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Background Mothers who have children removed from their care often have complex needs. These women have poor health outcomes and are dying earlier than their peers from preventable and amenable causes. Yet there is little known about how health care services might mitigate these risks. This study aimed to listen to the voices of women who had children removed from their care to understand their experiences of health and healthcare. Methods We used a narrative approach to collect and analyse interview data with six mothers who had experienced child removal in England. Each participant was asked to reflect on their life and main health challenges. Results Three narrative subplots were developed to consolidate experiences of unmet health need: (i) 'on paper you're normal': narratives of complex need, (ii) 'in my family, everyone had issues': narratives of whole family need and (iii) 'I'm still mummy, no matter where they are': narratives of maternal identity and health. Conclusions Findings highlight limitations within current systems of support, including a culture of distrust and women falling between the gaps of services. Women's narratives illustrate opportunities for health intervention, especially immediately following child removal. [ABSTRACT FROM AUTHOR]

In recent years, there has been considerable policy and academic interest in the existence of ethnic inequalities in the Criminal Justice System. A large body of sentencing research has been dedicated to exploring whether ethnic minority defendants are treated more harshly than similarly situated white defendants. This paper extends this research utilizing Ministry of Justice linked criminal justice datasets and multilevel models to assess the effect of ethnicity and other defendant case and contextual factors on sentencing outcomes in the Crown Court. The analysis shows that legal characteristics such as plea, pre-trial detention, offence type and severity are important factors determining sentencing outcomes although they do not fully explain disparities in these outcomes between ethnic groups. Ethnic disparities in imprisonment persist and, in some cases, become more pronounced after controlling for defendant case and court factors. In contrast, ethnic disparities in sentence length are largely explained by legal factors, and after adjusting for other predictors of sentencing outcomes, observed differences between most (but not all) ethnic minority groups and the white British disappear. [ABSTRACT FROM AUTHOR]

Family group conferences (FGCs) in child welfare share decision-making with family members by bringing the immediate and wider family together to make a plan to meet a child's needs. This paper reports survey findings on FGC provision in the UK in 2022 and explores whether in England the presence of an FGC service and the rate of FGC provision is associated with the rate of children in care, entering care, in kinship foster care and leaving care. Seventy-nine per cent (n  = 167) of local authorities in the UK provided FGCs to families, and 14 per cent (n  = 29) did not. Services that were more established offered a more diverse range of FGCs. The introduction of FGCs in English local authorities was associated with a higher rate of children in care, but also higher rates of kinship foster care, a key goal of FGCs where it is not possible for children to stay with their parents. Higher rates of FGCs were associated with more children leaving care, possibly due to reunification with birth families. To understand in more detail, the circumstances of children in and leaving care in local authorities with FGCs, individual data linkage studies are needed. [ABSTRACT FROM AUTHOR]

This paper explores how the selection of peer researchers influences and shapes peer research projects. It draws on two empirical studies formed from two community action projects in England. Peer research is a method for involving young people as coresearchers within their community or in specific settings such as educational environments and the two projects recruited school children of different ages and ethnic backgrounds; in both cases they were representative of the potential participant population. One project (Community House) was based in a junior school setting and concentrated on evaluating a community centre project. The second project (Knife Angel: Hear My Voice) was a youth work setting and brought together a group of young people to explore an intervention aimed at impacting crime and violence in the local community. This paper discusses how the demographic characteristics of the peer researchers shaped, influenced and impacted the success of both community action projects. We discuss how children and young people bring their unique skills to preparing the questionnaire and dissemination. Using researcher reflexivity, we consider the methodological implications of the findings and contribute to theory building about community action and the impact of participatory research. [ABSTRACT FROM AUTHOR]

This paper is a reflective piece on the thought processes individuals and teams have when engaging in decoloniality work in Teacher Training/Education. We argue that until the self is decolonized, the process of decolonialization becomes rhetoric. We also question how much we can decolonize whilst working in the academy whose very culture, symbols and practices are borne out of colonialism and the period of enlightenment; whose very raison d'être is to elevate some knowledge over others and to claim cultural and academic superiority. The current political landscape in England approaches anti-racism as a political ideology that must be avoided in schools and education and this ideological battlefield is evident in teacher education. We aim to recognize the tensions and resistance to decolonialize, which demonstrates the messy and contingent process of moving between shifting positions and subjectivities. It confronts the challenge of the teacher–practitioner who must balance their own moral and philosophical grounding whilst attending the political imperatives of the work. This can take the form of according with the policies and procedures of the institutions in which they are situated which can often be balkanizing and debilitating. [ABSTRACT FROM AUTHOR]

This paper seeks to explore how hospitals can be reconfigured to adopt more 'health-promoting' approaches and values. Specifically, the paper focuses on the role of hospital chaplaincy and argues that spiritual care should be considered alongside other health domains. Using semi-structured interviews, the aim of the paper is to explore the experiences of patients who accepted (n = 10) and declined (n = 10) hospital chaplaincy services. Data were analysed drawing on principles of interpretative phenomenological analysis (IPA). The findings suggested that participants who accessed chaplaincy services reported using the chaplains for pastoral, religious and spiritual care which contributed positively to their sense of well-being. This included religious rituals and supportive conversations. The majority of these participants had existing links with a faith institution. Participants who declined chaplaincy services reported having personal religious or spiritual beliefs. Other reasons cited, included: that the offer was made close to discharge; they had different support mechanisms; they were unaware of what the chaplaincy service offered. Participants identified a number of skills and attributes they associated with chaplains. They perceived them as being religious but available to all, somebody to talk to who was perceived as impartial with a shared knowledge and understanding. The paper concludes by highlighting the important role of chaplaincy as part of a holistic health-promoting hospital. This has implications not only for the design, delivery and promotion of chaplaincy services but also for health promotion more broadly to consider spiritual needs. [ABSTRACT FROM AUTHOR]

Introduction Inappropriate antibiotic use contributes to antimicrobial resistance. High-income countries have high rates of antibiotic use, with a prevalence of health inequalities amongst populations. Objectives To understand the influence of factors commonly known to be associated with health inequalities on antibiotic use in high-income countries. Methods Factors commonly known to be associated with health inequalities were defined as protected characteristics under UK's Equality Act (age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race/ethnicity, religion or belief, sex, sexual orientation), socioeconomic characteristics (income, insurance, employment status, deprivation, education), geography (urban versus rural, region) and vulnerable groups. The study followed PRISMA-ScR and, PRISMA-E statements. Results Fifty-eight of 402 identified studies met inclusion criteria. Fifty of those papers (86%) included one or more protected characteristics, 37 (64%) socioeconomic characteristics, 21 (36%) geography and 6 (10%) vulnerable groups. Adults in older age groups, especially those in residential care, had the highest antibiotic use. The influence of race or ethnicity and antibiotic use was particular to country context. Areas of high deprivation had higher antibiotic use compared with areas of no or low deprivation, and geographical variation existed within countries. When faced with health system barriers, migrants relied on alternative routes of antibiotic supply other than prescription. Recommendations for future research To investigate how factors and wider social determinants of health interplay and impact antibiotic use, using frameworks/approaches to reduce health inequalities such as England's Core20PLUS approach. Antimicrobial stewardship initiatives should equip healthcare professionals to review patients at the highest risk of antibiotic use. [ABSTRACT FROM AUTHOR]

In this paper, Curating Spaces of Hope is offered as a new paradigm for postsecular partnership for uncertain times. The need for a new paradigm is set out intially using literatures from faith based organisations. The case is made that the understanding of faith or the 'F' is inadequate, and that in order to make sense of the role it plays in social policy, a fresh framing is needed. For this, literatures from political philosophy, sociology or religion and social policy are engaged. These set out the space for mapping different worldviews, as part of the diversifying beleif landscape in the UK, and the policy context into which they are speaking. The paper then turns to empircal data to make the case for the new paradigm of postsecualr partnership, Curating Spaces of Hope. This case is made in three phases. First auto-ethnographic data is used as the basis for a social movement in the north west of England which takes place over 3 years. This is used as the premise for ethnographic research which maps postsecular contexts and informs the production of Curating Spaces of Hope. The paper then turns to the COVID-19 pandemic, as a lens through which to view current contexts of uncertainty. Three case studies are then offered which point to early applications of Curating Spaces of Hope and opportunities for building postsecular partnerships in the north west England. [ABSTRACT FROM AUTHOR]

Many coastal towns in England face a unique set of overlapping challenges: a longstanding socio-economic stagnation and environmental threats coming from the physical location. This paper examines coastal communities in the context of the left-behind debate. The consequences of de-industrialisation and failures in public policies recall other left-behind geographies. We look at a selection of case studies, apparently dealing with the decline of traditional coastal economic activities, but really affected by a decoupling of their socio-economic profile from their coastal specificity. More work is needed to nurture the existing coastal imaginaries, requiring regional coordination and a place-based approach to regeneration. [ABSTRACT FROM AUTHOR]

Lentigo maligna (LM) is a melanoma in situ with distinct clinical features and histology. It commonly affects men after the sixth decade of life. Incidence rates of LM have increased based on early 21st century data from different countries; however, data are suboptimal. Data from England show a plateauing crude incidence between 2013 and 2019. By comparison, invasive melanoma and other types of melanoma in situ commonly appears in younger age groups (median age 58 and 67 years old, respectively) and incidence is rising. The most important risk factors for LM include fair skin and cumulative ultraviolet solar radiation exposure. Although LM is limited to the epidermis and connected skin adnexa, it may progress to invasive LM melanoma. The reported rate of malignant progression varies, reflecting a challenge for LM epidemiology research as often lesions are removed on diagnosis. LM poses a challenge in diagnosis and management. Although it can be diagnosed clinically or dermoscopically, histopathological assessment of biopsied skin tissue remains the gold standard. Reflectance confocal microscopy allows for better appreciation of the complexity of LM at a cellular level, often progressing beyond clinical margins. Management of LM may involve Mohs micrographic surgery or excision, although recurrence may occur even with 5 mm clinical margins. Imiquimod cream may be effective, but incomplete treatment and recurrence has been reported. Conservative management with observation or radiotherapy may be used in selected patients' cases. Five-year net survival rates are excellent. This paper reviews the natural history, epidemiology, aetiology, pathogenesis, diagnosis and management of LM. [ABSTRACT FROM AUTHOR]

Frailty represents an integrative prognostic marker of risk that associates with a myriad of age-related adverse outcomes in older adults. As a concept, frailty can help to target scarce resources and identify subgroups of vulnerable older adults that may benefit from interventions or changes in medical management, such as pursing less aggressive glycaemic targets for frail older adults with diabetes. In practice, however, there are several operational challenges to implementing frailty screening outside the confines of geriatric medicine. Electronic frailty indices (eFIs) based on the theory of deficit accumulation, derived from routine data housed in the electronic health record, have emerged as a rapid, feasible and valid approach to screen for frailty at scale. The goal of this paper is to describe the early experience of three diverse groups in developing, implementing and adopting eFIs (The English National Health Service, US Department of Veterans Affairs and Atrium Health—Wake Forest Baptist). These groups span different countries and organisational complexity, using eFIs for both research and clinical care, and represent different levels of progress with clinical implementation. Using an implementation science framework, we describe common elements of successful implementation in these settings and set an agenda for future research and expansion of eFI-informed initiatives. [ABSTRACT FROM AUTHOR]

The introduction of healthcare-based apprenticeships to become both a physician associate and a doctor has been approved for delivery in England. This will revolutionize medical training and it is hoped that medical training would be more accessible. This has generated a mixture of reactions, some enthusiastic and others concerned. This paper gauges interest among staff at Barking, Havering, and Redbridge University Hospitals NHS Trust in pursuing training as a doctor and/or physician associate through the apprenticeship route. Applicants were interviewed to discover their motivations for interest, and the potential benefit to the Trust of these new opportunities was also assessed. This revealed that applicants were primarily driven through intrinsic motivations, such as a lifelong dream to be a doctor and a desire to fulfil a patient-facing role. Many expressed financial and social situations were a barrier to prior application, making the apprenticeship role more attractive. Healthcare professionals should accurately represent the population that they serve, which is currently not the case. The prospective applicants, with diverse backgrounds and existing healthcare experience, can help to improve patient care through their diverse perspective and understanding of multidisciplinary team working. This article highlights the potential of medical-based apprenticeships to help address longstanding challenges in medical education and workforce diversity. Furthermore, there could be significant financial and practical benefits to the trust of upskilling enthusiastic staff. However, there is currently a lack of clarity regarding selection processes and entry criteria, which must be addressed. [ABSTRACT FROM AUTHOR]

Record numbers of police officers are voluntarily resigning in England and Wales yet there is a lack of research which analyses why. Findings from an analysis of 62 interviews with police leavers who voluntarily resigned from the police service within England and Wales between January 2021 and June 2022 suggest that officers are leaving primarily due to perceptions of organizational injustice which focus upon: a lack of voice; concerns about promotion/progression; poor leadership; and a lack of organizational flexibility. This paper takes this latter reason—organizational flexibility—as its focus and through an inductive analysis of these leavers' voices, aims to both enrich the scarce qualitative academic literature on police workforce resignations and retention but also to offer significant evidence for future consideration of workforce optimization. The findings indicate that although sympathetic to operational policing complexities, participants were frustrated by organizational inflexibility. Three key areas were identified where the police service was perceived to be unsupportive or unreceptive—(a) dealing with additional needs, disabilities, or health issues of officers, (b) conflicts with non-work commitments, primarily those associated with childcare/parental responsibilities, and (c) supporting officers transitioning to part-time working. These structural barriers to effective workplace functioning were exacerbated by the cultural norms of overwork and 'fitting in' and were additionally particularly experienced by female resigners. The authors call for a challenge to the cultural barriers towards flexible working, the modelling of flexible working at all levels of the organization, and a focus on reciprocal flexibility between employer and employee. Until this issue can be tackled, it is argued that retention will continue to be an underestimated but significant site of inequality within policing. [ABSTRACT FROM AUTHOR]

Background During the 1997–2010 Labour government, several policies were implemented to narrow health inequalities as part of a national health inequalities strategy. Many of these policies are likely to have had a disproportionately large impact on people aged 65 and over. We aimed to understand the association between the health inequalities strategy period and inequalities in mortality at age 65–69. Methods We use population at risk and mortality data covering 1991–2019 to calculate mortality rate at age 65–69 at the Local Authority level. We use the 2019 Index of Multiple Deprivation to examine geographical inequalities. We employ segmented linear regression models with marginal spline terms for the strategy period and interact these with an indicator of deprivation to understand how inequalities changed before, during and after the strategy. The reporting of this study adheres to STROBE guidelines. Results Mortality rates in each deprivation quintile improved continuously throughout the period of study. Prior to the programme (1991–9) there was no significant change in absolute inequalities. However, during the strategy (2000–10) there was a significant decrease in absolute inequalities of −9.66 (−17.48 to −1.84). The period following the strategy (2011–19) was associated with a significant increase in absolute inequalities of 12.84 (6.60 to 19.08). Our results were robust to a range of sensitivity tests. Conclusion The English health inequalities strategy was associated with a significant reduction in absolute inequality in mortality age 65–69. Future strategies to address inequalities in ageing populations may benefit from adopting a similar approach. [ABSTRACT FROM AUTHOR]

Avoidable harm—that is, harm to service users caused by unsafe or improper interventions, practices or services and which could have been mitigated or prevented—is embedded in social care legislation and inspections. However, the concept of avoidable harm has largely been defined by policymakers, academics, practitioners, regulators and services, with little known about service users' experiences of avoidable harm in practice. This survivor-controlled review maps and synthesises peer-reviewed literature on service users experience of social and psychological avoidable harm in mental health social care (MHSC) in England. The review was guided by an Advisory Group of practitioners and service users. Six databases were systematically searched between January 2008 and June 2020 to identify relevant literature. Following de-duplication, 3,529 records were screened using inclusion and exclusion criteria. This led to full-text screening of eighty-four records and a final corpus of twenty-two papers. Following data extraction, thematic analysis was used to synthesise data. Six key themes were identified relating to relationships and communication, information, involvement and decision-making, poor support, fragmented systems and power-over and discriminatory cultures. Impacts on MHSC service users included stress, distress, disempowerment and deterioration in mental health. We discuss our findings and indicate future research priorities. [ABSTRACT FROM AUTHOR]

In this paper, we estimate the path of daily SARS-CoV-2 infections in England from the beginning of the pandemic until the end of 2021. We employ a dynamic intensity model, where the mean intensity conditional on the past depends both on past intensity of infections and past realized infections. The model parameters are time-varying, and we employ a multiplicative specification along with logistic transition functions to disentangle the time-varying effects of nonpharmaceutical policy interventions, of different variants, and of protection (waning) of vaccines/boosters. Our model results indicate that earlier interventions and vaccinations are key to containing an infection wave. We consider several scenarios that account for more infectious variants and different protection levels of vaccines/boosters. These scenarios suggest that, as vaccine protection wanes, containing a new wave in infections and an associated increase in hospitalizations in the near future may require further booster campaigns and/or nonpharmaceutical interventions. [ABSTRACT FROM AUTHOR]

The Police Uplift Programme in England and Wales aims to recruit more than 20,000 new police officers into the service. There is little known about the potential consequences associated with a large-scale recruitment drive and the effect of introducing a younger cohort of officers into the ranks of the police. This article is based on a narrative review of 2,110 English-language titles including grey literature exploring the implications for the police who are younger in age and service workforce profile. Titles were identified through electronic and handsearching methods. Fifty-nine titles were assessed for inclusion, of which 48 were subject to a full-text review. The majority of papers were from North America. Three themes were identified from the review: (1) issues related to cultural considerations including younger officers' preference for transparent and linear relationships and highlighting an emphasis on public service; (2) well-being and work–life balance considerations; and (3) harnessing the skill base through effective recruitment and retention practices. The findings suggest that police forces can create a narrative for new recruits as adult learners committed to public service combined with enhanced leadership styles that prioritize teamwork, transparency, and personal development. [ABSTRACT FROM AUTHOR]

Background The term 'long COVID' describes ongoing symptoms and conditions experienced by people infected with SARS-CoV-2. This paper illustrates how a public health approach was used to influence and inform the development of post-COVID services across two Integrated Care Systems (ICSs). Methods A literature review was conducted between October and December 2020 to identify prevalence estimates for long COVID. The prevalence estimates were applied to locally available data on the susceptible population to estimate the number of people with long COVID. They were also used to develop a dashboard to predict fluctuations in the number of people experiencing persistent symptoms over time. Results A substantial number of people in each ICS may have experienced persistent symptoms or complications as a result of COVID-19. In Lancashire and South Cumbria, it is estimated that 33 000 people may have experienced post-COVID-19 syndrome since the beginning of the pandemic, which will include respiratory or cardiovascular complications. Conclusions The findings have been valuable in informing early service developments, engaging with managers and clinicians, and supporting applications for funding at a local level. Continued attention to emergent evidence on this topic will be vital in refining estimates and supporting service planning in the longer term. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic saw unprecedented resources and funds driven into research for the development, and subsequent rapid distribution, of vaccines, diagnostics and directly acting antivirals (DAAs). DAAs have undeniably prevented progression and life-threatening conditions in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, there are concerns of antimicrobial resistance (AMR), antiviral resistance specifically, for DAAs. To preserve activity of DAAs for COVID-19 therapy, as well as detect possible mutations conferring resistance, antimicrobial stewardship and surveillance were rapidly implemented in England. This paper expands on the ubiquitous ongoing public health activities carried out in England, including epidemiologic, virologic and genomic surveillance, to support the stewardship of DAAs and assess the deployment, safety, effectiveness and resistance potential of these novel and repurposed therapeutics. [ABSTRACT FROM AUTHOR]

This article explores the patriotism and national identity of English soldiers during the First World War. Using this conflict as a case-study, it draws together work on Great War mentalities and scholarship on Englishness. It argues that individuals' national identity focused on and formed around the 'implicit nation', which was primarily concerned with communities and parochial local (or regional) spaces. There was no 'essential' England: the homeland could be rural or urban, natural or human. English national identity embraced this plurality. Using published material, soldiers' newspapers and private letters, diaries and postcards, this article highlights the ways in which allegiance to an 'implicit nation' was nurtured by a military that championed local and regional identities. As subjects, not citizens, soldiers naturally centred their attention on the communities and landscapes of their homeland. The war did not diminish men's emotional connections to these homelands; in fact, it made them all the stronger. In concentrating on the subjective and emotional features of patriotism, this paper suggests that Englishness was inherently heterogeneous and drew its strength from this. Rather than a commitment to abstract structures such as the state, or theoretical political principles, it argues that English national identity embraced a composite, or patchwork, of mutually supporting patriotisms attached to particular homelands. It was a sense of these homelands that underlay men's identification with Britishness, the Empire and the monarchy. Importantly, soldiers' experience of the First World War gave this a new (or at least more vocal) articulation. [ABSTRACT FROM AUTHOR]

Background Valuable learning derived from public health practice can be captured through practice-based case studies, also known as practice examples. Practice examples of participatory interventions supplement the evidence base by providing information on the complexities of implementation in communities. This paper reports on a Public Health England project to build a bank of community-centered practice examples based on robust processes of collection and curation. Methods The multidisciplinary project had three phases: (i) development and piloting a process to collect practice examples, (ii) refining review processes and gathering further examples via national and regional teams (iii) maintenance of an accessible collection on the library platform. Results The project resulted in a searchable collection of 55 practice examples illustrating participatory approaches in public health practice. The collection shows diversity in terms of settings, population, focus and type of approach used to work with communities. A secondary outcome was the development of generic guidance and templates for further collections on public health topics. Conclusions This project illustrates how information on the implementation of community-centered approaches in real-life contexts can be gathered and disseminated through a transferable process. Having collections of practice examples supports knowledge exchange in public health as learning is shared. [ABSTRACT FROM AUTHOR]

The 'multistate lifetable' is a widely used model for the long-term health impacts of public health interventions. It requires estimates of the incidence, case fatality, and sometimes also remission rates, for multiple diseases by age and gender. The case fatality is the rate of death from a disease for people with a disease, and is commonly not observed directly. Instead, we often observe the mortality in the general population. Similarly, we might know the disease prevalence, but not the incidence. This paper presents Bayesian continuous-time multistate models for estimating transition rates between disease states based on incomplete data. It unifies and extends two previous methods, by using a formal statistical model, with more efficient computational algorithms. This allows rates for different ages, areas, and time periods to be related in more flexible ways, and allows models to be formally checked and compared. The methods are made more widely usable through an R package. The models are used to estimate case fatality for multiple diseases in the city regions of England, based on incidence, prevalence, and mortality data from the Global Burden of Disease study. The estimates can be used to inform health impact models relating to those diseases and areas. [ABSTRACT FROM AUTHOR]

This paper describes how toxicological considerations are an essential component of acute chemical incident response, and how the UK Health Security Agency (UKHSA), as Category 1 responders under the Civil Contingencies Act (2004), provide that expert, authoritative, and timely advice to protect people from exposure to harmful substances. Background information about the general response to emergencies is provided, which gives context to how scientific advice has a positive impact. The importance of chemical identification and speciation, local, and systemic effects, and exposure characteristics are described. The public health risk assessment is considered in conjunction with mixtures, mass casualties, recovery, and psychological impacts. A brief summary of the type of incidents that the UKHSA are notified about is also provided. [ABSTRACT FROM AUTHOR]

Background Adolescent mental health (AMH) needs in England have increased dramatically and needs exceed treatment availability. This study undertook a comparative assessment of the health and economic return on investment (ROI) of interventions to prevent and treat mental disorders among adolescents (10–19 years) and examined intervention affordability and readiness. Methods Interventions were identified following a review of published and grey literature. A Markov model followed a simulated adolescent cohort to estimate implementation costs and health, education, and economic benefits. Intervention affordability was assessed, comparing annual cost per adolescent with NHS England per capita spending, and an expert panel assessed intervention readiness using a validated framework. Results Over 10- and 80-year horizons, interventions to treat mild anxiety and mild depression were most cost-effective, with the highest individual lifetime ROI (GBP 5822 GBP 1 and GBP 257: GBP 1). Preventing anxiety and depression was most affordable and 'implementation ready' and offered the highest health and economic benefits. A priority package (anxiety and depression prevention; mild anxiety and mild depression treatment) would avert 5 million disability-adjusted life-years (DALYS) and achieve an ROI of GBP 15: GBP 1 over 10 years or 11.5 million DALYs (ROI of GBP 55: GBP 1) over 80 years. Conclusion The economic benefits from preventing and treating common adolescent mental disorders equivalent to 25% of NHS England's annual spending in 2021 over 10 years and 91% over 80 years. Preventing and early treatment for anxiety and depression had the highest ROIs and strong implementation readiness. [ABSTRACT FROM AUTHOR]

Biomolecular analysis of historical parchment legal documents is providing new insight into their production and use. Successful interpretation of this data is dependent on understanding if the location and date written on the document accurately reflect where the animal from which the parchment was produced was raised and when it died. Our analysis reveals that the location the deed concerns, or that of the stationer through whom it was sold, typically bears no relation to the animal's origin, but that the date the agreement was signed was probably only a few months after the animal's death. [ABSTRACT FROM AUTHOR]

The core of Beverton and Holt's seminal work of the 1950s had been anticipated by Baranov 30 years earlier, but his contributions, published in Russian, remained poorly known to Anglophone scientists until after 1945. By that time, Russell and Graham had presented parallel ideas, though without Baranov's mathematics. Limited subsequent acknowledgement of the Russian's contributions has left an impression that each of his advances was achieved independently in England, hence that they contributed little to the Beverton–Holt model. I here construct a timeline of events linking and separating the Russian and English studies. From it, I argue that both Russell's presentation of the underlying concepts and Graham's decision to pursue a mathematical realization of his "Modern Theory" may have been influenced by translations of Baranov's papers. Moreover, when Holt developed the "simple" Beverton–Holt model during 1946–1947, he certainly drew on Baranov's exponential model of mortality, though perhaps only via Ricker. [ABSTRACT FROM AUTHOR]

Coastal communities have received little attention in the public health literature, perhaps because our mental maps tend to associate socio-economic deprivation and health inequalities with inner cities. Mapping a range of key health indicators at small area level, this paper reveals a distinct core-periphery pattern in disease prevalence, with coastal communities experiencing a high burden of ill health across almost all conditions included in the Quality and Outcomes Framework dataset. Other sources suggest poor outcomes for children and young people living in coastal areas. Low rates of participation in higher education contrast with high rates of hospitalisation for self-harm, alcohol and substance use. Reflecting a shift in the distribution of children living in poverty since the 1990s, this may be an early indicator of a future public health crisis in these communities. Exploring reasons for the health challenges facing the periphery, this perspective piece calls for more public health research that can accommodate the complex and interlinked problems facing coastal communities and a more concerted effort to align public health with economic, education, local government and transport policies at the national level. [ABSTRACT FROM AUTHOR]

This paper explores the ethical challenges in deciding whether to vaccinate individuals lacking the decision-making capacity needed to provide informed consent during a public health emergency like COVID-19. The best interests standard ordinarily governs such decisions, which under the law in jurisdictions like England, Wales and Singapore takes into account the individual's past wishes and present preferences. However, in a public health emergency, the interests of third parties become more salient: those whom the unvaccinated individual might expose to infection have an interest in the individual's being vaccinated. While current mental capacity law has not been interpreted to take such public health considerations into account, we argue that such considerations are nevertheless ethically relevant, and can legitimately be weighed up alongside other considerations such as the preferences of the individual and impacts on their health. This is most relevant for individuals lacking decision-making capacity who have previously declined or presently resist vaccination. The public health impact of vaccination may in some instances be enough to outweigh preferences of the individual and justify providing vaccination against their past or present wishes. [ABSTRACT FROM AUTHOR]

This paper uses a surge in stop and search operations following a high‐profile murder to look at their effect on recorded crime. Difference‐in‐difference estimates using detailed geocoded data at the street‐level suggest a doubling to trebling of the number of searches in streets close to the place of the murder. IV estimates on the effects of stops and searches on crime suggest little effect on property crime, weapons offences and violent crime or drug offences. Some specifications find reductions in anti‐social behaviour, suggesting that any effects on crime are due to an increased police presence on the streets. [ABSTRACT FROM AUTHOR]

Financial austerity has brought considerable pressure upon policing services in England and Wales in the past decade. For the British government, one mitigatory vehicle to alleviate this pressure is the expansion of police collaborative units operating across two or more police forces. To date however, such cross-force collaborations have been beset by a series of problems and progress has been inexorably slow. Drawing upon the reflections of police officers and staff involved at varying stages of cross-force collaborations, this paper explores why collaborations have so far largely failed. The paper argues that while the challenges of cross-force collaborations echo those of previous police efforts to work with external partners, these difficulties are intensified during cross-force collaborations in which partners present divergent policing agendas. As such, cross-force collaborations may be usefully understood as 'complex problems,' marking them out as particularly challenging and demanding new and distinct approaches to problem-solving. [ABSTRACT FROM AUTHOR]

The refurbishment of the St Pancras Renaissance Hotel (formerly the Midland Grand Hotel) provided a unique opportunity to investigate the interior design history of this iconic London landmark. During the refurbishment, wallpapers were uncovered from the initial decorative schemes of the hotel in the 1870s and from later interior design schemes until the building's closure in the 1980s. This article demonstrates how the CoBRA (Conservation-based Research and Analysis) methodology can be applied to increase our understanding of the history of interiors. The conservation process adds a new perspective to the historiography of the papered interior and its significance in the interior design process. By combining archival research with access to the original wallpapers during the retrieval and subsequent conservation process, it has been possible to construct an account of this commercial building's decorative schemes. Many of the earliest wallpapers were supplied by Jeffrey and Co., a London firm that worked with William Morris and other prominent designers. The wallpapers illustrate how the approach to the interior design of this building evolved over time, moving away from the Gothic Revival style of interior. [ABSTRACT FROM AUTHOR]

Older people in England who pay for social care from their own funds ('self-funders') receive little help in seeking and arranging care compared to older people funded by their local council. This suggests an implicit assumption that people funded by local councils need help to manage their care whereas self-funders do not. This article reports findings from a scoping review of published evidence from England, Scotland and Wales on the skills that older people need, and the help they get, to seek, arrange or manage use of social care, and how this help affects outcomes. Searches undertaken in October 2018 resulted in the inclusion of thirty-six empirical papers and seven reviews. Thematic analysis identified the importance of everyday life and specific business skills, and personal attributes including objectivity when evaluating options. The review identified two significant gaps in the evidence: first, how help in seeking and arranging care compensated for lack of, or complemented existing, skills; and secondly, how outcomes for people receiving help in arranging care compared with those not receiving help. The article concludes that a tailored approach to supporting older people arrange and manage care, irrespective of funding, should be considered. [ABSTRACT FROM AUTHOR]

This comparative study, conducted at the height of the COVID-19 pandemic, explores how the contrasting governance systems in Australia and England responded to complex and rapidly evolving problems presented by the crisis. Comparing how national and local governments worked together and alongside other forms of subnational governance, the findings highlight the efficacy of multi-scalar governance arrangement in Australia over the fragmented, overly-centralised and inconsistent arrangements in England. As nations plan their recovery paths from the economic and social challenges of the crisis, the findings encourage a reset of spatial policy towards one that values and resources greater decentralisation and place-based recovery. [ABSTRACT FROM AUTHOR]

Background There is a strong national drive within the UK government and National Health Service for social prescribing. Previous research studies have mainly focused on service user perspectives and evaluating their experiences. There is limited evidence on how the general public perceive and understand what social prescribing is and how these views could influence service planning and delivery. This paper seeks to understand perceptions of social prescribing within the wider community. Methods Semi-structured focus groups were conducted with 37 members of the public in four areas in north-west England. We explored public awareness and understanding of social prescribing. Results Limited knowledge of the term social prescribing was found amongst participants as well as limited involvement in community discussions of the topic. Concerns were raised about the short-term nature of activities and the need for adequate resourcing to support continuity of service provision. The social prescribing link worker was considered to be important in supporting engagement with services and it was preferred this role was undertaken by people with local knowledge. Conclusions The findings provide evidence of public perspectives on social prescribing and highlight how wider community perceptions can supplement service user feedback to support social prescribing service planning, commissioning and delivery. [ABSTRACT FROM AUTHOR]

Background Policy responses to the Global Financial Crisis emphasized wide-ranging fiscal austerity measures, many of which have been found to negatively impact health outcomes. This paper investigates change in patterns of mortality at local authority level in England (2010–11 to 2017–18) and the relation with fiscal austerity measures. Methods Data from official local authority administrative records are used to quantify the gap between observed deaths and what was anticipated in the 2010-based subnational population projections. Regression analyses are used to explore the relation between excess deaths, austerity and wider process of population change at local authority level. Results We estimate 231 707 total excess deaths, the majority of which occurred since 2014–15 (89%) across the majority of local authorities (91%). Austerity is positively associated with excess deaths. For working age adults, there is a clear gradient to the impact of austerity, whereas for older adults, the impact is more uniform. Conclusions Fiscal austerity policies contributed to an excess of deaths for older people and widened social inequalities for younger populations. These results call for an end to all austerity measures and require further research into areas with the highest total excess deaths as a priority following the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background To control the spread of coronavirus disease 2019 (COVID-19), governments are increasingly relying on the public to voluntarily manage risk. Effectiveness is likely to rely in part on how much the public trusts the Government's response. We examined the English public's trust in the Conservative Government to control the spread of COVID-19 after the initial 'crisis' period. Methods We analyzed eight rounds of a longitudinal survey of 1899 smartphone users aged 18–79 in England between October 2020 and December 2021. We fitted a random-effects logit model to identify personal characteristics and opinions associated with trust in the Conservative Government to control the spread of COVID-19. Results Trust was lowest in January 2021 (28%) and highest in March 2021 (44%). Being older, having lower educational attainment and aligning with the Conservative Party were predictors of higher levels of trust. Conversely, being less deprived, reporting that Government communications were not clear and considering that the measures taken by the Government went too far or not far enough were predictors of being less likely to report a great deal or a fair amount of trust in the Government to control the pandemic. Conclusion Trust in the Government's response was found to be low throughout the study. Our findings suggest that there may be scope to avoid losing trust by aligning Government actions more closely with scientific advice and public opinion, and through clearer public health messaging. However, it remains unclear whether and how higher trust in the Government's response would increase compliance with Government advice. [ABSTRACT FROM AUTHOR]

Conservation genetic analyses of many endangered species have been based on genotyping of microsatellite loci and sequencing of short fragments of mtDNA. The increase in power and resolution afforded by whole genome approaches may challenge conclusions made on limited numbers of loci and maternally inherited haploid markers. Here, we provide a matched comparison of whole genome sequencing versus microsatellite and control region (CR) genotyping for Eurasian otters (Lutra lutra). Previous work identified four genetically differentiated "stronghold" populations of otter in Britain, derived from regional populations that survived the population crash of the 1950s–1980s. Using whole genome resequencing data from 45 samples from across the British stronghold populations, we confirmed some aspects of population structure derived from previous marker-driven studies. Importantly, we showed that genomic signals of the population crash bottlenecks matched evidence from otter population surveys. Unexpectedly, two strongly divergent mitochondrial lineages were identified that were undetectable using CR fragments, and otters in the east of England were genetically distinct and surprisingly variable. We hypothesize that this previously unsuspected variability may derive from past releases of Eurasian otters from other, non-British source populations in England around the time of the population bottleneck. Our work highlights that even reasonably well-studied species may harbor genetic surprises, if studied using modern high-throughput sequencing methods. [ABSTRACT FROM AUTHOR]

Background People living with chronic kidney disease (CKD) need to be able to live well with their condition. The provision of psychosocial interventions (psychological, psychiatric and social care) and physical rehabilitation management is variable across England, as well as the rest of the UK. There is a need for clear recommendations for standards of psychosocial and physical rehabilitation care for people living with CKD, and guidance for the commissioning and measurement of these services. The National Health Service (NHS) England Renal Services Transformation Programme (RSTP) supported a programme of work and modified Delphi process to address the management of psychosocial and physical rehabilitation care as part of a larger body of work to formulate a comprehensive commissioning toolkit for renal care services across England. We sought to achieve expert consensus regarding the psychosocial and physical rehabilitation management of people living with CKD in England and the rest of the UK. Methods A Delphi consensus method was used to gather and refine expert opinions of senior members of the kidney multi-disciplinary team (MDT) and other key stakeholders in the UK. An agreement was sought on 16 statements reflecting aspects of psychosocial and physical rehabilitation management for people living with CKD. Results Twenty-six expert practitioners and other key stakeholders, including lived experience representatives, participated in the process. The consensus (>80% affirmative votes) amongst the respondents for all 16 statements was high. Nine recommendation statements were discussed and refined further to be included in the final iteration of the 'Systems' section of the NHS England RSTP commissioning toolkit. These priority recommendations reflect pragmatic solutions that can be implemented in renal care and include recommendations for a holistic wellbeing assessment for all people living with CKD who are approaching dialysis, or who are at listing for kidney transplantation, which includes the use of validated measurement tools to assess the need for further intervention in psychosocial and physical rehabilitation management. It is recommended that the scores from these measurement tools be included in the NHS England Renal Data Dashboard. There was also a recommendation for referral as appropriate to NHS Talking Therapies, psychology, counselling or psychotherapy, social work or liaison psychiatry for those with identified psychosocial needs. The use of digital resources was recommended to be used in addition to face-to-face care to provide physical rehabilitation, and all healthcare professionals should be educated to recognize psychosocial and physical rehabilitation needs and refer/sign-post people with CKD to appropriate services. Conclusion There was high consensus amongst senior members of the kidney MDT and other key stakeholders, including those with lived experience, in the UK on all aspects of the psychosocial and physical rehabilitation management of people living with CKD. The results of this process will be used by NHS England to inform the 'Systems' section of the commissioning toolkit and data dashboard and to inform the National Standards of Care for people living with CKD. [ABSTRACT FROM AUTHOR]

Background Flooding can cause long-term, significant impacts on mental health in affected populations. We explored help-seeking behaviour of households affected by flooding. Methods A cross-sectional analysis was conducted on National Study of Flooding and Health data on households flooded in England in winter 2013/14. Participants (Year 1: n  = 2006; Year 2: n  = 988; Year 3: n  = 819) were asked if they sought help from health services and other sources. Logistic regression was conducted to calculate odds ratios (ORs) of help-seeking in flooded and disrupted participants compared to unaffected, adjusted for a priori confounders. Results The odds of seeking help from any source 1 year after flooding were greater for flooded participants [adjusted OR (aOR): 1.71, 95% confidence interval (CI): 1.19–1.45] and those disrupted by flooding (aOR: 1.92, 95% CI: 1.37–2.68) compared to unaffected participants. This continued in the second year (flooded: aOR 6.24, 95% CI: 3.18–13.34; disrupted: aOR: 2.22, 95% CI: 1.14–4.68), and help-seeking remained greater in flooded than unaffected participants in the third year. Flooded and disrupted participants were particularly likely to seek help from informal sources. Help-seeking was more prevalent amongst participants with mental health outcomes, but a notable proportion of individuals with any mental health outcome did not seek help (Year 1: 15.0%; Year 2: 33.3%; Year 3: 40.3%). Conclusions Flooding is associated with increased demand for formal and informal support, persisting for at least 3 years, and an unmet need for help amongst affected individuals. Our findings should be considered in flood response planning to reduce the long-term adverse health impacts of flooding. [ABSTRACT FROM AUTHOR]

Summary: In 2017, health and social care organizations contributed 6.3% of carbon emissions in England. Efforts to reduce the environmental footprint of the National Health Service (NHS) have been broadly focused on reducing demand, through prevention and patient empowerment, and modifying supply side factors by focusing on lean care systems and low carbon alternatives. This narrative review concentrates on supply side factors to identify sustainable practices with a focus on actions that could be implemented in dermatology departments. For this study, a literature review was conducted In MEDLINE in April 2020. The search terms included 'environmental sustainability' and 'climate change' with 'dermatology', 'telemedicine', 'NHS', 'surgery' and 'operating theatres'. Out of 95 results, 20 were deemed relevant to the review. Although the review showed that there is clearly growing interest in environmental sustainability, the identified literature lacked examples of comprehensive implementation and evaluation of initiatives. The literature discussed distinct areas including transport, waste management and procurement as part of a lean healthcare system. A number of papers highlighted the potential contribution of carbon‐reducing actions without citing verifiable outcome data. This narrative review highlights the need for detailed environmental impact assessments of treatment options in dermatology, in tandem with economic analysis. In conclusion, we have identified a clear need for evidence‐based guidance setting out implementable actions with identifiable benefits achievable within local clinical teams. This will require engagement between clinicians, patients and healthcare organizations. [ABSTRACT FROM AUTHOR]

The identification of factors associated with mental and behavioural disorders in early childhood is critical both for psychopathology research and the support of primary health care practices. Motivated by the Millennium Cohort Study, in this paper we study the effect of a comprehensive set of covariates on children's emotional and behavioural trajectories in England. To this end, we develop a quantile mixed hidden Markov model for joint estimation of multiple quantiles in a linear regression setting for multivariate longitudinal data. The novelty of the proposed approach is based on the multivariate asymmetric Laplace distribution which allows to jointly estimate the quantiles of the univariate conditional distributions of a multivariate response, accounting for possible correlation between the outcomes. Sources of unobserved heterogeneity and serial dependency due to repeated measures are modelled through the introduction of individual‐specific, time‐constant random coefficients and time‐varying parameters evolving over time with a Markovian structure respectively. The inferential approach is carried out through the construction of a suitable expectation–maximization algorithm without parametric assumptions on the random effects distribution. [ABSTRACT FROM AUTHOR]

The containment of infectious diseases is most successful when at-risk populations have a high level of relevant health literacy (HL). To achieve this both literacy needs and patterns of knowledge sharing must be understood within the context of the disease being studied. It is also important to understand these processes from both offline (HL) and online (eHL) perspectives and amongst demographics with access to different types of information and social capital, and who have different levels of vulnerability. This paper discusses the insights gained over a series of 30 interviews with the UK residents aged either 19 − 30 years of age or older than 70 years—focussing on how they seek, understand, evaluate and convey information about COVID-19 during the current pandemic. Using thematic analysis, we identified themes around motivations to seek information, the information journey, digital choice and engagement, dilemmas and challenges of managing and appraising information, and sharing information. There was little difference in the eHL between the two age groups who both had high levels of education and were sophisticated digital citizens. The COVID-19 pandemic highlights three dominant processes in managing complex and uncertain information: some individuals may suffer from information fatigue but there was no evidence of any impact on their behaviours; others seek and share information across many networks; and there were strikingly high levels of distrust leading to complex processes of meaning-making demanding critical health literacy skills. [ABSTRACT FROM AUTHOR]

In this paper, I will begin by charting some of the conceptions of mental health in young people today, paying particular attention to recent mental health education policies in England. I will focus on the concept of 'resilience' as central to these policies, and how this represents an impoverished understanding of mental health, what it means to 'overcome' mental health issues, and what, in fact, might constitute an 'appropriate' response to the world we (now) live in. In order to explore an alternative conception of mental health in light of this, I turn to an example from existentialist literature—Dostoevsky's Notes from underground. On the surface, this novel appears to be an account of a man suffering from a mental breakdown. Ultimately, however, I argue that texts such as this enable us to explore more fully what it is to experience mental health issues, and that also point us to the fundamental vulnerabilities and uncertainties that are an intimate part of being human. [ABSTRACT FROM AUTHOR]

This paper evaluates traineeships, a voluntary programme of work placement and preparation that aims to help young unemployed people in England compete for jobs and apprenticeships. Applying the method of local instrumental variables to administrative data, we estimate the marginal treatment effects on apprenticeship take‐up and employment. The heterogeneous impacts are then aggregated to form an estimate of the average impact of treatment for all participants. The results suggest that, among younger trainees, participation increases the probability of becoming an apprentice and that this holds across the distribution of unobserved heterogeneity. For older trainees, we find no significant effect on the probability of becoming an apprenticeship on average but some evidence of a negative effect among those more resistant to participating. We find no effects on employment for either age group. [ABSTRACT FROM AUTHOR]

Traces the evolution of paper money in England. Circulation of fiduciary orders; Carolean paper orders; Promissory notes; Bills of exchange; Emergence of assignability; Earliest checks; Printing of money by the Bank of England.

In this article I begin by discussing the persistent problem of relations between educational inequality and the attainment gap in schools. Because benefits accruing from an education are substantial, the 'gap' leads to large disparities in the quality of life many young people can expect to experience in the future. Curriculum knowledge has been a focus for debate in England in relation to educational equality for over 40 years. Given the contestation surrounding views about curriculum knowledge and equality I consider the thinking of two philosophers, Jacques Derrida and Emmanuel Levinas, and their work on justice, to trouble the curriculum framework and discourse of knowledge promoted through the policy text of The Importance of Teaching: The Schools White Paper (2010) and later associated policy reforms to the General Certificate of Secondary Education ( GCSE) curriculum in England. The Schools White Paper aims to make the curriculum more challenging to students by introducing tight controls in terms of the assessment framework and curriculum knowledge. I argue that, when considered through Derrida's perspective on language and meaning and Levinas' view on the ethical responsibility for the other, the reforms present obstacles to the search for a just curriculum. I look to the work of Sharon Todd and Paul Standish for a re-imagination of curriculum as or through relations in the light of Derrida's and Levinas' philosophies. [ABSTRACT FROM AUTHOR]

We evaluate the impact of a price floor for alcohol introduced in Scotland in 2018, using a difference-in-differences strategy with England as a control group. We show that the policy led to the largest reductions in alcohol units purchased among the heaviest drinkers—the group who, at the margin, are likely to create the largest externalities from drinking. The price floor is well targeted at heavy drinkers because they buy a much greater fraction of their units from cheap products and switched away from these products strongly, with only limited substitution towards more expensive products. We show that if the marginal external cost of drinking is at least moderately higher for heavy than lighter drinkers, then a price floor outperforms an ethanol tax. However, more flexible tax systems can achieve similar reductions in externalities to the price floor, but avoid the large transfers from public funds to the alcohol industry that arise under the floor. [ABSTRACT FROM AUTHOR]

We investigate a structural model of demographic-economic interactions for England during 1570 to 1850. We estimate that the annual rate of population growth consistent with constant real wages was 0.4% before 1760 but 1.5% thereafter. We find that exogenous shocks increased population growth dramatically in the early decades of the Industrial Revolution. Simulations of our model show that if these demographic shocks had occurred before the Industrial Revolution the impact on real wages would have been catastrophic and that these shocks were largely responsible for very slow growth of real wages during the Industrial Revolution. [ABSTRACT FROM AUTHOR]

Background: Immediate breast reconstruction after mastectomy can improve the quality of life for women with breast cancer and rates are increasing. Long-term inpatient costs of care were estimated to understand the impact of different immediate breast reconstruction procedures on healthcare expenditure. Methods: Hospital Episode Statistics Admitted Patient Care data were used to identify women undergoing unilateral mastectomy and immediate breast reconstruction in English National Health Service hospitals (1 April 2009 to 31 March 2015) and any subsequent procedures performed to revise, replace, or complete the breast reconstruction. Costs were assigned to Hospital Episode Statistics Admitted Patient Care data using the Healthcare Resource Group 2020/21 National Costs Grouper. Generalized linear models were used to estimate mean cumulative costs for five immediate breast reconstruction procedures over 3 and 8 years, adjusting for covariates (age/ethnicity/deprivation). Results: A total of 16 890 women underwent mastectomy and immediate breast reconstruction: implant (5192; 30.7 per cent), expander (2826; 16.7 per cent), autologous latissimus dorsi flap (2372; 14.0 per cent), latissimus dorsi flap with expander/implant (3109; 18.4 per cent), and abdominal free-flap reconstruction (3391; 20.1 per cent). The mean (95 per cent c.i.) cumulative cost was lowest for latissimus dorsi flap with expander/implant reconstruction (€20 103 (€19 582 to €20 625)) over 3 years and highest for abdominal free-flap reconstruction (€27 560 (€27 037 to €28 083)). Over 8 years, expander (€29 140 (€27 659 to €30 621)) and latissimus dorsi flap with expander/implant (€29 312 (€27 622 to €31 003)) reconstructions were the least expensive, while abdominal free-flap reconstruction (€34 536 (€32 958 to €36 113)) remained the most expensive, despite having lower costs for revisions and secondary reconstructions. This was driven primarily by the cost of the index procedure (€5435 (expander reconstruction) to €15 106 (abdominal free-flap reconstruction)). Conclusion: Hospital Episode Statistics Admitted Patient Care Healthcare Resource Group data provided a comprehensive longitudinal cost assessment of secondary care. Although abdominal free-flap reconstruction was the most expensive option, higher costs of the index procedure need to be balanced against ongoing long-term costs of revisions/secondary reconstructions, which are higher after implant-based procedures. [ABSTRACT FROM AUTHOR]