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Background: The 2022/23 influenza season in the United Kingdom saw the return of influenza to prepandemic levels following two seasons with low influenza activity. The early season was dominated by A(H3N2), with cocirculation of A(H1N1), reaching a peak late December 2022, while influenza B circulated at low levels during the latter part of the season. From September to March 2022/23, influenza vaccines were offered, free of charge, to all aged 2–13 (and 14–15 in Scotland and Wales), adults up to 49 years of age with clinical risk conditions and adults aged 50 and above across the mainland United Kingdom. Methods: End‐of‐season adjusted vaccine effectiveness (VE) estimates against sentinel primary‐care attendance for influenza‐like illness, where influenza infection was laboratory confirmed, were calculated using the test negative design, adjusting for potential confounders. Methods: Results In the mainland United Kingdom, end‐of‐season VE against all laboratory‐confirmed influenza for all those > 65 years of age, most of whom received adjuvanted quadrivalent vaccines, was 30% (95% CI: −6% to 54%). VE for those aged 18–64, who largely received cell‐based vaccines, was 47% (95% CI: 37%–56%). Overall VE for 2–17 year olds, predominantly receiving live attenuated vaccines, was 66% (95% CI: 53%–76%). Conclusion: The paper provides evidence of moderate influenza VE in 2022/23. [ABSTRACT FROM AUTHOR]

This paper reports teacher and learner perspectives on how assessment and reform influences pedagogical practices and behaviours. The research was conducted in a context of policy reform, at a time when Wales' revised General Certificate of Secondary Education (GCSE) specifications had been implemented, and learners were preparing for their assessments; but, also during the period of debate on the development of Wales' new curriculum, which has taken a distinct and contrasting position on assessment to the assumptions underlying the reform of Welsh GCSEs implemented from 2015. These data, therefore, offer unique insights into the affordances and limitations of two sharply contrasting systems at a time of considerable change, offering reflections on the current curriculum and its attendant assessment practices, and also a prospective analysis of how the principles embedded in the new curriculum could challenge these existing assumptions and conventions. Findings suggest that teachers and learners currently inhabit an assessment‐driven system, which encourages performative practices in pedagogy and is governed by external accountability; and that these practices are at odds with the principles of assessment articulated in Successful Futures. Consequently, teachers in this study expressed uncertainty about how assessment for certification purposes at GCSE could be compatible with the principles of the Curriculum for Wales. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editors discuss issues arising from the implementation of curriculum reform, based on a review of the education system, in Wales.

The paper explores tensions in the articulation of progression in learning across the Humanities disciplines. Informed by our review of research in the Humanities disciplines, international curricula on progression in these areas and reflections from professional activity within the newly defined Humanities 'Area of Learning and Experience' in the new Welsh curriculum, this paper describes how learning progression in Humanities has been conceptualised within the new curriculum and then delineates and critically reviews four challenges that emerged when identifying and describing the progression in learning in the new Humanities curriculum. Tensions include the relationship between disciplines; the balance between knowledge, skills and values; the differences between underlying models of progression in Humanities; and balancing the complexity of learning with practical considerations for a national curriculum. Underpinned by the Integrity Model of Change, this paper makes a contribution, through providing new insights on broad aspects of learning progression in Humanities and highlighting the potential benefits and challenges of taking particular decisions within each of these four tensions. Implications for curriculum planning and future research are offered, including the fundamental role of professional learning in curriculum development and enactment. [ABSTRACT FROM AUTHOR]

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Introduction: In the United Kingdom, policy and guidance changes regarding the role of dental therapists (DTs) were implemented in recent years with a view to changing dental care to a more preventive‐focussed, teamwork approach. However, success in the adoption of this model of working has been varied. Aims: Adopting a realist approach, our aim was, to examine the use of DTs in general dental practices in Wales, exploring what works, why, how and in what circumstances. Materials and Methods: The research comprised two stages. (a) A structured literature search, dual‐coding papers for high‐level factors describing the conditions or context(s) under which the mechanisms operated to produce outcomes. From this, we derived theories about how skill‐mix operates in the general dental service. (b) Six case studies of general dental practices (three with a dental therapist/three without a dental therapist) employing a range of skill‐mix models incorporating semi‐structured interviews with all team members. We used the case studies/interviews to explore and refine the theories derived from the literature. Results: Eighty‐four papers were coded. From this coding, we identified seven theories which reflected factors influencing general dental practices within three broad contexts: the dental practice as a business, as a healthcare provider and as a workplace. We tested these theories in interviews with 38 dental team members across the six care studies. As a result, we amended five of the theories. Conclusion: Our analysis provides theory about outcomes that DTs may facilitate and the mechanisms that may assist the work of DTs within different contexts of general dental practice. [ABSTRACT FROM AUTHOR]

Curriculum integration is a feature of many new curricula that have emerged in different countries since around the turn of the millennium. It focuses on removing the boundaries between traditional subject specialisms, to enable more holistic and 'joined‐up' learning opportunities. This study draws on the experiences of a group of primary and secondary teachers in Wales, engaged in creating a framework for an integrated curriculum for expressive arts. Whilst the teachers are united in their ambition for establishing a curriculum that gives greater status to the arts, curriculum integration presents significant challenges, notably in how subject knowledge is understood and presented within an integrated curriculum. The teachers take different approaches to curriculum integration, with primary teachers favouring a transdisciplinary approach, with child‐led learning and themes taking precedence, and secondary teachers opting for multidisciplinary approaches, where the themes are organising devices but where subjects take priority. Differing practices suggest differing conceptions of subject knowledge and mastery within an integrated curriculum. Drawing, in particular, on Bernstein's concepts relating to knowledge discourses, this paper suggests that the danger of an integrated curriculum is weakened disciplinary knowledge. Whilst this paper relates to the arts, the messages about curriculum integration might be applied more widely. [ABSTRACT FROM AUTHOR]

Sustainable Intensification (SI) has been popularised in recent years as an approach seeking to balance the potentially conflicting demands of enhancing agricultural outputs with reducing the negative impacts arising from the current food system. Proponents have argued that SI can benefit from collaboration between farmers, but understanding is limited by a lack of data on current collaborative practices. Questions have also been raised as to whether the SI agenda pays sufficient attention to social sustainability as part of a fully integrated conception of SI. Tackling these issues, this paper reports on mixed methods data collection from seven case areas across the UK, with a particular focus on the experience of upland livestock farmers in north Wales. We evidence: (1) The extent, forms and preferences associated with farmers' collaboration; with findings demonstrating higher levels of collaboration than anticipated and a preference for informal forms of co‐working. (2) The underpinning and mutually reinforcing role of social interconnectedness in the delivery of diverse outcomes from collaboration. (3) How SI is perceived to threaten social sustainability, and thus work against a more integrated model of delivery. The paper concludes by arguing for a genuinely integrative model of SI to secure collaborations going forwards. [ABSTRACT FROM AUTHOR]

Despite predominantly lower social class origins, the second generation of established immigrant groups in the UK are now attaining high levels of education. However, they continue to experience poorer labour market outcomes than the majority population. These worse outcomes are often attributed in part to their disadvantaged origins, which do not, by contrast, appear to constrain their educational success. This paper engages with this paradox. We discuss potential mechanisms for second‐generation educational success and how far we might expect these to be replicated in labour market outcomes. We substantiate our discussion with new empirical analysis. Drawing on a unique longitudinal study of England and Wales spanning 40 years and encompassing one per cent of the population, we present evidence on the educational and labour market outcomes of the second generation of four groups of immigrants and the white British majority, controlling for multiple measures of social origins. We demonstrate that second‐generation men and women's educational advantage is only partially reflected in the labour market. We reflect on the implications of our findings for future research. [ABSTRACT FROM AUTHOR]

This paper critically explores how survey and routinely collected data could aid in assessing the generalisability of public health evidence. We propose developing approaches that could be employed in understanding the relevance of public health evidence, and investigate ways of producing meta‐analytic estimates tailored to reflect local circumstances, based on analyses of secondary data. Currently, public health decision makers face challenges in interpreting global review evidence to assess its meaning in local contexts. A lack of clarity on the definition and scope of generalisability, and the absence of consensus on its measurement, has stunted methodological progress. The consequence of failing to tackle generalisability means that systematic review evidence often fails to fulfil its potential contribution in public health decision making. Three approaches to address these problems are considered and emerging challenges discussed: (1) purposeful exploration after a review has been conducted, and we present a framework of potential avenues of enquiry and a worked example; (2) recalibration of the results to weight studies differentially based on their similarity to conditions in an inference population, and we provide a worked example using UK Census data to understand potential differences in the effectiveness of community engagement interventions among sites in England and Wales; (3) purposeful exploration before starting a review to ensure that the findings are relevant to an inference population. The paper aims to demonstrate how a more nuanced treatment of context in reviews of public health interventions could be achieved through greater engagement with existing large sources of secondary data. [ABSTRACT FROM AUTHOR]

The research goals were to obtain an understanding of who the users of e‐books in the NHS are, what they are using e‐books for, and when and how they use them. This article presents the methodology used and the findings from the research. It also explores the outputs and next steps from the research, both for the individual countries and collectively. The Five Nations group, (library leads in England, Northern Ireland, Ireland, Scotland and Wales) commissioned research into healthcare staff use and non‐use of e‐books to understand the behaviours, needs and expectations of healthcare staff and to identify shared challenges around e‐books to inform policy and practice. [ABSTRACT FROM AUTHOR]

International Union for the Conservation of Nature (IUCN) guidelines state that anticipated impacts must be considered in wildlife reintroduction, including the impacts on humans. Further, since reintroduction projects can be halted by resulting human–wildlife conflicts or human–human conflicts about wildlife, the perceptions of stakeholders and publics are of great importance. Eurasian beaver (Castor fiber) reintroduction is being debated in Great Britain at a devolved level. A decision has already been taken in Scotland to allow beavers already present to remain, while a number of reintroduction trials are taking place in England (both fenced and unfenced). There are also proposals for a reintroduction trial in Wales. We use a sub‐set of results from a nationwide survey (n = 2,759) to identify four social areas that we propose decision‐makers should consider in the debate: key stakeholder perceptions; engagement methods; attitudes towards legal protection and management responsibilities; and support for management techniques. In this paper, we investigate the complex social dimensions of wildlife reintroduction and we argue that emphasis should be placed on the need to recognise societal perceptions of potential management solutions, beyond perceptions of reintroduction itself. This is paramount in order to develop a management strategy that is more likely to garner social support and reduce potential future conflicts, should beaver reintroduction proceed. [ABSTRACT FROM AUTHOR]

The National Institute for Health Research (NIHR) aims to improve national 'health and wealth' by providing infrastructural support to enable clinical research in National Health Service settings in England and Wales. Cognisant of the consequences of studies' failure to achieve required numbers of participants, it also actively campaigns to promote patient awareness of research, and willingness to participate in trials. In this paper, we analyse recent NIHR campaigns and policies designed to encourage patients to participate in clinical research to interrogate how they are implicated in the national bioeconomy. In doing so we expand the notion of 'clinical labour' to include the work of patient recruitment and highlight an emergent obligation on patients to contribute to research processes. Whereas once patient knowledge and experience may have been devalued, here we draw on the concept of 'assetisation' (Birch 2012) to explore the emergent relationship between healthcare system and patient as research participant. We consider how patients' contribution goes beyond the provision of standardised objects of valuation so that patients themselves may be perceived as assets to, not only recipients of, the national healthcare system. [ABSTRACT FROM AUTHOR]

Until the latter part of the twentieth century, Iron Age burial in Britain was thought to be largely archaeologically invisible. However, over the last 40 years the recovery of large assemblages of human remains, often from pits and ditches rather than beneath monumental structures, has changed our understanding of Iron Age funerary practices. The problem, though, is that the majority of this material derives from core areas of study, particularly southern England and Yorkshire. Our knowledge of burial in the more peripheral areas of Britain, such as Wales, is much more poorly understood. The perceived paucity of burials from such regions is often still interpreted as resulting from the practice of archaeologically invisible disposal methods such as excarnation or the scattering of cremated remains. This paper presents a comprehensive review and analysis of Iron Age human remains in Wales. Although the resource for study is relatively small, a variety of practices, disposal methods and treatments of bodies can be recognized which challenge our current narratives. The scarcity of burials when compared to other parts of Britain, such as Wessex, is suggested to be a result of both poor preservation and bias in archaeological research strategies, rather than the dominance of an 'invisible' burial rite. [ABSTRACT FROM AUTHOR]

Since the 1970s, there has been growing academic interest in children and young people living in state care and, more recently, in the lives of disabled children. However, there has been little attention on the lives of disabled children who are looked after by the state. This paper compares and critiques what is known about the numbers of disabled children who are looked after in England, Northern Ireland, Scotland and Wales. We discuss the conceptual and methodological limitations of systematically collecting data on disabled children in state care across the UK. We argue that to ensure that the rights of disabled children in state care are identified, acknowledged and upheld, ‘being counted’ is a fundamental first step. [ABSTRACT FROM AUTHOR]

Brown macroalgae habitats provide a range of ecosystem services, offering coastal protection, supporting and increasing biodiversity, and more recently have been recognized for their potential role as blue carbon habitats. Consequently, accurate areal estimates of these habitats are vitally important. Satellite imagery is often utilized for areal estimates of vegetated habitats due to their ability to capture vast areas but are disadvantaged by their lower resolution. In contrast, imagery collected by unmanned aerial vehicles (UAV) provide high‐resolution datasets but are unable to cover the necessary spatial scale required for calculating areal estimates at regional, national or international scales. This study successfully and accurately corrects the outputs from low‐resolution Sentinel 2 imagery to the standard of high‐resolution UAV imagery by using a novel brown algae index and a simple regression model to provide accurate spatial estimates. This model was applied to rocky shores across Wales, UK to predict a spatial extent of 6.2 km2 for three fucoid macroalgae species; Ascophyllum nodosum, Fucus vesiculosus and F. serratus. The regression model was validated in two ways. First, the data used to create the regression model was split to train and test (50:50) the model, with a root mean square error of ~8%–14%. Secondly, spatial estimates of fucoids in independent aerial imagery were assessed using aerial photography interpretation and compared to that of the regression model (7% difference). The carbon standing stock of fucoids calculated from the spatial estimate (6.2 km2) was found to be significantly lower than that of other marine carbon stores, indicating that fucoids do not significantly contribute as a blue carbon habitat based on biomass alone. This study produces a robust and accurate remote sensing technique to estimate spatial extent of macroalgae at large spatial scales, with possible worldwide applicability. [ABSTRACT FROM AUTHOR]

In 1910, David Lloyd George, who was serving as chancellor of the exchequer in the Liberal government, opined that: 'Wales had been solid for disestablishment for 40 years' (The Times, 18 Jan. 1910, p.12). According to Lloyd George, this aspiration had been thwarted by the political reality that: 'if a Bill went up to the House of Lords it would not have the slightest chance of getting through'. At its core, the quest for the disestablishment of the Anglican church in Wales was viewed as an unprecedented constitutional and political change. It threatened to dismember one of the pillars of the English state and thereby sever a church/state relationship which, it was argued, predated parliament itself. This article will address the democratic deficit in Wales where the desire of the electorate had been repeatedly frustrated over decades, and the way disestablishment legislation would eventually be enacted through the provisions of the Parliament Act 1911. The final ignominy was that the delay inherent in the new parliamentary process would jeopardise the disestablishment that it had enabled, and this was evident in the first years of the Great War. [ABSTRACT FROM AUTHOR]

Our knowledge of the endophytic fungal community associated with needles of Sitka spruce (Picea sitchensis) is rather limited, which contrasts with the importance of this tree species for forestry in the UK. In our study, we focused on the detailed characterization of multiple isolates tentatively placed into the genera Nothophaeocryptopus and Rhizosphaera that were obtained from needles of Sitka spruce and co‐occurring Norway spruce (Picea abies) and Douglas fir (Pseudotsuga menziesii) at four sites in Scotland and Wales. After a thorough analysis of their phenotype and analysis of two nuclear regions (ITS rDNA and gene for β‐tubulin), we propose two species new to science and one new combination. Nothophaeocryptopus piceae was isolated from healthy green or brown needles from spruces and is currently known only as a sterile culture, but the taxonomic novelty is well supported by host affinity and results of molecular data analysis. Rhizosphaera minteri may also be distinguished based on the combination of host and molecular data, but morphologically, it is similar to R. pini. Finally, Hormonema merioides and R. pseudotsugae are found to be conspecific and a new combination R. merioides is proposed following the phylogenetic placement of this species. Our study highlights the importance of multiple approaches used in the identification of microfungi associated with coniferous needles. It is evident that morphologically identical fungi may represent distinct species differing in their host range and severity on the host. This study also provides a basis for future monitoring of these fungi associated with important coniferous forestry trees in the UK. [ABSTRACT FROM AUTHOR]

Aims: People with type 2 diabetes can enter remission but may relapse or develop legacy complications. This analysis assesses whether people with remission from type 2 diabetes continue receiving annual care processes recommended in national guidelines and the potential impacts of formal recognition of remission. Methods: People with type 2 diabetes with and without formal recognition (diagnostic code) of remission, and with and without evidence of remission (HbA1c < 48 mmol/mol without prescription for glucose‐lowering drugs in preceding 26 weeks), included in the 2018/19 National Diabetes Audit (NDA) for England and Wales were followed up to identify care processes received between 1 January 2019 and 31 March 2020. Results: Of the 2,822,145 people with type 2 diabetes in the cohort, 16,460 (0.58%) were coded with remission in the 2018/19 NDA. After adjustment for age, sex, socioeconomic deprivation and ethnicity, people coded with remission were less likely to receive each care process than those without such coding irrespective of HbA1c measurements (relative risk (RR) of receiving all 8 care processes 0.70 (95% CI 0.69–0.72)). For the 339,235 people with evidence of remission, irrespective of diagnostic coding compared to those without such evidence, the RR for receiving all 8 care processes was 0.94 (95% CI 0.93–0.94). Conclusions: People coded with remission of type 2 diabetes were less likely to receive diabetes care processes than those without such coding. People with evidence of remission had only a slightly reduced likelihood of receiving care processes. Formal recognition of remission may affect the provision or uptake of care processes. [ABSTRACT FROM AUTHOR]

Agricultural plastic waste from nonpackaging polymers, such as those used in silage production, constitutes the majority of the UK's agricultural plastic waste due to inadequate management. This study included online and telephone interviews with 12 British dairy farmers (nine from England, three from Wales) to understand the use of non‐packaging plastic in silage production on British dairy farms. It examined their current silage production techniques and agricultural plastic waste management behaviours and highlighted the challenges of reducing plastic waste on dairy farms through the lens of circular economy. The findings show that UK dairy farmers have adhered to the mantra of reduce, reuse and recycle. They use silage clamps for high volumes of silage production, try to reuse some used silage sheets and express a strong interest in having their waste plastic collected and recycled. However, the lack of effective agricultural plastic waste collection services, inequitable enforcement of plastic waste management regulations and rising costs of waste plastic collection in the UK make it difficult for them to recycle effectively. © 2022 The Author. Polymer International published by John Wiley & Sons Ltd on behalf of Society of Industrial Chemistry. [ABSTRACT FROM AUTHOR]

Background and purpose: Although psychiatric diagnoses are recognized in idiopathic dystonia, no previous studies have examined the temporal relationship between idiopathic dystonia and psychiatric diagnoses at scale. Here, we determine rates of psychiatric diagnoses and psychiatric medication prescription in those diagnosed with idiopathic dystsuponia compared to matched controls. Methods: A longitudinal population‐based cohort study using anonymized electronic health care data in Wales (UK) was conducted to identify individuals with idiopathic dystonia and comorbid psychiatric diagnoses/prescriptions between 1 January 1994 and 31 December 2017. Psychiatric diagnoses/prescriptions were identified from primary and secondary health care records. Results: Individuals with idiopathic dystonia (n = 52,589) had higher rates of psychiatric diagnosis and psychiatric medication prescription when compared to controls (n = 216,754, 43% vs. 31%, p < 0.001; 45% vs. 37.9%, p < 0.001, respectively), with depression and anxiety being most common (cases: 31% and 28%). Psychiatric diagnoses predominantly predated dystonia diagnosis, particularly in the 12 months prior to diagnosis (incidence rate ratio [IRR] = 1.98, 95% confidence interval [CI] = 1.9–2.1), with an IRR of 12.4 (95% CI = 11.8–13.1) for anxiety disorders. There was, however, an elevated rate of most psychiatric diagnoses throughout the study period, including the 12 months after dystonia diagnosis (IRR = 1.96, 95% CI = 1.85–2.07). Conclusions: This study suggests a bidirectional relationship between psychiatric disorders and dystonia, particularly with mood disorders. Psychiatric and motor symptoms in dystonia may have common aetiological mechanisms, with psychiatric disorders potentially forming prodromal symptoms of idiopathic dystonia. [ABSTRACT FROM AUTHOR]

Background and aims: Mortality and drug treatment data suggest that the median age of people who inject drugs is increasing. We aimed to describe changes in the characteristics of people injecting drugs in the United Kingdom (UK). Design: Repeat cross‐sectional surveys and modelling. Setting: Low‐threshold services in the United Kingdom such as needle and syringe programmes. Participants: A total of 79 900 people who recently injected psychoactive drugs in the United Kingdom, recruited as part of the Unlinked Anonymous Monitoring Survey (England, Wales, Northern Ireland, 1990–2019) and Needle Exchange Surveillance Initiative (Scotland, 2008–2019). Measurements Age of people currently injecting, age at first injection, duration of injecting (each 1990–2019) and estimates of new people who started injecting (1980–2019). Findings In England, Wales and Northern Ireland between 1990 and 2019, the median age of people injecting increased from 27 (interquartile range [IQR], 24–31) to 40 (IQR, 34–46); median age at first injection increased from 22 (IQR, 19–25) to 33 (IQR, 28–39); and median years of injecting increased from 7 (IQR, 3–11) to 18 (IQR, 9–23). Values in Scotland and England were similar after 2008. The estimated number that started injecting annually in England increased from 5470 (95% prediction interval [PrI] 3120‐6940) in 1980 to a peak of 10 270 (95% PrI, 8980‐12 780) in 1998, and then decreased to 2420 (95% PrI, 1320‐5580) in 2019. The number in Scotland followed a similar pattern, increasing from 1220 (95% PrI, 740–2430) in 1980 to a peak of 3080 (95% PrI, 2160–3350) in 1998, then decreased to a 270 (95% PrI, 130–600) in 2018. The timing of the peak differed between regions, with earlier peaks in London and the North West of England. Conclusions: In the United Kingdom, large cohorts started injecting psychoactive drugs in the 1980s and 1990s and many still inject today. Relatively few people started in more recent years. This has led to changes in the population injecting drugs, including an older average age and longer injecting histories. [ABSTRACT FROM AUTHOR]

Organisations funded by Sport England or UK Sport must work towards achieving standards for safeguarding and protecting children in sport as set by the National Society for the Prevention of Cruelty to Children's Child Protection in Sport Unit (CPSU) and encourage a culture of listening to children. The present research was commissioned by the NSPCC CPSU to understand the practices of UK sports clubs regarding this objective. An electronic questionnaire was distributed through the national governing bodies of sport working with the CPSU. Some 64 clubs/squads representing 6,000+ juniors (under 18 years) responded. Quantitative data were analysed using simple statistics and qualitative data were themed utilising Foucault's theory of power and following Braun and Clark's six‐phase guide. Discourse, hierarchical judgement and docility were considered with reference to formal management and cultural environments. Semantic and latent themes were explored. The themes identified were: expectation awareness, reframing voice and preserving discourse. Clubs recognise the value of listening to children. However, existing power relations valorise adult knowledge fields over the experiences of juniors. Technology could provide an effective solution as it is remote, potentially anonymous and culturally accessible. As power is a productive force, problematisation of organisational culture could centralise children's voices and limit/prevent abuse. [ABSTRACT FROM AUTHOR]

Background: A third of children admitted to paediatric intensive care units (PICUs) in the United Kingdom (UK) are transported by paediatric critical care transport services (PCCTs). Parents have described the transfer journey as particularly stressful. Critical care nurses have a key role in mitigating the impact of the journey on parents. Evaluating parents' experiences is important to inform service improvements. Aim and objectives: Our aim was to describe the development of a new measure of parents' experiences of PCCTs, derived from data collected in the Differences in access to Emergency Paediatric Intensive Care and care during Transport (DEPICT) study. Design: A descriptive cross‐sectional survey was used. Methods: As part of the DEPICT study, a 17‐item transport experience questionnaire was developed and given to parents of children transported by PCCTs to 24 UK PICUs during a 12‐month period. Analyses included exploratory factor analysis and a validation review by a PCCT stakeholder group. Results: Families of 1722 children (1798 journeys) completed questionnaires. Five items were excluded from further analysis as correlation coefficients were <0.3. Two factors explained 53% of the variance and all 12 items loaded on one of these factors. Factor 1 (8 items) explained 47% of the variance, had excellent internal reliability and the clustered items were conceptually coherent with a specific relevance to PCCTs; these were offered for consideration, with other items possibly discarded. Twenty‐eight PCCT clinicians reviewed the questions. Using a 70% agreement threshold, one additional, previously discarded, item was identified for inclusion, resulting in a nine‐item experience measure. Conclusion: Our brief measure of parents' experience of critical care transport provides a standardized measure that can be used across all PCCTs, enabling national benchmarking of services and potentially increasing the collection and use of parent experience data to improve services. Relevance to clinical practice: Being able to measure experience provides an opportunity to understand how to make services better to improve experience. [ABSTRACT FROM AUTHOR]

This paper describes a qualitative study of practitioner perspectives on regulated water resources planning practice in England and Wales. The study focuses on strengths and weaknesses of existing practice and the case for change towards a risk-based approach informed by stochastic modelling assessments. In-depth, structured interviews were conducted to capture the views of planners, regulators and consultants closely involved in the planning process. We found broad agreement that the existing water availability assessment methods are fallible; they lack transparency, are often highly subjective and may fail to adequately expose problems of resilience. While most practitioners believe these issues warrant a more detailed examination of risk in the planning process, few believe there is a strong case for a fundamental shift towards risk-based planning informed by stochastic modelling assessments. The study identifies perceived business risks associated with change and exposes widespread scepticism of stochastic methods. [ABSTRACT FROM AUTHOR]

Context: Too many people living with chronic kidney disease are opting for and starting on hospital‐based dialysis compared to a home‐based kidney replacement therapy. Dialysis services are becoming financially unsustainable. Objective: This study aimed to assess the efficacy of coproductive research in chronic kidney disease service improvement to achieve greater sustainability. Design: A 2‐year coproductive service improvement study was conducted with multiple stakeholders with the specific intention of maximizing engagement with the national health kidney services, patients and public. Setting and Participants: A national health kidney service (3 health boards, 18 dialysis units), patients and families (n = 50), multidisciplinary teams including doctors, nurses, psychologists, social workers, and so forth (n = 68), kidney charities, independent dialysis service providers and wider social services were part of this study. Findings: Coproductive research identified underutilized resources (e.g., patients on home dialysis and social services) and their potential, highlighted unmet social care needs for patients and families and informed service redesign. Education packages were reimagined to support the home dialysis agenda including opportunities for wider service input. The impacts of one size fits all approaches to dialysis on specialist workforce skills were made clearer and also professional, patient and public perceptions of key sustainability policies. Discussion and Conclusions: Patient and key stakeholders mapped out new ways to link services to create more sustainable models of kidney health and social care. Maintaining principles of knowledge coproduction could help achieve financial sustainability and move towards more prudent adult chronic kidney disease services. Patient or Public Contribution: Involved in developing research questions, study design, management and conduct, interpretation of evidence and dissemination. [ABSTRACT FROM AUTHOR]

Objective: To compare pregnancy rates and outcomes for women with cystic fibrosis in the UK with those of the general population and assess the effect of the introduction of disease‐modifying treatment. Design: A population‐based longitudinal study, 2003–17. Setting: United Kingdom. Population: Women aged 15–44 years in the UK cystic fibrosis (CF) Registry compared with women in England and Wales. Methods: We calculated pregnancy and live‐birth rates for the CF population and the general population of England and Wales. For women with CF we compared pregnancy rates before and after ivacaftor was introduced in 2013. We further used CF registry data to assess pregnancy outcomes for mothers with CF, and to assess the relationship between maternal pre‐pregnancy lung function and nutritional status and child gestational age. Main outcome measures: Pregnancy and live‐birth rates and child gestational age. Results: Of 3831 women with CF, 661 reported 818 pregnancies. Compared with the general population, the pregnancy rate was 3.3 times lower in the CF population (23.5 versus 77.7 per 1000 woman‐years); the live‐birth rate was 3.5 times lower (17.4 versus 61.4 per 1000 woman‐years) with 70% of pregnancies in CF women resulting in live births; termination of pregnancy rates were also lower (9% versus 22%). Pregnancy rates increased post‐ivacaftor for eligible women with CF, from 29.7 to 45.7 per 1000 woman‐years. There was no association between pre‐pregnancy lung function/nutrition status and gestational age. Conclusions: Pregnancy rates in women with CF are about one‐third of the rates in the general population with favourable outcomes, and increased for eligible women post‐ivacaftor. Pregnancy rates in women with CF are about a third of the rate in England and Wales with 70% live births. Ivacaftor increases the rate. [ABSTRACT FROM AUTHOR]

Aim: Delayed closure of ileostomy following an anterior resection for rectal cancer in the UK is common. The aims of this study were (i) to investigate the variation in patient pathways between hospitals, (ii) to identify the key learning points from units with the shortest time to closure and (iii) to develop guidance for a pathway to minimize delay in ileostomy closure. Method: This was a mixed methods study. Thirty-eight colorectal units in the UK completed a short online survey. Nine colorectal units in Wales filled in an additional, expanded version of the survey. Semi-structured interviews were performed with clinicians from the six best performing units in terms of timely ileostomy closure. The optimal pathway suggested is based on the best evidence available and the Association of Coloproctology of Great Britain and Ireland guidelines. Results: Qualitative analysis revealed that 5% of units (n = 2) have a local target time for ileostomy closure. Of all units, 90% (n = 34) would consider implementing a pathway if guidelines were developed. In-depth interviews highlighted the importance of a multidisciplinary approach, a dedicated coordinator to facilitate timely booking, and consensus on whether closure should be performed before or after adjuvant chemotherapy. Conclusion: There is a lack of national guidance in timing of contrast studies and ileostomy closure. Key aspects to consider are better information at consent regarding stoma closure timing, a dedicated person to track patients and the planning of contrast studies at discharge from initial surgery. With a dedicated approach closure of ileostomy within 10–12 weeks is feasible for most units. [ABSTRACT FROM AUTHOR]

The UK has experienced substantial income and wealth inequalities at the individual and regional levels. The coronavirus disease 2019 (COVID‐19) pandemic reveals how inherited domestic economic and cultural disparities lead to greater vulnerability, even in front of the 'Great Leveller'. We argue that the geography of the pandemic in the UK follows the geography of deprivation and cultural and economic discrimination that existed before the pandemic. We demonstrate this through analysis of multiple deprivation and cultural (ethnic) concentration data, unemployment claims, and small business statistics, as well as lung cancer deaths in non‐pandemic times and weekly death statistics during the early part of the pandemic (3/1/2020 until 27/03/2020) across England and Wales. We apply data decomposition analysis to detect this discrimination and map it against the geography of the pandemic. Our study not only illustrates the geography of the pandemic disease but also demonstrates how past cultural and economic discrimination creates vulnerable groups and places among the general public in times of exogenous shocks. Finally, we discuss our findings in light of the emerging impact of Brexit. [ABSTRACT FROM AUTHOR]

The use of regulation of sex work is undergoing sweeping changes across Europe and client criminalization is becoming very widespread, with conflicting claims about the intended and actual consequences of this policy. We discuss changes in demand for paid sex accompanying the criminalization of prostitution in the United Kingdom, which moved from a relatively permissive regime under the Wolfenden Report of 1960, to a much harder line of aiming to crack down on prostitution with the Prostitution (Public Places) Scotland Act 2007 and the Policing and Crime Act of 2009 in England and Wales. We make use of two waves of the British National Survey of Sexual Attitudes and Lifestyles (NATSAL2, conducted in 2000–2001 and NATSAL3, conducted in 2010–2012) to document the changes in both the amount of demand for paid sex and in the type of clients that have taken place across the two waves, and their possible implications for policies that frame prostitution as a form of crime. [ABSTRACT FROM AUTHOR]

Dermacentor reticulatus (Ixodida: Ixodidae, Fabricius 1794) is one of the most widely distributed and abundant tick species in central Europe and is a vector for a range of pathogens. Nevertheless, many aspects of its ecology and distribution remain poorly understood. To quantify the seasonal abundance of this species in the U.K. and the environmental factors that determine this, weekly sampling at sites throughout Wales and southern England was undertaken for 12 months. This showed that the activity of adult D. reticulatus peaked February and March and that no individuals were collected between May and mid‐October; no questing tick activity was observed when the 5‐day average temperature was greater than 15 °C. A single nymph was collected by dragging, confirming speculation over the nidicolous status of larval and nymphal stadia. Laboratory analysis found that D. reticulatus were able survive cold shock and the lower lethal temperature was estimated to be between −18 and −20 °C. Habitat was significantly associated with tick activity, with higher numbers of ticks collected from low lying vegetation in marsh environments than from exposed grassland or woodland. A strong association was observed between activity and saturation deficit suggesting that the seasonal pattern of activity seen in the field, within the sites where it was abundant, is more strongly determined by temperature than humidity. Range expansion within the U.K. should be expected, bringing with it an elevated disease risk for animal and human hosts. [ABSTRACT FROM AUTHOR]

We used the HealthWise Wales (HWW) platform to explore public knowledge about the UK Yellow Card scheme (YCS), the spontaneous reporting scheme for suspected adverse drug reactions (ADRs) and whether a short information video could improve awareness. Members of the public in Wales (n = 1606) completed a questionnaire about the YCS, watched the information video and then completed a follow‐up questionnaire. Almost half (46.5%) of respondents said they had previously experienced an ADR (>90% of the ADRs involving prescribed medicines). Before the video, 18% of respondents knew how to report an ADR via the YCS and of these, 34% were from allied‐health professions. Immediately after watching it, 71% participants reported knowing how to report and 82% reported being confident to report. If this awareness were maintained, such an approach could contribute to improved reporting of suspected ADRs by the public. [ABSTRACT FROM AUTHOR]

The survey addresses three key reform debates relating to devolution in Wales. These concern first, the case for the further devolution of powers, notably those over criminal justice and policing; second, the defence of Wales' devolved powers in the context of Brexit; and third, the rooting of devolution in new constitutional ideals, primarily the Welsh government's preferred model of the UK as a voluntary association of nations, or the alternative pressed by the independence movement. In each case, there are strong pressures within Wales for resolutions which sustain and develop devolution; and in the case of independence, have the potential, with reform debates elsewhere, to transform the UK Union. However, there are also grounds for reflecting on the contested nature of further change, the long road that a case for independence may yet have to travel, and the interests of UK government. [ABSTRACT FROM AUTHOR]

Objective: To review quality of care in births planned in midwifery-led settings, resulting in an intrapartum-related perinatal death.Design: Confidential enquiry.Setting: England, Scotland and Wales.Sample: Intrapartum stillbirths and intrapartum-related neonatal deaths in births planned in alongside midwifery units, freestanding midwifery units or at home, sampled from national perinatal surveillance data for 2015/16 (alongside midwifery units) and 2013-16 (freestanding midwifery units and home births).Methods: Multidisciplinary panels reviewed medical notes for each death, assessing and grading quality of care by consensus, with reference to national standards and guidance. Data were analysed using thematic analysis and descriptive statistics.Results: Sixty-four deaths were reviewed, 30 stillbirths and 34 neonatal deaths. At the start of labour care, 23 women were planning birth in an alongside midwifery unit, 26 in a freestanding midwifery unit and 15 at home. In 75% of deaths, improvements in care were identified that may have made a difference to the outcome for the baby. Improvements in care were identified that may have made a difference to the mother's physical and psychological health and wellbeing in 75% of deaths. Issues with care were identified around risk assessment and decisions about planning place of birth, intermittent auscultation, transfer during labour, resuscitation and neonatal transfer, follow up and local review.Conclusions: These confidential enquiry findings do not address the overall safety of midwifery-led settings for healthy women with straightforward pregnancies, but suggest areas where the safety of care can be improved. Maternity services should review their care with respect to our recommendations.Tweetable Abstract: Confidential enquiry of intrapartum-related baby deaths highlights areas where care in midwifery-led settings can be made even safer. [ABSTRACT FROM AUTHOR]

This article examines the role of the devolved governments of Scotland and Wales in promoting the voluntary Living Wage. It shows that active promotion of the Living Wage standard has emerged in both countries from a broader commitment to an economic policy of 'inclusive growth'. Employment law is not a devolved matter, and the article identifies a broad range of economic incentives and soft forms of regulation that have been used by the devolved governments to promote the Living Wage in the absence of hard power to legislate. Non‐legislative forms of state intervention are often regarded sceptically, but the article shows that the attempts of devolved governments to spread the Living Wage have been impactful, particularly in Scotland. [ABSTRACT FROM AUTHOR]

River processes are widely assumed to have impacted the integrity of lithic assemblages when artifacts are found in fluvial sediments, but the specifics of these influences remain largely unknown. We conducted a real‐world experiment to determine how the initial stages of fluvial entrainment affected lithic artifact assemblages. We inserted replica artifacts with radio frequency identification tags into a gravel‐bedded river in Wales (UK) for seven months and related their transport distances to their morphology and the recorded streamflow. In addition, nine artifacts were recovered at the end of the experiment and analyzed for microwear traces. In sum, our results show that in a gravel‐bedded river with a mean discharge of 5.1 m3/s, artifact length and width were the main variables influencing artifact transport distances. The experiment also resulted in characteristic microwear traces developing on the artifacts over distances of 485 m or less. These results emphasize the multifaceted nature of alluvial site formation processes in a repeatable experiment and highlight new ways to identify the transport of replica Paleolithic material. Research Highlights: Replica lithic artifacts were tagged with radio frequency identification (RFID) tags and inserted into a gravel‐bedded river and recovered after seven months.River transport results in highly variable postdeposition surface modifications but this can be clearly differentiated from use‐wear or intentional retouch.RFID tagging is a valuable and cost‐effective method for conducting real‐world taphonomic experiments due to high rates of artifact recovery. [ABSTRACT FROM AUTHOR]

Objectives: To explore current practice and the role of UK care homes and Admiral Nurses in helping people living with dementia and their family carers prepare for end‐of‐life. Methods: We conducted an online survey with all UK Admiral Nurses (59% response rate) and a random sample of Gold Standards Framework accredited care homes in England and Wales (38% response rate). We used descriptive statistics to report survey findings. Results: While respondents commonly discussed the progressive nature of dementia with people living with dementia and family carers, they less frequently spoke to people with dementia or carers about the nature of dementia as life shortening, terminal, or a disease you can die from. Admiral Nurses highlighted that where service models reduced continuity of care, opportunities for ongoing discussion and developing relationships that supported these discussions were reduced. Admiral Nurses and care homes raised concerns about conversations being left too late, when the person with dementia no longer had capacity to engage. There was a high level of agreement with all European Association of Palliative Care and National Institute for Health and Care Excellence (NICE) statements presented regarding end‐of‐life care planning and discussions. Conclusions: Our survey of care homes and Admiral Nurses, combined with findings from our previous survey of UK memory services, increases our understanding of how services help people with dementia and family carers prepare for end‐of‐life. We found fragmentation across the service system, lack of continuity, and tensions regarding when these conversations should be initiated and by whom. [ABSTRACT FROM AUTHOR]

Issues Addressed: To establish the views of clinicians on the feasibility and effectiveness of using a novel lifestyle prescription form (LRx) which requires co-signing by clinician and patient and is uniquely based on the design of the standard drug prescription form, in the primary and secondary health care settings.Methods: Thirty-six participants were issued with a "prescription" pad, of 20 LRx scripts, for 1 month and requested to issue an LRx prescription to patients they deemed suitable during their consultation, recording their reason for use of the LRx. Each clinician was then asked to complete a comprehensive feedback questionnaire.Results: Feedback of the LRx was overwhelmingly positive. The script was viewed as a more effective way to convey and support cardiovascular lifestyle advice, than usual care. Forty per cent (196 of 480) of the LRx scripts that were provided to primary and secondary care clinicians during the study period were issued. In most consultations, the LRx script was issued to reaffirm dietary advice. Nurses and health care assistants were more likely than doctors to use the LRx in response to a request for lifestyle advice from a patient.Conclusions: The LRx may be a useful addition to the clinician's communication toolkit to stimulate lifestyle behaviour changes in their patients. The main barrier to use in the study was lack of consultation time. SO WHAT?: Issuing the LRx is a method of solidifying lifestyle advice that clinicians could utilise, providing them with another tool in their behaviour change arsenal, particularly with familiarity with the tool. [ABSTRACT FROM AUTHOR]

The majority of shore platforms form in rocks that are characterised by layered stratigraphy and pervasive jointing. Plucking of weathered, joint and bed bounded blocks is an important erosion process that existing models of platform development do not represent. Globally, measuring platform erosion rates have focused on microscale (< 1 mm) surface lowering rather than mesoscale (0.1‐1 m) block detachment, yet the latter appears to dominate the morphological development of discontinuity rich platforms. Given the sporadic nature of block detachment on platforms, observations of erosion from storm event to multi‐decadal timescales (and beyond) are required to quantify shore platform erosion rates. To this end, we collected aerial photography using an unmanned aerial vehicle to produce structure‐from‐motion‐derived digital elevation models and orthophotos. These were combined with historical aerial photographs to characterise and quantify the erosion of two actively eroding stratigraphic layers on a shore platform in Glamorgan, south Wales, UK, over 78‐years. We find that volumetric erosion rates vary over two orders of magnitude (0.1‐10 m3 yr‐1) and do not scale with the length of the record. Average rates over the full 78‐year record are 2‐5 m3 yr‐1. These rates are equivalent to 1.2‐5.3 mm yr‐1 surface lowering rates, an order of magnitude faster than previously published, both at our site and around the world in similar rock types. We show that meso‐scale platform erosion via block detachment processes is a dominant erosion process on shore platforms across seasonal to multi‐decadal timescales that have been hitherto under‐investigated. © 2019 The Authors. Earth Surface Processes and Landforms published by John Wiley & Sons Ltd [ABSTRACT FROM AUTHOR]

Fair Work Wales, the report of the Wales Fair Work Commission, details the characteristics of fair work and recommends how to promote them. Its wider significance is that it offers a blueprint for what the UK should be doing—a challenge that could hardly be more fundamental. It is a timely reminder for employment relations teachers and researchers that the world of work may be changing but what they do and how they go about it really do matter. [ABSTRACT FROM AUTHOR]

Buried palaeo‐valley systems have been identified widely beneath lowland parts of the UK including eastern England, central England, south Wales and the North Sea. In the Midland Valley of Scotland palaeo‐valleys have been identified yet the age and genesis of these enigmatic features remain poorly understood. This study utilizes a digital data set of over 100 000 boreholes that penetrate the full thickness of deposits in the Midland Valley of Scotland. It identified 18 buried palaeo‐valleys, which range from 4 to 36 km in length and 24 to 162 m in depth. Geometric analysis has revealed four distinct valley morphologies, which were formed by different subglacial and subaerial processes. Some palaeo‐valleys cross‐cut each other with the deepest features aligning east–west. These east–west features align with the reconstructed ice‐flow direction under maximum conditions of the Main Late Devensian glaciation. The shallower features appear more aligned to ice‐flow direction during ice‐sheet retreat, and were therefore probably incised under more restricted ice‐sheet configurations. The bedrock lithology influences and enhances the position and depth of palaeo‐valleys in this lowland glacial terrain. Faults have juxtaposed Palaeozoic sedimentary and igneous rocks and the deepest palaeo‐valleys occur immediately down‐ice of knick‐points in the more resistant igneous bedrock. The features are regularly reused and the fills are dominated by glacial fluvial and glacial marine deposits. This suggests that the majority of infilling of the features happened during deglaciation and may be unrelated to the processes that cut them. [ABSTRACT FROM AUTHOR]

Introduction: Dental bodies across Europe have published curricula aiming to guide the development of a graduating dentist who is safe and competent, and which also contain direction on what knowledge and understanding of patient's health, drugs and disease a recent graduate should have. Materials, Methods and Aim: A questionnaire to survey Foundation Dentists in Wales regarding their undergraduate teaching and assessment in human disease/clinical medical science for dentistry and how this translates to their knowledge, attitudes and confidence in the dental management of patients who may have chronic disease or disability. Results: A 97% response rate to the questionnaire from Foundation Dentists graduating from schools across the UK showed that the large majority felt their teaching and learning in human disease/clinical medical science for dentistry was appropriately delivered and assessed, and that they were well prepared for independent dental practice and to plan and safely manage treatments for all their patients. Discussion: This survey of newly qualified dentists representing graduates from different types of dental courses and both newer and long‐established schools across the UK reports the foundation dentists felt that they are competent and safe to care for all patients, including those with complex medical histories. Conclusions: The foundation dentists surveyed have completed dental undergraduate courses containing the appropriate education and assessment for human health and disease, such that they are prepared to manage their patient population safely, and are well placed to serve their patients as the population continues to age and the amount of medical morbidity increases. [ABSTRACT FROM AUTHOR]

Distributions of Daubenton's bat (Myotis daubentonii), common pipistrelle, (Pipistrellus pipistrellus), and soprano pipistrelle (Pipistrellus pygmaeus) were investigated along and altitudinal gradient of the Lledr River, Conwy, North Wales, and presence assessed in relation to the water surface condition, presence/absence of bank‐side trees, and elevation. Ultrasound recordings of bats made on timed transects in summer 1999 were used to quantify habitat usage. All species significantly preferred smooth water sections of the river with trees on either one or both banks; P. pygmaeus also preferred smooth water with no trees. Bats avoided rough and cluttered water areas, as rapids may generate high‐frequency echolocation‐interfering noise and cluttered areas present obstacles to flight. In lower river regions, detections of bats reflected the proportion of suitable habitat available. At higher elevations, sufficient habitat was available; however, bats were likely restricted due to other factors such as a less predictable food source. This study emphasizes the importance of riparian habitat, bank‐side trees, and smooth water as foraging habitat for bats in marginal upland areas until a certain elevation, beyond which bats in these areas likely cease to forage. These small‐scale altitudinal differences in habitat selection should be factored in when designing future bat distribution studies and taken into consideration by conservation planners when reviewing habitat requirements of these species in Welsh river valleys, and elsewhere within the United Kingdom. [ABSTRACT FROM AUTHOR]

SUMMARY: Objectives: To monitor minimum standards in hospital transfusion laboratories in relation to qualifications, training, competency and the use of information technology over time against published recommendations. Background: The United Kingdom Transfusion Laboratory Collaborative was formed in 2006 with representatives from relevant organisations and has published standards for transfusion laboratory practice. The standards are set to ensure safe transfusion laboratory practice. Regular surveys are performed to see the extent to which laboratories are able to meet these standards and where any problems lie. Methods: An electronic survey is sent to hospital transfusion laboratories on a single mid‐week day in the spring and is repeated every 2 years from 2011, to be completed by the lead in transfusion for the day. The questions cover staffing, training, funding and workload. Results: Transfusion laboratories are having difficulty with staffing, particularly recruitment of suitably trained biomedical scientists, and with funding and time for training and education. Laboratory errors reported to the Serious Hazards of Transfusion haemovigilance scheme (SHOT) have not decreased with time, related to the under‐resourced workforce. Conclusion: Problems in laboratory staffing and expertise in hospital transfusion laboratories need to be urgently addressed. The transfusion laboratory provides a key service to hospitals. The Blood Services in England and Wales are developing supportive strategies. [ABSTRACT FROM AUTHOR]

After historical declines in population sizes and ranges, we compare and contrast the recent history and contemporary variation in the status of Great Britain's eight native mammalian carnivore species from the 1960s to 2017.Wildcat Felis silvestris conservation status is unfavourable and is masked by hybridisation with domestic cats Felis catus. Red foxes Vulpes vulpes remain widespread but are currently declining. European otter Lutra lutra, European pine marten Martes martes and European polecat Mustela putorius populations are characterised by rapid recovery. Otters have almost completely recolonised Great Britain, polecats have expanded their range throughout southern Britain from refugia in Wales and pine martens have expanded their range from the Scottish Highlands. European badgers Meles meles have generally increased in population density. Status assessments of stoats Mustela erminea and weasels Mustela nivalis are data‐deficient but available evidence suggests that stoats may have increased while weasels may have declined.Anthropogenic processes influencing carnivore status include legal protections, habitat quality, reintroductions, predator control, pollutants, hybridisation and diseases and their associated control practices. Population effects of contaminants, such as anticoagulant rodenticides, remain poorly characterised. The widespread interface with domestic and feral cats makes the wildcat's situation precarious. Recent declines in rabbit Oryctolagus cuniculus populations are a concern, given that several carnivore species depend on them as food.We conclude that, with the exception of the wildcat, the status of Great Britain's mammalian carnivores has markedly improved since the 1960s. Better understanding of the social aspects of interactions between humans and expanding predator populations is needed if conflict is to be avoided and long‐term co‐existence with people is to be possible. [ABSTRACT FROM AUTHOR]

Duffy et al. (2019, https://doi.org/10.1029/2019GB006195) assess age‐related trends in tree‐ring oxygen isotope (δ18O) series from the UK using two approaches. They argue that their conventional approach, which also forms the basis for the frequently used Regional Curve Standardization (RCS) method, is incapable of identifying age‐related trends and that detrending the data would distort climatic indications. However, their study disregards much of the existing dendrochronological literature essential also for their trend detection approaches. Here, we reanalyze the data from their supplementary item and show that detrending δ18O series using the RCS method does not remove long‐term trends—indicative of summertime drying in England and Wales—and that the data set used in Duffy et al. (2019) is likely too small to draw wider implications. Key Points: The Regional Curve Standardization should not be neglected in efforts to assess nonclimatic, age‐related trends in any tree‐ring dataThe effects of data heterogeneity for curve estimation can be considerably reduced by increasing the sample size of tree‐ring seriesMore testing with larger sample size and using the existing tree‐ring methods is needed for detailed assessments of age‐related trends [ABSTRACT FROM AUTHOR]

Abstract: Background and aim: The introduction of the Alcohol Act in Scotland on 1 October 2011, which included a ban on multi‐buy promotions, was probably associated with a fall in off‐trade alcohol sales in the year after its implementation. The aim of this study was to test if the same legislation was associated with reduced levels of alcohol‐related deaths and hospital admissions in the 3‐year period after its introduction. Design: A natural experiment design using time–series data to assess the impact of the Alcohol Act legislation in Scotland. Comparisons were made with unexposed populations in the rest of Great Britain. Setting: Scotland with comparable data obtained for geographical control groups in other parts of Great Britain. Participants: For alcohol‐related deaths, a total of 17 732 in Scotland and 88 001 in England and Wales throughout 169 4‐week periods between January 2001 and December 2013 and for alcohol‐related hospital admissions, a total of 121 314 in Scotland and 696 892 in England throughout 182 4‐week periods between January 2001 and December 2014. Measurements: Deaths and hospital admissions in Scotland and control groups that were wholly attributable to alcohol for consecutive 4‐week periods between January 2001 and December 2014. Data were obtained by age, sex and area‐based socio‐economic position. Findings: There was no evidence to suggest that the Alcohol Act was associated with changes in the overall rate of alcohol‐related deaths [incidence rate ratio (IRR) = 0.99, 95% confidence interval (CI) = 0.91–1.07)] or hospital admissions (IRR = 0.98, 95% CI = 0.95–1.02) in Scotland. In control group analyses, the pseudo intervention variable was not associated with a change in alcohol‐related death rates in England/Wales (IRR = 0.99, 95% CI = 0.95–1.02), but was associated with an increase in alcohol‐related hospital admission rates in England (IRR = 1.05, 95% CI = 1.03–1.07). In combined models, the interaction analysis did not provide support for a ‘net effect’ of the legislation on alcohol‐related deaths in Scotland compared with England/Wales (IRR 0.99, 95% CI = 0.95–1.04), but suggested a net reduction in hospital admissions for Scotland compared with England (IRR = 0.93, 95% CI = 0.87–0.98). Conclusion: The implementation of the Alcohol Act in Scotland has not been associated clearly with a reduction in alcohol‐related deaths or hospital admissions in the 3‐year period after it was implemented in October 2011. [ABSTRACT FROM AUTHOR]

We performed a set of numerical experiments for a severe extratropical storm that hit the United Kingdom in December 2013 using the Weather Research and Forecasting (WRF) model in a nested setup. Four experiments were performed, using the original orography (ORG), a 50% increase in orography (T50), a 100% increase (i.e. double; T100), and a total removal (flattening) of the mountainous terrain (RMV) over Wales. The results show that rainfall amounts and distribution are sensitive to the modifications made. Moreover, the analysis of the vertical distribution of water vapor, as well as vertical velocities, indicates that higher mountains act as a windbreak and confine moisture to the windward side. Lower mountains let moisture flow and contribute to rain patterns in England (leeward side). Changes in Mean Sea Level Pressure (MSLP) were also observed, and the results agree with rainfall amounts. Furthermore, the time series of the spatial average of Convective Available Potential Energy (CAPE) suggests that orography has a stronger influence on storm dynamics than it does on storm genesis. Increased orography results in deeper storms and intensifies vertical flows, changing the dynamics and the energy of the environment. [ABSTRACT FROM AUTHOR]

Aim To understand the scope for improving children's glycaemic outcomes by reducing variation between clinics and examine the role of insulin regimen and clinic characteristics. Methods Cross-sectional analysis of 2012-2013 National Paediatric Diabetes Audit data from 21 773 children aged < 19 years with Type 1 diabetes cared for at 176 clinics organized into 11 regional diabetes networks in England and Wales. Variation in HbA1c was explored by multilevel models with a random effect for clinic. The impact of clinic context was quantified by computing the per cent of total variation in HbA1c which occurs between clinics (intraclass correlation coefficient; ICC). Results Overall, 69 of the 176 diabetes clinics (39%) had a glycaemic performance that differed significantly from the national average after adjusting for patient case-mix with respect to age, gender, diabetes duration, deprivation and ethnicity. However, differences between clinics accounted for 4.7% of the total variation in HbA1c. Inclusion of within-clinic HbA1c standard deviation led to a substantial reduction in ICC to 2.4%. Insulin regimen, clinic volume and diabetes networks had a small or moderate impact on ICC. Conclusions Differences between diabetes clinics accounted for only a small portion of the total variation in glycaemic control because most of the variation was within clinics. This implies that national glycaemic improvements might best be achieved not only by targeting poor centres but also by shifting the whole distribution of clinics to higher levels of quality. [ABSTRACT FROM AUTHOR]

Background and Aims Premises licensed for the sale and consumption of alcohol can contribute to levels of assault-related injury through poor operational practices that, if addressed, could reduce violence. We tested the real-world effectiveness of an intervention designed to change premises operation, whether any intervention effect changed over time, and the effect of intervention dose. Design A parallel randomized controlled trial with the unit of allocation and outcomes measured at the level of individual premises. Setting All premises (public houses, nightclubs or hotels with a public bar) in Wales, UK. Participants A randomly selected subsample ( n = 600) of eligible premises (that had one or more violent incidents recorded in police-recorded crime data; n = 837) were randomized into control and intervention groups. Intervention and comparator Intervention premises were audited by Environmental Health Practitioners who identified risks for violence and provided feedback by varying dose (informal, through written advice, follow-up visits) on how risks could be addressed. Control premises received usual practice. Measurements Police data were used to derive a binary variable describing whether, on each day premises were open, one or more violent incidents were evident over a 455-day period following randomization. Findings Due to premises being unavailable at the time of intervention delivery 208 received the intervention and 245 were subject to usual practice in an intention-to-treat analysis. The intervention was associated with an increase in police recorded violence compared to normal practice (hazard ratio = 1.34, 95% confidence interval = 1.20-1.51). Exploratory analyses suggested that reduced violence was associated with greater intervention dose (follow-up visits). Conclusion An Environmental Health Practitioner-led intervention in premises licensed for the sale and on-site consumption of alcohol resulted in an increase in police recorded violence. [ABSTRACT FROM AUTHOR]