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This paper presents the first spatial analysis of racial disparities in the UK welfare sanction regime. As part of their austerity programme, the UK government tightened the conditionality of welfare programmes and intensified the use of financial penalties against welfare claimants who failed to demonstrate compliance with these conditions. Analysing Jobseeker's Allowance (JSA) data from the Department of Work and Pensions (DWP) and the Office for National Statistics between 2012 and 2019 we draw attention to the spatially uneven and highly racialised geography of welfare sanctions in England. Claimants from racially minoritised backgrounds are consistently more likely to be referred for a sanction by Jobcentre caseworkers and receive an adverse decision at the hands of institutional decision‐makers. Within this, however, there are important scalar and spatial differences that warrant critical attention. In rural England, the risk of being sanctioned is substantially higher for all groups, but especially for Mixed heritage and Black/Black British claimants who in some areas are over twice as likely to be sanctioned as their White counterparts. Since ethnicity data have not been published for Universal Credit sanction decisions, the presented evidence offers critical insight into the potential persistence of racial injustice in applying welfare sanctions. We identify 'hotspots' of racism in the sanction regime, most of which are in rural areas, before offering three interpretative frameworks through which spatial and racial disparities might be explained. Any suggestion that such disparities simply derive from the behaviour of DWP staff fails to adequately account for deeply entrenched histories of welfare racism, rural racism and the role of welfare sanctioning in dynamics of racial capitalism: that is, disciplining and impoverishing racialised populations in ways that generate conditions for capital accumulation. By contributing new empirical and theoretical insights to the often neglected study of rural austerity and welfare, the paper calls for scholarship to investigate the variegations of welfare, austerity and racial capitalism in diverse rural contexts. [ABSTRACT FROM AUTHOR]

My Kidneys & Me (MK&M), a digital health intervention delivering specialist health and lifestyle education for people with CKD, was developed and its effects tested (SMILE-K trial, ISRCTN18314195, 18/12/2020). 420 adult patients with CKD stages 3–4 were recruited and randomised 2:1 to intervention (MK&M) (n = 280) or control (n = 140) groups. Outcomes, including Patient Activation Measure (PAM-13), were collected at baseline and 20 weeks. Complete case (CC) and per-protocol (PP) analyses were conducted. 210 (75%) participants used MK&M more than once. PAM-13 increased at 20 weeks compared to control (CC: +3.1 (95%CI: −0.2 to 6.4), P = 0.065; PP: +3.6 (95%CI: 0.2 to 7.0), P = 0.041). In those with low activation at baseline, significant between-group differences were observed (CC: +6.6 (95%CI: 1.3 to 11.9), P = 0.016; PP: +9.2 (95%CI: 4.0 to 14.6), P < 0.001) favouring MK&M group. MK&M improved patient activation in those who used the resource compared to standard care, although the overall effect was non-significant. The greatest benefits were seen in those with low activation. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to explore and map Safeguarding Adults England data for 2022–2023 by local authority to enable identification and exploration of any differences between local authorities. Design/methodology/approach: Colour symbology maps were produced to enable visual analysis of safeguarding concerns and Section 42 enquiries per 100,000 of the population, as well as the conversion of safeguarding concerns to Section 42 enquiries. Statistical hotspots were calculated using the Getis-Ord Gi* for Section 42 enquiries per 100,000 of the population across age classes. Findings: Findings show regional differences across England in terms of the number of documented concerns, Section 42's and conversion rates. Some regions had statistically higher or lower Section 42 enquiries per 100,000 of population across age classes compared to their bordering geographical neighbours. Reflections on these findings lead to a series of recommendations. Originality/value: This paper addresses a need to explore further and analyse adult safeguarding data to inform practice, through choropleth mapping. [ABSTRACT FROM AUTHOR]

The core function of joint registries is to collect, collate, and present data about patients who undergo joint replacement surgery, and afford clinicians and administrators a range of analytic functions to monitor service performance. This article describes the development, evolution, and future of arthroplasty registries, drawing particularly from the experience of the Scottish Arthroplasty Project (SAP). The SAP was established in 1999 and is one of the oldest arthroplasty registries in the world. It collects information on patients undergoing hip, knee, ankle, shoulder, and elbow arthroplasty. The primary aim is to encourage continual improvement in the quality of care provided for arthroplasty patients in Scotland. It is distinct in terms of administration and methodology from the National Joint Registry (NJR) of England, Wales, and Northern Ireland as it monitors patients rather than implants. Since its inception, its work has contributed to a reduction in overall complication rates and a significant decrease in hospital length of stay for the growing number of patients undergoing arthroplasty. It continues to provide a robust database that is used to underpin national guidance through data-driven research. The research carried out by dedicated SAP fellows has enhanced the research portfolio of the SAP and raised its profile through high quality peer-reviewed publications. The SAP continues to evolve and by collaborating with other Scottish registries it will provide larger datasets containing greater diversity and granularity of information. These developments as well as ongoing analysis of existing areas ensure that the SAP continues to maintain and improve standards in arthroplasty across Scotland. [ABSTRACT FROM AUTHOR]

Background: Cardiac rehabilitation (CR) services aim to improve heart disease patients' health and quality of life and reduce the risk of further cardiac events. Depression and anxiety are common among CR patients but psychological treatments have usually had small effects. In contrast, the recent NIHR-funded PATHWAY trial found that group Metacognitive Therapy (MCT) was associated with improvements in anxiety and depression when added to CR and was more effective than usual CR alone. The next stage is to test implementation of MCT within the National Health Service through the creation of a network of CR beacon sites. The study will test the quality of data capture following addition of a new MCT data-field to the national audit of cardiac rehabilitation (NACR), examine level of adoption at sites, examine mental health outcomes benchmarked against usual CR and the PATHWAY data, examine the enablers and barriers to implementation and the expected resource requirements. The study has been registered: NCT05956912 (13th July, 2023). Methods: Beacon sites will be recruited as preliminary adopters of group MCT from NHS CR services in England. A national invitation for expressions of interest from CR services will be issued and those meeting eligibility criteria will be considered for inclusion. Two staff at each site will receive training in MCT, and mixed-methods will be used to address questions concerning the quality of patient data recorded, level of adoption at sites, the characteristics of patients attending MCT, the impact of adding MCT to CR on mental health outcomes, and patient, healthcare staff and commissioner views of barriers/enablers to implementation. Exploration of implementation will be informed by Normalisation Process Theory. Discussion: The study will support development of an NHS roll-out strategy, assess the mental health outcomes associated with MCT, examine treatment fidelity in real-world settings, and evaluate revised data collection structures that can be used to assess the impact of national-level implementation. [ABSTRACT FROM AUTHOR]

Background Social isolation and loneliness are associated with increased risk of adverse health outcomes at older ages. This study evaluated whether isolation and loneliness are related to inadequate intake of micronutrients in the diet. Methods We tested associations between social isolation and loneliness and dietary micronutrient intake 2 years later in 3713 men and women (mean age 68.26, standard deviation 7.81 years) who completed two online 24-h dietary recalls. Associations of isolation and loneliness with intake of nine minerals and vitamins that fell below national recommendations were tested using logistic regressions, adjusting for age, gender, ethnicity, education, marital status, smoking and physical activity and total energy intake. Results The prevalence of low dietary intake varied markedly across micronutrients. Social isolation (1-point increase in a score ranging 0–5) was associated with increased odds (adjusted for covariates) of low intake of magnesium [odds ratio (OR) 1.153, 95% confidence interval (CI) 1.037–1.282, P  = .009], potassium (OR 1.201, 95% CI 1.087–1.327, P  < .001), vitamin B6 (OR 1.263, 95% CI 1.110–1.438, P  < .001), folate (OR 1.211, 95% CI 1.093–1.341, P  < .001) and vitamin C (OR 1.238, 95% CI 1.098–1.394, P  < .001). These associations remained unchanged when food insecurity and impaired activities of daily living were taken into account. By contrast, loneliness was not related to the inadequate intake of any micronutrient. Conclusions Low intake of micronutrients increases risk of age-related health problems. Attention to the dietary quality of older people with limited social contacts and little involvement in community activities might enhance health outcomes. [ABSTRACT FROM AUTHOR]

Objectives This study evaluated the scale-up of a remote monitoring service, capturing monthly Rheumatoid Arthritis Impact of Disease scores and patient-generated text messages, for patients with rheumatoid arthritis (RA; in remission or with low disease activity) attending routine outpatient clinics across six hospitals. We explored patients and staff experiences and implementation outcomes. Methods A pragmatic, mixed methods approach was used, with active patient involvement throughout. We undertook a rapid review, analysed service-level data, and conducted a patient survey and patient and staff interviews, informed by the Capability, Opportunity, Motivation, Behaviour (COM-B) and Exploration, Preparation, Implementation, Sustainment (EPIS) theoretical frameworks. Results The review included 37 articles, covering themes of patient and clinician acceptability, engagement, feasibility and clinical impact. Service-level data (n  = 202) showed high levels of patient engagement with the service. The patient survey (n  = 155) showed patients felt the service was easy to use, had confidence in it and felt it improved access to care. Patient interview (n  = 22) findings mirrored those of the survey. Motivating factors included increased responsiveness and ease of contact with clinical teams. Views from staff interviews (n  = 16) were more mixed. Some implementation barriers were specific to roll-out sites. Prioritization of staff needs was emphasized. Conclusion Patients were positive about the service and engagement was high. Staff views and engagement were more mixed. Results suggest that equal levels of patient and staff engagement are required for sustainability. These findings further our understanding of the implementation challenges to scaling remote monitoring interventions for patients with rheumatoid arthritis in routine care settings. [ABSTRACT FROM AUTHOR]

Background: Despite increasing evidence of the potential inaccuracy and unwarranted practice of regular GRV measurement in critically in adults, this practice persists within the United Kingdom. Aim: To explore adult intensive care nurses' decision‐making around the practice of GRV measurement to guide enteral feeding. Study Design: A cross‐sectional 16 item electronic survey in four adult intensive care units (ICUs) in England and Wales. Results: Two hundred and seventy‐three responses were obtained across four ICUs with acceptable response rates for most [Unit 1 74 /127 = 58.2%; Unit 2 87/129 = 67.4%; Unit 3 77/120 = 64.1%; Unit 4 35/168 = 20.8%]. Most (243/273 (89%) reported measuring GRV 4–6 hourly, with most (223/273 82%) reporting that the main reason was to assess feed tolerance or intolerance and 37/273 (13.5%) saying their unit protocol required it. In terms of factors affecting decision‐making, volume obtained was the most important factor, followed by the condition of the patient, with aspirate colour and appearance less important. When asked how they would feel about not measuring GRV routinely, the majority (78.2%) of nurses felt worried (140/273 = 51.2%) or very worried (74/273 = 27%). Conclusions: Factors affecting the nurses' decision‐making around GRV were based largely on fear of risk (around vomiting and pulmonary aspiration) and compliance with unit protocols. Relevance to Clinical Practice: Despite increasing evidence suggesting it is unnecessary, nurses' beliefs around the value of this practice persist and it continues to be embedded into unit protocols around feeding. [ABSTRACT FROM AUTHOR]

This paper explores the ways in which working-class boys negotiated the content and delivery of physical education at a 'typical', white working-class secondary school located in the north of England. The study utilised a quasi-ethnographical case-study design conducted over a non-continuous three-month period involving covert and overt participant observation, guided conversations, and group interviews. A total of 48 key stage 4 (Year 10 and 11) male pupils were selected to take part in eight focus groups following the observation of approximately 340 key stage four (KS4) pupils in PE lessons. The data revealed that the vast majority of these male pupils arrived at the school with a narrow sporting repertoire as result of the upbringings and lifestyles made up of 'traditional' working-class activities such as football and fishing. Their strong predisposition for recreational involvement in these activities impacted directly on what the young males would, and could, do during PE at school and in this way were able to influence (to lesser and greater degrees) the content and delivery of their PE experiences. The findings of the study, therefore, go some way explaining how PE in many working-class secondary schools may come to influence the long standing, class-related adult participation anomalies that continue to exist in the UK. [ABSTRACT FROM AUTHOR]

Background: Shared housing for adults with intellectual disabilities with staff support, is a common housing model internationally. We explored an overlooked aspect of group homes, namely the extent to which they enable a sense of 'feeling at home' for residents. Method: A diverse group of 19 housemates participated in a photovoice study. Participants took photos in their homes and discussed them in individual interviews and in groups. Data was analysed using reflexive thematic analysis. Results: Residents' experience of home was multi‐dimensional. 'Feeling at home' related to home as a site of identity cultivation (personal home); physical comfort or 'misfitting' (physical home) and home as the locus of key relationships (social home). Conclusion: Achieving a sense of 'feeling at home' requires engagement in practices of home‐making. Many of our participants required support from staff to engage in these practices. For some housemates their experience of home was conditional and precarious. [ABSTRACT FROM AUTHOR]

Background During the 1997–2010 Labour government, several policies were implemented to narrow health inequalities as part of a national health inequalities strategy. Many of these policies are likely to have had a disproportionately large impact on people aged 65 and over. We aimed to understand the association between the health inequalities strategy period and inequalities in mortality at age 65–69. Methods We use population at risk and mortality data covering 1991–2019 to calculate mortality rate at age 65–69 at the Local Authority level. We use the 2019 Index of Multiple Deprivation to examine geographical inequalities. We employ segmented linear regression models with marginal spline terms for the strategy period and interact these with an indicator of deprivation to understand how inequalities changed before, during and after the strategy. The reporting of this study adheres to STROBE guidelines. Results Mortality rates in each deprivation quintile improved continuously throughout the period of study. Prior to the programme (1991–9) there was no significant change in absolute inequalities. However, during the strategy (2000–10) there was a significant decrease in absolute inequalities of −9.66 (−17.48 to −1.84). The period following the strategy (2011–19) was associated with a significant increase in absolute inequalities of 12.84 (6.60 to 19.08). Our results were robust to a range of sensitivity tests. Conclusion The English health inequalities strategy was associated with a significant reduction in absolute inequality in mortality age 65–69. Future strategies to address inequalities in ageing populations may benefit from adopting a similar approach. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to understand the impact of pain management programmes, focusing on the unwanted effects and their influence on patients' long-term use of self-management strategies. Design: Qualitative study. Setting: Specialist musculoskeletal hospital in North London, England. Participants: Patients with chronic musculoskeletal pain that have completed a pain management programme. Intervention: Multidisciplinary pain management programmes. Main measures: Data were collected regarding patients' experiences and unwanted effects from the pain management programme using semi-structured interviews. Data were analysed using thematic analysis. Results: Fourteen participant interviews were included in the analysis (median age 54 years, 12 females). Four themes were generated from the data: Benefits and burdens, Pain management programme and real life, Social support and Healthcare interventions. Unwanted effects included heightened anxiety related to negative interactions with peers, being in a new environment, worries about ability to cope with the programme, social anxiety from being in a group, the strain on families due to participants being away from home and a sense of abandonment at end of the programme. Burdens associated with implementing pain management strategies were identified, including the emotional burden of imposing their self-management on close family and competing demands with time and energy spent on self-management at the expense of work or home commitments. Conclusions: Pain management programmes have an important role in helping patients to learn how to self-manage chronic pain. Their unwanted effects and the treatment burdens associated with long-term self-management may be an important consideration in improving the longevity of their beneficial effects. [ABSTRACT FROM AUTHOR]

This article considers the visual symbolism of policing as reflected by the presence or absence of police stations. The focus is England where recent years have witnessed a prolonged period of police station closure. The article draws on interviews with police estate managers and considers their reasons given for closure and consequent impact on visibility. The discussion is influenced by visual criminology and semiotics, as well as the concept of the abstract police developed by Jan Terpstra and colleagues, that police officers are now more abstract from the communities they serve, and from each other. Station closure was explained as being due to austerity, but also the unsuitability of 'legacy' buildings, changes in demand, and changes in police models. In these contexts, some closures may seem appropriate with public engagement maintained online. Moreover, poor community relations mean some may prefer not to have a local station. Yet, we argue that the visual presence or absence of a local police station can be read semiotically as a symbol of the police's investment, or conversely lack of interest, in the community. The significance of these debates is discussed. [ABSTRACT FROM AUTHOR]

Populations of anadromous brown trout, also known as sea trout, have suffered recent marked declines in abundance due to multiple factors, including climate change and human activities. While much is known about their freshwater phase, less is known about the species' marine feeding migrations. This situation is hindering the effective management and conservation of anadromous trout in the marine environment. Using a panel of 95 single nucleotide polymorphism markers we developed a genetic baseline, which demonstrated strong regional structuring of genetic diversity in trout populations around the English Channel and adjacent waters. Extensive baseline testing showed this structuring allowed high‐confidence assignment of known‐origin individuals to region of origin. This study presents new data on the movements of anadromous trout in the English Channel and southern North Sea. Assignment of anadromous trout sampled from 12 marine and estuarine localities highlighted contrasting results for these areas. The majority of these fisheries are composed predominately of stocks local to the sampling location. However, there were multiple cases of long‐distance movements of anadromous trout, with several individuals originating from rivers in northeast England being caught in the English Channel and southern North Sea, in some cases more than 1000 km from their natal region. These results have implications for the management of sea trout in inshore waters around the English Channel and southern North Sea. [ABSTRACT FROM AUTHOR]

Aim: The British Isles have been worked for millennia to extract metal ores to feed industrial development, leaving a legacy of mine water pollution that continues to impact freshwater communities in many regions. Brown trout (Salmo trutta L.) have long been observed to persist in these metal‐impacted systems as apex predators, with previous studies showing a small number of impacted populations to be highly genetically divergent. We sought to understand the scale of genetic diversity across regions and the repeatability of genetic divergence in trout populations affected by metal pollution. Location: We examined four mine water‐impacted regions across the British Isles: west Wales, northeast England, southwest England and southeast Ireland. Methods: We employed a panel of 95 SNP loci to screen 1236 individuals from 71 sites representing paired metal‐impacted and clean sites from across the four regions. From these, we obtained diversity statistics, assessed genetic structuring of populations and modelled historical demographic scenarios to understand which factors most credibly explain genetic variation in divergent populations. Results: We evidenced hierarchical population structure in the regions studied, in line with expectations from phylogeographic history. However, in a hierarchical analysis of genetic structuring the first level of differentiation was driven by the divergence of the metal‐impacted trout of Cornwall in southwest England. Within regions we observed reduced genetic diversity and repeated patterns of local genetic sub‐structuring between paired samples from metal‐impacted and relatively clean sites. Demographic history analyses suggested the timing of these splits to be relatively recent and to be associated with periods of peak mining activity. Main conclusions: Our findings demonstrate distinct patterns of genetic isolation and reduced diversity arising from legacy pollution in freshwater ecosystems, with impacts being most apparent where both chemical pollution and physical barriers are present. Management should focus on the amelioration of mine water wash‐out and the removal of barriers to fish movement to safeguard genetic diversity in impacted populations. [ABSTRACT FROM AUTHOR]

Aims: The COVID‐19 pandemic caused significant disruption to routine activity in primary care. Medication reviews are an important primary care activity ensuring safety and appropriateness of prescribing. A disruption could have significant negative implications for patient care. Using routinely collected data, our aim was first to describe codes used to record medication review activity and then to report the impact of COVID‐19 on the rates of medication reviews. Methods: With the approval of NHS England, we conducted a cohort study of 20 million adult patient records in general practice, in‐situ using the OpenSAFELY platform. For each month, between April 2019 and March 2022, we report the percentage of patients with a medication review coded monthly and in the previous 12 months with breakdowns by regional, clinical and demographic subgroups and those prescribed high‐risk medications. Results: In April 2019, 32.3% of patients had a medication review coded in the previous 12 months. During the first COVID‐19 lockdown, monthly activity decreased (−21.1% April 2020), but the 12‐month rate was not substantially impacted (−10.5% March 2021). The rate of structured medication review in the last 12 months reached 2.9% by March 2022, with higher percentages in high‐risk groups (care home residents 34.1%, age 90+ years 13.1%, high‐risk medications 10.2%). The most used medication review code was Medication review done 314530002 (59.5%). Conclusions: There was a substantial reduction in the monthly rate of medication reviews during the pandemic but rates recovered by the end of the study period. Structured medication reviews were prioritized for high‐risk patients. [ABSTRACT FROM AUTHOR]

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

Background: Consultation with primary healthcare professionals may provide an opportunity to identify patients at higher suicide risk. Aim: To explore primary care consultation patterns in the 5 years before suicide to identify suicide high-risk groups and common reasons for consulting. Design and setting: This was a case–control study using electronic health records from England, 2001 to 2019. Method: An analysis was undertaken of 14 515 patients aged ≥15 years who died by suicide and up to 40 matched live controls per person who died by suicide (n = 580 159), (N = 594 674). Results: Frequent consultations (>1 per month in the final year) were associated with increased suicide risk (age- and sex -adjusted odds ratio [OR] 5.88, 95% confidence interval [CI] = 5.47 to 6.32). The associated rise in suicide risk was seen across all sociodemographic groups as well as in those with and without psychiatric comorbidities. However, specific groups were more influenced by the effect of high-frequency consultation (>1 per month in the final year) demonstrating higher suicide risk compared with their counterparts who consulted once: females (adjusted OR 9.50, 95% CI = 7.82 to 11.54), patients aged 15–<45 years (adjusted OR 8.08, 95% CI = 7.29 to 8.96), patients experiencing less socioeconomic deprivation (adjusted OR 6.56, 95% CI = 5.77 to 7.46), and those with psychiatric conditions (adjusted OR 4.57, 95% CI = 4.12 to 5.06). Medication review, depression, and pain were the most common reasons for which patients who died by suicide consulted in the year before death. Conclusion: Escalating or more than monthly consultations are associated with increased suicide risk regardless of patients' sociodemographic characteristics and regardless of the presence (or absence) of known psychiatric illnesses. [ABSTRACT FROM AUTHOR]

We investigate the long-run impact of education on longevity using data for England and Wales from the Health and Lifestyle Survey. Longevity is modelled by survival analysis using a mixed proportional hazard model. For identification we propose a Regression Discontinuity Design implied by an increase in the minimum school leaving age in 1947 (from 14 to 15) combined with a principal stratification method for estimation of the mortality hazard rate. This method allows us to derive the causal effect of extended education on longevity. In line with earlier studies we do not find credible evidence of a causal impact of the additional years of schooling that were induced by the reform on longevity. [ABSTRACT FROM AUTHOR]

Background: Randomised trials are essential to reliably assess medical interventions. Nevertheless, interpretation of such studies, particularly when considering absolute effects, is enhanced by understanding how the trial population may differ from the populations it aims to represent. Methods: We compared baseline characteristics and mortality of RECOVERY participants recruited in England (n = 38,510) with a reference population hospitalised with COVID-19 in England (n = 346,271) from March 2020 to November 2021. We used linked hospitalisation and mortality data for both cohorts to extract demographics, comorbidity/frailty scores, and crude and age- and sex-adjusted 28-day all-cause mortality. Results: Demographics of RECOVERY participants were broadly similar to the reference population, but RECOVERY participants were younger (mean age [standard deviation]: RECOVERY 62.6 [15.3] vs reference 65.7 [18.5] years) and less frequently female (37% vs 45%). Comorbidity and frailty scores were lower in RECOVERY, but differences were attenuated after age stratification. Age- and sex-adjusted 28-day mortality declined over time but was similar between cohorts across the study period (RECOVERY 23.7% [95% confidence interval: 23.3–24.1%]; vs reference 24.8% [24.6–25.0%]), except during the first pandemic wave in the UK (March–May 2020) when adjusted mortality was lower in RECOVERY. Conclusions: Adjusted 28-day mortality in RECOVERY was similar to a nationwide reference population of patients admitted with COVID-19 in England during the same period but varied substantially over time in both cohorts. Therefore, the absolute effect estimates from RECOVERY were broadly applicable to the target population at the time but should be interpreted in the light of current mortality estimates. Trial registration: ISRCTN50189673- Feb. 04, 2020, NCT04381936- May 11, 2020. [ABSTRACT FROM AUTHOR]

Background: Palliative care provision should be driven by high quality research evidence. However, there are barriers to conducting research. Most research attention focuses on potential patient barriers; staff and organisational issues that affect research involvement are underexplored. The aim of this research is to understand professional and organisational facilitators and barriers to conducting palliative care research. Methods: A mixed methods study, using an open cross-sectional online survey, followed by working groups using nominal group techniques. Participants were professionals interested in palliative care research, working as generalist/specialist palliative care providers, or palliative care research staff across areas of North West England. Recruitment was via local health organisations, personal networks, and social media in 2022. Data were examined using descriptive statistics and content analysis. Results: Participants (survey n = 293, working groups n = 20) were mainly from clinical settings (71%) with 45% nurses and 45% working more than 10 years in palliative care. 75% were not active in research but 73% indicated a desire to increase research involvement. Key barriers included lack of organisational research culture and capacity (including prioritisation and available time); research knowledge (including skills/expertise and funding opportunities); research infrastructure (including collaborative opportunities across multiple organisations and governance challenges); and patient and public perceptions of research (including vulnerabilities and burdens). Key facilitators included dedicated research staff, and active research groups, collaborations, and networking opportunities. Conclusions: Professionals working in palliative care are keen to be research active, but lack time, skills, and support to build research capabilities and collaborations. A shift in organisational culture is needed to enhance palliative care research capacity and collaborative opportunities across clinical and research settings. [ABSTRACT FROM AUTHOR]

Background: Long COVID potentially increases healthcare utilisation and costs. However, its impact on the NHS remains to be determined. Methods: This study aims to assess the healthcare utilisation of individuals with long COVID. With the approval of NHS England, we conducted a matched cohort study using primary and secondary care data via OpenSAFELY, a platform for analysing anonymous electronic health records. The long COVID exposure group, defined by diagnostic codes, was matched with five comparators without long COVID between Nov 2020 and Jan 2023. We compared their total healthcare utilisation from GP consultations, prescriptions, hospital admissions, A&E visits, and outpatient appointments. Healthcare utilisation and costs were evaluated using a two-part model adjusting for covariates. Using a difference-in-difference model, we also compared healthcare utilisation after long COVID with pre-pandemic records. Results: We identified 52,988 individuals with a long COVID diagnosis, matched to 264,867 comparators without a diagnosis. In the 12 months post-diagnosis, there was strong evidence that those with long COVID were more likely to use healthcare resources (OR: 8.29, 95% CI: 7.74–8.87), and have 49% more healthcare utilisation (RR: 1.49, 95% CI: 1.48–1.51). Our model estimated that the long COVID group had 30 healthcare visits per year (predicted mean: 29.23, 95% CI: 28.58–29.92), compared to 16 in the comparator group (predicted mean visits: 16.04, 95% CI: 15.73–16.36). Individuals with long COVID were more likely to have non-zero healthcare expenditures (OR = 7.66, 95% CI = 7.20–8.15), with costs being 44% higher than the comparator group (cost ratio = 1.44, 95% CI: 1.39–1.50). The long COVID group costs approximately £2500 per person per year (predicted mean cost: £2562.50, 95% CI: £2335.60–£2819.22), and the comparator group costs £1500 (predicted mean cost: £1527.43, 95% CI: £1404.33–1664.45). Historically, individuals with long COVID utilised healthcare resources more frequently, but their average healthcare utilisation increased more after being diagnosed with long COVID, compared to the comparator group. Conclusions: Long COVID increases healthcare utilisation and costs. Public health policies should allocate more resources towards preventing, treating, and supporting individuals with long COVID. [ABSTRACT FROM AUTHOR]

By embedding a spatially explicit ecosystem services modelling tool within a policy simulator we examine the insights that natural capital analysis can bring to the design of policies for nature recovery. Our study is illustrated through a case example of policies incentivising the establishment of new natural habitat in England. We find that a policy mirroring the current practice of offering payments per hectare of habitat creation fails to break even, delivering less value in improved flows of ecosystem services than public money spent and only 26% of that which is theoretically achievable. Using optimization methods, we discover that progressively more efficient outcomes are delivered by policies that optimally price activities (34%), quantities of environmental change (55%) and ecosystem service value flows (81%). Further, we show that additionally attaining targets for unmonetized ecosystem services (in our case, biodiversity) demands trade-offs in delivery of monetized services. For some policy instruments it is not even possible to achieve the targets. Finally, we establish that extending policy instruments to offer payments for unmonetized services delivers target-achieving and value-maximizing policy designs. Our findings reveal that policy design is of first-order importance in determining the efficiency and efficacy of programmes pursuing nature recovery. This article is part of the theme issue 'Bringing nature into decision-making'. [ABSTRACT FROM AUTHOR]

To improve education performance at home, countries cross nationally policy-borrow from jurisdictions ranked highly in international league tables. This paper examines a practical example of one such instance of policy borrowing, Teaching for Mastery (TfM). Over a six year period, interviews were conducted with teachers working in primary schools in the East Midlands region of England. The focus of these interviews was to explore informants' experiences of enacting TfM and their analysis of the UK government's motives for undertaking this borrowing. Applying Baudrillard's ideas around hyperreality and image to these data indicated two key themes: 1) TfM discourses masked crucial aspects of the original policy, with the result that 2) TfM became non-relational to the original and thus hyperreal. The paper suggests strategies that might mitigate against policy becoming hyperreal and concludes that government must carefully consider its motives for engaging in the borrowing process from the outset. [ABSTRACT FROM AUTHOR]

Proton magnetic resonance spectroscopy (1H‐MRS) is increasingly used for clinical brain tumour diagnosis, but suffers from limited spectral quality. This retrospective and comparative study aims at improving paediatric brain tumour classification by performing noise suppression on clinical 1H‐MRS. Eighty‐three/forty‐two children with either an ependymoma (ages 4.6 ± 5.3/9.3 ± 5.4), a medulloblastoma (ages 6.9 ± 3.5/6.5 ± 4.4), or a pilocytic astrocytoma (8.0 ± 3.6/6.3 ± 5.0), recruited from four centres across England, were scanned with 1.5T/3T short‐echo‐time point‐resolved spectroscopy. The acquired raw 1H‐MRS was quantified by using Totally Automatic Robust Quantitation in NMR (TARQUIN), assessed by experienced spectroscopists, and processed with adaptive wavelet noise suppression (AWNS). Metabolite concentrations were extracted as features, selected based on multiclass receiver operating characteristics, and finally used for identifying brain tumour types with supervised machine learning. The minority class was oversampled through the synthetic minority oversampling technique for comparison purposes. Post‐noise‐suppression 1H‐MRS showed significantly elevated signal‐to‐noise ratios (P <.05, Wilcoxon signed‐rank test), stable full width at half‐maximum (P >.05, Wilcoxon signed‐rank test), and significantly higher classification accuracy (P <.05, Wilcoxon signed‐rank test). Specifically, the cross‐validated overall and balanced classification accuracies can be improved from 81% to 88% overall and 76% to 86% balanced for the 1.5T cohort, whilst for the 3T cohort they can be improved from 62% to 76% overall and 46% to 56%, by applying Naïve Bayes on the oversampled 1H‐MRS. The study shows that fitting‐based signal‐to‐noise ratios of clinical 1H‐MRS can be significantly improved by using AWNS with insignificantly altered line width, and the post‐noise‐suppression 1H‐MRS may have better diagnostic performance for paediatric brain tumours. [ABSTRACT FROM AUTHOR]

We described the longitudinal changes in sexual behaviour and associated factors among newly diagnosed with HIV men who have sex with men participating in a prospective observational study from a London HIV clinic (2015–2018). Participants self-completed questionnaires at baseline, months 3 and 12. Information collected included socio-demographic, sexual behaviour, health, lifestyle and social support. Trends in sexual behaviours over one year following diagnosis and associated factors were assessed using generalized estimating equations with logit link. Condomless sex (CLS) dropped from 62.2% at baseline to 47.6% at month-three but increased again to 61.8% at month-12 (p-trend = 0.790). Serodiscordant-CLS increased between month-three and month-12 (from 13.1% to 35.6%, p-trend < 0.001). The prevalence of serodiscordant-CLS with high risk of transmitting to their partners at month-three was 10.7%. CLS was higher among men who reported recreational drug use (adjusted Odds Ratio (aOR) 3.03, 95%CI 1.47–6.24, p = 0.003), those with undetectable viral load (aOR 2.17, 95%CI 1.22-3.84, p = 0.008) and those who agreed with a statement "condoms are not necessary when HIV viral load is undetectable" (aOR 3.41, 95%CI 1.58–7.38, p = 0.002). MSM continued to engage in CLS after HIV diagnosis, which coincided with U = U publications and increased throughout the study. [ABSTRACT FROM AUTHOR]

Background and Objective: The tyrosine kinase inhibitors cabozantinib and axitinib have been widely used in England to treat advanced renal cell carcinoma following prior vascular endothelial growth factor-targeted therapy, but data on real-world usage remain limited. Our objective was to describe the real-world treatment patterns and outcomes of patients with advanced renal cell carcinoma who received second-line or later-line (≥ 2L) cabozantinib or axitinib after vascular endothelial growth factor-targeted therapy in clinical practice in England. Methods: This retrospective cohort study used clinical practice data (collected 2011–20) from the English Cancer Analysis System database. Patient characteristics, treatment sequence and duration, and overall survival (time from initiation of cabozantinib/axitinib treatment to death) were evaluated. Results: Data from 1485 eligible adults with advanced renal cell carcinoma were analyzed: 440 received ≥ 2L cabozantinib (2L for 88.6% of them); 1045 received ≥ 2L axitinib (2L for 89.5%). The most common first-line treatments were sunitinib (2L cabozantinib subcohort, 48%; 2L axitinib subcohort, 46%) and pazopanib (46% and 54%, respectively); nivolumab was the most common third-line treatment (18% and 19%, respectively). Median (interquartile range) 2L therapy duration was 5.52 (2.73–11.74) months for cabozantinib and 4.60 (1.45–12.36) months for axitinib. Following adjustment for potential confounders using inverse probability weighting, overall survival (median [interquartile range]) was longer for ≥ 2L cabozantinib (11.2 [5.7–28.0] months) than for ≥ 2L axitinib (10.4 [4.7–22.0] months; log-rank p = 0.0034). Conclusions: The Cancer Analysis System database is a valuable research resource providing extensive real-world clinical data. Real-world overall survival was longer with ≥ 2L cabozantinib than with axitinib. Clinical Trial Registration: ClinicalTrials.gov, NCT04637204; registered November 2020. Plain Language Summary: Cabozantinib and axitinib are anticancer drugs called tyrosine kinase inhibitors. They work by blocking the activity of proteins that cancer cells use to help them divide and grow. Cabozantinib and axitinib are treatment options for a common type of kidney cancer called renal cell carcinoma (RCC). There is evidence about how well cabozantinib and axitinib work in clinical trials, but it is less clear how well they work in standard practice outside of clinical trials. We investigated how cabozantinib and axitinib are used and how well they work as part of 'real-world' RCC care. We did this by analyzing patient data from an English cancer database. All patients in the study had advanced RCC and had been treated with at least one previous anticancer drug. This includes a type of drug that blocks new blood vessels forming, which tumors need for rapid growth. Most of the 1485 patients received cabozantinib or axitinib after receiving only one previous anticancer drug. These patients were treated for a median of 5.5 months with cabozantinib and 4.6 months with axitinib. Patients lived for a median of 11.2 months after starting cabozantinib treatment and a median of 10.4 months after starting axitinib treatment. This study provides new evidence showing how well cabozantinib and axitinib work in everyday RCC care. The results add to those from clinical trials and show the value of the English cancer registry for conducting studies of routine cancer care. [ABSTRACT FROM AUTHOR]

The activities soccer players engage in during their formative years are thought to significantly contribute to the acquisition of expert performance. Whilst this area has seen great interest in male players, there has been little research in females. The study examined developmental activities engaged in by professional female soccer players in England. 56 female soccer players that had either progressed to professional status in adulthood (professional), or did not (ex-academy), completed the Participant History Questionnaire. Professional players started engaging in soccer at an earlier age than their ex-academy counterparts, resulting in greater engagement in practice and play during childhood. During adolescence, professional players engaged in higher amounts of practice than ex-academy players. Engagement in competition and practice was rated as high in physical and cognitive effort by all, yet ex-academy players reported higher levels of physical effort during early adolescence, and cognitive effort during late adolescence. Findings provide an illustration of the talent pathways of professional female soccer players in England and may inform future talent development systems. Large interindividual variation in soccer-specific and other-sport activity data highlight the importance of further understanding the environments of individual soccer nations and their potential impact on the talent identification and development processes. [ABSTRACT FROM AUTHOR]

This study draws on data provided to the Covid-19 & Church-21 Survey by 826 'non-ministering' Anglicans living in England in order to explore why some people gave up worshipping online or in church during the Covid-19 lockdown in 2021. Nearly a quarter of the participants had given up online worship, attending offline services in church, or both: 15 per cent had given up on online worship, 13 per cent had given up on going to church, and 5 per cent had given up on both. Giving up was significantly correlated with negative experience of services. Those under the age of forty and Anglo-Catholics were most likely to give up online worship. Women and extraverts were most likely to give up on socially distanced services in church. The results indicate the sorts of people who might drift from the church post-pandemic and what the Church could concentrate on to prevent this process. [ABSTRACT FROM AUTHOR]

In this article, we examine detainee experiences of dignity in police detention through the lens of materiality. To do this, we draw on sociological and anthropological literature on the 'material turn' and its application to criminal justice settings, and a mixed-methods study of police custody in England and Wales. First, we conceptualise different dimensions of materiality in police custody. Second, we show how some forms of materiality, in conjunction with staff–detainee relationships, shape detainee dignity rooted in equal worth, privacy and autonomy. Third, we examine how the intertwining of the social and material in police custody opens up new possibilities for theorising police work. The materiality of police work is active, not just symbolic. Alongside social relations, it shapes citizen experiences of the police, including of 'hard' and 'soft' forms of policing, and by implication, pain and injustice. Materiality therefore provides a further way of theorising the production of social order inside and outside police detention. [ABSTRACT FROM AUTHOR]

Background: The disproportionate effect of COVID-19 on long term care facility (LTCF) residents has highlighted the need for clear, consistent guidance on the management of pandemics in such settings. As research exploring the experiences of LTCFs during the pandemic and the implications of mass hospital discharge, restricting staff movement, and limiting visitation from relatives are emerging, an in-depth review of policies, guidance and recommendations issued during this time could facilitate wider understanding in this area. Aims: To identify policies, guidance, and recommendations related to LTCF staff and residents, in England issued by the government during the COVID-19 pandemic, developing a timeline of key events and synthesizing the policy aims, recommendations, implementation and intended outcomes. Method: A scoping review of publicly available policy documents, guidance, and recommendations related to COVID-19 in LTCFs in England, identified using systematic searches of UK government websites. The main aims, recommendations, implementation and intended outcomes reported in included documents were extracted. Data was analysed using thematic synthesis following a three-stage approach: coding the text, grouping codes into descriptive themes, and development of analytical themes. Results: Thirty-three key policy documents were included in the review. Six areas of recommendations were identified: infection prevention and control, hospital discharge, testing and vaccination, staffing, visitation and continuing routine care. Seven areas of implementation were identified: funding, collaborative working, monitoring and data collection, reducing workload, decision making and leadership, training and technology, and communication. Discussion: LTCFs remain complex settings, and it is imperative that lessons are learned from the experiences during COVID-19 to ensure that future pandemics are managed appropriately. This review has synthesized the policies issued during this time, however, the extent to which such guidance was communicated to LTCFs, and subsequently implemented, in addition to being effective, requires further research. In particular, understanding the secondary effects of such policies and how they can be introduced within the existing challenges inherent to adult social care, need addressing. [ABSTRACT FROM AUTHOR]

On February 28, 2021, a fireball dropped ∼0.6 kg of recovered CM2 carbonaceous chondrite meteorites in South‐West England near the town of Winchcombe. We reconstruct the fireball's atmospheric trajectory, light curve, fragmentation behavior, and pre‐atmospheric orbit from optical records contributed by five networks. The progenitor meteoroid was three orders of magnitude less massive (∼13 kg) than any previously observed carbonaceous fall. The Winchcombe meteorite survived entry because it was exposed to a very low peak atmospheric dynamic pressure (∼0.6 MPa) due to a fortuitous combination of entry parameters, notably low velocity (13.9 km s−1). A near‐catastrophic fragmentation at ∼0.07 MPa points to the body's fragility. Low entry speeds which cause low peak dynamic pressures are likely necessary conditions for a small carbonaceous meteoroid to survive atmospheric entry, strongly constraining the radiant direction to the general antapex direction. Orbital integrations show that the meteoroid was injected into the near‐Earth region ∼0.08 Myr ago and it never had a perihelion distance smaller than ∼0.7 AU, while other CM2 meteorites with known orbits approached the Sun closer (∼0.5 AU) and were heated to at least 100 K higher temperatures. [ABSTRACT FROM AUTHOR]

Aims: Elective hip and knee replacement operations were suspended in April 2020 due to the COVID-19 pandemic. The impact of this suspension and continued disruption to the delivery of joint replacement surgery is still emerging. We describe the impact of the pandemic on the provision of publicly funded elective hip and knee replacement surgery at one teaching hospital in England and on which patients had surgery. Methods: We included all elective primary and revision hip and knee replacements performed at one hospital between January 2016 and June 2021. Using data for the years 2016–2019, we estimated the expected number of operations and beds occupied per month in January 2020 to June 2021 using time series linear models (adjusting for season and trend). We compared the predictions with the real data for January 2020 to June 2021 to assess the impact of the pandemic on the provision of elective hip and knee replacements. We compared the length of stay and characteristics (age, gender, number of comorbidities, index of multiple deprivation) of patients who had surgery before the pandemic with those who had surgery during the pandemic. Results: We included 6,964 elective primary and revision hip and knee replacements between January 2016 and June 2021. Between January 2020 and June 2021 primary hip replacement volume was 59% of predicted, and 47% for primary knee replacements. Revision hip replacement volume was 77% of predicted, and 42% for revision knee replacement. Median length of stay was one day shorter for primary (4 vs 3 days) and revision (6 vs 5 days) operations during the pandemic compared with before. Patients operated on during the pandemic were younger and had slightly more comorbidities than those operated on before the pandemic. Conclusions: The restricted provision of elective hip and knee replacements during the COVID-19 pandemic changed the patient casemix, but did not introduce new inequalities in access to these operations. Patients were younger, had more comorbidities, and stayed in hospital for less time than those treated before the pandemic. Approximately half the number of operations were performed during the pandemic than would have been expected and the effect was greatest for revision knee replacements. [ABSTRACT FROM AUTHOR]

Multi-component Positive Psychology Interventions (mPPIs) in secondary schools have been shown to improve mental health outcomes for young people. The Hummingbird Project mPPI is a six-week program of workshops designed to introduce a variety of positive psychology (PP) concepts to secondary school-aged children in schools to improve well-being, resilience, and hope. The effects on mental distress, however, were not explored. The current study, therefore, was designed to replicate the effects of the Hummingbird Project mPPI on positive mental health and to also explore the effects on symptoms of mental distress. Secondary school-aged children (N = 614; mean age = 11.46 years) from a sample of secondary schools located across the North West of England (N = 7) participated in the study; the majority of children were in Year 7 (94%). The PP concepts explored included happiness, hope, resilience, mindfulness, character strengths, growth mindset, and gratitude. The results showed significant improvements associated with the mPPI in well-being (as measured by the World Health Organization Well-Being Index; WHO-5), hope (as measured by the Children’s Hope Scale; CHS), and symptoms of mental distress (as measured by the Young Person’s Clinical Outcomes in Routine Evaluation; YP-CORE) from pre- to post-intervention. While acknowledging the limits due to pragmatic concerns regarding the implementation of a control group, the effectiveness of the Hummingbird Project mPPI on well-being was replicated alongside reducing the symptoms of mental distress. Future evaluation, however, will need to implement more robust designs and consider follow-up duration to assess the longer-term effects of the Hummingbird Project mPPI. [ABSTRACT FROM AUTHOR]

Physical inactivity within an ageing population is an ongoing public health concern for policymakers. Engagement in sport forms a foundation of policy designed to encourage physical activity participation and improve health and wellbeing. This study aimed to (i) understand the extent to which older adults participate in sport and the (ii) correlates that predict this involvement within an English population sample of older adults. A further aim was (iii) to examine the extent in which sports participation may vary due to the opportunity provided across Active Partnerships in England. To address this, a multi-level analysis framed through COM-B was conducted of the 2021 English Active Lives dataset (i.e., during the COVID-19 pandemic). The Active Lives survey provides population-level insight into sport, exercise, and physical activity participation across England. It samples upwards of n = 180,000 participants beyond the age of 16 years and asks questions on factors that influence participation. Our findings drawn from a sample of n = 68,808 older adults (i.e., >60-years of age) indicate that when accounting for variation across regions sports participation was significantly predicted by age (β = -.246, p =.040) and multiple deprivation (β =.706, p =.030). Further, our analysis suggests sports participation across regions is associated with changes in the perceptions of opportunity to participate (β = -28.70, p =.001). As the UK transitions from the COVID-19 pandemic, findings have implications for the promotion of sports participation for older adults, in that local, regional, and national stakeholders must do more to change perceptions of social and physical opportunity within an ageing population. This may be achieved through adaptations to the recreational sporting landscape, raising awareness, and supportive policy changes on a national level. [ABSTRACT FROM AUTHOR]

As part of a wider study into the educational attitudes and experiences of white, working-class male pupils in the north of England, this paper explored the ways that male pupils in years 10 and 11 navigated and experienced the six-level (A-F) academic banding system present in their British mainstream secondary school (Ayrefield Community school – ACS). Following an initial four-week period of both covert and overt observations (including guided conversations), three distinct groups of male pupils emerged. Influenced in part by Paul Willis' seminal study (1977) of males in a working-class school environment, these three 'lads' groups were representative of pupils in the top, middle, and bottom academic bands and were subsequently named Performers, Participants and Problematics respectively by the researcher. Following this initial phase of observations, a total of 74 male pupils from these top (n = 29), middle (n = 26) and lower (n = 19) academic bands were specifically selected to take part in a total of 14 group interviews with the aim being to explore the lads' experiences of, and attitudes towards, being taught in academic bands, as well as their views on education and qualifications more generally. Passages from these group interviews are combined with guided conversation responses to make up the findings presented in this paper which are then explored and explained using some key concepts from Norbert Elias's field of figurational sociology alongside key academic literature linked to the use of academic banding in schools. The paper suggests that despite the fact that all male pupils at ACS were exposed to very similar working-class upbringings and social pressures as part of their wider social figuartions, members of each of the three lads' groups became part of, and were subsequently influenced by, the specific, school-based figuartions that emerged as a result of their allocation to their respective academic group. Influenced by the increasingly diverse and complex social relations within these school-based figuartions, the lads from the three different groups seemed set to achieve relative 'success' at school, albeit on route to different destinations, for different reasons, and towards quite starkly different end goals – all whilst still being very much aware of, and influenced by, the wider social figuration of which they were inextricably a part. [ABSTRACT FROM AUTHOR]

The correlation of the Coniacian and Santonian chalks of the Anglo-Paris Basin is described on the basis of detailed lithological logs and extensive records of macrofossils and microcrinoids. In the almost complete absence of ammonites, inoceramid bivalves afford the highest resolution correlation of these stages in chalks, but their value here is limited by the absence of key genera and species, most notably in the Upper Coniacian and middle and Upper Santonian. Echinoids and other macrofossils (brachiopods, stalked crinoids, belemnites) have proved useful, but many are long-ranging or uncommon. Some marker beds, including flints and marl seams, provide useful correlations across the basin, but are locally absent. For the Upper Santonian, the stemless benthonic crinoids Uintacrinus and Marsupites provide high-resolution correlation, both within the basin and to other regions. The successions on the basin margins, in the far north of France (Nord, Pas de Calais) and the southwest (Touraine) are condensed and yield ammonites in association with important inoceramid species. The controls on sedimentation caused by sea-level changes are evaluated on a basinal and global scale, most especially for the Upper Santonian. [ABSTRACT FROM AUTHOR]

Background: In England, court‐based mental health liaison and diversion (L&D) services work across courts and police stations to support those with severe mental illness and other vulnerabilities. However, the evidence around how such services support those with neurodevelopmental disorders (NDs) is limited. Aims: This study aimed to evaluate, through the lens of court and clinical staff, the introduction of a L&D service for defendants with NDs, designed to complement the existing L&D service. Methods: A realist evaluation was undertaken involving multiple agencies based within an inner‐city Magistrates' Court in London, England. We developed a logic model based on the initial programme theory focusing on component parts of the new enhanced service, specifically training, screening, signposting and interventions. We conducted semi‐structured interviews with the court staff, judiciary and clinicians from the L&D service. Results: The L&D service for defendants with NDs was successful in identifying and supporting the needs of those defendants. Benefits of this service included knowledge sharing, awareness raising and promoting good practice such as making reasonable adjustments. However, there were challenges for the court practitioners and clinicians in finding and accessing local specialist community services. Conclusion: A L&D service developed for defendants with NDs is feasible and beneficial to staff and clinicians who worked in the court setting leading to good practice being in place for the defendants. Going forward, a local care pathway would need to be agreed between commissioners and stakeholders including the judiciary to ensure timely and equitable access to local services by both defendants and practitioners working across diversion services for individuals with NDs. [ABSTRACT FROM AUTHOR]

Around the world, there are persistent and growing health inequalities both between and within countries. The U.K. Government's flagship policy for addressing inequalities is called 'Levelling Up'. One of its missions is to narrow the gap in healthy life expectancy (HLE) between the healthiest and unhealthiest areas in England and to improve overall HLE by 5 years by 2035. We show that smoking is one of the major causes of health inequalities. We find a 17-year difference in HLE between local authorities, and that the number of years spent in ill health tended to be greatest in areas with the highest mortality from smoking-related disease. Our aim is to see if the 5-year target could be achieved, assuming there were drastic controls on the sale and consumption of tobacco. We show that never smokers enjoy six more years of good health at age 20 than current or ex-smokers. A complete ban on smoking would lead to a 2.5-year improvement in HLE, and also lengthen the working lives of both men and women. We conclude that while a complete tobacco ban is significant, other public health measures are needed for the full achievement of the target. The paper briefly considers wider issues and suggestions for further research and its international significance. [ABSTRACT FROM AUTHOR]

Professional curiosity has recently become a 'buzzword' in the field of probation and social work. However, little research has sought to understand what professional curiosity means definitionally, conceptually or operationally. In this article, we analyse interview data from 49 probation practitioners in England and Wales to explore what professional curiosity means in the context of probation and what the main barriers are to enacting professional curiosity. We argue that professional curiosity is primarily used to assess risk and that practitioners face multiple barriers to its enactment which are rarely acknowledged or dealt with in policy and practice guides. These barriers fall into three groups: structural, relational and emotional. We conclude the article by examining the findings through the lens of neo-liberalism and probation values. The article therefore extends knowledge of professional curiosity operationally while also seeking to explain its position in a neo-liberal policy context. This research has important implications for policy and practice. Rather than simply asking practitioners to ask questions and be on the lookout for disguised compliance, probation providers should recognise and acknowledge these barriers to practice. [ABSTRACT FROM AUTHOR]

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

Background: Previous research has illustrated a drift in the fidelity of behaviour change techniques (BCTs) during the design of the pilot NHS England Low‐Calorie Diet (NHS‐LCD) Programme. This study evaluated a subsequent domain of fidelity, intervention delivery. Two research questions were addressed: (1) To what extent were BCTs delivered with fidelity to providers programme plans? (2) What were the observed barriers and facilitators to delivery? Methods: A mixed‐methods sequential explanatory design was employed. Remote delivery of one‐to‐one and group‐based programmes were observed. A BCT checklist was developed using the BCT Taxonomy v1; BCTs were coded as present, partially delivered, or absent during live sessions. Relational content analysis of field notes identified observed barriers and facilitators to fidelity. Results: Observations of 122 sessions across eight samples and two service providers were completed. Delivery of the complete NHS‐LCD was observed for five samples. Fidelity ranged from 33% to 70% across samples and was higher for group‐based delivery models (64%) compared with one‐to‐one models (46%). Barriers and facilitators included alignment with the programme's target behaviours and outcomes, session content, time availability and management, group‐based remote delivery, and deviation from the session plan. Conclusions: Overall, BCTs were delivered with low‐to‐moderate fidelity. Findings indicate a dilution in fidelity during the delivery of the NHS‐LCD and variation in the fidelity of programmes delivered across England. Staff training could provide opportunities to practice the delivery of BCTs. Programme‐level changes such as structured activities supported by participant materials and with sufficient allocated time, might improve the delivery of BCTs targeting self‐regulation. [ABSTRACT FROM AUTHOR]

Plain Language Summary: Nearly synchronous global changes in geomagnetic polarity give both a detailed irregular pacing to geological time and provide a glimpse into heat transfer processes across the core—mantle boundary which drives the Earth's geodynamo. Although the Late Carboniferous is characterized by some well‐studied reversals, details of the tempo of polarity changes in the Early Carboniferous are unknown. This work addresses this by providing a detailed record of polarity changes over a ∼2 million year interval at around 334.5–332.5 million years ago‐from the Trowbarrow Quarry section in NW England. We demonstrate that these limestones likely preserve magnetization from close to their time of formation and record at least 31 polarity reversals. These observations support the idea that the Earth's dynamo was in a hyperactive reversing state similar to those sustained for tens of Myr in the Late Jurassic, parts of the Cambrian and the Late Ediacaran. It further corroborates a ∼200 Myr cyclicity in paleomagnetic field behavior since the Precambrian, potentially linked to variable core heat flow forced by mantle convection. The pattern of geomagnetic polarity changes during the Early Carboniferous (Mississippian) is not known in detail. This information sparsity is addressed by determining a magnetostratigraphy from the late Asbian (late Visean at ∼333 Ma) in Trowbarrow Quarry, UK. This is the stratotype section of the late Asbian and has a detailed foraminiferal zonation based on the same set of paleomagnetic samples, establishing a detailed biostratigraphy. The 195 m‐thick section was sampled at an average spacing of 1.1 m, yielding a detailed magnetostratigraphy comprising nine major magnetozone couplets, and seven submagnetozones. The section dataset has a 78% bias to normal polarity determined from 177 sampling levels. The magnetization is carried by a mixture of hematite and detrital magnetite, with 68% of specimens dominated by hematite magnetizations. The primary magnetization passes a fold test showing its age was prior to the latest Carboniferous. The hematite is inferred to be largely of detrital, eolian origin, although some reddened levels are associated with emergent surfaces, suggesting that a small fraction of hematite is associated with platform emergence. The Mississippian age magnetization is partly overprinted with Kiaman Superchron‐age and Brunhes‐age magnetizations. Using the duration of the section based on astrochronology indicates a reversal frequency of 15.7 ± 0.75 Myr−1, indicating that the geodynamo was in a hyperactive reversing state between 335 and 333 Ma. Key Points: A 195 m section, representing ∼2 Myr, yields a magnetostratigraphy comprizing nine major magnetozone couplets and seven submagnetozonesPrimary magnetizations are predominantly carried by hematite with lesser important detrital magnetite. Data pass regional fold testsA reversal frequency of 15.7 ± 0.75 Myr−1 is calculated, suggesting that the geodynamo was in a hyperactive state at ∼333 Ma [ABSTRACT FROM AUTHOR]

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

The late Asbian appears to mark the initial, well‐documented, onset of far‐field glacio‐eustatic changes in equatorial Mississippian strata. This work unravels the nature of cyclicity in upper Asbian shallow marine carbonates, using a combination of petrographic study, rock magnetic proxies and astrochronological testing on samples from the Trowbarrow section, NW England. Rock magnetic data express the content of two types of siliciclastic sources; a marine‐delivered magnetite‐dominated source, and an eolian‐delivered, hematite‐dominated source. The eolian‐sourced material generally peaked during regressive and low‐stand parts of the carbonate rhythms. Astrochronologic testing methods based around the average spectral misfit and TimeOpt methodology show the magnetite abundance proxies are principally carrying the astronomically forced signal. Two likely sedimentation rate models are derived from the five better magnetic proxies using evolutive methods. In addition, a set of three likely major hiatus levels are inferred in the sedimentation rate models, based on testing possible major hiatus scenarios with TimeOpt methods, using eccentricity modulation. From these, using the three best proxies, an average astrochronologic duration for the Trowbarrow section suggests a late Asbian duration of 1976 ± 86 kyr (1σ), and a basal late Asbian age of 334.48 ± 0.35 Ma (2σ). Coupled atmosphere‐ocean models for the late Paleozoic, suggest that lows in short eccentricity correspond to glacials, when inferred delivery of siliciclastic sediment to the carbonate ramp is generally at a maximum. The glacial and lower sea‐level intervals also coincide with maximum delivery of eolian siliciclastics, likely linked to increased aridity and less vegetation cover on adjacent and distal parts of Laurentia. Plain Language Summary: Around 332–333 million years ago changes in sea‐level driven by changes in polar ice volume were an important control on the sedimentation patterns through time in carbonates from low paleolatitudes. Understanding the pacing of these changes has implications for timescales and paleoceanographic processes. These cyclical changes in carbonate lithology are related to changes in magnetic properties within the late Asbian (late Visean) section at Trowbarrow in NW England. The magnetic changes principally express differences in the small content of silica‐based clastics, but also reflect changing Fe‐oxide mineralogy between times of hematite‐rich and magnetite‐rich clastic input. The changes are responding to differences in eolian delivery and marine dispersal of the clastics. Eolian delivery of clastics was at its peak near sea‐level lowstands, when nearby terrestrial systems were the most arid and supplying the most dust. Statistical assessments show that the magnetite abundance signal principally expresses changes in astronomical eccentricity. Primarily using the expected eccentricity pacing, two age models are constructed, which includes three levels of detectable hiatus in the section. Using these two age models and the three best magnetic proxies, the average late Asbian duration is 1976 ± 86 kyr, with the base of the late Asbian at 334.48 ± 0.35 Ma. Key Points: Rock magnetic properties show the included siliciclastics are from hematite‐rich eolian dust and marine‐dispersed sourcesThe magnetite mineral abundance proxies principally carry the primary eccentricity‐driven astronomical signalAn astrochronology for the late Asbian indicates its duration is 1976 ± 86 kyr [ABSTRACT FROM AUTHOR]

Background Falls are common in older adults and can devastate personal independence through injury such as fracture and fear of future falls. Methods to identify people for falls prevention interventions are currently limited, with high risks of bias in published prediction models. We have developed and externally validated the eFalls prediction model using routinely collected primary care electronic health records (EHR) to predict risk of emergency department attendance/hospitalisation with fall or fracture within 1 year. Methods Data comprised two independent, retrospective cohorts of adults aged ≥65 years: the population of Wales, from the Secure Anonymised Information Linkage Databank (model development); the population of Bradford and Airedale, England, from Connected Bradford (external validation). Predictors included electronic frailty index components, supplemented with variables informed by literature reviews and clinical expertise. Fall/fracture risk was modelled using multivariable logistic regression with a Least Absolute Shrinkage and Selection Operator penalty. Predictive performance was assessed through calibration, discrimination and clinical utility. Apparent, internal–external cross-validation and external validation performance were assessed across general practices and in clinically relevant subgroups. Results The model's discrimination performance (c-statistic) was 0.72 (95% confidence interval, CI: 0.68 to 0.76) on internal–external cross-validation and 0.82 (95% CI: 0.80 to 0.83) on external validation. Calibration was variable across practices, with some over-prediction in the validation population (calibration-in-the-large, −0.87; 95% CI: −0.96 to −0.78). Clinical utility on external validation was improved after recalibration. Conclusion The eFalls prediction model shows good performance and could support proactive stratification for falls prevention services if appropriately embedded into primary care EHR systems. [ABSTRACT FROM AUTHOR]

Background A growing number of older people provide unpaid care, but contemporary research evidence on this group is limited. Aim This study aims to describe the characteristics of older people who provide unpaid care and how these vary by socioeconomic position. Methods Using recent information from the English Longitudinal Study of Ageing (ELSA wave 9, 2019), we analysed cross-sectional data on 1,282 unpaid carers aged ≥50. Data on sociodemographics, health, social wellbeing, care intensity and caregiver–recipient relationships were extracted. Total net non-pension wealth quintiles were used as a relative measure of socioeconomic position. Differences between the poorest and richest wealth quintiles were examined through logistic regression. Findings Most older carers in ELSA were female and looking after another older person. Poor mental and physical health and social isolation were common, and socially patterned. Compared with carers in the middle wealth group, the poorest group were more likely to be living with the person they cared for (odds ratio (OR) 1.56 [95% confidence interval (CI) 1.03–2.36]) and more likely to experience loneliness (OR 2.29 [95% CI 1.42–3.69]), dependency (i.e. the need for help with activities of daily living) (OR 1.62 [95% CI 1.05–2.51]), chronic pain (OR 1.81 [95% CI 1.23–2.67]), a higher number of diseases (OR 1.75 [95% CI 1.15–2.65]) and fair/poor self-rated health (OR 2.59 [95% CI 1.79–3.76]). The poorest carers were also less likely to have a high quality of life (OR 0.51 [95% CI 0.33–0.80]) or be in work (OR 0.33 [95% CI 0.19–0.59]). Conclusion Our findings suggest that financially disadvantaged unpaid carers (and their households) may have the greatest needs for intervention and support. Focussing resources on this group has potential to address social inequalities. [ABSTRACT FROM AUTHOR]

This study presents an analysis of the experiences of 15 men convicted of sexual offences, from England and Wales, who have completed the Horizon treatment programme in the community, facilitated by The Probation Service. We found that whilst men felt initially coerced into the programme, finishing the programme was experienced as a significant loss of support. Beyond the programme, the men described the constraints on their citizenship, difficulty accessing support, and rejection in society due to their offence. We conclude by discussing the limitations of personal rehabilitation, the need for social rehabilitation, including tailored support beyond the programme, the importance of user voice and a 'community integration paradox'. [ABSTRACT FROM AUTHOR]

Examining the entanglement of democracy and social justice in education and the relationship to social mobility, this paper critiques the individualising nature of social mobility in policy discourse as inimical to human flourishing and education as a public good. The rhetoric of social mobility which responsibilises individuals for their success, without due regard to the systemic changes needed to enable this and the societal barriers to social mobility experienced disproportionately by some groups in society, is detrimental to social justice. A conception of education as a pathway to social mobility must be located in a wider vision of civic engagement in a more inclusive and fairer society. Yet civic engagement in education at the local level has been eroded, as illustrated in this paper by the example of an evolving model of school governance in England. As a corporatist, market driven reform, this model exemplifies how local democratic ties between schools and engagement with their communities can be undermined. Social mobility to enable opportunities, access and participation in democratic civic society becomes a fantasy when society is riven with systemic inequalities, lacks the necessary conditions to enable human flourishing and links to community engagement in education for democratic renewal are downplayed. [ABSTRACT FROM AUTHOR]