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The COVID-19 pandemic has highlighted the benefits which digital technology offers to all aspects of dental practice and education. This paper provides an overview of how digital technology has enhanced clinical and administrative procedures within dental practice, including computer-aided design/computer-aided manufacture (CAD/CAM), digital radiography, 3D printing, patient records, electronic patient referrals and electronic communications from dental practices. It then considers the development of teledentistry (mHealth) and its benefits in enabling distant consultations with patients, who for one reason or another are unable to visit dental practices easily. It then goes on to consider how and why digital dental distance learning materials were provided to general dental practitioners in England by the Department of Health (DoH) (England) and how they evolved. Finally, this paper considers the use of digital technology in dental education by dental schools. [ABSTRACT FROM AUTHOR]

Understanding the factors that influence domestic violence and abuse (DVA) victims to withdraw from the Criminal Justice System globally continues to be a key focus for professionals and academics working within this area. There is a dearth of extant literature examining the motivations behind victim withdrawal, particularly retraction occurring post provision of an initial statement. This paper examines the phenomenon of retraction, by thematically analysing N = 60 police retraction statements (PRS) collected by police officers in a large suburban police force in the North West of England. In examining these statements, insight can also be garnered from those victims still in an active relationship with their abusers. Findings highlight female victims' motivations for retraction and are framed around victim problem solving including: a) accepting the relationship which resulted in a discordance in proceeding with the prosecution of the abuser b) rejecting the relationship thereby rendering the prosecution as redundant c) engaging in procedural problem solving where alternative measures such as civil actions were sought to substitute a CJS prosecution and d) the effect of children where motivations were split between retracting to return to the complete family unit including the victim as the mother and retracting due to recognising the importance of the father's role without involvement from the mother. Notwithstanding limitations, this paper demonstrates that there is significant value in conducting an analysis of PRSs in furthering the understanding of why victims choose to retract at this point in their prosecution journey. The extracts from this dataset add insight and understanding into DVA female victim motivations to retract post-initial statement provision and highlight the differences within victim populations who retract their original statement. [ABSTRACT FROM AUTHOR]

The most significant episode in the assetisation of housing (underpinning its financialisation) is often understood to be the economic restructuring that took place during the 1980s – particularly deregulation of the banking sector and credit liberalisation. Research has reported on the housing 'investor subject' that emerged during this time, as an integral part of the transition towards financialised economies. This article provides new evidence about the housing consumer subject, and its place in this transition, by drilling into UK housing policy history and its discourses around the consumer relationship with housing. Using archive data from the Parliamentary and National Archives alongside interviews with key informers, we illustrate three cases of housing policy development in which the consumer demand for, and relationship with, housing is discursively reconditioned. We conclude that the housing investor subject was pursued in housing policy reform and its discourses well before the 1980s and the economic reforms commonly identified as the causes of financialisation. In addition, these discourses are found to have been reconditioned in order to align with broader macroeconomic policy concerns of the time. The article therefore provides a rare view of assetisation from within the state apparatus, revealing how housing policy and its discourses around consumption became functionally integrated within wider macroeconomic goals. [ABSTRACT FROM AUTHOR]

Background: Sapropterin has been approved as a treatment option for individuals with Phenylketonuria in the United Kingdom. Individuals are assessed as responsive to Sapropterin by a ≥30% reduction in Phenylalanine (Phe) concentrations using dried blood spot (DBS) specimens. DBS quality is critical for accurate and precise measurement of Phe. Currently, UK national guidelines for DBS specimen acceptance do not exist for patient-collected DBS specimens. We adopted evidence-based guidelines for specimen acceptance criteria and retrospectively assessed the impact of introducing these guidelines on specimen rejection rates. Methods: Laboratories were invited to audit the quality of DBS specimens routinely received for Phe monitoring using: (1) existing acceptance/rejection criteria and (2) proposed national guidelines. Results: Ten laboratories audited 2111 specimens from 1094 individuals. Using existing local guidelines, the median rejection rate was 4.0% (IQR 1.5–7.2%). This increased to 21.9% (IQR 10.0–33.0%) using the proposed guidelines. Where reason(s) for rejection were provided (n = 299); 211/299 (70.6%) of DBS specimens were too small or multi-spotted. 380 individuals had more than one sample evaluated; 231/380 (60.8%) provided specimens of acceptable quality, 37/380 (9.7%) consistently provided poor-quality DBS specimens. Conclusions: There is significant variability in the quality of patient-collected DBS specimens. If unacceptable specimens are not rejected, imprecise/inaccurate results will be used in clinical decision making. Using annual workload data for England, this equates to 12,410 incorrect results. Individuals and parents/carers should receive ongoing training in blood collection technique to ensure use of evidence-based acceptability criteria does not cause undue distress from increased sample rejection rates. [ABSTRACT FROM AUTHOR]

Background: The Health of the Nation Outcomes Scales for people with Learning Disabilities (HoNOS-LD) is an 18-item measure which provides a structured and standardized approach to rating various clinical and psychosocial outcomes and has been in use nationally since 2002. Aims: To revise and improve the HoNOS-LD's utility in contemporary intellectual disability (ID) services whilst retaining its original objectives and five-point severity ratings. Method: ID clinicians were invited to complete an online survey, rating each item on the existing measure for being fit for purpose, identifying issues and suggesting improvements based on their experience of using the HoNOS-LD in practice. Scales were then assessed and revised sequentially; survey responses were used to inform discussion and revisions to the HoNOS-LD by the Advisory Board. Results: A total of 75 individuals replied. Respondents had used HoNOS-LD for an average of 8.0 years (S.D. 5.28 years) and 88% found the scale to be useful in their practice. On average, respondents used HoNOS-LD ratings to inform care 42.4% of the time (S.D. 33.5%). For each scale there was a significant negative correlation between the percentage of positive/very positive respondent ratings and the number of changes proposed. Common changes included simplifying terms, reducing ambiguity and replacing anachronistic language. Conclusion: The changes outlined in this paper are based on the advisory group's expert consensus. These changes are intended to improve reliability and validity but now need empirical testing as well as review by service users. [ABSTRACT FROM AUTHOR]

Although media influence has long been recognised within adoption, there has been relatively little research into the nature of coverage. This article focuses on press articles from five UK national daily newspapers and their Sunday sister papers in the years 2010‒2014. This broadly coincides with the period of Coalition Government in the UK and its focus on adoption reform. Findings reveal strong support for the Government's reform programme, its rationale within child welfare and many of its specific measures, but with some contrasts between individual newspapers and critical comment found almost entirely within one pairing. Particular themes concern excessive bureaucracy and politically motivated opposition to adoption. Race and ethnicity emerge as the most frequently covered issues, dominated by critique of barriers to transracial adoption. Principal themes are often developed with inaccurate, misleading or exaggerated reporting, which in turn raises the question of how adoption agencies might respond to this. [ABSTRACT FROM AUTHOR]

School-to-school collaboration has been central to many improvement efforts over recent decades. In an attempt to promote both improvement and equity current developments in England have included changing formal governance arrangements to promote collaboration for improvement through ‘federations’ and ‘chains’ of schools. However, federations and school chains remain a relatively under-explored area and there is a noticeable absence of research exploring the impact of such arrangements on student outcomes. This paper draws on a programme of research including the national evaluation of federations, the first quantitative study of the impact of federations on student outcomes and a longitudinal qualitative study of the development of federations to consider two key questions: What is a federation? And do federations make a difference? In order to achieve this, the paper provides an overview of the key characteristics of federations and considers their contribution to improvement efforts. In conclusion the paper reflects on a number of issues and implications associated with developing a federated school system. [ABSTRACT FROM PUBLISHER]

In an era of global environmental deterioration and income inequity, public health faces many challenges, including the growing number of individuals, especially older people, with chronic diseases. Dementia is increasingly being seen not just as a biomedical problem to solve but as a public and community challenge to address more broadly. Concepts like prevention, brain health, and quality of life/well-being are receiving more attention. The engagement of community in addressing these challenges is being seen as critical to successful social adaptation. Arts programs are reinvigorating cultural responses to the growing number of older people with cognitive challenges. The humanities offer ways of understanding the power of words and stories in public discourse and a critical lens though which to view political and economic influences. In this paper, we report on a panel held in London on the occasion of the conference at the Royal Society for Public Health in March, 2017, in which the authors presented. Key issues discussed included problem framing, the nature of evidence, the politics of power and influence, and the development of effective interventions. In this paper, we review the rejection of two policies, one on dementia and one on the arts and humanities in public health, by the American Public Health Association; the emergence of policies in the UK; and some of the state of the art practices, particularly in training, again focusing on the UK. [ABSTRACT FROM AUTHOR]

Will the UK Industrial Strategy deliver anything substantial to the North of England? This article examines the faltering steps taken to develop Local Industrial Strategies by Local Enterprise Partnerships and Mayoral Combined Authorities and argues Place Leadership and Industrial Strategy will both need to be substantially re-galvanised after COVID 19. It is also still not clear if a significant step change can be made by the Johnson Conservative government of 2019, which will have a major impact on Northern economies. Agencies' capacity to intervene in the Northern economy and deliver is a major issue, alongside stronger leadership. Analytically the paper uses theory on Multi-Sectoral Collaboration and Place Leadership to show how uniqueness of place, past and current interpersonal connections and networks can facilitate or frustrate economic development. Place leaders must create institutional arrangements, seek agreement over visions, objectives and strategies, otherwise the lack of shared information, resources, activities and capabilities lead to 'contestation' over space and action. We analyse the levels of cohesion or contestation in four different localities as each develops a Local Industrial Strategy. [ABSTRACT FROM AUTHOR]

This paper interrogates the relationship between working-class participation in higher education ( HE) in England and social and cultural mobility. It argues that embarking on a university education for working-class people has been construed in governmental discourses as an instrumental means of achieving upward mobility, or of aspiring to 'become middle class'. Education in this sense is thus not only understood as having the potential to confer value on individuals, as they pursue different 'forms of capital', or symbolic 'mastery' ( Bourdieu, 1986), but as incurring a form of debt to society. In this sense, the university can be understood as a type of 'creditor' to whom the working-class participants are symbolically indebted, while the middle classes pass through unencumbered. Through the analysis of empirical research conducted with staff from working-class backgrounds employed on a university Widening Participation project in England, the article examines resistance to dominant educational discourses, which understand working-class culture as 'deficient' and working-class participation in HE as an instrumental means of securing upward mobility. Challenging the problematic notion of 'escape' implicit in mobility discourses, this paper concludes by positing the alternative concept of 'fugitivity', to contest the accepted relationship in HE between creditor and debtor. [ABSTRACT FROM AUTHOR]

Objectives: The paper reports on an empirical study of Health and Wellbeing Boards (HWBs) in England. Established by the Health and Social Care Act 2012, HWBs act as place-based hubs for leaders in health, social care, local government and other sectors to come together to address health improvement and the wider determinants of health. Methods: We conducted a three-year study of HWBs (2015–2017) in five localities across England. This involved collecting qualitative data from semi-structured interviews with key actors in the HWBs at strategic and operational levels, and focus group sessions with voluntary-sector participants at each HWB. Results: HWBs have largely followed the path of previous partnerships in terms of a lack of clear aims and objectives, lack of ownership and accountability by partners, and an absence of any significant impact on health outcomes. Conclusions: Many of the features of unsuccessful partnership working were largely displayed by HWBs. Boards require more executive power and ownership from the bottom up if they are to have any real impact. [ABSTRACT FROM AUTHOR]

The objective was to give an overview of self-reported recreational drug use amongst attendees of sexual health clinics in London and compare this to existing datasets. Between December 2013 and March 2014, attendees of two sexual health clinics in London were surveyed. Data collected were: sexual history, smoking and alcohol and recreational drug use. Data were analysed using SPSS (version 21). A total of 1472 respondents were included; 778 (52.9%) men, 676 (45.9%) women and 3 (0.2%) transgender (15 [1.0%] did not answer). Mean age was 30.6 ± 9.0 years. A total of 339 (43.6%) men were men who have sex with men (MSM), and 18 (2.4%) women were women who have sex with women. Lifetime prevalence of use was: alcohol 94.1%; cannabis 48.5%; 'poppers' (volatile nitrites) 28.2%; cocaine 26.8% and 3,4-methylenedioxy-methamphetamine pills 23.2%. Our population had higher current popper, methamphetamine and mephedrone use than the Crime Survey of England and Wales but lower use of cannabis, poppers and Viagra than the European MSM Internet Survey. Global Drug Survey and Part of the Picture respondents' use were higher than our population for all drugs. Drug use in this population had a different pattern to general population surveys and studies involving only MSM. [ABSTRACT FROM AUTHOR]

Accurately measuring the prevalence of sexual violence is difficult. Police-recorded crime figures are known to underestimate the true extent of sexual violence, and so researchers have tended to rely on survey estimates instead. But estimates from surveys are not uniform, with recent estimates from the UK National Survey of Sexual Attitudes and Lifestyles apparently twice as large as official figures from the major crime surveys (the Crime Survey for England and Wales and the Scottish Crime and Justice Survey). In this study we use harmonized data from these three surveys and the UK component of the EU Violence Against Women Survey to explore the features of the surveys that may have contributed to these differences. [ABSTRACT FROM AUTHOR]

In this study, we explore how participants articulate experiences of emotions during Covid-19 lockdown in the UK. We posit that emotions fulfil experiential and interpersonal functions, which are construed and conveyed through language choices. An online narrative survey was carried out. About 88 responses were analysed. Participants were from England and Wales. The mean age was 48.9 years old (SD = 62). A mixed-method approach was used. This combined quantitative Corpus Linguistics analysis and qualitative Interpretative Phenomenological Analysis with linguistic analysis. The findings show similarities to the public health and medical literature that highlight negative emotions, such as fear, distrust and anger in participants. However, we also found positive emotions not considered elsewhere, including happiness, relaxation, safety, optimism for the future and connectedness arising from the thematic IPA analysis. Emotions were construed using language explicitly labelling emotions and language implicitly signalling emotions. Our study highlights implications for managing risk behaviours associated with transmission in public health practices such as social distancing, as indicated by negative emotions. We also bring to light implications with perceived benefits of engaging in protective behaviours and social support central to public health measures, as suggested by the communication of positive emotions. [ABSTRACT FROM AUTHOR]

Objectives: A participatory qualitative study exploring women's experiences of ageing with HIV in London, United Kingdom. The research considered how the concept of 'community' was relevant to women's experiences and what constructions of 'community' could be discerned in the experiences, accounts given and discourses employed by older women living with HIV. Methods: The research presented in this article was conducted as a PhD study between 2015 and 2019. The study was structured in multiple and overlapping phases, and adopted a feminist and participatory approach. The methods used in the research were as follows: participatory literature review, participatory creative workshops, policy review and stakeholder interviews, life story interviews, and a participatory analysis workshop. Results: Eighteen women living with HIV aged over 50 participated in creative workshops and fourteen women in life story interviews. Women's experiences of ageing with HIV are shaped by intersecting identities, community responses, and personal connections. Ageing with HIV brings challenges, added to and augmented by other difficulties women face in their lives, but women draw on individual and community assets in order to adapt, cope and thrive. Belonging to a community of women living with HIV and a broader community of people living with HIV created a vital space of safety, in which women found support, advice, and meaning. Conclusions: Women ageing with HIV countered the 'violence of invisibility' through forming community with other women living with HIV, rejecting stigma, and enacting a personal form of advocacy through care for others. [ABSTRACT FROM AUTHOR]

Emotions and the emotional labour of researchers have been increasingly recognised in social science disciplines, with many researchers providing personal and reflexive accounts. Such debates are less well recognised in health-related disciplines, particularly public health, who remain at earlier stages of valuing and understanding qualitative research. Drawing on personal experiences and methodological reflections gathered from a qualitative study, undertaken with young people over the course of 16 months during the COVID-19 pandemic in England, UK, the aim of this article is to offer further insight into the impact of researcher emotion, by specifically focussing on longitudinal, diary-based methods. My reflections are framed as three overlapping and intersecting themes. First, that qualitative longitudinal methods (and diary studies in particular) have enormous potential to curate rich emotional narratives. Second, that despite these positives, there are tensions or conflicting dynamics in using a method which helps to explore young people's emotions but also involves emotional labour for the researcher. Third, that greater attention should be paid to ensuring ethical care for researchers, particularly those engaging with qualitative longitudinal and/or creative methods. Such strategies should not solely rely on self-care and must be considered at institutional or funding body level. To this end, my personal experiences and reflections, as well as those from previous offerings, are used here to underpin a framework for researchers or research teams embarking upon novel qualitative longitudinal methods: 1. Do not underestimate emotional burden. 2. Ensure meaningful debriefing is available. 3. Establish boundaries. 4. Make space for emotion throughout fieldwork as well as during analysis and writing ('entering and exiting the field'). [ABSTRACT FROM AUTHOR]

One of the current and visible controversies in UK policing that challenges the heart and foundation of the principle of law is arguably the apparent disproportionate use of stop and search powers involving ethnic minority communities. Prior research found that differential exposure by the police to certain types of suspected offenders led to the development of cognitive scripts that operate as stereotypes and which may play a role in informing suspicions concerning police stops and searches. Focusing on whether police officers use negative stereotypes to inform suspicions when conducting stops and searches, this study examined more than 2,100 stop and search records held by a police force in England, in addition to conducting 20 semi-structured interviews with frontline serving police officers from the same force. It was found that the use of stop and search powers is consistent with: (a) the use of stereotypes with respect to age, appearance, and social class; and (b) the disproportionate recorded use of stop and search powers involving Black, Asian and Mixed communities. The implications of these findings are discussed. [ABSTRACT FROM AUTHOR]

Background: Antimicrobial usage and stewardship programmes during COVID-19 have been poorly studied. Prescribing practice varies despite national guidelines, and there is concern that stewardship principles have suffered. Aim: To analyse antibiotic prescriptions during the COVID-19 pandemic at a teaching hospital and to propose improved approaches to stewardship. Methods: We reviewed COVID-19 admissions to medical wards and intensive care units (ICUs) in a London teaching hospital to assess initial antibiotic usage and evidence of bacterial co-infection, and to determine if our current antibiotic guidelines were adhered to. Findings: Data from 130 inpatients (76% medical and 24% ICU) were obtained. On admission, 90% were treated with antibiotics. No microbiological samples taken on admission provided definitive evidence of respiratory co-infection. In 13% of cases, antibiotics were escalated, usually without supporting clinical, radiological or laboratory evidence. In 16% of cases, antibiotics were stopped or de-escalated within 72 h. Blood results and chest radiographs were characteristic of COVID-19 in 20% of ward patients and 42% of ICU patients. Overall mortality was 25% at 14 days – similar to rates described for the UK as a whole. Conclusion: The majority of patients received antibiotics despite limited evidence of co-infection. Most patients received narrower spectrum antibiotics than recommended by NICE. As understanding of the natural history of COVID-19 infections progresses, stewardship programmes will need to evolve; however, at this point, we feel that a more restrictive antibiotic prescribing approach is warranted. We propose strategies for effective stewardship and estimate the effect this may have on antibiotic consumption. [ABSTRACT FROM AUTHOR]

Rates of childhood overweight and obesity continue to rise in England, along with a growing gap in obesity prevalence between children in the most and least deprived areas. To address child obesity, the UK government is increasingly considering how to intervene in the (food) environments that shape people's purchases, rather than focusing solely on individual health behaviors. With the COVID-19 pandemic and subsequent lockdowns having rapidly reconfigured life in the UK, it is important to understand how these changes may have impacted food practices and engagement with food environments. This remote, longitudinal qualitative study seeks to explore how the COVID-19 pandemic and its impacts are shaping families relationships with the food and the food environment. A sample of 60–80 parents/carers of school or nursery-aged children will be recruited from across three case study sites in England to take part in semi-structured interviews and set of flexible creative activities at three time points over the course of a year. Findings will provide practical policy insights for England's obesity prevention strategy as well as methodological insights in terms of conducting research into lived experience remotely. [ABSTRACT FROM AUTHOR]

Online abuse, facilitated via social media and mobile technologies, has recently attracted considerable academic attention. The nonconsensual sharing of intimate images—revenge pornography—can have a devastating effect on victims, is a global problem, and constitutes interpersonal violence. The national helpline in the United Kingdom has now received over 7,000 calls. In the United Kingdom, new legislation making revenge pornography a crime was introduced in 2014, yet the police do not always respond appropriately to victims. This article presents the findings of a national online survey of police understanding of revenge pornography, undertaken in the United Kingdom in March 2017. The study set out to investigate police knowledge of revenge pornography legislation, their confidence in responding to cases of revenge pornography, and what level of training they had received. A total of 783 members of the police force responded to the survey and, to the authors' knowledge, this the first study to seek to quantify the understanding of revenge pornography by police officers and staff in England and Wales. The findings suggest that the police in the United Kingdom have a limited understanding of revenge pornography legislation and lack confidence both in investigating cases and in effectively responding to victims. The implications of the study demonstrate that there is an urgent need for training across police forces to ensure that cases of revenge pornography are appropriately responded to, victims are safeguarded, and offenders brought to justice. [ABSTRACT FROM AUTHOR]

There is a growing interest in precision medicine where individual heterogeneity is incorporated into decision-making and treatments are tailored to individuals to provide better healthcare. One important aspect of precision medicine is the estimation of the optimal individualized treatment rule (ITR) that optimizes the expected outcome. Most methods developed for this purpose are restricted to the setting with two treatments, while clinical studies with more than two treatments are common in practice. In this work, we summarize methods to estimate the optimal ITR in the multi-arm setting and compare their performance in large-scale clinical trials via simulation studies. We then illustrate their utilities with a case study using the data from the INTERVAL trial, which randomly assigned over 20,000 male blood donors from England to one of the three inter-donation intervals (12-week, 10-week, and eight-week) over two years. We estimate the optimal individualized donation strategies under three different objectives. Our findings are fairly consistent across five different approaches that are applied: when we target the maximization of the total units of blood collected, almost all donors are assigned to the eight-week inter-donation interval, whereas if we aim at minimizing the low hemoglobin deferral rates, almost all donors are assigned to donate every 12 weeks. However, when the goal is to maximize the utility score that "discounts" the total units of blood collected by the incidences of low hemoglobin deferrals, we observe some heterogeneity in the optimal inter-donation interval across donors and the optimal donor assignment strategy is highly dependent on the trade-off parameter in the utility function. [ABSTRACT FROM AUTHOR]

Background: The literature contains limited information on the problems faced by dying patients with COVID-19 and the effectiveness of interventions to manage these. Aim: The aim of this audit was to assess the utility of our end-of-life care plan, and specifically the effectiveness of our standardised end-of-life care treatment algorithms, in dying patients with COVID-19. Design: The audit primarily involved data extraction from the end-of-life care plan, which includes four hourly nursing (ward nurses) assessments of specific problems: patients with problems were managed according to standardised treatment algorithms, and the intervention was deemed to be effective if the problem was not present at subsequent assessments. Setting/participants: This audit was undertaken at a general hospital in England, covered the 8 weeks from 16 March to 11 May 2020 and included all inpatients with COVID-19 who had an end-of-life care plan (and died). Results: Sixty-one patients met the audit criteria: the commonest problem was shortness of breath (57.5%), which was generally controlled with conservative doses of morphine (10–20 mg/24 h via a syringe pump). Cough and audible respiratory secretions were relatively uncommon. The second most common problem was agitation/delirium (55.5%), which was generally controlled with standard pharmacological interventions. The cumulative number of patients with shortness of breath, agitation and audible respiratory secretions increased over the last 72 h of life, but most patients were symptom controlled at the point of death. Conclusion: Patients dying of COVID-19 experience similar end-of-life problems to other groups of patients. Moreover, they generally respond to standard interventions for these end-of-life problems. [ABSTRACT FROM AUTHOR]

To date, the Government has not issued any national ethical guidance to support clinical decision-making in England during periods of potentially reduced healthcare resources in the context of the evolving COVID-19 1 pandemic at the time of writing. In the ensuing vacuum left by a lack of national guidance, ethical frameworks and approaches have been drafted by professional bodies, individual hospitals and trusts. It is clear that in delivering healthcare during this pandemic, more specific guidance is needed to ensure fair and consistent allocation policies, to attain public trust and confidence and to support clinicians so that decisions do not fall on them to make alone and unsupported. This article sets out how we in our institution, a UK tertiary and secondary level stand-alone paediatric provider Trust, set up a Clinical Decision-Making Committee to inform proactive clinical and ethical decision-making, to ensure that all patients are treated appropriately and fairly during these unprecedented times. [ABSTRACT FROM AUTHOR]

Objective: In patients with velocardiofacial syndrome (VCFS), medial displacement of the internal carotid arteries (ICAs) may increase the risk of vascular injury during the surgical correction of velopharyngeal dysfunction (VPD). Some surgeons advocate the use of vascular imaging studies prior to surgery. Nevertheless, the role of preoperative imaging is still controversial. This study aimed to review the current practice of the UK cleft units and also examine our own practice at the Evelina London Children's Hospital in relation to children with VCFS undergoing speech surgery over the previous 7 years. Design: A questionnaire was sent to all UK cleft surgeons to enquire about the management and use of preoperative vascular imaging in patients with VPD and VCFS. A retrospective study was also conducted of the unit's 7-year series of patients with VPD and VCFS. Results: Thirty-four completed questionnaires were returned (response rate 100%). Most UK surgeons (73.5%) do not regularly order preoperative vascular imaging for patients with VCFS although some reportedly would consider it if a posterior pharyngeal wall pulsation was visible. In our unit, between 2013 and 2019, a total of 40 patients affected by VCFS have been assessed for VPD. A magnetic resonance angiography (MRA) was performed for 23 patients. Medial deviation of the ICAs was identified in 7 (30%) patients. Conclusions: The results of the national survey showed no consensus on routine use of preoperative vascular imaging. Our retrospective study showed a 30% prevalence of medialized ICAs in our patient cohort. In these patients, the MRA findings influenced the choice of speech surgery. [ABSTRACT FROM AUTHOR]

Although rebalancing the UK economy has long been a focus of UK governments, this has recently used the rhetoric of 'levelling up'. Amongst other policy instruments, the UK's Modern Industrial Strategy has been an indicator of the core economic priority areas, with selected local areas also invited to produce their own local industrial strategies to provide a more nuanced delivery of those goals. This article considers the economic profile of five of the Combined Authority areas tasked with delivering the first of these local industrial strategies. By examining the profile of educational attainment, and the core sectors, it examines how well equipped they are to capitalise on these key growth sectors. The article finds that in many cases, the combined authorities have sectors which are comparatively under-represented in terms of the national economy, and have a population which is broadly ill-equipped to access job opportunities in those sectors. [ABSTRACT FROM AUTHOR]

Background: Morbid obesity (body mass index ⩾40 kg/m2) carries a higher risk of non-communicable disease and is associated with more complex health issues and challenges than obesity body mass index ≥30kg/m2 and <40kg/m2, resulting in much higher financial implications for health systems. Although obesity trends have previously been projected to 2035, these projections do not separate morbid obesity from obesity. This study therefore complements these projections and looks at the prevalence and development of morbid obesity in the UK. Methods : Individual level body mass index data for people aged >15 years in England, Wales (2004–2014) and Scotland (2008–2014) were collated from national surveys and stratified by sex and five-year age groups (e.g. 15–19 years), then aggregated to calculate the annual distribution of healthy weight, overweight, obesity and morbid obesity for each age and sex group. A categorical multi-variate non-linear regression model was fitted to these distributions to project trends to 2035. Results : The prevalence of morbid obesity was predicted to increase to 5, 8 and 11% in Scotland, England and Wales, respectively, by 2035. Welsh women aged 55–64 years had the highest projected prevalence of 20%. In total, almost five million people are forecast to be classified as morbidly obese across the three countries in 2035. Conclusions : The prevalence of morbid obesity is predicted to increase by 2035 across the three UK countries, with Wales projected to have the highest rates. This is likely to have serious health and financial implications for society and the UK health system. [ABSTRACT FROM AUTHOR]

Background: From diagnosis through to adulthood, a cleft lip and/or palate (CL/P) poses a number of challenges for those affected. Alongside the care provided by clinical teams, complementary information and support is offered by charitable organizations. In 2011, the Cleft Lip and Palate Association received funding to implement a new regional service across England and Scotland, with the aim of increasing support at a local level. The Centre for Appearance Research at the University of the West of England were commissioned to conduct an independent evaluation of the service over 7 years. Methods: A pragmatic, mixed-methods approach was utilized to assess the impact of the service from the perspective of charity volunteers; children, young people, and adults with CL/P; caregivers; and clinicians. Feedback forms were distributed to stakeholders at a variety of events, and qualitative feedback was collected via focus groups and an online survey. Results: The majority of participants indicated they had gained access to a local support network, felt more able to cope with CL/P-related challenges, and felt more confident in themselves. Qualitative investigation provided further support for these findings and highlighted additional benefits of the regional service for clinical teams. Conclusions: The evaluation provides encouraging evidence toward the contribution of a relatively small charitable organization in the context of cleft care. The importance of a pragmatic approach to community-based evaluation and the benefits of collaborative working between researchers and the charitable sector were also highlighted. [ABSTRACT FROM AUTHOR]

This article draws on original, empirical research that focused on the use of an experimental mobile application developed by the authors and used in the domain of youth justice in England. Against a backdrop of the theory of the paradox of technology with ideas of the networked self and child rights, the article explores the use of social technology with vulnerable/marginalised young people. Given the dearth in knowledge and understanding, in this area of social technology and young people in conflict with the law, the article focuses on an important, original and fast-developing issue in contemporary youth justice. Principally, the article explores the experiences and views of practitioners to promote a better understanding of the opportunities and challenges in the adoption of social technology in working with marginalised young people. Practitioner perceptions on the use of social technology in their own practice and its associated risks and benefits are also revealed. Study findings indicate that digital opportunities and challenges are embedded in organisational and cultural structures and practices. The article discusses implications for youth justice and ultimately for young people in conflict with the law who are caught up in the system. The article raises important issues about the likely increasing use of technology as a tool in rehabilitation and desistance; and its key messages will be of considerable interest to practitioners, managers and policy-makers who will have little option, as time goes on, to enter this controversial field. [ABSTRACT FROM AUTHOR]

Background: Randomized controlled trials provide high-level evidence, but the necessity to include selected patients may limit the generalisability of their results. Methods: Comparisons were made of baseline and outcome data between patients with acute ischemic stroke (AIS) recruited into the alteplase-dose arm of the international, multi-center, Enhanced Control of Hypertension and Thrombolysis Stroke study (ENCHANTED) in the United Kingdom (UK), and alteplase-treated AIS patients registered in the UK Sentinel Stroke National Audit Programme (SSNAP) registry, over the study period June 2012 to October 2015. Results: There were 770 AIS patients (41.2% female; mean age 72 years) included in ENCHANTED at sites in England and Wales, which was 19.5% of alteplase-treated AIS patients registered in the SSNAP registry. Trial participants were significantly older, had lower baseline neurological severity, less likely Asian, and had more premorbid symptoms, hypertension and atrial fibrillation. Although ENCHANTED participants had higher rates of symptomatic intracerebral hemorrhage than those in SSNAP, there were no differences in onset-to-treatment time, levels of disability (assessed by the modified Rankin scale) at hospital discharge, and mortality over 90 days between groups. Conclusions: Despite the high level of participation, equipoise over the dose of alteplase among UK clinician investigators favored the inclusion of older, frailer, milder AIS patients in the ENCHANTED trial. Clinical trial registration: Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01422616 [ABSTRACT FROM AUTHOR]

After the failure of the care.data programme, a revised opt-out system has been introduced for British citizens to protect their health data from 2018. However, there are several exemptions from the previous and the revised opt-out systems, some of which are overly broad. For instance, the opt-outs may be completely ignored in the case of 'anonymised' data. The data protection terminology in the United Kingdom is slightly different from that in the European Union, and the key issue is that the terms are not used consistently, even in the most important documents and guidelines. This situation may lead to a weak opt-out system with transparency issues, which might erode public trust and lead to a repeat of the care.data failure. Furthermore, the United Kingdom intends to comply with the General Data Protection Regulation after Brexit, thus these differences may cause compatibility issues in the future. [ABSTRACT FROM AUTHOR]

Increasing concerns about the societal impact of medical research fraud have led to calls for its criminalization within the United Kingdom, but there has been little discussion of how the criminal law could be applied in this context. The author proposes a legal framework whereby acts of falsification or fabrication may be prosecuted under a general offence of fraud contained within the Fraud Act 2006 in England and Wales. The threshold for prosecution may be determined by assessing the effect of an act on the reliability and robustness of research findings and using a Two-stage Full Code Test modelled on the Crown Prosecution Service Policy for Prosecutors in Respect of Cases of Encouraging or Assisting Suicide. This provides a pragmatic approach to handling an unyielding problem that affects many sectors of society and necessitates the implementation of an explicit government policy aimed at balancing the protection of public interests against the promotion of medical advancement. [ABSTRACT FROM AUTHOR]

English and Welsh responses to rape have long been critically examined, leading to attempted improvements in the criminal justice system. Despite this, little attention has been paid to the Criminal Injuries Compensation Scheme (CICS) and the difficulties applying it to rape. To begin addressing this gap, researchers interviewed three, and qualitatively surveyed 22, Independent Sexual Violence Advisors. The findings suggest that CICS may not only reinforce rape myths and disadvantage vulnerable survivors, but is also a source of validation and contributes to survivor justice. The study, while exploratory, therefore, highlights the need for further discussion about rape survivor compensation. [ABSTRACT FROM AUTHOR]

Objective To assess the cost-effectiveness of strategies to increase cervical cancer screening uptake at first invitation (STRATEGIC trial). Methods We performed an economic analysis alongside the STRATEGIC trial, comparing each of seven novel interventions for improving cervical screening uptake with control general practices in Greater Manchester and Grampian (United Kingdom). A template was developed to measure the intervention costs. Trial estimates of screening uptake were combined with data from the literature to estimate healthcare costs of each intervention. The added lifetime costs and quality adjusted life years (QALYs) of attending cervical screening were estimated by a systematic literature review, with relevant results pooled and weighted by study quality. Trial results and estimated lifetime costs and benefits of screening were then combined in a decision analytic model, giving an incremental cost per QALY gained for each intervention. Uncertainty was addressed in probabilistic and univariate sensitivity analyses. Results Intervention costs per screening round per woman attending varied from about £1.20 (2014 UK) for the nurse navigator intervention to £62 for the unrequested HPV self-sampler kit. The meta-analysis revealed a lifetime discounted benefit from screening of 0.043 QALYs per woman attending, at an additional lifetime discounted cost of £234. The incremental cost per QALY gained in all interventions was below £13,000. Probabilistic sensitivity analyses suggested that only unrequested self-sampling and timed appointments have a high probability of being cost-effective. Conclusions Unrequested self-sampling and timed appointments are likely to be cost-effective interventions. Further research is required on the duration of effects and on implementing combinations of interventions. [ABSTRACT FROM AUTHOR]

Psychiatric illness and sleeping disorders are important co-morbidities of human immunodeficiency virus (HIV) infection, which impact both the individual and antiretroviral therapy (ART) selection. This systematic review aimed to assess the prevalence of psychiatric illness and sleep disturbance in people living with HIV (PLHIV) in the UK. Systematic searches for publications reporting epidemiological data for psychiatric co-morbidities and sleep disturbance with HIV were conducted in Embase, MEDLINE, Cochrane Library, eight key conferences (2013-2015), and by hand-searching references of included publications. Data were extracted from publications (2000 onwards) reporting the UK prevalence of depression, anxiety, suicide ideation, or sleep disturbance as a co-morbidity of HIV infection. Comparative UK general population data were obtained from the 2007 Adult Psychiatric Morbidity in England household survey, the 2012 Health Survey for England, and 'PatientBase' (epidemiological database). Sixteen publications met the inclusion criteria. Amongst PLHIV in the UK, the prevalence of depression varied from 17-47%, compared with a reported 2-5% prevalence for the UK general population. A similar disparity was observed in the prevalence of anxiety (22-49% PLHIV versus 4-5% general population), depression or anxiety (50-58% PLHIV versus 27% general population), difficulty sleeping (61% PLHIV versus 10% population), and suicide ideation (31% PLHIV versus 1% general population). This systematic review of UK data demonstrates that rates of psychiatric illness and sleep disturbance are substantially higher amongst PLHIV than in the general population. These data underline the importance of fully considering sleep and psychiatric issues prior to selection and prescription of antiretroviral drugs, as well as the need for ongoing psychiatric and psychological support for PLHIV on ART. [ABSTRACT FROM AUTHOR]

The article asks why institutional reforms work in one place and not another and why old ways of doing things can prove so resilient. It argues in favour of a concept of institutional formation, which is different from 'institutional design' as a time-limited event or 'institutional change' as an open-ended historical trajectory. Institutional formation is conceptualised as an animated, nested and embedded process. A multi-level framework is developed that specifies the links between institutional actors, institutional rules and institutional contexts. The model is elaborated with reference to a case study of local government reform in England, specifically the devolution of responsibilities from central government to voluntary collaborations of elected local authorities ('combined authorities'). The model is used to explain variation in the process of institutional formation in two different city-regions, focusing on the role of leaders, legacies and localities. [ABSTRACT FROM AUTHOR]

The article focuses on two Afghan boys arrived in North East of England and placed in long-term foster placement, and mentions about decision taken by court regarding them. Topics include properly accommodating unaccompanied asylum-seeking children under section 20 of the Children Act 1989; supporting the leaving care provisions, and implementing decisions about education, care and medical treatment.

This article presents the results of a case study that aims to highlight the processes by which French female migrants in London and Manchester attempt to de/re/construct identities to negotiate the challenges of the cultural and social structures in England. This research centres on 15 semi-structured interviews with French women residents of diverse backgrounds. The interviews conducted represent counter-narratives to existing studies which focus only on highly skilled French migrants in London and define them as free movers and ‘invisible migrants’. This study attempts to fill a gap by examining solely French women migrants in Manchester and London as a strategic research site for a number of key research questions taken from the current literature of intra-European migration, gender and identity. Indeed, the ways in which migrants negotiate their identity are crucial to migration studies and have to be analysed in relation to women’s specific experience. The study exemplifies how migrants’ identities are a ground of negotiation, contestation, deconstruction and reconstruction. Patterns that emerged in this study first highlight the high heterogeneity among women’s strategies of self-identification and definition and sense of belonging in a changing Europe. The article concludes by proposing a refined notion of transculturality as a useful concept for future explorations of changes in contemporary European societies and the role women can have in them. [ABSTRACT FROM AUTHOR]

Policy discourses in support of school reform in England have linked the objective of raising standards with that of tackling inequality. The assumption that a single policy strategy can tackle both objectives simultaneously is problematic. In this article, I examine issues of equity by studying admissions policy and practice. Drawing on a programme of interviews with the staff of a secondary school in England, I provide evidence of the interplay between policy discourses, the values and ethos of the school, and the professional practice of those who work there. Discussions and debates about the school’s admissions policy reveal cognitive and ethical dilemmas relating to equity and educational inclusion, particularly in the case of children with special educational needs and disabilities. In a policy context that requires schools to operate in a regulated, competitive market, school leaders may reluctantly restrict opportunities for children who already face physical, educational and social challenges. [ABSTRACT FROM AUTHOR]

Objective: To provide an example of a new methodology for using multiple characteristics in the study of population aging and to assess its usefulness. Method: Using the English Longitudinal Study of Aging (ELSA), we investigate three characteristics of each person 60 to 85 years old, by level of education, hand-grip strength in 2004 (measured in kilos), chair rise speed in 2004 (measured in rises per minute), and whether the person survived from 2004 to 2012. Because the three characteristics are measured in different units, we convert them into a common metric, called alpha-ages. Results: We find that the average of the alpha-age differentials in the measures of upper body and lower body strength predicts educational differentials in subsequent survival better than either physical measure alone. Discussion: This result demonstrates the benefit of combining characteristics, using alpha-ages to convert incommensurate observations into a common metric. [ABSTRACT FROM AUTHOR]

In this article, we analyze the relationship between social disadvantage and crime, starting from the paradox that most persistent offenders come from disadvantaged backgrounds, but most people from disadvantaged backgrounds do not become persistent offenders. We argue that despite the fact that social disadvantage has been a key criminological topic for some time, the mechanisms which link it to offending remain poorly specified. Drawing on situational action theory, we suggest social disadvantage is linked to crime because more people from disadvantaged versus affluent backgrounds develop a high crime propensity and are exposed to criminogenic contexts, and the reason for this is that processes of social and self-selection place the former more frequently in (developmental and action) contexts conducive to the development and expression of high crime propensities. This article will explore this hypothesis through a series of analyses using data from the Peterborough Adolescent and Young Adult Development Study (PADS+), a longitudinal study which uses a range of data collection methods to study the interaction between personal characteristics and social environments. It pays particular attention to the macro-to-micro processes behind the intersection of people with certain characteristics and environments with certain features – i.e., their exposure – which leads to their interaction. [ABSTRACT FROM AUTHOR]

Concern about declining legitimacy of national democratic institutions has driven an expansion of reforms to increase public participation. This article tests the claim that greater local civic participation is associated with increased democratic legitimacy. It makes explicit a theoretical basis for this relationship and builds indices for civic participation and legitimating attitudes. Empirical implications are tested in a series of hierarchical linear and ordered probit models using detailed individual-level data from the UK Citizenship Survey. I find that participation is persistently positively associated with attitudes expressive of democratic legitimacy, even when accompanied by negative evaluations of local authority outcomes, and that this effect is specific to procedural and fairness evaluations of legitimacy rather than governmental trust. This article thus broadly supports assumptions of democratic legitimation from expanding civic participation. [ABSTRACT FROM AUTHOR]

Appreciative inquiry was developed in the late 1980s as a process to encourage social innovation by involving people in discovering the ‘best of what is’. Recent research has suggested that appreciative inquiry practitioners’ focus on positivity is now inhibiting appreciative inquiry’s focus on generative theory. This article responds by asking the question ‘what is critical appreciation?’, then seeks answers by studying the critical turn in a Big Lottery Research project. By tracking the narratives of research assistants as they describe the ‘life worlds’ and ‘systems’ in their community, we clarify the recursive processes that lead to deeper levels of appreciation. We contribute to the development of critical appreciative processes that start with a critical inquiry to deconstruct experience and then engage critical appreciative processes during the remainder of the appreciative inquiry cycle to construct new experiences. The initial critical inquiry establishes which system imperatives colonize the life world of participants whilst subsequent critical appreciative processes build participants’ aspirations to design new social systems. [ABSTRACT FROM AUTHOR]

For three years from 2008 every school in England had a designated school improvement partner (SIP), portrayed as a critical friend, whose role was to support and challenge the headteacher. A mixed-methods study involving a national survey and face-to-face interviews evaluated the enactment of the national policy from the perspective of the direct recipients – the headteachers/school principals. Headteachers’ perceptions of their school improvement partners, and their experiences of the support and challenge provided by SIPs, varied. Much seemed to depend on individual SIP’s expertise and conduct. The SIPs’ prescribed agenda was seen as too focused on data rather than discussions about learning and teaching, and requirements for SIPs to report to the local authority and governors were in tension with trustful relationships with headteachers. The SIP programme could be interpreted as a commitment to the entitlement of headteachers to support and challenge, or as a mechanism for surveillance and discipline. Lessons are drawn for the ‘national’ and ‘local leaders of education’ who have replaced SIPs, and for anyone internationally concerned with support and challenge for school principals. [ABSTRACT FROM PUBLISHER]

The literature on integrated care is limited with respect to practical learning and experience. Although some attention has been paid to organizational processes and structures, not enough is paid to people, relationships, and the importance of these in bringing about integration. Little is known, for example, about provider engagement in the organizational change process, how to obtain and maintain it, and how it is demonstrated in the delivery of integrated care. Based on qualitative data from the evaluation of a large-scale integrated care initiative in London, United Kingdom, we explored the role of provider engagement in effective integration of services. Using thematic analysis, we identified an evolving engagement narrative with three distinct phases: enthusiasm, antipathy, and ambivalence, and argue that health care managers need to be aware of the impact of professional engagement to succeed in advancing the integrated care agenda. [ABSTRACT FROM PUBLISHER]

Objectives: To examine the difference in gender and its impact on selected quality-of-life (QoL) domains of Social Production Function theory among older adults in England. Method: Based on an annual national adult social care service user survey conducted in the United Kingdom in 2016. QoL was assessed by a single-item construct, and independent variables were home design, access to information and local area, self-rated health, perceived pain/discomfort, perceived anxiety/depression, activities of daily living, use and satisfaction of formal and informal care, and demographic variables. Results: A total of 28,955 respondents aged 65+ years were interviewed. Multinomial logistic regression analysis found four interaction effects for predicting a very good/good QoL: (a) Female receiving non-co-residing informal care (odds ratio [OR] = 1.501, p <.01), (b) female feeling safe (OR = 1.499, p <.01), (c) female feeling satisfied with social contact with people (OR = 1.465, p <.05), and (d) female being helped in the use of time (OR = 1.370, p <.05). Conclusion: Findings suggest gender differences in QoL as men and women are heterogeneous with different health and disease patterns, health-/help-seeking behaviors, roles and responsibilities, and levels of resilience, needs, risks, and access and control resources. Practitioners should adopt a gender-specific assessment and personalized interventions to promote gender equality, empowerment, and long-term sustainable development for an aging society. [ABSTRACT FROM AUTHOR]