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Background and objectives: Pulp bleaching is a concern of many conservationists. Research has been conducted with the aim of evaluating some traditional bleaching materials used in the preservation of documents and books, such as hydrogen peroxide and sodium borohydride, which shows that these materials do not significantly improve the mechanical properties of historical papers. Also, investigating the effect of reducing agents on oxidized papers has shown the effectiveness of tert-butylamine borane complex. In another study, five dyeing processes with oxidizers (calcium hypochlorite, hydrogen peroxide in two concentrations, light bleaching and potassium permanganate) and two dyeing processes with reducing agents (sodium borohydride and tert-butylamine borane) were compared. Their effect on alfa cellulose (Whatman filter paper) and two different historical papers have been investigated. The results indicate that all the tested dye removal methods have led to a clear increase. Due to the differences of opinion, in this research, the effectiveness of two reducing agent sodium borohydride and sodium dithionite on the appearance and structural characteristics of paper is investigated. Methodology: In this research, Whatman Filter Paper No. 1 (Whatman Filter Paper No. 1) made in England with a thickness of 180 microns, diameter of 11 cm, basis weight of 87 grams per square meter and ash content of 0.06% was used. . Chemical reagents including potassium persulfate, sodium borohydride and sodium dithionite reagent grade were prepared in a laboratory from Merck, Germany.Three solutions including potassium persulfate (2% by weight/volume), sodium borohydride (1% by weight/volume), sodium dithionite (1% by weight/volume) in distilled water (distilled water, pH; 7), to perform tests on zinc. Paper samples have been used by immersion. Whatman filter paper samples were subjected to oxidation in 2% peta persulfate in distilled water for 2 days (48 hours) and then the samples were immersed. Next, the identified samples were modified by two solutions of sodium borohydride and sodium dithionite 1% in distilled water for 1 to 5 hours and then purified in distilled water. Also, the samples were subjected to accelerated aging according to ASTM standard number D4714-96 at a temperature of 90±2 centigrade and a relative humidity of 50±2% for 384 hours. Test methods include potentiostat, colorimetry, tensile strength, pH measurement, scanning electron microscope and infrared examination. Results: The results show that potassium persulfate is the most neutralizing solution among the three solutions used on the first day, and it also indicates the reducing power of two solutions of sodium dithionite and sodium borohydride, which according to the test results, sodium borohydride is the reducing power compared to sodium dithionite. The sample prepared with pH 3.92, after accelerated aging, was accompanied by an increase of several units of pH after modification with two reducing substances. Examining the data obtained from the tensile strength test shows that in comparison with the tested samples with a tensile index of 1.06, the samples modified with sodium borohydride and sodium dithionite increased the index in all five modified periods. The infrared spectrometry investigation of the samples modified with sodium borohydride and sodium dithione shows that this old material improves the structure of cellulose after aging by changing the C=O bonds to C-O and reducing the area of 1640 cm-1.. The reduction of the absorption band in the region of 1640 cm-1 has been opened in almost all time cases with this material compared to the modified sample. Based on the data, samples modified with sodium borohydride and sodium dithionite had a significant increase (approximately 25 units) in the Lfactor (light-darkness) after aging, indicating that two substances have increased the brightness of the sample by reviving the color compounds. In the microscopic examination of the surface of the fibers, in the samples identified with potassium persulfate, local separation of the fibers is observed. In the samples modified with sodium borohydride and sodium dithionite, fibers with higher consistency and entanglement are observed. Conclusion: Double bonds and carbon groups in paper samples formed with potassium persulfate have been the main responsible for the yellowness and darkness of the paper. The reducing agents, sodium borohydride and sodium dithionite reduce this aldehyde and ketone to hydrocarbon. With the loss of multiple conjugates, the light absorption of the paper is reduced and this causes the paper to brighten. The double bonds and their regeneration also cause rearrangement of the cellulose chain, which has resulted in increasing the mechanical resistance and strength of the paper samples. [ABSTRACT FROM AUTHOR]

Purpose: To report distribution of codes associated with a rheumatoid arthritis (RA) diagnosis recorded in Clinical Practice Research Datalink (CPRD) Aurum compared to the previously validated CPRD GOLD database as a critical step toward making decisions about CPRD Aurum's suitability for medical research.Patients and Methods: We analyzed the distribution of codes for RA diagnoses, labs, and treatments in the new CPRD Aurum database, compared to the CPRD GOLD database by selecting relevant indicators of RA diagnosis, treatment, and clinical care. We included all patients in England in CPRD Aurum and CPRD GOLD with an incident diagnosis code for RA on or after 1 January 2005 and at least two years recorded data before first RA diagnosis.Results: We found 53,083 and 18,167 patients with a new diagnosis code for RA in CPRD Aurum and CPRD GOLD, respectively. In both databases approximately 67% were female with similar mean ages at first diagnosis. There were few differences in RA-related recording patterns between the two data sources. Before first RA diagnosis, CPRD Aurum patients had more RA-specific labs and other supporting clinical codes. After diagnosis, CPRD Aurum patients had more RA diagnoses coded and more often had 10+ general RA labs than patients in CPRD GOLD. More CPRD GOLD patients had 10+ prescriptions for conventional disease-modifying antirheumatic drugs (cDMARD) compared to CPRD Aurum. Otherwise, the distribution of drugs used to treat RA was similar between databases. The standardized incidence of RA was similar between databases.Conclusion: Overall, among patients with a diagnosis code for RA, recording of diagnoses, prescription drugs, and labs were similar between CPRD Aurum and CPRD GOLD. Slight differences were found for a few variables, but overall, we found consistency between the databases. In addition, standardized incidence of RA was similar between databases. [ABSTRACT FROM AUTHOR]

Background: This paper evaluates the introduction of ten Community Health and Well-being Workers (CHWW) in four pilot sites across Cornwall. The period evaluated was from the initial start in June 2022 until June 2023, covering the project setup and implementation across a range of Primary Care Networks (PCNs) and Voluntary sector partners (VSCO). Methods: All ten CHWWs and their managers at each site were interviewed (n = 16) to understand the barriers and enablers to implementation and wider learning that could be captured around the project setup. Qualitative methods were used for data collection, including semi-structured interviews and focus groups. Transcripts were thematically analysed for cross-cutting themes, as well as site-specific effects. Results: In terms of learning, we cover the following key areas, which were of most importance to the successful implementation of the pilot: The CHWWs were introduced into an already established, successful social prescribing (SP) system by the time the CHWW project began. CHWWs can access some of the same training and office space as SPs, with overlapping meeting schedules allowing them joint input on some topics. It seemed that all the pre-work in terms of relationships and learning about a similar role helped a rapid implementation. Each site's CHWW management structure uses the same line management as the SPs. Roles were clustered together to remove duplication, maximise coverage and triaging of residents. The largest barrier to overcome was integrating VSCO staff into NHS systems. Conversely, hosting CHWWs within an NHS organisation has pros and cons, namely better access to NHS data and staff, but longer lead-in time for registration on systems, and more bureaucracy for procurement/spend. Conclusions: Looking to the future, the pilot's success has spread the programme to other integrated care areas in the country, with ongoing plans for further rollout and evaluation in the coming years. [ABSTRACT FROM AUTHOR]

Background: Festivals play an important role in improving death and grief literacy, enabling members of the public to engage with these often-sensitive topics. Good Grief Weston festival was co-designed and delivered with the community in Weston-super-Mare, a coastal town in South-West England with high levels of socioeconomic disadvantage but rich community assets. It was held in person over 8 days in May 2023. Objectives: To evaluate the reach and impact of Good Grief Weston festival and gather data to inform future festivals. Design: Mixed methods evaluation (survey and focus groups). Methods: Online and paper surveys assessing participants' characteristics and experiences were administrated during and after the festival. Survey participants who indicated their willingness to participate were invited to attend a focus group. Focus groups were recorded, transcribed and analysed using thematic analysis. Data were collected by trained community co-researchers. Results: Approximately 3000 people attended the festival. Of 204 completed surveys, 64.5% were from women, age range ⩽15 to ⩾75 years; 88.2% identified as White; 14.9% deaf, disabled/with a chronic condition; 18.9% neurodivergent; 9.0% gay, bisexual or queer. Festival participants were entertained (70.9%), inspired (68.5%), felt part of a like-minded community (54.3%), talked to someone new (49.2%), learnt about grief/bereavement (34.3%), shared or expressed experiences (30.3%) and found out about local support (19.7%). 71.3% reported that they felt more confident talking about grief after attending. Median experience rating was 5 (IQR 0; possible range 1 = poor to 5 = excellent). In free-text comments, participants expressed appreciation for the festival and described benefits in attending. Two focus groups were conducted (n = 8 participants, all women), lasting c.1.5 h. Focus groups added rich descriptions of the festival's value, and data to inform the next festival. Conclusion: Findings suggest festivals of this nature can play a central role in a public health approach. Plain language summary: What was the impact of Good Grief Weston festival? Why was the study done? Previous studies have shown that many people feel unsupported by their community after the death of a loved one. We designed a festival to improve knowledge and support for bereaved people. We did this study to assess how the festival affected the people who attended. What did the researchers do? The team included researchers and people and organisations from the local community. Together, we designed and ran a festival on the topic of death, grief and bereavement in Weston-super-Mare, a coastal town with areas of high deprivation. The festival took place over an eight-day period in May 2023 and included creative, interactive and educational events. The team collected feedback on attendees' experiences of the festival. We did this using online and paper feedback forms, postcards, and focus groups to collect as many opinions as possible. What did the researchers find? We found that a wide range of people attended the festival. Most people who took part in the research rated the festival as 'excellent'. They told us they learnt about grief and bereavement and found out about local support services. Attendees met new people, shared their experiences, and felt that the festival built community spirit. They also made suggestions to improve any future festivals. What do the findings mean? The findings show that in-person festivals can effectively engage the public on the topic of death, grief and bereavement. They can also help develop connections between people and organisations in communities. These connections and learning opportunities may help communities to support their members through bereavement. [ABSTRACT FROM AUTHOR]

The 1996 Act has completed its quarter-century cycle of existence. At the time of its enactment, it was praised by scholars and practitioners as a “masterful… comprehensive” piece of legislation and one that was destined to “enhance the attractiveness of England as an arbitral forum”. These predictions proved exceedingly accurate. However, over time the legislation’s various shortcomings began to surface. Itsreview by the Law Commission was, therefore, very timely. This paper considersthe present state of English arbitration lawconsidering the provisions ofthe 1996Act and substantive and/or noteworthy recommendations proposed to the legislation, alongside the relevant case-law, and considers the appropriateness and potential utility of these recommendations. In particular, this article considers the following issues: the governing law of an arbitration agreement, the arbitrators’ duty of disclosure,theirimmunity from liability,the summary disposal of claims and defences,the confidentiality of arbitration and court powersin support of arbitral proceedings and emergency arbitrations. The paper concludesthat although the reform proposals are mostly commendable and sufficient to satisfy users’ concerns and expectations, not all are agreeable. Reform proposals do not go far enough. Most notably, the rule concerning the arbitrators’ duty of disclosure should recognise that, in appropriate instances, the subjective expectations of the parties should be addressed in the assessment. The parties’ reasonable and/or legitimate expectations should not be ignored when deciding what facts and circumstances to disclose to ensure that the partiesretain confidence in the process and remain the ultimate arbiters of their dispute. [ABSTRACT FROM AUTHOR]

This paper builds on a previous article describing an innovative approach to enhance the service user and practitioner's experience of novel collaborative approach to service improvement. It aims to explore the impact of this through the voices of service users as collaborators and co-authors. The Recovery and Collaborative Care Planning Café (RCCPC) designed with World Café principles, created a safe space to foster inquiry and learning about recovery between service users, carers, and practitioners in an NHS Trust. An important part of the method was in changing conversations towards recovery and living well with conditions applying CHIME concepts (Connectedness, Hope, Identity, Meaning, and Empowerment). Story is a qualitative method known as a well-established effective means of engaging others in sharing experiences and perspectives. Through the stories of service users' experiences participating in the RCCP Cafe, it was clear that they felt that CHIME concepts had a positive impact on the way that their conversations evolved. Accounts of how these conversations had resulted in personal growth and increased connectedness emerged. [ABSTRACT FROM AUTHOR]

Objective: This work aims to analyze the 100 most cited papers in radiotherapy or chemoradiotherapy for cervical cancer. Methods: The 100 most cited papers in radiotherapy or chemoradiotherapy between 1990 and 2020 were identified with Thompson Reuters Web of Science citation indexing on August 24, 2020. The publication years, source titles, countries/regions, total citations, and average citations per year were extracted from the Web of Science. The research type and research domain were classified by the authors. Results: These 100 papers were cited a total of 28,714 times, and the median number of citations was 169.5 (ranging from 116 to 1,700 times). The most cited paper was "Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer" by Rose et al., with a total citation of 1,700 times. The International Journal of Radiation Oncology Biology Physics (40 papers), Radiotherapy and Oncology (14 papers), and the Journal of Clinical Oncology (12 papers) published the largest number of papers. USA (47 papers), Austria (18 papers), Canada (13 papers), and England (13 papers) contributed the largest number of papers. Image-guided adaptive brachytherapy (IGABT) had the largest number of papers (25 papers). Concurrent chemotherapy was the most cited research domain, with 10,663 total citations and 592.4 citations per paper. Conclusion: In the present study, we conducted a bibliometric analysis of the 100 most cited papers in radiotherapy or concurrent chemoradiotherapy for cervical cancer in the past 30 years. IGABT and concurrent chemotherapy were the most cited research domains. [ABSTRACT FROM AUTHOR]

During the 2022 summer, Europe experienced heatwaves with record temperatures, and a study has argued that they caused about 62,000 deaths between 30 May and 4 September. The total number of excess deaths during the same period was about 137,000, indicating that the heatwaves were a substantial contributor. Not ruling out that explanation entirely, this paper argues that it was unlikely a strong cause. First, if the heatwaves were a strong cause of numerous deaths, one would assume that the older and deprived were relatively likely to die. However, during the 2022 summer heatwaves in England, which were claimed to have caused about 2900 deaths, the oldest age cohort did not have a higher excess death rate than the middle age cohort, and the excess death rate actually decreased with deprivation status. Moreover, Iceland had among Europe's highest excess death rates during the summer, which cannot be attributed to heatwaves. During June, July, and August 2022, comparable southern hemisphere countries furthermore had high excess death rates, which cannot be attributed to heatwaves either, as it was during their winter. Also, Europe's excess death rate was higher during the 2022–2023 winter than during the 2022 summer, and intuitively not attributed to heatwaves, but neither to cold weather, as that winter was abnormally mild. Finally, the paper discusses the puzzling issue that about 56% more women than men, relative to the population, presumably died from the heatwaves. [ABSTRACT FROM AUTHOR]

In this paper, we draw upon a study exploring how COVID-19 and social isolation impacted young people's (aged 13–18) experiences of online sexual and gendered risks and harms in England during nationwide lockdowns and upon their return to school. We explore the complexities, tensions and ambiguities in youth navigating algorithmised feeds on social media apps such as TikTok and content featuring idealised cis-gendered, heterosexualised feminine and masculine embodiment. Young people repeatedly witness hateful and abusive comments that are algorithmically boosted. We argue that this toxic content normalises online hate in the form of body shaming and sexual shaming, developing the concept of the postdigital to analyse the offline, affective, embodied and material dimensions of online harm, harassment and abuse. We also explore young people's direct experiences of receiving harmful comments, including girls' and gender and sexuality-diverse youth's experiences of body and sexual shaming, as well as boys' experiences of fat shaming; which, in many instances, we argue must be classified as forms of image-based abuse. Using our postdigital lens, we argue that the ways heteronormative, cis-gendered masculine and feminine embodiment are policed online shapes behaviour and norms in young people's everyday lives, including in and around school, and that better understanding and support around these issues is urgently needed. [ABSTRACT FROM AUTHOR]

Background: Collaborative Online International Learning (COIL) involves international online activities that allow the support of transversal competencies in diverse and multicultural environments without moving from home. This paper presents the learning experiences and satisfaction of undergraduate nursing students at the University of Girona (Spain) from a COIL activity involving clinical simulation in collaboration with the University of Coventry (United Kingdom). Methods: Qualitative study of content analysis. Twelve students from each of the two universities participated in the data collection process using reflective diaries. Results: The data analysis highlighted five topics related to the COIL activity involving clinical simulation: (a) initial attitudes towards the COIL activity; (b) main learning through the COIL activity; (c) positive aspects of the COIL activity; (d) weaknesses of the COIL activity and proposals for improvement; and (e) overall evaluation of the COIL activity. Conclusions: The main learning outcomes referred to by students were the relationships between transversal competencies and the skills for life, language skills, cultural skills, and more specific skills related to clinical standards. The students were most satisfied with the teaching activities and specified positive aspects and weaknesses that will add value to future versions of the activities. [ABSTRACT FROM AUTHOR]

Until recently the healthcare system in England was based on a commissioning/provider model. However, this has been replaced with an Integrated Care Systems (ICSs) approach, aimed at improving health and wellbeing and reducing inequalities through local collaborative partnerships with public sector organizations, community groups, social enterprise organizations and other local agencies. Part of this new approach is an emphasis on the role of community assets (i.e., local resources), that are considered integral to promoting positive health and wellbeing outcomes. This paper presents research from a series of three research studies on "community assets" conducted in the East of England within a newly established ICS. Based on analysis of qualitative data highlighting the lived experience of community asset members, this paper shows the positive wellbeing impact on vulnerable community members that assets provide. Further insight on the local impact and the collaborative nature of the research is provided suggesting that new asset-based approaches recognize the social determinants of health. This presents a shift away from positivistic linear approaches to population health and wellbeing to a new non-linear collaborative approach to addressing health inequalities and promoting wellbeing. The authors suggest that exploring this through a complexity theory lens could illuminate this further. Finally, the authors warn that while community assets have an important role to play in empowering citizens and providing much needed support to vulnerable and disadvantaged communities, they are not a substitute for functioning funded public sector services that are currently being undermined by ongoing local governments funding cuts. As such, while community assets can help ameliorate some of the negative effects people experience due to economic, structural and health disadvantages, only a more fair and more equal distribution of resources can address growing health inequalities. [ABSTRACT FROM AUTHOR]

Population Health Management – often abbreviated to PHM – is a relatively new approach for healthcare planning, requiring the application of analytical techniques to linked patient level data. Despite expectations for greater uptake of PHM, there is a deficit of available solutions to help health services embed it into routine use. This paper concerns the development, application and use of an interactive tool which can be linked to a healthcare system's data warehouse and employed to readily perform key PHM tasks such as population segmentation, risk stratification, and deriving various performance metrics and descriptive summaries. Developed through open-source code in a large healthcare system in South West England, and used by others around the country, this paper demonstrates the importance of a scalable, purpose-built solution for improving the uptake of PHM in health services. [ABSTRACT FROM AUTHOR]

Although the relationship between religion and football has gained considerable interest during the last twenty years, scant attention has been paid to the relationship between pilgrimage and football. This paper seeks to advance the study of this relationship through an exploration of collective memory about football disasters that throws fresh light on central themes within pilgrimage studies—pilgrimage as both a journey to a sacred place and the performance of diverse rituals at such places. The paper explores, in particular, the ways in which three different tragedies involving English football clubs have been commemorated through journeys to and ritual performance at places seen as sacred to those involved in commemoration—football stadiums and urban spaces, and cathedrals and pilgrimage shrines in England, Germany and Italy. Through this analysis, we seek to show how the commemoration of football disaster is linked to pilgrimage as a process where people seek healing and reconciliation through the public performance of rituals that link the local to the global. [ABSTRACT FROM AUTHOR]

Examining the entanglement of democracy and social justice in education and the relationship to social mobility, this paper critiques the individualising nature of social mobility in policy discourse as inimical to human flourishing and education as a public good. The rhetoric of social mobility which responsibilises individuals for their success, without due regard to the systemic changes needed to enable this and the societal barriers to social mobility experienced disproportionately by some groups in society, is detrimental to social justice. A conception of education as a pathway to social mobility must be located in a wider vision of civic engagement in a more inclusive and fairer society. Yet civic engagement in education at the local level has been eroded, as illustrated in this paper by the example of an evolving model of school governance in England. As a corporatist, market driven reform, this model exemplifies how local democratic ties between schools and engagement with their communities can be undermined. Social mobility to enable opportunities, access and participation in democratic civic society becomes a fantasy when society is riven with systemic inequalities, lacks the necessary conditions to enable human flourishing and links to community engagement in education for democratic renewal are downplayed. [ABSTRACT FROM AUTHOR]

The last 30 years has seen an exponential increase in Historical Institutional Abuse Inquiries.1 One feature of these has been to place adult survivor voices at the center of Inquiry work, meaning that child abuse victims and survivors2 are engaging with Inquiries, sharing their experiences, with this participation often presented as empowering and healing. This initiative challenges long held beliefs that child sexual abuse survivors are unreliable witnesses, which has led to epistemic injustice and a hermeneutical lacunae in survivor testimony. However to date there has been limited research on what survivors say about their experiences of participation. The Truth Project was one area of work of the Independent Inquiry into Child Sexual Abuse3 in England and Wales. It invited survivors of Child Sexual Abuse to share their experiences including the impacts of abuse and their recommendations for change. The Truth Project concluded in 2021 and heard from more than 6,000 victims of child sexual abuse. The evaluation of the Trauma Informed Approach designed to support survivors through their engagement with the project was a mixed methods, two phase methodology. A total of 66 survey responses were received. Follow-up interviews were conducted with seven survey respondents. The Trauma Informed Approach was found to be predominantly helpful in attending to victim needs and minimizing harm. However, a small number of participants reported harmful effects post-session. The positive impacts reported about taking part in the Truth Project as a one-off engagement challenges beliefs that survivors of child sexual abuse cannot safely talk about their experiences. It also provides evidence of the central role survivors should have in designing services for trauma victims. This study contributes to the epistemic justice literature which emphasizes the central role of relational ethics in the politics of knowing, and the importance of developing a testimonial sensibility when listening to marginalized groups. [ABSTRACT FROM AUTHOR]

Background: This paper outlines a pilot of a new memory aide for breastfeeding conducted in the Northeast of England and North Cumbria between April and August 2023. The United Kingdom has some of the lowest rates of breastfeeding, particularly in the Northeast of England, and as such more needs to be done to support mothers to breastfeed for as long as they would like to. Good support from health professionals can be effective in influencing decisions to breastfeed as well as helping to ensure initiation and continuation of breastfeeding but there is evidence to suggest that professionals and students do not always feel adequately trained and it is here, where memory aides may have value. Methods: Key breastfeeding practitioners and educators were brought together to select one of two memory aides for principles of attachment for effective breastfeeding. The selected memory aide, LATCHS, was piloted with 57 participants with a key role in promotion and support of breastfeeding in the Northeast of England and North Cumbria. Results: Participants conveyed mixed views about the proposed memory aide with more experienced staff reporting more favourable opinions than student midwives and early years practitioners. Experienced staff felt the new memory aide would complement an early memory aide, CHINS, which focused on principles of positioning. Discussion: Findings of the pilot indicate there is a role for a mnemonic to help practitioners understand, recall, and retain theory around attachment for effective breastfeeding and that memory aides can play an important role in complementing existing approaches to education and practice. The participants felt the proposed memory aide had some limitations and suggested important ways for it to be improved, particularly in adding an E to reflect the expecting wording. This produced the final memory aide: LATCHES. Conclusion: Using data from the pilot, the memory aide was refined, and the final version LATCHES agreed for wider dissemination. Future research is needed to understand the value of LATCHES on the wider breastfeeding workforce and whether any future improvements can be made to enhance its utility. [ABSTRACT FROM AUTHOR]

This paper assesses how strategic planning for nature can be improved for England's built and natural environment using mainstreaming and landscape-scale concepts. Whilst both concepts feature in academic literature, there has been limited attention on their role as catalytic agents for strategic planning. Addressing this gap, evidence is used from two stakeholder workshops involving 62 senior policy experts managing a range of operational and hypothetical strategic spatial planning challenges. The results reveal a significantly weakened strategic planning arena characterised by policy disintegration, short termism and uncertainty. Key findings highlight the fallacy of pursuing strategic planning for nature in isolation from wider policy integration fusing environmental, economic and social components from the outset. Current barriers to progress include institutional inertia, technocratic vocabularies and neoliberalist priorities exacerbated by a weak underlying theory. Conversely opportunities for mainstreaming processes may help knowledge generation and exchange within transdisciplinary partnerships, whilst landscape scale thinking can improve understanding of issues using natures inherent geometry transforming processes and outcomes. The paper recommends the adoption of strategic planning pathways using mainstreaming and landscape-scale approaches working in tandem. Whilst focused on the English context, our findings are transferable to other planning systems in the Global North, especially those championing neoliberal market led policies. [ABSTRACT FROM AUTHOR]

Care, management, and statute each mandate restraint-reporting in psychiatric settings in England. PROD-ALERT in this journal ("PA1") correlated log incidence of restraint, log institutional size, and log detention. The period was September 2020 to August 2021. It showed a clear trend among reporters. Restraint correlated with institutional size and use of legal detention. Some large detaining providers reported no restraints per month despite that trend. Inference from size suggested that non-complete reporters restrained 1,774 people per month. This paper "PA2" develops analysis repeating it for September 2021 to August 2022. PA2 shows how to count L-information, i.e., questionable information, added by null reports, by applying an L-test to data sets. PA2 uses illustrative vignettes about human height to ground L-information scores from English restraint reporting. In PA2, reported restraint again correlates with size and detention as in PA1. PA2 shows evolving data. Providers still follow a trend in restraint by size and detention. Providers which newly report restraint are on trend. Inference suggests that non-complete reporters restrained 1,305 people per month (536-3233), 95% CI, a large but reduced number since PA1. English restraint data have an L-test L-information score of increase in information by a factor of L = 145. This is as surprising as claiming that an average English man of 1.72 m is 2.64 m tall. Persons restrained per month is a robust measure continuing to log-correlate with size and legal compulsion. Providers over a certain size who report null restraint probably have some. Restraint remains underreported in England. Imputation of incomplete reporters shows a large shrinking cohort of patients detained by incomplete reporters. Knowledge of this may promote reporting. Improved reporting, and the infrastructure and integrity it demands, may help providers measure and reduce restraint. PA1 remains unrefuted. L-test can measure L-information in intuitively representable ways. The informational effect of nulls on the reliable data set is similar to a claim that an average-heighted man is as tall as people with clinical gigantism. [ABSTRACT FROM AUTHOR]

This paper explored the effectiveness of ensemble performance on the development of adolescent's life skills. An explorative qualitative study investigated young musicians' self-perception about the benefits and challenges of learning and playing music together. A convenience sampling technique was adopted for interviewing 15 adolescents (12–18 years old) who participated in a long-term music education programme led by a charity in the North-West of England. The data were analysed using NVivo, employing a thematic analysis approach. Two main themes emerged from the analyses: (1) the main benefits of playing and learning in an ensemble: the development of music and life skills; (2) the challenges experienced by the musicians learning in the ensemble. The findings suggest that participants were conscious of the positive effects of playing in an ensemble on their lives. This extended beyond merely learning a musical instrument, i.e. acquiring music skills. In particular, young musicians recognised they had developed greater self-confidence and cognitive skills such as critical thinking and self-awareness. Primarily, they developed effective communication and interpersonal skills. At the same time, these young musicians recognised they had to face challenges related to the process of learning music in an ensemble, such as managing emotions of frustration and adapting to different music learning styles and techniques. Finally, suggestions are made for the implementation and evaluation of future projects to explore the impact and effectiveness of classical music programmes, with a particular emphasis on ensemble-based initiatives and their influence on life skills. [ABSTRACT FROM AUTHOR]

We estimate the importance of local labour structure in the spread of COVID‐19 during the first year of the pandemic. We build a unique dataset across 6791 English neighbourhoods that distinguishes between people living (residents) and people working (workers) in a neighbourhood, and differentiate between jobs that can be done from home (homeworkers), jobs that likely continued on‐site (keyworkers), and non‐essential on‐site jobs. We find that a 10 percentage points increase in keyworker jobs among residents is associated with 3.15 more cases per 1000 (4.8% relative to the mean), while a 10 percentage points increase in homeworker jobs among residents is associated with a decrease of 7.74 cases per 1000 (11.8% relative to the mean). Results for the composition of workers show the same sign, but smaller magnitudes. A dynamic analysis of the monthly incidence of reported cases shows that these relationships are particularly strong during lockdown periods. These results are heterogeneous across neighbourhoods, with larger positive effect of keyworkers, and lower protective effect of homeworkers, in higher deprivation areas. We explore the role of occupation skill intensity in driving these neighbourhood differences. These findings highlight important asymmetries in the distributional impact of the policy response to COVID‐19. This paper is part of the Economica 100 Series. Economica, the LSE "house journal" is now 100 years old. To commemorate this achievement, we are publishing 100 papers by former students, as well as current and former faculty. Enrico Vanino is affiliated to the Department of Geography and Environment of the LSE. [ABSTRACT FROM AUTHOR]

Fuel poverty was a significant problem during the cost‐of‐living crisis that started in 2021 as energy prices increased. Local authorities launched warm bank schemes around the United Kingdom to address this problem by providing warm spaces for residents to visit who could not heat their homes. This paper reports on an evaluation of the warm bank scheme launched by South Tyneside Council in winter 2022, locally known as Welcoming Places. Over 70 locations were opened around the borough. The evaluation consisted of two stages. In stage 1, we conducted semistructured interviews (n = 16) with residents who attended Welcoming Places and two focus groups with people running them (n = 9). In stage 2, we discussed the initial findings from stage 1 in a focus group with residents (n = 8). Three major themes are presented: "help and support with the cost‐of‐living crisis," "it's worth its weight in gold," and "capability and strength of Welcoming Places." This is one of the first evaluations of a warm bank scheme in England. We illustrate how the Welcoming Places in South Tyneside were used and experienced by residents. The scheme was valued by residents, provided significant support during the cost‐of‐living crisis, and had a positive impact on self‐reported mental health among participants. Warm bank schemes offer a practical, rapid public health response to the cost‐of‐living crisis for local authorities as well as improving residents' mental health and well‐being; however, holistic approaches must be taken to address the underlying causes of fuel poverty. [ABSTRACT FROM AUTHOR]

Background: People with severe mental illness (SMI) experience higher rates and poorer outcomes of physical long‐term conditions (LTCs). The management of SMI and LTCs is highly complex and many people with SMI rely on informal carers for support, which may lead to high levels of caregiver burden, and caregiver burnout. Caregiver burnout can result in poor health outcomes for informal carers and a reduction in the quality of care they are able to provide. Therefore, it is important to understand the caring experience to identify and address factors that contribute to burden and burnout. Methods: This paper reports a secondary qualitative analysis of semistructured interviews and focus groups conducted with informal carers of people who have coexisting SMI and LTCs. We recruited 12 informal carers in England between December 2018 and April 2019. The transcripts were coded and analysed thematically. Results: We identified two overarching themes and five subthemes. The themes included 'Fighting on all fronts: Mounting strain between demands and resources', which described the challenge of providing care in the context of coexisting SMI and LTCs, and 'Safekeeping: The necessity of chronic hypervigilance', which captured how informal carers' roles were defined by managing high‐risk situations, leading to hypervigilance and paternalistic approaches to care. Conclusion: The experience of informal carers for people with SMI and coexisting LTCs is marked by limited access to support and the management of significant risk, which could contribute to high caregiver burden. Further primary research is needed to understand how the experiences of the caregiver role for people with SMI and LTCs influence caregiver burden. Patient or Public Contribution: Our PPI panel DIAMONDS Voice provided guidance on this study from conception, design and development of interview guides and recruitment materials to final write‐up. DIAMONDS Voice consists of service users and carers who have experience of SMI and LTCs. Three carer members reviewed the final manuscript, and two are credited as authors. [ABSTRACT FROM AUTHOR]

Existing research on the social and cultural (S&C) values of treescapes tends to be limited in scope, for example to recreation, aesthetic or health values, and much is primarily qualitative, which provides rich detail but does not lend itself easily to incorporation into decision‐making. Having a way to quantify the range of S&C values associated with treescapes is important if decision‐makers are to effectively take these into account. This issue is particularly important currently with ambitious plans to increase tree cover alongside growing threats to treescapes from climate change and tree pests and diseases.This paper outlines the development of a new composite measure to quantify the S&C values associated with treescapes. The development of the measure resulted in a set of 19 statements across six categories of S&C value.We present results from using the measure in a survey with a representative sample of 5000 people across England together with the results of a factor analysis, which suggests a way to simplify the measure into five statements.We examine the measure through the lens of relational values and suggest that a majority of the values in our measure are relational.Policy implications. The composite measure can be used by decision‐makers looking to develop their evidence base regarding the value of treescapes in their area, or for exploring the impact of tree pests and diseases. It has already been used by more than one local authority in England. While data collection was limited to England, we suggest that the measure is applicable across a wider range of countries. Read the free Plain Language Summary for this article on the Journal blog. Read the free Plain Language Summary for this article on the Journal blog. [ABSTRACT FROM AUTHOR]

This study evaluates the integration of the Professional Capability Framework (PCF) in England's social work education and its potential applicability in the Czech Republic. As England has advanced its social work training through holistic approaches and continuous professional development [1], this paper explores the feasibility of adapting such reforms to enhance the Czech educational system. By conducting a comparative analysis, the research identifies gaps in the Czech framework and suggests tailored adaptations from the English model. This streamlined examination not only furthers the international discourse on social work education but also proposes actionable strategies for cross-cultural educational enhancements. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to gain consensus among young people with a stoma due to inflammatory bowel disease (IBD) on the priorities for the content of an intervention for the self‐management of stoma‐related distress. The current identification and management of distress in young people with a stoma is often suboptimal in clinical settings and there is a need for improved support resources. Methods: Two consensus group meetings were carried out via online video conferencing, using nominal group technique. Participants generated, rated on a Likert scale and discussed, topics for inclusion in a future self‐management intervention. Results: Nineteen young people, aged 19–33, with a stoma due to IBD took part in one of two group meetings. Participants were located across England, Scotland, and Northern Ireland. Twenty‐nine topics were generated by participants, seven of which reached consensus of ≥80%, that is, a mean of ≥5.6 on a 7‐point Likert scale. These were: receiving advice from young people with lived experience of stoma surgery; advice on/addressing concerns about romantic relationships, sex and intimacy; information about fertility and pregnancy related to stoma surgery; stoma 'hacks', for example, useful everyday tips regarding clothing, making bag changes easier and so forth; reflecting on and recognising own emotional response to surgery; tips on managing the stoma during the night; and processing trauma related to the illness and surgery journey. Conclusions: Findings extend previous research on young people's experiences of stoma surgery, by generating consensus on young people's priorities for managing distress related to surgery and living with a stoma. These priorities include topics not previously reported in the literature, including the need for information about fertility and pregnancy. Findings will inform the development of a self‐management resource for young people with an IBD stoma and have relevance for the clinical management of stoma‐related distress in this population. Patient or Public Contribution: Three patient contributors are co‐authors on this paper, having contributed to the study design, interpretation of results and writing of the manuscript. The study's Patient and Public Involvement and Engagement advisory group also had an integral role in the study. They met with the research team for four 2‐h virtual meetings, giving input on the aims and purpose of the study, recruitment methods, and interpretation of findings. The group also advised on the age range for participants. The views of young people with a stoma are the central component of the study reported in this paper, which aims to gain consensus among young people with an IBD stoma on their priorities for the content of a resource to self‐manage distress related to stoma surgery. [ABSTRACT FROM AUTHOR]

This paper presents the findings of a national survey of over 3400 teachers across all phases of education in England, 10 weeks into school closure. In this paper we report on the teachers' experiences and their testimonies of the effects of the lockdown on their wellbeing as they navigate the situation, trying to cope with teaching and adjusting to the use of new technology to deliver lessons in the confines of their home. We present their voices as they related their experiences and emotions in real time as the event unfolded. Teachers reported an increased workload with a proportionately large amount of time spent on administrative duties and planning, but less on actual teaching. On average, these teachers spent 15 h a week marking during the lockdown. Under half of the respondents said they felt happy and cheerful often, while only 17% said they did not feel this way often. Almost all teachers said they felt that what they were doing was important and worthwhile. The most common emotions expressed by teachers were fear, isolation, neglect, anxiety, and confusion. The inconsistency and lack of clarity of government guidelines added to teachers' anxiety. The negative media portrayal of teachers did not help. The majority of teachers reported little previous experience in online teaching and only a quarter were confident in using edtech to deliver remote teaching. Only a third of teachers said they were adequately supported for online teaching. This has implications for future teacher development and initial teacher training. However, there were equally numerous positive experiences reported by teachers. Active support from parents and consistent school-home communication were seen as important in ensuring students' continued engagement with learning. These lessons are beneficial in supporting the long-term sick and school refusers post-lockdown. [ABSTRACT FROM AUTHOR]

Costumes played a significant role at the royal courts of King Henry VIII, and courtiers maintained scrupulous cautiousness regarding their presentability and dress. Theatricality is a persistent trope in Mantel's Neo - Tudor novels, often exercised through strategically displayed extravagant fabrics. This study interprets the clothing culture at the courts of King Henry VIII, as represented in the three Wolf Hall novels. As social classes became increasingly stratified during the Renaissance, the bourgeoisie distinguished themselves from the commoners and sustained inclusivity into the monarchical elite by enacting strategic theatricality. This paper demonstrates how the theatricality of magnificence was performed through the politics of apparel, ornamentation, and distinguished fashion. Referring to works by John Matusiak, Tracy Borman, Maria Hayward, and Elizabeth Currie, this study argues that fashion was at the core of Royal Tudor governance, and Mantel utilises this trope to camouflage or amplify the magnitude of a political persona. In the context of the Tudor Sumptuary Laws, this paper also analyses how Mantel used dress as a motif of theatricality to demonstrate class segregation during sixteenth-century England. The gendering of clothes and its political ramifications shall be another issue tackled by this paper, focusing on the sartorial choices of the characters of Anne Boleyn, Katherine, and Jane Seymour. [ABSTRACT FROM AUTHOR]

This paper reviews the research on successful school principalship carried out in England over the last 20 years. Drawing on evidence synthesized from the International Successful School Principalship Project (ISSPP) and related English school leadership research conducted by ISSPP scholars, this review aims to answer a conceptual research question: How do the principalship's moral purposes and contextual understanding shape the time-sensitive, informed adoption of combinations and accumulations of strategies that lead to sustained school success? This paper identifies five research insights derived from case studies in England and elaborates on the complex, values-led layered web of interactions between the school principal and key stakeholders within and outside the school in the context of frequent social changes and policy interventions in England. Whilst the pace has been greater and more intense than in many other countries, the direction has been, and remains, similar. The body of scholarship here reviewed engages with national policies as filtered and then enacted by successful principals. While 'effective' principals lead to students' success as measured by performance on national tests and examinations, our focus is upon an empirically founded definition of 'successful' school leadership that is located in complexity theory and encompasses the enactment of the core purposes of education that include but go beyond the functional. In doing so, it avoids 'what to do' formulae and the limitations of certain theoretical 'leadership' models, finding that successful school leaders' work embodies a broader humanistic view of student learning and achievement, which implies the preordinance of the personal over the functional. Taken together, these research insights contribute to the ISSPP's continued effort to refine and advance the knowledge base of successful school leadership within and across different countries. [ABSTRACT FROM AUTHOR]

Background: The National Health Service (NHS) and general practice are increasingly adopting digital services. These services can impact both positively and negatively upon patient experiences, and access to digital services is not equal amongst all groups. Within a wider project examining digital facilitation (the Di-Facto study) our team conducted a patient survey amongst English primary care practices aiming to investigate patient views of what supports uptake and use of web-based services. This paper reports on the analysis of the free-text responses from the patient survey. Methods: The Di-Facto patient survey was distributed to practices in eight clinical commissioning groups (CCGs) in England between 2021–2022. We examined free-text responses to two questions relating to access to primary care web-based and support for web-based services. We used qualitative reflexive thematic analysis based on a six-stage process to analyse responses. Results: Of the 3051 patients who responded to the Di-Facto survey, 2246 provided a free-text response. We present our findings in two major themes: systems and structures and their impact on use of web-based services, and 'what works for me', a description of how respondents described what worked, or did not work in terms of their interactions with web-based services. Respondents described how the technology, such as poor practice website design, confusion over multiple digital apps, data security and concerns about eConsultation offerings impacted on use of web-based services. Respondents described practice level barriers, such as a lack of or inconsistent provision, which prevented optimal use of web-based services. Respondents described personal and technical barriers that impacted on their use of digital services, and described which web-based services worked well for them. Respondents felt that web-based services were not a replacement for face-to-face interactions with a doctor. Conclusions: This analysis of free-text responses from a large patient survey highlights the system, practice, and person level barriers and facilitators to use of digital services in primary care. With an increasing push towards digital solutions in NHS primary care, practices should consider the design, rollout and communication of their web-based services to support patient access. [ABSTRACT FROM AUTHOR]

This paper reports the study which explored the learning and teaching of the topics of climate change, sustainability and disaster risk reduction in secondary-level teacher education programs in England and Japan. Through interviewing teacher educators, the study particularly probed how teacher education programs used local knowledge and collaboration in discussing the above topics. Geography tends to be the main subject area for these global agendas, but its crammed curriculum is "an ongoing challenge" for teacher education. Some researchers demonstrate that university-based initial teacher education has "ignored" training teachers on how to implement environmental and sustainability education at schools. Besides, the inquiries into how initial teacher education equips geography teachers for the learning and teaching of disaster risk reduction are still scarce. This paper aims to fill this gap by bringing together the fields of geography education, climate change and sustainability education, disaster risk reduction education and initial teacher education. [ABSTRACT FROM AUTHOR]

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Granger causality provides a framework that uses predictability to identify causation between time series variables. This is important to policymakers for effective policy management and recommendations. Granger causality is recognized as the primary advance on the causation problem. The objective of this paper is to conduct a bibliometric analysis of Granger causality publications indexed in the Web of Science database. Harzing's Publish or Perish and VOSviewer were used for performance analysis and science mapping. The first paper indexed was published in 1981 and there has been an upward trend in the annual publication of Granger causality studies which are shifting towards the areas of environmental science, energy, and economics. Most of the publications are articles and proceeding papers under the areas of business economics, environmental science ecology, and neurosciences/neurology. China has the highest number of publications while the United States has the highest number of citations. England has the highest citation impact. This paper also constructed country co-authorship, co-analysis of cited references, cited sources, and cited authors, keyword co-occurrence, and keyword overlay visualization maps. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic led to 231,841 deaths and 940,243 hospitalisations in England, by the end of March 2023. This paper calculates the real-time infection hospitalisation risk (IHR) and infection fatality risk (IFR) using the Office for National Statistics Coronavirus Infection Survey (ONS CIS) and the Real-time Assessment of Community Transmission Survey between November 2020 to March 2023. The IHR and the IFR in England peaked in January 2021 at 3.39% (95% Credible Intervals (CrI): 2.79, 3.97) and 0.97% (95% CrI: 0.62, 1.36), respectively. After this time, there was a rapid decline in the severity from infection, with the lowest estimated IHR of 0.32% (95% CrI: 0.27, 0.39) in December 2022 and IFR of 0.06% (95% CrI: 0.04, 0.08) in April 2022. We found infection severity to vary more markedly between regions early in the pandemic however, the absolute heterogeneity has since reduced. The risk from infection of SARS-CoV-2 has changed substantially throughout the COVID-19 pandemic with a decline of 86.03% (80.86, 89.35) and 89.67% (80.18, 93.93) in the IHR and IFR, respectively, since early 2021. From April 2022 until March 2023, the end of the ONS CIS study, we found fluctuating patterns in the severity of infection with the resumption of more normative mixing, resurgent epidemic waves, patterns of waning immunity, and emerging variants that have shown signs of convergent evolution. The severity of SARS-CoV-2 infection varied over the course of the pandemic due to factors such as changes in variant characteristics and population immunity from previous infection or vaccination. Here, the authors estimate infection hospitalisation and infection fatality rates in England over time from the start of the pandemic until March 2023. [ABSTRACT FROM AUTHOR]

Background: Mild cognitive impairment (MCI) is commonly defined as a transitional subclinical state between normal aging and dementia. A growing body of research indicates that health behaviors may play a protective role against cognitive decline and could potentially slow down the progression from MCI to dementia. The aim of this study is to conduct a bibliometric analysis of literature focusing on health behaviors and MCI to summarize the factors and evidence regarding the influence of health behaviors on MCI. Methods: The study performed a bibliometric analysis by retrieving publications from the Science Citation Index and Social Sciences Citation Index subdatabases within the Web of Science Core Collection. Utilizing VOSviewer and CiteSpace software, a total of 2,843 eligible articles underwent co-citation, cokeywords, and clustering analyses. This methodology aimed to investigate the current status, trends, major research questions, and potential future directions within the research domain. Results: The bibliometric analysis indicates that research on healthy behaviors in individuals with MCI originated in 2002 and experienced rapid growth in 2014, reflecting the increasing global interest in this area. The United States emerged as the primary contributor, accounting for more than one-third of the total scientific output with 982 articles. Journals that published the most articles on MCI-related health behaviors included "Journal of Alzheimer's Disease," "Neurobiology of Aging," "Frontiers in Aging Neuroscience," and other geriatricsrelated journals. High-impact papers identified by VOSviewer predominantly cover concepts related to MCI, such as diagnostic criteria, assessment, and multifactorial interventions. Co-occurrence keyword analysis highlights five research hotspots in health behavior associated with MCI: exercise, diet, risk factors and preventive measures for dementia, cognitive decline-related biomarkers, and clinical trials. Conclusion: This study provides a comprehensive review of literature on health behavior in individuals with MCI, emphasizing influential documents and journals. It outlines research trends and key focal points, offering valuable insights for researchers to comprehend significant contributions and steer future studies. [ABSTRACT FROM AUTHOR]

Background: Childhood, adolescent and young adult (CAYA) cancer survivors are vulnerable to adverse late-effects. For CAYA cancer survivors, tobacco smoking is the most important preventable cause of ill-health and early death. Yet, effective strategies to support smoking cessation in this group are lacking. The PRISM study aims to undertake multi-method formative research to explore the need for, and if appropriate, inform the future development of an evidence-based and theory-informed tobacco smoking cessation intervention for CAYA cancer survivors. Materials and methods: PRISM involves three phases of: 1) an environmental scan using multiple strategies to identify and examine a) smoking cessation interventions for CAYA cancer survivors that are published in the international literature and b) current smoking cessation services in England that may be available to, or tailorable to, CAYA cancer survivors; 2) a qualitative study involving semi-structured interviews with CAYA cancer survivors (aged 16–29 years and who are current or recent ex-smokers and/or current vapers) to explore their views and experiences of smoking, smoking cessation and vaping; and 3) stakeholder workshops with survivors, healthcare professionals and other stakeholders to consider the potential for a smoking cessation intervention for CAYA cancer survivors and what such an intervention would need to target and change. Findings will be disseminated to patient groups, healthcare professionals and researchers, through conference presentations, journal papers, plain English summaries and social media. Discussion: PRISM will explore current delivery of, perceived need for, and barriers and facilitators to, smoking cessation advice and support to CAYA cancer survivors from the perspective of both survivors and healthcare professionals. A key strength of PRISM is the user involvement throughout the study and the additional exploration of survivors' views on vaping, a behaviour which often co-occurs with smoking. PRISM is the first step in the development of a person-centred, evidence- and theory-based smoking cessation intervention for CAYA cancer survivors who smoke, which if effective, will reduce morbidity and mortality in the CAYA cancer survivor population. [ABSTRACT FROM AUTHOR]

Telerehabilitation (TR) shows promise as a method of remote service delivery, yet there is little guidance to inform implementation in the context of the National Health Service (NHS) in England. This paper presents the protocol for a realist synthesis study aiming to investigate how TR can be implemented to support the provision of high-quality, equitable community-based stroke rehabilitation, and under what conditions. Using a realist approach, we will synthesise information from (1) an evidence review, (2) qualitative interviews with clinicians (n ≤ 30), and patient–family carer dyads (n ≤ 60) from three purposively selected community stroke rehabilitation services in England. Working groups including rehabilitation professionals, service-users and policy-makers will co-develop actionable recommendations. Insights from the review and the interviews will be synthesised to test and refine programme theories that explain how TR works and for whom in clinical practice, and draw key messages for service implementation. This protocol highlights the need to improve our understanding of TR implementation in the context of multidisciplinary, community-based stroke service provision. We suggest the use of a realist methodology and co-production to inform evidence-based recommendations that consider the needs and priorities of clinicians and people affected by stroke. [ABSTRACT FROM AUTHOR]

Background: The Brief Educational Workshops in Secondary Schools Trial (BESST) is an England-wide school-based cluster randomised controlled trial assessing the clinical and cost-effectiveness of an open-access psychological workshop programme (DISCOVER) for 16–18-year-olds. This baseline paper describes the self-referral and other recruitment processes used in this study and the baseline characteristics of the enrolled schools and participants. Method: We enrolled 900 participants from 57 Secondary schools across England from 4th October 2021 to 10th November 2022. Schools were randomised to receive either the DISCOVER day-long Stress workshop or treatment as usual which included signposting information. Participants will be followed up for 6 months with outcome data collection at baseline, 3-month, and 6-month post randomisation. Results: Schools were recruited from a geographically and ethnically diverse sample across England. To reduce stigma, students were invited to self-refer into the study if they wanted help for stress. Their mean age was 17.2 (SD = 0.6), 641 (71%) were female and 411 (45.6%) were from ethnic minority groups. The general wellbeing of our sample measured using the Mood and Feelings Questionnaire (MFQ) found 314 (35%) of students exhibited symptoms of depression at baseline. Eighty percent of students reported low wellbeing on the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS) suggesting that although the overall sample mean is below the cut-off for depression, the self-referral approach used in this study supports distressed students in coming forward. Conclusion: The BESST study will continue to follow up participants to collect outcome data and results will be analysed once all the data have been collected. Trial registration: ISRCTN registry ISRCTN90912799. Registered on 28 May 2020. [ABSTRACT FROM AUTHOR]

Coronavirus disease-19 (COVID-19) has disproportionately affected certain demographics in England, exacerbating existing health disparities. Effective therapeutics are a critical line of defence against COVID-19, particularly for patients at elevated risk for severe disease. Surveillance systems were established to monitor the usage of COVID-19 therapeutics in hospital and community settings and to inform stewardship. Three antiviral therapies—nirmatrelvir plus ritonavir (Paxlovid®), remdesivir (Veklury®), and molnupiravir (Lagevrio®)—and two neutralising monoclonal antibody therapies (nMAbs)—sotrovimab (Xevudy®) and casirivimab with imdevimab (Ronapreve®)—were in use in England between July 2020 and April 2023. This paper aims to illuminate trends in the utilisation of COVID-19 therapeutics treatment in both hospital and community settings, stratified by the Index of Multiple Deprivation (IMD) in England. Chapter 3 of the English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) Report 2022 to 2023 also discusses the epidemiological surveillance of these five directly acting antiviral COVID-19 therapeutics' use in England between 2022 and 2023. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this paper is to investigate what factors are associated to cardiovascular disease and what differences exists between Asians living in the UK (from the English Longitudinal Study of Ageing) and the Asians living in India (from the Longitudinal Ageing Study in India). Methods: Logistic regression was used to investigate how demographic and physical performance factors were associated with cardiovascular disease using data from Wave 6 of the English Longitudinal Study of Ageing and Wave 1 of the Longitudinal Study of Ageing in India, with the main variable of interest being country of residence, Asians in England or Asians in India. Results: A total of 83,997 participants were included in the analyses. In the primary analysis, 73,396 participants from LASI were compared to 171 Asians in ELSA. After adjusting for age, blood pressure, resting heart rate, sex, waist circumference, gait, handgrip strength and standing balance, there was a statistically significant difference for the outcome of CVD between Whites ELSA (reference) and the participants of LASI (odds ratio = 0.77; 95% confidence interval = 0.60 to 0.99). There were no significant differences in CVD between the LASI participants, Asian ELSA, and the Non-White but not Asian ELSA groups. Discussion: No difference was found between Asians that live in India compared to ethnic minorities living in England, including Asians, after adjusting for confounders, but was found between Whites in ELSA compared to LASI participants. A key limitation was the massive disparity in sample sizes between the ELSA subgroups and LASI. Further work is required where comparable sample sizes and longitudinal analyses allow trends to be identified and to investigate the factors associated with the difference in CVD between two similar ethnicities living in distinct locations. Conclusion: After adjusting for risk factors, there was no difference in CVD between localised Asians and the ethnic minorities in the UK, but there was a difference between the majority ethnicities in the respective countries. [ABSTRACT FROM AUTHOR]

It seems probable that some form of medically-assisted dying will become legal in England and Wales in the foreseeable future. Assisted dying Bills are at various stages of preparation in surrounding jurisdictions (Scotland, Republic of Ireland, Isle of Man, Jersey), and activists campaign unceasingly for a change in the law in England and Wales. There is generally uncritical supportive media coverage, and individual autonomy is seen as the unassailable trump card: 'my life, my death'. However, devising a law which is 'fit for purpose' is not an easy matter. The challenge is to achieve an appropriate balance between compassion and patient autonomy on the one hand, and respect for human life generally and medical autonomy on the other. More people should benefit from a change in the law than be harmed. In relation to medically-assisted dying, this may not be possible. Protecting the vulnerable is a key issue. Likewise, not impacting negatively on societal attitudes towards the disabled and frail elderly, particularly those with dementia. This paper compares three existing models of physician-assisted suicide: Switzerland, Oregon (USA), and Victoria (Australia). Vulnerability and autonomy are discussed, and concern expressed about the biased nature of much of the advocacy for assisted dying, tantamount to disinformation. A 'hidden' danger of assisted dying is noted, namely, increased suffering as more patients decline referral to palliative-hospice care because they fear they will be 'drugged to death'. Finally, suggestions are made for a possible 'least worse' way forward. One solution would seem to be for physician-assisted suicide to be the responsibility of a stand-alone Department for Assisted Dying overseen by lawyers or judges and operated by technicians. Doctors would be required only to confirm a patient's medical eligibility. Palliative-hospice care should definitely not be involved, and healthcare professionals must have an inviolable right to opt out of involvement. There is also an urgent need to improve the provision of care for all terminally ill patients. [ABSTRACT FROM AUTHOR]

Wolf Rock Lighthouse is a Victorian era masonry structure located in an extreme environment facing the fiercest Atlantic storms off the southwest coast of England whose dynamic behaviour has been studied since 2016. Initially, a modal test was used to determine modal parameters; then, in 2017, a monitoring system was installed that has operated intermittently providing response data for a number of characteristic loading events. These events have included wave loads due to storms, a small UK earthquake, helicopters landing on the helideck, and the grounding of a ship on the reef. This is believed to be the most extensive experimental campaign on any structure of this type. This paper briefly describes a unique project involving the characterisation and measurement of dynamic behaviour due to different forms of dynamic loading. [ABSTRACT FROM AUTHOR]

Background: Globally, it is estimated that one in three adults live with two or more long‐term conditions (multiple long‐term conditions, MLTCs), that require self‐management. People who experience socioeconomic deprivation face significant health inequalities due to a range of interrelated characteristics that lead to a lack of resources and opportunities. Previous research with underserved populations indicate low levels of trust towards primary care providers and potential barriers for developing patient‐healthcare professional relationships. The purpose of this paper is to explore the barriers and facilitators to self‐managing MLTCs, amongst people who experience socioeconomic deprivation. Methods: Semistructured one‐to‐one interviews with adults (n = 28) living in London and Sheffield, United Kingdom with MLTCs who are experiencing socioeconomic deprivation. Participants were recruited through general practices, community channels and social media. Data were analysed in NVivo using reflexive thematic analysis methods. Findings: Four analytical themes were developed: (1) challenges in accessing healthcare services, financial assistance, and cultural awareness; (2) empowerment and disempowerment through technology, including digital exclusion, and use of technology; (3) impact and causes of exclusion on self‐management, including social isolation, area‐based and economic exclusion, and health‐related stigma and (4) adapting self‐management strategies, including cost‐effective, and culturally/lifestyle appropriate strategies. Conclusions: Future health interventions and services need to be developed with consideration of the combined complexities of managing MLTCs while experiencing socioeconomic deprivation. Increased awareness in practitioners and commissioners of the complexities surrounding the lives of people experiencing socioeconomic deprivation, and the need for targeted strategies to promote self‐management of MLTCs are of great importance. Patient or Public Contribution: A patient advisory group contributed to all stages of the study, including providing important feedback on study documents (topic guides and recruitment materials), as well as providing critical insights surrounding the interpretation of interview data. [ABSTRACT FROM AUTHOR]

Introduction: In England, primary care networks (PCNs) offer opportunities to improve access to and sustainability of general practice through collaboration between groups of practices to provide care with a broader range of practitioner roles. However, there are concerns that these changes may undermine continuity of care. Our study investigates what the organisational shift to PCNs means for continuity of care. Methods: The paper uses thematic analysis of qualitative data from interviews with general practitioners and other healthcare professionals (HCPs, n = 33) in 19 practices in five PCNs, and their patients (n = 35). Three patient cohorts within each participating practice were recruited, based on anticipated higher or lower needs for continuity of care: patients over 65 years with polypharmacy, patients with anxiety or depression and 'working age' adults aged between 18 and 45 years. Findings: Patients and clinicians perceived changes to continuity in PCNs in our study. Larger‐scale care provision in PCNs required better care coordination and information‐sharing processes, aimed at improving care for 'vulnerable' patients in target groups. However, new working arrangements and ways of delivering care in PCNs undermine HCPs' ability to maintain continuity through ongoing relationships with patients. Patients experience this in terms of reduced availability of their preferred clinician, inefficiencies in care and unfamiliarity of new staff, roles and processes. Conclusions: New practitioners need to be effectively integrated to support effective team‐based care. However, for patients, especially those not deemed 'vulnerable', this may not be sufficient to counter the loss of relationship with their practice. Therefore, caution is required in relation to designating patients as in need of, or not in need of continuity. Rather, continuity for all patients could be maintained through a dynamic understanding of the need for it as fluctuating and situational and by supporting clinicians to provide follow‐up care. Patient and Public Involvement (PPI): A PPI group was recruited and consulted during the study for feedback on the study design, recruitment materials and interpretation of findings. [ABSTRACT FROM AUTHOR]

Accounting for the values placed on nature by the public is key to successful policies in reversing ongoing biodiversity declines. However, biodiversity values are rarely included in policy decisions, resulting in poorer outcomes for people and nature.Our paper addresses an important evidence gap related to the non‐availability of values for appraising large‐scale policies and investment programmes for species recovery and habitat improvement at the national level.We use a stated preference choice modelling approach to estimate household preferences and Willingness to Pay for species recovery and habitat improvement over a wide range of habitats in England.The framing of our stated preference study is crucial to the evidence we develop. Within the study, we define species recovery as incremental improvements to habitat quality and present respondents with choices between conservation policy options that improve different habitat types. We then use the response data to estimate values for habitat quality improvements, and the associated improvements to species presence and abundance. We are thus able to estimate economic benefits for 'wild species recovery' simultaneously across a wide range of habitat types.Willingness to pay values for habitat improvement was found to be highest for improvements from 'moderate' to 'full' species recovery by 2042; and for habitat types which have relatively low current extents in England, such as lowland fens.Policy Implications: biodiversity policy designers can make use of stated preference methods to guide decisions over which aspects of biodiversity targets to focus more resources on, since this enables policy to reflect public preferences, and thus engages higher public support for conservation. In our specific data and context, this implies prioritising the restoration of species recovery to high levels and focussing resources on scarcer rather than more abundant habitat types. Read the free Plain Language Summary for this article on the Journal blog. Read the free Plain Language Summary for this article on the Journal blog. [ABSTRACT FROM AUTHOR]

There has been an increasing acknowledgement in the UK of the importance of recognising frailty as a condition that leaves older people vulnerable to dramatic, sudden changes in health triggered by seemingly small events. In policy, the approach to managing frailty is often an emphasis on staying well with limited consideration to frailty as an end-of-life phase. Meanwhile, discharge from hospital continues to be complex. Overstretched acute hospitals are juxtaposed with community and social services that struggle to keep up with the demand of those being discharged and the labelling of older people as "bed blockers" at the centre of delayed discharges. This paper reports a study underpinned by constructivist grounded theory methodology, with the aim of exploring the experiences and perceptions of stakeholders. Semistructured interviews were conducted with 57 participants including patients, their informal carer(s), community hospital staff, community health professionals, and care home managers. The core category of "the drive to discharge conveyor belt" was derived from data analysis. A significant finding of this study was that of the carer, their burden, and their intrinsic role in facilitating discharge, filling in gaps in services, coordinating services, and enabling the patient to stay at home, with little consideration of their choices or autonomy. The "drive to discharge" impacts older people, their informal carers, and health professional. This study suggests how they may be supported, through an ethical lens. [ABSTRACT FROM AUTHOR]

Estimating loss reserves is a crucial activity for non-life insurance companies. It involves adjusting the expected evolution of claims over different periods of active policies and their fluctuations. The chain-ladder (CL) technique is recognized as one of the most effective methods for calculating claim reserves in this context. It has become a benchmark within the insurance sector for predicting loss reserves and has been adapted to estimate variability margins. This variability has been addressed through both stochastic and possibilistic analyses. This study adopts the latter approach, proposing the use of the CL framework combined with intuitionistic fuzzy numbers (IFNs). While modeling with fuzzy numbers (FNs) introduces only epistemic uncertainty, employing IFNs allows for the representation of bipolar data regarding the feasible and infeasible values of loss reserves. In short, this paper presents an extension of the chain-ladder technique that estimates the parameters governing claim development through intuitionistic fuzzy regression, such as symmetric triangular IFNs. Additionally, it compares the results obtained with this method with those derived from the stochastic chain ladder by England and Verrall. [ABSTRACT FROM AUTHOR]

Globally, due to climate change and increased rates of coastal erosion, along with the need to protect sensitive habitats, there is an increasing requirement for a sustainable approach which considers both the effect of the marine environment on critical infrastructure and the impact of that infrastructure on the local environment. This paper presents a methodology for assessing the impact of a marine structure on longshore dynamics and shoreline evolution by using an external coupling of the phase-resolving ARTEMIS wave model and the shoreline evolution model, UNIBEST. The methodology can be applied at any coastal location, but for this study, it was applied to Sizewell Bay on the east coast of England to assess the impact of a shore-normal jetty on a gently curving stretch of shoreline with relatively complex offshore geomorphology. Results from simulating 22 years of shoreline evolution have shown that, at the jetty location, the shoreline at Sizewell will migrate seaward up to 45 m compared with the no-jetty case. Immediately south of the jetty, the shoreline was predicted to retreat landward by about 15 m. This behaviour is similar to observed changes at other locations, and the predicted longshore transport rates are in agreement with findings from previous studies, validating the methodology. [ABSTRACT FROM AUTHOR]

Climatic changes can cause unpredictability in flood regimes that traditional flood risk management (FRM) approaches may struggle with. Therefore, flood resilience is seen as a supplementation to these approaches, putting a larger emphasis on flood acceptance and minimising consequences. An (emergent) group contributing towards flood resilience is civil society. This paper examines how civil society contributions can be furthered and guided in the Netherlands as well as exploring potential limitations in doing so. To achieve this, England is used as a good practice example due to a more developed and defined role for civil society being present here. Data were collected on both actual (England and the Netherlands) and potential (The Netherlands) civil society contributions. These were compared to identify potential avenues for Dutch civil society contributions to flood resilience that can be further investigated. The research shows that the most promising avenues are improving advocacy from citizens, improving local flood awareness and developing relationships between FRM authorities and existing citizen groups that can be harnessed and mobilised to support flood resilience. Additionally, the research also provides insights into potential limitations for transferring resilience approaches from one context to another beyond the cases discussed in this publication. [ABSTRACT FROM AUTHOR]

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Rising demands and competition for water resources within all sectors are placing increasing pressure on the environment. Almost all direct abstractions in England require a licence (permit) from the regulatory authority, the Environment Agency. Assessing and setting 'reasonable' peak quantities of water that can be legally abstracted in an environmentally sustainable manner is central to the whole licence determination process. To protect environmental flows and other abstractors within each catchment, the regulatory authority needs to be able to set sensible limits in the licence conditions, including total seasonal volumes and peak rates of water use, particularly for abstractions from hydrologically sensitive surface water sources. This paper describes the development of a methodology to assess the 'reasonable' peak rates of water use for agricultural irrigation in support of catchment water resources management and planning. A daily time step water balance model was used to simulate peak monthly and daily water requirements for irrigation using long-term historical weather records for agroclimatically contrasting sites. The model-simulated outputs were then compared against observed data from selected case study farms, and against data reported in a national water abstraction database. Guidelines were then developed for setting peak monthly, daily, hourly, and absolute abstraction rates for irrigation, taking into account the environmental sensitivity of different types of water source. The application of the procedure and its relevance in other countries where catchment water resources are under intense pressure from agriculture are described. [ABSTRACT FROM AUTHOR]