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Abstract: This paper discusses some key findings taken from a qualitative study conducted with gay and lesbian adopters and foster carers in England and Wales. The study examined the experiences of 24 self‐identified lesbians and gay men, who had been involved in adoption or fostering processes since the introduction of the Adoption and Children Act, 2002. This article will explore why participants chose to adopt or foster and their approach to relationships generated through these routes. Findings indicate that gay and lesbian applicants troubled dominant conceptualisations of family and kinship and revealed both heteronormative and nuclear constructions of parenting within adoption and fostering social work. In contrast, participants often demonstrated a reflexive and creative approach to caring for looked after children. This paper will therefore consider how professionals can recognise nuanced or complex relationships, situated beyond traditional frameworks, through drawing upon wider concepts within sociological literature. [ABSTRACT FROM AUTHOR]

Abstract: Within a context of substantial adoption policy reform in England, this paper explores post adoption support. Findings from a small‐scale survey of 22 local authorities in England and interviews with 11 adoption practitioners (from 11 of the authorities that completed the survey) are presented and related national policy discussed. The paper argues that support should continue postmatching a child with their adoptive parent(s) and that this should be the norm rather than the exception. It also emphasizes the need to improve the availability of and access to post adoption support in a timely manner. [ABSTRACT FROM AUTHOR]

Abstract: Continence is a key moment of care that can tell us about the wider care of people living with dementia within acute hospital wards. The spotlight is currently on the quality of hospital care of older people across the UK, yet concerns persist about their poor treatment, neglect, abuse, and discrimination within this setting. Thus, within hospitals, the care of people living with dementia is both a welfare issue and a human rights issue. The challenge of continence care for people living with dementia can be seen as the ‘canary in the coal mine’ for the unravelling of dignity within the acute setting. This paper draws on an ethnographic study within five hospitals in England and Wales, selected to represent a range of hospital types, geographies and socio‐economic catchments. Observational fieldwork was carried out over 154 days in acute hospitals known to admit large numbers of people living with dementia. This paper starts to fill the gap between theory and data by providing an in‐depth ethnographic analysis examining the ways in which treatment as a person is negotiated, achieved or threatened. We examine how the twin assaults on agency of a diagnosis of dementia and of incontinence threaten personhood. The acute threats to this patient group may then act to magnify perils to treatment as a person. Our findings suggest that personal dignity and the social construction of moral personhood are both threatened and maintained in such a setting. We show how empirical ethnographic data can lend weight to, and add detail to, theoretical accounts of moral personhood and dignity. [ABSTRACT FROM AUTHOR]

The place of evidence to inform educational effectiveness has received increasing attention internationally in the last two decades. An important contribution to evidence-informed policy has been greater attention to experimental trials including randomised controlled trials ( RCTs). The aim of this paper is to examine the use of evidence, particularly the use of evidence from experimental trials, to inform national curriculum policy. To do this the teaching of grammar to help pupils' writing was selected as a case. Two well-regarded and influential experimental trials that had a significant effect on policy, and that focused on the effectiveness of grammar teaching to support pupils' writing, are examined in detail. In addition to the analysis of their methodology, the nature of the two trials is also considered in relation to other key studies in the field of grammar teaching for writing and a recently published robust RCT. The paper shows a significant and persistent mismatch between national curriculum policy in England and the robust evidence that is available with regard to the teaching of writing. It is concluded that there is a need for better evidence-informed decisions by policy makers to ensure a national curriculum specification for writing that is more likely to have positive impact on pupils. [ABSTRACT FROM AUTHOR]

The Daily Mail's coverage of the 1993 race murder of Stephen Lawrence has been held up as an example of newspaper journalism at its best. It is a cause of pride to the paper, which has asserted that its 1997 front page accusing five men of the murder, and the comment and reporting that followed, brought about significant social and policy changes and helped achieve justice. The coverage has also been cited by the paper to rebut critics who accuse it of intolerance. Examined in detail here and set in their context, the paper's claims about its role in the case prove to be either exaggerated or not supported by evidence. The Mail's engagement in the Lawrence case involved a famous instance of editorial brilliance, but insofar as its campaign brought about or contributed to changes, they were not usually changes sought by the paper and they were sometimes contrary to its aims. [ABSTRACT FROM AUTHOR]

This paper reports on data from a qualitative case study of child protection social work in one local authority. Ethnographic methods were used and constructionist grounded theory employed to collect and analyse 329 pages of historical documents about the local authority child protection service, 246.5 hours of observations of social work practice and 19 interviews of social workers and their team managers. By interpreting the experiences of the social workers through the conceptual debates about the changes in the field of social administration, the social workers could be seen to want to perform a traditional form of social work but were required to perform a contemporary form of social administration. The aims and purposes of this form of practice could be considered to be distinct from those of social work as understood by the social workers, and as such, the social workers experienced the practice environment as constraining and often felt disillusioned. This paper conceptualizes these forms of practice, contributing to the debates about what practice is and how we are to analyse and categorize it for the purposes of influencing the institutions that create and maintain contemporary practice. [ABSTRACT FROM AUTHOR]

The spatial experiences of transgender and gender non‐conforming ("trans") people continue to occupy the margins of geography, especially compared to the amount of work centred on lesbian and gay lives. Though research on trans geographies in educational and health settings is expanding, most literatures stem from the USA. This paper shares findings from a study about the experiences of trans people who study and/or work on a specific university campus in northern England. Our findings demonstrate how particular spaces of the campus are generative of interactions which enable micro‐aggressions and misrecognition. [ABSTRACT FROM AUTHOR]

This paper reports on an empirical study of child protection services in a local authority where rates of investigations and interventions rose to unprecedented levels during the course of a single year. The aim of the research was to explore explanations for this rise in demand among the providers of children's social care in the area. Using an interpretative qualitative design, a series of focus groups and interviews were carried out with practitioners and managers (n = 25) from statutory services and Early Help. The findings identified a combination of long‐term and short‐term drivers of demand. Long‐term factors emphasized the impact of rising levels of deprivation combined with cuts to community‐based services for children and young people. Short‐term factors ranged from a more proactive approach to child neglect to more effective multi‐agency partnerships and joint decision making. The interaction between these factors was found to be accentuating an underlying shift to "late intervention" across the sector. The findings are contextualized in relation to contemporary debates about the crisis of demand for children's social care and the complex relationship between prevention and protection. [ABSTRACT FROM AUTHOR]

Background and context: Breastfeeding peer support is valued by women, but UK trials have not demonstrated efficacy. The ABA feasibility trial offered proactive peer support underpinned by behaviour change theory and an assets‐based approach to women having their first baby, regardless of feeding intention. This paper explores women's and infant feeding helpers' (IFHs) views of the different components of the ABA intervention. Setting and participants: Trained IFHs offered 50 women an antenatal meeting to discuss infant feeding and identify community assets in two English sites—one with a paid peer support service and the other volunteer‐led. Postnatally, daily contact was offered for the first 2 weeks, followed by less frequent contact until 5 months. Methods: Interviews with 21 women and focus groups/interviews with 13 IFHs were analysed using thematic and framework methods. Results: Five themes are reported highlighting that women talked positively about the antenatal meeting, mapping their network of support, receiving proactive contact from their IFH, keeping in touch using text messaging and access to local groups. The face‐to‐face antenatal visit facilitated regular text‐based communication both in pregnancy and in the early weeks after birth. Volunteer IFHs were supportive of and enthusiastic about the intervention, whereas some of the paid IFHs disliked some intervention components and struggled with the distances to travel to participants. Conclusions: This proactive community assets‐based approach with a woman‐centred focus was acceptable to women and IFHs and is a promising intervention warranting further research as to its effect on infant feeding outcomes. [ABSTRACT FROM AUTHOR]

In this paper I seek to explore the role of biodiversity offsetting in the evolution of public debates over controversial urban development projects and the way it may influence the outcome of social‐environmental conflicts. By drawing on empirical data obtained through 25 interviews with key stakeholders involved in a conflict around executive housing in North East England, 48 interviews with several stakeholders involved in offsetting across England, and an extensive document analysis, I explore the depoliticising effects of offsetting as an indicative example of actually existing neoliberal conservation. I also pay attention to the way offsetting relates to the fast policy complex to trace the links between neoliberalisation and depoliticisation particularly in the era following the 2008 financial crash. Understanding social‐environmental conflicts through the lens of the post‐political hypothesis can shed light on the way both participatory planning and neoliberal conservation, by favouring technocratic management and consensual policy‐making, attempt to remove contestation and agonistic engagement from the public terrain. On the other hand, seeing conflicts only through the post‐political hypothesis has important limits, primarily because it implies a catholic hegemony of post‐politics that can be both disorienting and paralysing. I conclude by showing through five key propositions the necessity for contextualised readings of historically and geographically specific political practices and for analysing depoliticisation by means of a theory of hegemony. [ABSTRACT FROM AUTHOR]

The extreme conditions of the summer season in 2018 in England gave rise to comparisons with earlier drought events. Using the information provided by documentary records, such as chronicles, accounts and diaries, this paper investigates extreme summer droughts in the period 1200–1700, and their impacts under the conditions of natural climate variability and before the provision of modern infrastructure. [ABSTRACT FROM AUTHOR]

Despite the introduction of guidelines and procedures aimed at encouraging and supporting children and young people to complain about the services they receive, children in care still face barriers to doing so in practice. This paper explores what happens when children in care are dissatisfied with the services they receive. Specifically, this study examines the complaints procedure for children in care. The findings are based on semistructured interviews with children in care, social workers, senior managers, and independent reviewing officers from one English local authority. Thematic analysis of these data identified five emergent themes: (a) complaints by children in care are managed at the lowest possible level, (b) senior managers have an overly optimistic view about children in care being informed of complaint procedures and being encouraged to do so, (c) children in care are worried about complaining, which is recognized by professionals, (d) children's voices are often not heard, and (e) when issues are clearly defined, independent reviewing officers have some degree of success in resolving complaints from children in care. [ABSTRACT FROM AUTHOR]

In boundary line analysis a biological response (e.g., crop yield) is assumed to be a function of a variable (e.g., soil nutrient concentration), which limits the response in only some subset of observations because other limiting factors also apply. The response function is therefore expressed by an upper boundary of the plot of the response against the variable. This model has been used in various branches of soil science. In this paper we apply it to the analysis of some large datasets, originating from commercial farms in England and Wales, on the recorded yield of wheat and measured concentrations of soil nutrients in within‐field soil management zones. We considered boundary line models for the effects of potassium (K), phosphorus (P) and magnesium (Mg) on yield, comparing the model with a simple bivariate normal distribution or a bivariate normal censored at a constant maximum yield. We were able to show, using likelihood‐based methods, that the boundary line model was preferable in most cases. The boundary line model suggested that the standard RB209 soil nutrient index values (Agriculture and Horticulture Development Board, nutrient management guide (RB209), 2017) are robust and apply at the within‐field scale. However, there was evidence that wheat yield could respond to additional Mg at concentrations above index 0, contrary to RB209 guidelines. Furthermore, there was evidence that the boundary line model for yield and P differs between soils at different pH and depth intervals, suggesting that shallow soils with larger pH require a larger target P index than others. Highlights: Boundary line analysis is one way to examine how soil variables influence crop yield in large datasets.We showed that boundary line models could be applied to large datasets on soil nutrients and crop yield.The resulting models are consistent with current practice for P and K, but not for Mg.Models suggest that more refined recommendations for P requirement could be based on soil pH and depth. [ABSTRACT FROM AUTHOR]

Background: The existing evidence is limited in terms of perspectives of preschool children with speech and language needs and their views on activities used to support their needs. This paper discusses a stream of work from the interdisciplinary research programme known as "Child Talk," based in England, UK. The overall purpose of this work stream was to gain the perspectives of preschool children aged 2 to 5 years and 11 months, with speech and language needs, to use in the development of an evidence‐based framework of activities. Methods: Twenty‐four preschool children with a variety of needs from diverse backgrounds took part. An observational methodology was used to capture children's experiences. Children were filmed during a series of sessions, with innovative head‐mounted cameras worn by the children and supported by researcher field notes. Framework analysis was used to analyse the data based on the body movement, vocalization, and visual attention of the children during these sessions. Results and Conclusions: Results included that children expressed enjoyment and engagement in the activities. The children expressed themselves and demonstrated their focus "multimodally" through combinations of body language, vocalization, and visual attention. These modalities were present across all contexts and children. It highlights the importance of encouraging participation in preschool children and consequently this innovative piece of work has national and international importance. [ABSTRACT FROM AUTHOR]

Background: Hospital admissions for preventable reasons [ambulatory care sensitive (ACS) conditions] can indicate gaps in access to or quality of primary care. This paper seeks to document the numbers and causes of these admissions in England for people with intellectual disabilities (ID) compared with those without. Methods: Observational cohort study of number and duration of emergency admitted patient episodes for ACS conditions, overall and by cause, using the Clinical Practice Research Datalink GOLD primary care database and the linked Hospital Episode Statistics Admitted Patient Care dataset. Results: The study covered 5.2% of the population of England from April 2010 to March 2014 giving a total population base of 59 280 person‐years for people with ID and 11 103 910 for people without identified ID. The rate of emergency admissions for ACS conditions for people with ID was 77.5 per 1000 person‐years. As a crude comparison, this was 3.0 times the rate for those without ID, but standardising for the distinct demography of this group, the number of episodes was 4.8 times that expected if they had the same age‐specific and sex‐specific rates. Stay durations for these episodes were longer for both young‐age and working‐age people with ID. Overall people with ID used 399.8 bed‐days per 1000 person‐years. As a crude comparison, this is 2.8 times the figure for people without ID. Standardising for their age and sex profile, it is 5.4 times the number expected if they had the same age‐specific and sex‐specific rates. For patients with ID, 16.6% (one in six) of all admitted patient episodes and 24.3% (one in four) of in‐patient care days for people with ID were for ACS conditions. Corresponding figures for those without ID were 8.3% (one in 12) and 14.4% (one in seven). The difference in rates between those with and without ID was most marked in people of working age. The three most common causes of emergency episodes for ACS conditions in people with ID were convulsions and epilepsy, influenza pneumonia and aspiration pneumonitis. Influenza pneumonia was also a common cause for people without ID. Episodes for convulsions and epilepsy and aspiration pneumonitis were specifically associated with people with ID. Conclusions: Rates of hospital admissions for ACS conditions provide an important indicator of health literacy, basic self‐care (or support by carers) and the accessibility of primary care. High rates are seen for some conditions specifically associated with premature death in people with ID. Local monitoring of these figures could be used to indicate the effectiveness of local primary health services in providing support to people with ID. [ABSTRACT FROM AUTHOR]

Smoking in high‐income countries is now concentrated in poor communities whose relatively high smoking prevalence is explained by greater uptake but above all by lower quit rates. Whilst a number of barriers to smoking cessation have been identified, this is the first paper to situate cessation itself as a classed and cultural practice. Drawing on ethnographic research carried out in a working‐class community in the North of England between 2012 and 2015, I theorise smoking cessation as a symbolic practice in relation to the affective experience of class and social mobility. I show that ambivalence about upward mobility as separation and loss translated into ambivalence about smoking cessation. The reason for this was that the social gradient in smoking operated dynamically at the level of the individual life course, i.e. smoking cessation followed upward mobility. A serious health problem was an appropriate reason to quit but older women continued to smoke despite serious health problems. This was linked to historical gender roles leading to women placing a low priority on their own health as well as the intergenerational reproduction of smoking through close affective links with smoking parents. [ABSTRACT FROM AUTHOR]

Summary: This paper is concerned with the deposition of Middle and Late Bronze Age metalwork in three study areas extending from the coast of south‐east England to the edge of the Fenland. It considers where hoards and single finds have been discovered and is based on inspection of over 300 findspots on the ground. It investigates regions in which tools and ornaments are common, but also extends to those with a stronger representation of weapons. While rapiers, swords and spears are found in rivers, terrestrial finds often come from sites close to springs, aquifers and confluences and favour areas with fresh water rather than salt water. Others are from more prominent locations on high ground or in low‐lying positions like dry valleys. We suggest that such places played a role in a tiered cosmology. Metalwork was deposited where the underworld or the sky came into contact with the landscapes inhabited in daily life. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: Decisions about whether to refer or admit a patient to an intensive care unit (ICU) are clinically, organizationally, and ethically challenging. Many explicit and implicit factors influence these decisions, and there is substantial variability in how they are made, leading to concerns about access to appropriate treatment for critically ill patients. There is currently no guidance to support doctors making these decisions. We developed an intervention with the aim of supporting doctors to make more transparent, consistent, patient‐centred, and ethically justified decisions. This paper reports on the implementation of the intervention at three NHS hospitals in England and evaluates its feasibility in terms of usage, acceptability, and perceived impact on decision making. Methods: A mixed method study including quantitative assessment of usage and qualitative interviews. Results: There was moderate uptake of the framework (28.2% of referrals to ICU across all sites during the 3‐month study period). Organizational structure and culture affected implementation. Concerns about increased workload in the context of limited resources were obstacles to its use. Doctors who used it reported a positive impact on decision making, with better articulation and communication of reasons for decisions, and greater attention to patient wishes. The intervention made explicit the uncertainty inherent in these decisions, and this was sometimes challenging. The patient and family information leaflets were not used. Conclusions: While it is feasible to implement an intervention to improve decision making around referral and admission to ICU, embedding the intervention into existing organizational culture and practice would likely increase adoption. The doctor‐facing elements of the intervention were generally acceptable and were perceived as making ICU decision making more transparent and patient‐centred. While there remained difficulties in articulating the clinical reasoning behind some decisions, the intervention offers an important step towards establishing a more clinically and ethically sound approach to ICU admission. [ABSTRACT FROM AUTHOR]

Objectives: To understand the potential impact of exposure misclassification on water fluoridation studies in England, this paper aims to describe the long‐term variation in water fluoride concentrations in both artificially and naturally fluoridated water supplies. Methods: Water fluoridation dose monitoring data were requested from all five English public water suppliers who artificially fluoridate their water, as well as from one water company that supplies naturally fluoridated water. Descriptive statistics were calculated, including annual means, standard deviations, minimum‐maximum and absolute and relative frequencies. Results: Data were made available by two of the five English water companies who supply artificially fluoridated water and one water company that supplies naturally fluoridated water (40 398 individual samples). The data for fluoridated water spanned 18‐35 years, whilst the data on naturally fluoridated water spanned 14 years. The artificially fluoridated samples showed wide variation in fluoride dose control, both between different water treatment works and over time. Mean fluoride concentrations in the artificially fluoridated supplies ranged from 0.53 (SD 0.47) to 0.93 (SD 0.22) mg F/L and were within the optimal range of 0.7‐1.0 mg F/L in 27.7%‐77.8% of samples. The naturally fluoridated supplies had a higher mean fluoride concentration of 1.06 (SD 0.18) and 1.15 (SD 0.16) mg F/L than the artificially fluoridated supplies, with lower variation over time. The naturally fluoridated supplies were above the optimal range in 75.5% and 53% of samples. Conclusions: Assumptions that populations living in areas with a water fluoridation scheme have received optimally fluoridated water (0.7‐1.0 mg F/L) are invalid. To support future research endeavours, as well as to provide 'external control' and facilitation of optimal dosing, it is recommended that a quarterly record of water fluoride concentrations (mean, standard deviation and minimum and maximum) are made available for every water supply in England, in a format that can be mapped against residential postcodes. [ABSTRACT FROM AUTHOR]

Background and Aims: Youth alcohol consumption has declined significantly during the past 15 years in many high‐income countries, which may have significant public health benefits. However, if the reductions in drinking occur mainly among lighter drinkers who are at lower risk, then rates of alcohol‐related harm among young people today and adults in future may not fall in line with consumption. There is conflicting evidence from Swedish school studies, with some suggesting that all young people are drinking less, while others suggest that alcohol consumption among heavier drinkers may be stable or rising while average consumption declines. This paper extends the geographical focus of previous research and examines whether the decline in youth drinking is consistent across the consumption distribution in England. Design Quantile regression of 15 waves of repeat cross‐sectional survey data. Setting: England, 2001–16. Participants: A total of 31 882 schoolchildren (50.7% male) aged 11–15 who responded to the Smoking Drinking and Drug Use among Young People surveys. Measurements Past‐week alcohol consumption in UK units at each fifth percentile of the consumption distribution. Findings Reductions in alcohol consumption occurred at all percentiles of the consumption distribution analysed between 2001 and 2016, but the magnitude of the decline differed across percentiles. The decline in consumption at the 90th percentile [β = −0.21, confidence interval (CI) = −0.24, −0.18] was significantly larger than among either lighter drinkers at the 50th percentile (β = −0.02, CI = −0.02, −0.01) or heavier drinkers at the 95th percentile (β = −0.16, CI = −0.18, −0.13). Conclusions: Alcohol consumption among young people in England appears to be declining across the consumption distribution, and peaks among heavy drinkers. The magnitude of this decline differs significantly between percentiles of the consumption distribution, with consumption falling proportionally less among the lightest, moderate and very heaviest youth drinkers. [ABSTRACT FROM AUTHOR]

The Common Assessment Framework provides a model of early intervention, which is familiar in local authorities throughout England, and asserts a participatory framework of child and family engagement. This paper is based on a qualitative study of parents and children who were subject to a multi‐agency process of early intervention in children's social care in a local authority in the Midlands of England. I advance the concept of assemblage to consider the basis of an active service user participation as rather more a struggle to achieve than something that has been granted by practitioner agencies. Interview extracts are used to show the enrolment and assembly of participation as a process of service users developing their active human agency in a multi‐agency setting. The article explores the assembling of skills in administration and management of meetings and plans, accessing knowledge and expertise through service user networks, and challenging professional expertise and institutional space while developing personal qualities of confidence and voice as a means of marshalling an effective participation in a multi‐agency setting. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives: Although Bangladeshis are three times more likely to be carers than White British, Bangladeshi family carers are the most deprived, neglected, and effectively a hidden group in the United Kingdom.1 There is a paucity of research within the Bangladeshi community that is capable of explaining and predicting the experiences and concerns of Bangladeshi family carers providing care for their relatives with dementia. The purpose of this study is to explore the perspectives of Bangladeshi family carers' knowledge and day‐to‐day experiences living in England. Methods: This is a qualitative study involving semistructured face‐to‐face interviews with six Bangladeshi family carers living in London and Portsmouth. Interviews were recorded with the consent and transcribed verbatim. Data were managed by using NVivo software, and thematic analysis was performed. Results: This paper explores that most carers have a lack of knowledge and awareness of the symptoms of dementia. The results of this study are in contrast to previous studies, where South Asian carers perceived dementia as being possessed by evil spirits or God's punishment for previous life's sins; this study reveals that Bangladeshi family carers believed dementia was a medical condition. Unlike earlier South Asian studies, however, all family carers in this study also believed that there was no stigma attached to dementia. Conclusions: Further research is warranted to investigate the religious beliefs, familism, and interpersonal motives as theoretical perspectives to explain how Bangladeshi family carers negotiate and construct their caregiving roles for their relatives with dementia. [ABSTRACT FROM AUTHOR]

This paper problematises the concept of social mobility through an exploration of it in relation to Higher Education policy in England. Based upon a content analysis of a number of key policy documents from distinct eras, it identifies definitions and understandings of social mobility within them, exploring how such references have changed over time, and critiquing the differences between the imagined ideals of what policy rhetoric seeks to do and the reality of policy implementation. In particular, it considers the characterisation of social mobility as an individualised concern; it positions aspirations of improving social mobility within the market of Higher Education; and it ultimately asks whether Higher Education can solve the government's social mobility problem. [ABSTRACT FROM AUTHOR]

School food provision is an important lever to shape the eating behaviours and dietary intake of school‐aged children and young people, and may help to address issues of childhood obesity, inadequate nutrient intakes and the widening gap of health inequalities. The regulation of school food has been an issue since the 1940s, with the challenges of developing a school food policy that supports health and wellbeing and that can be effectively translated in practice remaining to the present day. This paper examines changes to school food provision in England since the 1940s, with regard to the political structure and decisions made by each respective government. It considers the lessons learned from the development of school food policies over this period and possible ways to improve the standards of school food in the future. [ABSTRACT FROM AUTHOR]

Background: Children and young people with learning disabilities experience poor health outcomes and lengthier hospital admissions than those without learning disabilities. No consistently applied, systematic approach exists across the NHS to identify and record this population. This paper describes practices in English hospitals to identify children and young people with learning disabilities. Method: Interviews: 65 NHS staff. Questionnaire: 2,261 NHS staff. Conducted across 24 NHS hospitals in England. Results: No standardized approach exists to identify children or young people with a learning disability or for this information to be consistently recorded, communicated to relevant parties within a hospital, Trust or across NHS services. Staff reported a reliance on parents to inform them about their child's needs but concerns about "flagging" patients might be a significant barrier. Discussion: Without an integrated systematic way across the NHS to identify children with learning disabilities, their individual needs will not be identified. [ABSTRACT FROM AUTHOR]

Background and aims: During the past three decades an expansive literature has emerged that is dedicated to analysing the processes of policy transfer. One neglected pathway involves subnational agents emulating crime control innovations that have emerged in subnational jurisdictions of other nations. This paper presents the case of the London Mayor's Office for Policing and Crime's (MOPAC) Alcohol Abstinence Monitoring Requirement (AAMR) Pilot to examine the multi‐level factors that facilitate and/or constrain international–subnational crime and justice policy transfer. Methods: A qualitative case study design reconstructed the (in)formal events that led to components of the South Dakota 24/7 Sobriety Project (USA) being either abandoned or integrated into MOPAC's AAMR Pilot. Evidence is drawn from elite interviews and documentary materials. Results: A series of inter/transnational‐, macro‐domestic‐, meso‐ and micro‐level factors enabled and/or obstructed processes of complete international–subnational policy transfer. Exclusion of domestic violence perpetrators from the London Pilot was fuelled by interest‐group hostility and mobilization. Use of alcohol tags rather than breathalysers to monitor compliance was a result of political–economic constraints, concern surrounding intrusion, technological innovation and policy‐orientated learning. The decision to omit an 'offender pays' funding mechanism was a consequence of legal incompatibility and civil service reluctance, while 'flash incarceration' for breach was not implemented due to European policy harmonization. Conclusions: The London Alcohol Abstinence Monitoring Requirement Pilot was a policy 'synthesis' that combined ideas, goals, vocabulary, principles, technology and practices from the South Dakota model with the existing English and Welsh criminal justice framework. Structural factors and the actions of particular agents limited the extent to which policy transfer occurred. [ABSTRACT FROM AUTHOR]

The National Institute for Health Research (NIHR) aims to improve national 'health and wealth' by providing infrastructural support to enable clinical research in National Health Service settings in England and Wales. Cognisant of the consequences of studies' failure to achieve required numbers of participants, it also actively campaigns to promote patient awareness of research, and willingness to participate in trials. In this paper, we analyse recent NIHR campaigns and policies designed to encourage patients to participate in clinical research to interrogate how they are implicated in the national bioeconomy. In doing so we expand the notion of 'clinical labour' to include the work of patient recruitment and highlight an emergent obligation on patients to contribute to research processes. Whereas once patient knowledge and experience may have been devalued, here we draw on the concept of 'assetisation' (Birch 2012) to explore the emergent relationship between healthcare system and patient as research participant. We consider how patients' contribution goes beyond the provision of standardised objects of valuation so that patients themselves may be perceived as assets to, not only recipients of, the national healthcare system. [ABSTRACT FROM AUTHOR]

In this paper, we examine how space is integral to the practices and politics of restructuring health and care systems and services and specifically how ideas of assemblage can help understand the remaking of a region. We illustrate our arguments by focusing on health and social care devolution in Greater Manchester, England. Emphasising the open‐ended political construction of the region, we consider the work of assembling different actors, organisations, policies and resources into a new territorial formation that provisionally holds together without becoming a fixed totality. We highlight how the governing of health and care is shaped through the interplay of local, regional and national actors and organisations coexisting, jostling and forging uneasy alliances. Our goal is to show that national agendas continued to be firmly embedded within the regional project, not least the politics of austerity. Yet through keeping the region together as if it was an integrated whole and by drawing upon new global policy networks, regional actors strategically reworked national agendas in attempts to leverage and compete for new resources and powers. We set out a research agenda that foregrounds how the political reorganisation of health and care is negotiated and contested across multiple spatial dimensions simultaneously. [ABSTRACT FROM AUTHOR]

The experiences and needs of lesbian, gay, bisexual, trans and queer/questioning (LGBTQ) young people in care have been overlooked in England, in both policy and research. This paper reports on findings from the first study of LGBTQ young people in care in England and focuses on the nature of foster carers' experiences and perspectives on caring for LGBTQ young people. Qualitative interviews regarding the fostering role in caring for LGBTQ young people were conducted with a sample of foster carers (n = 26) and analysed thematically. Foster carers described the importance of offering LGBTQ young people not only the nurturing relationships that all children in care need but also availability, sensitivity and acceptance to help young people manage stigma and other challenges associated with minority sexual orientation and gender identity. The Secure Base caregiving model provided a framework for analysing the different dimensions of these relationships. Understanding caregiving roles and relationships for LGBTQ young people in care has important implications for recruiting, training, matching and supporting foster carers to care for LGBTQ young people effectively. [ABSTRACT FROM AUTHOR]

Child sexual exploitation (CSE) is a category of child abuse that was historically created to recognize the victimhood of children and young people, illuminating the ways that their evolving capacity to consent to sex is manipulated and undermined. Using evidence from the evaluation of specialist foster care provision and a CSE training course for foster carers, this paper considers how training might be used to widen the pool of potential foster carers for children affected by CSE and identifies qualities displayed by effective carers. It argues that improving the recruitment of foster carers can create safer home environments for teenagers at risk of or experiencing sexual exploitation and reduce the risk of further harm and that informed and effective foster care provision is crucial to prevent both the sexual exploitation of looked‐after teenagers and placement breakdowns that can ultimately increase risk. [ABSTRACT FROM AUTHOR]

Aim: To compare mortality rates for cardiovascular disease, cancer, and respiratory disease between adults with cerebral palsy (CP) and the general population.Method: A cohort study was conducted using data from adults with CP in England, identified through a primary care data set (the Clinical Practice Research Datalink), with linked data on death registrations from the Office for National Statistics. Cause of death was categorized according to International Classification of Diseases codes. Standardized mortality ratios (SMRs) were calculated to compare mortality rates between adults with CP and the general population, adjusted for age, sex, and calendar year.Results: Nine hundred and fifty-eight adults with CP were identified (52.5% males, 47.5% females; median age at start of follow-up 31y [interquartile range 22-43y]) and followed for a total of 7693 person-years. One hundred and forty-two patients (15%) died during follow-up. Adults with CP had an increased risk of death due to cardiovascular disease (SMR: 3.19, 95% confidence interval [CI] 2.20-4.62) and respiratory disease (SMR: 13.59, 95% CI 9.89-18.67), but not from malignant neoplasms (SMR: 1.42, 95% CI 0.83-2.45).Interpretation: We found that adults with CP in England have increased risk of death due to diseases of the circulatory and respiratory systems, supporting findings from two studies that compared cause-specific mortality rates between adults with CP in the USA and the general population. Further research is required into primary and secondary prevention of cardiovascular and respiratory disease in people with CP worldwide.What This Paper Adds: Adults with cerebral palsy (CP) in England have 14-fold increased risk of mortality due to diseases of the respiratory system. They have a 3-fold increased risk of mortality due to diseases of the circulatory system. Adults with CP had an increased risk of death due to cerebrovascular disease and ischaemic heart disease. The elevated risk of ischaemic heart disease, however, did not reach statistical significance at the 5% per cent level. [ABSTRACT FROM AUTHOR]

Background: Engaging with the public is a key element of health research; however, little work has examined experiences of public involvement in research dissemination. The aim of this paper was to assess the extent of public involvement, experiences of public advisers and resulting changes in the dissemination of the North West Coast Household Health Survey (HHS). Methods: Three writing groups allowed public advisers to contribute to the dissemination of the HHS. A public workshop was set up to aid the co‐production of the research evidence and discuss the experiences of public advisers involved with the survey in March 2018. A focus group with public advisers was conducted in August 2018 to understand their experiences of involvement. Data were analysed using thematic analysis and coded by two researchers. Writing groups are still on‐going. Results: Fourteen public advisers contributed via three face‐to‐face writing groups, by actively interpreting findings and helping in the write‐up of research articles and by presenting talks at the public workshop. At the workshop, seven public advisors contributed to setting priorities for data analysis from the HHS. Five public advisers took part in the focus group, which highlighted that whilst public advisers were generally satisfied with their involvement, they would like to be involved in more activities. Conclusions: Members of the public shaped the dissemination of evidence and provided guidance for future steps. Public advisers were mostly positive about their involvement in the dissemination of the HHS, but highlighted the need for more transparency and support from researchers. [ABSTRACT FROM AUTHOR]

The crossover between systemic psychotherapy and social work has received renewed attention in recent years. Expanding numbers of local authorities are commissioning systemic training and encouraging social workers to apply these ideas within the field of child protection. It is therefore vital and timely to listen to social workers' experiences, in order to attain feedback on how this can best be achieved. This research study interviewed five case‐holding social workers in a London local authority child protection team about their experiences, and used Interpretative Phenomenological Analysis (IPA) to analyse the data. This paper discusses two themes: 'the importance of the organisation' and 'the process of applying learning'. Recommendations for improvements are made for academic and employment organisations from the research findings. The overall argument is that there is a significant opportunity for the field of systemic psychotherapy to learn from and improve the social work field, and vice versa. Practitioner points: Organisational stability, clarity and commitment to systemic practice has a significant impact on social workers' abilities to apply systemic ideas in their practiceSocial workers value being able to put systemic ideas into practice and learning the 'doing' of as well as the 'thinking' behind systemic practiceSystemic psychotherapy has an opportunity to learn from its application to social work, particularly if applied to diverse workforces, who in turn work with diverse client groups [ABSTRACT FROM AUTHOR]

Background: Mentally disordered offenders may suffer discrimination on the basis of mental disorder, or on the basis of being offenders, or both.Aims: The aim of this paper is to outline a framework for examining discrimination affecting mentally disordered offenders. It is argued that there should be systematic comparisons between offenders with mental disorder and nonoffenders with mental disorder in order to identify and characterise specific failures to ensure equivalence of mental health care; and systematic comparisons between offenders with mental disorder and offenders without mental disorder in order to identify how mental disorder may constitute a barrier to forms of support and constructive intervention available to other offenders.Methods: A critical review was conducted of official documents presenting criminal justice and mental health policy for England and Wales, principally since 2012, together with reports of inspectorate and oversight bodies and relevant research studies.Findings: There is evidence that offenders with mental disorder may not be able to access mental health care equivalent to that for nonoffenders with mental disorder. There is also evidence that they may not be able to access interventions available to other offenders. Further disadvantage may arise in the criminal courts since, in England and Wales, if inpatient care is required, the powers of criminal courts to effect hospital admission under Part III of mental health legislation are weakened by the statutory requirement of information that places are available. This is discriminatory against offenders with mental disorder insofar as forms of court disposal for other offenders are not prevented by the capacity of criminal justice agencies.Conclusions and Implications: The review supports the need for systematic comparisons to identify forms of disadvantage and discrimination experienced by mentally disordered offenders in relation to both mental health and criminal justice policies services. [ABSTRACT FROM AUTHOR]

This paper discusses a recent study on three 'Youth Commission' on police and crime projects. Professional viewpoints were interpreted to understand how they valued young people's participation and made sense of their experiences and capabilities. Framed within policing reforms, the 'Youth Commission' projects regard young people as co‐producers, who work in partnership with professionals to address police and crime issues. The focus is upon professionals and their relationships with young people for transformative participation and social outcomes. Working in partnerships showed interdependency but identifies further challenges if professionals do not truly value young people's participation. [ABSTRACT FROM AUTHOR]

Aim: To test the hypothesis that children and young people with neurological conditions who missed outpatient appointments have more emergency inpatient admissions and Accident and Emergency centre (A&E) visits than those who missed none.Method: Retrospective cohort of individuals aged up to 19 years with neurological conditions, identified from routine hospital data in England, UK from April 1st, 2003 to March 31st, 2015 using an International Statistical Classification of Diseases and Related Health Problems, coding framework. Counts of emergency inpatient admissions and A&E visits per person per year were modelled (random intercept negative binomial regression) with outpatient attendance the independent variable of interest.Results: The cohort numbered 524 613 individuals. Those who missed outpatient appointments had 19 per cent (95% confidence interval [CI] 18-19) more emergency inpatient admissions and 16 per cent (95% CI 15-17) more A&E visits per year than those who missed none. 'Did not attends' had a larger increase in unplanned health care than patient or provider cancellations. If no appointments were missed, the models predict there would have been 107 000 fewer A&E visits from 2007/2008 to 2014/2015 and 104 000 fewer emergency inpatient admissions from 2003/2004 to 2014/2015.Interpretation: Missed outpatient appointments were associated with increased unplanned health care. Improving outpatient attendance may have the potential to reduce emergency inpatient admissions and A&E visits.What This Paper Adds: Missed outpatient appointments by children and young people with neurological conditions are associated with increased unplanned health care. Both emergency inpatient admissions and Accident and Emergency centre visits are increased. 'Did not attends' are more strongly associated with unplanned health care than cancellations. [ABSTRACT FROM AUTHOR]

The article presents the authors' clarification of papers regarding the Saint Mary's Hospital Tracheostomy MultiDisciplinary Team's (TMDT) approach to tracheostomy care in London, England. They mention the responsibility of Julie Oxton in organizing the tracheostomy training sessions for nurses and physiotherapists. They clarify that the training day, which took place during the ward round under Otolaryngology supervision, was not a formalized training session.

Our updated review of over 93 000 biopsies complements the previous decade-long evaluation of nearly half-a-million biopsies and illustrates the impact COVID-19 has had on prostate cancer diagnostics. The reduced sepsis and emergency readmission rates associated with the transperineal approach were alluded to in our paper reviewing the clinical and financial implications of a decade of NHS prostate biopsies from 2008 to 2019 [[1]]. Abbreviations AUR acute urinary retention GA general anaesthetic HES Hospital Episode Statistics LA local anaesthetic NEL non-elective The move towards transperineal biopsy and retreat from the traditional transrectal approach termed "TREXIT" is in vogue. [Extracted from the article]

LINKED CONTENT: This article is linked to Dhanda et al papers. To view these articles, visit https://doi.org/10.1111/apt.17307 and https://doi.org/10.1111/apt.17335 [ABSTRACT FROM AUTHOR]

LINKED CONTENT: This article is linked to Dhanda et al papers. To view these articles, visit https://doi.org/10.1111/apt.17307 and https://doi.org/10.1111/apt.17366 [ABSTRACT FROM AUTHOR]

Limited research has been conducted in relation to social work and the impact upon kinship carers' own children in a UK context. This paper argues that pressure from government policy imperatives and organizational priorities creates tension and conflict in the professional self in the context of kinship care and with kinship carers' own children. It will examine the professional self through social work narratives utilising the two concepts economy of performance and ecology of practice. This paper focuses upon data from four focus groups and 16 semi-structured interviews carried out with 29 social workers within one local authority in the north of England. Transcripts were analysed using thematic analysis. Only data related to the professional self are examined. The discussion explores how social workers attempted to navigate the tension in their everyday practice. It illuminates the impact upon their performance in kinship care and implications for practice with carers' own children. The conclusion reveals the need for social workers to create a space within which kinship carers' own children's voices are heard. [ABSTRACT FROM AUTHOR]

This paper engages with the continuing emphasis given to evidence-based policy and 'what works' approaches in educational research, highlighting some of the continuing epistemological challenges from a post-positivist perspective. To illustrate these, it uses the case of bursaries awarded by universities to improve outcomes for students from disadvantaged backgrounds as an example of an education intervention designed to address structural inequality. The paper then discusses critical reflections arising from a project commissioned by the Office for Fair Access in England, which aimed to enable universities to evaluate the impact of the bursaries that they award. These reflections provide a lens to explore the limitations of experimental and quasi-experimental designs in complex social fields. The paper concludes that we lack a strong understanding of the relationship between financial and educational disadvantage prior to and during higher education, and this undermines efforts to 'prove' that certain interventions will 'level the playing field'. [ABSTRACT FROM AUTHOR]

This paper uses international data from a range of sources, principally the 2013 round of the Teaching and Learning International Survey (TALIS 2013), to provide new information on classroom disciplinary climate in secondary schools in England. The paper advances the literature in three distinct ways. Firstly, the data show that teachers in England perceive that there is considerable disruption in their classrooms. While some reports, especially from official sources, have suggested that classroom disruption is minimal in schools in England that does not seem plausible given these results from TALIS. Secondly, since TALIS contains comparable data for over 30 countries, the results for England can be set in a wider context. Reports in the media frequently highlight pupil disruption and suggest that classroom climate tends to be worse in England than in many other countries. In fact what emerges from the international comparison is that, on each of the items measuring classroom climate in TALIS 2013, the results for England were somewhat better than both the all-country average and the average for a group of European comparators. Thirdly, the survey also includes a range of information about the school in which the teacher worked, the pupils which they taught, and the teachers themselves. We draw on this data to investigate which school-level characteristics, teacher attributes, and characteristics of pupils in the classroom, were associated with favourable classroom climate in England. While some commentators have focused exclusively on school-level factors, we emphasise the importance of within-school variation. [ABSTRACT FROM AUTHOR]

The social positioning and treatment of persons with dementia reflects dominant biomedical discourses of progressive and inevitable loss of insight, capacity, and personality. Proponents of person-centred care, by contrast, suggest that such loss can be mitigated within environments that preserve rather than undermine personhood. In formal organisational settings, person-centred approaches place particular responsibility on 'empowered' direct-care staff to translate these principles into practice. These staff provide the majority of hands-on care, but with limited training, recognition, or remuneration. Working within a Foucauldian understanding of power, this paper examines the complex ways that dementia care staff engage with their own 'dis/empowerment' in everyday practice. The findings, which are drawn from ethnographic studies of three National Health Service ( NHS) wards and one private care home in England, are presented as a narrative exploration of carers' general experience of powerlessness, their inversion of this marginalised subject positioning, and the related possibilities for action. The paper concludes with a discussion of how Foucault's understanding of power may help define and enhance efforts to empower direct-care staff to provide person-centred care in formal dementia care settings. [ABSTRACT FROM AUTHOR]

Aim The aim of this paper is to explore what might be gained from collecting and analysing visual data, such as photographs, scans, drawings, video and screen recordings, in clinical educational research. Its focus is on visual research that looks at teaching and learning 'as it naturally occurs' in the work place, in simulation centres and other sites, and also involves the collection and analysis of visual learning materials circulating in these sites. Background With the ubiquity of digital recording devices, video data and visual learning materials are now relatively cheap to collect. Compared to other domains of education research visual materials are not widely used in clinical education research. The paper sets out to identify and reflect on the possibilities for visual research using examples from an ethnographic study on surgical and inter-professional learning in the operating theatres of a London hospital. Main contribution The paper shows how visual research enables recognition, analysis and critical evaluation of (1) the hidden curriculum, such as the meanings implied by embodied, visible actions of clinicians; (2) the ways in which clinical teachers design multimodal learning environments using a range of modes of communication available to them, combining, for instance, gesture and speech; (3) the informal assessment of clinical skills, and the intricate relation between trainee performance and supervisor feedback; (4) the potentialities and limitations of different visual learning materials, such as textbooks and videos, for representing medical knowledge. Discussion and conclusion The paper concludes with theoretical and methodological reflections on what can be made visible, and therefore available for analysis, explanation and evaluation if visual materials are used for clinical education research, and what remains unaccounted for if written language remains the dominant mode in the research cycle. Opportunities for quantitative analysis and ethical implications are also discussed. [ABSTRACT FROM AUTHOR]

Background Early identification of children with potential development delay is essential to ensure access to care. The Ages & Stages Questionnaires (ASQ) is used as population outcome indicators in England as part of the 2.5-year review. Method The aim of this article was to systematically review the worldwide evidence for the psychometric properties of the ASQ third edition (ASQ-3TM) and the Ages & Stages Questionnaires®: Social-Emotional (ASQ:SE). Eight electronic databases and grey literature were searched for original research studies available in English language, which reported reliability, validity or responsiveness of the ASQ-3TM or ASQ:SE for children aged between 2 and 2.5 years. Twenty studies were included. Eligible studies used either the ASQ-3TM or the ASQ:SE and reported at least one measurement property of the ASQ-3TM and/or ASQ:SE. Data were extracted from all papers identified for final inclusion, drawing on Cochrane guidelines. Results Using 'positive', 'intermediate' and 'negative' criteria for evaluating psychometric properties, results showed 'positive' reliability values in 11/18 instances reported, 'positive' sensitivity values in 13/18 instances reported and 'positive' specificity values in 19/19 instances reported. Conclusions Variations in age or language versions used, quality of psychometric properties and quality of papers resulted in heterogeneous evidence. It is important to consider differences in cultural and contextual factors when measuring child development using these indicators. Further research is very likely to have an important impact on the interpretation of the ASQ-3TM and ASQ:SE psychometric evidence. [ABSTRACT FROM AUTHOR]

This paper reports upon the learning that emerged from a development project which aimed to facilitate improvements in multiagency work in domestic abuse and safeguarding children. The two-year project (2011-13), funded by the Department for Education and led by WomenCentre, a specialist voluntary sector organisation based in West Yorkshire, was undertaken in nine local authorities in the north of England. Activities undertaken during the project included case mapping, service user and professional engagement exercises, observation of local multiagency meetings and provision of training. An evaluative research study examined the work of the project and the learning that emerged. Drawing upon data from telephone interviews with project participants, analysis of case mapping and project reports, this paper discusses some critical issues which emerged from this project. The paper draws attention to the different understandings and priorities which shape interprofessional practice in relation to safeguarding children and domestic abuse, and the complexities of the wider interagency environment including coordination, resources and expertise. Recommendations for improving multiagency work to achieve better outcomes for women and children experiencing domestic abuse are discussed. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Messages Multiagency working in domestic abuse and safeguarding children is complex and could be improved., The impact of professional differences in how cases are understood and managed, particularly in relation to 'risk', as well as different professional priorities and approaches to working with families should be recognised and considered within the multiagency context., Practitioners may want to consider whether 'case mapping' is pertinent to their own safeguarding practices and processes. [ABSTRACT FROM AUTHOR]

This paper considers the effect of recent education policy on assessment practices in English primary schools and how these affect relationships between teachers and pupils in an increasingly market-driven school system. Previous research has focused largely on the effect of markets at a systemic level, but less attention has been paid to how marketisation plays out in teachers' work at classroom level. Similarly, research on assessment has tended to examine teachers' practices in relation to pupils' learning rather than examining it in terms of the role it plays in teachers' professional working lives. This paper brings these ideas together, using the latter as the context for understanding the former. In particular, it focuses on recent policy changes to the way schools in England are evaluated, moving from final attainment to pupils' progress 'in-year', and considers their potential for altering the dynamics within schools rather than just between them. It draws on a small-scale, interpretive, empirical study involving interviews with primary teachers in England. Data from this study are used to illustrate how tensions can arise for teachers and how internal market competition can be set up between them in which pupils' achievements become a commodity to be made use of, encouraging teachers to consider pupils' achievements as private, rather than public, goods. The paper thus provides a starting point for exploring the effect of market-orientated education policy on teachers' assessment practices at the in-school level and briefly examines some of the implications of this effect. [ABSTRACT FROM AUTHOR]

This paper considers how literary and cinematic constructions of Essex noir expose the darker, chaotic sides to working-class embourgeoisement: initially via post-War suburbanisation and later, via Margaret Thatcher's attempt to encourage competitive individualism and entrepreneurship. Noir angles a 'dark mirror' to suburban Essex and develops a distinctive aesthetics of social and cultural change, while also puncturing myths of social mobility and suburban security. The paper points to both affinities and breaks between noir's bleak pessimism and Walter Benjamin's understanding of history as overcoming the concept of progress. [ABSTRACT FROM AUTHOR]

Objectives: To report on the routine clinical implementation of cell-free DNA (cfDNA) analysis of maternal blood for trisomies 21, 18 and 13 in twin pregnancy and to define the performance of the test by combining our results with those identified in a systematic review of the literature.Methods: The data for the prospective study were derived from screening for trisomies 21, 18 and 13 in twin pregnancies at 10 + 0 to 14 + 1 weeks' gestation. Two populations were included; first, self-referred women to the Fetal Medicine Centre in London or Brugmann University Hospital in Brussels and, second, women selected for the cfDNA test after routine first-trimester combined testing at one of two National Health Service hospitals in England. This dataset was used to determine the performance of screening for the three trisomies. Search of MEDLINE, EMBASE, CENTRAL (The Cochrane Library), ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform (ICTRP) was carried out to identify all peer-reviewed publications on clinical validation or implementation of maternal cfDNA testing for trisomies 21, 18 and 13 in twin pregnancy. A meta-analysis was then performed using our data and those in the studies identified by the literature search.Results: In our dataset of 997 twin pregnancies with a cfDNA result and known outcome, the test classified correctly 16 (94.1%) of the 17 cases of trisomy 21, nine (90.0%) of the 10 cases of trisomy 18, one (50.0%) of the two cases of trisomy 13 and 962 (99.4%) of the 968 cases without any of the three trisomies. The literature search identified seven relevant studies, excluding our previous papers because their data are included in the current study. In the combined populations of our study and the seven studies identified by the literature search, there were 56 trisomy-21 and 3718 non-trisomy-21 twin pregnancies; the pooled weighted detection rate (DR) and false-positive rate (FPR) were 98.2% (95% CI, 83.2-99.8%) and 0.05% (95% CI, 0.01-0.26%), respectively. In the combined total of 18 cases of trisomy 18 and 3143 non-trisomy-18 pregnancies, the pooled weighted DR and FPR were 88.9% (95% CI, 64.8-97.2%) and 0.03% (95% CI, 0.00-0.33%), respectively. For trisomy 13, there were only three affected cases and two (66.7%) of these were detected by the cfDNA test at a FPR of 0.19% (5/2569).Conclusions: The performance of cfDNA testing for trisomy 21 in twin pregnancy is similar to that reported in singleton pregnancy and is superior to that of the first-trimester combined test or second-trimester biochemical testing. The number of cases of trisomies 18 and 13 is too small for accurate assessment of the predictive performance of the cfDNA test. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]