Like much of the European centre-left, Britain's Labour Party has struggled to appeal to its former core working class support base in recent years. However, this is largely a failure to connect with the ‘white working class’ (WWC) specifically, whereas support among ethnic minorities remains robust. We hypothesise that Labour could be experiencing a ‘trade-off’, whereby efforts to cater to minorities harm its perceived ability to represent WWC interests. We test this thesis by examining whether WWC voters are more likely to view minority and working class representation in zero-sum terms and shun Labour when they associate the party with minority interests. We show that the WWC are somewhat less likely to view working class and ethnic minority representation as strongly correlated, and Labour's perceived ability to represent minorities is negatively associated with WWC support. This is not (primarily) about ethnocentrism. Instead, we suggest that ‘relative political deprivation’ is crucial.

The 2019 UK General Election had seismic consequences for British politics. After three years of political turmoil following the 2016 referendum on Britain’s membership of the European Union (EU), the 2019 election marked a victory for the Leave side of the Brexit debate, putting to rest questions of a second referendum and any chance of Parliament blocking the Withdrawal Bill. The United Kingdom left the EU on January 31, 2020. Although there were clear consequences for Britain’s EU membership, there is debate about whether 2019 was a “Brexit election” (Prosser 2020)—even a critical election (Green 2021)—or the continuation of long-term realignments in British politics (Cutts et al. 2020; Jennings and Stoker 2017). By most accounts, Brexit dominated the 2019 election as a political issue, but whether this represents a key moment in a process of realignment of voters in Britain remains to be seen.

Past findings on the connection between class position and political preferences are overwhelmingly derived from cross-sectional studies, which provided a limited basis for inferring causality. This study uses long-term panel data on thousands of British respondents to measure the impact of intra-generational class mobility across a range of political identities and preferences. Upward class mobility leads to small increases in economic conservatism, but party choice, class identity and attitudes to non-economic issues do not change. This updating of economic values is much smaller than cross-sectional differences between classes. These results are consistent with the short-run effects of class mobility operating primarily through a limited economic self-interest mechanism. Beliefs that are plausibly unconnected to economics are unaffected. The overall association between class and a range of identities, opinions and preferences is therefore more likely to be caused by early life experiences and longer-term socialization than by the immediate material interests associated with jobs.

Background: Healthcare services are increasingly shifting from inpatient to outpatient settings. Outpatient settings such as emergency departments (EDs), oncology clinics, dialysis clinics, and day surgery often involve invasive procedures with the risk of acquiring healthcare-associated infections (HAIs). As a leading cause of HAI, Clostridioides difficile infection (CDI) in outpatient settings has not been sufficiently described in Canada. The Canadian Nosocomial Infection Surveillance Program (CNISP) aims to describe the epidemiology, molecular characterization, and antimicrobial susceptibility of outpatient CDI across Canada. Methods: Epidemiologic data were collected from patients diagnosed with CDI from a network of 47 adult and pediatric CNISP hospitals. Patients presenting to an outpatient setting such as the ED or outpatient clinics were considered as outpatient CDI. Cases were considered HAIs if the patient had had a healthcare intervention within the previous 4 weeks, and they were considered community-associated if there was no history of hospitalization within the previous 12 weeks. Clostridioides difficile isolates were submitted to the National Microbiology Laboratory for testing during an annual 2-month targeted surveillance period. National and regional rates of CDI were stratified by outpatient location. Results: Between January 1, 2015, and June 30, 2019, 2,691 cases of outpatient-CDI were reported, and 348 isolates were available for testing. Most cases (1,475 of 2,691, 54.8%) were identified in outpatient clinics, and 72.8% (1,960 of 2,691) were classified as community associated. CDI cases per 100,000 ED visits were highest in 2015, at 10.3, and decreased to 8.1 in 2018. Rates from outpatient clinics decreased from 3.5 in 2016 to 2.7 in 2018 (Fig. 1). Regionally, CDI rates in the ED declined in Central Canada and increased in the West after 2016. Rates in outpatient clinics were >2 times higher in the West compared to other regions. RT027 associated with NAP1 was most common among ED patients (26 of 195, 13.3%), whereas RT106 associated with NAP11 was predominant in outpatient clinics (22 of 189, 11.6%). Overall, 10.4% of isolates were resistant to moxifloxacin, 0.5% were resistant to rifampin, and 24.2% were resistant to clindamycin. No resistance was observed for metronidazole, vancomycin, or tigecycline. Compared to CNISP inpatient CDI data, outpatients with CDI were younger (51.8 ± 23.3 vs 64.2 ± 21.6; P < .001), included more females (56.4% vs 50.9%; P < .001), and were more often treated with metronidazole (63.0% vs 56.1%; P < .001). Conclusions: For the first time, CDI cases identified in outpatient settings were characterized in a Canadian context. Outpatient CDI rates are decreasing overall, but they vary by region. Predominant ribotypes vary based on outpatient location. Outpatients with CDI are younger and are more likely female than inpatients with CDI.

Funding: None

Disclosures: Susy Hota reports contract research for Finch Therapeutics.

Party identification has been thought to provide the central organizing element for political belief systems. This article makes the contrasting case that core values concerning equality and government intervention versus individualism and free enterprise are fundamental orientations that can themselves shape partisanship. The authors evaluate these arguments in the British case using a validated multiple-item measure of core values, using ordered latent class models to estimate reciprocal effects with partisanship on panel data from the British Household Panel Study, 1991–2007. The findings demonstrate that core values are more stable than partisanship and have far stronger cross-lagged effects on partisanship than vice versa in both polarized and depolarized political contexts, for younger and older respondents, and for those with differing levels of educational attainment and income, thus demonstrating their general utility as decision-making heuristics.

Whiteley et al. criticize our re-analysis of the valence model of party choice. In reply, we argue that they are mistaken with regard to their understanding of some of the claims made in our paper and, in one instance, the variables included in the analysis. We also point to flaws in their interpretation of the distinction between weak and contemporaneous endogeneity and the assumptions of their vector error correction model. Their argument privileging aggregate analysis introduces predictable inferential problems and also, it might be suggested, potentially casts doubt on their own research, which uses individual-level analysis to make the case for the valence model. For these reasons, we see no reason to moderate the negative implications of our analysis for the validity of the model.

The influential valence model of voting developed over the last decade by the British Election Study (BES) team assumes that party and leadership performance evaluations have a causal impact on party choice. An alternative perspective argues that such performance evaluations are instead the consequences of party choice. This article examines the analytical and empirical underpinnings of the BES valence model and compares it to the party-driven approach. To do so, it estimates cross-lagged structural equation models of the association between Labour Party preference and evaluations of the Labour government's performance during the 2005–10 British electoral cycle. It shows that party preference has a stronger effect on performance evaluations than vice versa; performance evaluations have no significant effect on party preference toward the end of the electoral cycle. The study also finds that, contrary to claims made concerning their merits as simplifying heuristics, performance assessments have no impact on short-term movements in party choice for less politically attentive voters. To a substantial degree, evaluations of party performance express—rather than explain—party choice, and would appear to have limited merit as simplifying heuristics.

Objectives: Pediatric emergency medicine (PEM) physicians receive little opportunity to practice and perform chest tube insertion. We sought to develop and validate a scoring tool to assess chest tube insertion competency and identify areas where training is required for PEM physicians.

Methods: We developed a 40-point, 20-item (scored 0, 1, or 2) assessment tool entitled the Tool for Assessing Chest Tube Insertion Competency (TACTIC) and studied how PEM physicians and fellows scored when inserting a chest tube into a pork rib model. Participants were scored at baseline and compared to themselves after receiving targeted training using Web-based animations and presentations followed by expert instruction and practice on chest tube insertion task trainers. All insertions were video recorded and reviewed by two blinded reviewers. Eight common videos were reviewed to assess interrater reliability.

Results: The TACTIC demonstrated good interrater reliability with an r2=0.86. Our cohort demonstrated a significant improvement in TACTIC scores by taking part in targeted training (precourse TACTIC=65%, 95% CI 54–76 v. postcourse TACTIC=84%, 95% CI 80–88), highlighting the construct validity of the TACTIC. Individual participants increased their TACTIC scores by an average of 17%.

Conclusions: The TACTIC demonstrates good interrater reliability, content validity, and construct validity in assessing a PEM practitioner’s skill inserting chest tubes in a simulated setting.

Why has the association between class and party declined over time? Contrary to conventional wisdom that emphasizes the fracturing of social structures and blurring of class boundaries in post-industrial society, it is argued here that class divisions in party preferences are conditioned by the changing shape of the class structure and the effect of parties’ strategic ideological responses to this transformation on the choices facing voters. This thesis is tested using British survey data from 1959 to 2006. We demonstrate that increasing class heterogeneity does not account for the decline of the class–party association, which occurs primarily as a result of ideological convergence between the main parties resulting from New Labour's shift to the centre.