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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]

Objective: To determine impact of undertaking an international educational program during a nurse's or midwife's pre-registration program on subsequent practice, focusing on how nurses and midwives were transformed personally through participation in such programs. Background: Participation in international educational programs has been reported to enhance nursing and midwifery students' personal and professional development, however long-term impacts remain unclear. This paper presents findings drawn from a larger grounded theory study. Study design and Methods: Charmaz's grounded theory methodology was used to elicit experiences from 13 general nurses, two mental health nurses, three midwives and four dual qualified nurse/midwives across eight different countries. Data analysis led to the creation of three categories, with this paper reporting on the category of Developing as a Person. Findings: Participation in international educational programs can be transformative for nurses and midwives with long-lasting impacts, contributing positively to their personal growth and development. Discussion: The study findings underscore significant long-term impacts of international educational programs for nurses and midwives. These outcomes highlight the importance of incorporating international experiences into healthcare education. Conclusion: By providing opportunities for healthcare professionals to engage with diverse settings and populations, organisations and educational institutions can foster the development of well-rounded and globally competent practitioners. Implications for research, policy, and practice: The study's findings hold significant implications for research, policy, and practice in healthcare education. To deepen our understandings, additional longitudinal research across diverse countries is warranted. Policymakers have an opportunity to acknowledge the positive impact of these programs on the personal growth and development of nurses and midwives, potentially leading to the integration of global competency requirements into licensure programs. In order to provide comprehensive education, educational institutions should consider the inclusion of study abroad opportunities, cultural exchanges, and global clinical placements within nursing and midwifery curricula. What is already known about the topic? • International educational programs are widely used as a way of developing nursing and midwifery students' cultural understandings. • Previous studies have reported on short-term impacts of international educational programs. What this paper adds: • Long-term impacts of participation in an international educational program on nurses and midwives are described. • Personal development and subsequent transformations occur for nurses and midwives as a result of participation in international educational programs. [ABSTRACT FROM AUTHOR]

This paper explores the redistribution and rescaling of societal risk in rural Britain during the COVID-19 pandemic, as one episode of the permacrisis. Drawing on empirical work in three contrasting areas of Scotland and England, we analyse individuals' experiences of risk and of the institutions which offer them support in times of crisis (markets, state, voluntary and community organisations, and family and friends). Our findings reveal the unequal distribution of societal risk during the pandemic, exacerbated by a legacy of precariatisation and individualisation in the labour market and welfare reforms. Although the state acted to mitigate risk and financial hardship during the lockdown, it was often voluntary and community organisations that filled the gaps left by the inability of the state to reach effectively into rural areas. Social infrastructure and institutional capital are therefore central to the mitigation of vulnerability and societal risk. This raises important questions about the capacity of institutions to provide support in times of crisis to rural citizens. Unless there is societal pooling of risk through such institutions to ensure social protection and that nobody is disadvantaged by where they live, future episodes of the permacrisis are likely to exacerbate inequalities and vulnerabilities in rural communities. [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]

Objectives: This paper considers home from the perspective of people living with dementia supporting ongoing discourse around ageing in place and the significance of creating more inclusive communities. Methods: Forty‐six home tour interviews led by people living with dementia were conducted in England and Scotland to better understand the connectivity between home and neighbourhood for people living with dementia. These interviews used a range of participatory and creative approaches including video, photographic images and in situ interviews. Data were analysed via reflexive thematic analysis. Results: Three themes were identified in data analysis. 1. Connected home and neighbourhood, where participants revealed the dynamic relationship between home and neighbourhood; 2. Practices of home, where participants discussed the everyday nature of their homes and routines; and 3. Displaying home and family, which reflected participant's biographical homes in the context of living with dementia. Discussion: The findings show that home holds multiple meanings for people living with dementia. For example, home is understood as a part of the neighbourhood and an extension of the home space into gardens and backyards, thus extending existing discourses that solely focus on the inside of people's homes. For people living with dementia, homes are also sites of negotiation and renegotiation where new meanings are created to reflect the changing nature and context of the home. There is not one fixed solution to these issues. Support and understanding for people living with dementia will need to evolve to adapt to the shifting dynamics and multiple meanings of home. Key points: Neighbourhoods begin within homes and are interconnected. This relationship has important implications for the discourse of ageing in place.'Home' for people living with dementia holds the same meanings for those without dementia, but with some notable differences. It is important to recognise the shifting dynamics of home and to recognise the complexity of home in the context of dementia. There is not a fixed solution to the challenges of ageing at home with dementia, but support and understanding need to evolve alongside people with lived experience.Homes are a site of renegotiation where new meanings are created to reflect the changing nature of home and the lived experience of home for those with dementia.The study has provided findings through innovation in the research design. The employment of creative methods enabled people living with dementia to participate in sharing their own narratives of home.The work provides evidence where there is a current gap in understanding 'what matters' about home for people living with dementia. [ABSTRACT FROM AUTHOR]

In this paper, we use a UK case study to explore how the COVID-19 pandemic affected the mental health (emotional, psychological, social wellbeing) of farmers. We outline the drivers of poor farming mental health, the manifold impacts of the pandemic at a time of policy and environmental change, and identify lessons that can be learned to develop resilience in farming communities against future shocks. We undertook a survey answered by 207 farmers across the UK, focusing on drivers of poor mental health and the effect of the COVID-19 pandemic. We also conducted 22 in-depth interviews with individuals in England, Scotland and Wales who provide mental health support to farmers. These explored how and why the COVID-19 pandemic affected the mental health of farmers. These interviews were supplemented by 93 survey responses from a similar group of support providers (UK-wide). We found that the pandemic exacerbated underlying drivers of poor mental health and wellbeing in farming communities. 67% of farmers surveyed reported feeling more stressed, 63% felt more anxious, 38% felt more depressed, and 12% felt more suicidal. The primary drivers of poor mental health identified by farmers during the pandemic included decreased social contact and loneliness, issues with the general public on private land, and moving online for social events. Support providers also highlighted relationship and financial issues, illness, and government inspections as drivers of poor mental health. Some farmers, conversely, outlined positive impacts of the pandemic. The COVID-19 pandemic is just one of many potential stressors associated with poor farming mental health and its impacts are likely to be long-lasting and delayed. Multiple stressors affecting farmers at the same time can create a tipping point. Therefore, there is a need for long-term support and ongoing evaluation of the drivers of poor mental health in farming families. [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]

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

This paper explores the impact of policy changes and budget cuts on services and support faced by people with learning disabilities. Drawing upon collaborative research in England and Scotland and interviews with commissioners and support organisations, we show how landscapes of care and support are unstable and fragmented. We identify how pressures of time, resource and precaritisation in the workforce are creating 'debilitating landscapes of care' that further erode the capacities of both the people that work in the sector and people with learning disabilities. Some challenges that people with learning disabilities face in this context include finding appropriate local support, narrowing access as a result of reductions in benefit entitlements and identifying quality providers amid a complex array of private and charitable provision. Capacity to cope with these challenges is contingent on access to quality advocacy, supportive family, friendships, productive occupational learning environments and peer support, but these are not always available. The impact of COVID-19 has only served to intensify some of the issues we identify and the urgent need for a response. Our analysis is inspired by Berlant's (2007) conception of 'slow-death' and Puar's (2017) associated conceptualisation of 'debility'. [ABSTRACT FROM AUTHOR]

The financialization of everyday life has received considerable attention since the 2008 global financial crisis. Financialization is thought to have created active financial subjects through the ability to participate in mainstream financial services. While the lived experience of these mainstream financial subjects has been the subject of close scrutiny, the experiences of financial subjects at the financial fringe have been rarely considered. In the UK, for example, the introduction of High-Cost, Short-Term Credit [HCSTC] or payday loan regulation was designed to protect vulnerable people from accessing unaffordable credit. Exploring the impact of HCSTC regulation is important due to the dramatic decline of the high-cost credit market which helped meet essential needs in an era of austerity. As such, the paper examines the impact of the HCSTC regulation on sixty-four financially marginalized individuals in the UK that are unable to access payday loans. First, we identify the range of socioeconomic strategies that individuals employ to manage their finances to create a typology of financial subjectivity at the financial fringe. Second, we demonstrate how the temporal and precarious nature of financial inclusion at the financial fringe adds nuance to existing debates of the everyday lived experience of financialization. [ABSTRACT FROM AUTHOR]

In recent years, both international law (notably the UN Convention on the Rights of the Child (UNCRC) and the UN Convention on the Rights of Persons with Disabilities) and domestic legislation have led to a new emphasis on children's rights in the field of special educational needs and disabilities (SEND) in England and additional support needs (ASN) in Scotland. Scotland has moved ahead of England in extending these rights, but research has pointed to shortfalls in the practical realisation of the rights agenda in both jurisdictions. The Covid-19 pandemic, resulting in temporary school closures, has created further barriers to the realisation of children's educational rights. The Scottish Government has developed a Children's Rights and Wellbeing Impact Assessment framework, and proposed new legislation incorporating the UNCRC into domestic legislation promised to generate further pressure for improvement in the delivery of rights. In England, there are less focused channels for influencing policy delivery. In the context of the domestic rights on SEND and ASN and the pandemic response, this paper provides a comparative assessment of the potential contribution of Children's Rights Impact Assessments (CRIAs) to the protection of children's rights, finding their potential not yet fully realised. [ABSTRACT FROM AUTHOR]

Across the four UK jurisdictions, there are distinct disparities in exclusion rates of school students. Northern Ireland, alongside Scotland and Wales, has demonstrated over time, lower rates of permanent exclusions and temporary exclusions compared with England. This paper examines these disparities from the perspectives of representatives from various system-level educational bodies and third sector organisations representing children and families who experienced the exclusion process. The paper will also present policy and legal frameworks associated with exclusion in Northern Ireland. We interviewed 9 stakeholders, associated with practices of school exclusion in Northern Ireland, from a range of system-level education bodies and advocacy groups. Findings include positive strategies perceived to keep exclusion levels low, types of obstacles or resistance to anti-exclusion policy, participants' perspectives on unofficial exclusion practice, and perspectives on official exclusion data. What emerges from interviews is a series of tensions between implementing a child-centred approach and diminishing support services and resources. We conclude that those working within the Northern Ireland education system, are committed to an inclusive approach. However, the development and implementation of effective supporting frameworks take time and consultation, and there is evidence of tension between the perceptions of those working at a system-level and those working in schools. [ABSTRACT FROM AUTHOR]

Much research surrounds the move from publicly owned and operated bus markets to publicly controlled and privately operated markets, or in the case of Great Britain, a fully deregulated market. Little research however exists concerning the counter move and the issues that this may raise. Such a step would be consistent with Gwilliam's regulatory cycle, which suggests that a combination of self seeking behaviour of suppliers and unrealistic aspirations of politicians leads to instability in the regulatory arrangements for the provision of bus services. Consequently, the associated structural and institutional arrangements go through a cycle of private/public ownership and competitive/regulated markets. The paper discusses some of the practicalities at the regional level of introducing the measures provided by the Bus Services Act 2017 in England and the Transport Act 2019 in Scotland, both of which offer the option of a partial or full economic reregulation of bus services. Theories of radical policy change are examined and applied in the context of the issue through interviews with key informants in regional authorities in Scotland and England. The overriding conclusion from this analysis is that whilst deregulating the market does not actually break Gwilliam's regulatory cycle, it makes it very difficult to 're-connect', and thus a further long term consequence of bus deregulation in Britain in the mid 1980s is that future policy options may have been severely restricted in the very long term. • Identifying the key factors required to bring about radical transport policy change. • Bus de-regulation represented a clear break in the regulatory cycle and as such has compromised longer term policy actions. • The importance of real transport governance and the financial ability to carry through policy actions. • A major divergence between actions policy makers think is required, and the realities to which those actions are targeted. [ABSTRACT FROM AUTHOR]

The voluntary sector acts as the last line of defense for some of the most marginalized people in societies around the world, yet its capacities are significantly reduced by chronic resource shortages and dynamic political obstacles. Existing research has scarcely examined what it is like for voluntary sector practitioners working amidst these conditions. In this paper, we explore how penal voluntary sector practitioners across England and Scotland marshaled their personal and professional resources to "keep going" amidst significant challenges. Our analysis combines symbolic interactionism with the concept of story‐lines. We illuminate the narratives that practitioners mobilized to understand and motivate their efforts amidst the significant barriers, chronic limitations, and difficult emotions brought forth by their work. We position practitioners' story‐lines as a form of emotion work that mitigated their experiences of anger, frustration, overwhelm, sadness, and disappointment, enabling them to move forward and continue to support criminalized individuals. Our analysis details three story‐lines—resignation, strategy, and refuge—and examines their consequences for practitioners and their capacities to intervene in wicked social problems. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to present data about access to and use of health and social care services by adults with learning disabilities during the COVID-19 pandemic in England, Northern Ireland, Scotland and Wales. Design/methodology/approach: Data were collected in three waves between December 2020 and September 2021 and concerned the use of health and social care services during the COVID-19 pandemic. Data were collected at one or more time-points directly from 694 adults with learning disabilities and through separate proxy reports by family carers and paid support staff of another 447 adults with learning disabilities. Findings: Many people with learning disabilities who reported regularly accessing services/supports pre-pandemic were not receiving them during the timeframe of this study. There were indications of increasing access to some services and supports between Wave 2 and 3, but this was not universal. Practical implications: People in Cohort 2, who were likely to have severe/profound learning disabilities, were less frequently reported to access online community activities than people in Cohort 1, which is likely to exacerbate existing social isolation for this cohort and their family carers. Service providers should seek to ensure equitable access to services and activities for all people with learning disabilities in the event of future lockdowns or pandemics. Originality/value: This is the largest longitudinal study about the impact of the COVID-19 pandemic on health and social care services for adults with learning disabilities in the UK. We primarily collected data directly from adults with learning disabilities and worked with partner organisations of people with learning disabilities and family members throughout the study. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to critically analyse the concept of mandatory reporting in adult safeguarding in the jurisdictions of Australia, Canada, England, Northern Ireland and Scotland. Design/methodology/approach: A rapid realist evaluation of the literature on this topic was carried out in order to answer the question: "what works, for whom and in what circumstances?" Particular attention was paid to Context(s), Mechanism(s) and Outcome(s) configurations of adult safeguarding reporting systems and processes. Findings: The evaluation found a range of arguments for and against mandatory reporting and international variations on the scope and powers of mandatory reporting. Research limitations/implications: This review was undertaken in late 2018 so subsequent policy and practice developments will be missing from the evaluation. The evaluation focussed on five jurisdictions therefore, the findings are not necessarily translatable to other contexts. Practical implications: Some jurisdictions have introduced mandatory reporting and others are considering doing so. The potential advantages and challenges of introducing mandatory reporting are highlighted. Social implications: The introduction of mandatory reporting may offer professionals increased powers to prevent and reduce the abuse of adults, but this could also change the dynamic of relationships within families, and between families and professionals. Originality/value: This paper provides an accessible discussion of mandatory reporting across Ireland and internationally which to date has been lacking from the literature. [ABSTRACT FROM AUTHOR]

Purpose: Organisational culture and leadership, employee skills and aptitudes, access to resources, and training are regularly cited as important determinants of the development of innovative work behaviour (IWB). The purpose of the work reported in this paper was to investigate a further set of possible determinants of the development of IWB: those that are information-related. Design/methodology/approach: A mixed methods approach was adopted. Quantitative and qualitative data were collected by questionnaire, interview and focus groups in three large public sector case study organisations in Scotland, Finland and England. Findings: A set of information-related determinants of the development of IWB is evidenced, adding to the list of determinants that are already well documented. Notably workplace information literacy (IL) appears to furnish a bridge between determinants of the development of IWB and workplace learning. Originality/value: That information-related determinants may be valuable to the development of IWB has not previously merited specific consideration, nor been recognised, in the wider IWB literature. The identification of these determinants in this research should encourage researchers and professionals beyond the domain of information science to pay serious attention to IL. This is particularly important in respect of the role of workplace IL in processes that lead to new knowledge creation and innovation. [ABSTRACT FROM AUTHOR]

In Part I of this paper we have introduced the closed-form conditions for guaranteeing regional frequency stability in a power system. Here we propose a methodology to represent these conditions in the form of linear constraints and demonstrate their applicability by implementing them in a generation-scheduling model. This model simultaneously optimises energy production and ancillary services for maintaining frequency stability in the event of a generation outage, by solving a frequency-secured Stochastic Unit Commitment (SUC). We consider the Great Britain system, characterised by two regions that create a non-uniform distribution of inertia: England in the South, where most of the load is located, and Scotland in the North, containing significant wind resources. Through several case studies, it is shown that inertia and frequency response cannot be considered as system-wide magnitudes in power systems that exhibit inter-area oscillations in frequency, as their location in a particular region is key to guarantee stability. In addition, securing against a medium-sized loss in the low-inertia region proves to cause significant wind curtailment, which could be alleviated through reinforced transmission corridors. In this context, the proposed constraints allow to find the optimal volume of ancillary services to be procured in each region. [ABSTRACT FROM AUTHOR]

There has been widespread interest in the potential for the significant behavioural and policy adaptations rendered necessary by Coronavirus to act as a catalyst for radical longer term policy change in transport. However, this body of work to date has been limited in its consideration of how such policy change might be brought about. Translating the lessons from the Coronavirus response to other ongoing strategic challenges such as decarbonisation requires analysis of what the pandemic has revealed about processes of policy formulation and how institutions responsible for policy implementation actually work. This paper explores the extent to which rapid policy change has actually been possible in the transport sector in England and Scotland during the pandemic, and key examples of how such change has been both achieved and blocked. Two rounds of interviews with senior stakeholders from across the transport sector were undertaken in June and November 2020 to inform the analysis. We find that the pandemic has accelerated some policy commitments that were already planned, but at a time of huge stress on the whole of government and its partner delivery organisations, the potential to deliver radical policy adaptation was limited. However, Coronavirus is recognised as being a potentially path-changing disruption to existing trajectories in terms of the adaptations to business practices, industry structures, ways of working and the public finances. Paradoxically, whilst recognising these uncertainties, decision-makers are yet to deviate from pre-pandemic planning assumptions and policy plans and this risks missing the opportunities to steer how those changes unfold. • Addresses research gap in the study of governance responses during disruptions. • Identifies transport as a distant policy sub-sector in a crisis that affected all parts of government. • Finds that the response to the pandemic has accelerated already planned policies but generated few new policies. • Long-term impacts on the future structure of cities, use of public transport and uptake of active travel could still emerge. • The leading strategic thinkers on transport policy are still unsure what kinds of future demand to plan for. [ABSTRACT FROM AUTHOR]

The Mellow Futures programme is a specially adapted parenting programme for mothers with learning difficulties that combines group work with home‐based support. This paper reports on the findings of prospective and retrospective interviews with professionals who had referred mothers to the programme in England or Scotland between 2013 and 2015. The aim was to explore their perceptions of the programme as a whole, and its impact on the mothers they had referred to it. Mothers attending the Mellow Futures programme were invited to consent for a key professional to be contacted as part of the evaluation, generally those social workers who had referred the mothers to the programme. The 'referrers' were interviewed at the start and end of the programme. Thirty referrers contributed their views on the impact of the programme. Twenty‐six were very positive about the impact of the Mellow Futures programme on the mothers: the programme was thought to have increased the mothers' confidence and self‐esteem; supported them to work through issues; and helped them strengthen their relationship‐building skills. Four referrers felt that the programme had not had any impact on the mothers they were supporting. The Mellow Futures programme focused on relationships, rather than parenting techniques, and three fundamentally important relationships in the mothers and babies' lives were targeted: the relationship/attachment between mother and baby; the supportive, ongoing relationships between the mothers in the group; and the mothers' more positive engagement with the professionals concerned with the welfare of their baby. The research confirms that, from the perspectives of referrers, linking group and home‐based support can successfully help mothers with learning difficulties to care for their children. [ABSTRACT FROM AUTHOR]

Aims: The United Kingdom and Australia have developed highly divergent policy responses to electronic nicotine delivery systems (ENDS). To understand the historical origins of these differences, we describe the history of tobacco control in each country and the key roles played in setting ENDS policy in its early stages by public health regulations and policy networks, anti‐smoking organizations, 'vaper' activist networks and advocates of harm reduction policies towards injecting drug use. Methods: We analysed key government reports, policy statements from public health bodies and non‐government organizations (e.g. cancer councils and medical organizations) on ENDS; submissions to an Australian parliamentary inquiry; media coverage of policy debates in medical journals; and the history of tobacco control policy in Australia and England. Key discourses about ENDS were identified for each country. These were compared across countries during a multi‐day face‐to‐face meeting, where consensus was reached on the key commonalities and divergences in historical approaches to nicotine policy. This paper focuses on England, as different policy responses were apparent in constituent countries of the United Kingdom, and Scotland in particular. Results: Policymakers in Australia and England differ markedly in the priority that they have given to using ENDS to promote smoking cessation or restricting smokers' access to prevent uptake among young people. In understanding the origins of these divergent responses, we identified the following key differences between the two countries' approaches to nicotine regulation: an influential scientific network that favoured nicotine harm reduction in the United Kingdom and the absence of such a network in Australia; the success of different types of health activism both in England and in Europe in opposing more restrictive policies; and the greater influence on policy in England of the field of illicit drug harm reduction. Conclusions: An understanding of the different policy responses to electronic nicotine delivery systems (ENDS) in England and Australia requires an appreciation of how actors within the different policy structures, scientific networks and activist organizations in each country and region have interpreted the evidence and the priority that policymakers have given to the competing goals of preventing adolescent uptake and encouraging smokers to use ENDS to quit smoking. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to present data about access to health and social care services during the COVID-19 pandemic for adults with learning disabilities across England, Northern Ireland, Scotland and Wales. Design/methodology/approach: Data were collected directly from 621 adults with learning disabilities and through separate proxy reports by family carers and paid support staff of another 378 adults with learning disabilities. The data were collected between December 2020 and February 2021 and concerned the use of health and social care services since the start of the first COVID-19 national lockdown in March 2020. Findings: Access to and use of health and social care services significantly reduced for adults with learning disabilities across the UK during the COVID-19 pandemic between March 2020 and February 2021, with many people not receiving any services at all during that period. Similar patterns were seen across England, Northern Ireland, Scotland and Wales. However, data suggest some variations between countries for some services. Practical implications: Future pandemic planning must ensure that access to these essential services is not completely lost for adults with learning disabilities and their family carers, as it was in some cases during the COVID-19 pandemic in 2020. Originality/value: This is the largest study about the impact of the COVID-19 pandemic on health and social care services for adults with learning disabilities in the UK. The authors primarily collected data directly from adults with learning disabilities, and worked with partner organisations of people with learning disabilities throughout the study. [ABSTRACT FROM AUTHOR]

In the digital age, space has become increasingly structured by the circuitry of global capital, communications and commodities. This 'network society' splinters and fragments territorial space according to the hidden logic of networked global capital; with successful criminal entrepreneurs connecting bases in low-risk, controllable territories with high-profit markets. Drawing on a recent, large-scale study of organised crime in Scotland, in this paper we elaborate the relationship between place, territory and criminal markets in two contrasting communities. The first is an urban neighbourhood with a longstanding organised crime footprint, where recognised local criminal groups have established deep roots. The second is a rural community with a negligible organised crime footprint, where the drug economy is serviced by a mobile criminal network based in England. Through comparison of the historical roots and contemporary routes of these criminal markets, we note both similarity and difference. While both communities demonstrated evidence of 'networked territorialism', key differences related to historical and social antecedents, in particular the impact of deindustrialisation. [ABSTRACT FROM AUTHOR]

The policing of young people, especially through stop-and-search, has been rigorously debated in the context of rising violence in the UK. While concepts based on procedural justice theory and perceptions of police fairness are directly relevant to these debates, these have rarely been tested on young people, nor have they taken account of the impact of stop-and-search. This paper examines young people's experiences of stop-and-search in two Scottish and two English cities, and tests the relationship between these experiences, their trust in the police, their perceptions of police legitimacy and their compliance with the law. The study finds that Scottish adolescents, who experienced higher volume stop-and-search, had more negative attitudes to the police and perceived them to be less procedurally fair than English adolescents. Structural equation modelling confirms that principles of procedural justice theory do apply to young people in this UK sample. However, our findings suggest that stop-and-search may damage trust in the police and perceptions of police legitimacy, regardless of the volume of police stop-and-search, and this may result in increased offending behaviour. With ongoing calls to increase the use of stop-and-search in response to recent increases in knife crime in England, we argue that its use needs to be carefully balanced against the, as yet poorly evidenced, benefits of the use of the tactic. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the role that Donor Transplant Co‐ordinators have played and the future potential of Specialist Nurses for Organ Donation (SN‐ODs), within organ donation strategies in the UK and other countries. Background: Organ donation and transplantation rates vary extensively around the world. However, there is a universal shortage of deceased donors, prompting different approaches to increase transplantation rates. Within the UK, the Clinical Lead for Organ Donation and Specialist Nurse in Organ Donation undertake a key role in the implementation of the Organ Donation Strategy. The Human Transplantation (Wales) Act 2015 is a recent development which facilities a deemed (presumed) consent approach to organ donation, the Specialist Nurse in Organ Donation undertakes a major role identifying the potential donor in this situation by confirming the deemed consent status of the donor and supporting bereaved relatives. UK governments in England and Scotland are currently seeking legislative changes to an opt‐out system of organ donation, in line with the Wales change. Design: This discursive paper explores the role from Donor Transplant Co‐ordinator to Specialist Nurse in Organ Donation (SN‐OD) within organ donation policy in different settings, but with a specific focus on the UK. The paper clarifies the current and future potential of nurses working with bereaved families when requesting authorisation for donation. Implications for nursing: The current scope and future potential of Donor Transplant Co‐ordinator and Specialist Nurse in Organ Donation roles need better recognition. Little empirical data exist about the key role that these nurses play in the organ donation process, especially in relation to gaining authorisation to proceed to donation. Conclusion: There is a need to clarify the role of the Specialist Nurse in Organ Donation and their impact on improving rates of organ donation. [ABSTRACT FROM AUTHOR]

Excessive exposure to ultraviolet (UV) radiation from the sun in summer can cause skin cancer and in Britain there are around 1500 new cases of non-melanoma skin cancer (NMSC) each year, caused by exposure to solar UV at work. Little is known about the magnitude of UV exposure amongst outdoor construction workers in Britain, although this is one of the main groups at risk. The aim of this paper is to summarise measurements of erythema-weighted UVB radiation amongst construction workers in Scotland and the Southeast of England and interpret the data in terms of the risk of NMSC. The measurements were made as part of an intervention study using short mobile phone text messages to alter worker behaviour to either reduce UV exposure in summer or increase serum vitamin D in winter; the intervention is only briefly reported here. Data were collected from 67 workers from 9 worksites, of whom 41 provided measures of UV exposure for 758 working days. Daily exposure ranged from 0 to 13.47 standard erythema dose (SED), with the mean exposure for outdoor workers being 2.0 SED and the corresponding value for indoor workers being 0.7 SED. These data were obtained from a sensor located on the back of the workers hard hat; others have measured exposure on the wrist or upper arm and these locations probably, on average, have higher levels of UV exposure. It is likely that an outdoor construction worker in Britain could accumulate sufficient solar UV exposure over 30–40 years of work to more than double their risk of NMSC. We argue that employers in Britain should take a more proactive approach to manage sun safety and they should take responsibility for skin health surveillance for their workers. [ABSTRACT FROM AUTHOR]

Substantial evidence shows that candidates' and parties' performances in constituencies at UK general elections are influenced by the intensity of their local campaigns, but that evidence is almost invariably based on analyses of voting across all constituencies. Most constituencies are unlikely to change hands, however. This paper explores whether the impact of spending varies according to seat marginality and analyses the pattern of spending and canvassing in the 123 Labour-Conservative marginals in England and all 59 constituencies in Scotland. The results are consistent with expectations: campaigning and canvassing matters most where campaigning and canvassing should matter most. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to explore debates about the powers social workers may need to undertake safeguarding enquiries where access to the adult is denied.Design/methodology/approach The paper takes as a starting point a scoping review of the literature undertaken as part of a study exploring social work responses to situations where they are prevented from speaking to an adult at risk by a third party.Findings A power of entry might be one solution to situations where social workers are prevented from accessing an adult at risk. The paper focuses on the Scottish approach to legal powers in adult safeguarding, established by the Adult Support and Protection Act (Scotland) 2007 and draws out messages for adult safeguarding in England and elsewhere. The literature review identified that debates over the Scottish approach are underpinned by differing conceptualisations of vulnerability, autonomy and privacy, and the paper relates these conceptualisations to different theoretical stances.Social implications The paper concludes that the literature suggests that a more socially mediated rather than an essentialist understanding of the concepts of vulnerability, autonomy and privacy allows for more nuanced approaches to social work practice in respect of using powers of entry and intervention with adults at risk who have capacity to make decisions.Originality/value This paper provides a novel perspective on debates over how to overcome challenges to accessing adults at risk in adult safeguarding through an exploration of understandings of vulnerability, privacy and autonomy. [ABSTRACT FROM AUTHOR]

The paper reports a study that examines how to determine if a road traffic collision took place in daylight or in the dark. An innovative method was developed, based on solar altitude, to establish cut-off points of daylight and darkness determined from a study of daylight availability in England, Scotland and Wales. This approach provides a rigorous method to differentiate daytime and night-time collisions. The criteria were used in a study of the collisions reported in the STATS19 data set for the weeks either side of the clock changes that are necessary between Greenwich Mean Time and British Summer Time. By comparing periods with the same clock time either side of the time change, using the aforementioned method, it was possible to isolate collisions within the same time period that during one week occurred in darkness and in the other week in daylight. The initial finding was that there are 19.3% more collisions in the dark periods and there is an even greater increase (31.7%) in pedestrian injuries. [ABSTRACT FROM AUTHOR]

The mouth may be presented and understood in different ways, be subject to judgement by others and, as we age, may intrude on everyday life due to problems that affect oral health. However, research that considers older people's experiences concerning their mouths and teeth is limited. This paper reports on qualitative research with 43 people in England and Scotland, aged 65–91, exploring the significance of the mouth over the lifecourse. It uses the concept of 'mouth talk' to explore narratives of maintaining, losing and replacing teeth. Participants engaged in 'mouth talk' to downplay the impact of the mouth, demonstrate socially appropriate ageing, and distance themselves from 'real' old age by retaining a moral identity and sense of self. They also found means to challenge dominant discourses of ageing in how they spoke about missing teeth. Referring to Leder's notion of 'dys-appearance' and Gilleard and Higgs' work on the social imaginary of the fourth age, the study illustrates the ways in which 'mouth talk' can contribute to sustaining a sense of self in later life, presenting the ageing mouth, with and without teeth, as an absent presence. It also argues for the importance of listening to stories of the mouth in order to expand understanding of people's approaches to oral health in older age. [ABSTRACT FROM AUTHOR]

This final report of the Lancet Commission into liver disease in the UK stresses the continuing increase in burden of liver disease from excess alcohol consumption and obesity, with high levels of hospital admissions which are worsening in deprived areas. Only with comprehensive food and alcohol strategies based on fiscal and regulatory measures (including a minimum unit price for alcohol, the alcohol duty escalator, and an extension of the sugar levy on food content) can the disease burden be curtailed. Following introduction of minimum unit pricing in Scotland, alcohol sales fell by 3%, with the greatest effect on heavy drinkers of low-cost alcohol products. We also discuss the major contribution of obesity and alcohol to the ten most common cancers as well as measures outlined by the departing Chief Medical Officer to combat rising levels of obesity-the highest of any country in the west. Mortality of severely ill patients with liver disease in district general hospitals is unacceptably high, indicating the need to develop a masterplan for improving hospital care. We propose a plan based around specialist hospital centres that are linked to district general hospitals by operational delivery networks. This plan has received strong backing from the British Association for Study of the Liver and British Society of Gastroenterology, but is held up at NHS England. The value of so-called day-case care bundles to reduce high hospital readmission rates with greater care in the community is described, along with examples of locally derived schemes for the early detection of disease and, in particular, schemes to allow general practitioners to refer patients directly for elastography assessment. New funding arrangements for general practitioners will be required if these proposals are to be taken up more widely around the country. Understanding of the harm to health from lifestyle causes among the general population is low, with a poor knowledge of alcohol consumption and dietary guidelines. The Lancet Commission has serious doubts about whether the initiatives described in the Prevention Green Paper, with the onus placed on the individual based on the use of information technology and the latest in behavioural science, will be effective. We call for greater coordination between official and non-official bodies that have highlighted the unacceptable disease burden from liver disease in England in order to present a single, strong voice to the higher echelons of government. [ABSTRACT FROM AUTHOR]

Research into the role of place in shaping inequalities in health has focused largely on examining individual and/or localised drivers, often using a context-composition framing. Whilst this body of work has advanced considerably our understanding of the effects of local environments on health, and re-established an awareness of the importance of place for health, it has done so at the expense of marginalising and minimising the influences of macro political and economic structures on both place and health. In this paper, we argue that: (i) we need to scale up our analysis, moving beyond merely analysing local horizontal drivers to take wider, vertical structural factors into account; and (ii) if we are serious about reducing place-based health inequalities, such analysis needs be overtly linked to appropriate policy levers. Drawing on three case studies (the US mortality disadvantage, Scotland's excess mortality, and regional health divides in England and Germany) we outline the theoretical and empirical value of taking a more political economy approach to understanding geographical inequalities in health. We conclude by outlining the implications for future research and for efforts to influence policy from 'scaling up' geographical research into health inequalities. • Health-place research commonly examines focuses individual and/or localised drivers. • Health geography should 'scale up' analysis of health-place relationships. • Research needs to account for wider, vertical and structural factors. • Political economic approaches add value to insight on geographic health inequalities. • Considers the policy implications of taking a political economy approach. [ABSTRACT FROM AUTHOR]

The ways in which examination standards are conceptualised and operationalised differently across nations has not been given sufficient attention. The international literature on standard-setting has been dominated by the psychometrics tradition. Broader conceptualisations of examination standards have been discussed in the literature in England, which has curriculum-related examinations at the end of schooling. There has, however, been little analysis of conceptualisations of examination standards in Scotland. Different education systems and examinations operate in Scotland and England, and the stated value positions and processes relating to examination standards differ markedly. This paper critically examines policy positions on assessment standards in Scotland and England through the lens of recent theories of standard-setting. By analysing public statements on standards, the paper illuminates similarities and differences in conceptual bases and operational approaches, and examines the effects of these on outcomes for candidates. We conclude that both systems are operationalising attainment-referencing, but with different processes in Scotland and England and these practices do not fit within previous examination standards classifications. As such, the paper moves examination standards theory forward by concluding that there is at least one superordinate definitional category that draws upon more than one definitional stance. [ABSTRACT FROM AUTHOR]

A Travel Plan is a travel demand management tool which has the potential to alter the means of travel to or from any destination or origin of movement to modes of transport other than the private car. A Travel Plan typically comprises of a package of measures which interact to achieve such modal shift. Travel Plans or their equivalents have been used successfully in various parts of the world to manage travel demand. Ultimately however, the success or failure of a Travel Plan meeting its intended objectives hinges on an appropriate mechanism, usually legal, to ensure that the measures within the plan are observed and properly implemented. Although both are constituent parts of the UK, England and Scotland operate under separate legal and governance systems. In the international context of Travel Planning, this results in the unique and novel situation of two countries of virtually identical demographics but with potentially different implementation systems. This paper investigates the differences between the two approaches adopted, making reference to best practice examples from local authorities in both countries. Firstly, the legal position of Travel Plans is investigated through a comparison of the relevant English and Scottish legislation. Particular reference is made to the ability of such legislation to facilitate ‘soft’ measures and secure a long term agreement with owners or occupiers. Both of these aspects are critical to the successful enforcement of Travel Plans. Evidence from previous research suggests that central government policy can be used as an incentive to ensure that local authorities promote and monitor Travel Plan activity associated with development. However, given the legal complexities of land use planning and the limited resources of local authorities, clear and direct national government guidance is also considered an important factor. In recognition of these facts, the paper goes on to compare and contrast the approaches to policy and guidance adopted by the two countries. Through a combination of desktop and interview surveys, the practical application of the legal, policy and guidance aspects of travel planning in the two countries is reviewed. Using a review of local authority approaches in England and Scotland, conclusions are drawn with regard to the relevant strengths and weaknesses of approaches adopted in each country. Previous research suggests that the implementation of single-use development Travel Plans is now widely observable across the UK, albeit with varying degrees of long-term success. However, implementation of Travel Plans across wide area, mixed use development carries with it additional challenges, both in legal and practical terms. Specific reference is made to how local authorities are able to address these issues. The paper concludes with a discussion of these findings and makes a number of suggestions on how the processes may be improved to facilitate better application, monitoring and enforcement of Travel Plans across the UK and internationally. [ABSTRACT FROM AUTHOR]

The objective of this paper is to investigate the respective influence of various urban pattern characteristics on inundation flow. A set of 2000 synthetic urban patterns were generated using an urban procedural model providing locations and shapes of streets and buildings over a square domain of 1 × 1 km 2 . Steady two-dimensional hydraulic computations were performed over the 2000 urban patterns with identical hydraulic boundary conditions. To run such a large amount of simulations, the computational efficiency of the hydraulic model was improved by using an anisotropic porosity model. This model computes on relatively coarse computational cells, but preserves information from the detailed topographic data through porosity parameters. Relationships between urban characteristics and the computed inundation water depths have been based on multiple linear regressions. Finally, a simple mechanistic model based on two district-scale porosity parameters, combining several urban characteristics, is shown to capture satisfactorily the influence of urban characteristics on inundation water depths. The findings of this study give guidelines for more flood-resilient urban planning. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of the paper is to report the findings from research into the governance of adult protection in Scotland, with particular focus on the outcomes of provision for multi-agency leadership and management of adult safeguarding in the Adult Support and Protection (Scotland) Act 2007. Comparisons will be drawn between these findings and the evidence on the governance of adult safeguarding in England. Design/methodology/approach – The study comprised a thematic analysis of Adult Protection Committee (APC) biennial reports on implementation of the 2007 Act to the Scottish Government, associated documentation, and key informant interviews with professionals involved in adult protection leadership and practice. Findings – A rich and complex pattern of arrangements, activities, experiences and challenges were identified across a number of dimensions, including management structures of APCs, development of policies and procedures, multi-agency working, training, performance assessment and quality management, engagement of service users and carers and operation of the 2007 Act. Research limitations/implications – Service users and carers were not directly involved in the documentary review or key informant interviews. There remains a need to investigate the impacts on practice and service user experience of different forms of governance of adult protection arrangements. Practical implications – The paper identifies outcomes and challenges in respect of multi-agency approaches to governance taken by APCs in Scotland. Originality/value – The paper offers the first formal evaluation of governance of adult protection systems in Scotland and includes comparative analysis with research findings on the governance of adult safeguarding in England. [ABSTRACT FROM AUTHOR]

Disgust is a complex phenomenon that pervades a number of social situations. To date, disgust has primarily been understood as an individually experienced emotion or as a way of defining boundaries between people or objects; the detailed social practices through which disgust is choreographed, however, have yet to be fully explored. The social implications of disgust are particularly apparent when food and eating are involved, as it is in such settings that individuals, objects, and social boundaries coincide. In this paper, I argue that the enactment of disgust is an inherently social event, and that we can evidence it as such through the way in which it is produced and oriented to in everyday interaction. The setting for this paper is family mealtimes, as a situation in which children and parents explore the boundaries of what is, and what is not, disgusting. A large corpus of video and audio recordings of mealtimes in England and Scotland were analysed using a discursive psychological approach, with a focus on explicating the sequential and prosodic features of disgust markers (DMs), such as 'eugh' and 'yuck'. The analysis demonstrates that DMs are typically preceded by a 'noticing' by speakers and that 'eugh' is usually uttered alone and at the start of a turn in talk. It is argued that, regardless of their putative status as emotions or cultural concepts, DMs work as assessments of food and eating practices in everyday interaction. They orient others to a trouble source and attend to people's entitlements to 'know' disgust. The implications for our understanding of disgust as a social psychological concept are further explored. [ABSTRACT FROM AUTHOR]

This paper considers the origins and traces the history of the Social Fund, an ideologically-motivated social policy departure of the Thatcher era. It identifies the controversy, in research communities amongst others, which surrounded the establishment of the Fund, and considers the evidence of recurring difficulties in its practical operation over a thirty-year period. It then turns to the Coalition administration in Westminster’s decision to divest itself of responsibility for key parts of the Fund, devolving such obligations to local authorities in England, the Parliament in Scotland and the Assembly in Wales. The paper sets out a comparison of the approaches being developed to discharge the Fund’s prior responsibilities in the three nations. It concludes that the essential policy thrust lies in a determination to roll back central state obligations in poverty relief and income maintenance which had hitherto been accepted by all post-war administrations. [ABSTRACT FROM AUTHOR]

This paper explores the work of teacher education in England and Scotland. It seeks to locate this work within conflicting sociocultural views of professional practice and academic work. Drawing on an activity theory framework that integrates the analysis of these seemingly contradictory discourses with a study of teacher educators’ practical activities, including the material artefacts that mediate the work, the paper offers a critical perspective on the social organisation of university-based teacher education. Informed by Engeström’s activity theory’s concept of transformation, the paper extends the discussion of contradictions in teacher education to consider the wider sociocultural relations of the work. The findings raise important questions about the way in which teacher education work within universities is organised and the division of labour between schools and universities. [ABSTRACT FROM PUBLISHER]

Background: Increasing age is the biggest risk factor for dementia, of which Alzheimer's disease is the commonest cause. The pathological changes underpinning Alzheimer's disease are thought to develop at least a decade prior to the onset of symptoms. Molecular positron emission tomography and multi-modal magnetic resonance imaging allow key pathological processes underpinning cognitive impairment - including β-amyloid depostion, vascular disease, network breakdown and atrophy - to be assessed repeatedly and non-invasively. This enables potential determinants of dementia to be delineated earlier, and therefore opens a pre-symptomatic window where intervention may prevent the onset of cognitive symptoms.Methods/design: This paper outlines the clinical, cognitive and imaging protocol of "Insight 46", a neuroscience sub-study of the MRC National Survey of Health and Development. This is one of the oldest British birth cohort studies and has followed 5362 individuals since their birth in England, Scotland and Wales during one week in March 1946. These individuals have been tracked in 24 waves of data collection incorporating a wide range of health and functional measures, including repeat measures of cognitive function. Now aged 71 years, a small fraction have overt dementia, but estimates suggest that ~1/3 of individuals in this age group may be in the preclinical stages of Alzheimer's disease. Insight 46 is recruiting 500 study members selected at random from those who attended a clinical visit at 60-64 years and on whom relevant lifecourse data are available. We describe the sub-study design and protocol which involves a prospective two time-point (0, 24 month) data collection covering clinical, neuropsychological, β-amyloid positron emission tomography and magnetic resonance imaging, biomarker and genetic information. Data collection started in 2015 (age 69) and aims to be completed in 2019 (age 73).Discussion: Through the integration of data on the socioeconomic environment and on physical, psychological and cognitive function from 0 to 69 years, coupled with genetics, structural and molecular imaging, and intensive cognitive and neurological phenotyping, Insight 46 aims to identify lifetime factors which influence brain health and cognitive ageing, with particular focus on Alzheimer's disease and cerebrovascular disease. This will provide an evidence base for the rational design of disease-modifying trials. [ABSTRACT FROM AUTHOR]

Since the 1970s, there has been growing academic interest in children and young people living in state care and, more recently, in the lives of disabled children. However, there has been little attention on the lives of disabled children who are looked after by the state. This paper compares and critiques what is known about the numbers of disabled children who are looked after in England, Northern Ireland, Scotland and Wales. We discuss the conceptual and methodological limitations of systematically collecting data on disabled children in state care across the UK. We argue that to ensure that the rights of disabled children in state care are identified, acknowledged and upheld, ‘being counted’ is a fundamental first step. [ABSTRACT FROM AUTHOR]

Background: Two to 4% of emergency hospital admissions are caused by preventable adverse drug events. The estimated costs of such avoidable admissions in England were £530 million in 2015. The data-driven quality improvement in primary care (DQIP) intervention was designed to prompt review of patients vulnerable from currently prescribed non-steroidal anti-inflammatory drugs (NSAIDs) and anti-platelets and was found to be effective at reducing this prescribing. A process evaluation was conducted parallel to the trial, and this paper reports the analysis which aimed to explore response to the intervention delivered to clusters in relation to participants' perceptions about which intervention elements were active in changing their practice.Methods: Data generation was by in-depth interview with key staff exploring participant's perceptions of the intervention components. Analysis was iterative using the framework technique and drawing on normalisation process theory.Results: All the primary components of the intervention were perceived as active, but at different stages of implementation: financial incentives primarily supported recruitment; education motivated the GPs to initiate implementation; the informatics tool facilitated sustained implementation. Participants perceived the primary components as interdependent. Intervention subcomponents also varied in whether and when they were active. For example, run charts providing feedback of change in prescribing over time were ignored in the informatics tool, but were motivating in some practices in the regular e-mailed newsletter. The high-risk NSAID and anti-platelet prescribing targeted was accepted as important by all interviewees, and this shared understanding was a key wider context underlying intervention effectiveness.Conclusions: This was a novel use of process evaluation data which examined whether and how the individual intervention components were effective from the perspective of the professionals delivering changed care to patients. These findings are important for reproducibility and roll-out of the intervention.Trial Registration: ClinicalTrials.gov, NCT01425502 . [ABSTRACT FROM AUTHOR]

Background:Deaths associated with alcohol and/or drugs belong to a category of ‘special’ deaths due to three characteristics: traumatic circumstances of the death, stigma directed to both the bereaved and the deceased, and resulting disenfranchised grief experienced by the bereaved. These factors can impede those who are bereaved in this way from both grieving and accessing support. In response to a lack of research in this area this paper reports on an interview study that has aimed to better understand the experiences and needs of this neglected group of bereaved people. Method:Interviews with 106 adults (parents, children, spouses, siblings, nieces and friends) bereaved through substance use in Scotland and England. Results:Five themes describe interviewee experiences: possibility of death, official processes, stigma, grief and support. These findings suggest what is dominant or unique in this group of bereaved people; namely, that living with substance use (including anticipatory grief), experiencing the subsequent death (often traumatic and stigmatised) and the responses of professionals and others (more likely negative than positive) can disenfranchise grief and negatively impact bereavement and seeking support. Conclusions:This article describes a large and unique sample, the largest in the world to be recruited from this population. Our study raises awareness of a hitherto largely ignored and marginalised group of bereaved people, highlighting what might be particular to their bereavement experience and how this may differ from other bereavements, thereby providing an evidence base for improving the availability, level and quality of support. [ABSTRACT FROM AUTHOR]

Background and aims Regulation of electronic cigarettes has moved to the top of the addiction policy agenda, as demonstrated by the recent focus across the United Kingdom on introducing age-of-sale restrictions. However, the views of those affected by such regulation remain largely unexplored. This paper presents the first detailed qualitative exploration of adolescents' perceptions of existing, and opinions about potential e-cigarette regulation. Methods Sixteen focus groups, including a total of 83 teenagers between the ages of 14 and 17 years, were conducted in deprived, mixed and affluent urban areas in Scotland and England between November 2014 and February 2015. Transcripts were imported into Nivivo 10, coded thematically and analysed. Results Participants critically considered existing evidence and competing interests in regulatory debates and demonstrated sophisticated understanding of the advantages and disadvantages of regulation. They overwhelmingly supported strong e-cigarette regulation and endorsed restrictions on sales to minors, marketing and e-cigarette use in public places. Concern about potential health harms of e-cigarette use and marketing increasing the acceptability of vaping and smoking led these adolescents to support regulation. Conclusions In focus group discussions, a sample of UK adolescents exposed to particular communications about e-cigarettes supported strict regulation of e-cigarettes, including banning sales to minors and use in indoor public areas. [ABSTRACT FROM AUTHOR]

Background: Pain is often poorly managed in people who have a dementia. Little is known about how this patient population is managed in hospital, with research to date focused mainly on care homes. This study aimed to investigate how pain is recognised, assessed and managed in patients with dementia in a range of acute hospital wards, to inform the development of a decision support tool to improve pain management for this group.Methods: A qualitative, multi-site exploratory case study. Data were collected in four hospitals in England and Scotland. Methods included non-participant observations, audits of patient records, semi-structured interviews with staff and carers, and analysis of hospital ward documents. Thematic analysis was performed through the lens of decision making theory.Results: Staff generally relied on patients' self-report of pain. For patients with dementia, however, communication difficulties experienced because of their condition, the organisational context, and time frames of staff interactions, hindered patients' ability to provide staff with information about their pain experience. This potentially undermined the trials of medications used to provide pain relief to each patient and assessments of their responses to these treatments. Furthermore, given the multidisciplinary environment, a patient's communication about their pain involved several members of staff, each having to make sense of the patient's pain as in an 'overall picture'. Information about patients' pain, elicited in different ways, at different times and by different health care staff, was fragmented in paper-based documentation. Re-assembling the pieces to form a 'patient specific picture of the pain' required collective staff memory, 'mental computation' and time.Conclusions: There is a need for an efficient method of eliciting and centralizing all pain-related information for patients with dementia, which is distributed in time and between personnel. Such a method should give an overall picture of a patient's pain which is rapidly accessible to all involved in their care. This would provide a much-needed basis for making decisions to support the effective management of the pain of older people with dementia in hospital. [ABSTRACT FROM AUTHOR]

Aims and objectives This systematic review provides an overview of the literature published on Releasing Time to Care: The Productive Ward between 2005 and June 2011. Background Releasing Time to Care: The Productive Ward programme was developed by the NHS Institute for Innovation and Improvement and launched in England in 2007. The programme comprises thirteen modules that aim to increase time for direct patient care, improve the patient and staff experience and make changes to the ward environment to improve efficiency. Design A systematic literature review. Methods The terms ' Releasing Time to Care' and ' Productive Ward' were applied to key healthcare databases; CINAHL, Medline, Science Direct, Pro Quest, Health Business Elite, British Nursing Index, Embase, Health Management Information Consortium and PsychInfo. All papers were read and subject to a quality assessment. Results The literature search identified 95 unique sources. A lack of research on The Productive Ward programme meant it was necessary to include non-empirical literature. In total, 18 articles met the inclusion criteria. Seven key themes were identified: the patient and staff experience, direct care time, patient safety, financial impact, embedding and sustainability, executive support and leadership, and common barriers and determinants of success. It also highlighted areas that require further exploration such as long-term sustainability of the programme and consistent data measurement between organisations. Conclusion The review tentatively reports how The Productive Ward programme has been used to transform nursing practice for the benefit of patients and frontline staff, and how it resulted in cost savings. The literature review identified a potential positive results bias in the current literature whereby favourable outcomes were reported. Relevance to clinical practice This paper summarises the types of evidence and current literature on The Productive Ward providing a reference for frontline staff implementing the programme. [ABSTRACT FROM AUTHOR]

In November 1645, Parliament coordinated the arrival of two armies before the Nottinghamshire town of Newark on Trent to besiege this major royalist garrison. To the north of the town was the Scottish army under the Earl of Leven and to the south English forces under the command of Colonel-General Poyntz of the Northern Association. Situated at the meeting of two great highways, and commanding the crossing nearest to the Humber on the river Trent, Newark had provided a major link between the king's headquarters at Oxford and the northern towns of Newcastle and York. Although the besieging armies were of comparable strength, the Scottish army alone was to generate extensive discontent and numerous petitions from parishes in the immediate vicinity of the town about the behaviour of its troops. Using both state papers and surviving local records, this paper seeks to explore the impact and logistics of both armies and examine whether the complaints against the Scots reflected major differences in their circumstances or was simply a coordination of local xenophobia by the parliamentarian gentry of the region seeking to influence wider political struggles at Westminster. [ABSTRACT FROM AUTHOR]

The objective of this article is to explore how education for innovation of our young people may help develop an innovative mindset. The article develops the theoretical justification of a skills set which, it is argued, is fundamental for the development of an innovative mindset of young people, and consequently their personal development. We focus here on the qualitative work - focus groups and interviews with teaching staff and students aged 14-19 years - that informed our understanding of the five characteristics of this mindset; leadership, creativity, self-efficacy, energy and risk-propensity. The research attempted to capture the differences in context, constraints and school types and ethos that potentially shaped behavioural expression. Case studies based on types of school revealed detailed differences in context - regional, local and personal - that shaped students' engagement and their innovative behaviour in particular. The paper also reflects on teaching style, extracurricular opportunities for skills' development and student motivation to acquire an innovation skills set. The paper reflects on practical and policy implications of this work and identifies areas for further research. [ABSTRACT FROM AUTHOR]

This paper draws on interview data from national policy makers in England, Scotland and the European Commission to illustrate differences in the referencing of 'Europe' in education policy-making in England and Scotland in order to highlight the emergent complexity of post-devolution policy-making in education through a focus on relations and interactions with Europe, as expressed in the negotiation and development of performance data systems. We suggest that policy-makers in England reference global influences, rather than Europe, while policy-makers in Scotland reference Europe in order to project a new positioning of Scotland in closer alignment with Europe. Europeanisation in education thus produces differing policy responses from closely aligned, indeed, in the case of England and Scotland, contiguous policy spaces. Thus the paper seeks to contribute to the literature on 'travelling' education policy and its 'local' mediation and to connect the development of devolution and the changing policy space of education in Europe. [ABSTRACT FROM AUTHOR]