"Because I've Got a Learning Disability, They Don't Take Me Seriously:" Violence, Wellbeing, and Devaluing People With Learning Disabilities.

For people with learning disabilities, targeted violence has become routinized. In this article, we seek to explore the impact pervasive victimization has on their experience of community and participation and, through this, their health and wellbeing. People with learning disabilities experience significant inequality in health and wellbeing compared to their non-disabled peers, and the role of violence and victimization remains mostly neglected. By drawing on in-depth qualitative interviews with people with learning disabilities, we argue that abuse, disrespect and devaluing profoundly erode wellbeing. The complex forms of violence experienced by people with learning disabilities are critical to understanding the significant inequalities in health and wellbeing experienced by people with learning disabilities. We focus on community and misrecognition to move the focus from one that examines causation towards one that uncovers the layers of invisibility, and the complex relations that structure experiences from the perspective of people with learning disabilities themselves. By doing this, we locate violence and victimization as health and wellbeing concerns and seek to add a more comprehensive and holistic understanding of the social determinants of health. For the inequalities that structure the lives of people with learning disabilities to be holistically understood, they must be reframed as an issue of social justice, and violence must be identified as a central contributor to these inequalities.

Evaluability assessment: An application in a complex community improvement setting.

Evaluation is essential to understand whether and how policies and other interventions work, why they sometimes fail, and whether they represent a good use of resources. Evaluability assessment (EA) is a means of collaboratively planning and designing evaluations, seeking to ensure they generate relevant and robust evidence that supports decision-making and contributes to the wider evidence base. This article reports on the context, the process undertaken and evidence from participants in an EA facilitated with public service workers involved in implementing a complex, area-based community improvement initiative. This is a novel context in which to conduct an EA. We show how the process allows practitioners at all levels to identify activities for evaluation and co-produce the theory of change developed through the EA. This enables evaluation recommendations to be developed that are relevant to the implementation of the programme, and which take account of available data and resources for evaluation.

Striking lung cancer response to self-administration of cannabidiol: A case report and literature review.

In spite of new drugs, lung cancer is associated with a very poor prognosis. While targeted therapies are improving outcomes, it is not uncommon for many patients to have only a partial response, and relapse during follow-up. Thus, new drugs or re-evaluation of existing therapies used to treat other non-malignant diseases (drug repurposing) are still needed. While this research both in vitro and in vivo is being carried out, it is important to be attentive to patients where the disease responds to treatments not considered standard in clinical practice. We report here a patient with adenocarcinoma of the lung who, after declining chemotherapy and radiotherapy, presented with tumour response following self-administration of cannabidiol, a non-psychoactive compound present in Cannabis sativa. Prior work has shown that cannabidiol may have anti-neoplastic properties and enhance the immune response to cancer. The data presented here indicate that cannabidiol might have led to a striking response in a patient with lung cancer.

The cost of school holidays for children from low income families.

School holidays can be stressful periods for children from low-income families. Poor provision of appropriate childcare, limited access to enrichment activities, and food insecurity mean that children's health and well-being can suffer and their learning stagnate or decline. This article examines and documents the evidence that has emerged on this topic and aims to raise its profile and the impact on children's lives. It makes the case for further academic scrutiny of this unexamined and neglected subject.

Implementing health and social care integration in Scotland: Renegotiating new partnerships in changing cultures of care.

Health and social care integration has been a long-term goal for successive governments in Scotland, culminating in the implementation of the recent Public Bodies (Joint Working) Scotland Act 2014. This laid down the foundations for the delegation of health and social care functions and resources to newly formed Integrated Joint Boards. It put in place demands for new ways of working and partnership planning. In this article, we explore the early implementation of this Act and how health and social care professionals and the third sector have begun to renegotiate their roles. The paper draws on new empirical data collated through focus groups and interviews with over 70 professionals from across Scotland. The data are explored through the following key themes: changing cultures, structural imbalance, governance and partnership and the role of individuals or "boundary spanners" in implementing change. We also draw on evidence from other international systems of care, which have implemented integration policies, documenting what works and what does not. We argue that under the current framework much of the potential for integration is not being fulfilled and that the evidence suggests that at this early stage of roll-out, the structural and cultural policy changes that are required to enable this policy shift have not yet emerged. Rather, integration has been left to individual innovators or "boundary spanners" and these are acting as key drivers of change. Where change is occurring, this is happening despite the system. As it is currently structured, we argue that too much power is in the hands of health and despite the rhetoric of partnership working, there are real structural imbalances that need to be reconciled.

Personalization of health care in England: have the wrong lessons been drawn from the personal health budget pilots?

The Government has introduced personal health budgets in England's National Health Service (NHS). A three-year programme of pilots has shown that personal health budgets have improved outcomes and are generally cost-effective. They are seen as a key step toward creating a personalized service. However, the Government is attributing the success of the pilots to entirely the wrong factors. It believes that a process similar to the one introduced in social care - where it is called self-directed support - based on the person being given a sum of money 'up-front' with which to plan their own care - is responsible for the better outcomes. However, this is not supported by the evidence from the pilots which points to quite different factors being at play. The consequences are potentially very serious. The success of the pilots will not be repeated in roll out. Further, there is the potential to greatly weaken the service by creating confused process and practice, and additional dysfunctional bureaucracy. The practice and process implications from a correct reading of the reasons for success within the pilots centre on replacing the consumerist concepts underpinning self-directed support with what we have called 'flexibility through partnership'. This will require freeing up the resource base as cash and creating a policy framework to enable decisions about how much resource each person should get within a cash-limited budget that will almost certainly be less than would be required to meet all assessed need.

A short history of powered wheelchairs.

This article recounts some early findings on a history of powered wheelchairs in the 20th century from an analysis of archival materials, oral accounts, and secondary sources. The primary goal of this article is not to provide the definitive history of powered wheelchairs, but rather to further our understanding of wheelchair innovation through a historical analysis. The paper sheds light on some of the richness and complexities involved in powered wheelchair innovation, highlights the nonlinearity of that process, and explores the roles of and the relationships between social and technological change. Although it is evident that powered mobility has revolutionized the life experiences of many disabled people, enabling independence, social interaction, and even the facilitation of socio-psychological development, few have charted the social and technological topography that brought this revolutionary change about. In partially mapping the history of powered wheelchairs, this paper draws attention to the idea that wheelchairs are not simply technical devices, but also social and political machines entwined with socio-political conditions and expectations.