Central London Research Articles

Dental Health Adjuncts and Care: Exploring Access Among Asylum Seekers and Refugees in London, United Kingdom.

This work examines and describes dental health among people seeking asylum and refugees (PSAR) who are evaluated by the Respond service. This includes access to and use of oral health products, access to dental care, and experience of dental pain. The Respond service pilot offered holistic health assessments to PSAR in temporary accommodation within North Central London between July 2021 and March 2023. Relevant data were extracted from anonymized health records of individuals seen by Respond. Data were analyzed with SPSS (version 28.0.0.0; IBM) to produce descriptive statistics and regression models. An overall 1,390 PSAR were included; 78.7% were male. The mean ages of adults and children were 31.6 and 6.8 y. Seventy-seven countries of birth were reported, most commonly Iran (23.1%). Over two-thirds (67.1%) of PSAR were not accompanied by family members; only 17.2% had UK family links. The mean travel duration was 769.3 days; migration reasons were multifactorial, including persecution (31.2%) and conflict (20.5%). In addition, 77.3% of PSAR reported having access to a toothbrush; only 50.8% indicated routinely brushing their teeth, with 38.9% having seen a dentist in <36 mo. Dental pain was common (28.8%). Only 45.8% of children (<16 y) had access to a toothbrush, 32.3% were brushing their teeth twice daily, and 9.7% cited dental pain. Logistic regression identified significant predictors of routine toothbrushing, access to dental care, and dental pain. Female PSAR were more likely to routinely brush their teeth (adjusted odds ratio [OR], 3.19; P < 0.001) and access dental care (adjusted OR, 0.57; P < 0.05). PSAR aged 30 to 39 y (adjusted OR, 1.97; P < 0.05) and those with informal travel modes (adjusted OR, 1.82; P < 0.001) were more likely to experience pain. There is variation in the dental experience of PSAR, but a significant proportion are failing to perform routine toothbrushing, are not regularly accessing dental care, and are experiencing dental pain.Knowledge Transfer Statement: The results of this analysis suggest that there is variation in the dental experience of people seeking asylum and refugees, but many are failing to perform routine toothbrushing, are not regularly accessing dental care, and are experiencing dental pain.

Hands Up Program: Results of a feasibility study of a randomized controlled trial of a bone health exercise and education program for adults aged 50-65 post distal radius fracture.

Distal radius fractures (DRF) that occur from a fall from level ground are considered fragility fractures and may be the first indication that someone has compromised bone mineral density and is at risk of having osteoporosis. Women at about 50 years of age experience a dramatic increase risk of these fractures. Rehabilitation after DRF focuses on restoring range of motion and strength in the wrist, but rarely address future bone health concerns. We developed a 6-week therapist-developed remote full body exercise and osteoporosis/bone-health education program (called The Hands Up Program). This study was designed to evaluate the feasibility of a larger trial examining the effects of a whole-body exercise and education program for people 50-65 after a DRF. Community dwelling individuals between the age of 50-65 with a radiographically confirmed DRF were recruited from the Roth| McFarlane Hand and Upper Limb Center in London, Ontario. Participants were randomized in a 1:1 ratio into either the Hands Up Program which was a twice weekly exercise and education program for 6 weeks, or the control group where they proceeded with usual care. The intervention was delivered online through a website where participants created a unique username and password to access. The primary feasibility outcomes of the study were recruitment rate (74 participants in 1 year), retention rate (75% completion), and intervention adherence rate (60% of completion of the exercise program). Secondary outcomes included strength, range of motion, self-reported outcomes, and bone density. Overall, 74 participants were recruited in 14 months. Retention did not meet the criteria for success, as only 53% of the participants attended their 12-month visit. Adherence was also not met albeit close with 55% completing the exercise program. Twelve participants withdrew from the study, five due to the time commitment, four without explanation, one due to group allocation, one due to COVID and one participant moved. One participant was deemed ineligible after consent. Four of the participants that withdrew were in the intervention group, and four in the control group, five participants withdrew before they were allocated to a group. Feedback from patients indicated potential improvements to the program: lower assessment burden, spacing out the intervention so that the education portion could be delivered during the immobilization phase of recovery, and creating a more individualized program. Adherence and retention were both a challenge, although adherence was close to target. While achieving adherence to exercise in bone health is a known challenge, given the importance of prevention in the at-risk DRF population and the challenges in co-design and delivery during the pandemic, we believe evaluation of a revitalized program is warranted.

Changes in practice of exercise advice provision following the publication of ESC 2020 guidelines on sports cardiology and exercise at a central London inherited cardiac conditions outpatient service

Abstract ESC 2005 and AHA guidelines 2015 in sports cardiology restricted individuals with hypertrophic cardiomyopathy (HCM) from moderate and high intensity exercise and limited them to low intensity sport.1,2 Perceived increased risk of sudden cardiac death (SCD) with vigorous exercise in individuals with HCM was based on early registry data from the United States.3 This enforced sedentary lifestyle has led to an increasing trend towards obesity, atrial fibrillation and atherosclerotic coronary artery disease in patients with HCM.4 Recent ESC 2020 guidelines on exercise5 has enabled clinicians to recommend safe levels of exercise for these patients. We audited how well our outpatient practice reflected the guidance set out in 2020 ESC guidelines on exercise for patients with cardiovascular disease. Electronic records of 731 patients with a clinical diagnosis of HCM seen in our outpatient service between 2008-2023 were audited to determine whether written advice on exercise was given and if this was in line with the current ESC guidelines at any encounter. 731 patients with a mean age of 62±14.5 (range 17-91 years) were seen in our specialist outpatient service. 68% were male. 51% of patients received exercise advice either at their initial visit ± a follow-up visit. A significant proportional increase (16%,P&amp;lt;0.001) was seen in the number of patients receiving exercise advice at their initial visit after publication of the ESC 2020 guidelines (Table 1). 43% (270/634) of those who had their initial visit pre-guidelines received updated exercise advice as per 2020 ESC guidelines during follow-up. There was an increase in the proportion of patients receiving exercise advice each year after publication of ESC guidelines (Graph 1). Immediately following the publication, a high proportion received specific advice pertaining to intensity and duration of exercise (68% in 2020) with a slight decline subsequently (43%, 36% and 47% in 2021, 2022 and 2023 respectively). 27 patients had an implantable cardioverter defibrillator (ICD) in situ at the time of initial review with a further 127 undergoing ICD insertion under our care. SCD risk was documented for 66% (468/704) of patients according to the 2014 ESC Risk-SCD Model. 63% (214/338) of low-risk patients received exercise advice, whilst 77% (40/52) and 54% (42/78) of intermediate and high-risk patients received exercise advice respectively. 22 deaths (3%) were recorded during the follow-up period with none occurring during exercise. All cases except 2 were non-cardiac related. An overall improvement was seen in our practice with a significant increase in the number of patients receiving exercise advice after publication of the new guidelines. Despite this, only 51% of our patients received any written guidance on exercise demonstrating a need for further improvement in our outpatient practice to reflect the paradigm shift in the approach to exercise in individual with HCM as set out by the ESC 2020 guidance.

Clinical Outcome Patterns of Use of Radium-223 in Patients with Metastatic Castration-Resistant Prostate Cancer

Introduction: Radium-223 dichloride (radium-223) is a bone-targeting radioisotope therapy that aids in the survival of patients with metastatic castration-resistant prostate cancer (mCRPC) to bones. This study aimed to describe the clinical characteristics and outcomes of patients with mCRPC treated with radium-223 in a real-world setting. Methods: This was a retrospective study of patients with mCRPC treated with radium-223 between 2016 and 2020 at the London Health Sciences Centre in London, Canada. The baseline characteristics between the patients receiving 1–3 and 4–6 treatment cycles were compared using a two-sample t-test and Chi-square test. ANOVA was used to determine if there was a difference in each diagnostic variable per treatment cycle. Kaplan–Meier curves were generated to estimate progression-free survival (PFS) and overall survival in the patients treated with different numbers of cycles. Results: Fifty eligible patients were identified. The median age was 71 years (IQR: 66–76). Most patients (62%) received radium-223 beyond the third-line treatment. The mean number of radium-223 treatments was four. While 60% of the patients received 4–6 injections, 40% received 1–3 injections. Fifty-eight percent (58%) of the patients demonstrated a clinical benefit, with the remainder expressing either disease progression (28%) or stable disease (10%). The patients treated with 4–6 cycles had a delay to disease progression compared to those given 1–3 cycles of radium-223 (F5,35 = 10.52, p &lt; 0.001). A higher alkaline phosphatase level prior to treatment was associated with a longer PFS (z33 = 2.362, p = 0.018). Treatment-related hospitalization for skeletal-related events was noted in 8% of the patients, and 14% required treatment discontinuation due to hematologic toxicity. Conclusions: This study confirms the safety of radium-223 in patients with mCRPC in a real-world setting. The radium-223 treatment was associated with a clinical benefit in the majority of the patients, particularly in those with higher pre-treatment serum alkaline phosphatase levels. Further studies to identify the predictive biomarkers are warranted to better guide the contemporary use of radium-223.

'You are too much in this modern world, that's why you are like this': Understanding perceptions of mental health among Somali women in London.

This is a qualitative study exploring the perceptions of mental health among Somali women living in London. Participants, over the age of 18, female and identifying as Somali, were recruited from a community centre in West London. Seven participants were recruited and semi-structured interviews were conducted to better understand perceptions of mental health, care-seeking, treatment and different understandings of these issues within the Somali community in London. Interview transcripts were imported into NVIVO version 14 to be coded, and description-focussed coding and thematic analysis were used to interpret key themes. Concerns around judgement, shame and stigma are key issues affecting attitudes towards mental health in this group. Other important issues affecting conceptualisations and attitudes towards mental health were intergenerational differences, isolation from the community, stigma and secrecy. Participants also reported the importance of protective factors, particularly faith and family in their lives. This research adds to existing literature in exploring perceptions of mental health in Somali communities in the UK and such research is helpful in identifying cultural barriers to recognition and treatment of mental health within this community.

Obsessive-compulsive symptoms relating to psychosocial functioning for people with schizophrenia, schizoaffective disorder, or bipolar disorder.

To assess the psychosocial functioning concerning obsessive-compulsive symptoms (OCS) and/or obsessive-compulsive disorder (OCD) comorbidity in people with schizophrenia, schizoaffective disorder, or bipolar disorder diagnosed in a large case register database in Southeast London. Data were retrieved from the South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLaM BRC) register using Clinical Record Interactive Search (CRIS) system, a platform allowing research on full but de-identified electronic health records for secondary and tertiary mental healthcare services. Information of schizophrenia, schizoaffective disorder, bipolar disorder diagnosis and OCS/OCD status was ascertained from structural or free-text fields through natural language processing (NLP) algorithms based on artificial intelligence techniques during the observation window of January 2007 to December 2016. Associations between comorbid OCS/OCD and recorded Health of the Nation Outcome Scales (HoNOS) for problems with activities of daily living (ADLs), living conditions, occupational and recreational activities, and relationships were estimated by logistic regression with socio-demographic confounders controlled. Of 15,412 subjects diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder, 2,358 (15.3%) experienced OCS without OCD, and 2,586 (16.8%) had OCD recorded. The presence of OCS/OCD was associated with more problems with relationships (adj.OR = 1.34, 95% CI: 1.25-1.44), ADLs (adj.OR = 1.31, 95%CI: 1.22-1.41), and living conditions (adj.OR = 1.31, 95% CI: 1.22-1.41). Sensitivity analysis revealed similar outcomes. Comorbid OCS/OCD was associated with poorer psychosocial functioning in people with schizophrenia, schizoaffective disorder, or bipolar disorder. This finding highlights the importance of identification and treatment of comorbid OCS among this vulnerable patient group.

Construction of a deep basement with a single-level prop – prop forces and wall movements

This paper describes the construction of a deep basement in central London. The construction sequence for the basement was a combination of top-down and blue-sky excavation to enable phased delivery of the project. Temporary single-level props enabled blue-sky construction by managing ground movements. Ground movements associated with the basement construction and impact on third-party assets were monitored to validate the design using three-dimensional targets and inclinometers. The ground movements were predicted at each stage of construction using simple models with more complex three-dimensional soil–structure finite-element analysis used when examining the whole basement behaviour under the temporary and permanent loads. Temporary prop loads, and thermal loads on props were also monitored during the bulk digging. The small strain constitutive models for London Clay was shown to closely predict the observed movements.

The Determinants of Office Yields in European Cities

This paper examines the drivers of prime office yields in Europe. Specifically, the paper uses 16 European cities across 8 European countries including United Kingdom, France, Germany, Italy, Spain, Belgium, Netherlands, and Ireland from Q1 2007 to Q2 2024. The premier cities include Berlin, Paris, Central London, Frankfurt, and Munich while the primary cities are Hamburg, Dusseldorf, Madrid, Milan, Amsterdam and Dublin. Lastly, the secondary cities comprised of Barcelona, Rome, Brussels, Cologne, and Lyon. For the estimation technique, we use quantile regression and OLS while accounting for country, city and time fixed effects. From the baseline results, we find that take-up, prime rent, vacancy rate and foreign investment have a negative and statistically significant effect on office prime yields. In the case of the results obtained from the quantile regression, vacancy rate is seen as the most significant determinant of office yields. Prime rent emerged as a significant determinant of office yields. The result of this work is particularly useful for investors, policy makers and analysts as it provides an in-depth understanding of how office yield varies over time in different European Cities as well as the factors which influence office yields.

High time resolution quantification of PM2.5 oxidative potential at a Central London roadside supersite

The oxidative potential (OP) of airborne particulate matter (PM) is gaining increasing attention as a health-relevant metric to describe the capacity of PM to promote oxidative stress and cause adverse health effects. To date, most OP studies use filter-based approaches to sample PM and quantify OP, which have relatively poor time resolution (∼24 h) and underestimate the contribution of reactive components to OP due to the time delay between sample collection and analysis. To address this important limitation, we have developed a novel instrument which uses a direct-to-reagent sampling approach, providing robust, continuous, high time resolution (5 min) OP quantification, hence overcoming analytical limitations of filter-based techniques. In this study, we deployed this instrument in the Marylebone Road Air Quality Monitoring Station in London, UK, alongside a broad suite of high time resolution PM2.5 composition measurements for three months continuous measurement during Summer 2023. High time resolution OP quantification reveals dynamic changes in volume-normalised (OPv) and mass normalised (OPm) OP evolving over ∼hourly timescales, observed at an average PM2.5 mass concentration of 7.1 ± 4.2 µg m−3, below the WHO interim 4 target of 10 µg m−3. In addition, high time resolution data facilitates directional analysis, allowing us to determine the influence of wind speed and wind direction on OP, and the identification of PM2.5 chemical components and sources which drive dynamic changes in OP; this includes traffic emissions, as well as emissions from the London Underground into the ambient airshed. These results demonstrate the capacity of high time resolution measurements to provide new insights into the temporal evolution of OP, as well as the composition and emission sources which drive OP, developing our understanding of the characteristics of PM2.5 which may promote adverse health impacts.

Espérance Bridge

Espérance Bridge is one of the final infrastructure elements to be delivered on the King’s Cross estate in central London. The 25 metre footbridge spans over the Regent’s Canal to connect the major railway stations and Pancras Square in the south with shopping and eating hotspots, Granary Square and Coal Drops Yard in the north. As part of the original King’s Cross master plan, the bridge strengthens the link between the two halves of the site, enabling visitor flow and giving residents better access to public transport. The bridge also enlivens the canal corridor, providing a platform to observe Camley Street Natural Park to the west and the Ghat Steps to the east. Designed and constructed during a global pandemic and opening in the summer of 2021, the bridge is an innovative take on a traditional warren truss bridge that uses tapering and folded steel plates to create an elegant and sculptural form. The bold pomegranate red carbon steel plates set against the diagonal stainless steel tension ties illustrate the structural behaviour of the warren truss. Re-use of existing foundations to support the bridge ensured a seamless integration of the abutments into the setting, whilst also providing cost and carbon benefits.

Delivering Military Ethics Education to the Colombian Armed Forces: Centre for Military Ethics’ Collaboration with Colombian Military Educational Facilities

ABSTRACT This article describes the progress and impact of the King’s College London Centre for Military Ethics since its collaboration with the Colombian military forces’ educational institutions. More specifically, the article focusses on expanding the military ethics course across different educational facilities of the Colombian Army and the Colombian Navy and Air Force. The impact of the education delivered using an online course designed to be completed without a tutor is analysed and presented. The final part of the article describes a way forward as far as the Colombian project is concerned, as well as the refinement of the course materials and launch of new tools.

Children’s Health in London and Luton (CHILL) cohort: a 12-month natural experimental study of the effects of the Ultra Low Emission Zone on children’s travel to school

BackgroundThe Ultra-Low Emission Zone (ULEZ), introduced in Central London in April 2019, aims to enhance air quality and improve public health. The Children's Health in London and Luton (CHILL) study evaluates the impact of the ULEZ on children's health. This analysis focuses on the one-year impacts on the shift towards active travel to school.MethodsCHILL is a prospective parallel cohort study of ethnically diverse children, aged 6–9 years attending 84 primary schools within or with catchment areas encompassing London’s ULEZ (intervention) and Luton (non-intervention area). Baseline (2018/19) and one-year follow-up (2019/20) data were collected at school visits from 1992 (58%) children who reported their mode of travel to school ‘today’ (day of assessment). Multilevel logistic regressions were performed to analyse associations between the introduction of the ULEZ and the likelihood of switching from inactive to active travel modes, and vice-versa. Interactions between intervention group status and pre-specified effect modifiers were also explored.ResultsAmong children who took inactive modes at baseline, 42% of children in London and 20% of children in Luton switched to active modes. For children taking active modes at baseline, 5% of children in London and 21% of children in Luton switched to inactive modes. Relative to the children in Luton, children in London were more likely to have switched from inactive to active modes (OR 3.64, 95% CI 1.21–10.92). Children in the intervention group were also less likely to switch from active to inactive modes (OR 0.11, 0.05–0.24). Moderator analyses showed that children living further from school were more likely to switch from inactive to active modes (OR 6.06,1.87–19.68) compared to those living closer (OR 1.43, 0.27–7.54).ConclusionsImplementation of clean air zones can increase uptake of active travel to school and was particularly associated with more sustainable and active travel in children living further from school.

PE106 Running a successful benign robotic surgical programme in a tertiary, central London teaching hospital; feasibility and outcomes

PE106 Running a successful benign robotic surgical programme in a tertiary, central London teaching hospital; feasibility and outcomes

The Impacts of COVID-19 Lockdowns on Road Transport Air Pollution in London: A State-Space Modelling Approach.

The emergence of the COVID-19 pandemic in 2020 led to the implementation of legal restrictions on individual activities, significantly impacting traffic and air pollution levels in urban areas. This study employs a state-space intervention method to investigate the effects of three major COVID-19 lockdowns in March 2020, November 2020, and January 2021 on London's air quality. Data were collected from 20 monitoring stations across London (central, ultra-low emission zone, and greater London), with daily measurements of NOx, PM10, and PM2.5 for four years (January 2019-December 2022). Furthermore, the developed model was adjusted for seasonal effects, ambient temperature, and relative humidity. This study found significant reductions in the NOx levels during the first lockdown: 49% in central London, 33% in the ultra-low emission zone (ULEZ), and 37% in greater London. Although reductions in NOx were also observed during the second and third lockdowns, they were less than the first lockdown. In contrast, PM10 and PM2.5 increased by 12% and 1%, respectively, during the first lockdown, possibly due to higher residential energy consumption. However, during the second lockdown, PM10 and PM2.5 levels decreased by 11% and 13%, respectively, and remained unchanged during the third lockdown. These findings highlight the complex dynamics of urban air quality and underscore the need for targeted interventions to address specific pollution sources, particularly those related to road transport. The study provides valuable insights into the effectiveness of lockdown measures and informs future air quality management strategies.

Investigating the impact of socioeconomic status on amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by the gradual death of motor neurons in the brain and spinal cord, leading to fatal paralysis. Socioeconomic status (SES) is a measure of an individual’s shared economic and social status, which has been shown to have an association with health outcomes. Understanding the impact of SES on health conditions is crucial, as it can influence and be influenced by health-related variables. The role of socioeconomic status in influencing the risk and progression of ALS has not been established, and understanding the various factors that impact ALS is important in developing strategies for treatment and prevention. To investigate this relationship, we recruited 413 participants with definite, probable, or possible ALS according to the El Escorial criteria, from three tertiary centers in London, Sheffield, and Birmingham. Logistic regression was used to examine the association between case-control status, socioeconomic criteria, and ALS risk. Linear regression was used to examine the association between age of onset and socioeconomic variables. Two sensitivity analyses were performed, one using an alternative occupational classifier, and the other using Mendelian Randomization analysis to examine association. There was no significant relationship between any variables and ALS risk. We found an inverse relationship between mean lifetime salary and age of ALS onset (Beta = −0.157, p = 0.011), but no effect of education or occupation on the age of onset. The finding was confirmed in both sensitivity analyses and in Mendelian Randomization. We find that a higher salary is associated with a younger age of ALS onset taking into account sex, occupation, years of education, and clinical presentation.

Laboratory reference intervals influence referral patterns for hemoglobin abnormalities in the Ontario virtual care system.

This retrospective cross-sectional study investigates the impact of laboratory-specific hemoglobin reference intervals on electronic consultation (eConsult) referral patterns for suspected anemia and elevated hemoglobin at a tertiary care center in London, Ontario that serves Southwestern Ontario. The study analyzed referrals through the Ontario Telemedicine Network's eConsult platform for hemoglobin abnormalities, excluding patients under 18 years old, between July 1, 2019, and June 30, 2023.The main outcome measures were influence of hemoglobin reference intervals on the referral patterns for suspected anemia and elevated hemoglobin, as well as the extent of pre-referral laboratory testing. Of the 619 eConsults reviewed, 251 referrals for suspected anemia and 93 for elevated hemoglobin were analyzed. Referral patterns showed significant variance in hemoglobin levels based on different laboratory thresholds. Referrals for suspected anemia in females from laboratories whose lower limit was 120 g/L or greater had a hemoglobin concentration 7.5 g/L greater than referrals that used laboratories with a threshold lower than 120 g/L. The study also identified potential areas for improvement in pre-referral investigations; 44% of eConsults did not provide a ferritin level, 53% were missing a B12 level, and 81% were missing a reticulocyte count. In conclusion, laboratory reference intervals for hemoglobin significantly influence referral patterns for suspected hemoglobin abnormalities in Ontario's eConsult system. There is a need for standardized reference intervals and comprehensive pre-referral testing to avoid unnecessary medicalization and referrals. We propose an anemia management algorithm to guide primary care providers in the pre-referral investigation process.

An integrated approach to neuroscience care: An innovative model to support the new integrated care system

Integrated care systems join up health and care services, so that people have the support they need, in the right place, at the right time. The aims include improving outcomes in healthcare, tackling inequalities in access and enhancing productivity and value for money. This is needed for neuroscience care as the traditional delivery of neuroscience care is inefficient, outdated and expensive, and can involve complex referral pathways and long waiting times.In preparation for the formation of the integrated care system (ICS), a novel innovative collaboration across multiple NHS trusts developed across North Central London in 2021. We developed a model where neuroscience specialists engage in collaborative care with clinicians outside the specialist hospital setting. Pivotal to the pathway is a multidisciplinary meeting, and collaborative working enables joint clinical reviews, diagnostics and medication initiation.This innovative collaboration has already significantly improved access, addressed inequalities due to borough variation and enhanced the delivery and quality of neuroscience care in our ICS. It is a translatable model that can be adapted to suit other regions in the UK. It fulfils many of the objectives of the integrated care system and these benefits are seen without the need for significantly more resource.

Missed opportunities to prevent risk of offending in young people with ADHD – a service evaluation from a central London FCAMHS service

ABSTRACT This service evaluation aims to explore the needs of young people (YP) with ADHD engaging in risk behaviours. Demographic, clinical, social, and service involvement data were extracted from records of 443 YP referred to a Forensic Community CAMHS service. A sixth (74, 16.7%) had a diagnosis of ADHD. They had similar CAMHS input (55, 74.3%) compared to those with autism but many more had Youth Offending Team (YOT) involvement (22, 29.7% with ADHD; 5, 6.4% with ASC). A quarter (20, 27.8%) were in mainstream school with a fifth (13, 18.1%) out of education or training (NEET). Half (41, 55.4%) had an Education, Health, and Care Plan (EHCP). The prevalence of ADHD in YP referred and high levels of YOT input suggests missed opportunities to prevent the development of poor outcomes and criminalisation, including those not open to CAMHS and, therefore, unable to access medication, and those out of education without an EHCP.

Microgeographic speed, reliability, and traffic externalities

This paper estimates congestion externalities on a broad sample of roads in England’s capital region. A fixed effects approach that compares across times of day finds that 10% more traffic increases travel time by 4%, erodes reliability, and finds smallest marginal effects on high-capacity roads. I incorporate both expected travel time and reliability into a model of congestion externalities. Combining the model with travel data, I find that Central London’s Congestion Charge exceeds tolled drivers’ external costs if they only reflect travel time and reliability. Despite the large toll in London’s city centre, I find that deadweight loss in untolled parts of the city remains substantial, and that accounting for reliability increases deadweight loss by as much as 55%.

Who is inspired to follow Bishop Barron? Applying psychological type and psychological temperament theory among lay Catholic participants at an event sponsored in London by the Word on Fire Institute

ABSTRACT The present study draws on psychological type theory and psychological temperament theory to test the extent to which Bishop Barron’s ministry shaped by the Word on Fire Institute is reaching people less effectively reached by Catholic congregations. Data provided by 168 male and 292 female participants attending Bishop Barron’s day conference in central London during February 2023, who completed the Francis Psychological Type Scales, demonstrated that this event attracted significantly higher proportions of intuitive types and of thinking types, compared with Catholic churchgoers. However, like Catholic congregations, extraverts and perceiving types remained under-represented among the followers of Bishop Barron. The implications of these findings are discussed for the ongoing nurture of those attracted to Bishop Barron alongside inherited congregations.