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The global spread of non-native species is leading to an increasing frequency of multiple co-occurring non-native species. We examined the co-occurrence of the bivalve mollusc Dreissena polymorpha (zebra mussel) with three Ponto-Caspian amphipods (Dikerogammarus villosus, Dikerogammarus haemobaphes, and Chelicorophium curvispinum) across England and Wales in association with in-situ substrate size. For all three amphipod species, substrate grain size where amphipods co-occurred with D. polymorpha was significantly finer than when recorded in isolation. Subsequently, we confirmed this via aquarium experiments. We examined the occurrence of D. villosus with D. polymorpha when present with cobbles, gravel, or sand from three population sources (co-location with abundant D. polymorpha populations, co-location with low populations, and naïve). Experiments demonstrated that D. villosus actively sought shelter on or near D. polymorpha, with their co-location being significantly more prevalent in finer grained substrates (sand > gravel > cobble). The strength of this co-location differed by population source, with those co-located with high D. polymorpha densities demonstrating a greater association. Our analyses and experiments indicate that D. polymorpha may facilitate Ponto-Caspian amphipod establishment in otherwise suboptimal locations, whereby mussel shells provide favourable structural habitat for the amphipods, analogous to the presence of coarse-grained benthic sediment. [ABSTRACT FROM AUTHOR]

Autistic people in England face worse health outcomes than non-autistic people. Autism-specific annual health checks have been proposed as one solution to this issue. This study identified strategies to incentivise primary care providers to offer autism-specific annual health checks, using a behavioural science approach. In phase 1, we conducted interviews and focus groups with autistic people (n = 10) and primary care providers (n = 11). In phase 2, we conducted a national survey of primary care providers (n = 196). Qualitative data were analysed using a framework method and the Theoretical Domains Framework. Quantitative data were analysed descriptively, and comparisons between sub-groups of survey respondents were made using Mann–Whitney U and Kruskal–Wallis tests. The most salient theoretical domain was environmental context and resources. Participants identified lack of time and staff as key barriers to implementation. Delegating tasks to non-physician practitioners and automating processes were seen as key facilitators. Autism-specific knowledge was another relevant domain; education produced and delivered by autistic people was posited to increase health check uptake and quality. Overall, participants were enthusiastic about autism-specific annual health checks but were concerned about the practical aspects of implementation. We identified specific barriers and facilitators that can be addressed prior to policy adoption to maximise chances of success. Autistic people are more likely to have mental and physical health problems than non-autistic people. Annual health checks could reduce these problems by finding and treating them early. Annual health checks are yearly medical appointments where a primary healthcare provider (such as a doctor or nurse) can check things like a patient's weight and heart rate and ask if they have any worries about their health. In this study, we wanted to understand what might encourage primary healthcare providers to use annual health checks with their autistic patients. First, we spoke to 10 autistic people and 11 primary healthcare providers. Using the findings from these conversations, we created an online survey for primary healthcare providers in England. We used the findings from the interviews and survey to help us understand what would encourage primary healthcare providers to offer annual health checks for autistic people. Our participants said that a lack of time and staff would make it hard to provide health checks. To help, they said other members of staff (such as nurses and healthcare assistants) could do the health checks, rather than doctors. They also said parts of the process could be made automatic to save time (e.g. sending automatic reminders). Knowledge about autism was important too (e.g. knowing about the common conditions autistic people have, and how to best support autistic patients). Participants said training on these topics, produced and delivered with autistic people, could encourage them to use annual health checks with their autistic patients. [ABSTRACT FROM AUTHOR]

Objectives: The post-medieval period in Europe saw a dramatic increase in metabolic bone disease related to vitamin D deficiency (VDD). Recent paleopathological work has utilized interglobular dentin (IGD) as a proxy for poor vitamin D status during development, while enamel peptide analysis allows the identification of chromosomal sex in non-adult remains. Here we explore the relationship between sex, the presence of IGD, and macroscopic markers of VDD in an industrial era assemblage from Northeast England. Materials and methods: 25 individuals (9 females, 9 males, 9 unknown sex) from the cemetery site at Coach Lane, North Shields (1711–1857) were selected for paleopathological analysis, histological assessment of IGD, and enamel peptide determination of chromosomal sex. Results: Ground tooth sections from 21 individuals were of suitable quality for detection of IGD, and enamel peptide analysis confirmed the chromosomal sex of ten individuals. Sixteen individuals (76.1%) exhibited ≥1 episode of IGD. Nine of these (42.8%) exhibited >1 episode and four (19%) exhibited ≥4 episodes in regular intervals. Male sex was significantly associated with the presence of IGD (p = 0.0351; 100% males vs. 54.5% females). Females were more likely to exhibit macroscopic evidence of VDD (45.5% females vs 30% males) but this was not statistically significant. Discussion and conclusions: Periods of poor mineral metabolism during childhood appear much more prevalent at Coach Lane than macroscopic evidence suggests. Evidence of seasonal IGD episodes indicates that northern latitude played a major role in poor VD status in the Northeast of England. The significant association of IGD with male sex may be due to sex-related differences in dentinal mineralization or a higher risk of poor VD status in males aged <5 years. More work is needed to establish an evidence-based threshold for pathological levels of IGD before the presence of this feature can confidently be used as a biomarker for poor VD status. [ABSTRACT FROM AUTHOR]

Background: Very young children from lower socioeconomic status (SES) backgrounds often show poorer language development. Whilst there have been attempts to provide early intervention programmes, these sometimes miss the most disadvantaged groups. Aims: This report presents preliminary feasibility and effectiveness data for a novel language intervention designed for parents of toddlers in the United Kingdom. Methods and Procedures: In total, 43 UK families of 2–4‐year‐olds were recruited to the study, half of whom completed an 8‐week course (Tots Talking) focussed on parent interaction, and half of whom acted as wait‐list controls. Results and Outcomes: Results suggest that such programmes are feasible for families with 86% staying in the intervention. In addition, greater changes in underlying communication skills such as joint attention and gesture were evident compared to wait‐list controls. Conclusions and Implications: We conclude that pre‐verbal skills may be more important to measure as initial outcomes than language or vocabulary change in this population. What This Paper Adds: What is already known on the subject: Children from lower socioeconomic status (SES) backgrounds are at higher risk of communication difficulties and there is a need for community intervention programmes for very young children. What this study adds: This study suggests that such programmes can be feasible and effective, but that very early/basic communicative skills (such as joint attention) may be boosted first rather than language or vocabulary. What are the clinical implications of this work?: Children's centres and other community services could feasibly run short parent facing courses emphasising contingent communication in low SES families and other diverse groups. These may be more successful run with younger preschoolers. Joint attention may be a better focus of intervention before expecting vocabulary or language change. Community health professionals may find this information useful in referring and supporting families in need. [ABSTRACT FROM AUTHOR]

Occupational burnout is highly prevalent in the mental healthcare workforce and associated with poorer job satisfaction, performance and outcomes. To evaluate the effects of the Mind Management Skills for Life Programme on burnout and wellbeing. N = 173 mental health nurses were recruited from the English National Health Service during the acute phase of the COVID-19 crisis. Participants were allocated to an immediate intervention or a delayed intervention control group, using a stepped wedge randomized controlled trial design. Measures of burnout (OLBI) and wellbeing (WEMWBS) were completed at four time-points: [1] baseline; [2] after the first group finished the intervention; [3] after the second group finished the intervention; and [4] six-months follow-up. Between-group differences were compared at each time-point using ANCOVA adjusting for baseline severity. Statistically significant effects on burnout (d = 0.60) and wellbeing (d = −0.62) were found at time-point 2, favouring the intervention relative to waitlist control. No significant differences were found at subsequent time-points, indicating that both groups improved and maintained their gains after the intervention. This intervention led to moderate improvements in burnout and wellbeing, despite the adverse circumstances of the COVID-19 pandemic at the time of the study. [ABSTRACT FROM AUTHOR]

While the relationship between offending and mental health is complex, research findings indicate that those in conflict with the law have higher levels of mental illness and need than the general population. This article considers the findings of a joint thematic inspection of the criminal justice journey for individuals with mental health needs, with a particular focus on the probation stage. Inspectors from across justice and health reviewed cases to establish the extent to which needs were identified and met. Interviews were also undertaken with 67 individuals who had lived experience of mental illness while in the criminal justice system. Findings are considered in relation to the identification of mental health needs; the role of trauma; probation practitioners' skills, knowledge and support; case management; and access to required services. This inspection led to identified effective practice and key agencies agreeing to a number of actions in response to inspectors' recommendations. [ABSTRACT FROM AUTHOR]

Background: An Improving Access to Psychological Therapies (IAPT) service in England has implemented cognitive analytic therapy guided self-help (CAT-GSH) alongside cognitive behavioural guided self-help (CBT-GSH) in order to support enhanced patient choice. This study sought to explore the acceptability to psychological wellbeing practitioners (PWPs) of delivering CAT-GSH. Method: This study used a qualitative design with semi-structured interviews and associated thematic analysis (TA). A sample of n=12 PWPs experienced in delivering CAT-GSH were interviewed. Results: Five over-arching themes (containing 12 subthemes) were identified and conceptually mapped: (a) the past-present focus (made up of working with clients' pasts and the different type of change work), (b) expanding the treatment offer (from the perspective of PWPs and clients), (c) the time and resources required to effectively deliver CAT-GSH (to enable safe and effective delivery for clients and personal/professional development for PWPs), (d) understanding CAT-GSH (made up of confidence, learning new therapeutic language/concepts and appreciating the difference with CBT-GSH) and (e) joint exploration (made up of therapeutic/supervisory relationships and enhanced collaboration). Conclusion: CAT-GSH appears an acceptable (but challenging) approach for PWPs to deliver in IAPT services. Services should prioritise training and supervision for PWPs to ensure good governance of delivery. [ABSTRACT FROM AUTHOR]

Background There is an urgent need to address high levels of work-related violence (WRV) in Britain to improve the workplace experience of both employers and employees. Aims This study specifically explores prevalence rates of work-related violence assaults (WRVAs) for staff at high risk that have supervisor responsibilities and work full-time. Methods Five years of data were used for analysis from the Crime Survey of England and Wales (CSEW). Data were filtered for victims of crime from a working population in Britain. Results Forty-four per cent of respondents who are supervisors and have full-time jobs report that they had been victims of WRVAs. This figure is higher than other previous studies of WRV. Conclusions The current study provides further alternative evidence to support high prevalence rates of WRV by selecting for analysis specific work characteristics data that are strongly associated with WRV (supervisor responsibilities and full-time work). It is therefore recommended that future work explores different means of intervention for organizations to implement within the workplace to reduce WRV and protect workers from harm. [ABSTRACT FROM AUTHOR]

In October 2012, a maternal pertussis vaccination program was implemented in England following an increased incidence and mortality in infants. We evaluated the cost-effectiveness of the program by comparing pertussis-related infant hospitalizations and deaths in 2012–2017 with nonvaccination scenarios. Despite considerable uncertainties, findings support the cost-effectiveness of the program. [ABSTRACT FROM AUTHOR]

Since 2014, the government in England has undertaken a programme of work to explore the measurement of learning gain in undergraduate education. This is part of a wider neoliberal agenda to create a market in higher education, with student outcomes featuring as a key construct of value for money. The Higher Education Funding Council for England (subsequently dismantled) invested £4 million in funding 13 pilot projects to develop and test instruments and methods for measuring learning gain, with approaches largely borrowed from the US. Whilst measures with validity in specific disciplinary or institutional contexts were developed, a robust single instrument or measure has failed to emerge. The attempt to quantify learning represented by this initiative should spark debate about the rationale for quantification--whether it is for accountability, measuring performance, assuring quality or for the enhancement of teaching, learning and the student experience. It also raises profound questions about who defines the purpose of higher education; and whether it is those inside or outside of the academy who have the authority to decide the key learning outcomes of higher education. This article argues that in focusing on the largely technical aspects of the quantification of learning, government-funded attempts in England to measure learning gain have overlooked fundamental questions about the aims and values of higher education. Moreover, this search for a measure of learning gain represents the attempt to use quantification to legitimize the authority to define quality and appropriate outcomes in higher education. [ABSTRACT FROM AUTHOR]

Postoperative vaginal vault brachytherapy (VBT) reduces local recurrence in operable endometrial cancer. Radiographer-led delivery of VBT, carried out without image guidance, was implemented at Addenbrooke's in 2010 to maximise skills mix and to improve service delivery. The purpose of this study was to evaluate the safety and effectiveness of this service. This was a single-centre retrospective study of endometrial cancer patients treated with postoperative high dose rate VBT ± external beam radiotherapy (EBRT) between January 2010 and December 2016. In total, 414 patients were analysed: 307 received adjuvant VBT alone and 107 patients received pelvic EBRT followed by VBT. Thirty-seven per cent of patients receiving VBT alone were high risk according to ESMO-ESGO-ESTRO criteria. After a median follow-up of 59 months (range 2–118), 9/414 (2.2%) patients had isolated vaginal recurrences, 15/414 (3.6%) had locoregional recurrence (vaginal, pelvic node or both), whereas 62/414 (15%) patients had distant recurrence. The 5-year actuarial isolated vaginal recurrence rate was 2.3% (VBT alone 2.1%, EBRT + VBT 3.0%). Grade 3 urinary or bowel toxicity occurred in 2/414 (0.6%) patients treated with EBRT and VBT. None of the patients treated with VBT alone had grade 3 complications. Radiographer-led delivery of VBT, without the use of image guidance, is a safe and effective service. • Radiographer-led delivery of radiotherapy services maximises skills mix. • Vaginal vault brachytherapy delivered exclusively by radiographers is safe. • Despite no image guidance, the 5-year isolated vaginal recurrence rate was only 2.3%. • Late bowel and bladder toxicity was minimal. [ABSTRACT FROM AUTHOR]

Introduction: All the surgeries carry risks, which may lead to readmission at a later date. At present, there is limited Trauma and Orthopaedic (T&O) specific data in the literature. As a result, a prospective regional service evaluation aimed to discover the current complication and readmission rates across all T&O procedures and identify any factors associated with these outcomes.Methods: Data were collected at six sites across Yorkshire and Humber for all T&O procedures during October 2016. Patient demographics and procedure-specific data were collected. Post-operative complications and length of stay were recorded. All the patients were then followed up for 30 days post-discharge to determine if they experienced complications which resulted in readmission and further surgical intervention.Results: 1411 patients having a total of 64 operations were recorded with 1391 completing follow-up (98.5%). Overall in-patient complication rate was 8.4% with the readmission rate being 4.4%. An ASA grade of three or more was found to be associated with readmission. Procedure-related factors such as the use of VTE prophylaxis and prophylactic antibiotics, as well as the elective nature of certain operations were negatively associated with readmission. The largest subgroup of patients was those undergoing total hip (THR) or knee replacements (TKR). For these 234 patients, the readmission rate for TKR and THR being 3.77% and 3.13%, respectively.Conclusions: This large, multi-centre project describes readmission rates following trauma and orthopaedic surgery. In the presented study, the elective nature of the procedure was associated with a reduced risk of readmission. [ABSTRACT FROM AUTHOR]

An electronic survey was undertaken in the period March-June 2016 to assess the experience of people who had been transported under the Mental Health Act 1983 (MHA). The location of the survey was the South West of England. The questions asked related to the individual's experience of using transport, the time taken to be transported, what was good about the journey, what was unsatisfactory and what could be done to improve the experience. There were 16 responses in total. The findings have been summarised into five main themes: physical comfort, transport type, transport time, professional approach and monitoring. People who had been transported reported that the current method of transport (either via the police or NHS ambulance services) had led to them feeling stigmatised and that there was often a lack of understanding from these agencies around the specific needs of people with mental health conditions. In general, individuals subject to the MHA faced a long wait for some form of transportation. There was a preference for transport in a car, as opposed to a police vehicle or ambulance. [ABSTRACT FROM AUTHOR]

Objective To evaluate the efficacy of the Patient Reporting and Action for a Safe Environment intervention. Design A multicentre cluster randomised controlled trial. Setting Clusters were 33 hospital wards within five hospitals in the UK. Participants All patients able to give informed consent were eligible to take part. Wards were allocated to the intervention or control condition. Intervention The ward-level intervention comprised two tools: (1) a questionnaire that asked patients about factors contributing to safety (patient measure of safety (PMOS)) and (2) a proforma for patients to report both safety concerns and positive experiences (patient incident reporting tool). Feedback was considered in multidisciplinary action planning meetings. Measurements Primary outcomes were routinely collected ward-level harm-free care (HFC) scores and patient-level feedback on safety (PMOS). Results Intervention uptake and retention of wards was 100% and patient participation was high (86%). We found no significant effect of the intervention on any outcomes at 6 or 12 months. However, for new harms (ie, those for which the wards were directly accountable) intervention wards did show greater, though non-significant, improvement compared with control wards. Analyses also indicated that improvements were largest for wards that showed the greatest compliance with the intervention. Limitations Adherence to the intervention, particularly the implementation of action plans, was poor. Patient safety outcomes may represent too blunt a measure. Conclusions Patients are willing to provide feedback about the safety of their care. However, we were unable to demonstrate any overall effect of this intervention on either measure of patient safety and therefore cannot recommend this intervention for wider uptake. Findings indicate promise for increasing HFC where wards implement ≥75% of the intervention components. [ABSTRACT FROM AUTHOR]

Background: In the UK, GPs play a key role in the identification and management of children, young people, and adults on the autism spectrum, but there is a paucity of research on GPs' perceptions of working with these patients.Aim: To understand GPs' perceived self-efficacy in identifying and managing their patients on the autism spectrum, and the factors affecting this.Design and Setting: An online self-report survey was developed for completion by GPs across the UK.Method: A total of 304 GPs in the UK took part. The survey collected responses on participants' background, training, and experience, both as a GP and with regard to autism, and included a 22-item knowledge of autism questionnaire, a 14-item self-efficacy scale targeting GPs' perceived confidence in identifying and managing their autistic patients, and an open question eliciting participants' experiences of working with autistic people.Results: In total, 39.5% (n = 120) of GP participants reported never having received formal training in autism. Despite demonstrating good knowledge of its key features, participants reported limited confidence in their abilities to identify and manage autistic patients, with many citing a number of barriers that overwhelmingly focused on perceived failings of the current healthcare system (such as a lack of clarity around referral pathways).Conclusion: There is an urgent need for improved local specialist service provision alongside clearer referral pathways for diagnosis to improve both GPs' confidence in caring for their autistic patients and the healthcare experiences of autistic patients and their families. Local clinical commissioning groups are best served to assist GPs in ensuring that they can reliably detect the condition and make appropriate provisions for support. [ABSTRACT FROM AUTHOR]

Background: We describe drug-induced liver injury (DILI) secondary to antituberculous treatment (ATT) in a large tuberculosis (TB) centre in London; we identify the proportion who had risk factors for DILI and the timing and outcome of DILI.Methods: We identified consecutive patients who developed DILI whilst on treatment for active TB; patients with active TB without DILI were selected as controls. Comprehensive demographic and clinical data, management and outcome were recorded.Results: There were 105 (6.9%) cases of ATT-associated DILI amongst 1529 patients diagnosed with active TB between April 2010 and May 2014. Risk factors for DILI were: low patient weight, HIV-1 co-infection, higher baseline ALP, and alcohol intake. Only 25.7% of patients had British or American Thoracic Society defined criteria for liver test (LT) monitoring. Half (53%) of the cases occurred within 2 weeks of starting ATT and 87.6% occurred within 8 weeks. Five (4.8%) of seven deaths were attributable to DILI.Conclusions: Only a quarter of patients who developed DILI had British or American Thoracic Society defined criteria for pre-emptive LT monitoring, suggesting that all patients on ATT should be considered for universal liver monitoring particularly during the first 8 weeks of treatment. [ABSTRACT FROM AUTHOR]

Three studies were conducted to investigate people's conceptions of online trolls, particularly conceptions associated with psychological resilience to trolling. In Study 1, a factor analysis of participants' ratings of characteristics of online trolls found a replicable bifactor model of conceptions of online trolls, with a general factor of general conceptions towards online trolls being identified, but five group factors (attention-conflict seeking, low self-confidence, viciousness, uneducated, amusement) as most salient. In Study 2, participants evaluated hypothetical profiles of online trolling messages to establish the validity of the five factors. Three constructs (attention-conflict seeking, viciousness, and uneducated) were actively employed when people considered profiles of online trolling scenarios. Study 3 introduced a 20-item 'Conceptions of Online Trolls scale' to examine the extent to which the five group factors were associated with resilience to trolling. Results indicated that viewing online trolls as seeking conflict or attention was associated with a decrease in individuals' negative affect around previous trolling incidents. Overall, the findings suggest that adopting an implicit theories approach can further our understanding and measurement of conceptions towards trolling through the identification of five salient factors, of which at least one factor may act as a resilience strategy. [ABSTRACT FROM AUTHOR]

Aims The aims of this study were as follows: (i) To assess the prevalence of periodontitis among patients with primary Sjögren's syndrome ( pSS) and comparator groups of patients with rheumatoid arthritis ( RA) and osteoarthritis ( OA). (ii) To perform a pilot study to compare serum antibody responses to 10 oral/periodontal bacteria in these patient groups and a historical comparator group of patients with periodontitis. Materials and Methods Standard clinical periodontal assessments were performed on 39 pSS, 36 RA and 23 OA patients and 'In-house' antibody ELISAs for serum antibodies against 10 oral/periodontal bacteria were performed in these groups. Results Forty-six percent of the pSS group, 64% of the RA group and 48% of the OA group had moderate/severe periodontitis. These frequencies did not reach statistical significance between groups. Raised antibody levels to Prevotella denticola were found in the pSS, RA and periodontitis groups compared to the OA group. Significant between group differences were seen for Aggregatibacter actinomycetemcomitans, Prevotella intermedia and Campylobacter showae. None of these differences were specifically associated with pSS. Conclusion This study showed no increase in periodontitis in pSS patients. Although the P. denticola data are of interest, identifying bacterial triggering factors for pSS will likely require alternative strategies including modern techniques such as microbiome analysis. [ABSTRACT FROM AUTHOR]

Background: Venous leg ulcers (VLUs) are the commonest cause of leg ulceration, affecting 1 in 100 adults. There is a significant health burden associated with VLUs - it is estimated that the cost of treatment for 1 ulcer is up to £1300 per year in the NHS. The mainstay of treatment is with graduated compression bandaging; however, treatment is often prolonged and up to one quarter of venous leg ulcers do not heal despite standard care. Two previous trials have suggested that low-dose aspirin, as an adjunct to standard care, may hasten healing, but these trials were small and of poor quality. Aspirin is an inexpensive, widely used medication but its safety and efficacy in the treatment of VLUs remains to be established.Methods/design: AVURT is a phase II randomised double blind, parallel-group, placebo-controlled efficacy trial. The primary objective is to examine whether aspirin, in addition to standard care, is effective in patients with chronic VLUs (i.e. over 6 weeks in duration or a history of VLU). Secondary objectives include feasibility and safety of aspirin in this population. A target of 100 participants, identified from community leg ulcer clinics and hospital clinics, will be randomised to receive either 300 mg of aspirin once daily or placebo. All participants will receive standard care with compression therapy. The primary outcome will be time to healing of the reference ulcer. Follow-up will occur for a maximum of 27 weeks. The primary analysis will use a Cox proportional hazards model to compare time to healing using the principles of intention-to-treat. Secondary outcomes will include ulcer size, pain evaluation, compliance and adverse events.Discussion: The AVURT trial will investigate the efficacy and safety of aspirin as a treatment for VLU and will inform on the feasibility of proceeding to a larger phase III study. This study will address the paucity of information currently available regarding aspirin therapy to treat VLU.Trial Registration: The study is registered on a public database with clinicaltrials.gov ( NCT02333123 ; registered on 5 November 2014). [ABSTRACT FROM AUTHOR]

Adults learning to navigate to a hidden goal within an enclosed space have been found to prefer information provided by the distal cues of an environment, as opposed to proximal landmarks within the environment. Studies with children, however, have shown that 5- or 7-year-olds do not display any preference toward distal or proximal cues during navigation. This suggests that a bias toward learning about distal cues occurs somewhere between the age of 7 years and adulthood. We recruited 5- to 11-year-old children and an adult sample to explore the developmental profile of this putative change. Across a series of 3 experiments, participants were required to navigate to a hidden goal in a virtual environment, the location of which was signaled by both extramaze and intramaze landmark cues. During testing, these cues were placed into conflict to assess the search preferences of participants. Consistent with previously reported findings, adults were biased toward using extramaze information. However, analysis of the data from children, which incorporated age as a continuous variable, suggested that older children in our sample were, in fact, biased toward using the intramaze landmark in our task. These findings suggest the bias toward using distal cues in spatial navigation, frequently displayed by adults, may be a comparatively late developing trait, and one that could supersede an initial developmental preference for proximal landmarks. [ABSTRACT FROM AUTHOR]

E. P. Thompson's work on the making of the English working class is recalled in this paper for its continued relevance to historical materialist perspectives on global movements and class formations. Much commentary on Thompson's work confirms divisions between a first and second British New Left and largely confines the working class to an insular, English phenomenon, one which may present significant insight to a particular account of historical movement and change, but lacks wider spatial and conceptual resonance. This paper questions this view, and its wider implications for the writing of contemporary British history, while pointing towards the greater significance and application of Thompson's work on the making of the English working class than previously acknowledged. This has further implications for recent expressions of ‘global class formation’ as seen in the work of Michael Hardt and Antonio Negri. [ABSTRACT FROM PUBLISHER]

Background: Little is known about the long-term mortality and causes of death after first psychiatric admission.Method: A consecutive series of 87 patients admitted for the first time from a strictly defined catchment area to Saxondale Hospital, Nottinghamshire, who were discharged in 1974 and 1975, were traced in 1992 to either their general practitioner or death. The causes of their deaths were ascertained and the observed mortality was compared with expected mortality.Results: Twelve subjects had died. None had committed suicide, and there were no open verdicts or accidental deaths. Although the observed mortality was higher than expected, there was no significant excess.Conclusions: There may be little scope for reducing suicide rates by targeting patients for careful follow-up after discharge from their first psychiatric admission. More research is required before large investments are made in potentially fruitless interventions to achieve the objectives of The Health of the Nation. [ABSTRACT FROM AUTHOR]

Corona ions produced by high-voltage power lines (HVPLs) can alter the nearby electrical environment, potentially increasing aerosol charge levels downwind. However, there is a lack of knowledge concerning the concentration and mobility of ions from AC HVPLs and their dispersion away from the line. We present ion concentration and mobility measurements made near AC HVPLs in South-West England. Examples of typical mobility spectra are shown highlighting features commonly observed. Corona was observed during 33 of 46 measurements, at 9 of 11 sites, with positive or 'bipolar' (both polarities) ion production commonly seen. Ion production usually increases atmospheric concentrations by only a modest amount, but extreme cases can enhance concentration by an order of magnitude or more. A polarity imbalance is required to increase aerosol charge via ion attachment; this was observed on 15 of 24 days when positive corona was observed, but was not seen for negative ions. Ion mobility was higher downwind compared with upwind for both ion polarities, but the increase was not statistically significant. Future work should focus on identifying and characterising 'heavy-producing' HVPLs, and obtaining results in conditions which may favour negative ion production e.g. high humidity, inclement weather or during nighttime. [ABSTRACT FROM AUTHOR]

To address measurement of patient safety, the NHS in England has introduced the NHS Safety Thermometer using the Commissioning for Quality and Innovation (CQUIN) scheme. The scheme offers a financial reward to all providers of NHS care measuring four common harms using the NHS Safety Thermometer on one day each month, with further incentives to achieve improvement goals in subsequent years of the scheme. This article discusses the background to the scheme and a rationale for the focus on pressure ulcers, falls in care, catheter use and urinary tract infection, and venous thromboembolism. The implementation process for this scheme in a large NHS foundation trust is detailed together with its effect within the authors' organisation on harm-free care for their patients. [ABSTRACT FROM AUTHOR]

Background: This study evaluates the effects of a language and literacy intervention for children with Down syndrome. Methods: Teaching assistants (TAs) were trained to deliver a reading and language intervention to children in individual daily 40-min sessions. We used a waiting list control design, in which half the sample received the intervention immediately, whereas the remaining children received the treatment after a 20-week delay. Fifty-seven children with Down syndrome in mainstream primary schools in two UK locations (Yorkshire and Hampshire) were randomly allocated to intervention (40 weeks of intervention) and waiting control (20 weeks of intervention) groups. Assessments were conducted at three time points: pre-intervention, after 20 weeks of intervention, and after 40 weeks of intervention. Results: After 20 weeks of intervention, the intervention group showed significantly greater progress than the waiting control group on measures of single word reading, letter-sound knowledge, phoneme blending and taught expressive vocabulary. Effects did not transfer to other skills (nonword reading, spelling, standardised expressive and receptive vocabulary, expressive information and grammar). After 40 weeks of intervention, the intervention group remained numerically ahead of the control group on most key outcome measures; but these differences were not significant. Children who were younger, attended more intervention sessions, and had better initial receptive language skills made greater progress during the course of the intervention. Conclusions: A TA-delivered intervention produced improvements in the reading and language skills of children with Down syndrome. Gains were largest in skills directly taught with little evidence of generalization to skills not directly taught in the intervention. [ABSTRACT FROM AUTHOR]

Background: Suicide rates in older people in England and Wales have declined in recent years. The challenge, therefore, is to sustain this downward trend. Better understanding of the current methods of suicide used by older people may inform strategies to sustain this decline. Methods: A study to ascertain the up to date status of methods of suicides used by older people in England and Wales was undertaken using the latest available national mortality data (suicides and open verdicts) from the Office of National Statistics for the years 2001 to 2007. Suicide in this study is measured by and includes the combination of deaths due to suicides (ICD-10 codes X60-X84) and open verdicts (ICD-10 codes Y10-Y34). The chi square test (corrected for continuity) was used to examine the differences in the methods of suicide between: (i) those under the age of 65 years and those aged 65 years and over in both sexes; (ii) males and females aged 65 years and over. Results: Hanging, strangulation and suffocation (males, 40.2%; females 20.1%), drowning and submersion (males, 8.2%; females 11.4%), and other and unspecified drugs, medicaments and biological substances (males, 8%; females, 20.4%) were the most common methods of suicide in older people. There were significant differences in the methods of suicide used by older men and women, and by older and younger people in both sexes. Suicide by unspecified means was common in both older men and women and higher in older women than older men. Unfortunately, data on the potential method of suicide is not available for these "unspecified means. Conclusions: The clear differences in the methods of suicide between older and younger people and between older men and women suggest a need to develop different strategies to reduce access to these methods of suicide for different age and sex groups. Also, potentially preventable methods of suicide may be hidden behind suicide by unspecified means. Therefore, there is a need to accurately ascertain and document methods of suicide, as they may offer opportunities for prevention. [ABSTRACT FROM AUTHOR]

A recent focus meeting on Controlling Acute Inflammation was held in London, April 27-28, 2006, organized by D.W. Gilroy and S.D. Brain for the British Pharmacology Society. We concluded at the meeting that a consensus report was needed that addresses the rapid progress in this emerging field and details how the specific study of resolution of acute inflammation provides leads for novel anti-inflammatory therapeutics, as well as defines the terms and key components of interest in the resolution process within tissues as appreciated today. The inflammatory response protects the body against infection and injury but can itself become dysregulated with deleterious consequences to the host. It is now evident that endogenous biochemical pathways activated during defense reactions can counter-regulate inflammation and promote resolution. Hence, resolution is an active rather than a passive process, as once believed, which now promises novel approaches for the treatment of inflammation-associated diseases based on endogenous agonists of resolution. [ABSTRACT FROM AUTHOR]

Focuses on the management of hotel in England. Standard performance of the hotel sector; Financial stability of the hotels; Marketing strategy of the hotel management.

• White British population STR allele frequency data. • Population data for White British population. • Genetic diversity in European populations including White British. We report allele frequencies and standard population genetics parameters for 23 forensic autosomal STR loci tested among White British population. In addition, we use generated allele frequency data to compare the extent of genetic variation with 19 other European populations. [ABSTRACT FROM AUTHOR]

Abstract: Since overall changes in crime rates are largely independent of the work of the police, the level of crime per se is not a measure of police performance. Where policing is a response to victimisation, a more appropriate measure would be the level of repeat victimisation. The empirical study is an evaluation of the first year of a police divisional Domestic Violence Unit (DVU) which operated in response to calls to 'domestic' incidents. In the first year of operation of the DVU, repeat calls to domestic incidents declined in the division, while those in the six other divisions increased. However, this pattern did not hold when 'all calls' were the measure, so that a potentially beneficial effect would have been missed. The substantive implications for the policing of domestic violence and the use of repeat victimisation as a measure for the evaluation of police crime prevention work are considered. [ABSTRACT FROM AUTHOR]

Fine needle cytology of palpable head and neck lesions: a comparison of sampling methods with and without suctionPatients attending the ear, nose and throat (ENT) department at St James's University Hospital, Leeds, UK, for evaluation of palpable head and neck lesions have a fine needle cytology (FNC) specimen taken and receive the result at the same out-patient visit. This study was designed to discover if there is a significant difference in the efficiency of the methods with and without suction. The method was chosen randomly on each occasion and the adequacy or otherwise of the specimen was determined taking into account the site and nature of the lesion and the total cellularity of the sample. The level of blood contamination was also compared by each method. When benign and malignant lesions from all sites were analysed together the method with suction produced a significantly higher number of adequate samples than the method without suction. The exception was in the case of samples from lymph node lesions measuring < 1 cm, where adequate specimens were only obtained without suction. The non-suction technique was particularly poor at sampling salivary gland lesions in the 1–1.5 cm category. There was no significant difference in the level of blood contamination between the two methods at any site. These results are at variance with most other similar studies and possible reasons for this are discussed. [ABSTRACT FROM AUTHOR]

Examines the changes in sodium excretion and sodium balance after withdrawal of long term nifedipine in London, England. Use of nifedipine for treating angina and hypertension; Reduction of urinary sodium excretion during withdrawal of nifedipine; Effect of nifedipine treatment on the reduction in sodium balance of the patient.

Mortality rates from motor neuron disease in England and Wales for the years 1959-1979 were studied through death certification data supplied by the Office of Population Censuses and Surveys. The age- and sex-adjusted mortality rate increased over the period from 1.2 per 100 000 per year in 1959-61 to 1.6 in 1977-79, the increase being most apparent in women over age 45 years and men over 60 years. The ratio of the sex-specific mortality rates remained fairly constant at 1.6:1 (male to female). The distribution of motor neuron disease deaths within England and Wales showed more variation between counties and between Hospital Regions than expected, and areas of high motor neuron disease mortality along the south coast and low mortality in the Midlands could be identified. The variation was most marked in those aged over 65 years at death. Examination of occupation, as listed on the death certificates, showed an excess of motor neuron disease deaths in leather workers in all three periods for which data were available (1959-63, 1970-72 and 1975). A small study of the certified cause of death of 56 motor neuron disease patients showed that a high percentage (88%) had motor neuron disease given as the cause of death. [ABSTRACT FROM AUTHOR]

The present study investigates the occurrence of daytime behaviour problems and mammal stress in a group of children with Down's syndrome (DS) compared with a group of their non-intellectually disabled siblings, a group of non-intellectually disabled children from the general population and a group of children with an intellectual disability other than Down's syndrome. The Aberrant Behavior Checklist (ABC) and the Malaise Inventory were completed by the mothers. Associations between daytime behaviour problems and maternal stress were also explored. Overall, the children with DS and the children with other intellectual disabilities showed significantly higher rates of behavioural disturbance on all five of the ABC subscales (Irritability, Lethargy, Stereotypies, Hyperactivity and Inappropriate Speech) and on the Total ABC score. However, the children with other intellectual disabilities also showed significantly higher scores than the children with DS on four of the ABC subscales: Irritability, Lethargy, Stereotypies and Hyperactivity, as well as the Total ABC score. The siblings and children from the general population showed very similar behaviour scores. A number of significant age and sex differences were found in the occurrence of daytime behaviour problems. Maternal stress was significantly higher in the group with other forms of intellectual disability than the other three groups, and a number of significant associations were found between parental ratings of daytime behaviour problems and maternal stress in all four samples. The implications of the findings are discussed, including the need for early assessment to minimize adverse effects on the child's development and on family life. [ABSTRACT FROM AUTHOR]

Information about several papers discussed at the 2013 Public Health England (PHE) Annual Conference held September 10-11 is presented. Topics include the impact of antimicrobial stewardship guidelines on antimicrobial use and resistance, public health, and vaccines to link today's public health practice and policy. The conference featured several speakers including Richard Loy, Dr. Andrew Dodgson, and Professor Jonathan Cooke.

The article discusses a report which provided possible explanations for the increase in the use of Court-ordered curfews. Derbyshire, Kent and Essex, England were revisited and community cases where electronic monitoring forms part of the community sentence and Home Detention Curfew (HDC) cases were examined. The report found that in 2012 the percentage of community orders imposed have fallen from 90 percent in 2008 to 29 percent in 2012.

An assessment of risk-taking behaviour among men who have sex with men (MSM) attending a sauna venue was undertaken, using a standardized questionnaire, after which outreach screening was introduced targeting MSM. The epidemiology of the continuing outbreak of syphilis was reviewed to determine the factors driving the outbreak and assess the benefit of continuing outreach screening. Findings among the 163 respondents at the sauna included a high rate of casual sex and a tendency not to disclose HIV status. Over 12 months, 51 cases of early syphilis were recorded. Our review showed a decline in incidence in MSM after outreach screening, but an increase in heterosexual spread. Given the frequent anonymous nature of syphilis transmission, traditional contact tracing is ineffective. Outreach screening is required at gay venues and other community settings to target at-risk populations. [ABSTRACT FROM AUTHOR]

Background: A national pre-registration pharmacist training recruitment scheme, which replaces local recruitment models, was introduced in England and Wales in 2017. The national recruitment system allows pharmacy students to apply for the 52 weeks training programmes (mandatory requirement for registration as a pharmacist), through a single application system prior to undertaking a nationally administered assessment. This study aimed to explore experiences of pharmacy students on the national recruitment scheme, particularly their views on the selection methodology, application process, and offer outcomes. Methods: This mixed method study involved a) an online survey of all (approximate n = 2800) year 4 (final year of MPharm degree) pharmacy students in England and Wales and b) a qualitative focus group with four students. The study population was eligible to participate in the 2017/18 national recruitment scheme. Survey respondents were invited to participate in a focus group. Quantitative data were analysed using descriptive and inferential analysis. Qualitative data were analysed using the framework technique. Participation was voluntary. Ethical approval from University of Birmingham was obtained. Results: A total of 307 completed surveys were returned (approximate response rate 11%). Respondents were generally satisfied with the application process and commended the fairness of the selection methodology and convenience in allowing them to apply to multiple training providers. Most survey respondents (n = 181, 72.9%) were either satisfied or highly satisfied with the training programme they were offered based on their assessment performances. Three themes and eight sub-themes obtained from the analysis of over 200 open comments data from the survey and transcript of a focus group with four participants. Results suggested the need to widen the timeframe available for applicants to shortlist their preferred employers, improve the method of programme listing in the application system, and consideration of prior achievements including academic performances and placement experiences to be included in the selection methodology. Conclusions: Experiences of pharmacy students on the national recruitment scheme suggest that respondents considered the selection methodology to be fair. Student engagement and satisfaction with the recruitment system can be maximised through improved listing of employers and widening the timescales for students to shortlist their preferred employers during application process. Inclusion of University achievements in the selection methodology will require consideration of evidence based approaches. Low response rate limits generalisation of findings. [ABSTRACT FROM AUTHOR]

Health Pathfinder is a multilevel system change intervention initiated to transform the health response to domestic violence and abuse in eight sites in England. The current study drew upon interviews with health professionals (n = 27) and victim-survivors (n = 20) to provide a realist account of how this intervention achieved its goals. Findings show that five change mechanisms explain why Health Pathfinder was effective as an ecological intervention: awareness, expertise, relationships, empowerment, and evidence. Positive progress in respect of each mechanism had meaningful impacts on victim-survivor experiences of enquiry, disclosure, and uptake of services and had the potential to meaningfully impact health inequities. [ABSTRACT FROM AUTHOR]

The article presents opinion on problems which were seen in proposals which were offered by Liam Donaldson, the chief medical officer of England's Department of Health & Social Services. Donaldson had proposed broad changes to the regulation of the medical profession in that country. A discussion of problems associated with the proposals handling of medical partnerships and affiliates is presented.

Focuses on the educational implications of the meeting of Clinical Governance in London, England. Impact of Clinical Governance on generic aspect of training; Assessment of the quality of clinical care provided by the team; Effect of Clinical Governance on corporate responsibility.

The article focuses on the findings of a study conducted by the St. Mary's Hospital Medical School on a whole class of medical students entering the first year at Manchester University Medical School in England. Results show the prevalence of feelings of depression and apathy about six weeks after the students entered the wards in their clinical period. Various adolescent tasks and social and psychological crises encountered are cited.