The ‘first three years’ movement and the infant brain:a review of critiques

This article reviews a particular aspect of the critique of the increasing focus on the brain and neuroscience; what has been termed by some, 'neuromania'. It engages with the growing literature produced in response to the 'first three years' movement: an alliance of child welfare advocates and politicians that draws on the authority of neuroscience to argue that social problems such as inequality, poverty, educational underachievement, violence and mental illness are best addressed through 'early intervention' programmes to protect or enhance emotional and cognitive aspects of children's brain development. The movement began in the United States in the early 1990s and has become increasingly vocal and influential since then, achieving international legitimacy in the United States, Canada, New Zealand, Australia, the UK and elsewhere. The movement, and the brain-based culture of expert-led parent training that has grown with it, has been criticised for claiming scientific authority whilst taking a cavalier approach to scientific method and evidence; for being overly deterministic about the early years of life; for focusing attention on individual parental failings rather than societal or structural problems, for adding to the expanding anxieties of parents and strengthening the intensification of parenting and, ultimately, for redefining the parent-child relationship in biologised, instrumental and dehumanised terms. © 2014 John Wiley & Sons Ltd.

An analysis of the effectiveness of a behavioural based safety intervention in a UK paper mill

This research examines a behavioural based safety (BBS) intervention within a paper mill in the South East of England. Further to this intervention two other mills are examined for the purposes of comparison — one an established BBS programme and the other an improving safety management system through management ownership. BBS programmes have become popular within the UK, but most of the research about their efficacy is carried out by the BBS providers themselves. This thesis aims to evaluate a BBS intervention from a standpoint which is not commercially biased in favour of BBS schemes. The aim of a BBS scheme is to either change personnel behaviours or attitudes, which in turn will positively affect the organisation's safety culture. The research framework involved a qualitative methodology in order to examine the effects of the intervention on the paper mill's safety culture. The techniques used were questionnaires and semi structured interviews, in addition to observation and discussions which were possible because of the author's position as participant observer. The results demonstrated a failure to improve any aspect of the mill's safety culture, which worsened following the BBS intervention. Issues such as trust, morale, communication and support of management showed significant signs of negative workforce response. The paper mill where the safety management system approach was utilised demonstrated a significantly improved safety culture and achieved site ownership from middle managers and supervisors. Research has demonstrated that a solid foundation is required prior to successfully implementing a BBS programme. For a programme to work there must be middle management support in addition to senior management commitment. If a trade union actively distances itself from BBS, it is also unlikely to be effective. This thesis proposes that BBS observation programmes are not suitable for the papermaking industry, particularly when staffing levels are low due to challenging economic conditions. Observers are not available when there are high hazard situations and this suggests that BBS implementation is not the correct intervention for the paper industry.

Evaluating EU regional policy

This article presents a challenge to the ways in which EU regional policy has been evaluated in the past. Given the complexity of the 'policy framework' and its objectives, it is argued that existing evaluation methodologies are not only inappropriate but create a real risk of misleading policy-makers in their search for identifying which programmes and initiatives are the most effective in tackling the scale of regional disparity that exists across the European Union. For example, the search for an 'average effect' of intervention, whether in terms of jobs created or GVA generated, does not adequately recognise the context within which policy operates. The article argues that only by attempting to adopt a realist evaluation framework can the discourse on effective regional policy be advanced. Examples are provided from a body of work on the evaluation of business support interventions in the UK as well as a broader study of the way in which regulations impacts upon firm performance and growth. This methodological approach provides an opportunity for the evaluator to identify the causal mechanisms which connect the range of policy interventions and their outcomes. In brief, it has greater potential to inform the policy-maker as to what works and, more importantly, in what contexts.

Transforming the eastern neighbourhood: the security implications of European Union Activity in Ukraine 2000-2006

This thesis examines the external activities of the European Union conducted in the wider Europe against the backdrop of eastern enlargement. It focuses on the technical aspects of EU diplomacy, using qualitative research methodology to study the programmes and initiatives launched since the year 2000 in the countries lying along the Union’s new border to the east. Drawing on evidence from Ukraine, it hypothesises that the EU is an agent of transformation in the eastern neighbourhood and that this transformation has important implications for the regional order in the post-Soviet space. The thesis constitutes an investigation into the transformational activities engaged by the EU in Ukraine conducted with an eye to their strategic implications. It documents and analyses three instances of EU intervention in Ukraine’s internal processes that relate to management of cross-border traffic in the Ukrainian-Russian borderland, restructuring of the country’s energy sector, and conduct of its contentious presidential election in 2004. It is argued that while these interventions have explicitly sought to advance the Union’s security with respect to certain twenty-first century transnational threats, they have at the same time served to confer important strategic advantages on the EU that include giving the bloc greater knowledge and control over developments in Ukraine and that contribute to the dismantling of infrastructural, institutional and other ties between Kiev and the other Soviet successor states, notably Russia. The effect of the European Union’s actions in the region, whether intended or not, has thus been to undermine any competing regional initiatives that cut across its own functions, and thereby to assert itself as the primary integration project in Europe. By showing how technical interventions in the politics, economics and administration of Ukraine can yield important geopolitical dividends, this thesis demonstrates that, in the context of EU external relations, high and low politics are interlinked.

Adverse drug reaction teaching in UK undergraduate medical and pharmacy programmes

Objectives: To assess the extent of teaching about the Committee on Safety of Medicine's Yellow Card scheme and adverse drug reactions within UK Schools of Medicine and Pharmacy. Methods: A self-completed questionnaire sent to all heads of undergraduate schools of medicine and pharmacy within the UK. Results: The majority of undergraduate syllabuses feature the Yellow Card Scheme. Knowledge of the Yellow Card Scheme was assessed in 79% of pharmacy programmes and 57% of medical schools. Specialist speakers on the Yellow Card Scheme were infrequently used. Fewer than half of respondents provided students with a guide to reporting ADRs (43% pharmacy and 43% medical). There is some disagreement about the value of supplying students with printed material about the Yellow Card Scheme. Half of medical Schools did not think that supplying 'Current Problems In Pharmacovigilance' would be useful. Conclusions: It was found that in both medicine and pharmacy, courses differed substantially in teaching about the Yellow Card Scheme and adverse drug reactions (ADRs). There is scope for increased involvement of the Medicines and Healthcare products Regulatory Agency in undergraduate education, in line with recommendations from the National Audit Office.

State intervention in technology in the post war years: case studies in technology policy

This thesis is concerned with the means by which the state in Britain has attempted to influence the technological development of private industry in the period 1945-1979. Particular emphasis is laid on assessing the abilities of technology policy measures to promote innovation. With that objective, the innovation literature is selectively reviewed to draw up an analytical framework to evaluate the innovation content of policy (Chapter 2). Technology policy is taken to consist of the specific measures utilised by government and its agents that affect the technological behaviour of firms. The broad sweep of policy during the period under consideration is described in Chapter 3 which concentrates on elucidating its institutional structure and the activities of the bodies involved. The empirical core of the thesis consists of three parallel case studies of policy toward the computer, machine tool and textile machinery industries (Chapters 4-6). The studies provide detailed historical accounts of the development and composition of policy, relating it to its specific institutional and industrial contexts. Each reveals a different pattern and level of state intervention. The thesis concludes with a comparative review of the findings of the case studies within a discussion centred on the arguments presented in Chapter 2. Topics arising include the state's differential support for the range of activities involved in innovation, the location of state-funded R&D, the encouragement of supplier-user contact, and the difficulties raised in adoption and diffusion.

The role of analogy in spelling in English primary school children - a partial intervention study

The English writing system is notoriously irregular in its orthography at the phonemic level. It was therefore proposed that focusing beginner-spellers’ attention on sound-letter relations at the sub-syllabic level might improve spelling performance. This hypothesis was tested in Experiments 1 and 2 using a ‘clue word’ paradigm to investigate the effect of analogy teaching intervention / non-intervention on the spelling performance of an experimental group and controls. The results overall showed the intervention to be effective in improving spelling, and this effect to be enduring. Experiment 3 demonstrated a greater application of analogy in spelling, when clue words, which participants used in analogy to spell test words, remained in view during testing. A series of regression analyses, with spelling entered as the criterion variable and age, analogy and phonological plausibility (PP) as predictors, showed both analogy and PP to be highly predictive of spelling. Experiment 4 showed that children could use analogy to improve their spelling, even without intervention, by comparing their performance in spelling words presented in analogous categories or in random lists. Consideration of children’s patterns of analogy use at different points of development showed three age groups to use similar patterns of analogy, but contrasting analogy patterns for spelling different words. This challenges stage theories of analogy use in literacy. Overall the most salient units used in analogy were the rime and, to a slightly lesser degree, the onset-vowel and vowel. Finally, Experiment 5 showed analogy and phonology to be fairly equally influential in spelling, but analogy to be more influential than phonology in reading. Five separate experiments therefore found analogy to be highly influential in spelling. Experiment 5 also considered the role of memory and attention in literacy attainment. The important implications of this research are that analogy, rather than purely phonics-based strategy, is instrumental in correct spelling in English.

The evaluation and development of the lead authority partnership scheme as a central intervention strategy for health and safety enforcement by local authorities

The research comprises a suite of studies that examines and develops the Lead Authority Partnership Scheme (LAPS) as a central intervention strategy for health and safety by local authority (LA) enforcers. Partnership working is a regulatory concept that in recent years has become more popular but there has been little research conducted to investigate, explore and evaluate its practical application. The study reviewed two contrasting approaches to partnership working between LAs and businesses, both of which were intended to secure improvements in the consistency of enforcement by the regulators and in the health and safety management systems of the participating businesses. The first was a well-established and highly prescriptive approach that required a substantial resource commitment on the part of the LA responsible for conducting a safety management review (SMR) of the business. As a result of his evaluation of the existing ‘full SMR’ scheme, the author developed a second, more flexible approach to partnership working. The research framework was based upon a primarily qualitative methodology intended to investigate and explore the impact of the new flexible arrangements for partnership working. The findings from this study of the flexible development of the scheme were compared and contrasted with those from studies of the established ‘full SMR’ scheme. A substantial degree of triangulation was applied in an attempt to strengthen validity and broaden applicability of the research findings. Key informant interviews, participant observation, document/archive reviews, questionnaires and surveys all their particular part to play in the overall study. The findings from this research revealed that LAPS failed to deliver consistency of LA enforcement across multiple-outlet businesses and the LA enforced business sectors. Improvement was however apparent in the safety management systems of the businesses participating in LAPS. Trust between LA inspector and safety professional was key to the success of the partnerships as was the commitment of these key individuals. Competition for precious LA resources, the priority afforded to food safety over health and safety, the perceived high resource demands of LAPS, and the structure and culture of LAs were identified as significant barriers to LA participation. Flexible approaches, whilst addressing the resource issues, introduced some fresh concerns relating to credibility and delivery. Over and above the stated aims of the scheme, LAs and businesses had their own reasons for participation, notably the personal development of individuals and kudos for the organisation. The research has explored the wider implications for partnership working with the overall conclusion it is most appropriately seen as a strategic level element within a broader structured intervention strategy.

Priority evaluation in transportation policies and programmes

This work is concerned with the development of techniques for the evaluation of large-scale highway schemes with particular reference to the assessment of their costs and benefits in the context of the current transport planning (T.P.P.) process. It has been carried out in close cooperation with West Midlands County Council, although its application and results are applicable elsewhere. The background to highway evaluation and its development in recent years has been described and the emergence of a number of deficiencies in current planning practise noted. One deficiency in particular stood out, that stemming from inadequate methods of scheme generation and the research has concentrated upon improving this stage of appraisal, to ensure that subsequent stages of design, assessment and implementation are based upon a consistent and responsive foundation. Deficiencies of scheme evaluation were found to stem from inadequate development of appraisal methodologies suffering from difficulties of valuation, measurement and aggregation of the disparate variables that characterise highway evaluation. A failure to respond to local policy priorities was also noted. A 'problem' rather than 'goals' based approach to scheme generation was taken, as it represented the current and foreseeable resource allocation context more realistically. A review of techniques with potential for highway problem based scheme generation, which would work within a series of practical and theoretical constraints were assessed and that of multivariate analysis, and classical factor analysis in particular, was selected, because it offerred considerable application to the difficulties of valuation, measurement and aggregation that existed. Computer programs were written to adapt classical factor analysis to the requirements of T.P.P. highway evaluation, using it to derive a limited number of factors which described the extensive quantity of highway problem data. From this, a series of composite problem scores for 1979 were derived for a case study area of south Birmingham, based upon the factorial solutions, and used to assess highway sites in terms of local policy issues. The methodology was assessed in the light of its ability to describe highway problems in both aggregate and disaggregate terms, to guide scheme design, coordinate with current scheme evaluation methods, and in general to improve upon current appraisal. Analysis of the results was both in subjective, 'common-sense' terms and using statistical methods to assess the changes in problem definition, distribution and priorities that emerged. Overall, the technique was found to improve upon current scheme generation methods in all respects and in particular in overcoming the problems of valuation, measurement and aggregation without recourse to unsubstantiated and questionable assumptions. A number of deficiencies which remained have been outlined and a series of research priorities described which need to be reviewed in the light of current and future evaluation needs.

Appropriate wage rate and related issues for employment intensive public works programmes in Timor Leste

Employment generating public works (EGPW) are an important part of GoTL’s strategy to reduce unemployment, underemployment and poverty and contribute to social stability. The term EGPW is used in this report as a generic term to encompass labour intensive (LI) and labourbased (LB) approaches. The distinction between these approaches is made below. SEFOPE is being supported by a number of international agencies to develop and implement employment generating public works programmes (EGPWPs). Other government ministries and agencies and NGOs offering different wage rates are also engaged in such programmes and projects. In setting wage rates for such programmes, it is necessary to take account of (a) the nature of benefits they offer (e.g. the balance between employment creation and effective use of labour); (b) the beneficiaries to be targeted, and (c) any adverse impacts on other economic activities. The purposes of this assignment are: (a) to make recommendations on appropriate wage rates for unskilled casual employment on public works programmes, and (b) make a broad assessment of the labour supply response to the employment opportunities created by employment intensive programmes. The latter would help in gauging the scale of such activities required.

Evaluating authentic behaviour change in leadership development programmes

The global economic crisis that hit the western countries strongly has emphasised the need to abandon the economic-performance significance of leadership and return to a meaning-making significance. While a lot of research has been done in the field of leadership and management disciplines, little has been done on how to develop leadership. This study evaluated the degree in which leadership training in the market-place today was effective at developing authentic leadership and, therefore, at changing individual behaviour. Since none of the leadership theories address how behavioural change is actually achieved, theories of change were integrated in the current study. A conceptual model combining Authentic Leadership Development (ALD) theory and the Theory of Planned Behaviour (TPB) was proposed. Furthermore, this study explored the relationship between a positive contemplation of change and the actual change observed in individuals after the leadership intervention. In order to test this conceptualisation, a longitudinal quasi-experimental study was conducted. Leaders were surveyed in this study one month before and one month after the programme. Three complementary questionnaires were distributed to participants in one of four leadership development programmes (two corporate initiatives and two business-school programmes). Analyses showed that leaders who attended a leadership intervention (as compared to a control group) developed higher levels of authentic leadership, as rated by them-selves and others in their working environment and controlling for baseline scores. The results also indicated that intentions were developed through the interventions and that the development of such intentions translated into changes in authentic behaviour. Intentions mediated the relationship between attitude and authentic leader-ship. In addition, when contemplation of change was high and attitudes towards authentic leadership were positive, the development of intentions was stronger. The implications of these findings for the theory and practice of leadership development programmes and the impact on organisational performance are discussed.

Developing a complex intervention to reduce time to presentation with symptoms of lung cancer

Background - Lung cancer is the commonest cause of cancer in Scotland and is usually advanced at diagnosis. Median time between symptom onset and consultation is 14 weeks, so an intervention to prompt earlier presentation could support earlier diagnosis and enable curative treatment in more cases. Aim - To develop and optimise an intervention to reduce the time between onset and first consultation with symptoms that might indicate lung cancer. Design and setting - Iterative development of complex healthcare intervention according to the MRC Framework conducted in Northeast Scotland. Method - The study produced a complex intervention to promote early presentation of lung cancer symptoms. An expert multidisciplinary group developed the first draft of the intervention based on theory and existing evidence. This was refined following focus groups with health professionals and high-risk patients. Results - First draft intervention components included: information communicated persuasively, demonstrations of early consultation and its benefits, behaviour change techniques, and involvement of spouses/partners. Focus groups identified patient engagement, achieving behavioural change, and conflict at the patient–general practice interface as challenges and measures were incorporated to tackle these. Final intervention delivery included a detailed self-help manual and extended consultation with a trained research nurse at which specific action plans were devised. Conclusion -The study has developed an intervention that appeals to patients and health professionals and has theoretical potential for benefit. Now it requires evaluation.

Effectiveness and uptake of screening programmes for coronary heart disease and diabetes:a realist review of design components used in interventions

Objective - To evaluate behavioural components and strategies associated with increased uptake and effectiveness of screening for coronary heart disease and diabetes with an implementation science focus. Design - Realist review. Data sources - PubMed, Web of Knowledge, Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register and reference chaining. Searches limited to English language studies published since 1990. Eligibility criteria - Eligible studies evaluated interventions designed to increase the uptake of cardiovascular disease (CVD) and diabetes screening and examined behavioural and/or strategic designs. Studies were excluded if they evaluated changes in risk factors or cost-effectiveness only. Results - In 12 eligible studies, several different intervention designs and evidence-based strategies were evaluated. Salient themes were effects of feedback on behaviour change or benefits of health dialogues over simple feedback. Studies provide mixed evidence about the benefits of these intervention constituents, which are suggested to be situation and design specific, broadly supporting their use, but highlighting concerns about the fidelity of intervention delivery, raising implementation science issues. Three studies examined the effects of informed choice or loss versus gain frame invitations, finding no effect on screening uptake but highlighting opportunistic screening as being more successful for recruiting higher CVD and diabetes risk patients than an invitation letter, with no differences in outcomes once recruited. Two studies examined differences between attenders and non-attenders, finding higher risk factors among non-attenders and higher diagnosed CVD and diabetes among those who later dropped out of longitudinal studies. Conclusions - If the risk and prevalence of these diseases are to be reduced, interventions must take into account what we know about effective health behaviour change mechanisms, monitor delivery by trained professionals and examine the possibility of tailoring programmes according to contexts such as risk level to reach those most in need. Further research is needed to determine the best strategies for lifelong approaches to screening.

When does food refusal require professional intervention?

Food refusal can have the potential to lead to nutritional deficiencies, which increases the risk of a variety of communicable and non-communicable diseases. Deciding when food refusal requires professional intervention is complicated by the fact that there is a natural and appropriate stage in a child's development that is characterised by increased levels of rejection of both previously accepted and novel food items. Therefore, choosing to intervene is difficult, which if handled badly can lead to further food refusal and an even more limited diet. Food refusal is often based on individual preferences; however, it can also be defined through pathological behaviours that require psychological intervention. This paper presents and discusses several different types of food refusal behaviours; these are learningdependent, those that are related to a medical complication, selective food refusal, fear-based food refusal and appetiteawareness-autonomy-based food refusal. This paper describes the behaviours and characteristics that are often associated with each; however, emphasis is placed on the possibility that these different types of food refusal can often be co-morbid. The decision to offer professional intervention to the child and their family should be a holistic process based on the level of medical or psychological distress resulting from the food refusal. © 2009 Bentham Science Publishers Ltd.

Multiple component patient safety intervention in English hospitals:controlled evaluation of second phase

Objective: To independently evaluate the impact of the second phase of the Health Foundation's Safer Patients Initiative (SPI2) on a range of patient safety measures. Design: A controlled before and after design. Five substudies: survey of staff attitudes; review of case notes from high risk (respiratory) patients in medical wards; review of case notes from surgical patients; indirect evaluation of hand hygiene by measuring hospital use of handwashing materials; measurement of outcomes (adverse events, mortality among high risk patients admitted to medical wards, patients' satisfaction, mortality in intensive care, rates of hospital acquired infection). Setting: NHS hospitals in England. Participants: Nine hospitals participating in SPI2 and nine matched control hospitals. Intervention The SPI2 intervention was similar to the SPI1, with somewhat modified goals, a slightly longer intervention period, and a smaller budget per hospital. Results: One of the scores (organisational climate) showed a significant (P=0.009) difference in rate of change over time, which favoured the control hospitals, though the difference was only 0.07 points on a five point scale. Results of the explicit case note reviews of high risk medical patients showed that certain practices improved over time in both control and SPI2 hospitals (and none deteriorated), but there were no significant differences between control and SPI2 hospitals. Monitoring of vital signs improved across control and SPI2 sites. This temporal effect was significant for monitoring the respiratory rate at both the six hour (adjusted odds ratio 2.1, 99% confidence interval 1.0 to 4.3; P=0.010) and 12 hour (2.4, 1.1 to 5.0; P=0.002) periods after admission. There was no significant effect of SPI for any of the measures of vital signs. Use of a recommended system for scoring the severity of pneumonia improved from 1.9% (1/52) to 21.4% (12/56) of control and from 2.0% (1/50) to 41.7% (25/60) of SPI2 patients. This temporal change was significant (7.3, 1.4 to 37.7; P=0.002), but the difference in difference was not significant (2.1, 0.4 to 11.1; P=0.236). There were no notable or significant changes in the pattern of prescribing errors, either over time or between control and SPI2 hospitals. Two items of medical history taking (exercise tolerance and occupation) showed significant improvement over time, across both control and SPI2 hospitals, but no additional SPI2 effect. The holistic review showed no significant changes in error rates either over time or between control and SPI2 hospitals. The explicit case note review of perioperative care showed that adherence rates for two of the four perioperative standards targeted by SPI2 were already good at baseline, exceeding 94% for antibiotic prophylaxis and 98% for deep vein thrombosis prophylaxis. Intraoperative monitoring of temperature improved over time in both groups, but this was not significant (1.8, 0.4 to 7.6; P=0.279), and there were no additional effects of SPI2. A dramatic rise in consumption of soap and alcohol hand rub was similar in control and SPI2 hospitals (P=0.760 and P=0.889, respectively), as was the corresponding decrease in rates of Clostridium difficile and meticillin resistant Staphylococcus aureus infection (P=0.652 and P=0.693, respectively). Mortality rates of medical patients included in the case note reviews in control hospitals increased from 17.3% (42/243) to 21.4% (24/112), while in SPI2 hospitals they fell from 10.3% (24/233) to 6.1% (7/114) (P=0.043). Fewer than 8% of deaths were classed as avoidable; changes in proportions could not explain the divergence of overall death rates between control and SPI2 hospitals. There was no significant difference in the rate of change in mortality in intensive care. Patients' satisfaction improved in both control and SPI2 hospitals on all dimensions, but again there were no significant changes between the two groups of hospitals. Conclusions: Many aspects of care are already good or improving across the NHS in England, suggesting considerable improvements in quality across the board. These improvements are probably due to contemporaneous policy activities relating to patient safety, including those with features similar to the SPI, and the emergence of professional consensus on some clinical processes. This phenomenon might have attenuated the incremental effect of the SPI, making it difficult to detect. Alternatively, the full impact of the SPI might be observable only in the longer term. The conclusion of this study could have been different if concurrent controls had not been used.