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Diet modifies the risk of colorectal cancer (CRC), and inconclusive evidence suggests that yogurt may protect against CRC. We analysed the data collected from two separate colonoscopy-based case–control studies. The Tennessee Colorectal Polyp Study (TCPS) and Johns Hopkins Biofilm Study included 5446 and 1061 participants, respectively, diagnosed with hyperplastic polyp (HP), sessile serrated polyp, adenomatous polyp (AP) or without any polyps. Multinomial logistic regression models were used to derive OR and 95 % CI to evaluate comparisons between cases and polyp-free controls and case–case comparisons between different polyp types. We evaluated the association between frequency of yogurt intake and probiotic use with the diagnosis of colorectal polyps. In the TCPS, daily yogurt intake v. no/rare intake was associated with decreased odds of HP (OR 0·54; 95 % CI 0·31, 0·95) and weekly yogurt intake was associated with decreased odds of AP among women (OR 0·73; 95 % CI 0·55, 0·98). In the Biofilm Study, both weekly yogurt intake and probiotic use were associated with a non-significant reduction in odds of overall AP (OR 0·75; 95 % CI 0·54, 1·04) and (OR 0·72; 95 % CI 0·49, 1·06) in comparison with no use, respectively. In summary, yogurt intake may be associated with decreased odds of HP and AP and probiotic use may be associated with decreased odds of AP. Further prospective studies are needed to verify these associations.
The third sector's involvement in public service delivery is undoubtedly a high profile and much debated aspect of the sector's overall role in society. It is one that is both very deeply rooted and long-sustained, but also one that has grown rapidly in the last 15 years. Arguably there has, until recently, been a relative dearth of empirical academic research seeking to understand the content, consequences and controversies of this engagement. This volume, in bringing together contributions from a wide range of academics who have been part of the Third Sector Research Centre, has been an attempt to address that gap in as coherent and comprehensive a manner as possible. Public service delivery remains controversial, both for many within the sector (‘looking in’) and for those equally concerned with the future of public services (‘looking out’).
As Rob Macmillan has recently put it, two narratives seem to consistently frame contemporary debates in this area. The first, a narrative of necessity and transition, suggests that TSOs need to adapt to a changing and highly challenging operating environment by becoming more professional and business-like, more efficient and impact-focused. Such calls are often associated with government (New Labour just as much as the Coalition) but also with national sector bodies. This narrative often implies a move closer to the market and to private sector modes of behaviour as a way to survive and even, perhaps, to thrive. From a more critical standpoint, there comes a narrative of jeopardy and loss, in which TSOs are drifting away from their distinctive moorings in civil society into the mainstream, adopting more hybrid characteristics in their entanglements with both the state and the private sector (Milbourne, 2013; Rochester, 2013; Benson, 2014); and such hybridisation is rarely seen as a contest in which civil society values can be reasserted (Mullins and Acheson, 2014). Both narratives seem to point to a wider truth (again, ‘looking out’) of the continued adoption of commercial approaches and a process of marketisation within public services; but with perhaps a growing preference for large private sector providers over the third sector in recent years in several sectors (employment services and criminal justice) compared to housing where large non-profits, previously the ‘preferred providers’ had been holding their own in the climate of ‘open public services’.
This book could not have been written a decade ago. From 1997 to the mid-2000s, the UK government strongly promoted the third sector in the delivery of public services, but it was too early to reach research-based judgements about the implications of its expanding role. As part of its wider efforts to ‘modernise’ public services, New Labour matched its rhetoric with a significant injection of resources designed to build and strengthen the relationship between the state and the third sector based on the Third Way idea of a ‘partnership’ (Kendall, 2000; Carmel and Harlock, 2008). In its turn, the Coalition government of 2010–15 promoted a vision of a ‘Big Society’, in which ‘civil society’ would play a stronger role in both service delivery and wider civic life, albeit in a context of austerity in public finances. The Conservative government elected in 2015 appears less receptive, suggesting a potentially more troubling future for the sector. An earlier generation of books reflected the relatively more marginal role the sector then had, but also presciently highlighted the pressures and dilemmas that have faced the sector as its role has grown (see Davis Smith et al, 1995; Harris and Rochester, 2001). Reflecting on this tumultuous 18-year period (1997–2015), the book aims to provide a broad overview of the emerging implications of the third sector's delivery of public services, informed by research conducted at the Third Sector Research Centre (TSRC). The book focuses on England, reflecting the centre's focus on that country at a time when devolution was driving policy divergence between the constituent parts of the UK. The English experience is of particular international relevance as it has witnessed a deeper implementation of the market-based policies, which have been a significant feature of public services reform in the UK.
Debates about the third sector's involvement in public service delivery have always taken place in a wider context. Even 20 years ago, Kendall and Knapp commented that one appeal of the voluntary sector was as a ‘way to legitimize constraints on, or even cuts in public social expenditures at times of fiscal austerity’ (Kendall and Knapp, 1996: 7).
Housing is perhaps the ideal field in which to explore the argument that something has changed in public services involving the replacement of monolithic, hierarchical public sector organisations with a wider range of agencies funded and regulated by government. This chapter draws on a series of Third Sector Research Centre (TSRC) studies (referenced throughout the chapter) to assess changing roles for housing associations and other housing TSOs involved in public housing services. Tensions between state, market and community drivers of hybridity are revealed, with underlying implications for the independence, funding, activities and potential to challenge state policies by TSOs. Rather than being ‘distant uncles’ of the third sector (Mullins, 2010: 3), and despite having developed a distinct organisational field, housing associations have been at the centre of recent changes in the funding, role and independence of the third sector.
The market share of local authorities in the field of subsidised housing for low income groups in England has certainly declined from their zenith in 1979 when one in every three households rented housing from a local authority, to the present day when fewer than one in 12 is a council tenant. A large part of this change is accounted for by the growth of housing associations, non-profit distributing third sector bodies, who had a virtual monopoly of state capital subsidies for new housing from 1980 to 2010, and to whom over half of local authorities have now transferred their entire housing stock. Their market share has grown from one in 50 households in 1980 to one in 10 today.
However, this neat depiction of a shift of housing from state monopoly providers to a third sector field is complicated by a number of factors. Not least a change in which most public housing subsidy now reaches low-income households through personal subsidies rather than capital subsidies. Housing benefit has been one of the fastest increasing parts of the welfare budget, now standing at £24 billion and a significant share of this has supported the growth of the private rented sector, which is rapidly becoming the main tenure for low-income households seeking accommodation. Moreover, as the housing association sector has grown so too have individual associations, with the largest now having over 120,000 homes.
This edited collection explores areas such as social enterprise, capacity building, volunteering and social value, and charts the historical development of the state-third sector relationship, reviewing the major debates and controversies accompanying recent shifts in that relationship.
The paper begins by considering the importance of springs as a focus for votive deposits in Bronze Age Britain. This is not a new idea, but nowhere has this association been examined through the excavation of one of these features. The point is illustrated by excavation at the findspot of a famous group of Late Bronze Age weapons, the Broadward hoard, discovered in 1867. Little was known about the site, where it was found or the character of the original deposit, but a study of contemporary accounts of the hoard, combined with geophysical and topographical surveys, led to small-scale excavation in 2010, which showed that the deposit had most probably been buried in a pit on the edge of a spring. Other finds associated with the spring included an Early Bronze Age macehead, a Roman pot and various Saxon and medieval animal bones. The latest deposit, with a post-medieval carbon date, included a wooden knife or dagger. An adjacent palaeochannel provided an important environmental sequence for this part of the English–Welsh borderland and suggests that the Late Bronze Age hoard had been deposited not far from a settlement. A nearby earthwork enclosure was associated with a clay weight, which may be of similar date. Despite the limited scale of the fieldwork, it illustrates the potential for treating springs associated with artefact finds on the same terms as other archaeological deposits.
A series of editorials in this Journal have argued that psychiatry is in the midst of a crisis. The various solutions proposed would all involve a strengthening of psychiatry's identity as essentially ‘applied neuroscience’. Although not discounting the importance of the brain sciences and psychopharmacology, we argue that psychiatry needs to move beyond the dominance of the current, technological paradigm. This would be more in keeping with the evidence about how positive outcomes are achieved and could also serve to foster more meaningful collaboration with the growing service user movement.