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Smoking rates are known to be higher amongst those committed to prison than the general population. Those in prison suffer from high rates of comorbidities that are likely to increase their risk of cardiovascular disease (CVD), making it more difficult to manage. In 2016, a tobacco ban began to be implemented across prisons in England and Wales, UK. This study aims to measure the effect of the tobacco ban on predicted cardiovascular risk for those quitting smoking on admission to prison.

Using data from a prevalence study of CVD in prisons, the authors have assessed the effect of the tobacco ban on cardiovascular risk, using predicted age to CVD event, ten-year CVD risk and heart age, for those who previously smoked and gave up on admission to prison.

The results demonstrate measurable health gains across all age groups with the greatest gains found in those aged 50 years and older and who had been heavy smokers. Quitting smoking on admission to prison led to a reduced heart age of between two and seven years for all participants.

The data supports tobacco bans in prisons as a public health measure to reduce risk of CVD. Interventions are needed to encourage maintenance of smoking cessation on release from prison for the full health benefits to be realised.

Those in prison have expert knowledge of issues affecting their health and wellbeing. The purpose of this paper is to report on work undertaken with male prisoners. This paper presents learning and findings from the process of engaging imprisoned men as peer researchers.

The peer researcher approach offers an emic perspective to understand the experience of being in prison. The authors established the peer research role as an educational initiative at a long-stay prison in Wales, UK to determine the feasibility of engaging imprisoned men as peer researchers. Focus groups, interviews and questionnaires were used by the peer researchers to identify the health and wellbeing concerns of men in prison.

The project positively demonstrated the feasibility of engaging imprisoned men as peer researchers. Four recurring themes affecting health and wellbeing for men in a prison vulnerable persons unit were identified: communication, safety, respect and emotional needs. Themes were inextricably linked demonstrating the complex relationships between prison and health.

This was the first prison peer-research project to take place in Wales, UK. It demonstrates the value men in prison can play in developing the evidence base around health and wellbeing in prison, contributing to changes within the prison to improve health and wellbeing for all.

The purpose of this service user narrative and viewpoint article is to describe interprofessional and interpersonal barriers to peer support on a men’s mental health ward over the course of a year from a lived experience perspective.

A reflective journal was kept and participant observation was conducted over the course of the year.

There is sometimes a fissure and binary of “Us” and “Them” on the ward. In other words, staff can sometimes perceive peer support workers to be “one of us” (a member of staff) or “one of them” (a service user). For service users, the opposite is sometimes true: “one of us” (a service user) or “one of them” (a member of staff). Peer support workers must bridge this gap and strive to be “one of us” with both these groups, which is no easy task. A good ward manager or peer team leader can smooth over interprofessional differences and support the peer worker in their efforts of care towards the recovery of people with mental health problems.

Little has been written on this topic in a mental health inpatient setting as most papers address community peer support work, which is very different from peer support in hospital. This paper addresses one of the first peer support pilot projects in hospital of its kind in NHS England so is quite innovative and perhaps even unique.

The purpose of this service user paper and narrative is to highlight that peer support is not a continuous, easy or uniform process but given to disruption, fragmentation, breakdowns in relationships and hurdles. This is illustrated in a summary of the case of “Christopher”.

A reflective journal was kept, and participant observation was conducted for just under a year on the ward where Christopher was under Section.

Peer support can be given to fissure, breakages in relationships and discontinuity. This can negatively impact the mental health of peer support workers. With this in mind, it is vitally important to ensure that the people who take up this role are appropriately trained, supported and supervised. There needs to be a focus on “restorative” supervision and supervision by someone with experience of the peer support role as well as buddying between peer workers.

There is an abundance of literature and research on peer support in the community but little in the inpatient setting, making this paper novel and a contribution to understanding peer support on mental health wards.

The purpose of this study is to describe peer support work in a men’s mental health unit from a lived experience and service user’s perspective. The intertwining of process (a lived experience perspective) and subject (the therapeutic value of peer support) leads to greater knowledge and insight into peer support for people with mental health problems.

This service user narrative draws on the extracts from a reflective journal of interactions and conversations with people with mental health problems as well as feedback from service users and staff about the value of peer support. These methods allow a first-person, service user’s, reflective and narrative account of peer support work.

Peer support work, particularly hearing voices sessions, are found to be highly therapeutic and worthwhile. They promote insight and create feelings of safety and hope in what can sometimes be a frightening and hostile ward environment. Peer support provides emotional and practical support. Sharing stories and experiences of mental illness with people leads to trust, feelings of being valued, heard and accepted as well as better experiences of care and being seen as a person first. Due to their shared experiences, peer support workers are able to befriend people with mental health problems on the ward. Peer support work bridges the gap and vacuum of care between people with mental health problems and staff. It compensates for understaffing to provide more holistic and person-centred care and support.

Lived experience/ service user perspectives and narratives on peer support are rare, particularly in a hospital setting. This article provides a rich, perhaps overlooked and hidden narrative on the nature of peer support work. People with mental health problems, like Ben, are often excluded from society, health and social care, education, employment and research. This narrative opens up a pathway to understanding peer support from a service user perspective.

The purpose of this service user narrative is to highlight the stigma and prejudice that is often targeted at people with schizophrenia and severe mental illness, which causes fear and isolation. The therapeutic effect of peer support is further explored as offering hope, connection, aspirations, advocacy, autonomy and openness for service users as well as the possibility of recovery and a reduction in feelings of stigma, prejudice and exclusion.

Ben was diagnosed with paranoid schizophrenia in 2003, so this paper draws on over 20 years of experience of the harmful label of schizophrenia. In the last 15 months, he has been working as a peer worker on a men’s mental health ward in the East of England. He has kept a reflective journal and conducted participant observation on the ward, which informs this paper and its findings.

There are observations based on peer support on the ward in the last 15 months and over 20 years as a schizophrenic. People with schizophrenia and severe mental illness are stigmatised and experience discrimination and prejudice. This paper introduces the new idea and neologisms of schizophobia and insanophobia that people with severe mental illness will experience in their daily lives, in health and social care settings (such as the men’s ward), in education and in employment. People with mental illness are also often discriminated against as being a danger or a risk to themselves and others. They are often considered as aggressive or violent. Their diagnosis can stop them from getting a job, a mortgage or even from travelling to some places in the world. But this paper details the violent assault by a nurse on a patient while Ben was working on a long stay ward in a large psychiatric asylum in 1990. It is pertinent to note that things have progressed since the 1990's but there continues to be the stigmatisation of people with a severe mental illness, which requires societal and systemic change. In Ben’s experience, people with mental illness seem far more likely to experience violence upon their person rather than being violent towards other people, such as staff, members of the public, family or carers.

This service user narrative is a first person account, so it is original. It is of further value because it outlines the ways in which peer support can help with feelings of stigma and exclusion as well openness about hearing voices/ seeing things (hallucinations) and strange thought or beliefs (delusions).

Market entry strategies range from foreign direct investment to licensing with varying levels of commitment, risk and opportunity. Exporting products or services is one of the most common of the intermediate market entry strategies. It is typically accomplished through authorized international channels of distribution. However, when significant price differences exist between markets, alternative, parallel channels of distribution are almost certain to arise. These parallel channels, often referred to as gray marketing, are generally legal but unauthorized distribution channels that create an alternative export market entry. After a review of the literature, a case study highlights these complex issues from the perspective of both manufacturer and parallel marketer. The case study provides a tool for evaluating theory and a basis for discussing this important alternative mode of market entry. The case and the discussion which follows also highlight the role of international trade shows as an important element of the marketing mix for entering many foreign markets.

The physical health needs of people with mental health problems are currently under addressed and often ignored, both in training and in practice. The PRIMROSE trial intervention was designed to remedy that – focusing in particular on risk of cardiovascular disease (CVD). This paper describes how people with experience of using mental health services and carers contributed to the development of the PRIMROSE intervention. It draws out key messages for educators, researchers and practitioners.

Using a case study approach the paper outlines how a Third sector organisation supported the study team in setting up a Lived Experience Advisory Panel (LEAP), drawing on a pre-existing model and recent thinking about service user and carer involvement in research. It is described how the approach sought to engage wider involvement of people with an interest in CVD while also offering more focused input into specifically the development of the trial intervention.

An innovative approach was taken whereby a large LEAP, comprising 27 service users and carers, was supporting the development of the study mainly through e-mail and web updates and feedback, while a sub-group of the LEAP, with eight members, met three times and had a focus on inputting ideas into the development of the intervention. The creation of a LEAP proved helpful to the project, resulting in an enhanced and more relevant intervention – summed up in a series of eleven recommendations. Appointment of an independent chair of the sub-group proved invaluable and there is learning from this project for other similar initiatives.

This study has value for others who are developing practice interventions. A range of suggestions were made which will have relevance for training, ensuring that physical health issues are not ignored. There is much to learn too from the process of this project, for the involvement of service users and carers in research, education and in practice development.

To illuminate the underlying logic of western Kansas farmers’ decisions to irrigate at unsustainable rates and the state’s regulatory policies and practices that enable depletion of the Ogallala aquifer.

Ethnographic interviewing of 39 western Kansas farmers, state water management personnel, and archival research.

Farmers occupy an ambiguous position as petty capitalists who focus attention on their own farms with seasonal planning horizons, and they hold a view of “good stewardship” that melds economic and noneconomic considerations, and that provides a rationale for unsustainable irrigation practices. The state resolves the contradiction between the finite groundwater resource and ideological commitments to economic growth by devolving responsibility for water management to groundwater users.

While the small sample size is likely to be representative of the larger pool of irrigators, further research with other farmers representative of the region will be necessary to verify findings.

Depletion of the Ogallala aquifer contributes to farm consolidation and community decline, and the ecological costs will leave future farmers and remaining communities without the benefits of groundwater. Western Kansas will likely have to revert to a system of dryland farming.

This article addresses the critical need for exceptional leaders to shepherd the nationʼs Historically Black Colleges and Universities (HBCUs) in a post-Brown era where African American students enjoy unlimited access to higher education in the United States. The article spotlights the many contributions Black colleges and universities have made to American society against insuperable odds since their inception in the mid-nineteenth century. It studies selected examples of HBCUs whose graduates have distinguished themselves in areas where other institutions enjoy centers of excellence. The article traces the historical inequities between major and minority institutions, the challenges HBCUs face in surmounting these disparities, and the growing tendency of Black students to exercise their options by enrolling at White colleges and universities. With the loss of a pure monopoly on African American students, Black colleges now must find leaders of exceptional talent and vision in order to ensure their survival. The article recommends strategies designed to surmount hurdles and enhance the viability of Black colleges and universities in an increasingly competitive environment.