Search

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

Purpose: Despite a known risk of cellulitis recurrence, the management of the wider impact and risk factors has been neglected. The innovative National Cellulitis Improvement Programme (NCIP) addresses this by providing evidence-based and individualised care to improve patient reported outcomes and reduce the risk of recurrence. The aim of this paper is to examine the longer-term impact of cellulitis and to identify a suitable and clinically relevant Patient Reported Outcome Measure (PROM). Methods: A review of existing cellulitis-specific PROMs was undertaken, alongside literature detailing the patient-focused impact of cellulitis, to identify a suitable PROM for clinical use. A group of expert therapists and patient representatives (n = 14) shared their individual and collective experiences over a series of events to discuss and debate the impact of cellulitis and review available PROMs. CELLUPROM© is introduced with anonymised PROM data and case study information reported to establish the impact of CELLUPROM© within usual NCIP care. Results: No cellulitis-specific PROMs were identified. Literature focused on the signs and symptoms of an acute episode of cellulitis, with outcome measures primarily used to evidence the impact of an intervention. An enduring physical, social and emotional impact of cellulitis was identified in this study, providing the basis for the new cellulitis-specific PROM (CELLUPROM©), which has been implemented with good effect in clinical care. Conclusion: This study has highlighted the lasting impact of cellulitis. Using CELLUPROM© within the risk-reduction NCIP has helped develop Value-Based Healthcare and support programme evaluation. [ABSTRACT FROM AUTHOR]

Background/aims: The value of using qualitative methods within clinical trials is widely recognised. How qualitative research is integrated within trials units to achieve this is less clear. This paper describes the process through which qualitative research has been integrated within Cardiff University's Centre for Trials Research (CTR) in Wales, UK. We highlight facilitators of, and challenges to, integration. Methods: We held group discussions on the work of the Qualitative Research Group (QRG) within CTR. The content of these discussions, materials for a presentation in CTR, and documents relating to the development of the QRG were interpreted at a workshop attended by group members. Normalisation Process Theory (NPT) was used to structure analysis. A writing group prepared a document for input from members of CTR, forming the basis of this paper. Results: Actions to integrate qualitative research comprised: its inclusion in Centre strategies; formation of a QRG with dedicated funding/roles; embedding of qualitative research within operating systems; capacity building/training; monitoring opportunities to include qualitative methods in studies; maximising the quality of qualitative research and developing methodological innovation. Facilitators of these actions included: the influence of the broader methodological landscape within trial/study design and its promotion of the value of qualitative research; and close physical proximity of CTR qualitative staff/students allowing sharing of methodological approaches. Introduction of innovative qualitative methods generated interest among other staff groups. Challenges included: pressure to under-resource qualitative components of research, preference for a statistical stance historically in some research areas and funding structures, and difficulties faced by qualitative researchers carving out individual academic profiles when working across trials/studies. Conclusions: Given that CTUs are pivotal to the design and conduct of RCTs and related study types across multiple disciplines, integrating qualitative research into trials units is crucial if its contribution is to be fully realised. We have made explicit one trials unit's experience of embedding qualitative research and present this to open dialogue on ways to operationalise and optimise qualitative research in trials. NPT provides a valuable framework with which to theorise these processes, including the importance of sense-making and legitimisation when introducing new practices within organisations. [ABSTRACT FROM AUTHOR]

A growing body of scholarship draws attention to prisons and environmental justice, pointing out the propensity for prisons to be located on contaminated sites and to be in close proximity to polluting industries, as well as for prisons themselves to contribute to local environmental degradation. Prisoners' immobility renders them unable to relocate away from harmful environments, and there are now numerous suggestions that their wellbeing suffers as a result of the poor quality of many local environments. However, since a relationship between environmental quality and prisoner wellbeing is yet to be robustly demonstrated, there is currently no firm evidence base from which to argue for positive change. This paper therefore examines the effect of the environmental quality of the locations of prisons, approximated as the presence of greenspace in the immediate vicinity of prisons, local species biodiversity and local levels of air and noise pollution, on wellbeing outcomes in a set of prisons in England and Wales. It finds that good environmental quality, in the form of high biodiversity and/or low air pollution, enhances the already-recognized positive effects of greenspace on the wellbeing of incarcerated populations. On the basis of these findings, this paper makes evidence-based policy recommendations intended to enhance the wellbeing of incarcerated populations. [ABSTRACT FROM AUTHOR]

An increasing body of research suggests that bilingualism is possible and perhaps even advantageous for autistic individuals. However, several factors might influence parents' decisions about raising their autistic child bilingually, including national language policies, educational contexts, advice received from key professionals, and the child's individual strengths and needs. Accordingly, there is a clear imperative to understand how the views of different stakeholders converge and diverge when language decisions are made in the context of autism. This paper brings new insights by synthesising the findings of three qualitative studies that used interpretative phenomenological analysis (IPA) to explore the perspectives and experiences of bilingual autistic children (n = 11), parents (n = 16), and educational practitioners (n = 13) of bilingualism in autism in England and Wales. Despite wide variation between and within groups, a striking tension emerged between individuals' beliefs about bilingualism in general, which were positive, and their experiences of bilingualism in autism specifically, which often foregrounded more monolingual approaches. This paper examines this tension, with a particular focus on stakeholders' attitudes towards the feasibility of bilingualism, families' language choices in the context of autism, and how notions of contextual linguistic diversity accentuated differences between England and Wales. We conclude by arguing that greater awareness of both bilingualism and neurodiversity in educational and clinical settings may improve the experiences of bilingual autistic children and, crucially, the language advice families receive. [ABSTRACT FROM AUTHOR]

Despite a widespread focus on grandparents, a large proportion of kinship care in the UK is provided by older siblings. What drives older siblings to become kinship carers, and how this might differ from other kinship carers, is not well represented in academic literature. In this study, narrative interviews were carried out with thirteen adults across England, Scotland, and Wales who had experience being the main carer for their younger sibling(s) when their parents could not care for them sufficiently. The narrative method elicited holistic accounts of participants experiences of being a sibling carer, and the analysis generated three groups of narrative accounts highlighting how and why some sibling kinship care arrangements come about—with siblings wanting to bring their younger siblings back into their family; siblings trying to keep their younger siblings in their family; or older siblings stepping in to fill a gap in parenting at home. The paper draws on the narrative accounts of participants to build the groups, presenting an illustrative narrative account to represent each group. Importantly, these accounts demonstrate how becoming a kinship carer as an older sibling may, or may not, be recognised or fit into wider narratives of what becoming a kinship carer looks like. It is hoped that these accounts will prompt practitioners and policymakers to look more closely at the role of siblings when considering who is and who should be involved in deciding how to support children to remain within their family network. [ABSTRACT FROM AUTHOR]

The question of land ownership is fundamental to any modern society and has been blamed as the root of numerous social inequalities. This paper explores one potential solution to the land question, Land Value Tax (LVT), which was first popularised in the 1880s by Henry George. Despite its long history, LVT has not been widely implemented, but recently proposals to replace existing property taxes with this form of taxation have re-emerged on the political scene. While the Welsh Government has recently explored the idea of introducing an LVT, there are limited studies on this form of taxation in the context of a discretionary planning system, such as the Welsh planning system. This paper conducts exploratory qualitative research using Wales as a case study. Data was collected via semi-structured interviews with experts across various related fields, primarily within taxation and planning, to establish the potential effects of LVT in practice, with a particular focus on how it might affect the equity of planning outcomes. Overall, the research showed that despite the strong theoretical potential, fundamental practical issues would diminish the ability of LVT to effectively influence planning. LVT is argued to be largely incompatible with a discretionary planning system (e.g., the Welsh planning system), and therefore, the research concluded that many of the potential benefits of LVT could be better achieved through reforms to existing taxes and planning processes, particularly land value capture mechanisms. [ABSTRACT FROM AUTHOR]

Background: A COVID-19 hospital guideline was implemented across all 18 acute hospitals in Wales in March 2020, promoting ward management of COVID pneumonitis and data collected across the first 3 Waves of the pandemic (Wave 1 March 1st 2020 to November 1st 2020, Wave 2 November 2st 2020 to February 21st 2021 and Wave 3 June 1st 2021 to December 14th 2021). The aim of this paper is to compare outcomes for patients by admission setting and type of ventilatory support given, with a particular focus on CPAP therapy. Methods: This is a retrospective observational study of those aged over 18 admitted to hospital with community acquired COVID-19 between March 2020 and December 2021. The outcome of interest was in-hospital mortality. Univariate logistic regression models were used to compare crude outcomes across the waves. Multivariable logistic regression models were used to assess outcomes by different settings and treatments after adjusting for Wave, age, sex, co-morbidity and deprivation. Results: Of the 7,803 records collected, 5,887 (75.4%) met the inclusion criteria. Analysis of those cases identified statistically significant outcome improvements across the waves for all patients combined (Waves 1 to 3: 31.5% to 18.8%, p<0.01), all ward patients (28.9% to 17.7%, p<0.01), and all ICU patients (44.3% to 32.2%, p = 0.03). Sub group analyses identified outcome improvements in ward patients without any oxygen therapy (Waves 1 to 3: 22.2% to 12.7%, p<0.01), with oxygen therapy only (34.0% to 12.9%, p<0.01) and with CPAP only (63.5% to 39.2%, p<0.01). The outcome improvements for ICU patients receiving CPAP only (35.7% to 24.6%, p = 0.31) or invasive ventilation (61.6% to 54.6%, p = 0.43) were not statistically significant though the numbers being admitted to ICU were small. The logistic regression models identified important age and comorbidity effects on outcomes. The multivariable model that took these into account suggested no statistically significantly greater risk of death for those receiving CPAP on the ward compared to those receiving CPAP in ICU (OR 0.89, 95% CI: 0.49 to 1.60). Conclusions: There were successive reductions in mortality in inpatients over the three Waves reflecting new treatments and better management of complications. Mortality for those requiring CPAP was similar in respiratory wards and ICUs after adjusting for differences in their respective patient populations. [ABSTRACT FROM AUTHOR]

Project HELIX 2016-2020 was developed and implemented in Wales, to improve technical and safety/science knowledge; and sustainable innovation in food manufacturing small to medium enterprises (SMEs). The paper aims to place Project HELIX within the wider context of regional and food sector development and then examine the project's rationale and delivery methods relative to this. It reflects on the effectiveness of the project (or otherwise) in constructing regional advantage from knowledge transfer and knowledge spillovers. Finally, the paper identifies areas of further research both in terms of the firm level and in relation to other food sector initiatives more generally. [ABSTRACT FROM AUTHOR]

Billions of historical climatological observations remain unavailable to science as they exist only on paper, stored in numerous archives around the world. The conversion of these data from paper to digital could transform our understanding of historical climate variations, including extreme weather events. Here we demonstrate how the rescue of such paper observations has improved our understanding of a severe windstorm that occurred in February 1903 and its significant impacts. By assimilating newly rescued atmospheric pressure observations, the storm is now credibly represented in an improved reanalysis of the event. In some locations this storm produced stronger winds than any event during the modern period (1950–2015) and it is in the top-4 storms for strongest winds anywhere over land in England and Wales. As a result, estimates of risk from severe storms, based on modern period data, may need to be revised. Examining the atmospheric structure of the storm suggests that it is a classic Shapiro–Keyser-type cyclone with "sting-jet" precursors and associated extreme winds at locations and times of known significant damage. Comparison with both independent observations and qualitative information, such as photographs and written accounts, provides additional evidence of the credibility of the atmospheric reconstruction, including sub-daily rainfall variations. Simulations of the storm surge resulting from this storm show a large coastal surge of around 2.5 m, comparing favourably with newly rescued tide gauge observations and adding to our confidence in the reconstruction. Combining historical rescued weather observations with modern reanalysis techniques has allowed us to plausibly reconstruct a severe windstorm and associated storm surge from more than 100 years ago, establishing an invaluable end-to-end tool to improve assessments of risks from extreme weather. [ABSTRACT FROM AUTHOR]

This paper's aim is to explore the challenges of developing an education 'evidence ecosystem' for Wales. Methodology. The analysis is derived from ongoing research and debates with key stakeholders in higher education and the Welsh Government and draws on policy research from other small countries. Results. It might be argued that Wales provides the perfect environment for developing such an ecosystem because of its size, commitment to evidencebased policy, political consensus, collaborations between policy-makers, researchers and the education profession. That it has not yet been able to do so illustrates the constraints of wider political and historical circumstances which structure provision, particularly in small countries. The paper concludes by considering how some of these challenges might be addressed so that the potential can be realised. [ABSTRACT FROM AUTHOR]

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]

The Becoming Breastfeeding Friendly (BBF) in Great Britain study was conducted during 2017–2019 comprising three country studies: BBF England, Wales and Scotland. It was part of an international project being coordinated during the same period by the Yale School of Public Health across five world regions to inform countries and guide policies to improve the environment for the promotion, protection and support of breastfeeding. This paper reports on the application of the BBF process that is based on an implementation science approach, across the countries that constitute Great Britain (England, Wales and Scotland). The process involves assessing 54 benchmarks across eight interlocking gears that drive a country's 'engine' towards a sustainable policy approach to supporting, promoting and protecting breastfeeding. It takes a consensus‐oriented approach to the evaluation of benchmarks and the development of recommendations. This paper provides a critical overview of how the process was conducted, the findings and recommendations that emerged and how these were managed. We draw on critical theory as a theoretical framework for explaining the different outcomes for each country and some considerations for future action. Key messages: Undertaking an international, comparable approach to develop evidence‐based policy recommendations for scaling up the breastfeeding environment can provide useful data on which to draw explanations and conclusions on national variation.The findings from the BBF process across England, Scotland and Wales suggest that improving breastfeeding in Great Britain is dependent on the degree of political will and having a coordinated national breastfeeding strategy in place or not, along with access to robust breastfeeding data.A critical theory lens helps to bring to light some differences in the research and policy process that can explain differences between countries in the United Kingdom. [ABSTRACT FROM AUTHOR]

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

Background: The Welsh Government has commissioned a number of projects to consider the influence their implementation of Minimum Pricing for Alcohol (MPA) legislation in March 2020 had on the alcohol consumption and related behaviours of drinkers. Given the MPA's overlap with the COVID-19 pandemic and its related lockdown measures and restrictions, this rapidly became a story about the early impact of COVID-19 as it did MPA. This paper captures the core thematic messages from this specific strand of work, and in doing so reflects on (1) how early experiences of COVID-19 and the first lockdown influenced consumption and purchasing of alcohol behaviours and, in turn, (2) how relevant the introduction of MPA was for any of these. Methods: Semi-structured interviews were conducted by telephone with 32 drinkers 9 months after the implementation of the legislation in March 2020. The sample was recruited from three sources: the National Survey for Wales; a third sector organisation offering housing support to the homeless; and through an online survey on MPA. Results: COVID-19 had more relevance than MPA to drinkers. Furthermore, when MPA did have an influence on their behaviour, it was felt most keenly by the harmful drinkers in the study. These drinkers described spending more on alcohol, switching to other potentially more harmful substances, such as crack cocaine and synthetic cannabinoids, and more involvement in acquisitive crime and begging after the price increase. While our results might be an early indication of the influence of MPA on harmful drinkers, the small sample of this group in our study limits the generalisability of the findings. Conclusion: To date, the implementation of MPA has had little influence on the drinking patterns or lives of the drinkers in our sample. It is important that future research examines the longer-term influences of MPA before any conclusions on its effectiveness can be drawn. [ABSTRACT FROM AUTHOR]

Copyright of Quaestio Iuris (QI) is the property of Editora da Universidade do Estado do Rio de Janeiro (EdUERJ) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This research paper examines the significance of the judges in the problem-solving courts of England and Wales's Choices and Consequences (C2) and Prolific Intensive (PI) programmes using the lenses and language of therapeutic jurisprudence. These unique schemes mobilise an intensive combination of strict control measures (with a view to deterring people from reoffending) alongside a personalised package of rehabilitative support overseen by a judge in a problem-solving court. Our findings strongly indicate that the judge-led problem-solving court is the bedrock of the schemes. Acknowledging that this practice relies upon strong leadership from a judge as a community convener with the authority and profile to initiate and sustain the programme, this paper identifies the strengths and barriers that this finding may pose. Our data also points to the difficulties of achieving support for the model at all judicial levels. Readiness (or lack of) within judges in the future could hamper the prospects of both current and new schemes. Moreover, finding a judge with a susceptible personality lowers chances. The authors conclude that the UK's current punitive, rapid results ethos of the justice system is not working. The international problem-solving court movement has shown that long-term success often ensues when practices are embedded into a broader culture of rehabilitative justice supported by visible communities. By tapping into the broader international community, the key will be a changing cultural process to make keen and compatible judges easier to come by. [ABSTRACT FROM AUTHOR]

The Mawgridge's case in 1707 set the precedent where adultery was recognised as a justified trigger for the husband's killing of his wife's lover; this crystallised a partial defence for provocation. However, in an 1810 case, the killing of the unfaithful wife followed a manslaughter conviction rather than murder for the first time. This study aims to investigate the shaping of a legally permissible violence, that is, the mitigation of the husband's culpability in killing his adulterous wife. This provides the opportunity to question the (ir)rationality behind the judiciary's discourse in the case of R v Clinton 2012; here, despite infidelity being abolished in 2009 in England and Wales as a defence for murder, the judges still insisted on its relevance in our culture and hence on legal culpability. The theoretical framework in this paper draws upon the scholarship of masculinity, the family, and the law. This paper discusses the contribution of the hegemonic male identity in creating this legal violence and fortifying social-hierarchical structure. [ABSTRACT FROM AUTHOR]

Although both the analysis of regional culture and urbanisation are long-standing preoccupations in geography, few studies have considered the relationship between the two, the former traditionally being a topic in cultural geography, while the latter is usually interpreted and analysed as a process in economic geography. Taking evidence from the 1851–1911 censuses of England and Wales, this article analyses individual migration paths to identify stable regions of human interaction by applying a sophisticated community-detection algorithm. By accurately mapping the regions within which the majority of migration occurred between 1851 and 1911 and arguing that the stability of these geographies is evidence of more than just mutable communities but rather of persistent regional cultures, this article responds to previous studies that have sought to identify the cultural provinces of England and Wales. Indeed, by demonstrating that the regions bear a striking resemblance to those that have long been hypothesised as being distinct cultural provinces of England and Wales, this article empirically corroborates their existence. In order to further demonstrate that the regions constitute cultural provinces, this paper incorporates these boundaries into a spatial interaction model (SIM). The results of the SIM not only shows that the boundaries between the regions limited the number of migrants that crossed them–over and above that explained by control variables–and therefore represented the boundaries of cultural provinces, demarcating discrete regions of human interaction–but that such boundaries disproportionately restricted rural-urban migrants, thereby slowing the pace at which England and Wales urbanised. This paper therefore demonstrates that urbanisation should not only be interpreted as only an economic phenomenon, but a cultural one also, and that if urbanisation is to be fully understood, individuals' attachment to place as a component of their identity, ought to be formally incorporated into models of migration. [ABSTRACT FROM AUTHOR]

Technology has become an integral part of our educational systems, and its importance in our schools cannot be overstated. However, digital skills, unlike other literacy skills, such as reading, writing, and numeracy, still have many discontinuities between how children use them at home versus in school. Therefore, in Wales (UK), digital skills are being promoted as part of the Digital Competence Framework (DCF) and feature highly in the new Curriculum for Wales (2022). Moreover, the new Digital Technology General Certificate of Secondary Education (GCSE) in Wales has been introduced to provide learners with the opportunity to gain a qualification that builds digital skills, knowledge, and understanding. However, this also brings many challenges for teachers, such as a lack of confidence, knowledge, and training, as well as a lack of resources and fear of change, to name a few. These challenges, in turn, have an impact on pupils' motivation and performance, as well as parents' ability to support their children. This paper presents a qualitative case study on the development of a new digital technology learning community for primary and secondary school pupils, their teachers, and parents in Blaenau Gwent, Wales (UK). Firstly, the paper will provide insight into what was required to establish an effective learning community, including ensuring engagement and buy-in from all stakeholders. Secondly, through the description, analysis, and interpretation of findings from two studies, the paper will highlight the impact of the DTLSN learning community on teachers and pupils in Blaenau Gwent, especially in terms of their learning and teaching. [ABSTRACT FROM AUTHOR]

Background: The mental health of children/young people is a growing concern internationally. Numerous reports and reviews have consistently described United Kingdom children's mental health services as fragmented, variable, inaccessible and lacking an evidence base. Little is known about the effectiveness of, and implementation complexities associated with, service models for children/young people experiencing 'common' mental health problems like anxiety, depression, attention deficit hyperactivity disorder and self-harm., Aim: To develop a model for high-quality service design for children/young people experiencing common mental health problems by identifying available services, barriers and enablers to access, and the effectiveness, cost effectiveness and acceptability of such services., Design: Evidence syntheses with primary research, using a sequential, mixed-methods design. Inter-related scoping and integrative reviews were conducted alongside a map of relevant services across England and Wales, followed by a collective case study of English and Welsh services., Setting: Global (systematic reviews); England and Wales (service map; case study)., Data Sources: Literature reviews: relevant bibliographic databases and grey literature. Service map: online survey and offline desk research. Case study: 108 participants (41 children/young people, 26 parents, 41 staff) across nine case study sites., Methods: A single literature search informed both reviews. The service map was obtained from an online survey and internet searches. Case study sites were sampled from the service map; because of coronavirus disease 2019, case study data were collected remotely. 'Young co-researchers' assisted with case study data collection. The integrative review and case study data were synthesised using the 'weaving' approach of 'integration through narrative'., Results: A service model typology was derived from the scoping review. The integrative review found effectiveness evidence for collaborative care, outreach approaches, brief intervention services and the 'availability, responsiveness and continuity' framework. There was cost-effectiveness evidence only for collaborative care. No service model appeared to be more acceptable than others. The service map identified 154 English and Welsh services. Three themes emerged from the case study data: 'pathways to support'; 'service engagement'; and 'learning and understanding'. The integrative review and case study data were synthesised into a coproduced model of high-quality service provision for children/young people experiencing common mental health problems., Limitations: Defining 'service model' was a challenge. Some service initiatives were too new to have filtered through into the literature or service map. Coronavirus disease 2019 brought about a surge in remote/digital services which were under-represented in the literature. A dearth of relevant studies meant few cost-effectiveness conclusions could be drawn., Conclusions: There was no strong evidence to suggest any existing service model was better than another. Instead, we developed a coproduced, evidence-based model that incorporates the fundamental components necessary for high-quality children's mental health services and which has utility for policy, practice and research., Future Work: Future work should focus on: the potential of our model to assist in designing, delivering and auditing children's mental health services; reasons for non-engagement in services; the cost effectiveness of different approaches in children's mental health; the advantages/disadvantages of digital/remote platforms in delivering services; understanding how and what the statutory sector might learn from the non-statutory sector regarding choice, personalisation and flexibility., Study Registration: This study is registered as PROSPERO CRD42018106219., Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/09/08) and is published in full in Health and Social Care Delivery Research ; Vol. 12, No. 13. See the NIHR Funding and Awards website for further award information.

Background: The paper explores how regional actors engage with energy systems, flows and infrastructures in order to meet particular goals and offers a fine-tuned analysis of how differences arise, highlighting the policy-relevant insights that emerge. Methods: Using a novel framework, the research performs a comparative case study analysis of three regions in Italy and two of the devolved territories of the UK, Wales and Scotland, drawing on interviews and documentary analysis. Results: The paper shows that acknowledging the socio-materialities of renewable energy allows a fine-tuned analysis of how institutions, governance and infrastructure can enable/constrain energy transitions and policy effectiveness at local and regional levels. The heuristic adopted highlights (i) the institutions that matter for renewable energy and their varied effects on regional renewable energy deployment; (ii) the range of agencies involved in strategically establishing, contesting and reproducing institutions, expectations, visions and infrastructure as renewable energy deployment unfolds at the regional level and (iii) the nature and extent of infrastructure requirements for and constraints on renewable energy delivery and how they affect the regional capacity to shape infrastructure networks and facilitate renewable energy deployment. The paper shows how the regions investigated developed their institutional and governance capacity and made use of targets, energy visions and spatial planning to promote renewable energy deployment. It shows that several mediating factors emerge from examining the interactions between regional physical resource endowments and energy infrastructure renewal and expansion. The analysis leads to policy-relevant insights into what makes for renewable energy deployment. Conclusion: The paper contributes to research that demonstrates the role of institutional variations and governance as foundations for geographical differences in the adoption of renewable energy, and carries significant implications for policy thinking and implementation. It shows why and how policy-makers need to be more effective in balancing the range of goals/interests for renewable energy deployment with the peculiarities and specificities of the regional contexts and their infrastructures. The insights presented help to explain how energy choices and outcomes are shaped in particular places, how differences arise and operate in practice, and how they need to be taken into account in policy design, policy-making and implementation. [ABSTRACT FROM AUTHOR]

Background: Little is known about the effectiveness of, and implementation complexities associated with, service delivery models for children and young people (CYP) experiencing 'common' mental health problems such as anxiety, depression, behavioural difficulties and self-harm. This paper outlines how a model for high-quality service design for this population group was developed by identifying available services, their effectiveness, cost-effectiveness and acceptability, and the barriers and enablers to access. Methods: Sequential, mixed-methods design, combining evidence syntheses (scoping and integrative reviews of the international literature) with primary research (a collective case study in England and Wales). Data from these two elements were collaboratively synthesised in a subsequent model-building phase. Results: The scoping review yielded a service model typology. The integrative review found effectiveness evidence only for four models: collaborative care (the only service model to also have cost-effectiveness evidence), outreach approaches, brief intervention services and an organisational framework called 'Availability, Responsiveness and Continuity'. No service model seemed more acceptable than others. Three case study themes were identified: pathways to support; service engagement; and learning and understanding. The model-building phase identified rapid access, learning self-care skills, individualised support, clear information, compassionate and competent staff and aftercare planning as core characteristics of high-quality services. These characteristics were underpinned by four organisational qualities: values that respect confidentiality; engagement and involvement; collaborative relationships; and a learning culture. Conclusions: A consistent organisational evidence-base for service design and delivery in CYP's mental health spanning many years appears to have had little impact on service provision in England and Wales. Rather than impose – often inflexible and untested – specific local or national models or frameworks, those commissioning, designing and delivering mental health services for CYP should (re)focus on already known, fundamental components necessary for high-quality services. These fundamental components have been integrated into a collaboratively produced general model of service design for CYP with common mental health problems. While this general model is primarily focused on British service provision, it is broad enough to have utility for international audiences. [ABSTRACT FROM AUTHOR]

Simple Summary: Existing cross-cultural research on animal welfare often overlooks the way that policy and law are not the exclusive domain of central government. This can result in an over-simplification or misrepresentation of the true situation. The political culture and institutional arrangements for governing the modern state are more complex than a "one-size-fits-all" approach. It is argued that cross-cultural research needs to give greater attention to differences within as well as between unitary states. Specifically, it needs to examine developments in constituent nations and territories. Here we illustrate this by drawing on new research in the United Kingdom, and examine how 'devolution'—or decentralized government for Wales and Scotland—is providing contrasting opportunities for NGOs, campaigners, and the public to lobby to improve animal welfare policy based on local practices, beliefs, and demands (collectively known as the "political culture"). Our findings show how this is important because it results in contrasting animal welfare policies and laws in the constituent nations of the UK. It is argued that extant cross-cultural research on animal welfare often overlooks or gives insufficient attention to new governance theory, civil society, politics, and the realities of devolved or (quasi-)federal, multi-level governance in the modern state. This paper synthesizes relevant social theory and draws on new empirical findings of civil society accounts of campaigning on animal welfare policies and law in the United Kingdom. It is presented as a corrective to arguably reductive, earlier unitary state-based analyses. Our core, evidence-based argument is that cognizance of civil society activism and the contrasting institutional governance structures and political cultures of constituent nations in unitary states—such as the UK—are providing opportunities for the territorialization of legally grounded animal welfare regimes, and culturally distinctive practices. [ABSTRACT FROM AUTHOR]

Using administrative data linkage, this paper sought to quantify the impacts of family homelessness on pupil absence from school. It addresses a gap in United Kingdom (UK) homelessness research, which draws predominantly on qualitative methods and where there is a greater focus on people who fall outside of the statutory system, i.e., single people living on the streets, rather than families. Education records for the academic years 2012/13 to 2015/16 relating to pupils aged 5 to 15 years old living in a coastal city in Wales, UK, were linked to data on households assessed by the statutory housing service operating across the same region. Analysis of mean half-day sessions absent from school, and Poisson panel regression were used to explore associations between absenteeism (authorised, unauthorised, and total), and whether pupils were living in a household making a statutory homelessness application, i.e., experiencing family homelessness. On average, in any given academic year, pupils experiencing family homelessness (PEFH) missed 5 days more of school than pupils not experiencing family homelessness (PnEFH). Adjusted regression analysis found that the rate of total absence was 7% higher amongst PEFH compared to PnEFH, whilst for unauthorised absence it was 13% higher. When a student experienced family homelessness, this led to an increase in their rate of total absences by 5%--adjusting for other factors--compared to when they were not homeless. Findings have implications for statutory education and housing provision, specifically the need for greater cross-disciplinary working to prevent and alleviate the harms caused when families experience homelessness. [ABSTRACT FROM AUTHOR]

In an era where an increasing number of people find it challenging to grasp scientifically accurate environmental data, the need for more engaging museum exhibits to convey this information has never been more crucial. This article discusses Daptec Flat Holm which is a data physicalisation technology project on Flat Holm Island, Wales. Flat Holm Island is designated as a site of special scientific interest and is a local nature reserve. This project aims to understand how we might improve people's engagement with environmental data through a multi-sensory museum exhibit. To achieve this, the project team applied a new creative approach to make the presentation of environmental data more engaging to a diverse science museum audience. Employing a user-centered methodology, this study reveals insights derived from three distinct user experience investigations conducted during the summer of 2022. The main contribution lies in how the researchers have extracted the nuances from the audience reactions and then identified potential audience types, their points of engagement, as well as their challenges. In detail, the findings illustrate how the application of a vignette data analysis technique revealed distinct audience types, including passive observers, active users, engaged ambassadors, disinterested participants, critical friends, and enthusiastic collaborators. In summary, the paper offers recommendations into how we might further engage a broader audience in technology mediated environmental museum exhibitions. [ABSTRACT FROM AUTHOR]

This discussion paper explores the development and implementation of a new flexible route into the teaching profession. This flexible route is offered within an education system in the midst of wide reform, which has partnership working between universities and schools at the centre of its Initial Teacher Education. Key elements of the new programme examined include how student teachers acquire the knowledge they need, with interconnectivity, immersive practice and blended learning of significance. This case study illustrates the importance of flexibility in the development of the student teacher's personal construct and communities of practice. The programme's adaptive learner-centred approach is delivering an alternative, flexible route into the teaching profession, broadening the experience base of the future teaching workforce and beginning to successfully address key government policy drivers. [ABSTRACT FROM AUTHOR]

Human mortality has been improving faster than expected over the past few decades. This unprecedented improvement has caused significant financial stress to pension plan sponsors and annuity providers. The widely recognized Lee–Carter model often assumes linearity in its period effect as an integral part of the model. Nevertheless, deviation from linearity has been observed in historical mortality data. In this paper, we investigate the applicability of four nonlinear time-series models: threshold autoregressive model, Markov switching model, structural change model, and generalized autoregressive conditional heteroskedasticity model for mortality data. By analyzing the mortality data from England and Wales and Italy spanning the years 1900 to 2019, we compare the goodness of fit and forecasting performance of the four nonlinear models. We then demonstrate the implications of nonlinearity in mortality modeling on the pricing of longevity bonds as a practical illustration of our findings. [ABSTRACT FROM AUTHOR]

This paper reports original evidence about the experiences of 109 girls and women criminalised in England and Wales under the controversial legal doctrine of joint enterprise (JE). Over three-quarters of the women were convicted of murder or manslaughter. Yet, in no cases was evidence presented that the girl or woman used a deadly weapon. In 90% of the cases, the defendants engaged in no violence at all, and in nearly half of the cases, they were not present at the scene of the violent incident. In seeking to make sense of these findings, JE becomes a lens through which we can conceptualise gendered processes of criminalisation. Decisions to charge women that reflect strategic approaches to policing and prosecuting some forms of violence and harm, alongside prosecution and defence strategies used in the courtroom that reproduce patriarchy, class stigma and racism, will be explored. Simultaneously, the criminalising processes actively obscure and silence the wider context and personal histories of the lives of girls and women, which once surfaced, expose wider tensions in addressing all harms to deliver justice for women. [ABSTRACT FROM AUTHOR]

Background: Dental caries is common in young people and has wide-ranging ramifications for health and quality of life. Text messaging interventions show promise as a means to promote oral health behaviour change among young people. This paper reports the internal pilot of the Brushing RemInder 4 Good oral HealTh (BRIGHT) trial, which is evaluating an intervention comprising an oral health classroom lesson and text messages about toothbrushing, on caries in young people. Pilot trial objectives were to evaluate the feasibility and appropriateness of recruitment and data collection methods, the randomisation strategy, and intervention delivery against progression criteria for the main trial. Methods: This is an internal pilot trial embedded within an assessor-blinded, two-arm, cluster randomised controlled trial. Participants were pupils aged 11–13 years (in year 7/S1 or year 8/S2) in secondary schools in England, Scotland, and Wales with above average pupil eligibility for free school meals. Following completion of pupil baseline questionnaires and dental assessments, year groups within schools were randomised to the intervention or control arm. Approximately 12 weeks later, participants completed a follow-up questionnaire, which included questions about sources of oral health advice to assess intervention contamination between year groups. At the end of the pilot phase, trial conduct was reviewed against pre-specified progression criteria. Results: Ten schools were recruited for the pilot, with 20 year groups and 1073 pupils randomised (average of 54 pupils per year group). Data collection methods and intervention delivery were considered feasible, the response rate to the follow-up questionnaire was over 80%, there was an indication of a positive effect on self-reported toothbrushing, and interest was obtained from 80% of the schools required for the main trial. Despite partial intervention contamination between year groups, within-school randomisation at the level of the year-group was considered appropriate for the main trial, and the sample size was revised to account for partial contamination. Facilitators and barriers to recruitment and data collection were identified and strategies refined for the main trial. Conclusions: Progression to the main trial of BRIGHT, with some design refinements, was concluded. The internal pilot was an efficient way to determine trial feasibility and optimise trial processes. Trial registration: ISRCTN registry, ISRCTN12139369, registered 10/05/2017 [ABSTRACT FROM AUTHOR]

This paper argues that the politics of Brexit has created a particular challenge for intellectuals in Wales because although for the most part they have been interested in forging cultural connections with Europe and the rest of the world, they were forced to accept in June 2016 that not only a majority of British voters decided to leave the European Union, but also that a majority of Welsh voters had done so, so that there was a disconnect between Wales's intellectuals and its population as a whole. Going on from here the paper argues that establishing diversity, cosmopolitanism and interculturalism as typical aspects of Welsh culture, which has long been practised by Welsh intellectuals and writers, has more recently been taken up as part of the process by which Brexit was symbolically challenged within Wales. A key component of this commitment to a form of cultural politics that is both nationalist and also politically progressive in Wales has been its literature, which through various material means has been constructed and framed along these lines. Focusing first on specialist book series, then on literary festivals, thirdly on sites of literary tourism in Wales and finally on literary prizes, the paper explores ways in which qualities of cosmopolitanism and interculturalism have been embedded in that literature and hence in the wider culture. In turn, it suggests that establishing these characteristics as intrinsic features of the national culture has provided Welsh intellectuals with some means of overcoming the gap between the intelligentsia and the wider population created by Brexit and so enabling a reconnection between them. [ABSTRACT FROM AUTHOR]

Social Network Analysis (SNA) has shed light on cultures where the influence of patronage, preferment, and reciprocal obligations are traditionally important. We argue here that episcopal appointments, culture, and governance within the Catholic Church are ideal topics for SNA interrogation. This paper presents preliminary findings, using original network data for the Catholic Bishops' Conference of England and Wales and the United States Conference of Catholic Bishops. These show how a network-informed approach may help with the urgent task of understanding the ecclesiastical cultures in which sexual abuse occurs, and/or is enabled, ignored, and covered up. Particular reference is made to Theodore McCarrick, the former DC Archbishop recently "dismissed from the clerical state", and Michael Bransfield, Bishop Emeritus of Wheeling-Charleston. Commentators naturally use terms such as "protégé", "clique", "network", and "kingmaker" when discussing both the McCarrick and Bransfield affairs, and church politics more generally: precisely such folk-descriptions of social and political life that SNA is designed to quantify and explain. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Rural Medicine (Wolters Kluwer India Pvt Ltd) is the property of Wolters Kluwer India Pvt Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The term value‐based healthcare (VBHC) describes an approach to the organization and delivery of care that emphasizes reducing the cost of care while improving outcomes. This involves increased investment earlier in the care pathway e.g., in the prevention, timely diagnosis, and screening for complications in order to maximize the overall impact of care. Key elements of VBHC include the collection and interpretation of relevant data to drive quality improvement and appropriateness of care, a focus on a continuum of care from prevention through to complications, an awareness of the financial drivers of the cost of care and a recognition that meaningful outcomes of care are those that are important to patients. Although VBHC has its origins in North America and has mostly been applied to private health systems, the principles can also be applied to national health services. In publicly funded health systems, where resources are finite, VBHC initiatives aim to eliminate ineffective care that has no beneficial impact or added value for patients and to optimize patient outcomes by delivering care that meets the changing healthcare needs of a population over time. The National Health Service in Wales has established a VBHC Office and has begun to realize the benefits of adopting VBHC approaches. The Irish Health Service Executive (HSE) can learn from the approaches used in Wales. In this paper we explore some of the principles of VBHC through case studies from Ireland and Wales highlighting how national health services are using VBHC to achieve improvement in outcomes for people living with diabetes. [ABSTRACT FROM AUTHOR]

Young people experience significant harm in a range of social contexts and from adults and peers unconnected to their caregivers. The recognition of this by policymakers in England, Scotland, and Wales has resulted in child protection policy frameworks increasingly requiring social work responses to the extra-familial contexts where such harm occurs, as well as to the young people affected. This paper presents results from an embedded research project in which five local children's social care departments used a Contextual Safeguarding framework to respond to this shifting policy direction. The data collected via ethnographic methods over three years included meeting and practice observations (n = 65), meeting participation (n = 334), reviews of young people's case files (n = 122), interviews (n = 27) and focus groups (n = 33) with professionals, focus groups (n = 6), interviews (n = 2) and surveys (n = 78) with parents and young people, and analysis of local policies and procedures (n = 101). At two stages in the project, the researchers used this dataset to review the progress in each participant site against the Contextual Safeguarding framework. Reporting on the progress made across the five sites, this paper identifies elements of the system change that appeared most feasible or challenging. The results demonstrate four ways in which current policy reforms fall short in creating national contexts that are conducive to the implementation of Contextual Safeguarding, despite local progress towards this goal. The implications for the policy and practices are outlined, with fundamental questions asked of the statutory systems which need to protect, but all too often criminalise, young people abused beyond their front doors. [ABSTRACT FROM AUTHOR]

This paper demonstrates for the first time that prisons with a higher proportion of natural vegetation within their perimeter have lower levels of staff sickness absence. It makes three significant contributions. First, it extends studies of workplace nature contact into the un-researched carceral context. Second, whereas previous workplace nature contact studies have largely utilized single-site surveys, it presents national-level, statistically robust analysis. Third, it brings a novel new perspective to studies of sickness absence within correctional workforces, by considering the effect of the physical environment. Econometric estimations presented in the paper confirm lower levels of staff sick-leave in prisons with more greenspace. This relationship persists when we control for prison size, security level, age, level of crowding, levels of self-harm and violence among prisoners, and assaults against staff. The findings are significant in demonstrating the benefits of nature contact in workplaces in general, and carceral environments in particular. Importantly, this has the potential to influence future prison design. [ABSTRACT FROM AUTHOR]

Background: Skin cancer comprises half of all cancers in England and Wales. Most skin cancers can be prevented with safer sun exposure. As over exposure as a child can greatly increase future skin cancer risk, early and accessible sun safety education and promotion of sun safe behaviours is critical. Scientists agree there is no such thing as a 'safe tan', yet the public, including children, often have positive perceptions of tanned skin. To protect against future skin cancer, it is important to understand and address these misconceptions. The Curriculum for Wales with its area for Health and Well-being, and autonomy for schools in designing curriculum content, presents an ideal way to facilitate this exploration. Aims: Gather data regarding perceptions towards tanning to explore the perceived effects of a tan on health. Inform the development and testing of an educational toolkit for integration within the Curriculum for Wales to encourage positive health behaviours and attitudes of school children towards tanning and sun exposure. Methods: SunChat is a mixed methods exploratory study comprising three work streams: Workshops with school children to understand their perceptions on tanning. An online multiple-choice survey with parents/carers to understand perceptions, attitudes and behaviours towards tanning both for themselves and their children. An informal focus group with primary school educators to explore challenges in engaging with the school community around the Health and Well-being Area in the Curriculum for Wales. Discussion: To date, there has been no work in Wales exploring children's, parents/carers', and educators' perceptions of tanning and how healthier attitudes can be encouraged. This study will engage with participants to scope current perceptions on tanning and the perceived effects tanning has on health. Findings will feed into future toolkit and curriculum development for health in schools in Wales and beyond. [ABSTRACT FROM AUTHOR]

Laws mandating vaccination against Covid-19 as a condition of employment in health and care sectors were commonplace during the pandemic. Using weekly data at the local authority level, we examine the impact of the vaccine mandate for elderly care homes in England on vaccine take-up, staffing levels, and mortality. Our identification strategy involves (1) comparing take-up and staffing in English elderly care homes relative to other social care settings unaffected by the mandate; (2) comparing take-up and staffing in English elderly care homes relative to those in Wales where the mandate also did not apply; and (3) comparing Covid-19 mortality among English elderly care home residents relative to mortality in domestic homes in England and to care homes in Wales. Our results suggest that the mandate substantially decreased the proportion of care home workers who remained unvaccinated (equivalent to between 28,000 and 41,000 fewer unvaccinated staff), but this came at the cost of a reduction in staffing levels of between 3% and 4% (equivalent to 14,000 to 18,000 staff). We observe this effect most strongly in areas of low unemployment. Our results do not provide evidence that the vaccine mandate was successful in its primary aim of reducing care home deaths. Relatively wide confidence intervals mean inferences regarding mortality are more uncertain than for vaccination uptake and staffing. This paper was accepted by Carri W. Chan, healthcare management. Supplemental Material: The data and e-companion are available at https://doi.org/10.1287/mnsc.2023.4832. [ABSTRACT FROM AUTHOR]

Background: COVID-19 caused disruption to healthcare services globally, resulting in high numbers of hospital admissions and with those discharged often requiring ongoing support. Within the UK, post-discharge services typically developed organically and were shaped over time by local need, funding, and government guidance. Drawing on the Moments of Resilience framework, we explore the development of follow-up services for hospitalised patients by considering the links between resilience at different system levels over time. This study contributes to the resilient healthcare literature by providing empirical evidence of how diverse stakeholders developed and adapted services for patients following hospitalisation with COVID-19 and how action taken at one system level influenced another. Methods: Qualitative research comprising comparative case studies based on interviews. Across three purposively selected case studies (two in England, one in Wales) a total of 33 semi-structured interviews were conducted with clinical staff, managers and commissioners who had been involved in developing and/or implementing post-hospitalisation follow-up services. The interviews were audio-recorded and professionally transcribed. Analysis was conducted with the aid of NVivo 12. Results: Case studies demonstrated three distinct examples of how healthcare organisations developed and adapted their post-discharge care provision for patients, post-hospitalisation with COVID-19. Initially, the moral distress of witnessing the impact of COVID-19 on patients who were being discharged coupled with local demand gave clinical staff the impetus to take action. Clinical staff and managers worked closely to plan and deliver organisations' responses. Funding availability and other contextual factors influenced situated and immediate responses and structural adaptations to the post-hospitalisation services. As the pandemic evolved, NHS England and the Welsh government provided funding and guidance for systemic adaptations to post-COVID assessment clinics. Over time, adaptations made at the situated, structural, and systemic levels influenced the resilience and sustainability of services. Conclusions: This paper addresses understudied, yet inherently important, aspects of resilience in healthcare by exploring when and where resilience occurs across the healthcare system and how action taken at one system level influenced another. Comparison across the case studies showed that organisations responded in similar and different ways and on varying timescales to a disruption and national level strategies. [ABSTRACT FROM AUTHOR]

Background: Long-acting injectable buprenorphine (LAIB) is a new treatment for opioid use disorder that has been introduced against an international policy backdrop of recovery and person-centred care. This paper explores the goals that people want to achieve from LAIB to identify potential implications for policy and practice. Methods: Data derive from longitudinal qualitative interviews conducted with 26 people (18 male; 8 female) initiating LAIB in England and Wales, UK (June 2021-March 2022). Participants were interviewed up to five times by telephone over six months (107 interviews in total). Transcribed interview data relating to each participant's treatment goals were coded, summarised in Excel, and then analysed via a process of Iterative Categorization. Results: Participants often articulated a desire to be abstinent without defining exactly what they meant by this. Most intended to reduce their dosage of LAIB but did not want to rush. Although participants seldom used the term 'recovery', almost all identified objectives consistent with current definitions of this concept. Participants articulated broadly consistent goals over time, although some extended the timeframes for achieving treatment-related goals at later interviews. At their last interview, most participants remained on LAIB, and there were reports that the medication was enabling positive outcomes. Despite this, participants were aware of the complex personal, service-level, and situational factors that hindered their treatment progress, understood the additional support they needed to achieve their goals, and voiced frustrations when services failed them. Conclusions: There is a need for wider debate regarding the goals people initiating LAIB are seeking and the diverse range of positive treatment outcomes LAIB could potentially generate. Those providing LAIB should offer regular on-going contact and other forms of non-medical support so that patients have the best opportunity to succeed. Policies relating to recovery and person-centred care have previously been criticised for responsibilising patients and service users to take better care of themselves and to change their own lives. In contrast, our findings suggest that these policies may, in fact, be empowering people to expect a greater range of support as part of the package of care they receive from service providers. [ABSTRACT FROM AUTHOR]

Background: Children and young people's (CYP) mental health is a major public health concern internationally and the recent Covid-19 pandemic has amplified these concerns. However, only a minority of CYP receive support from mental health services due to the attitudinal and structural barriers they and their families encounter. For over 20 years, report after report has consistently highlighted the shortcomings of mental health services for CYP in the United Kingdom and attempts to improve services have been largely unsuccessful. The findings reported in this paper are from a multi-stage study that aimed to develop a model of effective, high-quality service design for CYP experiencing common mental health problems. The aim of the stage reported here was to identify CYP's, parents' and service providers' perceptions of the effectiveness, acceptability and accessibility of services. Methods: Case studies were conducted of nine different services for CYP with common mental health problems in England and Wales. Data were collected using semi-structured interviews with 41 young people, 26 parents and 41 practitioners and were analysed using the Framework approach. Patient and Public Involvement was integrated throughout the study with a group of young co-researchers participating in data collection and analysis. Results: Four key themes defined participants' perceptions of service effectiveness, acceptability and accessibility. Firstly, open access to support with participants highlighting the importance of self-referral, support at the point of need and service availability to CYP/parents. Secondly, the development of therapeutic relationships to promote service engagement which was based on assessment of practitioner's personal qualities, interpersonal skills and mental health expertise and underpinned by relational continuity. Thirdly, personalisation was viewed as promoting service appropriateness and effectiveness by ensuring support was tailored to the individual. Fourthly, the development of self-care skills and mental health literacy helped CYP/parents manage and improve their/their child's mental health problems. Conclusions: This study contributes to knowledge by identifying four components that are perceived to be central to providing effective, acceptable and accessible mental health services for CYP with common mental health problems irrespective of service model or provider. These components could be used as the foundations for designing and improving services. [ABSTRACT FROM AUTHOR]

This paper considers housing activity transmission across space using local indicators of spatial association. Activity does not diffuse like a ripple across England and Wales. Elevated activity appears to be associated with a south east-north west divide. The south east grows more quickly than the north west for a period of time, after which there is a switch in rank order. It is argued that changes in activity is associated with changing credit conditions to which the south east is more sensitive. Furthermore, it is proposed that activity features a type of participant induced on to the market by favourable price changes and credit conditions. It is argued that the reduced activity associated with 'missing mortgage movers' post-2007 reflects the lack of mortgage mover participation, which could have negative consequences for the macroeconomy. [ABSTRACT FROM AUTHOR]

With increasing costs of healthcare in England and Wales following the COVID-19 pandemic, finding alternatives to traditional medical interventions is more important than ever. Social prescribing provides a way of addressing health and well-being through using non-medical methods that may help relieve costs to the NHS. Evaluating interventions, such as social prescribing, which have high social (but not easily quantifiable) value, can be problematic. Social return on investment (SROI) is a method of assigning monetary values to both social value as well as traditional assets, so provides a way of evaluating social prescribing initiatives. This protocol outlines the steps that will be taken in a systematic review of the SROI literature surrounding social prescribing-type integrated health and social care interventions based in the community in England and Wales. Online academic databases such as PubMed Central, ASSIA and Web of Science will be searched, as will grey literature sources such as Google Scholar, the Wales School for Social Prescribing Research (WSSPR) and Social Value UK. Titles and abstracts from the articles returned by the searches will be reviewed by one researcher. Those selected for full text review will be independently reviewed and compared by two researchers. Where the researchers disagree a third reviewer will help resolve any differences. Information collected will include identifying stakeholder groups, assessing the quality of SROI analyses, identifying intended and unintended changes of social prescribing interventions, and comparing social prescribing initiatives in terms of SROI costs and benefits. Quality assessment will be independently conducted on the selected papers by two researchers. The researchers will discuss to obtain consensus. Where there is disagreement, a third researcher will resolve these cases. A pre-existing quality framework will be developed and used to assess the quality of the literature. Protocol registration Prospero registration number:CRD42022318911. [ABSTRACT FROM AUTHOR]

This paper is offered as a contribution to understanding historical trade. The method of input-output modelling is utilised to evaluate the evolution of cities (and their associated regions) in England and Wales between 1851 and 1911. The construction of input-output accounts for each city region is based on "heroic" data assumptions, which enable the construction of a demonstration model illustrating a new iterative approach to historical analysis. In its current application, the model enables estimates to be made of mesolevel trade between cities, which enhances our analysis of urban evolution in this period. [ABSTRACT FROM AUTHOR]

Non-stationary methods of flood frequency analysis are widespread in research but rarely implemented by practitioners. One reason may be that research papers on non-stationary statistical models tend to focus on model fitting rather than extracting the sort of results needed by designers and decision makers. It can be difficult to extract useful results from non-stationary models that include stochastic covariates for which the value in any future year is unknown. We explore the motivation for including such covariates, whether on their own or in addition to a covariate based on time. We set out a method for expressing the results of non-stationary models as an integrated flow estimate, which removes the dependence on the covariates. This can be defined either for a particular year or over a longer period of time. The methods are illustrated by application to a set of 375 river gauges across England and Wales. We find annual rainfall to be a useful covariate at many gauges, sometimes in conjunction with a time-based covariate. For estimating flood frequency in future conditions, we advocate exploring hybrid approaches that combine the best attributes of non-stationary statistical models and simulation models that can represent changes in climate and river catchments. [ABSTRACT FROM AUTHOR]

Over the centuries there have been a number of attempts, for economic, political and religious reasons, to create Welsh settlements overseas. The most successful of these, in terms of longevity at least, and perhaps the best known of all Welsh emigration ventures, was the establishment in 1865 of a Welsh Settlement in Patagonia, in what is now the Province of Chubut in Argentina, where perhaps as many as 5,000 of the inhabitants still speak Welsh fluently or have some ability with the language. The preservation of Welsh identity was central to the Patagonian project, which aimed to create a new Welsh-speaking, self-governing Wales overseas, founded on Christian and democratic principles. From the outset, songs played an important role in fostering the ideals that inspired the founders of the Settlement, ideals that would come progressively under threat as the Argentine government increasingly asserted its authority over the Settlement, promoting Argentinian identity and replacing Welsh with Spanish as the medium of education. This paper gives an overview of the development of the Welsh Settlement in Chubut down to the present day, focussing especially on the role of song in nurturing the dream of the Settlement's founders. [ABSTRACT FROM AUTHOR]

Mixture cure rate models have been developed to analyze failure time data where a proportion never fails. For such data, standard survival models are usually not appropriate because they do not account for the possibility of non-failure. In this context, mixture cure rate models assume that the studied population is a mixture of susceptible subjects who may experience the event of interest and non-susceptible subjects that will never experience it. More specifically, mixture cure rate models are a class of survival time models in which the probability of an eventual failure is less than one and both the probability of eventual failure and the timing of failure depend (separately) on certain individual characteristics. In this paper, we propose a Bayesian approach to estimate parametric mixture cure rate models with covariates. The probability of eventual failure is estimated using a binary regression model, and the timing of failure is determined using a Weibull distribution. Inference for these models is attained using Markov Chain Monte Carlo methods under the proposed Bayesian framework. Finally, we illustrate the method using data on the return-to-prison time for a sample of prison releases of men convicted of sexual crimes against women in England and Wales and we use mixture cure rate models to investigate the risk factors for long-term and short-term survival of recidivism. [ABSTRACT FROM AUTHOR]

Copyright of Comparative Maritime Law / Poredbeno Pomorsko Pravo is the property of Jadranski zavod HAZU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Medication errors regardless of the degree of patient harm can have a negative emotional impact on the healthcare staff involved. The potential for self-victimization of healthcare staff following medication errors can add to the moral distress of healthcare staff. The stigma associated with errors and their disclosure often haunts healthcare professionals, leading them to question their own professional competence. This paper investigates the negative emotions expressed by healthcare staff in their reported medication administration error incidents along with the immediate responses they received from their seniors and colleagues after the incident.Method: This is a retrospective study using a qualitative descriptive design and text mining. This study includes free-text descriptions of medication administration error incidents (n = 72,390) reported to National Reporting & Learning System in 2016 from England and Wales. Text-mining by SAS text miner and content analysis was used to analyse the data.Results: Analysis of data led to the extraction of 93 initial codes and two categories i.e., 1) negative emotions expressed by healthcare staff which included 4 sub-categories of feelings: (i) fear; (ii) disturbed; (iii) sadness; (iv) guilt and 2) Immediate response from seniors and colleagues which included 2 sub-categories: (i) Reassurance and support and (ii) Guidance on what to do after an error.Conclusion: Negative emotions expressed by healthcare staff when reporting medication errors could be a catalyst for learning and system change. However, negative emotions when internalized as fear, guilt, or self-blame, could have a negative impact on the mental health of individuals concerned, reporting culture, and opportunities for learning from the error. Findings from this study, hence, call for future research to investigate the impact of negative emotions on healthcare staff well-being and identify ways to mitigate these in practice. [ABSTRACT FROM AUTHOR]

Patient and public involvement in health research is important to ensure that research remains relevant to the patient groups it intends to benefit. The UK NIHR funded Blueprint study aimed to develop a 'model' of effective service design for children and young people with common mental health problems. To ensure Blueprint's findings were rooted in lived experience and informed by different perspectives, six young adults with lived experience of mental health issues were recruited, trained and employed as co-researchers to work alongside academic researchers. Blueprint collaborated with a third sector partner (McPin) to recruit, employ and mentor the co-researchers and deliver a bespoke training and mentoring package to support their development. Since Blueprint's scheduled work plan was significantly impacted by the Covid-19 pandemic, planned co-researcher activities had to be adapted to accommodate distance learning and remote fieldwork and analysis. Blueprint's co-researchers, academic researchers and a representative of McPin collaboratively used a process of reflexivity and thematic analysis to capture Blueprint's involvement journey. We identified numerous benefits but also challenges to involvement, some of which were exacerbated by the pandemic. Navigating and overcoming these challenges also allowed us to collectively identify key guidelines for involvement for the wider research community which focus on enabling access to involvement, supporting co-researchers and optimising involvement for the benefit of co-researchers and research teams. This paper presents an overview of the Blueprint involvement journey from co-researcher, academic researcher and McPin perspectives, sharing our learning from the recruitment, training, fieldwork and analysis phases in order to inform the knowledge base on lived experience involvement and provide guidance to other researchers who seek to emulate this approach. Plain English summary: The Blueprint study worked with young co-researchers with lived experience to explore services in England and Wales for children and young people with common mental health problems like depression, anxiety and self-harm. Blueprint aimed to find out what services exist, how children, young people and their families find out about and access these services, what the services actually do, and whether they are helpful and offer value for money. Blueprint worked closely with McPin, a charity that works to support young people with lived experience get involved in research. Together we developed a training and mentoring package to support the co-researcher's development and their preparation for the role which included research interviews with service users, parents/carers and service providers and data analysis. The co-researchers, research team and McPin worked together to reflect on the successes and challenges of this approach to research and the challenges of carrying out this work during a global pandemic. We have summarised what we have learnt about how best to enable and support co-researcher involvement to provide guidance to other researchers. [ABSTRACT FROM AUTHOR]