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Plain language summary: Over one‐quarter of women in the UK have a caesarean birth (CB). More than one in 20 of these births occurs near the end of labour, when the cervix is fully dilated (second stage). In these circumstances, and when labour has been prolonged, the baby's head can become lodged deep in the maternal pelvis making it challenging to deliver the baby. During the caesarean birth, difficulty in delivery of the baby's head may result – this emergency is known as impacted fetal head (IFH). These are technically challenging births that pose significant risks to both the woman and baby. Complications for the woman include tears in the womb, serious bleeding and longer hospital stay. Babies are at increased risk of injury including damage to the head and face, lack of oxygen to the brain, nerve damage, and in rare cases, the baby may die from these complications. Maternity staff are increasingly encountering IFH at CB, and reports of associated injuries have risen dramatically in recent years. The latest UK studies suggest that IFH may complicate as many as one in 10 unplanned CBs (1.5% of all births) and that two in 100 babies affected by IFH die or are seriously injured. Moreover, there has been a sharp increase in reports of babies having brain injuries when their birth was complicated by IFH. When an IFH occurs, the maternity team can use different approaches to help deliver the baby's head at CB. These include: an assistant (another obstetrician or midwife) pushing the head up from the vagina; delivering the baby feet first; using a specially designed inflatable balloon device to elevate the baby's head and/or giving the mother a medicine to relax the womb. However, there is currently no consensus for how best to manage these births. This has resulted in a lack of confidence among maternity staff, variable practice and potentially avoidable harm in some circumstances. This paper reviews the current evidence regarding the prediction, prevention and management of IFH at CB, integrating findings from a systematic review commissioned from the National Guideline Alliance. [ABSTRACT FROM AUTHOR]

The article presents the discussion on claims about the nutritional and health benefits of foods and drinks Position Paper emphasises the learnings gaining through the implementation of the European Food Safety Authority evidence‐based process for assessment of proposed claims; and main audience for the Academy's work is the nutrition science community/profession and its stakeholders.

Plain language summary: Increasingly, births around the world are started artificially using medications or other methods. This process is known as induction of labour. As it becomes more common, methods are needed to meet the different clinical needs and birth preferences of women. Induction of labour typically includes a combination of the medication dinoprostone inserted into the vagina, artificial rupture of membranes ('releasing the waters'), and synthetic oxytocin (hormone given via a drip). This paper reviews some of the methods less commonly used for induction in the UK, namely a drug called misoprostol, which can be given orally or vaginally, and 'mechanical' methods, where labour is started by stretching the cervix (neck of the womb), most commonly with a soft silicone tube with a balloon near the tip, filled with water. Low‐dose oral misoprostol tablets are now commercially available in the UK. Other methods for labour induction are not reviewed in detail in this paper. The evidence suggests mechanical induction of labour (using a balloon catheter) and misoprostol are both at least as safe and effective as using the standard drug, dinoprostone. There is evidence to suggest a balloon catheter may reduce the chance of serious negative outcomes for babies when compared with dinoprostone, and that giving low‐dose oral misoprostol results in fewer caesarean births. Where possible and after informed consent, the method of induction of labour should be personalised to suit the individual woman, her clinical condition, and the setting in which she is giving birth. Local contexts and resources also need to be taken into account. To date, research into women's perspectives and experiences of induction of labour have been significantly lacking. [ABSTRACT FROM AUTHOR]

Latent fingerprint deposits on thermal paper sourced from the U.S., China, the U.K., and Australia have been visualized by heating. U.S. and Chinese sourced paper produced two distinct types of fingerprint development. In one type (type 1), the paper dye colors where the deposit is present (as previously reported) and in the other type (type 2) the 'inverse' of this gives paper coloring only in areas not coincident with the deposit. Both development types gave identifiable fingerprints, the majority fading within 24 h of heating. Fingerprint development from U.K. and Australian sourced paper was exclusively type 1 and resistant to fading. Temperatures for fingerprint visualization were higher for U.S. paper (64-71°C) and Chinese paper (75-95°C) than for U.K. and Australian sourced paper (43-50°C). Particularly for Chinese sourced paper, these temperatures were within a few degrees of the normal paper color temperature. A mechanism for type 2 fingerprint development is proposed. [ABSTRACT FROM AUTHOR]

A consensus statement for the management for patients of all ages with all stages of nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) - All StAGEs - is proposed by representatives of the UK National Cancer Research Institute (NCRI) Hodgkin lymphoma study group and the Children's Cancer & Leukaemia Group. Based on current practices and published evidence, a consensus has been reached regarding diagnosis, staging and risk-ik7 stratified management which includes active surveillance, low- and standard-dose immunochemotherapy and radiotherapy., (© 2022 British Society for Haematology and John Wiley & Sons Ltd.)

Objective: The Patient Information Leaflet (PIL) is an authoritative document that all people with epilepsy in the EU receive when prescribed antiseizure medication (ASM). We undertook the first independent, comprehensive assessment to determine how understandable they are. Regulators state that when patients are asked comprehension questions about them, ≥80% should answer correctly. Also, recommended is that PILs have a maximum reading requirement of US grade 8. Methods: Study 1: We obtained 140 current ASM PILs written in English. "Readability" was assessed using four tests, with and without adjustment for influence of familiar, polysyllabic words. A total of 179 online materials on epilepsy were also assessed. Study 2: Two PILs from Study 1 were randomly selected (Pregabalin Focus; Inovelon) and shown to 35 people from the UK epilepsy population. Their comprehension was assessed. Study 3: To understand whether the student population provides an accessible alternative population for future examination of ASM PILs, Study 3 was completed, using the same methods as Study 2, except that participants were 262 UK university students. Results: Study 1: No PIL had a reading level of grade 8. Median was grade 11. Adjusting for context, the PILs were still at grade 10.5. PILs for branded ASMs were most readable. PILs were no more readable than (unregulated) online materials. Study 2: Users struggled to comprehend the PILs' key messages. The eight questions asked about pregabalin were typically answered correctly by 54%. For Inovelon, it was 62%. Study 3: Most student participants comprehended the PILs' key messages. The questions about Inovelon were answered correctly by 90%; for pregabalin it was 86%. Significance: This is the first independent and comprehensive examination of ASM PILs. It found that PILs being used fail to meet recommendations and regulatory requirements and risk not being understandable to a substantial proportion of users. In finding that people from the epilepsy population differ markedly in comprehension of PILs compared to students, this study highlights the importance of completing user testing with the target population. [ABSTRACT FROM AUTHOR]

This article presents the results of a life-cycle materials and energy flow analysis for the pulp and paper cycle in the United Kingdom. Material flows are reconstructed for the period between 1987 and 1996 for all major processes associated with the paper cycle, and system energy requirements are calculated over this period using the best available data. Attention is drawn to the import dependence of U.K. paper demand, and the significant energy requirements associated with upstream forestry processes. The historical trend analysis is then used to model possible future developments in materials and energy consumption until 2010 under a variety of assumptions about process technology improvements, wastepaper utilization rates, and changing demand trends. The results indicate that policy options to increase recycling yield some energy benefits, but these are small by comparison with the benefits to be gained by reducing consumption of paper and improving process technology. The structure of the electricity supply industry in the United Kingdom means that global energy benefits could also be achieved by increasing the contribution from imported pulp. [ABSTRACT FROM AUTHOR]

Plain language summary: This paper deals with the use of hormone replacement therapy (HRT) after the removal of fallopian tubes and ovaries to prevent ovarian cancer in premenopausal high risk women. Some women have an alteration in their genetic code, which makes them more likely to develop ovarian cancer. Two well‐known genes which can carry an alteration are the BRCA1 and BRCA2 genes. Examples of other genes associated with an increased risk of ovarian cancer include RAD51C, RAD51D, BRIP1, PALB2 and Lynch syndrome genes. Women with a strong family history of ovarian cancer and/or breast cancer, may also be at increased risk of developing ovarian cancer. Women at increased risk can choose to have an operation to remove the fallopian tubes and ovaries, which is the most effective way to prevent ovarian cancer. This is done after a woman has completed her family. However, removal of ovaries causes early menopause and leads to hot flushes, sweats, mood changes and bone thinning. It can also cause memory problems and increases the risk of heart disease. It may reduce libido or impair sexual function. Guidance on how to care for women following preventative surgery who are experiencing early menopause is needed. HRT is usually advisable for women up to 51 years of age (average age of menopause for women in the UK) who are undergoing early menopause and have not had breast cancer, to minimise the health risks linked to early menopause. For women with a womb, HRT should include estrogen coupled with progestogen to protect against thickening of the lining of the womb (called endometrial hyperplasia). For women without a womb, only estrogen is given. Research suggests that, unlike in older women, HRT for women in early menopause does not increase breast cancer risk, including in those who are BRCA1 and BRCA2 carriers and have preventative surgery. For women with a history of receptor‐negative breast cancer, the gynaecologist will liaise with an oncology doctor on a case‐by‐case basis to help to decide if HRT is safe to use. Women with a history of estrogen receptor‐positive breast cancer are not normally offered HRT. A range of other therapies can be used if a woman is unable to take HRT. These include behavioural therapy and non‐hormonal medicines. However, these are less effective than HRT. Regular exercise, healthy lifestyle and avoiding symptom triggers are also advised. Whether to undergo surgery to reduce risk or not and its timing can be a complex decision‐making process. Women need to be carefully counselled on the pros and cons of both preventative surgery and HRT use so they can make informed decisions and choices. [ABSTRACT FROM AUTHOR]

The article announces the submission of papers about systems thinking and operational research in commemoration of the contribution of Emeritus Professor Mike Jackson.

Background: Patients who are critically ill are at increased risk of hospital acquired pneumonia and ventilator associated pneumonia. Effective evidence based oral care may reduce the incidence of such iatrogenic infection. Aim: To provide an evidence‐based British Association of Critical Care Nurses endorsed consensus paper for best practice relating to implementing oral care, with the intention of promoting patient comfort and reducing hospital acquired pneumonia and ventilator associated pneumonia in critically ill patients. Design: A nominal group technique was adopted. A consensus committee of adult critical care nursing experts from the United Kingdom met in 2018 to evaluate and review the literature relating to oral care, its application in reducing pneumonia in critically ill adults and to make recommendations for practice. An elected national board member for the British Association of Critical Care Nurses chaired the round table discussion. Methods: The committee focused on 5 aspects of oral care practice relating to critically ill adult patients. The evidence was evaluated for each practice within the context of reducing pneumonia in the mechanically ventilated patient or pneumonia in the non‐ventilated patient. The five practices included the frequency for oral care; tools for oral care; oral care technique; solutions used and oral care in the non‐ventilated patient who is critically ill and is at risk of aspiration. The group searched the best available evidence and evaluated this using the Grading of Recommendations Assessment, Development, and Evaluation system to assess the quality of evidence from high to very low, and to formulate recommendations as strong, moderate, weak, or best practice consensus statement when applicable. Results: The consensus group generated recommendations, delineating an approach to best practice for oral care in critically ill adult patients. Recommendations included guidance for frequency and procedure for oral assessment, toothbrushing, and moisturising the mouth. Evidence on the use of chlorhexidine is not consistent and caution is advised with its routine use. Conclusion: Oral care is an important part of the care of critically ill patients, both ventilated and non‐ventilated. An effective oral care programme reduces the incidence of pneumonia and promotes patient comfort. Relevance to Clinical practice: Effective oral care is integral to safe patient care in critical care. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic and the UK government's subsequent coronavirus action plan have fundamentally impacted on every aspect of healthcare. One area that is severely affected is ear, nose and throat (ENT)/laryngology where speech and language therapists (SLTs) engage in a diverse range of practice with patients with a range of conditions, including voice disorders, airway problems, and head and neck cancers (HNCs). A large majority of these patients are in high‐risk categories, and many specialized clinical practices are vulnerable. In addition, workforce and research issues are challenged in both the immediate context and the future. Aims: To discuss the threats and opportunities from the COVID‐19 pandemic for SLTs in ENT/laryngology with specific reference to clinical practice, workforce and research leadership. Methods & Procedures: The relevant sections of the World Health Organisation's (WHO) health systems building blocks framework (2007) were used to structure the study. Expert agreement was determined by an iterative process of multiple‐group discussions, the use of all recent relevant policy documentation, and other literature and shared documentation/writing. The final paper was verified and agreed by all authors. Main Contribution: The main threats to ENT/laryngology SLT clinical services include increased patient complexity related to COVID‐19 voice and airway problems, delayed HNC diagnosis, reduced access to instrumental procedures and inequitable care provision. The main clinical opportunities include the potential for new modes of service delivery and collaborations, and harnessing SLT expertise in non‐instrumental assessment. There are several workforce issues, including redeployment (and impact on current services), training implications and psychological impact on staff. Workforce opportunities exist for service innovation and potential extended ENT/SLT practice roles. Research is threatened by a reduction in immediate funding calls and high competition. Current research is affected by very limited access to participants and the ability to conduct face‐to‐face and instrumental assessments. However, research opportunities may result in greater collaboration, and changes in service delivery necessitate robust investigation and evaluation. A new national set of research priorities is likely to emerge. Conclusions & Implications: The immediate impact of the pandemic has resulted in major disruption to all aspects of clinical delivery, workforce and research for ENT/laryngology SLT. It is unclear when any of these areas will resume operations and whether permanent changes to clinical practice, professional remits and research priorities will follow. However, significant opportunity exists in the post‐COVID era to re‐evaluate current practice, embrace opportunities and evaluate new ways of working. What this paper addsWhat is already known on the subjectENT/laryngology SLTs manage patients with a range of conditions, including voice disorders, airway problems and HNCs. The diverse scope of clinical practice involves highly specialized assessment and treatment practices in patients in high‐risk categories. A large majority of active research projects in this field are patient focused and involve instrumental assessment. The COVID‐19 pandemic has created both opportunities and threats for ENT SLT clinical services, workforce and research.What this paper adds to existing knowledgeThis study provides a discussion of the threats and opportunities from the COVID‐19 pandemic for ENT/laryngology SLT with specific reference to clinical practice, workforce and research leadership.What are the potential or actual clinical implications of this work?The COVID‐19 pandemic has resulted in major disruption to all aspects of clinical delivery, workforce and research for ENT/laryngology SLT. Changes to clinical practice, professional remits and research priorities are of indeterminant duration at this time, and some components could be permanent. Significant clinical practice, workforce and research opportunities may exist in the post‐COVID era. [ABSTRACT FROM AUTHOR]

Focuses on issues raised by the White Paper on the future of higher education from the perspective of the post-92 universities, established by the Act of parliament in 1992 in Great Britain. Failure of the White Paper in recognizing realities of shape and structure of educational system; Vision of future of higher education offered by the White Paper.

Whilst forest management certification emerged in the early 1990s as a potential market-based solution to the problem of forest loss and degradation, certified timber has not yet taken a significant share of timber and wood product markets. Although the lack of supply of certified timber is acknowledged as a problem, market barriers to the uptake of certified products are poorly understood. This study sought to identify and compare barriers to the uptake of certified wood and wood products in the UK's paper and construction industries. Findings indicate marked variation in barriers between individual companies and between the industries. Key barriers identified include: organizational constraints – strategic commitment, inadequate systems, staff skills and financial provision; supply constraints – material availability, supply chain complexities, entrenched supplier relationships; and demand constraints – lack of knowledge, weak demand, price sensitivity, traditional expectations and availability of substitutes. Ways to overcome these barriers are discussed. Copyright © 2005 John Wiley & Sons, Ltd and ERP Environment. [ABSTRACT FROM AUTHOR]

Plain language summary: What is it?: Fetal neonatal alloimmune thrombocytopenia (FNAIT), also known as neonatal alloimmune thrombocytopenia (NAIT) or fetomaternal alloimmune thrombocytopenia (FMAIT), is a rare condition which affects a baby's platelets. This can put them at risk of problems with bleeding, particularly into the brain. One baby per week in the UK may be seriously affected and milder forms can affect one in every 1000 births. How is it caused?: Platelets are blood cells that are very important in helping blood to clot. All platelets have natural proteins on their surface called human platelet antigens (HPAs). In babies, half of these antigens are inherited from the mother and half from the father. During pregnancy, some of the baby's platelets can cross into the mother's bloodstream. In most cases, this does not cause a problem. But in cases of FNAIT, the mother's immune system does not recognise the baby's HPAs that were inherited from the father and develops antibodies, which can cross the placenta and attack the baby's platelets. These antibodies are called anti‐HPAs, and the commonest antibody implicated is anti‐HPA‐1a, but there are other rarer antibody types. If this happens, the baby's platelets may be destroyed causing their platelet count to fall dangerously low. If the platelet count is very low there is a risk to the baby of bleeding into their brain before they are born. This is very rare but if it happens it can have serious effects on the baby's health. How is it inherited?: A baby inherits half of their HPAs from its mother and half from its father. Consequently, a baby may have different HPAs from its mother. As the condition is very rare, and even if the baby is at risk of the condition we have no way of knowing how severely they will be affected, routine screening is not currently recommended. What can be done?: FNAIT is usually diagnosed if a previous baby has had a low platelet count. The parents are offered blood tests and the condition can be confirmed or ruled out. There are many other causes of low platelets in babies, which may also need to be tested for. As the condition is so rare, expertise is limited to specialist centres and normally a haematologist and fetal medicine doctor will perform and interpret the tests together. Fortunately, there is an effective treatment for the vast majority of cases called immunoglobulin, or IVIg. This 'blood product' is given intravenously through a drip every week to women at risk of the condition. It may be started from as early as 16 weeks in the next pregnancy, until birth, which would be offered at around 36–37 weeks. Less common treatments that may be considered depending on individual circumstances include steroid tablets or injections, or giving platelet transfusions to the baby. What does this paper tell you?: This paper considers the latest evidence in relation to treatment options in the management of pregnancies at risk of FNAIT. Specifically, we discuss the role of screening, when IVIg should be started, what dose should be used, and what evidence there is for maternal steroids. We also consider in very rare selected cases, the use of fetal blood sampling and giving platelet transfusions to the baby before birth. Finally, we consider the approaches to blood testing mothers to tell if babies are at risk, which is offered in some countries, and development of new treatments to reduce the risk of FNAIT. [ABSTRACT FROM AUTHOR]

Summary: The International Collaboration for Transfusion Medicine Guidelines (ICTMG) has published guidance on transfusion for haemoglobinopathies. To give a UK perspective on this guidance, each of the recommendations in the ICTMG guideline were reviewed and the applicability for transfusion practice in the UK considered with reference to relevant published British Society for Haematology (BSH) guidelines and national standards. There was much consensus; however, there was disparity surrounding the recommendations for routinely extended matching in those with alloimmunisation. [ABSTRACT FROM AUTHOR]

Introduction: Loneliness can have a negative impact on people's physical and psychological well‐being; building social capital is a potential means of addressing this connection. Community initiatives (e.g. groups, clubs, neighbourhood activities) may be a route that enables people to build social capital to tackle loneliness. Understanding what is known, and where gaps in knowledge exist, is important for advancing research on this topic. Methods: A scoping review was undertaken to explore the question – What community initiatives, with a focus on well‐being, have been evaluated in the United Kingdom that include information about social capital and loneliness? Four databases (Medline, CINAHL, ASSIA and Embase) were searched for relevant research papers. References were screened by two researchers to identify if they met the review's inclusion criteria. Data were summarised as a narrative and in tables. Results: Five papers met the review's inclusion criteria. They all used qualitative methods. Findings suggested that social capital could be developed through creating a sense of trust, group cohesion and reciprocity among participants in the community initiatives. This connection enabled people to experience a sense of belonging and to feel they had a meaningful relationship with others, which appeared to alleviate feelings of loneliness. Conclusion: More research is warranted on the review topic, including studies that have employed quantitative or mixed methods. Clarity around definitions of social capital and loneliness in future research is required. Engagement with community initiatives can provide a formalised route to help people develop connections and counteract limitations in their social networks. However, individuals may be wary about attending community initiatives, needing support and encouragement to do so. Social prescribing link workers are one means of motivating people to access groups, events or organisations that could improve their well‐being. [ABSTRACT FROM AUTHOR]

Looks at a survey of articles citing the works of Peter Checkland and Michael Jackson on operational research and the systems community in Great Britain. Definition of emergence of systems thinking; Stages in the general development of the management sciences; Information on the research papers written by Checkland and Jackson.

Attitudes to sign languages or language policies are often not overtly discussed or recorded but they influence deaf young people's educational opportunities and outcomes. Two qualitative studies from Scotland investigate the provision of British Sign Language as accommodation in public examinations. The first explores the views of deaf pupils and staff about the official system for face‐to‐face interpretation of exam papers. The second investigates a centrally translated digital paper with embedded video questions. Discussion focuses on contrasts between the USA and UK approaches to accommodations, raising issues of standardized technical terms in signed languages, the right to respond in sign, and candidate choice. [ABSTRACT FROM AUTHOR]

Rag paper is a common denominator for many Romantic‐era medial forms. The term "media ecology" has become increasingly accepted in media theory, and its spatial and ecological affinities connect it to the urgent topic of climate change. Media ecology invites book historians to consider the labor as well as the origins of the materials that underwrite our culture. This consideration of paper recasts the literary archive as an accretion of physical as well as intellectual labor. The physical labor necessary for the making of rag paper included increasingly industrialized agricultural work and textile production, as well as rag collecting and sorting, as many period authors were aware. At the inception of the Bank Restriction Period (1797–1821), the introduction of low‐denomination paper banknotes changed the London media ecology in ways that had a devastating effect on the English poor, including the very orders of agricultural and textiles workers, rag collectors, and papermill rag‐room women who had a hand in paper making. The Bank of England investigated and prosecuted hundreds, resulting in poverty, transportation, imprisonment, and executions. Paper notes and their forgeries invited considerations of other forms of cultural value and circulation, including literary authorship, and the article ends with the Bank of England's current celebration of Jane Austen as a literary icon by including her portrait on the polymer £10 note. [ABSTRACT FROM AUTHOR]

Background: Working together and co‐production with public advisors have become popular among health researchers. This practice extends to doctoral researchers who involve public advisors at different stages of their research or throughout their doctoral journey. Objective: A doctoral researcher and two public advisors jointly evaluated public involvement in doctoral research. Methods: Using the established public involvement evaluation framework by Gibson and colleagues, public advisors and a doctoral researcher mapped and evaluated their experiences of public involvement in doctoral research. The four‐dimensional framework allowed the authors to reflect on (1) the strength of the public voice, (2) the number of ways in which public advisors had an opportunity to get involved, (3) whether the discussion was about the public or organisation's (doctoral researcher, university or funder) concerns and (4) if the organisation changed or resisted feedback. Results are presented in a diagrammatic and narrative way. Results: Public advisors saw themselves as having a stronger voice in doctoral research than the doctoral researcher perceived. All agreed that there existed multiple ways for public advisors to be involved. Public advisors' feedback was taken on board, but it was also limited due to restrictions of what the doctoral programme allowed. Conclusion: Public advisors ensured that the doctoral research was more relevant to the public. The ongoing involvement also shaped the doctoral researcher's thinking and views. Patient and Public Involvement: Two public advisors were involved throughout the 3 years of this doctoral research. They co‐evaluated this involvement and are co‐authors of this paper. [ABSTRACT FROM AUTHOR]

Nurse‐led clinics are known to positively impact and benefit patients; however, there is little understanding of the role of the nurse in a nurse‐led male Lower Urinary Tract Symptoms (LUTS) clinic. LUTS affect up to 30% of males over 65 in the United Kingdom and can significantly impact the quality of life of the person experiencing them. LUTS can be managed with conservative changes, as well as with medication and surgical intervention. The aim of this scoping review is to map what is known about the role of the nurse in a nurse‐led male LUTS clinic and what research tells us regarding, the barriers and enablers in nurses leading a male LUTS clinic. This scoping review follows the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for Scoping Reviews (PRISMA‐SCR) checklist and the methodological guidelines set out by the Joanna Briggs institute. A literature search was carried out over three databases (CINAHL, Medline Ovid, ProQuest health and medical collection) and systematically searched from 2000 to 2021. Grey literature was also searched, and citation chaining was undertaken. Following a systematic review of the literature, four papers met the inclusion criteria for this scoping review. The emergent themes across the four papers consisted of structure, assessment and resources, and effectiveness of the nurse‐led male LUTS clinic. There was clear agreement across the literature regarding the investigations and assessment the nurse should carry out. Ongoing practical, theoretical, and observational training and education is required to ensure the nurse is competent in running a male LUTS clinic. The papers reviewed showed the nurse provided a supportive role to the consultant. However, there is evidence indicating there is a move towards autonomous practice. There is a dearth of the current research relating to the role of the nurse in nurse‐led male LUTS clinics and the enablers and barriers in nurses leading male LUTS clinics. Further research should be considered to gain a better understanding of where nurse‐led male LUTS clinics currently take place, what the role of the nurse is in leading a LUTS clinic and what enablers and barriers exist. [ABSTRACT FROM AUTHOR]

ObjectiveTo investigate the content validity of Paper 1 of the MRCGP examination. MethodExploratory factor analysis was carried out on candidate responses to Paper 1 of the May and October MRCGP examination in 1998. Contribution of each test question across factors was assessed using a pattern matrix of the oblique rotation. Common dimensions and variations between factor sets were identified. Key testing areas were then matched against the ‘domains of competence’ intended to be assessed by Paper 1 (as defined within the examination blueprint matrix). ResultsWhilst critical appraisal, disease prevention/evidence-based medicine and clinical management emerged as areas tested consistently, content variation was observed between factor sets extracted from both sittings. In addition, some overlap, in terms of domains tested, was seen among other assessment instruments used within the examination. ConclusionPaper 1 conforms to the majority of its stated intentions. However, further development of techniques for investigating validity will be required in order to minimize content variation between both sittings of the examination as well as to help more closely define areas of competence to be tested by Paper 1 of the MRCGP examination. [ABSTRACT FROM AUTHOR]

The content of 'O' and 'A' level papers on modern British and European History set by two GCE Examination Boards was analysed to find out what particular aspects of the past were emphasised and thus to throw light on the experience of history as a subject which was gained by the candidates. These papers, which are taken by the great majority of the candidates, were found to be dominated by political history, up to 77% of the questions being devoted to the affairs of governments and political leaders. Foreign politics was especially important in papers on European history reaching as high as 44% of the questions set and domestic politics was central to papers on British history attaining means in different groups of papers between 40 and 50%. At the end of the article the wisdom of the approach to school history evident in these papers is questioned. [ABSTRACT FROM AUTHOR]

People with learning disabilities are living longer. Older people with learning disabilities should be included in policies and plans that are for all older people. National plans and policies for older people often do not say anything about older people with learning disabilities, and it is hard to know whether older people with learning disabilities are benefiting. People who plan services locally often do not have good information on older people with learning disabilities. Using the Equalities Act 2010 could help people who plan services and write policy to think about older people with learning disabilities but this is not happening at the moment. People who work with older people with learning disabilities should be aware of policy for all older people, so that older people with learning disabilities do not miss out. This paper seeks to explore the opportunities and challenges generated by current policy, guidance and legislation in England relating to older people, in terms of the practical implications for older people with learning disabilities. Using the broad themes housing, employment, social inclusion and isolation, care and support, and promoting better health and well-being, this paper discusses potential practical opportunities and concerns for older people with learning disabilities arising from policy and legislation such as current initiatives regarding integration, personalisation and the dementia policy. Consideration is given to the implications of changing policy and practice for both current and future generations of people with a learning disability as they reach older age. This discussion paper concludes that whilst there is potential for older people with a learning disability to benefit from policy and practice aimed at improving the lives of older people generally, the tendency for policy to be targeted at specific groups without adequately considering the diversity of those groups often leaves those with a learning disability at the margins of being able to make the most of changes. [ABSTRACT FROM AUTHOR]

The article focuses on the sustainable raw materials that are used for gift wrapping during the Christmas seasons in Great Britain. It mentions that Professor Chris Carr reveals more possibilities that turkey and duck feathers or even sheep droppings may be used to develop Christmas wrapping paper. It also notes the British government's statistics which encourages recycling in the country.

Objective: Only a minority of suicide decedents leave a suicide note. Typically, the notes are handwritten on paper; however, electronic suicide notes have been reported with increasing frequency. This emerging phenomenon remains generally under-researched. The aim of this study was to compare the psychosocial and clinical antecedents of suicide decedents who left E-notes with those who left paper notes or no notes.Method: The study was embedded in the Southwestern Ontario Suicide Study (SOSS). The SOSS was a three-year case series of consecutive deaths by suicide that occurred in the region between 2012 and 2014. Data on psychosocial and clinical antecedents were collected with a modified version of the Manchester questionnaire used in the UK.Results: Of the 476 suicides files reviewed, 45.8% contained a suicide note. A total of 383 separate suicide notes were left: 74.3% were paper notes and 25.7% were E-notes. The results of the multivariate regression analyses indicate that the likelihood of leaving a suicide note was negatively associated with a history of admissions to a mental health unit, while the likelihood of leaving an E-note was negatively associated with age, positively associated with presence of a mental disorder, and negatively associated with history of hospital admissions.Conclusions: Future studies with larger samples need to consider the timing of the text messages, and appraise whether there was the intent of seeking help or rescue in the text messages. [ABSTRACT FROM AUTHOR]

Contract lawyers are often divided between two schools of thought: formalism and contextualism. In the realm of contractual interpretation, this division illuminates various debates surrounding the modern contextual approach. Ultimately, however, the divide between the 'real and the paper deal' does not fully reflect the relevant fault lines. The real contest is between rival interpretations attempting to make the most coherent sense of the available text and context surrounding the document. In characterising the true nature of the exercise, I draw upon theories of coherence to articulate a framework of 'contextual coherence' that involves concepts of competing narratives, the rational motivations of the parties, and the need for a holistic assessment of the best hypothesis, in accordance with the English courts' 'iterative approach' to interpretation. I demonstrate that this framework enables us to explain and evaluate recent cases such as the UK Supreme Court decision of Arnold v Britton. [ABSTRACT FROM AUTHOR]

This paper reflects on the origins of Tivers' 1978 paper "How the other half lives: the geographical study of women," tracing these through a consideration of societal expectations at the time, which were mirrored in the content and approach of 1970s Geography in the UK. Attention is given here both to this original context of the paper and to its context in subsequent publications and in the overall career of the author. [ABSTRACT FROM AUTHOR]

This article presents abstracts of research papers on anesthesia, including "Cardiac Arrest Following the Use of Hydrogen Peroxide -- Time to Reconsider Its Use," by M. Akuji, "High Flow Nasal Cannula as an Oxygen Delivery Device During Awake Fibreoptic Intubation," by S. Badiger et al. and "Accidental Intra-arterial Injection of Rocuronium Via Misplaced Intravenous Cannula," by C. Crossland et al.

This article deconstructs the language of the 2010 UK Coalition Government's White Paper, The Importance of Teaching. It uses analytical frameworks related to rhetoric established by Aristotle and Cicero. It explores the mechanisms of language using both critical discourse analysis and content analysis, offering quantitative data on the content of the paper and qualitative data on the literary strategies employed. It is concerned not only with how what is communicated persuades but also the ethics of persuasion; what is suggested and to what end. The article suggests a mutually reinforcing relationship between poverty of language and poverty of thought. The Coalition Government asserts an heroic stance to act radically to free victimised teachers from the burdens of bureaucracy imposed by the previous government. However, rather than radical action to make change, the findings suggest that the White Paper presents an illusory carapace of change that conceals fundamental continuity. It reassures all of the commitment of government and audiences to change while sustaining education as fundamentally unchanged. [ABSTRACT FROM AUTHOR]

The article examines issues relating to the wastepaper industry in Great Britain. IT has been suggested that of all the secondary materials presently discarded as waste, recovery of paper and board residuals can offer the greatest economic savings. Production has been concentrated in larger units and the industry as a whole has sought 10 specialise in a limited range of end-products, many of which are based on substantial inputs of recycled fibre. During 1980 some 16 mills and 44 machines were closed down. In total the industry lost some 20 percent of its production capacity, including 500,000 tonnes of recycled fibre using capacity. The fibre board containers market is the second largest sector in the packaging products industry and corrugated cases, which occupy 95 percent of this market, can contain up to 65 percent recycled fibre. The wastepaper supply enterprises have sought to meet the mills' requirements. Wastepaper is not an homogeneous product and there are a number of sub-markets in existence based on the quality or grade of the paper and board residuals concerned. On the supply side, while some of the merchant enterprises are large firms in their own right, and at least one has begun to diversify into aluminum can recovery, the enterprises are characteristically small scale and numerous. by recycling residuals from a range of generation sources.

Many English Examination Boards will make some use of the differentiated paper method of assessment in the new scheme of 16+ examining, but it is not clear whether problems of comparability have been adequately solved. This article presents an analysis based on well-defined assumptions incorporated into a measurement model and utilising regression. Marks on the paper not taken by a group are estimated from their joint marks on the common paper and the paper specific to their group. The marks are then weighted using the measurement model and combined to produce a rank order over both the groups. In an appendix, the weighting method used is related to the more usual method of weighting adopted when combining scores. [ABSTRACT FROM AUTHOR]

This article argues that reforms of higher education finance for undergraduates in England introduced by the Blair government in 2006 provided a progressive strategy for achieving the central objectives of higher education of quality (better), access (wider) and size (larger). Reforms in 2012 are a not a strategy but a collection of ad hoc arrangements. They include the good (a higher fees cap, a higher interest rate on student loans, better information and improved support for part-time study), the bad (abolishing most taxpayer support for teaching in the arts and humanities and the social sciences, and raising excessively the threshold at which loan repayments start) and the unspeakable (abolishing Education Maintenance Allowances and AimHigher). The reforms are fiscally costly and hence perpetuate the central problem of capped student numbers, and will not stand the test of time. The concluding section outlines the next White Paper. [ABSTRACT FROM AUTHOR]

Reports on the British Society of Allergy and Clinical Immunology's position paper on latex allergy. Types of allergic reaction to latex; Allergenicity of dry rubber.

Discusses the British government's White paper on urban policy. Challenges faced by cities or ways in which they can be met; Differences of the 2000 White Paper with previous versions; Financial context of the White Paper.

This paper examines the ways in which a group of middle class second generation Bangladeshi adults construct and account for their experiences of racism. Using a discursive analysis of tape recorded conversations, the study shows how various discursive practices construct racism in participant's descriptions of racist experiences, and how these constructions serve particular functions. For instance, the discourses of an ‘improved present’ and ‘racism as present but hidden’ are identified. In these discourses, I argue, racism is constructed as a problem of the past and therefore only a comparatively minor problem at present, or as present phenomenon, but manifesting itself in more subtle covert forms. I argue that these discourses may be considered as problematic in that they can be seen as potentially sustaining and perpetuating particular kinds of social relations. What I also wish to argue is that this kind of analysis demonstrates the need for a theorization of the subject. In this case, the need for racism to be understood from the perspective of these middle class second generation Bangladeshis. Copyright © 2000 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Introduction: To contribute to addressing diagnostic health inequalities in the United Kingdom, this review aimed to investigate determinants of diagnostic service use amongst people experiencing high deprivation in the United Kingdom. Methods: A systematic review was conducted using three databases (EBSCO, Web of Science and SCOPUS) to search studies pertaining to diagnostic service use amongst people experiencing high deprivation. Search terms related to diagnostics, barriers and facilitators to access and deprivation. Articles were included if they discussed facilitators and/or barriers to diagnostic service access, contained participants' direct perspectives and focussed on individuals experiencing high deprivation in the United Kingdom. Articles were excluded if the full text was unretrievable, only abstracts were available, the research did not focus on adults experiencing high deprivation in the United Kingdom, those not including participants' direct perspectives (e.g., quantitative studies) and papers unavailable in English. Results: Of 14,717 initial papers, 18 were included in the final review. Determinants were grouped into three themes (Beliefs and Behaviours, Emotional and Psychological Factors and Practical Factors), made up of 15 sub‐themes. These were mapped to a conceptual model, which illustrates that Beliefs and Behaviours interact with Emotional and Psychological Factors to influence Motivation to access diagnostic services. Motivation then influences and is influenced by Practical Factors, resulting in a Decision to Access or Not. This decision influences Beliefs and Behaviours and/or Emotional and Psychological Factors such that the cycle begins again. Conclusion: Decision‐making regarding diagnostic service use for people experiencing high deprivation in the United Kingdom is complex. The conceptual model illustrates this complexity, as well as the mediative, interactive and iterative nature of the process. The model should be applied in policy and practice to enable understanding of the factors influencing access to diagnostic services and to design interventions that address identified determinants. Patient or Public Contribution: Consulting lived experience experts was imperative in understanding whether and how the existing literature captures the lived experience of those experiencing high deprivation in South England. The model was presented to lived experience experts, who corroborated findings, highlighted significant factors for them and introduced issues that were not identified in the review. [ABSTRACT FROM AUTHOR]

This article offers a discursive analysis of the Conservative green paper for international development, published as part of the closely fought election campaign of 2010 that culminated in a UK coalition government with the Liberal Democrats. The article examines the paper in comparison with the discursive shifts represented by the first Department for International Development (DfID) white paper, published by the outgoing Labour administration in 1997. In contrast with the optimistic and globalist developmentalism that characterised Labour's development discourse, the green paper sounds a more cautious note, using empire to focus on Britain's leadership role in poverty alleviation rather than on global progress, and brings back the full force of developmentalism only at the point where it seeks to legitimate spending on security concerns as a development concern. The article then moves on to examine the green paper's most explicit discursive move, the signalling of a 'post-bureaucratic age'. This move towards increased information provision to promote transparency and accountability is likely to signal greater control by powerful donors in securitised times, albeit with a potential re-scaling of responsibility for poverty alleviation to the poorest local communities. Finally, the article looks briefly at information technologies in relation to the transnational spatiality of civil society, arguing that attention needs to be paid to the more embodied forms of transnational association encouraged by the green paper, and to the selection and impacts of information, which need to be seen in the discursive context of wider Conservative constructions of the 'big society'. [ABSTRACT FROM AUTHOR]

The article focuses on the use of non-recyclable paper fibers in compost for agricultural purposes. During paper recycling in Great Britain, half a million tons of small paper fibres are wasted. These waste papers can be reused as a superior quality plant compost by replacing current chemical products. It also helps in reducing wilt diseases and has the same disease suppressing-properties like green compost. New by-products can also be developed from the huge industrial waste created in raw pulp production. Paper mills sludge can be turned into levulinic acid by the Biofine process. However, very few commercial organizations take the initiative to make paper an environmental friendly product.

In its first years in office, the Labour Government set out a wide-ranging and ambitious set of policies aimed at reducing poverty, inequality and social exclusion. A decade on, with the party facing probable catastrophic defeat in the next general election, how far can these ambitions be said to have been met? This article summarises the evidence. It also examines the most recent government White Paper on social mobility, New Opportunities: Fair Chances for the Future, published in January 2009, and asks whether this paper represents a serious last attempt to renew the equal opportunities agenda. [ABSTRACT FROM AUTHOR]

Extreme high temperatures are associated with increased incidences of rail buckles. Climate change is predicted to alter the temperature profile in the United Kingdom with extreme high temperatures becoming an increasingly frequent occurrence. The result is that the number of buckles, and therefore delays, expected peryear will increase if the track is maintained to the current standard. This paper uses a combination of analogue techniques and a weather generator to quantify the increase in the number of buckles and rail related delays in the southeast of the United Kingdom. The paper concludes by assigning a cost to the resultant rise in delays and damage before making recommendations on how these effects can be mitigated. Copyright © 2008 Royal Meteorological Society [ABSTRACT FROM AUTHOR]

National censuses are expensive. They are conducted infrequently. They collect information that some feel infringes their human rights, and people are required by law to complete them. The outputs are not perfect, and in some situations may be misleading. Some suggest that censuses hark back to a period when regularly collected administrative data were not available. These are some of the views held about national censuses. Why, then, would others argue that they are an essential resource? In this paper, we consider some of the pros and cons of conducting national censuses, before introducing a series of papers that draw on early data available from the 2001 UK census. We argue that these papers, and the wealth of research that will be conducted in the future with 2001 census data, make a strong case for supporting the compulsory collection of personal information about the ‘entire’ population every ten years. [ABSTRACT FROM AUTHOR]

Examines the role and purpose ascribed to company law under the British government's White Paper 'Modernising Company Law.' British government's attitude towards corporate activity; Overview of the British Department of Trade and Industry Review, which provided for the White Paper's recommendations; Governments' perception of its role in regulating companies, their directors, shareholders and those affected by corporate activity.

Throughout history the legislative framework for the treatment of the mentally ill has reflected societies’ attitudes, and the proposals in the United Kingdom (UK) govern-ment's White Paper ‘Reforming the Mental Health Act’ are no exception. This paper examines some of the fundamental ethical issues invoked by the proposals, particularly the concept of paternalism and use of risk assessment in determining ‘best interests’. The issue of power in relation to the mentally ill is also examined, alongside the impact of the change on nurses’ ethical decision making. As will be seen, the proposed Act will require high standards of professional practice to ensure the ethical application of care, particularly in the case of individuals diagnosed as suffering from ‘dangerous and severe personality disorders’. Nurses need to ensure that the interventions used are of the highest quality and are indeed in the patient's ‘best interests’. If they are not, then again nurses need to be very clear as to why the profession should be involved at all. Nurses should demonstrate vigilance and high professional standards to ensure they are maintaining rigorous safeguards to promote the public interest. Although relating specifically to UK legislation the underlying ethical dilemmas posed by this proposed legislation are relevant to all mental health nurses, as they challenge fundamental assumptions regarding the role of nurses in supporting mental health legislation that may have a social, rather than therapeutic, function. [ABSTRACT FROM AUTHOR]

Context The White Paper, The New NHS: Modern, Dependable, once again heralds change and new expectations of primary care in the UK. Objectives This discussion paper aims to encourage reflection on the implications for primary care teams of current governmental strategy, and to address the pivotal role which education can play in equipping practitioners for their roles. Key areas The paper examines the opportunities and threats for primary care in the new NHS developments, the strengths and weaknesses of the role that education currently plays in primary care, and how recent innovations might be used to give a more holistic approach to the needs of practitioners. The challenges for clinical governance of lay engagement and ethical decision making are seen as two crucial outcomes for an educational strategy which must be practice-led, and must interface individual practitioner education with the needs of the team and the community as a whole. I draw on a range of policy documents and educational literature to alert the reader to the different choices which can be made when thinking about appropriate educational models and methods; and offer a detailed structure for a practical educational strategy that may effectively unite theory and practice. The key elements are a three-tier link between practices, primary care groups, and district-level resources for all educational and training activity, and the aim of continuing multiprofessional development which will underpin the new NHS. [ABSTRACT FROM AUTHOR]