Hoarding disorder is a surprisingly common problem which impacts on most areas of life. People who hoard typically have multiple agencies involved in their care due to the complex health and safety impact and risks associated with hoarding. ‘Treatment’ involves finding ways of supporting discarding large amounts, typically underpinned by CBT principles. We evaluated the impact and outcomes of a conference designed to boost professionals’ confidence and understanding in working with hoarding problems, both individually and with other agencies with a view to improving inter-agency service provision. Changes in professionals’ confidence and understanding were evaluated immediately before and after the conference. Conference participants’ qualitative responses related to service improvements were analysed using content analysis. People with personal experience of hoarding issues subsequently participated in a focus group where the results of the conference were presented. These data were analysed using thematic analysis. Confidence and understanding in working with hoarding problems substantially increased from pre- to post-conference. Professionals identified a range of possible improvements, most commonly working more closely and improving communication with other agencies. People with personal experience suggested improvements across three over-arching themes: developing an improved understanding of hoarding, the need for improved resources, and improved multi-agency working. A multi-agency conference increased confidence and understanding in professionals working with hoarding problems, and improvements specified by both people with personal experience and professionals provide a useful guide to service improvement. Results provide a framework in which CBT approaches should be embedded.

In England, the dominant policy narrative recognises no association between spending on children’s services and quality and a limited association between quality and deprivation. We combined 374 inspection outcomes between 2011 and 2019 with data on preventative and safeguarding expenditure and Indices of Multiple Deprivation (IMD) scores. A multilevel logistic regression model predicting ‘good’ or ‘outstanding’ judgements suggests each £100 increase in preventative spending per child was associated with a 69 per cent increase (95 per cent CI: 27.5 per cent, 124 per cent) in the odds of a positive inspection. A one-decile increase in deprivation was associated with a 16 per cent (95 per cent CI: −25 per cent, −5.7 per cent) decrease. Safeguarding expenditure was not associated with outcomes. Deprived communities have worse access to good-quality children’s services and government policies that have increased poverty and retrenched preventative services have likely exacerbated this inequality. Further, inattention to socioeconomic context in inspections raises concerns about their use in ‘take over’ policies.

The first demonstration of laser action in ruby was made in 1960 by T. H. Maiman of Hughes Research Laboratories, USA. Many laboratories worldwide began the search for lasers using different materials, operating at different wavelengths. In the UK, academia, industry and the central laboratories took up the challenge from the earliest days to develop these systems for a broad range of applications. This historical review looks at the contribution the UK has made to the advancement of the technology, the development of systems and components and their exploitation over the last 60 years.

Background: There are national policy drivers for mental health services to demonstrate that they are effectively meeting the psychological needs of people with long-term health conditions/medically unexplained symptoms (LTC/MUS). Aims: To evaluate the implementation of a stepped-care service delivery model within an Improving Access to Psychological Therapies (IAPT) service for patients with depression or anxiety in the context of their LTC/MUS. Method: A stepped-care model was designed and implemented. Clinical and organizational impacts were evaluated via analyses of LTC/MUS patient profiles, throughputs and outcomes. Results: The IAPT service treated N = 844 LTC and N = 172 MUS patients, with the majority (81.81%) receiving a low intensity intervention. Dropout across the service steps was low. There were few differences between LTC and MUS outcome rates regardless of step of service, but outcomes were suppressed when compared to generic IAPT patients. Conclusions: The potential contribution of IAPT stepped-care service delivery models in meeting the psychological needs of LTC/MUS patients is debated.

Can conservatives be feminists? This article examines the issue by exploring the case of the British Conservative Party, drawing on a new survey of party members. Under David Cameron's leadership, reforms have been made to the party's parliamentary selection procedures and distinct women's policies developed, thus addressing both the descriptive and substantive representation of women. We examine party members' attitudes towards three types of gender issue: basic orientations towards gender roles and relations; specific policy measures relevant to the substantive representation of women; and the descriptive representation of women. Detailed empirical analysis reveals that there is significant support for progressive liberal feminist positions on each of these dimensions in the party, and that sex, age and basic ideological dispositions drive such attitudes to varying degrees. Even so, support for a liberal feminist position on the descriptive representation of women – that is, the aspect of gender politics where the leadership has been most active – remains on the whole quite limited.

Several single nucleotide polymorphisms (SNPs) in candidate genes of DNA repair and hormone pathways have been reported to be associated with endometrial cancer risk. We sought to confirm these associations in two endometrial cancer case-control sample sets and used additional data from an existing genome-wide association study to prioritize an additional SNP for further study. Five SNPs from the CHEK2, MGMT, SULT1E1 and SULT1A1 genes, genotyped in a total of 1597 cases and 1507 controls from two case-control studies, the Australian National Endometrial Cancer Study and the Polish Endometrial Cancer Study, were assessed for association with endometrial cancer risk using logistic regression analysis. Imputed data was drawn for CHEK2 rs8135424 for 666 cases from the Study of Epidemiology and Risk factors in Cancer Heredity study and 5190 controls from the Wellcome Trust Case Control Consortium. We observed no association between SNPs in the MGMT, SULT1E1 and SULT1A1 genes and endometrial cancer risk. The A allele of the rs8135424 CHEK2 SNP was associated with decreased risk of endometrial cancer (adjusted per-allele OR 0.83; 95%CI 0.70-0.98; p = .03) however this finding was opposite to that previously published. Imputed data for CHEK2 rs8135424 supported the direction of effect reported in this study (OR 0.85; 95% CI 0.65–1.10). Previously reported endometrial cancer risk associations with SNPs from in genes involved in estrogen metabolism and DNA repair were not replicated in our larger study population. This study highlights the need for replication of candidate gene SNP studies using large sample groups, to confirm risk associations and better prioritize downstream studies to assess the causal relationship between genetic variants and cancer risk. Our findings suggest that the CHEK2 SNP rs8135424 be prioritized for further study as a genetic factor associated with risk of endometrial cancer.

The text of this paper, together with the abstract of the discussion held by the Institute of Actuaries on 24 June 1996, are printed in British Actuarial Journal, 2, V, pages 1273-1322.