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Historically, there has been less research carried out on earwitness than eyewitness testimony. However, in some cases, earwitness evidence might play an important role in securing a conviction. This paper focuses on accent which is a central characteristic of voices in a forensic linguistic context. The paper focuses on two experiments (Experiment 1, n = 41; Experiment 2, n = 57) carried out with participants from a wide range of various locations around the United Kingdom to rate the accuracy and confidence in recognizing accents from voices from England, Scotland, Wales, Northern Ireland, and Ireland as well as looking at specificity of answers given and how this varies for these regions. Our findings show that accuracy is variable and that participants are more likely to be accurate when using vaguer descriptions (such as "Scottish") than being more specific. Furthermore, although participants lack the meta-linguistic ability to describe the features of accents, they are able to name particular words and pronunciations which helped them make their decision. [ABSTRACT FROM AUTHOR]

Introduction: Integrated care and patient experience are central to the coordination and delivery of high quality health and social care in the UK, but their joint application is poorly understood. This systematic review aimed to gain an understanding of patient experience within current integrated care services in the UK, and specifically, whether they reflect person-centred coordinated care (PCCC). Methods: Following PRISMA, electronic databases (ProQuest, EBSCO and Cochrane Library) were searched from 2012 to 2019 for primary, peer-reviewed literature. Papers were included where patients' or carers' experiences of integrated care were reported. Papers were excluded where they focused on acute integrated care interventions, measured experience via satisfaction scores only, or findings lacked sufficient depth to answer the research question. Quality was assessed using Mixed Methods Appraisal Tool, and findings synthesised using a framework approach, incorporating the Rainbow Model of Integrated Care and Measuring Integrated Care Patient Framework. Results: Sixteen studies were included. Person-centred and shared responsibility experiences were most often discussed. Experiences were not always described as positive and some patients experienced a lack of PCCC. Clinical, professional/organisational and functional integration processes were associated with experiencing domains of PCCC. Discussion: People with complex needs experience a lack of coordination across teams and wider community resources, and limited associations were made between integration processes and patient experience. Further research which gives context to individual experience, provides greater detail of integration processes and utilises validated patient experience measures of PCCC is required to understand the association between integration processes and domains of PCCC. [ABSTRACT FROM AUTHOR]

This chapter explores employer perspectives on the extension of behavioural conditionality to working social security claimants ('in-work conditionality'). As policymakers across Europe and other developed nations have pursued increasingly interventionist approaches to activating the unemployed through conditional welfare policies, the UK has gone a significant and 'unprecedented' step further by requiring those in receipt of in-work benefits to demonstrate their efforts to increase their working hours and/or pay. As the actors ultimately in control over the jobs people can access and progress in, understanding employer perspectives on this new policy development is critical, which, however, has so far been overlooked by policymakers and researchers. We address this omission through presenting original analysis of 84 semi-structured interviews conducted with a diverse group of employers. We find that while the UK's Work First approach to activation has seemingly encountered little resistance from employers to date, this new Work First, Work More approach may be a step too far. We contribute theoretically by identifying a potential role for employers as latent path disruptors in policy development, and challenge the commonly-held assumption that employers are typically supportive of extensions of behavioural conditionality to social security claimants. [ABSTRACT FROM AUTHOR]

Objective: To conduct a systematic review of the evidence for when a hospital admission for an older person can be avoided in subacute settings. We examined the definition of admission avoidance and the evidence for the factors that are required to avoid admission to hospital in this setting. Methods: Using defined PICOD criteria, we conducted searches in three databases (Medline, Embase and Cinahl) from January 2006 to February 2018. References were screened by title and abstract followed by full paper screening by two reviewers. Additional studies were searched from the grey literature, experts in the field and forward and backward referencing. Data were narratively described, and concept analysis was used to investigate the definition of admission avoidance. Results: A total of 17 studies were considered eligible for review; eight provided a definition of admission avoidance and 10 described admission avoidance criteria. We identified three factors which play a key role in admission avoidance in the subacute setting: (1) ambulatory care sensitive conditions and common medical scenarios for the older person, which included respiratory infections or pneumonia, urinary tract infections and catheter care, dehydration and associated symptoms, falls and behavioural management, and managing ongoing chronic conditions; (2) criteria/tools, referring to interventions that have used clinical expertise in conjunction with a range of general and geriatric triage tools; in condition-specific interventions, the decision whether to admit or not was based on level of risk determined by defined clinical tools; and (3) personnel and resources, referring to the need for experts to make the initial decision to avoid an admission. Supervision by nurses or physicians was still needed at subacute level, requiring resources such as short-stay beds, intravenous antibiotic treatment or fluids for rehydration and rapid access to laboratory tests. Conclusion: The review identified a set of criteria for ambulatory care sensitive conditions and common medical scenarios for the older person that can be treated in the subacute setting with appropriate tools and resources. This information can help commissioners and care providers to take on these important elements and deliver them in a locally designed way. [ABSTRACT FROM AUTHOR]

In the United Kingdom, individuals requiring inpatient care for mental health purposes can be admitted to hospital with their consent as informal patients, or formally through procedure(s) prescribed by law. There are, however, instances where individuals otherwise referred to as informal patients are on admission without their consent or in circumstances that amount to deprivation of their liberty as defined by the United Kingdom Supreme Court and without recourse to lawful procedures by their clinical team as stipulated by the European Convention on Human Rights. Such instances might be without the awareness of the individuals or their clinical teams or the clinical teams might be unclear as to which statute applies to patient care. This paper has been written to help clinicians define the legal status of patients at the point of admission, during their stay on the inpatient unit and the statute(s) that apply to different in-patient situations. [ABSTRACT FROM AUTHOR]

Objectives: While the presence of publication bias in clinical research is well documented, little is known about its role in the reporting of health services research. This paper explores stakeholder perceptions and experiences with regard to the role of publication and related biases in quantitative research relating to the quality, accessibility and organization of health services. Methods: We present findings from semi-structured interviews with those responsible for the funding, publishing and/or conduct of quantitative health services research, primarily in the UK. Additional data collection includes interviews with health care decision makers as 'end users' of health services research, and a focus group with patient and service user representatives. The final sample comprised 24 interviews and eight focus group participants. Results: Many study participants felt unable to say with any degree of certainty whether publication bias represents a significant problem in quantitative health services research. Participants drew broad contrasts between externally funded and peer reviewed research on the one hand, and end user funded quality improvement projects on the other, with the latter perceived as more vulnerable to selective publication and author over-claiming. Multiple study objectives, and a general acceptance of 'mess and noise' in the data and its interpretation was seen to reduce the importance attached to replicable estimates of effect sizes in health services research. The relative absence of external scrutiny, either from manufacturers of interventions or health system decision makers, added to this general sense of 'low stakes' of health services research. As a result, while many participants advocated study pre-registration and using protocols to pre-identify outcomes, others saw this as an unwarranted imposition. Conclusions: This study finds that incentives towards publication and related bias are likely to be present, but not to the same degree as in clinical research. In health services research, these were seen as being offset by other forms of 'novelty' bias in the reporting and publishing of research findings. [ABSTRACT FROM AUTHOR]

Objectives: The paper reports on an empirical study of Health and Wellbeing Boards (HWBs) in England. Established by the Health and Social Care Act 2012, HWBs act as place-based hubs for leaders in health, social care, local government and other sectors to come together to address health improvement and the wider determinants of health. Methods: We conducted a three-year study of HWBs (2015–2017) in five localities across England. This involved collecting qualitative data from semi-structured interviews with key actors in the HWBs at strategic and operational levels, and focus group sessions with voluntary-sector participants at each HWB. Results: HWBs have largely followed the path of previous partnerships in terms of a lack of clear aims and objectives, lack of ownership and accountability by partners, and an absence of any significant impact on health outcomes. Conclusions: Many of the features of unsuccessful partnership working were largely displayed by HWBs. Boards require more executive power and ownership from the bottom up if they are to have any real impact. [ABSTRACT FROM AUTHOR]

Objectives: People with cirrhosis are encouraged to participate in shared decision-making with their doctors, but studies suggest that doctors limit the amount of information that is shared. In this study we explore the presence of medical power in clinical encounters in 2015 from a patient perspective and highlight its effects on healthcare interactions. Methods: Qualitative semi-structured interviews were conducted with ten people with cirrhosis attending a tertiary liver transplant centre in southern England. We explored their understanding of their disease and prognosis, and their participation in decision-making. Using the lens of medical power as a framework, we analysed findings into thematic sentences to summarise key ideas whilst preserving the complexity of identified concepts. Results: Three key concepts explained patient perspectives of their communication with doctors: (1) portraying a positive image to doctors, (2) avoiding confrontation with doctors, (3) feeling powerless in the face of doctors' medical knowledge. These concepts show deeper dynamic issues of power during healthcare encounters, illustrated by participants' reluctance to voice their concerns and express themselves, challenge decisions, or seek information. Conclusion: People with cirrhosis struggle to articulate their concerns or challenge decisions on their care and treatment and may worry about potential consequences. Our findings demonstrate the continuing persistence of issues of power at play in contemporary health care. [ABSTRACT FROM AUTHOR]

Tourist decision-making is complex and understanding why some tourists may reject a cruise vacation is important for continued growth of the cruise sector. Image elicitation was employed in twenty interviews with cruisers and non-cruisers in the UK. Findings revealed risk perceptions influence cruise decision-making as vacation choices reflect self. Cruisers choose cruise vacations to reduce risk to self and affirm self-concept, and non-cruisers perceive social and psychological risk in cruising. Non-cruisers find social value in disassociation from and rejecting cruise vacations, illuminating how self-congruity influences cruise decision-making. Theoretical contributions and practical implications for industry are identified with specific recommendations. [ABSTRACT FROM AUTHOR]

Objective: Work is an important aspect of everyday life. This remains true for those living with and beyond cancer. Less is known about how the meaning of work may change over the cancer journey, the needs of the individual in response to changes and how healthcare professionals and employing organisations can meet these needs. The aim of this study was to explore the lived experience of work after treatment for breast cancer in a group of professional working women within the UK. Methods: This article presents an Interpretative Phenomenological Analysis (IPA) of the experiences of 15 professional women diagnosed with breast cancer. Results: We discuss these women's journey from (1) rethinking the meaning of work to (2) making decisions about work ability and advice on work to (3) transitioning back in to the workplace and the value of continued engagement with employer. Discussion: The findings from this study demonstrate the complex interplay between living with cancer, treatment decisions and work. This study highlights two key areas for inclusion in practice: (1) support from Healthcare Professionals and judgements of functional ability and work ability and (2) the role of line managers in managing cancer and work. [ABSTRACT FROM AUTHOR]

In the UK, decisions to approve adoptive parents and foster carers and authorise adoptions rest with specialist panels. While their formal role and function are clear, there is concern that their composition and the biographies and background characteristics of members could introduce bias and influence the decisions made. This article examines the validity of these criticisms with findings from a study of eight agencies, 15 panels and 22 members. It was found that the panel system achieves its aims in terms of having a representative constitution and providing considered recommendations in a timely manner to senior managers, but that individual biography affects panel members in carrying out their role to an unexpectedly high degree, possibly leading to flawed decisions. Actions to remedy this problem, at both an individual and group level, are suggested. [ABSTRACT FROM AUTHOR]

Erasmus student mobility is the most recognised element of Erasmus+ and clearly popular with an increase in student uptake from 3,000 in 1987 to over 300,000 today. Recent studies show that students from lower socio-economic backgrounds are less likely to study abroad than better-off students, thereby benefitting less from improved employment opportunities and language competences often associated with mobility. Unequal uptake is generally explained by students' choices: disadvantaged students hold lower social capital which leads them to decide against mobility. However, not much is known about the importance of students' selection into universities and fields of study. Using multilevel logistic regressions, this article examines whether social segregation in universities and field of study matters beyond individual characteristics for explaining unequal Erasmus mobility uptake. The study exploits rich population data of around 200,000 UK first-degree graduates of the year 2014/2015 deriving from the Higher Education Statistics Agency (HESA) data. Results show that while student characteristics like ability and social status are important predictors of Erasmus mobility, they only explain one part of unequal uptake. In addition, social segregation of universities and fields of study contribute to the unequal mobility pattern found. Student mobility is less common for students enrolled in fields of study and universities attended by disadvantaged students conditional on student characteristics. This implies that student mobility could become more inclusive if grant funding and incentives targeted universities attended by a high proportion of disadvantaged students. [ABSTRACT FROM AUTHOR]

Recent technological and market changes in the television industry appear to have transformed the corporate configurations which conduce to economic success in the production industry. As a result, many leading independent television production companies in the United Kingdom and elsewhere across Europe have become prime targets for corporate activity and many have been subject to takeover, often by the US media groups. Does this matter? Does the concept of 'national' television content still have any relevance in the digital era? Drawing on a multiple-case-study-based analysis of several UK-based television production companies over recent years, this article examines how corporate takeovers in the production sector may affect creative decision-making and impact on the nature and quality of television content. Against a background of increased investment interest from multinationals in indigenous players in the United Kingdom and across Europe, the analysis presented makes a timely and policy-relevant contribution to knowledge. [ABSTRACT FROM AUTHOR]

Gender differences in the accumulation of pension savings are well documented. Work in this field has concluded that while differing lifetime work profiles (and family history) explained much of the difference, other factors such as pension knowledge and confidence in decision-making, may also be significant. This research, commissioned by the Fawcett Society and funded by Scottish Widows, explores some of these factors through the use of 30 semi-structured interviews and a focus group with women (aged 24–39) about their attitudes and motivations towards pension saving. It concentrates on discussions around pension knowledge, advice and decision-making, and identifies challenges in relation to women’s pension knowledge and the use of male ‘role models’ in making decisions. The article then explores potential policy mechanisms to enhance women’s pension saving for retirement, including the manner in which information and advice is provided and strategies to improve confidence in pension decision-making. [ABSTRACT FROM AUTHOR]

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The police have been disclosing criminal records and other non-conviction information to employers for the last 30 years as part of the pre-employment screening of job applicants. This employment has largely consisted of work with children and vulnerable adults. The Criminal Records Bureau (CRB) took some of this work – the disclosure of criminal records – off the police in 2002 and its successor, the Disclosure and Barring Service (DBS), has continued to do so since 2012. The police, however, have always been left with the residual task of deciding what other ‘non-conviction information’ should be passed to employers. This article seeks to critically examine the disclosure of non-conviction information to employers by the police. The background and legal and ethical context surrounding this area of police decision-making are considered, as are the guidance provided to the police, the practicalities of decision-making and the additional guidance published for the police on similar disclosures; we also consider the court judgements that have been both supportive and critical of this area of police decision-making. [ABSTRACT FROM AUTHOR]

Discussion of unanticipated problems in care with patients and their families (‘open disclosure’) is now widely advocated. Despite international efforts and the introduction of a range of policies and guidance to promote such discussions, the expectations of policy makers and patients are often not matched in practice. We consider some reasons for the persistence of shortfalls in the occurrence and quality of open disclosure. We draw on research conducted to investigate the implementation of a ‘Being open’ policy in England, reflecting particularly on insights derived from interviews with health care professionals. Health care professionals were broadly supportive of the idea of open disclosure. Some expressed well-recognized concern about punishment and being blamed, but this did not appear to be the main driver of their communication practices. Their accounts of what happened around particular problems in health care indicated that they brought a complex range of considerations to bear on questions of whether and how these were discussed with patients and relatives. Guidance about open disclosure based on assessments of levels of harm to patients can complicate and perhaps distort health care professionals’ approaches, particularly when the extent and/or cause of harm was uncertain. Health care professionals who engage in open disclosure must be able to negotiate appropriate ways through complex and sensitive discussions. The responses of patients and relatives are not always predictable and even the best open disclosure practice may not resolve problems and concerns. Guidance, training and support for staff need to reflect these challenges. [ABSTRACT FROM PUBLISHER]

The article discusses a study on the organizational factors affecting the quality of handover in the emergency care pathway and provides a qualitative account of how practitioners try to align their various personal and organizational priorities and backgrounds when handing over patients through care boundaries. Topics discussed include a qualitative account on how organizational priorities like the management of patient flows can affect the quality of handover in emergency care.

The author reflects on the emergence of a hollowed out state evidencing a shift from government to governance with the openness of governments to devolve and distribute power and subsequent growth of self-governing networks. Topics discussed include how patient safety is seen as a paradigm that unites various communities for a common goal and indications that safety solution cannot be imported from one setting to another without professional and organisational ways of seeing.