English Midlands Research Articles

Knocking on the door: policy, agency and path creation in the post-industrial city

ABSTRACT At the time of the Millennium, Nottingham, a former manufacturing city in the English Midlands, faced serious challenges as a consequence of de-industrialisation. This was the context from which a new development path based on life sciences emerged. This paper explores the role of policy interventions and the agency of local actors in this path creation process. Kingdon’s [1995. Agendas, Alternatives, and Public Policy. 2nd ed. New York: Longman] multiple streams framework (MSF) is used as an analytical framework through which to assess the interaction and local implementation of three related strands of national policy: regional policy, industrial policy (with an emphasis on clusters) and innovation policy and their role in the emergence of a life science cluster in the city. The case is explored with reference to the experience of other European cities that have faced similar structural challenges and sought to respond with development strategies based on life sciences.

Talking about frailty: health professional perspectives and an ideological dilemma

AbstractFrailty is increasingly used in clinical settings to describe a physiological state resulting from a combination of age-related co-morbidities. Frailty also has a strong ‘lay’ meaning that conjures a particular way of being. Recent studies have reported how frail older people perceive the term frailty, showing that frailty is often an unwanted and resisted label. While there are many scores and measures that clinicians can use to determine frailty, little has been published regarding how health-care professionals use and make sense of the term. This paper reports the findings of a qualitative study that explored how health professionals perceive frailty. Forty situated interviews were conducted with health-care professionals working in an emergency department in the English Midlands. The interview talk was analysed using discourse analysis. The findings show that the health professionals negotiate an ‘ideological dilemma’ – a tension between contradictory sets of meanings and consequences for action – based on their ‘lay’ and clinical experience of the term frailty. It is concluded that this dilemma could have a negative impact on the assessment of frailty depending on the system of assessment used.

Exploring the challenges faced by frontline workers in health and social care amid the COVID-19 pandemic: experiences of frontline workers in the English Midlands region, UK

ABSTRACT The first cases of Coronavirus (COVID-19) were reported in Wuhan, China in December 2019. Globally millions of people have been diagnosed with the virus whilst thousands have died. As the virus kept spreading health and social care frontline workers (HSCFW) were faced with difficulties when discharging their duties. This paper was set out to explore the challenges faced by different frontline workers in health and social care during the COVID-19 pandemic. The research utilized an explorative qualitative approach. A total of forty (N = 40) in-depth one-to-one semi-structured interviews were undertaken with HSCFW who included support workers (n = 15), nurses (n = 15), and managers (N = 10). Health and social care workers were drawn from domiciliary care and care homes (with and without nursing services). All the interviews were done online. The data were thematically analyzed, and the emergent themes were supported by quotes from the interviews held with participants. Following data analysis the research study found that lack of pandemic preparedness, shortage of Personal Protective Equipment (PPE), anxiety and fear amongst professionals, challenges in enforcing social distancing, challenges in fulfilling social shielding responsibility, anxiety and fear amongst residents and service users, delay in testing, evolving PPE guidance and shortage of staff were challenges faced by frontline health and social care workers during COVID-19 pandemic. The results of the current study point to a need for adequate pandemic preparedness within the health and social care sector to protect both frontline workers and the individuals they look after.

The Decline of the Clerical Magistracy in the Nineteenth-Century English Midlands

A significant proportion of Church of England clergy in the early nineteenth century took up the role of magistrate to help enforce the law in local communities, partly in consequence of the growth of clerical wealth and status which had begun in the previous century. This legal role was perceived by some as contradictory to clerical pastoral duties, and as such detrimental to the church. Some would view it as contributing to a decline of the Church of England, which was seen as too much associated with the established powers in an era of social change. After the peak of the 1830s, the number of clerical magistrates began to fall dramatically, marking the emergence of a more exclusively religious clerical profession uneasy with the antagonisms associated with local law enforcement. This study, focusing on the diverse county of Staffordshire, presents the case that the decline of the clerical magistracy is an early indicator of the withdrawal of the clergy from involvement in secular concerns, and as such provides important evidence for the growth of secularization in British society.

‘Imitating the epic battles of old’: Uppingham football, 1853–1889

ABSTRACT Football was the winter game at Uppingham School, a boys’ boarding school in the English Midlands, throughout the headmastership of Edward Thring. The rules of play were never static for they evolved under pressures from boys, former pupils, masters and the headmaster, and through comparison with the football codes played at other schools and at the universities. An examination of the rich archive material held at the school enables a case study of the evolution of Uppingham football to be traced throughout its thirty-six-year lifetime, from its introduction by Thring in 1853 until its abandonment by his successor in 1889.

Built not Bought

This article explores the connections between amateur enthusiasm and performative display within the modified Volkswagen community in the UK. Enthusiast labour is key to performance within this community and through discussion of the built not bought debate, this article shows that participants distinguish between amateur and professional labour; illustrating the relative prestige placed on the former. Drawing on ethnographic fieldwork conducted within the modified VW community in the English Midlands and Mid Wales, throughout 2014 and 2015, this article argues that modified VW cars perform in three key ways: through static displays at car shows; mobile displays on public roads; and sonic performances that echo beyond the car itself. Each of these performances serves to highlight the connections between the amateur labour put into cars and their performed display within particular spaces. The article concludes by showing that modified car enthusiasts are often motivated to perform by a desire to be seen, both by the public in public motorscapes but also by audiences of their peers at car shows, who can appreciate the car as the fruit of their enthusiast labour. Conceptually, this article contributes to the intersection of enthusiasm research, understandings of amateur labour and the geographies of the car.

Sickness in the Workhouse: Poor Law Medical Care in Provincial England, 1834–1914 by Alistair Ritch

Reviewed by: Sickness in the Workhouse: Poor Law Medical Care in Provincial England, 1834–1914 by Alistair Ritch Alannah Tomkins Alistair Ritch. Sickness in the Workhouse: Poor Law Medical Care in Provincial England, 1834–1914. Rochester Studies in Medical History. Rochester, N.Y.: University of Rochester Press, 2019. 309 pp. $128.00 (978-1-58046-975-3). The divide between professional history and professional medicine is not totally impermeable, but the barrier is seldom crossed. Historians retrain as clinicians very rarely: practitioners more often become historians of their institution or field. It is a brave person who seeks expertise in more than one context, so Alistair Ritch is notable for moving from consultant physician in Birmingham to historian of workhouse infirmaries in the wider West Midlands. This book begins with the contention that workhouse infirmaries inevitably developed in tandem with voluntary hospitals, under different but complementary regimes. The voluntary hospital admitted the curable and exerted a lot of discrimination over the cases they accepted and retained, while workhouses had a statutory responsibility to cater for the poor settled in their areas. This meant that, initially, historians have observed a broad division between the "acute" capacity of a hospital and the "chronic" accommodation offered by a workhouse. Under Ritch's gaze, this difference remains but is substantially complicated. His remit is the Birmingham and Wolverhampton workhouses, wherever possible incorporating institutions before 1834 as well as after. Chapters consider the "fevers" that preyed on the Victorian poor, and that necessarily afflicted workhouse patients, as drivers of institutional refinements including isolation wards and separate buildings. The disorderly lunatic poor were contained in both of the chosen workhouses despite the rapid expansion of institutional provision for the "mad" in England over the nineteenth century, and both were found wanting by Lunacy Commissioners in the 1850s and later. Ritch goes on to analyze the working lives of workhouse medical officers, to account for patients including their occupancy of different wards, and to consider the integration of trained nurses to these poor law institutions. Collectively the chapters assemble a mass of useful data. Nonetheless, a broad question remains: what was the wider significance of the Birmingham or Wolverhampton workhouse experience for the resident poor in English institutions? In illustration of this point: venereal disease is covered in chapter 3 about disorderly behavior, and before reading this short section I anticipated that it might touch on the way that tertiary syphilis deprived its victims of both physical and mental control. Instead the subheading covered some of the circumstances whereby workhouse inmates contracted venereal disease (ensuring that here "disorderly" relates to sexual misdemeanor rather than disease victimhood). The section subsequently provided brief historical summaries of the emergence of syphilis and gonorrhea plus their treatments (both per se and in the English Midlands specifically), without pushing the analysis further. The section therefore misses the chance to consider why Birmingham and Wolverhampton offer us interesting illustrations for the application of venereal therapies. Why was Birmingham one of only eight provincial workhouses to make use of the first diagnostic blood test for syphilis? Did this relate to economies of scale in large institutions, or was it the [End Page 529] result of a specific policy decision at Birmingham? Was the use of salvarsan for selected Wolverhampton paupers instituted very early in context (in 1912, after the drug's development in 1910), or on the contrary was it applied very meanly (being given only to selected patients)? In short, what can we now appreciate about workhouse medicine by considering it in these two places? What was distinctive and what was run-of-the-mill? The discussion throughout is somewhat light on context, and this is reflected in the historiographical remit. Sheldon and Woods's Atlas of Victorian Mortality is missing, for example, despite Ritch's periodic focus on diagnoses and incidence of illness, while too little is made of the advances by research predecessors including Angie Negrine, Kim Price, and others.1 Consequently, some of the general claims are not backed up or made with sufficient finesse: has the case of the sick poor really been neglected up to now (p. 2)? There is undoubtedly a point to be made here about...

In Search of a Dust Bowl Narrative for the Twenty-First Century

In Search of a Dust Bowl Narrative for the Twenty-First Century Frank Uekötter (bio) Dust Bowls of Empire: Imperialism, Environmental Politics, and the Injustice of "Green" Capitalism. By Hannah Holleman. New Haven, CT: Yale University Press, 2018. xvii + 231 pp. Notes, index. $35.00, cloth. Legacies of Dust: Land Use and Labor on the Colorado Plains. By Douglas Sheflin. Lincoln: University of Nebraska Press, 2019. xiv + 406 pp. Map, photographs, notes, bibliography, index. $55.00, cloth. Documents of the Dust Bowl. Edited by R. Douglas Hurt. Santa Barbara, CA: ABC-CLIO, 2019. xxvii + 240 pp. Bibliography, index. $94.00, cloth. For everyone studying the Dust Bowl, the first order of business should be to realize how odd it is that we keep returning to this topic. With so many issues waiting to be explored at the intersection of agricultural and environmental history, scholars should have a good reason to look at one and the same event again and again. Do they have one? Elbow room is tight in the field, and every new book needs to squeeze in. The competition includes a book that won a Bancroft Prize (Donald Worster's Dust Bowl in 1980) and the winner of the 2006 National Book Award for Nonfiction (Timothy Egan for The Worst Hard Time). Scholars also need to cope with the combined cultural thrust of John Steinbeck's The Grapes of Wrath, Dorothea Lange's photographs, and the music of Woody Guthrie. Is this a case akin to the wall full of graffiti that magically attracts artists (and those who see themselves as such) for yet another layer of paint? Or should we think in terms of the broken records of the shellac days that kept skipping back? The latter metaphor might lose readers below age fifty, though. Of course, the Dust Bowl had dramatic pictures. It is safe to assume that the plight of the Southern Plains would have received different coverage, if any, in the absence of spectacular photographs. The Dust Bowl offered the perfect images for the United States of the Depression years: in the words of David Danbom, Caucasians could watch "someone white with whom they could identify and who was worse off than they were."1 Dramatic photographs no longer stand out in an age awash with visuals, but something else has emerged that draws [End Page 161] writers to the issue. The Dust Bowl has shown itself to be a powerful and remarkably versatile template. If you have a cause that needs a little boost, just link it to the Dust Bowl. Needless to say, there is nothing illegitimate on principle about writing history in light of the concerns of one's time. In fact, some people say that this is why we engage with history. Residents of the Great Plains might object that templates are often imported from some- where else and have shallow roots in the land; narratives of the Dust Bowl are also about the cultural occupation of a peripheral region. It may provide a quantum of solace that marginalization is a common experience in rural areas worldwide. In industrialized societies, farmers are hopelessly outnumbered and cannot compete with the monetary and cultural capital that resides in the big cities. In any case, the present reviewer is not in a position to speak for the region. He has never lived in the Great Plains—a month at Iowa State University was the closest approximation—and if you write about the Dust Bowl in the urban wilderness of the English Midlands, it takes a particularly strenuous intellectual effort to understand that a few days without rain might be a problem. However, there is also an intellectual argument for a word of caution. Invoking the drama and the extent of human misery can turn into a surrogate for theoretical and empirical sophistication. Disputing an argument based on the Dust Bowl feels like leaving people dying in the dirt: no matter whether you have a reason, everyone will talk about your heart of stone. It is the environmentalist equivalent of the argumentum ad Hitlerem. Nobody will challenge you if you have the Dust Bowl on your side. We can see the approach at...

A lower Carboniferous (Visean) tetrapod trackway represents the earliest record of an edopoid amphibian from the UK

The ichnological fossil record has previously provided key evidence for the diversification of land vertebrates (tetrapods) during the Carboniferous Period, following the invasion of the land. Within the UK, tetrapod ichnofossils from the late Carboniferous of the English Midlands are well documented, but few such fossils are known from earlier in the period. We present a rare ichnological insight into early Carboniferous tetrapod diversification in the United Kingdom based on a Visean-aged specimen collected from an interdistributary trough palaeoenvironment at Hardraw Scar, Wensleydale, North Yorkshire. This specimen represents the stratigraphically oldest known tetrapod trackway from the UK. We refer this specimen to Palaeosauropus sp., providing the earliest known occurrence of an edopoid temnospondyl. Supplementing the sparse record of contemporary body fossils from the early Carboniferous, this provides further insights into the diversification of temnospondyl amphibians across Euramerica. Supplementary material: A 3D model of the plaster cast produced from the trackway specimen is available at https://doi.org/10.5519/0022377 and a lower resolution version is available on Sketchfab ( https://skfb.ly/6OAxR ).

Talking Textiles, Making Value: Catalyzing Fashion, Dress, and Textiles Heritage in the Midlands

There are hundreds of small museums, archives, and collections in the English Midlands, United Kingdom (UK), many of which are the legacy of the region’s rich industrial heritage. A surprising number of these include dress and textiles in various forms, from the costume collection of Charles Paget-Wade at Berrington Hall (Leominster) to intricately stitched smocks made by local needlewomen in Herefordshire, and the wealth of manufacturers’ samples that comprise the silk ribbon trade archive at the Herbert Museum, Coventry. These are challenging times for many such organizations as they face cutbacks in staff and local authority funding. Yet they offer a unique and largely unexploited resource for staff, students, and researchers in art and design higher education (HE), not only for primary research but also as a catalyst for design innovation.The discussion here, which takes the format of group research practitioner interview, builds on a Knowledge Exchange event that was held December 2017 at the Fashion Lab, University of Wolverhampton (UoW). The event brought together a diverse group of fashion and textiles professionals to talk, exchange ideas, take part in object handling sessions, mind-map, and brain-storm how to catalyze connections between heritage collections and HE and build value. With seed funding from the Museum-University Partnership Initiative (see National Coordinating Center for Public Engagement—NCCPE 2019), the day built on a series of scoping visits to collections in the region undertaken by Professor Fiona Hackney and Dr Emily Baines. The group involved staff, students and museum professionals including those from UoW, De Montfort University, Hereford College of Arts, Nottingham Trent University, artist Ruth Singer who leads the Arts Council-funded Criminal Quilts project in association with Staffordshire Record Office (Singer 2019), and representatives from Herefordshire Museum Service, the Herbert Gallery (Coventry), Walsall Museums Service, the Lace Guild Stourbridge, and Ironbridge Gorge Museum Trust. The following conversation reflects themes that emerged in the project including: the need to embed archival work and primary research in fashion and textiles curricula at all levels, the development of hubs to connect university research with museum practice, the added value of artist-led projects, and the significance of place-based textiles heritage as a catalyst for new business and sustainable design practice.

Musical culture and the primary school: an investigation into parental attitudes to Whole Class Ensemble Teaching in the English primary school and potential impacts on children’s musical progress

AbstractMusical cultures in primary schools are influenced by motivators which include intrinsic and extrinsic factors. Whole Class Ensemble Teaching (WCET) as realised through provision from Music Education Hubs in England is an extrinsic factor which has been widely influential. This article explores the dynamics in play in parental engagement in music provision, as realised through domains of musical value and progression in the context of WCET provision. It presents research, based on data from one primary school in the English Midlands, drawing on responses from children, parents, the WCET teacher and the head teacher of the school. The research used semi-structured interviews and graphical elicitation as research methodologies to create a conceptual map of theoretical perspectives for parental responses to WCET and suggests that triangulating motivating influences from parents, WCET and learners remain an emergent domain.

Working, Singing, and Telling in the 19th-Century Flemish Pillow-Lace Industry

The female lacemaker who sings at her work is a European literary trope from Shakespeare to Nerval. However, there is considerable evidence from many countries that pillow lacemakers did sing while working, and that their repertoire of songs was in part learnt in the lace schools that many of them attended from about the age of six. Such schools were often under some kind of religious authority. In the English Midlands, the Erzgebirge region of Saxony, and Flanders, trainee lacemakers learnt “tells” that provided a rhythm to the production process; many of these tells were noted down in the 19th century. This article examines the corpus of Flemish tells to explore lacemakers’ own responses to the strict environment of the lace school. Singing together helped establish a corporate identity that lacemakers were proud to proclaim, and reinforced bonds of mutual sympathy between workers. But tells in particular were meant to foster competition. Tells could be used to voice resistance to, or at least the fantasy of escape from, the lace mistress as well as the parents who forced their children into this occupation. But lace mistresses also used tells to teach moral and religious lessons, and to break young girls to the discipline of the school and the relentless expectations of production.

A domestic operational rating for UK homes: Concept, formulation and application

A Domestic Operational Rating (DOR) scheme is presented for assessing the energy performance of occupied dwellings. The DOR is complementary to the method used to generate the asset rating of UK dwellings: the Standard Assessment Procedure (SAP). The DOR is transparent, easy to calculate, based on readily available information, producible from daily smart meter data, calculable for any period on a rolling year basis and applicable across all UK homes.The DOR method was developed using a new primary data set collected from 114 homes as part of the DEFACTO project. All were semi-detached, gas centrally heated, privately owned and internet connected properties, located in the English Midlands. The mean daily energy demands are analysed alongside information gathered through an energy survey and household questionnaires. These data are presented and analysed for the first time in this paper.The DOR method, which is described in full, generates metrics that indicate the absolute and relative energy demands, greenhouse gas emissions and energy costs of homes. The DOR ratings for the D114 homes were stable from year to year. Comparing the DOR with homes’ asset (SAP) ratings, indicates that the SAP rating poorly reflects the inter-home variation of households’ actual energy demand. For the D114 homes, it was possible produce a reduced data Domestic Operational Rating, rdDOR, using the energy demands measured on only a few cold days.Although developed in the UK context, the DOR is generally applicable to national, regional or local housing stocks in which daily energy demand is metered. Potential improvements to the DOR, and the need for trials using smart meter data from diverse homes and locations, are discussed.

Witchcraft in the East Midlands 1517-1642

ABSTRACTIn the immediate period before the Reformation, the most fundamental belief was of the sacred power of God sustaining and keeping safe the natural world, a supernatural God. Yet there were other supernatural angelic and demonic beings, and also people who were locally known as being holy folk, healers, magicians, cunning folk – and witches. This article examines links between the ideas of Luther and witchcraft allegations in the Midlands. It commences with a discussion of the opinions of Luther on witchcraft and magic during the Reformation in Germany and then moves to examine the increasing fear of witchcraft in the English Midlands. Early modern court records and other primary sources for the East Midlands are surveyed, to show how ideas on witchcraft move over space and time and give a clearer picture of the existence of witchcraft in the Midlands.

Enhancing Learning for Early Years Foundation Degree Students: Empowerment through Heutagogy and Reflecting on the Notion of Knowledgeable Others

Abstract This paper reports on a small-scale practitioner enquiry undertaken with 17 work-based learners studying on a two-year Early Years Foundation Degree programme in a higher education institution in England. The first aim of the enquiry was to identify the perspectives of a cohort of work-based Early Years Foundation Degree students on teaching strategies they experienced at a higher education institution in the English midlands. The second aim was to identify how the findings could be applied to curricular and andragogic enhancements for future students. Beliefs and attitudes questionnaires were administered to the students half way through their programme. Findings indicate that students valued strategies that included the direct input of the lecturers they regarded as ‘more knowledgeable others’ (Vygotsky, 1978), yet they rated peer support as less effective for their learning. Findings indicate that early years students’ applications of learned theory to work-based practice may need to go beyond a singular notion of ‘communities of practice’ (Lave & Wenger, 1991). Although these students are positioned and position themselves as more knowledgeable others in their own workplace communities, they regard themselves as lacking knowledge in their higher education community. As members of these various communities, they straddle heutagogic and andragogic approaches in their respective communities of practice. In recognition of this, the paper argues that not only should higher education lecturers working with work-based students adopt andragogic strategies but they should also promote heutagogic approaches that increase student autonomy. They should also communicate explicitly to their students the value of such strategies for learning in the field, both in theory and practice.

Fast-track fisticuffs? An ethnographic exploration of time and white-collar boxing

Whilst white-collar boxing at first appears to be named according to the social class of its practitioners, this paper will argue that this initial appearance is misleading. Based on the analysis of 32 interviews and six months of ethnographic data collection at a boxing club in the English Midlands, it argues that white-collar boxers do not recognise the classed connotations of the term white-collar, to which sociologists tend to be accustomed. Within this lifeworld, white-collar has become a temporal signifier, referring to a version of the sport in which participation is for beginners and limited to eight weeks, culminating in a public boxing match in front of a large crowd. This eight-week participation model is outlined and identified as being drastically different from other forms of boxing, which are emblematic of modernity. White-collar boxing therefore provides entry into a wider discussion on the social construction of time. Acceleration and condensation of time are routinely discussed in this field, and it is suggested that a conceptual split between condensed and accelerated time allows for this white-collar boxing to be understood. Ultimately, white-collar boxing is theorised as the condensed reproduction of the idealised career of the professional boxer.

Implementing an integrated meter and sensor system (IMSS) in existing social housing stock

The current rollout of smart meters for gas and electricity, both in the UK and internationally, will help suppliers to better forecast demand and supply accurate bills to consumers. However, even with an in-home display (IHD), the benefits of a smart meter to a domestic customer are limited by the so-called ‘double invisibility’ of energy [1] and the standardisation of IHD design for an imagined home ‘micro-resource manager’ [2]. Furthermore, low-income households may be limited in the benefits they can reap from such systems; already living within a tight budget, suggestions for further energy-related cost savings may be detrimental to their health and wellbeing. This makes it important that the impact of actions taken to save energy is communicated. This can be done using indoor environmental measures, including carbon dioxide, relative humidity and temperature, as part of an integrated meter and sensor system (IMSS) and an associated IHD or digital application. Such a system gives users the ability to make informed decisions about their energy use and indoor environmental health. This paper explores the potential barriers to implementing an IMSS in practice. It explains how an IMSS was designed, based on a review of meter and sensor systems; details the process is taken to trial the IMSS in 19 social housing properties in the English Midlands; and makes recommendations for a larger scale rollout of IMSSs. The paper also reviews current progress in cloud storage and security as relevant to IMSSs and smart metering.

The Sherwood Foresters of 1916: memories and memorials

ABSTRACTThis paper examines the memorialisation of the Sherwood Foresters who fought during the Easter Rising of 1916 in Dublin. These men, from Nottinghamshire and Derbyshire in the English midlands, suffered the greatest casualties of the British regiments involved in the insurrection, and participated in the firing squads that executed the rebel leaders. Yet the public and artistic memorialising of these English soldiers is not widely known, and this interdisciplinary paper seeks to tell the unfamiliar story of what happened to the Sherwood Foresters after the fighting of Easter Week ceased. We use archival material in order to explore how, at the time of the Rising, these men believed that they would be remembered. We examine the way that the Sherwood Foresters of Easter Week subsequently appeared in literature and drama. And we analyse the way that those soldiers have been commemorated in funerary memorials.

A Quantitative Evaluation of MIRU-VNTR Typing Against Whole-Genome Sequencing for Identifying Mycobacterium tuberculosis Transmission: A Prospective Observational Cohort Study.

BackgroundMycobacterial Interspersed Repetitive Unit-Variable Number Tandem Repeat (MIRU-VNTR) typing is widely used in high-income countries to determine Mycobacterium tuberculosis relatedness. Whole-genome sequencing (WGS) is known to deliver greater specificity, but no quantitative prospective comparison has yet been undertaken.MethodsWe studied isolates from the English Midlands, sampled consecutively between 1 January 2012 and 31 December 2015. In addition to routinely performed MIRU-VNTR typing, DNA was extracted from liquid cultures and sequenced using Illumina technology. Demographic and epidemiological data for the relevant patients were extracted from the Enhanced Tuberculosis Surveillance system run by Public Health England. Closely related samples, defined using a threshold of five single nucleotide variants (SNVs), were compared to samples with identical MIRU-VNTR profiles, to samples from individuals with shared epidemiological risk factors, and to those with both characteristics.Findings1999 patients were identified for whom at least one M. tuberculosis isolate had been MIRU-VNTR typed and sequenced. Comparing epidemiological risk factors with close genetic relatedness, only co-residence had a positive predictive value of over 5%. Excluding co-resident individuals, 18.6% of patients with identical MIRU-VNTR profiles were within 5 SNVs. Where patients also shared social risk factors and ethnic group, this rose to 48%. Only 8% of MIRU-VNTR linked pairs in lineage 1 were within 5 SNV, compared to 31% in lineage 4.InterpretationIn the setting studied, this molecular epidemiological study shows MIRU-VNTR typing and epidemiological risk factors are poorly predictive of close genomic relatedness, assessed by SNV. MIRU-VNTR performance varies markedly by lineage.FundingPublic Health England, Health Innovation Challenge Fund, NIHR Health Protection Research Unit Oxford, NIHR Oxford Biomedical Research Centre.

‘There’s this glorious pill’: gay and bisexual men in the English midlands navigate risk responsibility and pre-exposure prophylaxis

ABSTRACTPre-exposure prophylaxis (PrEP) is currently being trialed for seronegative gay and other men who have sex with men (GMSM) at risk of HIV infection in England. However, research from other countries where PrEP is available shows limited literacy and uptake by GMSM at risk of HIV. We collected focus group data from 18 GMSM (13 HIV− and 5 HIV+) from Leicester, an ethnically diverse city in the English Midlands. Data were analysed using thematic analysis and three themes are presented. The first theme ‘I can’t get my head around people like that’: Representations of PrEP users within and beyond gay communities explores how PrEP users are vilified by some GMSM and the wider media. The second theme, ‘There’s a culture of anti-trust’: PrEP, stigma and the interpersonal politics of HIV disclosure discusses how PrEP influences HIV disclosure and sexual decision-making in casual sero-discordant sexual encounters in a context where seropositive men experienced pervasive HIV stigma and HIV− men were suspicious of HIV+ sexual partners. In the final theme, ‘I’m still suspicious’: Discourses of doubt and distrust participants voiced concern over the safety of PrEP and the motives of drug companies, healthcare agencies and PrEP activists. We consider these findings through a critical lens of wider theorising around the relationship between public health agencies and GMSM communities and consider the impact of these perspectives on likely engagement with PrEP in an English context. We call for more critically informed and nuanced ways of promoting health and well-being amongst men from these communities.