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

Aims The literature review aimed to identify the barriers the Punjabi and/or Sikh community have in accessing support for alcohol addiction. Method A systematic review of the literature was undertaken of four scholarly databases, Google Scholar and grey literature on UK-based research conducted after 1980 into alcohol addiction in the Punjabi and/or Sikh community. Fourteen papers met the inclusion criteria outlined in the paper and were included in the review. Results Ten main barriers to accessing support were found; stigma, religion, lack of understanding of addiction, over reliance on a medical model of treatment and disregard of therapy, cultural implications of being a member of the Punjabi and/or Sikh community and the addiction community, gender and generational differences and a lack of government commitment to alcohol support for BME communities with a lack of culturally specific services. Conclusion Despite the many barriers explored, the role of stigma remained a powerful theme throughout often underpinning other barriers. A key recommendation across many papers was the need for culturally sensitive support services. Several areas for future research were identified. [ABSTRACT FROM AUTHOR]

Elites often use merit to explain, justify, and make sense of their advantaged positions. But what exactly do they mean by this? In this paper, we draw on 71 interviews with elites in Denmark and the UK to compare self-justifications of meritocratic legitimacy. Our results indicate that while elites in both countries are united by a common concern to frame their merits as spontaneously recognized by others (rather than strategically promoted by themselves), the package of attributes they foreground vary significantly. In the UK, elites tend to be "talent meritocrats" who foreground their unique capacity for ideational creativity or risk taking, innately good judgment, and "natural" aptitude, intelligence, or academic ability. In contrast, in Denmark, elites are more likely to be "hard work meritocrats" who emphasize their unusual work ethic, extensive experience (as a signal of accumulated hard work), and contributions outside of work, particularly in civil society. We tentatively argue that one explanation for this cross-national variation is the role that different channels of elite recruitment play in amplifying legitimate notions of merit. In the UK, for example, elite private schools act to nurture ideas of exceptionalism and natural talent, whereas in Denmark elite employers socialize the connection between hard work and success. These findings suggest that nationally specific understandings of merit can have quite different implications for the legitimation of inequality. [ABSTRACT FROM AUTHOR]

Motivation Polygenic risk scores (PRSs) predict individuals' genetic risk of developing complex diseases. They summarize the effect of many variants discovered in genome-wide association studies (GWASs). However, to date, large GWASs exist primarily for the European population and the quality of PRS prediction declines when applied to other ethnicities. Genetic profiling of individuals in the discovery set (on which the GWAS was performed) and target set (on which the PRS is applied) is typically done by SNP arrays that genotype a fraction of common SNPs. Therefore, a key step in GWAS analysis and PRS calculation is imputing untyped SNPs using a panel of fully sequenced individuals. The imputation results depend on the ethnic composition of the imputation panel. Imputing genotypes with a panel of individuals of the same ethnicity as the genotyped individuals typically improves imputation accuracy. However, there has been no systematic investigation into the influence of the ethnic composition of imputation panels on the accuracy of PRS predictions when applied to ethnic groups that differ from the population used in the GWAS. Results We estimated the effect of imputation of the target set on prediction accuracy of PRS when the discovery and the target sets come from different ethnic groups. We analyzed binary phenotypes on ethnically distinct sets from the UK Biobank and other resources. We generated ethnically homogenous panels, imputed the target sets, and generated PRSs. Then, we assessed the prediction accuracy obtained from each imputation panel. Our analysis indicates that using an imputation panel matched to the ethnicity of the target population yields only a marginal improvement and only under specific conditions. Availability and implementation The source code used for executing the analyses is this paper is available at https://github.com/Shamir-Lab/PRS-imputation-panels. [ABSTRACT FROM AUTHOR]

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

Background Older people are often explicitly or implicitly excluded from research, in particular clinical trials. This means that study findings may not be applicable to them, or that older people may not be offered treatments due to an absence of evidence. Aims The aim of this work was to develop recommendations to guide all research relevant to older people. Methods A diverse stakeholder group identified barriers and solutions to including older people in research. In parallel, a rapid literature review of published papers was undertaken to identify existing papers on the inclusion of older people in research. The findings were synthesised and mapped onto a socio-ecological model. From the synthesis we identified themes that were developed into initial recommendations that were iteratively refined with the stakeholder group. Results A range of individual, interpersonal, organisational, community and policy factors impact on the inclusion of older people in research. A total of 14 recommendations were developed such as removing upper age limits and comorbidity exclusions, involving older people, advocates and health and social care professionals with expertise in ageing in designing the research, and considering flexible or alternative approaches to data collection to maximise opportunities for participation. We also developed four questions that may guide those developing, reviewing and funding research that is inclusive of older people. Conclusion Our recommendations provide up to date, practical advice on ways to improve the inclusion of older people in health and care research. [ABSTRACT FROM AUTHOR]

Background Given the globally ageing population, care homes have an important role in delivering palliative and end-of-life care. Advance care planning (ACP) is promoted to improve the quality of end-of-life care in this setting. While many professionals can be involved in ACP, little is known about what influences multi-professional involvement and how multi-professional working impacts the ACP process in the UK. This study investigated multi-professional practice in relation to ACP in nursing homes. Design and methods An ethnography was undertaken in two UK nursing homes using multiple methods of data collection: observations, interviews and document review. Participants included the following: nursing home residents (n  = 6), relatives (n  = 4), nursing home staff (n  = 19), and visiting health and social care professionals (n  = 7). Analysis integrated thematic analysis, mapping of resident ACP trajectories and documentary analysis. Findings This paper suggests that multi-professional and relatives' involvement in ACP was disjointed. Continuity and coordination were disrupted by misalignment of visiting professional and nursing home organisational structures. Findings show a 'knotworking' approach to teamwork and power imbalance between nursing home staff and visiting professionals, such as general practitioners. While residents wished their relatives to be involved in their ACP, this was not formally recognised, and limited support existed to facilitate their involvement. Conclusion The structure and organisation of multi-professional and relatives' involvement in ACP led to fragmentation of the process. This marginalised the voice of both the resident and nursing home staff, thereby limiting ACP as a tool to enhance quality of end-of-life care. [ABSTRACT FROM AUTHOR]

Background Alcohol increases cancer risk, but less is known about public awareness of this link. This scoping review summarizes recent findings on the public awareness of alcohol as a cancer risk factor in European Union and UK. Methods Four databases (Web of Science, MEDLINE, PsycInfo, CINAHL) were searched for papers containing data on awareness of alcohol as cancer risk factor in EU or UK published between January 2017 and December 2022, and complemented with grey literature searches. Results In total, 45 studies were included covering 18 EU countries (Austria, Belgium, Cyprus, Czechia, Denmark, Finland, France, Germany, Hungary, Ireland, Italy, Netherlands, Poland, Romania, Slovakia, Slovenia, Spain, Sweden) and UK, presenting data collected between 2009 and 2022. Studies covered general population (17 studied a nationally representative sample), women, health professionals, patients and young people. Awareness of alcohol causing cancer in general was higher and studied more often than awareness of alcohol's impact on specific cancers. Among the EU general population, awareness of the link between alcohol and breast cancer ranged between 10% and 20%, head and neck cancer 15–25%, colorectal and oesophagus cancer 15–45% and liver cancer 40%. Awareness was higher among young people and specialized health professions and lower among women (the latter specifically for the breast cancer). Conclusions While awareness rates varied depending on the exact question wording, many studies showed low awareness of the alcohol-cancer link, especially for specific types such as breast and colon cancer. Public should be better informed about alcohol consumption-related cancer risk. [ABSTRACT FROM AUTHOR]

The forum shows that I correctly diagnosed the place that 'people's war' has in the historiography of the Second World War; that, if anything, I underestimated the grip that the connected series of beliefs about 'people's war' have come to have over some historians of the British Second World War; and how difficult it is to start a conversation about framing assumptions and the nature of the historiography of the war. In this response I aim to get above the din of detail and try to understand the underlying positions being taken by the respondents. I will try to tease out their rather hidden assumptions, in order to clarify better what is at issue and at stake, thereby making a fresh attempt to take this discussion forward. I will also extend the discussion by considering works that have already rejected the conceptualisation of 'people's war' defended in this forum. I hope that my original paper and the forum itself will together make the case that we need fresh ways of thinking about the British Second World War, as well as suggest that new ways are already in being and that the concept of 'people's war' as currently used by many historians needs to be abandoned. [ABSTRACT FROM AUTHOR]

Although health education programmes have been implemented in higher music education (HME) and their evaluations published in peer-reviewed journals, guidelines as to what ought to be included in these programmes are still missing. This study aimed to document expert discussions on the content of an ideal health education curriculum for HME students in the UK, integrating critical thinking. Four interdisciplinary workshops were conducted, where 67 experts in relevant fields took part, and were asked to discuss four lists of topics and concepts created based on literature reviews (cognitive biases, logical fallacies, critical appraisal tools and health topics). Only the list on health topics is relevant here. Notes taken by the participants and ourselves were thematically analysed. Four themes were identified, two of which are reported in this paper: (i) The health education curriculum and (ii) A settings-based approach to health. Part I of this project (published elsewhere) is focussed on the critical thinking content of health education for conservatoire students. The present paper focusses on the ideal health education curriculum and its implications for the wider context of health promotion. [ABSTRACT FROM AUTHOR]

Currently in the UK and Ireland, after a hip fracture most patients do not receive bone protection medication to reduce the risk of refracture. Yet randomised controlled trial data specifically examining patients with hip fracture have shown that intravenous zoledronate reduces refracture risk by a third. Despite this evidence, use of intravenous zoledronate is highly variable following a hip fracture; many hospitals are providing this treatment, whilst most are currently not. A range of clinical uncertainties, doubts over the evidence base and practical concerns are cited as reasons. This paper discusses these concerns and provides guidance from expert consensus, aiming to assist orthogeriatricians, pharmacists and health services managers establish local protocols to deliver this highly clinically and cost-effective treatment to patients before they leave hospital, in order to reduce costly re-fractures in this frail population. [ABSTRACT FROM AUTHOR]

Over the past few decades, a small but growing group of people have worked remotely from their homes. With the arrival of the coronavirus pandemic, millions of people found themselves joining this group overnight. In this position paper, we examine the kinds of work that 'went remote' in response to the pandemic, and consider the ways in which this transition was influenced by (and in turn came to influence) contemporary trends in digital workplace measurement and evaluation. We see that employers appeared reluctant to let certain classes of employee work remotely. When the pandemic forced staff home, employers compensated by turning to digital surveillance tools, even though, as we argue, these tools seem unable to overcome the significant conceptual barriers to understanding how people are working. We also observed that, in the United Kingdom context, the pandemic didn't mean remote work for a significant proportion of the population. We assert that, to maximize its impact, 'future of work' research in human-centred computing must be more inclusive and representative of work, rather than focusing on the experiences of knowledge workers and those involved in new forms of work. [ABSTRACT FROM AUTHOR]

Between 1962 and 1965, a broad definition of dependence allowed for the migration of Commonwealth Citizens to join working family members in Britain. This article investigates how the Home Office targeted male dependent youth as a category that could reduce unwanted immigration from the Commonwealth, particularly South Asia. Home Office officials obscured the stories of dependent migrants, constructed the figure of the 'bogus child', and denigrated male familial connections, which resulted in the denial of family reunion. Colonial assumptions about the mendacity of South Asians and the illegibility of South Asian family forms shaped British policy. The 1965 White Paper and the 1968 Commonwealth Immigrants Act foreclosed the possibility of a broad definition of family and consolidated the legitimacy of the cisheterosexual family. Home Office discussions dovetailed with an emergent common sense circulated in newspapers and public debate about the illegitimacy of the South Asian family in Britain. This article interrogates the racist reasoning of the Home Office and this emergent common sense not only to show how immigration policy generates racialization but also to reveal the specificity of South Asian racialization in the post-imperial social formation. [ABSTRACT FROM AUTHOR]

Taking the idea of refugee 'journeys to health' (Newbold and McKeary, 2018) as a point of departure this paper examines the case of Chilean exiles in the UK. Reflecting on interviews conducted with Chilean exiles the analysis highlights how the health-related challenges that many people have experienced change over time. For some the passing of time has enabled people to make sense of what happened to them following the military coup in Chile in 1979 and this has helped them to 'move on'. For others, on-going challenges remain, for example a number of people still experienced PTSD. The paper also reflects on the difficulties encountered by refugees when dealing with formal health providers. While all of the respondents had full entitlements to NHS services the paper reflects on the informal barriers that continue to shape refugees' engagement with health care providers and limit their ability to address health concerns. [ABSTRACT FROM AUTHOR]

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

Background COVID-19 brought additional challenges to Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision-making, which was already a contentious issue. In the UK, reports of poor DNACPR decision-making and communication emerged in 2020, including from the regulator, the Care Quality Commission. This paper explores the experiences of people who discussed DNACPR with a healthcare professional on behalf of a relative during the coronavirus pandemic, with the aim of identifying areas of good practice and what needs to be improved. Methods a total of 39 people participated in semi-structured interviews via video conferencing software or telephone. Data were evaluated using Framework Analysis. Findings results are presented around three main themes: understanding, communication and impact. Participants' understanding about DNACPR was important, as those with better understanding tended to reflect more positively on their discussions with clinicians. The role of relatives in the decision-making process was a frequent source of misunderstanding. Healthcare professionals' communication skills were important. Where discussions went well, relatives were given clear explanations and the opportunity to ask questions. However many relatives felt that conversations were rushed. DNACPR discussions can have a lasting impact—relatives reported them to be significant moments in care journeys. Many relatives perceived that they were asked to decide whether their relative should receive CPR and described enduring emotional consequences, including guilt. Conclusion the pandemic has illuminated deficiencies in current practice around DNACPR discussion, which can have difficult to anticipate and lasting negative consequences for relatives. This research raises questions about the current approach to DNACPR decision-making. [ABSTRACT FROM AUTHOR]

The 2022 UK diphtheria outbreak has wider contextual importance: it highlights that even in a country with good overall herd immunity against many infectious diseases from high vaccination coverage, strong surveillance mechanisms for infections that may re-emerge are essential. Factors before, during and after migration may increase the risk of asylum seekers contracting diphtheria and other vaccine preventable infections. Keywords: diphtheria; outbreak; asylum seekers; United Kingdom EN diphtheria outbreak asylum seekers United Kingdom 1 3 3 09/13/23 20230701 NES 230701 In 2022, in figures mirrored across Europe,[1] the UK saw a 7-fold increase in annual reported diphtheria cases[2],[3]; all among asylum seekers.[2],[3] Diphtheria has been rare in the UK since the introduction of the routine immunization programme in 1942, with most cases related to international travel.[4] In this paper, we give an overview of diphtheria infection, explore potential contributing factors to the unprecedented increase in cases among asylum seekers, examine the UK Health Security Agency (UKHSA) outbreak response and identify factors that may reduce the likelihood of resurgence of diseases of poverty and overcrowding. [Extracted from the article]

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

Inter-war Britain witnessed rising tax avoidance and evasion, reflecting a combination of elite opposition to higher tax rates and the almost complete absence of any effective legal or reputational sanctions against tax evaders. Legal tax avoidance carried little social stigma and even illegal evasion rarely led to criminal prosecution or public censure, on account of the confidential, non-judicial procedure by which cases were resolved. This paper explores how a combination of elite opposition to higher tax rates, a growing judicial ideology (especially in the higher courts) based around protecting 'civil liberties' (essentially construed in terms of private property rights), and an ambiguous stance on tax avoidance among policy-makers, created the conditions for the rapid growth of tax avoidance. This in turn fostered a booming tax avoidance industry that became a persistent feature of the British tax environment. The paper also explores the wider political economy of tax avoidance and evasion and how a political philosophy shared by leading judges, right-wing 'anti-waste' movements, some Conservative politicians, and many wealthy taxpayers, formed a precursor of neo-liberal political philosophy. Finally, it charts the changed tax climate of the late 1930s, when the growing threat of total war aligned the interests of the wealthy with those of the rest of society and allowed policy-makers to present tax payment as a patriotic duty. In this context, collective liberty and an ideology of 'fair shares' eclipsed the rhetoric of the rights of the propertied individual, thereby undermining the legitimacy of tax avoidance. [ABSTRACT FROM AUTHOR]

Following Greta Thunberg's school strike in Stockholm in August 2018 and the October 2018 'declaration of rebellion' by activists in the UK, 2019 saw several climate protest movements rise to public attention, including Fridays for Future (FFF), Extinction Rebellion (XR), and the US Sunrise Movement. What is striking about them is that they rather bluntly refer to science in their campaigns. In this paper, we present an in-depth and comparative study of how the new climate protest movements relate to scientific evidence. Employing a narrative analysis of different types of data (websites, press releases, and media coverage), we study the movements' understandings of 'the science' as well as of science's role in policy processes. We find that the movements in their initial phase predominantly rely on science for their legitimation and adopt a scientific worldview with very little 'green ambivalence'. Notably, FFF and XR hold a deficit model of existing climate communication and enact roles as science communicators. [ABSTRACT FROM AUTHOR]

In 1964, the UK government imposed an arms embargo on South Africa, which it maintained until the end of the white minority rule. What explains this embargo? Using mainly archival evidence, this paper demonstrates that domestic political dynamics in the United Kingdom mediated the influence of the transnational anti-apartheid and anti-colonial struggles on the British government. The United Kingdom imposed and maintained this embargo due in part to a domestic advocacy network, whose hub was the Anti-Apartheid Movement. The paper provides a comprehensive explanation of an important issue in British foreign policy, the anti-colonial struggle, and Southern Africa's history. There are theoretical implications for foreign policy analysis concerning the role of advocacy networks, interactions between local and global activism, the role of political parties' ideology and contestation, the effects on foreign policy of changes in a normative environment, the effects of norm contestation, and normative determinants of sanctions. [ABSTRACT FROM AUTHOR]

Prevention and elimination of modern slavery is a priority of this era, eliciting responses at an international level and in domestic laws. The duty of organisations to ensure transparency in their supply chains is the strongest representation of corporate responsibility in this field. Less attention has been given to the current/potential role of insolvency mechanisms, in relation to companies' commission of modern slavery offences, and in relation to their failure to comply with their supply-chain obligations. This paper engages with this novel question by examining the proposition to incorporate a directors' disqualification sanction into the United Kingdom framework governing companies' modern slavery supply chain obligations. This represents an opportunity, insofar as the disqualification regime is ostensibly well-placed to address weaknesses in companies' compliance with their responsibilities. However, it represents a challenge in that adoption and implementation would have to navigate drawbacks such as the limitations of existing grounds for disqualification and potential weaknesses in the design and enforcement of a bespoke sanction. Moreover, it should confront uncertainty as to whether disqualification is an effective tool for preventing misconduct by the professional/executive class of managers at the helm of large companies. Increased emphasis on regulating the human rights obligations of companies makes it imperative that this question is addressed. [ABSTRACT FROM AUTHOR]

In the UK, the introduction of austerity measures for public services has intensified the thinking around inter-organizational collaboration between emergency services and other public and/or private sector organizations. Theoretically, while collaborative benefits are held up as beacons that drive organizations to participate in inter-organizational arrangements, a high number of such arrangements fail. In this paper, we explored the factors that influenced the collaboration process in the context of developing 'collaborative information infrastructures', from an organizational and collaboration level perspective, via a multiple case study approach. Our findings offer insights into how policymakers and public managers could improve their practices by considering their approach towards, and impact of, these factors when implementing collaborative projects in information technology and information systems. [ABSTRACT FROM AUTHOR]

Introduction: Patient recollection of details discussed during medical consultation is often limited (Figure 1a). For genital gender-affirming surgery (gGAS) consultations, lengthy discussions and deep contemplation surrounding surgical options are critical. Inadequate communication can result in patient complaints and medico-legal action, whereupon issues such as a lack of discussion or poor documentation can lead to medico-legal liability against the care provider and hospital system. As a result, strategies must be developed to ensure that information discussed during complex medical consultations are made available so patients can properly weigh out the care options presented. Objective: 1) Assess medico-legal incidents in Urologic and surgical specialties in the UK, US, and a Californian quaternary care center, 2) evaluate the advantages and feasibility of offering audio-recordings of patient consultations, and 3) create a user-friendly smartphone app for recording healthcare consultations. Methods: A literature review evaluated current evidence on medical liability claims in the UK and US was conducted. Additionally, our center's Department of Risk Management provided information pertaining to medico-legal cases against our institution. Separately, gGAS patients consented to audio-record their consultation. Copies were provided to patients and kept in their medical records. A follow-up survey assessed its usefulness, and based upon patient feedback, a smartphone application was developed. Results: A PubMed search yielded 921 results on "medical malpractice claims" from 2013–2023. In Urologic Surgery, 32 papers addressed medical malpractice, with 2 providing data over the last 15 years. In the UK, 660 claims were made from 2010–2020, of which 8.2% were due to poor communication (37 = informed consent; 17 = lack of follow-up). In the US, from 2020–2022, 38.3% of Urologists faced at least one legal proceeding in their career, and 5.3% were sued within 1 year for any reason. Our institution's Department of Risk Management reported 32% of lawsuits were related to surgical care. Informed consent involved 8% of cases and had a component in 32%. The average financial settlement for medical malpractice was $125,000.00 USD, and trial costs averaged $75,000.00 USD. 50/71 patients completed an anonymized, online survey post-audio recording. Positive results were noted regarding recording quality, comfort whilst being recorded, and wishes for future consultation recordings (Figure 1b). In addition, most patients felt less anxiety, and had greater confidence in their treatment choice (Figure 1c) Based upon patient responses, we developed a smartphone App which records 90 minutes of audio, allows for file and hyperlink attachments to be sent to patients before immediately deleting all information (Figure 1d). Routine use of audio-recordings led to a reduction in patient queries to our office. Conclusions: Routine audio recording of patient consultations provides significant benefits with minimal cost to providers. As per our institution's Office of Risk Management, it offers protection against medico-legal risks. Adequate discussion, good documentation and providing adjuncts for patients can help prevent a large proportion of medicolegal complaints in addition to optimizing patient care. Considering that patients face similar challenges across different disciplines and regions, a larger study (multi-center, international, multi-language) is warranted. Disclosure: No. [ABSTRACT FROM AUTHOR]

Introduction: Patient recollection of details discussed during medical consultation is often limited (Figure 1a). For genital gender-affirming surgery (gGAS) consultations, lengthy discussions and deep contemplation surrounding surgical options are critical. Inadequate communication can result in patient complaints and medico-legal action, whereupon issues such as a lack of discussion or poor documentation can lead to medico-legal liability against the care provider and hospital system. As a result, strategies must be developed to ensure that information discussed during complex medical consultations are made available so patients can properly weigh out the care options presented. Objective: 1) Assess medico-legal incidents in Urologic and surgical specialties in the UK, US, and a Californian quaternary care center, 2) evaluate the advantages and feasibility of offering audio-recordings of patient consultations, and 3) create a user-friendly smartphone app for recording healthcare consultations. Methods: A literature review evaluated current evidence on medical liability claims in the UK and US was conducted. Additionally, our center's Department of Risk Management provided information pertaining to medico-legal cases against our institution. Separately, gGAS patients consented to audio-record their consultation. Copies were provided to patients and kept in their medical records. A follow-up survey assessed its usefulness, and based upon patient feedback, a smartphone application was developed. Results: A PubMed search yielded 921 results on "medical malpractice claims" from 2013–2023. In Urologic Surgery, 32 papers addressed medical malpractice, with 2 providing data over the last 15 years. In the UK, 660 claims were made from 2010–2020, of which 8.2% were due to poor communication (37 = informed consent; 17 = lack of follow-up). In the US, from 2020–2022, 38.3% of Urologists faced at least one legal proceeding in their career, and 5.3% were sued within 1 year for any reason. Our institution's Department of Risk Management reported 32% of lawsuits were related to surgical care. Informed consent involved 8% of cases and had a component in 32%. The average financial settlement for medical malpractice was $125,000.00 USD, and trial costs averaged $75,000.00 USD. 50/71 patients completed an anonymized, online survey post-audio recording. Positive results were noted regarding recording quality, comfort whilst being recorded, and wishes for future consultation recordings (Figure 1b). In addition, most patients felt less anxiety, and had greater confidence in their treatment choice (Figure 1c) Based upon patient responses, we developed a smartphone App which records 90 minutes of audio, allows for file and hyperlink attachments to be sent to patients before immediately deleting all information (Figure 1d). Routine use of audio-recordings led to a reduction in patient queries to our office. Conclusions: Routine audio recording of patient consultations provides significant benefits with minimal cost to providers. As per our institution's Office of Risk Management, it offers protection against medico-legal risks. Adequate discussion, good documentation and providing adjuncts for patients can help prevent a large proportion of medicolegal complaints in addition to optimizing patient care. Considering that patients face similar challenges across different disciplines and regions, a larger study (multi-center, international, multi-language) is warranted. Disclosure: No. [ABSTRACT FROM AUTHOR]

In this article we develop a method based on model-X knockoffs to find conditional associations that are consistent across environments, while controlling the false discovery rate. The motivation for this problem is that large datasets may contain numerous associations that are statistically significant and yet misleading, as they are induced by confounders or sampling imperfections. However, associations replicated under different conditions may be more interesting. In fact, sometimes consistency provably leads to valid causal inferences even if conditional associations do not. Although the proposed method is widely applicable, in this paper we highlight its relevance to genome-wide association studies, in which robustness across populations with diverse ancestries mitigates confounding due to unmeasured variants. The effectiveness of this approach is demonstrated by simulations and applications to UK Biobank data. [ABSTRACT FROM AUTHOR]

This paper examines the development of the impact of family background on young people's political engagement during adolescence and early adulthood in order to test a number of hypotheses derived from the impressionable years and family socialization perspectives. The study analyses data of the British Household Panel Study and Understanding Society to assess these hypotheses. Political interest and voting intentions are used as outcomes of political engagement. The study finds parental education to have no effect on initial levels of these outcomes at age 11 but to be positively related to the change in these outcomes between ages 11 and 15. This indicates that the effect of parental education becomes stronger over time and that social disparities in political engagement are widening significantly during early adolescence. In contrast, parental political engagement is positively related to initial levels of voting intentions at age 11 but not related to the change in voting intentions between ages 11 and 15, which supports the hypothesis drawn from the family socialization perspective. Neither parental education nor parental political engagement are related to post-16 changes in political engagement. These results point to early adolescence as a crucial period for the manifestation of social inequalities in political engagement. They provisionally suggest that the influence of parental education runs through educational conditions in lower secondary and that these conditions could play an important role in amplifying the said inequalities. [ABSTRACT FROM AUTHOR]

Migrants in the UK from the Central and Eastern European states that acceded to the European Union in 2004 and 2007 often have close proximity to precarity. This contribution illustrates that the positioning of the migrants in the casualised labour market has not occurred by accident but has been brought about by the (disingenuous) way in which nationals of the accession states were permitted access to the UK labour market. The positioning has been further maintained through the increasingly restrictive direction of the intertwined EU-UK response to claims for support from vulnerable EU migrant citizens. This piece presents the idea of 'confined labour market citizenship' as a way to understand the way many migrants have experienced working and living in the UK in the years following EU enlargement. This concept, it is argued, is able to capture: the role of the UK state as it regulated post-accession migration rules and implemented laws relating to social security entitlement; the influence of the broader EU framework on free movement and citizenship of the Union; and the impact of employers 'on the ground' in creating and exacerbating conditions of precarity and exploitation. The analysis throughout the paper exposes how EU8 and EU2 migrants have served as scapegoats for the result of the Brexit referendum, deflecting attention from the instrumentalisation of the migration issue by politicians. They have also been guinea pigs, testing out a confined version of EU citizenship with less tolerance for those in precarious and insecure work. [ABSTRACT FROM AUTHOR]

The current COVID-19 pandemic confines people to their homes, disrupting the fragile social fabric of deprived neighbourhoods and citizen's participation options. In deprived neighbourhoods, community engagement is central in building community resilience, an important resource for health and a prerequisite for effective health promotion programmes. It provides access to vulnerable groups and helps understand experiences, assets, needs and problems of citizens. Most importantly, community activities, including social support, primary care or improving urban space, enhance health through empowerment, strengthened social networks, mutual respect and providing a sense of purpose and meaning. In the context of inequalities associated with COVID-19, these aspects are crucial for citizens of deprived neighbourhoods who often feel their needs and priorities are ignored. In this perspectives paper, illustrated by a varied overview of community actions in the UK and The Netherlands, we demonstrate how citizens, communities and organizations may build resilience and community power. Based on in-depth discussion among the authors we distilled six features of community actions: increase in mutual aid and neighbourhood ties, the central role of community-based organizations (CBOs), changing patterns of volunteering, use of digital media and health promotion opportunities. We argue that in order to enable and sustain resilient and confident, 'disaster-proof', communities, areas which merit investment include supporting active citizens, new (digital) ways of community engagement, transforming formal organizations, alignment with the (local) context and applying knowledge in the field of health promotion in new ways, focussing on learning and co-creation with citizen initiatives. [ABSTRACT FROM AUTHOR]

A significant yet overlooked aspect in many states' extraterritorial migration control efforts is their immigration liaison officers (ILOs) posted to foreign jurisdictions, who make decisions and take actions abroad to support their country's immigration goals. Importantly, this occurs within an interconnected system of nation-states, requiring mid-level officials from multiple states to co-operate. Yet, there is very little analysis on what happens in these foreign jurisdictions where officials from across national and organisational boundaries interact and negotiate the management of migration flows. This article aims to fill this gap by drawing on empirical research on the UK's overseas immigration liaison network. Analysis is based on original interviews with Home Office officials, Freedom of Information requests, and documentary research. I find that UK ILOs are a main contact point between the country they represent, local authorities in the host state, and Global North counterparts from other states, making them key sites for the transnational exchange of information, 'intelligence' and 'know-how'. In this way, they are like 'knowledge brokers', contributing to a 'global–local diffusion' of ideas. Despite power hierarchies, this is not a one-way transfer from the Global North to the South. Instead, I find Global South actors are also key subjects in this process. By going beyond policies on paper and formal inter-state agreements, this study offers important insight into a largely hidden yet central part of a state's extraterritorial migration control: informal spaces of negotiation between mid-level officials from across national and organisational boundaries who negotiate and contest migration control practices. [ABSTRACT FROM AUTHOR]

Background vaccination uptake in the UK and increased care home testing are likely affecting care home visitation. With scant scientific evidence to date, the aim of this longitudinal qualitative study was to explore the impact of both (vaccination and testing) on the conduct and experiences of care home visits. Methods family carers of care home residents with dementia and care home staff from across the UK took part in baseline (October/November 2020) and follow-up interviews (March 2021). Public advisers were involved in all elements of the research. Data were analysed using thematic analysis. Results across 62 baseline and follow-up interviews with family carers (n  = 26; 11) and care home staff (n  = 16; 9), five core themes were developed: delayed and inconsistent offers of face-to-face visits; procedures and facilitation of visits; variable uptake of the COVID-19 vaccine; misinformation, education and free choice; frustration and anger among family carers. The variable uptake in staff, compared to family carers, was a key factor seemingly influencing visitation, with a lack of clear guidance leading care homes to implement infection control measures and visitation rights differently. Conclusions we make five recommendations in this paper to enable improved care home visitation in the ongoing, and in future, pandemics. Visits need to be enabled and any changes to visiting rights must be used as a last resort, reviewed regularly in consultation with residents and carers and restored as soon as possible as a top priority, whilst more education needs to be provided surrounding vaccination for care home staff. [ABSTRACT FROM AUTHOR]

In recent years, there has been a risen interest in heat recovery systems for building applications due to concerns about the energy crisis and global climate change. In this paper, the intention to understand the performance of a window thermoelectric heat pump/heat recovery system (Ecopump) for heating has been developed. An overview to the prototype design, heat transfer model, experimental parameters and environmental feasibility is discussed. The variation of MATLAB modelling results followed the same regularity as the experimental results. The MATLAB model along with Revit has been used to simulate the Ecopump's performance when installed in a sustainable house in the UK. From the calculation, Ecopump can provide 670 kWh heating energy and reduce 90.6 kg CO2 emissions per year. The proposed Ecopump system combined with window frame could be a promising technology to enhance space heating for domestic buildings while reducing energy consumption during daily ventilation. Further in situ experiments should be conducted to explore its comprehensive performance in the future. [ABSTRACT FROM AUTHOR]

Matched sampling methodology (MSM) has been used in remittance studies to understand remittance transfers. However, a detailed examination of the role of trust as a central element in producing reliable and valid research conclusions when a matched sample methodology is used has been missing in the literature. This paper fills this lacuna by arguing that cultivating trust in matched sampling research on remittance transfers, a sensitive subject matter, between African immigrants and their relatives presents a more nuanced narrative of remittance transfers. This approach shows that not only do African immigrants in the 'Global North' send remittances back home, but immigrants also receive remittances (reverse remittances) from their relatives on the continent. Using remittance research conducted among Ghanaian immigrants in the UK and their relatives in Ghana, this article identifies three 'avenues of trust'—'public avenues of trust', 'intermediate avenues of trust', and 'private avenues of trust'—to highlight the processes and challenges that researchers encounter while establishing contact with research participants and the role that trust plays in gathering accurate information. Focusing on the role of trust in MSM is in line with recent theoretical paradigms of remittance research that call for soliciting information from both origin and destination countries. [ABSTRACT FROM AUTHOR]

Introduction: Patient recollection of details discussed during medical consultation is often limited (Figure 1a). For genital gender-affirming surgery (gGAS) consultations, lengthy discussions and deep contemplation surrounding surgical options are critical. Inadequate communication can result in patient complaints and medico-legal action, whereupon issues such as a lack of discussion or poor documentation can lead to medico-legal liability against the care provider and hospital system. As a result, strategies must be developed to ensure that information discussed during complex medical consultations are made available so patients can properly weigh out the care options presented. Objective: 1) Assess medico-legal incidents in Urologic and surgical specialties in the UK, US, and a Californian quaternary care center, 2) evaluate the advantages and feasibility of offering audio-recordings of patient consultations, and 3) create a user-friendly smartphone app for recording healthcare consultations. Methods: A literature review evaluated current evidence on medical liability claims in the UK and US was conducted. Additionally, our center's Department of Risk Management provided information pertaining to medico-legal cases against our institution. Separately, gGAS patients consented to audio-record their consultation. Copies were provided to patients and kept in their medical records. A follow-up survey assessed its usefulness, and based upon patient feedback, a smartphone application was developed. Results: A PubMed search yielded 921 results on "medical malpractice claims" from 2013-2023. In Urologic Surgery, 32 papers addressed medical malpractice, with 2 providing data over the last 15 years. In the UK, 660 claims were made from 2010-2020, of which 8.2% were due to poor communication (37 = informed consent; 17 = lack of follow-up). In the US, from 2020-2022, 38.3% of Urologists faced at least one legal proceeding in their career, and 5.3% were sued within 1 year for any reason. Our institution's Department of Risk Management reported 32% of lawsuits were related to surgical care. Informed consent involved 8% of cases and had a component in 32%. The average financial settlement for medical malpractice was $125,000.00 USD, and trial costs averaged $75,000.00 USD. 50/71 patients completed an anonymized, online survey post-audio recording. Positive results were noted regarding recording quality, comfort whilst being recorded, and wishes for future consultation recordings (Figure 1b). In addition, most patients felt less anxiety, and had greater confidence in their treatment choice (Figure 1c) Based upon patient responses, we developed a smartphone App which records 90 minutes of audio, allows for file and hyperlink attachments to be sent to patients before immediately deleting all information (Figure 1d). Routine use of audio-recordings led to a reduction in patient queries to our office. Conclusions: Routine audio recording of patient consultations provides significant benefits with minimal cost to providers. As per our institution's Office of Risk Management, it offers protection against medico-legal risks. Adequate discussion, good documentation and providing adjuncts for patients can help prevent a large proportion of medicolegal complaints in addition to optimizing patient care. Considering that patients face similar challenges across different disciplines and regions, a larger study (multi-center, international, multi-language) is warranted. Disclosure: No. [ABSTRACT FROM AUTHOR]

This paper analyses promissory discourse for genome editing and human health in the UK, attending to the articulation of public goods and their beneficiary publics. Focusing on promissory reasoning about an emerging technology field as anticipatory and ethical considerations as integral to such debates, the notion of ethical regime as a mode of governance is applied to the concept of promissory regime. By analyzing key documents and interviews with opinion leaders—thus focusing on the discursive dimension—an enabling promissory ethical regime for genome editing and its contestation are identified. This regime posits scientific knowledge production now, and improved treatment or prevention of hereditary diseases later, as key goods of genome editing for human health and as a sociotechnical project worthy of support. Specific publics are created as beneficiaries. These publics and goods play out as ethical rationales for the promissory governance of the emerging field of human genome editing. [ABSTRACT FROM AUTHOR]

With the development of genome-wide association studies, how to gain information from a large scale of data has become an issue of common concern, since traditional methods are not fully developed to solve problems such as identifying loci-to-loci interactions (also known as epistasis). Previous epistatic studies mainly focused on local information with a single outcome (phenotype), while in this paper, we developed a two-stage global search algorithm, Greedy Equivalence Search with Local Modification (GESLM), to implement a global search of directed acyclic graph in order to identify genome-wide epistatic interactions with multiple outcome variables (phenotypes) in a case–control design. GESLM integrates the advantages of score-based methods and constraint-based methods to learn the phenotype-related Bayesian network and is powerful and robust to find the interaction structures that display both genetic associations with phenotypes and gene interactions. We compared GESLM with some common phenotype-related loci detecting methods in simulation studies. The results showed that our method improved the accuracy and efficiency compared with others, especially in an unbalanced case–control study. Besides, its application on the UK Biobank dataset suggested that our algorithm has great performance when handling genome-wide association data with more than one phenotype. [ABSTRACT FROM AUTHOR]

Objective Real-world secukinumab gastrointestinal-related adverse events (GIRAE) data during treatment for AS and PsA are lacking. We aimed to obtain this through baseline evaluation of pre-existing IBD rates and predictors of GIRAE. Methods Patient electronic and paper records commencing secukinumab from 10 UK hospitals between 2016 and 2019 were reviewed. GIRAE after initiation were defined as: definite [objective evidence of IBD (biopsy proven), clear temporal association, resolution of symptoms on drug withdrawal, no alternative explanation felt more likely], probable (as per definite, but without biopsy confirmation) or possible (gastrointestinal symptoms not fulfilling definite or probable criteria). Results Data for all 306 patients started on secukinumab were analysed: 124 (40.5%) AS and 182 (59.5%) PsA. Twenty-four of 306 (7.8%) experienced GIRAE after starting secukinumab. Amongst patients who developed GIRAE, four (1.3%) had definite, seven (2.3%) probable and 13 (4.2%) possible IBD. All definite cases were patients with AS and stopped secukinumab; two had pre-existing IBD and two (0.7%) were de novo cases of which one required surgical intervention. Seven patients (2.3%) had pre-existing diagnoses of IBD prior to initiation, of which five patients experienced GIRAE. Conclusion Absolute rates of new IBD in patients starting secukinumab are low. The majority of patients developing new GIRAE did not develop objective evidence of IBD or stop therapy. For patients with pre-existing IBD and AS the risk of GIRAE is much higher, and prescribing alternatives should be considered. [ABSTRACT FROM AUTHOR]

Today's technological frontrunners are tomorrow's economic champions. In order to triumph in the global innovation race, nations go to great lengths to boost domestic innovation. An increasingly popular instrument of such government support is known as the 'R&D tax incentive'. Scholars have particularly noted its greater incentive impact on small- and medium-sized enterprises (SMEs). However, correct use of this fiscal tool remains clouded by legal and economic complexities, often leading to misallocation of tax money. This study draws on the rich experience of the UK as a seasoned lawmaker in this field, to derive internationally transferrable policy lessons and principles that may be used in assessing and optimizing the potency of research and development tax incentives for SMEs. Following a theoretical analysis of the historical legal developments, annual government statistics, literature, and policy papers, this study argues that policymakers must take into account appropriateness, cost-efficiency, and accessibility in the design. [ABSTRACT FROM AUTHOR]

Orthopaedic surgeons have a responsibility to minimise risks of ionising radiation to patients, themselves and staff. This study aims to establish the understanding of radiation practice, legislation and risk by orthopaedic surgeons. A nationwide online survey of UK-based orthopaedic surgeons was conducted. Participants answered 18 multiple-choice questions assessing level of radiation safety training, basic principles/knowledge of ionising radiation, relevant legislation and operating practice. A total of 406 surgeons completed the survey. 92% reported using intraoperative ionising radiation at least once per week. 38% received no formal training on radiation safety. Knowledge of basic principles of radiation and legislation was limited. There was variable knowledge when labelling an image intensifier machine and choosing its safest orientation. Poor uptake of radiation protection equipment was noted. Only 19% agreed they had adequate training in ionising radiation safety and 27% reported receiving adequate training in equipment emitting ionising radiation in the operating theatre. Many orthopaedic surgeons in the UK do not believe they are adequately trained in radiation safety. There is a deficiency amongst practicing surgeons in basic knowledge, relevant legislation and practicalities of the use of ionising radiation in the operating room. This could potentially put patients and health-care professionals at additional risk. We recommend that a standardised national training programme on the basic principles and safety of ionising radiation is implemented for all practicing orthopaedic surgeons. This paper is the first UK national survey amongst orthopaedic surgeons and is one of the largest reported internationally. [ABSTRACT FROM AUTHOR]

Introduction process evaluations (PE) are increasingly used in parallel with randomised controlled trials (RCT) to inform the implementation of complex health interventions. This paper explores the learning accrued from conducting a PE within the Falls in Care Homes Study (FinCH), a large UK RCT. Methods in the FinCH study, six purposively sampled care homes provided data for the PE, which followed a realist approach. In this study researchers kept written diaries of their experiences in completing the interviews, focus groups and observations. We have reflected on these and present the main themes for discussion. Findings care home staff were enthusiastic to participate in the PE but researchers found it difficult to collect data due to staff not having time to take part, environmental factors such as no space for focus groups and low levels of research understanding. Researchers found that the expectations of the PE protocol were often unrealistic due to these limitations. Flexible and pragmatic approaches such as interviews in place of focus groups enabled data collection but required a reduced sample size and length of data collection to be accepted by researchers. Conclusion to enable care home staff to participate in successful PEs, researchers should build flexibility into research schedules, spend time building trust, collaborate with all levels of care home staff prior to data collection, increase research capacity in care home staff and co-design research projects. [ABSTRACT FROM AUTHOR]

Neither the idea that Britain 'stood alone' in 1940, nor that the British war was a 'people's war', were at all common during the Second World War. If anything was thought to be 'alone', it was the empire, though the more common view was that the empire always had allies. 'People's war' was a rare synonym for 'total war' and was sometimes used in an internationalist sense of a war of many peoples, and as the sort of war Britain should be, but was not, fighting. However, from 1945 a national 'alone' came into usage, for example by Churchill; but only from the 1960s was it a commonplace in history books. 'People's war' became more widely used in histories written in the 1960s, which defined it in a national progressive sense, although the term did not become common until the 1990s. Both ideas were essentially the creations of historians, who nationalised the history of what was an imperial and internationalist war, often turning it into a radically different domestic story focused on a national Home Front (ignoring the many imperial home fronts), a story which marginalised the military, foreign and political history of the war, and indeed the social history of the military as well. Historians later assumed that 'alone' and 'people's war' represented wartime nationalist ideologies, and wrote about them critically. Yet until recently they did not recognise that it was the very particular nature of the histories written in the 1960s which had generated these terms, and which embodied very particular analyses of British history and of the Second World War. The paper ends by arguing that much greater understanding is needed of the core assumptions which lie beneath the historiography of twentieth-century Britain. [ABSTRACT FROM AUTHOR]

Background dementia policy suggests diagnosing dementia early can reduce the risk of potentially harmful hospital admissions or emergency department (ED) attendances; however, there is little evidence to support this. A diagnosis of mild cognitive impairment (MCI) before dementia is a helpful proxy to explore early diagnosis. This study investigated the association between an early diagnosis of dementia and subsequent hospitalisations and ED attendances. Method a retrospective cohort study of electronic health care records from 15,836 patients from a large secondary care database in South London, UK. Participants were divided into two groups: those with a diagnosis of MCI before dementia, an early diagnosis, and those without. Cox regression models were used to compare the risk of hospitalisation and ED attendance after dementia diagnosis and negative binomial regression models were used to compare the average length of stay and average number of ED attendances. Results participants with an early diagnosis were more likely to attend ED after their diagnosis of dementia (HR = 1.09, CI = 1.00–1.18); however, there was no difference in the number of ED attendances (IRR = 1.04, CI = 0.95–1.13). There was no difference in the risk of hospitalisation (HR = 0.99, CI = 0.91–1.08) or length of stay between the groups (IRR = 0.97, CI = 0.85–1.12). Conclusion the findings of this study do not support the assumption that an early diagnosis reduces the risk of hospitalisation or ED attendance. The patterns of health service use in this paper could reflect help-seeking behaviour before diagnosis or levels of co-morbidity. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide Open in new tab Download slide OBJECTIVES We sought to provide further evidence on the safety and efficacy of aortic valve neocuspidization (AVNeo) using autologous pericardium in adult patients with aortic valve disease by reporting clinical and echocardiographic results from the first UK experience and performing a meta-analytic comparison with other biological valve substitutes. METHODS We reported clinical and echocardiographic outcomes of 55 patients (mean age 58 ± 15 years) undergoing AVNeo with autologous pericardium in 2 UK centres from 2018 to 2020. These results were included in a meta-analytic comparison between series on AVNeo (7 studies, 1205 patients, mean weighted follow-up 3.6 years) versus Trifecta (10 studies, 8705 patients, 3.8 years), Magna Ease (3 studies, 3137 patients, 4.1 years), Freedom Solo (4 studies, 1869 patients, 4.4 years), Freestyle (4 studies, 4307 patients, 7 years), Mitroflow (4 studies, 4760 patients, 4.1 years) and autograft aortic valve (7 papers, 3839 patients, 9.1 years). RESULTS In the present series no patients required intraoperative conversion. After mean follow-up of 12.5 ± 0.9 months, 3 patients presented with endocarditis and 1 required reintervention. The remaining patients had absent or mild aortic valve insufficiency with very low peak and mean transvalvular gradients (16 ± 3.7 and 9 ± 2.2 mmHg, respectively). Meta-analytic estimates showed non-significant difference between AVNeo and all but Magna Ease valves with regards to structural valve degeneration, reintervention and endocarditis. When compared Magna Ease valve, AVNeo and other valve substitutes showed an excess of valve-related events. CONCLUSIONS AVNeo is safe, associated with excellent haemodynamic profile. Its midterm risk of valve-related events is comparable to most biological valve substitutes. Magna Ease is potentially the best biological choice as far as risk of reintervention is concerned. [ABSTRACT FROM AUTHOR]

Telecare technologies support people to live in the community safely. In the UK, the existing analogue telephone services for telecare will be switched off by 2025, as the telecommunications infrastructure is upgraded to digital connectivity. Internationally, analogue telephone services are also being decommissioned. The shift from analogue to digital presents a rare and major opportunity for new digital solutions that address current issues with adoption and use of telecare. This paper describes a user-centred study to design innovative digital telecare concepts. The main contributions are as follows: findings from user engagement activities, which identified issues that may be more important and less important to users; the synthesis of ideas generated through the design process, which identified four themes for future work in the field–community-based support, telecare you do not wear or notice, expand the use of telecare and introduce telecare earlier; and seven concept designs that illustrate how the themes could be approached. [ABSTRACT FROM AUTHOR]

Collecting sensitive data using surveys is one of the most challenging tasks facing survey methodologists as people may choose to answer questions untruthfully to present themselves in a positive light. In 2014, Mneimneh et al. proposed mixed Rasch models to detect socially desirable answering behaviors. This approach combines item response theory models with latent class analysis to differentiate substantive and biased answering patterns. Their results identified two latent classes, one of which was consistent with socially desirable answering. Our aim is to expand their approach to detecting social desirability by using a mixture confirmatory factor analysis (CFA) in round 7 of the European Social Survey. First, we attempt to estimate social desirability in three constructs separately (RQ1): effect of immigration on the country, allowing people to come in the country and social connection, using a mixture CFA. We then extend the analysis by (RQ2) introducing constraints between the latent classes, (RQ3) combining different constructs in one model, and (RQ4) comparing results in Belgium and the United Kingdom. In contrast with the paper published by Mneimneh et al. in 2014, the models with two latent classes do not have the best model fit. In addition, validation with the presence of a third person, the respondent's reluctance to give answers and personality traits are not systematically in line with our expectations. A small simulation shows that the method would work if the data would behave as we expect, with social desirability being the main factor influencing answering patterns. We conclude that a mixture CFA might not be able to identify social desirability in different survey contexts, especially in complex data as originating in cross-national social surveys. [ABSTRACT FROM AUTHOR]

Objective The aim of this paper is to present a UK-based consensus of principles and recommendations to guide rheumatology US training and practice. Method A Delphi process was conducted involving 19 US experts representing each of the 14 regions of the UK. A working group of experienced British Society for Rheumatology Ultrasound Special Interest Group (BSRUSSIG) members made seven proposals that were presented to the whole group for further discussion. This resulted in minor modifications and seven preliminary recommendations. Members were then asked to anonymously agree or disagree with each recommendation using an electronic ballot. A threshold of 75% was used to determine consensus agreement. Results were collated by an independent chairperson and presented to the BSRUSSIG in a face to face meeting where agreement for each recommendation was ratified and an action plan agreed for dissemination of the results and future development work. Results Using a validated process, experts in rheumatology US have worked through an iterative process and have unanimously agreed seven recommendations for rheumatology training and practice. These cover a hierarchy of practice indications, education and training, including the need for practitioners to demonstrate lifelong learning, as well as a commitment to support mentors and trainers through the BSRUSSIG. Conclusion These are the first specific education and practice recommendations for rheumatology US in the UK and have been developed and endorsed by the BSRUSSIG. We intend that these proposals will help to support and validate rheumatology US practice and inform the development of future rheumatology training curricula and education programmes. [ABSTRACT FROM AUTHOR]

The paper examines asylum seekers' perceptions of the prohibition to work policy through the lens of burden(s). Drawing from individual interviews with asylum seekers and key informants and group discussions, the findings show the multiple—economic, social, and emotional—burdens that the prohibition to work inflicts on asylum seekers and problematizes the static understanding of burdens to reveal the processes of 'becoming' a burden on others. A comparison of enforced joblessness and undocumented work highlights the benefits of being able to work, even when this is risky, and the different burdens associated with the choice to not work, and consequently experience forced unemployment, or to break the rules and work in the undocumented sector. The concept of the burden paradox highlights the inconsistencies between the UK government's goal to minimize burdens for asylum seekers and the host society and its policy implementation that increases them for both. [ABSTRACT FROM AUTHOR]

References 1 Raahimi M, Sheppeard R, Livesey A. Monitoring for methotrexate induced liver fibrosis in many UK dermatology centres is out of date and needs reform. Comment on: 'Monitoring for methotrexate-induced liver fibrosis in many UK dermatology centres is out of date and needs reform' Dear Editor, I read with great interest the recent paper by Raahimi I et al i . in I Clinical and Experimental Dermatology i on the subject of noninvasive monitoring for methotrexate-induced liver fibrosis.1 The British Association of Dermatologists (BAD) guidelines, which advocate monitoring of Type III procollagen peptide (PIIINP) in patients taking methotrexate, are out of alignment not just with the British Society of Gastroenterology (BSG)2 but also with the European Association for the Study of the Liver (EASL)3 and the American Academy of Dermatology (AAD)4, all of which recommend serial measurement of the Fibrosis (Fib)-4 score for patients at risk of liver fibrosis. [Extracted from the article]

Background: In the first wave of COVID-19, the UK Government relied heavily on digital channels to provide information to the public. This disproportionately excluded older people - one of the groups with least access to (or experience of) using the internet. Approximately 11.5 million people in the UK lack digital skills and 4.8 million people never go online, with around half (51%) of these being aged over 65. The Greater Manchester (GM) response was to work collaboratively with a number of key Ageing groups to develop Keeping Well at Home, a booklet providing evidence based health and wellbeing information and advice for older people during COVID-19 restrictions. Methods: An evaluation of the booklet was undertaken during summer 2020 by the Healthy Ageing team at the Applied Research Collaboration GM. As national restrictions on movement remained in place at the time, a postal questionnaire was distributed to a sample of older adults in GM. Results: Nearly 500 questionnaires were returned. The response was overwhelmingly positive; 92% found the information helpful; 90% agreed the booklet would help older people stay healthy during lockdown; 74% had used the home exercises section; 78% found the tips for keeping their mind well helpful. Around 50% of respondents did not have internet access. Paper based resources was the preferred choice for 92% of respondents with only 6% opting for digital versions. Conclusions: The evidence from the evaluation challenges the growing trend towards communicating just through digital channels, and emphasises the need for tailored paper-based materials for older adults. The Keeping Well at Home booklet also shows the value of working with older adults to ensure the content and design are inviting to readers. Information, support and services must be made available in an offline equivalent and proactively disseminated to reach those who otherwise would not have access to it. Key messages: Print-based communications are preferred over digital for some groups; ensuring inclusivity is critical as the ‘digital by default’ approach excludes large numbers of our population. Including target group representatives as co-editors to advise on content and stylistic design is key to ensure content is relevant and useful. [ABSTRACT FROM AUTHOR]

Background Intake of macronutrients and its components are associated with mortality and morbidity. Isocaloric substitution analysis is a tool to examine how changing the source of energy intake (e.g. from saturated to monounsaturated fat) is associated with health. However, conventional methods assume linearity, which may be untrue in many cases. This paper presents a nonlinear alternative, using UK Biobank data as an example data set. Methods Nonlinear isocaloric substitution analysis was conducted using penalised cubic splines in Cox proportional hazard models. In the UK Biobank, 195,658 participants completed at least one dietary questionnaire and were included in the analyses. Diet was assessed using the Oxford WebQ, a web-based 24-hour recall questionnaire. Prospective all-cause mortality was derived from on linked death records. Results More than half of the associations between macronutrient intake and all-cause mortality were nonlinear. Nonlinear isocaloric substitution analysis provides effect sizes conditional on the current intake, while conventional analysis provides an average over the whole range of intake. For example, conventional isocaloric substitution estimated no effect of replacing sugar with starch. However, the nonlinear method revealed that replacing sugar with starch was associated with a higher risk when the current starch intake was greater than 30% of total energy, and with a lower risk when current intake was less than 25%. Conclusions Nonlinear isocaloric substitution provides an alternative to conventional isocaloric substitution analysis when the underlying association is nonlinear. Key messages Nonlinear associations are common in nutritional epidemiology. In such cases, nonlinear isocaloric substitution analyses should be used. [ABSTRACT FROM AUTHOR]