Search

The delivery of integrated care requires the establishment of effective professional relationships that foster collaborative working across health systems. Evidence for how to prepare practitioners to work in those settings is limited. By exploring an innovative postgraduate Programme for Integrated Child Health (PICH) this article highlights the conditions by which effective collaboration can be encouraged. Our qualitative evaluation of PICH involved one-to-one semi-structured interviews with 23 postgraduate general practice and paediatric trainees and their mentors. We analysed the data using the concept of the 'third space', where multiple discourses between individuals with diverse professional backgrounds occur, enabling creative exploration of tensions inherent in new ways of working in order to identify enablers and barriers to collaboration. Our analysis identified three themes that enabled collaboration: effective communication, boundary work and educational spaces; and four themes that were barriers: traditional hierarchical professional identities, curriculum design, financial systems and workplace spaces. PICH demonstrated the value of educational spaces and their role in enabling collaborative practice, as participants explored their professional identities and those of other disciplines. Structural factors in the workplace which inhibit collaborative practice were also evident. We conclude by proposing a model for collaborative learning in third spaces based upon the recognition that, while educational programmes alone will not lead to change, they have the potential to inform the development of productive workplace spaces that will be required if collaborative practice in healthcare is to become a reality.

Although participation in academic speaking events is a key to developing disciplinary understanding, students for whom English is a second language may have limited access to these learning events due to an increasingly dialogic and active higher education pedagogy which places considerable demands on their oracy skills. Drawing on the Oracy Skills Framework we explore disciplinary tutors' and students' expectations of oracy skills required for disciplinary study. An analysis of both quantitative and qualitative data found that disciplinary tutors placed importance on the cognitive dimension of oracy skills such as argumentation and asking questions, whilst students placed importance on linguistic accuracy. The findings also suggest that tutors and students lack a shared metalanguage to talk about oracy skills. We argue that a divergence of expectations and lack of shared terminology can result in compromising students' access to valuable classroom dialogue. The paper concludes with a number of practical suggestions through which both tutors and students can increase their understanding of oracy skills.

Objectives: The primary objective of this study was to examine the role of self-efficacy in mathematics and mathematical mindset in effort regulation in mathematics. Effort regulation was defined as 'management of effort in learning activities in the face of difficulties'. Design: A large-scale survey (N=1448) with four cohorts of students in years 7, 8, 9 and 11 (M age=14.0 years, SD=0.46) was conducted. Methods: 1448 participants, from two comprehensive schools in the UK, completed a pen and paper survey. Demographic characteristics, measures of prior attainment and cognitive ability were provided by the schools. Results: Findings from this study showed that mathematical mindset and self-efficacy in mathematics both positively predicted effort regulation in mathematics. Furthermore, it appears that the effect of mathematical mindset on effort regulation in mathematics was mediated through self-efficacy in mathematics. Conclusions: This study provides initial support for the relationship between mathematical mindset and effort regulation in mathematics as a key process, mediated by self-efficacy in mathematics. These results contribute to the current understanding of effort regulation in adolescents and are indicative of possible ways to enhance effort regulation in mathematics. Implications of the findings for future research are discussed.

Tomicus piniperda is a common pest of pine trees responsible for significant economic damage. Although the impact of T. piniperda on forestry is likely to increase in the future due to climate change, little is known about its dispersal within the United Kingdom (UK) or between continental Europe and the UK.This study addressed these knowledge gaps using mitochondrial and microsatellite DNA markers.Mitochondrial DNA revealed high levels of genetic diversity as previously reported for this species across Europe. Nuclear DNA diversity revealed two geographically incoherent groups (Scotland, Wales, Belgium and the Netherlands vs. England and Switzerland). These genetic patterns likely reflect a combination of historical gene flow, anthropogenic introduction and restricted contemporary gene flow between the UK and Europe.Significant structure was found among UK samples suggesting T. piniperda might not disperse extensively between pine stands. This differs from widespread gene flow across continental Europe and may be due to the low percentage of land covered by forests in the UK in addition to the high fragmentation of its forest cover.Genetic variation was higher among the Scottish samples compared to those from more southern clines, suggesting the potential proximity of Scotland to a Pleistocene glacial refuge for T. piniperda. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to review the progress made by UK higher education institutions (HEIs) to deliver the enterprise education agenda. The key areas for research included the type, content and delivery methods of graduate enterprise education being offered in the UK. Design/methodology/approach: A questionnaire was e-mailed to 123 HEIs in the UK, together with a brief introduction stating the purpose of the research. These were followed up by telephone calls to request responses. Findings: The paper finds that provision of entrepreneurship education is varied, with both entrepreneurship and innovation courses on offer. Entrepreneurship education is most often offered at postgraduate level and on a part time basis. Overall, delivery methods proved to be more traditional than anticipated, with few instances of action learning or the use of technology to support learning. There were differences between pre- and post-1992 HEIs, and little attention was given to topic areas evident in relevant UK policy initiatives. Research limitations/implications: Supports entrepreneurship education, key capacities need to be addressed within HEIs, at senior and other levels, so that graduate enterprise embodies the entrepreneurial spirit and delivers the expected results of governmental focus and intervention. Originality/value: This is one of the first surveys to explore how enterprise education is delivered within UK HEIs. (Contains 10 tables.)

Purpose: Secure mental health services in one UK region have acted within a network to develop a range of involvement practices. A new quality benchmarking tool has been created to appraise the implementation of these involvement practices. The purpose of this paper is to report upon a qualitative evaluation of this development. Design/methodology/approach: Staff and service users involved in the co-production of the benchmarking tool were engaged in a series of focus groups and participatory inquiry approaches enacted in the course of scheduled network meetings. Data thus collected was subject to thematic analysis. Findings: Four distinct themes were identified which were titled: Taking time, taking care; The value not the label; An instrument of the network; and All people working together. These are discussed in relation to recent theorising of co-production. Research limitations/implications: Effectively, this study represents a case study of developments within one region. As such, the findings may have limited transferability to other contexts. Practical implications: Staff and service users can work together effectively to the benefit of each other and overall forensic services. The benchmarking tool provides a readymade mechanism to appraise quality improvements. Social implications: Despite a prevailing culture of competition in wider health-care policy, cooperation leads to enhanced quality. Originality/value: The benchmarking tool is a unique development of a longstanding involvement network, demonstrating the positive implications for enacting co-production within secure services. [ABSTRACT FROM AUTHOR]

Laughter is a ubiquitous and important social signal, but its nature is yet to be fully explored. One of the open empirical questions is about the role of context in the interpretation of laughter. Can laughs presented on their own convey specific feelings and social motives? How influential is social context when a person tries to understand the meaning of a laugh? Here we test the extent to which the classification of laughs produced in different situations is guided by knowing the context within which these laughs were produced. In the current study, stimuli were spontaneous laughs recorded in social situations engineered to elicit amusement, embarrassment, and schadenfreude. In a between-subjects design, participants classified these laughs being assigned to one of the four experimental conditions: audio only, audio-visual, side-by-side videos of two interactants, and side-by-side videos accompanied by a brief vignette. Participants' task was to label each laugh as an instance of amusement, embarrassment, or schadenfreude laugh, or "other." Laughs produced in situations inducing embarrassment were classified more accurately than laughs produced in other situations. Most importantly, eliminating information about the social settings in which laughs were produced decreased participants' classification accuracy such that accuracy was no better than chance in the experimental conditions providing minimal contextual information. Our findings demonstrate the importance of context in the interpretation of laughter and highlight the complexity of experimental investigations of schadenfreude displays. [ABSTRACT FROM AUTHOR]

Improving young people's (YP) mental health and well‐being is a global public health priority. Despite continued commitment within the UK policy agenda to improve the mental health and well‐being of YP, the incidence of mental health issues continues to rise. This has been further compounded by the outbreak of COVID‐19 which has disproportionately affected YP in the most socioeconomically disadvantaged areas. Understanding YP's perspectives on what supports their mental health is important to develop policies that meet their needs. We conducted focus groups (n = 18 with 42 YP aged 13–21) in three geographical areas with high levels of deprivation in England, UK. Recruited through six local youth organisations, each group of YP took part in three interlinked focus groups designed to explore their perceptions of what impacts their health in their local area, and their understandings of health inequalities through participatory methods. Throughout their discussions, YP foregrounded the significance of mental health and mental health support structures. YP perceived challenges to accessing mental health provision and an unmet need for support within their local communities. Alongside this, YP consistently highlighted the importance of youth groups for promoting good mental health and mitigating challenges to poor mental health. However, ongoing cuts to the voluntary sector and universal services continue to impact areas and individuals in the greatest need. In the face of deficits in formal mental health support, our findings highlight the pressing need for increased investment in services focused on prevention (such as youth groups) in areas of high deprivation. [ABSTRACT FROM AUTHOR]

Covid-19 has altered medical education worldwide. Given recent events, UK Longitudinal Integrated Clerkships (LICs), which are relatively new innovations, may have changed in structure and delivery, or may have demonstrated resilience. Collating the responses and experiences of UK institutions may yield transferrable recommendations for institutions wishing to develop sustainable LICs. A mixed-methods survey concerning LIC prevalence, variety, and experiences of responses to Covid-19 was circulated to all 33 UK medical schools through academic networks. 25 survey responses were received, representing 20 institutions. 12 faculty completed follow up semi-structured interviews. 13 LICs were reported: 1 wasn't running during 2020, 5 were running unchanged, and 7 with alterations. 2 additional LICs were planned. Thematic analysis of free-text survey and interview responses revealed that relationships between faculty and institutions were central in facilitating recent adaptations to UK LICs. Given model flexibility, an increased drive to develop LICs was also evident. Barriers to adapting programmes included uncertainty regarding progression of Covid-19 restrictions and issues with secondary care access. Investing in faculty development and support networks could increase LIC sustainability. By highlighting the relative resilience of UK LIC placements during Covid-19, these findings offer important insight for the future delivery of sustainable LICs within, and beyond, the UK. [ABSTRACT FROM AUTHOR]

Purpose: Workforce development is crucial to the offender personality disorder (OPD) service to provide contemporary, evidenced care and treatment. This study aims to provide an overview and the research evaluation results of a regional higher education programme delivered to a range of criminal justice workers used on the OPD pathway. Design/methodology/approach: Three modules were developed and delivered; these are (1) enhancing understanding (20 students), (2) formulation and therapeutic intervention (20 students) and (3) relationships, teams and environments (17 students). A mixed-methods study evaluated participant confidence and compassion. Pre, post and six-month follow-up questionnaires were completed. Additionally, a series of focus groups were conducted to gain in-depth qualitative feedback with a cross-section of students across the modules (N = 7). Quantitative data was collected and analysed separately due to the three modules all having different content. Qualitative data was analysed, and a synthesis of qualitative findings was reported from data taken across the three modules. Findings: A total of 52 students participated, drawn from three modules: Module 1 (N = 19); Module 2 (N = 18); Module 3 (N = 15). Confidence in working with people with a personality disorder or associated difficulties improved significantly following completion of any of the modules, whereas compassion did not. Results have been synthesised and have assisted in the future shaping of modules to meet the learning needs of students. Research limitations/implications: Further evaluation of the effectiveness of educational programmes requires attention, as does the longer-term durability of effect. Further research is required to explore the post-training impact upon practice, and further exploration is required and larger sample sizes to draw definitive conclusions related to compassion. Practical implications: This unique model of co-production that draws upon the expertise of people with lived experience, occupational frontline and academics is achievable and well received by students and can be reproduced elsewhere. Social implications: The positive uptake and results of this study indicate a need for expansion of accessible OPD workforce training opportunities across the UK. Further research is required to explore student feedback and comparisons of effectiveness comparing different modes of training delivery, especially in light of the pandemic, which has forced organisations and higher education institutions to develop more digital and distance learning approaches to their portfolios. Originality/value: This novel research provides an evaluation of the only higher education credit-bearing modules in the UK focussed solely upon the OPD workforce and aligned with the national drive for non-credit bearing awareness level training "knowledge and understanding framework" (KUF). [ABSTRACT FROM AUTHOR]

Background: Antibiotic overuse is linked to increased risk of antimicrobial resistance. Long-term antibiotics are commonly used for treating acne and prophylaxis of urinary tract infection. Their contribution to the overall burden of antibiotic use is relatively unknown. Aim: To describe the volume of commonly prescribed long-term (≥28 days) antibiotic prescriptions in adolescents and young adults, trends over time, and comparisons with acute prescriptions. Design and setting: A retrospective cohort study using UK electronic primary care records. Method: Patients born between 1979 and 1996 and with data in the Care and Health Information Analytics database were included. The main outcome measures were antibiotic prescription rates per 1000 person-years and antibiotic prescription days per person-year between the ages of 11 and 21. Results: In total, 320 722 participants received 710 803 antibiotic prescriptions between the ages of 11 and 21 years from 1998 to 2017. Of these 710 803 prescriptions, 191 443 (26.93%) were for long-term antibiotics (≥28 days and ≤6 months in duration). Long-term antibiotics accounted for more than two-thirds (72.48%) of total antibiotic exposure (days per person-year). Total long-term antibiotic prescribing peaked in 2013 at just under 6 days per person-year and declined to around 4 days in 2017. Conclusion: Among adolescents and young adults, exposure to long-term antibiotics (primarily lymecycline used for acne) was much greater than for acute antibiotics and is likely to make an important contribution to antimicrobial resistance. Urgent action is needed to reduce unnecessary exposure to long-term antibiotics in this group. Increasing the use of, and adherence to, effective non-antibiotic treatments for acne is key to achieving this. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Raptor Research is the property of Raptor Research Foundation and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The COVID-19 pandemic led to lockdowns in countries across the world, changing the lives of billions of people. The United Kingdom’s first national lockdown, for example, restricted people’s ability to socialize and work. The current study examined how changes to socializing and working during this lockdown impacted ongoing thought patterns in daily life. We compared the prevalence of thought patterns between two independent real-world, experience-sampling cohorts, collected before and during lockdown. In both samples, young (18 to 35 y) and older (55+ y) participants completed experience-sampling measures five times daily for 7 d. Dimension reduction was applied to these data to identify common “patterns of thought.” Linear mixed modeling compared the prevalence of each thought pattern 1) before and during lockdown, 2) in different age groups, and 3) across different social and activity contexts. During lockdown, when people were alone, social thinking was reduced, but on the rare occasions when social interactions were possible, we observed a greater increase in social thinking than prelockdown. Furthermore, lockdown was associated with a reduction in future-directed problem solving, but this thought pattern was reinstated when individuals engaged in work. Therefore, our study suggests that the lockdown led to significant changes in ongoing thought patterns in daily life and that these changes were associated with changes to our daily routine that occurred during lockdown. [ABSTRACT FROM AUTHOR]

Background: Current research shows that many UK medical graduates continue to feel underprepared to work as a junior doctor. Most research in this field has focused on new graduates and employed the use of retrospective self-rating questionnaires. There remains a lack of detailed understanding of the challenges encountered in preparing for clinical practice, specifically those faced by medical students, where relevant educational interventions could have a significant impact. Through use of a novel on-call simulation, we set out to determine factors affecting perceived preparation for practice in final year medical students and identify ways in which we may better support them throughout their undergraduate training. Methods: 30 final year medical students from Imperial College London participated in a 90-minute simulation on hospital wards, developed to recreate a realistic on-call experience of a newly qualified doctor. Students partook in pairs, each observed by a qualified doctor taking field notes on their decisions and actions. A 60-minute semi-structured debrief between observer and student pair was audio-recorded for analysis. Field notes and students' clinical documentation were used to explore any challenges encountered. Debrief transcripts were thematically analysed through a general inductive approach. Cognitive Load Theory (CLT) was used as a lens through which to finalise the evolving themes. Results: Six key themes emerged from the on-call simulation debriefs: information overload, the reality gap, making use of existing knowledge, negative feelings and emotions, unfamiliar surroundings, and learning 'on the job'. Conclusions: The combination of high fidelity on-call simulation, close observation and personalised debrief offers a novel insight into the difficulties faced by undergraduates in their preparation for work as a junior doctor. In using CLT to conceptualise the data, we can begin to understand how cognitive load may be optimised within this context and, in doing so, we highlight ways in which undergraduate curricula may be adapted to better support students in their preparation for clinical practice. Recommendations are centred around enhancing the expertise of the learner through 'whole task' training approaches and integrated learning, as well as navigating negative emotions and supporting lifelong 'learning while working'. [ABSTRACT FROM AUTHOR]

The rise in popularity and demand for nonsurgical injectable aesthetic procedures is inherently accompanied by an increase in reported complications, particularly those related to infection. Aseptic technique is under the control of aesthetic practitioners and can be modified to minimize the potential for cross‐contamination and infection. This should be a key consideration during all clinical procedures, particularly those involving breach of the skin's natural defenses and the use of soft tissue filler. A consensus group of five UK expert aesthetic clinicians were convened to discuss current best practice for aseptic techniques in medical aesthetics. The aim of the consensus group was to recommend a step‐by‐step procedure to achieve optimal aseptic practice in private clinics, and define important considerations for reducing infection risk during the whole patient journey: pre‐, during‐ and postaesthetic procedure. Recommendations were based on current evidence and extensive clinical experience. Various procedure recommendations were made to achieve and maintain a high standard of asepsis and infection control. Guidance was divided into three phases for patients and health care professionals, covering preprocedure (including patient selection), during‐procedure, and postprocedure considerations. Although adherence to standard hospital guidance on handwashing and cleanliness measures is a cornerstone of controlling cross‐contamination, aesthetic clinics carry a high potential risk of infection—particularly as popular treatments with dermal fillers primarily involve the face. This expert consensus guidance recommends procedures to mitigate the potential risks of asepsis. [ABSTRACT FROM AUTHOR]

Aim: To understand the experiences of carers who were confronted by the development of impulsive and compulsive behaviours. Background: Impulsive and compulsive behaviours (ICBs) are a serious complication in Parkinson's disease (PD) strongly associated with dopamine replacement therapy used to treat patients. These behaviours comprise abnormal activities such as pathological gambling, binge eating, compulsive shopping and hypersexuality. These behaviours place a considerable burden on patients and on their carers and families. Design: An exploratory qualitative study. Methods: Using a convenience sampling approach, 13 carers were recruited to participate in semi‐structured interviews. Interviews were conducted over the telephone. Verbatim transcripts were analysed using a thematic analysis approach. COREQ guidelines were adhered to in the reporting of this study. Results: Five main themes were identified: (a) realisation—developing awareness of ICB symptoms and their causes; (b) reacting—confronting and attempts to manage ICBs; (c) reaching out—help‐seeking and selective disclosure; (d) reframing—shifting perspectives on ICBs over time; and (e) resignation—impact on relationships and facing the future. Conclusions: The profound impact of ICBs on quality of life, relationships and economic stability was clear in the carers' accounts. Possible avenues for future clinical research are suggested. Relevance to clinical practice: The potentially devastating effects of ICBs provide a strong imperative for nurses and other health professionals to ensure that close monitoring for symptom development together with patient education is always part of practice. [ABSTRACT FROM AUTHOR]

Background: Primary spontaneous pneumothorax occurs in otherwise healthy young patients. Optimal management is not defined and often results in prolonged hospitalisation. Data on efficacy of ambulatory options are poor. We aimed to describe the duration of hospitalisation and safety of ambulatory management compared with standard care.Methods: In this open-label, randomised controlled trial, adults (aged 16-55 years) with symptomatic primary spontaneous pneumothorax were recruited from 24 UK hospitals during a period of 3 years. Patients were randomly assigned (1:1) to treatment with either an ambulatory device or standard guideline-based management (aspiration, standard chest tube insertion, or both). The primary outcome was total length of hospital stay including re-admission up to 30 days after randomisation. Patients with available data were included in the primary analysis and all assigned patients were included in the safety analysis. The trial was prospectively registered with the International Standard Randomised Clinical Trials Number, ISRCTN79151659.Findings: Of 776 patients screened between July, 2015, and March, 2019, 236 (30%) were randomly assigned to ambulatory care (n=117) and standard care (n=119). At day 30, the median hospitalisation was significantly shorter in the 114 patients with available data who received ambulatory treatment (0 days [IQR 0-3]) than in the 113 with available data who received standard care (4 days [IQR 0-8]; p<0·0001; median difference 2 days [95% CI 1-3]). 110 (47%) of 236 patients had adverse events, including 64 (55%) of 117 patients in the ambulatory care arm and 46 (39%) of 119 in the standard care arm. All 14 serious adverse events occurred in patients who received ambulatory care, eight (57%) of which were related to the intervention, including an enlarging pneumothorax, asymptomatic pulmonary oedema, and the device malfunctioning, leaking, or dislodging.Interpretation: Ambulatory management of primary spontaneous pneumothorax significantly reduced the duration of hospitalisation including re-admissions in the first 30 days, but at the expense of increased adverse events. This data suggests that primary spontaneous pneumothorax can be managed for outpatients, using ambulatory devices in those who require intervention.Funding: UK National Institute for Health Research. [ABSTRACT FROM AUTHOR]

For the first time we aimed to: (1) assess fat-free mass (FFM) and RMR in youth soccer players, (2) compare measured RMR to estimated RMR using previously published prediction equations, and (3) develop a novel population-specific prediction equation. In a cross-sectional design, 99 males from a Premier League academy underwent assessments of body composition (DXA) and RMR (indirect-calorimetry). Measured RMR was compared to estimated values from five prediction equations. A novel RMR prediction equation was developed using stepwise multiple regression. FFM increased (P<0.05) between U12 (31.6±4.2 kg) and U16 (56.3±5.3 kg) after which no further increases occurred (P>0.05). RMR in the U12s (1655±195 kcal.day−1), U13s (1720±205 kcal.day−1) and U14s (1846±218kcal.day−1) was significantly lower than the U15s (1957±128 kcal.day−1), U16s (2042±155 kcal.day−1), U18s (1875±180 kcal.day−1) and U23s (1941±197 kcal.day−1) squads (P>0.05). FFM was the single best predictor of RMR (r2=0.43; P<0.01) and was subsequently included in the novel prediction equation: RMR (kcal.day−1) = 1315 + (11.1 x FFM in kg). Both FFM and RMR increase from 12-16 years old, thus highlighting the requirement to adjust daily energy intake to support growth and maturation. The novel prediction RMR equation developed may help to inform daily energy requirements. [ABSTRACT FROM AUTHOR]

Coercive practices, such as physical restraint, are used globally to respond to violent, aggressive and other behaviours displayed by mental health service users.1 A number of approaches have been designed to aid staff working within services to minimise the use of restraint and other restrictive practices. One such approach, the 'REsTRAIN Yourself' (RYS) initiative, has been evaluated in the UK. Rapid ethnography was used to explore the aspects of organisational culture and staff behaviour exhibited by teams of staff working within 14 acute admission mental health wards in the North West region of the English NHS. Findings comprise four core themes of space and place; legitimation; meaningful activity; and, therapeutic engagement that represent characteristics of daily life on the wards before and after implementation of the RYS intervention. Tensions between staff commitments to therapeutic relations and constraining factors were revealed in demarcations of ward space and limitations on availability of meaningful activities. The physical, relational and discursive means by which ward spaces are segregated prompts attention to the observed materialities of routine care. Legitimation was identified as a crucial discursive practice in the context of staff reliance upon coercion. Trauma‐informed care represents a potentially alternative legitimacy. [ABSTRACT FROM AUTHOR]

In this article, we discuss whether it is possible for UK institutions to influence the international longitudinal integrated clerkship (LIC) narrative, in the context of supplying future clinicians to a fragmented health service that is battling a General Practice recruitment crisis. Perhaps more importantly, we will discuss whether the 'LIC model' fits the UK undergraduate framework. We intend to present some emerging evidence of LICs in the UK, informed by a UK-wide survey and observations from a 2019 UK LIC think tank and then discuss whether the global CLIC definition applies to the UK context with possible ways forward. [ABSTRACT FROM AUTHOR]

International efforts to minimize coercive practices include the US Six Core Strategies© (6CS). This innovative approach has limited evidence of its effectiveness, with few robustly designed studies, and has not been formally implemented or evaluated in the UK. An adapted version of the 6CS, which we called 'REsTRAIN Yourself' (RY), was devised to suit the UK context and evaluated using mixed methods. RY aimed to reduce the use of physical restraint in mental health inpatient ward settings through training and practice development with whole teams, directly in the ward settings where change was to be implemented and barriers to change overcome. In this paper, we present qualitative findings that report on staff perspectives of the impact and value of RY following its implementation. Thirty‐six staff participated in semi‐structured interviews with data subject to thematic analysis. Eight themes are reported that highlight perceived improvements in every domain of the 6CS after RY had been introduced. Staff reported more positively on their relationships with service users and felt their attitudes towards the use of coercive practices such as restraint were changed; the service as a whole shifted in terms of restraint awareness and reduction; and new policies, procedures, and language were introduced despite certain barriers. These findings need to be appreciated in a context wherein substantial reductions in the use of physical restraint were proven possible, largely due to building upon empathic and relational alternatives. However, yet more could be achieved with greater resourcing of inpatient care. [ABSTRACT FROM AUTHOR]

Background Little is known about the contribution of genetic variation to food timing, and breakfast has been determined to exhibit the most heritable meal timing. As breakfast timing and skipping are not routinely measured in large cohort studies, alternative approaches include analyses of correlated traits. Objectives The aim of this study was to elucidate breakfast skipping genetic variants through a proxy-phenotype genome-wide association study (GWAS) for breakfast cereal skipping, a commonly assessed correlated trait. Methods We leveraged the statistical power of the UK Biobank (n  = 193,860) to identify genetic variants related to breakfast cereal skipping as a proxy-phenotype for breakfast skipping and applied several in silico approaches to investigate mechanistic functions and links to traits/diseases. Next, we attempted validation of our approach in smaller breakfast skipping GWAS from the TwinUK (n  = 2,006) and the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) consortium (n  = 11,963). Results In the UK Biobank, we identified 6 independent GWAS variants, including those implicated for caffeine (ARID3B/CYP1A1), carbohydrate metabolism (FGF21), schizophrenia (ZNF804A), and encoding enzymes important for N 6-methyladenosine RNA transmethylation (METTL4, YWHAB , and YTHDF3), which regulates the pace of the circadian clock. Expression of identified genes was enriched in the cerebellum. Genome-wide correlation analyses indicated positive correlations with anthropometric traits. Through Mendelian randomization (MR), we observed causal links between genetically determined breakfast skipping and higher body mass index, more depressive symptoms, and smoking. In bidirectional MR, we demonstrated a causal link between being an evening person and skipping breakfast, but not vice versa. We observed association of our signals in an independent breakfast skipping GWAS in another British cohort (P =  0.032), TwinUK, but not in a meta-analysis of non-British cohorts from the CHARGE consortium (P  = 0.095). Conclusions Our proxy-phenotype GWAS identified 6 genetic variants for breakfast skipping, linking clock regulation with food timing and suggesting a possible beneficial role of regular breakfast intake as part of a healthy lifestyle. [ABSTRACT FROM AUTHOR]

Purpose: The ability of healthcare systems to deliver world-class compassionate care depends on the quality of training and education of staff. Matching student-centered learning with patient-centered care is the focus for much curricula reform. This study explores the effect a novel longitudinal curriculum had on medical students' attitudes and experiences to better identify central tenets needed in our education system. Methods: Single-center, qualitative focus-group study conducted in 2017 of medical students in a longitudinally integrated clinical apprenticeship at a large UK medical school. Students were randomly assigned to focus groups to describe their educational journey and explore how longitudinal learning prepared them for a medical career, valuing their unique position as student participants in the healthcare system. Results: Four themes emerged from students' experiences: navigating the patient journey, their professional development, their learning journey, and the healthcare system. Conclusions: Listening to student voices lends insights for educators refining educational models to produce doctors of tomorrow. This project identified the educational value of students having authentic roles in helping patients navigate the healthcare system and the benefits of consistent mentorship and greater autonomy. The gulf between gaining skills as a future doctor and gaining skills to pass summative exams calls into question assessment methods. [ABSTRACT FROM AUTHOR]

There has been a longstanding debate and mixed evidence on the link between psychopathy and intelligence. Most of the existing research comes from male prisoners, with the literature on female psychopathy and intelligence remaining sparse. Thus, the current study explored the correlational association between psychopathy and intelligence in a sample of high-risk violent female offenders. This is the first study of its kind from the Offender Personality Disorder (OPD) pathway for women in the United Kingdom (UK). The sample includes high-risk violent women presenting with severe personality disorder. In the present study, we conducted a correlational examination between total scores, and the 2-factor and 4-facet structure of the Psychopathy Checklist-Revised (PCL-R) with intelligence using the Wechsler Adult Intelligence Scale (WAIS). No significant associations were found between total PCL-R scores, or factor 2, and intelligence. Positive associations were found between verbal comprehension and factor 1 and the interpersonal facet. Thus, the results suggest high-risk violent female offenders with interpersonal psychopathic traits demonstrate higher levels of verbal comprehension skills. This finding may help explain why psychopathic female offenders, who can be characterized by deceitful and egocentric behaviours, may be able to successfully charm and con others for their own personal gain. [ABSTRACT FROM AUTHOR]

"Beyond reasonable doubt" and "sure" are not fit for purpose as descriptors of the criminal standard of proof. They should be replaced by the more accurate "no realistic doubt ", which should be defined and accompanied by an explanation that while absolute certainty is not required, the standard of proof is very high and probability is insufficient. The direction to the jury should contain a set form of words for the new definition together with clear guidance on how to use the standard in reaching a verdict. [ABSTRACT FROM AUTHOR]

Bad character--application to adduce pursuant to the Criminal Justice Act 2003 ss. 101 (l)(f) and (g)--whether necessary to adduce bad character to correct a false impression--whether attack on the integrity on the officer in the case sufficient to trigger gateway (g) [ABSTRACT FROM AUTHOR]

An editorial is presented to the article highlights some of the public health hazards implicit within the government's treatment of migrants and locates within a wider frame of mental health. Topics include the backdrop of global health, social care and other workers' heroic struggles for the COVID-19 pandemic; and the majority of citizens strive through lockdown and social distancing to create an environment inimical.

Abstract Objectives Planning and implementing public health initiatives in mass gatherings such as the Olympic Games pose unique challenges for interorganizational collaboration, which involves interaction among multiple and diverse agencies. Nonetheless, there is limited empirical evidence to support interagency collaboration and public health planning decisions in mass gatherings and how leadership can shape such interactions. We empirically explored these topics in the 2012 London Olympics to identify lessons to inform planning for future mass gatherings. Study design This is a qualitative case study. Methods Data comprised 39 semistructured interviews with key informants conducted before, during, and after the games; in addition, direct observations of field exercises and documentary analysis were also used. Open coding and thematic analysis was used to analyze the data. Results We identified two main leadership challenges that influenced interagency collaboration: organizational public health leadership and coordinating collaborative decision-making. Two facilitative conditions helped overcome the previous challenges: nurturing interorganizational linkages and creating shared understanding by activating codified frameworks at the organizational level. Conclusions Our study highlights leadership issues in interagency collaboration in mass gatherings. Practical implications arising from this study may inform the ways the organizers of mass gatherings, public health and safety agencies, and professionals can engage in effective partnerships and joint working. Highlights • Early engagement of the organizers is vital for the success of public health interventions. • The use of interorganizational linkages is a mechanism that appears to break down the barriers between the parties. • The use of united codified principles facilitates interagency collaboration. [ABSTRACT FROM AUTHOR]

Best evidence-witness applying to refresh memory using copy document-prosecution failing to produce original-district judge in magistrates' court applying best evidence rule-district judge refusing application-extent of best evidence rule-whether best evidence rule applicable-whether verification of document by reference to a copy of the document in question and not the original permissible-Criminal Justice Act 2003 s. 139(1) [ABSTRACT FROM AUTHOR]

Background: Music therapy is increasingly used as an adjunct therapy to support symptom management in palliative care. However, studies to date have paid little attention to the processes that lead to changes in patient outcomes. To fill this gap, we examined the processes and experiences involved in the introduction of music therapy as an adjunct complementary therapy to palliative care in a hospice setting in the United Kingdom (UK). Methods: Using a realistic evaluation approach, we conducted a qualitative study using a variety of approaches. These consisted of open text answers from patients (n = 16) on how music therapy helped meet their needs within one hospice in Northern Ireland, UK. We also conducted three focus groups with a range of palliative care practitioners (seven physicians, seven nursing staff, two social workers and three allied health professionals) to help understand their perspectives on music therapy's impact on their work setting, and what influences its successful implementation. This was supplemented with an interview with the music therapist delivering the intervention. Results: Music therapy contains multiple mechanisms that can provide physical, psychological, emotional, expressive, existential and social support. There is also evidence that the hospice context, animated by a holistic approach to healthcare, is an important facilitator of the effects of music therapy. Examination of patients' responses helped identify specific benefits for different types of patients. Conclusions: There is a synergy between the therapeutic aims of music therapy and those of palliative care, which appealed to a significant proportion of participants, who perceived it as effective. [ABSTRACT FROM AUTHOR]

The article focuses on the decision of Great Britain Court of Appeal in the case R. v Awoyemi (Toby) regarding the possession of firearms with intent and gang crime and admissible of evidence with directions from jury under Great Britain's Criminal Justice Act.

This Note documents the motivations, process and challenges in developing the 10 Gender Principles for Dealing with the Legacy of the Past in Northern Ireland. The Principles are the outcome of a targeted intervention by a group of women from civil society and academia in Ireland and the UK to challenge the exclusions of ongoing negotiations to agree on a process to deal with the past. The Principles were shaped by a small-scale consultation with women bereaved by the conflict. The Note discusses some of the implications of the initiative for efforts elsewhere to craft practical feminist interventions into transitional justice processes, including the challenges inherent to such work. [ABSTRACT FROM AUTHOR]

This article presents the results from an analysis of data from service providers and young adults who were formerly in state care about how information about the sexual health of young people in state care is managed. In particular, the analysis focuses on the perceived impact of information sharing between professionals on young people. Twenty-two service providers from a range of professions including social work, nursing and psychology, and 19 young people aged 18–22 years who were formerly in state care participated in the study. A qualitative approach was employed in which participants were interviewed in depth and data were analysed using modified analytical induction (Bogdan & Biklen, 2007). Findings suggest that within the care system in which service provider participants worked it was standard practice that sensitive information about a young person’s sexual health would be shared across team members, even where there appeared to be no child protection issues. However, the accounts of the young people indicated that they experienced the sharing of information in this way as an invasion of their privacy. An unintended outcome of a high level of information sharing within teams is that the privacy of the young person in care is compromised in a way that is not likely to arise in the case of young people who are not in care. This may deter young people from availing themselves of the sexual health services. [ABSTRACT FROM PUBLISHER]

A qualitative study of staff and service users' views of recovery was undertaken in a UK high secure hospital working to implement recovery practices. 30 staff and 25 service users participated in semi-structured interviews or focus groups. Thematic analysis identified four broad accounts of how recovery was made sense of in the high secure environment: the importance of meaningful occupation; valuing relationships; recovery journeys and dialogue with the past; and recovery as personal responsibility. These themes are discussed with an emphasis on service user strategies of cooperation or resistance, respectively advancing or impeding progress through the system. In this context the notion of cooperation is, for many, commensurate with compliance with a dominant medical model. The policy framing of recovery opens up contemplation of treatment alternatives, more participatory approaches to risk management, and emphasise the value of relational skills, but may not elude the overarching bio-psychiatric episteme. [ABSTRACT FROM AUTHOR]

Background: A study of involvement initiatives within secure mental health services across one UK region, where these have been organized to reflect alliances between staff and service users. There is little previous relevant international research, but constraints upon effective involvement have been noted. Objective: To explore and evaluate involvement initiatives in secure mental health settings. Design: A case study design with thematic analysis of qualitative interviews and focus groups. Setting and participants: Data collection was carried out between October 2011 and February 2012 with 139 staff and service users drawn from a variety of secure mental health settings. Findings: Our analysis offers four broad themes, titled: safety and security first?; bringing it all back home; it picks you up; it's the talk. The quality of dialogue between staff and services users was deemed of prime importance. Features of secure environments could constrain communication, and the best examples of empowerment took place in non ‐ secure settings. Discussion: Key aspects of communication and setting sustain involvement. These features are discussed with reference to Jurgen Habermas's work on communicative action and deliberative democracy. Conclusions: Involvement initiatives with service users resident in secure hospitals can be organized to good effect and the active role of commissioners is crucial. Positive outcomes are optimized when care is taken over the social space where involvement takes place and the process of involvement is appreciated by participants. Concerns over risk management are influential in staff support. This is germane to innovative thinking about practice and policy in this field. [ABSTRACT FROM AUTHOR]

With increasing ethnic and racial diversity in the classroom, understanding classroom dynamics and the use of space has become increasingly important. In particular, when theoretical perspectives, such as that offered by intergroup contact research, promotes the importance of contact between competing groups to improve relations. Adopting a behavioural approach, the research presented here observed intergroup behaviour between Protestants and Catholics, through seating choice, in three integrated secondary schools in Northern Ireland. In addition, it considered the use of classroom seating plans by teachers. The sample involved students from Year 8 (aged 11-12) and Year 10 (aged 13-14), and their teachers. For observations of seating behaviour, data collection took place at three time points in the school year (September, January and June). Teachers were asked to complete a questionnaire regarding their use of seating plans during the January data collection phase. Seating choice was analysed using a statistical index of segregation. Results found persistent religious segregation over time, despite intergroup contact potential. In addition, the use of teacher enforced seating plans was examined and evaluated, suggesting that they may be restricting natural opportunities for intergroup friendship formation. Findings are discussed in relation to implications for theoretical understandings of contact theory, research methods and policy. [ABSTRACT FROM AUTHOR]

Objectives: To examine the experiences of mental health service users who took part in an arts-based programme at Tate Modern, a major London art gallery. Study design: Exploratory qualitative design. Methods: Data were collected using in-depth semi-structured interviews with 10 mental health service users who had taken part in a community-based programme at Tate Modern. Additionally, six art educators from Tate Modern were interviewed. Concepts that emerged from the text were identified using thematic analysis. Results: All participants valued the gallery-based programme. The three overarching thematic areas were: the symbolic and physical context in which the programme workshops were located; the relational and social context of the programme workshops; and reflections on the relationship between the arts-based programme and subsequent mental health. Conclusions: Art galleries are increasingly seen to function as vehicles for popular education with mental health service users. This study adds to the growing body of evidence related to how mental health service users experience and reflect on arts-related programmes targeted at them. This study indicates that emphasis on how users experience gallerybased programmes may contribute to a more nuanced understanding of the relationship between art and mental health. [ABSTRACT FROM AUTHOR]

The authors reflect other future of the mental health nursing workforce in Great Britain as of November 2015. Topics discussed include the endemic extent of mental distress in modern urbanized societies and necessity for the State to provide meaningful support; need of specialist training for nurses; and sociology of work and a critique of mental health nursing profession.

Advocacy serves to promote the voice of service users, represent their interests and enable participation in decision-making. Given the context of increasing numbers of people detained under the Mental Health Act and heightened awareness of the potential for neglect and abuse in human services, statutory advocacy is an important safeguard supporting human rights and democratising the social relationships of care. This article reports findings from a national review of Independent Mental Health Advocate ( IMHA) provision in England. A qualitative study used a two-stage design to define quality and assess the experience and impact of IMHA provision in eight study sites. A sample of 289 participants - 75 focus group participants and 214 individuals interviewed - including 90 people eligible for IMHA services, as well as advocates, a range of hospital and community-based mental health professionals, and commissioners. The research team included people with experience of compulsion. Findings indicate that the experience of compulsion can be profoundly disempowering, confirming the need for IMHA. However, access was highly variable and more problematic for people with specific needs relating to ethnicity, age and disability. Uptake of IMHA services was influenced by available resources, attitude and understanding of mental health professionals, as well as the organisation of IMHA provision. Access could be improved through a system of opt-out as opposed to opt-in. Service user satisfaction was most frequently reported in terms of positive experiences of the process of advocacy rather than tangible impacts on care and treatment under the Mental Health Act. IMHA services have the potential to significantly shift the dynamic so that service users have more of a voice in their care and treatment. However, a shift is needed from a narrow conception of statutory advocacy as safeguarding rights to one emphasising self-determination and participation in decisions about care and treatment. [ABSTRACT FROM AUTHOR]

The article presents the authors' views on the role of higher education on litigants in person (LiP) in Great Britain. They discuss the Legal Aid, Sentencing and Punishment of Offenders Act 2012 as well its direct impact on the number of LiPs in court. Other topics include the problems faced by LiPs, assistance for LiPs in England and Wales, LiPs in Australia and the U.S. They also tackle court-based advice programs.

The article reports the decision of the Court of Appeal Northern Ireland in the case "R. v Grimes (Michael Hugh)" concerning admissibility of good character in criminal justice administration.

The article focuses on development of the Integrated Clinical Apprenticeship (ICA) for assistance of medical students in their transformation to student doctors. Topics discussed include association of the Imperial College London in an introduction of ICA along with on-job training; assessment of the ICA's curriculum y comparison of ICA students with other medical students; and increment in an exposure for medical care services by ICA towards undergraduate primary care students.

Purpose -- The purpose of this paper is to inform understanding of female offenders who commit domestic violence. This contentious area of research is growing and there are strong indications that men and women perpetrate similar levels of domestic violence. This has resulted in increasing interest in understanding the characteristics of such offenders as well as considering treatment pathways. Design/methodology/approach -- In this study, female prisoners (n=92) completed a measure of psychological and physical aggression (Revised Conflict Tactics Scales, Straus et al., 1996) to explore the types of domestic violence experienced and perpetrated in most recent and previous relationships. Findings -- Results indicated high levels of psychological aggression and physical assaults both experienced and perpetrated by female offenders in current and previous relationships. Physical assaults tended to be severe and high levels of mutual violence were reported both in most recent and previous relationships. Practical implications -- The findings suggest the importance of service provision and treatment pathways for female domestic violence perpetrators. On the basis of the findings, treatment needs of such offenders are considered and potential treatment pathways are reflected upon. Originality/value -- There are little known publications exploring the prevalence and characteristics of female domestic violence perpetrators in prison. Research has also tended to focus on current relationships as opposed to considering both current and previous relationships. This paper explores these areas and will be of interest to practitioners working with this client group. [ABSTRACT FROM AUTHOR]

The article focuses on women in admiralty law in 2014. Topics include the number of female attorneys specializing in admiralty law in 2014, the development of admiralty law in Great Britain, and former U.S. Supreme Court Justice Sandra Day O'Connor's impact on U.S. admiralty law. Information is provided on admiralty law cases that have set precedent.

The objective was to examine the association between circumcision status and self-reported HIV infection among men who have sex with men (MSM) in Britain who predominantly or exclusively engaged in insertive anal intercourse. In 2007-2008, a convenience sample of MSM living in Britain was recruited through websites, in sexual health clinics, bars, clubs, and other venues. Men completed an online survey which included questions on circumcision status, HIV testing, HIV status, sexual risk behavior, and sexual role for anal sex. The analysis was restricted to 1,521 white British MSM who reported unprotected anal intercourse in the previous 3 months and who said they only or mostly took the insertive role during anal sex. Of these men, 254 (16.7 %) were circumcised. Among men who had had a previous HIV test (n = 1,097), self-reported HIV seropositivity was 8.6 % for circumcised men (17/197) and 8.9 % for uncircumcised men (80/900) (unadjusted odds ratio [OR], 0.97; 95 % confidence interval [95 % CI], 0.56, 1.67). In a multivariable logistic model adjusted for known risk factors for HIV infection, there was no evidence of an association between HIV seropositivity and circumcision status (adjusted OR, 0.79; 95 % CI, 0.43, 1.44), even among the 400 MSM who engaged exclusively in insertive anal sex (adjusted OR, 0.84; 95 % CI, 0.25, 2.81). Our study provides further evidence that circumcision is unlikely to be an effective strategy for HIV prevention among MSM in Britain. [ABSTRACT FROM AUTHOR]

Background Advocacy has a critical role to play in addressing concerns about access to appropriate mental health care and treatment for African and Caribbean men. Aim To investigate good practice principles and organizational models for mental health advocacy provision for African and Caribbean men. Study design The study consisted of: (i) A systematic literature review. Bibliographic and internet searching was undertaken from 1994 to 2006. The inclusion criteria related to mental health, advocacy provision for African and Caribbean men. (ii) Four focus groups with African and Caribbean men to explore needs for and experiences of mental health advocacy. (iii) An investigation into current advocacy provision through a survey of advocacy provision in England, Wales and Northern Ireland. (iv) Twenty-two qualitative stakeholder interviews to investigate the operation of mental health advocacy for this client group. The study was undertaken in partnership with two service user-led organizations and an African Caribbean mental health service. Results Primary research in this area is scant. Mainstream mental health advocacy services are often poor at providing appropriate services. Services developed by the Black Community and voluntary sector are grounded in different conceptualizations of advocacy and sharper understanding of the needs of African and Caribbean men. The lack of sustainable funding for these organizations is a major barrier to the development of high-quality advocacy for this group, reflecting a lack of understanding about their distinctive role. Conclusions The commissioning and provision of mental health advocacy needs to recognize the distinct experiences of African and Caribbean men and develop capacity in the range of organizations to ensure equitable access. [ABSTRACT FROM AUTHOR]