Central and local government and the provision of municipal medicine, 1919-39

This article examines the relationship between central and local government - and specifically the County Boroughs - in interwar England and Wales with respect to the provision of municipal health services. It is argued that this relationship was complex, with different local authorities being compliant to a greater or lesser degree with the aspirations of the Ministry of Health. The latter, it is further suggested, started off its life as a relatively dynamic, well-run and farsighted part of central government, but for a range of reasons lost authority and influence as the interwar era progressed. This was not helped by the limited powers the Ministry held. The local authorities, meanwhile, differed widely in their aspirations for municipally-provided health care. Some were reluctant to do much, others had ambitions somewhat in advance of those of the Ministry of Health. What did unite local authorities was their collective desire to preserve the longstanding tradition of a high degree of local independence. As is also shown, specifically local factors and personnel - for example the political dynamics of the council or the standing of the Medical Officer of Health - could significantly shape a County Borough's approach to health care. The article thus contributes to the history of English and Welsh local government and, especially, to the relatively neglected period in the history of the health services which falls between the demise of the Poor Law and the coming of the National Health Service

Evaluating the responsiveness of the Warwick Edinburgh Mental Well-Being Scale (WEMWBS) : group and individual level analysis

Background: Mental well-being now features prominently in UK and international health policy. However, progress has been hampered by lack of valid measures that are responsive to change. The objective of this study was to evaluate the responsiveness of the Warwick Edinburgh Mental Well-being Scale (WEMWBS) at both the individual and group level. Methods: Secondary analysis of twelve different interventional studies undertaken in different populations using WEMWBS as an outcome measure. Standardised response mean (SRM), probability of change statistic (P̂) and standard error of measurement (SEM) were used to evaluate whether WEMWBS detected statistically important changes at the group and individual level, respectively. Results: Mean change in WEMWBS score ranged from −0.6 to 10.6. SRM ranged from −0.10 (95% CI: -0.35, 0.15) to 1.35 (95% CI: 1.06, 1.64). In 9/12 studies the lower limit of the 95% CI for P̂ was greater than 0.5, denoting responsiveness. SEM ranged from 2.4 to 3.1 units, and at the threshold 2.77 SEM, WEMWBS detected important improvement in at least 12.8% to 45.7% of participants (lower limit of 95% CI>5.0%). Conclusions: WEMWBS is responsive to changes occurring in a wide range of mental health interventions undertaken in different populations. It offers a secure base for research and development in this rapidly evolving field. Further research using external criteria of change is warranted

Repeating platinum/bevacizumab in recurrent or progressive cervical cancer yields marginal survival benefits

Our objective was to assess overall survival of cervical cancer patients following prior platinum/bevacizumab chemotherapy, comparing retreatment with platinum/bevacizumab with alternative therapies. A retrospective analysis was performed of women who received platinum/bevacizumab (PB) chemotherapy for cervical cancer at Washington University between July 1, 2005 and December 31, 2015. Wilcoxon rank-sum exact test and Fisher's exact test were used to compare the treatment groups, and Kaplan Meier curves were generated. Cox regression analyses were performed, with treatment free interval and prior therapy response included as covariates. Of 84 patients who received PB chemotherapy, 59 (70%) received no second line chemotherapy, as they did not recur, progressed without further chemotherapy, were lost to follow up, or expired. Of the remaining 25 patients, 9 were retreated with the combination of platinum/bevacizumab (PB), 6 were retreated with a platinum regimen without bevacizumab (P), and 10 were retreated with neither (not-P). The only long-term survivor was in the not-P group and was treated with an immunotherapy agent. Median overall survival of all patients was 7.1 months. There was a marginal difference in survival between women in the PB and not-PB groups (11.8 versus 5.7 months; HR 3.02, 95% CI, 0.98–9.28). There was no difference in survival based on platinum interval (HR 0.81; 95% CI, 0.27–2.45). Outcomes are grim for women retreated after platinum/bevacizumab therapy and are only marginally improved by retreatment with a platinum/bevacizumab regimen. Rather than additional PB therapy, women with cervical cancer who recur after platinum/bevacizumab should consider supportive care or clinical trials

Center pivot irrigation in Nebraska : an institutional analysis case study

This paper is one of a series resulting from institutional analysis of photovoltaic (PV) acceptance. It reports the results of a study of institutional factors influencing acceptance of center-pivot irrigation in the Nebraska agricultural community. Center-pivot irrigation (CP) was an interesting topic for study because (1) it was a major recently introduced technological innovation in agriculture which (2) had potentially detrimental attributes--water and energy intensity. A brief historical review of the introduction and acceptance of center-pivot irrigation in the Nebraska agricultural community is presented. Institutions which were a likely part of this institutional arena relative to CP introduction and acceptance were identified. Their likely responses were hypothesized, then data collected regarding actual response. Three broad conslusions are drawn. First, there were definite, even controlling institutional influences in the acceptance of CP in the Nebraska agricultural community. Second, acceptance was facilitated in the Nebraska agricultural community because the innovation differentiation process yielded secondary attributes of CP that met prevailing social orders--productivity, automation, and felt need. Third, the innovation differentiation process for CP in the Nebraska agricultural community yielded both transformation and disconnection of detrimental attributes, creating the circumstances for attribute redefinition in the first instance and another innovation in the second instance.DOE Contract no. EX-76-A-01-2295

The Development of Municipal General Hospitals in English County Boroughs in the 1930s

When thinking of spurs to hospital development in the first half of the last century, it would be easy to assume that the greatest watershed was provided by the 1946 National Health Service Act. In this article, however, we focus on an earlier and often overlooked piece of legislation, which had a perhaps equally significant impact on the development of hospitals in England and Wales. This was the 1929 Local Government Act, which changed both the ownership and the focus of many of the largest hospitals in the country. As Robert Pinker has observed, the act “radically altered the percentage distribution of hospital beds in the public sector”. Such observations notwithstanding, municipal medicine in the 1930s has not received the historical attention it deserves, an omission which this article seeks in part to remedy. The terms of the act in respect of hospital development were permissive, and the extent to which local authorities acted had a great effect on the way in which their municipal hospital services developed, and hence the beds and facilities available at the time of the nationalization of the health services. The reaction of local authorities to the act, however, depended partly on their own choices, and partly on constraints over which they had less control.</jats:p

Cultivating Institutional Change: Infusing Principles of Diversity, Equity, and Inclusion into Everyday Honors College Practices

Envisioning and implementing strategic changes around diversity, equity, and inclusion in honors can be paradoxical. While honors colleges are traditionally regarded as tight-knit communities that serve as centers of curricular and pedagogical innovation, they have also been sites of exclusion because of outdated definitions of excellence based on inequitable presuppositions inherent to the university admissions process. Because many honors programs endeavor to produce publicly engaged graduates, creating a diverse, inclusive, and equitable learning environment is a moral imperative. Not only does it provide a safe and welcoming environment for learners, but it also models the type of behavior we want to see in our students. In this chapter, we compare and contrast the strategies for DEI work devised by Westminster College (Utah) and the Lewis Honors College at the University of Kentucky, noting the various ways these honors colleges prepared and implemented their strategies based on their distinct institutional profiles as, respectively, a small, private liberal arts college and a large, research-intensive, public land-grant university. We also identify how honors colleges might respond to their findings once they have gathered information on students’ lived experiences relative to diversity, equity, and inclusion to achieve a true culture of belonging. Alternate title: Cultivating Institutional Change: Infusing Principles of DEI into Everyday Honors College Practice

Teaching The Early: Formal Methods in School

In this paper, we describe a programme of school engagement aimed at instilling a discipline of computational thinking within pupils before they embark on a university course. The workshops we deliver are designed mainly to increase the pipeline of school leavers going on to study computer science or software engineering, specifically by changing perceptions on what this means amongst the vast majority - particularly girls - who think it is just a geeky topic for boys.Over the past number of years, student enrolment has been increasing dramatically in our university's undergraduate computer science and software engineering degree programmes. Also, the performance of the students on first-year formal methods modules - which has historically been poor - has risen substantially. Whilst there are many influences contributing towards these trends, we present evidence that our efforts with school engagement has to a non-trivial extent contributed towards these: both through the way the undergraduate programme has been adapted to incorporate the Technocamps approach, and through providing a pipeline of students who understand the principles of computational thinking

Methodology for Analysis of Diet Grit Size on Molar Attrition for Fourche Maline and Caddo People

Using the Murphy (1959) system for scoring the degree of dentin exposure, Fourche Maline (Woodland) molars show a greater attrition rate than Caddo (Mississippian) molars. Archeological evidence suggests that this differential in attrition rates is caused by the use of stone grinders for food preparation in the Fourche Maline culture and their absence among the Caddo. Analysis of scratches on the occlusal surface of molars from these samples confirms this hypothesis. Several techniques for observing these scratches and reconstructing the grit sizes and grit particle frequencies responsible for this differential abrasion are evaluated

Teaching Computing via a School Placement

Across Wales - as, but even more so than, elsewhere - there is a critical shortage of teachers who are qualified to teach Computer Science. This issue is particularly coming to the fore now due to on-going changes to the national school curriculum which is seeing a rigorous computer science curriculum replacing the ICT curriculum which has been passed off as computing in most schools over the past several decades. In this paper we describe the efforts made by Technocamps to tackle this problem by encouraging computer science graduates to consider education as a viable career option. In particular, we outline a credit-bearing module which incorporates an extensive school placement. We discuss the challenges with setting up and running such a module as well as its effectiveness