Areas Of England Research Articles

Fetal Alcohol Spectrum Disorder and Neuropsychology: Exploring the implications of new NICE quality standards (2022) for neuropsychologists through a pilot assessment service

Recently released NICE Quality Standards for the assessment and diagnosis of Fetal Alcohol Spectrum Disorder (FASD) in children and young people emphasise neuropsychological assessment as an important part of the process. However, for many areas of England & Wales this may not be in line with current service provision. We conducted a scoping study of services within Oxfordshire to understand the current support available for children with possible FASD. In addition, we offered a pilot neuropsychology assessment service for seven children referred by a Community Paediatrician. We found that many services across Oxfordshire work with children who they suspect to have FASD, but no service offers FASD assessment or specific intervention. A trial neuropsychology service confirmed evidence for significant heterogeneity within this population, and therefore the need for careful, hypothesis driven assessment, to which neuropsychologists are well-placed to contribute.

Dissolved sulfate δ34S and the origin of sulfate in coal mine waters; NE England

Coal mine waters have been sampled during a reconnaissance study in the East Midlands, South Yorkshire and Tyneside areas of England. Almost all the mine waters had similarδ18O andδ2H concentrations, indicating a derivation from Holocene recharge (average of −7.9 and −54‰, respectively, excluding two outliers). Most mine waters emerging by shallow gravity drainage have dissolved sulfateδ34S levels of <+10‰, suggesting a derivation of sulfate from the oxidation of pyrite. Deeper mine waters, pumped from boreholes or shafts, tended to be more saline with dissolved sulfateδ34S levels of >+14‰ and, in two cases, >+30‰. The sulfate in these latter waters cannot be readily explained as deriving from pyrite oxidation. Alternative hypotheses (evaporitic or marine brines, evaporite dissolution or partially-closed-system microbial sulfate reduction) can be invoked as explanations. A more general hypothesis proposes that deep groundwaters/mine waters can be regarded as saline ‘sinks’, whose sulfateδ34S concentration is controlled by a dynamic equilibrium between rates of sulfate mobilization from various sources and sulfate removal by precipitation or microbial reduction.Supplementary material: Supplementary Material A (a detailed description of sample sites and results) and Supplementary Material B (locations of sample sites) are available athttps://doi.org/10.6084/m9.figshare.c.6418981

A longitudinal study reveals persistence of antimicrobial resistance on livestock farms is not due to antimicrobial usage alone.

There are concerns that antimicrobial usage (AMU) is driving an increase in multi-drug resistant (MDR) bacteria so treatment of microbial infections is becoming harder in humans and animals. The aim of this study was to evaluate factors, including usage, that affect antimicrobial resistance (AMR) on farm over time. A population of 14 cattle, sheep and pig farms within a defined area of England were sampled three times over a year to collect data on AMR in faecal Enterobacterales flora; AMU; and husbandry or management practices. Ten pooled samples were collected at each visit, with each comprising of 10 pinches of fresh faeces. Up to 14 isolates per visit were whole genome sequenced to determine presence of AMR genes. Sheep farms had very low AMU in comparison to the other species and very few sheep isolates were genotypically resistant at any time point. AMR genes were detected persistently across pig farms at all visits, even on farms with low AMU, whereas AMR bacteria was consistently lower on cattle farms than pigs, even for those with comparably high AMU. MDR bacteria was also more commonly detected on pig farms than any other livestock species. The results may be explained by a complex combination of factors on pig farms including historic AMU; co-selection of AMR bacteria; variation in amounts of antimicrobials used between visits; potential persistence in environmental reservoirs of AMR bacteria; or importation of pigs with AMR microbiota from supplying farms. Pig farms may also be at increased risk of AMR due to the greater use of oral routes of group antimicrobial treatment, which were less targeted than cattle treatments; the latter mostly administered to individual animals. Also, farms which exhibited either increasing or decreasing trends of AMR across the study did not have corresponding trends in their AMU. Therefore, our results suggest that factors other than AMU on individual farms are important for persistence of AMR bacteria on farms, which may be operating at the farm and livestock species level.

Socioeconomic gradient in mortality of working age and older adults with multiple long-term conditions in England and Ontario, Canada

BackgroundThere is currently mixed evidence on the influence of long-term conditions and deprivation on mortality. We aimed to explore whether number of long-term conditions contribute to socioeconomic inequalities in mortality, whether the influence of number of conditions on mortality is consistent across socioeconomic groups and whether these associations vary by working age (18–64 years) and older adults (65 + years). We provide a cross-jurisdiction comparison between England and Ontario, by replicating the analysis using comparable representative datasets.MethodsParticipants were randomly selected from Clinical Practice Research Datalink in England and health administrative data in Ontario. They were followed from 1 January 2015 to 31 December 2019 or death or deregistration. Number of conditions was counted at baseline. Deprivation was measured according to the participant’s area of residence. Cox regression models were used to estimate hazards of mortality by number of conditions, deprivation and their interaction, with adjustment for age and sex and stratified between working age and older adults in England (N = 599,487) and Ontario (N = 594,546).FindingsThere is a deprivation gradient in mortality between those living in the most deprived areas compared to the least deprived areas in England and Ontario. Number of conditions at baseline was associated with increasing mortality. The association was stronger in working age compared with older adults respectively in England (HR = 1.60, 95% CI 1.56,1.64 and HR = 1.26, 95% CI 1.25,1.27) and Ontario (HR = 1.69, 95% CI 1.66,1.72 and HR = 1.39, 95% CI 1.38,1.40). Number of conditions moderated the socioeconomic gradient in mortality: a shallower gradient was seen for persons with more long-term conditions.ConclusionsNumber of conditions contributes to higher mortality rate and socioeconomic inequalities in mortality in England and Ontario. Current health care systems are fragmented and do not compensate for socioeconomic disadvantages, contributing to poor outcomes particularly for those managing multiple long-term conditions. Further work should identify how health systems can better support patients and clinicians who are working to prevent the development and improve the management of multiple long-term conditions, especially for individuals living in socioeconomically deprived areas.

The Cost of Shoreline Protection: A Comparison of Approaches in Coastal New England and the Mid-­Atlantic

Shoreline hardening is a method of coastal hazard protection that is often implemented by government agencies and individual property owners. As awareness of the potential negative effects of shoreline hardening has increased, natural and nature-based approaches have gained in popularity. Most research related to shoreline protection has focused on understanding the environmental and ecological effects. However, for hybrid, nature-based approaches, in particular, there is limited information available to compare their monetary costs. To fill this gap, this study used information collected from public shoreline protection projects within the New England and Mid-Atlantic areas to estimate the costs of these measures based on the materials used, such as vegetation, sand, and/or stone. This approach allows for a detailed measurement of potential project inputs and provides needed cost information on the types of materials local governments and other stakeholders may use in their shoreline protection approaches. Results suggest that approaches that use natural materials tend to cost less than those that use more traditional, engineered materials, and nature-based approaches tend to cost somewhere in-between. Specifically, projects can be divided into four subgroups based on their average per-unit costs: (A) walls (mean: $5,628, se: $680) or stone at exposed sites (mean: $4,943, se: $725); (B) sand for beach nourishment (mean: $3,094, se: $397) or stone at low exposure sites ($3,014, se: $379); (C) stone and vegetation at low exposure sites (mean: $1,626, se: $217), stone and sand for other purposes at low exposure sites (mean: $1,411, se: $173), or sand for other purposes (mean: $1,384, se: $151); and (D) stone and sand for other purposes at low exposure sites (mean: $1,411, se: $173), sand for other purposes (mean: $1,384, se: $151), vegetation (mean: $1,300, se: $159), or vegetation and sand for other purposes (mean: $1,285, se: $172). Finally, monitoring and maintenance costs are often not accounted for, which may negatively affect the long-term success of shoreline protection efforts. Coupled with information on environmental and ecological effects of these different approaches, this information will allow for more informed decisions on how coastal and inland communities can best adapt to coastal risks.

Experiences and understanding of apathy in people with neurocognitive disorders and their carers: a qualitative interview study

apathy, defined as reduced goal-directed activity, interests and emotion, is highly prevalent in neurocognitive disorders (NCDs). Apathy has important consequences for the individuals who experience it and their carers, yet the lived experiences of apathy in this population are not well understood. to explore how people with NCDs and their carers understand and experience apathy. in-depth semi-structured interviews were conducted in participants' homes. Sixteen people with NCDs (dementia or mild cognitive impairment) and 14 carers, living in four geographical areas of England, took part. Interviews were audio-recorded and transcribed verbatim. Transcripts were analysed using reflexive thematic analysis. four themes were generated: 'Apathy is Poorly Understood'; 'Too much trouble: Mediating Effort and Outcome'; 'Preserving Identity in the Face of Loss of Capability and Autonomy' and 'Opportunity and Exclusion'. apathy is experienced as an understandable response to the everyday struggle people with NCDs face to preserve identity in the face of threats to capability and autonomy and is exacerbated by the lack of support and opportunities. Social and environmental modifications may help reduce apathy. In line with previous qualitative research, this challenges the dominant view of apathy as a neuropsychiatric symptom that excludes the social-environmental context.

Assessing the impact of regional transformative outreach activities aimed at widening university access, and participation among under-represented groups in schools

Transformative outreach activities, including study skills workshops, motivational speakers and campus visits, are common across the educational sector. However, little is known about their impact on non- traditional students' decisions regarding higher education. Designed to raise the higher education aspirations of young people in Years 9 to 13 (aged 13 – 18), the Uni Connect programme delivers outreach activities to young people in areas in England, UK, where higher education participation is much lower than expected based on attainment in national examinations taken at ages 15 and 16. This article presents the findings of a student activity survey conducted as part of the Lincolnshire Uni Connect regional evaluation. Surveys were sent to participating students between May and July 2020 to assess the impact of the outreach activities they had received during the school year. A total of 672 valid responses were received: 247 (37%) from Uni Connect students. Impact was measured against the NERUPI evaluation framework, which comprises five elements: knowing, choosing, becoming, practicing and understanding, and is designed to determine the success of widening participation initiatives. The data showed activities focusing on NERUPI outcomes 'know' and 'become' were the most effective. Findings from the study raise important questions about the choice and effectiveness of transformative activities aimed at underrepresented groups.

Review of 1.75 million referrals over 34 months identifies the disruptive impact of the SARS-CoV-2 pandemic on oral surgery care in England: a service evaluation.

Aims This study aimed to use electronic referral management system (eRMS) oral surgery data across multiple sites in England to evaluate the service over a 34-month period in relation to: 1) pre- and post-pandemic referral rates in oral surgery; 2) examining the data for signs of inequality in obtaining a referral for oral surgery; and 3) considering the impact on service provision for oral surgery in England.Methods Oral surgery referral data were available from an eRMS for areas of England covered by this service for the 34-month period of March 2019 to December 2021 (inclusive), which included 12 months of pre-pandemic data and the first 22 months of the pandemic. The data were from the following regions in England: Central Midlands; Cheshire and Merseyside; East Anglia and Essex; Greater Manchester; Lancashire; Thames Valley; and Yorkshire and the Humber.Results The total number of referrals received was 1,766,895 during this 34-month period, with pre-pandemic referral levels averaging at 25,498 per month, with a reduction to 698 per month in April 2020. Referrals have risen to a peak of 217,646 for the month of November 2021. An average of 1.5% of referrals were rejected pre-pandemic, compared with 2.7% per month post-pandemic.Discussion Pre-pandemic referral numbers were predictably stable within a narrow range which have then increased dramatically post-pandemic. The variations in oral surgery referral patterns place significant strain on oral surgery services across England. This not only has consequences on the patient experience, but also on workforce and workforce development, to ensure that there is not a long-term destabilising impact.Conclusion Analysis of 1.75 million referrals to oral surgery services in England has highlighted the ongoing impact of the pandemic and the need to actively minimise adverse impacts on patients, NHS services and the workforce.

Horizontal and vertical responsibilisation in the resettlement field

PurposeThe Offender Rehabilitation Act 2014 extended post-release supervision to individuals serving short prison sentences while introducing an extended array of actors into the resettlement field. This paper aims to explore the barriers that prison practitioners and community probation workers faced in their attempts to provide resettlement support, and how in response to these barriers, these practitioners enacted particular responsibilisation strategies.Design/methodology/approachThis empirical research features the perspectives of 19 prison, probation and third-sector actors within a case-study area in England. Qualitative interviews were carried out, alongside observations and field notes of daily practice.FindingsFindings indicate that despite the promise of additional support, practitioners face significant barriers inhibiting their ability to provide effective resettlement assistance. The three specific barriers identified are institutional, temporal and political-economic. In response, practitioners enacted particular responsibilisation strategies, shifting blame vertically down to service users and horizontally towards the other actors involved in managing these individuals.Practical implicationsThis article concludes with a brief overview of the latest iteration of resettlement practice, before exploring how a desistance-focused approach by practitioners may improve resettlement outcomes.Originality/valueThese findings help to expand our understanding of the responsibilisation literature, particularly how responsibilisation operates at a practitioner level, and how barriers become refracted and reframed into responsibilisation strategies. This article also draws on the “mass supervision” literature to demonstrate how the introduction of multiple agencies obfuscates individual responsibility for resettlement and large caseloads erode supervisory practice.

Longitudinal relationships across emotional distress, perceived emotion regulation, and social connections during early adolescence: A developmental cascades investigation.

Early adolescence is a vulnerable period for emotional distress. Both emotion regulation and social connection to peers and family adults are understood to be associated with distress. However, existing longitudinal work has not explored these constructs jointly in a way that estimates their reciprocal relationships over adolescence. We present a three-wave random-intercepts cross-lagged panel model of reciprocal relationships between emotional distress, perceived emotion regulation, and social connections during early adolescence, among 15,864 participants from education settings in disadvantaged areas of England, over three annual waves (at ages 11/12, 12/13, and 13/14 years). Findings showed that emotional distress and perceived emotion regulation share a negative relationship over time, and that higher perceived emotion regulation predicts greater family connection in the initial stages of early adolescence (from age 11-12 to 12-13 years). Findings also indicated that connection to peers is positively associated with family connection, but also positively predicts slightly greater distress in the later stages of early adolescence (from age 12-13 to 13-14 years). Findings indicate a risk of negative spiral between emotional distress and perceived emotion regulation in early adolescence, and that social connection may not necessarily play the role we might expect in reducing distress.

‘Pine Decline or pine declines?’ Analysis and Interpretation of Bog-Pines from Wem Moss, Shropshire, UK

A dendrochronological investigation was undertaken on subfossil Scots pine (Pinus sylvestris L.) stumps following their discovery during conservation management at Wem Moss, a small (28 ha) former raised mire in Shropshire, UK. Two ring-width chronologies were constructed from 14 of the 17 trees sampled spanning 198 and 208 years, respectively. Whilst dendrochronological dating was not possible, radiocarbon assays provided an estimated age for this mire-rooting woodland of between 3015 and 2505 years cal. BCE, coinciding with the age traditionally associated with the widespread mortality of pine trees throughout much of the UK and Ireland, often referred to as the Pine Decline (ca. 4000 radiocarbon years BP). Placed in a wider geographical context, the Wem Moss pines are located within the lowland Meres and Mosses region, where previous studies on subfossil pine have demonstrated protracted declines in mire-rooting trees. These have included tree mortality significantly post-dating the Pine Decline, especially at larger peatland sites that exceed 5 km2. Such macrofossil evidence for the presence of Scots pine into the late Holocene is supported by continuous Pinus pollen representation at peatland sites in the Welsh Marches (English–Welsh border), suggesting the possible survival of native Scots pine trees in this area up to the present day. The investigation of Wem Moss bog pines and their wider geographical context highlights the incomplete and patchy nature of palaeo-vegetational records and also the need for future genetic research on living Scots pine in possible refugial areas in Britain and Ireland.

Centralisation of specialist cancer surgery services in two areas of England: the RESPECT-21 mixed-methods evaluation

BackgroundCentralising specialist cancer surgical services is an example of major system change. High-volume centres are recommended to improve specialist cancer surgery care and outcomes.ObjectiveOur aim was to use a mixed-methods approach to evaluate the centralisation of specialist surgery for prostate, bladder, renal and oesophago-gastric cancers in two areas of England [i.e. London Cancer (London, UK), which covers north-central London, north-east London and west Essex, and Greater Manchester Cancer (Manchester, UK), which covers Greater Manchester].DesignStakeholder preferences for centralising specialist cancer surgery were analysed using a discrete choice experiment, surveying cancer patients (n = 206), health-care professionals (n = 111) and the general public (n = 127). Quantitative analysis of impact on care, outcomes and cost-effectiveness used a controlled before-and-after design. Qualitative analysis of implementation and outcomes of change used a multisite case study design, analysing documents (n = 873), interviews (n = 212) and non-participant observations (n = 182). To understand how lessons apply in other contexts, we conducted an online workshop with stakeholders from a range of settings. A theory-based framework was used to synthesise these approaches.ResultsStakeholder preferences– patients, health-care professionals and the public had similar preferences, prioritising reduced risk of complications and death, and better access to specialist teams. Travel time was considered least important.Quantitative analysis (impact of change)– only London Cancer’s centralisations happened soon enough for analysis. These changes were associated with fewer surgeons doing more operations and reduced length of stay [prostate –0.44 (95% confidence interval –0.55 to –0.34) days; bladder –0.563 (95% confidence interval –4.30 to –0.83) days; renal –1.20 (95% confidence interval –1.57 to –0.82) days]. The centralisation meant that renal patients had an increased probability of receiving non-invasive surgery (0.05, 95% confidence interval 0.02 to 0.08). We found no evidence of impact on mortality or re-admissions, possibly because risk was already low pre-centralisation. London Cancer’s prostate, oesophago-gastric and bladder centralisations had medium probabilities (79%, 62% and 49%, respectively) of being cost-effective, and centralising renal services was not cost-effective (12% probability), at the £30,000/quality-adjusted life-year threshold.Qualitative analysis, implementation and outcomes– London Cancer’s provider-led network overcame local resistance by distributing leadership throughout the system. Important facilitators included consistent clinical leadership and transparent governance processes. Greater Manchester Cancer’s change leaders learned from history to deliver the oesophago-gastric centralisation. Greater Manchester Cancer’s urology centralisations were not implemented because of local concerns about the service model and local clinician disengagement. London Cancer’s network continued to develop post implementation. Consistent clinical leadership helped to build shared priorities and collaboration. Information technology difficulties had implications for interorganisational communication and how reliably data follow the patient. London Cancer’s bidding processes and hierarchical service model meant that staff reported feelings of loss and a perceived ‘us and them’ culture.Workshop– our findings resonated with workshop attendees, highlighting issues about change leadership, stakeholder collaboration and implications for future change and evaluation.LimitationsThe discrete choice experiment used a convenience sample, limiting generalisability. Greater Manchester Cancer implementation delays meant that we could study the impact of only London Cancer changes. We could not analyse patient experience, quality of life or functional outcomes that were important to patients (e.g. continence).Future researchFuture research may focus on impact of change on care options offered, patient experience, functional outcomes and long-term sustainability. Studying other approaches to achieving high-volume services would be valuable.Study registrationNational Institute for Health and Care Research (NIHR) Clinical Research Network Portfolio reference 19761.FundingThis project was funded by the NIHR Health and Social Care Delivery Research programme and will be published in full inHealth and Social Care Delivery Research; Vol. 11, No. 2. See the NIHR Journals Library website for further project information.

OWL: an optimized and independently validated machine learning prediction model for lung cancer screening based on the UK Biobank, PLCO, and NLST populations.

A reliable risk prediction model is critically important for identifying individuals with high risk of developing lung cancer as candidates for low-dose chest computed tomography (LDCT) screening. Leveraging a cutting-edge machine learning technique that accommodates a wide list of questionnaire-based predictors, we sought to optimize and validate a lung cancer prediction model. We developed an Optimized early Warning model for Lung cancer risk (OWL) using the XGBoost algorithm with 323,344 participants from the England area in UK Biobank (training set), and independently validated it with 93,227 participants from UKB Scotland and Wales area (validation set 1), as well as 70,605 and 66,231 participants in the Prostate, Lung, Colorectal, and Ovarian cancer screening trial (PLCO) control and intervention subpopulations, respectively (validation sets 2 & 3) and 23,138 and 18,669 participants in the United States National Lung Screening Trial (NLST) control and intervention subpopulations, respectively (validation sets 4 & 5). By comparing with three competitive prediction models, i.e., PLCO modified 2012 (PLCOm2012), PLCO modified 2014 (PLCOall2014), and the Liverpool Lung cancer Project risk model version 3 (LLPv3), we assessed the discrimination of OWL by the area under receiver operating characteristic curve (AUC) at the designed time point. We further evaluated the calibration using relative improvement in the ratio of expected to observed lung cancer cases (RIEO), and illustrated the clinical utility by the decision curve analysis. For general population, with validation set 1, OWL (AUC=0.855, 95% CI: 0.829-0.880) presented a better discriminative capability than PLCOall2014 (AUC=0.821, 95% CI: 0.794-0.848) (p<0.001); with validation sets 2 & 3, AUC of OWL was comparable to PLCOall2014 (AUCPLCOall2014-AUCOWL < 1%). For ever-smokers, OWL outperformed PLCOm2012 and PLCOall2014 among ever-smokers in validation set 1 (AUCOWL=0.842, 95% CI: 0.814-0.871; AUCPLCOm2012=0.792, 95% CI: 0.760-0.823; AUCPLCOall2014=0.791, 95% CI: 0.760-0.822, all p<0.001). OWL remained comparable to PLCOm2012 and PLCOall2014 in discrimination (AUC difference from-0.014 to 0.008) among the ever-smokers in validation sets 2 to 5. In all the validation sets, OWL outperformed LLPv3 among the general population and the ever-smokers. Of note, OWL showed significantly better calibration than PLCOm2012, PLCOall2014 (RIEO from 43.1% to 92.3%, all p<0.001), and LLPv3 (RIEO from 41.4% to 98.7%, all p<0.001) in most cases. For clinical utility, OWL exhibited significant improvement in average net benefits (NB) over PLCOall2014 in validation set 1 (NB improvement: 32, p<0.001); among ever smokers of validation set 1, OWL (average NB=289) retained significant improvement over PLCOm2012 (average NB=213) (p<0.001). OWL had equivalent NBs with PLCOm2012 and PLCOall2014 in PLCO and NLST populations, while outperforming LLPv3 in the three populations. OWL, with a high degree of predictive accuracy and robustness, is a general framework with scientific justifications and clinical utility that can aid in screening individuals with high risks of lung cancer. National Natural Science Foundation of China, the US NIH.

P284 Assessing Patient Experience in an Inflammatory Bowel Disease service. Can we measure an effect from socioeconomic deprivation – experience from the AWARE-IBD programme?

Abstract Background There is increasing international attention on delivery of services for people with Inflammatory bowel diseases (IBD). Experience of care is defined and measured as ‘what’ happened, ‘how’ and ‘how often’ and is an important facet of service provision. Socioeconomic deprivation may be associated with poor disease-related outcomes and sub-optimal utilisation of services but its effect on experience of care in people with inflammatory bowel disease has not been reported. Methods An invitation to participate in a research study nested within the AWARE-IBD quality improvement programme was sent to 4082 patients attending the IBD service at a single UK teaching centre in October 2021. A second invitation was sent in May 2022 followed by telephone recruitment targeted to those from the most deprived deciles based on the index of multiple deprivation (IMD), a measure of relative deprivation for small areas in England (‘lower-layer super areas’, approximately 1500 residents). Participants returned an IBD specific patient reported experience measure (PREM) via a web application comprising 38 items across 3 domains: ‘My Care Team’, “What matters to me’, ‘Living with Crohn’s or Colitis’. Each item was scored 1 (poorest experience) to 5 (best experience). Median scores for individual items and by domain was compared in the following demographic groups: IMD decile IMD (1 = most deprived; 10 = least deprived), age, gender, disease type (ulcerative colitis or Crohn’s disease). Results PREM responses were received from 249/4,082 (6%) patients. Patients from the most deprived decile were underrepresented in respondents compared to the invited cohort (Decile 1 22/249 (9%) vs 667/4,063(16%) p=0.002) and patients from the least deprived decile were over-represented; Decile 10: 38/249 (15%) vs 379/4063(9%) p=0.002). Respondents were otherwise broadly comparable to the invited cohort in terms of age, gender and disease type. Experience of care for respondents for individual PREM items or by domain did not differ according between IMD deciles (Figure 1), age, gender or disease type. Conclusion Measuring experience of care is an important part of IBD service quality improvement. No effect from socioeconomic deprivation was demonstrated. This finding conflicts with the literature on links between socioeconomic factors and quality of care and results across a service should be interpreted with caution. Experience of those at greatest risk is difficult to elicit with survey based experience measurement. Instead, tailored engagement exercises are required including qualitative and ethnographic approaches to better understand the impact of deprivation on experience.

Recent trends in the spatial distribution of human capital: Are skill levels converging across regions in England and Wales?

AbstractIn modern knowledge‐based societies human capital is the single most important determinant of regional inequalities in productivity and standards of living. Using a newly constructed data set that allows the analysis of educational attainments at different levels of geography, this paper evaluates spatial inequalities and the degree of convergence in the distribution of human capital across areas in England and Wales during the second decade of the 21st century. Our results show this was a period characterised by a large increase in educational attainment and skill intensity. However, the growth in skill intensity was far from uniform across space. In particular, we find strong evidence of both absolute σ‐divergence and β‐convergence in the distribution of skills. Thus, even if low‐skill areas grew on average more than other areas with higher skill intensity at the start of the period, the stochastic dominance analyses provide strong evidence of an unambiguous increase in absolute inequalities so that by end of the decade the skill gap between low‐ and high‐skill areas had significantly widened. We present new spatial and aspatial evidence that sheds light on those inequalities and the changes in the spatial configuration of human capital over the last decade. Despite the implementation of policies aimed at reducing regional inequalities, many low skill areas struggled to attract talent so that the gap with most skilled areas widened over that period likely contributing to the persistence of the well‐documented large spatial economic inequalities in this country.

A short history of the Ordovician System: from overlapping unit stratotypes to global stratotype sections and points

Abstract The Ordovician System was introduced by Charles Lapworth as a solution to the overlapping unit stratotypes loosely defined by Adam Sedgwick, for the Cambrian, and Roderick Murchison, for the Silurian. The Ordovician has emerged as one of the longest and most significant of the geological periods. Following an interval of intensive research of all the key regions of the globe, unit stratotypes in the type areas of England and Wales have been replaced by seven global stages and three series based on Global Stratotype Sections and Points (GSSPs), enhancing the definition of these chronostratigraphic units and facilitating global correlation. As a consequence, the biological and geological events during the period can be recognized and the magnitude and significance of biotic originations and extinctions understood with some confidence.

A spatio-temporal framework for modelling wastewater concentration during the COVID-19 pandemic

The potential utility of wastewater-based epidemiology as an early warning tool has been explored widely across the globe during the current COVID-19 pandemic. Methods to detect the presence of SARS-CoV-2 RNA in wastewater were developed early in the pandemic, and extensive work has been conducted to evaluate the relationship between viral concentration and COVID-19 case numbers at the catchment areas of sewage treatment works (STWs) over time. However, no attempt has been made to develop a model that predicts wastewater concentration at fine spatio-temporal resolutions covering an entire country, a necessary step towards using wastewater monitoring for the early detection of local outbreaks.We consider weekly averages of flow-normalised viral concentration, reported as the number of SARS-CoV-2N1 gene copies per litre (gc/L) of wastewater available at 303 STWs over the period between 1 June 2021 and 30 March 2022. We specify a spatially continuous statistical model that quantifies the relationship between weekly viral concentration and a collection of covariates covering socio-demographics, land cover and virus associated genomic characteristics at STW catchment areas while accounting for spatial and temporal correlation.We evaluate the model’s predictive performance at the catchment level through 10-fold cross-validation. We predict the weekly viral concentration at the population-weighted centroid of the 32,844 lower super output areas (LSOAs) in England, then aggregate these LSOA predictions to the Lower Tier Local Authority level (LTLA), a geography that is more relevant to public health policy-making. We also use the model outputs to quantify the probability of local changes of direction (increases or decreases) in viral concentration over short periods (e.g. two consecutive weeks).The proposed statistical framework can predict SARS-CoV-2 viral concentration in wastewater at high spatio-temporal resolution across England. Additionally, the probabilistic quantification of local changes can be used as an early warning tool for public health surveillance.

Evaluating the effects of two different kinesiology taping techniques on shoulder pain and function in patients with hypermobile Ehlers-Danlos syndrome.

Ehlers-Danlos Syndrome (EDS) is a group of inherited connective tissue disorders which predominantly affects women and has a prevalence as high as 1 in 5,000 individuals. Hypermobile EDS (hEDS) is the most common subtype of EDS and is characterized by multi-joint pain, particularly in large joints such as the shoulder. Physical therapy is often utilized to address the pain, physical impairments, and functional loss in patients with EDS. Kinesiology Tape (KT) is an intervention commonly used by physical therapists for treating shoulder pain and dysfunction. Studies related to the effectiveness of KT in patients with shoulder pain is equivocal and there are a lack of studies specifically studying the effects of KT in an EDS population. The purpose of this study was to assess the efficacy and short-term effects of two different KT techniques on shoulder pain and function in individuals with hEDS and shoulder pain. Participants were recruited from EDS support groups in the New England area of the United States; were diagnosed with hEDS by their physician; and had shoulder pain. Baseline demographic information was obtained for each participant followed by completion of 4 patient reported outcome (PRO) measures: the Upper Extremity Functional Index, QuickDASH (Disabilities of the Arm, Shoulder, & Hand), Shoulder Pain and Disability Index, and the Western Ontario Shoulder Instability Index. Current pain level, average pain over the past 24 h, and worst pain over the past 24 h were recorded using the numeric pain rating scale (NPRS). Subjects were randomly assigned to receive either an experimental shoulder KT procedure or a control shoulder taping. Immediately after taping, the NPRS was reassessed. Subjects then returned 48 h later to repeat the NPRS and PRO measures. There was no significant difference between the experimental and control tape groups for any outcome measure. There was a significant improvement from pre-taping to 48-hours post taping for each of the 4 PRO measures with large effect sizes (p < 0.001; ƞ p 2 = .517-.719). Likewise, average, and worst pain over the last 24 h significantly improved with large effect sizes over the same period (p = 0.005; ƞ p 2 = .225 and p < 0.001; ƞ p 2 = .382, respectively). Current NPRS levels significantly improved from pre-tape to immediately post-tape (p = .023, ƞ p 2 = .131) and was maintained through the 48-hour follow up, although no further improvement was seen. KT is an inexpensive and relatively safe intervention that is easy to apply and can offer temporary improvements in pain and function for patients with EDS and shoulder pain.

Recruitment and retention in dentistry in the UK: a scoping review to explore the challenges across the UK, with a particular interest in rural and coastal areas.

Introduction There is currently reduced access to NHS dental services in the UK, particularly in England, with rural and coastal areas significantly affected. Recruitment and retention in dentistry has been highlighted as an issue contributing to the problem.Objectives To explore what is known or unknown about recruitment and retention of the dental workforce in the UK, with a particular focus on rural and coastal areas. We were keen to gain information relating to factors affecting recruitment and retention, geographical distribution of the workforce, anticipated challenges, strategies or proposals to assist workforce planning and the extent of empirical research.Methods Searches for peer-reviewed literature and reports were undertaken and included when they met the eligibility criteria. Data were extracted and the findings narratively synthesised.Discussion The findings suggested wide ranging recruitment and retention issues of the dental workforce in the UK. Most issues were associated with NHS dentists, followed by dental nurses across both the NHS and private sectors. The worst affected parts of the country were rural and coastal areas.Conclusion It appears from the evidence that there are many dental professionals discussing recruitment and retention issues, followed by stakeholders. However, there is limited research and data to initiate change.

Rapid rise in COVID-19 among young people in England – learning for the future

ObjectivesWe determined the age and sociodemographic distribution of COVID-19 cases between January and September 2020 to identify the group with the highest incidence rates at the beginning of the second wave in England. Study designWe undertook a retrospective cohort study design. MethodsSARS-CoV-2 cases in England were linked with area-level socio-economic status indicators using quintiles of the Index of Multiple Deprivation (IMD). Age-specific incidence rates were stratified by IMD quintile to further assess rates by area-level socio-economic status. ResultsBetween July and September 2020, SARS-CoV-2 incidence rates were highest amongst those aged 18–21 years, reaching rates of 213.9 (18–19 years) and 143.2 (20–21 years) per 100,000 population by week ending 21 September 2022. Stratification of incidence rates by IMD quintile evidenced that despite high rates observed in the most deprived areas of England amongst the very young and older age groups, the highest rates were observed in the most affluent areas of England amongst the 18- to 21-year-olds. ConclusionsThe reversal of sociodemographic trend in COVID-19 cases in England for those aged 18–21 years at the end of the summer of 2020 and beginning of the second wave showed a novel pattern of COVID-19 risk. For other age groups, the rates remained highest for those from more deprived areas, which highlighted persisting inequalities. Combined, this demonstrates the need to reinforce awareness of COVID-19 risk for young people, particularly given the late inclusion of the 16–17 years age group for vaccination administration, as well as continued efforts to reduce the impact of COVID-19 on vulnerable populations.