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

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]

Background: Big data research requires public support. It has been argued that this can be achieved by public involvement and engagement to ensure that public views are at the centre of research projects. Researchers should aim to include diverse communities, including seldom‐heard voices, to ensure that a range of voices are heard and that research is meaningful to them. Objective: We explored how researchers involve and engage seldom‐heard communities around big data research. Methods: This is a qualitative study. Researchers who had experience of involving or engaging seldom‐heard communities in big data research were recruited. They were based in England (n = 5), Scotland (n = 4), Belgium (n = 2) and Canada (n = 1). Twelve semistructured interviews were conducted on Zoom. All interviews were audio‐recorded and transcribed, and we used reflexive thematic analysis to analyse participants' experiences. Results: The analysis highlighted the complexity of involving and engaging seldom‐heard communities around big data research. Four themes were developed to represent participants' experiences: (1) abstraction and complexity of big data, (2) one size does not fit all, (3) working in partnership and (4) empowering the public contribution. Conclusion: The study offers researchers a better understanding of how to involve and engage seldom‐heard communities in a meaningful way around big data research. There is no one right approach, with involvement and engagement activities required to be project‐specific and dependent on the public contributors, researchers' needs, resources and time available. Patient and Public Involvement: Two public contributors are authors of the paper and they were involved in the study design, analysis and writing. [ABSTRACT FROM AUTHOR]

Introduction: In the United Kingdom, fractures of the cervical dens process in older and/or frail patients are usually managed nonsurgically in a hard collar. However, hard collars can lead to complications and this management approach is now being questioned, with growing interest in maximising patients' short‐term quality‐of‐life. It is vital that patients' perspectives are considered; yet, there is a dearth of literature examining the aspect. To help inform wider decision‐making about use of collar/no collar management of dens fractures in older/frail people, we explored older/frail people's experience of the two management approaches and how they affected their perceived quality‐of‐life. Methods: We interviewed older and/or frail adults with a recent dens fracture (aged ≥65 years or with a clinical frailty score of ≥5) or their caregiver. Participants were recruited from both arms of a clinical trial comparing management using a hard collar for 12 weeks (SM) with early removal of the collar (ERC) and were interviewed following randomisation and again, 12–16 weeks later. Data were analysed using a framework approach. Results: Both participant groups (SM/ERC) reported substantial, negative quality‐of‐life (QoL) experiences, with the fall itself and lack of access to care services and information being frequent major contributory factors. Many negative experiences cut across both participant groups, including pain, fatigue, diminished autonomy and reduced involvement in personally meaningful activities. However, we identified some subtle, yet discernible, ways in which using SM/ERC reinforced or alleviated (negative) QoL impacts, with the perceived benefits/burdens to using SM/ERC varying between different individuals. Conclusion: Study findings can be used to support informed decision‐making about SM/ERC management of dens fractures in older/frail patients. Patient or Public Contribution: Public and patient involvement contributors were involved in the study design, development of interview topic guides and interpretation of study findings. [ABSTRACT FROM AUTHOR]

‘Fair labelling’ has become common currency in criminal law scholarship over recent decades, but the principle's scope and justification has never been analysed in detail. Basic questions remain unanswered, such as the intended audience for these labels and whether they assume the same importance in respect of both offences and defences. This article traces the intellectual history of the principle and examines its possible justifications in respect of offence labelling, noting that labelling is important in two distinct senses: that of description, and that of differentiation. It goes on to sketch out some considerations which are of importance in the principle's application, before concluding with a discussion of its applicability to defences. [ABSTRACT FROM AUTHOR]

The chronology provides a record of flash flood events in Britain based on data collated mainly between 1700 and 2020. The primary purpose of the chronology is to improve the risk assessment of flash floods of given magnitude. It is divided into 18 regions of the country and contains descriptions of nearly 8000 events. It extends a previous chronology covering northern and southwest England which is provided as an online resource in (http://ceg-fepsys.ncl.ac.uk/outputs/). Flash floods have had a variety of previous definitions but are here defined in terms of the speed of onset which can apply to both river floods and surface water floods. The chronology for the first time provides a comprehensive list of surface water floods and their recorded impact on cities, towns and villages. It also draws attention to the prevalence of very rapid rates of rise in river level either as 'walls of water', or at a rate likely to endanger life as a result of intense rainfall. Nearly 300 such events have been identified mainly in upland areas of northern England, Wales and Scotland. Practical and theoretical issues with respect to flood risk assessment and warning are discussed. The chronology is available to download and is hosted on https://www.jbatrust.org/how-we-help/publications-resources/rivers-and-coasts/uk-chronology-of-flash-floods-1/ [ABSTRACT FROM AUTHOR]

Objective: Due to cardiovascular safety concerns, the European Medicines Agency (EMA) recommended new contraindications and changes to product information for diclofenac across Europe in 2013. This study aims to measure their impact among targeted populations. Method: Quarterly interrupted time series regression (ITS) analyses of diclofenac initiation among cohorts with contraindications (congestive cardiac failure [CHF], ischaemic heart disease [IHD], peripheral arterial disease [PAD], cerebrovascular disease [CVD]) and cautions (hypertension, hyperlipidaemia, diabetes) from Denmark, the Netherlands, England and Scotland. Results: The regulatory action was associated with significant immediate absolute reductions in diclofenac initiation in all countries for IHD (Denmark −0.08%, 95%CI −0.13, −0.03; England −0.09%, 95%CI −0.13 to −0.06%; the Netherlands −1.84%, 95%CI −2.51 to −1.17%; Scotland −0.34%, 95%CI −0.38 to −0.30%), PAD and hyperlipidaemia, the Netherlands, England and Scotland for hypertension and diabetes, and England and Scotland for CHF and CVD. Post‐intervention there was a significant negative trend in diclofenac initiation in the Netherlands for IHD (−0.12%, 95%CI −0.19 to −0.04), PAD (−0.13%, 95%CI −0.22 to −0.05), hypertension, hyperlipidaemia and diabetes, and in Scotland for CHF (−0.01%, 95%CI −0.02 to −0.007%), IHD (−0.017, 95%CI −0.02, −0.01%), PAD and hypertension. In England, diclofenac initiation rates fell less steeply. In Denmark changes were more strongly associated with the earlier EMA 2012 regulatory action. Conclusion: Although significant reductions in diclofenac initiation occurred, patients with contraindications continued to be prescribed diclofenac, the extent of which varied by country and target condition. Understanding reasons for such variation may help to guide the design or dissemination of future safety warnings. [ABSTRACT FROM AUTHOR]

Objective: Use of the Growth Assessment Protocol (GAP) has increased internationally under the assumption that it reduces the stillbirth rate. The evidence for this is limited and based largely on an ecological time-trend study. Discordance in the uptake of the GAP program between Scotland and England/Wales enabled us to assess the assertion that implementation of GAP leads to a reduced stillbirth rate.Methods: We analyzed data from the National Records for Scotland and the Office for National Statistics on the number of singleton maternities and stillbirths in Scotland and in England and Wales, respectively, from 1 January 2000 to 31 December 2015. National uptake of the GAP program over time in each of the regions was recorded. Stillbirth rate per 1000 maternities was calculated, according to year of delivery, and compared between Scotland and England/Wales.Results: During the study period, there were 870 632 singleton maternities in Scotland, of which 4243 were stillbirths, and there were 10 469 120 singleton maternities in England and Wales, of which 51 562 were stillbirths. There was a marked difference in uptake of the GAP program between the two regions, with substantially fewer maternity units in Scotland implementing the program. Stillbirth rates were static up to 2010, with a decline thereafter in both regions, to 3.75 (95% CI, 3.25-4.30) per 1000 maternities in Scotland and 4.30 (95% CI, 4.15-4.46) per 1000 maternities in England and Wales in 2015. From 2010 onwards, the decline in Scotland was faster, equating to 48 (95% CI, 47.9-48.1) fewer stillbirths per 100 000 maternities in Scotland than in England and Wales from 2010 to 2015 compared with 2000 to 2009.Conclusions: We observed a decline in stillbirth rate in England and Wales, which coincided with implementation of the GAP program. However, a concurrent decline in stillbirth rate was observed in Scotland in the absence of increased implementation of GAP. The secular rates of change in stillbirth rate in England and Wales cannot be used to infer efficacy of the GAP program. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Abstract: Background: Colorectal cancer (CRC) screening programmes using a guaiac faecal occult blood test (gFOBt) reduce CRC mortality. Interval cancers are diagnosed between screening rounds: reassurance from a negative gFOBt has the potential to influence the pathway to diagnosis of an interval colorectal cancer. Methods: Twenty‐six semi‐structured face‐to‐face interviews were carried out in Scotland and England, with individuals diagnosed with an interval colorectal cancer following a negative gFOBt result. Results: Participants reported they were reassured by a negative gFOBt, interpreting their result as an “all clear”. Therefore, most did not suspect cancer as a possible cause of symptoms and many did not recall their screening result during symptom appraisal. Among those who did consider cancer, and did think about their screening test result, reassurance from a negative gFOBt led some to “downplay” the seriousness of their symptoms with some interviewees explicitly stating that their negative test result contributed to a delayed decision to seek help. Conclusion: Screening participants need to be informed of the limitations of screening and the ongoing risk of developing colorectal cancer even when in receipt of a negative result: the importance of minimizing delay in seeking medical advice for colorectal symptoms should be emphasized. [ABSTRACT FROM AUTHOR]

Increasing breastfeeding rates would improve maternal and child health, but multiple barriers to breastfeeding persist. Breast pump provision has been used as an incentive for breastfeeding, although effectiveness is unclear. Women's use of breast pumps is increasing and a high proportion of mothers express breastmilk. No research has yet reported women's and health professionals' perspectives on breast pumps as an incentive for breastfeeding. In the Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS) study, mixed methods research explored women's and professionals' views of breast pumps as an incentive for breastfeeding. A survey of health professionals across Scotland and North West England measured agreement with ‘a breast pump costing around £40 provided for free on the NHS’ as an incentive strategy. Qualitative interviews and focus groups were conducted in two UK regions with a total of 68 participants (pregnant women, new mothers, and their significant others and health professionals) and thematic analysis undertaken. The survey of 497 health professionals found net agreement of 67.8% (337/497) with the breast pump incentive strategy, with no predictors of agreement shown by a multiple ordered logistic regression model. Qualitative research found interrelated themes of the ‘appeal and value of breast pumps’, ‘sharing the load’, ‘perceived benefits’, ‘perceived risks’ and issues related to ‘timing’. Qualitative participants expressed mixed views on the acceptability of breast pumps as an incentive for breastfeeding. Understanding the mechanisms of action for pump type, timing and additional support required for effectiveness is required to underpin trials of breast pump provision as an incentive for improving breastfeeding outcomes. © 2016 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Background Women with one previous caesarean section must decide which mode of delivery they would prefer in their next pregnancy. This involves a choice between attempted vaginal birth and elective caesarean section. Objective To explore women's mode of delivery preferences and the values placed on the outcomes of decision making. Greater insight into these issues could benefit both clinical care and future research. Design Observational study using longitudinal data collected within a randomized controlled trial. Setting and Participants Seven hundred and forty-two women with one previous caesarean section recruited at four antenatal clinics in South West England and Scotland. Main outcome measures Mode of delivery preference recorded at 19 and 37 weeks' gestation and visual analogue scale ratings of health and delivery outcomes. Results Comparison of mid and late pregnancy preferences and actual mode of delivery shows that 57% of women hold the same mode of delivery preferences at both times and 65% of women actually have the birth they prefer. The visual analogue scale ratings show variation in the way women value the outcomes of the decision. Discussion and Conclusions Understanding the way women's mode of delivery preferences change, how these relate to actual mode of delivery and how women value the outcomes of their decision will be beneficial to health professionals who wish to support women both during pregnancy and after birth. In addition, the visual analogue scale ratings provide evidence that may improve the development of population-level and economic models of decision making. [ABSTRACT FROM AUTHOR]

James VI (1567–1625) was chronically indebted, and this caused him frequent problems. This article presents two series of systematic data that together indicate the main contours of his indebtedness: (1) end-of-year deficits, and (2) hived-off debts which the Crown left unpaid for long periods (sometimes permanently). The hived-off debts, reconstructed individually, constitute a narrative of fiscal policy-making. Instead of a large and catastrophic bankruptcy, James in effect had numerous small bankruptcies. He benefited from an emerging structure of Scottish domestic credit. He eventually repaid many of his debts after succeeding to the English throne in 1603. [ABSTRACT FROM AUTHOR]

1. This account presents information on all aspects of the biology of Primula veris that are relevant to understanding its ecological characteristics and behaviour. The main topics are presented within the standard framework of the Biological Flora of the British Isles: distribution, habitat, communities, responses to biotic factors, responses to environment, structure and physiology, phenology, floral and seed characters, herbivores and diseases, history and conservation. 2. Primula veris is a distylous, perennial rosette hemicryptophyte, mostly found in well-drained, herb-rich meadows and grasslands, in scrub or woodland rides and edges, and on calcareous cliffs. It occurs on base-rich loams or clays, on limestone, and sometimes in dunes. 3. Native to the British Isles, it is characteristic of many mesotrophic and calcicolous lowland grassland communities, but it also extends into upland valleys in northern England and Scotland. In Ireland it is also native and most abundant in the central plain. Primula veris occurs throughout the temperate areas of Europe as far east as the Russian border. 4. Primula veris is a shade-intolerant species that shows reduced performance and flowering under shade or increased competition. The species is not able to penetrate anoxic soil layers and is therefore mostly absent from locations that are characterized by a high water table. It has a well-developed drought tolerance. 5. Primula veris is an obligate outbreeder which entirely depends on foraging insects for successful pollination. Although the species shows heterostyly, with two reciprocal morphs (pin and thrum), only relatively low levels of intermorph pollination have been reported. Seed dispersal is restricted to a few centimetres from maternal plants, whereas pollen flow is wider, but still limited to a few metres from parental plants. Both are factors that contribute to a significantly fine-scale spatial genetic structure and small neighbourhood size. 6. At several locations throughout the British Isles, P. veris occurs together with P. elatior and especially P. vulgaris. The hybrid P. veris ×  P. vulgaris =  P. ×  polyantha occurs frequently in mixed populations, whereas the hybrid P. veris ×  P. elatior =  P. ×  media has been rarely reported in Britain. 7. Although P. veris is still a widespread grassland herb, it is less abundant in the British Isles and continental Europe than before. This decline can be attributed to changes in land-use practices, such as the loss of traditional hay–meadow management, the loss of grazing and an increase of ploughing, in combination with ongoing destruction and nutrient enrichment of permanent grasslands. However, from 1980 onwards the species has increased substantially in many areas of the UK, largely because its seeds are included in wildflower seed-mixtures that are sown on new or upgraded road and motorway verges, embankments and urban conservation areas. [ABSTRACT FROM AUTHOR]

Question: How successful is restoration that is focused on a single dominant plant at enabling the reassembly of the whole vegetation assemblage and what factors affect the relative success of such restoration? Location: Moorlands in England and Scotland, UK. Methods: Vegetation composition was sampled in grassdominated (degraded), restored and long established Calluna vulgaris-dominated (target) areas within eight moorland restoration sites. Additional soil and biogeographic data were collected. Data were analysed by Canonical Correspondence Analysis, which allowed the impact of moorland management to be examined. Results: All sites showed good restoration success when the dominant managed species (Calluna vulgaris, Molinia caerulea and Nardus stricta) were considered. Restoration success of the remainder of the plant assemblage, disregarding these dominant species, was lower with restored samples at some sites differing little from their respective degraded samples. Moors restored solely by grazing exclusion were more similar to their respective targets than were those restored by more intensive mechanical means. The most important factors in explaining vegetation assemblages were management status (i.e. whether samples represented degraded, restored or target parts of the moor) and latitude. Conclusions: The project demonstrates that, where possible, restoration should be attempted by grazing exclusion alone. Furthermore the importance of applying local restoration targets and of monitoring the whole plant assemblages when assessing the success of moorland restoration is highlighted. [ABSTRACT FROM AUTHOR]

In this article we question recent psychological approaches that equate the constructs of citizenship and social identity and which overlook the capacity for units of governance to be represented in terms of place rather than in terms of people. Analysis of interviews conducted in England and Scotland explores how respondents invoked images of Britain as “an island” to avoid social identity constructions of nationality, citizenship, or civil society. Respondents in Scotland used island imagery to distinguish their political commitment to British citizenship from questions relating to their subjective identity. Respondents in England used island imagery to distinguish the United Kingdom as a distinctive political entity whilst avoiding allusions to a common or distinctive identity or character on the part of the citizenry. People who had moved from England to Scotland used island imagery to manage the delicate task of negotiating rights to social inclusion in Scottish civil society whilst displaying recognition of the indigenous population's claims to distinctive national culture and identity. [ABSTRACT FROM AUTHOR]

This study explores the impact of manipulating the salience of national categories upon the willingness of highly identifying Scots to take up either short-term or long-term jobs in Scotland as compared to England. The results support the hypotheses (a) that high-identifying Scots increase preference for intra- over extranational locations when national categories are salient, (b) that this effect is fully mediated by “fitting in”—that is, the sense of being “at home” in Scottish as compared to English locations, and (c) that these relationships only hold for long-term as opposed to short-term jobs. We discuss these results in terms of the impact of identity definitions upon spatialised action and the economic/political importance of this relationship. [ABSTRACT FROM AUTHOR]

This article presents information on issues related to the English and Scottish Tobacco trade in the seventeenth and eighteenth centuries. The study presented in this article provides an analysis of the volume and organization of tobacco smuggling into England and Scotland in the late seventeenth and eighteenth centuries. The importance of these smuggling trades has been made clear in a number of studies, but no quantitative estimates have been made of their probable pattern and extent. It is informed that the seventeenth-century expansion of the English tobacco trade reached a peak in the late 1680s. In the next fifty years, until the early 1730s, legal imports stagnated, and then picked up once more, increasing at a moderate rate until mid-century. Nevertheless, though the rate of expansion was slow, there were important changes in the structure of the trade: specifically a nearly threefold increase in the volume of re-exports accompanied by a fall in both the absolute level and per capita rate of home consumption.