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Background: Antibiotic-resistant bacteria (ARB) are selected by the use of antibiotics. The rational design of interventions to reduce levels of antibiotic resistance requires a greater understanding of how and where ARB are acquired. Our aim was to determine whether acquisition of ARB occurs more often in the community or hospital setting.Methods: We used a mathematical model of the natural history of ARB to estimate how many ARB were acquired in each of these two environments, as well as to determine key parameters for further investigation. To do this, we explored a range of realistic parameter combinations and considered a case study of parameters for an important subset of resistant strains in England.Results: If we consider all people with ARB in the total population (community and hospital), the majority, under most clinically derived parameter combinations, acquired their resistance in the community, despite higher levels of antibiotic use and transmission of ARB in the hospital. However, if we focus on just the hospital population, under most parameter combinations a greater proportion of this population acquired ARB in the hospital.Conclusions: It is likely that the majority of ARB are being acquired in the community, suggesting that efforts to reduce overall ARB carriage should focus on reducing antibiotic usage and transmission in the community setting. However, our framework highlights the need for better pathogen-specific data on antibiotic exposure, ARB clearance and transmission parameters, as well as the link between carriage of ARB and health impact. This is important to determine whether interventions should target total ARB carriage or hospital-acquired ARB carriage, as the latter often dominated in hospital populations. [ABSTRACT FROM AUTHOR]

Background Public sources fund the majority of UK infection research, but citizens currently have no formal role in resource allocation. To explore the feasibility and willingness of citizens to engage in strategic decision making, we developed and tested a practical tool to capture public priorities for research. Method A scenario including six infection themes for funding was developed to assess citizen priorities for research funding. This was tested over two days at a university public festival. Votes were cast anonymously along with rationale for selection. The scenario was then implemented during a three-hour focus group exploring views on engagement in strategic decisions and in-depth evaluation of the tool. Results 188/491(38%) prioritized funding research into drug-resistant infections followed by emerging infections(18%). Results were similar between both days. Focus groups contained a total of 20 citizens with an equal gender split, range of ethnicities and ages ranging from 18 to >70 years. The tool was perceived as clear with participants able to make informed comparisons. Rationale for funding choices provided by voters and focus group participants are grouped into three major themes: (i) Information processing; (ii) Knowledge of the problem; (iii) Responsibility; and a unique theme within the focus groups (iv) The potential role of citizens in decision making. Divergent perceptions of relevance and confidence of 'non-experts' as decision makers were expressed. Conclusion Voting scenarios can be used to collect, en-masse, citizens' choices and rationale for research priorities. Ensuring adequate levels of citizen information and confidence is important to allow deployment in other formats. [ABSTRACT FROM AUTHOR]

Background: Antimicrobial resistance is driven by multiple factors. Resolving the threat to human and animal health presented by drug-resistant infections remains a societal challenge that demands close collaboration between scientists and citizens. We compared current public views about key contributing factors to antimicrobial resistance with those expressed by experts.Methods: Overarching factors contributing to antimicrobial resistance were identified following a review of literature. The factors were then described in plain language and attached to ballot boxes at a public engagement event organised by a university. Responses to each factor were counted at the end of the event.Results: Four hundred five responses were received from 3750 visitors (11 % response rate). Nearly half of responses (192/405, 47 · 4 %) considered the misuse/overuse of antibiotics in humans as the main determinant of antimicrobial resistance. The misuse of antibiotics in animal health obtained 16 · 3 % (66/405) responses. However, the lack of quick tests to diagnose infections received 10/405 votes (2 · 47 %), and the lack of effective vaccines received one vote (0 · 25 %).Conclusions: The majority of responses ascribed the emergence of drug-resistant infections to the misuse of antibiotics in human and animals. Suboptimal dosing, availability of diagnostics and environmental contamination were considered less influential on the development of antimicrobial resistance. The growing recognition of broader multifaceted drivers of drug resistance by experts is not yet echoed in the public mind. [ABSTRACT FROM AUTHOR]

Background: Appropriate antimicrobial prescribing is essential for patient care, yet up to half of antimicrobial prescriptions written in the UK are sub-optimal. Improving prescriber education has recently been promoted as a mechanism to optimise antimicrobial use, but identification of key learning objectives to facilitate this is so far lacking. Using qualitative methods we investigated junior doctor knowledge, attitudes, and behaviours around antimicrobial prescribing to identify key areas to address in future educational programmes.Methods: A cross-sectional survey of qualified doctors in training in West London was undertaken exploring antimicrobial prescribing practices and educational needs.Results: Among 140 junior doctors from 5 London hospitals, a third (34 %) reported prescribing primarily unsupervised, and two thirds (67 %) reported difficulties obtaining prescribing support outside of hours. 20 % stated not feeling confident in writing an antimicrobial prescription, but confidence was increased through having confirmatory diagnostic results (24) and obtaining advice from a senior doctor (26 %); whether this senior was from their own specialty, or an infection-specialist, varied significantly (p < 0.01) by experience. Only a small percentage (5-13 %; depending on number of years post-qualification) of participants stated their previous antimicrobial education was effective. 60 % of those in their first year post qualification reported wanting further education in antimicrobial prescribing, rising to 74 % among more experienced junior doctors. Specific areas of educational need identified were (i) principles of antimicrobial prescribing, (ii) diagnosis of infections, (iii) clinical review of patients with infections, (iv) prescribing in the context of antimicrobial resistance, and (v) laboratory testing and test results.Conclusions: A significant proportion of junior doctors report lone prescribing of antimicrobials in the context of low self-perceived confidence and knowledge in this field, and frequent difficulty in accessing help when necessary. Innovative training, targeting five specific areas identified through this needs assessment, is urgently needed by junior doctors practising in secondary care. [ABSTRACT FROM AUTHOR]

Elizabethkingia meningoseptica is an infrequent colonizer of the respiratory tract; its pathogenicity is uncertain. In the context of a 22-month outbreak of E. meningoseptica acquisition affecting 30 patients in a London, UK, critical care unit (3% attack rate) we derived a measure of attributable morbidity and determined whether E. meningoseptica is an emerging nosocomial pathogen. We found monomicrobial E. meningoseptica acquisition (n = 13) to have an attributable morbidity rate of 54% (systemic inflammatory response syndrome ≥2, rising C-reactive protein, new radiographic changes), suggesting that E. meningoseptica is a pathogen. Epidemiologic and molecular evidence showed acquisition was water-source-associated in critical care but identified numerous other E. meningoseptica strains, indicating more widespread distribution than previously considered. Analysis of changes in gram-negative speciation rates across a wider London hospital network suggests this outbreak, and possibly other recently reported outbreaks, might reflect improved diagnostics and that E. meningoseptica thus is a pseudo-emerging pathogen. [ABSTRACT FROM AUTHOR]

The current paper describes the use of fibre reinforced polymer (FRP) composites as primary structural members. In particular FRP composite bridge decks are discussed and the Asset project, which comprised the development of a FRP composite bridge deck system, is described in detail. The analysis, design and testing undertaken within the project are also discussed in detail. The culmination of the project, the reconstruction of West Mill Bridge in Oxfordshire, is described and conclusions made on the particular advantages of using FRP composites for bridge decks. [ABSTRACT FROM AUTHOR]

Background The Improving Outcomes in Urological Cancers guidelines recommended centralisation of cystectomy services to improve outcomes for bladder cancer (BCa) patients. Objective To investigate trends in all-cause and cause-specific survival to see if there was an improvement in survival after centralisation was implemented. To analyse trends in the number of acute hospital trusts undertaking cystectomy. Design, setting, and participants We used routine data to capture information on radical cystectomy (RC) in BCa patients aged 20 yr and older between 1998 and 2010 ( n = 16 033). Outcome measurements and statistical analysis We calculated 30-d and 90-d mortality, and 30-d, 90-d, 1-yr, and 5-yr survival. The average number of RCs per trust was derived. Trends were identified using regression analysis. Results and limitations The 30-d crude mortality decreased from 5.2% to 2.1% ( p < 0.001) and 90-d crude mortality decreased from 10.3% to 5.1% ( p < 0.001). There was an increase in 30-d relative survival from 96% to 98% ( p < 0.001), in 90-d relative survival from 91% to 96% ( p < 0.001), in 1-yr relative survival from 71% to 80% ( p < 0.001), and in 5-yr relative survival from 49% to 56% (2004–2006 data; p < 0.001). The mean number of RCs performed by trusts in England increased from six to 24 ( p < 0.001). Smoking status and stage at diagnosis were not available. Conclusions Survival after RC has increased alongside decreases in short-term mortality. There is little evidence of a cohort effect. The trends in survival are linear and we conclude that the continued survival improvements are a result of a combination of service improvements that include service reconfiguration, improved surgical training, neoadjuvant chemotherapy, enhanced recovery principles, and continued improvements in perioperative care. Patient summary We analysed routinely collected hospital data. Outcomes for patients who undergo cystectomy have improved for all age groups. This is likely to be due to a combination of changes in practice. [ABSTRACT FROM AUTHOR]

In recent years, social campaigns and high-profile cases have brought increased attention to violence against women. Athletes can be role models, shaping both prosocial and antisocial attitudes. Their engagement in violence prevention could be an effective tool to tackle violence against women through bystander intervention. This part of a mixed-method feasibility study reports on the quantitative evaluation of an evidence-led bystander program, Football Onside, implemented at a football club in South West England in June 2018 to February 2020. The study employed a quasi-experimental design with intervention and control groups. Football coaches and club members (n = 50) completed measures of rape and domestic abuse myths, bystander intent and efficacy, self-reported bystander behaviors, readiness for change, perceptions of peer helping and myth acceptance, law knowledge, and program evaluation. Fidelity was also assessed. The analysis compared between- and within-group differences in mean changes over time using mixed-effects models. Participant ratings of learning outcomes were high, and fidelity was maintained throughout the intervention. Between-group comparison revealed mixed results, with greater improvements in the intervention group for bystander intent and efficacy at post-test and follow-up, domestic abuse myths at post-test, and rape myth acceptance at follow-up. Model contrasts for within intervention group revealed improvements in rape and domestic abuse myth acceptance, bystander intent and efficacy, perceived law knowledge at both time points, and perceived peer myths and helping at post-test. At follow-up, intervention participants reported significantly higher engagement in bystander behaviors. No significant effects were found for perceived importance of legal knowledge. Our research highlights the potential efficacy of a bystander program tailored for football club members. Cluster-randomized control trials are now required to examine bystander attitudes and behavior change processes among professional athletes. [ABSTRACT FROM AUTHOR]

Aim To explore the experiences, concerns and priorities of patients newly diagnosed with advanced malignant spinal cord compression and had significant problems with mobility at presentation. Background The consequences of malignant spinal cord compression can be devastating. Patients and their families are under pressure to adapt quickly to the significant functional impairment that occurs while coping with a diagnosis of advanced cancer. Much of the literature has focused on diagnosis and treatment and little is known about patients' experiences, priorities and concerns. Design A descriptive qualitative methodology was adopted using semi-structured interviews and Framework Analysis techniques. Method A semi-structured interview schedule was developed to explore patient's descriptions of their experiences leading up to diagnosis and during their admission to the cancer centre along with their thoughts and feelings about their future with malignant spinal cord compression. The interviews took place after completion of radiotherapy before discharge home. Interviews were carried out between April 2009-March 2010. Findings Ten participants were interviewed. A dual narrative was identified in which participants talked about their concerns and emphasized their ability to cope and maintain a positive outlook. Patients' concerns and priorities were identified. Maintaining hope emerged as an important element of coping. Uncertainty was a source of hope. Conclusion The study provides insights into the experience of malignant spinal cord compression from symptom occurrence to diagnosis and beyond. The findings highlight the importance of early discharge planning and family involvement in meeting patients' priorities for care. [ABSTRACT FROM AUTHOR]

Abstract Goals of work  The goal of this study is the determination of key themes to aid the analysis of qualitative data collected at three cancer support centres in England, using the Measure Yourself Concerns and Wellbeing (MYCaW) questionnaire. Patients and methods  People with cancer who use complementary therapies experience and value a wide range of treatment effects, yet tools are urgently required to quantitatively measure these outcomes. MYCaW is an individualised questionnaire used in cancer support centres providing complementary therapies, scoring ‘concerns or problems’ and ‘well-being’ and collecting qualitative data about other major events in a patient’s life and what has been most important to the patient. Content analysis on 782 MYCaW questionnaires from people at these cancer support centres was carried out. The ‘concerns,’ ‘other things going on in their life’ and ‘important aspects of centre’ were thematically categorised and externally validated by a focus group, and the inter-rater reliability was calculated. Main results  Clinical information from a cancer patient’s perspective was collected that is not measured on standard quality-of-life questionnaires; furthermore, some themes acknowledge the multi-faceted aspects of complementary and alternative medicine provision, rather than information only relating to the therapeutic intervention. Categories for qualitative MYCaW analysis have been established providing a tool for future research and/or service delivery improvement within cancer support centres such as these. Conclusions  The established themes provide a framework to aid analysis of qualitative aspects of complementary therapy care for people with cancer, improving our understanding of how the patient’s cancer experience can be aided by complementary therapies in specialised cancer centres. [ABSTRACT FROM AUTHOR]

The article presents an analysis of historical writings and historical thought during the sixteenth and seventeenth centuries. It also explores critical transformations in historical thinking in early modern England, and in particular the changes in the mental apprehension, cognition, and communicative articulation of elements of the past. The essay focuses on mentalities in the narrower sense of the thought processes at work in any informed individual's act of making sense of the past, and a significant specie of conversational currency in a way it had not been earlier.

Presents the author's impressions of terminal care practices employed by the staff of St. Christopher's Hospice in London, England. Details of the accommodations and population of the hospice; Emphasis of drug therapy on pain alleviation; Impact of hospice director Cicely Saunders on the care of dying patients.

From the 1870s to the 1920s Poor Law institutions in England developed from destinations of last resort to significant providers of health-care. As part of this process a general professionalisation of Poor Law work took place. The change was facilitated by wider social, philosophical and political influences in nineteenth century England. The introduction of trained nurses into the Poor Law was part of a diaspora of both ideas and people from voluntary institutions and organisations. Unrecognised in 1834, nurses eventually became the most numerous class of workhouse officers. This was not accomplished without dispute and acrimony. As a group and as individuals nurses were often at the centre of disputes. Utilising a social history framework and drawing on contemporary written sources, including Poor Law and nursing journals, this paper highlights the role played by Poor Law nurses in the diffusion of values and attitudes that helped to transform the workhouse regime from one of punishment to therapy. [ABSTRACT FROM AUTHOR]

Presents the abstract from the Fifth Palliative Care Congress at the University of Warwick in Warwickshire, England. "Palliative Care Out-of-Hours: Patient and Career Views," by A. Worth, K. Boyd and M. Kendall; "Palliative Care for Patients With Chronic Heart Failure," by J. Sykes and T. Chester; "User, Career Needs and Service Provision in Nonmalignant Disease," by J. Brown.

Previous studies in recently detoxified dependent alcoholics have shown severely disturbed sleep and impaired quality of life. Although this association has been found to predict short-term relapse to heavy drinking, no sequential studies have been conducted to monitor significant changes in sleep quality and quality of life in abstaining alcoholics. Fifty-seven inpatients at a voluntary sector 12-Step alcohol detoxification unit in South London were administered a series of questionnaires assessing sleep (Pittsburgh Sleep Quality Index, PSQI), Quality of Life (Euro-Qol) and Depression and Anxiety (Hospital Anxiety and Depression Scales, HADS). Questionnaires were administered at baseline and for 12 weeks at monthly intervals. At baseline, PSQI scores showed that 52 of the 57 participants suffered from impaired sleep. The scores, however, did not correlate significantly with any of the other measurements. All except two participants acknowledged impaired Quality of Life in at least one area. With respect to the follow-up measurements 23 (40%) participants completed the study. Quality of life and depression scores improved significantly over a 12-week period but sleep and anxiety scores did not. At 12 weeks the mean PSQI score was still above the cut-off point for 'sleep caseness'. Quality of life and depression show a significant improvement over a 3-month period of abstinence, although at this point the subjects are still experiencing difficulties with sleep and anxiety. This information could help in the planning of future rehabilitation and treatment programmes. [ABSTRACT FROM AUTHOR]

Drawing on data generated by a 3-year study, informed by ethnographic principles, of the interface between Gypsy culture and the educational system in the South West of England, this article focuses specifically on the experiences of young Gypsy males [1]. The manner in which they perform specific forms of masculine identity though business skills and dealing, fighting, and sex talk are considered. Tensions are highlighted regarding the ways in which these performances are valued in different communities of practice, and how this operates to maintain an atmosphere of suspicion regarding the educational system. [ABSTRACT FROM AUTHOR]

Recent years have seen a renewed emphasis in UK healthcare policy on access to services, yet there has been little research into possible inequalities in access for people from different ethnic backgrounds. This paper examines access from the point of view of a group of Bangladeshi people with diabetes, whose views were obtained as part of a wider evaluation of diabetes services. Their message is a powerful one. The problems they experienced, however, cannot be attributed solely to cultural insensitivity, in which providers adopt a 'like it or lump it' approach. The wider evaluation provides a context within which to identify similarities with, as well as differences from, other groups in the community, and the findings show that the experiences of this vulnerable group highlight more general weaknesses in service provision. The paper also shows that conventional analysis of access in terms of barriers to be overcome misses a crucial dimension: the ability to make full use of services. Gaining access does not mean that needs will be met appropriately, and patients vary in the extent to which they are able and enabled to play an active role in obtaining the services they need. [ABSTRACT FROM AUTHOR]

The National Service Framework for Older People (NSF), published recently by the Department of Health in England, represents a major initiative to improve services for this group of patients. It describes an ambitious 10-year plan to address ageism, person-centered care, hospital care, specialist care (in the core areas of stroke, falls and mental health), health promotion and medicines use. Successful implementation of the NSF will unequivocally improve access to key services for older people including specialist care and community services. However, considerable commitment and new resources will be required to realize the intentions of this complex initiative. [ABSTRACT FROM AUTHOR]

This article reports on an investigation into the motivation of secondary school students in the South-west of England to learn foreign languages. A questionnaire was constructed based on a model derived from the motivation literature to examine students' responses on 16 constructs related to motivation. This was administered to 228 students in years 7, 8 and 9. The analysis revealed a decrease in motivation with age, and higher level of motivation among girls than boys. It also revealed a strikingly higher motivation to learn German than French, which was even more marked when the boys only were considered. These findings were further investigated using interviews. Both girls and boys were able to provide clear explanations for differences between the genders, as well as for the language differences. These included such aspects as French being considered feminine, it not being 'cool' for boys to be seen to make an effort at French, and the tendency for boys not to try at anything that appears to be tedious. [ABSTRACT FROM AUTHOR]

This article looks at the controversy surrounding the 1902 Education Act in Staffordshire, and the role of the Education Committee and its first Director, Graham Balfour, during the first ten years of the implementation of the Act. The 1902 Education Act has often been seen as a watershed in the conflict between Nonconformist and Established Church educationalists. This study shows that while religious controversy dominated the months surrounding the passing of the Act and continued to preoccupy certain interest groups for many years, the new bureaucracy created in 1902 changed the central issues in elementary education. Religious priorities were replaced by financial and organisational priorities. Balfour's success in dealing with these new priorities provided elementary education in Staffordshire with a unity and stability notably absent during the 19th century. This article assesses Balfour's perspective, the attitudes and expectations of religious and educational groups, and the reality of elementary education in Staffordshire after the implementation of the 1902 Education Act. [ABSTRACT FROM AUTHOR]

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The article reviews the concert "Riot," performed by the Backbeat Percussion in London, England on February 9, 2007, featuring works like "Wayfaring Stranger," by Peter Edwards.

The article discusses the medieval English Lowcray and Loughera in Ireland in old English poems. The article adds that if English lowcray really is from Loughrea, it offers four conclusions. It suggests English needlework often began existence as Irish flax. It points to Loughrea as a centre of the Irish linen industry, where cloth was exported via Galway to Bristol. The poet's mocking tone may imply that some of this linen was of inferior color. Finally, it indicates economic resources of the Burkes of Clanricard. They were powerful in the late middle ages, pressurizing the merchants of Galway and fighting in the Sligo region.

We have found an overall improvement in the prescribing of antiretroviral therapy (ART) in the Yorkshire region between 1997 and 1999 but have identified a clinic where a significant number of patients continue on suboptimal treatment. It has been shown that the substantial reduction in the HIV-associated morbidity and mortality was related to the introduction of protease inhibitors (PIs), which became part of triple ART regimens in mid 1990s. There is evidence that treatment with 2 agents will eventually fail and such prescribing needs to be addressed. Further investigation has shown that patient choice has been an important issue in this locality. Treatment options need to be negotiated between patient and physician and prescribing contrary to patients' wishes may adversely affect adherence. The British HIV Association (BHIVA) guidelines were updated earlier this year to reflect recent advances in management. In view of the importance of optimal prescribing, ART is kept as a standing item on the agenda at our regional audit meetings. These are held every 4 months. We will continue to audit this topic at regular intervals. [ABSTRACT FROM AUTHOR]