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The COVID-19 pandemic has highlighted the benefits which digital technology offers to all aspects of dental practice and education. This paper provides an overview of how digital technology has enhanced clinical and administrative procedures within dental practice, including computer-aided design/computer-aided manufacture (CAD/CAM), digital radiography, 3D printing, patient records, electronic patient referrals and electronic communications from dental practices. It then considers the development of teledentistry (mHealth) and its benefits in enabling distant consultations with patients, who for one reason or another are unable to visit dental practices easily. It then goes on to consider how and why digital dental distance learning materials were provided to general dental practitioners in England by the Department of Health (DoH) (England) and how they evolved. Finally, this paper considers the use of digital technology in dental education by dental schools. [ABSTRACT FROM AUTHOR]

Background: Sapropterin has been approved as a treatment option for individuals with Phenylketonuria in the United Kingdom. Individuals are assessed as responsive to Sapropterin by a ≥30% reduction in Phenylalanine (Phe) concentrations using dried blood spot (DBS) specimens. DBS quality is critical for accurate and precise measurement of Phe. Currently, UK national guidelines for DBS specimen acceptance do not exist for patient-collected DBS specimens. We adopted evidence-based guidelines for specimen acceptance criteria and retrospectively assessed the impact of introducing these guidelines on specimen rejection rates. Methods: Laboratories were invited to audit the quality of DBS specimens routinely received for Phe monitoring using: (1) existing acceptance/rejection criteria and (2) proposed national guidelines. Results: Ten laboratories audited 2111 specimens from 1094 individuals. Using existing local guidelines, the median rejection rate was 4.0% (IQR 1.5–7.2%). This increased to 21.9% (IQR 10.0–33.0%) using the proposed guidelines. Where reason(s) for rejection were provided (n = 299); 211/299 (70.6%) of DBS specimens were too small or multi-spotted. 380 individuals had more than one sample evaluated; 231/380 (60.8%) provided specimens of acceptable quality, 37/380 (9.7%) consistently provided poor-quality DBS specimens. Conclusions: There is significant variability in the quality of patient-collected DBS specimens. If unacceptable specimens are not rejected, imprecise/inaccurate results will be used in clinical decision making. Using annual workload data for England, this equates to 12,410 incorrect results. Individuals and parents/carers should receive ongoing training in blood collection technique to ensure use of evidence-based acceptability criteria does not cause undue distress from increased sample rejection rates. [ABSTRACT FROM AUTHOR]

The British public view asylum-seekers in generally negative terms. Yet whilst there are an abundance of reports and opinion polls that measure levels of hostility in order to fuel political ‘debate’ very little is known about how asylum seekers are spoken about in more quotidian contexts. Based on an ethnographic study of racism in Southend-on-Sea, Essex this paper identifies two kinds of narrative (abstract truths and context-dependent stories) commonly used by established members of the community to speak about asylum-seekers. The paper then seeks to explain why more affluent, suburban residents of the town tend to draw upon the abstract narrative while less wealthy, centrally located residents are more likely to regale context-dependent stories about asylum seekers. An explanation for this sociospatial phenomenon is constructed around a Bourdieusian theory of practice that unravels local class relations and maps out a field for local symbolic prestige. Finally this microanalysis is used as a springboard to consider the wider relationship between racist narratives and social and cultural reproduction. [ABSTRACT FROM AUTHOR]

School-to-school collaboration has been central to many improvement efforts over recent decades. In an attempt to promote both improvement and equity current developments in England have included changing formal governance arrangements to promote collaboration for improvement through ‘federations’ and ‘chains’ of schools. However, federations and school chains remain a relatively under-explored area and there is a noticeable absence of research exploring the impact of such arrangements on student outcomes. This paper draws on a programme of research including the national evaluation of federations, the first quantitative study of the impact of federations on student outcomes and a longitudinal qualitative study of the development of federations to consider two key questions: What is a federation? And do federations make a difference? In order to achieve this, the paper provides an overview of the key characteristics of federations and considers their contribution to improvement efforts. In conclusion the paper reflects on a number of issues and implications associated with developing a federated school system. [ABSTRACT FROM PUBLISHER]

This paper focuses upon the Glasgow 2014 Commonwealth Games (CWG) legacy proposals regarding the regeneration of the East End. It provides a preliminary pre-event evaluation by examining local progress towards urban regeneration legacies, primarily physical and economic renewal. Following an examination of the events' legacy landscape and problems within the legacy planning process, the paper outlines the socio-economic profile of the locale. Thereafter, the relevance of the CWG to the area is highlighted and an evaluation of the progress towards physical and economic urban regeneration goals is charted. Key risks in the legacy planning process are identified. It is suggested that while there are elements of good practice in local progress towards legacy planning and regeneration, there are community issues that could pose tensions. [ABSTRACT FROM AUTHOR]

Will the UK Industrial Strategy deliver anything substantial to the North of England? This article examines the faltering steps taken to develop Local Industrial Strategies by Local Enterprise Partnerships and Mayoral Combined Authorities and argues Place Leadership and Industrial Strategy will both need to be substantially re-galvanised after COVID 19. It is also still not clear if a significant step change can be made by the Johnson Conservative government of 2019, which will have a major impact on Northern economies. Agencies' capacity to intervene in the Northern economy and deliver is a major issue, alongside stronger leadership. Analytically the paper uses theory on Multi-Sectoral Collaboration and Place Leadership to show how uniqueness of place, past and current interpersonal connections and networks can facilitate or frustrate economic development. Place leaders must create institutional arrangements, seek agreement over visions, objectives and strategies, otherwise the lack of shared information, resources, activities and capabilities lead to 'contestation' over space and action. We analyse the levels of cohesion or contestation in four different localities as each develops a Local Industrial Strategy. [ABSTRACT FROM AUTHOR]

This paper explores the notion of local urban policy hybridity in Manchester, England. It presents the findings of qualitative research set in the context of the parallel entrepreneurial city and sustainable regeneration debates. The research objective was to examine the extent of Manchester's conversion to the politics of the entrepreneurial city on the assumption that this signals a departure from efforts towards the city's achievement of sustainable regeneration and social equity goals. Manchester was selected because it has been held up as an iconic entrepreneurial city. The continuing entrepreneurial city debate, instigated by David Harvey in the 1980s, runs alongside that of sustainable regeneration in ways that are seen as sometimes complementary but usually contradictory. The software package NVivo 7 was used to assist with data analysis. The methodological approach was based loosely on the grounded theory approach of Strauss and Corbin: the approach of the analysis mainly followed the qualitative interpretive approach of discourse analysis. Key community strategy documents are found to interweave elements of the entrepreneurial and managerial governance discourses and also incorporate conceptual elements that have emerged recently such as a concern with crime, sustainability and community involvement. The paper provides valuable insights into the hybrid nature of Manchester's actually existing local community strategies which feature a robust adherence to the managerial mode of local urban policy. [ABSTRACT FROM AUTHOR]

This paper interrogates the relationship between working-class participation in higher education ( HE) in England and social and cultural mobility. It argues that embarking on a university education for working-class people has been construed in governmental discourses as an instrumental means of achieving upward mobility, or of aspiring to 'become middle class'. Education in this sense is thus not only understood as having the potential to confer value on individuals, as they pursue different 'forms of capital', or symbolic 'mastery' ( Bourdieu, 1986), but as incurring a form of debt to society. In this sense, the university can be understood as a type of 'creditor' to whom the working-class participants are symbolically indebted, while the middle classes pass through unencumbered. Through the analysis of empirical research conducted with staff from working-class backgrounds employed on a university Widening Participation project in England, the article examines resistance to dominant educational discourses, which understand working-class culture as 'deficient' and working-class participation in HE as an instrumental means of securing upward mobility. Challenging the problematic notion of 'escape' implicit in mobility discourses, this paper concludes by positing the alternative concept of 'fugitivity', to contest the accepted relationship in HE between creditor and debtor. [ABSTRACT FROM AUTHOR]

This paper considers the ways in which parents talk about choosing secondary schools in three areas of Greater Manchester. It argues that this can be a moment when parents are considering their own attitudes to, and shaping their children's experiences of, multiculture. Multiculture is taken as the everyday experience of living with difference. The paper argues that multiculture needs to be understood as shaped not only by racialized, ethnic or religious difference (as it is commonly understood) but also by other differences which parents may consider important, particularly class and approaches to parenting. We stress the need to examine what parents say about schooling in the context in which they are talking, which is shaped by local areas and the experiences of their children in primary schools. Based on interviews with an ethnically mixed groups of parents from different schools, we show how perceptions of the racialized and class demographics of schools can influence parents' choice of secondary schools. The paper also argues that attention needs to be paid to the ways in which terms such as 'multicultural' and 'mix' are applied uniformly to very different contexts, be they particular schools or local areas, suggesting there is a paucity of language in Britain when talking about multiculture. [ABSTRACT FROM AUTHOR]

In this paper we argue that postgraduate education forms an important, but hitherto neglected, element in the distinctive institutional landscape of the City of London. In particular, and drawing on research into early-career financial and legal elites in the City, we show how postgraduate education tailored to the demands of employers within London plays an important role in indoctrinating early-career elites into situated, Cityspecific, working practices and, in so doing, helps to sustain the City's cultures and norms of financial practice. Specifying the role of postgraduate education in reproducing these situated City practices is significant because, although geographical variegation in working practices between international financial centres has been widely reported, less attention has been paid to how such institutionally embedded differences are created and sustained. By identifying education as one mechanism of creation and sustenance, our analysis enhances understanding of how the institutional landscapes that underlie financial centres might be maintained or, when necessary, challenged; challenge being significant in relation to attempts to reform practices and cultures in international financial centres in the wake of the 2007-08 crisis. [ABSTRACT FROM AUTHOR]

This paper is concerned with the ways in which women are sold cosmetic surgery, and how they 'make sense of' their own participation in this market. It draws on ongoing ethnographic research to explore how a group of young women who have paid for breast augmentation surgery narrate their decision to undergo surgery, the choices they make as consumers of cosmetic surgery, and their experience of having surgery. These narratives are compared with the ways in which breast augmentation surgery is sold to them by the companies and medical professionals involved in the rapidly expanding market for breast augmentation surgery. The paper shows how this particular group of young white working-class women shift between imagining the breast augmentation operation as a simple beauty treatment and recognizing it as medical surgery, and explores how this shapes their perceptions of the risks and benefits of buying new breasts. It also shows how those who market such procedures manage and manipulate perceptions of the process of breast augmentation surgery and the risks that attend on it in an effort to encourage this form of consumption. [ABSTRACT FROM AUTHOR]

This paper focuses upon the St Anns neighbourhood in Nottingham, a community first studied by Ken Coates and Bill Silburn in the 1960s which noted the great upheavals of the physical and social changes generated by the slum clearance programme of 10,000 back-to-back terraced houses, and the consequent building of the concrete council estate that is now St Anns. This paper draws upon both the physical and the social changes within the neighbourhood, and highlights what has remained constant despite the massive upheavals to working-class life over the last 40 years. This paper looks at the concept of belonging to a neighbourhood which has been stigmatized, finding value and an identity within the estate, and residents describing themselves as simultaneously and interchangeably as being from and simply being St Anns. [ABSTRACT FROM AUTHOR]

This paper focuses on private equity in the UK and is set in the context of debates about transformations in the City of London. The article focuses on a particular concept of trust as expressed by senior members of the private equity sector. The argument developed is based on interviews with five senior founding partners of private equity firms who talked to us about their background and education, their understanding of how private equity worked and the basis for successful money making and their relationships with those inside and outside the organization. All interviewees strongly asserted the need for absolute trust between senior partners as an essential condition for the successful operation of their business. At the same time, their description of trust in this context was that while it is deep, it is also easily broken, and that once broken, the breach cannot be forgiven. We call this 'brittle trust': asserted to be simultaneously strong while extremely fragile. The paper argues, drawing on Diego Gambetta's work on the Sicilian Mafia, that this concept of 'trust' reflects a particular understanding of the practice of private equity as a high risk, tough and unforgiving business that nevertheless requires high standards of personal integrity. The study allows us to understand something more about the social ideals that were built into this financial sector by its founders, which we argue formed a crucial part of the transformation of the financial sector. [ABSTRACT FROM AUTHOR]

Gloucestershire County Council (GCC) in the United Kingdom has recently initiated a project to replace all of its halogen lamps in traffic lights with low energy Light Emitting Diode (LED) lamp heads across the County. In order to assess energy savings and carbon reductions from the initiative before implementation, baseline energy monitoring was carried out at 45 sample sites using a power analyzer equipped with a data logger. A regression model to predict annual energy consumption was developed with the numbers of each type of lamp head for each junction as independent variables. The model parameters were then used to estimate baseline emissions for a single trial site where LEDs have been installed and for which energy monitoring was carried out. The estimated baseline energy consumption for this site and the monitored energy consumption after the LEDs have been installed were used to estimate the actual energy savings that can be expected from GCC's initiative. Annual energy savings from this analysis were estimated to range from 64.2 to 74.1 percent (95% Confidence Intervals). The cost savings resulting from the LED initiative were found to payback the investment over a period of about six years. This paper presents a low cost approach and method by which the energy and cost savings of a large scale replacement initiative can be estimated with a single pilot replacement installation of a traffic signal. Such an exercise would be useful for local governments to carry out before making large investment decisions. [ABSTRACT FROM AUTHOR]

Previous research suggests complexity may be a significant factor in a project's failure to achieve cost, time, and quality objectives. In this paper, we examine the project complexity literature to develop a simple framework consisting of structural and dynamic complexity. We use this to compare the complexity of two successful construction megaprojects-Heathrow Terminal 5 and the London 2012 Olympic Park-to consider how the complexity in the two projects was managed. Our analysis reveals differences in the approach to managing structural and dynamic complexity, but identifies common factors that may help project managers achieve positive outcomes for their complex projects. [ABSTRACT FROM AUTHOR]

The article offers a study on how one organization was able to achieve its goals through marketing research. Discussed are issues relevant to both councils and research agencies, and the case study demonstrates how consultation techniques must continue to evolve in order to meet the needs of its participants, if it wants to continue to be successful. Attention is given voter turnout in the 1998 Barnsley, England local election. The voters were grouped into four categories: conscientious voters, casual pragmatists, sceptical bystanders, and outright rejectors, and motivating and inhibiting factors are examined.

It is increasingly understood that the physical environment remains an important determinant of area-level health and spatial and socioeconomic health inequalities. Existing research has largely focused on the health effects of differential access to green space, the proximity of waste facilities, or air pollution. The role of brownfield--or previously developed--land has been largely overlooked. This is the case even in studies that utilise multiple measures of environmental deprivation. This paper presents the results of the first national-scale empirical examination of the association between brownfield land and morbidity and mortality, using data from England. Census Area Statistical ward-level data on the relative proportion of brownfield land (calculated from the 2009 National Land Use Database), standardised morbidity (2001 Census measures of 'not good' general health and limiting long-term illness), and premature (aged under 75 years) all-cause mortality ratios from 1998/99 to 2002/03 were examined using linear mixed modelling (adjusting for potential environmental, socioeconomic, and demographic confounders). A significant and strong, adjusted, area-level association was found between brownfield land and morbidity: people living in wards with a high proportion of brownfield land are significantly more likely to suffer from poorer health than those living in wards with a small proportion of brownfield land. This suggests that brownfield land could potentially be an important and previously overlooked independent environmental determinant of population health in England. The remediation and redevelopment of brownfield land should therefore be considered as a public health policy issue. [ABSTRACT FROM AUTHOR]

This paper refers to research with Ukrainian families in Bradford that was conducted in an attempt to investigate the transmission of values, with particular reference to food. Here we report on how this research led us towards a better understanding of how cultural 'taste' evolves between generations. The paper thus draws upon three studies undertaken in the 1980s, 1990s and more recently between 2005 and 2008 with those who identify themselves with the Ukrainian communities in the city. The first two studies used oral history to collect life stories, while the more recent research used a range of anthropological methods. We have sought to draw in particular on, and combine theoretical insights from, ) and Mannheim's concept of 'generational style' (1997). By combining the earlier testimonies with more recent data, we conclude that each generation has developed its own distinctive projects and styles as it has negotiated its historical times. In arriving at this conclusion we want to suggest that while the influences of technology and media are influential in transforming 'taste', and foodways in particular, the generational projects and their food ideologies were the main determinant factor shaping the foodways of the Ukrainian diaspora. [ABSTRACT FROM AUTHOR]

This paper examines the aims and outcomes of the Nottingham and Midland Counties Working Classes Industrial Exhibition of 1865-1866. The event ostensibly promoted the achievements of local working class residents and the paper analyses the presence and influence of those residents and the role that the Exhibition played within the town. In particular, Sutherland addresses the process by which the venue and its contents - including a versatile musical repertoire - were housed within a developing cultural quarter financed and approved by local government and industry leaders, a space that promoted rational cultural activity and modified contributions by individual exhibitors and performers, to produce an advertisement of stable civic identity. [ABSTRACT FROM AUTHOR]

The General Medical Council's call to modernize medical education prompted the University of Liverpool Medical School to develop a new undergraduate programme, integrating palliative medicine as 'core' curricula. Following successful piloting, the palliative medicine training programme was further developed and expanded. This paper examines whether the additional investment produces improved outcomes. In 1999, fourth year undergraduate medical students (Cohort 1, n=217) undertook a 2-week pilot education programme in palliative medicine. Subsequently, the training programme was refined and extended, incorporating advanced communication skills training, an ethics project and individual case presentations (Cohort 2, n=443). Congruent with the study's theoretical driver of self-efficacy, both cohorts were surveyed pre- and post-programme with validated measures of: (i) self-efficacy in palliative care scale; (ii) thanatophobia scale. No significant differences between cohorts' pre-programme scores were identified. Within each cohort, statistically and educationally significant post-education improvements were recorded in both scales. Further post-education analysis indicated that the extended programme produces significantly greater improvements in all domains of the self-efficacy in palliative care scale (communication, t=-7.28, patient management, t=-5.96, multidisciplinary team-working t=-3.77 at p<0.000), but not thanatophobia. Although improvements were recorded in both cohorts, participation in the extended education programme resulted in further statistically significant gains. Interpreted through the theoretical model employed, improved self-efficacy and outcome expectancies will result in behavioural change that leads to improved practice and better patient care. [ABSTRACT FROM AUTHOR]

The Competition Commission's analysis in 2007 of entry and exit conditions among small stores across more than one thousand British high streets provided a landmark piece of research on a topic in which debate and policy recommendations had moved significantly, and arguably dangerously, ahead of the available evidence base. Within a general context of a continuing long-term decline of specialist small stores in British town centres and high streets, it cast considerable doubt on the popularly held view that a broad-based decline of the independent convenience store sector was taking place across the UK, or that Britain's high streets were experiencing an accelerating decline in their small and specialist stores. Additionally, and even more controversially, the Commission's analysis was able to demonstrate that competitive entry by larger format corporate food retailing was not inevitably and uniformly associated with negative impacts on the small store sector. It is known that the Commission's research was paralleled by an identical analysis conducted on behalf of one of the main parties to the Groceries Market Inquiry by the University of Southampton. The first component of the Southampton analysis, which both corroborated and extended the Commission's findings, is available in the public domain. This paper now presents the second component of the Southampton analysis, which similarly both corroborates but also extends the vitally important `conditional entry' dimension of the Commission's research-focusing directly on the extent to which entry into the small store sector during the early to mid 2000s might have been constrained by, and exit from the sector accelerated by, the competitive impacts of larger format foodstore openings by the major corporate retailers. The paper shows: (a) that there is an important missing regional dimension within the Commission's analysis, and (b) that entry and exit into the small store sector in the UK during 2000-06 was constrained and/or accelerated by the competitive impacts of supermarket opening in a different fashion within `London and prospering southern England' than elsewhere in the country. That is to say, in the region of the UK in which arguments about the threat of corporate retail to the diversity of the small store sector had often proved particularly heated, the Southampton analysis shows small shops in town centres and high streets to have been more robust to the competitive opening of larger format corporate foodstores than elsewhere in the UK. In that context, the paper suggests that the findings represent an `inconvenient truth' which deserves consideration both in policy debate and in future processes of planning regulation reform. Discussion of the relevance of the findings in respect of the proposed changes to Planning Policy Statement 6 released for consultation by the Department for Communities and Local Government in July 2008 is presented. [ABSTRACT FROM AUTHOR]

On two occasions the Court of Appeal in England has addressed the legality of non-therapeutic circumcision performed on a minor unable to provide consent. Both cases involved disputes in post-separation families where one parent sought a male child's circumcision against the wishes of the other parent. In January 2008 the Supreme Court of Oregon was faced with a similar factual situation in the case of Boldt v Boldt. However, the boy at the centre of the dispute in Boldt was significantly older than in the English cases. The Supreme Court therefore concluded that the testimony of the boy himself, who is now 13, was required and remanded the case for a re-hearing in order that the trial court could specifically address his wishes with regard to circumcision. In this paper we offer a critique of the Oregon Court's somewhat elliptical reasoning in the Boldt case. We argue that cases involving male circumcision of older children raise important ethico-legal issues, which the Boldt judgements gloss over, and which English courts have yet to confront in the context of circumcision. Consequently, our aim in this paper is to use Boldt as a lens through which to explore and inform UK practice. We argue that this case fits into a characteristic pattern according to which judges, law makers and professional bodies shy away from confronting key ethico-legal questions raised by the tolerance in Anglo-American society of non-therapeutic genital cutting of male infants. In raising explicitly for the first time the position of older minors, the factual situation in Boldt affords us an opportunity to begin to address the limits of parents' rights to determine the future religious identity of their children. In seeking to analyse how Boldt and the questions to which it gives rise might inform UK law we focus on three issues. The first is the right of the boy at the centre of the dispute to determine which medical treatments or interventions to his body are permissible. The father's subsequent petitions for reconsideration and for certiorari mean that when the boy's testimony is finally heard by a court it is likely that he will be 14 or 15 years of age. We aim to assess how a UK court might respond if faced with the task of determining whether a minor could choose circumcision for himself in such a scenario. A subsidiary question here is the extent to which circumcision procedures are appropriately categorised as 'medical treatment'. Finally we offer some more tentative thoughts on what limits may legitimately be placed on parental rights to make choices for their children when their choices are motivated by religious belief. [ABSTRACT FROM AUTHOR]

The objective was to give an overview of self-reported recreational drug use amongst attendees of sexual health clinics in London and compare this to existing datasets. Between December 2013 and March 2014, attendees of two sexual health clinics in London were surveyed. Data collected were: sexual history, smoking and alcohol and recreational drug use. Data were analysed using SPSS (version 21). A total of 1472 respondents were included; 778 (52.9%) men, 676 (45.9%) women and 3 (0.2%) transgender (15 [1.0%] did not answer). Mean age was 30.6 ± 9.0 years. A total of 339 (43.6%) men were men who have sex with men (MSM), and 18 (2.4%) women were women who have sex with women. Lifetime prevalence of use was: alcohol 94.1%; cannabis 48.5%; 'poppers' (volatile nitrites) 28.2%; cocaine 26.8% and 3,4-methylenedioxy-methamphetamine pills 23.2%. Our population had higher current popper, methamphetamine and mephedrone use than the Crime Survey of England and Wales but lower use of cannabis, poppers and Viagra than the European MSM Internet Survey. Global Drug Survey and Part of the Picture respondents' use were higher than our population for all drugs. Drug use in this population had a different pattern to general population surveys and studies involving only MSM. [ABSTRACT FROM AUTHOR]

Accurately measuring the prevalence of sexual violence is difficult. Police-recorded crime figures are known to underestimate the true extent of sexual violence, and so researchers have tended to rely on survey estimates instead. But estimates from surveys are not uniform, with recent estimates from the UK National Survey of Sexual Attitudes and Lifestyles apparently twice as large as official figures from the major crime surveys (the Crime Survey for England and Wales and the Scottish Crime and Justice Survey). In this study we use harmonized data from these three surveys and the UK component of the EU Violence Against Women Survey to explore the features of the surveys that may have contributed to these differences. [ABSTRACT FROM AUTHOR]

Objectives: A participatory qualitative study exploring women's experiences of ageing with HIV in London, United Kingdom. The research considered how the concept of 'community' was relevant to women's experiences and what constructions of 'community' could be discerned in the experiences, accounts given and discourses employed by older women living with HIV. Methods: The research presented in this article was conducted as a PhD study between 2015 and 2019. The study was structured in multiple and overlapping phases, and adopted a feminist and participatory approach. The methods used in the research were as follows: participatory literature review, participatory creative workshops, policy review and stakeholder interviews, life story interviews, and a participatory analysis workshop. Results: Eighteen women living with HIV aged over 50 participated in creative workshops and fourteen women in life story interviews. Women's experiences of ageing with HIV are shaped by intersecting identities, community responses, and personal connections. Ageing with HIV brings challenges, added to and augmented by other difficulties women face in their lives, but women draw on individual and community assets in order to adapt, cope and thrive. Belonging to a community of women living with HIV and a broader community of people living with HIV created a vital space of safety, in which women found support, advice, and meaning. Conclusions: Women ageing with HIV countered the 'violence of invisibility' through forming community with other women living with HIV, rejecting stigma, and enacting a personal form of advocacy through care for others. [ABSTRACT FROM AUTHOR]

Emotions and the emotional labour of researchers have been increasingly recognised in social science disciplines, with many researchers providing personal and reflexive accounts. Such debates are less well recognised in health-related disciplines, particularly public health, who remain at earlier stages of valuing and understanding qualitative research. Drawing on personal experiences and methodological reflections gathered from a qualitative study, undertaken with young people over the course of 16 months during the COVID-19 pandemic in England, UK, the aim of this article is to offer further insight into the impact of researcher emotion, by specifically focussing on longitudinal, diary-based methods. My reflections are framed as three overlapping and intersecting themes. First, that qualitative longitudinal methods (and diary studies in particular) have enormous potential to curate rich emotional narratives. Second, that despite these positives, there are tensions or conflicting dynamics in using a method which helps to explore young people's emotions but also involves emotional labour for the researcher. Third, that greater attention should be paid to ensuring ethical care for researchers, particularly those engaging with qualitative longitudinal and/or creative methods. Such strategies should not solely rely on self-care and must be considered at institutional or funding body level. To this end, my personal experiences and reflections, as well as those from previous offerings, are used here to underpin a framework for researchers or research teams embarking upon novel qualitative longitudinal methods: 1. Do not underestimate emotional burden. 2. Ensure meaningful debriefing is available. 3. Establish boundaries. 4. Make space for emotion throughout fieldwork as well as during analysis and writing ('entering and exiting the field'). [ABSTRACT FROM AUTHOR]

Background/Context: On January 29, 2008 the Toronto District School Board (TDSB) approved a city-wide Africentric elementary school under their Alternative School policy, sparking a contentious debate. Calls for Black-focused schools also arose in 2008 in London in response to the disengagement of African Caribbean youth. The historical record indicates, however, that community campaigns for Black educational programs stretch back over 40 years in both cities. Focus of the Study: This paper analyzes the development of Black-focused education in Toronto and London from 1968 to 2008 through the responses of Black parents and community activists to the historic underachievement of African Caribbean students (particularly males) in the public schools of both cities. Black-focused education is situated within the larger social, political, and national contexts and the critical incidents that fueled the development of race equality policy. The article explores how the "politics of place" influenced the trajectory of Black-focused education in each city. Research Methodology: Two parallel historical case studies were conducted using primary source material from community-based archives, secondary sources on the history of African Caribbean immigration and the development of Black community organizations, and oral history interviews with 10 Black education activists in Toronto and 7 activists in London. Conclusions: This comparative study conceptualizes this transnational phenomena as "resistance to racism" and examines how Black-focused curriculum and ideology was adapted to local conditions in Canada and Britain. Parents and community activists aimed to develop the citizenship rights of African Caribbean students, establish a diasporic sensibility, and promote the right of children of African descent to a quality education wherever they may reside. [ABSTRACT FROM AUTHOR]

In this paper I explore some of the ways in which people with visual impairments see landscape and participate in visual cultures of landscape apprehension. I draw on ethnographic and interview material, developed while acting as a sighted guide for specialist blind and visually impaired walking groups who visit the landscapes of the Lake District and Peak District in Britain. Through this research material I show how landscape is likely to become present for people with blindness or visual impairment through both their individual capacities for sight and a complex mix of discursive, material, social, and historical relations. Specifically, I argue that there is an intercorporeal, collective dimension to this emergence of landscape and this intercorporeality is evident at both a perceptual and a discursive level. I suggest that future research needs to attend further to how landscape emerges and becomes present through intercorporeal processes. [ABSTRACT FROM AUTHOR]

Background: Antimicrobial usage and stewardship programmes during COVID-19 have been poorly studied. Prescribing practice varies despite national guidelines, and there is concern that stewardship principles have suffered. Aim: To analyse antibiotic prescriptions during the COVID-19 pandemic at a teaching hospital and to propose improved approaches to stewardship. Methods: We reviewed COVID-19 admissions to medical wards and intensive care units (ICUs) in a London teaching hospital to assess initial antibiotic usage and evidence of bacterial co-infection, and to determine if our current antibiotic guidelines were adhered to. Findings: Data from 130 inpatients (76% medical and 24% ICU) were obtained. On admission, 90% were treated with antibiotics. No microbiological samples taken on admission provided definitive evidence of respiratory co-infection. In 13% of cases, antibiotics were escalated, usually without supporting clinical, radiological or laboratory evidence. In 16% of cases, antibiotics were stopped or de-escalated within 72 h. Blood results and chest radiographs were characteristic of COVID-19 in 20% of ward patients and 42% of ICU patients. Overall mortality was 25% at 14 days – similar to rates described for the UK as a whole. Conclusion: The majority of patients received antibiotics despite limited evidence of co-infection. Most patients received narrower spectrum antibiotics than recommended by NICE. As understanding of the natural history of COVID-19 infections progresses, stewardship programmes will need to evolve; however, at this point, we feel that a more restrictive antibiotic prescribing approach is warranted. We propose strategies for effective stewardship and estimate the effect this may have on antibiotic consumption. [ABSTRACT FROM AUTHOR]

Rates of childhood overweight and obesity continue to rise in England, along with a growing gap in obesity prevalence between children in the most and least deprived areas. To address child obesity, the UK government is increasingly considering how to intervene in the (food) environments that shape people's purchases, rather than focusing solely on individual health behaviors. With the COVID-19 pandemic and subsequent lockdowns having rapidly reconfigured life in the UK, it is important to understand how these changes may have impacted food practices and engagement with food environments. This remote, longitudinal qualitative study seeks to explore how the COVID-19 pandemic and its impacts are shaping families relationships with the food and the food environment. A sample of 60–80 parents/carers of school or nursery-aged children will be recruited from across three case study sites in England to take part in semi-structured interviews and set of flexible creative activities at three time points over the course of a year. Findings will provide practical policy insights for England's obesity prevention strategy as well as methodological insights in terms of conducting research into lived experience remotely. [ABSTRACT FROM AUTHOR]

Online abuse, facilitated via social media and mobile technologies, has recently attracted considerable academic attention. The nonconsensual sharing of intimate images—revenge pornography—can have a devastating effect on victims, is a global problem, and constitutes interpersonal violence. The national helpline in the United Kingdom has now received over 7,000 calls. In the United Kingdom, new legislation making revenge pornography a crime was introduced in 2014, yet the police do not always respond appropriately to victims. This article presents the findings of a national online survey of police understanding of revenge pornography, undertaken in the United Kingdom in March 2017. The study set out to investigate police knowledge of revenge pornography legislation, their confidence in responding to cases of revenge pornography, and what level of training they had received. A total of 783 members of the police force responded to the survey and, to the authors' knowledge, this the first study to seek to quantify the understanding of revenge pornography by police officers and staff in England and Wales. The findings suggest that the police in the United Kingdom have a limited understanding of revenge pornography legislation and lack confidence both in investigating cases and in effectively responding to victims. The implications of the study demonstrate that there is an urgent need for training across police forces to ensure that cases of revenge pornography are appropriately responded to, victims are safeguarded, and offenders brought to justice. [ABSTRACT FROM AUTHOR]

There is a growing interest in precision medicine where individual heterogeneity is incorporated into decision-making and treatments are tailored to individuals to provide better healthcare. One important aspect of precision medicine is the estimation of the optimal individualized treatment rule (ITR) that optimizes the expected outcome. Most methods developed for this purpose are restricted to the setting with two treatments, while clinical studies with more than two treatments are common in practice. In this work, we summarize methods to estimate the optimal ITR in the multi-arm setting and compare their performance in large-scale clinical trials via simulation studies. We then illustrate their utilities with a case study using the data from the INTERVAL trial, which randomly assigned over 20,000 male blood donors from England to one of the three inter-donation intervals (12-week, 10-week, and eight-week) over two years. We estimate the optimal individualized donation strategies under three different objectives. Our findings are fairly consistent across five different approaches that are applied: when we target the maximization of the total units of blood collected, almost all donors are assigned to the eight-week inter-donation interval, whereas if we aim at minimizing the low hemoglobin deferral rates, almost all donors are assigned to donate every 12 weeks. However, when the goal is to maximize the utility score that "discounts" the total units of blood collected by the incidences of low hemoglobin deferrals, we observe some heterogeneity in the optimal inter-donation interval across donors and the optimal donor assignment strategy is highly dependent on the trade-off parameter in the utility function. [ABSTRACT FROM AUTHOR]

Background: The literature contains limited information on the problems faced by dying patients with COVID-19 and the effectiveness of interventions to manage these. Aim: The aim of this audit was to assess the utility of our end-of-life care plan, and specifically the effectiveness of our standardised end-of-life care treatment algorithms, in dying patients with COVID-19. Design: The audit primarily involved data extraction from the end-of-life care plan, which includes four hourly nursing (ward nurses) assessments of specific problems: patients with problems were managed according to standardised treatment algorithms, and the intervention was deemed to be effective if the problem was not present at subsequent assessments. Setting/participants: This audit was undertaken at a general hospital in England, covered the 8 weeks from 16 March to 11 May 2020 and included all inpatients with COVID-19 who had an end-of-life care plan (and died). Results: Sixty-one patients met the audit criteria: the commonest problem was shortness of breath (57.5%), which was generally controlled with conservative doses of morphine (10–20 mg/24 h via a syringe pump). Cough and audible respiratory secretions were relatively uncommon. The second most common problem was agitation/delirium (55.5%), which was generally controlled with standard pharmacological interventions. The cumulative number of patients with shortness of breath, agitation and audible respiratory secretions increased over the last 72 h of life, but most patients were symptom controlled at the point of death. Conclusion: Patients dying of COVID-19 experience similar end-of-life problems to other groups of patients. Moreover, they generally respond to standard interventions for these end-of-life problems. [ABSTRACT FROM AUTHOR]

Although rebalancing the UK economy has long been a focus of UK governments, this has recently used the rhetoric of 'levelling up'. Amongst other policy instruments, the UK's Modern Industrial Strategy has been an indicator of the core economic priority areas, with selected local areas also invited to produce their own local industrial strategies to provide a more nuanced delivery of those goals. This article considers the economic profile of five of the Combined Authority areas tasked with delivering the first of these local industrial strategies. By examining the profile of educational attainment, and the core sectors, it examines how well equipped they are to capitalise on these key growth sectors. The article finds that in many cases, the combined authorities have sectors which are comparatively under-represented in terms of the national economy, and have a population which is broadly ill-equipped to access job opportunities in those sectors. [ABSTRACT FROM AUTHOR]

Objective: In patients with velocardiofacial syndrome (VCFS), medial displacement of the internal carotid arteries (ICAs) may increase the risk of vascular injury during the surgical correction of velopharyngeal dysfunction (VPD). Some surgeons advocate the use of vascular imaging studies prior to surgery. Nevertheless, the role of preoperative imaging is still controversial. This study aimed to review the current practice of the UK cleft units and also examine our own practice at the Evelina London Children's Hospital in relation to children with VCFS undergoing speech surgery over the previous 7 years. Design: A questionnaire was sent to all UK cleft surgeons to enquire about the management and use of preoperative vascular imaging in patients with VPD and VCFS. A retrospective study was also conducted of the unit's 7-year series of patients with VPD and VCFS. Results: Thirty-four completed questionnaires were returned (response rate 100%). Most UK surgeons (73.5%) do not regularly order preoperative vascular imaging for patients with VCFS although some reportedly would consider it if a posterior pharyngeal wall pulsation was visible. In our unit, between 2013 and 2019, a total of 40 patients affected by VCFS have been assessed for VPD. A magnetic resonance angiography (MRA) was performed for 23 patients. Medial deviation of the ICAs was identified in 7 (30%) patients. Conclusions: The results of the national survey showed no consensus on routine use of preoperative vascular imaging. Our retrospective study showed a 30% prevalence of medialized ICAs in our patient cohort. In these patients, the MRA findings influenced the choice of speech surgery. [ABSTRACT FROM AUTHOR]

Background: From diagnosis through to adulthood, a cleft lip and/or palate (CL/P) poses a number of challenges for those affected. Alongside the care provided by clinical teams, complementary information and support is offered by charitable organizations. In 2011, the Cleft Lip and Palate Association received funding to implement a new regional service across England and Scotland, with the aim of increasing support at a local level. The Centre for Appearance Research at the University of the West of England were commissioned to conduct an independent evaluation of the service over 7 years. Methods: A pragmatic, mixed-methods approach was utilized to assess the impact of the service from the perspective of charity volunteers; children, young people, and adults with CL/P; caregivers; and clinicians. Feedback forms were distributed to stakeholders at a variety of events, and qualitative feedback was collected via focus groups and an online survey. Results: The majority of participants indicated they had gained access to a local support network, felt more able to cope with CL/P-related challenges, and felt more confident in themselves. Qualitative investigation provided further support for these findings and highlighted additional benefits of the regional service for clinical teams. Conclusions: The evaluation provides encouraging evidence toward the contribution of a relatively small charitable organization in the context of cleft care. The importance of a pragmatic approach to community-based evaluation and the benefits of collaborative working between researchers and the charitable sector were also highlighted. [ABSTRACT FROM AUTHOR]

This article draws on original, empirical research that focused on the use of an experimental mobile application developed by the authors and used in the domain of youth justice in England. Against a backdrop of the theory of the paradox of technology with ideas of the networked self and child rights, the article explores the use of social technology with vulnerable/marginalised young people. Given the dearth in knowledge and understanding, in this area of social technology and young people in conflict with the law, the article focuses on an important, original and fast-developing issue in contemporary youth justice. Principally, the article explores the experiences and views of practitioners to promote a better understanding of the opportunities and challenges in the adoption of social technology in working with marginalised young people. Practitioner perceptions on the use of social technology in their own practice and its associated risks and benefits are also revealed. Study findings indicate that digital opportunities and challenges are embedded in organisational and cultural structures and practices. The article discusses implications for youth justice and ultimately for young people in conflict with the law who are caught up in the system. The article raises important issues about the likely increasing use of technology as a tool in rehabilitation and desistance; and its key messages will be of considerable interest to practitioners, managers and policy-makers who will have little option, as time goes on, to enter this controversial field. [ABSTRACT FROM AUTHOR]

Background: Randomized controlled trials provide high-level evidence, but the necessity to include selected patients may limit the generalisability of their results. Methods: Comparisons were made of baseline and outcome data between patients with acute ischemic stroke (AIS) recruited into the alteplase-dose arm of the international, multi-center, Enhanced Control of Hypertension and Thrombolysis Stroke study (ENCHANTED) in the United Kingdom (UK), and alteplase-treated AIS patients registered in the UK Sentinel Stroke National Audit Programme (SSNAP) registry, over the study period June 2012 to October 2015. Results: There were 770 AIS patients (41.2% female; mean age 72 years) included in ENCHANTED at sites in England and Wales, which was 19.5% of alteplase-treated AIS patients registered in the SSNAP registry. Trial participants were significantly older, had lower baseline neurological severity, less likely Asian, and had more premorbid symptoms, hypertension and atrial fibrillation. Although ENCHANTED participants had higher rates of symptomatic intracerebral hemorrhage than those in SSNAP, there were no differences in onset-to-treatment time, levels of disability (assessed by the modified Rankin scale) at hospital discharge, and mortality over 90 days between groups. Conclusions: Despite the high level of participation, equipoise over the dose of alteplase among UK clinician investigators favored the inclusion of older, frailer, milder AIS patients in the ENCHANTED trial. Clinical trial registration: Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01422616 [ABSTRACT FROM AUTHOR]

English and Welsh responses to rape have long been critically examined, leading to attempted improvements in the criminal justice system. Despite this, little attention has been paid to the Criminal Injuries Compensation Scheme (CICS) and the difficulties applying it to rape. To begin addressing this gap, researchers interviewed three, and qualitatively surveyed 22, Independent Sexual Violence Advisors. The findings suggest that CICS may not only reinforce rape myths and disadvantage vulnerable survivors, but is also a source of validation and contributes to survivor justice. The study, while exploratory, therefore, highlights the need for further discussion about rape survivor compensation. [ABSTRACT FROM AUTHOR]

Psychiatric illness and sleeping disorders are important co-morbidities of human immunodeficiency virus (HIV) infection, which impact both the individual and antiretroviral therapy (ART) selection. This systematic review aimed to assess the prevalence of psychiatric illness and sleep disturbance in people living with HIV (PLHIV) in the UK. Systematic searches for publications reporting epidemiological data for psychiatric co-morbidities and sleep disturbance with HIV were conducted in Embase, MEDLINE, Cochrane Library, eight key conferences (2013-2015), and by hand-searching references of included publications. Data were extracted from publications (2000 onwards) reporting the UK prevalence of depression, anxiety, suicide ideation, or sleep disturbance as a co-morbidity of HIV infection. Comparative UK general population data were obtained from the 2007 Adult Psychiatric Morbidity in England household survey, the 2012 Health Survey for England, and 'PatientBase' (epidemiological database). Sixteen publications met the inclusion criteria. Amongst PLHIV in the UK, the prevalence of depression varied from 17-47%, compared with a reported 2-5% prevalence for the UK general population. A similar disparity was observed in the prevalence of anxiety (22-49% PLHIV versus 4-5% general population), depression or anxiety (50-58% PLHIV versus 27% general population), difficulty sleeping (61% PLHIV versus 10% population), and suicide ideation (31% PLHIV versus 1% general population). This systematic review of UK data demonstrates that rates of psychiatric illness and sleep disturbance are substantially higher amongst PLHIV than in the general population. These data underline the importance of fully considering sleep and psychiatric issues prior to selection and prescription of antiretroviral drugs, as well as the need for ongoing psychiatric and psychological support for PLHIV on ART. [ABSTRACT FROM AUTHOR]

Objective To assess the cost-effectiveness of strategies to increase cervical cancer screening uptake at first invitation (STRATEGIC trial). Methods We performed an economic analysis alongside the STRATEGIC trial, comparing each of seven novel interventions for improving cervical screening uptake with control general practices in Greater Manchester and Grampian (United Kingdom). A template was developed to measure the intervention costs. Trial estimates of screening uptake were combined with data from the literature to estimate healthcare costs of each intervention. The added lifetime costs and quality adjusted life years (QALYs) of attending cervical screening were estimated by a systematic literature review, with relevant results pooled and weighted by study quality. Trial results and estimated lifetime costs and benefits of screening were then combined in a decision analytic model, giving an incremental cost per QALY gained for each intervention. Uncertainty was addressed in probabilistic and univariate sensitivity analyses. Results Intervention costs per screening round per woman attending varied from about £1.20 (2014 UK) for the nurse navigator intervention to £62 for the unrequested HPV self-sampler kit. The meta-analysis revealed a lifetime discounted benefit from screening of 0.043 QALYs per woman attending, at an additional lifetime discounted cost of £234. The incremental cost per QALY gained in all interventions was below £13,000. Probabilistic sensitivity analyses suggested that only unrequested self-sampling and timed appointments have a high probability of being cost-effective. Conclusions Unrequested self-sampling and timed appointments are likely to be cost-effective interventions. Further research is required on the duration of effects and on implementing combinations of interventions. [ABSTRACT FROM AUTHOR]

The article asks why institutional reforms work in one place and not another and why old ways of doing things can prove so resilient. It argues in favour of a concept of institutional formation, which is different from 'institutional design' as a time-limited event or 'institutional change' as an open-ended historical trajectory. Institutional formation is conceptualised as an animated, nested and embedded process. A multi-level framework is developed that specifies the links between institutional actors, institutional rules and institutional contexts. The model is elaborated with reference to a case study of local government reform in England, specifically the devolution of responsibilities from central government to voluntary collaborations of elected local authorities ('combined authorities'). The model is used to explain variation in the process of institutional formation in two different city-regions, focusing on the role of leaders, legacies and localities. [ABSTRACT FROM AUTHOR]

Policy discourses in support of school reform in England have linked the objective of raising standards with that of tackling inequality. The assumption that a single policy strategy can tackle both objectives simultaneously is problematic. In this article, I examine issues of equity by studying admissions policy and practice. Drawing on a programme of interviews with the staff of a secondary school in England, I provide evidence of the interplay between policy discourses, the values and ethos of the school, and the professional practice of those who work there. Discussions and debates about the school’s admissions policy reveal cognitive and ethical dilemmas relating to equity and educational inclusion, particularly in the case of children with special educational needs and disabilities. In a policy context that requires schools to operate in a regulated, competitive market, school leaders may reluctantly restrict opportunities for children who already face physical, educational and social challenges. [ABSTRACT FROM AUTHOR]

Objective: To provide an example of a new methodology for using multiple characteristics in the study of population aging and to assess its usefulness. Method: Using the English Longitudinal Study of Aging (ELSA), we investigate three characteristics of each person 60 to 85 years old, by level of education, hand-grip strength in 2004 (measured in kilos), chair rise speed in 2004 (measured in rises per minute), and whether the person survived from 2004 to 2012. Because the three characteristics are measured in different units, we convert them into a common metric, called alpha-ages. Results: We find that the average of the alpha-age differentials in the measures of upper body and lower body strength predicts educational differentials in subsequent survival better than either physical measure alone. Discussion: This result demonstrates the benefit of combining characteristics, using alpha-ages to convert incommensurate observations into a common metric. [ABSTRACT FROM AUTHOR]

In this article, we analyze the relationship between social disadvantage and crime, starting from the paradox that most persistent offenders come from disadvantaged backgrounds, but most people from disadvantaged backgrounds do not become persistent offenders. We argue that despite the fact that social disadvantage has been a key criminological topic for some time, the mechanisms which link it to offending remain poorly specified. Drawing on situational action theory, we suggest social disadvantage is linked to crime because more people from disadvantaged versus affluent backgrounds develop a high crime propensity and are exposed to criminogenic contexts, and the reason for this is that processes of social and self-selection place the former more frequently in (developmental and action) contexts conducive to the development and expression of high crime propensities. This article will explore this hypothesis through a series of analyses using data from the Peterborough Adolescent and Young Adult Development Study (PADS+), a longitudinal study which uses a range of data collection methods to study the interaction between personal characteristics and social environments. It pays particular attention to the macro-to-micro processes behind the intersection of people with certain characteristics and environments with certain features – i.e., their exposure – which leads to their interaction. [ABSTRACT FROM AUTHOR]

Concern about declining legitimacy of national democratic institutions has driven an expansion of reforms to increase public participation. This article tests the claim that greater local civic participation is associated with increased democratic legitimacy. It makes explicit a theoretical basis for this relationship and builds indices for civic participation and legitimating attitudes. Empirical implications are tested in a series of hierarchical linear and ordered probit models using detailed individual-level data from the UK Citizenship Survey. I find that participation is persistently positively associated with attitudes expressive of democratic legitimacy, even when accompanied by negative evaluations of local authority outcomes, and that this effect is specific to procedural and fairness evaluations of legitimacy rather than governmental trust. This article thus broadly supports assumptions of democratic legitimation from expanding civic participation. [ABSTRACT FROM AUTHOR]