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Background: Few studies have evaluated postnatal anxiety and posttraumatic stress (PTS) before and during the Covid-19 pandemic using comparable data across time. We used data from two national maternity surveys in England to explore the impact of the pandemic on prevalence and risk factors for postnatal anxiety and PTS., Methods: Analysis was conducted using population-based surveys carried out in 2018 (n = 4509) and 2020 (n = 4611). Weighted prevalence estimates for postnatal anxiety and PTS were compared across surveys. Adjusted risk ratios (aRR) were estimated for the association between risk factors and postnatal anxiety and PTS., Findings: Prevalence of postnatal anxiety increased from 13.7 % in 2018 to 15.1 % in 2020 (+1.4 %(95%CI:-0.4-3.1)). Prevalence of postnatal PTS increased from 9.7 % in 2018 to 11.5 % in 2020 (+1.8 %(95%CI:0.3-3.4)), due to an increase in PTS related to birth trauma from 2.5 % to 4.3 % (+1.8 %(95%CI:0.9-2.6); there was no increase in PTS related to non-birth trauma. Younger age (aRR = 1.31-1.51), being born in the UK (aRR = 1.29-1.59), long-term physical or mental health problem(s) (aRR = 1.27-1.94), and antenatal anxiety (aRR = 1.97-2.22) were associated with increased risk of postnatal anxiety and PTS before and during the pandemic, whereas higher satisfaction with birth (aRR = 0.92-0.94) and social support (aRR = 0.81-0.82) were associated with decreased risk., Interpretation: Prevalence of postnatal PTS was significantly higher during the pandemic, compared to before the pandemic, due to an increase in PTS related to birth trauma. Prevalence of postnatal anxiety was not significantly higher during the pandemic. Risk factors for postnatal anxiety and PTS were similar before and during the pandemic., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

"A History of Divorce Law: Reform in England from the Victorian to Interwar Years" by Henry Kha explores the Matrimonial Causes Act of 1857 and its significance in the history of family law. Kha argues that previous scholars have primarily viewed the act as a procedural reform, but he believes it was a landmark moment that made divorce more accessible and signaled a shift from religious to secular authority. However, Kha's argument is challenged by the fact that the act maintained a double standard between men and women in divorce grounds. The book also examines the erosion of divorce law foundations in the early 20th century, but fails to fully explore the impact of the act on the number of divorces. [Extracted from the article]

Many studies have characterised resistomes in river microbial communities. However, few have compared resistomes in parallel rural catchments that have few point-source inputs of antimicrobial genes (ARGs) and organisms (i.e., AMR) - catchments where one can contrast more nebulous drivers of AMR in rural rivers. Here, we used quantitative microbial profiling (QMP) to compare resistomes and microbiomes in two rural river catchments in Northern England, the Coquet and Eden in Northumberland and Cumbria, respectively, with different hydrological and geographical conditions. The Eden has higher flow rates, higher annual surface runoff, and longer periods of soil saturation, whereas the Coquet is drier and has lower flowrates. QMP analysis showed the Eden contained significantly more abundant microbes associated with soil sources, animal faeces, and wastewater than the Coquet, which had microbiomes like less polluted rivers (Wilcoxon test, p < 0.01). The Eden also had greater ARG abundances and resistome diversity (Kruskal Wallis, p < 0.05), and higher levels of potentially clinically relevant ARGs. The Eden catchment had greater and flashier runoff and more extensive agricultural land use in its middle reach, which explains higher levels of AMR in the river. Hydrological and geographic factors drive AMR in rural rivers, which must be considered in environmental monitoring programmes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

By embedding a spatially explicit ecosystem services modelling tool within a policy simulator we examine the insights that natural capital analysis can bring to the design of policies for nature recovery. Our study is illustrated through a case example of policies incentivising the establishment of new natural habitat in England. We find that a policy mirroring the current practice of offering payments per hectare of habitat creation fails to break even, delivering less value in improved flows of ecosystem services than public money spent and only 26% of that which is theoretically achievable. Using optimization methods, we discover that progressively more efficient outcomes are delivered by policies that optimally price activities (34%), quantities of environmental change (55%) and ecosystem service value flows (81%). Further, we show that additionally attaining targets for unmonetized ecosystem services (in our case, biodiversity) demands trade-offs in delivery of monetized services. For some policy instruments it is not even possible to achieve the targets. Finally, we establish that extending policy instruments to offer payments for unmonetized services delivers target-achieving and value-maximizing policy designs. Our findings reveal that policy design is of first-order importance in determining the efficiency and efficacy of programmes pursuing nature recovery. This article is part of the theme issue 'Bringing nature into decision-making'. [ABSTRACT FROM AUTHOR]

SARS-CoV-2 pandemic had a significant impact on the society, economy, and health of people around the world with consequences that need to be better understood for future pandemic preparedness. This manuscript provides insights into the usage of pharmaceuticals for pain treatment management throughout SARS-CoV-2 pandemic. Four towns and cities with a total population of > 1 million people covering an area of 2000 km 2 in South West England were monitored for twenty-four months. Results showed different patterns in pain pharma usage, with small towns having higher population normalised daily loads (PNDLs) than big cities for majority of pain killers studied. This is likely due to demographics of these cities with smaller cities having older population. Per capita consumption of non-steroidal anti-inflammatory drugs (NSAIDs) increased compared to pre-pandemic usage in line with SARS-CoV-2 infections (ibuprofen and acetaminophen), while body pain drugs (diclofenac and naproxen) decreased in line with restrictions and closure of sports facilities. Changes in population normalised daily intake (PNDI) of pain killers were particularly apparent during the 1st and 3rd national lockdown. Comparison of PNDIs with prescriptions highlighted differences related to medication availability (OTC drugs) and patients' nonadherence (prescribed drugs). In addition, several instances of direct disposal events across the catchments were observed which raises an issue of lack of pharma compliance and general understanding of potential environmental impacts from pharma usage., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

SARS-CoV-2 pandemic affected lifestyle habits, and the mental health and wellbeing of people around the world. In this manuscript, two towns (Paulton and Radstock) and two cities (Bath and Bristol) in Southwest England (> 1 million people) were monitored for two years using Wastewater-Based Epidemiology to assess impacts of COVID (including management measures such as lockdowns and movement restrictions) on community lifestyle choices: illicit drugs, legal stimulants, abused pharmaceuticals and pain pharma usage. Results were triangulated with key dates captured during the pandemic (national lockdowns, restrictions and social distancing measures, etc.). This highlighted a reduction in cocaine intake (as benzoylecgonine) (community average: -36 %) during the first lockdown and an increase in illicit drugs usage after the 3rd national lockdown (community averages for amphetamine: +8 %, cocaine/benzoylecgonine: +39 %, ketamine:+70 %) when restrictions were removed, and social interaction and recreational activities increased. There was a reduction in the intake of caffeine (as 1,7-dimethylxanthine) (community average:-39 %) after 3rd national lockdown coinciding with pubs reopening while nicotine intake (via cotinine) remained stable indicating lack of impact of COVID on smoking habits. Pain pharma often used in pain management resulting from injuries linked with sport activities (naproxen and diclofenac) showed decrease in usage due to lockdown restrictions in physical exercise and access to gyms/sport facilities., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Sheep scab is endemic in Great Britain with an estimated national herd-level prevalence of 10.9% from a surveyed population of sheep farms. Previous studies have investigated how sheep farmers manage sheep scab on their farms in Great Britain, but there have not been any qualitative studies investigating sheep farmers perceptions on the roles different stakeholders have in the management of sheep scab. This qualitative study aims to explore how sheep farmers perceive their role and the different stakeholders' roles in the management of sheep scab, and how they would like sheep scab to be managed going forward. Semi-structured interviews were conducted with 43 sheep farmers from England, Scotland, and Wales. The data were analysed using reflexive thematic analysis, through the theoretical lens of Foucault's notion of 'biopower'. Two themes were generated: 'The feeling of powerlessness leads to a need of rules and regulations', with sub-themes: 'The need for governmental rules and regulations' and 'The need for rules and regulation at livestock markets', and 'An apparent lack of sheep scab surveillance', with sub-themes: 'The farmers perceive that the veterinarians have control over surveillance' and 'The farmers have control over surveillance on their farms'. In the first theme, the respondents suggested that more rules and regulations to control the management of sheep scab was required. This included reinstating of sheep scab as a notifiable disease in England and Wales, as well as more regulations at livestock markets to prevent the trading of infested sheep; both of which would subject the farmers to regulatory power mechanisms. The second theme centred around who has the control of surveillance on the farms. Most of the respondents perceived that the veterinarians had knowledge and expertise of the local area on sheep scab, which they were able to relay to the farmers. Thus, veterinarians exerted disciplinary power by creating 'docile' bodies. However, it also appeared that veterinarians were not regularly called onto farms. Although disciplinary power flows through the interactions between the farmer and veterinarian, the techniques currently used are not always having their desired effect. The study demonstrated that how sheep farmers want sheep scab to be managed is, at times, conflicting and contradictory, which highlights the complexity of sheep scab as a disease to manage., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

WHAT IS KNOWN ON THE SUBJECT?: Emergency departments (ED) are key settings to support and manage suicidal crisis; thus, ED staff are often the first point of contact for people in suicidal crisis. Despite this, some ED staff receive little training and/or education on how to best support such patients., What the Paper Adds to Existing Knowledge: Previous research focuses on one staffing role (e.g. triage nurses) whereas this paper includes staff working across the ED pathway. Administrative staff have often been excluded from research, despite representing a key part of the clinical pathway and being a person's initial contact with the ED. Overall findings demonstrate that staff experience a lack of confidence, training and burnout due to regularly supporting people in suicidal crisis. Staff also perceive there to be a negative ED culture, which often leads to poor attitudes towards suicidal crisis. The main challenges reported are an increase in working pressures, unavailability of resources and staff retention. Findings build upon previous research to highlight key challenges different staff face along the clinical pathway and the implications this can have on a patient's journey and follow-up care provided. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Findings are of particular importance and relevance to ED managers, and more broadly NHS England. Negative ED culture, poor staff attitudes and confidence can have a detrimental impact on both staff health and wellbeing, as well as a patient's journey throughout the ED, resulting in repeat presentations and absconding as appropriate support is not received. Policymakers need to consider staff burnout and lack of resources in mental health care strategies, and training programmes should be developed to improve culture and confidence among ED staff and managers to improve care for people attending EDs in suicidal crisis., Abstract: INTRODUCTION: Emergency departments (EDs) are often the first point of contact for people in suicidal crisis. Yet, previous work has tended to focus on only one type of staffing role, failing to account for different staff perspectives along the clinical pathway., Aims: To explore and synthesise the perspectives of ED administrative (i.e. receptionists), medical (triage nurses) and mental health staff (liaison psychiatrists) working with people presenting in suicidal crisis., Method: Qualitative study guided by thematic analysis of semi-structured interviews with 23 ED staff across six EDs in Cheshire and Merseyside, England., Results: Findings demonstrate that staff experience a lack of confidence, training and burnout due to regularly supporting people in suicidal crisis. The main challenges reported are an increase in working pressures, unavailability of resources and staff retention., Discussion: Staff felt unequipped to deal with suicide-related presentations. Organisational support is perceived to be lacking, with increased staffing pressures and poor service availability. This lack of support was linked to job dissatisfaction., Implications for Practice: Findings are of particular relevance to individual EDs and NHS England. Addressing the challenges staff are reporting can have positive implications for staff wellbeing, as well as a patient's experience and journey throughout the ED., (© 2023 The Authors. Journal of Psychiatric and Mental Health Nursing published by John Wiley & Sons Ltd.)

In England and Wales, fee-charging independent schools can be legally classified as charities and, therefore, receive associated benefits, the most obvious being taxation advantages. The high fees charged by many of these schools create financial exclusivity, which, it will be seen, confers significant social and cultural capital to those who can meet the economic barrier to entry. High fees lead to increased wealth for the schools, which is augmented by their charitable fiscal benefits. In exchange for receiving these charitable benefits, one might expect charity law to place significant social contribution requirements on these schools. However, this paper will argue that this is not the case: the law, in fact, requires very little from charitable independent schools. In practice, charity law cannot mitigate inequalities within elite education nor justify their taxation advantages. [ABSTRACT FROM AUTHOR]

Forest School in England is the practice of young children playing outside, rooted in the outdoor kindergartens of Scandinavia and more especially Denmark. Using observation and semi-structured interviews with children and adults in two settings, this case study approach allowed an in-depth look at where, how and what children played in a Forest School in England compared with a Forest Kindergarten in Denmark. This study found that even though each case had contextual differences, with different conceptualisations of pedagogy and play, children were active in the process of their play. Choosing to play in familiar places, which resources they needed, on their own or with peers, but away from adults, a common theme to the play was play stories or narratives. Bounded by the two cases, and explored through play pedagogy, this study offers practitioners and pedagogues a unique insight into how children experience and operate in two similar yet different forest environments. [ABSTRACT FROM AUTHOR]

Entrepreneurship Education (EE) programmes world-wide serve a highly standardized menu of activities for student consumption, such as pitching exercises, competitions and mini-companies. This situation has been called the McDonaldization of EE, where standard activities are adopted globally. In this paper we study the influence of Junior Achievement (JA) – the 'original burger' - to draw attention to the institutionalizing pressure it exerts on EE. We use data from JA organizational websites in England, Sweden and Denmark to describe JA as a global institution exerting homogenizing pressures on the field of EE. Five common dynamics are identified to explain in more detail how JA contributes to the homogenization of EE through: neutralizing ideology; propagating the mini-company template; evidencing strategically; facilitating communion and mythologizing success. New research avenues studying the influence of JA as a powerful institution and potential counter-actions to de-institutionalize EE are proposed. Junior Achievement has been studied before, but most investigations consider the impact of JA on individuals, in terms of effects on students' knowledge and skills. The contribution of this study is in how it focuses on the homogenizing influence of JA as an institution on the system of EE. [ABSTRACT FROM AUTHOR]

This paper provides an analysis of working from home patterns in England using data from the 2021 Census to understand (1) how patterns of working from home (WFH) in England have shifted since the COVID‐19 pandemic and (2) whether human mobility indicators, specifically Google Community Mobility Reports, provide a reliable proxy for WFH patterns recorded by the 2021 Census, providing a formal evaluation of the reliability of such datasets, whose applications have grown exponentially over the COVID‐19 pandemic. We find that WFH patterns recorded by the 2021 Census were unique compared with previous UK censuses, reflecting an unprecedented increase likely caused by persistent changes to employment during the COVID‐19 pandemic, with a clear social gradient emerging across the country. We also find that Google mobility in 'Residential' and 'Workplace' settings provides a reliable measurement of the distribution of WFH populations across Local Authorities, with varying uncertainties for mobility indicators collected in different settings. These findings provide insights into the utility of such datasets to support population research in intercensal periods, where shifts may be occurring, but can be difficult to quantify empirically. [ABSTRACT FROM AUTHOR]

The publication of the 2021 Census data revealed that four English cities—Birmingham, Leicester, London and Manchester—are now 'no majority' cities, meaning that no ethnic group, including the White British, comprise a majority (more than half) of their populations. This paper explores the residential diversification of these cities to ask: whether that diversification is reflected in the average neighbourhood of all ethnic groups or just some; whether the decline in the number of White British means that 'enclaves' of other ethnic groups are emerging instead; whether the White British are avoiding living in diverse neighbourhoods; and whether a co‐occurrence of the diversification is that residential segregation between the White British and other groups is increasing within and beyond the boundaries of these cities. Using a harmonised set of cross‐census neighbourhoods to provide a consistent geography across the 2001, 2011 and 2021 censuses, the results show that the residential neighbourhoods of the four cities have increased their ethnic diversity for the average member of all ethnic groups. Despite some growth in the number of neighbourhoods where a group other than the White British form a majority, especially in Leicester, the overall conclusion is one of residential diversification happening alongside residential desegregation. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject: Self‐harm by ligature is common within inpatient mental healthcare settings and is a dangerous method of self‐harm. Most fatal and non‐fatal suicidal behaviours in inpatient settings are a result of ligature use.There is a lack of research which has explored the experiences of staff members who work within inpatient settings where patients may self‐harm by ligature. What the paper adds to existing knowledge: Key issues related to self‐harm by ligature reported by staff included (1) understaffing increasing risk of ligature incidents, (2) spreading of self‐harm by ligature within inpatient settings and (3) negative attitudes of staff related to patients who self‐harm by ligature.Working with self‐harm by ligature can have negative impacts on staff's personal (e.g. fear of blame) and professional lives (e.g. increased cautiousness). Many staff members currently feel underprepared by training related to working with self‐harm by ligature, and unsupported after responding to a ligature incident. What are the implications for practice: Training about self‐harm by ligature needs to be improved and be accessible for all inpatient mental healthcare staff. Training should be coproduced, and could include practical components, education on potential reasons for self‐harm, and acknowledgement of the emotional impact on staff.Support for staff members who respond to ligature incidents should be available for all staff members who respond to self‐harm by ligature incidents. Stigma associated with accessing support should be challenged, alongside blame cultures within the workplace. Introduction: Self‐harm by ligature is a common form of self‐harm within inpatient mental health services in England, where most suicides within inpatient settings involve hanging or suffocation. However, little research has examined the experiences of staff members working with this method of self‐harm. Aim: We explored the experiences of clinical staff who work with patients who self‐harm by ligature. Method: A staff survey was developed and disseminated to clinical staff working in inpatient settings in England. Quantitative data were analysed using descriptive statistics, and qualitative data using the framework approach. The study was STROBE checklist compliant. Results: 275 staff members participated. Challenges most frequently reported about working with self‐harm by ligature included understaffing (210, 76.6%), spreading of ligature incidents (198, 72.8%) and negative attitudes held by clinical staff towards such patients (185, 68.5%). Participants' responses indicated that this work could have significant impacts on their professional and personal lives. Staff often reported inadequate training and lack of preparedness, alongside insufficient support opportunities following ligature incidents. Discussion: Staff had a diverse range of professional and personal experiences and identified multiple challenges associated with working with patients who have self‐harmed by ligature. Implications for Practice: There is a need to improve accessibility, format and content of training and support for staff working within inpatient settings where patients may self‐harm by ligature. [ABSTRACT FROM AUTHOR]

In the context of threats to their financial sustainability, this paper uses Resource Dependency Theory to explore the challenges being faced by a sample of 10 small new public universities in England. It discusses the responses being taken and prospects for the future in this segment of the sector. It concludes that some of the most important elements of income and expenditure are also areas where institutions have amongst the lowest levels of autonomy, including tuition fees, staff salaries and pension costs. It suggests that institutions are proactively seeking ways to both adapt their strategy and influence the environment in which they operate, including the introduction of new organisational forms, models for employing staff, the diversification into new programmes and markets, and greater use of domestic and international partnerships. [ABSTRACT FROM AUTHOR]

To improve education performance at home, countries cross nationally policy-borrow from jurisdictions ranked highly in international league tables. This paper examines a practical example of one such instance of policy borrowing, Teaching for Mastery (TfM). Over a six year period, interviews were conducted with teachers working in primary schools in the East Midlands region of England. The focus of these interviews was to explore informants' experiences of enacting TfM and their analysis of the UK government's motives for undertaking this borrowing. Applying Baudrillard's ideas around hyperreality and image to these data indicated two key themes: 1) TfM discourses masked crucial aspects of the original policy, with the result that 2) TfM became non-relational to the original and thus hyperreal. The paper suggests strategies that might mitigate against policy becoming hyperreal and concludes that government must carefully consider its motives for engaging in the borrowing process from the outset. [ABSTRACT FROM AUTHOR]

Using multi-level modelling, this article analyses data from 16 police agencies in England and Wales where one officer, carrying TASER, used force on one member of the public (N = 11,176). When compared to incidents involving handcuffing only, resistance, gender and mental health status of the member of the public and the need to protect officers or others were associated with increased odds of TASER drawing and firing. Incidents involving lone officers increased odds of firing compared to incidents where they were accompanied by an officer not using force. Compared to the White reference category, incidents involving Black/Black British members of the public, or a male officer, were associated with increased odds of drawing compared to handcuffing. Incidents involving Asian/Asian British members of the public, or children, were associated with decreased odds. As the proportion of incidents where TASER was carried increased, odds of use decreased. [ABSTRACT FROM AUTHOR]

From the 1650s the expansion of English interests in the Baltic fostered more competition for access to commercial markets. A desire from Sweden to meet its own commercial goals also led to a greater level of competition for shipping. An increasing association between England and Sweden brought about the greatest commercial shift in Baltic commerce during that century. Building on research that has established general trends in Anglo-Baltic commercial history during the period, this article assesses the growth and competition of English commercial ambition. The article consults data sets such as the Sound Toll Registers Online, and the Stockholm customs accounts, while taking into consideration contemporary diplomatic sources. It seeks to answer why, how and where English trade became competitive in the Baltic. It outlines general commercial flows by juxtaposing England's shipping next to its nearest competitors and consults three case studies to reveal previously unrealised nuances in Anglo-Baltic trade. [ABSTRACT FROM AUTHOR]

Background: While many countries have successfully deployed COVID-19 vaccination programmes, there are disparities in their uptake. One factor influencing vaccine coverage is religion. Existing research has found a link between religious beliefs and vaccine hesitancy. This study looks at religion in England to examine its relationship with public health., Methods: This analysis used data from a survey of over 12,000 respondents in England, conducted through the YouGov Online Panel. Respondents were asked whether they identified with a religion, and if so which, and the number of COVID-19 vaccinations they had received. We employed logistic regressions to analyse the data, accounting for age, gender, education, generalised trust, trust in government, and political ideology., Results: We find that respondents who identify as part of the Church of England have had significantly more COVID-19 vaccinations. Conversely, adherents to the Pentecostal Evangelical and Islamic faiths have had significantly fewer COVID-19 vaccinations. These relationships hold even when adjusting for age, education, level of trust, and political affiliation., Conclusion: This research indicates a potential influence of religious affiliation on vaccine uptake, highlighting the need for more carefully-tailored public health programmes. Recognizing the diverse associations of different religious affiliations on health behaviour is important for shaping future vaccination campaigns and policy interventions. Engaging with religious communities and leaders may be one method through which to deal with vaccine hesitancy and improve public health., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier India Pvt Ltd. All rights reserved.)

Background: In primary care, identifying pneumonia events in people with chronic obstructive pulmonary disease (COPD) may be challenging due to similarities in symptoms with COPD exacerbations and lack of diagnostic testing. This study explored the accuracy of pneumonia diagnosis coded in primary care by comparing diagnosis in primary care with diagnosis in hospital. Methods: A study population of people with COPD in England was created using the Clinical Practice Research Datalink Aurum database linked with Hospital Episode Statistics inpatient data. Pneumonia codes only, and pneumonia code with associated clinical and/or treatment codes (chest x-ray, symptoms, antibiotics, sputum and blood culture) were used to determine pneumonia events in primary care. Events that were followed by hospitalisation within 7 days were used to estimate the positive predictive value (PPV) of pneumonia coding in primary care, using primary diagnosis of pneumonia in secondary care as the gold standard. The PPV of primary care recording of hospitalised pneumonia was also calculated. Results: Two hundred seventy-four thousand one hundred fifty-six COPD patients were eligible for inclusion, of whom 7,560 had an eligible pneumonia event in primary care diagnosed between 2015–2019 which was not 'hospital-acquired' and was diagnosed and entered on the same day. Of the 2,094 events which were followed by hospitalisation within 7 days, 1,208 had a primary diagnosis of pneumonia in hospital, representing a PPV of pneumonia coding in primary care of 57.7% (95% CI 55.6%-59.8%). Another 284 (13.6%) were diagnosed as a COPD exacerbation and 114 (5.4%) were diagnosed as another respiratory disease. Use of additional pneumonia clinical and treatment codes had a modest effect on the PPV but substantially lowered the number of events. Of the 33,603 eligible pneumonia events identified in secondary care, only 11,445 were recorded in primary care within 42 days, representing a sensitivity of 34.1% (95% CI 33.6%-34.6%). Conclusions: Use of primary care pneumonia codes and associated clinical and treatment codes to determine pneumonia is not recommended due to significant levels of misdiagnosis and many hospitalised events failing to be recorded in primary care. [ABSTRACT FROM AUTHOR]

Background: The Brief Educational Workshops in Secondary Schools Trial (BESST) is an England-wide school-based cluster randomised controlled trial assessing the clinical and cost-effectiveness of an open-access psychological workshop programme (DISCOVER) for 16-18-year-olds. This baseline paper describes the self-referral and other recruitment processes used in this study and the baseline characteristics of the enrolled schools and participants., Method: We enrolled 900 participants from 57 Secondary schools across England from 4th October 2021 to 10th November 2022. Schools were randomised to receive either the DISCOVER day-long Stress workshop or treatment as usual which included signposting information. Participants will be followed up for 6 months with outcome data collection at baseline, 3-month, and 6-month post randomisation., Results: Schools were recruited from a geographically and ethnically diverse sample across England. To reduce stigma, students were invited to self-refer into the study if they wanted help for stress. Their mean age was 17.2 (SD = 0.6), 641 (71%) were female and 411 (45.6%) were from ethnic minority groups. The general wellbeing of our sample measured using the Mood and Feelings Questionnaire (MFQ) found 314 (35%) of students exhibited symptoms of depression at baseline. Eighty percent of students reported low wellbeing on the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS) suggesting that although the overall sample mean is below the cut-off for depression, the self-referral approach used in this study supports distressed students in coming forward., Conclusion: The BESST study will continue to follow up participants to collect outcome data and results will be analysed once all the data have been collected., Trial Registration: ISRCTN registry ISRCTN90912799. Registered on 28 May 2020., (© 2024. The Author(s).)

Background: The disproportionate effect of COVID-19 on long term care facility (LTCF) residents has highlighted the need for clear, consistent guidance on the management of pandemics in such settings. As research exploring the experiences of LTCFs during the pandemic and the implications of mass hospital discharge, restricting staff movement, and limiting visitation from relatives are emerging, an in-depth review of policies, guidance and recommendations issued during this time could facilitate wider understanding in this area. Aims: To identify policies, guidance, and recommendations related to LTCF staff and residents, in England issued by the government during the COVID-19 pandemic, developing a timeline of key events and synthesizing the policy aims, recommendations, implementation and intended outcomes. Method: A scoping review of publicly available policy documents, guidance, and recommendations related to COVID-19 in LTCFs in England, identified using systematic searches of UK government websites. The main aims, recommendations, implementation and intended outcomes reported in included documents were extracted. Data was analysed using thematic synthesis following a three-stage approach: coding the text, grouping codes into descriptive themes, and development of analytical themes. Results: Thirty-three key policy documents were included in the review. Six areas of recommendations were identified: infection prevention and control, hospital discharge, testing and vaccination, staffing, visitation and continuing routine care. Seven areas of implementation were identified: funding, collaborative working, monitoring and data collection, reducing workload, decision making and leadership, training and technology, and communication. Discussion: LTCFs remain complex settings, and it is imperative that lessons are learned from the experiences during COVID-19 to ensure that future pandemics are managed appropriately. This review has synthesized the policies issued during this time, however, the extent to which such guidance was communicated to LTCFs, and subsequently implemented, in addition to being effective, requires further research. In particular, understanding the secondary effects of such policies and how they can be introduced within the existing challenges inherent to adult social care, need addressing. [ABSTRACT FROM AUTHOR]

Background: Libraries in the UK have evolved from traditional book-lending institutions into dynamic community hubs, This study aims to explore the potential of libraries to act as community hubs to promote mental and physical health and wellbeing of community-dwelling adults, drawing on insights from both library users and library staff in England. Design: A mixed-method, cross-sectional study using online survey and interviews with community-dwelling adults and library staff. Methods: We collected data using a 14-item electronic survey and interviews with library users and staff to gauge perceptions. Descriptive statistics and thematic analysis were used to identify key trends and emergent themes. Results: We included 605 respondents from the survey and interviewed 12 library users and staff. Libraries remain popular and are considered a 'safe place by members of the community, regardless of their frequency of service usage irrespective of whether they are frequent users of services. However, a lack of awareness among library users about community-facing services could act as a hurdle to improving community health and wellbeing. Targeted engagement with residents is needed to increase awareness of libraries' services, including community interventions to help tackle loneliness and inequalities in digital and health literacy. Library staff often did not feel involved in important decision-making. Various barriers, drivers and practical recommendations were identified to leverage libraries as hubs to promote community health and wellbeing. Conclusion: Libraries already offer a variety of resources that directly or indirectly support the health and wellbeing of community-dwelling adults and young people. However, public awareness of these services is limited. As we navigate post-pandemic recovery, libraries can serve as platforms for community engagement, fostering resilience, mental health support and reducing social isolation. Recognising libraries' untapped potential can lead to healthier communities and improved wellbeing. [ABSTRACT FROM AUTHOR]

This paper explores news media discourse about care.data: an NHS England programme of work for amalgamating and sharing patient data from primary care for planning and research. It was scrapped in 2016 after three years of public outcry, delays and around 1.5 million opt-outs. I examine UK news media coverage of this programme through the 'fire object' metaphor, focusing upon the visions of purpose and value it inspired, the abrupt discontinuities, juxtapositions and transformations it performed, and the matters of concern that went unheeded. Findings suggest that, in care.data's pursuit of a societal consensus on NHS patient data exploitations, various visions for new and fluid data flows brought to presence narratives of transforming the NHS, saving lives, and growing the economy. Other realities and concerns that mattered for certain stakeholders, such as data ownership and commercialisation, public engagement and informed consent, commitment and leadership, operational capabilities, and NHS privatisation agendas, remained absent or unsettled. False dichotomies kept the controversy alive, sealing its fate. I conclude by arguing that such failed programmes can turn into phantom-like objects, haunting future patient data schemes of similar aspirations. The paper highlights the role news media can have in understanding such energetic public controversies., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

This study investigated the impact of local government spending on mental health in England between 2013 and 2019. Guided by the "Health in All Policies" vision, which encourages the integration of health in all decision-making areas, we explored how healthcare and multiple nonmedical budgeting decisions related to population mental health. We used random curve general cross-lagged modelling to dynamically partition effects into the short-run (from t to t + 1) and long-run (from t to t + 2) impacts, account for unobserved area-level heterogeneity and reverse causality from health outcomes to financial investments, and comprehensive modelling of budget items as an interconnected system. Our findings revealed that spending in adult social care, healthcare, and law & order predicted long-term mental health gains (0.004-0.081 SDs increase for each additional 10% in expenditure). However, these sectors exhibited negative short-term impulses (0.012-0.077 SDs decrease for each additional 10% in expenditure), markedly offsetting the long-term gains. In turn, infrastructural and environmental spending related to short-run mental health gains (0.005-0.031 SDs increase for each additional 10% in expenditure), while the long-run effects were predominantly negative (0.005-0.028 SDs decrease for each additional 10% in expenditure). The frequent occurrence of short-run and long-run negative links suggested that government resources may not be effectively reaching the areas that are most in need. In the short-term, negative effects could also imply temporary disruptions to service delivery largely uncompensated by later mental health improvements. Nonetheless, some non-health spending policies, such as law & order and infrastructure, can be related to long-lasting positive mental health impacts., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Aims: Long-term HbA1c (glycated haemoglobin) variability is associated with micro- and macrovascular complications in Type 2 diabetes (T2D). We explored prospective associations between HbA1c variability and serious infections, and how these vary by HbA1c level, age, sex and ethnicity., Methods: 411,963 T2D patients in England, aged 18-90, alive on 01/01/2015 in the Clinical Practice Research Datalink with ≥ 4 HbA1c measurements during 2011-14. Poisson regression estimated incidence rate ratios (IRRs) for infections requiring hospitalisation during 2015-19 by HbA1c variability score (HVS) and average level, adjusting for confounders, and stratified by age, sex, ethnicity and average level. Attributable risk fractions (AF) were calculated using reference categories for variability (HVS < 20) and average level (42-48 mmol/mol)., Results: An increased infection risk (IRR > 1.2) was seen with even modest variability (HVS ≥ 20, 73 % of T2D patients), but only at higher average levels (≥64 mmol/mol, 27 % patients). Estimated AFs were markedly greater for variability than average level (17.1 % vs. 4.1 %). Associations with variability were greater among older patients, and those with lower HbA1c levels, but not observed among Black ethnicities., Conclusions: HbA1c variability between T2D patients' primary care visits appears to be associated with more serious infections than average level overall. Well-designed trials could test whether these associations are causal., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Anthropogenic marine litter (AML) is a global environmental concern. One of the most conspicuous effects of AML is beach litter accumulation, the distribution of which is typically heterogenous. Little information is available on the potential effects of coastal topographic features on litter dispersal. We analysed the abundance, composition, and sources of beach litter on the East coast of England in relation to the presence of coastal groyne structures. Six beaches were surveyed in autumn and winter 2021 using the OSPAR methodology for monitoring beach litter. Litter abundance was lower on beaches with groynes present, which could infer that groynes deflect or bury AML. The presence of groynes had no significant effect on the composition/sources of beach litter. Single-use plastic packaging, fishing waste, and sewage-related debris were the largest contributors of beach litter in this region. Our findings indicate that man-made topographic features may affect marine litter dispersal and coastal accumulation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: Warthin's tumours are the second most common benign parotid tumours in the UK. The World Health Organization states that 5-14 per cent of patients have bilateral Warthin's tumours. This study aimed to: assess the presence of contralateral Warthin's tumours in patients who underwent surgery over the past 16 years at a head and neck unit in England, and perform the first systematic literature review on bilateral Warthin's tumours., Methods: A retrospective analysis was conducted on patients diagnosed with Warthin's tumour based on histology between 2005 and 2020. Additionally, a systematic review (International Prospective Register of Systematic Reviews ('PROSPERO') registration number: CRD42022326846) was performed using PubMed and the Cochrane Library., Results: Among 290 patients diagnosed with Warthin's tumours based on histology following surgery, 24.5 per cent had bilateral Warthin's tumours. The systematic review identified 157 papers, with 14 meeting the inclusion criteria., Conclusion: This study revealed that 24.5 per cent of patients had bilateral Warthin's tumours, deviating from the suggested range. These findings are of interest to surgeons discussing the disease with patients.

Purpose: Recovery Colleges (RCs) have been implemented across England with wide variation in organisational characteristics. The purpose of this study is to describe RCs across England in terms of organisational and student characteristics, fidelity and annual spending, to generate a RC typology based on characteristics and to explore the relationship between characteristics and fidelity., Methods: All RC in England meeting criteria on recovery orientation, coproduction and adult learning were included. Managers completed a survey capturing characteristics, fidelity and budget. Hierarchical cluster analysis was conducted to identify common groupings and generate an RC typology., Results: Participants comprised 63 (72%) of 88 RC in England. Fidelity scores were high (median 11, IQR 9-13). Both NHS and strengths-focussed RCs were associated with higher fidelity. The median annual budget was £200,000 (IQR £127,000-£300,000) per RC. The median cost per student was £518 (IQR £275-£840), cost per course designed was £5,556 (IQR £3,000-£9,416) and per course run was £1,510 (IQR £682-£3,030). The total annual budget across England for RCs is an estimated £17.6 m including £13.4 m from NHS budgets, with 11,000 courses delivered to 45,500 students., Conclusion: Although the majority of RCs had high levels of fidelity, there were sufficiently pronounced differences in other key characteristics to generate a typology of RCs. This typology might prove important for understanding student outcomes and how they are achieved and for commissioning decisions. Staffing and co-producing new courses are key drivers of spending. The estimated budget for RCs was less than 1% of NHS mental health spending., (© 2023. The Author(s).)

Payments for some diagnostic scans undertaken in outpatient settings were unbundled from Diagnosis Related Group based payments in England in April 2013 to address under-provision. Unbundled scans attracted additional payments of between £45 and £748 directly following the reform. We examined the effect on utilization of these scans for patients with suspected cancer. We also explored whether any detected effects represented real increases in use of scans or better coding of activity. We applied difference-in-differences regression to patient-level data from Hospital Episodes Statistics for 180 NHS hospital Trusts in England, between April 2010 and March 2018. We also explored heterogeneity in recorded use of scans before and after the unbundling at hospital Trust-level. Use of scans increased by 0.137 scans per patient following unbundling, a 134% relative increase. This increased annual national provider payments by £79.2 million. Over 15% of scans recorded after the unbundling were at providers that previously recorded no scans, suggesting some of the observed increase in activity reflected previous under-coding. Hospitals recorded substantial increases in diagnostic imaging for suspected cancer in response to payment unbundling. Results suggest that the reform also encouraged improvements in recording, so the real increase in testing is likely lower than detected., (© 2024 The Authors. Health Economics published by John Wiley & Sons Ltd.)

This is a perspective from an Independent Advocate in England, United Kingdom on the importance of equality in the involuntary treatment of children and young people (CYP). The article highlights the need for safeguards when CYP require detention as part of their mental health care. The paper raises concern that CYP and their families who are less empowered to advocate for optimal care plans may be at risk of less satisfactory outcomes from mental health detention. It notes that CYP in the care system may be particularly vulnerable to such outcomes due to their lower levels empowerment. To mitigate this risk, services need to be proactive in reducing inequity arising from differential levels of empowerment among service users. This could be achieved by adopting strong participation and coproduction activities and ensuring access to Advocacy services for all CYP., (© 2024 Association for Child and Adolescent Mental Health.)

In community nursing, the administration of insulin for people with type 2 diabetes can be delegated by registered nurses to healthcare support workers. Although a voluntary framework in England provides national guidance, little is known about its uptake. The project aim was to determine the roll-out, characteristics and support needs in relation to the delegation of insulin administration in community settings. An online survey was disseminated to community nursing services in England via social media and nursing networks. Of the 115 responding organisations, 81% (n=93) had an insulin delegation programme, with most initiated since 2018. From these services, 41% (n=3704) of insulin injections were delegated daily, with benefits for patients, staff and services reported, along with some challenges. Delegation of insulin administration is an established and valued initiative. Awareness of the national voluntary framework is increasing. National guidance is considered important to support governance arrangements and safety. [ABSTRACT FROM AUTHOR]

Background: There are not enough GPs in England. Access to general practice and continuity of care are declining. Aim: To investigate whether practice characteristics are associated with life expectancy of practice populations. Design and setting: A cross-sectional ecological study of patient life expectancy from 2015–2019. Method: Selection of independent variables was based on conceptual frameworks describing general practice's influence on outcomes. Sixteen non-correlated variables were entered into multivariable weighted regression models: population characteristics (Index of Multiple Deprivation, region, % White ethnicity, and % on diabetes register); practice organisation (total NHS payments to practices expressed as payment per registered patient, full-time equivalent fully qualified GPs, GP registrars, advanced nurse practitioners, other nurses, and receptionists per 1000 patients); access (% seen on the same day); clinical performance (% aged ≥45 years with blood pressure checked, % with chronic obstructive pulmonary disease vaccinated against flu, % with diabetes in glycaemic control, and % with coronary heart disease on antiplatelet therapy); and the therapeutic relationship (% continuity). Results: Deprivation was strongly negatively associated with life expectancy. Regions outside London and White ethnicity were associated with lower life expectancy. Higher payment per patient, full-time equivalent fully qualified GPs per 1000 patients, continuity, % with chronic obstructive pulmonary disease having the flu vaccination, and % with diabetes with glycaemic control were associated with higher life expectancy; the % being seen on the same day was associated with higher life expectancy in males only. The variable aged ≥45 years with blood pressure checked was a negative predictor in females. Conclusion: The number of GPs, continuity of care, and access in England are declining, and it is worrying that these features of general practice were positively associated with life expectancy. [ABSTRACT FROM AUTHOR]

Background: Significant health inequalities exist in England. Primary care networks (PCNs), comprised of GP practices, were introduced in England in 2019 with funding linked to membership. PCNs have been tasked with tackling health inequalities. Aim: To consider how the design and introduction of PCNs might influence their ability to tackle health inequalities. Design and setting: A sequential mixed-methods study of PCNs in England. Method: Linear regression of annual PCN-allocated funding per workload-weighted patient on income deprivation score from 2019–2023 was used. Qualitative interviews and observations of PCNs and PCN staff were undertaken across seven PCN sites in England (July 2020–March 2022). Results: Across 1243 networks in 2019–2020, a 10% higher level of income deprivation resulted in £0.31 (95% confidence interval [CI] = £0.25 to £0.37), 4.50%, less funding per weighted patient. In 2022–2023, the same difference in deprivation resulted in £0.16 (95% CI = £0.11 to £0.21), 0.60%, more funding. Qualitative interviews highlighted that, although there were requirements for PCNs to tackle health inequalities, the policy design, and PCN internal relationships and maturity, shaped and sometimes restricted how PCNs approached this task locally. Conclusion: Allocated PCN funding has become more pro-poor over time, suggesting that the need to account for deprivation within funding models is understood by policymakers. The following additional approaches have been highlighted that could support PCNs to tackle inequalities: better management support; encouragement and support to redistribute funding internally to support practices serving more deprived populations; and greater specificity in service requirements. [ABSTRACT FROM AUTHOR]

Background: The Additional Roles Reimbursement Scheme (ARRS) was set up to recruit 26 000 additional staff into general practice by 2024, with the aim of increasing patient access to appointments. Despite the potential benefits of integrating ARRS practitioners into primary care, their implementation has not always been straightforward. Aim: To explore the challenges and enablers to implementation of the ARRS including its impact on primary and secondary care systems. Design and setting: Qualitative interview study with ARRS healthcare professionals and key professional stakeholders involved in staff education or scheme implementation across three integrated care systems in England. Method: Participants (n = 37) were interviewed using semi-structured individual or paired interviews. Interviews were audio-recorded and transcribed. Data were analysed using framework analysis until data saturation occurred. Results: Using framework analysis, 10 categories were identified. Three were categorised as successes: staff valued but their impact unclear; multiple and certain roles maximise impact; and training hub support. Seven were categorised as challenges: scheme inflexibility; creating a sustainable workforce with career progression; managing scope and expectations; navigating supervision and roadmap progression; infrastructure and integration challenges; ARRS roles impact on wider systems; and tensions and perspectives of existing staff. Conclusion: Most ARRS staff felt valued, but the scheme broadened expertise available in primary care rather than reducing GP burden, which was originally anticipated. Some PCNs, especially those in areas of high deprivation, found it difficult to meet the population's needs as a result of the scheme's inflexibility, potentially leading to greater health inequalities in primary care. Recommendations are proposed to optimise the effective implementation of the primary care workforce model. Further research is required to explore administrative role solutions, further understand the impact of health inequalities, and investigate the wellbeing of ARRS staff. [ABSTRACT FROM AUTHOR]

Background: Enduring ethnic inequalities exist in mental healthcare. The COVID-19 pandemic has widened these. Aims: To explore stakeholder perspectives on how the COVID-19 pandemic has increased ethnic inequalities in mental healthcare. Method: A qualitative interview study of four areas in England with 34 patients, 15 carers and 39 mental health professionals from National Health Service (NHS) and community organisations (July 2021 to July 2022). Framework analysis was used to develop a logic model of inter-relationships between pre-pandemic barriers and COVID-19 impacts. Results: Impacts were largely similar across sites, with some small variations (e.g. positive service impacts of higher ethnic diversity in area 2). Pre-pandemic barriers at individual level included mistrust and thus avoidance of services and at a service level included the dominance of a monocultural model, leading to poor communication, disengagement and alienation. During the pandemic remote service delivery, closure of community organisations and media scapegoating exacerbated existing barriers by worsening alienation and communication barriers, fuelling prejudice and division, and increasing mistrust in services. Some minority ethnic patients reported positive developments, experiencing empowerment through self-determination and creative activities. Conclusions: During the COVID-19 pandemic some patients showed resilience and developed adaptations that could be nurtured by services. However, there has been a reduction in the availability of group-specific NHS and third-sector services in the community, exacerbating pre-existing barriers. As these developments are likely to have long-term consequences for minority ethnic groups' engagement with mental healthcare, they need to be addressed as a priority by the NHS and its partners. [ABSTRACT FROM AUTHOR]

Social workers routinely make judgements and decisions as part of their everyday practice. The nature and quality of these can have a significant and long‐lasting impact on the children and families concerned. In this paper, we present an analysis of more than 20 000 judgements (n = 21 193) made by social workers (n = 586) in relation to case vignettes, based on a series of anonymized referrals (n = 12) to social services in England. We do so to ascertain how accurately the social workers were able to predict subsequent actions, events and outcomes, and to calculate the ratio of true positives to false positives at various decision thresholds. We find that the social workers' predictions were more accurate than chance in relation to all but one of the referrals, albeit at the cost of a high rate of false positive errors. We consider these findings in relation to what appears to be a general lowering of the threshold for child protection interventions in England in recent years and in relation to who suffers the injustice of false positive errors in child and family social work. [ABSTRACT FROM AUTHOR]

This article presents personal stories from a participatory biographical arts-based study with a specific category of racialised migrants: individuals seeking asylum, in the North East of England. Responding to the important questions posed by this special issue, the article explores individual experiences of navigating the UK's hostile environment with a focus on the threefold punitive 'threat' of dispersal, detention, and destitution (Bloch and Schuster, 2005). Adopting an intersectional lens, the discussion highlights the impact of such policies and their compound effect of creating (un)safe and exclusionary everyday spaces, while also outlining the potential for resistance as illustrated by participants' actions and their creative (re)actions as part of the study's arts-based approach. [ABSTRACT FROM AUTHOR]

This article explores the impact of the 'hostile environment' on racialised migrant women's experiences of pregnancy and childbirth in England, arguing that the 'hostile environment' functions as a technology of 'stratified reproduction.' First coined by Shellee Colen, the concept of stratified reproduction describes the dynamic by which some individuals and groups may be supported in their reproductive activities, while others are disempowered and discouraged. This paper locates the stratified reproduction produced by the 'hostile environment' as intertwined with wider gendered and racialised discourses around British citizenship which have been 'designed to fail' racialised residents of the UK. Drawing on interviews with racialised migrant mothers in the north of England, this paper analyses how the proliferation and intensification of immigration controls interacts with gender, race, class, and other social regimes to differentially allocate the resources necessary for a safe and healthy pregnancy and childbirth, and how this is experienced materially by pregnant migrants. [ABSTRACT FROM AUTHOR]

This paper examines the relationship between public houses or pubs, and crime rates in England and Wales. The impact of pubs on local communities is generally studied and investigated within the context of third places, thus physical places that facilitate the accumulation of social capital within communities. We estimate Poisson Fixed-Effects (PFE) and a frontier Spatial Autoregressive (SAR) model on a unique panel dataset for 375 local authorities in England and Wales between 2003 and 2018. Results from the analysis indicate that the presence of pubs progressively relates to a higher incidence of major crimes when transitioning from rural to urban areas, mainly due to weaker level of community cohesion and a lack of resources to support formal policing in more urbanized centres. These findings highlight the importance of place-based strategies in tackling rising incidences of crimes, indicating that recent pub closures may have contributed to severing community ties that act as a deterrent to crime in certain areas. [ABSTRACT FROM AUTHOR]

Purpose: In England and Wales, Domestic Homicide Reviews (DHRs) are conducted into domestic abuse-related killings. In 2016, deaths by suicide were brought into the scope of this review system and, to distinguish them from reviews into domestic homicides, we describe these as 'Suicide Domestic Abuse-Related Death Reviews' (S-DARDR). To date, S-DARDRs have been little considered and, in response, this empirical paper seeks to unpack this process. Method: In a larger study, 40 DHR participants were interviewed, and a reflexive thematic analysis was undertaken. 18 participants discussed S-DARDRs. These interviews were re-read, with relevant extracts identified and re-analysed thematically. Through a shared critical reflection, we drew on our practice experience to interrogate the themes generated from the interviews and offer insight into the underlying challenges. Results: From the interviews, we generated four themes relating to commissioning and delivery; the involvement of stakeholders; intersections with other statutory processes; and purpose. Based on our shared critical reflection, we identified the underlying challenges as an under conceptualisation of S-DARDRs, alongside their de-mooring from the criminal justice system. Taken together, these challenges have implications for the conduct of S-DARDRs. We identify recommendations for policy and practice to address these challenges. Conclusion: The development of S-DARDRs has been little considered and challenges arise around when and how they should be undertaken. A shared understanding of key concepts and expectations around delivery is necessary if S-DARDRs are to enable robust learning and be a driver for systems change while also being accessible and understood by all stakeholders. [ABSTRACT FROM AUTHOR]

Legal definitions of sexual consent emphasise 'freedom' as central to valid consent; however, power inequalities may complicate freedom. This paper discusses findings from a two-stage focus group study with young people (aged 13–23) in England exploring the implications of power inequalities for sexual consent. In Stage 1, 77 participants explored and ranked the types of power inequalities they felt were common within young people's sexual relationships, with age, gender and popularity being identified as the most common power inequalities. In Stage 2, 43 participants discussed power inequalities using scenarios based on the Stage 1 findings and considered their implications for sexual consent. Thematic analysis of the data produced two themes: powerless and powerful roles in consent communication and power inequalities implicitly constrain freedom to consent. Consent communication was constructed as a unidirectional process whereby those with more power initiate, and those with less, gatekeep. Such roles require deconstruction to position consent as mutual and actively negotiated by partners. Further, since power inequalities were seen to place implicit constraints on freedom to consent, we advocate for an explicit exploration of power and privilege within Relationships and Sex Education to equip young people to recognise, challenge and negotiate these constraints. [ABSTRACT FROM AUTHOR]

Sea defence policy in England has proven contentious in the early twenty-first century, with government willing to defend the coast only where it is considered cost effective and not minded to compensate people for any resulting abandonment of homes. Additional focus is brought to this position by the 2015 United Nations Sustainable Development Goals (SDGs) which reflect a growing emphasis on climate change effects and other environmental hazards, and the wellbeing of the current generation and those to come. This requires policy makers to seek to balance economic, social and environmental dimensions, and to tackle inequalities; with a central commitment of the goals to "leave no one behind". Subsequent to publication of the SDGs, England was promised a revolution in the government's approach to Flood and Coastal Erosion Risk Management (FCERM). This paper seeks to understand the nature of this revolution with particular regard to extant issues around just governance. It finds that policy fails to deal with issues over the local acceptability of proposals for change and the bearing of risk, and instead lies principally in the elevation of the problematic concept of resilience and an accompanying ambivalence towards ideas of sustainability and sustainable development. International agreement that compensation should be paid to those countries suffering the worst effects of climate change, including sea level rise, suggests that adoption of a similar approach to vulnerable homeowners might be the more appropriate revolution and bring policy more into line with the aspirations of the SDGs. [ABSTRACT FROM AUTHOR]

This article draws on Incident Reporting System data from the National Offender Management Service over a ten-year period (2004–2014) and limited, small-scale interviews with four custodial managers. Pat Carlen's work (2008) on imaginary penalities provides the theoretical framework for an assessment of the reporting, recording and initial response to sexual assaults in prisons in England and Wales. The article argues that the recording of sexual assaults became part of a response to new management systems that emphasised compliance, process and audit rather than realising safety in custody. Although the data shows substantial levels of initial activity among staff it is, in essence, practice without prospect. The article suggests that outcomes generally for sexual assaults in prisons in England and Wales are uncertain. Incident reporting has become a bureaucratic process 'or paper shadow', which Goffman described as showing 'what has been done by whom, what is to be done, and who last had responsibility for it' (Goffman 1961: 73). [ABSTRACT FROM AUTHOR]

Introduction: The British Thyroid Association Ultrasound-classification is a risk stratification model which grades thyroid nodules in U2–5 based on their sonographic appearance. Existence of variability between the ultrasound operators when U-scoring is reported in the literature with some evidence found in the author's department. The aim of this study was to investigate whether there is significant disagreement in the department and identify potential reasons for variability. Methods: Eight operators, radiologists and sonographers, were recruited to grade 33 TNs and answer a tick box questionnaire using the British Thyroid Association lexicon. The inter-operator variability for the U-categories, indication for fine-needle aspiration biopsy and ultrasound features was assessed using Fleiss' kappa and Gwet-AC1. The operators' accuracy was measured against the most experienced operator in the department using Cohen's kappa and percentage agreement. Results: Fair agreement (Fleiss' K = 0.21) was obtained between the participants when U-scoring (U2–5). Fair-to-moderate agreement was noted between sonographers (K = 0.40). Significant variability was demonstrated between radiologists (p > 0.05). Indication for fine-needle aspiration biopsy reached fair to almost substantial agreement (radiologists' AC1 = 0.34, sonographers' AC1 = 0.58, overall AC1 = 0.41). No significant variability measured for echogenicity (K = 0.29), composition (K = 0.33), shape (K = 0.58), margin (K = 0.45), halo (K = 0.34) and vascularity (K = 0.44). Accuracy reached fair agreement (mean Cohen's K = 0.29) and moderate agreement (mean AC1 = 0.53) for the U-categories and fine-needle aspiration biopsy, respectively. Radiologists demonstrated lower accuracy. Conclusion: No significant inter-rater variability in U-scoring or recommending fine-needle aspiration biopsy was demonstrated between all the operators in the department. Radiologists showed significant variability in U-scoring and lower accuracy. Reliability and accuracy could be improved by addressing those problematic categories and features identified with this study. [ABSTRACT FROM AUTHOR]

City deals – place-based agreements between central and local state actors – are an increasingly common intervention for supporting economic performance in urban areas. This paper presents empirical evidence on the effectiveness of city deals by estimating the impact of the UK's City Deals scheme on rates of economic growth, productivity and job creation across England between 2010 and 2019. Because the City Deals were introduced in two waves, we estimate its effects using a differences-in-differences (DiD) with multiple time periods (MTPs) approach. Our DiD estimates indicate that, overall, the City Deals were associated with improvements in local economic performance, but that the first wave of city deals resulted in gains of around 2.5% to 3% that were not observed in the second wave. These results suggest that city deals are most effective when appropriate institutional structures are in place and highlight the value of MTP approaches. [ABSTRACT FROM AUTHOR]

Background: There is a need for robust evidence on the effectiveness and cost-effectiveness of domestic abuse perpetrator programmes in reducing abusive behaviour and improving wellbeing for victim/survivors. While any randomised controlled trial can present difficulties in terms of recruitment and retention, conducting such a trial with domestic abuse perpetrators is particularly challenging. This paper reports the pilot and feasibility trial of a voluntary domestic abuse perpetrator group programme in the United Kingdom., Methods: This was a pragmatic individually randomised pilot and feasibility trial with an integrated qualitative study in one site (covering three local-authority areas) in England. Male perpetrators were randomised to either the intervention or usual care. The intervention was a 23-week group programme for male perpetrators in heterosexual relationships, with an average of three one-to-one sessions, and one-to-one support for female current- or ex-partners delivered by third sector organisations. There was no active control treatment for men, and partners of control men were signposted towards domestic abuse support services. Data were collected at three-monthly intervals for nine months from male and female participants. The main objectives assessed were recruitment, randomisation, retention, data completeness, fidelity to the intervention model, and acceptability of the trial design., Results: This study recruited 36 men (22 randomly allocated to attend the intervention group programme, 14 to usual care), and 15 current- or ex-partners (39% of eligible partners). Retention and completeness of data were high: 67% of male (24/36), and 80% (12/15) of female participants completed the self-reported questionnaire at nine months. A framework for assessing fidelity to the intervention was developed. In interviews, men who completed all or most of the intervention gave positive feedback and reported changes in their own behaviour. Partners were also largely supportive of the trial and were positive about the intervention. Participants who were not allocated to the intervention group reported feeling disappointed but understood the rationale for the trial., Conclusions: It was feasible to recruit, randomise and retain male perpetrators and female victim/survivors of abuse and collect self-reported outcome data. Participants were engaged in the intervention and reported positive benefits. The trial design was seen as acceptable., Trial Registration: ISRCTN71797549, submitted 03/08/2017, retrospectively registered 27/05/2022., (© 2024. The Author(s).)

Introduction: Carbapenemase-producing Enterobacterales (CPE) are an important public health threat, with costly operational and economic consequences for NHS Integrated Care Systems and NHS Trusts. UK Health Security Agency guidelines recommend that Trusts use locally developed risk assessments to accurately identify high-risk individuals for screening, and implement the most appropriate method of testing, but this presents many challenges. Methods: A convenience sample of cross-specialty experts from across England met to discuss the barriers and practical solutions to implementing UK Health Security Agency framework into operational and clinical workflows. The group derived responses to six key questions that are frequently asked about screening for CPE. Key findings: Four patient groups were identified for CPE screening: high-risk unplanned admissions, high-risk elective admissions, patients in high-risk units, and known positive contacts. Rapid molecular testing is a preferred screening method for some of these settings, offering faster turnaround times and more accurate results than culture-based testing. It is important to stimulate action now, as several lessons can be learnt from screening during the COVID-19 pandemic, as well as from CPE outbreaks. Conclusion: Further decisive and instructive information is needed to establish CPE screening protocols based on local epidemiology and risk factors. Local management should continually evaluate local epidemiology, analysing data and undertaking frequent prevalence studies to understand risks, and prepare resources– such as upscaled screening– to prevent increasing prevalence, clusters or outbreaks. Rapid molecular-based methods will be a crucial part of these considerations, as they can reduce unnecessary isolation and opportunity costs. [ABSTRACT FROM AUTHOR]

An outbreak of SARS-CoV-2 (1 March to 10 May 2021) with an attack rate of 26.5% among approximately 1150 workers at a storage and distribution centre in England prompted a multidisciplinary outbreak investigation (5 May to 6 August 2021), with the aim of better understanding worker- and workplace-related risk factors for viral transmission in the warehousing sector. Overall, environmental factors (e.g., ventilation, humidity and temperature) were assessed to be appropriate at the facility. Nevertheless, 39 (51.3%) surface samples from across the site tested positive for low/ very low levels of SARS-CoV-2 RNA (Ct value ≥ 32.0 for all). Among the study participants, of whom 35.6% were confirmed or suspected cases, 95.5% reported having received COVID-19 prevention training, 100.0% reported handwashing, and 80.0% reported use of face coverings at work. Notably, 43.9% and 19.0% reported working with a symptomatic and a positive contact respectively. Furthermore, 80.5% and 46.3% had concerns regarding reduction in their income and future unemployment, respectively, due to self-isolation. The findings of this study suggest that, in addition to targeted workplace infection control measures and tailored work area specific risk assessments, an enhanced and equitable sick leave policy may help limit presenteeism and viral transmission in large workplaces. [ABSTRACT FROM AUTHOR]

Introduction: Past research into the effectiveness of multi-agency public protection arrangements (MAPPA) in reducing reoffending it limited. Thus, the current study aimed to evaluate proven reoffending patterns forMAPPAmanaged individuals. Methods: Proven reoffending for 39,501 MAPPA managed individuals was investigated by (1) examining patterns in the timing and frequency of proven reoffending for MAPPA managed individuals; (2) examining 1-, 3-, and 5-year proven reoffending patterns of MAPPA managed individuals by MAPPA category, age, and gender; and (3) comparing crime harm levels and recall to custody for MAPPA managed individuals pre- and post-MAPPA adoption. Results: Taken together, our findings show that proven reoffending rates for individualsmanaged under MAPPA are substantially lower than those reported in proven reoffending statistics for England and Wales. Discussion: Our results suggest that MAPPA is making a positive contribution to a managing individuals convicted of sexual and violent offenses. Additionally, our findings provide the best evidence to date that MAPPA management may also be effective at reducing less serious offenses which do not typically involve immediate removal from society. These findings are considered in light of their theoretical and practical implications while potential limitations and avenues for future research are outlined. [ABSTRACT FROM AUTHOR]