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This paper presents an overview of the arts-based methodology used in a research project that aimed to explore the impact of the lived experiences of racism on 10- and 11-year-old children in the United Kingdom. The research responds to the relative lack of literature concerning the racialised experiences of young children. We discuss how we developed the arts-based method of body mapping as an ethical approach to foregrounding the children's voices. We consider that this approach contributes to knowledge and understanding about exploring the nuanced and complex relationship between the children's external worlds and their internal feelings, and supporting them to process and communicate this. We suggest that the method presented is transferable, and present our ethically engaged, arts-based planning framework that can be used if others wish to adopt this way of working.

In the UK, the Research Excellence Framework is a mechanism used for ranking the quality of research in higher education institutions. While there has been analysis of the entire Research Excellence Framework, and of the Education unit of assessment more generally, analysis of how research on initial teacher education featured in the Research Excellence Framework has been minimal. In this article, we report on Phase I of an 18-month project that mapped the extent to which initial teacher education-focused research was included in the 2014 Research Excellence Framework. Employing a novel methodology and a theoretical framework based on policy as text and discourse, we identify a sample of 12 higher education institutions that provided initial teacher education programmes and returned outputs to the 2014 Research Excellence Framework. Analysis of over 1,600 outputs suggest that in the 2014 Research Excellence Framework only 5.5 per cent of these were focused on initial teacher education. We discuss the methodological approach, some headline findings and areas for future research, arguing that these add evidence to the literature of initial teacher education-focused research and, in doing so, can inform policy at the levels of schools, higher education institutions, Research Excellence Framework and the government. We conclude that although the Research Excellence Framework only concerns the UK, similar exercises are becoming increasingly prevalent globally, and therefore the extent to which research on initial teacher education was marginalised in the 2014 Research Excellence Framework is of interest to all concerned with teacher education.

Since the public intellectuals of the 1960s, there has been a shift towards the celebrity academic, as subjects such as history and science have transferred into popular television entertainment, often with female academics as the presenters. Using a case study of the British media, a post-feminist lens has been applied to examine how 17 celebrity academics have been represented. The use of gendered academic stereotypes such as the blue stocking, the school ma'am, the eccentric academic and the thinking man's crumpet were in evidence, alongside the male academic stereotypes of the hegemonic academic male, the nerd and the complicit male. With increasing numbers of women participating in the education workforce, one might expect gendered stereotypes to have become more positive. This research indicates that academic stereotypes should be added to the list of gendered stereotypes that need to be addressed as part of the work towards gender equality.

Cheating has been a long-standing issue in university assessments. However, the release of ChatGPT and other free-to-use generative AI tools has provided a new and distinct method for cheating. Students can run many assessment questions through the tool and generate a superficially compelling answer, which may or may not be accurate. We ran a dual-anonymous "quality assurance" marking exercise across four end-of-module assessments across a distance university computer science (CS) curriculum. Each marker received five ChatGPT-generated scripts alongside 10 student scripts. A total of 90 scripts were marked; every ChatGPT generated script for the undergraduate modules received at least a passing grade (>40%), with all of the introductory module CS1 scripts receiving a distinction (>85%). None of the ChatGPT-taught postgraduate scripts received a passing grade (>50%). We also present the results of interviewing the markers and of running our sample scripts through a GPT-2 detector and the TurnItIn AI detector, which both identified every ChatGPT-generated script but differed in the number of false positives. As such, we contribute a baseline understanding of how the public release of generative AI is likely to significantly impact quality assurance processes. Our analysis demonstrates that in most cases, across a range of question formats, topics, and study levels, ChatGPT is at least capable of producing adequate answers for undergraduate assessment.

How can academic developers support Early Career Academics (ECAs) to increase in confidence as they step into their new responsibilities? Previous work has demonstrated the negative impacts of ECAs' low self-efficacy, focusing recommendations on the need for systemic changes. Going further than previous academic development work to apply social cognitive theories of personality, we explore how ECAs can be equipped to understand, reflect on and increase their own confidence. We point to evidence-based approaches and recommend practical steps that can be taken to implement this approach in increasing the confidence of ECAs.

Increasingly across many UK higher education institutions staff and students are questioning and challenging systemic inequalities that affect racially minoritised groups in their learning and sense of belonging within the curriculum. Students are calling for inclusion of diverse sources of knowledge and perspectives, especially from scholars of colour and from the Global South, to enrich what is currently perceived to be a Eurocentric canon. One way to promote more culturally aligned pedagogy is through diversifying reading lists. This article presents findings from two pilot studies that explored the reading lists in one department in social sciences and one in the humanities at the University of Kent, UK. Applying critical race theory as a guiding framework, the first part of the article examines the ways in which a diverse curriculum must include the voices of the marginalised. It then describes the methods: a desk-based review of the reading lists, interviews with academics to inform the work, disseminate the findings, instigate further action and identify future needs, and student focus groups. Crucially, the project resulted from the collaboration between students and staff, and across departments and disciplines. We found that reading lists in both departments overwhelmingly comprised items by White male authors. Students and staff both reflected on the importance of not only curriculum diversification but also barriers to diversification and decolonisation. The article discusses the impact of this project, which has led to a Diversity Mark process, and the Diversity Mark Toolkit, which can be used in any discipline when putting together reading lists to create a more culturally competent curriculum. It concludes by considering other systemic changes needed, with particular attention to changes needed in library services and collections.

The UK government is proposing to replace M-level national award for special educational needs co-ordination training, mandated for SENCos in England, with an unaccredited national professional qualification. Such downgrading of their qualification level is intended to significantly increase the number of qualified SENCos; however, this is likely to reduce SENCos' capacity to exercise 'advocacy leadership' in support of students at risk of marginalization and social exclusion. We reject a neoliberal political discourse of continual improvement that neglects the need for critical literacy and research-informed inclusive practice on the part of SENCos, and suggest that endemic exclusionary practices in English schools are more likely to go unchallenged. The move towards nonaccredited SENCo status risks their deprofessionalisation, and this proposal is linked to an academisation agenda and efforts to normalize a trichotomised education system (comprising mainstream, 'special' and 'alternative' provision) by presenting such changes as an improvement.

This paper examines staff perspectives on institutional representations of a range of areas of diversity and inclusion in a key post-compulsory education sector: that of UK Higher Education (HE). The paper focuses on comparing representational statements made by institutions with the reality of their lived experiences as perceived by staff. The paper first reviews literature around key issues of promoting and progressing in these areas, and how these areas are represented by institutions and the sector as a whole. It presents and discusses data from a survey (n = 300) to show strong agreement with representational statements as mirroring those of institutions, yet statistically significant differences between representations and the reality of lived experiences, particularly in relation to the lived experiences of staff. These data are discussed in the light of progress made by institutions, and the challenges faced in translating representations into real lived experience. Suggestions for institutions and policy makers are made to help better align reality with these representations in the UK Higher Education sector and, theoretically, for post-compulsory education sectors elsewhere.

Global economic events have had a profound effect upon both businesses and the available workforce. Industries need a more skilful and advanced labour market and individuals who complete tertiary-level education are afforded better protection against economic uncertainties. Consequently, demand for higher education worldwide is growing, due to a rising number of globally mobile students. However, return on investment is important and curriculums offering employability enhancement and work opportunities are motivating factors when international students make their study decisions. This paper details one UK university's approach to enhancing international student employability skills and employment outcomes, using a 3-day experiential learning residential on an MBA programme. Employing a survey design, the research investigates the benefits of this residential to 182 international MBA students (all from the Indian subcontinent region). The findings report that the international students developed key employability skills via the residential which significantly increased their propensity to obtain subsequent employment. The results of this paper provide much needed insight into improving both the employability skills and employment outcomes of international students, especially students from the Indian subcontinent, via immersive experiential learning activities.

The UK’s new social security benefit, Universal Credit, is driving up food insecurity. Particularly problematic is the five-week wait for the first payment. Meanwhile, low wages and insecure contracts mean many food sector workers rely on Universal Credit. This qualitative study explores the effects of the five-week wait on food security among these workers. The findings show this is forcing them to depend on family, friends and foodbanks, inducing shame and isolation, and negatively impacting their physical and mental health. Meanwhile, working in the food sector offers little or no protection from these effects and, in some cases, exacerbates them. [ABSTRACT FROM AUTHOR]

Background: Primary care clinicians see people experiencing the full range of mental health problems. Determining when symptoms reflect disorder is complex. The Four-Dimensional Symptom Questionnaire (4DSQ) uniquely distinguishes general distress from depressive and anxiety disorders. It may support diagnostic conversations and targeting of treatment. Aim: To explore peoples' experiences of completing the 4DSQ and their perceptions of their resulting score profile across distress, depression, anxiety, and physical symptoms. Design and setting: A qualitative study was conducted in the UK with people recruited from primary care and community settings. Method: Participants completed the 4DSQ then took part in semi-structured telephone interviews. They were interviewed about their experience of completing the 4DSQ, their perceptions of their scores across four dimensions, and the perceived utility if used with a clinician. Interviews were transcribed verbatim and data were analysed thematically. Results: Twenty-four interviews were conducted. Most participants found the 4DSQ easy to complete and reported that scores across the four dimensions aligned well with their symptom experience. Distinct scores for distress, depression, and anxiety appeared to support improved self-understanding. Some valued the opportunity to discuss their scores and provide relevant context. Many felt the use of the 4DSQ with clinicians would be helpful and likely to support treatment decisions, although some were concerned about time-limited consultations. Conclusion: Distinguishing general distress from depressive and anxiety disorders aligned well with people's experience of symptoms. Use of the 4DSQ as part of mental health consultations may support targeting of treatment and personalisation of care. [ABSTRACT FROM AUTHOR]

Introduction and Background to Study: Published work on dementia research co-production focuses on developing health and social care interventions. Less is written about practicalities and experiences of co-producing dementia research funding applications. UK public contributors are typically from white middle class populations. Widening involvement is essential for co-produced research that meaningfully addresses health inequalities. We provide an example of a diverse lived experience group co-producing a dementia research funding application. An NIHR Dementia Career Development award funded PPIE work to develop a broad research idea. A culturally diverse lived experience group consisted of one person living with dementia, four carers and one former carer. Virtual group sessions drew on each person's unique experiences and expertise. Two co-leads collaborated closely with the researcher. Methods: We reflected on our experiences of diversity and inclusion within the group, based on a coproduced set of questions to guide reflection. Written records of reflections were captured and refined by the group. Results: We structured reflections into three overarching categories: Diversity and inclusion, Benefits to group members and Challenges. The group felt empowered, heard, and like equals in the process. Members valued diversity and mutual learning within the group. Involvement of co-leads was seen as democratic and inclusive. Some members felt Equality, Diversity and Inclusion (EDI) discussions were challenging. Discussion and Conclusions: We share valuable lessons learned in the process, including suggestions for facilitating EDI discussions, building in funding for time and travel to support relationship building, and ensuring PPIE remuneration processes are accessible and streamlined. [ABSTRACT FROM AUTHOR]

The article focuses on understanding the factors that contribute to non-attendance for cervical screening among women in the United Kingdom, as revealed by a literature review. It explores themes such as embarrassment and pain, lack of knowledge, and diverse health beliefs that hinder women from participating in cervical screening programs.

Purpose: This study examines the association between mental health problems in adolescence and general practice (GP) costs during adulthood up to age 50 in the UK. Methods: We conducted secondary analyses of three British birth cohorts (individuals born in single weeks in 1946, 1958 and 1970). Data for the three cohorts were analysed separately. All respondents who participated in the cohort studies were included. Adolescent mental health status was assessed in each cohort using the Rutter scale (or, for one cohort, a forerunner of that scale) completed in interviews with parents and teachers when cohort members were aged around 16. Presence and severity of conduct and emotional problems were modelled as independent variables in two-part regression models in which the dependent variable was costs of GP services from data collection sweeps up to mid-adulthood. All analyses were adjusted for covariates (cognitive ability, mother's education, housing tenure, father's social class and childhood physical disability). Results: Adolescent conduct and emotional problems, particularly when coexisting, were associated with relatively high GP costs in adulthood up to age 50. Associations were generally stronger in females than males. Conclusion: Associations between adolescent mental health problems and annual GP cost were evident decades later, to age 50, suggesting that there could be significant future savings to healthcare budgets if rates of adolescent conduct and emotional problems could be reduced. Trial registration: Not applicable. [ABSTRACT FROM AUTHOR]

This paper presents an overview of the arts‐based methodology used in a research project that aimed to explore the impact of the lived experiences of racism on 10‐ and 11‐year‐old children in the United Kingdom. The research responds to the relative lack of literature concerning the racialised experiences of young children. We discuss how we developed the arts‐based method of body mapping as an ethical approach to foregrounding the children's voices. We consider that this approach contributes to knowledge and understanding about exploring the nuanced and complex relationship between the children's external worlds and their internal feelings, and supporting them to process and communicate this. We suggest that the method presented is transferable, and present our ethically engaged, arts‐based planning framework that can be used if others wish to adopt this way of working. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the impact of usual care plus a fundamental nursing care guideline compared to usual care only for patients in hospital with COVID‐19 on patient experience, care quality, functional ability, treatment outcomes, nurses' moral distress, patient health‐related quality of life and cost‐effectiveness. Design: Parallel two‐arm, cluster‐level randomized controlled trial. Methods: Between 18th January and 20th December 2021, we recruited (i) adults aged 18 years and over with COVID‐19, excluding those invasively ventilated, admitted for at least three days or nights in UK Hospital Trusts; (ii) nurses caring for them. We randomly assigned hospitals to use a fundamental nursing care guideline and usual care or usual care only. Our patient‐reported co‐primary outcomes were the Relational Aspects of Care Questionnaire and four scales from the Quality from the Patient Perspective Questionnaire. We undertook intention‐to‐treat analyses. Results: We randomized 15 clusters and recruited 581 patient and 418 nurse participants. Primary outcome data were available for 570–572 (98.1%–98.5%) patient participants in 14 clusters. We found no evidence of between‐group differences on any patient, nurse or economic outcomes. We found between‐group differences over time, in favour of the intervention, for three of our five co‐primary outcomes, and a significant interaction on one primary patient outcome for ethnicity (white British vs. other) and allocated group in favour of the intervention for the 'other' ethnicity subgroup. Conclusion: We did not detect an overall difference in patient experience for a fundamental nursing care guideline compared to usual care. We have indications the guideline may have aided sustaining good practice over time and had a more positive impact on non‐white British patients' experience of care. Implications for the Profession and/or Patient Care: We cannot recommend the wholescale implementation of our guideline into routine nursing practice. Further intervention development, feasibility, pilot and evaluation studies are required. Impact: Fundamental nursing care drives patient experience but is severely impacted in pandemics. Our guideline was not superior to usual care, albeit it may sustain good practice and have a positive impact on non‐white British patients' experience of care. Reporting Method: CONSORT and CONSERVE. Patient or Public Contribution: Patients with experience of hospitalization with COVID‐19 were involved in guideline development and writing, trial management and interpretation of findings. [ABSTRACT FROM AUTHOR]

Klebsiella pneumoniae (K. pneumoniae) cultures from a hospital-wide outbreak in the UK, which lasted for over 12 months, were sequenced. We sought to sequence and genetically characterise the outbreak strain. Antibiotic Susceptibility Testing (AST) was performed on 65 K. pneumoniae isolates saved from the outbreak. All isolates were sequenced using the Oxford Nanopore Technologies (ONT) MinION flowcell: 10 isolates, including the isolate with the earliest collection date in 2017, were additionally sequenced on the NovaSeq 6000 platform to build high-accuracy nanopore-illumina assemblies. Among the sequenced strains, 60 were typed as ST628. 96.6% (n = 58/60) ST628 strains harboured a large ~247-kb FIB(K) plasmid carrying up to 11 antimicrobial resistance genes, including the extended-spectrum beta-lactamase (ESBL) gene, blaCTX-M-15. Clonality between the outbreak isolates was confirmed using single nucleotide polymorphism (SNP) typing. The outbreak strains were phylogenetically related to clinical ST628 strains identified in 2012, 6 years prior to the outbreak. A rare ESBL K. pneumoniae K2 ST628 strain harbouring a multi-drug resistant (MDR) plasmid encoding the ESBL gene blaCTX-M-15 was detected across multiple independent wards during the protracted nosocomial outbreak. Surveillance of this strain is recommended to prevent future nosocomial outbreaks. [ABSTRACT FROM AUTHOR]

This paper examines staff perspectives on institutional representations of a range of areas of diversity and inclusion in a key post-compulsory education sector: that of UK Higher Education (HE). The paper focuses on comparing representational statements made by institutions with the reality of their lived experiences as perceived by staff. The paper first reviews literature around key issues of promoting and progressing in these areas, and how these areas are represented by institutions and the sector as a whole. It presents and discusses data from a survey (n = 300) to show strong agreement with representational statements as mirroring those of institutions, yet statistically significant differences between representations and the reality of lived experiences, particularly in relation to the lived experiences of staff. These data are discussed in the light of progress made by institutions, and the challenges faced in translating representations into real lived experience. Suggestions for institutions and policy makers are made to help better align reality with these representations in the UK Higher Education sector and, theoretically, for post-compulsory education sectors elsewhere. [ABSTRACT FROM AUTHOR]

Background Problems in intrapartum electronic fetal monitoring with cardiotocography (CTG) remain a major area of preventable harm. Poor understanding of the range of influences on safety may have hindered improvement. Taking an interdisciplinary perspective, we sought to characterise the everyday practice of CTG monitoring and the work systems within which it takes place, with the goal of identifying potential sources of risk. Methods Human factors/ergonomics (HF/E) experts and social scientists conducted 325 hours of observations and 23 interviews in three maternity units in the UK, focusing on how CTG tasks were undertaken, the influences on this work and the cultural and organisational features of work settings. HF/E analysis was based on the Systems Engineering Initiative for Patient Safety 2.0 model. Social science analysis was based on the constant comparative method. Results CTG monitoring can be understood as a complex sociotechnical activity, with tasks, people, tools and technology, and organisational and external factors all combining to affect safety. Fetal heart rate patterns need to be recorded and interpreted correctly. Systems are also required for seeking the opinions of others, determining whether the situation warrants concern, escalating concerns and mobilising response. These processes may be inadequately designed or function suboptimally, and may be further complicated by staffing issues, equipment and ergonomics issues, and competing and frequently changing clinical guidelines. Practice may also be affected by variable standards and workflows, variations in clinical competence, teamwork and situation awareness, and the ability to communicate concerns freely. Conclusions CTG monitoring is an inherently collective and sociotechnical practice. Improving it will require accounting for complex system interdependencies, rather than focusing solely on discrete factors such as individual technical proficiency in interpreting traces. [ABSTRACT FROM AUTHOR]

Introduction: Online child sexual abuse (OCSA) affects considerable numbers of children globally and is associated with a variety of mental health problems. Existing practitioner studies suggest that young people are infrequently asked about online abuse and practitioners have a fragmented understanding of the problems experienced or how they might approach them. There are very few evidence-based interventions that guide clinical assessment or practice. Digital Health Interventions (DHIs) have the potential to be an effective option where children and young people's services are challenged, including accessibility and anonymity. The aim of this study was to explore mental health practitioners' views of how DHIs may play a role in supporting young people who have experienced OCSA, and the role they can play in healthcare delivery. Method: In-depth qualitative interviews and one focus group were conducted with 25 child mental health professionals across two sites (Manchester and Edinburgh). Data was analyzed using reflexive thematic analysis. Results: Three overarching themes and 9 sub-themes were identified: (1) feeling a little bit lost; (2) seeing potential problems; and (3) knowing what works. Practitioners expressed interest in a DHI to support this client group and saw it as a way of managing waiting lists and complementing existing therapies. They felt that many young people would see this as a preferred medium to inperson therapy, would be empowering, and offers new ways of learning how to stay safe online. However, there were concerns about how much time would be needed by staff to deliver a DHI, anxieties about safety issues in relation to content and data protection, some of which may be unique to this population of young people, and concerns about the absence of a therapeutic relationship with vulnerable children. Discussion: Our findings indicated that practitioners were uncertain about working with children subjected to OCSA but were receptive to the possibility of using a DHI to support their practice and to reduce waiting lists. Concerns were expressed about the time needed for staff training and support as well as concerns over patient safety and the lack of evidence about the effectiveness of an unsupported DHI. [ABSTRACT FROM AUTHOR]

Background: Explainer animations are a means to communicate aspects of clinical trials to participants in a more engaging and accessible way. Delivered well these have the potential to enhance recruitment and retention. The range of media technology used to deliver this material is expanding rapidly but is highly fragmented. Usage of explainer animations across the UK is unknown, the aim of this research was to determine current usage across the 52 registered UK Clinical Research Collaboration (UKCRC) Clinical Trials Units (CTUs) to understand the current landscape and any barriers that could be preventing wider uptake of this functionality. Methods: A survey link was emailed to all UKCRC CTU Directors and Trial Management Leads to ascertain current usage of explainer animations within their CTU. The survey ran between 01 February 2023 and 07 March 2023. Results: Responses were received from 35 CTUs—representing a response rate of 67%. 24 CTUs (69%) reported that they had created/used at least one explainer animation within their unit, although the usage, cost, length and production activities varied among the units. Conclusions: The survey showed that a high proportion of the UKCRC CTUs have used explainer animations to provide information to participants about clinical studies. For those not using the technology yet, the most common reasons cited were a lack of expertise, lack of resources and costs to produce them. One of the desired outcomes of this project is the creation of a free-to-use library of animations to encourage wider uptake and avoid duplication. [ABSTRACT FROM AUTHOR]

Background: Although APOE ε4 allele carriage confers a risk for coronary artery disease, its persistence in humans might be explained by certain survival advantages (antagonistic pleiotropy). Methods: Combining data from ~ 37,000 persons from three older age British cohorts (1946 National Survey of Health and Development [NSHD], Southall and Brent Revised [SABRE], and UK Biobank) and one younger age cohort (Avon Longitudinal Study of Parents and Children [ALSPAC]), we explored whether APOE ε4 carriage associates with beneficial or unfavorable left ventricular (LV) structural and functional metrics by echocardiography and cardiovascular magnetic resonance (CMR). Results: Compared to the non-APOE ε4 group, APOE ε4 carriers had similar cardiac phenotypes in terms of LV ejection fraction, E/e', posterior wall and interventricular septal thickness, and LV mass. However, they had improved myocardial performance resulting in greater LV stroke volume generation per 1 mL of myocardium (higher myocardial contraction fraction). In NSHD (n = 1467) and SABRE (n = 1187), ε4 carriers had a 4% higher MCF (95% CI 1–7%, p = 0.016) using echocardiography. Using CMR data, in UK Biobank (n = 32,972), ε4 carriers had a 1% higher MCF 95% (CI 0–1%, p = 0.020) with a dose-response relationship based on the number of ε4 alleles. In addition, UK Biobank ε4 carriers also had more favorable radial and longitudinal strain rates compared to non APOE ε4 carriers. In ALSPAC (n = 1397), APOE ε4 carriers aged < 24 years had a 2% higher MCF (95% CI 0–5%, p = 0.059). Conclusions: By triangulating results in four independent cohorts, across imaging modalities (echocardiography and CMR), and in ~ 37,000 individuals, our results point towards an association between ε4 carriage and improved cardiac performance in terms of LV MCF. This potentially favorable cardiac phenotype adds to the growing number of reported survival advantages attributed to the pleiotropic effects APOE ε4 carriage that might collectively explain its persistence in human populations. [ABSTRACT FROM AUTHOR]

Background: The accumulation of age‐associated cognitive deficits can lead to Mild Cognitive Impairment (MCI) and dementia. This is a major public health issue for the modern ageing population, as it impairs health, independence and overall quality of life. Keeping the brain active during life has been associated with an increased cognitive reserve, therefore reducing the risk of cognitive impairment in older age. Previous research has identified a potential relationship between musicality and cognition. Objectives: Explore the relationship between musicality and cognitive function in a large cohort of older adults. Methods: This was a nested study within the PROTECT‐UK cohort, which collects longitudinal computerised assessments of cognitive function in adults over 40. Participants were invited to complete the validated Edinburgh Lifetime Musical Experience Questionnaire (ELMEQ) to assess their musical experience and lifetime exposure to music. Linear regression analysis was performed using cognitive data from PROTECT‐UK. Results: Analysis identified an association between musicality and cognition in this cohort. Playing a musical instrument was associated with significantly better performance in working memory and executive function. Significant associations were also found between singing and executive function, and between overall musical ability and working memory. Conclusions: Our findings confirm previous literature, highlighting the potential value of education and engagement in musical activities throughout life as a means of harnessing cognitive reserve as part of a protective lifestyle for brain health. Key points: Playing a musical instrument was associated with significantly better working memory and executive function.Singing and overall musical ability was associated with more favourable cognition.Engagement with musical activities should be considered as part of public health initiatives to promote a protective lifestyle for brain health. [ABSTRACT FROM AUTHOR]

British and English national identities have long been considered to have porous boundaries whereby English individuals consider the terms more or less interchangeable. However, there is no empirical evidence to demonstrate whether primary feelings of either Britishness or Englishness are highly fluid within-individuals or whether individuals are consistent in their perceptions of their British or English identity. This is especially relevant in the post-Brexit referendum context where national identity is highly correlated with Brexit attitudes. Using panel data, we demonstrate that there is a notable degree of fluidity between identifying as British or English. This is higher than the fluidity between other national identities in the UK as well as more fluid than moving between any partisan or EU referendum identities. Remainers are more fluid than Leavers in their Englishness, whereas they are similar in the fluidity of their Britishness. [ABSTRACT FROM AUTHOR]

Objectives Glucocorticoids (GCs) ('steroids') are used to treat rheumatic diseases but adverse effects are common. We aimed to explore the impact of GC therapy on health-related quality of life (HRQoL), to inform the development of a treatment-specific patient-reported outcome measure (PROM) for use in clinical trials and practice. Methods Semi-structured qualitative interviews were conducted with patients from the UK, USA and Australia, treated for a rheumatic condition with GCs in the last 2 years. Purposive sampling was used to select participants with a range of demographic and disease features. An initial conceptual framework informed interview prompts and cues. Interviews elicited GC-related physical and psychological symptoms and salient aspects of HRQoL in relation to GC therapy. Interview data were analysed inductively to develop initial individual themes and domains. Candidate questionnaire items were developed and refined. Results Sixty semi-structured qualitative interviews were conducted (UK n  = 34, USA n  = 10, Australia n  = 16). The mean age was 58 years; 39/60 were female; and 18 rheumatic diseases were represented. Some 126 individual themes were identified and organized into six domains: physical symptoms; psychological symptoms; psychological impact of steroids; impact of steroids on participation; impact of steroids on relationships; and benefits of steroids. Candidate questionnaire items were tested and refined by piloting with patient research partners, iterative rounds of cognitive interviews and linguistic translatability assessment, informing a draft questionnaire. Conclusion We describe an international qualitative study to develop candidate items for a treatment-specific PROM for patients with rheumatic diseases. A future survey will enable the validation of a final version of the PROM. [ABSTRACT FROM AUTHOR]

Background: The impact of COVID-19 pandemic on the provision of drug and alcohol (D&A) services and associated outcomes have been under-researched. Aim: This study aimed to understand the experiences of service providers in relation to how drug and alcohol (D&A) services were affected during COVID-19 pandemic, including the adaptations made and lessons learnt for the future. Method: Focus groups and semi-structured interviews were conducted with participants from various D&A service organisations across the UK. Data were audio recorded, followed by transcription and thematic analysis. Results: A total of 46 participants representing various service providers were recruited between October and January 2022. The thematic analysis identified ten themes. COVID-19 required significant changes to how the treatment was provided and prioritised. Expansion of telehealth and digital services were described, which reduced service wait times and increased opportunities for peer network. However, they described missed opportunities for disease screening, and some users risked facing digital exclusion. Participants who provided opiate substitution therapy service spoke of improving service provider/user trust following the shift from daily supervised treatment consumption to weekly dispensing. At the same time, they feared fatal overdoses and non-adherence to treatment. Conclusion: This study demonstrates the multifaceted impact of the COVID-19 pandemic on UK-based D&A service provisions. The long-term impact of reduced supervision on Substance Use Disorder treatment and outcomes and any effect of virtual communications on service efficiency, patient-provider relationships and treatment retention and successes are unknown, suggesting the need for further study to assess their utility. [ABSTRACT FROM AUTHOR]

Background: Databases have become an important tool in understanding trends and correlations in health care by collecting demographic and clinical information. Analysis of data collected from large cohorts of patients can have the potential to generate insights into factors identifying treatments and the characteristics of subgroups of patients who respond to certain types of care. The Care Response (CR) database was designed to capture patient-reported outcome measures (PROMs) for chiropractic patients internationally. Although several papers have been published analysing some of the data, its contents have not yet been comprehensively documented. The primary aim of this study was to describe the information in the CR database. The secondary aim was to determine whether there was suitable information available to better understand subgroups of chiropractic patients and responsiveness to care. This would be achieved by enabling correlations among patient demographics, diagnoses, and therapeutic interventions with machine learning approaches. Methods: Data in all available fields were requested with no date restriction. Data were collected on 12 April 2022. The output was manually scanned for scope and completeness. Tables were created with categories of information. Descriptive statistics were applied. Results: The CR database collects information from patients at the first clinical visit, 14, 30, and 90 days subsequently. There were 32,468 patient responses; 3210 patients completed all fields through the 90 day follow up period. 45% of respondents were male; 54% were female; the average age was 49. There was little demographic information, and no information on diagnoses or therapeutic interventions. We received StartBack, numerical pain scale, patient global impression of change, and Bournemouth questionnaire data, but no other PROMs. Conclusions: The CR database is a large set of PROMs for chiropractic patients internationally. We found it unsuitable for machine learning analysis for our purposes; its utility is limited by a lack of demographic information, diagnoses, and therapeutic interventions. However, it can offer information about chiropractic care in general and patient satisfaction. It could form the basis for a useful clinical tool in the future, if reformed to be more accessible to researchers and expanded with more information collected. [ABSTRACT FROM AUTHOR]

Background: Coroners, who hold inquests to determine the causes of unnatural deaths in England and Wales, having recognised factors that could cause other deaths, are legally obliged to signal concerns by sending 'Reports to Prevent Future Deaths' (PFDs) to interested persons. We aimed to establish whether Coroners' concerns about medications are widely recognised. Methods: We searched MEDLINE, Embase and Web of Science up to 30 November, 2022 for publications linking PFDs and medications using a combination of search terms "coroner*", "inquest*", "medicine*", "medication*" and "prevent*". We also searched the BMJ, a UK journal that carries news items; and the databases Nexis Advance and News On the Web for reports in national newspapers between 2013 and 2022, using the search terms ("regulation 28" OR "prevent future deaths" OR "prevention of future deaths") AND "coroner". We recorded the number of publications, as well as their citations in Google Scholar at 23 May, 2023. Results: Only 11 published papers on medicines referenced UK PFDs, nine of which were from our group. The BMJ carried 23 articles mentioning PFDs, five related to medicines. Of 139 PFDs (out of over 4000) mentioned in national newspapers, only nine related to medicines. Conclusions: The PFDs related to medicines are not widely referred to in medical journals or UK national newspapers. By contrast, the Australian and New Zealand National Coronial Information System has contributed cases to 206 publications cited in PubMed, of which 139 are related to medicines. Our search suggests that information from English and Welsh Coroners' PFDs is under-recognised, even though it should inform public health. The results of inquiries by Coroners and medical examiners worldwide into potentially preventable deaths involving medicines should be used to strengthen the safety of medicines. [ABSTRACT FROM AUTHOR]

Objectives Increased iron stores have been associated with elevated risks of different infectious diseases, suggesting that iron supplementation may increase the risk of infections. However, these associations may be biased by confounding or reverse causation. This is important, since up to 19% of the population takes iron supplementation. We used Mendelian randomization (MR) to bypass these biases and estimate the causal effect of iron on infections. Methods As instrumental variables, we used genetic variants associated with iron biomarkers in two genome-wide association studies (GWASs) of European ancestry participants. For outcomes, we used GWAS results from the UK Biobank, FinnGen, the COVID-19 Host Genetics Initiative or 23andMe, for seven infection phenotypes: 'any infections', combined, COVID-19 hospitalization, candidiasis, pneumonia, sepsis, skin and soft tissue infection (SSTI) and urinary tract infection (UTI). Results Most of our analyses showed increasing iron (measured by its biomarkers) was associated with only modest changes in the odds of infectious outcomes, with all 95% odds ratios confidence intervals within the 0.88 to 1.26 range. However, for the three predominantly bacterial infections (sepsis, SSTI, UTI), at least one analysis showed a nominally elevated risk with increased iron stores (P  <0.05). Conclusion Using MR, we did not observe an increase in risk of most infectious diseases with increases in iron stores. However for bacterial infections, higher iron stores may increase odds of infections. Hence, using genetic variation in iron pathways as a proxy for iron supplementation, iron supplements are likely safe on a population level, but we should continue the current practice of conservative iron supplementation during bacterial infections or in those at high risk of developing them. [ABSTRACT FROM AUTHOR]

Background: Most adults in the UK experience at least one viral respiratory tract infection (RTI) per year. Individuals with comorbidities and those with recurrent RTIs are at higher risk of infections. This can lead to more severe illness, worse quality of life and more days off work. There is promising evidence that using common nasal sprays or improving immune function through increasing physical activity and managing stress, may reduce the incidence and severity of RTIs. Methods and design: Immune Defence is an open, parallel group, randomised controlled trial. Up to 15000 adults from UK general practices, with a comorbidity or risk factor for infection and/or recurrent infections (3 or more infections per year) will be randomly allocated to i) a gel-based nasal spray designed to inhibit viral respiratory infections; ii) a saline nasal spray, iii) a digital intervention promoting physical activity and stress management, or iv) usual care with brief advice for managing infections, for 12 months. Participants will complete monthly questionnaires online. The primary outcome is the total number of days of illness due to RTIs over 6 months. Key secondary outcomes include: days with symptoms moderately bad or worse; days where work/normal activities were impaired; incidence of RTI; incidence of COVID-19; health service contacts; antibiotic usage; beliefs about antibiotics; intention to consult; number of days of illness in total due to respiratory tract infections over 12 months. Economic evaluation from an NHS perspective will compare the interventions, expressed as incremental cost effectiveness ratios. A nested mixed methods process evaluation will examine uptake and engagement with the interventions and trial procedures. Trial status: Recruitment commenced in December 2020 and the last participant is expected to complete the trial in April 2024. Discussion: Common nasal sprays and digital interventions to promote physical activity and stress management are low cost, accessible interventions applicable to primary care. If effective, they have the potential to reduce the individual and societal impact of RTIs. Trial registration: Prospectively registered with ISRCTN registry (17936080) on 30/10/2020. Sponsor: This RCT is sponsored by University of Southampton. The sponsors had no role in the study design, decision to publish, or preparation of the manuscript. [ABSTRACT FROM AUTHOR]

Background: Few studies have examined online experience by young people who die by suicide. Methods: A 3-year UK-wide consecutive case series of all young people aged 10–19 who died by suicide, based on national mortality data. We extracted information on the antecedents of suicide of 544 of these 595 deaths (91%) from official investigations, mainly inquests. Results: Suicide-related online experience was reported in 24% (n = 128/544) of suicide deaths in young people between 2014 and 2016, equivalent to 43 deaths per year, and was more common in girls than boys (OR 1.87, 95% CI 1.23–2.85, p = 0.003) and those identifying as LGBT (OR 2.35, 95% CI 1.10–5.05, p = 0.028). Searching for information about method was most common (n = 68, 13%), followed by posting suicidal ideas online (n = 57, 10%). Self-harm, bereavement (especially by suicide), social isolation, and mental and physical ill-health were more likely in those known to have suicide-related online experience compared to those who did not. 29 (5%) were bullied online, more often girls (OR 2.84, 1.34–6.04, p = 0.007). Online bullying often accompanied face-to-face bullying (n = 16/29, 67%). Conclusions: Suicide-related online experience is a common, but likely underestimated, antecedent to suicide in young people. Although its causal role is unclear, it may influence suicidality in this population. Mental health professionals should be aware that suicide-related online experience – not limited to social media – is a potential risk for young patients, and may be linked to experiences offline. For public health, wider action is required on internet regulation and support for children and their families. [ABSTRACT FROM AUTHOR]

This article considers the levelling‐up agenda in the UK, examining the Johnson government's original proposals to tackle regional and local inequality and its continuation under new Prime Minister Rishi Sunak following the short‐lived premiership of Liz Truss. The 2022 Levelling Up in the United Kingdom White Paper is notable for the frank and wholesale critique it provides of previous governments'—both Tory and Labour—efforts to address the pressing issue of geographic inequality. The assessment was that a pattern of ad hoc and incoherent reforms needed to be replaced by a stable, long term and system‐wide approach to change. Yet, under Johnson, Truss and now Sunak, policy churn is continuing, with an approach that falls short in following the lessons set out in the White Paper. We provide a detailed analysis of the government's critique of past reforms, the lessons it has set out and why its reform programme is likely to repeat past failings. Crucially, the approach leaves the structure of central government almost untouched, with substantive reforms instead focussed at the local governance level. We argue the government's programme perpetuates the 'power‐hoarding' tendencies of the Westminster model, a key bulwark against meaningfully addressing the UK's spatial inequality problem. We conclude that the levelling‐up agenda, missions and targets are unlikely to be met under Rishi Sunak, reflecting the endemic nature of short‐termism and centralisation of power in the UK's public policy approach. We then consider the approach of Starmer's Labour Party to levelling up and the issues it needs to confront if it forms the next government. [ABSTRACT FROM AUTHOR]

Pride and festivals have contributed significantly to social change by increased visibility and campaigning for gay rights, highlighting the importance of the events industry in enhancing the LGBTQIA+ movement's representation. This has not been reflected in research with a lack of convergence between queer, social-cognitive behaviour and communication theories. This study addresses this gap by investigating the UK?news media's representations of Pride and their impact on public perceptions of the LGBTQIA+ community. 'Sentiwordnet' opinion mining software was used to analyse media representations of pride in eight UK newspapers. Selected images and headlines were then embedded into a survey to understand image perception, headline correlation and exposure to different media types. The study found limited influence of traditional news media on participants' perceptions of pride, despite some negative framing. Fifth estate journalism emerges as positive and influential, revealing a shift in media representation influences. The paper proposes a revised framework incorporating the Fifth estate when measuring public perceptions of LGBTQIA+. [ABSTRACT FROM AUTHOR]

Background: The Coronavirus disease 2019 (COVID-19) pandemic has impacted parental and child mental health and wellbeing in the UK. This study aimed to explore the experiences of parents of children with rare neurological and neurodevelopmental conditions with a known or suspected genetic cause (neurogenetic) across the first year of the pandemic in the UK. Methods: Semi-structured interviews were conducted with 11 parents of children with rare neurogenetic conditions. Parents were recruited via opportunity sampling from the CoIN Study, a longitudinal quantitative study exploring the impact of the pandemic on the mental health and wellbeing of families with rare neurogenetic conditions. Interviews were analysed using Interpretative Phenomenological Analysis. Results: Four main themes were identified: (1) "A varied impact on child wellbeing: from detrimental to 'no big drama'"; (2) "Parental mental health and wellbeing: impact, changes, and coping"; (3) "'The world had shut its doors and that was that': care and social services during the pandemic"; and (4) "Time and luck: abstract concepts central to parents' perspectives of how they coped during the pandemic". The majority of parents described experiencing an exacerbation of pre-pandemic challenges due to increased uncertainty and a lack of support, with a minority reporting positive effects of the pandemic on family wellbeing. Conclusions: These findings offer a unique insight into the experiences parents of children with rare neurogenetic conditions across the first year of the pandemic in the UK. They highlight that the experiences of parents were not pandemic-specific, and will continue to be highly relevant in a non-pandemic context. Future support should to be tailored to the needs of families and implemented across diverse future scenarios to promote coping and positive wellbeing. [ABSTRACT FROM AUTHOR]

The UK government is proposing to replace M‐level national award for special educational needs co‐ordination training, mandated for SENCos in England, with an unaccredited national professional qualification. Such downgrading of their qualification level is intended to significantly increase the number of qualified SENCos; however, this is likely to reduce SENCos' capacity to exercise 'advocacy leadership' in support of students at risk of marginalization and social exclusion. We reject a neoliberal political discourse of continual improvement that neglects the need for critical literacy and research‐informed inclusive practice on the part of SENCos, and suggest that endemic exclusionary practices in English schools are more likely to go unchallenged. The move towards nonaccredited SENCo status risks their deprofessionalisation, and this proposal is linked to an academisation agenda and efforts to normalize a trichotomised education system (comprising mainstream, 'special' and 'alternative' provision) by presenting such changes as an improvement. [ABSTRACT FROM AUTHOR]

Forensic entomology contributes important information to criminal investigations. This paper proposes a novel method to estimate the hatching time of fly larvae based on the temperature profile at the crime scene and on experimental data on larval development, where larvae are exposed to a constant temperature. We develop a dynamic model to estimate the growth curve under time-varying temperature profiles and the corresponding hatching time at the crime scene. Asymptotic properties are provided for the proposed estimators, and we explore their robustness via simulations. The proposed methodology is demonstrated on data from two criminal cases from the UK. [ABSTRACT FROM AUTHOR]

Background: Dyslipidaemia is an important cardiovascular risk factor for people with severe mental illness, contributing to premature mortality. The link between antipsychotics and dyslipidaemia is well established, while evidence on antidepressants is mixed. Aims: To investigate if antidepressant/antipsychotic use was associated with lipid parameters in UK Biobank participants and if CYP2C19 and CYP2D6 genetic variation plays a role. Methods: Review of self-reported prescription medications identified participants taking antidepressants/antipsychotics. Total, low-, and high-density lipoprotein cholesterol (L/HDL-C) and triglycerides derived from blood samples. CYP2C19 and CYP2D6 metabolic phenotypes were assigned from genetic data. Linear regression investigated aims, adjusted for key covariates. Results: Of 469,739 participants, 36,043 took antidepressants (53% female, median age 58, 17% taking cholesterol-lowering medications) and 3255 took antipsychotics (58% female, median age 57, 27% taking cholesterol-lowering medications). Significant associations were found between use of each amitriptyline, fluoxetine, citalopram/escitalopram, sertraline, paroxetine and venlafaxine with higher total cholesterol, LDL-C, and triglycerides and lower HDL-C, compared to participants not taking each medication. Venlafaxine was associated with the worst lipid profile (total cholesterol, adjusted mean difference: 0.21 mmol/L, 95% confidence interval (CI): 0.17 to 0.26, p < 0.001). Antipsychotic use was significantly associated with lower HDL-C and higher triglycerides. In participants taking sertraline, CYP2C19 intermediate metabolisers had higher HDL-C (0.05 mmol/L, 95% CI: 0.01 to 0.09, p = 0.007) and lower triglycerides (−0.17 mmol/L, 95% CI: −0.29 to −0.05, p = 0.007), compared to normal metabolisers. Conclusions: Antidepressants were significantly associated with adverse lipid profiles, potentially warranting baseline and regular monitoring. Further research should investigate the mechanistic pathways underlying the protective effects of the CYP2C19 intermediate metaboliser phenotype on HDL-C and triglycerides in people taking sertraline. [ABSTRACT FROM AUTHOR]

Background: Growing evidence suggests that population mental health outcomes have worsened since the pandemic started. The extent that these changes have altered common age-related trends in psychological distress, where distress typically rises until midlife and then falls after midlife in both sexes, is unknown. We aimed to analyse whether long-term pre-pandemic psychological distress trajectories were disrupted during the pandemic, and whether these changes have been different across cohorts and by sex. Methods and findings: We used data from three nationally representative birth cohorts comprising all people born in Great Britain in a single week of 1946 (National Survey of Health and Development, NSHD), 1958 (National Child Development Study, NCDS), or 1970 (British Cohort Study, BCS70). The follow-up data used spanned 39 years in NSHD (1982 to 2021), 40 years in NCDS (1981 to 2001), and 25 years in BCS70 (1996 to 2021). We used psychological distress factor scores, as measured by validated self-reported questionnaires (NSHD: Present State Examination, Psychiatric Symptoms Frequency, and 28- and 12-item versions of General Health Questionnaire; NCDS and BCS70: Malaise Inventory; all: 2-item versions of Generalized Anxiety Disorder scale and Patient Health Questionnaire). We used a multilevel growth curve modelling approach to model the trajectories of distress across cohorts and sexes and obtained estimates of the differences between the distress levels observed during the pandemic and those observed at the most recent pre-pandemic assessment and at the peak in the cohort-specific pre-pandemic distress trajectory, located at midlife. We further analysed whether pre-existing cohort and sex inequalities had changed with the pandemic onset using a difference-in-differences (DiD) approach. The analytic sample included 16,389 participants. By September/October 2020, distress levels had reached or exceeded the levels of the peak in the pre-pandemic life-course trajectories, with larger increases in younger cohorts (standardised mean differences [SMD] and 95% confidence intervals of SMDNSHD,pre-peak = −0.02 [−0.07, 0.04], SMDNCDS,pre-peak = 0.05 [0.02, 0.07], and SMDBCS70,pre-peak = 0.09 [0.07, 0.12] for the 1946, 1958, and 1970 birth cohorts, respectively). Increases in distress were larger among women than men, widening pre-existing sex inequalities (DiD and 95% confidence intervals of DiDNSHD,sex,pre-peak = 0.17 [0.06, 0.28], DiDNCDS,sex,pre-peak = 0.11 [0.07, 0.16], and DiDBCS70,sex,pre-peak = 0.11 [0.05, 0.16] when comparing sex inequalities in the pre-pandemic peak in midlife to those observed by September/October 2020). As expected in cohort designs, our study suffered from high proportions of attrition with respect to the original samples. Although we used non-response weights to restore sample representativeness to the target populations (those born in the United Kingdom in 1946, 1958, and 1970, alive and residing in the UK), results may not be generalisable to other sections within the UK population (e.g., migrants and ethnic minority groups) and countries different than the UK. Conclusions: Pre-existing long-term psychological distress trajectories of adults born between 1946 and 1970 were disrupted during the COVID-19 pandemic, particularly among women, who reached the highest levels ever recorded in up to 40 years of follow-up data. This may impact future trends of morbidity, disability, and mortality due to common mental health problems. Author summary: Why was this study done?: The COVID-19 pandemic has negatively impacted the mental health of the population, with disproportionate effects among specific subgroups such as women and younger people. Previous research suggests that, in the UK population, long-term trends of psychological distress are expected to reach their highest point during midlife (around age 30 to 45) and decrease towards older age. Little is known about where the potential impact of the COVID-19 pandemic stands in relation to those long-term trends of psychological distress, and whether this impact has been different across cohorts and sexes. What did the researchers do and find?: We used data on 16,389 participants from three British birth cohorts representing people born in Britain in 1946, 1958, and 1970, with data on psychological distress collected between 1982 and 2021 (age 36 to 75), 1981 and 2021 (age 23 to 63), and 1996 and 2021 (age 26 to 51), respectively. We measured the long-term psychological distress trajectories of different cohorts (people born in 1946, 1958, and 1970) and sexes (women and men). We found that psychological distress levels increased during the COVID-19 pandemic, reaching or exceeding the highest levels ever recorded in up to 40 years of data, and that this increase was larger among women. What do these findings mean?: This study suggests that, during the COVID-19 pandemic, there has been a new peak in the long-term trajectories of psychological distress in the UK population, one that was largely unexpected considering pre-existing trends, in addition to the peak already observed in midlife. This new peak in the psychological distress trajectories has been substantially larger in women than in men, widening the sex inequalities already existing prior to the pandemic onset. This new peak in distress may increase the trends of morbidity, disability, and mortality due to common mental health problems, with women likely being disproportionately affected. Public policies aimed at the provision of support and monitoring of population mental health, particularly among those most disproportionately affected by the pandemic, are needed to tackle existing and prevent future inequalities. [ABSTRACT FROM AUTHOR]

As the climate changes there is a need to reduce the reliance on Sitka spruce (Picea sitchensis (Bong) Carr.) in upland British forestry and increase species diversity to lower the risk of damage or loss of production due to biotic or abiotic events. An analysis of relevant species trials was carried out to assess the productivity of potential alternative conifer species on upland site types in Britain. Data from 87 forest experiments planted between 1929 and 1995 were analysed to compare long-term performance of 52 species with that of Sitka spruce under the same conditions and site type. Sites were broadly categorized using soil and climatic factors, which were used as primary factors in models predicting General Yield Class (GYC, the maximum mean annual increment in m3 ha−1 year−1) of the potential alternative species and of Sitka spruce. No species had significantly higher GYC estimates than Sitka spruce, but grand fir (Abies grandis (Douglas ex D. Don) Lindl.), noble fir (Abies procera (Rehder)), western hemlock (Tsuga heterophylla (Raf.) Sarg.), Lutz's spruce (Picea x lutzii (Little)), maritime pine (Pinus pinaster (Aiton)), Lawson cypress (Chamaecyparis lawsoniana (A. Murray bis) Parl.), Scots pine (Pinus sylvestris (L.)), Douglas-fir (Pseudotsuga menziesii (Mirb.) Franco) and western red cedar (Thuja plicata (Donn ex D.Don)) all had GYC estimates which were not significantly lower than that of Sitka spruce under certain soil and climate conditions. A further 26 species, particularly Abies species, had GYC within 3 m3 ha−1 year−1 of Sitka spruce but were present on too few sites for inclusion in statistical models. The results of the analysis provide objective evidence for the planting of a wider range of species where Sitka spruce may currently be first choice. In the absence of any major pest or disease affecting Sitka spruce, it is still a good choice for many upland sites, however, a wider range of options with equivalent productivity exist, allowing forest managers to diversify and reduce the risk of damage or loss of production due to biotic or abiotic events. [ABSTRACT FROM AUTHOR]

The changing nature of employment has led to increased awareness of leaveism, a practice involving employees using allocated time off when unwell, taking work home, and picking up work when on annual leave. However, there are theoretical, methodological, and policy/practice‐related weaknesses, apparent in current understandings. The main article aim is to develop, theoretically, the emergent notion of leaveism, drawing on concepts related to work intensification (WI) and ideal worker norms (IWNs), concepts underpinned by reference to information communication technologies (ICTs), then exploring such ideas via an electronic questionnaire (n = 959), aimed at UK‐based employees performing leaveism. The main argument is leaveism is more than a lacuna between presenteeism and sickness absence; it is an unsustainable employer‐driven social phenomenon sitting at the intersection of WI, IWNs and ICTs. The findings have policy/practice implications for human resource management (HRM) professionals, trade unions and governments. Recommendations for future research including exploring leaveism in an international context, and in a Covid‐19 pandemic‐defined era. [ABSTRACT FROM AUTHOR]

Introduction: Medicines cause over 1700 preventable deaths annually in England. Coroners' Prevention of Future Death reports (PFDs) are produced in response to preventable deaths to facilitate change. The information in PFDs may help reduce medicine-related preventable deaths. Objectives: We aimed to identify medicine-related deaths in coroners' reports and to explore concerns to prevent future deaths. Methods: We carried out a retrospective case series of PFDs across England and Wales, dated between 1 July, 2013 and 23 February, 2022, collected from the UK's Courts and Tribunals Judiciary website using web scraping, generating an openly available database: https://preventabledeathstracker.net/. We used descriptive techniques and content analysis to assess the main outcome criteria: the proportion of PFDs in which coroners reported that a therapeutic medicine or drug of abuse had caused or contributed to a death; the characteristics of included PFDs; coroners' concerns; the recipients of PFDs; and the timeliness of their responses. Results: There were 704 PFDs (18%; 716 deaths) that involved medicines, representing an estimated 19,740 years of life lost (average of 50 years lost per death). Opioids (22%), antidepressants (9.7%), and hypnotics (9.2%) were the most common drugs involved. Coroners expressed 1249 concerns, primarily around the major themes of patient safety (29%) and communication (26%), including minor themes of failures of monitoring (10%) and poor communication between organizations (7.5%). Most expected responses to PFDs (51%; 630/1245) were not reported on the UK's Courts and Tribunals Judiciary website. Conclusions: One in five coroner-reported preventable deaths involved medicines. Addressing coroners' concerns, including problems with patient safety and communication, should reduce harms from medicines. Despite concerns being raised repeatedly, half of the PFD recipients failed to respond, suggesting that lessons are not generally learned. The rich information in PFDs should be used to foster a learning environment in clinical practice that may help reduce preventable deaths. Clinical Trial Registration: https://doi.org/10.17605/OSF.IO/TX3CS. [ABSTRACT FROM AUTHOR]

This article provides a novel account of recent UK governance reforms, describing what can be termed an 'incoherent' state, ill-equipped to address complex, multi-dimensional policy challenges. This is evidenced through two interrelated case-studies: Covid-19 and levelling up. We highlight how the tradition of strongly centralised government combined with an ad hoc approach to reform has undermined inter-governmental relations and limited the possibility of effective policy. We conclude by arguing that current levelling up proposals, focused on redesigning sub-national government, reflect these deficiencies and therefore offer an insufficient remedy for the UK's imbalanced economic geography and resulting inequalities. The failure of past reform highlights the need for systemic transformation—including a new governance framework—to address meaningfully the UK's geography of discontent. [ABSTRACT FROM AUTHOR]

Music festivals (in the UK) have the potential to enhance the quality of life of attendees and participants, and therefore it might be argued they should be accessible to all. However, the barriers to participation that some may face when seeking to access and engage with festival experiences can often be attributed to the issue of marginalisation due to poverty. Utilising the three discourses of social inclusion put forward by Levitas as a framework, the study explores what UK music festival organisations are doing and could do to make their events more accessible to people living in poverty. Through an analysis of a series of festival websites and semi-structured interviews with festival organisers, some of the financial considerations that can influence participation and act as a barrier to making festivals an inclusive aspect of our cultural life were identified, and solutions were explored. The paper found that despite the social benefits of attending, those living in poverty have become an increasingly marginalised group of festival goers as a result of the disproportional rise in costs associated with attendance, which often goes beyond only the ticket price to include hidden extras. Whilst several festivals undertake outreach work and donate to charitable organisations, only a handful have specific initiatives that improve access for those living in poverty beyond spreading out the price of the ticket via instalments and volunteering opportunities. Findings suggest whilst many music festivals are starting to recognise the importance of the issue, few have specific initiatives but are willing to consider what they can do moving forward. [ABSTRACT FROM AUTHOR]

In the UK, the Research Excellence Framework is a mechanism used for ranking the quality of research in higher education institutions. While there has been analysis of the entire Research Excellence Framework, and of the Education unit of assessment more generally, analysis of how research on initial teacher education featured in the Research Excellence Framework has been minimal. In this article, we report on Phase I of an 18-month project that mapped the extent to which initial teacher education-focused research was included in the 2014 Research Excellence Framework. Employing a novel methodology and a theoretical framework based on policy as text and discourse, we identify a sample of 12 higher education institutions that provided initial teacher education programmes and returned outputs to the 2014 Research Excellence Framework. Analysis of over 1,600 outputs suggest that in the 2014 Research Excellence Framework only 5.5 per cent of these were focused on initial teacher education. We discuss the methodological approach, some headline findings and areas for future research, arguing that these add evidence to the literature of initial teacher education-focused research and, in doing so, can inform policy at the levels of schools, higher education institutions, Research Excellence Framework and the government. We conclude that although the Research Excellence Framework only concerns the UK, similar exercises are becoming increasingly prevalent globally, and therefore the extent to which research on initial teacher education was marginalised in the 2014 Research Excellence Framework is of interest to all concerned with teacher education. [ABSTRACT FROM AUTHOR]

Social theory has long predicted that social mobility, in particular downward social mobility, is detrimental to the well-being of individuals. Dissociative and "falling from grace" theories suggest that mobility is stressful due to the weakening of social ties, feelings of alienation, and loss of status. In light of these theories, it is a puzzle that the majority of quantitative studies in this area have shown null results. Our approach to resolve the puzzle is two-fold. First, we argue for a broader conception of the mobility process than is often used and thus focus on intra generational occupational class mobility rather than restricting ourselves to the more commonly studied intergenerational mobility. Second, we argue that self-reported measures may be biased by habituation (or "entrenched deprivation"). Using nurse-collected health and biomarker data from the UK Household Longitudinal Study (2010–2012, N  = 4,123), we derive a measure of allostatic load as an objective gauge of physiological "wear and tear" and compare patterns of mobility effects with self-reports of health using diagonal reference models. Our findings indicate a strong class gradient in both allostatic load and self-rated health, and that both first and current job matter for current well-being outcomes. However, in terms of the effects of mobility itself, we find that intragenerational social mobility is consequential for allostatic load, but not for self-rated health. Downward mobility is detrimental and upward mobility beneficial for well-being as assessed by allostatic load. Thus, these findings do not support the idea of generalized stress from dissociation, but they do support the "falling from grace" hypothesis of negative downward mobility effects. Our findings have a further implication, namely that the differences in mobility effects between the objective and subjective outcome infer the presence of entrenched deprivation. Null results in studies of self-rated outcomes may therefore be a methodological artifact, rather than an outright rejection of decades-old social theory. [ABSTRACT FROM AUTHOR]

Importance: Understanding the origins of clinical heterogeneity in bipolar disorder (BD) will inform new approaches to stratification and studies of underlying mechanisms.Objective: To identify components of genetic liability that are shared between BD, schizophrenia, and major depressive disorder (MDD) and those that differentiate each disorder from the others and to examine associations between heterogeneity for key BD symptoms and each component.Design, Setting, and Participants: Using data from the Bipolar Disorder Research Network in the United Kingdom, components of liability were identified by applying genomic structural equation modeling to genome-wide association studies of schizophrenia, BD, and MDD. Polygenic risk scores (PRS) representing each component were tested for association with symptoms in an independent BD data set. Adults with DSM-IV BD or schizoaffective disorder, bipolar type, were included. Data were collected from January 2000 to December 2013, and data were analyzed from June 2020 to February 2022.Main Outcomes and Measures: PRS representing the components of liability were tested for association with mania and depression, psychosis, and mood incongruence of psychosis in participants with BD, measured using the Bipolar Affective Disorder Dimensional Scale.Results: Of 4429 included participants, 3012 (68.0%) were female, and the mean (SD) age was 46.2 (12.3) years. Mania and psychosis were associated with the shared liability component (mania β = 0.29; 95% CI, 0.23-0.34; P = 3.04 × 10-25; psychosis β = 0.05; 95% CI, 0.04-0.07; P = 2.33 × 10-13) and the components that differentiate each of schizophrenia (mania β = 0.08; 95% CI, 0.03-0.14; P = .002; psychosis β = 0.03; 95% CI, 0.01-0.04; P = 1.0 × 10-4) and BD (mania β = 0.14; 95% CI, 0.09-0.20; P = 1.99 × 10-7; psychosis β = 0.02; 95% CI, 0.01-0.03; P = .006) from the other disorders. The BD differentiating component was associated with mania independently of effects on psychosis (β = 0.14; 95% CI, 0.08-0.20; P = 4.32 × 10-6) but not with psychosis independently of mania. Conversely, the schizophrenia differentiating component was associated with psychosis independently of effects on mania (β = 0.01; 95% CI, 0.003-0.03; P = .02), but not with mania independently of psychosis. Mood incongruence of psychosis was associated only with the schizophrenia differentiating component (β = 0.03; 95% CI, 0.01-0.05; P = .005). Depression was associated with higher MDD differentiating component (β = 0.07; 95% CI, 0.01-0.12; P = .01) but lower BD differentiating component (β = -0.11; 95% CI, -0.17 to -0.06; P = 7.06 × 10-5).Conclusions and Relevance: In this study of BD, clinical heterogeneity reflected the burden of liability to BD and the contribution of alleles that have differentiating effects on risk for other disorders; mania, psychosis, and depression were associated with the components of genetic liability differentiating BD, MDD, and schizophrenia, respectively. Understanding the basis of this etiological heterogeneity will be critical for identifying the different pathophysiological processes underlying BD, stratifying patients, and developing precision therapeutics. [ABSTRACT FROM AUTHOR]

This article considers some of the current obstacles and opportunities facing practitioners advising in cases where there are claims against directors of insolvent companies. Given the reports of fraud and impropriety following the introduction of significant financial measures by the UK government during the Covid-19 pandemic, claims against directors are likely to be a significant area of growth. The article explores current case law challenges when seeking to recover funds for creditors and some of the statutory and regulatory measures than can be applied alternatively. [ABSTRACT FROM AUTHOR]

An imported case of monkeypox was diagnosed in December 2019 in a traveller returning from Nigeria to the UK. Subsequently, environmental sampling was performed at two adjoining single‐room residences occupied by the patient and their sibling. Monkeypox virus DNA was identified in multiple locations throughout both properties, and monkeypox virus was isolated from several samples 3 days after the patient was last in these locations. Positive samples were identified following the use of both vacuum and surface sampling techniques; these methodologies allowed for environmental analysis of potentially contaminated porous and non‐porous surfaces via real‐time quantitative reverse transcriptase PCR analysis in addition to viral isolation to confirm the presence of infection‐competent virus. This report confirms the potential for infection‐competent monkeypox virus to be recovered in environmental settings associated with known positive cases and the necessity for rapid environmental assessment to reduce potential exposure to close contacts and the general public. The methods adopted in this investigation may be used for future confirmed cases of monkeypox in order to establish levels of contamination, confirm the presence of infection‐competent material and to identify locations requiring additional cleaning. [ABSTRACT FROM AUTHOR]