Rationale, design and methods of the Study of Work and Pain (SWAP): a cluster randomised controlled trial testing the addition of a vocational advice service to best current primary care for patients with musculoskeletal pain (ISRCTN 52269669)

Background Musculoskeletal pain is a major contributor to short and long term work absence. Patients seek care from their general practitioner (GP) and yet GPs often feel ill-equipped to deal with work issues. Providing a vocational case management service in primary care, to support patients with musculoskeletal problems to remain at or return to work, is one potential solution but requires robust evaluation to test clinical and cost-effectiveness. Methods/Design This protocol describes a cluster randomised controlled trial, with linked qualitative interviews, to investigate the effect of introducing a vocational advice service into general practice, to provide a structured approach to managing work related issues in primary care patients with musculoskeletal pain who are absent from work or struggling to remain in work. General practices (n = 6) will be randomised to offer best current care or best current care plus a vocational advice service. Adults of working age who are absent from or struggling to remain in work due to a musculoskeletal pain problem will be invited to participate and 330 participants will be recruited. Data collection will be through patient completed questionnaires at baseline, 4 and 12 months. The primary outcome is self-reported work absence at 4 months. Incremental cost-utility analysis will be undertaken to calculate the cost per additional QALY gained and incremental net benefits. A linked interview study will explore the experiences of the vocational advice service from the perspectives of GPs, nurse practitioners (NPs), patients and vocational advisors. Discussion This paper presents the rationale, design, and methods of the Study of Work And Pain (SWAP) trial. The results of this trial will provide evidence to inform primary care practice and guide the development of services to provide support for musculoskeletal pain patients with work-related issues. Trial registration Current Controlled Trials ISRCTN52269669

Aspirations and ambiguities – the need for focused IAG for school pupils considering progression to higher education (HE)

This is an Accepted Manuscript of an article published by Taylor & Francis in Journal of Further and Higher Education on 10th June 2019, available online: https://www.tandfonline.com/doi/full/10.1080/0309877X.2019.1616081The provision of Information, Advice and Guidance (IAG) for school pupils considering their next move after compulsory schooling is of great importance to them and their families. This study focused on three schools in a region in England that has suffered economic deprivation and low educational attainment. It sought to uncover how factors such as schools, teachers, friends and families, and the provision of IAG, impact on pupils’ ideas about careers and higher study. Several investigations have set out how this provision and subsequent choice of progression to higher education (HE) is mediated through a number of cultural, social, economic and institutional influences. This research followed a mixed-methods approach to data collection, incorporating both quantitative and qualitative data collection tools that provided elements of positivist and interpretivist paradigms. The results reveal a complex landscape, characterised by a limited understanding of progression to HE and a lack of clarity about options, but nevertheless, there are aspirations towards further study. The research has implications for IAG provision and has potential impact with respect to the need for a more consistent approach.Published onlin

Vehicle and Mission Design Options for the Human Exploration of Mars/Phobos Using "Bimodal" NTR and LANTR Propulsion

The nuclear thermal rocket (NTR) is one of the leading propulsion options for future human missions to Mars because of its high specific impulse (Isp-850-1000 s) capability and its attractive engine thrust-to-weight ratio (approximately equal 3-10). To stay within the available mass and payload volume limits of a "Magnum" heavy lift vehicle, a high performance propulsion system is required for trans-Mars injection (TMI). An expendable TMI stage, powered by three 15 thousand pounds force (klbf) NTR engines is currently under consideration by NASA for its Design Reference Mission (DRM). However, because of the miniscule burnup of enriched uranium-235 during the Earth departure phase (approximately 10 grams out of 33 kilograms in each NTR core), disposal of the TMI stage and its engines after a single use is a costly and inefficient use of this high performance stage. By reconfiguring the engines for both propulsive thrust and modest power generation (referred to as "bimodal" operation), a robust, multiple burn, "power-rich" stage with propulsive Mars capture and reuse capability is possible, A family of modular "bimodal" NTR (BNTR) vehicles are described which utilize a common "core" stage powered by three 15 klbf BNTRs that produce 50 kWe of total electrical power for crew life support, an active refrigeration / reliquification system for long term, "zero-boiloff" liquid hydrogen (LH2) storage, and high data rate communications. An innovative, spine-like "saddle truss" design connects the core stage and payload element and is open underneath to allow supplemental "in-line" propellant tanks and contingency crew consumables to be easily jettisoned to improve vehicle performance. A "modified" DRM using BNTR transfer vehicles requires fewer transportation system elements, reduces IMLEO and mission risk, and simplifies space operations. By taking the next logical step--use of the BNTR for propulsive capture of all payload elements into Mars orbit--the power available in Mars orbit grows to 150 kWe compared to 30 kWe for the DRM. Propulsive capture also eliminates the complex, higher risk aerobraking and capture maneuver which is replaced by a simpler reentry using a standardized, lower mass "aerodescent" shell. The attractiveness of the "all BNTR" option is further increased by the substitution of the lightweight, inflatable "TransHab" module in place of the heavier, hard-shell hab module. Use of TransHab introduces the potential for propulsive recovery and reuse of the BNTR/ERV. It also allows the crew to travel to and from Mar on the same BNTR transfer vehicle thereby cutting the duration of the ERV mission in half--from approximately 4.7 to 2.5 years. Finally, for difficult Mars options, such as Phobos rendezvous and sample return missions, volume (not mass) constraints limit the performance of the "all LH2" BNTR stage. The use of "LOX-augmented" NTR (LANTR) engines, operating at a modest oxygen-to-hydrogen mixutre ratio (MR) of 0.5, helps to increase "bulk" propellant density and total thrust during the TMI burn. On all subsequent burns, the bimodal LANTR engines operate on LH2 only (MR=0) to maximize vehicle performance while staying within the lift capability of two Magnum launches

Going it alone won’t work! The relational imperative for social innovation in social enterprises

Shifts in the philosophy of the “state” and a growing emphasis on the “Big Society” have placed an increasing onus on a newly emerging organizational form, social enterprises, to deliver innovative solutions to ease societal issues. However, the question of how social enterprises manage the process of social innovation remains largely unexplored. Based on insights from both in-depth interviews and a quantitative empirical study of social enterprises, this research examines the role of stakeholder relationships in supporting the process of social innovation within social enterprises. We find that social enterprises are adept at working with their stakeholders in the ideation stage of social innovation. In contrast, they often fail to harness knowledge and expertise from their partners during the social innovation implementation phase. Consequently, we propose a social innovation–stakeholder relationship matrix that provides social enterprises in particular with insight for developing stakeholder relationships to achieve their social innovation missions

The Regulatory Gift: Politics, regulation and governance

Abstract: This article introduces the ‘regulatory gift’ as a conceptual framework for understanding a particular form of government-led deregulation that is presented as central to the public interest. Contra to theories of regulatory capture, government corruption, ‘insider’ personal interest or profit-seeking theories of regulation, the regulatory gift describes reform which is overtly designed by Government to reduce or reorient regulators’ functions to the advantage of the regulated and in line with market objectives on a potentially macro (rather than industry-specific) scale. As a conceptual framework, the regulatory gift is intended to be applicable across regulated sectors of democratic states and in this article the empirical sections evidence the practice of regulatory gifting in contemporary UK politics. Specifically, this article analyses the UK Public Bodies Act (2011), affecting some 900 regulatory public bodies and its correlative legislation, the Regulator’s Code (2014), the Deregulation Act (2015) and the Enterprise Bill (2016). The article concludes that whilst the regulatory gift may, in some cases, be aligned with the public interest - delivering on cost reduction, enhancing efficiency and stimulating innovation - this will not always be the case. As the case study of the regulatory body, the UK Human Fertilisation and Embryology Authority (HFEA) demonstrates, despite the explicit claims made by legislators, the regulatory gift has the potential to significantly undermine the public interest

The strategic economic governance of Greater Manchester's local labour market by the local state: implications for young workers

This article explores how work and employment conditions for young workers are affected by the actions of the state at the spatial scale of the locality. The article argues that young workers have experienced deteriorating labour market conditions following shifts in the form which capitalist accumulation takes in the UK. This shift has altered the composition of the national state which has in turn led to changes in how it regulates both local labour markets and the economic strategies of the local state. One result of these changes is the diffusion of neoliberal labour market reforms which have led to negative material consequences for young workers; these are manifest in the expansion of low-waged work concentrated in a small number of sectors, and characterized by an intensified labour process

R&D Models: Lessons from Vaccine History

A preventive HIV vaccine offers the best hope for ending the AIDS pandemic. Scientific evidence suggests that an HIV vaccine is possible, and funding for HIV vaccine research and development (R&D) has increased substantially in recent years. The speed of progress toward an HIV vaccine will depend on the management of the effort as well as on its scale, however, and organizational issues have been the subject of vigorous debate. With this paper, we seek to shed light on these debates by examining the history of vaccine development, as well as some examples of large R&D initiatives in other areas. We focus on two issues: the roles of the public and private sectors, and the merits and risks of strong central direction of R&D. We also consider the scientific, regulatory, and institutional changes that complicate extrapolation from past experience to the case of HIV vaccines. Our analysis draws on extensive interviews with experts in the field as well as a literature review

Architecture, symbolic capital and elite mobilizations: The case of the Royal Bank of Scotland corporate campus

In this article, we apply the conceptual framework of Pierre Bourdieu, in particular forms of capital, social fields, field of power and modes of domination, to demonstrate how the study of a symbolically powerful building can provide insights into what are often opaque elite interactions. In order to do this, we focus on the corporate campus headquarters of a powerful financial institution, the Royal Bank of Scotland in the context of Scotland in the period 2000–2009. We pose the following questions: What is the relationship between corporate space and the field of power? What role does a corporate building play in circuits of capital conversion? What does this case tell us about the role of architecture in elite mobilisations? In addressing these questions, we contribute to critical organisation studies by identifying and theorising the role of corporate space in inter-elite dynamics and circuits of capital conversion. This approach, we argue, provides a methodological lever which could be applied to other symbolically important buildings in order to understand the nature and role of inter-field interactions in the conception and realisation of such buildings

What Do Community Benefits Agreements Deliver? Evidence From Los Angeles

Problem, research strategy, and findings: Advocates of community benefits agreements (CBAs) between coalitions of nongovernmental organizations (NGOs) and real estate developers contend that CBAs promote public accountability and responsiveness to community concerns. This study assesses the Los Angeles Sports and Entertainment District (LASED) CBA, which scholars and practitioners have described as a model for such agreements. I assess compliance with key provisions of the agreement related to jobs, affordable housing, and parks and recreational facilities. I also assess whether compliance with these provisions has yielded benefits beyond those required under existing laws and regulations. I find that the parties to the agreement have technically complied with many, although arguably not all, of its provisions. But some of the provisions in the CBA are not legally binding, other provisions overlap with requirements that the developer would have had to satisfy even without the CBA, and some reports required by the CBA are unavailable. As a result, outcomes such as living wage jobs and funding for affordable housing units are not clearly attributable to the CBA; other outcomes, such as targeted hiring, are unknown due to a lack of relevant information.Takeaway for practice: Although CBAs may not fulfill all the claims that advocates make on their behalf, they can play important roles in community development by directing public and private spending to underserved neighborhoods. But collecting and verifying the relevant data may be challenging, even if reporting requirements are clearly spelled out in the CBA. As the complexity of a CBA increases, so do the challenges of assessing outcomes and assigning responsibility for those outcomes