Will the lessons be learned? Reflections on local authority evaluations and the use of research evidence

Sure Start programmes are complex, community-based initiatives - forerunners of the Children's Centres Initiative - that have been evaluated nationally and locally. Using an in-depth, retrospective case study of an evaluation of one local programme, the authors raise key issues pertinent to both practice and evaluation in the field, highlighting conflicts and dilemmas both within evaluation generally and, specifically, relating to the evaluation of this programme.We illustrate the difficulties placed on local evaluators by the lack of clear structures within which to work, and provide useful lessons as we move forward into the development and evaluations of new services for children and families

Some Aspects of Social Security in Medieval England

Medieval historians have long maintained that social welfare in the com munities of rural England often involved private systems of support for the elderly. Individuallv arranged pension plans provide a case in point. The best evidence of these pension plans is found in the records of manor courts. To read the records is to learn how pension plans enabled the elderly to adjust their needs to local patterns of production and domestic structure, to law, to expressions of personal autonomy. and the confines of personal dependency. Simply stated, the old ac commodated their needs for support by looking to benefactors to manage their lands and tenements. The subsequent arrangement involved a contractual agree ment designed both to ensure and to supplement familial support, and also, under certain circumstances, to provide a substitute for it. As a result, not even peasants without children or spouses necessarily experienced dislocation. Contracts assured cooperation. They afforded the partners a way to negotiate mutually beneficial bargains wherein the conditional transfer of property was meant to guarantee securitv during retirement.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68108/2/10.1177_036319908200700401.pd

Pictures are necessary but not sufficient: Using a range of visual methods to engage users about school design

It has been argued by both educationalists and social researchers that visual methods are particularly appropriate for the investigation of people's experiences of the school environment. The current and expected building work taking place in British schools provides an opportunity for exploration of methods, as well as a need to establish ways to achieve this involvement of a range of school users, including students. This article describes a consultation that was undertaken in a UK secondary school as part of a participatory design process centred on the rebuilding of the school. A range of visual methods, based on photographs and maps, was used to investigate the views of a diverse sample of school users, including students, teachers, technical and support staff and the wider community. Reported here is the experience of using these tools, considering the success of different visually-based methods in engaging a broad cross section of the school community and revealing useful information. Using a range of visual methods allows a complex, but coherent, understanding of the particular school environment to be constructed and developed. It is further argued that such a range of visual and spatial methods is needed to develop appropriate understanding. The study, therefore, contributes to knowledge about specific visual research methods, appreciation of the relationship between tools, and a general methodological understanding of visual methods' utility for developing understanding of the learning environment

HS2 skills and employability strategic framework – fast track to inclusive growth across the East Midlands.

East Midlands Councils, D2N

Reviews

Danny Saunders and Nina Smalley (eds.), The International Simulation and Gaming Research Yearbook — Volume 8: Simulations and Games for Transition and Change, London: Kogan Page, 2000. ISBN: 0–7494–3397–3. Hardback, viii+271 pages, £40.00

Comparison of the spatial QRS-T angle derived from digital ECGs recorded using conventional electrode placement with that derived from Mason-Likar electrode position

Background: The spatial QRS-T angle is ideally derived from orthogonal leads. We compared the spatial QRS-T angle derived from orthogonal leads reconstructed from digital 12-lead ECGs and from digital Holter ECGs recorded with the Mason-Likar (M-L) electrode positions. Methods and results: Orthogonal leads were constructed by the inverse Dower method and used to calculate spatial QRS-T angle by (1) a vector method and (2) a net amplitude method, in 100 volunteers. Spatial QRS-T angles from standard and M-L ECGs differed significantly (57° ± 18° vs 48° ± 20° respectively using net amplitude method and 53° ± 28° vs 48° ± 23° respectively by vector method; p < 0.001). Difference in amplitudes in leads V4–V6 was also observed between Holter and standard ECGs, probably due to a difference in electrical potential at the central terminal. Conclusion: Mean spatial QRS-T angles derived from standard and M-L lead systems differed by 5°–9°. Though statistically significant, these differences may not be clinically significant

Research on making the most of HS2 investments and connectivity in the EM Labour Market.

East Midlands Councils, D2N2 LE

Novel electrocardiographic criteria for the diagnosis of arrhythmogenic right ventricular cardiomyopathy

Aims: In order to improve the electrocardiographic (ECG) diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC), we evaluated novel quantitative parameters of the QRS complex and the value of bipolar chest leads (CF leads) computed from the standard 12 leads. Methods and results: We analysed digital 12-lead ECGs in 44 patients with ARVC, 276 healthy subjects including 44 age and sex-matched with the patients and 36 genotyped members of ARVC families. The length and area of the terminal S wave in V1 to V3 were measured automatically using a common for all 12 leads QRS end. T wave negativity was assessed in V1 to V6 and in the bipolar CF leads computed from the standard 12 leads. The length and area of the terminal S wave were significantly shorter, whereas the S wave duration was significantly longer in ARVC patients compared with matched controls. Among members of ARVC families, those with mutations (n = 15) had shorter QRS length in V2 and V3 and smaller QRS area in lead V2 compared with those without mutations (n = 20). In ARVC patients, the CF leads were diagnostically superior to the standard unipolar precordial leads. Terminal S wave duration in V1 >48 ms or major T wave negativity in CF leads separated ARVC patients from matched controls with 90% sensitivity and 86% specificity. Conclusion: The terminal S wave length and area in the right precordial leads are diagnostically useful and suitable for automatic analysis in ARVC. The CF leads are diagnostically superior to the unipolar precordial leads

Mobilising and organising for large scale change in healthcare: 'The Right Prescription: A Call to Action on the use of antipsychotic drugs for people with dementia'

This study sought to explore the use of a mobilising and organising methodology as an approach to large scale change. We have chosen as an example of a mobilising and organising approach to change in action, the work of the NHS Institute for Innovation and Improvement to support the Department of Health Quality Improvement Productivity and Prevention (QIPP) programme, through acting as an enabler for a work stream which focuses on the prescribing of antipsychotic medication in people with dementia - part of the medicines management QIPP work stream. The aim of this study is to identify key components, and areas of achievement, within the call to action, to tell the story of how this approach has evolved to respond to the challenges inherent within the English NHS, to identify how this approach might be utilised by others and to identify lessons for the future implementation of such an approach within the public secto