a lack of evidence to support sustainability and the failure to address many of the well cited barriers, e.g. lack of awareness amongst patients, public and other healthcare professionals, and weak support for future investment in resource for training and dissemination. Conclusions: Healthcare systems are increasingly called on to adopt evidence-based interventions that improve quality, control costs, and maximize value, thus offering opportunity to accelerate the implementation of clinical pharmacy services and programs aimed at improving patient care. Interventions, such as the HLP project require focused efforts on implementation and evaluation of those implementation efforts to produce effective and lasting changes in complex health care systems. [ABSTRACT FROM AUTHOR]

Background: People with dementia living in care homes often experience clinically significant agitation; however, little is known about its economic impact. Objective: To calculate the cost of agitation in people with dementia living in care homes. Methods: We used the baseline data from 1,424 residents with dementia living in care homes (part of Managing Agitation and Raising QUality of lifE in dementia (MARQUE) study) that had Cohen-Mansfield Agitation Inventory (CMAI) scores recorded. We investigated the relationship between residents’ health and social care costs and severity of agitation based on the CMAI total score. In addition, we assessed resource utilisation and compared costs of residents with and without clinically significant symptoms of agitation using the CMAI over and above the cost of the care home. Results: Agitation defined by the CMAI was a significant predictor of costs. On average, a one-point increase in the CMAI will lead to a 0.5 percentage points (cost ratio 1.005, 95%CI 1.001 to 1.010) increase in the annual costs. The excess annual cost associated with agitation per resident with dementia was £1,125.35. This suggests that, on average, agitation accounts for 44% of the annual health and social care costs of dementia in people living in care homes. Conclusion: Agitation in people with dementia living in care homes contributes significantly to the overall costs increasing as the level of agitation increases. Residents with the highest level of agitation cost nearly twice as much as those with the lowest levels of agitation, suggesting that effective strategies to reduce agitation are likely to be cost-effective in this setting. [ABSTRACT FROM AUTHOR]

Aim: To gain a better understanding of the complex relationships of different measures of social position, educational level and income with alcohol consumption in England. Method: Between March 2014 and April 2018 data were collected on n = 57,807 alcohol drinkers in England taking part in the Alcohol Toolkit Study (ATS). Respondents completed the AUDIT-C measure of frequency of alcohol consumption, amount consumed on a typical day and binge drinking frequency. The first two questions were used to derive a secondary measure of quantity: average weekly unit consumption. Socio-economic factors measured were: social-grade (based on occupation), employment status, educational qualifications, home and car ownership and income. Models were constructed using ridge regression to assess the contribution of each predictor taking account of high collinearity. Models were adjusted for age, gender and ethnicity. Results: The strongest predictor of frequency of alcohol consumption was social-grade. Those in the two lowest occupational categories of social grade (e.g. semi-skilled and unskilled manual workers, and unemployed, pensioners, casual workers) has fewer drinking occasions than those in professional-managerial occupations (β = -0.29, 95%CI -0.34 to -0.25; β = -0.31, 95%CI -0.33 to -0.29). The strongest predictor of consumed volume and binge drinking frequency was lower educational attainment: those whose highest qualification was an A-level (i.e. college/high school qualification) drank substantially more on a typical day (β = 0.28, 95%CI 0.25 to 0.31) and had a higher weekly unit intake (β = 3.55, 95%CI 3.04 to 4.05) than those with a university qualification. They also reported a higher frequency of binge drinking (β = 0.11, 95%CI 0.09 to 0.14). Housing tenure was a strong predictor of all drinking outcomes, while employment status and car ownership were the weakest predictors of most outcomes. Conclusion: Social-grade and educational attainment appear to be the strongest socioeconomic predictors of alcohol consumption indices in England, followed closely by housing tenure. Employment status and car ownership have the lowest predictive power. [ABSTRACT FROM AUTHOR]

Background: Air pollution damages health by promoting the onset of some non-communicable diseases (NCDs), putting additional strain on the National Health Service (NHS) and social care. This study quantifies the total health and related NHS and social care cost burden due to fine particulate matter (PM2.5) and nitrogen dioxide (NO2) in England.Method and Findings: Air pollutant concentration surfaces from land use regression models and cost data from hospital admissions data and a literature review were fed into a microsimulation model, that was run from 2015 to 2035. Different scenarios were modelled: (1) baseline 'no change' scenario; (2) individuals' pollutant exposure is reduced to natural (non-anthropogenic) levels to compute the disease cases attributable to PM2.5 and NO2; (3) PM2.5 and NO2 concentrations reduced by 1 μg/m3; and (4) NO2 annual European Union limit values reached (40 μg/m3). For the 18 years after baseline, the total cumulative cost to the NHS and social care is estimated at £5.37 billion for PM2.5 and NO2 combined, rising to £18.57 billion when costs for diseases for which there is less robust evidence are included. These costs are due to the cumulative incidence of air-pollution-related NCDs, such as 348,878 coronary heart disease cases estimated to be attributable to PM2.5 and 573,363 diabetes cases estimated to be attributable to NO2 by 2035. Findings from modelling studies are limited by the conceptual model, assumptions, and the availability and quality of input data.Conclusions: Approximately 2.5 million cases of NCDs attributable to air pollution are predicted by 2035 if PM2.5 and NO2 stay at current levels, making air pollution an important public health priority. In future work, the modelling framework should be updated to include multi-pollutant exposure-response functions, as well as to disaggregate results by socioeconomic status. [ABSTRACT FROM AUTHOR]

Background: Cognitive stimulation therapy (CST) is a well-established group psychosocial intervention for people with dementia. There is evidence that home-based programmes of cognitive stimulation delivered by family caregivers may benefit both the person and the caregiver. However, no previous studies have evaluated caregiver-delivered CST. This study aimed to evaluate the effectiveness of a home-based, caregiver-led individual cognitive stimulation therapy (iCST) program in (i) improving cognition and quality of life (QoL) for the person with dementia and (ii) mental and physical health (well-being) for the caregiver.Methods and Findings: A single-blind, pragmatic randomised controlled trial (RCT) was conducted at eight study sites across the United Kingdom. The intervention and blinded assessment of outcomes were conducted in participants' homes. Three hundred fifty-six people with mild to moderate dementia and their caregivers were recruited from memory services and community mental health teams (CMHTs). Participants were randomly assigned to iCST (75, 30-min sessions) or treatment as usual (TAU) control over 25 wk. iCST sessions consisted of themed activities designed to be mentally stimulating and enjoyable. Caregivers delivering iCST received training and support from an unblind researcher. Primary outcomes were cognition (Alzheimer's Disease Assessment Scale-cognitive [ADAS-Cog]) and self-reported QoL (Quality of Life Alzheimer's Disease [QoL-AD]) for the person with dementia and general health status (Short Form-12 health survey [SF-12]) for the caregiver. Secondary outcomes included quality of the caregiving relationship from the perspectives of the person and of the caregiver (Quality of the Carer Patient Relationship Scale) and health-related QoL (European Quality of Life-5 Dimensions [EQ-5D]) for the caregiver. Intention to treat (ITT) analyses were conducted. At the post-test (26 wk), there were no differences between the iCST and TAU groups in the outcomes of cognition (mean difference [MD] = -0.55, 95% CI -2.00-0.90; p = 0.45) and self-reported QoL (MD = -0.02, 95% CI -1.22-0.82; p = 0.97) for people with dementia, or caregivers' general health status (MD = 0.13, 95% CI -1.65-1.91; p = 0.89). However, people with dementia receiving iCST rated the relationship with their caregiver more positively (MD = 1.77, 95% CI 0.26-3.28; p = 0.02), and iCST improved QoL for caregivers (EQ-5D, MD = 0.06, 95% CI 0.02-0.10; p = 0.01). Forty percent (72/180) of dyads allocated to iCST completed at least two sessions per week, with 22% (39/180) completing no sessions at all. Study limitations include low adherence to the intervention.Conclusions: There was no evidence that iCST has an effect on cognition or QoL for people with dementia. However, participating in iCST appeared to enhance the quality of the caregiving relationship and caregivers' QoL.Trial Registration: The iCST trial is registered with the ISRCTN registry (identified ISRCTN 65945963, URL: DOI 10.1186/ISRCTN65945963). [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess the predictors among high-risk drinkers in England of attempts to reduce alcohol consumption, the reasons given for these attempts and the association between the various reasons and alcohol consumption. Method: Data came from 2,800 high-risk drinkers taking part in the Alcohol Toolkit Study (ATS) between March 2014 and November 2016 who were attempting to reduce their alcohol consumption. Participants completed the Alcohol Use Disorders Identification Test (AUDIT) and were asked questions regarding their socio-demographic characteristics, attempts to cut down and reasons for doing so. Results: Those cutting down were significantly older (OR 1.01, p<0.001), were more likely to be female (OR 1.32, p<0.05), had higher AUDIT-C scores (OR 1.12, p<0. 001), were less likely to be of white ethnicity (OR 0.64, p<0. 001), and were more likely to reside in the South of England (OR 1.34, p<0. 001). They were also more likely to be of higher occupationally-based social-grades (p<0. 001). The main reported reasons for reducing consumption were: fitness (22.5%), weight loss (20.4%), future health (20.4%), advice from a health-care professional (7.9%) and cost (7.6%). Those reporting the followings reasons for cutting down had higher AUDIT-C scores than those who did not report these reasons: a concern about further health problems (β 0.20, p<0.05), advice from a doctor/health worker (β 0.38, p<0.05), that drinking was too expensive (β 0.42, p<0.01) and detoxification (β 0.42, p<0.01). Lower AUDIT-C scores were noted among those who reported that they knew someone who was cutting down (β -0.67, p<0.05), that there was no reason (β -0.36, p<0.05), or they didn’t know why they were cutting down (β -0.25, p<0.05). Conclusions: Around a fifth of high-risk drinkers in England report trying to reduce their drinking, particularly older, high-socioeconomic female drinkers from the south of England. Attempts to cut down appear to be driven by a desire to improve health, advice from others and cutting down on the cost of drinking. [ABSTRACT FROM AUTHOR]

Big changes to the way in which research funding is allocated to UK universities were brought about in the Research Excellence Framework (REF), overseen by the Higher Education Funding Council, England. Replacing the earlier Research Assessment Exercise, the purpose of the REF was to assess the quality and reach of research in UK universities–and allocate funding accordingly. For the first time, this included an assessment of research ‘impact’, accounting for 20% of the funding allocation. In this article we use a text mining technique to investigate the interpretations of impact put forward via impact case studies in the REF process. We find that institutions have developed a diverse interpretation of impact, ranging from commercial applications to public and cultural engagement activities. These interpretations of impact vary from discipline to discipline and between institutions, with more broad-based institutions depicting a greater variety of impacts. Comparing the interpretations with the score given by REF, we found no evidence of one particular interpretation being more highly rewarded than another. Importantly, we also found a positive correlation between impact score and [overall research] quality score, suggesting that impact is not being achieved at the expense of research excellence. [ABSTRACT FROM AUTHOR]

Background: We have assessed whether the linkage between routine primary and secondary care records provided an opportunity to develop an improved population based co-morbidity score with the combined information on co-morbidities from both health care settings. Methods: We extracted all people older than 20 years at the start of 2005 within the linkage between the Hospital Episodes Statistics, Clinical Practice Research Datalink, and Office for National Statistics death register in England. A random 50% sample was used to identify relevant diagnostic codes using a Bayesian hierarchy to share information between similar Read and ICD 10 code groupings. Internal validation of the score was performed in the remaining 50% and discrimination was assessed using Harrell’s C statistic. Comparisons were made over time, age, and consultation rate with the Charlson and Elixhauser indexes. Results: 657,264 people were followed up from the 1st January 2005. 98 groupings of codes were derived from the Bayesian hierarchy, and 37 had an adjusted weighting of greater than zero in the Cox proportional hazards model. 11 of these groupings had a different weighting dependent on whether they were coded from hospital or primary care. The C statistic reduced from 0.88 (95% confidence interval 0.88–0.88) in the first year of follow up, to 0.85 (0.85–0.85) including all 5 years. When we stratified the linked score by consultation rate the association with mortality remained consistent, but there was a significant interaction with age, with improved discrimination and fit in those under 50 years old (C = 0.85, 0.83–0.87) compared to the Charlson (C = 0.79, 0.77–0.82) or Elixhauser index (C = 0.81, 0.79–0.83). Conclusions: The use of linked population based primary and secondary care data developed a co-morbidity score that had improved discrimination, particularly in younger age groups, and had a greater effect when adjusting for co-morbidity than existing scores. [ABSTRACT FROM AUTHOR]

Background: The Alcohol Harm Paradox refers to observations that lower socioeconomic status (SES) groups consume less alcohol but experience more alcohol-related problems. However, SES is a complex concept and its observed relationship to social problems often depends on how it is measured and the demographic groups studied. Thus this study assessed socioeconomic patterning of alcohol consumption and related harm using multiple measures of SES and examined moderation of this patterning by gender and age. Method: Data were used from the Alcohol Toolkit Study between March and September 2015 on 31,878 adults (16+) living in England. Participants completed the AUDIT which includes alcohol consumption, harm and dependence modules. SES was measured via qualifications, employment, home and car ownership, income and social-grade, plus a composite of these measures. The composite score was coded such that higher scores reflected greater social-disadvantage. Results: We observed the Alcohol Harm Paradox for the composite SES measure, with a linear negative relationship between SES and AUDIT-Consumption scores (β = -0.036, p<0.001) and a positive relationship between lower SES and AUDIT-Harm (β = 0.022, p<0.001) and AUDIT-Dependence (β = 0.024, p<0.001) scores. Individual measures of SES displayed different, and non-linear, relationships with AUDIT modules. For example, social-grade and income had a u-shaped relationship with AUDIT-Consumption scores while education had an inverse u-shaped relationship. Almost all measures displayed an exponential relationship with AUDIT-Dependence and AUDIT-Harm scores. We identified moderating effects from age and gender, with AUDIT-Dependence scores increasing more steeply with lower SES in men and both AUDIT-Harm and AUDIT-Dependence scores increasing more steeply with lower SES in younger age groups. Conclusion: Different SES measures appear to influence whether the Alcohol Harm Paradox is observed as a linear trend across SES groups or a phenomenon associated particularly with the most disadvantaged. The paradox also appears more concentrated in men and younger age groups. [ABSTRACT FROM AUTHOR]

Introduction: While evidence that alcohol pricing policies reduce alcohol-related health harm is robust, and alcohol taxation increases are a WHO "best buy" intervention, there is a lack of research comparing the scale and distribution across society of health impacts arising from alternative tax and price policy options. The aim of this study is to test whether four common alcohol taxation and pricing strategies differ in their impact on health inequalities.Methods and Findings: An econometric epidemiological model was built with England 2014/2015 as the setting. Four pricing strategies implemented on top of the current tax were equalised to give the same 4.3% population-wide reduction in total alcohol-related mortality: current tax increase, a 13.4% all-product duty increase under the current UK system; a value-based tax, a 4.0% ad valorem tax based on product price; a strength-based tax, a volumetric tax of £0.22 per UK alcohol unit (= 8 g of ethanol); and minimum unit pricing, a minimum price threshold of £0.50 per unit, below which alcohol cannot be sold. Model inputs were calculated by combining data from representative household surveys on alcohol purchasing and consumption, administrative and healthcare data on 43 alcohol-attributable diseases, and published price elasticities and relative risk functions. Outcomes were annual per capita consumption, consumer spending, and alcohol-related deaths. Uncertainty was assessed via partial probabilistic sensitivity analysis (PSA) and scenario analysis. The pricing strategies differ as to how effects are distributed across the population, and, from a public health perspective, heavy drinkers in routine/manual occupations are a key group as they are at greatest risk of health harm from their drinking. Strength-based taxation and minimum unit pricing would have greater effects on mortality among drinkers in routine/manual occupations (particularly for heavy drinkers, where the estimated policy effects on mortality rates are as follows: current tax increase, -3.2%; value-based tax, -2.9%; strength-based tax, -6.1%; minimum unit pricing, -7.8%) and lesser impacts among drinkers in professional/managerial occupations (for heavy drinkers: current tax increase, -1.3%; value-based tax, -1.4%; strength-based tax, +0.2%; minimum unit pricing, +0.8%). Results from the PSA give slightly greater mean effects for both the routine/manual (current tax increase, -3.6% [95% uncertainty interval (UI) -6.1%, -0.6%]; value-based tax, -3.3% [UI -5.1%, -1.7%]; strength-based tax, -7.5% [UI -13.7%, -3.9%]; minimum unit pricing, -10.3% [UI -10.3%, -7.0%]) and professional/managerial occupation groups (current tax increase, -1.8% [UI -4.7%, +1.6%]; value-based tax, -1.9% [UI -3.6%, +0.4%]; strength-based tax, -0.8% [UI -6.9%, +4.0%]; minimum unit pricing, -0.7% [UI -5.6%, +3.6%]). Impacts of price changes on moderate drinkers were small regardless of income or socioeconomic group. Analysis of uncertainty shows that the relative effectiveness of the four policies is fairly stable, although uncertainty in the absolute scale of effects exists. Volumetric taxation and minimum unit pricing consistently outperform increasing the current tax or adding an ad valorem tax in terms of reducing mortality among the heaviest drinkers and reducing alcohol-related health inequalities (e.g., in the routine/manual occupation group, volumetric taxation reduces deaths more than increasing the current tax in 26 out of 30 probabilistic runs, minimum unit pricing reduces deaths more than volumetric tax in 21 out of 30 runs, and minimum unit pricing reduces deaths more than increasing the current tax in 30 out of 30 runs). Study limitations include reducing model complexity by not considering a largely ineffective ban on below-tax alcohol sales, special duty rates covering only small shares of the market, and the impact of tax fraud or retailer non-compliance with minimum unit prices.Conclusions: Our model estimates that, compared to tax increases under the current system or introducing taxation based on product value, alcohol-content-based taxation or minimum unit pricing would lead to larger reductions in health inequalities across income groups. We also estimate that alcohol-content-based taxation and minimum unit pricing would have the largest impact on harmful drinking, with minimal effects on those drinking in moderation. [ABSTRACT FROM AUTHOR]

Background: Recently a large clinical trial showed that the use of 13-valent pneumococcal conjugate vaccine (PCV13) among immunocompetent individuals aged 65 years and over was safe and efficacious. The aim of this study was to assess the cost-effectiveness of vaccinating immunocompetent 65 year olds with PCV13 vaccine in England. England is a country with universal childhood pneumococcal conjugate vaccination programme in place (7-valent (PCV7) since 2006 and PCV13 since 2010), as well as a 23-valent pneumococcal polysaccharide (PPV23) vaccination programme targeting clinical risk-groups and those ≥65 years. Method: A static cohort cost-effectiveness model was developed to follow a cohort of 65 year olds until death, which will be vaccinated in the autumn of 2016 with PCV13. Sensitivity analysis was performed to test the robustness of the results. Results: The childhood vaccination programme with PCV7 has induced herd protection among older unvaccinated age groups, with a resultant low residual disease burden caused by PCV7 vaccine types. We show similar herd protection effects for the 6 additional serotypes included in PCV13, and project a new low post-introduction equilibrium of vaccine-type disease in 2018/19. Applying these incidence projections for both invasive disease and community-acquired pneumonia (CAP), and using recent measures of vaccine efficacy against these endpoints for ≥65 year olds, we estimate that vaccination of a cohort of immunocompetent 65 year olds with PCV13 would directly prevent 26 cases of IPD, 69 cases of CAP and 15 deaths. The associated cost-effectiveness ratio is £257,771 per QALY gained (using list price of £49.10 per dose and £7.51 administration costs) and is therefore considered not cost-effective. To obtain a cost-effective programme the price per dose would need to be negative. The results were sensitive to disease incidence, waning vaccine protection and case fatality rate; despite this, the overall conclusion was robust. Conclusions: Vaccinating immunocompetent individuals aged ≥65 years with PCV13 is efficacious. However the absolute incidence of vaccine-type disease will likely become very low due to wider benefits of the childhood PCV13 vaccination programme, such that a specific PCV13 vaccination programme targeting the immunocompetent elderly would not be cost-effective. [ABSTRACT FROM AUTHOR]

Background: Identifying and tackling the social determinants of infectious diseases has become a public health priority following the recognition that individuals with lower socioeconomic status are disproportionately affected by infectious diseases. In many parts of the world, epidemiologically and genotypically defined community-associated (CA) methicillin-resistant Staphylococcus aureus (MRSA) strains have emerged to become frequent causes of hospital infection. The aim of this study was to use spatial models with adjustment for area-level hospital attendance to determine the transmission niche of genotypically defined CA- and health-care-associated (HA)-MRSA strains across a diverse region of South East London and to explore a potential link between MRSA carriage and markers of social and material deprivation.Methods and Findings: This study involved spatial analysis of cross-sectional data linked with all MRSA isolates identified by three National Health Service (NHS) microbiology laboratories between 1 November 2011 and 29 February 2012. The cohort of hospital-based NHS microbiology diagnostic services serves 867,254 usual residents in the Lambeth, Southwark, and Lewisham boroughs in South East London, United Kingdom (UK). Isolates were classified as HA- or CA-MRSA based on whole genome sequencing. All MRSA cases identified over 4 mo within the three-borough catchment area (n = 471) were mapped to small geographies and linked to area-level aggregated socioeconomic and demographic data. Disease mapping and ecological regression models were used to infer the most likely transmission niches for each MRSA genetic classification and to describe the spatial epidemiology of MRSA in relation to social determinants. Specifically, we aimed to identify demographic and socioeconomic population traits that explain cross-area extra variation in HA- and CA-MRSA relative risks following adjustment for hospital attendance data. We explored the potential for associations with the English Indices of Deprivation 2010 (including the Index of Multiple Deprivation and several deprivation domains and subdomains) and the 2011 England and Wales census demographic and socioeconomic indicators (including numbers of households by deprivation dimension) and indicators of population health. Both CA-and HA-MRSA were associated with household deprivation (CA-MRSA relative risk [RR]: 1.72 [1.03-2.94]; HA-MRSA RR: 1.57 [1.06-2.33]), which was correlated with hospital attendance (Pearson correlation coefficient [PCC] = 0.76). HA-MRSA was also associated with poor health (RR: 1.10 [1.01-1.19]) and residence in communal care homes (RR: 1.24 [1.12-1.37]), whereas CA-MRSA was linked with household overcrowding (RR: 1.58 [1.04-2.41]) and wider barriers, which represent a combined score for household overcrowding, low income, and homelessness (RR: 1.76 [1.16-2.70]). CA-MRSA was also associated with recent immigration to the UK (RR: 1.77 [1.19-2.66]). For the area-level variation in RR for CA-MRSA, 28.67% was attributable to the spatial arrangement of target geographies, compared with only 0.09% for HA-MRSA. An advantage to our study is that it provided a representative sample of usual residents receiving care in the catchment areas. A limitation is that relationships apparent in aggregated data analyses cannot be assumed to operate at the individual level.Conclusions: There was no evidence of community transmission of HA-MRSA strains, implying that HA-MRSA cases identified in the community originate from the hospital reservoir and are maintained by frequent attendance at health care facilities. In contrast, there was a high risk of CA-MRSA in deprived areas linked with overcrowding, homelessness, low income, and recent immigration to the UK, which was not explainable by health care exposure. Furthermore, areas adjacent to these deprived areas were themselves at greater risk of CA-MRSA, indicating community transmission of CA-MRSA. This ongoing community transmission could lead to CA-MRSA becoming the dominant strain types carried by patients admitted to hospital, particularly if successful hospital-based MRSA infection control programmes are maintained. These results suggest that community infection control programmes targeting transmission of CA-MRSA will be required to control MRSA in both the community and hospital. These epidemiological changes will also have implications for effectiveness of risk-factor-based hospital admission MRSA screening programmes. [ABSTRACT FROM AUTHOR]

Objective: To explore and document the experiences of those receiving support from a lay health trainer, in order to inform the optimisation and evaluation of such interventions. Design: Longitudinal qualitative study with up to four serial interviews conducted over 12 months. Interviews were transcribed and analysed using the constant comparative approach associated with grounded theory. Participants: 13 health trainers, 5 managers and 26 clients. Setting: Three health trainer services targeting disadvantaged communities in northern England. Results: The final dataset comprised 116 interviews (88 with clients and 28 with staff). Discussions with health trainers and managers revealed a high degree of heterogeneity between the local services in terms of their primary aims and activities. However, these were found to converge over time. There was agreement that health trainer interventions are generally ‘person-centred’ in terms of being tailored to the needs of individual clients. This led to a range of self-reported outcomes, including behaviour changes, physical health improvements and increased social activity. Factors impacting on the maintenance of lifestyle changes included the cost and timing of health-promoting activities, ill-health or low mood. Participants perceived a need for ongoing access to low cost facilities to ensure that any lifestyle changes can be maintained in the longer term. Conclusions: Health trainers may be successful in terms of supporting people from socio-economically disadvantaged communities to make positive lifestyle changes, as well as achieving other health-related outcomes. This is not a ‘one-size-fits-all’ approach; commissioners and providers should select the intervention models that best meet the needs of their local populations. By delivering holistic interventions that address multiple lifestyle risks and incorporate relapse prevention strategies, health trainers could potentially have a significant impact on health inequalities. However, rigorous, formal outcome and economic evaluation of the range of health trainer delivery models is needed. [ABSTRACT FROM AUTHOR]

The historiography of English republicanism is dominated by the concept of classical republicanism. Its greatest shortcoming has been neglect of that subject's religious dimension. The consequent need is not simply to recover the radical protestant republican religious agenda. It is to explain why, when classical republicanism came to England, it did so in the moral service of a religious revolution. One context for the answer lay in Christian humanism. Another was the reformation, both magisterial and radical. Both informed the practical identity of the republican experiment as an attempted reformation of manners. So did the rational Greek moral philosophy, as indebted to Plato as to Aristotle, common to certain humanist and Christian political languages. In addition many of the themes of republican writing reflect the struggle by a traditional society to respond to unsettling forces, not only of political and religious, but also social and economic, change. Drawing upon all of these contexts, republican writers attempted to oppose not only private interest politics, embodied by monarchy or tyranny, on behalf of the public interested virtues of a self-governing civic community. This was part of a more general critique of private interest society; a republican attempt, from pride, greed, poverty, and inequality, to go beyond the word ‘commonwealth’ and reconstitute what Milton called ‘the solid thing’. [ABSTRACT FROM AUTHOR]

William Pitt the Younger died in 1806 but had a long afterlife in political argument. Historians have argued that a reactionary cult of Pitt in early nineteenth-century toryism died with Catholic emancipation, but this article suggests that invocation of Pitt's character was more widespread and durable, because linked to the assertion and defence of party identities. Whig hostility to Pitt remained strong even in the middle of the nineteenth century. Lord John Russell attacked his character flaws to celebrate the continued vigour and distinctness of Foxite political culture within the Liberal party. Conversely, use of Pitt in argument about what the top party should be like did not end with reform. In the 1830s, traditional celebration of Pitt as a stern opponent of revolutionary agitation survived within a supposedly moderate conservatism. In Peel' s second administration, arguments about whether Pitt had been firm or flexible, liberal or intransigent, reflected and added to disputes about how much religious and economic liberalism Peel should endorse. It was schism between Peelites and protectionists, the article suggests, which broke the clear link between celebration of Pitt's character and one party, allowing a more wide-ranging, because less politically charged, appreciation of Pitt to develop. [ABSTRACT FROM AUTHOR]

Joint Reviews form the crown of the regulatory apparatus in social services in England and Wales, and reviewers have crafted an impressive methodology to investigate the workings of social services authorities. My aim in this article is to expose and explore the social processes underpinning this methodology, drawing upon interviews with people on both sides of the regulatory fence and an ethnographic study of Joint Reviews in action. I shall discuss the cultural politics of regulatory research and demonstrate the ways in which communications and interpretations in the field can be constructed, confused, and contested. This is not an argument against regulation but rather a quest for greater reflexivity in regulation and research. [ABSTRACT FROM AUTHOR]

The article presents a discussion of the Piltdown hoax. It explains that the said hoax had an impact on the development of paleoanthropology that is still being appreciated. It reveals the process and personalities of science. It conventionally interprets that the forgery was a masterful splicing of human and orangutan bones to provide material support for the theories of Grafton Elliott Smith and Arthur Keith. It states that the hoax involves an academic professional. The case for an accomplice has not been focused on, but a review of its arguments shows that it is strong.

One remark made more frequently by sociologists than by their gibing critics that sociology has not yet come to that development which commands from its adherents wholehearted agreement as to the objectives to be aimed at, the field to be limited, and the methods to be used. Not only is this lack of unanimity characteristic of the science as a whole, when viewed apart from national boundaries, but also even within each country there is still to be found great diversity of opinion as to the major concepts and abstractions of this field of inquiry. England seems to offer the one exception. It is not that English sociologists have consciously developed an agreement and so are working as a unified group for the advancement of their science, for they seem to be less aware of disagreement and of the controversial aspects of the situation than most workers in the field. It is rather that there seems to be a fairly general acceptance of the idea that there is something called a sociological point of view which can be applied to economics, anthropology, religion, or what not, but that point of view is infinitely elastic and does not cry to be defined nor elaborated into a separate discipline.

An area of research in which sociologists and historians would seem to share a rather obvious concern is that of social change. In his presidential address before the joint meeting of the Canadian Historical and Canadian Political Science Association, S. D. Clark emphasized this. "We cannot become students of change," he said, "without becoming historians. It is only by looking at what has happened to societies of the past, and over time, that the sociologist can derive the data on which to build his principles of social change." That is to say that the study of social change requires recognition of processes in time and must deal, insofar as time past is involved, with evidence that is historical. The student of social change must become a historian and the historian, insofar as he is interested in understanding and interpreting general processes, must become a social scientist. When, however, one searches the literature for particular studies of historical social change, one's findings are meager indeed, especially if one's standards, theoretically and methodologically, are reflective of those of contemporary social science, and one's historiographical standards, of contemporary history. If, in addition, one is searching for social change studies of a particular national history, then the material is even more limited. For this reason I have expanded this review, which was originally concerned with the American nineteenth century only, to include two studies of English history, because these two studies include important theoretical and methodological contributions to the study of history and social change in America. [ABSTRACT FROM AUTHOR]