North-West Essex Research Articles

How to Cost the Implementation of Major System Change for Economic Evaluations: Case Study Using Reconfigurations of Specialist Cancer Surgery in Part of London, England

BackgroundStudies have been published regarding the impact of major system change (MSC) on care quality and outcomes, but few evaluate implementation costs or include them in cost-effectiveness analysis (CEA). This is despite large potential costs of MSC: change planning, purchasing or repurposing assets, and staff time. Implementation costs can influence implementation decisions. We describe our framework and principles for costing MSC implementation and illustrate them using a case study.MethodsWe outlined MSC implementation stages and identified components, using a framework conceived during our work on MSC in stroke services. We present a case study of MSC of specialist surgery services for prostate, bladder, renal and oesophagogastric cancers, focusing on North Central and North East London and West Essex. Health economists collaborated with qualitative researchers, clinicians and managers, identifying key reconfiguration stages and expenditures. Data sources (n = approximately 100) included meeting minutes, interviews, and business cases. National Health Service (NHS) finance and service managers and clinicians were consulted. Using bottom-up costing, items were identified, and unit costs based on salaries, asset costs and consultancy fees assigned. Itemised costs were adjusted and summed.ResultsCost components included options appraisal, bidding process, external review; stakeholder engagement events; planning/monitoring boards/meetings; and making the change: new assets, facilities, posts. Other considerations included hospital tariff changes; costs to patients; patient population; and lifetime of changes. Using the framework facilitated data identification and collection. The total adjusted implementation cost was estimated at £7.2 million, broken down as replacing robots (£4.0 million), consultancy fees (£1.9 million), staff time costs (£1.1 million) and other costs (£0.2 million).ConclusionsThese principles can be used by funders, service providers and commissioners planning MSC and researchers evaluating MSC. Health economists should be involved early, alongside qualitative and health-service colleagues, as retrospective capture risks information loss. These analyses are challenging; many cost factors are difficult to identify, access and measure, and assumptions regarding lifetime of the changes are important. Including implementation costs in CEA might make MSC appear less cost effective, influencing future decisions. Future work will incorporate this implementation cost into the full CEAs of the London Cancer MSC.Trial RegistrationNot applicable.

The ‘Northwest Essex Anglo-Saxon Ring’, Falconry and Pagan–Christian Discursive Space

A unique gold finger ring, dated stylistically toc.ad580–650, was discovered by metal-detecting in Essex in 2011. The ‘northwest Essex Anglo-Saxon ring’ is highly decorated with Style II art and shows a distinctive juxtaposition of ‘pagan’ and ‘Christian’ imagery including birds of prey and an anthropomorphic figure holding a long cross in the right hand, a raptor in the left. In this article, I consider the possibility that the object provides further evidence that falconry was practised in early Anglo-Saxon England. I begin by examining the finger ring itself and the imagery upon it, situating this within an Anglo-Saxon and broader Continental context. I then explore the possible social context of the ring, focusing on the ‘ideology of predation’ within which falconry, as a high-status hunting pursuit, may have been performed. Evaluating the hybrid ‘pagan’ and ‘Christian’ elements of the imagery, I suggest that falconry, and the ring itself as a high-status and possibly royal object, may have played important roles in the dynamics of pagan–Christian ‘discursive space’.

The Widdington Sands: High-level Kesgrave Sands and Gravels near the Cam-Stort interfluve, Northwest Essex, UK

A small but stratigraphically significant exposure of Quaternary sandy sediments (Widdington Sands) was observed and recorded in the early 1970s in northwest Essex. These data are here re-examined and re-evaluated, yielding new insights into early proto-Thames aggradation following the marine recession of the Norwich Crag Formation (MIS 74–71, about 2 Ma). As the proto-Thames trajectory shifted south eastwards, a period of landscape stability ensued in the early Middle Pleistocene (MIS 19–13) during which the Valley Farm Soil was formed. This and the succeeding Barham Soil can be recognised in the stratigraphy, the second palaeosol heralding the arrival of glaciation in the Anglian Stage (MIS 12, 480–420 ka). These pedogenic signatures are enclosed within palaeokarstic features in the form of infilled sinkhole pipes. A large doline has functioned as a sediment trap preserving pre-truncation structures including reverse ring faults. These confirm basal support removal leading to upward migration of a dissolution cavity and roof collapse within the sinkhole pipe. The process and timing of subsidence can thus be defined more clearly than for similar features found in comparable Kesgrave aggradations of the Middle Thames. The likely glacitectonic origin of the planar sub-till surface is examined and discussed. Dating of Early Pleistocene fluvial activity is constrained by estimating the height of a former terrace surface whose elevation points to a correlation with the higher Stoke Row Member (MIS 64, 1.8 Ma), suggesting the oldest known proto-Thames activity within southern East Anglia.

John A. Raven.

John A. Raven.

BAYTHORNE HALL, A RAISED-AISLED HALL IN BIRDBROOK, ESSEX, AND ITS RELATIONSHIP TO OTHER RAISED-AISLED HALLS

Baythorne Hall is an isolated raised-aisled hall in north-west Essex, tree-ring dated to 1341, making it the earliest of the three raised-aisled halls that have been dated so far. Raised-aisled halls are buildings where the arcade posts are raised up on to a dropped tiebeam on the centre truss of the open hall, thus clearing the open hall of arcade posts. They are not the same as roof types that look like aisled structures raised up on to normal assembly tiebeams, a number of which were constructed considerably earlier than Baythorne Hall. Baythorne was originally published as a conventional aisled hall, long before it was realised that it was a raised-aisled hall. Although this fact is well known in East Anglia, the purpose of this article is to provide a printed correction of its status, to compare it with the other two dated raised-aisled halls, and to consider the purpose of the raised-aisle truss in the centre of the open hall.

Enough of Thorough: Watertown as a Case Study of Early Massachusetts Town Government

T HE toil of new plantation, contemporary New Englanders lame ted, was akin to Labors of Hercules. In addition to each family's considerable personal exertions in clearing land, raising dwellings, and planting crops, community infrastructure had to be developed so that land could be allocated, public buildings constructed, education delivered, and general welfare maintained. Among first six Massachusetts towns to be founded, Watertown, like its fellows, relied on its particular English precedents as it formed its governing organization. By 1630, English parishes had been expanding their range of duties over course of two generations, but different parishes had developed different administrative models. The founders of Watertown, then, who had formerly resided in East Anglia, discovered that they had more than one precedent from which to choose. For major issues, some eastern county parishes held to principle of consulting all householders to assess the mind of town. Such desire for broad-based oversight was also evident in 16o6, when Ashdon, in northwest Essex, began keeping parish accounts because a great suspicion was grown among some parishioners of honest and just business of such officers as were chosen. Other parishes, however, had developed oligarchic leaderships-self-perpetuating, non-accountable closed vestries intent on imposing culture of discipline on inferior and meaner sort of parishioners'-and it is this approach that historians have tended to

Ecological development of field corner tree plantations on arable land

The ecological development of field corner plantations on arable land in northwest Essex, UK, was studied. Forty plantations, aged between 1 and 15 years, were examined for soil nutrients, ground flora development, tree survival and natural tree regeneration. Plantation soils showed an overall increase in acidity, total nitrogen and total organic carbon compared with adjacent fields, but there was no difference in total phosphorus or potassium. Total nitrogen and organic carbon increased with age of plantation. The overall ground flora consisted of 182 species, but many occured in only a few plantations. The majority of species were competitors and ruderals. The total number of species, and the number of grassland and woodland species, increased with plantation area. Only arable weed species number was related to plantation age (negatively). Canopy closure markedly reduced the number of species in plantations. The presence of good quality hedgerows adjacent to plantations increased their species richness, especially of shade-tolerant herbs. Planted tree survival in individual plantations ranged from 32 to 98% but was generally good (mean 76%). Most losses occured in the first 9 years and were associated with competition with grasses or with adjacent hedgerows. The density of naturally sown seedlings ranged from 0 to 5667 (mean 360) ha -1. There was a correlation between age and the number of suckers, but not seedlings. More seedlings and suckers were found in plantations adjacent to good quality hedgerows.

The Red Crag and Norwich Crag formations of southern East Anglia

A western extension of the Plio-Pleistocene Red/Norwich Crag deposits is described from south-west Suffolk and north-west Essex. The facies geometry of these sediments is described, and related to that of the well-exposed Crag sequence of the Suffolk coast. The same pattern of sedimentation occurs throughout. The Red Crag Formation comprises a basal pebble bed overlain by shelly coarse sands, now largely decalcified. The overlying Chillesford Sand Member of the Norwich Crag Formation is dominated by well sorted fine sands which, except near the coast, are generally devoid of body or trace fossils. However, evidence of opposing current directions indicates that deposition took place in a marine tidal environment. There is no evidence in the western parts to indicate age relationships with the Pre-Ludhamian Red Crag and Bramertonian Chillesford Sand of the coastal area. The Red Crag and Norwich Crag formations ascend westwards from the coast as parallel sheets, each up to 15 m thick, through a range in elevation of at least 100m. This range is interpreted as being due largely to post-depositional tilting rather than to former high sea levels. It is unlikely that sedimentation was influenced by Quaternary faulting.

Kinship at the Core: An Anthropology of Elmdon, a Village in North-West Essex in the Nineteen-Sixties

1. The idea of a village 2. Elmdon families and the core 3. Elmdon as a community 4. Employment 5. Where and how one lives 6. Help and dependancy: kinship in practice 7. Ideas about relatedness 8. Marriage and the significance of outsiders 9. The real village.

: Kinship at the Core: An Anthropology of Elmdon, a Village in North-West Essex in the Nineteen-Sixties . Marilyn Strathern.

: Kinship at the Core: An Anthropology of Elmdon, a Village in North-West Essex in the Nineteen-Sixties . Marilyn Strathern.

Kinship at the Core: An Anthropology of Elmdon, a Village in North-West Essex in the Nineteen-Sixties.

Kinship at the Core: An Anthropology of Elmdon, a Village in North-West Essex in the Nineteen-Sixties.

Elmdon: Continuity and Change in a North-west Essex Village 1861-1964. By Jean Robin and The Fellowship of Song: Popular Singing Traditions in East Suffolk. By Ginette Dunn

Elmdon: Continuity and Change in a North-west Essex Village 1861-1964. By Jean Robin and The Fellowship of Song: Popular Singing Traditions in East Suffolk. By Ginette Dunn

Book review: Robin, J. 1980: Elmdon: continuity and change in a northwest Essex village 1861-1964 Cambridge: Cambridge University Press. xxxiv + 260 pp. £15.00

Book review: Robin, J. 1980: Elmdon: continuity and change in a northwest Essex village 1861-1964 Cambridge: Cambridge University Press. xxxiv + 260 pp. £15.00

Elmdon: Continuity and Change in a North-West Essex Village 1861-1964.

Elmdon: Continuity and Change in a North-West Essex Village 1861-1964.

Elmdon: Continuity and Change in a North-West Essex Village.

Elmdon: Continuity and Change in a North-West Essex Village.

Elmdon: Continuity and Change in a North-West Essex Village, 1861-1964

Elmdon: Continuity and Change in a North-West Essex Village, 1861-1964

Elmdon: Continuity and Change in a North-West Essex Village, 1861-1964

Elmdon: Continuity and Change in a North-West Essex Village, 1861-1964

Jean Robin: Elmdon. Continuity and change in a north-west Essex village 1861–1964. Cambridge University Press, 1980. 294 pp., 16 illustrations, 11 maps. £15.00.

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Elmdon: Continuity and Change in a North-West Essex Village, 1861-1964

1. Elmdon in 1861 2. Links with the world outside 3. Landownership in Elmdon, 1739-1930 4. The men on the land, 1860-1930 5. Farms, farmers and farm workers, 1930-64 6. Non-farming occupations 7. Marriage 8. Status and social mobility 9. Migration in the mid-nineteenth century 10. The changing population 11. Elmdon in 1964. The continuity and the change.

Jean Robin. <italic>Elmdon: Continuity and Change in a North-West Essex Village, 1861–1964</italic>. Foreword by Audrey Richards. New York: Cambridge University Press. 1980. Pp. xxxiv, 260. $34.50

Jean Robin. <italic>Elmdon: Continuity and Change in a North-West Essex Village, 1861–1964</italic>. Foreword by Audrey Richards. New York: Cambridge University Press. 1980. Pp. xxxiv, 260. $34.50