Undermining patient and public engagement and limiting its impact:the consequences of the Health and Social Care Act 2012 on collective patient and public involvement

Patient and public involvement has been at the heart of UK health policy for more than two decades. This commitment to putting patients at the heart of the British National Health Service (NHS) has become a central principle helping to ensure equity, patient safety and effectiveness in the health system. The recent Health and Social Care Act 2012 is the most significant reform of the NHS since its foundation in 1948. More radically, this legislation undermines the principle of patient and public involvement, public accountability and returns the power for prioritisation of health services to an unaccountable medical elite. This legislation marks a sea-change in the approach to patient and public involvement in the UK and signals a shift in the commitment of the UK government to patient-centred care. © 2013 John Wiley & Sons Ltd.

Milk for a girl and bananas for a boy:recipes and reasons for sex-preference practices in a British Internet forum

Using postings from an internet forum, this paper explores the ways in which some women try to influence the sex of a future child. The extensive reproductive work involved give an indication of the women’s commitment to being able to choose a particular sex; in this case a preference for girls rather than boys. The findings revealed stereotypical views of masculinity and femininity at the heart of the preference. The presumption of fixed gendered identities helped to frame this desire as ‘natural,’ lessen the threat to maternal identities, and reinforce the logic of ‘choice,’ and support their reproductive work practices.

Understandings of transnational families in debates on Migration and development

International migration sets in motion a range of significant transnational processes that connect countries and people. How migration interacts with development and how policies might promote and enhance such interactions have, since the turn of the millennium, gained attention on the international agenda. The recognition that transnational practices connect migrants and their families across sending and receiving societies forms part of this debate. The ways in which policy debate employs and understands transnational family ties nevertheless remain underexplored. This article sets out to discern the understandings of the family in two (often intermingled) debates concerned with transnational interactions: The largely state and policydriven discourse on the potential benefits of migration on economic development, and the largely academic transnational family literature focusing on issues of care and the micro-politics of gender and generation. Emphasizing the relation between diverse migration-development dynamics and specific family positions, we ask whether an analytical point of departure in respective transnational motherhood, fatherhood or childhood is linked to emphasizing certain outcomes. We conclude by sketching important strands of inclusions and exclusions of family matters in policy discourse and suggest ways to better integrate a transnational family perspective in global migration-development policy.

Through Class Darkly: Class in the British TV Noir

Class has always been at the heart of the television crime drama. Whether it is the post-war paternalism of Dixon of Dock Green (1955 – 1976), the harsh social realism of The Sweeney (1975-1978), or the almost mythical evocations of Britain in Heartbeat (1992 – 2010) and Midsomer Murders (1997- present), class and crime have always been seen as being inextricably linked. Since the 1990s, the British crime drama has been influenced by successive waves of cultural imports from, firstly, the US and then from Scandinavia. There is now a recognisable ‘genre’ for what we might think of as British TV Noir. Beginning with shows such as Cracker (1993 – 2006), Prime Suspect (1991 – 2006) and Messiah (2001) and continuing with dramas like Red Riding (2008), Southcliffe (2013) and Hinterland (2013 – present), the British TV Noir employs narratives and stylistic tropes that might usually be associated with the cinema of the 1940s. Although drawing influence from high profile shows such as Twin Peaks (1990 – 1991), Millennium (1996) and (latterly) The Wire (2002 – 2008), CSI (2000 – present) and The Killing (2007) these British Noir shows also articulate the nation’s shifting class system. As Susan Sydney-Smith has ably demonstrated, the crime drama is “historically contingent” (Sydney-Smith, 2002, p. 5) and shaped by the surrounding socio-political, as well aesthetic, context. To this end, this chapter traces the depiction of class in three key crime series – Prime Suspect, Red Riding and Southcliffe - and explores how social class, and more importantly, its changing face provides a constant background to the narratives and characterisations. These three texts were each produced at pivotal moments in Britain’s relationship to class – Prime Suspect was shown 6 months after Margaret Thatcher vacated office; Red Riding was produced in the midst of the global recession in 2008 and Southcliffe was made in the shadows of stringing welfare and immigration reforms. These texts span three successive political administrations and over two decades of social and political change. Understanding the relationship between criminal activity and class in these dramas however is far more complicated than simply reading the historical context through the text. Commensurate with its cinematic incarnation, TV Noir is both reflective and productive, employing visual and narrative tropes to manipulate, as well reflect, its audience’s moral and social positioning. The picture that emerges from an examination of class and the British TV Noir is one of suspicion and discontent. As Andrew Spicer suggests (with reference to British cinema) the Noir sensibility both depicts and critiques a society that it sees as being “class-ridden, racist and misogynist” (Spicer, 2002, p.202). This is certainly the case with the texts that are being examined here, as social positions and taxonomies are constantly being redefined and renegotiated.

Self-management of coronary heart disease in angina patients after percutaneous coronary intervention: A mixed methods study.

After having elective percutaneous coronary intervention (PCI) patients are expected to self-manage their coronary heart disease (CHD) by modifying their risk factors, adhering to medication and effectively managing any recurring angina symptoms but that may be ineffective. Objective: Explore how patients self-manage their coronary heart disease (CHD) after elective PCI and identify any factors that may infl uence that. Design and method: This mixed methods study recruited a convenience sample of patients (n=93) approximately three months after elective PCI. Quantitative data were collected using a survey and were subject to univariate, bivariate and multi-variate analysis. Qualitative data from participant interviews was analysed using thematic analysis. Findings: After PCI, 74% of participants managed their angina symptoms inappropriately. Younger participants and those with threatening perceptions of their CHD were more likely to know how to effectively manage their angina symptoms. Few patients adopted a healthier lifestyle after PCI. Qualitative analysis revealed that intentional non-adherence to some medicines was an issue. Some participants felt unsupported by healthcare providers and social networks in relation to their self-management. Participants reported strong emotional responses to CHD and this had a detrimental effect on their self-management. Few patients accessed cardiac rehabilitation.

Heart dimensions may influence the occurrence of the heart rate deflection point in highly trained cyclists

To determine whether the heart rate (HR) response to exercise in 21 highly trained cyclists (mean (SD) age 25 (3) years) was related to their heart dimensions. Methods—Before performing an incremental exercise test involving a ramp protocol with workload increases of 25 W/min, each subject underwent echocardiographic evaluation of the following variables: left ventricular end diastolic internal diameter (LVIDd), left ventricular posterior wall thickness at end diastole (LVPWTd), interventricular septal wall thickness at end diastole (IVSTd), left ventricular mass index (LVMI), left atrial dimension (LAD), longitudinal left atrial (LLAD) and right atrial (LRAD) dimensions, and the ratio of early to late (E/A) diastolic flow velocity. Results—The HR response showed a de- flection point (HRd) at about 85% V~ O2MAX in 66.7% of subjects (D group; n = 14) and was linear in 33.3% (NoD group; n = 7). Several echocardiographic variables (LVMI, LAD, LLAD, LRAD) indicative of heart dimensions were similar in each group. However, mean LPWTd (p<0.01) and IVSTd (p<0.05) values were signifi- cantly higher in the D group. Finally, no significant diVerence between groups was found with respect to the E/A. The HR response is curvilinear during incremental exercise in a considerable number of highly trained endurance athletes—that is, top level cyclists. The departure of HR increase from linearity may predominantly occur in athletes with thicker heart walls.

Romano-British wall-painting fragments: a spectroscopic analysis

Raman spectroscopic analyses of fragmented wall-painting specimens from a Romano-British villa dating from ca. 200 AD are reported. The predominant pigment is red haematite, to which carbon, chalk and sand have been added to produce colour variations, applied to a typical Roman limewash putty composition. Other pigment colours are identified as white chalk, yellow (goethite), grey (soot/chalk mixture) and violet. The latter pigment is ascribed to caput mortuum, a rare form of haematite, to which kaolinite (possibly from Cornwall) has been added, presumably in an effort to increase the adhesive properties of the pigment to the substratum. This is the first time that kaolinite has been reported in this context and could indicate the successful application of an ancient technology discovered by the Romano-British artists. Supporting evidence for the Raman data is provided by X-ray diffraction and SEM-EDAX analyses of the purple pigment.