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During the 2022 summer, Europe experienced heatwaves with record temperatures, and a study has argued that they caused about 62,000 deaths between 30 May and 4 September. The total number of excess deaths during the same period was about 137,000, indicating that the heatwaves were a substantial contributor. Not ruling out that explanation entirely, this paper argues that it was unlikely a strong cause. First, if the heatwaves were a strong cause of numerous deaths, one would assume that the older and deprived were relatively likely to die. However, during the 2022 summer heatwaves in England, which were claimed to have caused about 2900 deaths, the oldest age cohort did not have a higher excess death rate than the middle age cohort, and the excess death rate actually decreased with deprivation status. Moreover, Iceland had among Europe's highest excess death rates during the summer, which cannot be attributed to heatwaves. During June, July, and August 2022, comparable southern hemisphere countries furthermore had high excess death rates, which cannot be attributed to heatwaves either, as it was during their winter. Also, Europe's excess death rate was higher during the 2022–2023 winter than during the 2022 summer, and intuitively not attributed to heatwaves, but neither to cold weather, as that winter was abnormally mild. Finally, the paper discusses the puzzling issue that about 56% more women than men, relative to the population, presumably died from the heatwaves. [ABSTRACT FROM AUTHOR]

Although the relationship between religion and football has gained considerable interest during the last twenty years, scant attention has been paid to the relationship between pilgrimage and football. This paper seeks to advance the study of this relationship through an exploration of collective memory about football disasters that throws fresh light on central themes within pilgrimage studies—pilgrimage as both a journey to a sacred place and the performance of diverse rituals at such places. The paper explores, in particular, the ways in which three different tragedies involving English football clubs have been commemorated through journeys to and ritual performance at places seen as sacred to those involved in commemoration—football stadiums and urban spaces, and cathedrals and pilgrimage shrines in England, Germany and Italy. Through this analysis, we seek to show how the commemoration of football disaster is linked to pilgrimage as a process where people seek healing and reconciliation through the public performance of rituals that link the local to the global. [ABSTRACT FROM AUTHOR]

This paper reviews the research on successful school principalship carried out in England over the last 20 years. Drawing on evidence synthesized from the International Successful School Principalship Project (ISSPP) and related English school leadership research conducted by ISSPP scholars, this review aims to answer a conceptual research question: How do the principalship's moral purposes and contextual understanding shape the time-sensitive, informed adoption of combinations and accumulations of strategies that lead to sustained school success? This paper identifies five research insights derived from case studies in England and elaborates on the complex, values-led layered web of interactions between the school principal and key stakeholders within and outside the school in the context of frequent social changes and policy interventions in England. Whilst the pace has been greater and more intense than in many other countries, the direction has been, and remains, similar. The body of scholarship here reviewed engages with national policies as filtered and then enacted by successful principals. While 'effective' principals lead to students' success as measured by performance on national tests and examinations, our focus is upon an empirically founded definition of 'successful' school leadership that is located in complexity theory and encompasses the enactment of the core purposes of education that include but go beyond the functional. In doing so, it avoids 'what to do' formulae and the limitations of certain theoretical 'leadership' models, finding that successful school leaders' work embodies a broader humanistic view of student learning and achievement, which implies the preordinance of the personal over the functional. Taken together, these research insights contribute to the ISSPP's continued effort to refine and advance the knowledge base of successful school leadership within and across different countries. [ABSTRACT FROM AUTHOR]

This paper presents the findings of a national survey of over 3400 teachers across all phases of education in England, 10 weeks into school closure. In this paper we report on the teachers' experiences and their testimonies of the effects of the lockdown on their wellbeing as they navigate the situation, trying to cope with teaching and adjusting to the use of new technology to deliver lessons in the confines of their home. We present their voices as they related their experiences and emotions in real time as the event unfolded. Teachers reported an increased workload with a proportionately large amount of time spent on administrative duties and planning, but less on actual teaching. On average, these teachers spent 15 h a week marking during the lockdown. Under half of the respondents said they felt happy and cheerful often, while only 17% said they did not feel this way often. Almost all teachers said they felt that what they were doing was important and worthwhile. The most common emotions expressed by teachers were fear, isolation, neglect, anxiety, and confusion. The inconsistency and lack of clarity of government guidelines added to teachers' anxiety. The negative media portrayal of teachers did not help. The majority of teachers reported little previous experience in online teaching and only a quarter were confident in using edtech to deliver remote teaching. Only a third of teachers said they were adequately supported for online teaching. This has implications for future teacher development and initial teacher training. However, there were equally numerous positive experiences reported by teachers. Active support from parents and consistent school-home communication were seen as important in ensuring students' continued engagement with learning. These lessons are beneficial in supporting the long-term sick and school refusers post-lockdown. [ABSTRACT FROM AUTHOR]

An increasing body of research suggests that bilingualism is possible and perhaps even advantageous for autistic individuals. However, several factors might influence parents' decisions about raising their autistic child bilingually, including national language policies, educational contexts, advice received from key professionals, and the child's individual strengths and needs. Accordingly, there is a clear imperative to understand how the views of different stakeholders converge and diverge when language decisions are made in the context of autism. This paper brings new insights by synthesising the findings of three qualitative studies that used interpretative phenomenological analysis (IPA) to explore the perspectives and experiences of bilingual autistic children (n = 11), parents (n = 16), and educational practitioners (n = 13) of bilingualism in autism in England and Wales. Despite wide variation between and within groups, a striking tension emerged between individuals' beliefs about bilingualism in general, which were positive, and their experiences of bilingualism in autism specifically, which often foregrounded more monolingual approaches. This paper examines this tension, with a particular focus on stakeholders' attitudes towards the feasibility of bilingualism, families' language choices in the context of autism, and how notions of contextual linguistic diversity accentuated differences between England and Wales. We conclude by arguing that greater awareness of both bilingualism and neurodiversity in educational and clinical settings may improve the experiences of bilingual autistic children and, crucially, the language advice families receive. [ABSTRACT FROM AUTHOR]

A growing body of scholarship draws attention to prisons and environmental justice, pointing out the propensity for prisons to be located on contaminated sites and to be in close proximity to polluting industries, as well as for prisons themselves to contribute to local environmental degradation. Prisoners' immobility renders them unable to relocate away from harmful environments, and there are now numerous suggestions that their wellbeing suffers as a result of the poor quality of many local environments. However, since a relationship between environmental quality and prisoner wellbeing is yet to be robustly demonstrated, there is currently no firm evidence base from which to argue for positive change. This paper therefore examines the effect of the environmental quality of the locations of prisons, approximated as the presence of greenspace in the immediate vicinity of prisons, local species biodiversity and local levels of air and noise pollution, on wellbeing outcomes in a set of prisons in England and Wales. It finds that good environmental quality, in the form of high biodiversity and/or low air pollution, enhances the already-recognized positive effects of greenspace on the wellbeing of incarcerated populations. On the basis of these findings, this paper makes evidence-based policy recommendations intended to enhance the wellbeing of incarcerated populations. [ABSTRACT FROM AUTHOR]

In this paper, we draw upon a study exploring how COVID-19 and social isolation impacted young people's (aged 13–18) experiences of online sexual and gendered risks and harms in England during nationwide lockdowns and upon their return to school. We explore the complexities, tensions and ambiguities in youth navigating algorithmised feeds on social media apps such as TikTok and content featuring idealised cis-gendered, heterosexualised feminine and masculine embodiment. Young people repeatedly witness hateful and abusive comments that are algorithmically boosted. We argue that this toxic content normalises online hate in the form of body shaming and sexual shaming, developing the concept of the postdigital to analyse the offline, affective, embodied and material dimensions of online harm, harassment and abuse. We also explore young people's direct experiences of receiving harmful comments, including girls' and gender and sexuality-diverse youth's experiences of body and sexual shaming, as well as boys' experiences of fat shaming; which, in many instances, we argue must be classified as forms of image-based abuse. Using our postdigital lens, we argue that the ways heteronormative, cis-gendered masculine and feminine embodiment are policed online shapes behaviour and norms in young people's everyday lives, including in and around school, and that better understanding and support around these issues is urgently needed. [ABSTRACT FROM AUTHOR]

Background: Collaborative Online International Learning (COIL) involves international online activities that allow the support of transversal competencies in diverse and multicultural environments without moving from home. This paper presents the learning experiences and satisfaction of undergraduate nursing students at the University of Girona (Spain) from a COIL activity involving clinical simulation in collaboration with the University of Coventry (United Kingdom). Methods: Qualitative study of content analysis. Twelve students from each of the two universities participated in the data collection process using reflective diaries. Results: The data analysis highlighted five topics related to the COIL activity involving clinical simulation: (a) initial attitudes towards the COIL activity; (b) main learning through the COIL activity; (c) positive aspects of the COIL activity; (d) weaknesses of the COIL activity and proposals for improvement; and (e) overall evaluation of the COIL activity. Conclusions: The main learning outcomes referred to by students were the relationships between transversal competencies and the skills for life, language skills, cultural skills, and more specific skills related to clinical standards. The students were most satisfied with the teaching activities and specified positive aspects and weaknesses that will add value to future versions of the activities. [ABSTRACT FROM AUTHOR]

Telerehabilitation (TR) shows promise as a method of remote service delivery, yet there is little guidance to inform implementation in the context of the National Health Service (NHS) in England. This paper presents the protocol for a realist synthesis study aiming to investigate how TR can be implemented to support the provision of high-quality, equitable community-based stroke rehabilitation, and under what conditions. Using a realist approach, we will synthesise information from (1) an evidence review, (2) qualitative interviews with clinicians (n ≤ 30), and patient–family carer dyads (n ≤ 60) from three purposively selected community stroke rehabilitation services in England. Working groups including rehabilitation professionals, service-users and policy-makers will co-develop actionable recommendations. Insights from the review and the interviews will be synthesised to test and refine programme theories that explain how TR works and for whom in clinical practice, and draw key messages for service implementation. This protocol highlights the need to improve our understanding of TR implementation in the context of multidisciplinary, community-based stroke service provision. We suggest the use of a realist methodology and co-production to inform evidence-based recommendations that consider the needs and priorities of clinicians and people affected by stroke. [ABSTRACT FROM AUTHOR]

Coronavirus disease-19 (COVID-19) has disproportionately affected certain demographics in England, exacerbating existing health disparities. Effective therapeutics are a critical line of defence against COVID-19, particularly for patients at elevated risk for severe disease. Surveillance systems were established to monitor the usage of COVID-19 therapeutics in hospital and community settings and to inform stewardship. Three antiviral therapies—nirmatrelvir plus ritonavir (Paxlovid®), remdesivir (Veklury®), and molnupiravir (Lagevrio®)—and two neutralising monoclonal antibody therapies (nMAbs)—sotrovimab (Xevudy®) and casirivimab with imdevimab (Ronapreve®)—were in use in England between July 2020 and April 2023. This paper aims to illuminate trends in the utilisation of COVID-19 therapeutics treatment in both hospital and community settings, stratified by the Index of Multiple Deprivation (IMD) in England. Chapter 3 of the English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) Report 2022 to 2023 also discusses the epidemiological surveillance of these five directly acting antiviral COVID-19 therapeutics' use in England between 2022 and 2023. [ABSTRACT FROM AUTHOR]

Wolf Rock Lighthouse is a Victorian era masonry structure located in an extreme environment facing the fiercest Atlantic storms off the southwest coast of England whose dynamic behaviour has been studied since 2016. Initially, a modal test was used to determine modal parameters; then, in 2017, a monitoring system was installed that has operated intermittently providing response data for a number of characteristic loading events. These events have included wave loads due to storms, a small UK earthquake, helicopters landing on the helideck, and the grounding of a ship on the reef. This is believed to be the most extensive experimental campaign on any structure of this type. This paper briefly describes a unique project involving the characterisation and measurement of dynamic behaviour due to different forms of dynamic loading. [ABSTRACT FROM AUTHOR]

Estimating loss reserves is a crucial activity for non-life insurance companies. It involves adjusting the expected evolution of claims over different periods of active policies and their fluctuations. The chain-ladder (CL) technique is recognized as one of the most effective methods for calculating claim reserves in this context. It has become a benchmark within the insurance sector for predicting loss reserves and has been adapted to estimate variability margins. This variability has been addressed through both stochastic and possibilistic analyses. This study adopts the latter approach, proposing the use of the CL framework combined with intuitionistic fuzzy numbers (IFNs). While modeling with fuzzy numbers (FNs) introduces only epistemic uncertainty, employing IFNs allows for the representation of bipolar data regarding the feasible and infeasible values of loss reserves. In short, this paper presents an extension of the chain-ladder technique that estimates the parameters governing claim development through intuitionistic fuzzy regression, such as symmetric triangular IFNs. Additionally, it compares the results obtained with this method with those derived from the stochastic chain ladder by England and Verrall. [ABSTRACT FROM AUTHOR]

Globally, due to climate change and increased rates of coastal erosion, along with the need to protect sensitive habitats, there is an increasing requirement for a sustainable approach which considers both the effect of the marine environment on critical infrastructure and the impact of that infrastructure on the local environment. This paper presents a methodology for assessing the impact of a marine structure on longshore dynamics and shoreline evolution by using an external coupling of the phase-resolving ARTEMIS wave model and the shoreline evolution model, UNIBEST. The methodology can be applied at any coastal location, but for this study, it was applied to Sizewell Bay on the east coast of England to assess the impact of a shore-normal jetty on a gently curving stretch of shoreline with relatively complex offshore geomorphology. Results from simulating 22 years of shoreline evolution have shown that, at the jetty location, the shoreline at Sizewell will migrate seaward up to 45 m compared with the no-jetty case. Immediately south of the jetty, the shoreline was predicted to retreat landward by about 15 m. This behaviour is similar to observed changes at other locations, and the predicted longshore transport rates are in agreement with findings from previous studies, validating the methodology. [ABSTRACT FROM AUTHOR]

Rising demands and competition for water resources within all sectors are placing increasing pressure on the environment. Almost all direct abstractions in England require a licence (permit) from the regulatory authority, the Environment Agency. Assessing and setting 'reasonable' peak quantities of water that can be legally abstracted in an environmentally sustainable manner is central to the whole licence determination process. To protect environmental flows and other abstractors within each catchment, the regulatory authority needs to be able to set sensible limits in the licence conditions, including total seasonal volumes and peak rates of water use, particularly for abstractions from hydrologically sensitive surface water sources. This paper describes the development of a methodology to assess the 'reasonable' peak rates of water use for agricultural irrigation in support of catchment water resources management and planning. A daily time step water balance model was used to simulate peak monthly and daily water requirements for irrigation using long-term historical weather records for agroclimatically contrasting sites. The model-simulated outputs were then compared against observed data from selected case study farms, and against data reported in a national water abstraction database. Guidelines were then developed for setting peak monthly, daily, hourly, and absolute abstraction rates for irrigation, taking into account the environmental sensitivity of different types of water source. The application of the procedure and its relevance in other countries where catchment water resources are under intense pressure from agriculture are described. [ABSTRACT FROM AUTHOR]

Background: Equitable access to healthcare is a priority of many healthcare systems, aiming to ensure access is driven by need and not minority groups such as those defined by sexual orientation. However, there are healthcare areas where inequity in access across sexual orientation groups is found that are not justified based on need. Mandated LGBTQ+-specific training of the healthcare workforce may help address some barriers of access for these groups. The study aims to understand the potential economic implications for mandated LGBTQ+-specific healthcare training on the healthcare system in England, UK to inform commissioning of training provision. Methods: Cervical cancer screening was used as an exemplar case where there appears to be inequity in access for different sexual orientation groups. A decision model was developed and analysed that considered the impacts of greater uptake of screening for lesbian and bisexual women due to LGBTQ+ training. Costs took the perspective of the healthcare system and outcomes modelled were cancer cases averted in a timeframe of 5 years. Results: Based on cervical cancer screening alone, where training costs are fully attributed to this service, training would likely result in fewer cancer cases detected in the lesbian and bisexual populations, though this comes at a modest increase in healthcare sector costs, with this increase largely reflecting a greater volume of screens. Training costs do not appear to be a major component of the cost implications. Conclusions: In resource-constrained systems with increasing pressures for efficiency savings, the opportunity cost of delivering training is a realistic component of the commissioning decision. The findings in this paper provide a signal that mandated LGBTQ+ training in healthcare could lead to potentially greater outcomes and in breaking down barriers of access and could also enable the healthcare system to provide more equitable access to healthcare. [ABSTRACT FROM AUTHOR]

The rising prevalence of paediatric type 2 diabetes (T2D) is concerning, particularly with limited medical intervention despite evidence of accelerated disease progression. This study of a Barts Health NHS Trust cohort from 2008 to 2022 aims to elucidate the incidence, clinical outcomes, and complications associated with paediatric T2D. A retrospective analysis utilising electronic and paper records identified 40 patients with T2D. The incidence doubled from 2.6/year in 2008–2013 to 5.4/year in 2014–2018. Sixty-eight percent exhibited co-morbidities, notably learning disabilities. At diagnosis, the mean BMI was 32.4 ± 6.71 kg/m2, with no gender-based disparity and no significant change over a two-year follow-up. The initial HbA1c was 75.2 ± 21.0 mmol/mol, decreasing to 55.0 ± 17.4 mmol/mol after three months (p = 0.001) and then rising to 63.0 ± 25.5 mmol/mol at one year (p = 0.07). While 22/37 patients achieved HbA1c < 48 mmol/mol, only 9 maintained this for a year. Several metabolic and cardiovascular complications were observed at diagnosis and follow-up, with no significant change in frequency. In 2022, 15 patients transitioned to adult services. HbA1c at transition was 74.7 ± 27.6 mmol/mol, showing no change one year post-transition (71.9 ± 26.9 mmol/mol, p = 0.34). This study highlights substantial therapeutic failure, with current management falling short in achieving a sustained reduction in BMI or HbA1c. Novel treatment approaches are needed to improve clinical outcomes and address the high burden of co-morbidities and complications. [ABSTRACT FROM AUTHOR]

Introduction: The broader determinants of health including a wide range of community assets are extremely important in relation to public health outcomes. Multiple health conditions, multimorbidity, is a growing problem in many populations worldwide. Methods: This paper quantified the effect of community assets on major health conditions for the population of England over six years, at a fine spatial scale using a data analytic approach. Community assets, which included indices of the health system, green space, pollution, poverty, urban environment, safety, and sport and leisure facilities, were quantified in relation to major health conditions. The health conditions examined included high blood pressure, obesity, dementia, diabetes, mental health, cardiovascular conditions, musculoskeletal conditions, respiratory conditions, kidney and liver disease, and cancer. Cluster analysis and dendrograms were calculated for the community assets and major health conditions. For each health condition, a statistical model with all community assets was fitted, and model selection was performed. The number of significant community assets for each health condition was recorded. The unique variance, explained by each significant community asset per health condition, was quantified using hierarchical variance partitioning within an analysis of variance model. Results: The resulting data indicate major health conditions are often clustered, as are community assets. The results suggest that diversity and richness of community assets are key to major health condition outcomes. Primary care service waiting times and distance to public parks were significant predictors of all health conditions examined. Primary care waiting times explained the vast majority of the variances across health conditions, with the exception of obesity, which was better explained by absolute poverty. Conclusions: The implications of the combined findings of the health condition clusters and explanatory power of community assets are discussed. The vast majority of determinants of health could be accounted for by healthcare system performance and distance to public green space, with important covariate socioeconomic factors. Emphases on community approaches, significant relationships, and asset strengths and deficits are needed alongside targeted interventions. Whilst the performance of the public health system remains of key importance, community assets and local infrastructure remain paramount to the broader determinants of health. [ABSTRACT FROM AUTHOR]

Simple Summary: The platelet count is an established marker of cancer. In healthy populations, platelet count varies by age and sex; despite that variation, a single reference range is used. This study aimed to identify age- and sex-specific upper thresholds for platelet count at which cancer should be considered in primary care, using audits of primary care-based clinical data in England, Canada, and Australia. Across all three cohorts, there was a clear upwards trend in cancer incidence with increasing platelet count for both sexes and at all age groups. The appropriate threshold will vary by country and will depend on local healthcare needs and priorities. As colorectal and lung cancers predominate, initial investigation may target these sites. Further investigation, depending on the patient's symptoms, could be CT imaging, endoscopy, or CA125. The platelet count, a component of the full blood count, has been identified as a useful diagnostic marker for cancer in primary care. The reference range for the platelet count is 150 to 400 or 450 × 109/L; this range does not account for natural variation in platelet count by age and sex. This study used three primary care cohorts from England, Canada, and Australia. Patients aged 40 years and over with a full blood count were included and stratified by age (in 10-year bands), sex, (male/female), and platelet count group. Cancer incidence within one year of the test date was estimated from linked registry data. In all three countries, there was a clear upwards trend in cancer incidence with increasing platelet count for both sexes and at all age groups. Lung and colorectal were the most common sites. These results have important implications for the international application of this work; analysis of local health datasets will be crucial to determining appropriate thresholds. Appropriate upper thresholds will depend on local populations, healthcare needs, and priorities. Further research is needed to assess the likely impact of new recommendations on the healthcare system, on cancer outcomes, and patient benefit. [ABSTRACT FROM AUTHOR]

The aim of this study was to comparatively investigate education, job, and professional development satisfaction among intensive care unit nurses in Poland and England. A total of 258 ICU nurses from both countries were interviewed (72 Polish nurses working in Poland and 186 of various national backgrounds in England, including 50 of Polish origin). We used an 11-item structured survey followed by an open-ended qualitative interview retrospectively coded for statistical analysis. Regardless of national origin, nurses in England report significantly higher education satisfaction, attributed to better theoretical knowledge gain but not to other dimensions (such as practical knowledge or personal satisfaction). They also express greater satisfaction with job conditions regarding professional development, a state-of-the-art work environment, teamwork, and finance. The UK system is also considered significantly superior in promotion opportunities and participation in post-graduation training. In conclusion, systemic factors play a crucial role in career satisfaction and advancement in nursing, with the British band system having a clear advantage over the Polish one. [ABSTRACT FROM AUTHOR]

Here, we investigate whether England's 152 local flood risk management strategies (LFRMSs) satisfy minimal legislative criteria and address the growing surface water flood (SWF) risk caused by climate change. A systematic audit was used to assess the alignment of the LFRMSs with national climate change legislation and other relevant national strategies. An objective method to identify inclusion of a range of factors that good strategies should include was applied. LFRMSs are mostly meeting their minimum statutory requirements. However, there is a widespread issue across most LFRMSs regarding inadequate consideration of increasing SWF risk from climate changes, which highlights the need for enhanced LFRMSs by improved planning and climate change adaptation plans. There is some evidence of good practice within the LFRMS portfolio, which is discussed in the context of the ongoing LFRMS update process. Beyond England, there are implications for developing FRM processes at a local level that can be objectively assessed against national requirements. Communities in England face inadequately managed SWF risk in the future because of the range in plan quality across the LFRMSs. This research contributes to the ongoing examination of the full suite of 152 LFRMSs and, therefore, builds towards a complete assessment of the SWF management approach in England. This will help inform local climate change adaptation strategies that cater to the escalating threat of SWF due to climate change. [ABSTRACT FROM AUTHOR]

Simple Summary: Anal cancer incidence is rising, especially in women. This is an issue because anal cancer has a precancerous stage, which can be identified and treated before it progresses to cancer. Nevertheless, not all women would benefit from anal cancer screening and precancer detection. Given that women with other anogenital cancers are likely to share similar risk factor profiles, this study aims to explore the incidence trends of all anogenital cancers in women in England between 2014 and 2020, as well as the role of important factors such as age, deprivation and ethnicity in these incidences. The findings from this study will highlight the populations at highest risk of these cancers and will aid the implementation of an anogenital cancer prevention strategy. The incidences of anogenital HPV-related cancers in women are on the rise; this is especially true for anal cancer. Medical societies are now beginning to recommend anal cancer screening in certain high-risk populations, including high-risk women with a history of genital dysplasia. The aim of this study is to investigate national anogenital HPV cancer trends as well as the role of demographics, deprivation, and ethnicity on anogenital cancer incidence in England, in an attempt to better understand this cohort of women which is increasingly affected by anogenital HPV-related disease. Demographic data from the Clinical Outcomes and Services Dataset (COSD) were extracted for all patients diagnosed with anal, cervical, vulval and vaginal cancer in England between 2014 and 2020. Outcomes included age, ethnicity, deprivation status and staging. An age over 55 years, non-white ethnicity and high deprivation are significant risk factors for late cancer staging, as per logistic regression. In 2019, the incidences of anal and vulval cancer in white women aged 55–74 years surpassed that of cervical cancer. More needs to be done to educate women on HPV-related disease and their lifetime risk of these conditions. [ABSTRACT FROM AUTHOR]

Background: Diabetic foot osteomyelitis (DFO) is a major complication and can lead to significant morbidity and mortality. Systemic antibiotic therapy is often initiated first line to achieve quiescence of infection. To perform a multi-centre case review of systemic antibiotic intervention to treat adults with DFO in England and Wales and compare with national guidelines 'Diabetic foot problems: prevention and management'. Methods: Eight centres from England and Wales retrospectively collated data from a minimum of five adults (aged ≥ 18 years) from electronic case records. All patients were treated with systemic antibiotics following a new diagnosis of DFO (1 June 2021–31 December 2021). Results: 40 patients (35 males and 5 females) were included; the mean age was 62.3 years (standard deviation (SD) 13.0). Patients commenced systemic oral 14 (35%) or intravenous 26 (65%) antibiotic therapy following a new diagnosis of DFO. Twenty-seven (67.5%) patients were medically or surgically managed in the 12-week period with clinical quiescence of infection. Twenty-one patients (52.5%) had no recurrence of DFO infection within 12 weeks; seventeen (42.5%) of these patients had clinical quiescence of infection with systemic antibiotics alone without surgical intervention and nine (22.5%) of these cases had no recurrence of DFO. There were no cases of major amputation or death. All centres showed significant in-centre variability in systemic antibiotic management; variability was reported in the clinical and quantity indicators specifically to antibiotic selection, single versus dual therapy, mode of delivery and duration of treatment. Conclusions: This case review identifies there is existing variation when treating adults with systemic antibiotics for DFO. Further national guidance is required to standardise service delivery and care to improve patient outcomes. [ABSTRACT FROM AUTHOR]

We developed and trained a prototype AI-based object-recognition app, blockplay.ai, to recognise Cuisenaire rods placed on a tabletop, and speak the rods' lengths. We challenged 6-year-olds in a primary school in England to play a 'game': can you make the app say the two times table? Drawing methodologically on theories of embodiment, we analyse two videoclips, each of a child interacting with rods, the app and the task set by the researchers, as a dynamic, complex child-rods-app-task body-artefact system. Theoretically we draw on Davydovian concepts of learning as a concrete-to-abstract-to-new-concrete cycle, using abstract artefacts such as mathematical language to coordinate new perceptually-guided actions on concrete objects. In one videoclip the child's pattern of actions are consistent with a change, within a few minutes, from perceiving and acting on rods as counters, to perceiving and acting on rods as lengths; in the other videoclip, this does not happen. We analyse the changes in patterns of interactions as shifts to new stable attractors in a dynamic child-rods-app-task body-artefact system, driven by tensions generated by unexpected concrete-to-abstract relationships. We end by looking forward to the range of possible uses of object-recognition technology in the learning of mathematics, for example, provoking algebraic awareness. [ABSTRACT FROM AUTHOR]

Recent scholarship has highlighted the heterogeneity of second-generation Irish identities in Great Britain, yet the varieties of self-identification espoused by the English-raised children of Northern Irish parents remain almost wholly unexplored. This article redresses this neglect by examining the relationship between parentally transmitted memories of the Northern Ireland Troubles (c.1969–1998) and the forms of identity and self-understanding that such children develop during their lives in England. Drawing on original oral history testimony and using the concepts of narrative inheritance and postmemory as interpretive tools, it demonstrates the complex correlation that exists between parents' diverse approaches to memory-sharing and their children's negotiation of inherited conflict memory as they position themselves discursively within contemporary English society. Based on a close reading of five oral history interviews, the analysis reveals a spectrum of creative postmemory practices and identity enactments, whereby narrators agentively define themselves in relation to the meanings they attribute to inherited memories, or the dearth thereof, as they navigate their tangled transnational affinities and allegiances. The article also explores how these practices and enactments are subtly responsive to narrators' changing relationships to their narrative inheritances as their experience and awareness of their own and their parents' lives deepen over the life course. [ABSTRACT FROM AUTHOR]

How have funding, art education, and politics affected the development of performance and interdisciplinary art? In England in particular, performance as an experimental and radical art practice developed largely from underground activities, political action and a range of art forms. Funding bodies, colleges and art institutions eventually accommodated, albeit to a limited extent, this activity. As financial circumstances were sometimes difficult, artists often provided their own support structures and organisations. Some of these became established as they became successful. Performance art split from the theatrical and became defined as live art. In more recent times, conditions shifted again, and critical, experimental, or avant-garde theatre, film, music, etc., found refuge within contemporary art. Performance however, became increasingly confined and restricted by: the regulatory and academic requirements within universities; the need for evidence for some form of public or social purpose by funding bodies; and the increasingly hostile social and political circumstances. This research draws partly from personal experience and reflects on cultural conditions since the 1970s. [ABSTRACT FROM AUTHOR]

Coastal sediment grain size is an important factor in determining coastal morphodynamics. In this study, we explore a novel approach for retrieving the median sediment grain size (D50) of gravel-dominated beaches using Synthetic Aperture Radar (SAR) spaceborne imagery. We assessed this by using thirty-six Sentinel-1 (C-band SAR) satellite images acquired in May and June 2022 and 2023, and three NovaSAR (S-band SAR) satellite images acquired in May and June 2022, for three different training sites and one test site across England (the UK). The results from the Sentinel-1 C-band data show strong positive correlations (R2 ≥ 0.75 ) between the D50 and the backscatter coefficients for 15/18 of the resultant models. The models were subsequently used to derive predictions of D50 for the test site, with the models which exhibited the strongest correlations resulting in Mean Absolute Errors (MAEs) in the range 2.26–5.47 mm. No correlation (R2 = 0.04) was found between the backscatter coefficients from the S-band NovaSAR data and D50. These results highlight the potential to derive near-real time estimates of coastal sediment grain size for gravel beaches to better inform coastal erosion and monitoring programs. [ABSTRACT FROM AUTHOR]

Recent quantitative research on bilingual education suggests beneficial academic outcomes for pupils regardless of socio-economic status (SES). Bilingual education in England, a relatively novel phenomenon, may be better understood from teachers' perspectives; however, there is a paucity of qualitative research in this area. To fill the gap, the present study explores the unique perspective of a sample of bilingual schoolteachers regarding the children who attend bilingual schools and the effects of bilingual education on children's academic and non-academic development. Semi-structured interviews were conducted with six bilingual schoolteachers, and thematic analysis was adopted to interpret their experiences in greater depth. A thematic analysis revealed four superordinate themes: Academic and Socio-Cultural Effects, Privilege in Bilingual Education, Bilingual Education Takes Time, and Special Educational Needs. These results highlight academic, socio-cultural, and linguistic benefits with important implications for promoting equity in bilingual education. Further research should focus on schools with a higher proportion of students from lower socio-economic status backgrounds. [ABSTRACT FROM AUTHOR]

The introduction of 'special measures' within England and Wales (i.e., provisions for vulnerable and intimidated witnesses at court) marked a significant change in legal tradition and trial procedures such that victim and witness care was repositioned as a primary concern alongside the longstanding rights afforded to defendants. As public perceptions towards the legitimacy of criminal justice procedure remain a key concern among legal scholars and social scientists, this study aimed to examine individual differences in attitudes held towards the rights afforded to complainants and defendants within English courts. Adopting a cross-sectional study design, 114 UK adults were recruited to take part in an online survey. Questions centered around the importance of providing adequate witness care whilst protecting defendants' rights to a fair trial. A new measurement tool was developed to allow these attitudes to be systematically assessed and understood, termed the Attitudes Towards Vulnerable Victims Scale (ATVVS). Results indicate that respondent age, gender, level of education, and belief in a just world are important determinants of public support for the use of special measures at trial as well as perceptions towards complainant and defendants' rights. Taken together, findings indicate that misconceptions about vulnerable victims appear to underlie a lack of support for the use of special measures. [ABSTRACT FROM AUTHOR]

Distributed leadership has been shown to improve teacher job satisfaction and reduce teacher job stress. However, few studies have thoroughly explored the indirect effects of distributed leadership on increasing the teachers' burden in school administration and management, thereby increasing work stress, and decreasing job satisfaction. Data from the Teaching and Learning International Survey were analyzed to investigate the relationships among distributed school leadership, teachers' job stress, and job satisfaction. A total of 3976 teachers from 198 junior high schools in Shanghai, 2560 teachers from 166 junior high schools in the United States, 2376 teachers from 157 junior high schools in England, and 3573 teachers from 238 junior high schools in Australia were selected and examined using structural equation modeling. The results revealed that distributed school leadership directly predicted teachers' job satisfaction; teachers' job stress had an independent mediating effect on distributed leadership and teachers' job satisfaction, whereas teachers' time spent participating in school leadership had no mediating effect. We discuss the benefits of distributed school leadership on teachers' job satisfaction and the possible mechanisms for promoting it in practice. [ABSTRACT FROM AUTHOR]

The current study investigates public intentions to use an innovative, off-grid renewably powered EV charging technology called FEVER (Future Electric Vehicle Energy networks supporting Renewables). We report the findings of a questionnaire-based survey (QBS) conducted at a zoo in the south of England, exploring the prospect of demonstrating FEVER. The QBS was designed around a context-specific technology acceptance model (TAM) and administered both face-to-face (n = 63) and online (n = 158) from April to May 2023. The results indicate that most participants were willing to pay to use FEVER, particularly where revenue would benefit the zoo. The participants agreed they intended to use the chargers, and that they would be useful and easy to use. The participants agreed that there would be normative pressure to use the chargers, but that their use would be enjoyable. Of greatest concern was that the chargers would be blocked by others. The participants were ambivalent about concerns over charging duration and charge sufficiency. Structural equation modelling confirmed that the context-specific TAM explained 58% of people's use intentions. The core relationships of the TAM were confirmed, with 'perceived usefulness' additionally predicted by subjective norms and 'perceived ease of use' additionally predicted by anticipated enjoyment. Of the other variables, only concern that the chargers would be blocked was retained as a marginal predictor of 'perceived ease of use'. The implications of these findings for the co-design and demonstration of FEVER are discussed. [ABSTRACT FROM AUTHOR]

In the past two decades, students have been more willing to disclose their disability status when entering higher education (HE) in the United Kingdom (UK). Concurrently, higher education institutions (HEIs) have adopted disability policies and service teams for enhancing equality, diversity, and inclusion in the UK. The purpose of this integrative review is to understand the basis of these trends. The article suggests that there have been three major key paradigm shifts that underpin this cultural change. (1) There was a paradigm shift in terms of changing the dominant models for conceptualising disability from a medical model of disability to a social model of disability and to an affirmative model of disability, together with a debate and policy development demonstrating a concern for greater social inclusion and exclusion; (2) with a massive increase in students entering HE and the rising importance of league tables and ranking systems, universities experienced a paradigm shift from teacher-centred learning (TCL) to inclusive student-centred learning and teaching (SCLT); and (3) the increase in autism disclosure in HE signifies a shift in a conceptualisation of autism from a disorder to a disability and an example of neurodiversity. [ABSTRACT FROM AUTHOR]

Sweet chestnut, an Asiatic tree introduced in many parts of Europe including the United Kingdom, is planted for nut production, timber, and amenity. Its major threat is the disease called blight, caused by the fungus Cryphonectria parasitica, which infects through wounds by airborne spores. Field trapping using sticky rods rotating traps was performed in an infected area in Devon (between May 2021 and April 2023). An improved dual hydrolysis Taqman probes real-time PCR was used. The number of spores was calculated by comparing the cycle threshold to the Ct of standards with known amounts of conidia or known target fragment copies cloned into a plasmid. Weekly spore counts were in the range of around 60 to approximately 8.5 × 103, with fluctuations of peaks (mainly in late summer–autumn 2021) and troughs. The effects of weather parameters were modelled, finding correlations between spore numbers and temperature, humidity, dewpoint, rainfall, wind speed, and wind duration. Additionally, an insect trapping was performed to confirm the presence/absence and quantity of C. parasitica conidia potentially phoretic on some insects by using the same molecular approach. None of the ten collected insect species harboured spores of this fungus. [ABSTRACT FROM AUTHOR]

Adults accessing community mental health services are required to have a care plan, developed in collaboration with the person accessing the service. The variation in care plan templates in use in England and Wales, and their impact on care planning, is unknown. This study evaluates the community mental health care plan templates in use across England and Wales. Data were obtained from a Freedom of Information request to 50 NHS Mental Health Trusts. An evaluation tool was designed and used to extract data. Data were rated red, amber, or green against clinical and design standards. Forty-seven care plan templates were obtained. The clinical aspect of the care plan template had 60% adherence to the national standards, and the design aspects had 87% adherence. A 'high/low' typology is proposed against the design/clinical standards. The study identifies priority areas for improvement in the care plan templates as space to record the actions that service users and carers will take to contribute to their care plan, space to record the name and contact details for their care coordinator or lead professional, plus others involved in the person's care. This study was not registered. [ABSTRACT FROM AUTHOR]

Freshwater mussel populations are in sharp decline and are considered to be one of the most imperilled groups globally. Consequently, the number of captive breeding programmes has increased rapidly in recent years, coupled with subsequent reintroductions/population reinforcements to reverse these declines. The outcomes of mussel conservation translocations are seldom reported in the primary literature, hindering opportunities for learning and for population recovery at pace. Here, we describe the methods employed to carry out a successful conservation translocation of the freshwater pearl mussel (Margaritifera margaritifera) in a declining population in northwest England. Following a small-scale pilot release in 2017, four release sites were identified for a population reinforcement of over 1300 tagged mussels in 2021. Monitoring during 2022 showed high levels of retention of juveniles at three out of the four release sites, despite the occurrence of a significant flood event during October 2021. Subsequent releases of 1100 juveniles were carried out across the three successful sites in 2023. Ongoing and regular monitoring is essential in order to provide data on the longer-term fate of propagated juveniles in the wild. This will allow for adaptive management of release activities in this river. These data will be useful to design conservation translocation strategies for other imperilled pearl mussel populations in the UK and throughout Europe. [ABSTRACT FROM AUTHOR]

Rurality is rarely integrated into analyses of educational inequalities and this article presents an alternative perspective on rural–urban attainment and highlights the impact of rurality on educational outcomes. The traditional narrative of urban–rural educational disadvantage is that urban pupils do less well in the English exam system. Decontextualised data across different English exam performance measures demonstrate how rural pupils outperform their urban counterparts. Socioeconomic disadvantage (SED) has the most significant impact on attainment and this analysis explores the rural–urban attainment gap through this SED lens. An analysis of the Department for Education (DfE) data explores possible factors that might explain the emerging rural educational gap and presents an argument that rurality is another limiting factor that intersects with SED. This article demonstrates how rural underachievement in England has been hidden by the relative sizes and SED distribution of rural and urban populations. [ABSTRACT FROM AUTHOR]

Research has demonstrated positive relationships between fundamental movement skills (FMS) and mathematics achievement in children, and this relationship may be mediated by spatial ability. Engaging in physical activity (PA) may also have positive outcomes on mathematics achievement; however, no study has investigated this network of relationships together. This study aimed to examine the relationship between PA and mathematics achievement, and the mediating effects of FMS and spatial abilities, in primary school children. Using a cross-sectional design, data were collected from 182 children (aged 7 to 8 years old) across four schools in England. Objective moderate-to-vigorous PA (MVPA) levels and subjective parental reports of their children's PA participation were collected. Children's FMS were assessed, along with their performance on four spatial ability tasks and a mathematics test. Mediation analyses revealed no significant mediation effects of FMS and spatial abilities on the positive significant relationship between MVPA and mathematics achievement; however, spatial ability partially mediated the relationship between FMS and mathematics achievement. These results suggest that FMS and spatial ability may not be related to MVPA in this network of relationships, but children with more mature FMS perform better in mathematics due to them performing better on specific spatial ability tasks. [ABSTRACT FROM AUTHOR]

A monthly composite rainfall record for the period 1786–present representative of Manchester, northwest England is presented. The 235-year record ranks as the second-longest instrumental rainfall record available for northern England, and the fifth-longest for the UK, and contributes to a growing network of long homogenous rainfall series. A composite record is constructed, extended, and homogenised, and the record is analysed in terms of annual and seasonal variability, with a focus on extreme wet/dry events. Three primary meteorological stations in Manchester, located within 2 km of one another, form the basis of the reconstruction, with other records identified for infilling and extension based on their longevity, continuity, and proximity to the primary stations. A linear regression analysis is applied to produce a continuous record, and adjustment factors are applied to ensure homogeneity. Record homogeneity is assessed via cross-comparison with long-term records from the region (Carlisle, Chatsworth House and HadNWEP), and the methods are applied to assess relative homogeneity include the double-mass curve and Standard Normal Homogeneity tests. The Manchester record is deemed to be homogenous overall but includes two periods of increased uncertainty: 1786–1819, comprising the earliest observations and greatest number of different stations, and 1883–1911, which encompasses multi-year and multi-decadal drought events of (1883–1885 and 1890–1910) as identified by other long-term meteorological studies. The analysis of the entire record reflects long-term rainfall variability with an increasing, although not significant, trend in annual rainfall observed. Seasonally, a significant increase in winter rainfall is exhibited, in keeping with patterns observed in other regional studies. Seasonal rainfall totals are found to be highly variable at the decadal timescale. Several well-documented extreme wet (e.g., autumn 2000) and dry (e.g., summer 1976) seasons are identified, including historic events (e.g., the floods of summer 1872 and drought of summer 1887) from the less-well documented eighteenth and nineteenth centuries. [ABSTRACT FROM AUTHOR]

(1) Background: This study examines the effects of a 6-week swimming intervention on motor competence in children. (2) Methods: A total of 107 children (n = 52 boys, n = 55 girls) aged 7.8 ± 0.63 years that were recruited from five primary schools in central England participated in this study, undertaking either an aquatic intervention once a week for six weeks or acting as a control group completing their usual physical education program. Participants underwent pre- and post-assessments of general motor competence using the Test of Gross Motor Development, Third Edition (TGMD-3) (a process measure) and a composite of 10 m running sprint time and standing long jump distance (product measures). Aquatic motor competence was assessed via the Aquatic Movement Protocol (AMP). Fear of drowning and swimming opportunities were also assessed by implementing a questionnaire. (3) Results: Following a mixed-model ANOVA, an overall main effect was found from pre (40.05 ± 13.6) to post (48.3 ± 18.6) for TGMD-3 scores (p < 0.05) and pre (38.7 ± 31.7) to post (50.6 ± 36.8) for AMP scores (p = 0.001). A negative significant relationship was found between AMP scores with both fear of water (p = 0.01) and fear of drowning (p < 0.05). A positive significant relationship was found between swimming opportunities and AMP score (p = 0.001). (4) Conclusions: The aquatic-based intervention improves not only aquatic motor competence but also transfers improvements in dryland movement competencies. Future research should look to implement control groupings which do not participate in swimming to further investigate the difference between swimmers and non-swimmers; however, due to swimming being a part of the national curriculum in England, this may not be feasible. [ABSTRACT FROM AUTHOR]

Previous research highlighted that a fundamental rethink of the measurement of domestic abuse was needed in the Crime Survey for England and Wales (CSEW). The research reported here aimed to develop and test new questions on domestic abuse for the CSEW to improve the headline prevalence measure, including frequency of abuse, to develop a way of measuring controlling or coercive behavior within the overall prevalence measure, and to develop a measure of the impact of abuse. The research included focus groups and interviews with victims (n = 27) to assess a set of draft questions and cognitive testing of revised questions with victims and the general public (n = 42). A final set of 24 questions was developed for use with victims of both intimate partner and family abuse, with an additional question for family abuse. The new questions were found to echo victim experiences and were deemed acceptable and reliable measures by victims and the general public for domestic abuse, including controlling and/or coercive behavior and impact. An analytical approach was recommended to improve the headline prevalence measure of domestic abuse by establishing 'high' and 'low' abuse profiles using measures of both behavior and impact. [ABSTRACT FROM AUTHOR]

(1) Background: Pre-pandemic, child and adolescent mental health service (CAMHS) referrals were paper based in Liverpool and Sefton (England, United Kingdom), causing delays in waiting times. The "CYP as One" online mental health referral platform was co-created to overcome these challenges. (2) Methods: This study aims to improve "CYP as One" accessibility and usability and, subsequently, support CAMHS to improve waiting times. The current study utilised the Living Lab approach. We conducted content analysis on completed online referrals extracted from the "CYP as One" platform. These findings were supplemented by seven online focus groups, with 16-19-year-old young people, parents of children under 16, and health service providers. Thematic analysis was conducted on all data. (3) Results: The thematic analysis returned seven themes, namely (i) "CYP as One" vs. Traditional Referrals, (ii) Gender and Language Dynamics, (iii) Digital Empathy in Action, (iv) the Influence of the Provider Perspective, (v) Age and Social Sensitivity, (vi) Enhancing Access to Information, and (vii) Boosting Admin and Clinical Efficiency. (4) Conclusions: Digital content that seeks to replace in-person referrals can provide adequate support to children and young people who have faced difficulties accessing mental health services.