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Background: Nurse education has undergone considerable changes creating new opportunities and challenges for nurse teachers. Limited comparative research of the working lives of nurse teachers has been reported, thus similarities and differences that may exist are unidentified., Aim: This paper reports a study of the working lives of nurse teachers in mainland China and the United Kingdom., Design: A cross-sectional questionnaire survey., Participants: Census sample of nurse teachers working in four nursing schools in mainland China (n=3) and the United Kingdom (n=1). The overall response rate was 56.8% (China=61, 61.0%, UK=60, 53.1%)., Methods: Completion of questionnaire specifically developed for the study but comprising six validated tools to collecting data on: job satisfaction, sense of coherence, role conflict and role ambiguity, work empowerment and professional identification. Data on self-reported roles and personal details were also collected. Data were collected between September 2008 and January 2009., Results: Both samples were satisfied with their jobs overall but reported low levels of satisfaction with promotion. Chinese nurse teachers working full-time reported the lowest level for sense of coherence and professional identification. Nurse teachers working full-time in the United Kingdom reported the highest role conflict score. Sense of coherence and work empowerment were significantly and positively correlated to job satisfaction. Role conflict and role ambiguity were negatively correlated (but not always significantly) to job satisfaction and its facets. For respondents in mainland China, professional identification was significantly and positively correlated with overall job satisfaction and its facets., Conclusions: Strategies to improve job satisfaction with promotion opportunities for both samples are indicated. Respondents working full-time in both mainland China and the United Kingdom experienced greater challenges at work than their part-time colleagues., (© 2013.)

The author discusses his experiences as a Chinese international lecturer working in the accounting department of a British university, focusing on how he encouraged use of the Mind Maps (MM) method of graphical representation in teaching and learning. He comments on how the use of MM principals improved the clarity of teaching materials, increased his self-confidence as a lecturer, and improved his job satisfaction.

Background and Aims Research into craving is hampered by lack of theoretical specification and a plethora of substance-specific measures. This study aimed to develop a generic measure of craving based on elaborated intrusion ( EI) theory. Confirmatory factor analysis ( CFA) examined whether a generic measure replicated the three-factor structure of the Alcohol Craving Experience ( ACE) scale over different consummatory targets and time-frames. Design Twelve studies were pooled for CFA. Targets included alcohol, cigarettes, chocolate and food. Focal periods varied from the present moment to the previous week. Separate analyses were conducted for strength and frequency forms. Setting Nine studies included university students, with single studies drawn from an internet survey, a community sample of smokers and alcohol-dependent out-patients. Participants A heterogeneous sample of 1230 participants. Measurements Adaptations of the ACE questionnaire. Findings Both craving strength [comparative fit indices ( CFI = 0.974; root mean square error of approximation ( RMSEA) = 0.039, 95% confidence interval ( CI) = 0.035-0.044] and frequency ( CFI = 0.971, RMSEA = 0.049, 95% CI = 0.044-0.055) gave an acceptable three-factor solution across desired targets that mapped onto the structure of the original ACE (intensity, imagery, intrusiveness), after removing an item, re-allocating another and taking intercorrelated error terms into account. Similar structures were obtained across time-frames and targets. Preliminary validity data on the resulting 10-item Craving Experience Questionnaire ( CEQ) for cigarettes and alcohol were strong. Conclusions The Craving Experience Questionnaire (CEQ) is a brief, conceptually grounded and psychometrically sound measure of desires. It demonstrates a consistent factor structure across a range of consummatory targets in both laboratory and clinical contexts. [ABSTRACT FROM AUTHOR]

Aims To investigate the prevalence of awareness of the online illicit drug marketplace Silk Road ( SR), consumption of drugs purchased from SR and reasons for use and non-use of SR. Design and setting Global Drug Survey: purposive sample collected in late 2012. Participants The base sample ( n = 9470) reported recent drug purchase and resided in the United Kingdom ( n = 4315, median age 24, 76% male), Australia ( n = 2761, median age 32, 76% male) or the United States ( n = 2394, median age 21, 80% male). Measurements Online questionnaire. Findings A total of 65% of US, 53% of Australian and 40% of UK respondents had heard of SR; 18% of US, 10% of UK and 7% of Australian respondents had consumed drugs purchased through SR. Across the three countries, 3,4-methylenedioxy-N-methylamphetamine (MDMA) was the most commonly purchased drug (53-60%), followed by cannabis (34-51%), lysergic acid diethylamide (LSD) (29-45%) and the 2C family (16%-27%). The most common reasons for purchasing from SR were wider range (75-89%), better quality (72-77%), greater convenience (67-69%) and the use of vendor rating systems (60-65%). The most common reasons for avoiding SR purchase were adequate drug access (63-68%) and fear of being caught (41-53%). Logistic regressions found that, compared with people from the UK, Australians [odds ratio ( OR) = 3.37; 95% confidence interval ( CI) = 2.29, 4.97) and Americans (OR = 1.46; 95% CI = 1.10, 1.94) were more likely to use SR due to lower prices; and to avoid SR purchase due to fear of being caught ( Australia: OR = 1.65; 95% CI = 1.39, 1.96; USA: OR = 1.62; 95% CI = 1.37, 1.92). Conclusions While reasons for Silk Road use accord with broader online commerce trends (range, quality, convenience, ratings), its appeal to drug purchasers is moderated by country-specific deterrents and market characteristics. [ABSTRACT FROM AUTHOR]

Background: home-based telecare (TC) is utilised to manage risks of independent living and provide prompt emergency responses. This study examined the effect of TC on health-related quality of life (HRQoL), anxiety and depressive symptoms over 12 months in patients receiving social care.Design: a study of participant-reported outcomes [the Whole Systems Demonstrator (WSD) Telecare Questionnaire Study; baseline n = 1,189] was nested in a pragmatic cluster-randomised trial of TC (the WSD Telecare trial), held across three English Local Authorities. General practice (GP) was the unit of randomisation and TC was compared with usual care (UC).Methods: participant-reported outcome measures were collected at baseline, short-term (4 months) and long-term (12 months) follow-up, assessing generic HRQoL, anxiety and depressive symptoms. Primary intention-to-treat analyses tested treatment effectiveness and were conducted using multilevel models to control for GP clustering and covariates for participants who completed questionnaire measures at baseline assessment plus at least one other assessment (n = 873).Results: analyses found significant differences between TC and UC on Short Form-12 mental component scores (P < 0.05), with parameter estimates indicating being a member of the TC trial-arm increases mental component scores (UC-adjusted mean = 40.52; TC-adjusted mean = 43.69). Additional significant analyses revealed, time effects on EQ5D (decreasing over time) and depressive symptoms (increasing over time).Conclusions: TC potentially contributes to the amelioration in the decline in users’ mental HRQoL over a 12-month period. TC may not transform the lives of its users, but it may afford small relative benefits on some psychological and HRQOL outcomes relative to users who only receive UC.International Standard Randomised Controlled Trial Number Register: ISRCTN 43002091. [ABSTRACT FROM AUTHOR]

Background: the mortality is high in acutely ill oldest old patients. Understanding the prognostic factors which influence mortality will help clinicians make appropriate management decisions.Methods: we analysed prospective mortality audit data (November 2008 to January 2009) to identify variables associated with in-patient mortality in oldest old. We selected those with P < 0.10 from univariate analysis and determined at which cut-point they served as the strongest predictor of mortality. Using these cut-off points, we constructed multivariate logistic regression models. A 5-point score was derived from cut-off points which were significantly associated with mortality tested in a smaller independent re-audit sample conducted in October 2011.Results: a total of 405 patients (mean 93.5 ± 2.7 years) were included in the study. The mean length of stay was 18.5 ± 42.4 days and 13.8% died as in-patients. Variables (cut-off values) found to be significantly associated with in-patient mortality were admission sodium (>145 mmol/l), urea (≥14 mmol/l), respiratory rate (>20/min) and shock index (>1.0): creating a 5-point score (NaURSE: NaURS in the Elderly). The crude mortality rates were 9.5, 19.9, 34.4, 66.7, and 100% for scores 0, 1, 2, 3 and 4, respectively. Using the cut-off point of ≥2, the NaURSE score has a specificity of 87% (83.1–90.3) and sensitivity of 39% (28.5–50.0), with an AUC value of 0.69 (0.63–0.76). An external independent validation study (n = 121) showed similar results.Conclusions: the NaURSE score may be particularly useful in identifying oldest old who are likely to die in that admission to guide appropriate care. [ABSTRACT FROM AUTHOR]

Introduction: falling, and fear of falling, significantly affect older people and their lifestyle resulting in loss of confidence, restriction of activity and deteriorating quality of life. Multi-factorial assessment and active participation in an evidence-based exercise programme are key interventions to prevent and manage falls.Objective: to examine older people's experiences of therapeutic exercise as part of a falls prevention service in NHS Trusts in England, Wales and Northern Ireland.Methods: a cross-sectional survey targeted patients and staff members delivering exercise interventions for reducing falls. A multi-disciplinary group including patient and staff representatives developed a 20-item patient questionnaire and a 12-item staff questionnaire that were distributed to 94 NHS Trusts (113 participating sites within the NHS Trusts) in October 2011.Results: response was 57% for the patient sample and 88% for the staff sample. The median (IQR) age of patients was 82 (77–86) years. 72% were women. Two-thirds reported attending group-based therapeutic exercise classes generally of short duration (80% <12 weeks) and low intensity (85% one class per week) at hospitals and community venues. Balance and strength exercises were prescribed; 68% reported using resistance equipment such as ankle weights and/or exercise band. Only 52% reported exercises were made more difficult as they improved. However, patient satisfaction levels were high (95% satisfied or very satisfied). Patients and staff reported limited availability of strength and balance follow-up classes.Conclusion: despite high levels of patient satisfaction therapeutic exercise provision was limited and implementation of evidence-based exercise interventions by healthcare providers is incomplete and varies widely. Patients and staff wanted greater availability of long-term exercise services for falls prevention. [ABSTRACT FROM AUTHOR]

Background: simulation-based teaching is increasingly used in medical education, but no studies have evaluated its impact on learning in geriatric medicine. We developed and delivered a simulation teaching session on delirium, falls, elder abuse and breaking bad news. Simulation mannequins, professional role-players and simulated clinical documentation were all incorporated into scenarios. We evaluated the effect of this intervention on student learning and on students’ attitudes towards geriatric medicine.Methods: third year Newcastle University MBBS students at Northumbria base unit received the simulation-based teaching session. Students’ knowledge was assessed using a three question test mapped to learning outcomes for the elder abuse, delirium and falls stations. Each student undertook the test on three occasions: the day before the teaching session, immediately after the session and ∼1 month later, allowing evaluation of learning over time. Test scores were also compared with those achieved by another cohort of third year MBBS students at a different base unit, who received traditional ward-based and didactic teaching but no simulation teaching.Results: student knowledge improved significantly after the simulation session and this was maintained when reassessed a month later. Students who received the simulation-based training outperformed those who received usual teaching. Student feedback was overwhelmingly positive and the vast majority of students agreed that the session had a positive impact on their perceptions of geriatric medicine.Discussion: our findings demonstrate the efficacy of simulation-based teaching in undergraduate geriatric medicine, its acceptability to students and its positive influence on students' perceptions of the specialty. [ABSTRACT FROM AUTHOR]

Mealtimes in residential care homes are fundamentally social occasions, providing temporal structure to the day and opportunities for conversation and companionship. Food and drink are imbued with social meanings and used to express and create relationships between people. There is a dearth of research exploring care home residents' mealtime experiences in the United Kingdom. This paper reports on particular findings from a qualitative study which investigated factors influencing nutritional care provided to residents in two different types of residential care settings in South Wales, UK. Data were generated through focus group interviews with relevant staff members (N = 15), individual interviews with managers (N = 4) and residents (N = 16) of the care homes and their informal carers (N = 10), observation of food preparation and mealtimes throughout the day, and analysis of appropriate documents. Data were analysed using thematic analysis. This paper's focus is on the ways in which care home residents' experiences and understandings of mealtimes were influenced by various environmental factors, such as the home's geographical location, physical lay-out and ambience. Moreover, the shared meaning of mealtimes for residents, informal carers and staff was constructed from each group's socio-cultural background, family experiences and memories, and was integral to residents' sense of normality, community and identity. [ABSTRACT FROM PUBLISHER]

Aims: To examine how glassware functions as a marketing tool. Methods: Content analysis of trade journals. Results: Glassware is used as an integral part of marketing activity to recruit customers, revive brands, build profits and increase consumption. Conclusion: Glassware should be subject to the same control as other forms of marketing. Glasses could be re-engineered to promote safer drinking. [ABSTRACT FROM PUBLISHER]

This paper focuses on one site of chemistry that served multiple functions over its lifetime and played a pivotal role in the development of British pharmaceutical manufacturing. At the beginning of the nineteenth century, the Society of Apothecaries' premises in Blackfriars housed the largest pharmaceutical manufacturing laboratories in London and supplied drugs for use throughout the British Empire. Under the guidance of William Brande, the laboratories developed as sites of teaching, research and consultancy, activities which shaped the Society's public image and enhanced its commercial, regulatory and professional roles. However, as competition from other pharmaceutical firms increased, inherent contradictions in the Society's various remits, combined with its conservative approach to business, meant that there was no clear direction for the laboratories' development. In an era of growing specialisation, this multifunctional site became increasingly outdated by the end of the nineteenth century. [ABSTRACT FROM AUTHOR]

We ask whether the US government should replace its current discounting practices with a declining discount rate schedule, as the United Kingdom and France have done, or continue to discount the future at a constant exponential rate. We present the theoretical basis for a declining discount rate (DDR) schedule, but focus on how, in practice, a DDR could be estimated for use by policy analysts. We discuss the empirical approaches in the literature and review how the United Kingdom and France estimated their DDR schedules. We conclude with advice on how the United States might proceed to consider modifying its current discounting practices. [ABSTRACT FROM AUTHOR]

Originally published in 1904, Whittaker's A Treatise on the Analytical Dynamics of Particles and Rigid Bodies soon became a classic of the subject and has remained in print for most of these 108 years. In this paper, we follow the book as it develops from a report that Whittaker wrote for the British Society for the Advancement of Science to its influence on Dirac's version of quantum mechanics in the 1920s and beyond. [ABSTRACT FROM AUTHOR]

Objective: To assess recruitment of children to national clinical trials for acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML) in Great Britain during 1980-2007 and describe variation by some factors that might influence trial entry. Design and setting: Records of leukaemia patients aged 0-14 years at diagnosis were identified in the National Registry of Childhood Tumours and linked to birth registrations, Children's Cancer and Leukaemia Group records, Hospital Episode Statistics and Medical Research Council clinical trial registers. Trial entry rates were compared between categories of birth weight, congenital malformation, socioeconomic status and ethnicity. Results: 9147 ALL and 1466 AML patients were eligible for national clinical trials during 1980-2007. Overall recruitment rates were 81% and 60% respectively. For ALL, rates varied significantly with congenital malformation (Down syndrome 61%, other malformations 80%, none 82%; p<0.001) and ethnicity (South Asian 78%, other minority groups 80%, white 85%; p<0.001). For AML, rates varied with birth weight (< 2500 g 48%, 2500-4000 g 69%, >4000 g 67%; p=0.001) and congenital malformation (Down syndrome 28%, other malformations 56%, none 63%; p<0.001). Conclusions: Although recruitment rates to clinical trials for childhood leukaemia are high, future trials should monitor possible variation by birth weight, ethnicity and presence of congenital malformations. [ABSTRACT FROM AUTHOR]

The author reflects on the challenges faced by parents in seeking places for the unpredicted deliveries of preterm babies in Great Britain. He suggests medical personnel helping such parents make choices for their baby by supplementing them with the highest quality information. He mentions EPICure, a series of studies of survival and later health among babies and young people born at extremely low gestations during a 10-month period in 2006.

Objective To assess whether there have been any secular changes in orthopedic interventions in patients with rheumatoid arthritis (RA) since 1986, as examined in 2 early rheumatoid arthritis (RA) inception cohorts with up to 25 years of followup. Methods The study examined orthopedic data from the UK Early RA Study (1986-1999, 9 centers; n = 1,465) and the UK Early RA Network (2002-2012, 23 centers; n = 1,236) with linkage to national data sets (Hospital Episode Statistics, National Joint Registry, and Office of National Statistics). Clinical and laboratory measures and hand and foot radiographs were standardized and obtained yearly in both cohorts. The use of disease-modifying antirheumatic drugs (DMARDs), corticosteroids, and biologic therapies reflected the contemporary conventional practices and guidelines of the time frames examined. Recruitment years were grouped into 6 periods, and interventions were classified into major, intermediate, and minor categories. Results A total of 1,602 orthopedic surgical procedures were performed in 770 patients (29%) over a maximum of 25 years of followup. The 25-year cumulative incidence rate of major interventions was 21.7% (range 19.4-24.0%), and that of intermediate interventions was 21.5% (range 17.8-25.5%). There was a decline in the 10-year cumulative incidence of intermediate surgeries over time ( P < 0.001), but not of major/minor surgery. This decline coincided with a gradual shift from sequential monotherapy to combination DMARD therapies and biologic agents in recent recruitment periods. Conclusion Orthopedic surgery is an important and common outcome in RA. Only the rates of hand/foot surgery showed a consistent decline from 1986 to 2011. Possible explanations include differences in the pathophysiologic processes affecting the joints, variations in the responses to therapy between large-joint and small-joint destructive processes, and changes in service provision and thresholds for surgery over time. [ABSTRACT FROM AUTHOR]

This study investigated metacognitive monitoring abilities in adolescents with autism spectrum disorder in two experiments using the judgment-of-learning paradigm. Participants were asked to predict their future recall of unrelated word pairs during the learning phase. Experiment 1 compared judgments-of-learning made immediately after learning and judgments-of-learning made after a delay. We found that both groups overestimated their memory performance but that overall there were no group differences in judgment-of-learning accuracy. Additionally, both groups displayed the standard delayed judgment-of-learning effect (yielding greater judgment accuracy in delayed compared to immediate judgments), suggesting that both groups were able to use appropriate information in making their judgments-of-learning. Experiment 2 assessed whether adolescents with autism spectrum disorder could regulate their study time according to their judgments-of-learning using a self-paced learning procedure. Results showed that both groups spent more time learning items given lower judgments-of-learning. Finally, Experiment 2 showed that judgments-of-learning and study time varied according to item difficulty in both groups. As a whole, these findings demonstrate that adolescents with autism spectrum disorder can accurately gauge their memory performance while learning new word associations and use these skills to control their study time at learning. [ABSTRACT FROM PUBLISHER]

Anecdotal reports and empirical evidence suggest that sensory processing issues are a key feature of autism spectrum conditions. This study set out to investigate whether adults with autism spectrum conditions report more sensory over-responsivity than adults without autism spectrum conditions. Another goal of the study was to identify whether autistic traits in adults with and without autism spectrum conditions were associated with sensory over-responsivity. Adults with (n = 221) and without (n = 181) autism spectrum conditions participated in an online survey. The Autism Spectrum Quotient, the Raven Matrices and the Sensory Processing Scale were used to characterize the sample. Adults with autism spectrum conditions reported more sensory over-responsivity than control participants across various sensory domains (visual, auditory, tactile, olfactory, gustatory and proprioceptive). Sensory over-responsivity correlated positively with autistic traits (Autism Spectrum Quotient) at a significant level across groups and within groups. Adults with autism spectrum conditions experience sensory over-responsivity to daily sensory stimuli to a high degree. A positive relationship exists between sensory over-responsivity and autistic traits. Understanding sensory over-responsivity and ways of measuring it in adults with autism spectrum conditions has implications for research and clinical settings. [ABSTRACT FROM PUBLISHER]

Conceptual debates in terrorism research tend to understate the role that private companies play in countering terrorism, and rarely offer workable solutions around how the ‘terms of engagement’ between industry and the public sector could be improved in this field. This paper addresses this by considering the opportunity presented by the appointment of a ‘Director – Security Industry Engagement’ within the Office for Security and Counter Terrorism (OSCT) at the UK Home Office; a development which demonstrates how the public–private interactions which feature as part of the UK's ‘CONTEST’ strategy have become an increasingly important priority for the Government. To stimulate a new debate on this subject, the paper proposes both a revised approach towards ‘industrial engagement’ and a programme of key priorities which could form the basis of the new appointee's strategy. Whatever function the new Director fulfils, the private sector's role in countering terrorism should be bounded by strong principles and receive more effective oversight than at present. [ABSTRACT FROM AUTHOR]

Pollination services provided by insects play a key role in English crop production and wider ecology. Despite growing evidence of the negative effects of habitat loss on pollinator populations, limited policy support is available to reverse this pressure. One measure that may provide beneficial habitat to pollinators is England's entry level stewardship agri-environment scheme. This study uses a novel expert survey to develop weights for a range of models which adjust the balance of Entry Level Stewardship options within the current area of spending. The annual costs of establishing and maintaining these option compositions were estimated at £59.3-£12.4 M above current expenditure. Although this produced substantial reduction in private cost:benefit ratios, the benefits of the scheme to pollinator habitat rose by 7-140 %; significantly increasing the public cost:benefit ratio. This study demonstrates that the scheme has significant untapped potential to provide good quality habitat for pollinators across England, even within existing expenditure. The findings should open debate on the costs and benefits of specific entry level stewardship management options and how these can be enhanced to benefit both participants and biodiversity more equitably. [ABSTRACT FROM AUTHOR]

Objective To compare health outcomes during 14-year observational follow-up in women initially randomised to unopposed estrogen or placebo. Design At recruitment to the Estrogen for the Prevention of Re-Infarction Trial ( ESPRIT) women were assigned to estradiol valerate: 2 mg or placebo treatment for 2 years. Setting Women were recruited from 35 hospitals in the northwest of England and Wales in July 1996-February 2000. Sample Women aged 50-69 surviving their first myocardial infarction. Methods All women were followed by data linkage to UK mortality and cancer records; mean follow-up 14.1 and 12.6 years, respectively. In an intention-to-treat analysis, hazard ratios ( HRs) were computed, overall and stratified by age at recruitment. Outcome measures Death (all-cause, cardiac disease, stroke or cancer) and cancer incidence (any, breast or endometrium). Results There were 418 deaths in 1017 women randomised. The all-cause mortality HR of 1.07 (95% CI 0.88-1.29) indicated no significant difference between treatment groups. Women aged 50-59 years at recruitment had lower HRs than women aged 60-69 years for all outcomes except ischaemic heart disease. Among 149 incident cancers there were seven cases of breast cancer in the intervention arm and 15 in the placebo; HR 0.47 (95% CI 0.19-1.15). There were no deaths from endometrial cancer but three incident cases, one in the active arm and two in placebo. Conclusions These results suggest that unopposed estrogen may be used safely by women with an intact uterus surviving a first myocardial infarction. [ABSTRACT FROM AUTHOR]

Objective To compare the risk of fetal death on the day of childbirth, with the risk of death at other ages, and with the risks of some hazardous activities, on a common scale of risk per day. Design Review of publicly available data. Setting UK. Sample Data extracted from the Office of National Statistics and other sources. Methods Data from the Office of National Statistics and other sources were used to calculate death rates at different ages expressed as rates per day of life. Death rates for different activities were also calculated as risks per day, or risks per activity, as appropriate. All risks were expressed in micromorts, the number of one in a million chances of dying. Figures on life expectancy ( LE) were used to compare potential life years lost. Main outcome measures Daily, or unit of activity, risk of dying for different activities compared with the risk of dying on the day of childbirth. Results The risk of dying on the day of birth (0.43 per 1000, or 430 micromorts) exceeds that of any other average day of life until the 92nd year. It is comparable with other apparently more dangerous activities, such as undergoing major surgery. For comparison, the average risk of non-natural death per day and the increased risk from smoking one cigarette or travelling 200 miles by car are all about 1 micromort. Conclusions The lifetime risk of death in childbirth is low, but is concentrated in a short period, making being born a high-risk activity. Parents considering interventions to reduce these risks should be made aware of this. [ABSTRACT FROM AUTHOR]

Objective To compare long-term outcomes following microwave endometrial ablation ( MEA™) and thermal balloon ablation ( TBall). Design Follow up of a prospective, double-blind randomised controlled trial at 5 years. Setting A teaching hospital in the UK. Population A total of 320 women eligible for and requesting endometrial ablation. Methods Eligible women were randomised in a 1:1 ratio to undergo MEA or Tball. Postal questionnaires were sent to participants at a minimum of 5 years postoperatively to determine satisfaction with outcome, menstrual status, bleeding scores and quality of life measurement. Subsequent surgery was ascertained from the women and the hospital operative database. Main outcome measures The primary outcome measure was overall satisfaction with treatment. Secondary outcomes included evaluation of menstrual loss, change in quality of life scores and subsequent surgery. Results Of the women originally randomised 217/314 (69.1%) returned questionnaires. Nonresponders were assumed to be treatment failures for data analysis. The primary outcome of satisfaction was similar in both groups (58% for MEA™ versus 53% for TBall, difference 5%; 95% CI −6 to 16%). Amenorrhoea rates were high following both techniques (51% versus 45%, difference 6%; 95% CI −5 to 17%). There was no significant difference in the hysterectomy rates between the two arms (9% versus 7%, difference 2%; 95% CI −5 to 9%). Conclusions At 5 years post-treatment there were no significant clinical differences in patient satisfaction, menstrual status, quality of life scores or hysterectomy rates between MEA™ and Thermachoice 3, thermal balloon ablation. [ABSTRACT FROM AUTHOR]

Background Collaborative care (CC) is an organisational framework which facilitates the delivery of a mental health intervention to patients by case managers in collaboration with more senior health professionals (supervisors and GPs), and is effective for the management of depression in primary care. However, there remains limited evidence on how to successfully implement this collaborative approach in UK primary care. This study aimed to explore to what extent CC impacts on professional working relationships, and if CC for depression could be implemented as routine in the primary care setting. Methods This qualitative study explored perspectives of the 6 case managers (CMs), 5 supervisors (trial research team members) and 15 general practitioners (GPs) from practices participating in a randomised controlled trial of CC for depression. Interviews were transcribed verbatim and data was analysed using a two-step approach using an initial thematic analysis, and a secondary analysis using the Normalisation Process Theory concepts of coherence, cognitive participation, collective action and reflexive monitoring with respect to the implementation of CC in primary care. Results Supervisors and CMs demonstrated coherence in their understanding of CC, and consequently reported good levels of cognitive participation and collective action regarding delivering and supervising the intervention. GPs interviewed showed limited understanding of the CC framework, and reported limited collaboration with CMs: barriers to collaboration were identified. All participants identified the potential or experienced benefits of a collaborative approach to depression management and were able to discuss ways in which collaboration can be facilitated. Conclusion Primary care professionals in this study valued the potential for collaboration, but GPs' understanding of CC and organisational barriers hindered opportunities for communication. Further work is needed to address these organisational barriers in order to facilitate collaboration around individual patients with depression, including shared IT systems, facilitating opportunities for informal discussion and building in formal collaboration into the CC framework. [ABSTRACT FROM AUTHOR]

Background This study compared reported staffing levels for stroke care within UK in-patient stroke units to stroke strategy staffing guidelines published by the UK Department of Health and the Royal College of Physicians. The purpose was to explore the extent to which stroke teams are meeting recommended staffing levels. Method The data analyzed in this report consisted of the detailed therapist staffing levels reported in the demographic section of our national survey to determine upper limb treatment in stroke units (the ATRAS survey). A contact list of stroke practitioners was therefore compiled primarily in collaboration with the 28 National Stroke Improvement Networks. Geographic representation of the network areas was obtained by applying the straight-forward systematic sampling method and the Nth name selection technique to each Network list. In total 192 surveys were emailed to stroke care providers around England. This included multiple contacts within stroke teams (e.g. a stroke consultant and a stroke co-coordinator) to increase awareness of the survey. Results A total of 53 surveys were returned from stroke teams and represented 20 of the 28 network areas providing 71% national coverage. To compare reported staffing levels to suggested DoH guidelines, analysis was conducted on 19 of the 37 inpatient hospital care units that had no missing data for staff numbers, unit bed numbers, number of stroke patients treated per annum, average unit length-of-stay, and average unit occupancy rates. Only 42% of units analyzed reached the DoH guideline for physiotherapy and fewer than 16% of the units reached the guideline for speech & language therapy. By contrast, 84% of units surveyed reached the staffing guideline for occupational therapy. However, a post-hoc analysis highlights this as an irregularity in the DoH guidelines, revealing that all therapies are challenged to provide the recommended therapy time. Conclusions Most in-patient stroke units are operating below the DoH guidelines and are therefore challenged in providing the recommended amount of therapy and patient time to facilitate optimal functional recovery for stroke patients. [ABSTRACT FROM AUTHOR]

Background The National Health Service is reconfiguring health care services in order to meet the increasing challenge of providing care for people with long-term conditions and to reduce the demand on specialised outpatient hospital services by enhancing primary care. A review of cardiology referrals to specialised care and the literature on referral management inspired the development of a new GP role in Cardiology. This new extended role was developed to enable GPs to diagnose and manage patients with mild to moderate heart failure or atrial fibrillation and to use a range of diagnostics effectively in primary care. This entailed GPs participating in a four-session short course with on-going clinical supervision. The new role was piloted in a small number of GP practices in one county in England for four months. This study explores the impact of piloting the Extended Cardiology role on the GP's role, patients' experience, service delivery and. quality. Methods A mixed methods approach was employed including semi-structured interviews with GPs, a patient experience survey, a quality review of case notes, and analysis on activity and referral data. Results The participating GPs perceived the extended GP role as a professional development opportunity that had the potential to reduce healthcare utilisation and costs, through a reduction in referrals, whilst meeting the patient's wishes for the provision of care closer to home. Patient experience of the new GP service was positive. The standard of clinical practice was judged acceptable. There was a fall in referrals during the study period. Conclusion This new role in cardiology was broadly welcomed as a model of care by the participating GPs and by patients, because of the potential to improve the quality of care for patients in primary care and reduce costs. As this was a pilot study further development and continuing evaluation of the model is recommended. [ABSTRACT FROM AUTHOR]

Background Influenza and Influenza-like-illness (ILI) represents a substantial public health problem, but it is difficult to measure the overall burden as many cases do not access health care. Community cohorts have the advantage of not requiring individuals to present at hospitals and surgeries and therefore can potentially monitor a wider variety of cases. This study reports on the incidence and risk factors for ILI in the UK as measured using Flusurvey, an internet-based open community cohort. Methods Upon initial online registration participants were asked background characteristics, and every week were asked to complete a symptoms survey. We compared the representativeness of our sample to the overall population. We used two case definitions of ILI, which differed in whether fever/chills was essential. We calculated ILI incidence week by week throughout the season, and investigated risk factors associated with ever reporting ILI over the course of the season. Risk factor analysis was conducted using binomial regression. Results 5943 participants joined the survey, and 4532 completed the symptoms survey at least twice. Participants who filled in symptoms surveys at least twice filled in a median of nine symptoms surveys over the course of the study. 46.1% of participants reported at least one episode of ILI, and 6.0% of all reports were positive for ILI. Females had slightly higher incidence, and individuals over 65 had the lowest incidence. Incidence peaked just before Christmas and declined dramatically during school holidays. Multivariate regression showed that, for both definitions of ILI considered, being female, unvaccinated, having underlying health issues, having contact with children, being aged between 35 and 64, and being a smoker were associated with the highest risk of reporting an ILI. The use of public transport was not associated with an increased risk of ILI. Conclusions Our results show that internet based surveillance can be used to measure ILI and understand risk factors. Vaccination is shown to be linked to a reduced risk of reporting ILI. Taking public transport does not increase the risk of reporting ILI. Flusurvey and other participatory surveillance techniques can be used to provide reliable information to policy makers in nearly real-time. [ABSTRACT FROM AUTHOR]

Background Family carers play an essential role in providing end-of-life care to their relatives but have been found to experience uncertainty and a lack of confidence in fulfilling their caregiving roles, prompting recent calls for educational or information based resources to be developed for carers. Methods We carried out four focus groups with Clinical Nurse Specialists, healthcare assistants, former and current carers at a hospice in the UK, to explore the information and support needs of family carers. Results Our findings support previous research by highlighting a number of care situations where carers experience uncertainty and could seemingly benefit from greater information or instruction. Three main themes were identified which reflected carer experiences and needs in relation to potential information giving or educational interventions. These have been described as the knowledge and competence of carers; the preparedness of carers and low levels of carer identification with, and confidence in their roles as 'carers', which influences help seeking behaviours; and in turn how potential supportive interventions might be received by carers. Conclusions Family carers experience multiple needs for information and education, but meeting these needs remains a challenge. Our results suggest three domains which could underpin this type of intervention: developing knowledge and competence; facilitating preparedness; supporting role recognition and confidence building. We recommend an integrated information giving approach which addresses these domains by combining a resource pack for carers with a more explicit acknowledging role for health professionals. Together these could provide key information and also build confidence amongst family carers to ask for further support and advice as needed. [ABSTRACT FROM AUTHOR]

The article offers corporate governance news briefs as of May 1, 2014. Board Intelligence, provider of board packages in Great Britain has been conducting conferences regarding governance. Julie Garland McLellan, a corporate specialist from Australia has examined the cost of running boards and determined that 52% of respondents had no visibility of the cost. Massachusetts Institute of Technology (MIT) launches OpenCourseWare (OCW), a web-based publication of virtually all MIT course content.

Aims This study aimed to determine the association between the reduction in the number of Clostridium difficile infection ( CDI) cases reported by the English National Health Service ( NHS) hospitals and concurrent antimicrobial use. Methods A retrospective ecological study for January 2005 to December 2008 was conducted using data from 26 of the 29 NHS trusts (i.e. a trust manages one or more hospitals) located in the North West Strategic Health Authority of England. Antimicrobial use data, for patients of all ages, were provided by IMS Health, and CDI case data for patients aged ≥65 years were provided by the Health Protection Agency. Antimicrobial use was converted into defined daily doses ( DDDs). The overall association between antimicrobial use and CDI for the trusts was investigated using multilevel models. Results Our study shows a positive significant association between the CDI cases and the use of the following antimicrobials: 'third-generation cephalosporins' [11.62 CDI cases per 1000 DDDs; 95% confidence interval ( CI), 5.92-17.31]; 'fluoroquinolones' (4.79 CDI cases per 1000 DDDs; 95% CI, 2.83-6.74); and 'second-generation cephalosporins' (4.25 CDI cases per 1000 DDDs; 95% CI, 1.66-6.83). The strength of this association was not significantly different (95% CI) among the antimicrobial groups. Conclusions This study shows that the reduction in the number of CDI cases reported by the English NHS hospitals is associated with concurrent reductions in antimicrobial use. This means that the number of CDI cases over time decreased in a similar fashion to the usage of various antimicrobials. [ABSTRACT FROM AUTHOR]

The academic study of educational technology is often characterised by critics as methodologically limited. In order to test this assumption, the present paper reports on data collected from a survey of 462 'research active' academic researchers working in the broad areas of educational technology and educational media. The paper explores their familiarity and expertise with various methods of data collection and analysis. Data from the survey highlight a preference for relatively basic forms of descriptive research, coupled with a lack of capacity in advanced quantitative data collection and analysis. The paper concludes with some directions for 'methodological capacity building' to broaden the use of methods in educational technology research. [ABSTRACT FROM AUTHOR]

This paper deals with the assessment of the crossdisciplinarity of technology-enhanced learning ( TEL). Based on a general discussion of the concept interdisciplinarity and a summary of the discussion in the field, two empirical methods from scientometrics are introduced and applied. Science overlay maps and the Rao- Stirling diversity index are used to analyze the TEL field with a scientometric analysis. The science overlay maps show that a wide variety of disciplines contributes to research in the field. The analysis reveals that the field has been operating on a relatively high level of crossdisciplinarity in the last 10 years compared with six other fields of reference. Only in 2004 a decrease in the level of crossdisciplinarity could be identified. [ABSTRACT FROM AUTHOR]

The massive adoption of technology in learning processes comes with an equally large capacity to track learners. Learning analytics aims at using the collected information to understand and improve the quality of a learning experience. The privacy and ethical issues that emerge in this context are tightly interconnected with other aspects such as trust, accountability and transparency. In this paper, a set of principles is identified to narrow the scope of the discussion and point to pragmatic approaches to help design and research learning experiences where important ethical and privacy issues are considered. [ABSTRACT FROM AUTHOR]

This paper discusses a year-long technology integration project during which teachers and researchers joined forces to explore children's collaborative activities through the use of touch screens. In the research project discussed in this paper, 16 touch screens were integrated into teaching and learning activities in two separate classrooms; the learning and collaborative processes were captured by using a video, collecting over 150 hours of footage. By using digital research technologies and a longitudinal design, the authors of the research project studied how teachers and children gradually integrated touch screens into their teaching and learning. This paper examines the methodological usefulness of video-based multimodal analysis. Through reflection on the research project, we discuss how, by using video-based multimodal analysis, researchers and teachers can study children's touch-screen supported collaboration and how researchers and teachers can learn together. [ABSTRACT FROM AUTHOR]

This paper describes a technique for locating indicators of success within the data collected from complex learning environments, proposing an application of e-research to access learner processes and measure and track group progress. The technique combines automated extraction of tense and modality via parts-of-speech tagging with a visualisation of the timing and speaker for each utterance developed to code and analyse learner discourse, exploiting the results of previous, non-automated analyses for validation. The work is developed using a dataset of interactions within a multi-user virtual environment and extended to a more complex dataset of synchronous chat texts during a collaborative design task. This methodology extends natural language processing into computer-based collaboration contexts, discovering the linguistic micro-events that construct the larger phases of successful design-based learning. [ABSTRACT FROM AUTHOR]

The article reflects on the dissemination of the best practice of biomedical in Great Britain. He examines the impact of technological innovation to the clinical practice of general practitioners (GPs), who shows effort to build evidence-based primary care practice. He details three distinct models of behavior change in clinical decision making which include the accumulation model, the challenge model and the continuity model.

The author reflects on the role of traditional academic primary care (APC) in Great Britain. He examines the importance of investment in APC to increase the academic capacity of primary care in community-based teaching for the development of high-quality research programmes by the General Medical Council. He encourages the clinicians to continue the clinical academic career to develop a better profile among service practitioners.

The article focuses on the argument over the National Health Service (NHS) in Great Britain which claim that the service is a business. It states that NHS is paid for out of taxation and provide a service for medical care. It highlights the impact of National Health Service and Community Care Act 1990 to the NHS wherein money is no longer circulated within the service.

Background: It is important that health professionals have an understanding of each others' roles in order to promote patient- centred care and services available. Within obstetrics it is necessary, as key information informers, that midwives and student midwives understand the role physiotherapists can offer. Aim: To explore student midwives understanding of physiotherapy in the antenatal and postnatal setting and what role they recognise it plays within UK healthcare. Method: Adopting a qualitative exploratory approach, a focus group was conducted to explore midwifery students' experiences. Data were analysed using an adapted thematic analysis process. Results: Five key themes were identified: 1. Role recognition is needed, 2. Lack of knowledge: 'But we don't know what a physiotherapist does1, 3. A perceived view, U. Utilised? 'Yes. But...' and 5. Beneficial? Conclusion: Participants recognised the importance for role understanding, had a perceived view of physiotherapy closely related to the Association of Chartered Physiotherapists in Women's Health (ACPWH) role definition and described physiotherapy as beneficial. Numerous barriers prevent utilisation. Interprofessional education does not promote or aid role understanding. It is questionable whether student midwives are able to promote physiotherapy services appropriately. [ABSTRACT FROM AUTHOR]

The substituted β-keto amphetamine mephedrone (4-methylmethcathinone) was banned in the UK in April 2010 but continues to be used recreationally in the UK and elsewhere. Users have compared its psychoactive effects to those of 3,4-methylenedioxymethamphetamine ( MDMA, 'ecstasy'). This review critically examines the preclinical data on mephedrone that have appeared over the last 2-3 years and, where relevant, compares the pharmacological effects of mephedrone in experimental animals with those obtained following MDMA administration. Both mephedrone and MDMA enhance locomotor activity and change rectal temperature in rodents. However, both of these responses are of short duration following mephedrone compared with MDMA probably because mephedrone has a short plasma half-life and rapid metabolism. Mephedrone appears to have no pharmacologically active metabolites, unlike MDMA. There is also little evidence that mephedrone induces a neurotoxic decrease in monoamine concentration in rat or mouse brain, again in contrast to MDMA. Mephedrone and MDMA both induce release of dopamine and 5- HT in the brain as shown by in vivo and in vitro studies. The effect on 5- HT release in vivo is more marked with mephedrone even though both drugs have similar affinity for the dopamine and 5-HT transporters in vitro. The profile of action of mephedrone on monoamine receptors and transporters suggests it could have a high abuse liability and several studies have found that mephedrone supports self-administration at a higher rate than MDMA. Overall, current data suggest that mephedrone not only differs from MDMA in its pharmacological profile, behavioural and neurotoxic effects, but also differs from other cathinones. [ABSTRACT FROM AUTHOR]

Research Highlights and Abstract The article conducts a detailed and robust analysis of the social and attitudinal underpinnings of general support for the war in Afghanistan., The article contributes to scholarly understanding of public attitudes in Britain on foreign policy issues and to the wider literature on public opinion and war., The findings underline the long-standing 'gender gap' in attitudes to war, with men more in favour., Labour partisanship and political knowledge are directly related to support for the war, though there is only weak evidence that the effects of partisanship are mediated via political knowledge., This article analyses the micro-level factors affecting public opinion in Britain towards the long-running war in Afghanistan, a major foreign policy issue in the post-9-11 era. It examines the effects of social and attitudinal factors, including perceptions of how the war is going. There is a strong evidence of a 'gender gap', with men more in favour, while those with higher educational attainment are more supportive. Perceptions of the war's progress play a strong role in shaping general support. Labour partisans are more supportive while political knowledge is positively-related to support for the war. There is weaker evidence that the effects of partisanship are mediated via political knowledge. This article contributes to the scholarly understanding of public attitudes in Britain on foreign policy issues and to the wider literature on public opinion and military intervention. [ABSTRACT FROM AUTHOR]

Research Highlights and Abstract provides one of the first assessments of how British multi-national and English political parties have responded to existing and emergent identity tensions in England whilst continuing to defend the concept of the post-devolution British union-state., extends debates about multi-level party political systems in multi-national states which have typically focused on Scotland, Wales and, to a lesser extent, Northern Ireland., considers the potential that debates about English national identity could morph into a party politics of Englishness., assesses the potential for nascent English nationalism to encourage divergent party political responses to questions of English governance, citizenship and nation identity., This article assesses how the main British multi-national parties, whilst retaining an attachment of one form or another to the concept of the Union-state, have responded to existing and emergent identity tensions. Through examination of Labour, the Conservatives and the Liberal Democrats, with brief discussion of the BNP, UKIP and the English Democrats, it will consider the impact of devolution and the threat of separatist nationalism on party approaches and policy choices concerning English identity construction and governance. It will also explore the extent to which devolution has compromised the ability of UK politicians to 'speak of Britain' (they rarely use the term UK) and the four composite nations. By comparing and contrasting the narratives articulated by parties at different levels of governance it will ask whether a nascent 'party politics of Englishness' has emerged which can accommodate these challenges. [ABSTRACT FROM AUTHOR]

Research Highlights and Abstract Provides a reading of the literatures on multi-level governance and federalism to develop a series of propositions about the nature of the relationship between different levels of government in the devolved United Kingdom., Drawing on a survey of local government officers in Wales, the article reports support for both layer cake and marble cake interpretations of multi-level governance., The article concludes with a discussion of the applicability of these models to our understanding of devolution in the United Kingdom., Since the United Kingdom began its devolution programme in 1999 governments operating at four different territorial scales-embracing the EU, the UK, the national and the local-have played a part in the governance of Wales. Multi-level governance of this type can be likened to a layer cake, in which each government operates in its own distinct jurisdiction, or to a marble cake in which governments have overlapping and interlaced responsibilities. Drawing on a survey that asked senior officers in Welsh local government to rate the impact of different levels of government, this article finds support for both interpretations of multi-level governance. Although largely discredited as a description of American federalism, the layer cake simile may have a new lease of life in the analysis of Europe's devolved nations and regions. [ABSTRACT FROM AUTHOR]

Research Highlights and Abstract The article explores attitudes to New Labour in particular and politics in general through analysing their dramatization on TV., It indicates that such dramatizations are almost wholly negative, focusing on sleaze, spin and betrayal., The article explains the character of such dramas as being the result of the producers′ desire to present politics in terms their audiences will accept., It suggests that, as a consequence, popular hostility to politics is reinforced by television drama and so indicates that culture has an independent part to play in this process., Echoing Plato's banishment of artists, mainstream political scientists have excluded serious consideration of art from their discipline. Yet, there are grounds for believing that it can help address what Gerry Stoker suggests is one of social science's greatest failings: understanding 'what politics means to citizens'. This study of New Labour's television dramatization suggests it can help political scientists better appreciate the dynamics underpinning the much-noted decline of popular trust in representative politics. It looks at the reasons for the narrowing of the public's picture of politics by focusing on the changing production context for television drama during the New Labour period, something that led it to emphasise 'sleaze'. The article suggests such dramas consequently helped make more credible the public's pre-existing prejudices about what they supposed was the corrupt nature of Britain's political class. [ABSTRACT FROM AUTHOR]

The UNSC presidency functions under the twin assumptions of neutrality and impartiality. However, chairing multilateral negotiations in institutionalised bargaining fora always offers substantial opportunities to the country in office to pursue its own national interests. An important constraint for the presidency is the very short duration of the period in office, which does not allow chairs to capitalise on the existing informational asymmetries and use them to their own advantage. Can this institutional constraint be overcome? We address this issue by examining the British one-month presidency in January 1992. In a highly turbulent period, with mounting pressures for the UNSC to become more representative, the presidency secured the transition from the Soviet to the Russian UNSC seat without opening the Pandora's box of UNSC reform, in line with British preferences. [ABSTRACT FROM AUTHOR]

Objective: To ascertain the progress being made towards the implementation of stereotactic ablative body radiotherapy (SABR) treatment in the UK, to obtain details of current practice in centres with an active treatment programme and to assess the projected future provision. Methods: In August 2012, an online questionnaire was sent to all 65 UK radiotherapy institutions. The included questions covered the current number of patients being treated and the intended number of patients for each clinical site; immobilization and motion management methods; CT scanning protocols; target and organ-at-risk delineation; treatment planning; image-guidance and treatment protocols; and quality assurance methods. Results: 48/65 (74%) institutions responded by the end of November 2012, with 15 indicating an active SABR programme. A further four centres indicated that a SABR protocol had been established but was not yet in clinical use. 14 of the 29 remaining responses stated an intention to develop a SABR programme in the next 2 years. Conclusion: The survey responses confirm that SABR provision in the UK is increasing and that this should be expected to continue in the next 2 years. A projection of the future uptake would suggest that by the end of 2014, UK SABR provision will be broadly in line with international practice. [ABSTRACT FROM AUTHOR]

The article reports the findings of a qualitative study of Hindu, Muslim and Sikh teachers of religious education and the relationship between their biographies, professional beliefs and use of personal life knowledge in English, secondary school classrooms. This relationship was explored through a study of five beginning teachers and provided evidence of the role that their personal knowledge played in enabling them to support the learning of pupils in white majority and Muslim majority state schools. It also indicated the need for teacher education courses to provide opportunities for teachers to explore the relationship between their personal and professional lives and the potential dilemmas and dangers of sharing their personal knowledge and experiences with pupils. In the context of international concern to identify criteria for selecting beginning teachers, the article highlights the importance of initiatives aimed at increasing the ethnic/religious diversity of the teaching force. [ABSTRACT FROM PUBLISHER]

In England and Wales, religious education (RE) in non-faith schools has gradually changed from Christian education to the study of many religions and philosophies. However, the core values of RE have continued to be related to concerns about social cohesion and the building of shared values. The article briefly discusses changes in RE since 1944 and then considers attitudes to RE among a group of year 11 pupils (age 15–16) in one large multicultural comprehensive school, collected through questionnaires and group discussions. The subject name had been changed from RE to Religious Studies (RS) in 2004. The focus here is on pupils’ ideas of ‘the perfect RS pupil’; used as a means to access their understandings of the subject’s aims and their teachers’ expectations. The most popular responses were that the ideal pupil would be knowledgeable about religions and be tolerant and empathetic. This is in accord with the current social and political agenda for RE but lays it open to criticism that tolerance becomes an end in itself encouraging indifference to religions rather than a critical, evaluative perspective. [ABSTRACT FROM PUBLISHER]