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Background The Medical Certificate of Stillbirth (MCS) records data about a baby's death after 24 weeks of gestation but before birth. Major errors that could alter interpretation of the MCS were widespread in two UK-based regional studies. Methods A multicentre evaluation was conducted, examining MCS issued 1 January 2018 to 31 December 2018 in 76 UK obstetric units. A systematic case-note review of stillbirths was conducted by Obstetric and Gynaecology trainees, generating individual 'ideal MCSs' and comparing these to the actual MCS issued. Anonymized central data analysis described rates and types of error, agreement and factors associated with major errors. Results There were 1120 MCSs suitable for assessment, with 126 additional submitted data sets unsuitable for accuracy analysis (total 1246 cases). Gestational age demonstrated 'substantial' agreement [K = 0.73 (95% CI 0.70–0.76)]. Primary cause of death (COD) showed 'fair' agreement [K = 0.26 (95% CI 0.24–0.29)]. Major errors [696/1120; 62.1% (95% CI 59.3–64.9%)] included certificates issued for fetal demise at <24 weeks' gestation [23/696; 3.3% (95% CI 2.2–4.9%)] or neonatal death [2/696; 0.3% (95% CI 0.1–1.1%)] or incorrect primary COD [667/696; 95.8% (95% CI 94.1–97.1%)]. Of 540/1246 [43.3% (95% CI 40.6–46.1%)] 'unexplained' stillbirths, only 119/540 [22.0% (95% CI 18.8–25.7%)] remained unexplained; the majority were redesignated as either fetal growth restriction [FGR: 195/540; 36.1% (95% CI 32.2–40.3%)] or placental insufficiency [184/540; 34.1% (95% CI 30.2–38.2)]. Overall, FGR [306/1246; 24.6% (95% CI 22.3–27.0%)] was the leading primary COD after review, yet only 53/306 [17.3% (95% CI 13.5–22.1%)] FGR cases were originally attributed correctly. Conclusion This study demonstrates widespread major errors in MCS completion across the UK. MCS should only be completed following structured case-note review, with particular attention on the fetal growth trajectory. [ABSTRACT FROM AUTHOR]

As an increasing number of British universities are now requiring/encouraging mathematics applicants to have taken ‘extension papers’ such as the Mathematics Admissions Test (MAT), Advanced Extension Award (AEA) and Sixth Term Examination Paper (STEP), current students were asked how useful they were in preparation for their degree. The MAT was most commonly described as good preparation for undergraduate mathematics, whilst most participants who had taken the AEA were indifferent regarding its usefulness. Participants were positive about STEP, commending its similarity to undergraduate-style assessment and its challenging questions. The students’ views suggested that those wishing to be well prepared for tertiary mathematics should take one of these papers, preferably STEP. However, whilst universities may not necessarily wish to require applicants to pass extension papers, it may be beneficial for universities to recommend students to take them in order to improve their mathematical thinking and expectations of undergraduate mathematics study. [ABSTRACT FROM AUTHOR]

This article performs a close reading of a newly discovered archive of letters to and from Charles de Gaulle, written between 1941 and 1944, to show how de Gaulle engaged in a process of auto-mythification. The archive features wartime correspondence between de Gaulle and various leaders of the British government, intelligence, and military, such as Prime Minister Winston Churchill, Secretary of State for Foreign Affairs (1941) Anthony Eden, and Chief of the Imperial General Staff General Alan Brooke. The study illuminates the problematic nature of Anglo-French collaboration in terms of shifting cultural perspectives, particularly with regard to the notion of authority. Such notions are inevitably contested, and this collection of letters is an unusually effective resource to reconstruct the essentially dialogic aspects of this contestation. Through contextualization of the correspondence, including both contemporary and retrospective accounts of the war, the article enriches our understanding of the implicit and explicit conflicts between British and French forces and the rhetorical strategies utilized to further each writer's aims. [ABSTRACT FROM AUTHOR]

It is well documented in both the British press and mathematics education literature that many considerA-levels (qualifications for secondary school leavers in England,Wales and Northern Ireland) to be insufficient preparation for undergraduate mathematics study in theUK. A-levelMathematics and FurtherMathematics are not solely intended for those wishing to go on to study undergraduatemathematics, though this is often the onlymathematics study and preparation available to, and done by, most students. A number of British universities now require applicants to perform well on entrance examinations or 'extension' papers in addition to achieving certain grades in A-level Mathematics and, sometimes, Further Mathematics. This article outlines research which used the Mathematical Assessment Task Hierarchy (Smith et al., 1996) and builds upon the work of Darlington (2014) to describe the mathematical skills required to answer the questions in extension papers.These are then contrasted with skills required at A- and undergraduate level. Each of the three extension papers analysed (Advanced Extension Awards, Sixth Term Examination Papers and university admissions tests) were found to differ from each other, as well as from A-level and undergraduate examinations. This suggests that there are benefits for students doing such papers before university mathematics study. The advantages of doing these papers are not only for admissions tutors, who can use them as additional indicators of candidates'aptitudes, but also for the students themselves as they gain insights into the nature of undergraduatemathematics and related furthermathematical challenges. [ABSTRACT FROM AUTHOR]

The humble ballot paper is a defining technology of elections throughout the world. This article interrogates its contested past by demonstrating - over a long period and in the context of three contrasting countries - how and why it emerged in the early modern period and how it was then used, abused and regulated in the context of the expanded, and eventually mass, electoral arenas of the nineteenth and twentieth centuries. Ironically, by the time that the ballot paper was firmly established, its monopoly was already being challenged by mechanical and then electronic media, which may eventually condemn it to extinction. [ABSTRACT FROM AUTHOR]

European countries in which universities rely on public funding increasingly follow the lead of the United Kingdom and run Research Assessment Exercises. Given the subjective nature of such evaluations, some scientists prefer verifiable measures such as citation counts. This, however, also is prone to problems since the number of cites is correlated, among others, with the order of appearance in an issue. In particular, leading papers are more cited. It is, thus, difficult to assess whether they are of better quality, or whether this happens because they appear first in an issue. We make use of a natural experiment that was carried out by a journal in which papers are randomly ordered in some issues, while this order is at the editors’ discretion in other issues. Our estimates suggest that approximately two thirds of the additional cites are due to going first, and one third to higher quality. [ABSTRACT FROM PUBLISHER]

This article talks about international trade in the period between 1862-1879, or the greenback period. F.W. Taussig, a professor, concluded in 1917 that with the U.S., which was using inconvertible paper money as monetary standard, borrowing heavily and continuously from Great Britain, which was using gold as basis, there will be increased sterling supply in New York and lowered cost, in U.S. paper, of imported commodities. The author noted that when both countries are on a gold basis, there will be an influx of gold from Great Britain in the U.S. and general prices will rise, while they fall in Great Britain. He concluded that the large borrowing operations of the U.S. in the 1860s was an important factor in the disturbance of the normal course of trade.

In this article I begin by discussing the persistent problem of relations between educational inequality and the attainment gap in schools. Because benefits accruing from an education are substantial, the 'gap' leads to large disparities in the quality of life many young people can expect to experience in the future. Curriculum knowledge has been a focus for debate in England in relation to educational equality for over 40 years. Given the contestation surrounding views about curriculum knowledge and equality I consider the thinking of two philosophers, Jacques Derrida and Emmanuel Levinas, and their work on justice, to trouble the curriculum framework and discourse of knowledge promoted through the policy text of The Importance of Teaching: The Schools White Paper (2010) and later associated policy reforms to the General Certificate of Secondary Education ( GCSE) curriculum in England. The Schools White Paper aims to make the curriculum more challenging to students by introducing tight controls in terms of the assessment framework and curriculum knowledge. I argue that, when considered through Derrida's perspective on language and meaning and Levinas' view on the ethical responsibility for the other, the reforms present obstacles to the search for a just curriculum. I look to the work of Sharon Todd and Paul Standish for a re-imagination of curriculum as or through relations in the light of Derrida's and Levinas' philosophies. [ABSTRACT FROM AUTHOR]

Head injury is an important cause of death among young adults in the UK, and a significant burden on NHS resources. However, management is inconsistent, governed largely by local resources. The latest version of the NICE head injury guidelines suggests that more patients with traumatic brain injury should be transferred to receive specialist care. However, this raises issues about the capacity of regional neurosurgical units, particularly to accommodate patients who do not require surgical intervention. OBJECTIVES: To critically evaluate the basis of the NICE recommendations about transfer for neurosurgical care, and examine the configuration of specialist services to assess the implications of increasing the existing number of transfers. METHODS: A systematic literature review was conducted of articles discussing the provision of emergency neurosurgical care for adult head injuries in the UK. RESULTS: Fifty-eight papers met the criteria for inclusion in the literature review, including seven papers cited in the NICE guidance. Fifty-one papers related to neurosurgical care, including papers on bed occupancy, transfer times and transfer policies. CONCLUSIONS: The evidence NICE cited is of variable quality. Much of the research was conducted outside the UK, which raises questions about its relevance to the NHS. Care of traumatic brain injuries in the UK is already hampered by the inadequate capacity of regional neurosurgical units to meet demand, and transferring more patients would be likely to exacerbate this. Increasing the number of transfers could also worsen inequalities of access for other groups, such as elective patients, particularly in areas where facilities are most stretched. [ABSTRACT FROM AUTHOR]

The article presents the summaries of papers on dermatology presented at the main plenary sessions. The National Health Service (NHS) Plan 2000 proposed the development of specialist general practitioners (GPs) to take referrals from other GPs in specialties including dermatology. The NHS Modernization Agency Action on Dermatology program funded pilot site studies of dermatology GPwSI, services and preliminary results were encouraging. By the end of 2005, all referrals from primary care will be performed electronically using a referral template. Currently only a proportion of referrals are electronic, allowing comparison with established paper referrals.

China has become an impactful science superpower, but it is asserted that its influence provides it with disproportionate benefits that some national research policies have not thus far appreciated. To create context, Web of Science data are used to analyse research collaborations between the UK and China: trends in volume of output between 1981 and 2019; citation impact; and comparative performance across research fields. UK–China collaboration increased from fewer than 100 co-authored papers before 1990, to 750 per year in 2000, 3,324 in 2010, and 16,267 papers (10.9 per cent of UK output) in 2019. UK–China collaboration is concentrated in technology-based fields: in some (e.g. telecommunication), over 30 per cent of UK papers are in collaboration with Chinese-based researchers. The paper discusses the policy consequences to the UK of this indicative dependency, arguing that exiting from such collaborations is ill advised, provided the risks, perceived or real, are mapped, managed, and mitigated. [ABSTRACT FROM AUTHOR]

This note draws attention to the recent discovery of the papers of the Chartist and newspaper editor W. E. Adams (1832–1906), summarizes their contents and explains why they are to be found in the Russian State Archive of Socio-Political History in Moscow. [ABSTRACT FROM AUTHOR]

The article presents the summaries of papers related to dermatological surgery. The reported frequencies of dermatological malignancies in Great Britain population suggests an incidence of 125 basal cell carcinomas, 27 squamous cell carcinomas and 7 malignant melanomas per 100 000. Another study reports that the number of patients attending the researchers' melanoma screening clinic since its inception in 1997 has increased fourfold. This is in contrast to the number of melanomas diagnosed, which has remained constant. During that time, 15000 patients have attended and 500 melanomas have been diagnosed; 18 melanomas have been missed.

The article presents the summaries of papers related to paediatric dermatology. Atopic dermatitis (AD) accounts for at least 15% of referrals to secondary care dermatology, often requiring multiple visits and occupying much valuable time and resources. The researchers audited the usefulness of two quality-of-life measures, the Infants Dermatitis Quality of Life index (IDQOL) and Dermatitis Family Impact (DFI), which are easy to use in a routine clinical setting. A retrospective study on allergic contact dermatitis in children was conducted in Great Britain. 503 children were identified who had undergone patch testing consecutively in the reserchers' department between the years 1995 and 2004. This represents the largest study of children who have undergone patch testing in Great Britain.

Health inequalities research has a long history in the United Kingdom, and the development of government policies that are intended to explicitly address the existing health inequalities has been gathering pace since the Labour Party returned to power in 1997. In this paper, using the influential Acheson Report as a reference point, one of us (D.N.) describes how health inequalities policies have been developed, and the other (A.O.) assesses how, ideally, such policies ought to be developed. Although progress in the development of health inequalities policies has been made, the policies, and the evidence that has informed them, have been less than ideal. [ABSTRACT FROM PUBLISHER]

The article talks about the Working Paper published by the Modern British Studies (MBS) research centre on new ways of thinking about the transformation of British society, culture, politics and economy between 19th century and 2015. It highlights the cultures of democracy and the rising political, social and cultural change. It states that the paper can be used as a study material for understanding the state of history in present times.

OBJECTIVE: To determine the utility of a novel Paediatric Consultation Assessment Tool (PCAT). DESIGN: Developed to measure clinicians' communication behaviour with children and their parents/guardian, PCAT was designed according to consensus guidelines and refined at a number of stages. Volunteer clinicians provided videotaped real consultations. Assessors were trained to score communication skills using PCAT, a novel rating scale. SETTING: Eight UK paediatric units. PARTICIPANTS: 19 paediatricians collected video-recorded material; a second cohort of 17 clinicians rated the videos. MAIN OUTCOME MEASURES: Itemised and aggregated scores were analysed (means and 95% confidence intervals) to determine measurement characteristics and relationship to patient, consultation, clinician and assessor attributes; generalisability coefficient of aggregate score; factor analysis of items; comparison of scores between groups of patients, consultations, clinicians and assessors. RESULTS: 188 complete consultations were analysed (median per doctor = 10). 3 videos marked by any trained assessor are needed to reliably (r>0.8) assess a doctor's triadic consultation skills using PCAT, 4 to assess communication with just children or parents. Performance maps to two factors – "clinical skills" and "communication behaviour"; clinicians score more highly on the former (mean (SD) 95% CI 0.52 (0.075)). There were significant differences in scores for the same skills applied to parent and child, especially between the ages of 2 and 10 years, and for information-sharing rather than relationshipbuilding skills (2-tailed significance <0.001). CONCLUSIONS: The PCAT appears to be reliable, valid and feasible for the assessment of triadic consultation skills by direct observation. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To report the evidence for and challenges to the validity of Sheffield Peer Review Assessment Tool (SPRAT) with paediatric Specialist Registrars (SpRs) across the UK as part of Royal College of Paediatrics and Child Health workplace based assessment programme. DESIGN: Quality assurance analysis, including generalisability, of a multisource feedback questionnaire study. SETTING: All UK Deaneries between August 2005 and May 2006. PARTICIPANTS: 577 year 2 and 4 Paediatric SpRs. INTERVENTIONS: Trainees were evaluated using SPRAT sent to clinical colleagues of their choosing. Data were analysed reporting totals, means and SD, and year groups were compared using independent t tests. A factor analysis was undertaken. Reliability was estimated using generalisability theory. Trainee and assessor demographic details were explored to try to explain variability in scores. MAIN OUTCOME MEASURES: 4770 SPRAT assessments were provided about 577 paediatric SpRs. The mean scores between years were significantly different (Year 2 mean=5.08, SD=0.34, Year 4 mean=5.18, SD=0.34). A factor analysis returned a two-factor solution, clinical care and psychosocial skills. The 95% CI showed that trainees scoring ≥4.3 with nine assessors can be seen as achieving satisfactory performance with statistical confidence. Consultants marked trainees significantly lower (t=–4.52) whereas Senior House Officers and Foundation doctors scored their SpRs significantly higher (SHO t=2.06, Foundation t=2.77). CONCLUSIONS: There is increasing evidence that multisource feedback (MSF) assesses two generic traits, clinical care and psychosocial skills. The validity of MSF is threatened by systematic bias, namely leniency bias and the seniority of assessors. Unregulated self-selection of assessors needs to end. [ABSTRACT FROM AUTHOR]

The article presents research summaries related to clinicopathological cases in Great Britain. In one of the studies, it presented a patient having deeply pigmented Eccrine porocarcinoma (EP) which occurs at a site of previous radiotherapy. Another study presents the case of patient whose diagnosis is mycosis fungoides several years after a successful treatment of chronic myeloid leukaemia. Moreover, the case of cholesterol embolization syndrome presented as lobular panniculitis is cited.

The article presents summaries related to studies in dermatology in Great Britain. Medical students from the country conducted a survey to evaluate final year medical students' experience of dermatology. Another study conducted a retrospective review on the use of azathioprine in a childhood population over an 8-year period. Furthermore, a retrospective study on all skin surgical specimens processed by the teaching hospital hispathology department for 3-month period is conducted.

The article presents summaries regarding the symposium of registrars. One of the symposiums aimed in identifying the departments concerned in the management of skin lesions, the accurateness of the clinical diagnosis, and the appropriateness of the treatment. Another is an audit which aims to look at the number of sentinel lymph node biopsy (SLNB) in the management of melanoma in Great Britain. Moreover, a retrospective analysis on toxic epidermal necrolysis is presented.

The article presents research summaries related to dermatitis in Great Britain. According to a study, it has found out that the new fungicide could be the allergen responsible for sofa dermatitis. Another study examines the use of hair dye and the frequency and nature of reported adverse reactions and the risk factors. Furthermore, a study stresses the need for education of all users of epoxy resins in regard to the skin hazard in the workplace and using proper protective equipment.

The article presents research summaries related to dermatopathology in Great Britain. In one of the studies, it aims to increase the awareness of prototheca wickerhamii which causes neutropenic sepsis after a chemotherapy. Another study reports a case of histiocyctic sarcoma having secondary skin involvement and a presumed primary in the lung. Furthermore, a case report on symplastic haemangioma which is developing on a background of chronic leg ulcer is given.

The article presents research summaries related to dermatological surgery in Great Britain. It includes an evaluation among doctors if they informed their patients on their level of training in skin surgery before performing a practical procedure. In another study, pulsed dye laser treatment has been depicted to have a low incidence of adverse events. Moreover, a case series on the results of treatment for hidradenitis suppurativa having carbon dioxide laser is presented.

The article presents several summaries related to health studies in the Great Britain. It has been proven that there is growing risk of skin cancer with the use of artificial tanning devices. On the hand, the prevalence of and characteristic of polymorphic light eruption (PLE) in a larger cohort of the healthy British population has been assessed. Moreover, a case report concerning solar urticaria with a carrier state for erythropoietic protoporphyria is presented.

The article refers to a June 1753 letter written by English author Samuel Richardson to British poet Elizabeth Carter, as well as Carter's letter in response, which discuss the British Jewish naturalization Act of 1753. Richardson refers to a "little paper" which he included with his letter to Carter. The article argues that this was a pamphlet attributed to Philip Carteret Webb having the abbreviated title "The Bill, Permitting Jews to be Naturalized by Parliament, Having Been Misrepresented in the London Gazetteer, of Friday the 18th May."

— Alcohol misuse constitutes a major problem in our modern society and both physical and mental alcohol-related harm result in a large number of Accident and Emergency (A&E) attendances, thus imposing a significant burden on the workload and financial resources of the department. The current management of problem drinking by most A&E departments could be further improved. The introduction of a holistic approach that includes efficient screening instruments and effective brief, anti-alcoholic interventions, for the management of these patients must be considered. This should strengthen the preventive role of A&E departments, and, in the long term, may result in a decrease in the number of cases of alcohol misuse and in alcohol-related attendances. [ABSTRACT FROM PUBLISHER]

Background There is a challenging lack of evidence to inform best practice in the routine clinical care of juvenile idiopathic arthritis (JIA). Wide inter-centre variation in the definition and documentation of clinical data items is a major barrier to improvement. In response, we have developed a consensus agreed standardised core dataset called CAPTURE-JIA (n = 62 data items and a 'data dictionary' including agreed definitions of terms) designed to support routine collection of high-quality clinical data. The feasibility and acceptability of CAPTURE-JIA in clinical practice is not yet known and was the focus of this pilot study. Methods A purposeful sample of six paediatric rheumatology centres across England was invited to collect the CAPTURE-JIA dataset using paper collection forms (n = 20 patients/centre). The dataset was analysed for missing data. Six focus groups (n = 3-10) explored clinicians' views on acceptability and feasibility. Results One hundred and twenty-one patients were recruited over three months. The completeness of the dataset was similar across centres, with minor variations. The majority of data items (eg demographics, dates, ILAR type and examination) were >80% completed. However, 14/62 data items received >40% missing data. (Table 1) Further descriptive analyses highlighted incorrect completion of paper forms. Three themes emerged from the focus groups: problematic data items (missing from >10% forms at > 1 centre), format of clinician data forms and the role of digital data collection. Suggested solutions included minor changes to data item definitions and formatting. There were no refinements to the data items. Development of a digital data collection system was identified by all as essential. Due to a lack of clear consensus, the original CAPTURE forms included a number of ways to record joint count data. This proved confusing and a unanimous decision was taken to collect joint count data on all 83 joints in a tabular format. P10 Table 1: CAPTURE JIA data items with >40% missing data Data item  % forms with data item missing (if item required)  Relevant co-morbidities?  60  Macrophage activation syndrome?  100  Has the ILAR subtype changed?  50  Morning stiffness lasting >15 minutes?  42  History of any form of uveitis?  52  Date started uveitis mediation?  50  Strength of uveitis medication?  83  Counselled prior to new DMARD / biologic?  56  Enrolled in BECS/BCRD if new DMARD / biologic?  48  Joint count (homunculus or table format)  48  Physician assessment of systemic disease activity (VAS)  75  ESR  74  CRP  92  Plasma viscosity  100  Data item  % forms with data item missing (if item required)  Relevant co-morbidities?  60  Macrophage activation syndrome?  100  Has the ILAR subtype changed?  50  Morning stiffness lasting >15 minutes?  42  History of any form of uveitis?  52  Date started uveitis mediation?  50  Strength of uveitis medication?  83  Counselled prior to new DMARD / biologic?  56  Enrolled in BECS/BCRD if new DMARD / biologic?  48  Joint count (homunculus or table format)  48  Physician assessment of systemic disease activity (VAS)  75  ESR  74  CRP  92  Plasma viscosity  100  P10 Table 1: CAPTURE JIA data items with >40% missing data Data item  % forms with data item missing (if item required)  Relevant co-morbidities?  60  Macrophage activation syndrome?  100  Has the ILAR subtype changed?  50  Morning stiffness lasting >15 minutes?  42  History of any form of uveitis?  52  Date started uveitis mediation?  50  Strength of uveitis medication?  83  Counselled prior to new DMARD / biologic?  56  Enrolled in BECS/BCRD if new DMARD / biologic?  48  Joint count (homunculus or table format)  48  Physician assessment of systemic disease activity (VAS)  75  ESR  74  CRP  92  Plasma viscosity  100  Data item  % forms with data item missing (if item required)  Relevant co-morbidities?  60  Macrophage activation syndrome?  100  Has the ILAR subtype changed?  50  Morning stiffness lasting >15 minutes?  42  History of any form of uveitis?  52  Date started uveitis mediation?  50  Strength of uveitis medication?  83  Counselled prior to new DMARD / biologic?  56  Enrolled in BECS/BCRD if new DMARD / biologic?  48  Joint count (homunculus or table format)  48  Physician assessment of systemic disease activity (VAS)  75  ESR  74  CRP  92  Plasma viscosity  100  Conclusion Paper collection of the CAPTURE-JIA data items is feasible and acceptable in the routine clinical setting, but unlikely to be sustainable in the longer term if collected in duplicate with medical notes. A digital tool in the clinical domain, ideally interlocking with local systems, would offer many advantages, including more complete and time-efficient data collection. Conflicts of Interest The authors declare no conflicts of interest. [ABSTRACT FROM AUTHOR]

The article discusses the scarcity of the subject catalogue of the House of Commons usually being distributed in south-east of England and the solutions made possible by Chadwyck-Healey Limited. The author mentioned that the parliamentary paper was a vital tool for the study of the nineteenth century in Britain and in South America. He also reported that the Irish University Press decided to publish a 1000 volume series reprints of selected papers yet only small proportion of the papers were reprinted to solve the problem. The author also said that the company introduced microfiche reprints of the House of Commons Parliamentary Papers because of the incompetence of the first reprinted papers. The completion of the microfiche reprint is also reported.

Presents the subject index for the December 1, 1995 issue of "British Journal of Dermatology."

Focuses on the number of centers involved in kidney donor programs in Great Britain. Basis of donor assessment guidelines; Consequences of associated physiological, ethical and clinical implications; Number of renal transplants performed annually.

As people age they are at increased risk of cardiovascular disease, the leading cause of mortality and morbidity worldwide. Understanding cardiovascular ageing is essential to preserving healthy ageing and preventing serious health outcomes. This collection of papers published in Age and Ageing since 2011 cover key themes in cardiovascular ageing, with a separate collection on stroke and atrial fibrillation planned. Treating high blood pressure remains important as people age and reduces strokes and heart attacks. That said, a more personalised approach to blood pressure may be even more important as people age to lower blood pressure to tight targets where appropriate but avoid overtreatment in vulnerable groups. As people age, more people experience blood pressure drops on standing (orthostatic hypotension), particularly as they become frail. This can predispose them to falls. The papers in this collection provide an insight into blood pressure and orthostatic hypotension. They highlight areas for further research to understand blood pressure changes and management in the ageing population. Inpatient clinical care of older people with heart attacks differs from younger people in UK national audit data. People aged over 80 had improved outcomes in survival after heart attack over time, but had lower rates of specialist input from cardiology compared with younger people. This may partly reflect different clinical presentations, with heart attacks occurring in the context of other health conditions, frailty and multimorbidity. The care and outcomes of acute and chronic cardiovascular disease are impacted by the frailty and health status of an individual at baseline. The research included in this collection reinforces the wide variations in the ageing population and the necessity to focus on the individual needs and priorities, and provide a person-centred multidisciplinary approach to care. [ABSTRACT FROM AUTHOR]

In Victorian Britain rags were not only associated with the inadequate clothing of the poor, they were also viewed as a valuable commodity, widely collected for recycling into paper. This essay examines rags as simultaneously despised and precious objects, tracing the connections between Victorian accounts of poverty, the industrial recycling of rags into paper, and the redemption narratives created by Charles Dickens about rescued children. A supporter of Ragged Schools and champion of rags recycling, Dickens drew on the idea of the transformation of dirty rags into clean paper in his representations of ragged children. To him, the recycling of rags indicated the civilizing forces of modernity, and reading Dickens's representations of ragged children in this context reveals how cloth recycling became a paradigm for society's duties towards destitute children. This essay explains Dickens's juxtaposition of ragged children with references to rag-dealing in his novels; by this means he suggested that street children, like their ragged clothing, were capable of being purified and transformed into social usefulness. [ABSTRACT FROM PUBLISHER]

Service user and carer involvement in social work education is well established in the UK and other countries. There has however been limited research on the outcomes of this for social work practice and its subsequent impact on service users and carers. This has been noted in a previous systematic review involving one of the current authors. The current review aimed to synthesise literature from the previous decade (2011–2020) and follows on from the earlier review. PRISMA scoping review guidelines were followed and twenty-eight papers met the inclusion criteria that were framed. Data were extracted and tabulated according to the framework for the evaluation of educational programmes used in the previous review and analysed using narrative synthesis. A ten-item critical appraisal checklist was used to assess the rigour of all papers. The findings were similar to the earlier review. Most studies were from the UK and few evaluated change in students' skills or subsequent practice; none evaluated subsequent outcomes for service users and carers. All stakeholders were positive about the perceived benefits of service user and care involvement. Future research needs to use more robust evaluation methodologies and evaluate skills development for students and outcomes for service users and carers. [ABSTRACT FROM AUTHOR]

This paper introduces a set of papers analysing the likely economic impact of Brexit across key aspects of the UK economy as the country comes to the end of its first full year outside the European Union. The Brexit vote in 2016 was not just a vote on the UK's relations with the institutions of the European Union but was also a referendum on the fractured state of the UK as a nation. The resulting conflation of Brexit with domestic economic policy debates is reflected in this issue. A first cluster of papers focuses on the consequences of choosing to abandon the 'four freedoms' enshrined in the Treaty of Europe, the free movement of goods, services, capital, and labour across the EU, and a second is concerned with the indirect effects of Brexit in those areas of domestic policy that have been opened up by the Brexit decision. The economic consequences of Brexit are only just emerging, but these papers provide an informed perspective on the state of debate, and the likely implications of Brexit across a range of policy areas, both international and domestic. [ABSTRACT FROM AUTHOR]

Reflective supervision (RS) is a crucial component of social work practice but little is known about how RS works within the UK context and what the outcomes of RS are for social workers and their service users. A rapid literature review comprised searching four databases for academic and grey literature on the topic of social work RS. The Mixed Methods Appraisal Tool and the University College London's literature assessment method were employed in an expedited quality appraisal for all included papers. Twenty-seven papers were included. Findings suggest that a supportive, available manager or a peer-group enables reflective practice. Regularity of supervisory sessions and acknowledgement of a social worker's autonomy are seen as enablers of reflexivity. In contrast, task-oriented approach that is overly focused on accountability and hindered by the sparsity of resources proves problematic for both social workers and service users. Whilst theoretical papers were available, RS was not defined in a uniform fashion and there was limited evidence pertaining to supervisory practice. More research focusing on what works and what improvements are needed in RS, including adopting a participatory approach would help to bridge this gap and further inform policy and practice. [ABSTRACT FROM AUTHOR]

Background Whilst there has been recognition of the need to strengthen the evidence base for occupational health in the UK, it is not clear how much different groups contribute to the emerging research.Aims To establish the research contribution from different types of organization and how this has changed.Methods All original research papers published in Occupational Medicine in the 5-year periods July 1996 to June 2001 and July 2006 to June 2011 were reviewed. The lead authors’ affiliations were classified in the most relevant sector.Results The number of research papers published by authors affiliated to UK organizations was greater in the past 5 years than in a similar period a decade ago. The increase is wholly explained by a large increase in papers from universities. About one-fifth of all papers published in Occupational Medicine from UK sources had a principal affiliation with the National Health Service (NHS). The number of papers affiliated to large private sector companies reduced from 14 to 2. No papers arose from the work of established specialists employed by the large commercial providers of occupational health services.Conclusions Services provided in the NHS and other public sector organizations are important contributors of new evidence in occupational health. Commissioners of public sector services should take account of the importance of this to the research and innovation in occupational health. [ABSTRACT FROM PUBLISHER]

Background Obesity is the greatest health issue for this generation; schools have improved food offered within their grounds. The built environment surrounding schools and pupils' journeys home have not received the same level of attention. This review identified papers on impacts of hot food takeaways surrounding schools in the UK. Methods Methods were informed by the PRISMA (QUORUM) guidelines for systematic reviews. Searches were completed in 12 databases. Results A total of 14 papers were included and quality assured before data extraction. Three descriptive themes were found; descriptions of hot food takeaway's geography and impacts concerning schools, strategic food policy and pupils reported food behaviour. Conclusions Most included studies compared anthropometric measures with geographical location of hot food takeaways to find correlations between environment and childhood obesity. There was good evidence of more hot food takeaways in deprived areas and children who spend time in deprived neighbourhoods tend to eat more fast food and have higher BMIs. Few studies were able to quantify the correlation between school's environment and obesity amongst pupils. This lack of evidence is likely a factor of the studies' ability to identify the correlation rather than lack of a correlation between the two variables. [ABSTRACT FROM AUTHOR]

Interpellation, the production and hailing of subjectivities, is key to poststructuralist international relations (IR) theory and yet with some notable exceptions interpellation/hailing as an analytical concept remains somewhat undertheorized. This paper presents a Lacanian–Žižekian psychoanalytical theorization of interpellation in IR, while engaging with the ontology and epistemology of belonging. More specifically, this paper develops four major psychoanalytical concepts: void/lack, fantasy, jouissance, and desire, as it argues that void/lack at the subjective and objective levels renders interpellation possible and destabilises it, thus accounting for the im/possibility of belonging. This paper illustrates the psychoanalytical framework of interpellation by analyzing national-populism as manifested in the Brexit discourse in the UK as well as the interpellation in homonationalism. [ABSTRACT FROM AUTHOR]

Decision makers in adult social care are increasingly interested in using evidence from research to support or shape their decisions. The scope and nature of the current landscape of adult social care research (ASCR) need to be better understood. This paper provides a bibliometric assessment of ASCR outputs from 1996 to 2011. ASCR papers were retrieved using three strategies: from key journals; using keywords and noun phrases; and from additional papers preferentially citing or being cited by other ASCR papers. Overall, 195,829 ASCR papers were identified in the bibliographic database Scopus, of which 16 per cent involved at least one author from the UK. The UK output increased 2.45-fold between 1996 and 2011. Among selected countries, those with greater research intensity in ASCR generally had higher citation impact, such as the USA, UK, Canada and the Netherlands. The top five UK institutions in terms of volume of papers in the UK accounted for 26 per cent of total output. We conclude by noting the limitations to bibliometric analysis of ASCR and examine how such analysis can support the strategic development of the field. [ABSTRACT FROM AUTHOR]

This paper presents an extensive analysis of the UK's largest bifacial photovoltaic (PV) power plant, located in North Yorkshire. Commissioned in January 2020, this trailblazing facility, with a total installed capacity of 34.7 MW, is a benchmark for the evaluation of bifacial solar technology within the region. This pioneering study provides a thorough comparative assessment of bifacial and monofacial PV systems through a methodical investigation of their energy production, degradation rates, and spectral responses over a 4-year operational period. Our findings reveal that bifacial PV modules, distributed across four segments of the power plant, demonstrate a remarkable average power gain ranging between 15.12% and 17.31% compared with monofacial modules. Despite experiencing marginally higher annual degradation rates—1.17% for bifacial compared with 0.91% for monofacial systems—bifacial modules show superior resilience and energy yield, particularly during winter months when albedo effects are pronounced due to snow coverage. The study also highlights the strategic importance of spectral response analysis in optimizing PV performance. Bifacial modules have shown greater efficiency in capturing infrared radiation—a property that could be exploited to enhance overall energy yield under specific environmental conditions. The empirical data indicate a consistent performance of bifacial modules with an average normalized energy output clustering around the expected efficiency level. Therefore, the results of this study are pivotal for understanding the practical implications of deploying bifacial PV technology on a large scale. They provide valuable data for stakeholders in the solar energy sector, guiding future installations and innovations in solar panel technology. [ABSTRACT FROM AUTHOR]

The reconstruction of past trends in party membership can be fraught, especially when parties themselves kept no aggregate records. This was the case with the British Conservative party prior to 1946. The aggregate figures never existed, and the data that would be required to construct no longer exist to the required extent. Nonetheless, this article argues that it is methodologically possible to offer more detailed analysis than hitherto, by analysing local as well as national-level Conservative sources, triangulating with the national-level Labour party statistics and taking insights from more explicitly political science literature. This paper's substantive argument is that although Conservative membership fell after 1939, it did not collapse; that it recovered somewhat from early 1943 onwards and that recovery then afforded the party a base from which it was able to build, with spectacular success after 1945. [ABSTRACT FROM AUTHOR]

The euro and prices DID EMU AFFECT PRICE SETTING AND INFLATION PERSISTENCE? Surprisingly not; or at least not directly. Using data on individual consumer prices and on sectoral inflation rates from six euro area countries spanning several years before and after the introduction of the euro, we look at whether EMU has altered the behaviour of price setters and/or the dynamics of inflation. We find no evidence of such change in 1999, when the euro was introduced as an electronic unit of account. At the start of 2002, when the paper currency appeared, the frequency of price adjustments (both upward and downward) increased suddenly, while the average magnitude of price changes fell; both, however, quickly settled back to the earlier patterns. Conversely, we do find evidence of a permanent decline in the persistence of inflation after the mid-1990s. While in principle this could be attributable to the preparation of EMU, this interpretation is put into question by the fact that a similar decline occurred also in the UK and in the US. [ABSTRACT FROM AUTHOR]

The 'As Low As Reasonably Achievable' (ALARA) principle is one of the three fundamental elements of radiation protection. Noting that ionising radiation is both encountered naturally in the environment as part of everyday life, and artificially as part of a range of practices, the ALARA principle aims to provide a means of optimising radiation exposures. Historically, the stakeholders involved in the application of the ALARA process have primarily been assumed to be internal to an organisation, except for regulatory 'buy in'. However, could there be instances when the public should be a key stakeholder? This paper explores the area of perceived risk with reference to a particular case study in which the dredging of non-hazardous sediment in the UK near a now decommissioned nuclear power station raised substantial public concern about radiological exposure. This turned what was a straightforward construction activity into a complex public engagement and reassurance task, at a significant cost disproportionate to the level of radiological risk. Learning from this case study is used to highlight the key lessons learnt and the importance of public engagement, and how perceived risk and the associated societal stress could be incorporated into the ALARA process. The paper also highlights the ongoing work and guidance produced by the Society for Radiological Protection in the UK on the development of Guidance for Practitioners to support the Communication of Radiation Risk. [ABSTRACT FROM AUTHOR]

This paper explores the gentry response to disease and illness in the fifteenth century. It examines the private letter collections of the Paston, the Stonor and the Plumpton families through a comparative methodology. The first section, focusing upon disease terminology in the letters, explores the diagnostic understanding of these families. Analysis of incidences of particular diseases, such as malaria and sciatica, is used to demonstrate their comprehension of illness through symptomatic observation. The second section examines the methods used for treating disease, analysing the various remedies used by the families. Important emphasis is placed upon the choice between using medical professionals and home healing. Finally, the role of female family members is assessed, determining whether it was medicinal matriarchs or male physicians who dominated in the sphere of family medicine. Ultimately this paper will uncover the complex and sophisticated ways gentry families managed and treated disease in this period. [ABSTRACT FROM AUTHOR]

Background: Surgical waiting lists have risen dramatically across the UK as a result of the COVID-19 pandemic. The effective use of operating theatres by optimal scheduling could help mitigate this, but this requires accurate case duration predictions. Current standards for predicting the duration of surgery are inaccurate. Artificial intelligence (AI) offers the potential for greater accuracy in predicting surgical case duration. This study aimed to investigate whether there is evidence to support that AI is more accurate than current industry standards at predicting surgical case duration, with a secondary aim of analysing whether the implementation of the models used produced efficiency savings. Method: PubMed, Embase, and MEDLINE libraries were searched through to July 2023 to identify appropriate articles. PRISMA extension for scoping reviews and the Arksey and O'Malley framework were followed. Study quality was assessed using a modified version of the reporting guidelines for surgical AI papers by Farrow et al. Algorithm performance was reported using evaluation metrics. Results: The search identified 2593 articles: 14 were suitable for inclusion and 13 reported on the accuracy of AI algorithms against industry standards, with seven demonstrating a statistically significant improvement in prediction accuracy (P < 0.05). The larger studies demonstrated the superiority of neural networks over other machine learning techniques. Efficiency savings were identified in a RCT. Significant methodological limitations were identified across most studies. Conclusion: The studies suggest that machine learning and deep learning models are more accurate at predicting the duration of surgery; however, further research is required to determine the best way to implement this technology. Waiting lists for elective surgeries are rising in the UK. We conducted a scoping review with the aim to understand if artificial intelligence has the potential to improve the utilization of operating theatre resources through improved scheduling. [ABSTRACT FROM AUTHOR]

Background: Students must be proficient in surgical skills according to General Medical Council and Royal College of Surgeons of England guidelines. If these skills are not appropriately taught, there is a risk of an incoming junior workforce with inadequate surgical skills. This paper aimed to review the literature relating to undergraduate teaching of surgical skills in the UK and summarize future suggested training methods. Methods: The databases MEDLINE, Embase and SCOPUS were searched, and the existing literature relating to methodology of undergraduate teaching of surgical skills in the UK over the past 10 years was summarized. The Medical Education Research Quality Instrument was used to assess research quality. Results: A total of 19 papers were included. Cross-sectional evaluations and survey-based studies highlight a clear deficit in surgical skills teaching in the UK. Medical students are currently unable to fulfil their own learning needs and meet requirements set out by the General Medical Council. This lack of surgical teaching appears to negatively affect student desire to pursue a surgical career. The three main themes for improvement are extracurricular surgical skills days, near-peer teaching and simulation. Each method appeared to improve learning, although no studies utilized medium- to long-term follow-up to demonstrate efficacy and there lacks a clear consensus as to the 'standard' of undergraduate surgical skill education. There was also potential for selection bias and response shift bias in many of the studies assessing pre- and postintervention confidence and opinions. Conclusion: There is a concerning lack of surgical skills teaching that has resulted in medical students and junior doctors not having the necessary surgical skills as per General Medical Council guidance and students feel that their own learning needs are not met. This failure to address the learning deficit may be responsible for the fall in surgical competition ratios. While surgical skills teaching must be improved urgently, more robust evidence is required to evaluate the optimal ways of approaching this issue. Undergraduate medical students must be proficient in certain surgical skills as set out by General Medical Council and Royal College regulations. There appears a deficit in such teaching which we have discussed and attempted to address in terms of alternative methodology reported in the literature that can be used to teach these basic surgical skills. [ABSTRACT FROM AUTHOR]

This paper seeks to establish the degree of presence and potential impact of ethnic minority scientists on UK science. It does this by examining their published outputs (present in SCI). Ethnic minority researchers were identified and classed within seven distinct groups based on their surname. A fractional count of their papers was used to establish which field's they research into, what types of research they conduct (from basic to applied) and what is the potential impact of their work (citations to journal). Key findings suggest that in the last 20 years the proportion of ethnic-authored papers almost doubled, Chinese were the group which contributed most papers, ethnic minorities are best represented in engineering and technology, physics and chemistry and they tend to publish in applied journals with potential impact factor lower than that of non-ethnic authors. [ABSTRACT FROM AUTHOR]

Ballot order positional effects, electoral advantage gained from a candidate's surname location on the ballot paper, have been extensively studied. For ‘low-information’ elections especially candidates located at or near the top of the ballot paper are advantaged relative to their competitors. This examination of alphabetic bias uses data from local council election results in Britain. The examination of election contests featuring more than half a million candidates provides evidence of an alphabetic bias which increases as the number of vacancies increases. We calibrate the effects upon votes and vote share of alphabetical ordering of candidates. Comparing votes cast for last- and first-placed candidates in the ballot order demonstrates a clear advantage to those placed first. This increases in size as both the number of seats and competing candidates increases. Those located in the top half of the ballot paper are more likely to finish in the top half of the vote order. Subsequently, the distribution of surnames among elected councillors is clustered towards the top of the alphabet. Measures could remove the effects of alphabetic bias, such as randomising name order and introducing experiments in local council electoral practice, a cost-effective means for evaluating change. [ABSTRACT FROM PUBLISHER]