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Background/aims: The value of using qualitative methods within clinical trials is widely recognised. How qualitative research is integrated within trials units to achieve this is less clear. This paper describes the process through which qualitative research has been integrated within Cardiff University's Centre for Trials Research (CTR) in Wales, UK. We highlight facilitators of, and challenges to, integration. Methods: We held group discussions on the work of the Qualitative Research Group (QRG) within CTR. The content of these discussions, materials for a presentation in CTR, and documents relating to the development of the QRG were interpreted at a workshop attended by group members. Normalisation Process Theory (NPT) was used to structure analysis. A writing group prepared a document for input from members of CTR, forming the basis of this paper. Results: Actions to integrate qualitative research comprised: its inclusion in Centre strategies; formation of a QRG with dedicated funding/roles; embedding of qualitative research within operating systems; capacity building/training; monitoring opportunities to include qualitative methods in studies; maximising the quality of qualitative research and developing methodological innovation. Facilitators of these actions included: the influence of the broader methodological landscape within trial/study design and its promotion of the value of qualitative research; and close physical proximity of CTR qualitative staff/students allowing sharing of methodological approaches. Introduction of innovative qualitative methods generated interest among other staff groups. Challenges included: pressure to under-resource qualitative components of research, preference for a statistical stance historically in some research areas and funding structures, and difficulties faced by qualitative researchers carving out individual academic profiles when working across trials/studies. Conclusions: Given that CTUs are pivotal to the design and conduct of RCTs and related study types across multiple disciplines, integrating qualitative research into trials units is crucial if its contribution is to be fully realised. We have made explicit one trials unit's experience of embedding qualitative research and present this to open dialogue on ways to operationalise and optimise qualitative research in trials. NPT provides a valuable framework with which to theorise these processes, including the importance of sense-making and legitimisation when introducing new practices within organisations. [ABSTRACT FROM AUTHOR]

Background: The 2022/23 influenza season in the United Kingdom saw the return of influenza to prepandemic levels following two seasons with low influenza activity. The early season was dominated by A(H3N2), with cocirculation of A(H1N1), reaching a peak late December 2022, while influenza B circulated at low levels during the latter part of the season. From September to March 2022/23, influenza vaccines were offered, free of charge, to all aged 2–13 (and 14–15 in Scotland and Wales), adults up to 49 years of age with clinical risk conditions and adults aged 50 and above across the mainland United Kingdom. Methods: End‐of‐season adjusted vaccine effectiveness (VE) estimates against sentinel primary‐care attendance for influenza‐like illness, where influenza infection was laboratory confirmed, were calculated using the test negative design, adjusting for potential confounders. Methods: Results In the mainland United Kingdom, end‐of‐season VE against all laboratory‐confirmed influenza for all those > 65 years of age, most of whom received adjuvanted quadrivalent vaccines, was 30% (95% CI: −6% to 54%). VE for those aged 18–64, who largely received cell‐based vaccines, was 47% (95% CI: 37%–56%). Overall VE for 2–17 year olds, predominantly receiving live attenuated vaccines, was 66% (95% CI: 53%–76%). Conclusion: The paper provides evidence of moderate influenza VE in 2022/23. [ABSTRACT FROM AUTHOR]

Project HELIX 2016-2020 was developed and implemented in Wales, to improve technical and safety/science knowledge; and sustainable innovation in food manufacturing small to medium enterprises (SMEs). The paper aims to place Project HELIX within the wider context of regional and food sector development and then examine the project's rationale and delivery methods relative to this. It reflects on the effectiveness of the project (or otherwise) in constructing regional advantage from knowledge transfer and knowledge spillovers. Finally, the paper identifies areas of further research both in terms of the firm level and in relation to other food sector initiatives more generally. [ABSTRACT FROM AUTHOR]

It seems probable that some form of medically-assisted dying will become legal in England and Wales in the foreseeable future. Assisted dying Bills are at various stages of preparation in surrounding jurisdictions (Scotland, Republic of Ireland, Isle of Man, Jersey), and activists campaign unceasingly for a change in the law in England and Wales. There is generally uncritical supportive media coverage, and individual autonomy is seen as the unassailable trump card: 'my life, my death'. However, devising a law which is 'fit for purpose' is not an easy matter. The challenge is to achieve an appropriate balance between compassion and patient autonomy on the one hand, and respect for human life generally and medical autonomy on the other. More people should benefit from a change in the law than be harmed. In relation to medically-assisted dying, this may not be possible. Protecting the vulnerable is a key issue. Likewise, not impacting negatively on societal attitudes towards the disabled and frail elderly, particularly those with dementia. This paper compares three existing models of physician-assisted suicide: Switzerland, Oregon (USA), and Victoria (Australia). Vulnerability and autonomy are discussed, and concern expressed about the biased nature of much of the advocacy for assisted dying, tantamount to disinformation. A 'hidden' danger of assisted dying is noted, namely, increased suffering as more patients decline referral to palliative-hospice care because they fear they will be 'drugged to death'. Finally, suggestions are made for a possible 'least worse' way forward. One solution would seem to be for physician-assisted suicide to be the responsibility of a stand-alone Department for Assisted Dying overseen by lawyers or judges and operated by technicians. Doctors would be required only to confirm a patient's medical eligibility. Palliative-hospice care should definitely not be involved, and healthcare professionals must have an inviolable right to opt out of involvement. There is also an urgent need to improve the provision of care for all terminally ill patients. [ABSTRACT FROM AUTHOR]

Non-stationary methods of flood frequency analysis are widespread in research but rarely implemented by practitioners. One reason may be that research papers on non-stationary statistical models tend to focus on model fitting rather than extracting the sort of results needed by designers and decision makers. It can be difficult to extract useful results from non-stationary models that include stochastic covariates for which the value in any future year is unknown. We explore the motivation for including such covariates, whether on their own or in addition to a covariate based on time. We set out a method for expressing the results of non-stationary models as an integrated flow estimate, which removes the dependence on the covariates. This can be defined either for a particular year or over a longer period of time. The methods are illustrated by application to a set of 375 river gauges across England and Wales. We find annual rainfall to be a useful covariate at many gauges, sometimes in conjunction with a time-based covariate. For estimating flood frequency in future conditions, we advocate exploring hybrid approaches that combine the best attributes of non-stationary statistical models and simulation models that can represent changes in climate and river catchments. [ABSTRACT FROM AUTHOR]

The Mawgridge's case in 1707 set the precedent where adultery was recognised as a justified trigger for the husband's killing of his wife's lover; this crystallised a partial defence for provocation. However, in an 1810 case, the killing of the unfaithful wife followed a manslaughter conviction rather than murder for the first time. This study aims to investigate the shaping of a legally permissible violence, that is, the mitigation of the husband's culpability in killing his adulterous wife. This provides the opportunity to question the (ir)rationality behind the judiciary's discourse in the case of R v Clinton 2012; here, despite infidelity being abolished in 2009 in England and Wales as a defence for murder, the judges still insisted on its relevance in our culture and hence on legal culpability. The theoretical framework in this paper draws upon the scholarship of masculinity, the family, and the law. This paper discusses the contribution of the hegemonic male identity in creating this legal violence and fortifying social-hierarchical structure. [ABSTRACT FROM AUTHOR]

Although both the analysis of regional culture and urbanisation are long-standing preoccupations in geography, few studies have considered the relationship between the two, the former traditionally being a topic in cultural geography, while the latter is usually interpreted and analysed as a process in economic geography. Taking evidence from the 1851–1911 censuses of England and Wales, this article analyses individual migration paths to identify stable regions of human interaction by applying a sophisticated community-detection algorithm. By accurately mapping the regions within which the majority of migration occurred between 1851 and 1911 and arguing that the stability of these geographies is evidence of more than just mutable communities but rather of persistent regional cultures, this article responds to previous studies that have sought to identify the cultural provinces of England and Wales. Indeed, by demonstrating that the regions bear a striking resemblance to those that have long been hypothesised as being distinct cultural provinces of England and Wales, this article empirically corroborates their existence. In order to further demonstrate that the regions constitute cultural provinces, this paper incorporates these boundaries into a spatial interaction model (SIM). The results of the SIM not only shows that the boundaries between the regions limited the number of migrants that crossed them–over and above that explained by control variables–and therefore represented the boundaries of cultural provinces, demarcating discrete regions of human interaction–but that such boundaries disproportionately restricted rural-urban migrants, thereby slowing the pace at which England and Wales urbanised. This paper therefore demonstrates that urbanisation should not only be interpreted as only an economic phenomenon, but a cultural one also, and that if urbanisation is to be fully understood, individuals' attachment to place as a component of their identity, ought to be formally incorporated into models of migration. [ABSTRACT FROM AUTHOR]

Background: Little is known about the effectiveness of, and implementation complexities associated with, service delivery models for children and young people (CYP) experiencing 'common' mental health problems such as anxiety, depression, behavioural difficulties and self-harm. This paper outlines how a model for high-quality service design for this population group was developed by identifying available services, their effectiveness, cost-effectiveness and acceptability, and the barriers and enablers to access. Methods: Sequential, mixed-methods design, combining evidence syntheses (scoping and integrative reviews of the international literature) with primary research (a collective case study in England and Wales). Data from these two elements were collaboratively synthesised in a subsequent model-building phase. Results: The scoping review yielded a service model typology. The integrative review found effectiveness evidence only for four models: collaborative care (the only service model to also have cost-effectiveness evidence), outreach approaches, brief intervention services and an organisational framework called 'Availability, Responsiveness and Continuity'. No service model seemed more acceptable than others. Three case study themes were identified: pathways to support; service engagement; and learning and understanding. The model-building phase identified rapid access, learning self-care skills, individualised support, clear information, compassionate and competent staff and aftercare planning as core characteristics of high-quality services. These characteristics were underpinned by four organisational qualities: values that respect confidentiality; engagement and involvement; collaborative relationships; and a learning culture. Conclusions: A consistent organisational evidence-base for service design and delivery in CYP's mental health spanning many years appears to have had little impact on service provision in England and Wales. Rather than impose – often inflexible and untested – specific local or national models or frameworks, those commissioning, designing and delivering mental health services for CYP should (re)focus on already known, fundamental components necessary for high-quality services. These fundamental components have been integrated into a collaboratively produced general model of service design for CYP with common mental health problems. While this general model is primarily focused on British service provision, it is broad enough to have utility for international audiences. [ABSTRACT FROM AUTHOR]

Background: A COVID-19 hospital guideline was implemented across all 18 acute hospitals in Wales in March 2020, promoting ward management of COVID pneumonitis and data collected across the first 3 Waves of the pandemic (Wave 1 March 1st 2020 to November 1st 2020, Wave 2 November 2st 2020 to February 21st 2021 and Wave 3 June 1st 2021 to December 14th 2021). The aim of this paper is to compare outcomes for patients by admission setting and type of ventilatory support given, with a particular focus on CPAP therapy. Methods: This is a retrospective observational study of those aged over 18 admitted to hospital with community acquired COVID-19 between March 2020 and December 2021. The outcome of interest was in-hospital mortality. Univariate logistic regression models were used to compare crude outcomes across the waves. Multivariable logistic regression models were used to assess outcomes by different settings and treatments after adjusting for Wave, age, sex, co-morbidity and deprivation. Results: Of the 7,803 records collected, 5,887 (75.4%) met the inclusion criteria. Analysis of those cases identified statistically significant outcome improvements across the waves for all patients combined (Waves 1 to 3: 31.5% to 18.8%, p<0.01), all ward patients (28.9% to 17.7%, p<0.01), and all ICU patients (44.3% to 32.2%, p = 0.03). Sub group analyses identified outcome improvements in ward patients without any oxygen therapy (Waves 1 to 3: 22.2% to 12.7%, p<0.01), with oxygen therapy only (34.0% to 12.9%, p<0.01) and with CPAP only (63.5% to 39.2%, p<0.01). The outcome improvements for ICU patients receiving CPAP only (35.7% to 24.6%, p = 0.31) or invasive ventilation (61.6% to 54.6%, p = 0.43) were not statistically significant though the numbers being admitted to ICU were small. The logistic regression models identified important age and comorbidity effects on outcomes. The multivariable model that took these into account suggested no statistically significantly greater risk of death for those receiving CPAP on the ward compared to those receiving CPAP in ICU (OR 0.89, 95% CI: 0.49 to 1.60). Conclusions: There were successive reductions in mortality in inpatients over the three Waves reflecting new treatments and better management of complications. Mortality for those requiring CPAP was similar in respiratory wards and ICUs after adjusting for differences in their respective patient populations. [ABSTRACT FROM AUTHOR]

In an era where an increasing number of people find it challenging to grasp scientifically accurate environmental data, the need for more engaging museum exhibits to convey this information has never been more crucial. This article discusses Daptec Flat Holm which is a data physicalisation technology project on Flat Holm Island, Wales. Flat Holm Island is designated as a site of special scientific interest and is a local nature reserve. This project aims to understand how we might improve people's engagement with environmental data through a multi-sensory museum exhibit. To achieve this, the project team applied a new creative approach to make the presentation of environmental data more engaging to a diverse science museum audience. Employing a user-centered methodology, this study reveals insights derived from three distinct user experience investigations conducted during the summer of 2022. The main contribution lies in how the researchers have extracted the nuances from the audience reactions and then identified potential audience types, their points of engagement, as well as their challenges. In detail, the findings illustrate how the application of a vignette data analysis technique revealed distinct audience types, including passive observers, active users, engaged ambassadors, disinterested participants, critical friends, and enthusiastic collaborators. In summary, the paper offers recommendations into how we might further engage a broader audience in technology mediated environmental museum exhibitions. [ABSTRACT FROM AUTHOR]

Simple Summary: Existing cross-cultural research on animal welfare often overlooks the way that policy and law are not the exclusive domain of central government. This can result in an over-simplification or misrepresentation of the true situation. The political culture and institutional arrangements for governing the modern state are more complex than a "one-size-fits-all" approach. It is argued that cross-cultural research needs to give greater attention to differences within as well as between unitary states. Specifically, it needs to examine developments in constituent nations and territories. Here we illustrate this by drawing on new research in the United Kingdom, and examine how 'devolution'—or decentralized government for Wales and Scotland—is providing contrasting opportunities for NGOs, campaigners, and the public to lobby to improve animal welfare policy based on local practices, beliefs, and demands (collectively known as the "political culture"). Our findings show how this is important because it results in contrasting animal welfare policies and laws in the constituent nations of the UK. It is argued that extant cross-cultural research on animal welfare often overlooks or gives insufficient attention to new governance theory, civil society, politics, and the realities of devolved or (quasi-)federal, multi-level governance in the modern state. This paper synthesizes relevant social theory and draws on new empirical findings of civil society accounts of campaigning on animal welfare policies and law in the United Kingdom. It is presented as a corrective to arguably reductive, earlier unitary state-based analyses. Our core, evidence-based argument is that cognizance of civil society activism and the contrasting institutional governance structures and political cultures of constituent nations in unitary states—such as the UK—are providing opportunities for the territorialization of legally grounded animal welfare regimes, and culturally distinctive practices. [ABSTRACT FROM AUTHOR]

Flooding in 2021 has highlighted the increased risk to national resilience. This is against a backdrop of the UK climate projected to become more extreme over the next few decades. This paper considers the notable river and surface water flood events within England and Wales during 2021 and examines the performance of the Flood Forecasting Centre in highlighting the flood risk to our customers. We reflect on team debriefs as well as feedback and surveys from our customers. We distil our learnings and make connections with improvements in our underpinning science, forecasting tools, products and services. Finally, we highlight challenges associated with surface water flooding and suggest how we may collectively start to overcome these. [ABSTRACT FROM AUTHOR]

Introduction: Rural doctors typically work in low resource settings and with limited professional support. They are sometimes pushed to the limits of their usual scope of practice to provide the medical care needed by their community. In a previous phenomenological study, we described the concept of clinical courage as underpinning rural doctors' work in this context. In this paper, we draw on rural doctors' experiences during the unfolding COVID pandemic to re examine our understanding of the attributes of clinical courage. Methods: Semi structured interviews were conducted with rural doctors from 11 countries who had experience preparing for or managing patients with COVID 19. Interviews were transcribed verbatim and coded using NVivo. A deductive thematic analysis was undertaken to identify common ideas and responses related to the features of clinical courage. Results: Thirteen interviews from rural doctors during the unfolding COVID 19 pandemic affirmed and enriched our understanding of the attributes of clinical courage, particularly the leadership role rural doctors can have within their communities. Conclusion: This study extended our understanding that rural doctors' experience of clinical courage is consistent amongst participants in many parts of the world, including developing countries. [ABSTRACT FROM AUTHOR]

The term value‐based healthcare (VBHC) describes an approach to the organization and delivery of care that emphasizes reducing the cost of care while improving outcomes. This involves increased investment earlier in the care pathway e.g., in the prevention, timely diagnosis, and screening for complications in order to maximize the overall impact of care. Key elements of VBHC include the collection and interpretation of relevant data to drive quality improvement and appropriateness of care, a focus on a continuum of care from prevention through to complications, an awareness of the financial drivers of the cost of care and a recognition that meaningful outcomes of care are those that are important to patients. Although VBHC has its origins in North America and has mostly been applied to private health systems, the principles can also be applied to national health services. In publicly funded health systems, where resources are finite, VBHC initiatives aim to eliminate ineffective care that has no beneficial impact or added value for patients and to optimize patient outcomes by delivering care that meets the changing healthcare needs of a population over time. The National Health Service in Wales has established a VBHC Office and has begun to realize the benefits of adopting VBHC approaches. The Irish Health Service Executive (HSE) can learn from the approaches used in Wales. In this paper we explore some of the principles of VBHC through case studies from Ireland and Wales highlighting how national health services are using VBHC to achieve improvement in outcomes for people living with diabetes. [ABSTRACT FROM AUTHOR]

The Becoming Breastfeeding Friendly (BBF) in Great Britain study was conducted during 2017–2019 comprising three country studies: BBF England, Wales and Scotland. It was part of an international project being coordinated during the same period by the Yale School of Public Health across five world regions to inform countries and guide policies to improve the environment for the promotion, protection and support of breastfeeding. This paper reports on the application of the BBF process that is based on an implementation science approach, across the countries that constitute Great Britain (England, Wales and Scotland). The process involves assessing 54 benchmarks across eight interlocking gears that drive a country's 'engine' towards a sustainable policy approach to supporting, promoting and protecting breastfeeding. It takes a consensus‐oriented approach to the evaluation of benchmarks and the development of recommendations. This paper provides a critical overview of how the process was conducted, the findings and recommendations that emerged and how these were managed. We draw on critical theory as a theoretical framework for explaining the different outcomes for each country and some considerations for future action. Key messages: Undertaking an international, comparable approach to develop evidence‐based policy recommendations for scaling up the breastfeeding environment can provide useful data on which to draw explanations and conclusions on national variation.The findings from the BBF process across England, Scotland and Wales suggest that improving breastfeeding in Great Britain is dependent on the degree of political will and having a coordinated national breastfeeding strategy in place or not, along with access to robust breastfeeding data.A critical theory lens helps to bring to light some differences in the research and policy process that can explain differences between countries in the United Kingdom. [ABSTRACT FROM AUTHOR]

Background: COVID-19 caused disruption to healthcare services globally, resulting in high numbers of hospital admissions and with those discharged often requiring ongoing support. Within the UK, post-discharge services typically developed organically and were shaped over time by local need, funding, and government guidance. Drawing on the Moments of Resilience framework, we explore the development of follow-up services for hospitalised patients by considering the links between resilience at different system levels over time. This study contributes to the resilient healthcare literature by providing empirical evidence of how diverse stakeholders developed and adapted services for patients following hospitalisation with COVID-19 and how action taken at one system level influenced another. Methods: Qualitative research comprising comparative case studies based on interviews. Across three purposively selected case studies (two in England, one in Wales) a total of 33 semi-structured interviews were conducted with clinical staff, managers and commissioners who had been involved in developing and/or implementing post-hospitalisation follow-up services. The interviews were audio-recorded and professionally transcribed. Analysis was conducted with the aid of NVivo 12. Results: Case studies demonstrated three distinct examples of how healthcare organisations developed and adapted their post-discharge care provision for patients, post-hospitalisation with COVID-19. Initially, the moral distress of witnessing the impact of COVID-19 on patients who were being discharged coupled with local demand gave clinical staff the impetus to take action. Clinical staff and managers worked closely to plan and deliver organisations' responses. Funding availability and other contextual factors influenced situated and immediate responses and structural adaptations to the post-hospitalisation services. As the pandemic evolved, NHS England and the Welsh government provided funding and guidance for systemic adaptations to post-COVID assessment clinics. Over time, adaptations made at the situated, structural, and systemic levels influenced the resilience and sustainability of services. Conclusions: This paper addresses understudied, yet inherently important, aspects of resilience in healthcare by exploring when and where resilience occurs across the healthcare system and how action taken at one system level influenced another. Comparison across the case studies showed that organisations responded in similar and different ways and on varying timescales to a disruption and national level strategies. [ABSTRACT FROM AUTHOR]

Background: Long-acting injectable buprenorphine (LAIB) is a new treatment for opioid use disorder that has been introduced against an international policy backdrop of recovery and person-centred care. This paper explores the goals that people want to achieve from LAIB to identify potential implications for policy and practice. Methods: Data derive from longitudinal qualitative interviews conducted with 26 people (18 male; 8 female) initiating LAIB in England and Wales, UK (June 2021-March 2022). Participants were interviewed up to five times by telephone over six months (107 interviews in total). Transcribed interview data relating to each participant's treatment goals were coded, summarised in Excel, and then analysed via a process of Iterative Categorization. Results: Participants often articulated a desire to be abstinent without defining exactly what they meant by this. Most intended to reduce their dosage of LAIB but did not want to rush. Although participants seldom used the term 'recovery', almost all identified objectives consistent with current definitions of this concept. Participants articulated broadly consistent goals over time, although some extended the timeframes for achieving treatment-related goals at later interviews. At their last interview, most participants remained on LAIB, and there were reports that the medication was enabling positive outcomes. Despite this, participants were aware of the complex personal, service-level, and situational factors that hindered their treatment progress, understood the additional support they needed to achieve their goals, and voiced frustrations when services failed them. Conclusions: There is a need for wider debate regarding the goals people initiating LAIB are seeking and the diverse range of positive treatment outcomes LAIB could potentially generate. Those providing LAIB should offer regular on-going contact and other forms of non-medical support so that patients have the best opportunity to succeed. Policies relating to recovery and person-centred care have previously been criticised for responsibilising patients and service users to take better care of themselves and to change their own lives. In contrast, our findings suggest that these policies may, in fact, be empowering people to expect a greater range of support as part of the package of care they receive from service providers. [ABSTRACT FROM AUTHOR]

The Twins Early Development Study (TEDS) is a longitudinal study following a cohort of twins born 1994-1996 in England and Wales. Of the 13,759 families who originally consented to take part, over 10,000 families remain enrolled in the study. The current focus of TEDS is on mental health in the mid-twenties. Making use of over 25 years of genetically sensitive data, TEDS is uniquely placed to explore the longitudinal genetic and environmental influences on common mental health disorders in early adulthood. This paper outlines recent data collection efforts supporting this work, including a cohort-wide mental health assessment at age 26 and a multi-phase Covid-19 study. It will also provide an update on data linkage efforts and the Children of TEDS (CoTEDS) project. [ABSTRACT FROM AUTHOR]

Young people experience significant harm in a range of social contexts and from adults and peers unconnected to their caregivers. The recognition of this by policymakers in England, Scotland, and Wales has resulted in child protection policy frameworks increasingly requiring social work responses to the extra-familial contexts where such harm occurs, as well as to the young people affected. This paper presents results from an embedded research project in which five local children's social care departments used a Contextual Safeguarding framework to respond to this shifting policy direction. The data collected via ethnographic methods over three years included meeting and practice observations (n = 65), meeting participation (n = 334), reviews of young people's case files (n = 122), interviews (n = 27) and focus groups (n = 33) with professionals, focus groups (n = 6), interviews (n = 2) and surveys (n = 78) with parents and young people, and analysis of local policies and procedures (n = 101). At two stages in the project, the researchers used this dataset to review the progress in each participant site against the Contextual Safeguarding framework. Reporting on the progress made across the five sites, this paper identifies elements of the system change that appeared most feasible or challenging. The results demonstrate four ways in which current policy reforms fall short in creating national contexts that are conducive to the implementation of Contextual Safeguarding, despite local progress towards this goal. The implications for the policy and practices are outlined, with fundamental questions asked of the statutory systems which need to protect, but all too often criminalise, young people abused beyond their front doors. [ABSTRACT FROM AUTHOR]

This paper demonstrates for the first time that prisons with a higher proportion of natural vegetation within their perimeter have lower levels of staff sickness absence. It makes three significant contributions. First, it extends studies of workplace nature contact into the un-researched carceral context. Second, whereas previous workplace nature contact studies have largely utilized single-site surveys, it presents national-level, statistically robust analysis. Third, it brings a novel new perspective to studies of sickness absence within correctional workforces, by considering the effect of the physical environment. Econometric estimations presented in the paper confirm lower levels of staff sick-leave in prisons with more greenspace. This relationship persists when we control for prison size, security level, age, level of crowding, levels of self-harm and violence among prisoners, and assaults against staff. The findings are significant in demonstrating the benefits of nature contact in workplaces in general, and carceral environments in particular. Importantly, this has the potential to influence future prison design. [ABSTRACT FROM AUTHOR]

Background: Children and young people's (CYP) mental health is a major public health concern internationally and the recent Covid-19 pandemic has amplified these concerns. However, only a minority of CYP receive support from mental health services due to the attitudinal and structural barriers they and their families encounter. For over 20 years, report after report has consistently highlighted the shortcomings of mental health services for CYP in the United Kingdom and attempts to improve services have been largely unsuccessful. The findings reported in this paper are from a multi-stage study that aimed to develop a model of effective, high-quality service design for CYP experiencing common mental health problems. The aim of the stage reported here was to identify CYP's, parents' and service providers' perceptions of the effectiveness, acceptability and accessibility of services. Methods: Case studies were conducted of nine different services for CYP with common mental health problems in England and Wales. Data were collected using semi-structured interviews with 41 young people, 26 parents and 41 practitioners and were analysed using the Framework approach. Patient and Public Involvement was integrated throughout the study with a group of young co-researchers participating in data collection and analysis. Results: Four key themes defined participants' perceptions of service effectiveness, acceptability and accessibility. Firstly, open access to support with participants highlighting the importance of self-referral, support at the point of need and service availability to CYP/parents. Secondly, the development of therapeutic relationships to promote service engagement which was based on assessment of practitioner's personal qualities, interpersonal skills and mental health expertise and underpinned by relational continuity. Thirdly, personalisation was viewed as promoting service appropriateness and effectiveness by ensuring support was tailored to the individual. Fourthly, the development of self-care skills and mental health literacy helped CYP/parents manage and improve their/their child's mental health problems. Conclusions: This study contributes to knowledge by identifying four components that are perceived to be central to providing effective, acceptable and accessible mental health services for CYP with common mental health problems irrespective of service model or provider. These components could be used as the foundations for designing and improving services. [ABSTRACT FROM AUTHOR]

With increasing costs of healthcare in England and Wales following the COVID-19 pandemic, finding alternatives to traditional medical interventions is more important than ever. Social prescribing provides a way of addressing health and well-being through using non-medical methods that may help relieve costs to the NHS. Evaluating interventions, such as social prescribing, which have high social (but not easily quantifiable) value, can be problematic. Social return on investment (SROI) is a method of assigning monetary values to both social value as well as traditional assets, so provides a way of evaluating social prescribing initiatives. This protocol outlines the steps that will be taken in a systematic review of the SROI literature surrounding social prescribing-type integrated health and social care interventions based in the community in England and Wales. Online academic databases such as PubMed Central, ASSIA and Web of Science will be searched, as will grey literature sources such as Google Scholar, the Wales School for Social Prescribing Research (WSSPR) and Social Value UK. Titles and abstracts from the articles returned by the searches will be reviewed by one researcher. Those selected for full text review will be independently reviewed and compared by two researchers. Where the researchers disagree a third reviewer will help resolve any differences. Information collected will include identifying stakeholder groups, assessing the quality of SROI analyses, identifying intended and unintended changes of social prescribing interventions, and comparing social prescribing initiatives in terms of SROI costs and benefits. Quality assessment will be independently conducted on the selected papers by two researchers. The researchers will discuss to obtain consensus. Where there is disagreement, a third researcher will resolve these cases. A pre-existing quality framework will be developed and used to assess the quality of the literature. Protocol registration Prospero registration number:CRD42022318911. [ABSTRACT FROM AUTHOR]

Background: Dental caries is common in young people and has wide-ranging ramifications for health and quality of life. Text messaging interventions show promise as a means to promote oral health behaviour change among young people. This paper reports the internal pilot of the Brushing RemInder 4 Good oral HealTh (BRIGHT) trial, which is evaluating an intervention comprising an oral health classroom lesson and text messages about toothbrushing, on caries in young people. Pilot trial objectives were to evaluate the feasibility and appropriateness of recruitment and data collection methods, the randomisation strategy, and intervention delivery against progression criteria for the main trial. Methods: This is an internal pilot trial embedded within an assessor-blinded, two-arm, cluster randomised controlled trial. Participants were pupils aged 11–13 years (in year 7/S1 or year 8/S2) in secondary schools in England, Scotland, and Wales with above average pupil eligibility for free school meals. Following completion of pupil baseline questionnaires and dental assessments, year groups within schools were randomised to the intervention or control arm. Approximately 12 weeks later, participants completed a follow-up questionnaire, which included questions about sources of oral health advice to assess intervention contamination between year groups. At the end of the pilot phase, trial conduct was reviewed against pre-specified progression criteria. Results: Ten schools were recruited for the pilot, with 20 year groups and 1073 pupils randomised (average of 54 pupils per year group). Data collection methods and intervention delivery were considered feasible, the response rate to the follow-up questionnaire was over 80%, there was an indication of a positive effect on self-reported toothbrushing, and interest was obtained from 80% of the schools required for the main trial. Despite partial intervention contamination between year groups, within-school randomisation at the level of the year-group was considered appropriate for the main trial, and the sample size was revised to account for partial contamination. Facilitators and barriers to recruitment and data collection were identified and strategies refined for the main trial. Conclusions: Progression to the main trial of BRIGHT, with some design refinements, was concluded. The internal pilot was an efficient way to determine trial feasibility and optimise trial processes. Trial registration: ISRCTN registry, ISRCTN12139369, registered 10/05/2017 [ABSTRACT FROM AUTHOR]

The question is posed in this paper of what repercussions Brexit will have on maritime law and on the maritime industry of the European Union. This is because the Commercial Court in London has been dealing with disputes arising from the international carriage of goods by sea for centuries. Approximately 80% of all disputes before that Court and the Admiralty Court are maritime, shipping and shipbuilding disputes. Approximately 70% of such disputes are international. The majority of judges of the Commercial Court and of the Admiralty Court, as well as a substantial number of solicitors and barristers and court expert witnesses are specialised or have experience in shipping law. All this means that London has been and remains the dominant jurisdiction for resolving international shipping disputes. The pragmatic approach to the question of liability and allocation of risk in shipping ventures, and the detailed analysis of the specific circumstances of every case, among other things, make English court decisions unique. At the end of the UK exit negotiations on 31 December 2020, the Brussels I Recast, the Lugano Convention 2007, and Rome I and Rome II ceased to apply. These regulations and conventions deal with jurisdiction, recognition and enforcement of foreign judgments in civil and commercial matters among EU Member States and the law chosen by the parties. This means that the automatic recognition and enforcement of the English Commercial Court judgments by the courts in the European Union (and vice versa) has ended. In these circumstances, the question is whether shipping companies, marine insurance companies, shipyards and other marine industries in the European Union will continue to choose with confidence English law as the governing law of their contracts and English court jurisdiction for settling their shipping disputes. We believe that they will, especially because of the uniquely high level of certainty, clearness and predictability of English shipping law and English court decisions. Furthermore, because of the high level of understanding of the specifics of the maritime industry which has been provided by London to the maritime industries of the European Union and the world for centuries. [ABSTRACT FROM AUTHOR]

Mixture cure rate models have been developed to analyze failure time data where a proportion never fails. For such data, standard survival models are usually not appropriate because they do not account for the possibility of non-failure. In this context, mixture cure rate models assume that the studied population is a mixture of susceptible subjects who may experience the event of interest and non-susceptible subjects that will never experience it. More specifically, mixture cure rate models are a class of survival time models in which the probability of an eventual failure is less than one and both the probability of eventual failure and the timing of failure depend (separately) on certain individual characteristics. In this paper, we propose a Bayesian approach to estimate parametric mixture cure rate models with covariates. The probability of eventual failure is estimated using a binary regression model, and the timing of failure is determined using a Weibull distribution. Inference for these models is attained using Markov Chain Monte Carlo methods under the proposed Bayesian framework. Finally, we illustrate the method using data on the return-to-prison time for a sample of prison releases of men convicted of sexual crimes against women in England and Wales and we use mixture cure rate models to investigate the risk factors for long-term and short-term survival of recidivism. [ABSTRACT FROM AUTHOR]

Over the centuries there have been a number of attempts, for economic, political and religious reasons, to create Welsh settlements overseas. The most successful of these, in terms of longevity at least, and perhaps the best known of all Welsh emigration ventures, was the establishment in 1865 of a Welsh Settlement in Patagonia, in what is now the Province of Chubut in Argentina, where perhaps as many as 5,000 of the inhabitants still speak Welsh fluently or have some ability with the language. The preservation of Welsh identity was central to the Patagonian project, which aimed to create a new Welsh-speaking, self-governing Wales overseas, founded on Christian and democratic principles. From the outset, songs played an important role in fostering the ideals that inspired the founders of the Settlement, ideals that would come progressively under threat as the Argentine government increasingly asserted its authority over the Settlement, promoting Argentinian identity and replacing Welsh with Spanish as the medium of education. This paper gives an overview of the development of the Welsh Settlement in Chubut down to the present day, focussing especially on the role of song in nurturing the dream of the Settlement's founders. [ABSTRACT FROM AUTHOR]

Background: Medication errors regardless of the degree of patient harm can have a negative emotional impact on the healthcare staff involved. The potential for self-victimization of healthcare staff following medication errors can add to the moral distress of healthcare staff. The stigma associated with errors and their disclosure often haunts healthcare professionals, leading them to question their own professional competence. This paper investigates the negative emotions expressed by healthcare staff in their reported medication administration error incidents along with the immediate responses they received from their seniors and colleagues after the incident.Method: This is a retrospective study using a qualitative descriptive design and text mining. This study includes free-text descriptions of medication administration error incidents (n = 72,390) reported to National Reporting & Learning System in 2016 from England and Wales. Text-mining by SAS text miner and content analysis was used to analyse the data.Results: Analysis of data led to the extraction of 93 initial codes and two categories i.e., 1) negative emotions expressed by healthcare staff which included 4 sub-categories of feelings: (i) fear; (ii) disturbed; (iii) sadness; (iv) guilt and 2) Immediate response from seniors and colleagues which included 2 sub-categories: (i) Reassurance and support and (ii) Guidance on what to do after an error.Conclusion: Negative emotions expressed by healthcare staff when reporting medication errors could be a catalyst for learning and system change. However, negative emotions when internalized as fear, guilt, or self-blame, could have a negative impact on the mental health of individuals concerned, reporting culture, and opportunities for learning from the error. Findings from this study, hence, call for future research to investigate the impact of negative emotions on healthcare staff well-being and identify ways to mitigate these in practice. [ABSTRACT FROM AUTHOR]

The prevalence of dyslexia identification has increased significantly over the last two decades. Yet there is debate over whether there are distinct biological and cognitive differences between those with literacy difficulties and the subgroup of people identified as dyslexic. This is the first paper that provides evidence for this ongoing debate by investigating the socio-demographic factors, outside biology and cognition, that predict whether a child is identified as dyslexic in the UK. Using secondary data from the UK's Millennium Cohort Study, this paper examines the socio-demographic factors that predict whether a child's teacher identifies them as dyslexic at age 11. Gender, season of birth, socio-economic class and parental income are found to be significant predictors of the dyslexia label. Therefore, factors seemingly unrelated to the clinical aspects of dyslexia influence whether a child is identified as dyslexic in England and Wales. This suggests that label may not be evenly distributed across a population; furthermore, it may also indicate that resources for support may not be fairly allocated. The findings further support the argument that a 'dyslexic sub-group' within poor readers is created due to the impact of environmental factors. The results from this national-scale study thus questions the reliability, validity and moral integrity of the allocation of the dyslexia label across current education systems in the UK. [ABSTRACT FROM AUTHOR]

Background: Women in prison have comparatively greater health needs than men, often compounded by structures and policies within the prison system. The notion of a 'health-promoting' prison is a concept which has been put forward to address health inequalities and health deterioration in prisons. It has, however, not been fully discussed in relation to women in prison. The paper aims to distil the learning and evidence in relation to health promotion in female prisons using prison inspection reports of women's prisons in England and Wales.Methods: Prison inspection reports are one way of ascertaining the contemporary situation in prisons. Prison inspections are often unannounced and use a myriad of methods to draw conclusions around various aspects of prison life. Thirteen prison inspection reports were analysed thematically focusing on health promotion within the institutions. Two analysts conducted the work using NVivo 12.Results: Five core thematic areas were identified during the analysis of the reports. Saliently, a joined-up approach to health promotion was not a common feature in the prisons and indeed the focus tended to be on screening and 'lifestyle issues' rather than a concern for the underlying determinants of health. There was often an absence of a strategic approach to health promotion. There were some good examples of the democratic inclusion of women in prison in shaping services, but this was not widespread and often tokenistic. There were some examples of inequity and the inspection reports from a small number of institutions, illustrated that the health needs of some women remained unmet.Conclusions: The paper suggests that there is potentially some work before conditions in women's prisons could be described as 'health-promoting', although there are some examples of individual prisons demonstrating good practice. The health promoting prison movement has, implicitly at least, focused on the needs of men in prison and this has been to the exclusion of the female prison population. This does lead to several challenges and the potential for exacerbating health challenges faced by an already marginalised and vulnerable group. Greater focus on the health promotion needs of women in prison is required. [ABSTRACT FROM AUTHOR]

This paper considers the potential for the Mental Capacity Act (MCA) of England and Wales to incentivise the exclusion of people with dementia from research. The MCA is intended to standardise and safeguard the inclusion of people with cognitive impairments in research. This entails various procedural requirements, which in pressurised research contexts can lead researchers to exclude people with dementia as a means of simplifying bureaucratic constraints. I consider the risks of an 'unethical ethics', wherein procedural ethics indirectly causes the exclusion of people with dementia from research, undermining historic successes toward increased inclusivity. I suggest several solutions, including enhanced sensitivity to impairments and shifting the burden of proof from justifying inclusion to justifying exclusion. The paper responds to the 'ethics creep' tradition in procedural ethics, and critical appraisals of capacity legislation in dementia research. This approach recognises that institutional research ethics is itself a major ethical concern and can unwittingly beget unethical practices. Dementia researchers must be alert to such unethical ethics. [ABSTRACT FROM AUTHOR]

The treatment of vulnerable defendants by criminal justice systems or correctional systems varies within and between countries. The purpose of this paper is to examine three legal jurisdictions – New South Wales in Australia; Norway; England and Wales – to understand the extent of variation in practice within the court systems for defendants with intellectual disabilities (ID) and/or autism spectrum conditions (ASC). Two of the jurisdictions had a process for screening in place, either in police custody or at court, but this was not universally implemented across each jurisdiction. All three jurisdictions had a process for supporting vulnerable defendants through the legal system. Across the three jurisdictions, there was variation in disposal options from a mandatory care setting to hospital treatment to a custodial sentence for serious offences. This variation requires further international exploration to ensure the rights of defendants with ID or ASC are understood and safeguarded. [ABSTRACT FROM AUTHOR]

Social Network Analysis (SNA) has shed light on cultures where the influence of patronage, preferment, and reciprocal obligations are traditionally important. We argue here that episcopal appointments, culture, and governance within the Catholic Church are ideal topics for SNA interrogation. This paper presents preliminary findings, using original network data for the Catholic Bishops' Conference of England and Wales and the United States Conference of Catholic Bishops. These show how a network-informed approach may help with the urgent task of understanding the ecclesiastical cultures in which sexual abuse occurs, and/or is enabled, ignored, and covered up. Particular reference is made to Theodore McCarrick, the former DC Archbishop recently "dismissed from the clerical state", and Michael Bransfield, Bishop Emeritus of Wheeling-Charleston. Commentators naturally use terms such as "protégé", "clique", "network", and "kingmaker" when discussing both the McCarrick and Bransfield affairs, and church politics more generally: precisely such folk-descriptions of social and political life that SNA is designed to quantify and explain. [ABSTRACT FROM AUTHOR]

This paper examines the impact of widespread adoption of information and communication technologies (ICT) on urban structure worldwide. Has it offset agglomeration benefits and led to more dispersed spatial structures, or has it strengthened urban externalities and thus resulted in more concentrated spatial structures? Theoretical and empirical studies on this question have produced contradictory findings. The present study recognizes that assumptions made earlier about the evolution of technological capabilities do not necessarily hold today. As cutting-edge digital technologies have matured considerably, a fresh look at this question is called for. The paper addresses this issue by means of several data sets using instrumental variable methods. One is the UN data on Urban Settlements with more than 300, 000 inhabitants. Estimation methods with these data show that increased adoption of ICT has resulted in national urban systems that are less uniform in terms of city sizes and are characterized by higher population concentrations in larger cities, when concentration is proxied the Pareto (Zipf) coefficient for national city size distributions. Two, is disaggregated data for the urban systems of the US, defined as Micropolitan and Metropolitan Areas, and for the UK, defined as Built-up Areas in England and Wales, respectively. These data allow for the impacts to be studied for cities smaller than those included in the cross-country data. Increased internet usage improved a city's ranking in the US urban system. Similarly, increased download speed improves a built-up area's ranking in England and Wales. [ABSTRACT FROM AUTHOR]

Simple Summary: There is no consensus on the optimal treatment strategy for locally advanced vulvar cancer. In this paper, we aimed to highlight the outcomes from pelvic exenteration in our centre. Here, we not only demonstrated the role of pelvic exenteration in the treatment of locally advanced vulvar cancer, but we also revealed modifiable and non-modifiable factors that contribute to outcomes. Furthermore, we highlighted that tumours that are less than 40 mm diameter do not usually require flap reconstruction while tumours of 40 mm diameter or greater would often require flap reconstruction—a finding that we believe has not been previously reported in the literature. However, we recognise that research must continue into treatment options that limit the radicality of surgical resection, although such alternative approaches must offer comparable survival advantages. The treatment of locally advanced vulvar carcinoma (LAVC) represents a major challenge. We investigated the role of pelvic exenteration as a treatment of LAVC. Women who underwent pelvic exenteration for primary and recurrent LAVC in our centre between 2001 and 2019 were included. Among the 19 women included during the study period, 14 women (73.7%) had primary LAVC while 5 women (26.3%) had recurrent disease. Surgical resection margins were microscopically clear (R0) in 94.7% of patients—14/14 undergoing primary treatment and 4/5 undergoing treatment for recurrent disease. Complete closure of the wound was achieved in 100% of women, with no wound left to heal by secondary intention. Tumour size was a predictor of requiring myocutaneous flap reconstruction, with all tumours less than 40 mm undergoing primary closure, while almost all tumours 40 mm diameter or greater (14/15 women) required flap reconstruction (p = 0.001). The 30-day major morbidity rate was 42% and there was no perioperative death. The mean overall survival was 144.8 months (2–206 months), with 1-, 2- and 5-year survival rates of 89.5%, 75.1% and 66.7%, respectively. In our centre, a primary surgical approach to the management of LAVC has resulted in good survival outcomes with acceptable morbidity rates. [ABSTRACT FROM AUTHOR]

Objectives: This paper outlines fieldwork procedures for Wave 4 of the COVID‐19 Psychological Research Consortium (C19PRC) Study in the UK during November–December 2020. Methods: Respondents provided data on socio‐political attitudes, beliefs, and behaviours, and mental health disorders (anxiety, depression, and posttraumatic stress). In Phase 1, adults (N = 2878) were reinvited to participate. At Phase 2, new recruitment: (i) replenished the longitudinal strand to account for attrition; and (ii) oversampled from the devolved UK nations to facilitate robust between‐country analyses for core study outcomes. Weights were calculated using a survey raking algorithm to ensure the longitudinal panel was representative of the baseline sample characteristics. Results: In Phase 1, 1796 adults were successfully recontacted and provided full interviews at Wave 4 (62.4% retention rate). In Phase 2, 292 new respondents were recruited to replenish the panel, as well as 1779 adults from Wales, Scotland, and Northern Ireland, who were representative of the socio‐political composition of the adult populations in these nations. The raking procedure successfully re‐balanced the longitudinal panel to within 1% of population estimates for selected socio‐demographic characteristics. Conclusion: The C19PRC Study offers a unique opportunity to facilitate and stimulate interdisciplinary research addressing important public health questions relating to the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Background: In many countries, including in the United Kingdom (UK), COVID-19 social distancing measures placed substantial restrictions on children's lives in 2020 and 2021, including closure of schools and limitations on play. Many children faced milestones such as transition to secondary school having missed several months of face-to-face schooling in the previous academic years.Methods: This paper examines change in mental health difficulties, life satisfaction, school connectedness, and feelings about transition to secondary school among 10-11-year-olds in Wales, UK, using data from repeat cross-sectional surveys before and after the onset of the COVID-19 pandemic. Participants were 4032 10-11-year-old schoolchildren. The first cohort completed a school-based survey in 2019 (prior to introduction of social distancing measures), and the second in 2021 (following full return to school after two rounds of school closure).Results: The percentage of children reporting elevated emotional difficulties rose from 17% in 2019 to 27% in 2021 (Odds Ratio = 1.65; 95%CI = 1.23 to 2.20). There was no evidence of increased behavioural difficulties (OR = 1.04; 95%CI = 0.73 to 1.46). There was a tendency toward declines in life satisfaction in all analyses, but this intersected the null (OR = 0.86; 95%CI = 0.70 to 1.07). Children reported a high degree of school connectedness before and after the pandemic, with no evidence of change in ratings of teacher relationships, pupil relationships or pupil involvement in school life. There was no evidence of impacts of the pandemic on children's feelings about the transition to secondary school, with feelings becoming more positive as transition neared. Most findings were robust to a range of sensitivity analyses.Conclusions: Supporting children's emotional recovery from the COVID-19 pandemic is a public health priority requiring urgent and effective action at multiple levels of society. Maintaining connectedness to school through the pandemic may have played a role in preventing a steeper increase in child mental health difficulties. [ABSTRACT FROM AUTHOR]

The advent of the Portable Antiquities Scheme (PAS) has added a great deal to our understanding of prehistoric metal artefacts in England and Wales, namely in expanding enormously the corpuses of objects previously thought to be quite scarce. One such artefact type is the miniature socketed 'votive' axe, most of which are found in Wiltshire and Hampshire. As a direct result of developing such recording initiatives, reporting of these artefacts as detector finds from the early 2000s onwards has virtually trebled the number originally published by Paul Robinson in his 1995 analysis. Through extensive data-collection, synthesising examples recorded via the PAS with those from published excavations, the broad aims of this paper (in brief) are as follows: firstly, produce a solid typology for these artefacts; secondly, investigate their spatial distribution across England and Wales. As a more indirect third aim, this paper also seeks to redress the imbalance of focus and academic study specifically applying to Hampshire finds of this object type, which despite producing a significant proportion of the currently known corpus have never been the subject of detailed analysis. [ABSTRACT FROM AUTHOR]

The endangered Eurasian Otter (Lutra lutra) became a protected species in England and Wales in 1978. The gradual recovery of the species coincides with the rise in specimen fishing on stillwater fisheries and increased concerns about predation. Although otter-proof fencing has been identified as the most effective medium-long term solution, the lack of a formalised legal mechanism to remove otters from fenced fisheries compromised livelihoods and otter welfare. Recognising this, the UK Wild Otter Trust (UKWOT) successfully lobbied for a licence to humanely trap and remove them. This paper examines the initial media and stakeholder responses to Natural England introducing the CL36 'Class Licence' to live capture and transport Eurasian otters (Lutra lutra) that are trapped in fenced fisheries to prevent further damage. The paper analyses the UKWOT 'Interventions Spreadsheet' for the three years of the CL36 licence (November 2016 to June 2019) and the AT Fishery Management Advisors (FMA) 'Otter Log' (March 2017 to March 2019), to trace otter-related enquiries. Finally, the paper assesses the impact of the licence in practice, with reference to the successful live trapping and removal of otters from fenced fisheries. [ABSTRACT FROM AUTHOR]

British supermarket-panel data suggest no increases in overall sales and purchases of alcohol following COVID-19 lockdowns, yet survey and mortality data suggest otherwise. This paper attempts to unravel the paradox. Based on purchase data of 79,417 British households from Kantar Worldpanel, we undertake controlled interrupted time series analysis of the impact of COVID-19 confinement introduced on 23rd March 2020, and variably applied during 2020, compared to purchases during 2015 to 2019 as controls. We also undertook Poisson regression analyses to estimate if changes in purchases differed by household socio-demographic and economic factors. Excess off-trade household alcohol purchases (expressed as grams of ethanol) following the introduction of confinement, were 29.2% higher (95% CI = 25.8% to 32.5%) for the post-confinement months of 2020, being larger until mid-July 2020 (37.5%, 95%CI = 33.9 to 41.26%) when pubs re-opened with restrictions, and smaller (24.6%, 95%CI = 21.6 to 27.7) thereafter. During the time of complete pub closures, and fully adjusting for no on-trade purchases, household purchases of alcohol did not change when compared with the same time period during 2015–2019 (coefficient = -0.9%, 95%CI = -5.6 to 3.8). Excess purchases from 23rd March to 31st December 2020 varied by region of Great Britain, being higher in the north of England, and lower in Scotland and Wales. Excess purchases were greater in the most deprived households, compared with the least deprived households. Excess purchases increased substantially as the amount of alcohol normally purchased by a household increased, with the top one fifth of households that normally bought the most alcohol increasing their purchases more than 17 times than the bottom one fifth of households that bought the least alcohol. That the heaviest buyers of alcohol increased their purchases the most, with some independent impact of socio-economic disadvantage, might explain why reported alcohol problems and recent alcohol-related death rates might have increased. A conclusion of this is that alcohol policy to reduce high consumption of alcohol, and the availability of help and treatment to reduce alcohol consumption become more important during extraordinary times, such as COVID lockdowns. [ABSTRACT FROM AUTHOR]

Agriculture has a hugely important role to play in meeting many of the UN's Sustainable Development Goals (SDGs). Ensuring the economic resilience of farms and improving their capacity to respond to a wide range of challenges is key if agriculture is to contribute positively to achieving SDGs and sustainable growth. This paper aims to calculate the economic vulnerability and resilience of agriculture in England and Wales (UK), by analysing individual farm business data and using it to compute an aggregated agricultural resilience index at regional level across the two countries. The results of our analysis are visualised as maps, showing the geographical distribution of the input indicators and the final composite resilience index. We argue that this type of spatio-economic approach is useful for understanding the geography of agricultural resilience at sub-national levels, which could be valuable for helping to inform decisions and formulate strategies for promoting sustainable agriculture.. [ABSTRACT FROM AUTHOR]

During the COVID‐19 pandemic, first responders and health care workers faced elevated virus‐related risks through prolonged contacts with the public. Research suggests that these workers already experienced lower levels of psychological well‐being linked to occupational risks. Thus, the pandemic's impact might have particularly affected mental health in these groups. This paper analysed data from a large‐scale Welsh population study (N = 12,989) from June to July 2020. Levels of psychological distress were compared across various occupations, including police, fire and rescue, and NHS health care workers. Resilience was also indexed, and its role considered as a protective factor for psychological distress. Surprisingly, health care workers reported lower distress levels than the general population. Further, fire and rescue and police groups had lower distress than most groups and significantly higher resilience. Within police officers, higher resilience levels were protective for distress. Fire and rescue workers were half as likely as others to report distress, even accounting for demographic factors and resilience. The findings offer an optimistic view of psychological resilience in these critical occupations. They illustrate potential benefits to one's mental health of playing a crucial societal role during crises and reiterate the importance of enhancing resilience within groups who encounter high‐risk situations daily. Practitioner points: Our findings provide evidence that health care workers and first responders showed lower levels of psychological distress than the general population during the first period of lockdown due to the COVID‐19 pandemic in the United Kingdom. This may indicate that playing a critical role in society during an episode of crisis, and acting to help others, may be protective of one's own mental health.The research also provides an optimistic view of the psychological resilience of critical first responders and health care workers during a period early on in the COVID‐19 pandemic (June–July 2020). This highlights the benefits of fostering resilience in those working within high‐risk first responder and health care occupations. [ABSTRACT FROM AUTHOR]

Background: The laws governing abortion access vary across Europe. Even in countries with relatively liberal laws, numerous barriers to abortion access exist. In response to these barriers, evidence suggests that people living in countries with both restrictive and liberal laws travel outside of their home country for abortion care. England and Wales are common destinations for those who travel to seek abortions, but little is known about the motivations and experiences of those who undertake cross-country travel to England or Wales to obtain care. This paper aims to describe the abortion seeking and travel experiences of women and pregnant people who traveled to England and Wales for an abortion between 2017 and 2019. Methods: We recruited 97 participants who had traveled cross-country from both liberal and restrictive contexts to seek abortion care at three participating BPAS clinics in England and Wales. Participants completed an electronic survey about their reproductive histories, abortion decision-making, experiences seeking abortion care, and traveling. We conducted a descriptive analysis, and include comparisons between participants who traveled from liberal and restrictive contexts. Results: Over a third of participants considered abortion four weeks or more before presenting for care at BPAS, and around two-thirds sought abortion services in their home country before traveling. The majority of participants indicated that they would have preferred to have obtained an abortion earlier and cited reasons including scheduling issues, a dearth of local services, delayed pregnancy recognition, and financial difficulties as causing their delay. About seventy percent of participants reported travel costs between €101–1000 and 75% of participants reported that the cost of the abortion procedure exceeded €500. About half of participants indicated that, overall, their travel was very or somewhat difficult. Conclusions: This analysis documents the burdens associated with cross-country travel for abortion and provides insight into the factors that compel people to travel. Our findings highlight the need for expanded access to abortion care throughout Europe via the removal of legal impediments and other social or procedural barriers. Removing barriers would eliminate the need for cumbersome abortion travel, and ensure that all people can obtain necessary, high-quality healthcare in their own communities. Plain language summary: In Europe, people who live in countries where abortion is severely restricted or illegal altogether lack access to abortion care entirely, but even people who live in countries with more liberal laws face barriers due to gestational age limits, waiting periods, and a lack of trained and willing providers. Existing evidence suggests that restrictions and barriers compel people from both countries with restrictive laws as well as those from countries with more liberal laws to travel outside of their home country for abortion services. England and Wales are common destinations for people traveling within Europe to obtain abortion services, but little is known about the experiences of these travelers. We surveyed individuals who had traveled from another country to seek abortion services in England or Wales. Our analysis documents that many participants contemplated getting an abortion and sought care in their home countries before traveling. Likewise, many participants indicated that they would have preferred to have obtained an abortion earlier in their pregnancy, and referenced scheduling issues, a dearth of local services, delayed pregnancy recognition, and financial difficulties as causing their delay. A majority of participants indicated that covering the costs of their abortion, and the costs of travel was difficult, and that the travel experience in its entirety was difficult. Our findings document the reasons for, and burdens associated with abortion travel and highlight the need to expand access to abortion across Europe via the elimination of all legal restrictions and impediments. [ABSTRACT FROM AUTHOR]

Background: The laws governing abortion access vary across Europe. Even in countries with relatively liberal laws, numerous barriers to abortion access exist. In response to these barriers, evidence suggests that people living in countries with both restrictive and liberal laws travel outside of their home country for abortion care. England and Wales are common destinations for those who travel to seek abortions, but little is known about the motivations and experiences of those who undertake cross-country travel to England or Wales to obtain care. This paper aims to describe the abortion seeking and travel experiences of women and pregnant people who traveled to England and Wales for an abortion between 2017 and 2019. Methods: We recruited 97 participants who had traveled cross-country from both liberal and restrictive contexts to seek abortion care at three participating BPAS clinics in England and Wales. Participants completed an electronic survey about their reproductive histories, abortion decision-making, experiences seeking abortion care, and traveling. We conducted a descriptive analysis, and include comparisons between participants who traveled from liberal and restrictive contexts. Results: Over a third of participants considered abortion four weeks or more before presenting for care at BPAS, and around two-thirds sought abortion services in their home country before traveling. The majority of participants indicated that they would have preferred to have obtained an abortion earlier and cited reasons including scheduling issues, a dearth of local services, delayed pregnancy recognition, and financial difficulties as causing their delay. About seventy percent of participants reported travel costs between €101–1000 and 75% of participants reported that the cost of the abortion procedure exceeded €500. About half of participants indicated that, overall, their travel was very or somewhat difficult. Conclusions: This analysis documents the burdens associated with cross-country travel for abortion and provides insight into the factors that compel people to travel. Our findings highlight the need for expanded access to abortion care throughout Europe via the removal of legal impediments and other social or procedural barriers. Removing barriers would eliminate the need for cumbersome abortion travel, and ensure that all people can obtain necessary, high-quality healthcare in their own communities. Plain language summary: In Europe, people who live in countries where abortion is severely restricted or illegal altogether lack access to abortion care entirely, but even people who live in countries with more liberal laws face barriers due to gestational age limits, waiting periods, and a lack of trained and willing providers. Existing evidence suggests that restrictions and barriers compel people from both countries with restrictive laws as well as those from countries with more liberal laws to travel outside of their home country for abortion services. England and Wales are common destinations for people traveling within Europe to obtain abortion services, but little is known about the experiences of these travelers. We surveyed individuals who had traveled from another country to seek abortion services in England or Wales. Our analysis documents that many participants contemplated getting an abortion and sought care in their home countries before traveling. Likewise, many participants indicated that they would have preferred to have obtained an abortion earlier in their pregnancy, and referenced scheduling issues, a dearth of local services, delayed pregnancy recognition, and financial difficulties as causing their delay. A majority of participants indicated that covering the costs of their abortion, and the costs of travel was difficult, and that the travel experience in its entirety was difficult. Our findings document the reasons for, and burdens associated with abortion travel and highlight the need to expand access to abortion across Europe via the elimination of all legal restrictions and impediments. [ABSTRACT FROM AUTHOR]

Background: The system of secure care for young people in England and Wales comprises youth justice, welfare and mental health facilities. Empirical studies have failed to investigate the system as a whole. The National Adolescent Study in 2016 was the first to provide comprehensive system wide information. This paper, derived from that data set, addresses equity of service provision for young men and women in secure care who have mental health problems. Methods: The detained census population of English young people in 2016 was 1322 and detailed data were available on 93% of this population, including 983 young men and 290 young women. The descriptive census data were interrogated to identify associations between gender, other sociodemographic and clinical variables, using Chi-square and Fisher's exact tests. Results: Numerically more young men in secure care than young women in secure care warrant a psychiatric diagnosis but young women had a 9 fold increase in the odds of having a diagnosis compared with the young men. The pattern of mental health diagnoses differed significantly by gender as did the legislative framework under which females and males were placed. This different pattern of secure care placement continued to differ by gender when the nature of the mental health diagnosis was taken into account. Conclusions: No definitive explanation is evident for the significantly different placement patterns of young men and young women with the same mental health diagnoses, but the anticipated consequences for some, young men and some young women are important. Proper explanation demands an examination of process variables outwith the remit of this study. The lack of routine scrutiny and transparent processes across secure settings could be responsible for the development of these differential placement practices; these practices seem at odds with the duty placed on public services by the Equality Act. [ABSTRACT FROM AUTHOR]

The Glastir Monitoring and Evaluation Programme (GMEP) ran from 2013 until 2016 and was probably the most comprehensive programme of ecological study ever undertaken at a national scale in Wales. The programme aimed to (1) set up an evaluation of the environmental effects of the Glastir agri-environment scheme and (2) quantify environmental status and trends across the wider countryside of Wales. The focus was on outcomes for climate change mitigation, biodiversity, soil and water quality, woodland expansion, and cultural landscapes. As such, GMEP included a large field-survey component, collecting data on a range of elements including vegetation, land cover and use, soils, freshwaters, birds, and insect pollinators from up to three-hundred 1 km survey squares throughout Wales. The field survey capitalised upon the UK Centre for Ecology & Hydrology (UKCEH) Countryside Survey of Great Britain, which has provided an extensive set of repeated, standardised ecological measurements since 1978. The design of both GMEP and the UKCEH Countryside Survey involved stratified-random sampling of squares from a 1 km grid, ensuring proportional representation from land classes with distinct climate, geology and physical geography. Data were collected from different land cover types and landscape features by trained professional surveyors, following standardised and published protocols. Thus, GMEP was designed so that surveys could be repeated at regular intervals to monitor the Welsh environment, including the impacts of agri-environment interventions. One such repeat survey is scheduled for 2021 under the Environment and Rural Affairs Monitoring & Modelling Programme (ERAMMP). Data from GMEP have been used to address many applied policy questions, but there is major potential for further analyses. The precise locations of data collection are not publicly available, largely for reasons of landowner confidentiality. However, the wide variety of available datasets can be (1) analysed at coarse spatial resolutions and (2) linked to each other based on square-level and plot-level identifiers, allowing exploration of relationships, trade-offs and synergies. This paper describes the key sets of raw data arising from the field survey at co-located sites (2013 to 2016). Data from each of these survey elements are available with the following digital object identifiers (DOIs): Landscape features (Maskell et al., 2020a–c), https://doi.org/10.5285/82c63533-529e-47b9-8e78-51b27028cc7f , https://doi.org/10.5285/9f8d9cc6-b552-4c8b-af09-e92743cdd3de , https://doi.org/10.5285/f481c6bf-5774-4df8-8776-c4d7bf059d40 ; Vegetation plots (Smart et al., 2020), https://doi.org/10.5285/71d3619c-4439-4c9e-84dc-3ca873d7f5cc ; Topsoil physico-chemical properties (Robinson et al., 2019), https://doi.org/10.5285/0fa51dc6-1537-4ad6-9d06-e476c137ed09 ; Topsoil meso-fauna (Keith et al., 2019), https://doi.org/10.5285/1c5cf317-2f03-4fef-b060-9eccbb4d9c21 ; Topsoil particle size distribution (Lebron et al., 2020), https://doi.org/10.5285/d6c3cc3c-a7b7-48b2-9e61-d07454639656 ; Headwater stream quality metrics (Scarlett et al., 2020a), https://doi.org/10.5285/e305fa80-3d38-4576-beef-f6546fad5d45 ; Pond quality metrics (Scarlett et al., 2020b), https://doi.org/10.5285/687b38d3-2278-41a0-9317-2c7595d6b882 ; Insect pollinator and flower data (Botham et al., 2020), https://doi.org/10.5285/3c8f4e46-bf6c-4ea1-9340-571fede26ee8 ; and Bird counts (Siriwardena et al., 2020), https://doi.org/10.5285/31da0a94-62be-47b3-b76e-4bdef3037360. [ABSTRACT FROM AUTHOR]

Background: Health Impact Assessment (HIA) is promoted as a decision-informing tool by public health and governmental agencies. HIA is beneficial when carried out as part of policy development but is also valuable as a methodology when a policy is being implemented to identify and understand the wider health and well-being impacts of policy decisions, particularly when a decision needs to be taken rapidly to protect the population. This paper focusses on a HIA of the 'Staying at Home and Social Distancing Policy' or 'lockdown' in response to the COVID-19 pandemic in Wales conducted by the Welsh national public health institute. It describes the process and findings, captures the learning and discusses how the process has been used to better understand the wider health and well-being impacts of policy decisions beyond direct health harm. It also examines the role of public health institutes in promoting and using HIA.Methods: A HIA was conducted following a standard HIA five step process. A literature review was undertaken alongside 15 qualitative semi-structured interviews with key stakeholders, and relevant health and demographic data were collated. The results were triangulated and analysed to form a holistic assessment of the policy decision and its impacts.Results: A wide range of major health and well-being impacts of the lockdown in Wales were identified across the determinants of health, which included positive and negative social, economic, environmental and mental well-being impacts beyond the impact on direct health. Populations affected included children and young people, those on low incomes and women as well as those whose health has been directly impacted by COVID-19 such as older people. The work highlighted the benefit that HIA can bring in emphasizing impacts which can inform policy and shared learning with others.Conclusion: HIA is a largely underused tool to understand the impact of policy and political decisions, particularly when a decision has been taken at speed. This case study highlights how HIA provide evidence and information for advocacy and further work by public health institutes, health agencies and policy makers. [ABSTRACT FROM AUTHOR]

During the first wave of the COVID‐19 pandemic, management authorities of numerous Protected Areas (PAs) had to discourage visitors from accessing them in order to reduce the virus transmission rate and protect local communities. This resulted in social–ecological impacts and added another layer of complexity to managing PAs. This paper presents the results of a survey in Snowdonia National Park capturing the views of over 700 local residents on the impacts of COVID‐19 restrictions and possible scenarios and tools for managing tourist numbers. Lower visitor numbers were seen in a broadly positive way by a significant number of respondents while benefit sharing issues from tourism also emerged. Most preferred options to manage overcrowding were restricting access to certain paths, the development of mobile applications to alert people to overcrowding and reporting irresponsible behavior. Our findings are useful for PA managers and local communities currently developing post‐COVID‐19 recovery strategies. [ABSTRACT FROM AUTHOR]

Background: The laws governing abortion access vary across Europe. Even in countries with relatively liberal laws, numerous barriers to abortion access exist. In response to these barriers, evidence suggests that people living in countries with both restrictive and liberal laws travel outside of their home country for abortion care. England and Wales are common destinations for those who travel to seek abortions, but little is known about the motivations and experiences of those who undertake cross-country travel to England or Wales to obtain care. This paper aims to describe the abortion seeking and travel experiences of women and pregnant people who traveled to England and Wales for an abortion between 2017 and 2019. Methods: We recruited 97 participants who had traveled cross-country from both liberal and restrictive contexts to seek abortion care at three participating BPAS clinics in England and Wales. Participants completed an electronic survey about their reproductive histories, abortion decision-making, experiences seeking abortion care, and traveling. We conducted a descriptive analysis, and include comparisons between participants who traveled from liberal and restrictive contexts. Results: Over a third of participants considered abortion four weeks or more before presenting for care at BPAS, and around two-thirds sought abortion services in their home country before traveling. The majority of participants indicated that they would have preferred to have obtained an abortion earlier and cited reasons including scheduling issues, a dearth of local services, delayed pregnancy recognition, and financial difficulties as causing their delay. About seventy percent of participants reported travel costs between €101–1000 and 75% of participants reported that the cost of the abortion procedure exceeded €500. About half of participants indicated that, overall, their travel was very or somewhat difficult. Conclusions: This analysis documents the burdens associated with cross-country travel for abortion and provides insight into the factors that compel people to travel. Our findings highlight the need for expanded access to abortion care throughout Europe via the removal of legal impediments and other social or procedural barriers. Removing barriers would eliminate the need for cumbersome abortion travel, and ensure that all people can obtain necessary, high-quality healthcare in their own communities. Plain language summary: In Europe, people who live in countries where abortion is severely restricted or illegal altogether lack access to abortion care entirely, but even people who live in countries with more liberal laws face barriers due to gestational age limits, waiting periods, and a lack of trained and willing providers. Existing evidence suggests that restrictions and barriers compel people from both countries with restrictive laws as well as those from countries with more liberal laws to travel outside of their home country for abortion services. England and Wales are common destinations for people traveling within Europe to obtain abortion services, but little is known about the experiences of these travelers. We surveyed individuals who had traveled from another country to seek abortion services in England or Wales. Our analysis documents that many participants contemplated getting an abortion and sought care in their home countries before traveling. Likewise, many participants indicated that they would have preferred to have obtained an abortion earlier in their pregnancy, and referenced scheduling issues, a dearth of local services, delayed pregnancy recognition, and financial difficulties as causing their delay. A majority of participants indicated that covering the costs of their abortion, and the costs of travel was difficult, and that the travel experience in its entirety was difficult. Our findings document the reasons for, and burdens associated with abortion travel and highlight the need to expand access to abortion across Europe via the elimination of all legal restrictions and impediments. [ABSTRACT FROM AUTHOR]

Population researchers have contributed to the debate on minority group distribution and disadvantage and social cohesion by providing objective analysis. A plethora of new distribution measurement techniques have been presented in recent years, but they have not provided sufficient explanatory power of underlying trajectories to inform ongoing political debate. Indeed, a focus on trying to summarise complex situations with readily understood measures may be misplaced. This paper takes an alternative approach and asks whether a more detailed analysis of individual and environmental characteristics is necessary if researchers are to continue to provide worthwhile input to policy development. Using England and Wales as a test bed, it looks at four small sub-populations (circa 250,000 at the turn of the century) - two based on ethnic grouping: Bangladeshi and Chinese; and two based on an under-researched area of cultural background, religion: Jews and Sikhs. Despite major differences in longevity of presence in the UK, age profile, socio-economic progress, and levels of inter-marriage, there are, at a national level, parallels in the distribution patterns and trajectories for three of the groups. However, heterogeneity between and within the groups mean that at a local level, these similarities are confounded. The paper concludes that complex interactions between natural change and migration, and between suburbanisation and a desire for group congregation, mean that explanations for the trajectory of distribution require examination of data at a detailed level, beyond the scope of index-based methods. Such analyses are necessary if researchers are to effectively contribute to future policy development. [ABSTRACT FROM AUTHOR]

The Glastir Monitoring and Evaluation Programme (GMEP) ran from 2013 until 2016, and was probably the most comprehensive programme of ecological study ever undertaken at a national scale in Wales. The programme aimed to (1) set up an evaluation of the environmental effects of the Glastir agri-environment scheme and (2) quantify environmental status and trends across the wider countryside of Wales. The focus was on outcomes for climate change mitigation, biodiversity, soil and water quality, woodland expansion and cultural landscapes. As such, GMEP included a large field survey component, collecting data on a range of elements including vegetation, land cover and use, soils, freshwaters, birds and insect pollinators from up to 300 1 km squares throughout Wales. The field survey capitalised upon the UKCEH Countryside Survey of Great Britain, which has provided an extensive set of repeated, standardised ecological measurements since 1978. The design of both GMEP and the UKCEH Countryside Survey involved stratified-random sampling of squares from a 1 km grid, ensuring proportional representation from land classes with distinct climate, geology and physical geography. Data were collected from different land cover types and landscape features by trained professional surveyors, following standardised and published protocols. Thus, GMEP was designed so that surveys could be repeated at regular intervals to monitor the Welsh environment, including the impacts of agri-environment interventions. One such repeat survey is scheduled for 2021 under the Environment and Rural Affairs Monitoring and Modelling Programme (ERAMMP). Data from GMEP have been used to address many applied policy questions, but there is major potential for further analyses. The precise locations of data collection are not publicly available, largely for reasons of landowner confidentiality. However, the wide variety of available datasets can be (1) analysed at coarse spatial resolutions and (2) linked to each other based on square-level and plot-level identifiers, allowing exploration of relationships, trade-offs and synergies. This paper describes the key sets of raw data arising from the field survey at co-located sites, 2013 to 2016. Data from each of these survey elements are available with the following Digital Object Identifiers. Landscape features, https://doi.org/10.5285/82c63533-529e-47b9-8e78-51b27028cc7f, https://doi.org/10.5285/9f8d9cc6-b552-4c8b-af09-e92743cdd3de, https://doi.org/10.5285/f481c6bf-5774-4df8-8776-c4d7bf059d40; Vegetation plots, https://doi.org/10.5285/71d3619c-4439-4c9e-84dc-3ca873d7f5cc; Topsoil physico-chemical properties, https://doi.org/10.5285/0fa51dc6-1537-4ad6-9d06-e476c137ed09; Topsoil meso-fauna, https://doi.org/10.5285/1c5cf317-2f03-4fef-b060-9eccbb4d9c21; Topsoil particle size distribution https://doi.org/10.5285/d6c3cc3c-a7b7-48b2-9e61-d07454639656; Headwater stream quality metrics, https://doi.org/10.5285/e305fa80-3d38-4576-beef-f6546fad5d45 ; Pond quality metrics, https://doi.org/10.5285/687b38d3-2278-41a0-9317-2c7595d6b882; Insect pollinator and flower data, https://doi.org/10.5285/3c8f4e46-bf6c-4ea1-9340-571fede26ee8; Bird counts, https://doi.org/10.5285/31da0a94-62be-47b3-b76e-4bdef3037360. [ABSTRACT FROM AUTHOR]