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This paper analyzes a UK-based psychoeducational intervention for users of online child sexual exploitation material (CSEM). It is founded on 17 months of anthropological research in group programs with 81 participants and 15 staff. The article argues that group exercises help participants reframe knowledge about their offending, and ultimately reinforce the theoretical concept of discipline (Foucault) toward internal and external surveillance, normalization, and decreased risk. The paper first discusses factors participants believed contributed to offending. It then analyzes the program and participants' experiences, focusing on exercises about the mind (fantasy), Internet usage (disclosure and relationships), needs met by offending (Good Lives and true needs), and planning for the future (relapse prevention). Critical is that participants are encouraged to reengage offline lives and enact discipline on and to the online world. Thus, the article ends with an anthropologically-minded discussion about digital norms, online morality, and implications for Internet offender psychoeducational practice. [ABSTRACT FROM AUTHOR]

This research presents the results of a study about people with failed metal-on-metal hip implants, and draws on the STS concept of the technological imperative alongside research on the value of patient knowledge in clinical settings and the legitimacy of embodied stories. Popularly understood as positive and life changing, hip replacement surgery was hailed as 'the operation of the century', until a series of widespread failures of hundreds of thousands of hip implants, known collectively as metal-on-metal (MoM) hips, drew attention to the poor regulation of medical implants. This paper argues that poor regulation intersects with narratives of patients' pain, which are obstructed by surgeons and the UK regulatory body, with the effect of denying both patients' embodied experiences of implant failure, and their restitution to good health. Patient narratives about problems with their hip implant are the wellspring from which scientific evidence emerges which can indicate widespread implant failure. By obstructing these narratives the regulatory system undermines the very evidence it needs to operate effectively. [ABSTRACT FROM AUTHOR]

Scholars have been increasingly concerned with portrayals of terrorism in mainstream and alternative media outlets following the September I I and subsequent terrorist attacks in the United Kingdom and Spain. Communication researchers have examined public response and reaction to terrorist attacks, definitions of terrorism, policy questions, media portrayals of terrorism, and framing across different media and nations.This study undertakes a comparative framing analysis of media coverage of terrorism, as reported by prominent U.S. and U.K. newspapers, combining quantitative and qualitative methods. Findings revealed that the U.S. papers engaged in more episodic coverage and the U.K. papers in more thematic coverage of terrorism and terrorism-related events. The U.S. papers were consumed with presenting news associated with the military approach, whereas the U.K. papers were oriented toward diplomatic evaluations of terrorist events. [ABSTRACT FROM AUTHOR]

This article maps and compares four universities' policies and procedures for addressing faculty and staff sexual misconduct in higher education in the UK and US. While universities have engaged in significant work to grapple with student-student sexual misconduct, attention to misconduct perpetrated, and experienced, by higher education employees is relatively nascent. In this paper, we explore the maze of institutional processes and actors that victimsurvivors of FASSM might encounter. We describe what is known about prevalence of FASSM in the US and UK and offer an overview of the policy landscape in both settings. Inspired by Patricia Yancey Martin, we analyze publicly available policy documents on FASSM from two US and two UK universities and map out visually the range of investigative, reporting, and sanctioning processes. We introduce an analytic distinction between an actor and a practitioner within the FASSM context, whereby actors are those tasked with administrative duties in handling sexual misconduct reports, while practitioners are those with specialized knowledge and training that enables them to prioritize victim-survivor needs. These illustrative diagrams suggest that while university employees are tasked to act on reports and disclosures of sexual misconduct, it is difficult to identify specialist practitioners with expertise to support victim-survivors of FASSM. Ultimately, this work provides a deeper understanding of what practice looks like in relation to higher education FASSM, and we outline implications for future research directions. [ABSTRACT FROM AUTHOR]

Non-adherence to assigned treatment is a common issue in cluster randomised trials. In these settings, the efficacy estimand may also be of interest. Many methodological contributions in recent years have advocated using instrumental variables to identify and estimate the local average treatment effect. However, the clustered nature of randomisation in cluster randomised trials adds to the complexity of such analyses. In this paper, we show that the local average treatment effect can be estimated via two-stage least squares regression using cluster-level summaries of the outcome and treatment received under certain assumptions. We propose the use of baseline variables to adjust the cluster-level summaries before performing two-stage least squares in order to improve efficiency. Implementation needs to account for the reduced sample size, as well as the possible heteroscedasticity, to obtain valid inferences. Simulations are used to assess the performance of two-stage least squares of cluster-level summaries under cluster-level or individual-level non-adherence, with and without weighting and robust standard errors. The impact of adjusting for baseline covariates and of appropriate degrees of freedom correction for inference is also explored. The methods are then illustrated by re-analysing a cluster randomised trial carried out in a specific UK primary care setting. Two-stage least squares estimation using cluster-level summaries provides estimates with small to negligible bias and coverage close to nominal level, provided the appropriate small sample degrees of freedom correction and robust standard errors are used for inference. [ABSTRACT FROM AUTHOR]

Projections of both the short- and long-term course of the variant Creutzfeldt-Jakob disease (vCJD) epidemic in Great Britain have demonstrated great uncertainty due to the lack of knowledge of key aspects of the biology and epidemiology of this new disease. Such projections are sensitive to assumptions made regarding the pattern of exposure to BSE-infected animals, the effectiveness of control measures introduced in 1989 and 1996 in reducing this exposure, the functional form of the incubation period distribution and patterns of age-dependent susceptibility/exposure. This paper provides short-term projections for vCJD onsets using the time- and age-distributed onset data to the end of 2000, with results that are directly comparable to the other papers in this issue. These results demonstrate the continued uncertainty in the future scale of this disease. [ABSTRACT FROM AUTHOR]

Perfectionism is a multidimensional personality trait with two higher-order dimensions; perfectionistic strivings and perfectionistic concerns. The purpose of the present study was to explore and evaluate the two-factor model for the first time using three instruments developed to measure perfectionism in sport. In doing so, we (i) assessed the fit of two-factor models when including and excluding various contentious subscales (other-oriented perfectionism, parental pressure, coach pressure, organisation, and negative reactions to imperfection) and (ii) compared two-factor models to alternative one-factor (or unidimensional) models. Participants were recruited from community and university sports clubs in the UK (N = 527; M age = 18.07 years, SD = 0.49) and completed the Sport-Multidimensional Perfectionism Scale-2, the Multidimensional Inventory of Perfectionism in Sport, and the Performance Perfectionism Scale-Sport. Support was found for the two-factor model, with superior fit displayed each time the aforementioned subscales were excluded and, in all cases, when compared to a unidimensional model. The findings suggest that the two-factor model is an adequate representation of the underlying structure of instruments designed to measure perfectionism in sport with better fit and conceptual clarity offered by more parsimonious models. [ABSTRACT FROM AUTHOR]

Introduction: Parent/carers of disabled children want timely and personalized support. Research suggests that technology may address some limitations associated with traditional methods of communication with therapists (e.g. letter, telephone). This exploratory study examined United Kingdom (UK) parents and carers views on the use of digital technology (i.e. computers/phones) in supporting their child and the potential for its greater use in the care of children with complex needs. Methods: An online survey was distributed via special schools and support forums/networks. Questions explored use of and attitudes to digital technology in the care of children with complex needs. Descriptive statistical analyses and content analyses were undertaken on the data. Results: Respondents were 43 parents/carers whose children used rehabilitation services prior to the COVID-19 pandemic. The majority used digital technology frequently to support their child and saw the potential for greater use in rehabilitation services – provided this was not at the expense of in-person therapist contact. Conclusion: Parents and carers held positive views of digital technology as a tool to support their child and enhance rehabilitation services. Recommendations include regular service consultation on parental/child attitudes to digital service delivery and longitudinal studies to assess related health outcomes. [ABSTRACT FROM AUTHOR]

Anderson Gray McKendrick's 1926 paper, 'Applications of mathematics to medical problems', was the earliest reference cited in Dempster et al.'s 1977 paper that defined and popularized the EM algorithm. McKendrick's paper was prominently featured by Joseph Oscar Irwin in his 1962 inaugural address as the President of the Royal Statistical Society (in the UK), entitled 'The place of mathematics in medical and biological statistics'. The link of McKendrick's work to the EM algorithm is due to an improvement made by Irwin on a novel method McKendrick used for estimating an infection rate when the observed data do not distinguish between those individuals who are not susceptible to the infection and those who are susceptible, but do not develop symptoms. This article examines this link, along the way illustrating the central ideas underlying the EM algorithm as well as its properties; the examination also suggests a profiling strategy for speeding up EM, which may be worthy of general investigation. McKendrick's data on an epidemic of cholera are used for illustration and to compare EM with Irwin's method as well as the Newton-Raphson algorithm. Issues beyond computation are also discussed whenever appropriate. [ABSTRACT FROM AUTHOR]

Research was conducted on the steady-state heat loss of dwellings, as quantified by U-value assessment, to provide an appraisal with a range of factors that may impact energy performance and environmental behaviour. The study consisted of 50 houses built between 1915 and 2015 and 50 from pre-1915 identified as traditional construction. All were Scottish homes, and some were in poor condition. This paper finds that there is a close correlation between U-values of components and the age of a property and its energy efficiency. It also finds that the U-values of elements of houses built after 1985 increased more rapidly. It is considered that for older homes, there was less improvement/change on U-values. It is concluded that using renewable energy systems and sustainable technologies are necessary for old houses to meet Level 6 of the code for sustainable homes in the UK. A trend of U-value reduction with wall thickness was observed, but no simple correlation could be determined and each circumstance identified which materials could be applied to best effect. [ABSTRACT FROM AUTHOR]

Breathing is the activity which all forms of animated life share in common. The breath has been symbolised across cultures as the meaning of life itself. If breathing is imagined as life, gassing is the very opposite. Gassing is the intended (or unintended) means to prevent or obstruct breathing. Perhaps it is for this reason that the Nazi concentration camps are remembered as expressions of technological as much as metaphysical terror. The 2013 and 2017 Syrian chemical attacks show how gassing remains a ‘red line.’ This paper deals with the historical significance and complexity of air and breathing in law. Human dependency on the air has in early treaties been protected at times of war between ‘civilised’ nations but was exploited as an instrument against the breather during colonialism. Today, non-lethal-weapons, a more-than-technical term, are used extensively to discipline the biological body into political order. Engaging with the work of Foucault, Sloterdijk and others, I seek to make sense of the legal status of this contradictory political technology, which does not directly attack the body but rather conditions the atmospheric requirements for its animation. I argue for a move towards understanding law atmospherically as an extension of the body. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this clinical audit was to assess patient demographics, outcomes and experience with care in patients who received acupuncture in a private practice setting in the United Kingdom. Methods: Demographic and clinical data were extracted from patients' records over a 7-year period. The Measure Yourself Medical Outcomes Profile (MYMOP) questionnaire and an adapted Patient Global Impression of Change (PGIC) scale were used routinely to monitor patient outcomes over an 18-month period. Finally, a retrospective questionnaire was used to assess patient beliefs regarding treatment effectiveness, adverse events and overall experience with care. Patients not providing consent or known to be deceased were excluded. Results: Data were collected for 306 patients presenting with 376 separate health complaints, 58% of which were musculoskeletal. Follow-up outcomes (MYMOP scores (n = 51) and PGIC scale responses (n = 50)) showed a clinically significant improvement compared to baseline for the majority of health complaints (93% of PGIC scores were 'improved' and 79% MYMOP demonstrated > 1 point change). Total mean MYMOP severity scores were reduced by almost 50% (p < 0.001) after 1–4 weeks, and this was sustained in the medium-to-long term. There was a strong negative correlation (r = −0.767, p < 0.001) between the MYMOP and PGIC scores. A total of 118 health complaints were reported by 85/255 patients who responded to a retrospective questionnaire. Over 84% of patients believed that the treatments they received were 'effective' at addressing their health complaints. Seven minor adverse events were reported and four patients experienced negative treatment outcomes. Conclusions: Although musculoskeletal conditions were the most common, this audit found that patients sought treatment for a wide range of predominantly chronic health complaints, for many of which there is a currently a lack of quality evidence to support the use of acupuncture. Overall, the small sample of patients who responded to outcome questionnaires reported clinically meaningful and sustained improvements. [ABSTRACT FROM AUTHOR]

Introduction: The top 10 priorities for occupational therapy research in the United Kingdom were identified via a priority setting partnership and published in 2020. This study aimed to evaluate utilisation of the top 10 priorities since 2020 and identify recommendations to re-focus research efforts. Method: A mixed methods approach involving evidence checking and stakeholder consultation was undertaken. Direct and selective methods were used to recruit stakeholders, including previous steering group members, who were invited to take part in 30-minute semi-structured interviews. Results: Eighty-one evidence sources were included and addressed the research priorities 127 times. Stakeholders (N = 7) discussed the top 10 priorities in relation to five key themes: (1) what has been done; (2) the most addressed priorities; (3) the least addressed priorities; (4) barriers to using the priorities (three barriers emerged); and (5) what should be done next (six strategies emerged). Conclusion: There was strong agreement that research priority 1 (how does occupational therapy have an impact and make a difference on everyday lives?) was the most addressed; however, all research priorities require more attention. Recommendations to refocus research efforts included continuing to support priority-driven research and greater promotion of the priorities. [ABSTRACT FROM AUTHOR]

Introduction: This study explored treatment of executive functioning impairment in adults after acquired brain injury (ABI), clinician's confidence and support received, in a sample of occupational therapists in the United Kingdom. Methods: A 24-item online questionnaire was sent to 750 members of the Royal College of Occupational Therapists Specialist-Section in Neurological Practice. Data was collected at a nominal and ordinal level and included yes/no Likert-type scale and free field comments. Descriptive statistical analysis was completed. Results: Seventy-six occupational therapists working in a range of neurological settings completed the survey. Frequently used interventions included education (n = 57, 75%), task modification (n = 56, 73%), instrumental activities of daily living (ADL) (n = 54, 71%), personal ADL (n = 53, 70%) and goal setting (n = 53, 70%). Seventy-one percent used metacognitive strategies. Occupation-based metacognitive approaches were rarely used. Thirty-one (41%) participants reported being fairly confident and 28 (37%) were very confident. Support for clinical practice was accessed most frequently through joint clinical sessions (n = 30, 39%). Findings: Participants used various clinical interventions to treat service users with executive dysfunction after ABI. Meta-cognitive strategies were employed; however, occupation-based metacognitive approaches were infrequently utilised, suggesting uncertainty in adopting these in practice. The need for further training on evidence-based interventions and knowledge translation support was highlighted. [ABSTRACT FROM AUTHOR]

International trade poses a serious and growing threat to biosecurity through the introduction of invasive pests and disease: these have adverse impacts on plant and animal health and public goods such as biodiversity, as well as food production capacity. While international governmental bodies such as the World Trade Organization (WTO) recognise such threats, and permit governments to protect human, animal, and plant life or health, such measures must not be applied in a way that is restrictive to trade. This raises a fundamental (but little-examined) tension between effective biosecurity governance and the neoliberal priorities of international trade. In this paper we examine how such tensions play out in the different political and geographical contexts of Australia and the United Kingdom. A comparative approach enables close scrutiny of how trade liberalisation and biosecurity are coconstituted as compat-ible objectives as well as the tensions and contradictions involved in making these domains a single governable problem. The comparative analysis draws attention to the policy challenges facing Australia and the UK in governing national biosecurity in a neoliberal world. These challenges reveal a complex geopolitics in the ways in which biosecurity is practised, institutionalised, and debated in each country, with implications for which pests and diseases are defined as threats and, therefore, which commodities arc permitted to move across national borders. Despite efforts by the WTO to govern biosecurity as a technical matter of risk assessment and management, and to harmonise national practices, we contend that actual biosecurity practices continue to diverge between states depending on perceptions of risk and hazard, both to agricultural production and to rural environments as a whole, as well as unresolved tensions between internationalised neoliberalism and domestic concerns. [ABSTRACT FROM AUTHOR]

This paper analyses the legal protection of the journalist–source relationship from both sides and the underlying interests involved. The paper begins by analysing why the relationship deserves protection. The position of journalists at common law is analysed with a discussion of the application of the principle established in Norwich Pharmacal v Customs and Excise to journalists. The development of immunity from contempt in s. 10 of the Contempt of Court Act 1981 is examined to illustrate the ideological clash between the judiciary and journalists. The impact of the Human Rights Act and decisions of the European Court of Human Rights are analysed to assess whether this will lead to a change in attitudes in the UK. Finally, the potential threat to journalists posed by compelled evidentiary disclosure in criminal cases is reviewed, with a particular look at ‘special procedure' material. The US section begins with an analysis of the law at federal level, the decisions of the Supreme Court, including the leading decision of Branzburg v Hayes, as well as the role the legislature has played. The paper then analyses protections provided at state level, with a case study of the California shield law and a review of Californian jurisprudence. [ABSTRACT FROM AUTHOR]

Background: The impact of any scientific article has traditionally been measured by the number of citations received. More recently, alternative metrics (altmetrics) reflect the digital dissemination of knowledge across the online mediasphere. Purpose: To evaluate and compare the characteristics of top-cited articles with those of top Altmetric articles related to nuclear medicine (NM). Material and Methods: We performed a search of the Web of Science and Altmetric databases using 114 search terms to identify the 50 top-cited and 50 top Altmetric articles, respectively, in the field of NM. We then compared the following characteristics of the selected articles: publication type; journal category; country of origin; year of publication; topic; imaging modality; and accessibility. Chi-square tests were performed for statistical analysis. Results: There were no overlaps between the 50 top-cited and 50 top Altmetric articles. In general, compared to the leading Altmetric articles in this field, the cited articles were: more frequently review works published in NM and radiology journals (76% vs. 13%, P = 0.000); published in or before 2005 (84% vs. 0%, P = 0.000); the majority were related to oncology (56% vs. 44%, P = 0.000); and originated from the Netherlands (12% vs. 0%, P = 0.000). Compared to the top-cited articles, the leading Altmetric articles were: more frequently original articles published in other clinical field journals (54% vs. 0%, P = 0.000); primarily published between 2016 and 2018 (70% vs. 0%, P = 0.000); focused on neurology (50% vs. 22%, P = 0.000); and originated from the UK (18% vs. 2%, P = 0.000). Conclusion: Citation counts and Altmetric scores represent unique perspectives for evaluating the impact of NM research. [ABSTRACT FROM AUTHOR]

'Work-first' (or 'workfare') activation policies severely restrict the choices of the unemployed. Can third-sector organisations (TSOs), with their person-centred mission, support long-term unemployed adults to make their own choices, given individual and societal constraints? Commentators often focus on 'what works' in supporting those with complex needs; others draw on the 'capabilities approach' (CA). With commentators often talking past each other, two key issues emerge. First, what constitutes real choice, and, second, how do we deal with the testimonies of programme users when those experiencing social deprivation may overstate the choices available to them? We argue that the CA's dichotomisation of 'true/real' versus 'constrained/no' choice is problematic for a balanced assessment of choice possibilities across different programmes. Building on insights from current literatures, we develop a framework for researching choice possibilities. Using qualitative research, we apply this framework to a TSO employability programme in England, and find users have more control over their choices compared with UK workfare policy. The article contributes to international debates on the value of the CA, the links between programme form, user choice and well-being, and the scope for TSOs to deliver on their user-centred mission and prefigure better alternatives to workfare. [ABSTRACT FROM AUTHOR]

Background: Red blood cell transfusions are commonly used in palliative care to treat anaemia or symptoms caused by anaemia. In patients with advanced disease, there is little evidence of benefit to guide treatment decisions in the face of increased risk of harms. Aim: To determine national transfusion practice in hospices and compare this against National Institute for Health and Care Excellence and British Society of Haematology guidelines to develop recommendations to improve practice. Design and Setting: Prospective data collection on red blood cell transfusion practice in UK adult hospices over a 3-month census period. Results: A total of 121/210 (58%) hospices participated. A total of 465 transfusion episodes occurred in 83 hospices. Patients had a mean age of 71 years, and 96% had cancer. Mean pre-transfusion haemoglobin was 75 g/L (standard deviation = 11.15). Anaemia of chronic disease was the largest cause of anaemia (176; 38%); potentially amenable to alternative treatments. Haematinics were not checked in 70% of patients. Alternative treatments such as B12, folate and iron were rarely used. Despite transfusion-associated circulatory overload risk, 85% of patients were not weighed, and 84% had two or more units transfused. Only 83 (18%) patients had an improvement maintained at 30 days; 142 (31%) had <14 day improvement, and 50 (11%) had no improvement. A total of 150 patients (32%) were dead at 30 days. Conclusion: More rigorous investigation of anaemia, increased use of alternative therapies and more restrictive approach to red cell transfusions are recommended. Clinicians should discuss the limited benefit versus potentially higher risks with patients in hospice services to inform treatment decisions. [ABSTRACT FROM AUTHOR]

This paper critically examines the law of forum non conveniens, in particular the use of the ‘clearly inappropriate forum’ test in Australia, compared with the ‘more appropriate forum’ test applied in jurisdictions such as the UK and the US. It traces the development of the law in the UK in relation to forum non conveniens, including the English acceptance of the doctrine, and how it has been applied in various cases. Some criticism of the ‘more appropriate forum’ test is noted, and it is not recommended that the courts adopt the ‘laundry list’ approach evident in some US decisions, where up to 25 different factors are considered in assessing a forum non conveniens application. It considers the Australian ‘clearly inappropriate forum’ test, and concludes that the ‘clearly inappropriate forum’ test should no longer be followed in that it is unnecessarily parochial and is not consistent with other goals of the rules of private international law including comity. Links between Australia and the subject matter may well be tenuous. Confusion attends the application of the test in Australia at present, the court has rejected the English approach but claims to apply some of the factors mentioned in the English approach in the Australian test, and there is an undesirable schism between statutory rules applicable in domestic cases and the approach when the common law doctrine of forum non conveniens is used. The law regarding forum non conveniens should be harmonious with choice of law rules, and interest analysis can assist in formulating the desired approach to forum non conveniens applications. [ABSTRACT FROM AUTHOR]

Developments in biotechnology present difficult social and ethical challenges that need to be resolved by regulators among others. One crucial problem for regulators of new technologies is to ensure that regulation is both clear and sufficiently flexible to respond to new developments. This is particularly difficult to achieve in contentious fields such as medical biotechnology. In the European Union there is a divergence in the solutions to this problem which has lead to different regulatory frameworks for medical biotechnology. This paper compares and contrasts the British and Dutch regulatory frameworks for the selection of embryos by preimplantation genetic diagnosis as an example of the regulation of medical biotechnology. Some of the outcomes of the regulatory choices and possible reasons behind the divergent frameworks are discussed, such as the ethical outlooks and political systems in these countries. [ABSTRACT FROM AUTHOR]

Wei, Lin and Weissfeld (WLW) have applied an elaboration of Cox's proportional hazards regression to the analysis of recurrent events data. This application is controversial and has attracted criticism in a piecemeal fashion over 15 years. A frequently raised concern is the method's 'risk set': each individual is considered to be at risk of all recurrent events from the start of the observation period. The WLW method often gives estimates that exceed those provided by alternative approaches. This paper investigates whether the estimates are a consequence of biased estimation, or reflect a particular aspect of the treatment effect. Simulation studies show that the WLW method infringes the proportional hazards assumption when applied to recurrent events data, but that the bias this may cause is not behind the distinctive effect estimates. Instead, the method's risk set is demonstrated to be responsible, leading to discussion of the interpretation of the treatment effect being estimated. Analyses of medical data indicate that the infringement of the proportional hazards assumption is not necessarily greater than that experienced with other applications of proportional hazards regression and need not prohibit the application of WLW's method to recurrent events data. [ABSTRACT FROM AUTHOR]

Incubation period of the new variant Creutzfeldt-Jakob disease (vCJD) from infection to clinical onset and the eventual impact of the disease remain major concerns. Based on i) epidemiological conceptualization of human exposure to BSE contaminated material, ii) exponentially decreasing susceptibility after 15 years of age, and iii) typical incubation period (IP) distributions for time from infection to onset, we have previously estimated mean incubation period and projected number of vCJD cases. In this paper, we investigate the robustness of these estimates with respect to i-iii using the UK's 113 vCJD cases with clinical onset before December 2000. Mean incubation period was estimated at 16.4 years (95% CI 11.4-24.8), 15.9 years (95% CI 11.4-22.0), 14.1 years (95% CI 10.4-24.2) with the log-normal, Gamma and Weibull distributions respectively. Corresponding predictions for the total size of the epidemic ranged from 183 to 304. Maximal susceptibility to infection between 1.3 and 15.9 years and decreasing by 15% per year of age thereafter yielded the best fit. The shape of the IP distribution did not affect the predictions. In summary, within a set of reasonable assumptions, mean incubation period for vCJD ranged from 15 to 20 years, and the eventual impact of vCJD was a few hundred patients. [ABSTRACT FROM AUTHOR]

Background: Reiki is a biofield therapy which is based on the explanatory model that the fields of energy and information of living systems can be influenced to promote relaxation and stimulate a healing response. Objective: To conduct a pragmatic within-subject pilot trial of a remote Reiki program for frontline healthcare workers' health-related symptoms during the COVID-19 pandemic. Methods: Healthcare professionals in the UK (eg, physicians, nurses, and paramedics) were eligible to sign up for a distance Reiki program and were also invited to participate in the research study. Eight Reiki practitioners simultaneously gave each participant Reiki remotely for 20 minutes on 4 consecutive days. Feasibility of the research was assessed, including recruitment, data completeness, acceptability and intervention fidelity, and preliminary evaluation of changes in outcome measures. Participants' stress, anxiety, pain, wellbeing, and sleep quality were evaluated with 7-point numerical rating scales. Measures were completed when signing up to receive Reiki (pre) and following the final Reiki session (post). Pre and post data were analyzed using Wilcoxon signed ranks tests. Results: Seventy-nine healthcare professionals signed up to receive Reiki and took the baseline measures. Of those, 40 completed post-measures after the 4-day intervention and were therefore included in the pre-post analysis. Most participants were female (97.5%), and the mean age was 43.9 years old (standard deviations = 11.2). The study was feasible to conduct, with satisfactory recruitment, data completeness, acceptability, and fidelity. Wilcoxon signed ranks tests revealed statistically significant decreases in stress (M = −2.33; P <.001), anxiety (M = −2.79; P <.001) and pain (M = −.79; P <.001), and significant increases in wellbeing (M = −1.79; P <.001) and sleep quality (M = −1.33; P =.019). Conclusions: The Reiki program was feasible and was associated with decreased stress, anxiety and pain, and increased wellbeing and sleep quality in frontline healthcare workers impacted by the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Autistic people face high unemployment rates. One reason for this may be that hiring processes are inaccessible. This study aimed to establish autistic people's unique experiences of hiring processes in the United Kingdom, by comparing them to the experiences of non-autistic neurodivergent people and neurotypical people. Using qualitative and quantitative data from 225 autistic, 64 non-autistic neurodivergent and 88 neurotypical adults, we identified a series of (dis)similarities in participants' views and experiences of recruitment for employment. Similarities across the three groups included (1) frustration with the focus on social skills; (2) a perceived need for more flexible hiring processes; (3) a desire for more clarity and (4) the importance of the environment. Participants also acknowledged the important role employers play in one's decision to disclose a diagnosis or access need. Yet, autistic people faced a set of unique barriers to successful recruitment, over and above those that non-autistic people faced. For example, the perceived pressure to mask autistic traits to succeed and concerns about stigma and discrimination. Participants' recommendations for improvements included the use of more practical recruitment strategies (e.g. work trials), more clarity about what to expect, and improvements in recruiters' understanding of the challenges autistic and neurodivergent candidates may face. Autistic people are less likely to have a job than non-autistic people. One reason for this may be that hiring processes (e.g. job applications, interviews) can be challenging for autistic people. To better understand the experiences of hiring processes in the United Kingdom, we asked 225 autistic, 64 neurodivergent (but not autistic) and 64 adults with no reported area of neurodivergence questions about their experiences using an online survey. We found a range of similarities and differences in responses. For example, participants in all three groups were frustrated with the focus on social skills in recruitment and said they wanted more practical methods (e.g. work trials) that help them show their skills and abilities. Autistic and otherwise neurodivergent participants discussed the importance of the environment (e.g. the interview/assessment room) in improving experiences. Participants also discussed how employers can impact whether somebody decides to disclose their diagnosis or needs – or not. Autistic people experienced some barriers to successful recruitment that non-autistic people did not. For example, autistic people felt they had to hide their autistic traits to gain employment and many autistic people were worried about being discriminated against if they disclosed that they were autistic during the hiring process. To make experiences better, our participants said that employers should offer candidates different recruitment methods and give them more information about the hiring process. They also said employers should improve their understanding of autism and other hidden disabilities so they know the challenges that people might face during recruitment. [ABSTRACT FROM AUTHOR]

Background: Advance care planning supports patients to reflect on and discuss preferences for future treatment and care. Studies of the impact of advance care planning on healthcare use and healthcare costs are scarce. Aim: To determine the impact on healthcare use and costs of an advance care planning intervention across six European countries. Design: Cluster-randomised trial, registered as ISRCTN63110516, of advance care planning conversations supported by certified facilitators. Setting/participants: Patients with advanced lung or colorectal cancer from 23 hospitals in Belgium, Denmark, Italy, the Netherlands, Slovenia and the UK. Data on healthcare use were collected from hospital medical files during 12 months after inclusion. Results: Patients with a good performance status were underrepresented in the intervention group (p < 0.001). Intervention and control patients spent on average 9 versus 8 days in hospital (p = 0.07) and the average number of X-rays was 1.9 in both groups. Fewer intervention than control patients received systemic cancer treatment; 79% versus 89%, respectively (p < 0.001). Total average costs of hospital care during 12 months follow-up were €32,700 for intervention versus €40,700 for control patients (p = 0.04 with bootstrap analyses). Multivariable multilevel models showed that lower average costs of care in the intervention group related to differences between study groups in country, religion and WHO-status. No effect of the intervention on differences in costs between study groups was observed (p = 0.3). Conclusions: Lower care costs as observed in the intervention group were mainly related to patients' characteristics. A definite impact of the intervention itself could not be established. [ABSTRACT FROM AUTHOR]

The objective was to give an overview of self-reported recreational drug use amongst attendees of sexual health clinics in London and compare this to existing datasets. Between December 2013 and March 2014, attendees of two sexual health clinics in London were surveyed. Data collected were: sexual history, smoking and alcohol and recreational drug use. Data were analysed using SPSS (version 21). A total of 1472 respondents were included; 778 (52.9%) men, 676 (45.9%) women and 3 (0.2%) transgender (15 [1.0%] did not answer). Mean age was 30.6 ± 9.0 years. A total of 339 (43.6%) men were men who have sex with men (MSM), and 18 (2.4%) women were women who have sex with women. Lifetime prevalence of use was: alcohol 94.1%; cannabis 48.5%; 'poppers' (volatile nitrites) 28.2%; cocaine 26.8% and 3,4-methylenedioxy-methamphetamine pills 23.2%. Our population had higher current popper, methamphetamine and mephedrone use than the Crime Survey of England and Wales but lower use of cannabis, poppers and Viagra than the European MSM Internet Survey. Global Drug Survey and Part of the Picture respondents' use were higher than our population for all drugs. Drug use in this population had a different pattern to general population surveys and studies involving only MSM. [ABSTRACT FROM AUTHOR]

Recent Continental European scholarship has identified a problematic Anglocentric bias running through the field of comparative plural policing studies. It has sought to counter this bias by emphasizing a series of divergent plural policing trajectories between the more market-friendly countries in the Anglosphere and the more state-centric countries in Continental Europe. While acknowledging the significance of this corrective, we argue that it tends to overemphasize the levels of divergence between these two regions. We substantiate this claim by examining the rise of the private security industry and its regulation by the state in the UK (representing the Anglosphere) and Belgium (representing Continental Europe). Interpreting historical and contemporary data through Sabatier and Weible's advocacy coalition framework, which focuses on the cut and thrust of democratic politics, we observe how in both countries this important dimension of the plural policing landscape is characterized not by counterposed market-friendly and state-centric trajectories, but rather by a complex mix of state–market interactions. In other words, the dynamics of private security regulation are more state-centric in the UK and more market-friendly in Belgium than recent Continental European scholarship suggests. Moreover, we illustrate how, under conditions of post-financial crisis austerity, the overarching pattern is, if anything, one of convergence towards a common set of political dynamics. This is an important finding that not only makes an original contribution towards private security regulation scholarship but also encourages us to question the nature of Anglocentric bias within comparative plural policing studies. [ABSTRACT FROM AUTHOR]

Background: The Cleft Lip Education with Augmented Reality (CLEAR) project centers around the use of augmented reality (AR) in patient leaflets, as a visual means to overcome the "health literacy" gap. This trial followed Virtual Reality (VR CORE) guidelines for VR Phase 2 (Pilot) trials. Methods: Participants included families of children treated for Cleft Lip and Palate at the Royal Hospital for Children, Glasgow. Interventions were AR leaflet or Traditional Leaflet. Objectives were to calculate sample sizes, assess outcome instruments, trial design, and acceptability to patients. Primary outcome measure was Mental Effort Rating Scale, and secondary outcomes were Patient Satisfaction (Visual Analogue Scale), Usefulness Scale for Patient Information Material (USE) scale, and Instructional Materials Motivation Survey (IMMS). Randomization was by block randomization. The trial was single blinded with assessors blinded to group assignment. Results: 12 Participants were randomized, with crossover design permitting analysis of 12 per group. Primary outcome with Mental Effort Rating Scale indicated higher mental effort with Traditional compared to AR Leaflet (4.75 vs 2.00, P =.0003). Secondary outcomes for Satisfaction were Traditional 54.50 versus AR 93.50 (P =.0001); USE scale 49.42 versus 74.08 (P =.0011); and IMMS 112.50 versus 161.75 (P =.0003). Subjective interviews noted overwhelmingly positive patient comments regarding the AR leaflet. Outcome instruments and trial design were acceptable to participants. No harms were recorded. Conclusions: The CLEAR pilot trial provides early evidence of clinical efficacy of AR leaflets in patient education. It is hoped that this will provide a future paradigm shift in the way patient education is delivered. [ABSTRACT FROM AUTHOR]

This article analyses challenges in organising Polish workers by Unison (UK) and Unia (Switzerland). Using case studies of projects delivered by those unions with the aim to enhancing inclusion of Polish workers, the article argues that the internal union dynamics, such as union identity and structures are instrumental for a sustainable organisation of migrant members. Furthermore, the example of Unia demonstrates that an important factor for successful organising of Polish workers was the recognition of their collective agency and their contribution to union revitalisation. Finally, the research demonstrates that previous membership in Polish trade unions was not a significant factor influencing their involvement in British and Swiss workers' movements. [ABSTRACT FROM AUTHOR]

Objectives: Gender service utilisation according to ethnicity is largely under-researched. The present research looked at demographics and service user-engagement according to ethnicity of young people accessing a gender service for children. Method: A total of 2063 (M = 14.19 years, SD = 2.59, assigned male = 556, 1495 assigned female = 1495, no-specification =12) referrals were included in the analysis. Self-defined ethnicity in financial years (FY) 2016–2017, 2018–2019, and referrer-defined ethnicity in FY 2020–2021 were compared between years, to the national UK-population, and child and adolescent mental health service (CAMHS) averages. Numbers of offered, attended and non-attended appointments were compared across the White and the ethnic minority population (EMP). Results: Across years 93.35% young people identified as White (higher than the CAMHS and national population averages); 6.65% as EMP. Service utilisation was similar in FY 2016–2017. In FY 2018–2019, the EMP subgroup was offered and attended more appointments compared to the White subgroup, 'did not attended' average was similar. Conclusions: The majority of young people self-identified with a White ethnic-background. Service engagement was comparable between the EMP and White ethnicity subgroups in 2016–2017, while the EMP group was offered and attended more appointments in 2018–2019. Due to the low EMP group numbers, findings need to be interpreted with caution. [ABSTRACT FROM AUTHOR]

The article compares the process of digitalisation and outcomes from work restructuring in two banks from the United Kingdom and Luxembourg. The banking sectors in both countries have been challenged by digitalisation pressures such as online and mobile banking, pressures from 'Fintech' banks, and the automation of back-office operations. Yet, the adjustment paths in the two countries differed. In Luxembourg, there is an adjustment via limited lay-offs, and increased training and reskilling; however, in the United Kingdom, the main outcomes revolve around branch downsizing and offshoring of employment. These outcomes are explained by differences in institutional supports for collective voice institutions, as well as the role of the state. The findings demonstrate that the embedded employment relations' institutions and actors have shaped distinct paths of adjustment to digitalisation; and show how the impact of technology on work is neither deterministic nor unidirectional. [ABSTRACT FROM AUTHOR]

Background: Informed consent prior to nursing care procedures is an established principle which acknowledges the right of the patient to authorise what is done to him or her; consent prior to nursing care should not be assumed. Nursing care procedures have the potential to be unwanted by the patient and hence require an appropriate form of authorisation that takes into consideration the relationship between the nurse and patient and the ongoing nature of care delivery. Research question: How do nurses obtain consent from patients prior to nursing care?. Design: Critical incident technique and the collection of critical happenings. Participants: 17 participants who were all qualified nurses took part in in-depth interviews Ethical considerations: Ethical approval was obtained from the university ethics committee. Findings: Information giving is a key component prior to nursing care procedures. Nurses provide information to patients as a routine aspect of care delivery, and do so even when the patient is unable to communicate themselves. Whilst some participants described how information giving might be rushed or overlooked at times, it is clearly an established part of nursing care and is provided to ensure the patient knows what to expect when care is delivered. What is less clear is the extent to which information is given in order to seek the consent – rather than merely inform the patient – about nursing care. Conclusion: Implied consent is often an appropriate way in which consent is obtained prior to nursing care procedures. It takes into account the ongoing care provision and the relationship that exists between the nurse and patient. However implied consent should not be assumed. Nurses need to ensure that information is given not only to inform the patient about a procedure but to enable the patient to give his or her consent and to find an alternative way forward if the patient withholds their consent. [ABSTRACT FROM AUTHOR]

Social participation in out-of-home activities is important for people living with dementia, yet little is known about such participation. The aim of this study was to explore and compare out-of-home participation among people living with dementia in four countries by assessing different types of places of participation visited or no longer visited. A cross-sectional design was used to gather self-reported experiences concerning out-of-home participation among people with mild stage dementia living in Canada (n = 29), Sweden (n = 35), Switzerland (n = 35) and the UK (n = 64). Interviews were conducted using the Participation in ACTivities and places OUTside the Home for older adults (ACT-OUT) instrument. Participants still visited 16 (Median) places out of a possible total of 24, and they had abandoned 5 (Median) places. Neighbourhood was the place most participants still visited, whereas 50% of them had stopped going to a Sports facility, with no significant differences between country samples regarding how many participants had abandoned that place (Fisher's exact test, p > 0.01). There were significant differences between country samples in the frequency of present participation and abandonment of the Hospital, Dentist's office, Cemetery, Garden, and Forest (Fisher's exact test, all p < 0.01). Although the participants still visited a variety of places, they had stopped going to places previously visited, which indicates reductions in participation, posing an inherent risk to well-being. The similarities and differences across samples from the four countries suggest that healthcare services and access to public transport may contribute to the complex interactional process of out-of-home participation for people living with dementia. The findings highlight the need for initiatives targeting specific types of places to support continued participation in society, especially places at a higher risk of abandonment such as places for recreation and physical activity. [ABSTRACT FROM AUTHOR]

Social media platforms (SMPs) generate revenue from the automatic propertisation of data contributed by users (i.e. they process these data algorithmically to feed products and services they sell to other customers, especially advertisers). This comparative study of the UK and China builds on key law and policy documents as well as in-depth interviews with 25 experts. We find that neither the human rights–based regulatory approach in the UK nor the impact-based approach of China provides users with economically meaningful forms of redress for harm suffered due to insufficient protection of their rights as data subjects. The study reveals the reasons for this: (1) by analysing data subjects' rights in data protection law and establishing whether these rights preserve the economic interests of data subjects pertaining to their data; (2) by spelling out the conditions under which users can exercise their rights and (3) through an in-depth analysis of the existing mechanisms, which are not suitable to protect data subjects' economic interests during automatic propertisation. This also helps us to understand the social impacts of China's recently approved Personal Information Protection Law. Finally, it suggests two possible ways to improve the balance between the economic interests of data controllers and data subjects. [ABSTRACT FROM AUTHOR]

Background: The Surprise Question ('Would I be surprised if this patient died within 12 months?') identifies patients in the last year of life. It is unclear if 'surprised' means the same for each clinician, and whether their responses are internally consistent. Aim: To determine the consistency with which the Surprise Question is used. Design: A cross-sectional online study of participants located in Belgium, Germany, Italy, The Netherlands, Switzerland and UK. Participants completed 20 hypothetical patient summaries ('vignettes'). Primary outcome measure: continuous estimate of probability of death within 12 months (0% [certain survival]–100% [certain death]). A threshold (probability estimate above which Surprise Question responses were consistently 'no') and an inconsistency range (range of probability estimates where respondents vacillated between responses) were calculated. Univariable and multivariable linear regression explored differences in consistency. Trial registration: NCT03697213. Setting/participants: Registered General Practitioners (GPs). Of the 307 GPs who started the study, 250 completed 15 or more vignettes. Results: Participants had a consistency threshold of 49.8% (SD 22.7) and inconsistency range of 17% (SD 22.4). Italy had a significantly higher threshold than other countries (p = 0.002). There was also a difference in threshold levels depending on age of clinician, for every yearly increase, participants had a higher threshold. There was no difference in inconsistency between countries (p = 0.53). Conclusions: There is variation between clinicians regarding the use of the Surprise Question. Over half of GPs were not internally consistent in their responses to the Surprise Question. Future research with standardised terms and real patients is warranted. [ABSTRACT FROM AUTHOR]

Objectives: Turner syndrome (TS) is a rare sex chromosome aneuploidy, with an incidence of four in 10,000 new-born girls. TS is often associated with impaired social communication skills, but the extent to which these are attributable to Autism Spectrum Disorders (ASD) is uncertain. We made standardized assessments of the mental health and associated neurodevelopmental disorders in children and adolescents with TS and report on the prevalence of concurrent conditions. Methods: Our sample comprised 127 girls with TS, 5–19 years of age. We obtained reports of their mental health from a combination of diagnostic interview (the Development and Wellbeing Assessment (DAWBA)), from the Strengths and Difficulties Questionnaire (SDQ) and from the Social Responsiveness Scale (SRS-2). Sources of information included parents, teachers and self-reports. The prevalence of mental health disorders in this sample was compared with age/sex matched national English data from typical controls. Results: Most individuals with TS (83%) had experienced significant social communication difficulties and nearly one in four (23%) met diagnostic criteria for ASD on the DAWBA. One-third (34%) had at least one mental health or neurodevelopmental condition, and those girls with an ASD were at a greater risk of a co-occurring emotional disorder and/or attention deficit hyperactivity disorder (ADHD). Conclusion: Children and adolescents with TS are substantially more likely to meet criteria for ASD than their typically developing peers. Our finding has clinical implications for appropriate behavioural management from preschool through to adolescence. [ABSTRACT FROM AUTHOR]

It is possible to gain a lot of media literacy by mere exposure to the media. In that sense, there is no need for any formal media education. That, however, is not sufficient to gain professional proficiency in this field. A lot of systematic training is required to maintain the standards expected from this fourth pillar of democracy. Presently, the existing structure of media education is at a crossroads. With the changing technology, social structure and international relations the rationale behind the media education in India is getting changed. Under these circumstances we need to form an opinion on what should be the corresponding changes in media education system in India. This paper has compared the media education system of India with some universities of United Kingdom so as to discover the most appropriate path for the future growth of media education in India [ABSTRACT FROM AUTHOR]

In this paper we explore the dependence of vehicle emission profiles over a twenty-five year period on three factors: the rate of traffic growth (g), the fleet renewal rate (Ι), and the technology 'gain' (θ) following a step change in emission standards. Using analytic and numerical methods we determine the conditions relating to g, Ι, and θ which result in three types of emission profile. These consist of: type-I profiles, in which emissions continue to rise but at a reduced rate; type-Il profiles which fall, attain a minimum, and subsequently rise from a lower base; and type-Ill profiles which continue to fall over a forecasting period. For all profiles we determine the total reduction in vehicle emissions arising from revised standards, and the sensitivity of the total emissions to changes in their determining factors. Data from the UK are used to illustrate the approach which is extended in a wide range of sensitivity tests to explore differences in emission profiles between advanced industrialised and rapidly developing countries. We show that while it may be necessary for all countries to rely on both technological and behavioural policy instruments to reduce emissions, in advanced industrialised countries it may be more effective to improve emission standards, while, in contrast, moderating the rate of traffic growth may be relatively more effective in the rapidly industrialising world. The profiles resulting from the change in emission standards accompanying the introduction of catalytic converters are used to illustrate the general approach. [ABSTRACT FROM AUTHOR]

Comparative research is uniquely able to address theoretical questions about the relationship between journalism and political and cultural contexts. This study takes the reporting of political scandal as the entry-point to an analysis of the practice of investigative reporting in Britain and Spain in the 1990s and its status as a litmus test for a Fourth Estate understanding of the press' role. Using interview and documentary data, the research explores journalists' backgrounds, their assumptions about methods, relationships to sources and their perception of the public, political and peer response to their work. Journalists' views of the rationale for reporting political scandal are also explored. The analysis shows that there are a number of differences between the two groups of journalists but also that they are bound far more by common assumptions about the practices and purposes of reporting political scandal, which, taken together, provide a challenge to certain aspects of the production study research tradition and also evidence for the enduring influence of Fourth Estate understandings of the role of journalism across national contexts. [ABSTRACT FROM AUTHOR]

Objective: To explore the burden associated with childhood ADHD in a large observational study. Methods: We recruited familes with at least one child (6-18 years) with ADHD via 15 NHS trusts in the UK, and collected data from all family members. We made careful adjustments to ensure a like-for-like comparison with two different control groups, and explored the impact of controlling for a positive parental/carer ADHD screen, employment, and relationship status. Results: We found significant negative impacts of childhood ADHD on parents'/carers' hours and quality of sleep, satisfaction with leisure time, and health-related quality of life (measured by the EuroQol-5D [EQ-5D]). We found a decrement in life satisfaction, mental well-being (as measured by the Short-Warwick Edinburgh Mental Well-Being Scale [S-WEMWBS]), and satisfaction with intimate relationships, but this was not always robust across the different control groups. We did not find any decrement in satisfaction with health, self-reported health status, or satisfaction with income. Conclusion: The study quantifies the impact on the health and well-being of parents living with a child with ADHD using a survey of families attending ADHD clinics in the United Kingdom. [ABSTRACT FROM AUTHOR]

Business schools have great prestige and charge large amounts of money for their courses. But how good is the science on which they base their prescriptions for action? To find out we examined the published output from the only three British business schools with the highest (5*) research assessment ranking at the time the articles were published. We conclude that theory development and model construction are often elegant. However, the methods used to obtain primary empirical information to confirm or refute the theories or populate models are poor, at least from a positivist or pragmatic ontological perspective. Large scale comparative studies made up only a small proportion of research output from the business schools. Literature reviews were not systematic. The sampling frame and rationale for selection of cases for study are inadequately described. The methods of data collection were frequently not given in sufficient detail to enable the study to be replicated and the conclusions tended to go far beyond what the data by themselves could support. However, this does not have to be the case—there are excellent examples of research in social sciences. We conclude, therefore, that top-rated British business research is a scantily clad emperor. [ABSTRACT FROM AUTHOR]

Background: Day care services support older people living with long-term conditions (LTC's). Aims: The aims of the study were to determine outcomes in terms of loneliness and health-related quality of life for older people with LTCs attending day care services in the United Kingdom. Methods: Newly referred older people with LTCs to day care services in North West of England and Wales were invited to participate. The EQ-5D-3L and De Jong Loneliness questionnaires were completed at recruitment, 6 and 12 weeks. Results: Ninty-four older people (64% female), age range 65–99 years; mean number of LTCs 4.3 (range: 2–9) were recruited. About 52% lived alone and 36% lived in one of the 20% most deprived local authorities in England and Wales. Outcomes over 12 weeks were comparable for paid, blended, and for volunteer-led services. Conclusion: Following the Covid-19 pandemic, it is increasingly urgent to support older people with LTCs who may have lost physical and cognitive function during lockdown and to support their recovery. Our study suggests that volunteers can provide services and complement the care provided by paid staff, freeing up resources and enabling increasing numbers of older people to be supported. [ABSTRACT FROM AUTHOR]

Much of the literature on rape, victim blaming, and rape myth acceptance is focused on the United States, and there is a general dearth of such scholarly activity in other countries. This article offers insights on university students' perspectives in two new country contexts—India and the United Kingdom. A total of 693 students contributed to the data collection for this study. Rape myth acceptance was fairly low for both countries, however, students in India were more likely to endorse rape myths. Several demographic characteristics were significant for rape myth acceptance in each country. This study makes an important contribution to the extant literature to address paucity of knowledge and promote understandings to help develop country-specific and appropriate policy, practice, and education and awareness programs. In particular, the study provides novel comparative findings on rape myth acceptance in new country contexts to help advance academic thinking in this area of work. [ABSTRACT FROM AUTHOR]

For-profit hospitals' market share has increased in many nations over recent decades. Previous studies suggest that their growth is not attributable to superior performance on access, quality of care, or efficiency. We analyzed other factors that we hypothesized may contribute to the increasing role of for-profit hospitals. We studied the historical development of the for-profit hospital sector across 4 nations with contrasting trends in for-profit hospital market share: the United States, the United Kingdom, Germany, and the Netherlands. We focused on 3 factors that we believed might help explain why the role of for-profits grew in some nations but not in others: (1) the treatment of for-profits by public reimbursement plans, (2) physicians' financial interests, and (3) the effect of the political environment. We conclude that access to subsidies and reimbursement under favorable terms from public health care payors is an important factor in the rise of for-profit hospitals. Arrangements that aligned financial incentives of physicians with the interests of for-profit hospitals were important in stimulating for-profit growth in an earlier era, but they play little role at present. Remarkably, the environment for for-profit ownership seems to have been largely immune to political shifts. [ABSTRACT FROM AUTHOR]

There is a growing interest in precision medicine where individual heterogeneity is incorporated into decision-making and treatments are tailored to individuals to provide better healthcare. One important aspect of precision medicine is the estimation of the optimal individualized treatment rule (ITR) that optimizes the expected outcome. Most methods developed for this purpose are restricted to the setting with two treatments, while clinical studies with more than two treatments are common in practice. In this work, we summarize methods to estimate the optimal ITR in the multi-arm setting and compare their performance in large-scale clinical trials via simulation studies. We then illustrate their utilities with a case study using the data from the INTERVAL trial, which randomly assigned over 20,000 male blood donors from England to one of the three inter-donation intervals (12-week, 10-week, and eight-week) over two years. We estimate the optimal individualized donation strategies under three different objectives. Our findings are fairly consistent across five different approaches that are applied: when we target the maximization of the total units of blood collected, almost all donors are assigned to the eight-week inter-donation interval, whereas if we aim at minimizing the low hemoglobin deferral rates, almost all donors are assigned to donate every 12 weeks. However, when the goal is to maximize the utility score that "discounts" the total units of blood collected by the incidences of low hemoglobin deferrals, we observe some heterogeneity in the optimal inter-donation interval across donors and the optimal donor assignment strategy is highly dependent on the trade-off parameter in the utility function. [ABSTRACT FROM AUTHOR]

In order to design efficient interventions aimed to improve public health, policy makers need to be provided with reliable information of the health burden of different risk factors. For this purpose, we are interested in the proportion of cases that could be prevented had some harmful exposure been eliminated from the population, i.e. the attributable fraction. The attributable fraction is a causal measure; thus, to estimate the attributable fraction from observational data, we have to make appropriate adjustment for confounding. However, some confounders may be unobserved, or even unknown to the investigator. A possible solution to this problem is to use instrumental variable analysis. In this work, we present how the attributable fraction can be estimated with instrumental variable methods based on the two-stage estimator or the G-estimator. One situation when the problem of unmeasuredconfounding may be particularly severe is when assessing the effect of low educational qualifications on coronary heart disease. By using Mendelian randomization, a special case of instrumental variable analysis, it has been claimed that low educational qualifications is a causal risk factor for coronary heart disease. We use Mendelian randomization to estimate the causal risk ratio and causal odds ratio of low educational qualifications as a risk factor for coronary heart disease with data from the UK Biobank. We compare the two-stage and G-estimator as well as the attributable fraction based on the two estimators. The plausibility of drawing causal conclusion in this analysis is thoroughly discussed and alternative genetic instrumental variables are tested. [ABSTRACT FROM AUTHOR]

Background: Few large studies describe initial disease trajectories and subsequent mortality in people with head and neck cancer. This is a necessary first step to identify the need for palliative care and associated services. Aim: To analyse data from the Head and Neck 5000 study to present mortality, place and mode of death within 12 months of diagnosis. Design: Prospective cohort study. Participants: In total, 5402 people with a new diagnosis of head and neck cancer were recruited from 76 cancer centres in the United Kingdom between April 2011 and December 2014. Results: Initially, 161/5402 (3%) and 5241/5402 (97%) of participants were treated with 'non-curative' and 'curative' intent, respectively. Within 12 months, 109/161 (68%) in the 'non-curative' group died compared with 482/5241 (9%) in the 'curative' group. Catastrophic bleed was the terminal event for 10.4% and 9.8% of people in 'non-curative' and 'curative' groups, respectively; terminal airway obstruction was recorded for 7.5% and 6.3% of people in the same corresponding groups. Similar proportions of people in both groups died in a hospice (22.9% 'non-curative'; 23.5% 'curative') and 45.7% of the 'curative' group died in hospital. Conclusion: In addition to those with incurable head and neck cancer, there is a small but significant 'curative' subgroup of people who may have palliative needs shortly following diagnosis. Given the high mortality, risk of acute catastrophic event and frequent hospital death, clarifying the level and timing of palliative care services engagement would help provide assurance as to whether palliative care needs are being met. [ABSTRACT FROM AUTHOR]

Comparative international data on patterns of inequality in child welfare interventions, for example, the proportion of children about whom there are substantiated child protection concerns or who are in out-of-home care, are far less developed than data about inequalities in health. Few countries collect reliable, comprehensive information and definitions, methods of data collection and analysis are rarely consistent. The four UK countries (England, Northern Ireland, Scotland and Wales) provide a potential 'natural experiment' for comparing intervention patterns. This study reports on a large quantitative, descriptive study focusing on children in contact with children's services on a single date in 2015. It found that children's chances of receiving a child protection intervention were related to family socio-economic circumstances, measured by neighbourhood deprivation, within all four countries. There was a strong social gradient which was significantly steeper in some countries than others. Ethnicity was another important factor underlying inequalities. While inequalities in patterns of intervention between the four countries were considerable, they did not mirror relative levels of deprivation in the child population. Inequalities in intervention rates result from a combination of demand and supply factors. The level and extent of inequity raise profound ethical, economic and practical challenges to those involved in child protection, the wider society and the state. [ABSTRACT FROM AUTHOR]

Background: Antipsychotics are often prescribed for long-term periods, however, most evidence of their impact on body weight comes from short-term clinical trials. Particularly, impact associated with dosage has been barely studied.Aims: The aim of this study was to describe the short- and long-term change in body weight of people initiated on high or low doses of the three most commonly prescribed second-generation antipsychotics.Methods: Retrospective cohorts of individuals with a diagnosed psychotic disorder observed from 2005 to 2015 in the UK primary care. The exposure was the first prescription of olanzapine, quetiapine or risperidone. The main outcome was change in body weight four years before and four years after initiation of antipsychotic treatment, stratified on sex and 'low' or 'high' dose.Results: In total, 22,306 women and 16,559 men were observed. Olanzapine treatment was associated with the highest change in weight, with higher doses resulting in more weight gain. After 4 years, given a high dose of olanzapine (> 5 mg), women gained on average +6.1 kg; whereas given a low dose (⩽ 5 mg), they gained +4.4 kg. During the first six weeks of olanzapine treatment, they gained on average +3.2 kg on high dose and +1.9 kg on low dose. The trends were similar for men. Individuals prescribed risperidone and quetiapine experienced less weight gain in both the short- and long-term.Conclusions: Olanzapine treatment was associated with the highest increase in weight. Higher doses were associated with more weight gain. Doctors should prescribe the lowest effective dose to balance mental-health benefits, weight gain and other adverse effects. [ABSTRACT FROM AUTHOR]