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This paper explores how the selection of peer researchers influences and shapes peer research projects. It draws on two empirical studies formed from two community action projects in England. Peer research is a method for involving young people as coresearchers within their community or in specific settings such as educational environments and the two projects recruited school children of different ages and ethnic backgrounds; in both cases they were representative of the potential participant population. One project (Community House) was based in a junior school setting and concentrated on evaluating a community centre project. The second project (Knife Angel: Hear My Voice) was a youth work setting and brought together a group of young people to explore an intervention aimed at impacting crime and violence in the local community. This paper discusses how the demographic characteristics of the peer researchers shaped, influenced and impacted the success of both community action projects. We discuss how children and young people bring their unique skills to preparing the questionnaire and dissemination. Using researcher reflexivity, we consider the methodological implications of the findings and contribute to theory building about community action and the impact of participatory research. [ABSTRACT FROM AUTHOR]

In recent years, there has been considerable policy and academic interest in the existence of ethnic inequalities in the Criminal Justice System. A large body of sentencing research has been dedicated to exploring whether ethnic minority defendants are treated more harshly than similarly situated white defendants. This paper extends this research utilizing Ministry of Justice linked criminal justice datasets and multilevel models to assess the effect of ethnicity and other defendant case and contextual factors on sentencing outcomes in the Crown Court. The analysis shows that legal characteristics such as plea, pre-trial detention, offence type and severity are important factors determining sentencing outcomes although they do not fully explain disparities in these outcomes between ethnic groups. Ethnic disparities in imprisonment persist and, in some cases, become more pronounced after controlling for defendant case and court factors. In contrast, ethnic disparities in sentence length are largely explained by legal factors, and after adjusting for other predictors of sentencing outcomes, observed differences between most (but not all) ethnic minority groups and the white British disappear. [ABSTRACT FROM AUTHOR]

Family group conferences (FGCs) in child welfare share decision-making with family members by bringing the immediate and wider family together to make a plan to meet a child's needs. This paper reports survey findings on FGC provision in the UK in 2022 and explores whether in England the presence of an FGC service and the rate of FGC provision is associated with the rate of children in care, entering care, in kinship foster care and leaving care. Seventy-nine per cent (n  = 167) of local authorities in the UK provided FGCs to families, and 14 per cent (n  = 29) did not. Services that were more established offered a more diverse range of FGCs. The introduction of FGCs in English local authorities was associated with a higher rate of children in care, but also higher rates of kinship foster care, a key goal of FGCs where it is not possible for children to stay with their parents. Higher rates of FGCs were associated with more children leaving care, possibly due to reunification with birth families. To understand in more detail, the circumstances of children in and leaving care in local authorities with FGCs, individual data linkage studies are needed. [ABSTRACT FROM AUTHOR]

This paper is a reflective piece on the thought processes individuals and teams have when engaging in decoloniality work in Teacher Training/Education. We argue that until the self is decolonized, the process of decolonialization becomes rhetoric. We also question how much we can decolonize whilst working in the academy whose very culture, symbols and practices are borne out of colonialism and the period of enlightenment; whose very raison d'être is to elevate some knowledge over others and to claim cultural and academic superiority. The current political landscape in England approaches anti-racism as a political ideology that must be avoided in schools and education and this ideological battlefield is evident in teacher education. We aim to recognize the tensions and resistance to decolonialize, which demonstrates the messy and contingent process of moving between shifting positions and subjectivities. It confronts the challenge of the teacher–practitioner who must balance their own moral and philosophical grounding whilst attending the political imperatives of the work. This can take the form of according with the policies and procedures of the institutions in which they are situated which can often be balkanizing and debilitating. [ABSTRACT FROM AUTHOR]

Lentigo maligna (LM) is a melanoma in situ with distinct clinical features and histology. It commonly affects men after the sixth decade of life. Incidence rates of LM have increased based on early 21st century data from different countries; however, data are suboptimal. Data from England show a plateauing crude incidence between 2013 and 2019. By comparison, invasive melanoma and other types of melanoma in situ commonly appears in younger age groups (median age 58 and 67 years old, respectively) and incidence is rising. The most important risk factors for LM include fair skin and cumulative ultraviolet solar radiation exposure. Although LM is limited to the epidermis and connected skin adnexa, it may progress to invasive LM melanoma. The reported rate of malignant progression varies, reflecting a challenge for LM epidemiology research as often lesions are removed on diagnosis. LM poses a challenge in diagnosis and management. Although it can be diagnosed clinically or dermoscopically, histopathological assessment of biopsied skin tissue remains the gold standard. Reflectance confocal microscopy allows for better appreciation of the complexity of LM at a cellular level, often progressing beyond clinical margins. Management of LM may involve Mohs micrographic surgery or excision, although recurrence may occur even with 5 mm clinical margins. Imiquimod cream may be effective, but incomplete treatment and recurrence has been reported. Conservative management with observation or radiotherapy may be used in selected patients' cases. Five-year net survival rates are excellent. This paper reviews the natural history, epidemiology, aetiology, pathogenesis, diagnosis and management of LM. [ABSTRACT FROM AUTHOR]

Many coastal towns in England face a unique set of overlapping challenges: a longstanding socio-economic stagnation and environmental threats coming from the physical location. This paper examines coastal communities in the context of the left-behind debate. The consequences of de-industrialisation and failures in public policies recall other left-behind geographies. We look at a selection of case studies, apparently dealing with the decline of traditional coastal economic activities, but really affected by a decoupling of their socio-economic profile from their coastal specificity. More work is needed to nurture the existing coastal imaginaries, requiring regional coordination and a place-based approach to regeneration. [ABSTRACT FROM AUTHOR]

Frailty represents an integrative prognostic marker of risk that associates with a myriad of age-related adverse outcomes in older adults. As a concept, frailty can help to target scarce resources and identify subgroups of vulnerable older adults that may benefit from interventions or changes in medical management, such as pursing less aggressive glycaemic targets for frail older adults with diabetes. In practice, however, there are several operational challenges to implementing frailty screening outside the confines of geriatric medicine. Electronic frailty indices (eFIs) based on the theory of deficit accumulation, derived from routine data housed in the electronic health record, have emerged as a rapid, feasible and valid approach to screen for frailty at scale. The goal of this paper is to describe the early experience of three diverse groups in developing, implementing and adopting eFIs (The English National Health Service, US Department of Veterans Affairs and Atrium Health—Wake Forest Baptist). These groups span different countries and organisational complexity, using eFIs for both research and clinical care, and represent different levels of progress with clinical implementation. Using an implementation science framework, we describe common elements of successful implementation in these settings and set an agenda for future research and expansion of eFI-informed initiatives. [ABSTRACT FROM AUTHOR]

The introduction of healthcare-based apprenticeships to become both a physician associate and a doctor has been approved for delivery in England. This will revolutionize medical training and it is hoped that medical training would be more accessible. This has generated a mixture of reactions, some enthusiastic and others concerned. This paper gauges interest among staff at Barking, Havering, and Redbridge University Hospitals NHS Trust in pursuing training as a doctor and/or physician associate through the apprenticeship route. Applicants were interviewed to discover their motivations for interest, and the potential benefit to the Trust of these new opportunities was also assessed. This revealed that applicants were primarily driven through intrinsic motivations, such as a lifelong dream to be a doctor and a desire to fulfil a patient-facing role. Many expressed financial and social situations were a barrier to prior application, making the apprenticeship role more attractive. Healthcare professionals should accurately represent the population that they serve, which is currently not the case. The prospective applicants, with diverse backgrounds and existing healthcare experience, can help to improve patient care through their diverse perspective and understanding of multidisciplinary team working. This article highlights the potential of medical-based apprenticeships to help address longstanding challenges in medical education and workforce diversity. Furthermore, there could be significant financial and practical benefits to the trust of upskilling enthusiastic staff. However, there is currently a lack of clarity regarding selection processes and entry criteria, which must be addressed. [ABSTRACT FROM AUTHOR]

Record numbers of police officers are voluntarily resigning in England and Wales yet there is a lack of research which analyses why. Findings from an analysis of 62 interviews with police leavers who voluntarily resigned from the police service within England and Wales between January 2021 and June 2022 suggest that officers are leaving primarily due to perceptions of organizational injustice which focus upon: a lack of voice; concerns about promotion/progression; poor leadership; and a lack of organizational flexibility. This paper takes this latter reason—organizational flexibility—as its focus and through an inductive analysis of these leavers' voices, aims to both enrich the scarce qualitative academic literature on police workforce resignations and retention but also to offer significant evidence for future consideration of workforce optimization. The findings indicate that although sympathetic to operational policing complexities, participants were frustrated by organizational inflexibility. Three key areas were identified where the police service was perceived to be unsupportive or unreceptive—(a) dealing with additional needs, disabilities, or health issues of officers, (b) conflicts with non-work commitments, primarily those associated with childcare/parental responsibilities, and (c) supporting officers transitioning to part-time working. These structural barriers to effective workplace functioning were exacerbated by the cultural norms of overwork and 'fitting in' and were additionally particularly experienced by female resigners. The authors call for a challenge to the cultural barriers towards flexible working, the modelling of flexible working at all levels of the organization, and a focus on reciprocal flexibility between employer and employee. Until this issue can be tackled, it is argued that retention will continue to be an underestimated but significant site of inequality within policing. [ABSTRACT FROM AUTHOR]

Background During the 1997–2010 Labour government, several policies were implemented to narrow health inequalities as part of a national health inequalities strategy. Many of these policies are likely to have had a disproportionately large impact on people aged 65 and over. We aimed to understand the association between the health inequalities strategy period and inequalities in mortality at age 65–69. Methods We use population at risk and mortality data covering 1991–2019 to calculate mortality rate at age 65–69 at the Local Authority level. We use the 2019 Index of Multiple Deprivation to examine geographical inequalities. We employ segmented linear regression models with marginal spline terms for the strategy period and interact these with an indicator of deprivation to understand how inequalities changed before, during and after the strategy. The reporting of this study adheres to STROBE guidelines. Results Mortality rates in each deprivation quintile improved continuously throughout the period of study. Prior to the programme (1991–9) there was no significant change in absolute inequalities. However, during the strategy (2000–10) there was a significant decrease in absolute inequalities of −9.66 (−17.48 to −1.84). The period following the strategy (2011–19) was associated with a significant increase in absolute inequalities of 12.84 (6.60 to 19.08). Our results were robust to a range of sensitivity tests. Conclusion The English health inequalities strategy was associated with a significant reduction in absolute inequality in mortality age 65–69. Future strategies to address inequalities in ageing populations may benefit from adopting a similar approach. [ABSTRACT FROM AUTHOR]

Background Adolescent mental health (AMH) needs in England have increased dramatically and needs exceed treatment availability. This study undertook a comparative assessment of the health and economic return on investment (ROI) of interventions to prevent and treat mental disorders among adolescents (10–19 years) and examined intervention affordability and readiness. Methods Interventions were identified following a review of published and grey literature. A Markov model followed a simulated adolescent cohort to estimate implementation costs and health, education, and economic benefits. Intervention affordability was assessed, comparing annual cost per adolescent with NHS England per capita spending, and an expert panel assessed intervention readiness using a validated framework. Results Over 10- and 80-year horizons, interventions to treat mild anxiety and mild depression were most cost-effective, with the highest individual lifetime ROI (GBP 5822 GBP 1 and GBP 257: GBP 1). Preventing anxiety and depression was most affordable and 'implementation ready' and offered the highest health and economic benefits. A priority package (anxiety and depression prevention; mild anxiety and mild depression treatment) would avert 5 million disability-adjusted life-years (DALYS) and achieve an ROI of GBP 15: GBP 1 over 10 years or 11.5 million DALYs (ROI of GBP 55: GBP 1) over 80 years. Conclusion The economic benefits from preventing and treating common adolescent mental disorders equivalent to 25% of NHS England's annual spending in 2021 over 10 years and 91% over 80 years. Preventing and early treatment for anxiety and depression had the highest ROIs and strong implementation readiness. [ABSTRACT FROM AUTHOR]