North Of England Research Articles

The ‘image of God’ and the schooling of virtue: Christian-ethos schools of character for the whole community

ABSTRACT This article reports how the Judeo-Christian belief that all persons are ‘made in God’s image’ (imago Dei) leads to an egalitarian and generous evaluation of children and young people educated in a group of Christian-ethos schools with no ‘faith-test’ for admission in socio-economically disadvantaged areas of the north of England. The inclusiveness of Christian humanist perspectives, ancient and modern, conceiving of imago Dei as the divine gift of moral virtue, underpins the model of character education evaluated here. Drawing on a tradition of generous Christian humanism is seen to equip these Christian-ethos schools to provide students of all faiths and none with an inclusive education of character. Baptising neo-Aristotelian virtue ethics underpinning character education and repristinating shared virtues also avoids privileging either confessional Christian nurture or pervasively secular character education and are relevant more widely.

Lively commodities and endemic diseases: Shifting commodity situations and nonhuman disability in cattle and sheep on UK farms

The concept of ‘lively commodities’ captures how aspects of the life of certain entities affect their commodification and exchange within capitalist economic systems. Their status as being, or comprised of, living things matters to their commodification in different ways in particular places and spaces and at particular times. This paper uses the empirical example of diseased farmed animals in the north of England to examine the effects of susceptibility to disease on the process of lively commodification, drawing on conceptualisations of nonhuman disability and relations of care alongside literature on lively commodities, and exploring cases of multi-lifeform co-production of disease. It thus focuses on moments where the liveliness of animals means that commodification ‘goes wrong’, because liveliness means susceptibility to injury and disease, alongside its potential for economic production. The paper focuses on two important endemic conditions affecting UK farming: lameness in cattle and sheep, and bovine viral diarrhoea (BVD) in cattle. These conditions significantly affect animals' welfare and impact on farm productivity. Drawing on qualitative analysis of transcripts from in-depth interviews with 29 farmers and 21 farm advisers (e.g. vets), the paper examines three empirical themes where farming practices are strongly affected by the lively nature of the commodities being produced: first, the anticipatory practice of breeding animals resistant or vulnerable to disease; second, lameness and nonhuman disability; and third, BVD and threats to agricultural biosecurity. The paper concludes by revisiting the concept of lively commodities in situations where farmed animals are diseased, and reflects on the implications of this for their shifting commodity status in particular times and places.

Piloting wastewater-based surveillance of norovirus in England

Wastewater-based epidemiology (WBE) gained widespread use as a tool for supporting clinical disease surveillance during the COVID-19 pandemic. There is now significant interest in the continued development of WBE for other pathogens of clinical significance. In this study, approximately 3,200 samples of wastewater from across England, previously collected for quantification of SARS-CoV-2, were re-analysed for the quantification of norovirus genogroup I (GI) and II (GII). Overall, GI and GII were detected in 93% and 98% of samples respectively, and at least one of the genogroups was detected in 99% of samples. GI was found at significantly lower concentrations than GII, but the proportion of each genogroup varied over time, with GI becoming more prevalent than GII in some areas towards the end of the study period (May 2021 – March 2022). Using relative strength indices (RSI), it was possible to study the trends of each genogroup, and total norovirus over time. Increases in norovirus levels appeared to coincide with the removal of COVID-19 related lockdown restrictions within England. Local Moran's I analyses indicated several localised outbreaks of both GI and GII across England, notably the possible GI outbreak in the north of England in early 2022. Comparisons of national average norovirus concentrations in wastewater against concomitant norovirus reported case numbers showed a significant linear relationship. This highlights the potential for wastewater-based monitoring of norovirus as a valuable approach to support surveillance of norovirus in communities.

Modelled impact of virtual fractional flow reserve in patients undergoing coronary angiography (VIRTU-4)

BackgroundThe practical application of ‘virtual’ (computed) fractional flow reserve (vFFR) based on invasive coronary angiogram (ICA) images is unknown. The objective of this cohort study was to investigate the potential...

Predictors of confidence in research: a cross-sectional survey of pharmacists in the north of England.

Pharmacist-led research is key to optimizing medicines use and improving pharmacy services, yet it is not yet widely embedded into careers. This study aims to identify predictors of confidence in meeting the research learning outcomes in the Royal Pharmaceutical Society (RPS) Post-Registration Foundation and Core Advanced curricula, to provide targeted recommendations for building research capability and capacity within the profession. The study was a cross-sectional electronic survey, distributed to eligible pharmacists in March 2023 (n = 253). The survey gathered demographic information, research experience, and self-reported confidence in meeting the research learning outcomes in the RPS Post-Registration Foundation and Core Advanced curricula. Pre-determined independent variables were analysed using two binomial logistic regression models (one per curriculum) to identify predictors of the dichotomous variable: confidence with meeting all research learning outcomes in that curriculum. Participants were more likely to self-report as confident (versus not confident) with meeting all research learning outcomes in a curriculum if they had recent experience (within the previous 12 months) of research or research-related activities, held a postgraduate research qualification, had undertaken research training outside of a postgraduate qualification, discussed research in their appraisal, or worked in the hospital sector. Conversely, male gender, years practicing, and protected time for research did not predict confidence. A targeted approach, including improving access to research methods training, experience-based learning, mentorship, and linking research projects to key organizational objectives, could be the key to developing research capability and capacity across all sectors and career stages.

Development of a Resource for Health Professionals to Raise Advance Care Planning Topics During Kidney Care Consultations: A Multiple User-Centered Design

Rationale & ObjectivePlanning and delivering treatment pathways that integrate end-of-life care, frailty assessment and enhanced supportive care is a service priority. Despite this, people with kidney failure are less likely to have an advance care plan, and receive hospice and palliative care, compared to other chronic illness populations. This is linked to health professionals feeling unskilled initiating conversations around future treatment and care options. This article describes research underpinning the development of a guide for kidney health professionals discussing end-of-life and advance care planning options with people with kidney failure and family members. Study DesignThe study comprised two parts: an initial cross-sectional qualitative approach using in-depth interviews with older adults with kidney failure and (bereaved) carers, followed by resource development with input from multiple stakeholders. Setting & ParticipantsOlder adults with kidney failure, and (bereaved) carers, recruited from two renal units in the North of England, and via online advertisements with national UK based, kidney patient charities. Resource development included input from co-applicants, independent advisory committee, patient and public involvement team, multidisciplinary health professionals and academics in the UK and Denmark. Analytical ApproachThematic analysis was used to analyze the data. ResultsTwenty-seven people were interviewed: older adults with kidney failure (n=18), carers (n=5), bereaved carers (n=4). Five themes are described: the context within which end-of-life conversations take place, preferences for end-of-life treatment and care, family members’ role and needs in supporting people with kidney failure at the end-of-life, expectations and experience of dialysis treatment, beliefs and experiences of death and dying. LimitationsParticipants were mainly White, British, and receiving hemodialysis. ConclusionsPeople with (lived) experience of kidney failure informed a guide which aims to build upon health professionals existing skills and improve confidence having conversations about future treatment and care. Kidney teams have expressed interest implementing the guide in practice and within their broader communications training packages.

Ultra-processed food consumption in UK adolescents: distribution, trends, and sociodemographic correlates using the National Diet and Nutrition Survey 2008/09 to 2018/19

PurposeWe quantified levels of ultra-processed food (UPF) consumption and investigated consumption patterns in a representative sample of UK adolescents.MethodsWe used data from 4-day food diaries from adolescents in the UK National Diet and Nutrition Survey (NDNS) (2008/09–2018/19). UPF were identified using the NOVA classification. We estimated the percentage of Total Energy Intake (%TEI) and the absolute weight (grams). Linear regression models quantified differences in UPF consumption across survey years and its association with participant’s individual characteristics. This was an analysis of the repeated cross-sectional data from the UK NDNS Rolling Programme waves 1–11 (2008/09–2018/19). A total of 2991 adolescents (11–18y) with complete information on dietary intake were included.ResultsMean UPF consumption was 861 (SD 442) g/d and this accounted for 65.9% (SD 13.4%) of TEI. Between 2008 and 2019, mean UPF consumption decreased from 996 to 776 g/d [ – 211 (95%CI – 302; – 120)] and from 67.7% to 62.8% of TEI [ – 4.8% (95%CI – 8.1; – 1.5)]. Higher %TEI was consumed by adolescents with lower socioeconomic status; white ethnicity and living in England North. A higher weight of UPF consumption (g/d) was associated with being male, white, age 18y, having parents with routine or manual occupation, living in England North, and living with obesity.ConclusionAverage energy intake from UPF has decreased over a decade in UK adolescents. We observed a social and regional patterning of UPF consumption, with higher consumption among adolescents from lower socioeconomic backgrounds, from a white ethnicity and living in England North. Our findings suggest inequalities associated with UPF intake and factors that might lie beyond individual choice.

Associations between the neighbourhood food environment and food and drink purchasing in England during lockdown: A repeated cross-sectional analysis.

Evidence for the effect of neighbourhood food environment (NFE) exposures on diet in the UK is mixed, potentially due to exposure misclassification. This study used the first national COVID-19 lockdown in England as an opportunity to isolate the independent effects of the NFE exposure on food and drink purchasing, and assessed whether these varied by region. Transaction-level purchasing data for food and drink items for at-home (1,221 households) and out-of-home consumption (171 individuals) were available from the GB Kantar Fast Moving Consumer Goods Panel for London and the North of England. The study period included 23rd March to 10th May 2020 ('lockdown'), and the same period in 2019 for comparison. NFE exposures included food outlet density and proximity, and NFE composition within a 1 km network buffer around the home. Associations were estimated for both years separately, adjusted for individual and household characteristics, population density and area deprivation. Interaction terms between region and exposures were explored. There were no consistent patterns of association between NFE exposures and food and drink purchasing in either time period. In 2019, there was some evidence for a 1.4% decrease in energy purchased from ultra-processed foods for each additional 500 m in the distance to the nearest OOH outlet (IR 0.986, 95% CI 0.977 to 0.995, p = 0.020). In 2020, there was some evidence for a 1.8% reduction in total take-home energy for each additional chain supermarket per km2 in the neighbourhood (IR 0.982, 95% CI 0.969, 0.995, p = 0.045). Region-specific effects were observed in 2019 only. Findings suggest that the differences in exposure to the NFE may not explain differences in the patterns or healthiness of grocery purchasing. Observed pre-pandemic region-specific effects allude to the importance of geographical context when designing research and policy. Future research may assess associations for those who relied on their NFE during lockdown.

Intellectual Disabilities and Neurocognitive Impairment in Adult Patients with Inherited Metabolic Diseases: A UK Single Centre Experience.

Inherited metabolic diseases (IMDs) are a group of heterogeneous genetic disorders resulting in substrate accumulation, energy deficiency, or complex molecular defects due to the failure of specific molecules to act as enzymes, cofactors, transporters, or receptors in specific metabolic pathways. The pathophysiological changes seen in IMDs are sometimes associated with intellectual disability (ID) or neurocognitive decline, necessitating multidisciplinary input. We here describe our experience at one tertiary metabolic centre in the UK. We reviewed the case prevalence and existing service provision in one adult IMD service covering a multi-ethnic population of 10 million in North England. In our cohort of 2268 IMD patients, 1598 patients had general metabolic conditions (70.5%), and 670 had lysosomal storage disease/disorders (LSD)s (29.5%). The overall prevalence of ID and neurocognitive decline was found to be 15.7% (n = 357), with patients with LSDs accounting for 23.5% (n = 84) of affected patients. Given the prevalence of ID in adults with IMDs, access to multidisciplinary input from neuropsychology and neuropsychiatry services is important. Education of healthcare professionals to diagnose IMDs in patients with ID, in addition to neurocognitive and neuropsychiatric presentations, will avoid missed diagnoses of IMD and will have a positive effect on patient outcomes.

Reflective practice and feedback – empowering university students’ teaching of dance in UK state schools

ABSTRACT A mixed methods approach for gathering data was adopted to report Level 5, 2nd (N = 34; F27, M7) and Level 6, 3rd (N = 29; M5, F24) year University students’ (N = 63) reflections of dance practice at Leeds Beckett University in the north of England. Five research instruments were utilised to gather data: questionnaires (including both open and closed questions), semi-structured interviews, reflective logs, pictorial evidence and observations. Reflections from practising primary (N = 9; F7, M2) and secondary (N = 8; M1, F7) teachers and their young people (N = 904, 5 to 18-year olds) also informed the students’ practice. The students’ production of original dance teaching resources (N = 17) delivered at the University based professional development days, attended by delegates (N = 121) from across the UK, served to qualify the suitability of the teaching and resources. The collaboratively created resources are highlighted as beneficial to enhance learning, teaching, self-efficacy, resilience and employability. The main aim and question therefore being realised, how to support and enhance the learning and teaching of dance in UK schools.

Fragments of citizenship: contested mosque architecture in the North of England

This paper examines the planning process behind the construction of a mosque building in the English city of York, to demonstrate how it is entangled with contested ideas of national identity. We argue that the politics of religious architecture, particularly mosque planning and architecture, serve as a litmus test for the ways multiculturalism is experienced in contemporary Britain. We explore objections during the planning process for this mosque alongside letters to a local newspaper, where objections included the effect of the mosque on urban infrastructure, the symbolic identity of the mosque within the wider city, and how the mosque would affect claims to citizenship more widely. Objections to this mosque application indicate that architecture and the urban environment are core elements of national identity, and it is through the planning process (of religious buildings) that claims about ‘who is a citizen’ are articulated. Democratic planning processes around the construction of individual buildings can allow groups to organise resistance to much wider cultures of multiculturalism and act as platforms for Islamophobic sentiments. We argue that planning processes work as discursive registers through which architectural aesthetics, cultural identities and fears of otherness are wrapped into the wider politics of public space.

The impact of Covid-19 road-space reallocation measures: Insights from the north of England

In response to the Covid-19 pandemic, governments around the world initiated a programme of temporary road-space reallocation measures. These temporary measures helped to create more space for social distancing and encouraged an uptake in active travel (including walking and cycling). This paper examines the impact of the pandemic on travel behaviour in two contrasting local authorities in the North of England, and specifically, examines the deployment and impact of the temporary road-space measures introduced. This research shows that, overall, there was a substantial degree of change in usual travel behaviours amongst the sample in both locations; and this included modest shifts towards active modes (which were more pronounced in Sheffield). Notably, awareness of the temporary measures was high in both Lancashire and Sheffield (77.7% across the whole sample). Yet, actual use of the measures was relatively low (33.0%), although those using them held largely favourable views of their experiences. Increases in cycling were seen across both those who were aware of the measures and those who were not, but notably, the highest increases in cycling (for commuting, shopping, and leisure trips) were across those who were aware and then went on to use the temporary measures. For  those  not  cycling  pre-pandemic,  there  appears  to  be  a  positive  relationship  between beginning to cycle and use of the measures. In contrast, the temporary measures appeared to have little impact on levels of walking.  

:Late Medieval Devotion to Saints from the North of England: New Directions

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Social inequalities in the use of online food delivery services and associations with weight status: cross-sectional analysis of survey and consumer data

BackgroundLittle is known about who uses online food delivery services and how use of these services is associated with social inequalities in food purchasing and diet-related health. This study explored...

Cheesemaking in Cheshire 1550–1750

This article supports a material turn in agricultural and food history by focusing on the utensils and equipment, along with the embodied practices involved in cheesemaking. The period of interest is the long seventeenth century when rich source material is available in the form of probate inventories—lists of the movable goods owned by deceased persons, mainly adult males, and widows. Our laboratory will be Cheshire, an English county that for 200 years, from the mid-seventeenth century, dominated the cheese supply of London and the industrial towns and cities of the north of England. We use 1600 inventories transcribed by Cheshire local historians, a significant portion of which mention cheese and cheesemaking. We argue that the making and marketing of Cheshire cheese was distinctive but that there was nothing inevitable about its success.

‘We are here our hearts are there’: Rurality, belonging and walking together

AbstractThe notion of the rural idyll is well recognised within scholarship. Allied to this imaginary is that rural areas comprise white and homogenous space, with socially conservative values that are exclusionary. In recent decades, studies have identified the arrival of migrants into so‐called New Immigration Destinations, rural spaces with little contemporary experience of immigration, often bringing with them a sense of cosmopolitanism. That research challenges discourses of a fully exclusive rural space, identifying acts of welcoming and hospitality. These acts are often performed in everyday spaces to help create a sense of belonging for new arrivals. Migrants’ sense of belonging to a place is often taken as an indicator of their integration into society. Research has shown that belonging is more than a term used to describe an attachment to place, it also relates to the politics (of belonging) and to notions of identity. We use the specificity of place to examine the intersection of belonging, rurality and ethnicity. Drawing on participatory walks with diverse migrants along Hadrian's Wall in the North of England (celebrating 1900‐year anniversary), we explore the significance of walking as a tool to engage with forced refugees. We do so through the dual perspectives of an art practitioner and a sociologist. The project included collective walks, creative artist lead learning workshops, which lead to a performative protest walk, and a public‐facing art exhibition. The act of walking together blurs boundaries arising from individual status or position, creating a bond from doing a shared activity enabling conversation and friendships to emerge. Through collective walking, we explore the barriers refugees and those in the asylum‐seeking system face in the rural space; and we show how belonging is emotional and relational. Emotional connections can become powerful tools for survival, especially in a cruel immigration system that dehumanises and fails to recognise individuals for who they really are. This is demonstrated in the title of this article ‘We are here our hearts are there’, which comes from one of our participants who deployed the phrase during the artistic performative protest along the Wall.

Closing the North–South divide, for good

Productivity is key to the regional inequalities in the UK. Following work published last year by Metro Dynamics1 on Greater Manchester, this paper seeks to understand productivity trends in neighbouring regions which have also managed to start to close the productivity gap in the decade to 2020. The paper also unpacks the differences in productivity trends within the North of England’s various economic sub-regions.

#3054 The hospital frailty risk score lacks service planning and decision-making utility in end stage kidney disease

Abstract Background and Aims Survival time for patients commencing dialysis is poor (median 2.0 years in our data) and treatment is invasive. While the age of patients commencing dialysis has increased significantly, the survival advantage diminishes with increasing comorbidity and frailty. The Hospital Frailty Risk Score (HFRS) is a recently-described score derived from ICD-10 codes which has been shown to correlate with outcomes in patients aged &amp;gt;75 years admitted to acute hospital settings. As part of a wider initiative to improve service planning and patient decision-making in the renal setting, we investigated the utility of the HFRS in modelling the survival time of dialysis patients with chronic kidney disease (CKD) both prior to reaching end-stage kidney disease (ESKD), and at dialysis start date. Method A secondary care dataset was obtained of all patients who attended pre-dialysis clinic at a single renal unit in the north of England between 2006–2019 (n = 2,573). Patients choosing dialysis and conservative management were included in the cohort; 1,081 eventually underwent dialysis including 329 patients who were aged ≥70 years when they commenced dialysis. 62.9% were male. Retrospective survival analysis was conducted using the HFRS prior to, and at, dialysis start date and estimates compared using the log-rank test. Results HFRS on dialysis start date was associated with survival time in patients aged ≥70 years (Low frailty Median = 2.5 years; CI = [2.1–3.0 years] vs. Intermediate frailty Median = 1.5 years; CI = [1.0–2.0 years] vs. High frailty Median = 1.3 years; CI = [0.2–2.2 years]; p = 0.005). No association was found between HFRS and survival in the same patients (aged ≥70 on dialysis start date), at any of 3 timepoints prior to dialysis: eGFR level of 20, 15, or 12 (p = 0.18, p = 0.63, p = 0.38 respectively). However, only 150/329 patients (46%) had HFRS recorded prior to eGFR level so sample size was limited. 60 patients’ HFRS had also worsened by dialysis start date (8 had improved). Additional analyses including all age groups found a weaker association between HFRS on dialysis start date and survival (Low frailty Median = 2.1 years; CI = [1.9–2.3 years] vs. Intermediate frailty Median = 1.7 years; CI = [1.5–2.0 years] vs. High frailty Median = 2.1 years; CI = [1.3–2.4 years]; p = 0.04). HFRS and survival were associated at eGFR 15 for all ages (p = 0.02) but not eGFR 20 or 12. Conclusion We identified issues with the HFRS and its implementation that present challenges to its utility for treatment decision-making or service planning in a renal setting. While the HFRS has previously been shown to be predictive of 30-day outcomes in an acute admissions unit, it performed poorly in our cohort of patients with CKD, a long-term condition where HFRS may worsen or improve between treatment choice and dialysis start. Although HFRS did predict outcome from dialysis start in patients aged ≥70 years, this is of limited use given the abundance of validated tools that predict outcome at ESKD. More work is needed to refine the HFRS for pre-ESKD decision-making in a renal setting.

Students we label international: an urgent call to reconceptualise research with international students

PurposeThis article problematises the international student label by critically examining the mechanisms that actively portray international students as necessarily different, deficient and uncritical. It broadly aims to tackle the following issues: (a) to challenge the underpinnings of the international label; (b) to uncover the role of neo-essentialist representations of cohorts of students labelled international in sustaining financial exploitation and deficit narratives; and (c) to criticise the current hyper-internationalisation strategy widely adopted by UK HEIs.Design/methodology/approachThe paper mainly relies on findings from research that adopted narrative inquiry to explore the experiences of students labelled international. Data were collected via a series of interviews with 15 postgraduate students at a university in the north of England. The paper also makes use of brief statistical analyses to provide a general overview about the status of UK higher education (international student admission, net economic impact and income).FindingsThe paper reveals the underpinnings of the international label and how it is mobilised to other non-UK-domiciled students. The paper equally establishes a strong link between hyper-internationalisation and the (un)sustainability of the UK’s higher education sector.Research limitations/implicationsThe research is expected to raise important questions around the experiences and realities endured by students labelled international. In particular, the paper challenges the international label and the mechanisms that sustain the label at institutional levels.Practical implicationsThe paper calls for abandoning the international label as a marker of a presumed difference. Equally, the paper highlights the current unsustainability of the UK’s higher education sector and suggests a gradual cap on international tuition fees to alleviate some of the educational inequalities endured by students international, and to ensure the sustainability of the higher education sector.Originality/valueThis is the first research that openly challenges the international label and substitutes it by “students labelled international”. Equally, this is the first paper that recommends to cap international tuition fees on account of findings from students' narratives and statistics that reveal the unsustainability of the UK's higher education sector. Finally, the paper’s conceptual contribution includes a reference to the idea of hyper-internationalisation.

Police recruitment and positive action: The social building blocks of service

Police recruitment in England and Wales has seen a large upsurge in recent years, with a government mandate to raise officer numbers by 20,000. Alongside this request, considerable pressure remains for the police service to diversify and recruit an increasing number of officers from under-represented groups. Although there are signs that the diversity of police forces in England and Wales is increasing, there is a paucity of available information and research on how this is happening. Existing research on current positive action programmes is underdeveloped. This study considers evidence gained from 26 long-form phenomenological interviews with new policing recruits in a single police force from the north of England. The interviews were structured using social network theory, allowing in-depth exploration of how recruits socially navigated their respective recruitment journeys. The sample provided comparative data on the journey for those experiencing positive actions and those without access to these initiatives. The data gathered offer a picture of recruits’ experiences during recruitment, allowing significant insight into the levels of social support they received. Social support is a critical element of well-being and retention. Empirical findings indicate that particular police recruitment stages exist as social building blocks for policing identity. These building blocks can be unequal depending on existing social resources. This differential identity-building during pre-socialization leads to a proposal for services to consider their positive action initiatives in a different light and ensure that they lead to the development of longer-term, supportive relationships for under-represented recruits.