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Health is only one part of the story - Case and Deaton carefully chart the underlying economic picture, which is no less stark. As well as the death data, Case and Deaton also show deteriorating health in this group, in particular depression, other mental illness and distress, and chronic pain and disability. In dissecting aggregate statistics, Case and Deaton home in on one group where health has deteriorated fastest - middle aged (45-54 years) white Americans. [Extracted from the article]

Reported here is one part of the nationally representative, Schools and Continuing Professional Development in England - State of the Nation research study which was funded by the Training and Development Agency for Schools (TDA). This paper sets out to understand how teachers and school leaders in England perceive the benefits and effectiveness of CPD activity. The investigation of benefits and effectiveness of CPD presented in the paper focuses on the various impacts that could result from participation, the forms and features of activities, as well as the conditions that make effectiveness more or less likely to occur. [ABSTRACT FROM AUTHOR]

Through analysing local administrative records, state administrative records, and personal correspondence, this article demonstrates how Sir John Peyton's role as Lieutenant of the Tower of London (1597–1603) provides us with a hitherto unexamined opportunity for commissioning, extracting, brokering, and obtaining intelligence. In doing so, it makes the case for re‐examining the often‐overlooked contribution of Elizabethan and Jacobean administrators to the history of intelligence‐gathering in early modern England, here focussing on the position of the Lieutenant of the Tower of London. [ABSTRACT FROM AUTHOR]

Extending screening intervals in ongoing cancer screening programmes can lead to challenging year‐on‐year variations in the number of screening tests. We explored how such variation could be diminished with a managed transition to the extended interval. We defined three extension scenarios: immediate extension for the entire target population; stepped transition by birth cohort; and gradual transition by reducing the number of available screening appointments. These were compared to a situation in which the interval remains unchanged in a demographic model covering a 15‐year period. The model was populated with observed parameters from England, a real‐world setting recommending cervical screening with 3‐year intervals at age 25‐49 and 5‐year intervals at age 50‐64. Informed by typical changes currently considered by several European programmes including the programme in England, we explored the effect on screening test numbers of an extension of the 3‐year interval to 5 years for women younger than 50. All three extension scenarios resulted in similar cumulative numbers of screening tests, which were about 30% lower compared to a situation in which the interval would remain unchanged. However, the year‐on‐year variation in the number of screening tests varied between the scenarios. This variation was around 4‐fold for the immediate scenario. In the stepped scenario, the yearly numbers could differ by around 20%, whereas in the gradual scenario they were virtually constant. A managed interval extension, transitioning different groups of the target population at different times, can substantially reduce the yearly variation in screening workload without increasing the total number of screening tests in the long term. [ABSTRACT FROM AUTHOR]

This paper describes one part of a feasibility study carried out in England which examined the costs, quality and effectiveness of continence services in areas with different approaches to provision. It involved the design of instruments to collect the views and perceptions of patients and an investigation of ways to develop a methodology to implement comparative studies. It is the design and piloting of the questionnaires and the way patients responded that forms the focus of this paper. The main sample group recruited for the study were women who had recently sought formal help with urinary incontinence and were likely to receive conservative treatment or management in the community. They were interviewed and asked to complete four questionnaires at two points in time. A smaller sub-group of disabled women, interviewed only once, were included to compare cost profiles for different client groups. The questionnaires which were developed address the impact of urinary incontinence (using a standard scale), the effectiveness of service provision in terms of patients’ clinical history, expectations and hoped-for outcomes, service receipt and its cost, and patients’ satisfaction with several aspects of service provision. In total 118 women were interviewed, including 28 disabled women. The study generated a set of survey instruments which might be used for a variety of purposes including audit and future research and which could inform purchaser and provider decisions by using patients’ perspectives of quality of life outcomes to enhance service development. [ABSTRACT FROM AUTHOR]

Adjacent species-rich and species-poor areas of a limestone outcrop were investigated in a heavy metal mining complex on Grassington Moor, Yorkshire, England, to determine reasons for the differences in their floras. Levels of soil lead, zinc, nitrogen, phosphorus and potassium were determined and the activities of the enzymes urease, acid phosphatase and dehydrogenase in the soil were measured. Soil respiration rates were also determined. The percentages of the variation in species-density accounted for by each factor were determined using a step-wise multiple regression technique. Binding of lead in organic forms resulting in low levels of available lead, together with higher levels of the major plant nutrients, were probably the main factors enabling a species-rich community to occur on one part of the outcrop. Possible ways in which the differences in habitat became established are discussed. [ABSTRACT FROM AUTHOR]

Objectives: Interventions to promote the wearing of face coverings if required in the future can only be developed if we know why people do or do not wear them. Study aims were, therefore, to assess public adherence to wearing face coverings to reduce transmission of SARS‐CoV‐2 and to gauge why people were or were not wearing face coverings in work, public transport, and indoor leisure settings. Design: Cross‐sectional survey. Methods: 10,622 adults (25 January–6 February 2022) who were representative of the UK population were asked about their (a) wearing of face coverings in work, public transport, and leisure settings; (b) sociodemographic characteristics; and (c) perceptions of capabilities, opportunities, and motivations ("COM‐B"). Data were analysed descriptively, using within‐participants ANOVA and multiple linear regression. Results: Participants reported mostly wearing face coverings in public transport settings (>80%), but substantially less in work (<50%) and leisure (<30%) contexts. Perceptions of capabilities, opportunities, and motivations to wear face coverings were consistently associated with the actual wearing of face coverings across the three settings, but there were marked deficits in automatic motivation and social opportunity. People living in England, describing themselves as White, and men were least likely to wear face coverings. Conclusions: Interventions targeted at men, people living in England, and those describing themselves as White that focus on increasing capabilities, providing greater opportunities and boosting motivations are suggested to promote the wearing of face coverings, with particular focus on addressing automatic motivation and social opportunity. [ABSTRACT FROM AUTHOR]

Extensive evidence indicates that education is an integral part of the settling in process for refugee and asylum‐seeking children. Furthermore, it has been suggested that positive teaching practice with refugee pupils should be asset‐based and holistic in nature. The present study examines educators' positive practices with refugee pupils and explores factors that shape these practices. Data were collected through participant observation and semi‐structured interviews with 17 class teachers, specialist teachers and teaching assistants at two schools in England. Numerous examples of positive practices were identified, from creating welcoming environments to promoting social–emotional well‐being to supporting English language learning. Factors that shaped these practices were identified using an ecological model of educator development. Such factors included educators' individual pedagogical knowledge about teaching refugee pupils and collective school‐level knowledge and practices. Some aspects of the national education system, such as rigid exam‐based curricula, were also cited as influential. Overall, this study offers examples of how individual educators and schools managed to enact positive practices with refugee pupils despite an unsupportive national context. [ABSTRACT FROM AUTHOR]

No one doubts the significant variation in the practice of transfusion medicine. Common examples are the variability in transfusion thresholds and the use of tranexamic acid for surgery with likely high blood loss despite evidence-based standards. There is a long history of applying different strategies to address this variation, including education, clinical guidelines, audit and feedback, but the effectiveness and cost-effectiveness of these initiatives remains unclear. Advances in computerised decision support systems and the application of novel electronic capabilities offer alternative approaches to improving transfusion practice. In England, the National Institute for Health and Care Research funded a Blood and Transplant Research Unit (BTRU) programme focussing on 'A data-enabled programme of research to improve transfusion practices'. The overarching aim of the BTRU is to accelerate the development of data-driven methods to optimise the use of blood and transfusion alternatives, and to integrate them within routine practice to improve patient outcomes. One particular area of focus is implementation science to address variation in practice., (© 2023 The Authors. British Journal of Haematology published by British Society for Haematology and John Wiley & Sons Ltd.)

Objective: Blood tests are commonly used in primary care as a tool to aid diagnosis, and to offer reassurance and validation for patients. If doctors and patients do not have a shared understanding of the reasons for testing and the meaning of results, these aims may not be fulfilled. Shared decision‐making is widely advocated; yet, most research focusses on treatment decisions rather than diagnostic decisions. The aim of this study was to explore communication and decision‐making around diagnostic blood tests in primary care. Methods: Qualitative interviews were undertaken with patients and clinicians in UK primary care. Patients were interviewed at the time of blood testing, with a follow‐up interview after they received test results. Interviews with clinicians who requested the tests provided paired data to compare clinicians' and patients' expectations, experiences and understandings of tests. Interviews were analysed thematically using inductive and deductive coding. Results: A total of 80 interviews with 28 patients and 19 doctors were completed. We identified a mismatch in expectations and understanding of tests, which led to downstream consequences including frustration, anxiety and uncertainty for patients. There was no evidence of shared decision‐making in consultations preceding the decision to test. Doctors adopted a paternalistic approach, believing that they were protecting patients from anxiety. Conclusion: Patients were not able to develop informed preferences and did not perceive that choice is possible in decisions about testing, because they did not have sufficient information and a shared understanding of tests. A lack of shared understanding at the point of decision‐making led to downstream consequences when test results did not fulfil patients' expectations. Although shared decision‐making is recommended as best practice, it does not reflect the reality of doctors' and patients' accounts of testing; a broader model of shared understanding seems to be more relevant to the complexity of primary care diagnosis. Patient or Public Contribution: A patient and public involvement group comprising five participants with lived experience of blood testing in primary care met regularly during the study. They contributed to the development of the research objectives, planning recruitment methods, reviewing patient information leaflets and topic guides and also contributed to discussion of emerging themes at an early stage in the analysis process. [ABSTRACT FROM AUTHOR]

Background: Obesity rates are higher among people of lower socioeconomic status. While numerous health behaviour interventions targeting obesity exist, they are more successful at engaging higher socioeconomic status populations, leaving those in less affluent circumstances with poorer outcomes. This highlights a need for more tailored interventions. The aim of this study was to enhance an existing weight loss course for adults living in low socioeconomic communities. Methods: The Behaviour Change Wheel approach was followed to design an add‐on intervention to an existing local authority‐run weight loss group, informed by mixed‐methods research and stakeholder engagement. Results: The COM‐B analysis of qualitative data revealed that changes were required to psychological capability, physical and social opportunity and reflective motivation to enable dietary goal‐setting behaviours. The resulting SMART‐C booklet included 6 weeks of dietary goal setting, with weekly behavioural contract and review. Conclusion: This paper details the development of the theory‐ and evidence‐informed SMART‐C intervention. This is the first report of the Behaviour Change Wheel being used to design an add‐on tool to enhance existing weight loss services. The process benefitted from a further checking stage with stakeholders. [ABSTRACT FROM AUTHOR]

Reform of the parole system has emerged as the cause célèbre of a resurgent law and order politics. Successive governments have seized upon the symbolic power of parole to demonstrate 'toughness' with respect to violent and sexual offending, to express solidarity with the victims of crime and reaffirm a populist credo that purportedly stands in opposition to an unaccountable and out of touch penal elite. Published in March 2022, the Ministry of Justice Root and Branch Review of the Parole System represents a continuation of this well-rehearsed political strategy, but arguably goes further than ever before in its willingness to dispense with established norms, rules and practices. This article surveys the contemporary politics of parole in England and Wales and reflects upon what these developments reveal about the shifting contours of a creeping authoritarian conservatism premised upon nostalgia, nationalism and the projection of a strong, centralised state. [ABSTRACT FROM AUTHOR]

Aims: For diseases with a genetic cause, genomics can deliver improved diagnostics and facilitate access to targeted treatments. Drug pharmacodynamics and pharmacokinetics are often dependent on genetic variation underlying these processes. As pharmacogenomics comes of age, it may be the first way in which genomics is utilised at a population level. Still required is guidance and standards of how genomic information can be communicated within the health record, and how clinicians should be alerted to variation impacting the use of medicines. Methods: The Professional Record Standards Body commissioned by NHS England developed guidance on using pharmacogenomics information in clinical practice. We conducted research with those implementing pharmacogenomics in England and internationally to produce guidance and recommendations for a systems‐based approach. Results: A consensus viewpoint is that systems need to be in place to ensure the safe provision of pharmacogenomics information that is curated, actionable and up‐to‐date. Standards should be established with respect to notification and information exchange, which could impact new or existing prescribing and these must be in keeping with routine practice. Alerting systems should contribute to safer practices. Conclusion: Ensuring pharmacogenetics information is available to make safer use of medicines will require a major effort, of which this guidance is a beginning. Standards are required to ensure useful genomic information within the health record can be communicated to clinicians in the right format and at the right times to be actioned successfully. A multidisciplinary group of stakeholders must be engaged in developing pharmacogenomic standards to support the most appropriate prescribing. [ABSTRACT FROM AUTHOR]

This article begins by exploring ideas about physical exercise as outlined in the advice literature that circulated widely in late medieval and early sixteenth‐century England. Whereas other aspects of these popular guides to health have attracted considerable interest on the part of medical and cultural historians, recommendations about exercise have been largely neglected. Yet it was deemed essential for both physical and mental wellbeing. Its principal function was to augment and redistribute the body's innate heat, which functioned as 'Nature's primary instrument', while improving digestion and the elimination of waste, encouraging restorative sleep, and combatting stress. These ideas spread rapidly throughout society, being harnessed to suit the practical needs of many classes of people, especially after the Black Death when keeping fit became a priority. Not even animals could escape current assumptions about the importance of remaining active, while political theorists emphasised the need to purge idle and unproductive elements from the communal body. [ABSTRACT FROM AUTHOR]

Purpose: Although urgent primary eye care schemes exist in some areas of England, their current safety is unknown. Accordingly, the aim of the present study was to quantify the clinical safety and effectiveness of a COVID‐19 Urgent Eyecare Service (CUES) across Luton, Bedford, Hull, East Riding of Yorkshire and Harrogate. Methods: Consenting patients with acute onset eye problems who had accessed the service were contacted to ascertain what the optometrist's recommendation was, whether this worked, if they had to present elsewhere and how satisfied they were with the CUES. Results: A total of 27% (170/629) and 6.3% (28/445) of patients managed virtually and in person, respectively, did not have their acute eye problem resolved. Regression analysis revealed that patients who attended a face‐to‐face consultation were 4.66 times more likely to be correctly managed [Exp (β) = 5.66], relative to those solely managed virtually. Optometrists' phone consultations failed to detect conditions such as stroke, intracranial hypertension, suspected space occupying lesions, orbital cellulitis, scleritis, corneal ulcer, wet macular degeneration, uveitis with macular oedema and retinal detachment. Of referrals to hospital ophthalmology departments, in total, 19% were false‐positives. Patients, however, were typically very satisfied with the service. Uptake was associated with socioeconomic status. Conclusion: The present study found that a virtual assessment service providing optometrist tele‐consultations was not effective at resolving patients' acute‐onset eye problems. The range and number of pathologies missed by tele‐consultations suggests that the service model in the present study was detrimental to patient safety. To improve this, optometrists should follow evidence based guidance when attempting to manage patients virtually, or in person. For example, patients presenting with acute‐onset symptoms of flashing lights and/or floaters require an urgent dilated fundus examination. Robust data collection on service safety is required on an ongoing basis. [ABSTRACT FROM AUTHOR]

This qualitative study, undertaken in England, explored young carers' perspectives on the nature of their caring responsibilities. The findings are significant, particularly in the context of England's Care Act 2014, which seeks to prevent children engaging in 'excessive' or 'inappropriate' caring. Our research placed children at the heart of the debate on what constitutes appropriate care. The findings raise key questions regarding effective implementation of contemporary child policy, duties of care towards children in caring roles and priorities for child protection and family support policy and practices, with the potential to inform thinking around child's well‐being in wider contexts. [ABSTRACT FROM AUTHOR]

The Ball State University Center for Peace and Conflict Studies in the United States has compiled altruistic stories from different countries such as India, Australia, the United States, and England since the onset of the COVID‐19 pandemic. We examined those stories to understand (1) who receives the most support, (2) what type of support is provided, (3) who those supporters are, and (4) why people support each other during the pandemic. Conducting a qualitative content analysis of 104 altruistic stories, we first identified that (a) older individuals , (b) people with sensitive health conditions, and disabilities, (c) frontline workers, and (d) working class and marginalized communities received the primary support. Second, we identified three types of support: (a) material, (b) social/emotional, and (c) psychological. Third, we found that support was coming from (a) different organizations, (b) advantaged groups, and (c) volunteers. Last, (a) sharing a community/humanity identity, (b) allyship, and (c) showing gratitude were the reasons behind altruistic and prosocial behavior. Our findings contribute to the literature by providing some possible reasons and ways that allies have supported disadvantaged communities via sharing the available resources and how showing gratitude can be a reason for altruism and prosocial behavior in a pandemic. [ABSTRACT FROM AUTHOR]

Uncertainty is inherent in modelled projections of bioenergy with carbon capture and storage (BECCS), yet sometimes treated peripherally. One source of uncertainty comes from different climate and soil inputs. We investigated variations in 70‐year UK projections of Miscanthus × giganteus (M × g), BECCS and environmental impacts with input data. We used cohort datasets of UKCP18 RCP8.5 climate projections and Harmonized World Soil Database (HWSD) soil sequences, as inputs to the MiscanFor bioenergy model. Low annual yield occurred 1 in 10 years as a UK‐average but yield uncertainty varied regionally, especially south and east England. BECCS projections were similar among cohorts, with variation resulting from climate cohorts of the same database ensemble (3.99 ± 0.14 t C ha−1 year−1) larger than uncertainty resulting from soil sequences in each grid block (3.96 ± 0.03 t C ha−1 year−1). This is supported by annual time series, displaying variable annual climate and a close yield–BECCS–climate relationship but partial correspondence of yield and BECCS with maximal soil variability. Each HWSD soil grid square contains up to 10 ranked soil types. Predominant soil commonly has over 50% coverage, indicating why BECCS from combined soil sequences were not significantly different from BECCS using the dominant soil type. Mean BECCS from the full climate ensemble combined with the full soil sequences, over the current area of cropping limits in England and Wales, is 3.98 ± 0.14 t C ha−1 year−1. The bioenergy crop has a mean seasonal soil water deficit of 65.79 ± 4.27 mm and associated soil carbon gain of 0.22 ± 0.03 t C ha−1 year−1, with bioenergy feedstock calculated at 131 GJ t−1 y−1. The uncertainty is specific to the input datasets and model used. The message of this study is to ensure that uncertainty is accounted for when interpreting modelled projections of land use impacts. [ABSTRACT FROM AUTHOR]

Policy PointsThis analysis finds that government obesity policies in England have largely been proposed in a way that does not readily lead to implementation; that governments rarely commission evaluations of previous government strategies or learn from policy failures; that governments have tended to adopt less interventionist policy approaches; and that policies largely make high demands on individual agency, meaning they rely on individuals to make behavior changes rather than shaping external influences and are thus less likely to be effective or equitable.These findings may help explain why after 30 years of proposed government obesity policies, obesity prevalence and health inequities still have not been successfully reduced.If policymakers address the issues identified in this analysis, population obesity could be tackled more successfully, which has added urgency given the COVID‐19 pandemic. Context: In England, the majority of adults, and more than a quarter of children aged 2 to 15 years live with obesity or excess weight. From 1992 to 2020, even though the government published 14 obesity strategies in England, the prevalence of obesity has not been reduced. We aimed to determine whether such government strategies and policies have been fit for purpose regarding their strategic focus, nature, basis in theory and evidence, and implementation viability. Method: We undertook a mixed‐methods study, involving a document review and analysis of government strategies either wholly or partially dedicated to tackling obesity in England. We developed a theory‐based analytical framework, using content analysis and applied thematic analysis (ATA) to code all policies. Our interpretation drew on quantitative findings and thematic analysis. Findings: We identified and analyzed 14 government strategies published from 1992 to 2020 containing 689 wide‐ranging policies. Policies were largely proposed in a way that would be unlikely to lead to implementation; the majority were not interventionist and made high demands on individual agency, meaning that they relied on individuals to make behavior changes rather than shaping external influences, and are thus less likely to be effective or to reduce health inequalities. Conclusions: The government obesity strategies' failure to reduce the prevalence of obesity in England for almost 30 years may be due to weaknesses in the policies' design, leading to a lack of effectiveness, but they may also be due to failures of implementation and evaluation. These failures appear to have led to insufficient or no policy learning and governments proposing similar or identical policies repeatedly over many years. Governments should learn from their earlier policy failures. They should prioritize policies that make minimal demands on individuals and have the potential for population‐wide reach so as to maximize their potential for equitable impacts. Policies should be proposed in ways that readily lead to implementation and evaluation. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the general public's source credibility attitudes towards health and social care professionals when giving advice associated with their 'traditional role' versus an 'expanded health behaviour change' role, to facilitate the implementation of the health behaviour change agenda. Design: A 3x3 experimental between‐subjects vignette questionnaire study with nine scenarios in which a general practitioner (GP), health visitor, or firefighter offered advice on either stopping smoking, preventing cot death, or fire safety. Combinations were either congruent with a traditional role (e.g., health visitor and cot death) or an expanded role (e.g., firefighter and stopping smoking). Methods: Adults were recruited from metropolitan locations in northern England. Participants were randomized to one scenario and complete a validated 18‐item source credibility questionnaire. Factor analysis explored source credibility components; ratings for traditional and expanded role scenarios were compared using Mann–Whitney tests. Results: 369 participants completed the questionnaire (49.3% women, 64% White British, age range: 16–83). Factor analysis confirmed three source credibility dimensions: competence, caring, and trustworthiness. Ratings were generally high across professions and scenarios; participants rated professionals as significantly more 'competent' where scenarios related to their traditional roles than expanded roles (U 9778.5, p <.001) but equally as caring (U = 14467.5, p<.485) and trustworthy (U 14250.5, p.348). Conclusions: GPs, health visitors, and firefighters were all perceived as credible sources of health behaviour change advice, but may be viewed as 'less competent' sources of messages associated with an expanded job role. Effective professional training and public engagement regarding the role expansion agenda are needed to support policy implementation. Statement of ContributionWhat is already known on this subject?Source credibility surrounds people's perceptions of the source of advice and includes competence, caring, and trustworthiness dimensions.This may have an important influence on people's attitudes and behaviour, especially when messages are complex or emotive.A wide range of public sector workers is now expected to routinely offer preventive health and safety advice, as part of role expansion.What does this study add?This experimental survey study compared source credibility perceptions of GPs, health visitors, and firefighters giving advice on topics associated with a traditional or expanded role.Professionals were perceived as less 'competent' when giving advice on 'expanded role' topics, such as a firefighter discussing smoking, with a small reduction in source credibility.This highlights that source credibility may be specific to professional identities.Policymakers may need to explore this further as part of implementing role expansion for prevention and self‐management in health and social care. [ABSTRACT FROM AUTHOR]

Infant facial features are typically perceived as "cute," provoking caretaking behaviours. Previous research has focused on adults' perceptions of baby cuteness, and examined how these perceptions are influenced by events of the adult reproductive lifespan, such as ovulation and menopause. However, globally, individuals of all ages, including pre‐pubertal children, provide notable proportions of infant care. In this study, we recruited participants in and around northern England, and tested 330 adults and 65 children aged 7–9 using a forced‐choice paradigm to assess preferences for infant facial cuteness in two stimulus sets and (as a control task) preferences for femininity in women's faces. We analysed the data with Hierarchical Bayesian Regression Models. The adults and children successfully identified infants who had been manipulated to appear cuter, although children's performance was poorer than adults' performance, and children reliably identified infant cuteness in only one of the two infant stimuli sets. Children chose the feminised over masculinised women's faces as more attractive, although again their performance was poorer than adults' performance. There was evidence for a female advantage in the tasks: girls performed better than boys when assessing the woman stimuli and one of the infant stimulus sets, and women performed better than men when assessing one of the infant stimulus sets. There was no evidence that cuteness judgements differed depending upon exposure to infants (children with siblings aged 0–2; adults with a baby caregiving role), or depending upon being just younger or older than the average age of menopause. Children and grandparents provide notable portions of infant caretaking globally, and cuteness perceptions could direct appropriate caregiving behaviour in these age groups, as well as in adults of reproductive age. [ABSTRACT FROM AUTHOR]

This paper develops understandings of how being publicly identified and consequently labelled as 'looked after' can have damaging consequences for young people, particularly in how they are perceived by their peers in the context of schooling. Based on qualitative research in northern England utilising participatory approaches with young people and interviews with support staff, we explore barriers that inhibit young people's sense of belonging. We highlight how the very processes and practices set up to support the young people can often have unintended consequences by routinely positioning them as Other, before considering the implications for education and schooling in particular. [ABSTRACT FROM AUTHOR]

This article addresses the provision of music education in schools in England, arguing that access to music education is the right of every child and therefore that a high‐quality and sustained curriculum offer must be provided in all state‐funded schools. Music education in England is widely recognised as being marginalised in state schools, despite it being a statutory requirement as part of the National Curriculum. This policy review examines several threats to music education, such as accountability measures, funding cuts, curriculum narrowing and erosion of the teaching workforce, identifying some of the key evidence in each case. [ABSTRACT FROM AUTHOR]

Over the last quarter century, non‐medical prescribing in the UK has grown significantly; eight non‐medical professional groups now have authority to prescribe a wide range of medicines, suggesting it could be a potent driver of pharmaceuticalisation. In this article, we present data from a case study of physiotherapists' prescribing practices. UK physiotherapists have had legal rights to prescribe medicines since 2005, but relatively little is known about the contribution they make to expanding patient access to medicines. We approached our study through a lens of governmentality to capture the mentalities and micro‐practices governing physiotherapist non‐medical prescribing. Ethnographic methods were used to gather data from an outpatient orthopaedic service in an NHS Trust in England employing physiotherapist prescribers. From the data, we identified a grid of intelligibility – an organising framework formulated by powerful discourses and technologies of government through which physiotherapist prescribing was acted into being. A primary effect of this grid was the constitution of new physiotherapist subjectivities, mostly as non‐prescribers of medicines contrary to policy intentions, underpinned by a familiar and enduring template of medical professionalism. [ABSTRACT FROM AUTHOR]

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

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In British political and intellectual circles, there is a longstanding disagreement between those envisaging an opportunity for the development of a radical English patriotism and those resistant to the idea of a progressive English imaginary. Despite their antithetical quality, both divergent frameworks were explored in the work of Scottish nationalist and New Left intellectual Tom Nairn, long before mainstream social science preoccupied itself with the 'English Question'. Notwithstanding his later espousal of Englishness as a contribution to democratic renewal, Nairn's earlier notion of an inherently regressive nationalism remains the dominant frame for many intellectuals and politicians confronted by the challenges of increasingly politicised English identities. Whilst he has been only one of a number of thinkers and writers who have informed and contested political thinking on this question in the UK, the influence of his early work upon liberal and left circles has been underestimated, an oversight that this article addresses. [ABSTRACT FROM AUTHOR]

This paper considers the application of deposit modeling within archaeological projects, summarizing the results of a Historic England funded project aimed at developing "good practice" for the application of these techniques within terrestrial environments. It provides an overview of what deposit modeling is, the environments where it can be used and the methods most commonly used. The paper identifies a series of issues and challenges in using deposit models within archaeological investigations, such as the archiving of geotechnical data, the testing of deposit models against the distribution of archaeological sites and features, and integrating sediment stratigraphies derived from deposit modeling with post‐excavation records. We argue that deposit modeling is a valuable tool for archeologists to employ and can be used to design appropriate excavation strategies to target sites and features, thereby increasing the information yield of a project. In this sense deposit modeling can be used as a framework for archaeological projects that are investigating sediment sequences in complex geomorphological environments, starting with pre‐evaluation data gathering, through to focusing excavation strategies, and within the post‐excavation analysis. Whilst this paper is focused upon the terrestrial archaeological record, the themes discussed have resonance for archaeological records across the globe, including the offshore zone. [ABSTRACT FROM AUTHOR]

Background: The Healthy Child Programme is the universal public health system in England to assess and monitor child health from 0 to 19. Following a review of measures for closer monitoring at age 2 years, the Department of Health for England implemented the Ages & Stages Questionnaires®, Third Edition (ASQ‐3™; Hereon, ASQ‐3). Aim: The aim of this study was to evaluate the acceptability and understanding of the ASQ‐3 in England by health professionals and parents. Method: A mixed‐methods approach was used. This paper reports on the qualitative data drawn from interviews with 40 parents and 12 focus groups with 85 health professionals. The data were analysed using applied thematic analysis. Findings Overall, parents and health professionals found the ASQ‐3 acceptable and understandable and could use it as a measure at age 2 years. The ability to work in partnership was valued. Some limitations included potential to cause anxiety, concerns around the safety of some of the items, and use of Americanized language. Health professional's training in the use the ASQ‐3 was inconsistent. Conclusion: The ASQ‐3 is an acceptable and understandable measure to use as part of the 2‐year assessment with some adaptations to the English context and some standardized training for health professionals. [ABSTRACT FROM AUTHOR]

Abstract: Can public sector reform change service performance for the better? This is a hotly contested debate that carries significant theoretical and practical importance. In England, as in many countries, modernisation was at the heart of local government reform and represented an interpretation of New Public Management into a policy framework. This paper examines the role of the modernisation change agenda in England and what this has subsequently meant for ‘service improvement’. Drawing on both document analyses and qualitative interviews with local government employees, we find that while modernisation sought to establish continuous improvement, unintended consequences of modernisation have led to Staff Reductions, Skill Deficiencies, and Loss of a Competent Middle Core in local government, as well as performance outcomes creating an environment for Commissioning, Service Reduction, and Self‐Policing. Implications for the lasting roles and behaviours of public managers affected by this national change agenda are discussed, and conclusions for theory and practice are drawn. [ABSTRACT FROM AUTHOR]

Abstract: Background: Therapeutic alliance refers to the interactional and relational processes operating during therapeutic interventions. It has been shown to be a strong determinant of treatment efficacy in psychotherapy, and evidence is emerging from a range of healthcare and medical disciplines to suggest that the construct of therapeutic alliance may in fact be a variable component of treatment outcome, engagement and satisfaction. Although this construct appears to be highly relevant to aphasia rehabilitation, no research to date has attempted to explore this phenomenon and thus consider its potential utility as a mechanism for change. Aims: To explore speech and language therapists’ perceptions and experiences of developing and maintaining therapeutic alliances in aphasia rehabilitation post‐stroke. Methods & Procedures: Twenty‐two, in‐depth, semi‐structured interviews were conducted with speech and language therapists working with people with aphasia post‐stroke. Qualitative data were analysed using inductive thematic analysis. Outcomes & Results: Analysis resulted in the emergence of three overarching themes: laying the groundwork; augmenting cohesion; and contextual shapers. Recognizing personhood, developing shared expectations of therapy and establishing therapeutic ownership were central to laying the groundwork for therapeutic delivery. Augmenting cohesion was perceived to be dependent on the therapists’ responsiveness and ability to resolve both conflict and resistance, as part of an ongoing active process. These processes were further moulded by contextual shapers such as the patient's family, relational continuity and organizational drivers. Conclusions & Implications: The findings suggest that therapists used multiple, complex, relational strategies to establish and manage alliances with people with aphasia, which were reliant on a fluid interplay of verbal and non‐verbal skills. The data highlight the need for further training to support therapists to forge purposive alliances. Training should develop: therapeutic reflexivity; inclusivity in goal setting, relational strategies; and motivational enhancement techniques. The conceptualization of therapeutic alliance, however, is only provisional. Further research is essential to elucidate the experiences and perceptions of alliance development for people with aphasia undergoing rehabilitation. [ABSTRACT FROM AUTHOR]

Background Self-management is a key recommendation for people with rheumatoid arthritis ( RA). Educational materials may support self-management, and increasingly patients are becoming involved with the development of these materials. The TITRATE trial compares the effectiveness of intensive management to standard care in patients with moderate RA across England. As part of the intensive management intervention, participants are given a handbook. Aim and objectives The aim of this study was to develop a handbook to support the intensive management. The objectives were to: (i) involve patients in the identification of relevant information for inclusion in the TITRATE handbook; (ii) ensure the content of the handbook is acceptable and accessible. Design We held an audio-taped workshop with RA patients. The transcript of the workshop was analysed using thematic content analysis. Results Five main themes were identified as follows: 'rheumatoid arthritis treatment, perceptions of rheumatoid arthritis, the importance of individualized goals, benefits of self-management and the patient handbook'. Feedback from the workshop was incorporated into the handbook, and patients' anonymous testimonies were added. Conclusion This study demonstrates that patient contribution to the development of educational material to support intensive management of RA is both feasible and valuable. A qualitative evaluation of the use and impact of the handbook with patients and practitioners is planned on completion of the TITRATE trial. [ABSTRACT FROM AUTHOR]

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Aim To explore ethnic inequalities in periodontal disease among British adults, and the role of socioeconomic position ( SEP) in those inequalities. Methods We analysed data on 1925 adults aged 16-65 years, from the East London Oral Health Inequality ( ELOHI) Study, which included a random sample of adults living in an ethnically diverse and socially deprived area. Participants completed a questionnaire and were clinically examined for the number of teeth with periodontal pocket depth ( PPD)≥4 mm and loss of attachment ( LOA)≥4 mm. Ethnic inequalities in periodontal measures were assessed in negative binomial regression models before and after adjustment for demographic (gender and age groups) and SEP indicators (education and socioeconomic classification). Results Compared to White British, Pakistani, Indian, Bangladeshi and Asian Others had more teeth with PPD≥4 mm whereas White East European, Black African and Bangladeshi had more teeth with LOA≥4 mm, after adjustments for demographic and SEP measures. The association of ethnicity with periodontal disease was moderated by education, but not by socioeconomic classification. Stratified analysis showed that ethnic disparities in the two periodontal measures were limited to more educated groups. Conclusion This study showed considerable ethnic disparities in periodontal disease between and within the major ethnic categories. [ABSTRACT FROM AUTHOR]

The pharmaceuticalisation of sleep is a contentious issue. Sleep medicines get a 'bad press' due to their potential for dependence and other side effects, including studies reporting increased mortality risks for long-term users. Yet relatively little qualitative social science research has been conducted into how people understand and negotiate their use/non-use of sleep medicines in the context of their everyday lives. This paper draws on focus group data collected in the UK to elicit collective views on and experiences of prescription hypnotics across different social contexts. Respondents, we show, drew on a range of moral repertoires which allowed them to present themselves and their relationships with hypnotics in different ways. Six distinct repertoires about hypnotic use are identified in this regard: the 'deserving' patient, the 'responsible' user, the 'compliant' patient, the 'addict', the 'sinful' user and the 'noble' non user. These users and non-users are constructed drawing on cross-cutting themes of addiction and control, ambivalence and reflexivity. Such issues are in turn discussed in relation to recent sociological debates on the pharmaceuticalisation/de-pharmaceuticalisation of everyday life and the consumption of medicines in the UK today. [ABSTRACT FROM AUTHOR]

Stenhouse's original vision of teacher research incorporated a strong emphasis on curriculum construction, interpretation and evaluation. This curricular emphasis is less prevalent in the present in the dominant 'professional development' and 'what works' traditions of teacher research. It is shown here, however, that this curricular focus has been maintained in the published discourse of history teachers in England. Using a citation analysis to illuminate the growth of professional knowledge, this paper shows how curricular issues drove history-teacher published discourse between 2004 and 2013, and how this discourse drew upon a highly subject-specific knowledge base in this period. Research by teachers in a tradition of 'curriculum theorising', it is argued here, could prove to be a powerful component in establishing a more systematic knowledge base for the profession. [ABSTRACT FROM AUTHOR]

The article presents the research that investigates the drivers of patient satisfaction in the primary care setting in Great Britain. The topics discussed include the correlation between patient experience and their overall satisfaction and approaches in determining the healthcare priorities and preferences of patients.

This paper examines the parallel discourses of 'lost' local flood expertise and the growing use of commercial consultancies to outsource aspects of flood risk work. We critically examine the various claims and counter-claims about lost, local and external expertise in flood management, focusing on the aftermath of the 2007 floods in East Yorkshire, England. Drawing on interviews with consultants, drainage engineers and others, we caution against claims that privilege 'local' floods knowledge as 'good' and expert knowledge as somehow suspect. This paper urges carefulness in interpreting claims about local knowledge, arguing that it is important always to think instead of hybrid knowledge formations. We conclude by arguing that experiments in the co-production of flood risk knowledge need to be seen as part of a spectrum of ways for producing shared knowledge. [ABSTRACT FROM AUTHOR]

English courts are frequently criticised for their flexible approach to the finding of implied choice and the use of the escape clause in the context of the Rome I Regulation/Convention on the law applicable to contractual obligations. This paper argues that such criticism is misplaced. Based on empirical evidence, the article shows that those choice of law decisions are directly influenced by their procedural context and respond to the need to balance the multiple policy issues generated by international commercial litigation. In particular, English decisions need to be assessed in light of three distinct factors: the standard of proof required at different stages of the procedure in England, the national policy to promote England as a center for commercial dispute resolution and the incentives to export English law in certain strategic industries. The use of implied choice and the escape clause to achieve these ends constitutes a legitimate practice that does not frustrate the aims of the EU choice of law regime. [ABSTRACT FROM AUTHOR]

The growth of managerialism has led to the expansion of technologies of control and monitoring within prisons, including key performance targets and audits. A longer-standing method of prison regulation is provided by HM Inspectorate of Prisons ( HMIP). This article draws upon ethnographic research in order to consider how inspection is located in the context of managerialism. The article explores the structure of inspection and the micro-processes of practice and culture. It is argued that prison inspection provides a distinctive form of monitoring that is concerned with the lived experience of imprisonment rather than management systems and promotes values of humanity as opposed to those of economic rationality propagated by managerial practices. [ABSTRACT FROM AUTHOR]

In January 2012, Scotland's First Minister Alex Salmond announced a radical measure that would see every Scottish school student study a Scottish text from a prescribed list. In 2010, Michael Gove announced that ‘Our literature is the best in the world’ and that every pupil should study particular authors. The ‘cultural heritage’ model of English is increasingly dismissed by teachers and students However, it is this ‘cultural heritage’ model which is preserved in the discourse of politicians. This paper explores the role that literary heritage texts play in the discourse of education policy in the context of devolution in twenty-first century Britain and considers the drivers and differences which can be seen in England and Scotland. [ABSTRACT FROM PUBLISHER]

ABSTRACT 5 Boroughs Partnership NHS Foundation Trust, in the Northwest of England, has trained over 500 staff in the Knowledge and Understanding Framework, level 1 personality disorder awareness training. This is a 3-day nationally devised training programme delivered via an innovative co-production model (i.e. co-delivery and partnership working with service users who have lived experience). This paper provides quantitative and qualitative information on the effectiveness of training delivery and also serves to provide some insight into the impact of service-user involvement via such a co-production model. Information on 162 participants using the Knowledge and Understanding Framework bespoke questionnaire (Personality Disorder Knowledge, Attitudes and Skills Questionnaire) suggests that the training can be effectively delivered by and within a local NHS Mental Health Trust. Results immediately post-training suggest an improvement in levels of understanding and capability efficacy and a reduction in negative emotional reactions. Indications from a 3-month follow-up suggest that while understanding and emotional reaction remain improved, capability efficacy regresses back to pre-training levels, suggesting the need for ongoing supervision and/or support to consolidate skills. Discussion includes guidelines for the implementation of a truly integrated co-production model of training provision, as well as advice relating to the maximization of long-term benefits. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This paper argues that direct control of the early years literacy curriculum recently exercised by politicians in England has made the boundaries between research, policy and practice increasingly fragile. It describes how policy came to focus most effort on the use of synthetic phonics programmes in the early years. It examines why the Clackmannanshire phonics intervention became the study most frequently cited to justify government policy and suggests a phonics research agenda that could more usefully inform teaching. It argues that, whilst academics cannot control how their research is eventually used by policy-makers, learned societies can strengthen their ethics policies to set out clearer ground rules for academic researchers working across knowledge domains and with policy-makers. A stronger framework to guide the ethical interpretation of research evidence in complex education investigations would allow more meaningful conversations to take place within and across research communities, and with research users. The paper suggests some features for such a framework. [ABSTRACT FROM AUTHOR]

Background School leavers with intellectual disabilities (ID) often face difficulties in making a smooth transition from school to college, employment or more broadly to adult life. The transition phase is traumatic for the young person with ID and their families as it often results in the loss of friendships, relationships and social networks. Method The aim of this study was to explore the family carers' views and experiences on transition from school to college or to adult life with special reference to ethnicity. Forty-three families (consisting of 16 White British, 24 Pakistani, 2 Bangladeshi and one Black African) were interviewed twice using a semi-structured interview schedule. The carers were interviewed twice, Time 1 (T1) and Time 2 (T2), T2 being a year later to observe any changes during transition. Results The findings indicate that although transition planning occurred it was relatively later in the young person's school life. Parents were often confused about the process and had limited information about future options for their son or daughter. All family carers regardless of ethnicity, reported lack of information about services and expressed a sense of being excluded. South Asian families experienced more problems related to language, information about services, culture and religion. Conclusions The majority of families lacked knowledge and awareness of formal services and the transition process. Socio-economic status, high levels of unemployment and caring for a child with a disability accounted for similar family experiences, regardless of ethnic background. The three key areas relevant for ethnicity are interdependence, religion and assumptions by service providers. [ABSTRACT FROM AUTHOR]

Background There is robust empirical evidence to support clinical decision making in secondary stroke prevention after transient ischaemic attack (TIA) or recovered stroke. However, little attention has been paid to patients' utilization of this evidence in coming to decisions about their treatment choices. Objective To examine the use of formal and informal knowledge by patients in making decisions about carotid endarterectomy (CEA) and medical treatment after TIA/recovered stroke. Setting and participants Twenty participants were recruited from an outpatient vascular surgical assessment clinic in England. Ten were receiving medical treatment alone, and 10 were undergoing CEA after TIA or recovered stroke. Method Twenty-eight in-depth qualitative interviews were conducted. An iterative approach was used whereby emergent themes were further explored in later interviews. Interviews were audiotaped, transcribed and coded. Results Participants gathered and utilized several types of knowledge in the process of making treatment decisions: Empirical knowledge (e.g. clinical trial findings); Pathophysiologic findings (e.g. results of clinical investigations); Experiential knowledge (e.g. personal experience of stroke); Goals and values (e.g. potential impact on family); System features (e.g. apparent urgency of treatment). Conclusions In addition to formal evidence, patients use other sources of informal or 'non-evidentiary' knowledge to support their decisions about treatment after TIA or recovered stroke. To enable evidence-based patient choice, health professionals need to appreciate the diverse types of evidence which patients use, to help them to access relevant and high-quality evidence, to balance evidence from different sources and to make choices which are congruent with their values and expectations. [ABSTRACT FROM AUTHOR]

The contribution of alien, particularly Italian, investment to the development of the medieval English economy has provoked opposing views which hitherto have had to rely chiefly on customs records and evidence of Italian loans to the state for statistical evidence. These, though, vary in their coverage and do not record the inland trade. This article uses the Statute Merchant certificates of debt from 1285 to analyse changing levels of commercial investment by alien and denizen merchants throughout all areas of the kingdom. It shows that Italian investment was declining from the 1280s in line with falling imports of foreign silver. It discusses the causes of this decline, and the effect on alien and denizen credit of imports of counterfeit sterling coins produced by European mints. It relates these financial developments in England, France, and Flanders to the sequence of events which led to English merchants increasing their numbers and mercantile capital at the beginning of the fourteenth century when they were first able to establish their domination of the country's export trade in wool. [ABSTRACT FROM AUTHOR]

ABSTRACT A method is described and tested for identifying and prioritizing actions to facilitate recovery (restoration) and/or conservation (maintenance) of populations of threatened marine species. The exercise was based on established approaches for terrestrial species and on assessing each species according to 'degree of threat' and 'recovery/conservation potential'., Assessment of both degree of threat and recovery/conservation potential was informed by researching the relevant life-history traits of each species and existing knowledge of natural fluctuations in abundance. 'Rarity' was a key consideration in assessing degree of threat but rarity measures for cetaceans and pelagic fishes were not available and a new methodology was therefore developed., Likely actions for maintenance or recovery of a population of a species were specified under the headings: 'Site Management', 'Translocation', 'Enforcement', 'Research', 'Monitoring' and 'Wider Environment'. The recovery/conservation goal for each species was identified according to SMART (Specific, Measurable, Attainable, Relevant and Time-bound) criteria., The terrestrial approach transferred well to marine species but with some adaptation as the marine environment is different to terrestrial ecosystems in the pressures and activities that are likely to adversely affect species, to our knowledge of decline in species and to the ecological processes that are likely to aid recovery., The species researched are prioritized for action according to degree of threat and recovery/conservation potential. Recovery/conservation goals are specified and the reasons for proposed actions are explained., Identifying measures for recovery or conservation was often difficult because the cause of decline or the threats to species were unknown or unclear. Better collation of relevant information would create a stronger evidence base, assist the provision of better advice, and therefore support better decision-making by managers., Application of the methodology to other marine species of conservation concern in a particular biogeographical or administrative area needs more meaningful lists than are currently used of species that are rare, scarce, in decline or threatened with decline., Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

In this article, I examine the narratives of migrant Pakistani men in their fifties and sixties, who became chronically ill over the course of their working lives in London. The men's life histories show that the body, and in particular the labouring body, needs more sustained attention in migration studies. Their narratives tell of how the physical toll of industrial labour resulted in chronic ill health, unemployment and various forms of 'redundant masculinities'. Moreover, the impoverishment that frequently followed from ill health ate away at local social status and transnational relationships. I argue that the existing work on transnationalism has normalized the experiences of an entrepreneurial migrant elite and obscured those of migrants who are bound to one place by force of circumstance. Chronic ill health is not merely the experience of a minority who fall between the cracks of epidemiological studies on 'healthy migrants', as some have recently suggested, but rather, common to industrial labour migration. [ABSTRACT FROM AUTHOR]

Accessible summary People with learning difficulties have been involved in research that asked them to tell their stories about how they support (help) each other., There were many times when people had helped each other in lots of different ways., People talked about times when they had listened to each other and helped each other when things were hard. They also spoke about working as a team and helping each other to learn., Supporting each other can make life better for people with learning difficulties and help to break down the barriers., Summary Mutual Support, a model of peer support by and for people with learning difficulties, was constructed through a participatory research process. The research focussed on individual narratives from people with learning difficulties. These narratives were then brought together to form a collective model of support. This paper outlines the detailed research process and positions the collective model of support within the self-advocacy and involvement movements. Direct quotes from people with learning difficulties illustrate the different aspects of the multifaceted model. The positive effects of Mutual Support, which form the basis of the implications for wider policy, theory and practice, are also outlined. These include people being able to participate more fully; ambitions being fulfilled; people who have been mentored becoming mentors themselves; and dignity and respect being reclaimed. The overall argument is that, as an example of empowerment through participation, peer support by and for people with learning difficulties has emancipatory potential. [ABSTRACT FROM AUTHOR]

In the north of England, during the nineteenth and early-twentieth centuries, Whit walks represented a public celebration of religious witness by individual Sunday schools, holding colourful processions through industrial streets. Little academic work has previously been done on this phenomenon, although there is scattered evidence available at the local level. The existence of sets of interviews with elderly people, however, has enabled a systematic analysis of their recollections to be carried out, supported by local newspaper reports over an extended period. This article highlights the changing nature of these religious celebrations, set against the social and cultural background of the period. [ABSTRACT FROM AUTHOR]