The end of the beginning? Taking forward local democratic renewal in the post-referendum North East.

This article draws upon the author’s commissioned research on the nature of regional governance following the 2004 Referendum in the North East on elected regional assemblies. The article aimed to both capture these views and to assess how the ‘No vote in the referendum has impacted on subsequent developments in sub-national governance. The article provides both an empirical overview of recent developments and engages with the wider conceptual debates on democratic renewal. The arguments covered in this output are aimed at both academic and practitioner audiences, and have been also disseminated at regional and national conferences

Self-guided trails – a route to more responsible tourism?

In recent years, the tourism industry has faced criticism by turning its attention to the development of more responsible tourism. This is a form of tourism that is mindful of the diverse needs of host communities, local business and the visitor. This paper investigates the development of more responsible tourism from the perspective of a popular tourist product – the self-guided trail or route. The trail or route provides a themed and interpreted journey through the urban or rural landscape, creating links between sites, attractions and other tourism businesses by providing information and storytelling along the way. These products have a global appeal and are becoming more prolific. Through a literature review on trails, the paper analyses their key characteristics and the rationales of developers and concludes that trails have the potential to contribute to more responsible tourism development. The paper proposes a series of planning principles which are derived from the literature and examples of good practice therein which may assist trail developers in creating more responsible tourism routes and trails. The discussion concludes with a case study of a project in Cornwall in the south-west of the UK, where responsible planning has underpinned recent trail development

Effectiveness of work skills programmes for offenders with mental disorders: a systematic review

Background: Academic literature and government initiatives have emphasised the importance of work as a means of improving health and reducing reoffending among offenders with mental disorders. Whilst a number of work skills programmes have shown promise for offenders more generally, evaluation of evidence for their effectiveness for those with a mental disorder is lacking, particularly in relation to improving employment outcomes. Aims: To assess the evidence on the effectiveness of work skills programmes for mentally disordered offenders. Method: A systematic review of the literature was conducted by searching the following databases: PsycINFO, CINAHL, Cochrane Library (Trials Register), Embase and Medline, using search terms which included Work Skills Programme*, Offend* and Mental*. Any empirical comparison study of work skills programmes was included in this review. The primary outcome was employment. Secondary outcomes included employment outcomes, reoffending, education, mental state, substance misuse, global functioning, quality of life, acceptability, leaving the study early and cost effectiveness or other economic outcomes. Results: Six articles met the inclusion criteria. Collectively they provided limited evidence that work skills programmes increase the likelihood of people with mental disorder who are offenders obtaining employment in the short term, but there are insufficient studies to determine the long-term impact of work skills programmes. Conclusions: There is modest evidence to support inclusion of specific work skills programmes in the treatment of offenders with mental disorder. Future studies should be of theoretically driven programmes, such as Individual Placement Support (IPS), use a standard set of relevant outcome measures and long enough follow-up for testing the effectiveness of any programme on engagement in competitive, paid employment as, even if skilled, offenders with mental disorder must constitute a hard to place group

The impact of mental health recovery narratives on recipients experiencing mental health problems: Qualitative analysis and change model.

BACKGROUND: Mental health recovery narratives are stories of recovery from mental health problems. Narratives may impact in helpful and harmful ways on those who receive them. The objective of this paper is to develop a change model identifying the range of possible impacts and how they occur. METHOD: Semi-structured interviews were conducted with adults with experience of mental health problems and recovery (n = 77). Participants were asked to share a mental health recovery narrative and to describe the impact of other people's recovery narratives on their own recovery. A change model was generated through iterative thematic analysis of transcripts. RESULTS: Change is initiated when a recipient develops a connection to a narrator or to the events descripted in their narrative. Change is mediated by the recipient recognising experiences shared with the narrator, noticing the achievements or difficulties of the narrator, learning how recovery happens, or experiencing emotional release. Helpful outcomes of receiving recovery narratives are connectedness, validation, hope, empowerment, appreciation, reference shift and stigma reduction. Harmful outcomes are a sense of inadequacy, disconnection, pessimism and burden. Impact is positively moderated by the perceived authenticity of the narrative, and can be reduced if the recipient is experiencing a crisis. CONCLUSIONS: Interventions that incorporate the use of recovery narratives, such as peer support, anti-stigma campaigns and bibliotherapy, can use the change model to maximise benefit and minimise harms from narratives. Interventions should incorporate a diverse range of narratives available through different mediums to enable a range of recipients to connect with and benefit from this material. Service providers using recovery narratives should preserve authenticity so as to maximise impact, for example by avoiding excessive editing

Ethnicity and consumption: South Asian food shopping patterns in Britain 1947-75

Authors' draft version also available on University of Surrey e-print repository. Final version published by Sage and available at http://joc.sagepub.com/This article reviews the literature that explores the relationship between ethnic identities and food consumption, with particular reference to business management studies. It focuses on the food shopping practices of south Asians in Britain in the period 1947 to 1975, to illustrate the need for more historically contextualized studies that can provide a more nuanced exploration of any interconnections between ethnic identity and shopping behaviour. The article draws on a reasonably long-standing interest in ethnicity and consumption in marketing studies, and explores the conceptual use of acculturation within this literature. The arguments put forward are framed by recent interdisciplinary studies of the broader relationship between consumption and identity, which stress the importance of contextualizing any influence of ethnic identifications through a wider consideration of other factors including societal status, gender and age, rather than giving it singular treatment. The article uses a body of empirical research drawn from recent oral histories, to explore how these factors informed everyday shopping practices among south Asians in Britain. It examines some of the shopping and wider food provisioning strategies adopted by early immigrants on arrival in Britain. It considers the interaction between the south Asian population and the changing retail structure, in the context of the development of self-service and the supermarket. Finally, it demonstrates how age, gender and socioeconomic status interacted with ethnic identities to produce variations in shopping patterns

Adapting Conservation Easements to Climate Change

Perpetual conservation easements (CEs) are popular for restricting development and land use, but their fixed terms create challenges for adaptation to climate change. The increasing pace of environmental and social change demands adaptive conservation instruments. To examine the adaptive potential of CEs, we surveyed 269 CEs and interviewed 73 conservation organization employees. Although only 2% of CEs mentioned climate change, the majority of employees were concerned about climate change impacts. CEs share the fixed-boundary limits typical of protected areas with additional adaptation constraints due to permanent terms on private lands. CEs often have multiple, potentially conflicting purposes that protect against termination but complicate decisions about principled, conservation-oriented adaptation. Monitoring is critical for shaping adaptive responses, but only 35% of CEs allowed organizations to conduct ecological monitoring. In addition, CEs provided few requirements or incentives for active stewardship of private lands. We found four primary options for changing land use restrictions, each with advantages and risks: CE amendment, management plan revisions, approval of changes through discretionary consent, and updating laws or policies codified in the CE. Conservation organizations, funders, and the Internal Revenue Service should promote processes for principled adaptation in CE terms, provide more active stewardship of CE lands, and consider alternatives to the CE tool

“Should I stay or should I go now?” : A qualitative study of why UK doctors retire

Funding information Our thanks go to the University of Aberdeen Development Trust and the British Medical Association (Scotland) for funding this work. ACKNOWLEDGEMENTS Our thanks to all those doctors who participated in the study. Our thanks also to the BMA (Scotland) for distributing the invitation to take part in the study to their members. No patients or any members of the public were involved in this study.Peer reviewedPostprintPostprin

Potential impact of pre-exposure prophylaxis for female sex workers and men who have sex with men in Bangalore, India: a mathematical modelling study

Introduction: In Bangalore, new HIV infections of female sex workers and men who have sex with men continue to occur, despite high condom use. Pre-exposure prophylaxis (PrEP) has high anti-HIV efficacy for men who have sex with men. PrEP demonstration projects are underway amongst Indian female sex workers. We estimated the impact and efficiency of prioritising PrEP to female sex workers and/or men who have sex with men in Bangalore. Methods: A mathematical model of HIV transmission and treatment for female sex workers, clients, men who have sex with men and low-risk groups was parameterised and fitted to Bangalore data. The proportion of transmission attributable (population attributable fraction) to commercial sex and sex between men was calculated. PrEP impact (infections averted, life years gained) and efficiency (life years gained/infections averted per 100 person years on PrEP) were estimated for different levels of PrEP adherence, coverage and prioritisation strategies (female sex workers, high-risk men who have sex with men, both female sex workers and high-risk men who have sex with men, or female sex workers with lower condom use), under current conditions and in a scenario with lower baseline condom use amongst key populations. Results: Population attributable fractions for commercial sex and sex between men have declined over time, and they are predicted to account for 19% of all new infections between 2016 and 2025. PrEP could prevent a substantial proportion of infections amongst female sex workers and men who have sex with men in this setting (23%/27% over 5/10 years, with 60% coverage and 50% adherence), which could avert 2.9%/4.3% of infections over 5/10 years in the whole Bangalore population. Impact and efficiency in the whole population was greater if female sex workers were prioritised. Efficiency increased, but impact decreased, if only female sex workers with lower condom use were given PrEP. Greater impact and efficiency was predicted for the scenario with lower condom use. Conclusions: PrEP could be beneficial for female sex workers and men who have sex with men in Bangalore, and give some benefits in the general population, especially in similar settings with lower condom use levels

Pregnancy termination for fetal abnormality: are health professionals’ perceptions of women’s coping congruent with women’s accounts?

Background: Pregnancy termination for fetal abnormality (TFA) may have profound psychological consequences for those involved. Evidence suggests that women’s experience of care influences their psychological adjustment to TFA and that they greatly value compassionate healthcare. Caring for women in these circumstances presents challenges for health professionals, which may relate to their understanding of women’s experience. This qualitative study examined health professionals’ perceptions of women’s coping with TFA and assessed to what extent these perceptions are congruent with women’s accounts. Methods: Fifteen semi-structured interviews were carried out with health professionals in three hospitals in England. Data were analysed using thematic analysis and compared with women’s accounts of their own coping processes to identify similarities and differences. Results: Health professionals’ perceptions of women’s coping processes were congruent with women’s accounts in identifying the roles of support, acceptance, problem-solving, avoidance, another pregnancy and meaning attribution as key coping strategies. Health professionals regarded coping with TFA as a unique grieving process and were cognisant of women’s idiosyncrasies in coping. They also considered their role as information providers as essential in helping women cope with TFA. The findings also indicate that health professionals lacked insight into women’s long-term coping processes and the potential for positive growth following TFA, which is consistent with a lack of aftercare following TFA reported by women. Conclusions: Health professionals’ perceptions of women’s coping with TFA closely matched women’s accounts, suggesting a high level of understanding. However, the lack of insight into women’s long-term coping processes has important clinical implications, as research suggests that coping with TFA is a long-term process and that the provision of aftercare is beneficial to women. Together, these findings call for further research into the most appropriate ways to support women post-TFA, with a view to developing a psychological intervention to better support women in the future