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This paper critically explores how survey and routinely collected data could aid in assessing the generalisability of public health evidence. We propose developing approaches that could be employed in understanding the relevance of public health evidence, and investigate ways of producing meta‐analytic estimates tailored to reflect local circumstances, based on analyses of secondary data. Currently, public health decision makers face challenges in interpreting global review evidence to assess its meaning in local contexts. A lack of clarity on the definition and scope of generalisability, and the absence of consensus on its measurement, has stunted methodological progress. The consequence of failing to tackle generalisability means that systematic review evidence often fails to fulfil its potential contribution in public health decision making. Three approaches to address these problems are considered and emerging challenges discussed: (1) purposeful exploration after a review has been conducted, and we present a framework of potential avenues of enquiry and a worked example; (2) recalibration of the results to weight studies differentially based on their similarity to conditions in an inference population, and we provide a worked example using UK Census data to understand potential differences in the effectiveness of community engagement interventions among sites in England and Wales; (3) purposeful exploration before starting a review to ensure that the findings are relevant to an inference population. The paper aims to demonstrate how a more nuanced treatment of context in reviews of public health interventions could be achieved through greater engagement with existing large sources of secondary data. [ABSTRACT FROM AUTHOR]

The research goals were to obtain an understanding of who the users of e‐books in the NHS are, what they are using e‐books for, and when and how they use them. This article presents the methodology used and the findings from the research. It also explores the outputs and next steps from the research, both for the individual countries and collectively. The Five Nations group, (library leads in England, Northern Ireland, Ireland, Scotland and Wales) commissioned research into healthcare staff use and non‐use of e‐books to understand the behaviours, needs and expectations of healthcare staff and to identify shared challenges around e‐books to inform policy and practice. [ABSTRACT FROM AUTHOR]

The article examines the long-term growth of the banking sector in Great Britain and money stock in the period 1844-1880. Detailed estimates of long-term monetary and banking growth in the country exist for the years after the late 1870s, although controversy remains as to their precise accuracy, but even reasonably accurate figures for the greater part of the nineteenth century have proved elusive. It is here that this paper makes a contribution by drawing heavily upon archive material to present new estimates for England and Wales for part of that early period, 1844-80. New estimates are made for commercial bank liabilities to the public and long-term trends in the growth of the money stock are calculated. Data for the number of banks and banking offices are readily available from 1844 in the directory "Banking Almanac," providing one measure of the growth of the commercial banking sector with some breakdown as to the institutional nature and geographical location of firms within the sector. However, they can provide but a crude measure of the growth and density of banking services.

This paper introduces new, homogenized UK national and regional rainfall series derived from 5-km gridded daily and monthly precipitation data. These new series have the advantage that they are based on readings from a dense network of rain gauges rather than a maximum of seven per region. Series developed by alternative statistical methods are analysed and compared. Error estimates are derived for the series, based on linear regressive residuals. Using individual regressions for each calendar month, the monthly series are extended back to 1766 for monthly precipitation in England and Wales (EW), to 1873 for monthly values for each of the five EW sub-regions, and to 1931 for daily values in all regions. A follow-up paper will provide analysis of how mean precipitation totals and extremes have changed over the respective periods. Copyright © 2011 Royal Meteorological Society [ABSTRACT FROM AUTHOR]

This paper discusses developments in the last five to six years in the provision of operational flood forecasting in England, Wales, and Scotland. Before the formation of the Environment Agency EA in England and Wales and the Scottish Environment Protection Agency SEPA, flood forecasting capabilities were fragmented. Just over a decade ago both organisations received governmental mandates for the provision of flood forecasting and warning nationally, and have as a result in recent years established systems providing national coverage: the National Flood Forecasting System, and Flood Early Warning System FEWS Scotland. These have facilitated a rapid expansion of catchments for which forecasts are provided, and the common framework used has enabled a more rapid introduction of scientific advances in forecasting techniques. This paper gives an overview of some of these recent developments, as well as providing an outlook to further developments to be undertaken in the near future. Copyright © 2009 Royal Meteorological Society [ABSTRACT FROM AUTHOR]

The National Institute for Health Research (NIHR) aims to improve national 'health and wealth' by providing infrastructural support to enable clinical research in National Health Service settings in England and Wales. Cognisant of the consequences of studies' failure to achieve required numbers of participants, it also actively campaigns to promote patient awareness of research, and willingness to participate in trials. In this paper, we analyse recent NIHR campaigns and policies designed to encourage patients to participate in clinical research to interrogate how they are implicated in the national bioeconomy. In doing so we expand the notion of 'clinical labour' to include the work of patient recruitment and highlight an emergent obligation on patients to contribute to research processes. Whereas once patient knowledge and experience may have been devalued, here we draw on the concept of 'assetisation' (Birch 2012) to explore the emergent relationship between healthcare system and patient as research participant. We consider how patients' contribution goes beyond the provision of standardised objects of valuation so that patients themselves may be perceived as assets to, not only recipients of, the national healthcare system. [ABSTRACT FROM AUTHOR]

Since the 1970s, there has been growing academic interest in children and young people living in state care and, more recently, in the lives of disabled children. However, there has been little attention on the lives of disabled children who are looked after by the state. This paper compares and critiques what is known about the numbers of disabled children who are looked after in England, Northern Ireland, Scotland and Wales. We discuss the conceptual and methodological limitations of systematically collecting data on disabled children in state care across the UK. We argue that to ensure that the rights of disabled children in state care are identified, acknowledged and upheld, ‘being counted’ is a fundamental first step. [ABSTRACT FROM AUTHOR]

Little research has been conducted on the changing geographical distribution of organic farming in England and Wales in the 1990s. Using officially published secondary data, this paper examines the changing patterns of organic farming between 1993 and 1997, based on the number of organic farms, the area devoted to organic farming, the number of exits from and conversions to organic farming, and specific organic enterprises. The analysis indicates a process of spatial rationalisation, in which organic farming is becoming increasingly concentrated in a core area in Central-Southern England. Further, more detailed work is required, of both an empirical and conceptual nature, before a full explanation of such patterns can be given. [ABSTRACT FROM AUTHOR]

ABSTRACT In Simpson and Jones (2012) we introduced new, homogenized UK national and regional rainfall series derived from 5 km gridded daily and monthly precipitation data. The monthly series were extended back to 1766 for monthly England and Wales ( EW) precipitation, to 1873 for monthly values for each of the five EW sub-regions, and to 1931 for daily values in all regions. Using data from those series, this paper provides analysis of how mean precipitation totals and extremes have changed over the respective periods. The results showed statistically significant upward trends in mean and extreme winter, spring and autumn precipitation for some Scottish regions, but trends over England and Wales were mostly insignificant, though England and Wales had a significant increase in winter precipitation over 1766-2011. The trend in summer precipitation over 1931-2011 has been statistically insignificant, though with a significant long-term downward trend for England and Wales over 1766-2011. Prior observations of a trend towards drier summers and wetter winters have been complicated by a recent succession of wet summers and dry winters. Many of the observed changes in seasonal precipitation totals are most likely associated with changes in the North Atlantic Oscillation. [ABSTRACT FROM AUTHOR]

ABSTRACT Demographic characteristics vary between ethnic groups, as a function of cultural preferences and norms, consequences of immigration, compositional differences in age structure, and discriminatory practices. The differences are of policy relevance, but one should not expect a single pattern of convergence, persistence, or divergence. This paper's key distinction between child and adult contributions to household size allows an explanatory account that recognises both fertility and traditional preferences for extended family households. Aggregating small area populations allows the statistical analysis of a demographic indicator across ethnic groups in relation to both area composition and time. Convergence over time of the number of children per household is interpreted as a fall from high fertility immediately after immigration. Stable high numbers of adults per household among Indian, Pakistani and Bangladeshi groups suggest continued demand for larger houses. These two patterns for England and Wales from 1991 to 2001 are confirmed with survey data for 2010. There is relatively little relationship between household size and local co-ethnic concentrations. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

ABSTRACT Until recently, little was known about kinship care in the UK. Research has begun to illuminate the circumstances which lead to children being cared for by relatives, and the stresses and strains experienced by carers. However, most UK research has only considered 'looked-after' children placed with formal approved kinship foster carers, although this group forms the smallest proportion of children in kinship arrangements. In this paper, we use microdata from the 2001 UK Population Census to examine the characteristics of kinship carers and children, and demonstrate that most children in kinship care are growing up in informal unregulated arrangements. Implications for policy and practice are discussed. [ABSTRACT FROM AUTHOR]

SummaryIntroduction1Definitions of ethnic groups and demographics of minority ethnic groups in the UK○ 1.1 Definitions of 'ethnic groups' and 'ethnicity'○ 1.2 Demographics and characteristics of minority ethnic groups in the UK– Countries of origin– Age/sex distribution and life expectancy– Geographical distribution and size of household– Religious beliefs– Education and employment patternsKey points2Overview of the health profile and dietary habits of minority ethnic groups in the UK○ 2.1 Available surveys○ 2.2 Overview of the health profiles among adults from minority ethnic groups– Overall health– Cardiovascular disease (CVD)– Coronary heart disease (CHD)– Stroke– Type 2 diabetes– Obesity○ 2.3 Possible causes of increased disease risk among minority ethnic groups○ 2.4 Smoking, drinking and physical activity habits○ 2.5 Dietary habits and nutritional status○ 2.6 Overview of the health profiles and dietary and health behaviour patterns of children from minority ethnic groups– Overall health– Diet and health behaviour patterns○ 2.7 Gaps in data availabilityKey points3Factors affecting food choice– Income and socio‐economic status– Food availability and access– Awareness of healthy eating– Religious beliefs– Food beliefs– Time and cooking skills– Generation and genderKey points4Traditional diets of minority ethnic groups○ 4.1 Overview of traditional diets of minority ethic groups– South Asians– African‐Caribbeans– Chinese○ 4.2 Dietary acculturation○ 4.3 Nutritional composition of ethnic‐style cuisineKey points5Nutritional interventions and health promotion among minority ethnic groups○ 5.1 Effective nutritional interventions○ 5.2 Health promotion interventions to prevent problems associated with fasting○ 5.3 Priorities for nutritional interventions and health promotion○ 5.4 Using behaviour change models○ 5.5 Current community initiatives○ 5.6 Catering for institutionalised individuals○ 5.7 Recommendations for future research, policy and practiceKey points6Conclusion• Acknowledgements• References Summary: According to the latest census, non‐white minority ethnic groups made up 7.9% of the UK's population in 2001. The largest of these groups were South Asians, Black African‐Caribbeans and Chinese. Studies have shown that some minority ethnic groups are more likely to experience poorer health outcomes compared with the mainstream population. These include higher rates of cardiovascular disease (CVD), type 2 diabetes and obesity. The differences in health outcomes may reflect interactions between diet and other health behaviours, genetic predisposition and developmental programming, all of which vary across different groups. As is the case for the rest of the population, the dietary habits of minority ethnic groups are affected by a wide variety of factors, but acquiring a better understanding of these can help health professionals and educationalists to recognise the needs of these groups and help them to make healthier food choices. Unfortunately, to date, there have been few tailored, well‐designed and evaluated nutritional interventions in the UK targeting minority ethnic population groups. Further needs assessment and better evaluation of nutritional interventions have been recommended to enhance the understanding of the effectiveness of different approaches amongst minority ethnic groups. This briefing paper will provide an overview of the health profile, dietary habits and other health behaviours of the three largest non‐white minority ethnic groups in the UK, explore the factors affecting their food choices, provide a summary of their traditional diets and review the evidence base to identify the factors that support successful nutrition interventions in these groups. [ABSTRACT FROM AUTHOR]

Since 1991, the evidence-in-chief of child witnesses in United Kingdom (UK) criminal proceedings can be an initial video-recorded interview between a police officer/social worker and the child witness. This paper reports on the results of a survey of the attitudes and opinions of police officers who conduct video interviews with child witnesses in 18 police forces in England and Wales. Notably, officers' views were sought on the conduct of interviews. This builds on previous surveys which have focused on general views of videotaping children's evidence (for example, Davies and others 1995) and training issues (for example, Davies, Marshall and Robertson, 1998). Our findings support previous reports in that police officers view current provisions for child witnesses as a step in the right direction (Davies and others, 1995) but there are some reported limitations for example, gaps in training (Davies, Marshall and Robertson, 1998). In addition, we highlight the difficulties that can arise in relation to language use and some differences of opinion amongst officers (for example, with respect to the use of props in interviewing). Copyright © 2000 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Aims: People with type 2 diabetes can enter remission but may relapse or develop legacy complications. This analysis assesses whether people with remission from type 2 diabetes continue receiving annual care processes recommended in national guidelines and the potential impacts of formal recognition of remission. Methods: People with type 2 diabetes with and without formal recognition (diagnostic code) of remission, and with and without evidence of remission (HbA1c < 48 mmol/mol without prescription for glucose‐lowering drugs in preceding 26 weeks), included in the 2018/19 National Diabetes Audit (NDA) for England and Wales were followed up to identify care processes received between 1 January 2019 and 31 March 2020. Results: Of the 2,822,145 people with type 2 diabetes in the cohort, 16,460 (0.58%) were coded with remission in the 2018/19 NDA. After adjustment for age, sex, socioeconomic deprivation and ethnicity, people coded with remission were less likely to receive each care process than those without such coding irrespective of HbA1c measurements (relative risk (RR) of receiving all 8 care processes 0.70 (95% CI 0.69–0.72)). For the 339,235 people with evidence of remission, irrespective of diagnostic coding compared to those without such evidence, the RR for receiving all 8 care processes was 0.94 (95% CI 0.93–0.94). Conclusions: People coded with remission of type 2 diabetes were less likely to receive diabetes care processes than those without such coding. People with evidence of remission had only a slightly reduced likelihood of receiving care processes. Formal recognition of remission may affect the provision or uptake of care processes. [ABSTRACT FROM AUTHOR]

Recent writing on the professions has given little consideration to the state's potential for threatening a professional formation. This paper argues that the reorganization of probation officer training in England and Wales is an instance of state-led de-professionalization. The process of problematizing the issue and the steps taken to try and mobilize public endorsement for radical policy change are traced, as are the counter-moves of groups attempting to maintain the existing training arrangements. This illuminates two aspects of contemporary public debate in the UK. First, it demonstrates the impact of the requirement that public sector organizations and occupations show ‘enterprise’ by successful self-promotion. Second, the episode is located within Habermas's concept of the public sphere, in which participation itself - let alone any possibility of achieving the desired outcome - now appears to depend upon relative resources and on attracting the attention of influential news media. [ABSTRACT FROM AUTHOR]

This short paper presents some results of an attempt to derive a suitable function to explain unit costs in the water supply industry in England and Wales. The data we used were the latest available at the time of writing. The data, in effect, were for the year 1965-66. It was not possible, because of lack of data, to carry out a time-series analysis to supplement our cross-section findings. At the moment the industry is composed of some 331 undertakings; our sample, which is based on data provided by I.M.T.A.,' covers 162 of those under- takings. In effect, it covers: 67 local authorities; 75 water boards; and 20 water companies. In this paper then we are concerned with the derivation of an industry average cost curve, or function. Although the resulting curve could be similar to the envelope curve, or to part of the envelope curve, as we know it, it will differ from the usual conception of that curve because of the nature of production conditions in the water supply industry. Section II notes the type and characteristics of the four cost functions we have fitted to the data. Section III briefly presents and assesses the statistical results obtained from using those functions. Section IV then makes some comments on the major issue of amalgamation in the light of the statistical results.

Background and aims: Mortality and drug treatment data suggest that the median age of people who inject drugs is increasing. We aimed to describe changes in the characteristics of people injecting drugs in the United Kingdom (UK). Design: Repeat cross‐sectional surveys and modelling. Setting: Low‐threshold services in the United Kingdom such as needle and syringe programmes. Participants: A total of 79 900 people who recently injected psychoactive drugs in the United Kingdom, recruited as part of the Unlinked Anonymous Monitoring Survey (England, Wales, Northern Ireland, 1990–2019) and Needle Exchange Surveillance Initiative (Scotland, 2008–2019). Measurements Age of people currently injecting, age at first injection, duration of injecting (each 1990–2019) and estimates of new people who started injecting (1980–2019). Findings In England, Wales and Northern Ireland between 1990 and 2019, the median age of people injecting increased from 27 (interquartile range [IQR], 24–31) to 40 (IQR, 34–46); median age at first injection increased from 22 (IQR, 19–25) to 33 (IQR, 28–39); and median years of injecting increased from 7 (IQR, 3–11) to 18 (IQR, 9–23). Values in Scotland and England were similar after 2008. The estimated number that started injecting annually in England increased from 5470 (95% prediction interval [PrI] 3120‐6940) in 1980 to a peak of 10 270 (95% PrI, 8980‐12 780) in 1998, and then decreased to 2420 (95% PrI, 1320‐5580) in 2019. The number in Scotland followed a similar pattern, increasing from 1220 (95% PrI, 740–2430) in 1980 to a peak of 3080 (95% PrI, 2160–3350) in 1998, then decreased to a 270 (95% PrI, 130–600) in 2018. The timing of the peak differed between regions, with earlier peaks in London and the North West of England. Conclusions: In the United Kingdom, large cohorts started injecting psychoactive drugs in the 1980s and 1990s and many still inject today. Relatively few people started in more recent years. This has led to changes in the population injecting drugs, including an older average age and longer injecting histories. [ABSTRACT FROM AUTHOR]

Organisations funded by Sport England or UK Sport must work towards achieving standards for safeguarding and protecting children in sport as set by the National Society for the Prevention of Cruelty to Children's Child Protection in Sport Unit (CPSU) and encourage a culture of listening to children. The present research was commissioned by the NSPCC CPSU to understand the practices of UK sports clubs regarding this objective. An electronic questionnaire was distributed through the national governing bodies of sport working with the CPSU. Some 64 clubs/squads representing 6,000+ juniors (under 18 years) responded. Quantitative data were analysed using simple statistics and qualitative data were themed utilising Foucault's theory of power and following Braun and Clark's six‐phase guide. Discourse, hierarchical judgement and docility were considered with reference to formal management and cultural environments. Semantic and latent themes were explored. The themes identified were: expectation awareness, reframing voice and preserving discourse. Clubs recognise the value of listening to children. However, existing power relations valorise adult knowledge fields over the experiences of juniors. Technology could provide an effective solution as it is remote, potentially anonymous and culturally accessible. As power is a productive force, problematisation of organisational culture could centralise children's voices and limit/prevent abuse. [ABSTRACT FROM AUTHOR]

Background: A third of children admitted to paediatric intensive care units (PICUs) in the United Kingdom (UK) are transported by paediatric critical care transport services (PCCTs). Parents have described the transfer journey as particularly stressful. Critical care nurses have a key role in mitigating the impact of the journey on parents. Evaluating parents' experiences is important to inform service improvements. Aim and objectives: Our aim was to describe the development of a new measure of parents' experiences of PCCTs, derived from data collected in the Differences in access to Emergency Paediatric Intensive Care and care during Transport (DEPICT) study. Design: A descriptive cross‐sectional survey was used. Methods: As part of the DEPICT study, a 17‐item transport experience questionnaire was developed and given to parents of children transported by PCCTs to 24 UK PICUs during a 12‐month period. Analyses included exploratory factor analysis and a validation review by a PCCT stakeholder group. Results: Families of 1722 children (1798 journeys) completed questionnaires. Five items were excluded from further analysis as correlation coefficients were <0.3. Two factors explained 53% of the variance and all 12 items loaded on one of these factors. Factor 1 (8 items) explained 47% of the variance, had excellent internal reliability and the clustered items were conceptually coherent with a specific relevance to PCCTs; these were offered for consideration, with other items possibly discarded. Twenty‐eight PCCT clinicians reviewed the questions. Using a 70% agreement threshold, one additional, previously discarded, item was identified for inclusion, resulting in a nine‐item experience measure. Conclusion: Our brief measure of parents' experience of critical care transport provides a standardized measure that can be used across all PCCTs, enabling national benchmarking of services and potentially increasing the collection and use of parent experience data to improve services. Relevance to clinical practice: Being able to measure experience provides an opportunity to understand how to make services better to improve experience. [ABSTRACT FROM AUTHOR]

Objective: To compare pregnancy rates and outcomes for women with cystic fibrosis in the UK with those of the general population and assess the effect of the introduction of disease‐modifying treatment. Design: A population‐based longitudinal study, 2003–17. Setting: United Kingdom. Population: Women aged 15–44 years in the UK cystic fibrosis (CF) Registry compared with women in England and Wales. Methods: We calculated pregnancy and live‐birth rates for the CF population and the general population of England and Wales. For women with CF we compared pregnancy rates before and after ivacaftor was introduced in 2013. We further used CF registry data to assess pregnancy outcomes for mothers with CF, and to assess the relationship between maternal pre‐pregnancy lung function and nutritional status and child gestational age. Main outcome measures: Pregnancy and live‐birth rates and child gestational age. Results: Of 3831 women with CF, 661 reported 818 pregnancies. Compared with the general population, the pregnancy rate was 3.3 times lower in the CF population (23.5 versus 77.7 per 1000 woman‐years); the live‐birth rate was 3.5 times lower (17.4 versus 61.4 per 1000 woman‐years) with 70% of pregnancies in CF women resulting in live births; termination of pregnancy rates were also lower (9% versus 22%). Pregnancy rates increased post‐ivacaftor for eligible women with CF, from 29.7 to 45.7 per 1000 woman‐years. There was no association between pre‐pregnancy lung function/nutrition status and gestational age. Conclusions: Pregnancy rates in women with CF are about one‐third of the rates in the general population with favourable outcomes, and increased for eligible women post‐ivacaftor. Pregnancy rates in women with CF are about a third of the rate in England and Wales with 70% live births. Ivacaftor increases the rate. [ABSTRACT FROM AUTHOR]

The clinical signs, treatments used and spread of psoroptic mange in cattle from October 2007 until March 2011 are described. The disease was first diagnosed in South West Wales, having not been reported in Great Britain since the 1980s. The likely source was identified as a farm that had imported two animals from mainland Europe in the summer of 2006. Since that time, disease has been diagnosed on a further 22 premises, the majority in South West Wales but also in South East and Mid Wales and on one farm in England. Bought in animals harbouring the Psoroptes species mite but not showing clinical signs were considered the greatest risk of introducing the infestation into a herd. This, together with the difficulties of treatment to eliminate the parasite, means that it is unlikely that this outbreak has been controlled. There is also a continuing threat of importing the disease from abroad. The disease is not notifiable in the UK. [ABSTRACT FROM AUTHOR]

Using data from England and Wales, we test the hypothesis that legalizing abortion reduces crime. The timing of changes in crime rates in aggregate data is generally inconsistent with this hypothesis. Using panel data on recorded crime from 1983 to 2001, we are able to replicate the negative association between abortion rates and reported crime that J. J. Donohue and S. D. Levitt found for the United States. However, this association breaks down under the scrutiny of robustness checks and is not present when we examine data on convictions broken down by age. Overall, we find no clear, consistent relationship between abortion and crime in England and Wales. [ABSTRACT FROM AUTHOR]

Buried palaeo‐valley systems have been identified widely beneath lowland parts of the UK including eastern England, central England, south Wales and the North Sea. In the Midland Valley of Scotland palaeo‐valleys have been identified yet the age and genesis of these enigmatic features remain poorly understood. This study utilizes a digital data set of over 100 000 boreholes that penetrate the full thickness of deposits in the Midland Valley of Scotland. It identified 18 buried palaeo‐valleys, which range from 4 to 36 km in length and 24 to 162 m in depth. Geometric analysis has revealed four distinct valley morphologies, which were formed by different subglacial and subaerial processes. Some palaeo‐valleys cross‐cut each other with the deepest features aligning east–west. These east–west features align with the reconstructed ice‐flow direction under maximum conditions of the Main Late Devensian glaciation. The shallower features appear more aligned to ice‐flow direction during ice‐sheet retreat, and were therefore probably incised under more restricted ice‐sheet configurations. The bedrock lithology influences and enhances the position and depth of palaeo‐valleys in this lowland glacial terrain. Faults have juxtaposed Palaeozoic sedimentary and igneous rocks and the deepest palaeo‐valleys occur immediately down‐ice of knick‐points in the more resistant igneous bedrock. The features are regularly reused and the fills are dominated by glacial fluvial and glacial marine deposits. This suggests that the majority of infilling of the features happened during deglaciation and may be unrelated to the processes that cut them. [ABSTRACT FROM AUTHOR]

SUMMARY: Objectives: To monitor minimum standards in hospital transfusion laboratories in relation to qualifications, training, competency and the use of information technology over time against published recommendations. Background: The United Kingdom Transfusion Laboratory Collaborative was formed in 2006 with representatives from relevant organisations and has published standards for transfusion laboratory practice. The standards are set to ensure safe transfusion laboratory practice. Regular surveys are performed to see the extent to which laboratories are able to meet these standards and where any problems lie. Methods: An electronic survey is sent to hospital transfusion laboratories on a single mid‐week day in the spring and is repeated every 2 years from 2011, to be completed by the lead in transfusion for the day. The questions cover staffing, training, funding and workload. Results: Transfusion laboratories are having difficulty with staffing, particularly recruitment of suitably trained biomedical scientists, and with funding and time for training and education. Laboratory errors reported to the Serious Hazards of Transfusion haemovigilance scheme (SHOT) have not decreased with time, related to the under‐resourced workforce. Conclusion: Problems in laboratory staffing and expertise in hospital transfusion laboratories need to be urgently addressed. The transfusion laboratory provides a key service to hospitals. The Blood Services in England and Wales are developing supportive strategies. [ABSTRACT FROM AUTHOR]

Abstract: Background and aim: The introduction of the Alcohol Act in Scotland on 1 October 2011, which included a ban on multi‐buy promotions, was probably associated with a fall in off‐trade alcohol sales in the year after its implementation. The aim of this study was to test if the same legislation was associated with reduced levels of alcohol‐related deaths and hospital admissions in the 3‐year period after its introduction. Design: A natural experiment design using time–series data to assess the impact of the Alcohol Act legislation in Scotland. Comparisons were made with unexposed populations in the rest of Great Britain. Setting: Scotland with comparable data obtained for geographical control groups in other parts of Great Britain. Participants: For alcohol‐related deaths, a total of 17 732 in Scotland and 88 001 in England and Wales throughout 169 4‐week periods between January 2001 and December 2013 and for alcohol‐related hospital admissions, a total of 121 314 in Scotland and 696 892 in England throughout 182 4‐week periods between January 2001 and December 2014. Measurements: Deaths and hospital admissions in Scotland and control groups that were wholly attributable to alcohol for consecutive 4‐week periods between January 2001 and December 2014. Data were obtained by age, sex and area‐based socio‐economic position. Findings: There was no evidence to suggest that the Alcohol Act was associated with changes in the overall rate of alcohol‐related deaths [incidence rate ratio (IRR) = 0.99, 95% confidence interval (CI) = 0.91–1.07)] or hospital admissions (IRR = 0.98, 95% CI = 0.95–1.02) in Scotland. In control group analyses, the pseudo intervention variable was not associated with a change in alcohol‐related death rates in England/Wales (IRR = 0.99, 95% CI = 0.95–1.02), but was associated with an increase in alcohol‐related hospital admission rates in England (IRR = 1.05, 95% CI = 1.03–1.07). In combined models, the interaction analysis did not provide support for a ‘net effect’ of the legislation on alcohol‐related deaths in Scotland compared with England/Wales (IRR 0.99, 95% CI = 0.95–1.04), but suggested a net reduction in hospital admissions for Scotland compared with England (IRR = 0.93, 95% CI = 0.87–0.98). Conclusion: The implementation of the Alcohol Act in Scotland has not been associated clearly with a reduction in alcohol‐related deaths or hospital admissions in the 3‐year period after it was implemented in October 2011. [ABSTRACT FROM AUTHOR]

Aim To understand the scope for improving children's glycaemic outcomes by reducing variation between clinics and examine the role of insulin regimen and clinic characteristics. Methods Cross-sectional analysis of 2012-2013 National Paediatric Diabetes Audit data from 21 773 children aged < 19 years with Type 1 diabetes cared for at 176 clinics organized into 11 regional diabetes networks in England and Wales. Variation in HbA1c was explored by multilevel models with a random effect for clinic. The impact of clinic context was quantified by computing the per cent of total variation in HbA1c which occurs between clinics (intraclass correlation coefficient; ICC). Results Overall, 69 of the 176 diabetes clinics (39%) had a glycaemic performance that differed significantly from the national average after adjusting for patient case-mix with respect to age, gender, diabetes duration, deprivation and ethnicity. However, differences between clinics accounted for 4.7% of the total variation in HbA1c. Inclusion of within-clinic HbA1c standard deviation led to a substantial reduction in ICC to 2.4%. Insulin regimen, clinic volume and diabetes networks had a small or moderate impact on ICC. Conclusions Differences between diabetes clinics accounted for only a small portion of the total variation in glycaemic control because most of the variation was within clinics. This implies that national glycaemic improvements might best be achieved not only by targeting poor centres but also by shifting the whole distribution of clinics to higher levels of quality. [ABSTRACT FROM AUTHOR]

Aims To investigate the relationships between age at diagnosis of diabetes, age at diabetic eye screening and severity of diabetic retinopathy at first and subsequent screenings in children aged 12 or 13 years. Methods Data were extracted from four English screening programmes and from the Scottish, Welsh and Northern Irish programmes on all children with diabetes invited for their first and subsequent screening episodes from the age of 12 years. Retinopathy levels at first and subsequent screens, time from diagnosis of diabetes to first screening and age at diagnosis in years were calculated. Results Data were available for 2125 children with diabetes screened for the first time at age 12 or 13 years. In those diagnosed with diabetes at 2 years of age or less, the proportion with retinopathy in one or both eyes was 20% and 11%, respectively, decreasing to 8% and 2% in those diagnosed between 2 and 12 years ( P < 0.0001). Only three children (aged 8, 10 and 11 years at diagnosis of diabetes) had images graded with referable retinopathy and, of these, two had non-referable diabetic retinopathy at all subsequent screenings. Of 1703 children with subsequent images, 25 were graded with referable diabetic retinopathy over a mean follow-up of 3.1 years, an incidence rate of 4.7 (95% confidence interval, 3.1-7.0) per 1000 per year. Conclusions In this large cohort of children, the low prevalence and incidence rates of referable diabetic retinopathy suggest that screening earlier than age 12 is not necessary. [ABSTRACT FROM AUTHOR]

Prostate cancer is the most common cancer in men in the UK accounting for 25% of all new cases of cancer. It is predicted to become the most common cancer overall by 2030. A national survey of the specialist nursing workforce caring for men with prostate cancer was completed across the four countries of the UK during June and July 2014. In total 302 specialist nurses completed the survey and data from 285 was used in the analysis. This is the biggest whole population survey of this workforce in recent years. The most common job title was clinical nurse specialist (185) and the most common band was agenda for change band 7 (174). However in Scotland 50% of the respondents stated that they were paid on band 6. Over half the group (158) had worked in prostate cancer care for more than 10 years. Few (48) had come into specialist posts from a specific specialist nurse development role. There is wide geographic variation in the provision of specialist nursing for men with prostate cancer. This is reflected in available hours and caseload sizes. The respondents reported frozen and vacant posts across the UK. This equated to 58·3 full time equivalents. The work of specialist nurses caring for men with prostate cancer is clinically complex and appears to cover most key times in the cancer journey. However workload appears to be limiting the care that the nurses are able to provide with over half the respondents (163) saying that they left work undone for patients. [ABSTRACT FROM AUTHOR]

Background: Knowledge of blood utilization can assist clinicians in directing patient blood management (PBM) initiatives and can facilitate demand planning by blood services. We describe a national study of red blood cell (RBC) utilization in England and North Wales in 2014.Study Design and Methods: All hospitals that are supplied with blood components by NHS Blood and Transplant (NHSBT) were asked to provide data on the age and sex of all recipients of transfusions of RBCs, and the clinical indication for every unit transfused, for two separate weeks in 2014. Clinical indication categories were derived from those used in previous studies in an English region. Completeness of data collection was checked against NHSBT issue and wastage data.Results: Data on 46,111 RBC units were collected, representing 73% of all RBCs issued by NHSBT during the weeks surveyed. A total of 67% of RBC units were transfused for a medical indication, with 27 and 6% being transfused for surgical and obstetric/gynecologic indications, respectively. For comparison, figures from a study in the North of England in 2009, on which this national study was based, showed that 64% of RBCs were transfused to medical patients. All but 20 units could be ascribed to a broad clinical heading, for example, "gastrointestinal bleeding."Conclusion: Our findings confirm the previous regional finding that the percentage of RBC units that are transfused to surgical patients in England and North Wales is now much lower than for medical patients and suggest that PBM initiatives should now focus on medical patients. [ABSTRACT FROM AUTHOR]

The article presents news briefs related to education in Great Britain as of March 2014. The Welsh government has released plans to develop a cohesive approach to legislation regarding special education and remove the remaining special education needs measures from the Education Bill. Guidance for education authorities and schools on accessibility duties outlined by the Scottish Education Act 2002 were published. England's Children and Families Bill is expected to complete Parliament by the spring of 2014.

ABSTRACT A lee wave forecast system has been run operationally at the UK Met Office since 2006. The forecasts are produced by a numerical model for flow over complex terrain (3DVOM) which is run for five separate hilly regions across the UK. These regions cover Dartmoor (southwest England), Snowdonia (north Wales), Cumbria and the Pennines (northern England), the Grampians (Scotland) and the Mourne and Sperrin mountains (Northern Ireland). Examples of verification of the model forecasts against aircraft and satellite observations are presented. Three years of forecast data for these regions have been used to generate a lee wave climatology for the UK. The model predicts large geographical differences, with lee waves occurring least frequently over Dartmoor and most frequently over Snowdonia and the Grampians. Large amplitude waves, with peak vertical velocities exceeding 3 m s−1 at 700 hPa or above, are more common in forecasts for the Grampian region than others. Lee waves occur more frequently in forecasts during winter months than in summer. The most favourable conditions are those in which there is little turning of the lower tropospheric winds and analysis suggests that the waves are typically trapped in the lower troposphere. The influence of the lee waves on the near-surface flow has also been investigated. Large accelerations and flow deflections can occur beneath the waves. It is suggested that the latter correspond to turbulent lee wave rotors. Preferred locations for this behaviour have been identified in the model forecasts for the Grampians and Pennines. [ABSTRACT FROM AUTHOR]

Observational studies show an inverse relationship between fat and sugar within diets, described as the 'fat-sugar seesaw'. It has been suggested however, that this is a consequence of expressing macronutrient intakes as percentages of energy intake rather than by the dietary choices made by individuals. To test this we examined the associations between macronutrient intakes in the diets of adults ( n = 1724) participating in the UK National Diet and Nutrition Survey (NDNS) and within the same adults across different days of the week. Pearson's correlations were calculated between the macronutrient intakes from fat, total sugar, intrinsic sugars, non-milk extrinsic sugars (NMES), non-sugar carbohydrate, protein and alcohol. Energy intakes relative to estimated basal metabolic rate (BMR) were calculated to partially account for differences in energy requirements. Pearson's correlations also examined associations between the same macronutrients in foods from the Nutrient Databank (ND), used to analyse dietary intakes in the NDNS. Correlations between fat and sugar(s) were calculated in five ways: (i) percentage energy between individuals; (ii) amount (g) between individuals; (iii) amount (g) relative to BMR between individuals; (iv) within individuals over seven days; and (v) between food items in the ND. Negative correlations were obtained between mean daily percentage energy intakes of fat and, total sugars, NMES and intrinsic sugars (all P < 0.001). However, when mean daily macronutrient intakes were expressed in weight (g)/day, these were all positively correlated (all P < 0.001). Mean estimated correlations between macronutrient intakes (g/day) for each individual across the days of the week were also positive, indicating a lack of fat-sugar seesaw effect. Within the ND, the correlation between fat and total sugar (g/100g of food) was weakly positive ( P = 0.006). Only when examining the correlation between fat and sugar(s) between individuals in percentage terms (% energy) was the fat-sugar seesaw evident; in all other methods the correlations between fat and sugar(s) were positive. Examination of the effects of using percentage energy values to describe the macronutrient composition demonstrated that the fat-sugar seesaw is only an inevitable mathematical consequence, rather than the result of dietary choice. Comparing diet composition in percentage terms alone can therefore be misleading. It is only when examined as absolute values (weight), as well as percentage contributions to energy, that the interrelationships between macronutrients can be studied fully. [ABSTRACT FROM AUTHOR]

Dickens J. The definition of social work in the United Kingdom, 2000-2010. This article reviews the approaches that the four countries of the United Kingdom - England, Scotland, Wales and Northern Ireland - have taken in recent years for organising, regulating and defining social work. Social work is one of the policy areas that have been devolved to the constituent countries. This has brought extensive organisational changes, multiple policy initiatives and a proliferation of regulatory and advisory agencies. The article focuses on the attempts by these official bodies to define social work, treating the United Kingdom as a case study of the tensions of specifying what social work is and what it should be. The various attempts expose the strains and overlaps between the different agencies, and a bigger struggle to contain and control social work. The article highlights four key dimensions in the enduring debates: values-roles, social-individual, care-control and public-professional. [ABSTRACT FROM AUTHOR]

A well-known use of perchlorate is as a rocket fuel propellant; however, more widespread uses include in munitions and fireworks, and it also occurs naturally. Perchlorate suppresses the thyroid, which can lead to a variety of adverse effects. It is a widespread contaminant in the United States, but limited occurrence data in the United Kingdom exist, and even less for drinking water. Monitoring of 20 raw and treated drinking water sites in England and Wales, covering four seasonal periods, showed that perchlorate is a low-level background contaminant of raw and treated drinking water. Low concentrations (treated drinking water: <0.020-2.073 μg/L, mean 0.747 μg/L) were detected at every higher-risk site. The concentrations were comparable in each of the four sampling exercises and no significant trends were apparent relating to the time of year, the type of risk or the method of chlorination. Limited data showed that removal by ion exchange and granular-activated carbon may occur. [ABSTRACT FROM AUTHOR]

The article discusses importance of good nutrition in children. It highlights the nutrition needed by children and adolescents which are high in relation to their size due to their demands for growth. It also explores the results of the National Diet and Nutrition Surveys (NDNS) wherein data on the eating patterns of people living in private households in Great Britain is provided.

Overweight and obese people appear to be at greater risk of suboptimal vitamin and mineral status compared with people of a healthy weight. Nutrients most affected include vitamin D, vitamin B, carotenoids, folate, vitamin C and iron. The reasons are unknown but may be caused by poor diets, increased requirements or obesity-related changes to nutrient absorption, excretion or metabolism, or a combination of these. Sequestration of fat-soluble vitamins by adipose tissues is also a major factor. Although dietary assessment in obese populations is hampered by under-reporting, there is evidence that dietary patterns characterised by energy-dense, processed foods are more common in groups with a higher body mass index. Dieting practices, bariatric surgery and the use of anti-obesity drugs may compound the risk of nutrient inadequacy, although sustained weight loss helps to improve vitamin D status. A poor nutrient status could accentuate the risk of chronic diseases already experienced by overweight people on account of their excessive fat mass. There is evidence that the use of dietary supplements can improve nutrient status and have a favourable impact on disease risk markers such as lipid profiles and insulin resistance. Whether currently dieting or not, overweight people may benefit from safeguarding vitamin and mineral adequacy by taking a multi-nutrient supplement alongside an increased intake of nutrient-rich foods. [ABSTRACT FROM AUTHOR]

Information about several topics discussed at the meeting of European Nutrition Foundations in Madrid on April 2010 is presented. Topics of the meeting include the nutrition in the school curriculum and regulations on foods and drinks provided in schools. The meeting features various executives including Juan Ballasteros.

The contribution of English and Welsh lead mines to the silver supplies of mints between Domesday Book and the end of the fifteenth century is assessed in this article, comparing evidence for the size of silver production with mint output data. It is shown that the proposal that northern Pennine mines were the principal source of the silver in the late twelfth-century English currency is untenable. Welsh mines supplied limited amounts of silver to local mints around 1200. Devon silver made a significant but not predominant contribution to mint output at times of bullion scarcity in the 1290s and the mid-fifteenth century. Imported silver was usually a greater source of the metal in the English currency than locally mined silver, and gold coins constituted most of England's money supply from the mid-fourteenth century onwards. [ABSTRACT FROM AUTHOR]

The article presents a study which evaluates the effects of riparian management on Wye River system's benthic macroinvertebrates. It uses routine, monitoring data of Great Britain's Environment Agency to compare assemblages in Wye catchments. Results show how customary monitoring data can bring out some riparian land-use effects and on stream biota management. It suggests that invertebrate biotic communities in Wye river system were more affluent after riparian management.

We reviewed and classified all patient safety incidents submitted from critical care units in England and Wales to the National Patient Safety Agency for the first quarter of 2008. A total of 6649 incidents were submitted from 141 organisations (median (range) 23 (1–268 incidents)); 786 were unrelated to the critical care episode and 248 were repeat entries. Of the remaining 5615 incidents, 1726 occurred in neonates or babies, 1298 were associated with temporary harm, 15 with permanent harm and 59 required interventions to maintain life or may have contributed to the patient’s death. The most common main incident groups were medication (1450 incidents), infrastructure and staffing (1289 incidents) and implementation of care (1047 incidents). There were 2789 incidents classified to more than one main group. The incident analysis highlights ways to improve patient safety and to improve the classification of incidents. [ABSTRACT FROM AUTHOR]

The joint-stock banks that established after the liberalizing legislation of 1826 were periodically criticized during the nineteenth century for their low-quality and rapidly deteriorating shareholder constituencies. The quality of a bank's shareholding constituency was of paramount importance because of unlimited shareholder liability. Using archival records, this article examines the quality of bank shareholder constituencies over the nineteenth century. The main finding is that shareholder constituencies did not deteriorate in quality until the introduction of limited liability. The non-deterioration of constituencies is attributed to bank deeds which locked in the aggregate quality of shareholder constituencies by empowering directors to vet all share transfers. [ABSTRACT FROM AUTHOR]

This article constitutes a response to the article by Fabien Jobard (in this issue) concerning the recent riots in France. It explores differences and commonalities between the events in France in 2005 and the urban disorders that occurred in England and Wales from the 1980s to 2001, placing the latter into three distinct categorical and temporal waves. Initially, it revisits the essence of Jobard's piece before providing an overview of the UK riots. It then analyses the overarching contexts of each of the three periods, and those of the French riots, as a basis for identifying the main causal similarities. [ABSTRACT FROM AUTHOR]

The article discusses several government documents of Great Britain on penal codes. It discusses the H.M. Chief Inspector of Prisons for England and Wales Annual Report 2007-08 in which 82 custodial establishments were examined. The "Police Service Strength England and Wales, 30 September 2008," by Simon Bullock and Ravi Mulchandani, offers information on the strength of police officers in England and Wales on September 30, 2008. "Crimes in England and Wales: Quarterly Update to September 2008," offers information on the overall level of crime which has been cited to be stable as compared with September 2007.

Can a more collaborative form of public management correct for the historical link between social and economic status (SES) and political participation? New initiatives to involve the citizen directly in public decision making--citizen governance--aim to include a wider representation of groups in society because they draw from service users and seek to recruit hard-to-reach groups. To test the claim that citizen governance may be more representative than other acts of political participation, this essay reports data from the 2005 English and Welsh Citizenship Survey. Using descriptive statistics and regression analysis, it finds evidence that citizen governance is more representative than civic activities, especially for young people and ethnic minority communities. Policy makers can fine-tune their interventions to reach underrepresented groups without believing the citizen governance is a panacea for long-running biases in civic participation. [ABSTRACT FROM AUTHOR]

A new source, 1840s Admiralty seamen's tickets, is used to explore three anthropometric issues. First, did being born in a city, with its associated disamenities, lead to stunting? Second, did being born near a city, whose markets sucked away foodstuffs, lead to stunting? Third, did child labour lead to stunting? We find that only those born in very large cities suffered a level of stunting that contemporaries could have observed. Being born near a city, which gave parents opportunities to trade away family calories, and perhaps increased exposure to disease, did not cause stunting. Britain was a well-integrated market; all families, whatever their locations, had options to trade and faced similar disease environments. Finally, although adults who had gone to sea young were shorter than those who did not enlist until fully grown, going to sea did not stunt. Instead, plentiful food at sea attracted stunted adolescents, who reversed most of their stunting as a result. But child labour at sea was different from other forms of children's work because wages were largely hypothecated to the child as food and shelter onboard. In contrast, where wages were paid to the child or his parents in cash, they became submerged in the household economy and their benefits were shared with other family members. [ABSTRACT FROM AUTHOR]

The article discusses the politics and policies of the British National Health System (NHS) as of September 2008. It examines the policymaking decisions of the governments of England, Northern Ireland, Scotland, and Wales. It discusses changes in government-run health systems and health care options in welfare states. The article examines the policies and proposals of British political parties including the Labour Party and the Scottish National Party (SNP). It discusses the creation of Foundation Trusts (FTs) through the NHS.

Male preference in many Asian cultures results in discriminatory practices against females, including neglect and infanticide. This preference, together with the availability of prenatal sex determination and sex-selective abortion, has led to an increase in sex ratios at birth in China, India, and South Korea. The resulting expected gender imbalances raise ethical, demographic, and social concerns. We analyzed birth statistics to see whether similar trends are apparent among births to foreign-born mothers in England and Wales. Before 1990, sex ratios at birth were consistently nearly one point lower (104) for the three major Asian groups in Britain compared with mothers born in Western countries. This is inconsistent with previous suggestions that Asian populations have a higher “natural” sex ratio at birth. In the birth statistics since 1990, we find a four-point increase in the sex ratio at birth for mothers born in India, attributable particularly to an increase at higher birth orders, mirroring findings reported for India. This suggests that sex-selective abortion is occurring among mothers born in India and living in Britain. By contrast, no significant increase was observed for Pakistan-born and Bangladesh-born mothers, among whom male preference also exists. It seems that male preference in different cultures does not necessarily lead to sex-selective abortion. [ABSTRACT FROM AUTHOR]

The article focuses on the accreditation scheme for health library services in England and Wales. It was determined that the use of an accreditation scheme for health library services can be an effective method to develop positive changes that improve access to the knowledge domain of health care for health care personnel. Organizations which are in charge in the library services for the National Health Service (NHS) should also adopt or maintain its use. However, in the survey on the assessment accreditation of NHS library services, it showed at least 15 percent positive perceptions for the accreditation.

Most riverflow records in the United Kingdom are relatively short, with some of the longest continuous series beginning in the late 1950s. In contrast, rainfall records are plentiful with many extending back into the early decades of the nineteenth century. Earlier works have developed a method for reconstructing riverflow data from the longer rainfall series. The work reported here extends previous reconstructions from the middle of the 1990s to 2002. The inclusion of recent very wet periods has allowed a more comprehensive validation of the reconstruction model. Comparisons of reconstructed and observed flows for 1980-2002 imply that land-use changes have had little effect on flows, at least at the monthly time step. In addition, for some catchments, the inadequacy of flow-gauging installations under such extreme flow conditions is discussed. The reconstructions could prove useful for flow naturalisation for some catchments. The wet autumn of 2000 and the ensuing hydrological extremes during 2000 and 2001 are put into the context of the full 1865-2002 flow reconstructions. For 1980-2002, there were few low flow periods. The years 1984, 1989 and especially 1995 rank in the five lowest flows since 1865 on more than one catchment, but low flows during 1870, 1887, 1921, 1933/4 and 1976 were more spatially extensive. Copyright © 2005 Royal Meteorological Society. [ABSTRACT FROM AUTHOR]

Policing, or to be more precise, the activities and policies of the 43 territorial police forces in England and Wales, has been the subject of extensive review and reform over the past 40 years. Indeed the whole history of the police is one of almost constant change and development but this has never been more apparent than in the recent past. Successive governments have embarked on a series of police reforms which have seen a significant shift in power to the Home Office and a consequent reduction in local accountability. At the same time, the police have been granted extensive new powers to deal with newly emerging threats ranging from locally-based crime and disorder to international terrorism, yet many of the reforms are taking place with little apparent understanding of the potential long-term consequences and without proper evaluation. The purpose of this introductory article is to set the scene for a series of articles which explore some of the theoretical issues which underpin modern policing practice and the practical consequences of some of those changes. [ABSTRACT FROM AUTHOR]