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Realistic targets for soil organic carbon (SOC) concentrations are needed, accounting for differences between soils and land uses. We assess the use of SOC/clay ratio for this purpose by comparing changes over time in (a) the National Soil Inventory of England and Wales, first sampled in 1978–1983 and resampled in 1994–2003, and (b) two long-term experiments under ley-arable rotations on contrasting soils in the East of England. The results showed that normalising for clay concentration provides a more meaningful separation between land uses than changes in SOC alone. Almost half of arable soils in the NSI had degraded SOC/clay ratios (< 1/13), compared with just 5% of permanent grass and woodland soils. Soils with initially large SOC/clay ratios (≥ 1/8) were prone to greater losses of SOC between the two NSI samplings than those with smaller ratios. The results suggest realistic long-term targets for SOC/clay in arable, ley grass, permanent grass and woodland soils are 1/13, 1/10, and > 1/8, respectively. Given the wide range of soils and land uses across England and Wales in the datasets used to test these targets, they should apply across similar temperate regions globally, and at national to sub-regional scales. [ABSTRACT FROM AUTHOR]

Simple measures of appropriate levels of soil organic matter are needed for soil evaluation, management and monitoring, based on readily measurable soil properties. We test an index of soil organic matter based on the soil organic carbon (SOC) to clay ratio, defined by thresholds of SOC/clay ratio for specified levels of soil structural quality. The thresholds were originally delineated for a small number of Swiss soils. We assess the index using data from the initial sampling (1978–83) of the National Soil Inventory of England and Wales, covering 3,809 sites under arable land, grassland and woodland. Land use, soil type, annual precipitation and soil pH together explained 21% of the variance in SOC/clay ratio in the dataset, with land use the most important variable. Thresholds of SOC/clay ratio of 1/8, 1/10 and 1/13 indicated the boundaries between "very good", "good", "moderate" and "degraded" levels of structural condition. On this scale, 38.2, 6.6 and 5.6% of arable, grassland and woodland sites, respectively, were degraded. The index gives a method to assess and monitor soil organic matter at national, regional or sub‐regional scales based on two routinely measured soil properties. Given the wide range of soils and land uses across England and Wales in the dataset used to test the index, we suggest it should apply to other European soils in similar climate zones. Highlights: We assess the use of SOC/clay ratios as guidelines for soil management in England and Wales.We use data from 3,809 sites to assess thresholds based on work for Polish, French and Swiss soils.SOC/clay threshold values can indicate degraded and good soil structural condition.The thresholds show the effect of land use and provide an index for use in England and Wales. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relation between first-trimester fetal growth discrepancy, as assessed by crown-rump length (CRL) at 11+0 to 13+6 weeks of gestation, and subsequent development of preeclampsia (PE) in dichorionic diamniotic (DCDA) twin pregnancies. The association between inter-twin CRL and birth weight (BW) discrepancy was also investigated. Methods: This was a retrospective, case-control study of DCDA twin pregnancies. Inter-twin CRL discrepancy was calculated as 100×(larger CRL-smaller CRL)/larger CRL. BW discordance was calculated as 100×(larger BW-smaller BW)/larger BW. Results: The study included 299 DCDA pregnancies that remained normotensive and 35 that subsequently developed PE. There was no significant difference in the inter-twin CRL discrepancy between pregnancies complicated by PE and those that were not [3.2%, interquartile range (IQR): 0.5-4.5% vs. 3.3%, IQR: 1.4-5.5%; P=0.17]. There was a positive correlation between inter-twin CRL and BW discrepancy but only in pregnancies that remained normotensive (P<0.001). In women that subsequently developed PE, there was no association between inter-twin CRL and BW discordance (P=0.54). Conclusions: In unselected DCDA twins, first-trimester CRL discrepancy is not different between pregnancies that subsequently develop PE and those that remain normotensive. Furthermore, in pregnancies that are complicated by PE, the association between inter-twin CRL and BW discrepancy appears to be lost. [ABSTRACT FROM AUTHOR]

More than twice as much carbon is held in soils as in vegetation or the atmosphere, and changes in soil carbon content can have a large effect on the global carbon budget. The possibility that climate change is being reinforced by increased carbon dioxide emissions from soils owing to rising temperature is the subject of a continuing debate. But evidence for the suggested feedback mechanism has to date come solely from small-scale laboratory and field experiments and modelling studies. Here we use data from the National Soil Inventory of England and Wales obtained between 1978 and 2003 to show that carbon was lost from soils across England and Wales over the survey period at a mean rate of 0.6% yr-1 (relative to the existing soil carbon content). We find that the relative rate of carbon loss increased with soil carbon content and was more than 2% yr-1 in soils with carbon contents greater than 100 g kg-1. The relationship between rate of carbon loss and carbon content is irrespective of land use, suggesting a link to climate change. Our findings indicate that losses of soil carbon in England and Wales—and by inference in other temperate regions—are likely to have been offsetting absorption of carbon by terrestrial sinks. [ABSTRACT FROM AUTHOR]

Agriculture is a major contributor to global greenhouse gas (GHG) emissions and must feature in efforts to reduce emissions. Organic farming might contribute to this through decreased use of farm inputs and increased soil carbon sequestration, but it might also exacerbate emissions through greater food production elsewhere to make up for lower organic yields. To date there has been no rigorous assessment of this potential at national scales. Here we assess the consequences for net GHG emissions of a 100% shift to organic food production in England and Wales using life-cycle assessment. We predict major shortfalls in production of most agricultural products against a conventional baseline. Direct GHG emissions are reduced with organic farming, but when increased overseas land use to compensate for shortfalls in domestic supply are factored in, net emissions are greater. Enhanced soil carbon sequestration could offset only a small part of the higher overseas emissions. The greenhouse gas (GHG) mitigation potential of organic methods is poorly understood. Here, the authors assess the GHG impact of a 100% shift to organic food production in England and Wales and find that direct GHG emissions are reduced with organic farming, but when increased land use abroad to allow for production shortfalls is factored in, GHG emissions are elevated well-above the baseline. [ABSTRACT FROM AUTHOR]

A multi-professional project was carried out in order to identify the interventions that nurses and pharmacists make in relation to drug administration (an intervention refers to 'the process of querying a prescription with a prescriber'). The project highlights the importance of both these occupational groups in identifying prescribing errors and preventing them from being translated into actual medication errors. It also identifies the need for adequate training for nursing and medical staff, along with system changes, in order to minimize the risk of medication errors.

Background: Hepatitis C virus (HCV) infection is a major public health problem recognised by the UK National Strategy that proposes that a care pathway for assessment, diagnosis, and treatment be established in all prisons, integrated within managed clinical networks. A prison sentence provides the opportunity to focus on traditionally hard to reach patients., Aims: To evaluate the prevalence of HCV infection in a UK prison cluster and to assess the effectiveness of a prison outreach service for hepatitis C., Subjects: Male prisoners., Methods: A nurse specialist led clinic within a cluster of adult prisons was established, offering health education on hepatitis C, advice on harm minimisation, and HCV testing. Infected prisoners were offered access to a care pathway leading to treatment. Outcome measures were uptake of the service, and diagnosis and treatment of hepatitis C., Results: A total of 8.5% of 1618 prisoners accepted testing: 30% had active infection with HCV. Most were ineligible for treatment due to psychiatric illness or did not receive treatment for logistic reasons. Injecting drug use was the major risk factor in all cases. Only 7% of HCV polymerase chain amplification positive inmates received treatment in prison., Conclusion: There is a large pool of HCV infected prisoners at risk of complications, constituting a source of infection during their sentence and after discharge. A prison outreach clinic and care pathway was perceived as effective in delivering health education, reducing the burden on prison and hospital services. It provided an opportunity for intervention but had a limited effect in eradicating HCV in prisoners and it remains unclear how this might be achieved.

Background: Managing patients' requests for appointments is an important general practice activity. No previous research has systematically observed how patients and receptionists negotiate appointments., Aim: To observe appointment making and investigate patients' and professionals' experiences of appointment negotiations., Design of Study: A qualitative study using participant observation., Setting: Three general practices on Tyneside; a single-handed practice, a practice comprising three doctors, and a seven-doctor practice., Method: Participant observation sessions, consisting of 35 activity recordings and 34 periods of observation and 38 patient and 15 professional interviews, were set up. Seven groups of patients were selected for interview. These included patients attending an 'open access' surgery, patients who complained about making an appointment, and patients who complimented the receptionists., Results: Appointment making is a complex social process. Outcomes are dependent on the process of negotiation and factors, such as patients' expectations and appointment availability. Receptionists felt that patients in employment, patients allocated to the practice by the Health Authority, and patients who did not comply with practice appointment rules were most demanding. Appointment requests are legitimised by receptionists enforcing practice rules and requesting clinical information. Patients volunteer information to provide evidence that their complaint is appropriate and employ strategies, such as persistence, assertiveness, and threats, to try and persuade receptionists to grant appointments., Conclusion: Appointment making is a complex social process where outcomes are negotiated. Receptionists have an important role in managing patient demand. Practices should be explicit about how appointments are allocated, including publishing practice criteria.